Regional Disparities Affect Adolescent Women's Access to Sexual and Reproductive Health Services Maternal Mortality in the Least Developed Region Is Nearly Twice the National Average
Two reports released today by the Guttmacher Institute, Investigación en Salud y Demografía (INSAD) and El Colegio de México shed new light on the sexual and reproductive health of young Mexican women and on barriers to improving maternal health in Mexico. Based on national surveys, the reports—"Addressing Adolescent Women's Sexual and Reproductive Health Needs in Mexico: Challenges and Opportunities" and "Barriers to Safe Motherhood in Mexico"—provide new evidence aimed at informing programs and interventions to better serve the needs of Mexican women and adolescents.
The first report, "Addressing Adolescent Women’s Sexual and Reproductive Health Needs in Mexico: Challenges and Opportunities," shows that young women’s lives differ greatly according to the region and state they live in and whether they reside in an urban or rural setting. Those living in the relatively less developed, less urbanized and poorer southern states have more limited access to sexual and reproductive health services and information than those living in more developed, more urbanized and better-off areas, such as Mexico City and the northern states.
The researchers found that marital, sexual and reproductive behavior also varies greatly, depending on where young women live. In 2006, 29% of women aged 20–24 in rural areas reported having been married before age 18, compared with 17% in urban areas. Fewer urban than rural women had had a birth before age 18 (14% vs. 22%)
Overall, contraceptive knowledge is high—97% of 15–19-year-old women knew of at least one contraceptive method in 2006—but contraceptive use has declined slightly among married women aged 15–24, from 56% in 1997 to 53% in 2006. Meanwhile, the proportion of married women who have an unmet need for contraception—that is, who are able to become pregnant but are not using any contraceptive method, even though they do not want to have a child soon or at all—increased among this age-group, from 23% to 31%. The situation is more critical among sexually active unmarried young women aged 15–24: Only 35% were using a contraceptive method in 2006.
"While the government has implemented a variety of strategies to improve the sexual and reproductive health of young Mexican women, greater efforts are needed to coordinate these initiatives and address geographic disparities," says Fatima Juárez, a coauthor and senior fellow at the Guttmacher Institute.
Juárez and her colleagues argue that the inclusion of sex education in the official curricula of primary and secondary schools has been a highly significant achievement, but they note that it is essential to train teachers to increase their knowledge of the subject matter and their confidence when teaching about issues related to sexual and reproductive behavior.
The second report, "Barriers to Safe Motherhood in Mexico," shows that while maternal mortality has decreased steadily since the 1950s, the level of maternal deaths remains high. In 2008, there were 57 maternal deaths per 100,000 live births in Mexico, a ratio that is five times that found in industrialized countries. Moreover, the maternal mortality ratio in the least developed region of the country (comprising the states of Guerrero, Oaxaca and Chiapas) is 97.3 maternal deaths per 100,000 live births—almost double the national average.
Such regional disparities are largely due to the uneven distribution of health care resources and providers, which favors urban areas, such as Mexico City.
The researchers found that hemorrhage and hypertension during pregnancy are the leading causes of maternal mortality, together accounting for slightly more than half of all maternal deaths in Mexico. Clandestine abortion is the fifth leading cause of maternal death in the country. According to the report, abortion-related mortality is unlikely to decrease until women have greater access to contraceptive services and safe, legal abortion.
While the Mexican government aims to reduce maternal mortality by more than half—to 22 deaths per 100,000 live births by 2015—the authors believe this goal will not be achieved unless greater efforts are made to narrow the regional gaps in access to obstetric services and increase access to high-quality emergency services.
The report finds that nongovernmental organizations are playing an important role in efforts to improve maternal health in Mexico. For example, the Committee for the Promotion of Safe Motherhood brings together private organizations and governmental institutions in initiatives to reduce maternal mortality, such as promoting universal access to emergency care and prioritizing service provision in the most deprived regions of the country.
"Coordinated initiatives such as this are the key to improving the maternal health of all Mexican women," says Jose Luis Palma, executive director of INSAD and coauthor of the report.
The reports, which are only available in Spanish, can be found at
http://www.guttmacher.org/pubs/Adolescentes-Mexico.pdf
http://www.guttmacher.org/pubs/Maternidad-Segura-Mexico.pdf
The Guttmacher Institute works to advance sexual and reproductive health in the United States and worldwide through an interrelated program of social science research, policy analysis and public education designed to generate new ideas, encourage enlightened public debate, promote sound policy and program development, and, ultimately, inform individual decision making. Learn more at Guttmacher.org.
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