Beyond the Step 10 New considerations about the experience of Baby Friendly Communities in Mexico SECOND WORLD BREASTFEEDING CONFERENCE, Johannesburg Dec. 2016 Marcos Arana Cedeño Comité Promotor de una Maternidad Segura y Voluntaria en Chiapas IBFAN, International Baby Food Action Network Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
In an effort to reduce the number of maternal deaths, in 2010 the Mexican government vigorously began implementing a policy of discouraging obstetric care at first-level health-care facilities and to refer an increasing number of childbirths to hospitals. As this policy was pursued, referrals to hospital slowly increased,and so too indiscriminate referrals, i.e., not only women who were experiencing complications during labor or who were judged to be at high risk. Centro Nacional de Equidad de Género y Salud Reproductiva, Estrategia Nacional para Acelerar la Reducción de la Muerte Materna en México, SSA, 2010.
Due to this Health policy women lost options in deciding what type of childbirth to have. Lower-income women suffer the greatest impact, given that the gradual disappearance of traditional midwifery means that soon they will not be able to access any type of non-hospital care. The growing availability of private care services offering “humanized” childbirth care is aimed at women who can pay for it. Thus the situation takes on a discriminatory hew that increases inequality, since only women with the means to pay will be able to decide how and where to give birth.
The loss of first-level obstetric care occurs as hospitals become overcrowded, leading to a perceptible drop in the quality of medical care. This downgraded care is manifested in many ways: from longer wait times, a lack of beds, bed linen, and other supplies, to the drop in technical quality of medical procedures. The tie-up in normal obstetric care severely weakens the ability to handle true emergencies, thus increasing lethality.Further, the work load associated with the back-up of obstetric services leads to unnecessary fatigue among medical and auxiliary personnel.
The Committee on the Promotion of Safe and Voluntarly Motherhood has identified the dismantling of obstetric care in primary health services as a major cause of obstetric violence* …and is an important source of obstacles for the adequate initiation of breastfeeding. *The dismantling of obstetric care at first-level public health institutions as a determinant of obstetric and gender-based violence against indigenous women of Chiapas AMICUS CURIAE , May 2016.
82% of the nearly 1,200,000 cesarean births every year in Mexico lack sufficient medical justification. INSP, “Elevada recurrencia a las cesáreas: Revertir la tendencia y mejorar la calidad en el parto, evidencia para la política pública en salud” Encuesta Nacional de Salud y Nutrición 2012, INSP, 2013.
Under this circunstances, two questions: 1. Is it possible to mainstream the adequate and sustainable implementaron of BFHI ? 2. Is indiscriminated hospital birth sustainable?
Indiscriminate hospital birth contribuyes to segmented pregnancy and obstetric care
On June 28, 1991, James Grant, the former director general of UNICEF launched the Baby Friendly Hospitals Initiative as an strategy to reduce the inadequate medical practices in hospitals affecting breastfeeding. BFHI was born in the recognition that hospitals ARE NOT the best place to initiate breastfeeding.
Step10. Foster the establishment of breastfeeding support groups and refer mother to them on discharge from the hospital or clinic.
Collective consultations for special circumstances: Teen age mother HIV positive Victims of sex abuse Migrants Displaced persons and refugees
Woman to Woman supports groups can contribuye to Restore the • conditions to combine safe motherhood, adequate breastfeeding and • the right to decide howto give birth.
37 years ago, bottle feeding was seen as normal; few people questioned it. Today, hospital birth is regarded as the norm.