gaps in reproductive and maternal health: the challenge...
TRANSCRIPT
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Gaps in reproductive and maternal health:
the challenge of inequality
Raffaela SchiavonIpas Mexico Country Director
Gender as the root of inequality
• Gender interacts with the social, economic and biological determinants and consequences of diseases;
• Gender creates different health outcomes for males and females, both in developed as developing countries;
• Gender results in different approaches to prevention, treatment, and coping with illness;
• Gender is the primary cause of specific illnesses and vulnerabilities in SRM health.
Vlasoff C. Gender Differences in Determinants and Consequenc es of Health and Illness, J Health Popul Nutr. 2007 Mar; 25(1): 47–61. PMCID: PMC3013263
GENDER and HEALTH VIOLENCE
One in three women has experienced eitherphysical or sexual violence from her partner
Self-harm and interpersonal violenceMales vs. Females 15-49, World2013
IHME 2013 : http://vizhub.healthdata.org/gbd-compare/
Self-harm
Interpersonal Violence
Self-harm and interpersonal violenceMales vs. Females 5-14 ys. World 2013
IHME 2013 : http://vizhub.healthdata.org/gbd-compare/
Self-harm
Interpersonal Violence
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Gender violence in Mexico
• Six out of 10 women > 15 ys. suffered sometype of violence; prevalence is as high 80% insome states
• Prevalence is higher among women whomarried younger (< 18 ys. vs. >25 ys)
• Five out of 10 women >15 ys. ever-in unionwas assaulted by partner.
ENDIRETH Mexico 2011
GENDER and HEALTH REPRODUCTIVE AND MATERNAL HEALTH
Reproductive and Maternal Health
Maternal Mortality Rate (MMR) and AdolescentFertility Rate (AFR) are sensitive indicators ofinequality, due to differential socio-economic-educational status, age and urban-rural-ethniccharacteristics; more generally, due to unequalopportunity of development, resulting in profound gapsin access to and quality of essential RMH services.
Additionally, during pregnancy, abortion and deliverycare, women face unequal barriers in legal andnormative frameworks, including family, communityand social norms, that differentially discriminate them,violating their human and reproductive rights.
GENDER and HEALTH MATERNAL MORTALITY
IHME 2013 : http://vizhub.healthdata.org/gbd-compare/
99% of maternal deaths occurin developing countries
Maternal Mortality
While MMR globally decreased from 380 to 210 maternal deaths x100,000 LB between 1990 and 2013, the reduction is uneven.
The differential between developed and underdeveloped world remains huge: in 2013, MMR in Africa 2013 was 30 times higher than in Europe*.
The life-time risk of dying for maternal causes was one in 17,000 in Italy/Israel, one in 3,700 in developed world but one in 38 in Sub-Saharian Africa**.
* http://www.who.int/gho/maternal_health/mortality/maternal/en/index1.html** http://data.worldbank.org/indicator/SH.MMR.RISK
Maternal Mortality, World 2013
IHME 2013 : http://vizhub.healthdata.org/gbd-compare/
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Maternal Mortality RateDeveloped vs. Developing Countries 2013
IHME 2013 : http://vizhub.healthdata.org/gbd-compare/
GapsinMaternalMortality,Mexico 2012
Source: Lozano R. 2012
RMM x 100,000 LB* RR
Cause of Death100 municipalities
Low HDI50 municipalitie swith High HDI
RMM B / RMM A(CI 95%)
Maternal (all) 142.1 41.7 3.4 (2.8-3.9)
Haemorrhage 49.4 7.2 6.9 (6.1-7.6)
Hypertension 37.1 10.9 3.4 (3.1-3.7)
Indirect 27.8 13.1 2.1 (2.0-2.2)
Other 15.4 4.4 3.6 (3.4-3.7)
Abortion 6.2 4.0 1.5 (1.5-1.6) Sepsis 6.2 0.6 9.9 (9.5-10.3)
Abortion Deaths by Social Security Mexico 1990-2014
19%
4%2%
10%
8%
56%
IMSS ISSSTE OTRA No Especifica Seguro Popular Ninguna
Source:INEGI/SALUD;Deaths inMexican Population Mexico,1990-2014.
Abortion Letality Rate by stateMexico 2000-2014
9,1
43,2
95,0
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
80,0
90,0
100,0
Ipas analys is : Mean Letality Rate: Nof Abortion Deaths x100,000 Abortion Hospitalizations
GENDER and HEALTH ADOLESCENT FERTILITY
Adolescent Fertility Rate World 2015
http://gamapserver.who.int/mapLibrary/Files/Maps/Global_maternal_health_adolescent_fertiltiy.png
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Adolescent Fertility Rate, Mexico 2014
65
70
75
80
1997 2009 2014
TFA
TFA
Polynoom (TFA)
NAL COL NAY GRODGOCHISCAMP SON VER SIN BC COAH CHIHMO
R OAX BCS TAB PUE HGOQROO TLAXMEXMICH ZAC SLP TAM
PS AGS JAL GTO YUC NL DF QRO
18 -1 9 años1 1 ,11 2 ,71 2 ,11 1 ,61 2 ,41 1 ,61 1 ,71 1 ,91 1 ,61 1 ,41 2 ,11 1 ,31 1 ,51 1 ,41 1 ,21 1 ,31 0 ,91 1 ,31 1 ,51 1 ,11 1 ,51 1 ,71 1 ,01 0 ,91 0 ,91 0 ,61 0 ,51 0 ,41 0 ,41 0 ,09 ,9 9 ,9 9 ,91 5 -1 7 años 8 9 ,9 9 ,7 9 ,7 9 ,3 9 ,5 9 ,0 9 ,0 8 ,7 9 ,1 8 ,5 8 ,7 8 ,4 8 ,4 8 ,4 8 ,4 8 ,5 8 ,0 7 ,9 7 ,9 7 ,6 7 ,5 8 ,0 7 ,8 7 ,8 7 ,8 7 ,6 7 ,1 7 ,2 7 ,0 7 ,2 6 ,7 6 ,11 0 -1 4 años0 ,7 0 ,8 0 ,8 1 ,2 0 ,7 0 ,8 1 ,3 0 ,7 0 ,9 0 ,7 0 ,6 1 ,1 0 ,8 0 ,9 1 ,0 0 ,8 1 ,1 0 ,7 0 ,6 0 ,8 0 ,7 0 ,6 0 ,7 0 ,6 0 ,7 0 ,7 0 ,5 0 ,6 0 ,5 0 ,7 0 ,5 0 ,6 0 ,5
0
5
10
15
20
25
Proportion of births in adolescentsby age groups and by states, Mexico 2008-2011
Distribution (%) of births to 10-14 ys girls by state, Mexico 2010-2014
0,0
2,0
4,0
6,0
8,0
10,0
12,0
14,0
TOTAL: 72.104
42%
17,79
18,27
19,22
20,20
16,5
17,0
17,5
18,0
18,5
19,0
19,5
20,0
20,5
Muy bajo Bajo Medio Alto
Mean age of first intercourse, by SE status Mexico 2014
Very Low Low Medium High Source: Echarri C, 2015
Proportionofwomen who did NOTusecontraception atfirst intercourse,by SEstatus
0,00,10,20,30,40,50,60,70,80,91,0
15 a 19 20 a 24 25 a 29 30 a 34 35 a 39 40 a 44 45 a 49 50 a 54
Muy bajo Bajo Medio Alto
Source: Echarri C, 2015
Because they did not know any contraceptives, where to get or how to use them
0,00
0,10
0,20
0,30
0,40
0,50
0,60
0,70
15 a 19 20 a 24 25 a 29 30 a 34 35 a 39 40 a 44 45 a 49 50 a 54
Muy bajo Bajo Medio Alto
Source: Echarri C, 2015
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Because they wanted to get pregnant..
0,000,050,100,15
0,200,250,300,350,400,450,50
15 a 19 20 a 24 25 a 29 30 a 34 35 a 39 40 a 44 45 a 49 50 a 54
Muy bajo Bajo Medio Alto
Source: Echarri C, 2015
The challenge of inequality
Four of the richest millonaires in Mexico concentrate 9% of the country GNPwhile 54,4% of the population (>50 millions) are poor.
OXFAM report 2015, G. Esquivel “Desigualdad Extrema en México: Concentración del Poder Económico y Político”
h ttp ://www2 .u nwomen .o rg /en /n ews/in -fo cu s/in tern atio nal-women s-d ay
Vero nica Ma g a r, Bull Wo rld Hea lth Org a n 20 15 ;9 3:7 4 3 | d o i: h ttp ://d x .d o i.o rg /10 .24 71 /BLT.15 .16 50 2 7
“It is time to build upon hard-won accomplishments of gender and women’s health
with an expanded social justice perspective”
Muchas gracias
Raffaela Schiavon Gerardo PoloErika Troncoso