Rural Health Care in Mexico: Cultural Differences in Childbearing Irma Alejandra Coronado Zarco

1. Rural Health Care in Mexico: Cultural Differences in Childbearing Irma Alejandra Coronado Zarco Instituto Nacional de Perinatología

3. Mexico • Biodiversity (third world place) • First place in reptiles • 2nd mammals • 4th amphibians and • vascular plants • 10th in butterflies • 20th birds

4. Mexico • 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

5. Mexico • 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

6. 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

7. Mexican society • 60% Mestizos (mixture of European and Amerindians) • 85 recognized languages (At least 56 indigenous) • “Catholic” 89%, “Evangelist” 6% (syncretism with native religions)

8. 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

9. Human development index 1 Norway 0.942 2 Switzerland 0.941 3 Canada 0.940 6 United States 0.939 54 Mexico 0.796 34 Argentina 0.844 38 Chile 0.831 54 Mexico 0.796 114 Bolivia 0.653 120 Guatemala 0.631 171 Burundi 0.313 172 Nigeria 0.277 173 Sierra Leona 0.275

10. Human development index Chiapas Guerrero Oaxaca 3 0 Mexico City Nuevo Leon - 3 0.7 0.8 0.9 1 Conapo. Human development report 2002. New York.2002

11. Women • 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

12. Rural Mexico • 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

13. 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

14. Children • Population < 15 years old: 33,184 million • 35% live in 3 of the poorest states (11,614 million) • Chiapas • Oaxaca • Guerrero INEGI 2004

15. 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

16. 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

17. Infant Mortality Rate (1000 born alive) United States Cuba 5.2 – 9.8 9.9 – 13.8 Chile Colombia Bolivia Peru Mexico Panama Argentina Venezuela 30 – 80.3 13.9 - 17 17.1 – 29.9 Panamerican Health Organization 2002

18. Infant mortality rates in Chihuahua Instituto de Salud Publica 2003

19. Infant mortality rates in Oaxaca Per 1000 born alive Instituto de Salud Publica 2003

20. 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

21. Principal death causes infant <1 year * Per 100,000 births CONAPO, 2002

22. 2.1 millonbirthsin 1 year Capacitated personal 84% Traditional methods 30%

23. Labor assistance Births in hospital or clinic % Doctor T. Midwife Other No specified

24. Poorest states Chiapas Oaxaca Guerrero Puebla Hidalgo Michoacán 55% Perinatal deaths

25. 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

26. Perinatal care Demedicalized Holistic Appropriate technology Family centered Regionalized Appropriate culturally Multidisciplinary Evidence based European Perinatal Care Task Force 1998

27. Lacandon

30. Rarramuris

33. 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

34. 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 When you feel that the seed sown in you blossoms…….

35. 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.

36. 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

37. 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.

38. Biological Affective Spiritual Social Psychological Economical One of the conditions of the human being with more potential

39. Human being Concern with the needs of mankind and the alleviation of its suffering Show compassion, sympathy, consideration for another creature

40. Well-being Health care (quality) Social support Economical support Birth settings Culture Environment Religion Education Information Emotional support

41. 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

42. Alternatives¿? • Avoiding stereotyping • Respect for differences • Sensitive and intelligent understanding • Intention for improvement

45. Coatlicue