A Decade of Efforts to Reduce Maternal and Neonatal Mortality: The Salud Mesoamerica Initiative

During the summer of 2012, on a visit to the Guna Yala indigenous region in northeastern Panama, we met Iranelda, a 16-year-old girl in labor whose baby was in a transverse position, requiring a cesarean section. She was ready to be transferred to Panama City to receive the necessary medical care. However, her family objected, trusting that the community's healers, with their ancestral knowledge, could handle the situation. We were deeply moved to learn that Iranelda lost her baby.

In 2012, 25% of women in the intervention areas of the Salud Mesoamérica Initiative (SMI) did not receive quality care during childbirth, leaving them at risk of complications. Only one in 10 newborns received all the clinical checkups and medical interventions needed in the first hours of life. Moreover, just 24% of women with obstetric complications and 22% of babies with neonatal complications received quality care. In this article, we share the progress made over the past decade and how this reality has changed.

A Program to Promote Prenatal Care

A few days ago, on a trip to Honduras, we met Olga, a 22-year-old Chortí woman who lives in Santa Rosita, a village of 120 inhabitants in the department of Copán, near the border with Guatemala.

Olga lost her mother when she was 12 due to complications from her last pregnancy. At that time, the community experienced around 15 maternal deaths annually. The main barrier was finding the money to travel-even to the nearest hospital, which was four hours away.

In 2020, Olga became pregnant. Remembering her mother's experience, she decided to attend all check-ups and follow the recommended care for herself and her baby. She became a prominent participant in the "Star Mothers" program, one of the initiatives promoted by the Salud Mesoamerica Initiative to promote prenatal care.

Health promoters regularly visited Olga to ensure her pregnancy progressed smoothly. The care provided by the health center in Los Arcos, just 15 minutes from her home, helped her have a trouble-free pregnancy. Two days before her delivery, she and her doctor traveled three hours to the hospital in Santa Rosa de Copán, where her daughter, Yeslin, was born without complications. The care at the maternal and child hospital was excellent.

Today, maternal and neonatal deaths in Olga's community have decreased. She and her daughter belong to a generation that should not experience the pain of losing a child or a mother to preventable causes.

In the SMI intervention areas in Panama, the proportion of pregnant women receiving proper treatment to prevent complications during childbirth and safeguard their health and their babies' health increased from 78% to 85%. In Honduras, institutional delivery coverage rose from 72% to 95%. Additionally, the quality of routine care for newborns improved from 22% to 75%.

Like Olga and Yeslin, millions of women and children have found hope through the Salud Mesoamérica Initiative. The dedication of governments, healthcare professionals, community leaders, donors, and partners has been essential in transforming lives and providing quality services to the most vulnerable. This collective effort has significantly narrowed the health equity gap in one of the most unequal regions in the world.

We achieved this by remembering Iranelda's story and finding inspiration in cases like Olga and Yeslin's. It is for them that the effort of these 10 years has been worth it. It is for them that we will continue working until every mother and every baby in Mesoamerica have access to the care they need.

About the Salud Mesoamerica Initiative

The Salud Mesoamerica Initiative (SMI) is a public-private partnership that seeks to improve health access and quality in the eight countries of Mesoamerica: Honduras, Guatemala, El Salvador, Belize, Nicaragua, Costa Rica, Panama, and the state of Chiapas in Mexico. The objective is to expand the coverage and quality of basic health services for 1.8 million women, children and adolescents, thereby closing the health equity gap for the poorest 20% of the population. The initiative was launched in 2011 and is managed by the Inter-American Development Bank (IDB). It is funded by the Bill & Melinda Gates Foundation, the Carlos Slim Foundation, and the governments of Canada and Spain, along with the beneficiary countries' governments.

In 10 years of implementation, the SMI has demonstrated measurable results in maternal, neonatal, and child health across Mesoamerican countries. These results have improved the population's health conditions, as reflected in indicators of coverage, access, and service quality, as well as the performance of their health systems.

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