Douglas J. Fife & Benjamin D. Fox & Graciela Agnela Javier with Don Bloxham, Spanish & Portuguese
The preliminary report of the findings of this study were written in Spanish so that the data could be of use to the local health organizations and the University of Acapulco Medical School in Guerrero, Mexico. Although the findings were written in Spanish, we do not want to limit the findings of our project to the Spanish literate population and for this reason we have written this brief summary in English.
High maternal death rates and low rates of prenatal check-up attendance in the state of Guerrero, Mexico have brought about the formation of the “Comite Promotor por una Maternidad sin Riesgo” (Committee to Promote a Maternity without Risk), which has published numerous studies on prenatal care in the area. While providing valuable information, these and other studies have called for more research about women’s sources of information on different prenatal topics and their knowledge of warning signs during pregnancy (1).
With the assistance of administrators of the State Health Department and research faculty of the University of Acapulco Medical School, we designed a questionnaire to determine what action women would take if warning signs were present during pregnancy and the source that taught them how to act in these circumstances. The warning signs used in the questionnaire were prolonged headaches, vaginal bleeding, painful urination, extremely swollen legs and feet (edema), premature water breaking, and cessation of fetal movement. We also included questions about frequency of prenatal care, insurance, educational level, taking medications during pregnancy, and knowledge of a state program designed to promote prenatal checkups.
We restricted our sample to women who were pregnant or who had given birth in the previous two years. The women were interviewed at the General Hospital of Acapulco and door to door in the rural villages of San Pedro Las Playas (Population 2394) and Tres Palos (population 4869) (2). We interviewed a total of 486 women between the ages of 14 and 45 years. Also, in conjunction with local and state health care administrators, we designed and distributed door to door an educational flyer containing information on the warning signs during pregnancy, the statewide program mentioned above, and the nearest location to receive medical attention.
Over 80% of all women interviewed stated that they would seek immediate medical attention for vaginal hemorrhaging, severe headaches, painful urination, and if fetal movement ceased, but for the warning signs related to preeclampsia/eclampsia, extremely swollen feet (edema) and an intense, prolonged headache, only 36.8% and 58% respectively of all women interviewed would seek immediate medical attention. These low levels are alarming because these are symptoms of preeclampsia/eclampsia, one of the major risk factors associated with maternal death in the state of Guerrero (3).
Of all the women who stated that they would not consult with a physician if their feet were extremely swollen during their pregnancy, we found that 30.6% of them would remain at home and do nothing, 30.3% answered that they did not know what they would do if this happened to them during their pregnancy, and 35.5% answered that they would try their own therapeutic techniques such as removing salt from their diet, resting, elevating their feet, and receiving massages to try to reduce the swelling. This is alarming in towns with a low occurrence of prenatal visits because the vast majority of pregnant women do not know that there may be complications associated with the swelling and the delivering doctor/mid-wife will not be forewarned.
79.2% of all women interviewed had attended at least one check-up with their doctor during their pregnancy, but what was alarming was the irregularity of the check-ups and their reasons for attending. Nearly 25% of the women interviewed at the Hospital General de Acapulco, 36% of the women interviewed in San Pedro Las Playas, and 32% of the women interviewed in Tres Palos attended check-ups only because they had pain or were confronted with some other warning sign, otherwise they would not have visited the doctor. The responses to why at least one check-up was not attended revealed that the leading reason for not attending a prenatal check-up was the cost. While this reason could be legitimate, the average cost of a prenatal visit in Tres Palos and San Pedro Las Playas is ten pesos (roughly one dollar), equivalent to the price of three small bottles of Coca-Cola (refrescos) which the majority of the locals are accustomed to buying daily.
The principal source that influenced these women to visit the doctor was the family, and when this was subdivided into specific members of the family we found that the mother, husband, and mother-in-law are the most influential in that order respectively. Also, of all the women interviewed in San Pedro Las Playas, 43.5% of them had given birth or plan to give birth using a mid-wife. Alarmingly, in Guerrero there is no licensing and no training for mid-wives at this time.
In order to reduce the number of women and children that die each year due to complications during pregnancy, the state of Guerrero, Mexico, has implemented a prenatal program in the past few years that eliminates the hospital and doctor’s fees for the birth when pregnant women attend at least 5 prenatal visits each in a different month during their pregnancy and bring with them a completed form verifying their doctor visits. We found that only 9.5% of all the women interviewed knew about the program, and surprisingly, of all the women who received a check-up and direct contact with a doctor in a state run institution promoting this program, only 13.3% knew about it. We also noticed much confusion, distrust, and poor communication about the program between doctors and patients and between doctors and state health care administrators.
- VILLEGAS A, MARTÍNEZ E, CUELLAR N, DE LA PAZ G, RAMÍREZ G, RAMÍREZ G. Estimación de Riesgo Materno y Perinatal en una Area Suburbana de Acapulco, Guerrero. Prioridada de Salud el CIET (Centro de Investigación de Enfermidades Tropicales) informa. 1995;5:7-10.
- INEGI Guerrero: Tomo I conte de población y viviendo 1995, definitives tablados básicos. Instituto nacional de estadistica, geografia e informática. Aguascalientes, Ags México: 1996.
- LANGERA, HERNÁNDEZ B, LOZANO R. La Morbimortalidad Materna en México: niveles y causas. Maternidad Sin Riesgos en México, México, 1994.