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HEALTH-BOLIVIA: Subsidy to Cut Maternal-Child Mortality

Franz Chávez

LA PAZ, Jun 3 2009 (IPS) - A new Bolivian government programme will provide special payments to pregnant women and mothers with children up to the age of two, with the aim of cutting the country’s maternal and infant mortality rates.

The cash transfers, which will total 258 dollars over the space of a woman’s pregnancy and her baby’s first two years of life, are conditional on regular pre- and post-natal care visits by the mother and checkups for her baby.

Two women a day die of complications in pregnancy or birth and 48 of 1,000 babies die before their first birthday in Bolivia, South America’s poorest country.

The left-wing government of Evo Morales, Bolivia’s first indigenous president, already created a monthly stipend for families with school-age children (the ‘Juancito Pinto’ payment of around 25 dollars a month per schoolchild, conditional on school attendance) as well as a subsidy for all Bolivians over 60 (the ‘Renta Dignidad’, a payment equivalent to roughly 25 dollars a month).

The minimum monthly wage in Bolivia is 90 dollars.

The new ‘Juana Azurduy’ mother-child subsidy – named for an indigenous woman who led a highlands uprising against Spanish rule – was implemented by government decree and began to be paid on May 27.

All pregnant women and children under the age of two who have no social security health coverage or other health insurance are eligible for the stipend.

Although the payments are small, they are an incentive for poor women to stick to a regular schedule of prenatal and post-natal visits, give birth in a hospital, and bring in their babies for regular checkups.

The new programme is based on the unification of several maternal-infant health initiatives in the public health system, which the government is strengthening with extra funding and by assigning 800 young doctors to rural areas, Deputy Minister of Health Promotion Jonathan Marquina told IPS.

“Each year 318,000 pregnancies are registered, but only 300,000 births take place in the health system. What happens in the other 18,000 cases?” President Morales asked at the recent ceremony for the inauguration of the new programme.

Health Ministry statistics indicate that 230 women die for every 100,000 live births in this country. Based on the figure of 300,000 births cited by Morales, that gives an average of 690 maternal deaths a year, or roughly two a day.

Among the Millennium Development Goals adopted by the international community in 2000, goal number 5 is to improve maternal health, with specific targets of reducing the maternal mortality ratio by three-quarters (between 1990 and 2015) and achieving universal access to reproductive health.

For Bolivia, that means cutting maternal mortality to 98 deaths per 100,000 live births.

UNICEF (the U.N. children’s fund) representative in Bolivia Gordon Jonathan Lewis applauded the new government programme because of the impact it could have in reducing mortality and malnutrition among children under two.

The conditional cash transfer is aimed at fomenting contact between women and the health services and guaranteeing that mothers come in for pre- and post-natal care, Lewis told IPS.

He pointed out that Bolivia has already made significant progress in reducing the maternal and infant mortality rates.

UNICEF’s State of the World’s Children 2007 report ranked Bolivia in 61st place for under-five mortality, with 57 of every 1,000 children dying before their fifth birthday – – down from 125 per 1,000 in 1990.

At the same time, the infant mortality rate – babies dying before their first birthday – dropped from 89 per 1,000 live births in 1990 to 48 per 1,000 in 2007.

But, he added, the high maternal mortality rate and the more than 14,000 children who die every year before turning one are disturbing.

Most maternal deaths occur in the first 72 hours after the birth, the UNICEF official noted.

Health services in rural areas must be strengthened, and awareness must be raised in local communities on the importance of prenatal and emergency care, he said.

Life expectancy in Bolivia is 65 years.

Vice President Álvaro García Linera said the idea for the ‘Juana Azurduy’ mother-child subsidy emerged in a conservation with Morales on the complex situation and challenges facing single mothers who are abandoned by the fathers of their children and treated with indifference, or even rejected, by their families.

“Single mothers are the most vulnerable, neglected and marginalised of all…and the state must help support these women,” said García Linera.

At the ceremony held to present the new programme in the central city of Cochabamba, 400 km southeast of La Paz, one woman told Morales about a ninth-grade student who was kicked out of school and given the cold shoulder by her family after she got pregnant.

“Two weeks later, her body was found. She had committed suicide,” said the woman.

According to García Linera, some 550,000 women and children in this country of 10.2 million people will receive the stipend in the first year of the programme.

The first 28.4 dollars will be handed out to the pregnant woman in four equal payments equivalent to just over seven dollars each, after she attends the obligatory prenatal checkups.

After giving birth in the hospital and attending the required post-natal checkup, the mothers will receive 17 dollars, and over the next two years they will get 12 payments of 17.70 dollars for the baby, as long as they bring the child in for checkups.

Deputy Minister Marquina hopes to draw more people to the primary health centres, which are currently underused, and plans to implement programmes designed to strengthen infrastructure in coordination with the country’s 327 municipalities.

The Health Ministry will also provide extra funds to provincial government health offices for them to hire more doctors, nurses and administrative staff, in order to improve overall nutrition and vaccination coverage.