SEATTLE — For far too long, maternal health care in Mexico has been in crisis. In 2013, the maternal death rate in Mexico stood at 38.2 maternal deaths out of every 100,000 live births. This was the highest maternal death rate of any OECD country and more than twice the rate of the third highest — New Zealand’s maternal mortality rate stood at 16.8. Mexico City has the highest maternal mortality rate of any state in Mexico, even though it also has the strongest health care system.
One of the obstacles to maternal health care in Mexico City is lack of access to prenatal care. According to the World Health Organization, antenatal care (ANC) is key, not only in saving lives but to improving lives, health-care utilization and quality of care. In 2014, 30 percent of women in Mexico City lacked access to prenatal care, and only 17 percent of them received prenatal care in the first trimester. For comparison, roughly 70 percent of women receive prenatal care in the first trimester alone in the United States.
Médico in Tu Casa Program
Dr. Jose Armando Ahued, Secretary of Public Health of Mexico City from 2009 to 2017, sought to tackle the problem of maternal health care in Mexico City. In 2014, he helped found the Médico in Tu Casa, or Doctor in Your Home, program. This program offers free prenatal check-ups to pregnant women, as well as services to elderly and disabled people. It also provides healthy food packages to people in their homes.
Through the Médico in Tu Casa program, access to quality maternal health care in Mexico City has improved, as has access to health care for other at-risk groups. By April 2016, the number of doctors and medical students participating in the program had risen from 3,000 to more than 10,000. These doctors had visited 27,500 pregnant women, and not a single woman or child participating in the program had died within 42 days of giving birth.
Seeing signs of success, other Mexican states have implemented similar programs. Other countries, including Argentina, Colombia, Kuwait and China have expressed interest in learning from the Médico in Tu Casa program as well.
One struggle the program has faced is a lack of data. Johabed Olvera-Esquivel, a graduate student in the School of Public and Environmental Affairs at Indiana University, is the first to undertake a comprehensive study the effects of the Médico in Tu Casa program. Her study is not yet complete, but she acknowledges that the municipal government is “committed” and has “good intentions” and that she hopes the program continues.
Helping Mothers and the Elderly
In 2016, the maternal mortality rate in Mexico fell to 36.7 maternal deaths per 100,000 births. This is a decrease from past years, to be sure, but not by as much as many hoped. Actually, the greatest impact of the program has been among disabled and elderly patients, not among the pregnant women Dr. Ahued initially set out to help. Though the program began as a way to improve maternal health care in Mexico City, 60 percent of the people Médico in Tu Casa currently reaches are over 65.
Partially for this reason, the incoming government of Mexico City, elected in 2018, plans to redirect the program to focus mainly on the elderly. However, the new Secretary of Public Health of Mexico City, Dr. Oliva Lopez Arellano, promises that: “All this existing activity will not disappear, it will be absorbed into a more comprehensive proposal of networks and services where more complete attention is provided.”
However the program changes in the future, it has already revolutionized the way many people think about maternal health care in Mexico City and elsewhere. In order to reduce maternal mortality, it is not enough to provide services in hospitals. It is important to meet people where they are.
– Eric Rosenbaum