Advertisement

Antenatal Care Among Poor and Indigenous Women in Central America and Mexico: A Cross-Country Study of Access, Utilization, and Barriers

  • Emily Dansereau
  • Bernardo Hernandez
  • Ali H. Mokdad
Chapter
Part of the Global Maternal and Child Health book series (GMCH)

Abstract

Antenatal care (ANC) is an important service for improving maternal, infant, and child health. Across Central America and Mexico, high national rates of antenatal care coverage mask significant disparities among subgroups, primarily among poorly educated, lower-income, and indigenous women. This chapter presents and discusses information from the largest cross-country study conducted among poor and indigenous communities in Mesoamerica. Within these communities, 95% of women receive ANC from a skilled provider in Nicaragua, 94% in El Salvador, 84% in Honduras, 78% in Panama, 75% in Chiapas, Mexico, and 31% in Guatemala. ANC should begin in the first trimester to detect and prevent complications; in Guatemala, 20% of poor pregnant women meet this guideline, as do as many as 77% in El Salvador. ANC should be ongoing throughout pregnancy, but only 18% of poor Guatemalan women receive the recommended four visits, compared to 81% in Nicaragua. Women’s education, ethnicity, poverty, and control over fertility are associated with receiving ANC services and will require systemic, intersectoral action to make progress. Health system changes are also needed, including training providers to be respectful of indigenous patients, including their culture and language, as well as overcoming geographic and financial barriers to care. Universal ANC is possible, but reinvigorated political and financial commitments are needed to ensure accessible, inclusionary, and culturally sensitive care for marginalized populations.

Keywords

Antenatal care Prenatal care Health service delivery Reproductive health Coverage Health access Mexico Central America Chiapas Latin America Disparities Indigenous women Health disparity Pregnancy Maternal health 

References

  1. Abdal Qader, M. A., Badilla, I., Mohd Amin, R., & Ghazi, H. F. (2012). Influence of antenatal care on birth weight: a cross sectional study in Baghdad City, Iraq. BMC Public Health, 12(Suppl 2), A38.  https://doi.org/10.1186/1471-2458-12-S2-A38 CrossRefPubMedCentralGoogle Scholar
  2. Ahmed, S., Creanga, A. A., Gillespie, D. G., & Tsui, A. O. (2010). Economic status, education and empowerment: implications for maternal health service utilization in developing countries. PLoS One, 5(6), e11190.  https://doi.org/10.1371/journal.pone.0011190 CrossRefPubMedPubMedCentralGoogle Scholar
  3. Aminu, M., Unkels, R., Mdegela, M., Utz, B., Adaji, S., & van den Broek, N. (2014). Causes of and factors associated with stillbirth in low- and middle-income countries: a systematic literature review. BJOG: An International Journal of Obstetrics and Gynaecology, 121(Suppl 4), 141–153.  https://doi.org/10.1111/1471-0528.12995 CrossRefGoogle Scholar
  4. Beeckman, K., Louckx, F., Downe, S., & Putman, K. (2013). The relationship between antenatal care and preterm birth: the importance of content of care. European Journal of Public Health, 23(3), 366–371.  https://doi.org/10.1093/eurpub/cks123 CrossRefPubMedGoogle Scholar
  5. Bello M., Alvaro-Rangel, M. (2002). La equidad y la exclusión de los pueblos indígenas y afrodescendientes en América Latina y el Caribe. Retrieved August 1, 2017, from http://repositorio.cepal.org//handle/11362/10800.
  6. Bhutta, Z. A., Das, J. K., Bahl, R., Lawn, J. E., Salam, R. A., Paul, V. K., et al. (2014). Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet, 384(9940), 347–370.  https://doi.org/10.1016/S0140-6736(14)60792-3 CrossRefPubMedGoogle Scholar
  7. Caffe, S., Plesons, M., Camacho, A. V., Brumana, L., Abdool, S. N., Huaynoca, S., et al. (2017). Looking back and moving forward: can we accelerate progress on adolescent pregnancy in the Americas? Reproductive Health, 14, 83.  https://doi.org/10.1186/s12978-017-0345-y CrossRefPubMedPubMedCentralGoogle Scholar
  8. Carroli, G., Rooney, C., & Villar, J. (2001). How effective is antenatal care in preventing maternal mortality and serious morbidity?. An overview of the evidence. Paediatric and Perinatal Epidemiology, 15(Suppl 1), 1–42.CrossRefPubMedGoogle Scholar
  9. Clark, M. A. (2015). The new left and health care reform in El Salvador. Latin American Politics and Society, 57(4), 97–118.  https://doi.org/10.1111/j.1548-2456.2015.00291.x CrossRefGoogle Scholar
  10. COMISCA. (2014). Plan estrategico regional para la prevencion del embarazo en adolescentes de Centroamerica y el Caribe. Retrieved from http://www.codajic.org/sites/www.codajic.org/files/FolletoPEA-CA-RD%20(2).pdf.
  11. Dansereau, E., McNellan, C. R., Gagnier, M. C., Desai, S. S., Haakenstad, A., Johanns, C. K., et al. (2016). Coverage and timing of antenatal care among poor women in 6 Mesoamerican countries. BMC Pregnancy and Childbirth, 16, 234.  https://doi.org/10.1186/s12884-016-1018-5 CrossRefPubMedPubMedCentralGoogle Scholar
  12. Davy, C., Harfield, S., McArthur, A., Munn, Z., & Brown, A. (2016). Access to primary health care services for Indigenous peoples: A framework synthesis. International Journal for Equity in Health, 15, 163.  https://doi.org/10.1186/s12939-016-0450-5 CrossRefPubMedPubMedCentralGoogle Scholar
  13. Dixit, P., Dwivedi, L. K., & Ram, F. (2013). Strategies to improve child immunization via antenatal care visits in India: A propensity score matching analysis. PLoS One, 8(6), e66175.  https://doi.org/10.1371/journal.pone.0066175 CrossRefPubMedPubMedCentralGoogle Scholar
  14. Eggleston, E. (2000). Unintended pregnancy and women’s use of prenatal care in Ecuador. Social Science & Medicine, 51(7), 1011–1018.  https://doi.org/10.1016/S0277-9536(00)00010-1 CrossRefGoogle Scholar
  15. Glei, D. A., Goldman, N., & Rodríguez, G. (2003). Utilization of care during pregnancy in rural Guatemala: Does obstetrical need matter? Social Science & Medicine, 57(12), 2447–2463.CrossRefGoogle Scholar
  16. Grown, C., Gupta, G. R., & Pande, R. (2005). Taking action to improve women’s health through gender equality and women’s empowerment. The Lancet, 365(9458), 541–543.  https://doi.org/10.1016/S0140-6736(05)17872-6 CrossRefGoogle Scholar
  17. Hautecoeur, M., Zunzunegui, M. V., & Vissandjee, B. (2007). Barriers to accessing health care services for the indigenous population in Rabinal, Guatemala. Salud Publica De Mexico, 49(2), 86–93.CrossRefPubMedGoogle Scholar
  18. Ibáñez-Cuevas, M., Heredia-Pi, I. B., Meneses-Navarro, S., Pelcastre-Villafuerte, B., & González-Block, M. A. (2015). Labor and delivery service use: indigenous women’s preference and the health sector response in the Chiapas highlands of Mexico. International Journal for Equity in Health, 14, 156.  https://doi.org/10.1186/s12939-015-0289-1 CrossRefPubMedPubMedCentralGoogle Scholar
  19. Instituto Nacional de las Mujeres. (2017). Estrategia Estrategia Nacional para la Prevención del Embarazo en Adolescentes. Mexico: Instituto Nacional de las Mujeres. Retrieved from https://www.gob.mx/inmujeres/acciones-y-programas/estrategia-nacional-para-la-prevencion-del-embarazo-en-adolescentes-33454 Google Scholar
  20. Jejeebhoy, S. J. (1996). Women’s education, autonomy, and reproductive behaviour: Experience from developing countries. Oxford, NY: Oxford University Press.Google Scholar
  21. Kilfoyle, K. A., Vitko, M., O’Conor, R., & Bailey, S. C. (2016). Health Literacy and women’s reproductive health: A systematic review. Journal of Women’s Health, 25(12), 1237–1255.  https://doi.org/10.1089/jwh.2016.5810 CrossRefPubMedPubMedCentralGoogle Scholar
  22. Leon, M. (2003). Perceptions of health care quality in Central America. International Journal for Quality in Health Care, 15(1), 67–071.  https://doi.org/10.1093/intqhc/15.1.67 CrossRefPubMedGoogle Scholar
  23. Levine, R. A., & Rowe, M. L. (2009). Maternal literacy and child health in less-developed countries: evidence, processes, and limitations. Journal of Developmental and Behavioral Pediatrics: JDBP, 30(4), 340–349.  https://doi.org/10.1097/DBP.0b013e3181b0eeff CrossRefPubMedGoogle Scholar
  24. Lincetto, O., Mothebesoane-Anoh, S., Gomez, P., Mujanja, S. (2006). Chapter 2: Antenatal Care. In Opportunities for Africa’s Newborns (pp. 51–62). WHO on behalf of The Partnership for Maternal Newborn and Child Health. Retrieved December 8, 2017, from www.who.int/pmnch/media/publications/oanfullreport.pdf.
  25. Locklear, T., Perez, A., Caceres, A., & Mahandy, G. (2013). Women’s health in Central America: The complexity of issues and the need to focus on indigenous healthcare. Current Women's Health Reviews, 9, 30–40.CrossRefGoogle Scholar
  26. Lori, J. R., Ofosu-Darkwah, H., Boyd, C. J., Banerjee, T., & Adanu, R. M. K. (2017). Improving health literacy through group antenatal care: a prospective cohort study. BMC Pregnancy and Childbirth, 17, 228.  https://doi.org/10.1186/s12884-017-1414-5 CrossRefPubMedPubMedCentralGoogle Scholar
  27. Mbuagbaw, L., Medley, N., Darzi, A. J., Richardson, M., Habiba Garga, K., & Ongolo-Zogo, P. (2015). Health system and community level interventions for improving antenatal care coverage and health outcomes. InCochrane database of systematic reviews. Hoboken: John Wiley & Sons, Ltd.  https://doi.org/10.1002/14651858.CD010994.pub2 CrossRefGoogle Scholar
  28. MINSAP, UNICEF. (2014). Cuba Encuesta de Indicadores Múltiples por Conglomerados 2014. Retrieved from https://mics-surveys-prod.s3.amazonaws.com/MICS5/Latin%20America%20and%20Caribbean/Cuba/2014/Final/Cuba%202014%20MICS_Spanish.pdf.
  29. Mokdad, A. H., Colson, K. E., Zúñiga-Brenes, P., Ríos-Zertuche, D., Palmisano, E. B., Alfaro-Porras, E., et al. (2015a). Salud Mesoamérica 2015 Initiative: design, implementation, and baseline findings. Population Health Metrics, 13(1), 3.  https://doi.org/10.1186/s12963-015-0034-4 CrossRefPubMedPubMedCentralGoogle Scholar
  30. Mokdad, A. H., Gagnier, M. C., Colson, K. E., Zúñiga-Brenes, P., Ríos-Zertuche, D., Haakenstad, A., et al. (2015b). Health and wealth in Mesoamerica: Findings from Salud Mesomérica 2015. BMC Medicine, 13, 164.  https://doi.org/10.1186/s12916-015-0393-5 CrossRefPubMedPubMedCentralGoogle Scholar
  31. Montenegro, R. A., & Stephens, C. (2006). Indigenous health in Latin America and the Caribbean. The Lancet, 367(9525), 1859–1869.  https://doi.org/10.1016/S0140-6736(06)68808-9 CrossRefGoogle Scholar
  32. PAHO. (2015). Intersectoral action and health equity in Latin America: An analytical approach. Washington, DC. Retrieved December 8, 2017, from http://iris.paho.org/xmlui/handle/123456789/33873.
  33. Paredes, I., Hidalgo, L., Chedraui, P., Palma, J., & Eugenio, J. (2005). Factors associated with inadequate prenatal care in Ecuadorian women. International Journal of Gynaecology and Obstetrics, 88(2), 168–172.  https://doi.org/10.1016/j.ijgo.2004.09.024 CrossRefPubMedGoogle Scholar
  34. PATH. (2011). The Nicaraguan health system: An overview of critical challenges and opportunities. Retrieved December 9, 2017, from: https://www.path.org/publications/files/TS-nicaragua-health-system-rpt.pdf.
  35. Pelcastre-Villafuerte, B., Ruiz, M., Meneses, S., Amaya, C., Márquez, M., Taboada, A., & Careaga, K. (2014). Community-based health care for indigenous women in Mexico: a qualitative evaluation. International Journal for Equity in Health, 13, 2.  https://doi.org/10.1186/1475-9276-13-2 CrossRefPubMedPubMedCentralGoogle Scholar
  36. Pervin, J., Moran, A., Rahman, M., Razzaque, A., Sibley, L., Streatfield, P. K., et al. (2012). Association of antenatal care with facility delivery and perinatal survival—a population-based study in Bangladesh. BMC Pregnancy and Childbirth, 12(1), 111.  https://doi.org/10.1186/1471-2393-12-111 CrossRefPubMedPubMedCentralGoogle Scholar
  37. Renkert, S., & Nutbeam, D. (2001). Opportunities to improve maternal health literacy through antenatal education: An exploratory study. Health Promotion International, 16(4), 381–388.CrossRefPubMedGoogle Scholar
  38. Secretaria de Salud Honduras. (2012). Estrategia nacional para la prevencion del embarazo en adolescentes de Honduras. Tegucigalpa: Secretaria de Salud Honduras. Retrieved http://www.paho.org/hon/index.php?option=com_docman&view=download&category_slug=salud-materna-nino-y-adolescente&alias=332-estrategia-nacional-para-la-prevencion-del-embarazo-en-adolescentes-en-honduras&Itemid=211 Google Scholar
  39. Serván-Mori, E., Contreras-Loya, D., Gomez-Dantés, O., Nigenda, G., Sosa-Rubí, S. G., & Lozano, R. (2017). Use of performance metrics for the measurement of universal coverage for maternal care in Mexico. Health Policy and Planning, 32(5), 625–633.  https://doi.org/10.1093/heapol/czw161 CrossRefPubMedGoogle Scholar
  40. Stephens, C., Nettleton, C., Porter, J., Willis, R., & Clark, S. (2005). Indigenous peoples’ health—why are they behind everyone, everywhere? The Lancet, 366(9479), 10–13.  https://doi.org/10.1016/S0140-6736(05)66801-8 CrossRefGoogle Scholar
  41. UNDP, UNFPA, WHO, World Bank Special Programme of Research, Development and Research Training in Human Reproduction. (2002). WHO antenatal care randomized trial: Manual for the implementation of the new model. Retrieved from http://whqlibdoc.who.int/hq/2001/WHO_RHR_01.30.pdf.
  42. UNICEF. (2016). Health Equity Report 2016: Analysis of reproductive, maternal, newborn, child, and adolescent health inequities in Latin America and the Caribbean to inform policymaking. Panama City, Panama. Retrieved from http://www.apromiserenewedamericas.org/wp-content/uploads/2016/11/20160929_LACRO_APR_Health-Equity-Report-SUMMARY-8.pdf.
  43. United Nations, Department of Economic and Social Affairs, Population Division. (2015). World fertility patterns 2015 - Data booklet. Retrieved from http://www.un.org/en/development/desa/population/publications/pdf/fertility/world-fertility-patterns-2015.pdf.
  44. WHO. (2011). Intersectoral action on health: A path for policy-makers to implement effective and sustainable action on health. Kobe, Japan. Retrieved from www.who.int/kobe_centre/publications/intersectorial_action_health2011/en/.

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Emily Dansereau
    • 1
  • Bernardo Hernandez
    • 1
  • Ali H. Mokdad
    • 1
  1. 1.Institute for Health Metrics and Evaluation and School of Public Health, University of WashingtonSeattleUSA

Personalised recommendations