Maternal and Child Health in Mexico

In the past high maternal mortality rates have been associated with lack of governmental concern, discrimination against women and low socioeconomical status (Pan American Health Organization, 1989; Mahler, 1986). However, with the widening access to affordable health care, maternal health in Mexico has improved over the decades. During 1989, 295 of 433 maternal deaths in Mexico City were preventable and were caused by hospital and healthcare professional errors (Rendon et al., 1993). In 2015, statistics show that maternal health has dramatically improved for in Mexico. Many more women choose hospitals over the traditional midwives. Out of 13,309 women from 14 hospitals, only 4 women died and the intra-hospital maternal mortality ratio, “limited to the first week following pregnancy termination and calculated per 100,000 live births,” was 30. In comparison to the 433 maternal deaths for 4 hospitals in 1989, Mexico’s medical care for women has dramatically risen in affordability, quality, access, and popularity in the 26 years (Chavez et al., 2015). In 2010 in the Latin American and the Caribbean (LAC) region, the average maternal mortality ratio was estimated at 88.9 per 100,000 births or 9,500 maternal deaths. The ratio decreased by forty one percent from the 1990-2010 period. In the same time frame, Mexico had an above-average rate for perinatal mortality compared to some of the LAC region (Thompson et al., 2015). As Latin America develops economically and urbanizes, health systems have tended to improve. Infant mortality in the LAC region has declined by half since 1980 to 27 deaths per 1,000 live births in 2010 (Restrepo-Méndez et al., 2015).

However, countries within the LAC region varied greatly in health intervention and quality of health care based on wealth inequalities. In 2003, Mexico was included in the "Countdown to 2015" initiative to reduce child mortality and improve maternal health. Mexico lacked internationally standard questionnaires to be included in the study’s examination of inequality in LAC region maternal health. Still, the trends in other Latin American countries included in the initiative likely reflect a similar situation in Mexico. Twenty-nine percent of the LAC population lives below the poverty line, placing them in a disadvantage for health interventions (Pan American Health Organization, 2012). In response, in the past few decades, many countries have combined poverty reduction strategies with expanding primary health care services aimed at health equity. Regardless, the poorest fifth of women and children lag behind in the data (Restrepo-Méndez et al., 2015).

Many studies indicate the association between skilled birth attendant (SBA) and the substantially lower risk for maternal and neonatal mortality. Qualifying for the distinction for SBA is based on competencies; however, there is a lack of standardization across countries in determining the criteria for SBA, training, and functions performed (Thompson et al., 2015). One of the largest inequalities observed in LAC region was the distribution of skilled birth attendant with only 60 percent women with access to SBA in poorest countries versus universal access in wealthiest countries (Restrepo-Méndez, 2015). The quality indicators include maintaining clean technique during birth, treating women with respect, and promoting the mother-child bond. Most obstetrician, physicians, and midwives sampled from the LAC region were observed to use clean equipment and respect the mother, but there was room for improvement for washing hands before and after care. Another study examined maternal health care providers’ ability to perform nine lifesaving skills. Out of the 76 varied maternal health providers sampled, only a fourth were trained to perform forceps or vacuum delivery, 58 percent were trained to perform manual removal of the placenta, 49 percent for conducting newborn resuscitation, and only 32 percent trained for manual vacuum aspiration. Authors noted providing information on the progress of labor and supporting the mother-child bond and breastfeeding were also items to be improved upon. If this is indicative of Mexico, most Mexican maternal health providers could have some room to improve their quality in care as well. (Thompson, 2015; Belizán, 2005). With the aim to improve maternal health, MacArthur Foundation sponsored the Midwifery Training Scholarship and Capacity Building Program in Mexico in 2015. The three-year strategy program focuses on increasing professional midwifery to improve reproductive and maternal healthcare.

Studies reveal a declining trend in breastfeeding which is an integral part of a baby’s health. The longer the infant is breastfed, the better the infant’s nutrition, immune system, protection against infant mortality, and parental relationship will be. From 1958 to 1978, breastfeeding gradually declined and early formula feeding rose. In a 1960 study of Tlaltizapan, Morelos, a town of 6,000, 91 percent of babies were nursing at 6 months of age. Ten years later, only 9 percent of six-month-old babies were nursing (Magaña et al., 1981). At the time of 1993, the decline in the number of six-month-old babies being breastfed continued to decline in developing countries like Mexico. Mothers who were young (20 years old or less), single, and were not in the social class of workers were highly unlikely to breastfeed children six months old or older. Out of the three months old and older babies in urban Guadalajara, Mexico, around one-third were breastfed. With the corresponding higher risk to early infant diseases, the early formula feeding trend is a growing hazard to Mexican natal health. However, it is likely more feasible for many single, young mothers to use formula than breastfeeding for months, or even years as some women do traditionally in rural areas (López & Pérez, 1993).

Besides indirect obstetric causes, domestic violence is one contributor to Mexican maternal deaths. In a 1978 study conducted in the Mexican state of Morelos, “violent deaths of women associated with unwanted pregnancy might have contributed to 15% of maternal mortality” (Espinoza & Camacho, 2005). Half of those women were adolescents who committed suicide after realization of unwanted pregnancy or prevention of reputation damage to the family. There is little recorded data for mothers who experience domestic violence, however, with cultural stigma and their own safety to consider (Espinoza & Camacho, 2005). These facts reveal a different side of to the causes of maternal deaths, one not found in hospitals or health care professionals, but in the home and in the circumstances of young pregnant women.

Related Articles

• Contraceptives and their Reception
• Abortion Politics in Latin America

Additional Sources

Health in the Americas+, 2017 Edition. Summary: Regional Outlook and Country Profiles

Improving Maternal Health in Mexico

MacArthur Foundation

References

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Chavez, S., Vogel, J., Souza, J., Mori, R., Lumbiganon, P., Pileggi-Castro, C., Bohren, M., . . . Togoobaatar, G. (2015). Obstetric transition in the World Health Organization Multicountry Survey on Maternal and Newborn Health: Exploring pathways for maternal mortality reduction. Rev Panam Salud Publica, 37(4/5), 203-210.

Espinoza, H., & Camacho, A. V. (2005). Maternal death due to domestic violence: An unrecognized critical component of maternal mortality. Revista Panamericana De Salud Pública, 17(2), 123-129.

Mahler H. The safe motherhood initiative: a call to action. Lancet. 1986;2 March: 668-771.

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Rendon, L., Langer, A., & Hernández, B. (1993). Women's living conditions and maternal mortality in Latin America. Pan American Journal of Public Health, 114, 56-64.

Restrepo-Méndez, M. C., Barros, A. J., Requejo, J., Durán, P., Serpa, L., & França, G. V. (2015). Progress in reducing inequalities in reproductive, maternal, newborn, and child health in Latin America and the Caribbean: An unfinished agenda. Rev Panam Salud Publica, 38(1), 9-16.

Thompson, J. E., Land, S., Camacho-Hubner, A. V., & Fullerton, J. T. (2015). Assessment of provider competence and quality of maternal/newborn care in selected Latin American and Caribbean countries. Rev Panam Salud Publica, 37(4/5), 343-350.

Vega López, M., & González Pérez, G. (1993). Maternal factors relating to breast-feeding duration in areas around Guadalajara, Mexico. Pan American Journal of Public Health, 27(4), 350-359.