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HEALTH-BOLIVIA: Childbirth Still a Gamble, Despite Care Efforts

Franz Chávez

LA PAZ, Jun 12 2006 (IPS) - While the birth of a child generally represents joy and life, in Bolivia, new motherhood is all too often plagued with fear, uncertainty and even death of mothers and newborns, report organisations dedicated to maternal and child health.

These social institutions and international organisations, grouped under the National Plan for Safe Births and Maternal Health , paint a picture of a few encouraging improvements on an otherwise bleak landscape.

Haiti and Bolivia have the highest pregnancy and birth risk levels in Latin America, according to the State of the World’s Mothers 2006 report, published by the international Save the Children organisation.

The 2003 National Demographic and Health Survey conducted by Bolivia’s National Institute of Statistics (INE) revealed a rate of 229 maternal deaths for every 100,000 live births. The next survey will be taken in 2007.

This figure represents a reduction in the number of women who died as a result of pregnancy, birth or post-partum complications, but it still falls well short of cutting maternal mortality by three quarters by 2015, as outlined in the Millennium Development Objectives (MDGs) adopted by the international community in 2000.

In 1989, maternal mortality stood at 416 women per 100,000 live births; it dropped slightly by 1998 to 390.

The Health Ministry estimates that by 2015, the lives of 144 women out of 100,000 will still be at risk due to maternity complications; the goal calls for bringing the ratio down to 104 per 100,000.

Several government initiatives and plans have been adopted since 1993, culminating in the 2002 implementation of the Universal Insurance for Mothers and Children (SUMI), which owes part of its success to the financial management and direct support of 328 municipal governments throughout the country, the programme’s department head, Ivett Mendoza, explained to IPS.

While the central government, through the nine Departmental Health Services, pays the salaries of doctors and support staff, under the SUMI legislation municipalities are responsible for maintenance, equipment and supply costs incurred for the free treatment of women before, during and up to six months after birth.

The government also develops training programmes for staff, provides professional development for health-clinic managers, and transfers administrative know-how to mayors, explained Mendoza.

However, despite the increase in SUMI’s budget funded by 10 percent of the Direct Hydrocarbons Tax that came into effect last September, income levels vary wildly among the 328 municipalities.

While the Amazon city of Cobija in the country’s north has an annual per capita income of more than 600 dollars, the 356 residents of the highlands municipality of Nazacara in the department (province) of La Paz make an average of 14 dollars per year.

“These differences mean we must find additional funding sources to cover free healthcare services,” said Mendoza.

The government now provides free health coverage, in 27 areas of medicine, to females from the time they are born until they turn 60, while males receive free healthcare only up to age five.

“The goal is to establish universal coverage and extend benefits for males up to the age of 21,” explained Mendoza.

“Since Mar. 8, public health services have reached more women by expanding the free care programme, which represents a shift in public policy towards mothers,” Congresswoman Elizabeth Salguero, a member of the governing Movement Towards Socialism party, told IPS.

Through the Chamber of Deputies’ health commission, of which she is a representative, Salguero has worked to strengthen public health services, particularly pushing the increase in the health budget, estimated at some 220 million dollars – equivalent to one-third of national public spending.

The extension of SUMI benefits for women to the age of 60 is not an insignificant accomplishment, and signals the first changes in state health policy, she added.

Salguero leads a group of female legislators who promote women’s rights, improvements to public healthcare, family planning services and prevention of teen pregnancy.

During the previous government, which ended its term in January, Congress approved, with the agreement of all parties, a law addressing access to family planning methods, birth control and confidential information for teens. But then president Carlos Mesa (2003-2005) sent it back to Congress with a general observation that it required more debate.

The analysis by the National Plan for Safe Births and Maternal Health identifies the actual birth and post-natal period as posing the highest risks, both for the woman and the newborn, but paradoxically there are fewer post-natal care services. In Bolivia, barely 13 percent of mothers receive post-natal health support, according to the study.

Health Ministry estimates attribute the major causes of maternal mortality in Bolivia to haemorrhaging (23 percent), birth-related infections (14 percent), complications from unsafe abortions (16 percent), and eclampsia (12 percent).

All of these are largely preventable from the medical perspective, with the exception of unsafe abortions, which falls outside the scope of health measures, as it is a direct consequence of the country’s laws against terminating pregnancies.

The infant mortality rate has also improved, but government projections show that it is unlikely to reach the MDG objective of a two-thirds reduction. From 1989 to 2003, the infant mortality rate was almost halved, falling from 120 deaths to 54 per 1,000 live births. Projections for 2015 are for 34 per 1,000 live births.

“These national averages conceal major gaps of exclusion, where rural mothers living in poverty – many of them indigenous and poorly educated – are at a much greater risk during childbirth and the postnatal period. They are up to 30 percent more likely to die than women in urban areas with more education,” indicates the report by the social organisations.

In Bolivia, rural communities are harder hit by poverty and illiteracy. According to the INE, 67.3 percent of the population lives in poverty overall, a figure that rises to 79.5 percent when considering only rural areas. The national illiteracy rate, meanwhile, is 13.28 percent, but it jumps to 25.77 percent in rural areas.

In rural zones, average per capita income is 600 dollars per person – roughly one dollar and 60 cents per day, said Bolivian Vice President Álvaro García Linera. But in the impoverished city of El Alto, basically a suburb of La Paz, some people survive on just 50 cents per day, according to private social support organisations.

The current government’s first diagnostic report on the issue announced policies designed to reduce maternal mortality, and recognised the importance of providing pre- and post-natal healthcare services to women as a “matter of human rights and social justice.”

Likewise, the government report defends its budget allocations for reproductive health and policies for women, by calling maternal health a “vital socioeconomic investment” and emphasising the necessity of empowering Bolivian women in areas of decision-making and public policy.

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