Jul 7 2004
Rates of infant and maternal mortality in indigenous communities are among the highest in the Americas, according to a new bulletin published by the Pan American Health Organization (PAHO).
In its most recent edition, "Healing our Spirit Worldwide"—PAHO's bulletin on indigenous health—notes that national averages often mask significant regional differences in these rates, citing the examples of Bolivia, Honduras and Guatemala. While overall maternal mortality in Bolivia, for example, stands at 390 per every 100,000 live births, in the department of Potosí, which has a larger indigenous population, the figure climbs to 496 per 100,000.
In Honduras, departments with large indigenous populations—including Colón, Copán, Intibuca, Lempira and La Paz—have maternal mortality ranging from 190 to 255 per 100,000 live births, while the national average is 147. In Guatemala, maternal mortality among indigenous women is 83 percent higher than the national rate.
The bulletin cites a number of factors, many of them cultural, which underlie these differences. They include:
- Health workers' lack of understanding of and sensitivity to traditional cultural practices.
- Poor communication between health workers and patients.
- Lack of emphasis in health policies on the need to expand medical coverage in indigenous communities.
To address such problems, PAHO is working with municipal organizations in the department of Potosí to carry out community programs that involve midwives and community leaders in efforts to improve sanitary conditions during childbirth and to identify high-risk cases and assure they are properly referred.
In a separate article, Aymara leader Martha Gonzáles explains how cultural barriers can come into play when indigenous women seek health services.
"Undressing during childbirth for us is synonymous with death," says Gonzáles. "When a pregnant woman goes to a health center, the first instruction she is given, is ‘Take off your clothes.' At that moment, a barrier has been erected between the physician and the Aymara woman, because Aymara women believe that at the moment of delivery there is an opening of the entire body. If our body has opened, we should cover ourselves much more because the cold can penetrate us. Penetration of the cold will result in illness. Furthermore there is not only an opening of the physical body, but of the place where the spiritual body exits and enters, which will require other care...."
Gonzáles participated in a meeting on maternal mortality at PAHO headquarters, where eight international agencies announced they would work together to reduce maternal mortality in Latin America and the Caribbean. She also pointed out the need for action on both sides of the cultural barrier: "We are supposed to learn Spanish in order to receive medical services, but the professionals do not even know how to say ‘how are you feeling' in Aymara," she said.
Other experts quoted in the bulletin called for more and better data on the distribution of indigenous populations, as well as on social and cultural determinants of health, in order to facilitate progress toward achieving the Millennium Development Goals.
Recent meetings in Panama, Colombia, Mexico, Guatemala, Argentina, Ecuador and the United States have addressed these and other problems of cultural diversity, according to the PAHO bulletin.
PAHO, which also serves as the Regional Office for the Americas of the World Health Organization, was established in 1902 and is the oldest health organization in the world. It works with all the countries of the Americas to improve the health and quality of life of their peoples.