Despite the impression there are teeming masses of Mexicans waiting to pour across the border into the United States, the birth rate in Mexico, once among the world’s highest, has taken a sharp nose dive. Four decades ago, Mexican mothers typically had seven children, whereas the average today is just over two and this is predicted to fall lower than the US average by 2040. This stark change has happened because of the active promotion of contraception in Mexico during the last decades, as well as the broader changes in education and work, where many women wish to take part in a working society. With strict laws against abortion, this means that four in ten married women in Mexico now choose sterilisation to keep their families small.
However, two million Mexicans are still born every year and though the maternal mortality rate has fallen by 36% since 1990, it remains higher than in many other South American countries. And it is the poorest mothers who face the highest risk. In the southern states of Chiapas, Oaxaca and Guerrero, women die in childbirth 70% more often than the national average. These regions are home to the indigenous Indian people of Mexico, many of whom are still desperately poor.
Though most maternal deaths are from preventable causes, many women in these regions still choose to have their children at home without medical intervention. This decision is partly cultural, since women fear being treated by male doctors and often speak poor Spanish. If they do decide to go to hospital, indigenous women have to travel long distances and often lack the financial means to pay for necessary medicines when they arrive. Even then, the quality of care can be low; 40% of urban deaths are caused by some form of medical malpractice.
More spending on training, midwives and contraceptives has been promised, with money donated by the Spanish government and the charities of Bill Gates and Carlos Slim. A total of 150 million dollars has been pledged for improving the health care of the poor in Central America and southern Mexico.Certainly, the most effective way to reduce maternal mortality is to invest in infrastructure, health and education. At a time when drug-related violence is escalating in Mexico, with the high-profile assassination of a candidate for governor in the northern state of Tamaulipas last month, it is to be hoped that the over-spilling of drug violence into politics will not distract Mexico’s leaders from their task of improving services for all their citizens and particularly for the poorest and most vulnerable.