 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Paula E. Brentlinger, MD, MPH1, Héctor J. Sánchez-Pérez, MD2, Marcos Arana Cedeño, MD, MPH3, Guadalupe Vargas Morales4, Miguel A. Hernán, MD, DrPH5, Mark A. Micek, MD, MPH1, and Doug Ford, JD6. (1) International Health Program, Department of Health Services, University of Washington, Box 354809, University of Washington, Seattle, WA 98195, (206) 543-8382, brentp2@u.washington.edu, (2) Investigador Titular Area Población y Salud, El Colegio de la Frontera Sur, Carretera Panamericana y Periférico Sur S/n, 29290 San Cristóbal de las Casas, Chiapas, Mexico, (3) Centro de Capacitación en Ecología y Salud para Campesinos, Calle 28 de Agosto No. 7, Int. 2, Centro, San Cristobal de las Casas, Chiapas, Mexico, (4) Población y Salud, El Colegio de la Frontera Sur, Carretera Panamericana y Periférico Sur S/N, 29290 San Cristóbal de las Casas, Chiapas, Mexico, (5) Dept. of Epidemiology, School of Public Health, Harvard University, 677 Huntington Ave, Bonton, MA 02115, (6) Physicians for Human Rights, 100 Boylston Street, Boston, NY 02116
Background: The ongoing conflict in Chiapas, Mexico, is said by some observers to have disrupted local access to health services, with resultant increases in mortality and morbidity. We attempted to describe pregnancy outcomes and utilization of antenatal and obstetrical services in the conflict zone, and their association with conflict-related factors. Methods: During the 8th year of the conflict (2001), we interviewed community leaders and health workers, and conducted a house-to-house survey, in 46 villages located in the region affected by the conflict. We attempted to identify all households in which a woman had delivered, miscarried, or suffered a maternal death during the preceding two years. Findings: We identified 1227 live births, 8 maternal deaths, and 27 perinatal deaths. Crude maternal and perinatal mortality ratios were substantially higher than those reported for the state of Chiapas and for Mexico nationally. Most births occurred at home. Observed cases of mortality were associated with alleged political and religious bias in provision of community-level health services (OR 2.7). Access to emergency obstetrical services was inadequate; 3 of the 8 cases of maternal mortality occurred in women who were still trying to reach local hospitals when they died. Fear of violence deterred many women from seeking care outside their communities. Conclusions: Observed ratios of maternal and perinatal mortality were worrisomely high in 46 communities located within the conflict zone. Access to emergency obstetrical services was not adequate, and was apparently worsened by factors related to the conflict.
Learning Objectives:
Keywords: Safe Mother Program, War
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.