Maternal mortality in Mexico

International research shows that prompt medical attention could avoid most maternal deaths in Mexico. Maternal mortality rates indicate access to health services and their quality. Measures required to reduce maternal mortality include access to contraception to prevent unwanted pregnancy, access to emergency obstetric care during complications, and qualified and respectful healthcare.

Mexico joined the United Nations Millennium Development Goals in 2007, promising to reduce the MMR of 22.3 deaths for every 100,000 births, but has not reached the target. The MMR was 57 in 2008, 62 in 2009 and 51 in 2010. Maternal mortality is the fourth cause of death of women in Mexico (10 percent die in traffic accidents, 8.5 percent by suicide and seven percent are murdered).

According to IPAS, ethnicity, education, access to health services and age are determining factors in Mexico's MMR. Indigenous women are at higher risk than other groups to die from pregnancy related causes. The less education a women has, the more likely she will die from pregnancy complications. One in three women who die during pregnancy cannot access state health services. An additional 39 percent only have access to a basic state service. Younger and older women are more at risk for maternal mortality.

The Observatorio de Mortalidad Maternal says that 14 percent of Mexican women who died in 2010 because of their pregnancy were indigenous women. This figure is small because the indigenous population is not evenly distributed throughout Mexico. States with large indigenous populations like Chiapas, Guerrero and Oaxaca have the highest mortality rates in the country, showing 20 percent of all maternal deaths in Mexico. In Guerrero and Oaxaca half of maternal deaths occur among indigenous women.

Indigenous women often cannot access full public health services during pregnancy. In fact, 20 percent of those who died from pregnancy complications had zero access to public health services. They are the group less likely to receive contraceptive education or products. They tend to become sexually active at age 16 (national average is 18), become pregnant within the first year of sexual activity, and have more children than other Mexican women. Indigenous women have difficulty acquiring reliable contraception. Guerrero, for example, has an unmet contraceptive need of 26 percent.

In Mexico, pregnancy causes 83 percent of all hospitalizations of girls between 10 and 19 years old. Among girls between 10 and 14 years old, one in three cases is caused by pregnancy. By age 20, half of the female population has at least one child. Teenage pregnancy is abundant in Mexico's northern states of San Luis Potosi, Nuevo Leon, Tamaulipas and Chihuahua. IPAS calculates that 20 to 30 percent of maternal deaths occur therein among teenagers. Most teenage pregnancies in Mexico result from the group's low contraception use (40 percent compared to 71 percent nationally). This is caused by poor sexual education and inadequate distribution of contraception.

Maternidad Sin Riesgo estimates that only 60 percent of Mexico's 4,200,000 annual pregnancies are carried to term. The rest end in abortion, miscarriages or stillbirths (Lozano et al, 1994). The Guttmacher Institute reckons that 19 percent of Mexican women end at least one pregnancy in their lives. Abortion is severely restricted in most of Mexico, except in confirmed rape cases. Because only Mexico City permits elective abortion in the first trimester, unqualified people perform most other abortions in unsafe conditions.

Officially, complications caused by abortion in Mexico account for six to seven percent of all maternal mortality deaths. However, the World Health Organisation calculates that maternal mortality related to abortion accounts for 13 percent of worldwide deaths and 24 percent in Latin America. Research published in Mexico suggests that abortion deaths are usually classified as haemorrhages or infections. This happens because most Mexicans do not accept abortion, and women can face murder charges and life imprisonment for procuring abortions. Healthcare providers probably prefer to not mention abortion as cause of death.

Mexico has tried to reduce maternal mortality by providing free healthcare to all pregnant women, including those without insurance. It has attempted to avail more healthcare professionals and train midwives, but the problem remains grave. IPAS believes the issue is not lack of public policy, but its inadequate realization by health authorities. It complains that officials do not properly distribute money to maternal health programs, and government investment is falling. Groups working with indigenous women say healthcare professionals need to:

• provide respectful and dignified care;

• offer explications, diagnoses and treatment in indigenous languages; and

• respect cultural sensitivities during examinations.

Evidently Mexico's high MMR is a result of inadequate care offered to the most vulnerable sectors of society: The poor, who lack health insurance; the young, who have limited access to contraception and sexual education; and indigenous women, who are poor, young and cannot access health services in a language they understand.

Cath Andrews is a professor of Mexican history.