Barriers to Reproductive Health in Mexico, Dr Olga M. Lazin-Andrei and Jessica Elihu,

UCLAMexico Country Profile:

• Population: 111,211,789 (July 2009 est.)• Age structure:• 0-14 years: 29.1% (male 16,544,223/female 15,861,141) • 15-64 years: 64.6% (male 34,734,571/female 37,129,793) • 65 years and over: 6.2% (male 3,130,518/female 3,811,543) (2009

est.)

• Median age: total: 26.3 years • male: 25.3 years, 72• female: 27.3 years (2009 est.) 77

Reproduction Issues• Population growth rate:

– 1.13% (2009 est.)

• Birth rate:– 19.71 births/1,000 population (2009 est.)

• Death rate:– 4.8 deaths/1,000 population (July 2009 est.)

• Net migration rate:– -3.61 migrant(s)/1,000 population (2009 est.)

• Urbanization:– urban population: 77% of total population (2008) – rate of urbanization: 1.5% annual rate of change (2005-10 est.)

• Sex ratio:– at birth: 1.05 male(s)/female – under 15 years: 1.04 male(s)/female – 15-64 years: 0.94 male(s)/female – 65 years and over: 0.82 male(s)/female – total population: 0.96 male(s)/female (2009 est.)

• Infant mortality rate:– total: 18.42 deaths/1,000 live births – male: 20.3 deaths/1,000 live births – female: 16.44 deaths/1,000 live births (2009 est.)

• Life expectancy at birth:– total population: 76.06 years – male: 73.25 years – female: 79 years (2009 est.)

Reproductive issues in• Total fertility rate:

– 2.34 children born/woman (2009 est.)

• HIV/AIDS - adult prevalence rate:– 0.3% (2007 est.)

• HIV/AIDS - people living with HIV/AIDS:– 200,000 (2007 est.)

• HIV/AIDS – deaths:– 11,000 (2007 est.)

• Major infectious diseases: syphilis– degree of risk; intermediate

Abortion Is Illegal in 17 States

States That Criminalize Abortion• Chihuahua 1994    

• Morelos

• Baja California Sur 2009 march          • Colima 2009 april           • Sonora 2009 may     • Quintana Roo 2009 may        • Guanajuato 2009 may         

• Durango 2009 june         

•Puebla 2009 june          •Nayarit 2009 july           •Jalisco 2009 august       •Yucatán 2009 september    

•Campeche 2009 september   

•San Luís Potosí 2009 september  

•Querétaro 2009 september   

•Oaxaca 2009 november   •Morelos 2009 necember    •Chiapas  

WOMEN NARRATIVES

“As a woman I had to learn not only to cook, to sew, and to raise my children, but also how to induce an abortion” (unskilled worker, mother of three).

 “I made a catheter using an electric cable from which I extracted the metal wires. I tried several times to insert it by myself and finally succeeded” (kindergarten teacher, mother of three).  “Nobody and nothing could stop me in my making the decision to get rid of my pregnancy. I assumed all risks involved; I did what I felt I should do for my family, to bring up my children” (maquiladora worker, mother of two).

State reproductive policies

• Up to 2007 Women are viewed as primarily reproductive resources

access to legal abortion restricted to:

- women who had been raped

- witch women always would do an abortion

- If the life of the mother was endangered

After 2007

• Mexico City (D.F) allows abortion

• Mexican state hospitals only offer abortion.

• Only half of Mexico City is in the Federal District, the other half penalizes abortion, as it is in the State of Mexico.

Ethnic breakdown

• Ethnic groups:mestizo (Amerindian-Spanish) 60%, Amerindian or predominantly Amerindian 30%, white 9%, other 1%

• Religions:Roman Catholic 76.5%, Protestant 6.3% (Pentecostal 1.4%, Jehovah's Witnesses 1.1%, other 3.8%), other 0.3%, unspecified 13.8%, none 3.1% (2000 census)

Country Profile:• Languages:Spanish only 92.7%, Spanish and

indigenous languages 5.7%, indigenous only 0.8%, unspecified 0.8%; note - indigenous languages include various Mayan, Nahuatl, and other regional languages.

• Literacy:definition: age 15 and over can read and write

• Total population: 91% male: 92.4% female: 89.6% (2004 est.)

Consequences• Of the 1.7 million abortions per year in Mexico, 850 thousand are induced.

Statistics further show that abortion is between the third or fourth cause of death and between the second to fourth causes of hospitalization in Mexico.

• While abortion is illegal in other Mexico, the threat of prosecution is usually only a threat. But if one is caught, it is a lifelong stigma.

• A research study in 1992 in Mexico City determined that of 600 women inmates in the Tepepan jail, only one had been convicted of provoking an abortion. She was 81 years old, nearly blind, and an alternative health care worker. (Martinez)

• As this case illustrates, there is minimal prosecution of the offenders. In fact, corruption ensures little prosecution. A woman pays the equivalent of approximately 1,000 U.S. dollars to secure her release from any charges that are brought (it is called the amparo, that is the Mexican habeas corpus law). It is no wonder abortion, while illegal, continues to flourish outside the mainstream of health care providers and procedures. Even the government speaks from both sides of its mouth, “Abortion is illegal, a sin, and punishable; pay up!”

Problems with Health Care System

• The Mexican health care system is sub-divided into many sectors including the salaried sector (social security), state sector (open to all), and the private sector consisting of many layers. All of these factions serve to create confusion, under-coverage and a lack of resources.

Reality of obtaining an abortion is harsh

• Doctors, who are punished for performing abortions and therefore usually abstain from them, are not trained. Those that have some training frequently do not keep up to date with new medical findings.

• Infant mortality rate: total: 18.42 deaths/1,000 live births male: 20.3 deaths/1,000 live births female: 16.44 deaths/1,000 live births (2009 est.) Indicator of health.

Life Expectancy at Birth

• Life expectancy at birth:

total population: 76.06 years male: 73.25 years female: 79 years (2009 est.) Causes: stroke, heart disease and diabetes. In children it is pneumonia.

- access, resources and health services coverage are critical

The Gaping Disparities Between Rich and Poor

• "The difference [in life expectancy] between the poorest and the richest states in Mexico is something like 11 years

• General AIDS mortality was 3.3.• AIDS mortality in Mexico has been steadily increasing, staying within the 20 first causes of death for both genders, since 1988.

Policy Barriers

• Inadequate resources

• Inefficient procurement

• Ineffective targeting

• Limited access in rural areas

• Limited sexual education

Improving Reproductive Health

• Improve targeting of the public sector FP services and commodities

• Include low cost contraceptives in the health insurance

• Train and allow family doctors to provide FP commodities, particularly in rural areas

• Support the growth of NGOs for wider coverage

Improvments Needed

• Promote male as well as female rights to RH services

• Design RH education programs for female and males – In school– In health centers – In the community in indigenous communities

• Strengthen male component of FP services

Incidence Rate of Syphilis and Human Papiloma Virus (HPV)

• Mexico 27,011 cases (104,959,594)2

• To estimate the seroprevalence for HIV, syphilis, hepatitis B and herpes 2, and analyze the risk factors associated with these diseases in female commercial sex workers (FCSW) and hetero-, bi-, and homosexual men. Women are being recently hit by the

human papiloma virus (HPV).

Test Results in the Cities:

Seroprevalence of T. pallidum antibodies was 6.5% in FCSW. 4.2% in heterosexual men, 10.1% in homosexual men and 7.1% in bisexual men. HB-Ags was found in 0.3% of FCSW, in 0.6% of heterosexual men, in 3.8% of homosexual men and in 1.1% of bisexual men. Anti-HBc was detected in 9% of FCSW, 5.9% of heterosexual men, 37% of homosexual men, and 27% of bisexual men. HIV antibodies were found in 0.2% of FCSW, 8.8% of heterosexual men, 42.7% of homosexual men and 27.7% of bisexual men. STDs and gonorheea, and Herpes 2 are also prevalent.

Maternal Mortality Ratio

• The maternal mortality ratio was 47.3 per 100,000 live births. The main causes of death were hemorrhage (30.9%), preeclampsia/eclampsia (28.2%), and septic shock (10.9%). Six factors were significantly associated with maternal death: age (OR = 1.09, 95% CI = 1.00-1.18), marital status (OR = 16.2, 95% CI = 1.3-196.1), number of antenatal visits (OR = 1.3, 95% CI = 1.0-1.6), preexisting medical conditions (OR = 23.3, 95% CI = 6.6-81.6)

Maternal Mortality Rates, 2

• obstetric complications in previous pregnancies (OR = 28.3, 95% CI = 4.9-163.0), and mode of delivery (OR = 1.6, 95% CI = 1.0-2.4).

• Conclusions: Socioeconomic, medical, and obstetric risk factors are associated with maternal deaths in Mexico. (Caesarian vs vaginal deliveries, in March 2007)

Research and Advocacy

• Advocacy Reduces Maternal Mortality in Mexico, by March 1, 2010

• Unusually high rates of maternal mortality among poor, rural and indigenous communities

• In 2005 the maternal mortality rate was 63.4 deaths per 100,000 live births. In the state of Guerrero the rate rose to 128 deaths per 100, 000 live births.

Increasing Awareness on Maternal Mortality

• A new focus developed around service delivery and the use of state funds in the marginalised states of Oaxaca, Guerrero (63.4 death per 100.000 live birth), and Chiapas in 2005.

• A coalition of civil society organization have reduced MM to 23.5%