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 Perinatología
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•Biodiversity (third world place)
•First place in reptiles
•2nd mammals
•4th amphibians and vascular plants
•10th in butterflies
•20th birds
Mexico
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• Population: 103.7 million
• Considerated one of the most populated countries in the world: 11th place
• Population density: 53 persons/km2
• Mexico City: 5,799 persons/km 2
• Chihuahua: 13 people/km 2
INEGI 2004
Mexico
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• 2.1 million births in a year
• Life expectancy at birth
• ♀ 77.4 • ♂ 72.4
• Growing rate• 1970 – 3.4%• 2004 – 1.3%
INEGI 2004
Mexico
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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 society
• 60% 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 society
• Diversification• Heterogeneity• Complexity• Potential
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54 Mexico 0.796
34 Argentina 0.84438 Chile 0.831
114 Bolivia 0.653120 Guatemala 0.631
1 Norway 0.9422 Switzerland 0.9413 Canada 0.940
6 United States 0.939
54 Mexico 0.796
171 Burundi 0.313172 Nigeria 0.277173 Sierra Leona 0.275
Human development index
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Conapo. Human development report 2002. New York. 2002
0
3
- 3
0.7 0.8 0.9 1
ChiapasGuerreroOaxaca
Mexico CityNuevo Leon
Human 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 rate• 1970 – 6 • 1987 – 3.8• 2004 – 2.2
INEGI 2004
Women
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• 1 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
Rural Mexico
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Rural Mexico
• 8th 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% haven´t 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)– Chiapas– Oaxaca– Guerrero
INEGI 2004
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Children
• 6% 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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Children
• Exclusive breast-feeding (6 months)– General 20 %– Urban 15%– Rural 33%
• Complete vaccination 94% (<1 year old)
• Low birth weight 4.5% (94,500)– Chiapas 8.3, – Oaxaca 5.3, – Guerrero 6.4
INEGI 2004
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United StatesCuba
MexicoPanama
ArgentinaVenezuela
BoliviaPeru
5.2 – 9.8
17.1 – 29.9
9.9 – 13.8
30 – 80.313.9 - 17
ChileColombia
Infant Mortality Rate (1000 born alive)
Panamerican Health Organization 2002
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Infant mortality rates in Chihuahua
Instituto de Salud Publica 2003
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Infant mortality rates in Oaxaca
Per 1000 born alive
Instituto 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
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Rank Cause Deaths Rate * %
1 Perinatal 18,569 906.50 50.8
2 Lower respiratory
tract infection
3,128 152.7 8.6
3 Congenital cardiac disease
2,634 128.59 7.2
4 Gastro-intestinal infection
1,493 72.89 4.1
5 Malnutrition 830 40.52 1.0
Principal death causes infant <1 year
* Per 100,000 births CONAPO, 2002
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Capacitated personal84%
2.1 millonbirths
in 1 year
Traditional methods
30%
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DoctorT. MidwifeOtherNo specified
Births in hospital or clinic %
Labor assistance
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55%Perinatal
deaths
Poorest states
ChiapasOaxaca
GuerreroPueblaHidalgo
Michoacán
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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 pública Méx v.39 n.1 Cuernavaca ene./feb. 1997
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Demedicalized
Appropriate technology
Regionalized
Evidence based
Holistic
Family centered
Appropriate culturally
Multidisciplinary
European Perinatal Care Task Force 1998
Perinatal care
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Lacandon
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Rarramuris
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Aztecs• Marriage 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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Aztecs• At 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 won´t 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 potential
Spiritual
Biological
Social
Economical
Psychological
Affective
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Human being
Concern 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 settings
Education
Information
Social support
Economical support
Culture
Religion
Emotional support
Well-being
Environment
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Health care resources
• Uneven distribution
• Resources destinated to health care
• México 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
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