Review of maternal mortality and maternal health outcomes in bolivia and chile


LATIN AMERICA: SELECTED COUNTRY PROFILES



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1.2LATIN AMERICA: SELECTED COUNTRY PROFILES


While the main focus of this paper is to discuss maternal health and mortality in Bolivia and Chile, selected Latin American countries are reviewed to put the Bolivian and Chilean experiences in context. The countries discussed share a Spanish colonial past and have similar cultural characteristics. Despite important improvements in maternal mortality reduction, not all Latin American countries have been successful in reaching Millennium Development Goal 5 [20]. The Pan American Health Organization (PAHO) has identified some of the difficulties that these countries are facing and how to overcome them, including reducing economic barriers, providing universal access to health care and high quality health care from conception to birth, improving the identification system for pregnancy complications and obstetric emergencies, investing in infrastructure, improving drug distribution to mothers, and providing safe medical care for abortions, among others [3].

Usually nutritional deficiencies, education, and socioeconomic conditions are at play when a country has a maternal mortality rate of more than 20 per 100,000 live births [3]. All of the Latin American countries discussed in this paper have a maternal mortality rate higher than 20 per 100,000 (see Figure 1). Bolivia and Chile have the highest and lowest rates of maternal mortality in Latin America, respectfully. Both countries will be discussed in depth in the following sections.


Information from CIA World Factbook

Figure 1. Maternal Mortality Rate in Latin America
Argentina is located between Chile and Uruguay and borders the South Atlantic Ocean. The population of the country is estimated to be 43,024,374 as of July 2014 [21]. Argentina is overwhelmingly Roman Catholic at 92%, although about 20% do not practice. Protestants make up 2% of the population, as do people who practice Judaism. Argentinians are primarily ethnically white (97%), being a mix of Spanish and Italian. The remainder of the population is mestizo or Amerindian. The official language is Spanish, but Italian, French, German, English, Quechua, and Mapudungun are also used [21].

The Argentinian maternal mortality rate between 2000-2008 was approximately 42 per 100,000. In 2009, it increased over 38.5% because of the H1N1 influenza epidemic that affected all parts of the country, especially pregnant women who were particularly vulnerable [22]. In 2010, the maternal mortality ratio was 77 per 100,000 [21]. Despite progress made to reduce maternal mortality by 2015, Argentina is not expected to reach MDG 5 [23]. Between 2004-2005, the contraceptive prevalence rate was 78.9 [21]. A recent PAHO report found that 93% of women had used contraception at some point and 78% used some form of contraception before giving birth to their first child [22]. Between 2003 and 2008, pregnancy among adolescent girls increased from 13.6% to 15.4% [22]. The total fertility rate in Argentina is 2.25 children per woman. Of Argentina’s $771 billion GDP, 8.1$ is spent on health expenditures (Figure 2 and Figure 3 for country comparisons). The GDP per capita in Argentina is $18,600 [21] (see Figure 4 for country comparisons).


Information from CIA World Factbook



Figure 2. GDP in Latin America

Information from CIA World Factbook


Figure 3. Healthcare Expenditure (% of GDP)

Information from CIA World Factbook


Figure 4. GDP Per Capita

Colombia is located in northern South America, with the Caribbean Sea to the north, the North Pacific Ocean to the west, and is surrounded by Venezuela, Panama, and Ecuador. The population of Colombia is estimated to reach 46,245,297 by July 2014 [24]. The official language is Spanish and the population is 90% Catholic. Ethnically, Colombia is diversified; 58% of the population is mestizo, 20% is white, 14% is mulatto, 4% is black, 3% is Amerindian-black mixed, and 1% is Amerindian [24].

In 2010, the maternal mortality rate in Colombia was 92 deaths per 100,000 live births. Colombia has not made enough progress to meet MDG 5 by 2015 [23]. The total fertility rate is 2.07 children per woman and the average age of the mother at first birth is 21.4 years old. In 2010, the contraceptive prevalence rate was 79.1% [24]. Fluctuations in maternal mortality and total fertility rate in Colombia are found between rural/urban and developed/underdeveloped regions [25]. The GDP of Colombia is $526.5 billion, of which, 6.1% is designated for health expenditures. The GDP per capita of the country is $11,100 [24].

Ecuador is located between Peru and Colombia and the Pacific Ocean to the west [26]. The population is estimated to be about 15,654,411, 95% of which is Roman Catholic. Ethnically, Ecuador is almost 72% mestizo, 7.4% Montubio, 7.2% Afroecuadorian, 7% Amerindian, and about 6% white. Castilian Spanish is the official language, spoken by 93% of the population. Additionally, indigenous languages like Quechua are also used [26].

In 2010, the Ecuadorian maternal mortality rate was 110 deaths per 100,000 live births [26], making it one of the highest in the region, second only to Bolivia (see Table 1). Ecuador has not made enough progress in maternal mortality reduction to meet the fifth MDG by 2015 [23]. Non-indigenous women are more likely to deliver in institutions while indigenous women usually give birth at home [27]. As of 2004, the mean age at a woman’s first birth was 21.8 years old. The total fertility rate in Ecuador is 2.29 per woman [26]. The contraceptive prevalence rate in 2004 was 72.7%. Of Ecuador’s $157.6 billion GDP, 7.3% is used for health care expenditures. The GDP per capita as of 2013 was $10,600 [26].

Paraguay is centrally located in South America, southwest of Brazil and northeast of Argentina. The population of 6,703,860 speaks Spanish and Guarani, both of which are the official languages. Ninety five percent of the population is mestizo. Religiously, 89.6% of the country is Roman Catholic, and 6.2% is Protestant [28].

Paraguay is facing high maternal mortality; in 2010, the rate was 99 deaths per 100,000 live births [28]. In order for Paraguay to meet MDG 5 by 2015, it would need to reduce the maternal mortality rate to 37.5 per 100,000 [29]. A PAHO report found that in 2008, over 90% of maternal deaths happened in health care facilities. Of these deaths, 60% occurred when fewer health care workers were present, in the early morning hours or late in the evening [29]. The contraception prevalence rate as of 2008 was 79.4% and the mean age of the mother at first birth was 22.9. The total fertility rate is estimated to be 1.96 children per woman. The GDP of Paraguay is $45.9 billion, of which 9.7% is allocated for health expenditures. Per capita GDP is $6,800 [28].

Peru is situated in western South America, bordered by the Pacific Ocean, between Ecuador and Chile. Over 80% of the population of 30,147,935 is Roman Catholic and 12.5% of the population is Evangelical [30]. Peru is an ethnically diverse country; 45% Amerindian, 37% mestizo, 25% white, and 3% black, Chinese and Japanese. The official languages are Spanish, Quechua, and Aymara [30].

The maternal mortality rate in Peru is 67/100,000 live births. The estimated total fertility rate of the country is 2.22 children per woman and the mother’s mean age at her first birth is 22.3 years. Peru’s contraceptive prevalence is 68.9% [30]. Most maternal deaths in Peru are among rural, poor, indigenous women. Since 2000, the country has made enormous progress in reducing maternal mortality from 185 deaths/100,000 live births. These improvements can be attributed to institutional birth increases, the implementation of culturally sensitive childbirth and pregnancy care, and the proliferation of birthing homes for pregnant women [31]. Despite this impressive progress, Peru is not likely to reach the fifth Millennium Development Goal [23]. Of the $344 billion GDP of Peru, 4.8% is spent on health expenditures. The GDP per capita is $11,100 [30].

Uruguay is located in southern South America, between Argentina and Brazil and borders the South Atlantic Ocean to the south. The population as of 2013 was 3,324,460, of which more than half is Christian. Spanish is its official language. Ethnically, the country is primarily white (88%), mestizo (8%), and black (4%). The entire nation has access to clean drinking water, making it a rarity in the area [32].

In terms of maternal mortality, Uruguay has one of the lowest rates in the region, at 29 per 100,000 live births [32]. The contraceptive prevalence rate is 77% and the total fertility rate is 1.86 children born per woman. The Uruguayan government has taken steps to ensure that the country is on track to reach the 5th Millennium Development Goal by 2015. Among these are policies to improve the quality of care that women receive during pregnancy and delivery and free contraceptives [33]. Perhaps the factor most important in reducing maternal mortality in Uruguay in recent years is the decriminalization of abortion. A bill was passed which allows for elective abortion up until the third month of pregnancy, even for reasons such as extreme poverty [34]. The country spends 8% of its $56.27 billion GDP on health expenditures and GDP per capita is $16,600 [32].

Venezuela is located between Colombia and Guyana, bordering the Caribbean Sea to the north [35]. Ethnically, the population of 28,868,486 is two-thirds mestizo, one-fifth European, and one-tenth African [35, 36]. Roman Catholicism is practiced by 96% of Venezuela. Spanish is the official language but various indigenous dialects are also spoken [35].



As of 2010, Venezuela’s maternal mortality rate was 92 per 100,000 [35]. Though improvements have been made, it is unlikely that Venezuela will reach the fifth MDG target [23]. A program called Proyecto Madre (Mother Project) was implemented in the country in 2006 with the goal of providing access to contraception, obstetric care, transportation services to pregnant women, and prenatal care. The program was reintroduced in 2009 as Mision Nino Jesus (Christ Child Project) [37]. The total fertility rate in Venezuela is 2.35 children per woman. In 1998, the contraception prevalence rate was 70.3%. 5.2% of the $407.4 billion GDP of the country is designated for health expenditure. The GDP per capita is $13,600 [35].


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