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Maternal Death and Pregnancy-Related Morbidity Among Indigenous Women of Mexico and Central America pp 327–348Cite as

Registration of Vital Events by the Civil Registry Office in an Indigenous Context: Implications for the Registration of Maternal Deaths

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Abstract

This work investigates the evolution of maternal mortality in the Tztozil-Tzeltal region at Los Altos de Chiapas in Mexico. We analyzed the archive of the Civil Registry Office from the past 25 years, focusing on the registration of female deaths from obstetric diseases. This region is characterized by being composed of greater than 90% indigenous people, and the limited presence of government actions before the eruption of the Zapatista movement in 1994. A thorough study was conducted to identify the causes and risk factors for maternal mortality underreporting based upon archival research, interviews, and personal observations in the registry offices. From a historical perspective, a gradual evolution of the Civil Registry Office eliminar becoming an administrative office accountable for the national statistics on mortality is discussed. Despite the leadership of the Mexican Secretariat of Health in the standardization and systematization of demographic information, the status of state health services in this region has resulted in other local functionaries, including Justices of the Peace, municipal presidents and agents, and other authorities, to have an increasing role in the registration of such vital events such as maternal death reporting in this region.

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Notes

  1. 1.

    “Ramo 33.” Federal Contributions for Federal Entities and Municipalities; is a budget mechanism designed to transfer resources to states and municipalities that enable them to strengthen their capacity to respond and meet government demands in the areas of education, health, basic infrastructure, financial strength, and public safety, as well as to implement food, welfare, and educational infrastructure programs. The distribution of these resources is regulated by the Fiscal Coordination.

  2. 2.

    Chiapas received a large amount of resources following the emergence of the Zapatista movement. In 1998, the budget assigned to Chiapas through the Ramo 33 Contribution Fund for Health Services (FASSA) was $654,961.35, and total health expenditure amounted to $2,060,823.71 (De la Torre 2006). In 2012, Chiapas received through FASSA $2,909,862,005 (SHCP 2014) and through the People’s Insurance (Seguro Popular) $3,533,300,000 (SP 2012), making a total of $6,443,162,005; that is to say, between 1998 and 2012, the federal budget assigned to Chiapas increased 3126 times. This does not take into account the additional resources that the states received through Ramo 12 of the Ministry of Health. In 2011, the resources allocated to the program Oportunidades amounted to 59,908 million pesos, which decreased to 32,053 in 2015. In 1998, the year in which this program started operating in Chiapas, the state received 3% of the national budget allocated to the program. In 2015 it received 7%, slightly less than that received by the Federal District, whose population is much higher (Presidencia de la República 2015 C 173). In 2015, 696,339 families in Chiapas (68% of the total) were affiliated to the program Prospera (Presidencia de la República 2015, 177–178 C). These figures placed Chiapas as the state with the highest percentage of families affiliated to Prosepera in the country.

  3. 3.

    The main indigenous languages spoken in Chiapas are Tzeltal and Tzotzil . Of the total the population in Chiapas over three years of age (which according to the intercensal survey of 2015 was estimated at 4,863,092), 28%, or 1,361,249 persons, were indigenous language speakers. Of these, 29.9% did not speak Spanish and spoke only one indigenous language. Of the speakers of an indigenous language, 39.48% spoke Tseltal and 34.78% spoke Tzotzil.

  4. 4.

    This is its main function; its powers may be consulted in the Ley General de Salud, Nueva Ley, published in the Diario Oficial de la Federación on February 7, 1984. Last reform published DOF 28-06-2005.

  5. 5.

    Article 348, Chapter V, Title fourteenth “Donation, transplantation and loss of life” of the Ley General de Salud.

  6. 6.

    The so-called Caste War took place from 1867 to 1870 between Chamulas and state authorities.

  7. 7.

    Officials of the CR, Municipality of Huixtán, Chiapas, 1994, October 26; Municipality of Larráinzar, Chiapas 1994, October 4.

  8. 8.

    Official of the CR, Chenalhó 1996, May 18.

  9. 9.

    Official of the CR, Municipality of Chenalhó and Chiapas 1996, May 18.

  10. 10.

    Official of the CR, Municipality of Zinacantán, Chiapas, 1994, March 30.

  11. 11.

    Official of the CR, Municipality of Zinacantán, Chiapas 1994, March 30, Official of the CR, Municipality of Chenalhó, Chiapas 1996, May 18.

  12. 12.

    Before the 1917 Constitution, public health was the responsibility of local entities and municipalities. There was no public system of health services, and medical care was provided through other public services or charity. The 1917 Constitution transformed this system, and the foundations of the current National Health System were established in the first half of the twentieth century. The rural population was not provided with medical care until 1928; however, the provision of public health services in Chiapas came later, mainly because the rural economy in this state was based on subsistence agriculture, and the public programs implemented in 1928 and 1936 focused on farmers of economic importance, excluding regions such as Los Altos de Chiapas (Freyermuth, 1993).

  13. 13.

    Official of the CR, Municipality of Altamirano, Chiapas, 1994.

  14. 14.

    Official of the CR, Municipality of Mitontic, Chiapas 1996.

  15. 15.

    Official of the CR, Municipality of Chamula, Chiapas 1994, March 3.

  16. 16.

    Casting evil (“mal echado”), envy or cutting the candle (“cortar vela”) are actions that require the use of witchcraft and are used in response to conflicts between individuals or families.

  17. 17.

    Air, or ic’, is one of the most common ailments among pregnant women, but it is dangerous only during this stage of pregnancy. Air can cause abdominal pain, back pain, and malposition of the child. In some cases, air can lead to death, causing a condition characterized by severe abdominal pain and accompanied by the perception of visual phosphenes. The air may be encapsulated by water, and when this happens the discomfort disappears when the water breaks (rupture of the amniotic membranes).

  18. 18.

    During sleep, people are more vulnerable and can acquire different types of diseases. An unpleasant experience in a dream can cause a disease, especially if the dream repeats itself.

  19. 19.

    This disease is acquired through sexual dreams or bad dreams.

  20. 20.

    For the Tzotzil people, “me’vinic” or “alteration” is something inherent to human beings, a sign of life that is present in children, women, men, Indians, and mestizos; it is located in the mouth of the stomach and can be recognized by its beat (pulsation of the abdominal aorta). The modification of this beat is what causes illness or death, and is known as “me’vinic.” When a person is sick, the alteration rises, and if the person is weak, it can cause death.

  21. 21.

    Official of the CR, Municipality of Larráinzar, Chiapas, 1994, October 4.

  22. 22.

    Official of the CR, Municipality of Chamula, 1992, October 8 and 1994, March 3, Official of the CR, Municipality of Chalchihuitán, 1996, May 14.

  23. 23.

    Official of the CR, Municipality of Chalchihuitán, Chiapas, 1996, May 14.

  24. 24.

    Official of the CR, Municipality of Zinacantán, Chiapas 1994, March 30.

  25. 25.

    Reproductive Age Mortality Survey (RAMOS), Measure evaluation.

  26. 26.

    Sources: Dirección General de Información en Salud (DGIS). Database of overall deaths, 2001 [online]: National Health Information System (SINAIS). [Mexico]: Secretariat of Health [query: April 10, 2003].

  27. 27.

    A doctor in the health clinic of Chamula told us about the difficulties to confirm a diagnosis.

  28. 28.

    Research project: “Maternal Mortality in Indigenous Regions.”

  29. 29.

    Maternal Mortality in 2000. Estimates developed by WHO, UNICEF, and UNFPA. https://books.google.com.mx/books?hl=es&lr=&id=2valPKR-7v4C&oi=fnd&pg=PT4&dq=Reproductive+Age+Mortality+Survey+(RAMOS)&ots=xicEo-PeXS&sig=vurcvK2fCRuc-_dtWRp6dNQCLGs&redir_esc=y#v=onepage&q=Reproductive%20Age%20Mortality%20Survey%20(RAMOS)&f=false. Accessed 27 June, 2016.

  30. 30.

    Official of Chenalhó 2015, June 18.

  31. 31.

    Official of Santiago el Pinar 2015, July 16.

  32. 32.

    Official of Chamula 2015, June 15.

  33. 33.

    Official of Chalchihuitán 2015, July 23.

  34. 34.

    Official of Zinacantán 2015, July 15.

  35. 35.

    Official of Chenalhó 2015, June 18.

  36. 36.

    Aldama 2015, June 24; Altamirano 2015, July 7.

  37. 37.

    CR official Chamula and Mitontic, 2015, June 15.

  38. 38.

    CR official of Chamula, Larráinzar, 2015. July 8.

  39. 39.

    Official of the CR, Municipalities of Aldama and Chalchihuitán 2015, April 1.

  40. 40.

    Official of the CR, Municipality of Zinacantán, 2015, Feb 13.

  41. 41.

    Our own estimates based on the Intercensal Survey of 2015.

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Authors and Affiliations

  1. CIESAS-Southeast, San Cristóbal de Las Casas, Chiapas, Mexico

    María Graciela Freyermuth Enciso M.D., Ph.D.

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  1. María Graciela Freyermuth Enciso M.D., Ph.D.
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Editors and Affiliations

  1. Medical College of Georgia, Augusta University, Augusta, Georgia, USA

    David A. Schwartz

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Enciso, M.G.F. (2018). Registration of Vital Events by the Civil Registry Office in an Indigenous Context: Implications for the Registration of Maternal Deaths. In: Schwartz, D. (eds) Maternal Death and Pregnancy-Related Morbidity Among Indigenous Women of Mexico and Central America. Global Maternal and Child Health. Springer, Cham. https://doi.org/10.1007/978-3-319-71538-4_17

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