BY DIEDERIK RUKA ATUQ Taken from https://www.javeriana.edu.co/pesquisa/mortalidad-materna-choco/
Historical inequalities and inequities, added to the geographical and climatological conditions of the Choco territory, are determining factors in the health of pregnant women in the department.
The rural conditions in the Colombian Pacific are different from the ruralities of other territories in the country. With a majority Afro-descendant and indigenous population, motherhood in Chocó, in addition to being a life-giving experience, is at the same time a challenging experience for one’s life.
Pregnant women have to face a wild, extensive, humid and tropical jungle. They must travel long distances and cross geographic, economic and cultural barriers to access services that meet the requirements of their pregnancy.
The Pan American Health Organization defines maternal deaths as the death suffered by a woman during pregnancy, childbirth or the postpartum period, regardless of its duration and place of occurrence. Furthermore, it must be generated by any cause associated with or aggravated by pregnancy or the care process.
A study with a multidimensional and interdisciplinary approach carried out by the Javeriana Public Health Institute, called Analysis of inequalities and inequities in maternal mortality in Chocó, Colombia, reveals the factors that increase the maternal mortality rate in the Chocó territory, which exceeds the goal of 45 deaths per 100,000 live births. This goal was set in relation to objective five of the Sustainable Development Goals.
Timely access to Maternal Care
Chocó is a remote, disconnected and difficult-to-access territory that throughout history has experienced abandonment by the State. Most of its mobility is by river or sea. However, it depends on access to gasoline, boat engines, the navigability of its rivers and the economic solvency to pay for usually expensive transportation.
For this reason, limited access to health services is a key factor that contributes to maternal mortality in the department. According to the study, rural and remote communities face the greatest barriers to accessing timely medical care during pregnancy and childbirth.
“In Chocó, many women have to travel long distances to reach a health center, and even then they may encounter a lack of trained medical personnel, a lack of infrastructure or basic medical equipment for the correct provision of care,” explains anthropologist Liany Katerine Ariza Ruiz, from the Public Health Institute of the Javeriana University.
This research, which also included the participation of professors, researchers and graduates of the Javeriana, shows that women from these vulnerable communities face a greater risk of complications during pregnancy and childbirth due to limited access to prenatal and obstetric care services. quality.
“This prolongs response times in emergency cases, increasing the risk of complications and maternal death,” adds the expert. Thus, this study reveals that the highest maternal mortality is being contributed by women from Afro-descendant communities and indigenous communities in the region.
“In this context, and by not responding to felt needs, the health system behaves as a social determinant of health that increases the social, economic and human costs of pregnant women and newborns,” adds Alexandra Matallana, researcher. from the same institute.
Inequalities and inequities in motherhood
Latin America and the Caribbean is the region with the greatest inequality in the world. Within this area, Colombia is among the countries with the greatest social inequality, along with Brazil, Haiti and Panama.
Along with Cesar and La Guajira, Chocó has one of the highest rates of poverty and inequality, and many of the maternal and neonatal deaths in these departments could be prevented because their causes are due to inequalities and social injustices.
According to Xaverian research, women who live in situations of extreme poverty face greater risks during pregnancy and childbirth.
The problem is not with the woman. The problem really lies in the structural, social, economic and political conditions that add to the poor conditions of the health system in the territory. Liany Katerine Ariza Ruiz
The conditions of poverty reflected in inadequate housing and public services, critically overcrowded homes, low economic and schooling levels, added to the geographic characteristics of the territory and limited access to a deficient health system, play a crucial role in maternal mortality in the Chocó.
These social determinants of health identified in the study reveal, as researchers have done in international studies, three delays that increase the vulnerability and risks to the health of women and their newborns.
These delays are:
•Delay in seeking help: delay in going to a health center in a timely manner to evaluate signs and symptoms in the pregnant woman.
•Delay in going to the health center: delay due to geographical aspects and socioeconomic difficulties that make timely travel difficult.
•Delay in receiving adequate and quality care: delay due to administrative barriers to receive specialized, timely and efficient care.
These delays, which contribute to maternal mortality, have worsened in recent years due to the confinement and restrictions on mobility suffered by the communities of these territories devastated by armed groups seeking control of illegal economies.
An ancient solution to maternal mortality
A pregnancy is not just an individual matter, it is a matter of a community, of a family that is pregnant. For this reason, maternal mortality is a crucial indicator of reproductive health that significantly affects the human development of a family and its society.
In line with the latest World Health Organization recommendations on prenatal care, minimum prenatal checkups have been increased from four to eight. These are essential for pregnant women to reduce maternal and perinatal deaths.
And although the ideal should be twelve controls, in areas like Chocó, they reach by far two within 40 weeks of gestation.
Thus, women prefer the care of a midwife, due to social and cultural proximity in a context of low state presence, added to the poor quality of health services in the territory.
However, and despite its important role with an estimated 18,000 births attended in the last 10 years, midwifery is carried out in the midst of a complex reality: violence and abuse in the midst of the armed conflict, precariousness in displacement and mobility, shortages of supplies such as gloves, gauze, blades and flashlights.
Added to these precarious conditions is the decrease in midwives due to the lack of interest of the new generations in continuing to carry out a work that is constantly delegitimized and discriminated against. All together, the result is that in some areas of the Chocó territory there is an almost total absence of community and institutional maternal care.
In the country, midwifery is stigmatized even though since 2022 the Constitutional Court, through ruling T-128-22, recognized midwifery as ancestral knowledge. He also urged the Ministry of Health and Social Protection to include midwives within the social security system with the aim of reducing inequities and social inequalities in these population groups, and of course, in the care processes for pregnant women and their newborns. born.
“When I finished my nursing studies, I was not so oriented towards recognizing traditional knowledge. We did not have that vision of recognizing the other, of recognizing tradition and of recognizing culture,” says Lilibeth Romero, nurse co-researcher of the study, scholarship holder and graduate of the Master of Public Health at the PUJ.
To effectively address the challenges of maternal mortality, this research was developed in two other departments with the highest maternal mortality rates in the country: La Guajira and Cesar.
In the constant search to improve the living conditions of the most vulnerable populations, the role of midwives is fundamental. Not only for emergency care and the care of pregnancies and newborns, but also because they are a community support for the reproduction of life, the generation of trust and the strengthening of community networks in these areas so fragmented by violence.
“A midwife is very important for many reasons. The Ministry of Health, no matter how hard it tries, does not cover all the townships and villages in our municipality. From here onwards there are townships from where it takes six hours to reach the urban area, and if a midwife is well trained, in case of emergency she could save many lives of both mothers and babies.” Interview with midwife Istmina – Project: Analysis of inequalities and inequities in maternal mortality in Chocó, Colombia.
Taking into account the above, in the department of Chocó the work carried out by the Association of the interethnic network of midwives and midwives of Chocó (AsorediparChocó) is invaluable. For more than 15 years, it has been carrying out a process of social and community strengthening with the midwives of the department, promoting the care of the lives of women and their children.
Based on the results of these analyses, public policy proposal documents were prepared, in which the findings were synthesized to subsequently socialize with the communities in the territories. He also designed the pilot of a chair in interculturality in health with an emphasis on maternal health.
The study highlights the importance of adopting a multidimensional approach that combines interventions in health, education and socioeconomic development of these territories to reduce inequalities and inequities in maternal health and guarantee a safer and healthier future for pregnant women and their families.
This study was framed in a research co-financed by Minciencias called Exchange and transfer of formal, traditional and community knowledge in maternal-perinatal health with a differential and intercultural approach. This had the participation of other institutions such as the University of the Andes, the Popular University of Cesar, the University of La Guajira, the Technological University of Chocó, Profamilia, Asoredipar Chocó and the Kankuamo indigenous Cabildo.
