Having returned from Mexico, Guatemalan refugees can find themselves in communities with minimal access to basic health services, including maternal and child health care. Mobile sexual and reproductive health units can raise awareness and use of antenatal and family planning services in remote areas. However, these services alone are insufficient to ensure a dramatic, sustained reduction in maternal mortality.

Guatemala has one of the highest maternal mortality rates in Latin America at 270 per 100,000 live births. This figure is likely to be higher among Guatemalan refugees who have returned to the country from Mexico since the signing of peace accords in 1998. Marie Stopes: Mexico offered mobile sexual and reproductive health services to 22 of these refugee communities from June 2001 to October 2003 in the state of Huehuetenango. This included family planning services, maternal and child health services and health education. In order to achieve long-term change beyond the project period, the mobile team also trained 28 community health promoters and 45 traditional midwives in the area.

A survey was used to measure the knowledge, attitude and practices of the target population, both before and after completion of the project. The survey was conducted through interviews with a sample of close to 400 people representative of the population at large. The research found that:

• Knowledge of problems during pregnancy increased, although it continued to be generally low. Knowledge of potential problems during childbirth increased from 54 percent to 67 percent.
• Access and use of services during childbirth increased significantly. All of the women who gave birth during the project's two years sought an attendant during the birth, up from 86 percent in the baseline study.
• Knowledge and use of family planning methods improved. Use of modern family planning methods went from 9 to 30 percent. Those who spoke Spanish, as well as their indigenous language, were more likely to use family planning methods.
• Although the project did increase awareness and use of family planning methods, fertility rates continued to be high in the area as fertility is highly regarded in these communities.

Before the project, the communities had no access to sexual and reproductive health services. The project successfully brought about changes in knowledge, behaviour and access to services. However, increased understanding of complications in pregnancy and childbirth and increased use of family planning are not sufficient to achieve a long-term reduction in maternal mortality without:

• an increase in transport to hospital in emergency cases
• greater female empowerment to take decisions regarding fertility and access to health care
• more extensive work with men to improve knowledge and awareness, thereby reducing barriers to access.

Source(s):
'Reducing maternal mortality among repatriated Guatemalan refugees', Marie Stopes International, by C. Alonso et al, 2004

Funded by: Packard Foundation; Moriah Foundation

id21 Research Highlight: 11 March 2005

Further Information:
Marie Stopes International
153-157 Cleveland Street
London W1T 6QW

Tel: +44 (0) 20 7574 7400
Contact the contributor: info@mariestopes.org.uk

Marie Stopes International

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