la salud reproductiva

Last week we had a great lecture on reproductive health in Guatemala given by Sammy, one of the Guatemalan docs who works in the clinic. There were some great differences when compared to the situation in the US but also some striking similarities. Some o the highlights:

– the birth rate (14.7%) is the second highest in latinoamerica

-the maternal mortality ratio is high (different reports about 120 per 100000 births; in the US about 21; Sweden 4; Greece 3) and is mostly caused by uterine hemorrhage and/or endometrial infection

– about 30-33% of births occur in the public hospital, 2% in the super expensive private hospital, and 65% out in the communities with comadronas (midwives).

– lots of factors contribute to the high maternal mortality (and also high rates of birth asphyxia), including several reasons that make it hard for a woman to get a C section when she needs one:  lack of good transport (or lack of any transport at all), midwives not recognizing the danger signs (actually less of a factor but still present), the poor treatment many women receive at the hospitals when they go there (much of this is due to the fact that the hospital staff are typically Spanish speaking mestizos, while the women are more likely Mayan and speak little or no Spanish. Also hospital rules don’t permit family members to stay with the laboring woman, a deal breaker for a lot of families), and lastly, the fact that often the woman doesn’t get to decide for herself but rather has the decision made for her by her husband or his family, especially her mother in law. They may decide its too expensive/difficult to go to the hospital, or just take too long making the decision. Another aspect of the family dynamics is that most families will only allow the comadrona to stay in the house for about 30 minutes after delivery- not enough time to watch for and deal with a uterine hemorrhage or an infection. So even women who are getting good care from a midwife still run a high risk of maternal mortality.

– prenatal care is composed of most of the same things we do in the US, wih the exception of a couple screening labs that they dont do here, and of course a huge lack of access (not that our prenatal access in the US is stellar!). The government will pay for 4 total prenatal visits in the public clinics, with more obviously available in the hospitals and private clinics.

– the family planning situation is really interesting and I’ll try to keep in concise since as Jamie said I could go on about this all day. Essentially (and similarly I the US) there are tons of myths floating around the public consciousness regarding different methods. This one makes you gain weight, this one makes you not get your period so all your blood builds up in your uterus until it explodes, the IUD will end up stuck in the front of your baby’s head, the IUD will fall out if you go over too big a bump on a chicken bus. Machismo also plays a strong role in women’s FP choices- many men refuse to use condoms, an also many men don’t want their spouses to use any birth control. Because of this, women often want a method that doesn’t change their periods so they can hide the fact that they are using birth control from their husbands. So the most common methods are the Depo shot (75%) the pill (20%) and then very low rates of use for the copper T and the guatemalan version of nexplanon which has the pleasing name of Jardelle.

-claire

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