26 de Abril: Un asunto de conciencia
Last week, The Lancet published an online study on worldwide maternal mortality that showed significant improvements in maternal death rates since 1980. Although it continues to sport the highest maternal mortality rate in Latin America, Bolivia emerged of the few countries that is demonstrating “accelerated progress” in this area. The full article may be accessed here:
According to the study, the major factors that have contributed to reducing maternal mortality rates in the last 30 years include dropping total fertility rates, increased income and educational levels among women, and an increase in skilled birth attendants.
Although it is somewhat difficult to measure, I would imagine that in the Bolivian case another factor has contributed to reducing maternal mortality: the Ministry of Health’s program for the treatment of hemorrhages in the first half of pregnancy. Facing high rates of maternal death in part due to complications from abortion, in 1998 the Ministry instituted a program to deal with the public health implications of illegal abortion without touching the legal issue of abortion itself. The program trains medical providers in the use of the cheap, effective, and safe manual vacuum aspirator (MVA) technology for the solution of incomplete abortion and miscarriage, and in extending non-judgmental care to women who may have attempted to provoke their own miscarriages.
Under the current provisions of the program, a woman experiencing vaginal bleeding in the first twenty weeks of her pregnancy can visit any public health facility to receive an MVA treatment for free under the Seguro Universal Materno Infantil (the universal maternal-child health insurance). Unlike in the early 1990s–when doctors would sometimes refuse women treatment until they provided the name of the person who had provoked their abortion–medical providers are now prohibited from questioning women about the circumstances of their bleeding. Prior to the introduction of this program, women experiencing bleeding in pregnancy were often too scared to go to a hospital for treatment, which often led to severe infection and even death. Although it is difficult to measure with precision the effects of the hemorrhage treatment program, the Ministry of Health believes that it has greatly reduced maternal deaths due to abortion.
Although legalizing abortion and regulating the facilities that provide it is likely the most effective (and most just) means of reducing abortion-related death, the Ministry’s hemorrhage treatment program is perhaps a good stepping stone toward that end. With the program for the treatment of hemorrhages in the first half of pregnancy, the Ministry is recognizing and elevating the public health aspects of abortion over questions of politics and the supposed protection of (fetal) “life.” Thanks to the dedicated work of individuals of conscience, this program provides an opportunity to keep Bolivia on the right track toward the reduction of maternal deaths. Hopefully, the next step will be the provision of legal and safe abortion to any woman who decides that she needs it.