Category: Colombia

Translated by Alex Moreland.

I chose this text for a number of different reasons. I liked that it was written in and about Colombia. Although I have never been to Colombia, I have a few ties to Colombia through family friends. I find it a little easier for me to translate South American Spanish than I do Spanish from Spain. Since I know more people from South America, it is easier to consult them if I get stuck on a phrase, and having a native speaker around is a great resource for translation.

The other reason I chose this text is I am very interested in childbirth. I want to become a midwife, which would mean working in the health care field that provides care to pregnant women, and then delivers the baby. This text is important to me because it details the hardships that developing countries face in their health care system and why their mortality rate can be so high.

Source text: “La atención del embarazo y del parto en Colombia falla en calidad y oportunidad de atención”

In Colombia, Prenatal and Childbirth Care is often Substandard or even Unavailable

Worldwide, more than half a million women die each year from complications of pregnancy and childbirth. Ninety-nine percent of these deaths occur in developing countries and 70,000 are young mothers between 15 and 19 years old.

These statistics come from a recent report by UNICEF entitled “Maternal and Newborn Health” which emphasizes that the risk of death is 300 times greater in poorer countries. Each year in Colombia, around 600 women die from complications during pregnancy or childbirth. According to the Minister of Social Protection, in December of 2008 the death rate for pregnant women was 44.7 per 100,000 live births.

“Most of these women die during the last stages of labor, right before the birth of the child. Pre-eclampsia and eclampsia, collectively known as hypertensive disorders of pregnancy, as well as postpartum hemorrhage are the main causes of death” says Mary Luz Mejía, sexual and reproductive health advisor for the United Nations Population Fund.

Postpartum hemorrhages, she says, pose a problem for the specialists. These should be handled before they get too complicated and they should have qualified health care professionals to control them in places where normal births are attended, “and therein lies the problem” she says.

This year, for example, 18,173 fetuses and infants died due to obstetric complications and birth trauma. Of these, 8,226 were less than 22 weeks gestation and 5,141 were 38 to 42 weeks gestation.

Quality

The standards that exist for care here during pregnancy and childbirth are good and sufficient. Declines in the quality of care are determined by the ability of the professionals that attend the birth and the equipment and necessary supplies that are available.

According to Mary Luz Mejía, the healthcare system put pregnancy and childbirth exclusively in the hands of doctors, “and if we had the certainty that our recent medical school graduates had the skills to handle normal pregnancies and deliveries, then they would. The regulations of prenatal care should correspond with the excellence of general medical training, which doesn’t happen in certain cases.”

Another element related to the problem of the quality of care, is the access to services. The regulations say that the EPS (health promoting entities) and the IPS (health providing institutions) are obligated to inform users of their rights and how to access them. However, Mejía suggests, this is not always met or known, as the insurers are intent on reducing the cost of care.

“The vast majority of maternal deaths are preventable, but often times we don’t have trained personnel with basic knowledge of when and where they should start appropriate management of complications,” says Mejía.

Furthermore, a recently published study in the journal of Obstetrics & Gynecology says that in recent years maternal complications during delivery such as blood clots, breathing difficulties, shock and need for transfusions have all increased, apparently due to the increase in the rate of cesarean sections.

“In our country, cesarean sections have reached levels above the international standard, and for reasons that are rather questionable. For example, a woman will ask her doctor for this intervention, and without any medical need or reason to support it, he accepts,” says Hernando Villamizar, president of the Colombian Society of Pediatrics. “Prenatal care in Colombia, although different depending on the region, has become better. But during birth, the care is not always as good and the timely detection of a problem is limited…The quality of care that is offered through EPS and different institutions that are linked to the system is not the best,” adds Doctor Villamizar.

On occasion, he says, you can’t even find good information or medical history at the time of delivery that offers the details of the prenatal care.

Maternal Behavior

Adding to all this, pregnant women are afraid to ask for time off of work to go to doctor’s appointments, and this slows the demand of health services.

In Bogotá, for example, there are maternal health social networks—20 for each locality of the city—that seek to place maternal health as a priority, supporting pregnant women in making suggestions, informing them of their rights, and guaranteeing them health assistance.

However, there are obstacles faced in the care of pregnant women. “There are three barriers: the decision to use the health services, access to the services, and the care”, says Sandra Patricia Rodríguez, coordinator of the mother-child social network of the District Department of Health.

In the first case, says Rodríguez, there are cultural beliefs and fears that prevent women from approaching doctors, and insurers should be able to identify them so they can motivate them to use the health services.

“There are geographic barriers, such as long distances between the mother’s place of residence and the place where the services are offered, and often they don’t have the money to travel from one place to the other,” says Rodríguez.

There are also administrative barriers: photocopy requirements or insurance problems, that don’t appear in the system or medical examinations in different parts of the city.

“Another barrier is related to the quality of care: the profile of the professionals that give the care, it requires them to have not only the technical and scientific capabilities, but the warmth so that the families feel comfortable, and sometimes this fails,” adds the expert.

The Department of Health of Bogotá has made a significant effort, she says, so that pregnant women, especially those that are not affiliated with the health system, are treated by OB/GYNs and receive adequate care to reduce the risks of morbidity and mortality.

Interesting Facts

• In Colombia, on average 720,832 babies are born alive each year. In 2006, 714,450 were born
• 87% of births are attended by doctors
• 20-35 is the age range which contains the most pregnancies and births
• It is estimated that more babies are born eight or nine months after holidays and long vacations, like the end of the year
• In Colombia, 100 girls are born for every 105 boys. However, for every 100 girls that die in the first year of life, 130 boys will die
• For every 1,000 live births, 22.5% of boys died in the first year of life in 2006. In children under one, 12,211 died in total. The group of 1 to 5 months had the highest number of deaths (2,850: 1,607 boys and 1,243 girls) followed by infants younger than one day (2,516: 1,429 boys and 1,085 girls)
• Neonatal mortality is about 12 per 1,000 live births, or about 8,000 to 9,000 newborns die each year, a good part due to preventable causes and improper handling
• Pregnant women, on average, attend their first prenatal checkup in the third month of pregnancy
• In Colombia, nearly 200,000 teenage girls become mothers each year

According to figures from Dane, in 2006, 536 pregnant women died. Main causes:

• 70 cases of hypertension
• 58 cases of eclampsia
• 57 cases of postpartum hemorrhage