Cauca mobilizes against maternal and child mortality

In the department of Cauca, 60.6 mothers die for every 100,000 live births and in Colombia, 55.3 mothers die for every 100,000 live births, especially in rural areas, according to figures from the Health Situation Analysis (ASIS).

This worrying panorama is found in a department that has been affected by the armed conflict, by social gaps and inequity, by institutional indifference and especially by failures in health care for pregnant women and newborns.

Sinergias, in its quest to reduce maternal and infant mortality, came to Cauca to implement a project to improve the quality of obstetric and newborn care in conjunction with the departmental and municipal health secretariats and other local institutions. This project was funded in a first phase by Unicef (2012-2015) and the Presidential Cooperation Agency (2013 and 2014) and is currently supported by MSD for Mothers (2016-2019).

The municipalities involved in this second phase of the project, as of 2016, are Almaguer, Caldono, Cajibío, Inzá, La Vega, Páez, Piendamó, Puracé, San Sebastián, Silvia, Toribío and Santander de Quilichao, the last one linked for 4 years.

Prenatal, delivery and postpartum care

Sinergias implemented a quality index to monitor compliance by health institutions with basic prenatal, childbirth and postpartum care actions. This index is composed of a series of actions that, according to evidence and current regulations, should be performed for all women in these care services.

These municipalities showed weakness in the performance of the index. The median was 14 basic actions out of a total of 21 in the prenatal stage (67%) and the same number for the 20 actions for childbirth and postpartum (70%). In other words, even half of the women received 14 or fewer of these key actions in each of these services.

Postpartum contraception

Another of Sinergias' work fronts in this territory is advising women and institutions on their right to receive postpartum contraceptive care. This strategy is key not only to reduce maternal and perinatal morbimortality, but also to guarantee women's sexual and reproductive rights. "The plan with my husband was not to have any more children, I had chosen the IUD (Copper Intrauterine Device), I had a check-up and everything, but they told me they had no equipment or clamps, to come back in a month. I didn't like it on that side, [...] I almost didn't trust those injections and my sister had told me that the IUD was safer, but I kept waiting for the device until I got pregnant", this is the testimony of a pregnant woman attended at an institution in a municipality of Cauca, who was not guaranteed effective postpartum contraception.

None of the IPSs involved in the project provide contraceptive counseling to all women -although the percentage has been increasing progressively- and in many cases women do not receive any information on the subject. Only one third of the women who gave birth in the project institutions left with a contraceptive method.

Women in action

The project is also promoting the empowerment of the women served in the decision-making process related to improving the quality of maternal and child health services. In this way, they know and enforce their rights in sexual and reproductive health, and those of children in the health system and are expected to be able to actively participate in decision-making on the type and quality of services they receive.

In 2016 we trained 40 women leaders in Inzá, Santander de Quilichao, Cajibío and Silvia. With this exercise, women prioritized problems and alternative solutions, giving way to 38 actions aimed at promoting sexual and reproductive rights and improving women's care. Of these actions, 18 progressed during the year. Of the women trained, 18 participated in some decision-making space. From the second half of 2017, this work will continue to seek more significant participation.

ICT, health and women

Women who benefit from the project will receive text messages on their cell phones with accurate and timely information on prenatal, childbirth and postpartum care. This will promote self-care practices and the use of services for pregnant and lactating women in Santander de Quilichao and Caldono, initially.

A team of specialists prepared the messages and last March workshops were held with women of different educational levels, from rural and urban areas, to socialize this information. With them, the messages were adjusted to a simple and practical language for all of them.

Improvement plans

The improvement of care for women and their newborns is made possible by the actions developed by the project with the collaboration of all the actors in the health system, which are reflected in the municipal improvement plans and the departmental plan, which have made it possible to achieve progress in key aspects of care such as induction to demand, application of guidelines and protocols, and evaluation of health services.

The level of execution of the improvement plans shows that Santander de Quilichao has an execution above 90% and Páez above 80%; Silvia and Toribío are above 70%; Cajibío, Inzá and Caldono above 60%, and Puracé, which started only in December 2016 is below 10%. The other municipalities started in May 2017 so results are not yet presented.

“It is a very important project for us, the department is very committed and although there are still many things to improve, clear progress can be seen in many indicators, which means an improvement in the quality of services received by thousands of women in the municipalities involved,” assured Pablo Montoya, director of Sinergias.

Sinergias will continue to lead the fight against maternal and infant mortality, so that morbimortality rates as high as those in Cauca do not continue to increase and, on the contrary, decrease. Women and children are and will continue to be our priority!