Several countries in Latin America are implementing various programs to improve pregnancy and childbirth care and thus reduce maternal, neonatal, and infant morbidity and mortality. Some examples include Plan Nacer in Argentina (later integrated into Plan Sumar), Rede Cegonha in Brazil, and Código Rojo in Bolivia, all of which have reported positive results.
In Mexico, maternal and child health are among the health system’s top priorities. The Instituto Mexicano del Seguro Social (IMSS), with which the IDB has collaborated on aging and early childhood development issues, seeks to ensure childbirth and postpartum care that is free from obstetric violence and aligned with the recommendations of the Comprehensive Maternal Care Model with Respectful Treatment (AMIIMSS, for its initials in Spanish). IMSS, which serves over 74 million people in the country, attends to approximately 400,000 births per year.
Pillars of Comprehensive Maternal Care
AMIIMSS is based on four pillars and includes 12 indicators to evaluate the degree of adherence of IMSS hospitals to this program. Hospitals that meet seven or more of the indicators are considered to have a high level of adherence, while those meeting six or fewer indicators have a low level of adherence:
The results of AMIIMSS are encouraging. A recent evaluation, which included 48 hospitals, reported that 40% of them had a high level of adherence to the program, and that the mothers and newborns attended there received better support before, during, and after childbirth, and had better health outcomes compared to hospitals with lower adherence.
For example, a higher proportion of women received information about labor or cesarean delivery; privacy measures were improved, for instance, through the use of curtains; fewer women were ignored when asking about their health or their baby’s; the percentage of women who received guidance on exclusive breastfeeding, the vaccination schedule, and warning signs for seeking hospital care increased. In addition, more newborns had a medical check-up and received the tuberculosis vaccine before discharge, and the proportion of cesarean deliveries and maternal complications was significantly reduced (see figure).
However, there is still room to improve care and communication. The evaluation did not identify differences in women’s perceptions between hospitals with high and low adherence to the program regarding:
- The knowledge and skills of health professionals;
- Respect toward patients;
- Clarity of explanations;
- Their participation in care decisions;
- The courtesy and helpfulness of staff;
- The availability of medical equipment or laboratory tests;
- The amount of time health personnel spent with them;
- Waiting times.
Recommendations to Improve Maternal and Child Health
- It is advisable to promote greater adherence to the four pillars of the AMIIMSS program among hospitals with low adherence, by providing them with the necessary resources and guidance. These include training, infrastructure, regulatory adaptation, and women’s empowerment.
- It is desirable that the current standard of 20% of trained personnel be progressively increased until the majority of healthcare staff involved in pregnancy and childbirth care have the competencies to provide respectful maternal care.
IMSS is making progress toward institutionalizing woman-centered care, an important step toward improving maternal and child health. Implementing large-scale health programs in complex health institutions such as IMSS is a major challenge, and the challenges are even greater when the program’s success depends on the collaboration and competencies of health personnel and the participation of users. But experience shows that with institutional will, continuous training, and active listening to women, it is possible to transform maternal care into something more respectful and friendly.
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