Rural Health Care in Mexico: Cultural Differences in Childbearing

Irma Alejandra Coronado Zarco

Instituto Nacional de Perinatología

 

•Biodiversity (third world place)

•First place in reptiles

•2nd mammals

•4th amphibians and vascular plants

•10th in butterflies

•20th birds

Mexico

• Population: 103.7 million

• Considerated one of the most populated countries in the world: 11th place

• Population density: 53 persons/km2

• Mexico City: 5,799 persons/km 2

• Chihuahua: 13 people/km 2

INEGI 2004

Mexico

• 2.1 million births in a year

• Life expectancy at birth

• ♀ 77.4 • ♂ 72.4

• Growing rate• 1970 – 3.4%• 2004 – 1.3%

INEGI 2004

Mexico

Mexico

• General mortality rate 4.5/1000 people

(60.6% chronical diseases)

• Average schooling (> 15 years old): 7.8 years

• ♀ 7.6• ♂ 8.1

• Illiteracy : 8%

INEGI

Mexican society

• 60% Mestizos (mixture of European and Amerindians)

• 85 recognized languages

(At least 56 indigenous)

• “Catholic” 89%, “Evangelist” 6% (syncretism with native religions)

Definitions ¿?

• Culture: The totallity of socially transmitted behavior patterns, arts, beliefs, institutions, and all other products of human work and thought characteristic of a community or population.

• Mexican society:– Multicultural society

• Diversification• Heterogeneity• Complexity• Potential

54 Mexico 0.796

34 Argentina 0.84438 Chile 0.831

114 Bolivia 0.653120 Guatemala 0.631

1 Norway 0.9422 Switzerland 0.9413 Canada 0.940

6 United States 0.939

54 Mexico 0.796

171 Burundi 0.313172 Nigeria 0.277173 Sierra Leona 0.275

Human development index

Conapo. Human development report 2002. New York. 2002

0

3

- 3

0.7 0.8 0.9 1

ChiapasGuerreroOaxaca

Mexico CityNuevo Leon

Human development index

• 51.4 % of the whole population

• Illiteracy rate ♀ 9.7% (♂ 6.1)

• Economically active 14,894,400

• Family leaders in 4,683,000 homes

• Men studying= women houseworking

• >52% of graduates from University

• Fecundity rate• 1970 – 6 • 1987 – 3.8• 2004 – 2.2

INEGI 2004

Women

• 1 out of 4 people live in rural area

(25,925 million)

• 40% of rural population are indigenous groups

(10,370 million)

• Agricultural activities from indians 75%, rest of the country 22%

• 2/3 of coffee production comes from indigenous groups

INEGI 2004

Rural Mexico

Rural Mexico

• 8th country with more indigenous groups in the world

• The fifth part of the territory belongs to indigenous groups

( 12% of natural reserves and 60% tropical rainforest)

• Most settlements < 500 people

• Illiteracy 46% and 76% haven´t completed elementary school

Tlahui-Politic No.2,II/1996

Children

• Population < 15 years old: 33,184 million

• 35% live in 3 of the poorest states (11,614 million)– Chiapas– Oaxaca– Guerrero

INEGI 2004

Children

• 6% Labor force (10-14 years old)

• 32% of children in rural areas works (13-17 years old) vs. 15.7% in urban areas

• Teenager pregnancy 17.2%

UNICEF, 2000

Children

• Exclusive breast-feeding (6 months)– General 20 %– Urban 15%– Rural 33%

• Complete vaccination 94% (<1 year old)

• Low birth weight 4.5% (94,500)– Chiapas 8.3, – Oaxaca 5.3, – Guerrero 6.4

INEGI 2004

United StatesCuba

MexicoPanama

ArgentinaVenezuela

BoliviaPeru

5.2 – 9.8

17.1 – 29.9

9.9 – 13.8

30 – 80.313.9 - 17

ChileColombia

Infant Mortality Rate (1000 born alive)

Panamerican Health Organization 2002

Infant mortality rates in Chihuahua

Instituto de Salud Publica 2003

Infant mortality rates in Oaxaca

Per 1000 born alive

Instituto de Salud Publica 2003

Children

• Each year 65,380 infants die

• 35,911 died in the first year of life

• 22,089 died before 28 days of life

• 16,452 died in the first week

• 7,417 in the first 24 hours

INEGI

Rank Cause Deaths Rate * %

1 Perinatal 18,569 906.50 50.8

2 Lower respiratory

tract infection

3,128 152.7 8.6

3 Congenital cardiac disease

2,634 128.59 7.2

4 Gastro-intestinal infection

1,493 72.89 4.1

5 Malnutrition 830 40.52 1.0

Principal death causes infant <1 year

* Per 100,000 births CONAPO, 2002

Capacitated personal84%

2.1 millonbirths

in 1 year

Traditional methods

30%

DoctorT. MidwifeOtherNo specified

Births in hospital or clinic %

Labor assistance

55%Perinatal

deaths

Poorest states

ChiapasOaxaca

GuerreroPueblaHidalgo

Michoacán

• The decrease observed in IMR in Mexico during the last years was due to a declining pediatric mortality rate

• Neonatal mortality rate was virtually unchanged.

• It is well-known that there are important problems in the vital statistics in Mexico due to underregistry of deaths in the first year of life, and particularly those that occur in the first month.

Salud pública Méx v.39 n.1 Cuernavaca ene./feb. 1997

Demedicalized

Appropriate technology

Regionalized

Evidence based

Holistic

Family centered

Appropriate culturally

Multidisciplinary

European Perinatal Care Task Force 1998

Perinatal care

Lacandon

Rarramuris

Aztecs• Marriage 14-16 years old

• Abortion was allowed

• Delivery is considerated a private and intimate event

• They prefer trustful companion

• Careful atention of pregnancy by ticitl (midwife)

• First pregancy was full of counceling about nutrition and excercise

• Increased caring the last 3 months

When you feel that the seed sown in you blossoms…….

• Extreme you hygienic habits so your child will learn to be neat

• Walk through the gardens and classrooms so your child will learn that school is also home

• Try to see only nice things so your child will appreciate beauty

• Control impulse and anger so your child will learn to dominate himself

• Learn all you can about science and arts so your child will learn to study

• Ask with respect to your mother and grandmother and the mother and grand mother of your husband to tell you about their experiences so your child will learn to respect older people and will feel proud of them

• You and your husband gather with the family so your child will know that he is part of it

• Embroid the clothes your child will use, to make him notice that he will have a good reception when he comes out of you into life.

Aztecs• At the end the ticitl verified

position of the fetus and if necessary practiced version

• Ticitl arrived in advance to birth to the house of pregnant women and got ready(special diet)

• During labor she offered a drink with oxytocin effects

• Elaborated methods to avoid fear during labor

• Fear lowers contraction intensity and prolongs delivery: asphyxia and infection

Gracious baby, the gods rised you

in the highest place of heaven; but

you must have in mind that life is

sad, painful, full of evil and misery;

you won´t be able to eat bread

without working. May God help

you in the many adversities that

are waiting for you.

One of the conditions of the human being with more potential

Spiritual

Biological

Social

Economical

Psychological

Affective

Human being

Concern with the needs of mankind and the alleviation of its suffering

Show compassion, sympathy, consideration for another creature

Health care (quality)

Birth settings

Education

Information

Social support

Economical support

Culture

Religion

Emotional support

Well-being

Environment

Health care resources

• Uneven distribution

• Resources destinated to health care

• México 6.1• Colombia 5.5• Argentina 9.5• United States

13.9%

WHO 2001

Alternatives¿?

• Avoiding stereotyping

• Respect for differences

• Sensitive and intelligent understanding

• Intention for improvement

Coatlicue