Fighting Maternal Mortality in Colombia

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Fighting Maternal Mortality in Colombia

Angela Castellanos

Colombia's maternal mortality rate has decreased in recent years, due largely to increased prenatal care. But the country still needs to increase the number of births attended by skilled personnel.

Every minute, a woman dies during pregnancy or childbirth.

It’s hard to believe it, but it is one of the findings revealed by Save the Children in its annual report State of the World’s Mothers, disclosed in May 2008. The report shows which countries are succeeding and which are failing to deliver basic health care to the mothers and children who need it most.

In the Americas, Cuba, Argentina, Uruguay and Costa Rica are ranked high on the mother index for "less developed countries," while the United States of America is located in the 27th position among the developed countries.

The maternal mortality ratio in Latin America and the Caribbean is estimated at about 190 deaths per 100,000 births. Only seven Latin American countries have indicators below 50 deaths per 100,000 births. According to Pan American Health Organization (PAHO), these countries are Uruguay, Chile, Cuba, Santa Lucia, Argentina, Brazil and Costa Rica.

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However, there are also disparities within the countries, particularly between women living in the countryside and women residing in cities. For instance, a woman from Santiago is quite likely to be attended by skilled personnel when giving birth, but we can not say the same about a woman from the Mapuche indigenous group living in the South of Chile.

Considering Latin America as a whole, the region has a favorable ratio of births attended by skilled personnel – 82% throughout the region, while in Africa the number plummets to 46%, and in Asia it’s 62%. Nevertheless, according to PAHO the "virtual lack of change in maternal mortality rates and the absolute number of such deaths (about 22,000 a year) in Latin America and the Caribbean over the past decade should be a cause for concern, since this is by no means a positive signal with regard to progress towards the target of a three-quarters reduction by 2015."

The statement above is made in regards to the fifth Millennium Development Goal’s (MDG) call to improve maternal health. Its target is to reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio.

One exception is Colombia, where the maternal mortality rate has decreased from 99 deaths per 100,000 births registered in 2001 to 68 in 2005, according to PAHO. One of the reasons for this good news? Attention to prenatal care has improved.

However, PAHO underlined the need for joint efforts in order to maintain this trend into the future. Colombia must still look to decrease the maternal mortality rate to 45 deaths per 100,000 births in order to accomplish the fifth Millennium Development Goal.

For that purpose, according to the UNDP Colombia, the country must increase to 90% the proportion of women receiving at least four prenatal controls (in 2005 was 85%); and increase to 95% the ratio of births attended by skilled personnel (in 2005 was 92%), among other targets.

A recommendation of Save the Children is to invest in community health care workers to reach the poorest of the poor with essential lifesaving care. Millions of poor and marginalized families do not get basic health care because it is simply unavailable, too far away or too expensive.

In fact, most of the Colombian women who die as a result of causes associated to maternity are the poorest, those who have a lower education level and more difficulties to access the institutional health services.

In Colombia, the causes of maternal mortality — directly associated to maternity- are in order of importance eclampsia (35%), complications occurred during the childbirth work and the childbirth itself (25%), pregnancy which ended in abortion (16%), other pregnancy complications (9%), puerperio complications (8%) and hemorrhages (7%).

However, statistics not include voluntary interruption of pregnancy, because abortion is illegal in this country, except in cases where pregnancy is the result of rape or incest, the fetus has a deformity that would prevent survival outside the womb, or the expectant mother’s health or life is in danger. Due to this restricted interdiction, many women get abortions in a clandestine manner, often in antiseptic conditions, which ended in serious health complications, including death.

To tackle the maternal mortality, Colombia has launched a "Chock Plan," which is aimed to putting the topic in the public agenda; monitoring the activities which the social and institutional actors have to accomplish to reduce this rate; and contributing to the reduction of the maternal mortality.

This nine month plan is focused in communication, visibility and dissemination of information regarding preventive measures, roles of those who have responsibilities, and social importance of safe maternity. The expected outcome is to create a favorable environment to implement successful health interventions.

The plan is leaded by the Ministry of Social Protection (former Ministry of Health) with the cooperation of provincial health authorities, private health care providers, and academics, among others.