Two new reports released jointly today by the Guttmacher Institute, Investigación en Salud y Demografía (INSAD), and El Colegio de México reveal growing gaps in access to reproductive health care for women, especially among poor women, and those living outside major urban areas.
The first report, Addressing Adolescent Women’s Sexual and Reproductive Health Needs in Mexico: Challenges and Opportunities (currently available only in Spanish), reveals that young women living in the less developed, less urbanized and poorer southern states of Mexico show strikingly different marital, sexual, and reproductive patterns than their counterparts in richer, more northern states, and have considerably less access to basic reproductive and sexual health services and information than those who live, for example, in Mexico City.
Researchers in Mexico found that in 2006, 29 percent of women ages 20 to 24 in rural areas married early, before age 18, while only 17 percent of women of the same age range in urban areas married early. Urban women were also less likely to have had their firts birth before age 18 than were rural women, 14 percent to 22 percent, respectively.
While researchers found that contraceptive knowledge among women in Mexico is high—97 percent of 15 to 19 year old women in the national survey knew of at least one contraceptive method in 2006. Contraceptive use has nonetheless declined slightly among married women ages 15 to 24, from 56 percent in 1997 to 53 percent in 2006.
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The study also found that the share of married women who have an unmet need for contraception increased from 23 percent to 31 percent. Women with “unmet need” are those who are able to become pregnant but do not wish to have another child or wish to delay their next birth but are not using any contraceptive method. They lack effective access to services or supplies. The study found the situation to be more critical among sexually-active unmarried young women ages 15 to 24: Only 35 percent were using a contraceptive method in 2006.
“While the government has implemented a variety of strategies to improve the sexual and reproductive health of young Mexican women, greater efforts are needed to coordinate these initiatives and address geographic disparities,” says Fatima Juárez, a coauthor and senior fellow at the Guttmacher Institute.
Juárez and her colleagues argue that the inclusion over the past several years of sex education in the official curricula of primary and secondary schools in Mexico has been a highly significant achievement, but they note that it is essential to train teachers to increase their knowledge of the subject matter and their confidence when teaching about issues related to sexual and reproductive behavior.
The second report, Barriers to Safe Motherhood in Mexico (also currently available only in Spanish) shows that while maternal mortality in Mexico has decreased steadily since the 1950s, the level of maternal deaths remains high. In 2008, there were 57 maternal deaths per 100,000 live births in Mexico, a ratio that is five times that found in industrialized countries. Moreover, women in poorer states of the country face even greater risks in pregnancy: The maternal mortality ratio in the least developed region of the country (comprising the states of Guerrero, Oaxaca and Chiapas) is 97.3 maternal deaths per 100,000 live births—almost double the national average.
Such regional disparities, note the authors of the report, are largely due to the uneven distribution of health care resources and providers, which favors urban areas, such as Mexico City.
The researchers found that hemorrhage and hypertension during pregnancy are the leading causes of maternal mortality, together accounting for slightly more than half of all maternal deaths in Mexico.
Clandestine abortion is the fifth leading cause of maternal death in the country. (See this April article by Marcy Bloom). According to the report, abortion-related mortality is unlikely to decrease until women have greater access to contraceptive services and safe, legal abortion.
While the Mexican government aims to reduce maternal mortality by more than half—to 22 deaths per 100,000 live births by 2015—the authors believe this goal will not be achieved unless greater efforts are made to narrow the regional gaps in access to obstetric services and increase access to high-quality emergency services.
The report finds that nongovernmental organizations are playing an important role in efforts to improve maternal health in Mexico. For example, the Committee for the Promotion of Safe Motherhood brings together private organizations and governmental institutions in initiatives to reduce maternal mortality, such as promoting universal access to emergency care and prioritizing service provision in the most deprived regions of the country.
“Coordinated initiatives such as this are the key to improving the maternal health of all Mexican women,” says Jose Luis Palma, executive director of INSAD and coauthor of the report.