Maternal Morbidity and Mortality in the Rural Trifinio Region of Southwestern Guatemala: Analysis of the Problems, Strategic Successes, and Challenges

Abstract

In Guatemala the maternal mortality ratio (MMR) is between 88 and 109 for every 100,000 live births, one of the highest in the Latin American region. Rural and indigenous populations in Guatemala experience disproportionately high maternal mortality as compared to urban, nonindigenous populations. Causes of maternal mortality and morbidity are most often viewed through the Three Delay framework. The first delay, deciding to seek care, is often due to a poor understanding of complications and risk factors presented during labor and often takes place at the household level. The second delay, reaching an adequate health care facility, is often caused by long distances to hospitals and health care centers, availability and cost of transport, poor roads and infrastructure, or fees required for medical care. The third delay, receiving adequate care, is most often due to poorly equipped medical facilities, a lack of medical supplies, inadequately trained medical staff, and/or inadequate referral systems. Solutions targeting these delays from the household to referral facility levels have been described in the global health literature. In rural Southwest Guatemala, the University of Colorado Center for Global Health partnered with a private Guatemalan agro-business to conduct a community maternal, neonatal, and child health needs assessment and then implement a maternal health program that targets the three delays with evidence-based solutions. Solutions implemented have focused on improving education of patients and health workers, increasing access and quality of care provided at each health system level, and improving health system infrastructure with thoughtful and efficient use of minimal resources. The problems identified, program successes, and difficulties encountered will be discussed.