CHAPTER I: INTRODUCTION
CHAPTER 3: CURRENT SITUATION OF GENDER EQUALITY IN
3.2 C URRENT SITUATION OF G ENDER E QUALITY ON H EALTH
國
立 政 治 大 學
‧
N a
tio na
l C h engchi U ni ve rs it y
3.2 Current situation of Gender Equality on Health
!
Along with a sufficient and equal access to education, an adequate health status is optimal to achieve gender equality. Equal access and conditions to essential health services can assure women’s opportunities in the employment sector and their ability to restore their position in society. In Central and Latin America, women and girls play an important, largely unpaid, role in generating household income, their health plays an important role in achieving these expected roles and accomplishing the few work opportunities they can access.
Many societies, mostly all highly developed countries, provide access to a broad range of public health and personal medical services. Health services may include sanitation, immunization, and reduction of the risk of transmission of HIV/AIDS, malnutrition and disease treatment, to mention some. In terms of access to health women require
additional services than those of men due to biological conditions. Besides the need to acquire proper sanitation, immunization or HIV/Aids treatment women must be cared for in conditions of prenatal care, contraceptive prevalence and are often quantified for fertility rates. Women worldwide, although in higher numbers in the developing world, are also exposed to maternal mortality. In order to further comprehend the current situation of gender equality in Honduras in the area of health, we will focus on this significant variable. Maternal Mortality is described as the chance of woman dying from complications during and after pregnancy, or throughout the delivery of a child or children (Abdoulaye, 2005)
Pregnancy can lead to several consequences such as severe bleeding after childbirth, infections, and high blood pressure during pregnancy (pre-eclampsia), complications from delivery, unsafe abortion and blood clots/embolism, to mention some. (Say L et al., 2014.)
‧
國立 政 治 大 學
‧
N a
tio na
l C h engchi U ni ve rs it y
Though global women are all exposed to this; maternal mortality continues to be a serious public health problem in the developing world. According to the UNICEF in 2013, women accounted for 210 deaths per 100,000 live births. The lifetime risk of maternal death in industrialized countries is 1 in 4,000, versus 1 in 51 in countries classified as ‘least developed’ (UNICEF Data, 2013). The prevalence of women dying during childbirth has become an inherent limitation for gender parity, specifically for women from poor backgrounds.
In Honduras, according to the World Bank’s database, the maternal mortality ratio, which is the number of women who die from pregnancy-related causes while pregnant or within 42 days after pregnancy, is reported to be 120 per 100,000 live births in the years 2010 to 2013, which is the most and only recent available information after the coup d’etat (World Bank, 2013). This makes Honduras the second highest country in Central America where women die due to pregnancy related issues. The table below showcases Costa Rica, Panama and Belize with significantly less deaths per pregnancies and El Salvador and Nicaragua with fewer women dying form life births and or complications afterwards, leaving only Guatemala as the highest number for maternal mortality in the region.
TABLE 3.3: Maternal Mortality Ratio in Central America.
Country 2010 2013
Panama 82 85
Costa Rica 33 38
Belize 60 45
Guatemala 140 140
El Salvador 71 69
Nicaragua 110 100
Honduras 120 120
‧
*Source: Table extracted from the latest update of indicators of the World Bank Group 2013. (World Bank Open Data, 2013) Web Link:( http://data.worldbank.org/indicator/SH.STA.MMRT)
In the past, Honduras reported higher numbers of maternal deaths but due to several international interventions, the numbers have decreased over the past years. In 1999, for example, a maternal death review was conducted at two hospitals in Honduras: Mario Catarino Rivas Hospital (HMCR) and Escuela Francisco Morazán Hospital (HEFM), the largest public hospitals in the capital city, Tegucigalpa. Most rural areas do not have the conditions this hospitals offer so many rural habitants migrate in case of health
emergencies or vulnerable conditions in order to be treated. Thirty-five maternal deaths were reported over a 30-month period at HMCR (estimated hospital maternal mortality ratio is 207 per 100,000 live births); 81 maternal deaths were reported during a 33-month period at HEFM (estimated hospital maternal mortality ratio is 262 per100, 000 live births) (Gilson, 2000). The previous research suggests that most of these deaths were preventable and the larger proportion of those losses could have been stopped if political will and multidisciplinary projects of preventions were put into place. It was determined that prevention and significant measures to reduce the problem were urgently required in the country.
Numerous and significant cases were brought upon the international community, and specific focus to eradicate and reduce maternal mortality was set. Underscored under the Eight Millennium Development goals (MDGS), several international agencies such as UNICEF, The World Bank, USAID and World Health Organization have supported the initiative through the provision of financial and technical resources.
In Honduras, there has been an implementation of projects in urban and rural
communities, targeting the goal as well as the generation of clear policy alternatives to demonstrate to the national authorities the problem was manageable; all the efforts combined have brought wide attention to the issue, making maternal mortality a political priority in the country. (Shiffman, 2007)
With the international support and pressure to meet the goals, government institutions incorporated a revision of the comprehensive care of women, which now includes a
‧
國立 政 治 大 學
‧
N a
tio na
l C h engchi U ni ve rs it y
gender emphasis as well as an updating of the rules on obstetrical and neonatal
emergencies, and also have incorporated the formation of technical groups to encourage the initiative. There are 28 public hospitals in Honduras, which are now all participating in the maternal mortality reduction initiative and have incorporated not only measures to reduce maternal deaths but also incorporate care programs for both men and women about sexual and reproductive health awareness. Unfortunately, only 12 of the total hospitals have an active committee working to prevent deaths due to pregnancy, and only five certified hospitals are open 24 hours a day to deal with obstetrical emergencies.
(Bautista, 2004)
After the coup, the alarming issue was also included in the Honduras’s National Health Plan 2010 – 2014 which includes three areas for crucial and necessary change:
“Accelerated increase in access to quality health services, Increased well-being and health of the majority of the population through the reduction of maternal and child mortality and the modification of the structure, functioning and response of the current health system.” The National Health Plan has incorporated as a priority goal the reduction of maternal mortality from 120 to 60 per 100,000 live births, under-five mortality from 30 to 19 per 1000. (The United States Global Health Initiative, 2012)
In Table 6, we can observe an overall improvement in the country regarding maternal mortality, since the year 1990 to the most recent collected data in 2013. We can also observe that from 2009, the year of the coup, although economical instability affected the entire country, the numbers for maternal mortality continue dropping.
‧
國立 政 治 大 學
‧
N a
tio na
l C h engchi U ni ve rs it y
Figure 3.1: Maternal Mortality InterAgency Group, Honduras 2013
*Source: Table extracted from World Health Organization (World Health Organization, 2013)
The current national goal is reducing by half the maternal mortality ratio in Honduras and it is projected that by 2015 the country will meet the goal of maternal mortality ratio to 77 per 100,000 live births as well as the goal set by the MDG’s of reducing the ratio to say 60 per 100,000 live births. (National Health Plan, 2010-2014)
However there still exist an enormous gap between rural and urban areas of the country in what relates to the percentage of births that take place in a specialized location, with expert people present, and under sanitary conditions. While, in 2001, the number of births in a specialized location in urban areas was of 82.4% the number was only 37.5% in rural areas. (Bussolo and Medvedev, 2006)
Historically, there has been a significant improvement in Honduras From the 1990’s were the maternal mortality ratio reached 207 per 100,000 live births to after the coup d’état were numbers seemed to reduce to an 120 per 100,000 live births. But there is still a long way to go in order to achieve international goals and reduce the maternal mortality ratio to 60 per 100,000. It is necessary, and almost critical, to meet the health goals in the country to provide adequate sanitary conditions and trained personnel to all women in Honduras, both rural and urban habitants.
‧
國立 政 治 大 學