Tackling Maternal Mortality In the Sierra Tarahumara, Mexico: A Community Based Intervention
- The participant will be able to identify three or more barriers to accessing care in remote settings.
- The participant will be able to identify the key components of an effective community-based pregnancy outreach education model
- The participant will be able to demonstrate an understanding of the three-delays model in relation to maternal mortality and apply that to diverse practice settings.
In 2008, Mexico had a maternal mortality rate(MMR) of 62.6/100,000 live births. However, the Tarahumara- the indigenous group who live in caves and small dwellings in the mountains of Northern Mexico, have a staggering MMR of roughly 998/100,000 live births. They have more than 10 times the burden of disease, representing only 3% of the population but thirty-eight percent of the maternal deaths in the state of Chihuahua. Many geographic, cultural, and socio-economical barriers exist, limiting the access to appropriate health care for the Tarahumara. The majority of Tarahumara women still give birth at home, unattended.
One HEART Worldwide (OHW) is a US based non-governmental organization that works to decrease maternal mortality one birth at time through using a community-based pregnancy education model.
Proposed change:
OHW has established an effective, replicable and sustainable model to reduce preventable deaths related to pregnancy and childbirth among vulnerable populations. Essential to the OHW model are integration of local resources, collaboration with local communities and providers, and respect for cultural norms and practices. OHW trains local health care providers to work within their communities to raise awareness, teach best practices and distribute prenatal vitamins and birth kits. The use of Misoprostil is an integral component of the OHW model. OHW implemented their Pregnancy and Village Outreach Training Program (PAVOT) in the pilot area of the Urique Municipality in the Sierra Madre, Chihuahua, Mexico in January 2010.
Implementation, outcomes and evaluation:
We recruited 12 volunteers from the project’s 8 pilot communities in a population of 3,100. We revised the PAVOT curriculum -complete with culturally appropriate picture based hand-outs and flipcharts. Volunteers attended a 3-day training which covered half of the curriculum and are now delivering PAVOT messages, prenatal vitamins and birth kits in their communities. Follow-up testing showed 90% retention of knowledge. The next training is scheduled for October. Birth kits were delivered to all pregnant women in the pilot area. The project is now managed by local indigenous staff and expanision beyond the pilot area is planned for 2011.
Implications for nursing practice:
The leading causes of maternal death are the same around the world- hemorrhage and pre-eclampsia. Be it in an acute care setting or a cave on a mountainside when a woman dies a maternal death, it was because there was a delay that occurred.
Keywords:
Three-delays, maternal mortality, indigenous, community-based education, barriers
