Rural Health Care in Mexico: Cultural Differences in Childbearing Irma Alejandra Coronado Zarco
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Transcript of Rural Health Care in Mexico: Cultural Differences in Childbearing Irma Alejandra Coronado Zarco
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Rural Health Care in Mexico: Cultural Differences in Childbearing
Irma Alejandra Coronado Zarco
Instituto Nacional de Perinatologa
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MexicoBiodiversity (third world place)
First place in reptiles
2nd mammals 4th amphibians and vascular plants
10th in butterflies
20th birds
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MexicoPopulation: 103.7 million
Considerated one of the most populated countries in the world: 11th place
Population density: 53 persons/km2Mexico City: 5,799 persons/km 2Chihuahua: 13 people/km 2
INEGI 2004
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Mexico
2.1 million births in a year
Life expectancy at birth 77.4 72.4
Growing rate1970 3.4%2004 1.3%
INEGI 2004
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Mexico
General mortality rate 4.5/1000 people (60.6% chronical diseases)
Average schooling (> 15 years old): 7.8 years 7.6 8.1
Illiteracy : 8%
INEGI
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Mexican society60% Mestizos (mixture of European and Amerindians)
85 recognized languages (At least 56 indigenous)
Catholic 89%, Evangelist 6% (syncretism with native religions)
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Definitions ?Culture: The totallity of socially transmitted behavior patterns, arts, beliefs, institutions, and all other products of human work and thought characteristic of a community or population.
Mexican society:Multicultural societyDiversificationHeterogeneityComplexityPotential
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54 Mexico 0.79634 Argentina 0.84438 Chile 0.831114 Bolivia 0.653120 Guatemala 0.6311 Norway 0.9422 Switzerland 0.9413 Canada 0.940
6 United States 0.939
54 Mexico 0.796171 Burundi 0.313172 Nigeria 0.277173 Sierra Leona 0.275Human development index
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Conapo. Human development report 2002. New York. 2002 03- 30.70.80.91ChiapasGuerreroOaxacaMexico CityNuevo LeonHuman development index
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51.4 % of the whole population
Illiteracy rate 9.7% ( 6.1)
Economically active 14,894,400
Family leaders in 4,683,000 homes
Men studying= women houseworking
>52% of graduates from University
Fecundity rate1970 6 1987 3.82004 2.2
INEGI 2004
Women
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Rural Mexico1 out of 4 people live in rural area (25,925 million)
40% of rural population are indigenous groups (10,370 million)
Agricultural activities from indians 75%, rest of the country 22%
2/3 of coffee production comes from indigenous groups
INEGI 2004
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Rural Mexico8th country with more indigenous groups in the world
The fifth part of the territory belongs to indigenous groups ( 12% of natural reserves and 60% tropical rainforest)
Most settlements < 500 people
Illiteracy 46% and 76% havent completed elementary school Tlahui-Politic No.2,II/1996
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Children Population < 15 years old: 33,184 million
35% live in 3 of the poorest states (11,614 million)ChiapasOaxacaGuerrero INEGI 2004
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Children6% Labor force (10-14 years old)
32% of children in rural areas works (13-17 years old) vs. 15.7% in urban areas
Teenager pregnancy 17.2% UNICEF, 2000
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ChildrenExclusive breast-feeding (6 months)General 20 %Urban 15%Rural 33%
Complete vaccination 94% (
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United StatesCubaMexicoPanamaArgentinaVenezuelaBoliviaPeru5.2 9.817.1 29.99.9 13.830 80.313.9 - 17ChileColombiaInfant Mortality Rate (1000 born alive)Panamerican Health Organization 2002
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Infant mortality rates in ChihuahuaInstituto de Salud Publica 2003
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Infant mortality rates in OaxacaPer 1000 born aliveInstituto de Salud Publica 2003
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Children
Each year 65,380 infants die
35,911 died in the first year of life
22,089 died before 28 days of life
16,452 died in the first week
7,417 in the first 24 hours
INEGI
- Principal death causes infant
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Capacitated personal84%2.1 millonbirthsin 1 yearTraditional methods30%
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DoctorT. MidwifeOtherNo specifiedBirths in hospital or clinic %Labor assistance
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55%Perinatal deathsPoorest states
ChiapasOaxacaGuerreroPueblaHidalgoMichoacn
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The decrease observed in IMR in Mexico during the last years was due to a declining pediatric mortality rate
Neonatal mortality rate was virtually unchanged.
It is well-known that there are important problems in the vital statistics in Mexico due to underregistry of deaths in the first year of life, and particularly those that occur in the first month.
Salud pblica Mxv.39n.1Cuernavacaene./feb.1997
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DemedicalizedAppropriate technologyRegionalizedEvidence basedHolisticFamily centeredAppropriate culturallyMultidisciplinaryEuropean Perinatal Care Task Force 1998Perinatal care
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Lacandon
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Rarramuris
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AztecsMarriage 14-16 years old
Abortion was allowed
Delivery is considerated a private and intimate event
They prefer trustful companion
Careful atention of pregnancy by ticitl (midwife)
First pregancy was full of counceling about nutrition and excercise
Increased caring the last 3 months
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When you feel that the seed sown in you blossoms.
Extreme you hygienic habits so your child will learn to be neat
Walk through the gardens and classrooms so your child will learn that school is also home
Try to see only nice things so your child will appreciate beauty
Control impulse and anger so your child will learn to dominate himself
Learn all you can about science and arts so your child will learn to study
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Ask with respect to your mother and grandmother and the mother and grand mother of your husband to tell you about their experiences so your child will learn to respect older people and will feel proud of them
You and your husband gather with the family so your child will know that he is part of it
Embroid the clothes your child will use, to make him notice that he will have a good reception when he comes out of you into life.
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AztecsAt the end the ticitl verified position of the fetus and if necessary practiced version
Ticitl arrived in advance to birth to the house of pregnant women and got ready(special diet)
During labor she offered a drink with oxytocin effects
Elaborated methods to avoid fear during labor
Fear lowers contraction intensity and prolongs delivery: asphyxia and infection
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Gracious baby, the gods rised you in the highest place of heaven; but you must have in mind that life is sad, painful, full of evil and misery; you wont be able to eat bread without working. May God help you in the many adversities that are waiting for you.
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One of the conditions of the human being with more potentialSpiritualBiologicalSocialEconomicalPsychologicalAffective
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Human beingConcern with the needs of mankind and the alleviation of its suffering
Show compassion, sympathy, consideration for another creature
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Health care (quality)Birth settingsEducationInformationSocial supportEconomical supportCultureReligionEmotional supportWell-beingEnvironment
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Health care resourcesUneven distribution
Resources destinated to health care Mxico 6.1 Colombia 5.5 Argentina 9.5 United States 13.9%
WHO 2001
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Alternatives?Avoiding stereotyping
Respect for differences
Sensitive and intelligent understanding
Intention for improvement
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Coatlicue