6 de Marzo: Y…la Juana Azurduy estaría de acuerdo?
A few days ago, the Inter Press Service News Agency published an article on Bolivia’s controversial “Bono Juana Azurduy,” a state subsidy that pays pregnant women to go to public health centers, instead of having their children at home. The Bono grants women a total of about $250US that is distributed in 17 separate payments when women present for prenatal visits, for the birth of the child, and for routine check-ups in the first two years of the child’s life. Although you would not know it by reading this article, the subsidy–named after a famous female revolutionary leader who commanded patriot forces against the Spanish in Bolivia’s battle for independence–has drawn considerable criticism from some sectors of the women’s rights and healthcare communities in Bolivia.
According to the Ministry of Health, the purpose of the Bono, which was introduced in 2009, is to reduce maternal mortality rates by encouraging women to have their children in health centers rather than in the home. Bolivia’s maternal mortality rate is the second-highest in Latin America ( after Haiti), taking the lives of 222 women per 100,000 live births. The leading causes of maternal death in Bolivia are believed to be hemorrhage, eclampsia, and complications from abortion. The Bono Juana Azurduy is effective in 98% of the country’s municipalities, and operates in conjunction with a universal maternal-child insurance program (called the SUMI), so that all costs of pregnancy and childbirth are shouldered by the state.
So, what’s the problem with the Bono? Apart from any philosophical criticisms one may have for paying women to go to the doctor, it is clear in that the program has put additional stress on a state health system that was already struggling. By creating incentives for women to go to health posts without increasing staff or other resources at these centers, the program is leading to overworked doctors and nurses and to a poorer quality of care. The IPS article notes that the numbers of pregnant women visiting health centers has increased by a factor of six since the introduction of the Bono. Some women report waiting several hours to be seen after traveling large distances to get to the centers. As former Minister of Health Ramiro Tapia said, “‘At the moment there is a gap between the good intentions and the day-to-day running of the programme.'”
Apart from its poor functioning, some members of feminist and community health groups take issue with the intentions of the Bono Juana Azurduy, arguing that it represents an attempt by the state to control women’s reproduction, by influencing how and when they have children. Activists working to protect the rights of indigenous women to practice traditional pregnancy rituals and birth techniques argue that the Bono is designed to discourage women from giving birth at home with the assistance of midwives. Many women prefer to give birth at home, where a midwife will help them to keep their bodies warm with blankets, hot chocolate, and soup, and where they are permitted to give birth in the traditional squatting position. Women often report being scared of western medical providers and facilities, where they say they are prevented from crying out in pain, forced to give birth on their backs in cold hospital rooms, and left for hours following labor without being served anything to eat. Although the financial incentive of the Bono has led more women to go to health posts, activists argue that little has been done to reduce discrimination against indigenous patients or to take their birth and pregnancy preferences into account.
Organizations fighting for the decriminalization of abortion contend that the Bono also represents an attempt by the state to reduce illegal abortion rates by providing incentives for women to continue their pregnancies. If true, activists believe that this impulse has more to do with improving Bolivia’s reputation internationally than with improving local women’s lives. As I have mentioned previously in the blog, unwanted pregnancy and abortion rates are higher in Bolivia than in any other country in the region, aside from Haiti, which government officials may feel “reflects poorly” on the country. However, providing women with a subsidy of $258US over a period of three years does little to offset the long-term costs of raising a child until adulthood, and will most likely have no impact on abortion rates–or on maternal deaths due to abortion.
Since the Bono’s namesake, Juana Azurduy, lived about 200 years ago and historical sources on her are somewhat scarce, it is difficult to imagine how she would feel about the recent maternal-child subsidy. We know that Azurduy spent some time in a convent as an adolescent, but her rebellious behavior had her kicked out. We know that she had a daughter and several sons, and evidently participated in combat against the Spanish during the course of her pregnancies. Did Azurduy ever rely on a midwife to deliver her child? Did she ever have an abortion? Did she feel she controlled her own reproduction–and was this even important to her? How would she feel, I wonder, to know that her name–and feminist and revolutionary legacy–are being used to characterize this Bono, which some see as a government incursion into women’s reproductive autonomy?
As I mentioned in an earlier posting, Monday, March 8 is International Women’s Day. To commemorate the date, feminist blog Gender Across Borders is hosting “Blog for International Women’s Day,” for which Eugenia de Altura and dozens of other blogs will be reflecting on the theme of “Equal Rights, Equal Opportunity: Progress for All.” So, come back and visit the site this Monday, and check out all the other blogs that are participating in the event.