POVERTY: A perilous journey: the mortal danger of poverty

Jun 24th 2010

OUTSIDE the main hospital in San Cristóbal de las Casas, women in traditional multicoloured garb queue up to see a doctor. Many are pregnant or carry infants on their backs. One expectant mother says she fears there will not be a bed for her when she enters labour—all too common in the overcrowded hospital. Tales of deaths from hypertension, haemorrhage or infection during or after giving birth are common in the second city of the state of Chiapas. In a nearby village, one doctor recalls a woman whose journey took so long that she died on the street outside his clinic.
Maternal mortality in Mexico has fallen by 36% since 1990, but it is still higher than in other Latin American countries. The problem is far worse among Indians and in the poorer south. Mothers in Chiapas, Oaxaca and Guerrero states die in childbirth 70% more often than the national average, and indigenous women are three times less likely to survive birth than non-indigenous women. Most of these deaths are preventable.

One of the first obstacles for a pregnant woman is transport. To reach a doctor you need to get a car, a driver, petrol, and someone to take care of the other children. The roads to the nearest town hospital are often slow and dangerous. As a result, many women—including one-third of Indian mothers—give birth without any medical help at all.
Another set of problems awaits at the hospital. Laboratory tests and medical supplies are often too costly for the poorest Mexicans. The quality of care is low: 40% of urban maternal deaths are caused by using the wrong medicine, by botched surgery or by other forms of malpractice.

Lastly, there are cultural and social difficulties. Many women are scared to go to a male obstetrician, which is frowned upon in areas with a macho, conservative culture. Those who do may have trouble communicating, since many indigenous women speak poor Spanish. Doctors sometimes make matters worse by denigrating rural patients, discouraging them from seeking medical help.

More spending on midwives and contraceptives would help save mothers’ lives. New money is on the way: the Spanish government and the charities of billionaires Bill Gates and Carlos Slim announced plans this month to spend $150m on health care for the poor in Central America and southern Mexico. But the best way to reduce maternal mortality is via investment in infrastructure, health and education—all of which would help the south catch up in general.

http://www.economist.com/node/16439044?story_id=16439044