Academic journal article Bulletin of the World Health Organization

Health Sector Reform and Reproductive Health in Latin America and the Caribbean: Strengthening the Links

Academic journal article Bulletin of the World Health Organization

Health Sector Reform and Reproductive Health in Latin America and the Caribbean: Strengthening the Links

Article excerpt

Voir page 674 le resume en francais. En la pagina 675 figura un resumen en espanol.


The health sectors in many countries of Latin America and the Caribbean (LAC) -- in different ways, at different speeds, and with mixed results --are currently being transformed: (1) by the introduction of sectorwide reforms to make the health services more effective and efficient (e.g. improving service quality and access, decentralizing management and decision-making, controlling costs, and expanding the role of the private sector), and (2) by the adoption of a broad-based reproductive health care model in accord with the action agendas that emerged from the International Conference on Population and Development (ICPD) in Cairo in 1994 and the Fourth World Conference on Women (FWCW) in Beijing in 1995. These international agreements call for a reproductive health approach based on human fights and responsiveness to holistic needs, particularly those of women.

Given the serious personal, economic, and social burden of reproductive health problems on people (especially women and adolescents) and on the health systems in low- and middle-income Latin American and Caribbean countries (Table 1), reproductive health should ideally be a priority focus within broader health sector reform. The various components of reproductive health care -- including pregnancy-related care, family planning information and services, prevention and treatment of sexually transmitted diseases (STDs) and reproductive tract infections (RTIs), and prevention and treatment of unsafe abortions (1) -- reflect key problems in the region and should be integrated into a high-quality health system that strives to meet the comprehensive health needs of the entire population based on human rights and gender-sensitive principles. However, very little information is available on the impact of health reforms on reproductive health care in practice. Since both movements (health sector reform and reproductive health care) are relatively recent in most LAC countries, there is no guarantee that the present motivations can continue or will last. For example, there is a clear risk that health sector reform will be driven by financial and/or political considerations and not by the need to improve health care quality.

Table 1. Reproductive health indicators in selected Latin American and Caribbean countries

                                      % of
                                    at birth
            MMR(a,b)   IMR(c,d)   in 1996(b,e)

LAC(g)         180        36           75
Bolivia        650        75           46
Brazil         220        43           73
Guatemala      200        51           35
Haiti         1000        74           20
Mexico         110        28            6

                           % of married
             % of women     women using    % of adult
             aged 15-19      a modern      population
            giving birth   contraceptive    infected
            each year(d)     method(b)     with HIV(f)

LAC(g)            8             58            0.52
Bolivia           9             18            0.07
Brazil            9             70            0.63
Guatemala        13             27            0.52
Haiti             8             14            5.17
Mexico            7             56            0.35

(a) Maternal mortality rate (MMR): the number of deaths of women from causes related to pregnancy and childbirth per 100 000 live births in a given year.

(b) Source: Population Reference Bureau (PRB): Women of our world, 1998.

(c) Infant mortality rate (IMR): the annual number of deaths of infants under 1 year of age per 1000 live births.

(d) Source: Population Reference Bureau (PRB): World population data sheet, 1998.

(e) Skilled personnel include doctors, nurses and midwives. …

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