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BUENOS AIRES, Feb 15 2005 (IPS) - Almost one-third of the maternal deaths reported in Argentina result from abortion, which is illegal in this South American nation, and a growing number of the fatalities correspond to women under the age of 20, including girls as young as 10.
"Since 2000, there have been maternal deaths recorded in minors under 15 years of age," Mabel Bianco, director of the Women’s Studies and Research Foundation (FEIM), told IPS.
Of the 78,000 patients admitted to public hospitals in 2000 for abortion-related causes, 11,015 were adolescents aged 15 to 19, and 550 were girls aged 10 to 14.
"In many cases, these pregnancies were the result of rape, sexual abuse or incest, which are also being reported in growing numbers," noted Bianco.
Girls and women between the ages of 10 and 24 make up 27 percent of Argentina’s population. Girls between 10 and 19 total 6.7 million, or 18 percent of the population, while there are 3.3 million women between the ages of 20 and 24.
The marked rise in teenage pregnancy in the last five years has been attributed to the fact that girls are becoming sexually active at an increasingly younger age, while sex education and family planning services are sorely lacking.
Overall maternal mortality in Argentina was 44 per 100,000 live births in 2003, with a total of 304 deaths caused by complications during pregnancy, childbirth and the puerperium (the six-week period following delivery) or as a result of abortion, according to statistics provided to IPS by the Ministry of Health.
Abortion-related complications, infection and haemorrhaging are the leading causes of maternal deaths in Argentina, and have been for several decades.
The maternal mortality ratio has remained almost unchanged in the last 20 years, indicating that little has been done in terms of preventive measures to bring the rate down, said Bianco.
The negligible change is especially significant since overall access to health care has improved during this time, she added.
According to studies carried out by the FEIM and the Reproductive and Sexual Rights Consortium, a coalition of non-governmental organisations, maternal deaths in Argentina are largely under-reported, and the true figures would be between 38.5 percent and 100 percent higher than those officially registered.
This is because many abortion-related deaths are reported as caused by cardiorespiratory arrest, septic shock or acute anaemia, without adding that the victim was or had recently been pregnant.
At the same time, part of the slight increase in maternal mortality registered since 2002 is due to the inclusion of a new category in official statistics, that of "late maternal death", referring to women who die from direct or indirect obstetric causes between 42 days and one year after delivery, Bianco explained.
The latest statistics from the Argentine Ministry of Health reveal that 54 percent of maternal deaths result from direct obstetric causes, 31 percent from abortion-related complications and 15 percent from indirect obstetric causes (referring to a previously existing disease or a disease that developed during pregnancy that was not due to direct obstetric causes but was aggravated by the physiologic effects of pregnancy).
Bianco stressed that over the last five years, there has been a considerable rise in the number of hospital admissions for abortion-related complications, adding that no statistics are compiled on medical consultations for this purpose that do not lead to hospitalisation.
Moreover, since abortion is illegal in Argentina, many women who need medical attention for complications arising from the termination of a pregnancy do not turn to public health care services.
Although exceptions are made in the 1921 Penal Code for cases when a pregnancy results from rape or is deemed to seriously endanger a woman’s life, these provisions are not generally applied by the country’s authorities.
There are also a growing number of cases where women are simply unable to seek medical attention. "The economic crisis has plunged wide segments of the population into poverty and extreme poverty, and one of the most tragic effects of the rise in unemployment and underemployment is that many people have been cut off from medical coverage, which was practically universal in the times of full employment in Argentina," said Bianco.
A survey conducted by the FEIM revealed that one-third of poor women consulted had no access to medical coverage, and the majority of women in this situation were between the ages of 20 to 29, generally the period of greatest fertility.
Maternal mortality is relatively low in Argentina in comparison with some of the other countries in the region, such as Bolivia, with a ratio of 230 deaths per 100,000 live births, and Paraguay, with 182.1. In Chile, however, the ratio is 16.7 per 100,000 live births, or 2.6 times lower than in Argentina, according to Pan American Health Organisation (PAHO) statistics.
The differences are even more marked in comparison with the industrialised countries. The maternal mortality ratio in Canada, for example, is 7.8 per 100,000 live births, while in the United States it is 9.9.
In Argentina, there are 20 times more abortion-related deaths reported than in countries where abortion is legal.
At the same time, compared with the average figures for the industrialised countries, there are 16 times more maternal deaths in Argentina caused by infections unrelated to induced abortions, three times more arising from high blood pressure and embolisms, and 2.5 times more due to anaesthesia-related complications.
"Maternal mortality is an eloquent indicator of the defencelessness of women during the reproductive stage," said Bianco.
"A death at any time during pregnancy, childbirth or the puerperium reflects a significant lack of protection, because this is a natural process, and if the conditions existed for women to make an independent decision and have access to preventative measures and quality medical care, there would be no need for statistics on risk, morbidity or mortality," she added.
Maternal mortality is notably higher among women with low incomes and those who live in the country’s poorer provinces.
The ratio in the city of Buenos Aires, the federal capital, is 14 per 100,000 live births, less than one-third of the national average (44), and in the province of Buenos Aires, it stands at 32.
By contrast, the ratios in the poorest provinces in northeastern and northwestern Argentina can be over three times as high, with 109 in Jujuy, 111 in La Rioja and 166 deaths per 100,000 live births in Formosa.
The country’s sexual and reproductive health policies are a key element in analysing this issue. Although a federal law on the matter was passed in 2002, its actual implementation has faced obstacles in a number of provinces.
The law led to the establishment of a National Programme for Sexual Health and Responsible Reproduction, run by the Ministry of Health, which purchases and distributes contraceptives throughout the country.
However, Bianco said, "the degree to which the programme is implemented varies greatly across different areas, because in some cases it is only partially carried out, and in others there has been an absolute refusal to comply."
There are provinces where oral contraceptives and condoms are still not distributed in health care facilities, or the use of intrauterine devices (IUDs) has been rejected.
The Ministry of Health has also failed to fully incorporate emergency contraceptive products like the so-called morning-after pill in the programme. As of now, they are only offered by public health care facilities in the city of Buenos Aires, the city of Rosario, located some 200 kilometres northwest of the capital, and the western province of Mendoza.
"Reducing maternal morbidity and mortality are officially stated goals, but they are not always pursued in practice," said Bianco.
In her opinion, the persistence of relatively high maternal mortality reflects two major problems. One is the lack of quality medical care during pregnancy, childbirth and the puerperium. The other is the fact that women must resort to unsafe clandestine abortions to end unplanned pregnancies which they are unable to prevent because of the absence or limitations of reproductive health and family planning services.
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