Abstract
ABSTRACT Mexico’s indigenous communities continue to experience higher levels of mortality and poorer access to health care services than non-indigenous regions, a pattern that is repeated across the globe. We conducted a two-year ethnographic study of pregnancies and childbirth in an indigenous Wixárika community to explore the structural causes of this excess mortality. In the process we also identified major differences between official infant mortality rates, and the numbers of infants born to women in our sample who did not survive. We interviewed 67 women during pregnancy and followed-up after the birth of their child. At baseline, socio-demographic data was collected as well as information regarding birthing intentions. In depth-interviews and semi-structured interviews were conducted with 62 of these women after the birth of their child, using a checklist of questions. Women were asked about choices regarding, and experiences of childbirth. Of the 62 women we interviewed at follow-up 33 gave birth at home without skilled attendance and five gave birth completely alone in their homes. Five neonates died during labour or the perinatal period. Concerns about human resources, the structure of service delivery and unwanted interventions during childbirth all appear to contribute to the low institutional childbirth rate. Our data also suggests a low rate of death registration, with the custom of burying infants where they die. This excess mortality, occurring in the context of unnecessary lone and unassisted childbirth are structurally generated forms of violence.
Highlights
Neonatal mortality accounted for 42% of under-five mortality in 2013, an increase from 37% in 1990 (Wang et al 2014)
In the process we identified major differences between official infant mortality rates, and the numbers of infants born to women in our sample who did not survive
Care in six Mesoamerican (Mexico and Central America) countries found that many women in the poorest regions were still not receiving adequate antenatal care (Mokdad et al 2015), while ethnic differences in facility childbirth rates were 15.2% vs. 41.5% in Guatemala and 29.1% vs. 73.9% in Mexico for indigenous and non indigenous women (Colombara et al 2016)
Summary
Neonatal mortality accounted for 42% of under-five mortality in 2013, an increase from 37% in 1990 (Wang et al 2014). A systematic review of childbirth care packages estimated that skilled birth attendance could reduce neonatal mortality by 25% (Lee et al 2011), while basic and comprehensive emergency obstetric care could reduce neonatal deaths by 40% and 85%, respectively. OSRIN care in six Mesoamerican (Mexico and Central America) countries found that many women in the poorest regions were still not receiving adequate antenatal care (Mokdad et al 2015), while ethnic differences in facility childbirth rates were 15.2% vs 41.5% in Guatemala and 29.1% vs 73.9% in Mexico for indigenous and non indigenous women (Colombara et al 2016). Data from across the globe coincides in the fact that health outcomes and skilled attendance at birth are worse among indigenous populations than their national average (Gracey and King 2009). We were unable to identify data that compared stillbirths for these populations but would expect this to reflect similar inequalities
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