Inés Acosta
MONTEVIDEO, Jul 26 2010 (IPS) – Uruguay is on the point of reaching the Millennium Development Goal for reducing the maternal mortality ratio, but it is still behind in other aspects of maternal health, like providing integrated sexual and reproductive health care, fighting syphilis and checking on mothers and babies during the postpartum period.
These targets are still far off and there is no exemption just because maternal mortality is low, said Lilián Abracinskas, head of the non-governmental organisation Mujer y Salud en Uruguay (MYSU, Women and Health in Uruguay).
She told IPS that public campaigns to promote mother-and-child health policies are also needed.
This country has been successful in lowering maternal mortality and is on track to meet the fifth of the eight Millennium Development Goals (MDGs), but it still needs to make progress in some aspects of health services for women of reproductive age.
The MDGs, adopted in 2000 by the United Nations member states, set out goals for reducing extreme poverty and hunger, promoting gender equity and empowerment of women, universal primary education, maternal and child health, combating major diseases, working for environmental sustainability and achieving a global partnership for development.
Uruguay s maternal mortality rate deaths related to pregnancy, childbirth, the postpartum period and abortions is the lowest in Latin America and the Caribbean, followed by Cuba and Chile. However, experts consulted by IPS agree that in spite of this success, vigilance must be maintained, and they are concerned because most of the deaths that occur are avoidable.
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One line of action that has had noteworthy success is the effort to eliminate deaths due to abortions carried out in unsafe conditions, in this small South American country where abortion is still illegal.
Most maternal deaths nowadays are caused by haemorrhages, puerperal infections and severe eclampsia, and the risk of these is reduced if mothers-to-be receive adequate prenatal care.
The fifth MDG aims at improving maternal health, by reducing the 1990 maternal mortality rate by three-quarters by 2015, and Uruguay is close to achieving it.
According to the 2009 Country Report on MDGs for Uruguay, drawn up by the National Council on Social Policies (CNPS), virtually all births are attended by qualified personnel, and 90 percent of pregnant women receive antenatal care from the first or second trimester of pregnancy.
The maternal mortality ratio in Uruguay fell from an average of 2.3 per 10,000 live births in the 1990s, equivalent to 13 deaths a year, to 1.5 per 10,000 live births in 2008, or seven deaths a year, similar to the rates found in the United States and some European countries.
Experts point out, however, that in 2009 the number of maternal deaths rose to 16, half of them caused by influenza A/H1N1.
The good news about the overall fall in this indicator is complemented by the marked reduction in infant mortality, which dropped from 13 per 1,000 live births in 2004 to 9.6 per 1,000 live births in 2009. Health Minister Daniel Olesker announced the target of achieving an infant mortality rate of 6.9 per 1,000 live births by the end of the government s term of office in 2015.
Combating unsafe abortions
In 2001 it was shown that abortions carried out in unsafe conditions were responsible for 28 percent of maternal mortality, and for 47 percent of maternal deaths at the state Pereira Rossell hospital in Montevideo, the country s main maternity and children s hospital, which attends most of the women suffering from complications caused by back-alley abortions.
A group of health professionals decided on a strategy called Iniciativas sanitarias contra el aborto provocado en condiciones de riesgo (Sanitary Initiatives Against Unsafe Abortion) in 2002, which helped to improve the situation.
It is a model for damage control and risk reduction for unsafe abortions, the head of the programme, Dr. Leonel Briozzo, a professor of obstetrics and gynaecology at the Faculty of Medicine of the state University of the Republic and head of the Strategic Planning department at the Health Ministry, told IPS.
A multi-disciplinary team carries out medical examinations of women who want to have an abortion, before and after the abortion procedure, and provides information and counselling for the women with the aim of minimising harm to their health.
Obstetrician Ana Labandera, the administrator of the Sanitary Initiatives programme, told IPS that the approach represents a change in the doctor-patient relationship, replacing the traditional paternalism of health professionals who tell women what to do, with care based on the women s rights.
The programme is carried out in the Pereira Rossell hospital, where the poor come for free medical attention, and in 2004 it was established as a standard for health care at the national level.
In 2005 this model began to be implemented in other areas of Montevideo and also in the departments (provinces) of San José and Canelones, in the south of the country, and Florida, in the centre. Seventy percent of women in this country of 3.3 million people reside in these provinces.
According to official statistics, there have been no deaths due to abortion complications in the country in the last two years.
A law on the right to sexual and reproductive health was passed by Congress in 2008. But its first article, which would have legalised first trimester abortion, was vetoed by then president Tabaré Vázquez of the leftwing Broad Front.
In Briozzo s view, abortion is always a health risk, but when it is illegal it causes illness and death.
However much we have managed to reduce the death rate from abortion, it remains a problem because of the stigma associated with it. Abortion must be decriminalised, he said.
Abracinskas said, Clearly there has to be a change in the law on abortion.
At present MYSU is carrying out a campaign for Legal Abortion 2010, with the aim of reversing the veto imposed by Vázquez in the new Congress, installed in February. Current President José Mujica, also of the Broad Front, has said that if the legislature approves a law decriminalising abortion, he will not veto it.
It is not the same thing to train personnel for a damage prevention strategy as to train a team to assist with an abortion, Abracinskas said. It would be marvellous if there were more synergy between parliamentary political decisions and those of the executive branch, in terms of making progress in sexual and reproductive health.
The coordinator of the Health Ministry s department of sexual and reproductive health, Leticia Rieppi, told IPS that in addition to the Sanitary Initiatives programme, a number of actions have been taken in recent years that have resulted in improvements to maternal health.
For instance, antenatal care has been a priority area since 2008, with extra funds for health centres that meet quality and quantity targets for prenatal services; and the United Nations Population Fund (UNFPA) has financed the purchase of contraceptives, for distribution through primary care services.
Rieppi praised women s organisations and groups for spreading the word about check-ups in pregnancy, but in her view the health system still needs to increase the proportion of women coming in for regular pre- and post-natal health checks.
Soon, sexual and reproductive health services will be offered at all public and private hospitals in the country. Contraceptives are about to be made available at health centres by prescription, at a cost of around 30 pesos (1.50 dollars), much cheaper than the price of a pack of birth control pills at chemist s shops, around 200 pesos (10 dollars).
