Final Blog Post Bolivia – Ashlyn Sovereen

Bolivia has one of the highest maternal mortality rates in the world and the highest maternal mortality rate in Latin America (UNICEF 2016).  There are 390 maternal deaths for every 100,000 live births in the country.  The global average falls at 402 deaths for every 100,000 births (Rööst et al. 2009).  While lower than the world’s average maternal mortality rate, Bolivia’s rate is higher than all of its surrounding regions.  There are several determining factors that contribute to the high maternal mortality rate of Bolivia, including one’s economic status; age; cultural traditions, especially among the indigenous people who make up the majority of the population; and cultural expectations for a woman’s role in the home.  These factors can be analyzed through the critical medical anthropological theory to explain how they promote a higher maternal mortality rate in Bolivia.

The critical medical anthropological theory “views health issues within the context of encompassing political and economic forces that pattern human relations; shape social behaviors; condition collective experiences; reorder local ecologies; and situate cultural meaning” (Bear et al. 2013).  In other words, the critical medical anthropological theory looks at the political, economic, and social factors that may affect health issues within a country.  This is outside the typical biomedical approach that views each person affected as their own case, ignoring potential risk factors in their lives that may be contributing to the health issue.

Medical anthropology has always had an applied orientation, allowing for medical anthropologist to understand and respond to “pressing health issues and problem around the world as they are influenced and shaped by human social organization, culture, and context” (Singer 2004).  It was Baer and Singer who introduced the term critical medical anthropology to look at the political, economic, and social aspects within a society that affect health issues.  Looking and analyzing these determinants of health helps medical anthropologists to identify the underlying causes of health issues.  This promotes a change in society that may eventually result in the prevention and cessation of such health issues, the ultimate goal of medical anthropologists.

The critical medical anthropological theory distances the health issue from medicalization and its negative connotations (Singer 1990).  The process of medicalization is seen as patronizing to the individual, moving away from personalization and more towards the maintenance of the body.  There are no preventative measures put into place.  As with biomedicine, when we become sick, we visit a doctor and are treated for our ailment.  There is no explanation as to what has happened to us and no advice given to us in how to prevent us from falling ill once again.  To give us such advice would not help those providing care to us as the demand for their care would decline with a decrease in the prevalence of such illnesses.  The critical medial anthropology approach does, however, analyze political, economic, and social factors that may cause the illness, among other health problems, in an effort to find a way to prevent such ailments from ever taking over the functioning within our bodies.

The economic status of the birthing mother is one of the determining factors that contributes to the high maternal mortality rate of Bolivia.  Developing countries are increasingly creating a divide between the wealthiest and the poorest members of their society.  As a result, inequalities in health have been increasing (Marmot 2005).  Inequalities result in increased poverty levels with poor nutrition, a lack of quality medical care, and limited access to a clean water source (Marmot 2005).  Bolivia is the poorest country in Latin America (UNICEF 2013).  As a result, the gap between its economic classes is large.  With this division of classes, a variation in life expectancies and illness can be found with those who are less well-off having shorter life expectancies and more illness than the rich (WHO 2003).  The biomedical approach and its corresponding medical care can prolong one’s survival; however, social and economic problems are what are causing such problems to begin with.  Biomedicine provides a quick fix to a problem – a tune up that solves the problem for the time being – but never eliminates it.  If the social determinate is not attacked with a potential solution, these health issues will never go away as this social determinate is what causes the eventual need for medical care in the first place (WHO 2003).  In Bolivia, this social determinate of poverty is what is bringing about health issues within the maternal mortality rate.  While in poverty, it is difficult to access the resources one needs to survive.  Nutrition levels are below that of recommendations and living conditions are found to be below par as those in poverty cannot afford these basic human needs.  Such problems are known to affect the development of not only the carrier of the child, but also the fetus’ environment.

Those in poverty often live a stressful life.  What money they do have may be spent in an attempt to relieve this stress, sometimes through the use of drugs.  This may result in drug addiction, including alcoholism.  With addiction, it is hard for the user to discontinue use.  If a woman who exhibits symptoms of alcoholism becomes pregnant, she may be unable to discontinue use, resulting in harm to the baby, and thus the mother, with fetal alcohol syndrome.

Poorer women are also more likely to have a home birth (Seioane et al. 2003).  Home births provide an added risk to the death of both the baby and the mother in the case of complications.  If something were to go wrong, transport to the hospital may not be feasible, resulting in the death of the mother and/or child.

Women living in poverty are also less likely to be educated, including the education in the prevention of pregnancy.  This has led to an increased rate of pregnancies among younger women in the lower class and thus the maternal mortality rate as pregnancy-related deaths are also most likely to occur between the ages of one and fourteen (Hakkert 2011).

Age is another determining factor that contributes to the high maternal mortality rate of Bolivia.  Pregnancy-related deaths are most likely to occur at a younger age (Hakkert 2011).  The average age at which a woman gives birth to her first child in Bolivia is 21.2 (Central Intelligence Agency 2016).  Compared to developed countries, including Greece with first time mothers averaging an age of 31.2, the age at which Bolivian women give birth to children is fairly young.  Their bodies may still be developing and may not be ready for the stress that accompanies both pregnancy and birth.  In countries where the average first time mother’s age is higher, around 30, the maternal mortality rate is lower (Central Intelligence Agency 2016).  This may be due to a lack of resources in regards to safe sex education (UNICEF 2016).  Without access to sex education, women may be subjected themselves to unsafe and unprotected sexual intercourse with their partners, resulting in an unplanned pregnancy and/or a sexually transmitted disease.  Sexual intercourse before marriage is becoming increasingly popular throughout the global culture.  Without access to such knowledge, pregnancy rates may increase in younger women, resulting in a higher percentage of births from younger mothers, increasing the maternal mortality rate.

Cultural traditions also have an impact on the high maternal mortality rate of Bolivia.  In Bolivia, the indigenous population makes up more than half of the total population (UNICEF 2016).  Indigenous peoples are more likely to have home births as they live in rural areas, far from public health centers with the aid of medical professionals to help with the delivery and care of both the child and his or her mother.  The indigenous people are also less likely to stray from their cultural traditions.  Traditionally, births take place in the home, surrounded by family and friends who bring her warm foods and drinks (Hirst n.d.).  Warmth is important to the expectant mother as it helps with blood flow.  The drinking of herbs, delivery of the baby in a dimly lit room, and the delivering of the bay in a squatting or kneeling position are also important to the cultural traditions of the indigenous Bolivian peoples.  A home birth allows for the honoring of cultural practices that may not always be promised as such traditions may interfere with the safety of the mother and/or her child.  In a hospital, babies are born exposed to bright lights while the mother is given cold liquids in place of hot foods and drinks.  The umbilical cord is cut with metal scissors in a hospital, instead of ceramic.  Indigenous women believe such a practice will bring about a wasteful and ungrateful child (Hirst n.d.).  In a hospital, however, medical professionals are there to help with the delivery of the child, the mother and her baby’s safety are of upmost priority.  While a home birth may uphold cultural traditions, it also increases the risk of death for both the mother and the child without access to medical care in the case of an emergency.  This would lead to an increased maternal mortality rate.

Cultural expectations with the role of a woman in the home also contribute to the high maternal mortality rate in Bolivia.  Women are expected to work in the home with roles of both care for the family and in reproduction (UNICEF 2016).  With an emphasis on family and reproduction, this increases the pressure for women to have children.  A woman would be seen as not fulfilling her goals and role in life without caring for her own children.  With this emphasis brings an increasing amount of pregnancies in the country.  With an increase in pregnancies, the number of deaths increase as well.  While school attendance is fairly high throughout the entirety of the grade school education career, attendance falls with the transition from primary to secondary school, especially among women (UNICEF 2016).  Women are dropping out of school to care for their families and to start their own at a young age.  Dropping out of school before completion decreases one’s chances of finding a job that can financially support a family.  In Latin America’s poorest country, this is a problem, especially in single parent homes.  Women are not seen as equals to men in Bolivia, making it more difficult for them decide their own life choices.  Women are seen to be the property of their husbands.  Even if the expectant mother wishes to deliver her child in a hospital, her husband may overrule this decision, deciding the child should be born in the home where a woman belongs, caring for her family.  This promotes an increase in maternal mortality rates with a decrease in the implementation of safe birth practices.

The critical medical anthropological theory allows medical anthropologists to look a health issues through a new perspective using political, economic, and social factors to find out why a health issue exists and how to prevent this health issue from continuing in the future.  Looking at these factors allows medical anthropologists to determine why a health issue is occurring, allowing for the suggestions of solutions on how to fix such issues.  In Bolivia, the maternal mortality rate is high with 390 deaths for every 100,000 births.  This is the highest maternal mortality rate throughout all of Latin America.  There are several underlying determining factors that promote this high maternal mortality rate among Bolivian women.  These determining factors include the expectant mother’s economic status, age, indigenous cultural values, and the role of women in society.  The expect mother’s economic status is especially relevant as Bolivia is Latin America’s poorest country.  Women with a poorer economic status do not have the same access to health care as those with a higher economic status.  While Bolivia has attempted to correct this issue through the implementation of government-funded health care, cultural values among the indigenous peoples have kept women in their homes for home births, increasing the expectant mother’s risk of death, along with her child.  Women are afraid that giving birth in the hospital will not allow for their cultural practices to be upheld, breaking tradition.  The role of women and an increase in pressure to reproduce and care for the family also promotes an increased rate with an increase in pregnancies at a young age, when a woman is most likely to die from pregnancy-related complications.  A move towards closing the gap between the rich and the poor while finding a way to incorporate cultural values into a hospital birth may help to decrease the maternal mortality rate in Bolivia.  Decreasing the gap will allow the poor better access to health care while incorporating cultural values into a hospital birth may also increase the amount of births in the safe environment of the hospital as the indigenous peoples will not feel as if they are limiting the success of their children with such a birth.  Such solutions will help to decrease the maternal mortality rate in Bolivia, and thus increase the health and well-being of the country as a whole.

Works Cited

Baer, H. A., Singer, M., & Susser, I. (2013). Medical Anthropology and the World System: Critical Perspectives (3rd ed.). Santa Barbara, CA: Praeger.

Hakkert, R. (2011). Follow-up surveys for census estimates of maternal mortality: Experiences from Bolivia and Mozambique. Journal of Population Research, 28(1), 15-30.

Hirst, E. (n.d.). Risk and Respect. Retrieved August 16, 2016, from http://cojmc.unl.edu/bolivia/risk_and_respect.html

Marmot, Michael. “Social Determinants of Health Inequalities.” The Lancet 365 (2005): 1099-104. Web.

Rööst, M., Altamirano, V., Liljestrand, J., & Essén, B. (2009, August). Priorities in emergency obstetric care in Bolivia–maternal mortality and near-miss morbidity in metropolitan La Paz. BJOG: An International Journal of Obstetrics & Gynaecology, 116(9), 1210-1217.

Singer, M. (1990). Reinventing medical anthropology: Toward a critical realignment. Social Science & Medicine, 30(2), 179-187.

Singer, M. (2004). Critical Medical Anthropology. Encyclopedia of Medical Anthropology, 1, 23-30. doi:10.1007/0-387-29905-x_3

The Situation of Women in Bolivia. (n.d.). Retrieved August 16, 2016, from http://www.unicef.org/bolivia/children_1538.htm

The World Factbook. (n.d.). Retrieved August 16, 2016, from https://www.cia.gov/library/publications/the-world-factbook/fields/2256.html

 

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