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Congressional Delegation Monitors Maternal/Child Health In Guatemala, Honduras
By Claudia Daileader, Editor, AIDSLink
 Many families in rural Central America used to believe that all sickness could be cured with love and faith. While for some illnesses this may be true, living conditions for many poor Central American families -- from unpaved roads to indoor pollution to severe weather -- mean that children are prone to repeated debilitating respiratory illnesses like pneumonia. And, in the past, maternal health had been ignored altogether.
But times are changing. This past August, the Global Health Council, with the support of the Bill & Melinda Gates Foundation, hosted its first Congressional Study Tour (CODEL) to examine programs addressing maternal and child health in Guatemala and Honduras.
These two countries were selected for several reasons:
They have both survived major crisis situations - a civil war that lasted for 36 years in Guatemala and the devastation of Hurricane Mitch in Honduras in 1998;
Both countries have succeeded in preparing and addressing a child and maternal health agenda;
Their successes in improving child and maternal health are due, in part, to investments made by the United States, thus the Global Health Council wished to highlight that government funding for child and maternal health issues really can make a difference.
 "I was thoroughly impressed with the successes made by the Guatemalan government and the local NGOs in improving the lives and health of women and children," said US Rep. Sheila Jackson Lee, D-TX, at a press conference held in Guatemala City. "I will certainly bring these impressions back to my colleagues in the United States when I return."
A Look at Family Planning
The government of Guatemala works closely with local non-governmental organizations (NGOs) to ensure that married women of fertile age are using appropriate family planning methods. In general, Guatemalan women lack empowerment to control their fertility and to protect their families' health. Currently 38 percent of women are using family planning methods, but these are mostly urban women. NGOs such as B'elejeb' B'atz', which means nine threads in K'iche (one of the Mayan languages spoken in Guatemala), is working in conjunction with the Population Council and Save the Children to provide rural women with family planning options and literacy training.
 Proper obstetrical care prior to and during birth still challenges the health care community of Guatemala. The maternal mortality rate in Guatemala remains the highest in all of Central America at 190 deaths per 100,000 live births. Traditional birth attendants and midwives, who are present at 50 percent of all births, play an essential role in diagnosing birthing problems and bringing women to the hospital when necessary. At the Coatepeque Hospital, in Coatepeque, Guatemala, the Johns Hopkins Program in International Obstetrics and Gynecology's (JHPIEGO) Maternal and Neonatal Health Project is promoting new practices for safe delivery and standardized management of obstetrics complications.
Because it is well known that the health of children is intricately linked to the health of mothers, Honduras, too, has taken strong action to improve the health of its mothers. Since 1990, the maternal mortality rate has fallen by 69 percent. Unfortunately, this still leaves Honduras with one of the highest maternal mortality rates in Central America. While the congressional delegation visited the Gustavo Boquin Medical and Maternity Center, the Honduran Minister of Health, Plutarco E. Castellanos, confirmed his commitment to improving women's health. Dr. Nils Daulaire, president and CEO of the Global Health Council, presented the Minister with a white ribbon, in memory of all women who have died during pregnancy and childbirth.
One key to decreasing maternal mortality rates is a strong voluntary family planning program. In the past decade, the voluntary use of contraceptives by women of child-bearing age in Honduras has increased by 31 percent. Women in urban areas are more likely to use contraceptives and the government is working with rural communities to increase access. The Family Planning Association (ASHONPLAFA) sponsors rural clinics around the country that are run in volunteer's homes where women can learn about family planning options available to them.
 Reducing Infant Mortality
The reduction of infant mortality rate ranks as one of Guatemala's health successes - it's been reduced 34 percent in the past 14 years. Educating women about spacing their children by two or more years has had a definite impact - women who space their children four or more years apart have helped lower infant mortality rates by 37 percent. In Patzun, Chimaltenango, local women work in conjunction with an NGO called Renacimiento. They receive literacy training from the NGO and also produce their own income through a sewing cooperative organized by the NGO. When literate, the women are more likely to gain control over their fertility, and are open to reading materials that educate them about infant mortality.
In Honduras, more than 50 percent of childhood deaths occur during the first month of life. As a result, the U.S. Agency for International Development (USAID) has been working with local hospitals to improve neonatal health care. At the Mario Catarino Hospital in San Pedro Sula, USAID purchased state-of-the-art neonatal intensive care equipment. The equipment, including incubators and respirators, supports premature children until they are strong enough to leave the hospital with their mothers.
Helping Children Grow Strong
 Child mortality in Guatemala ranked the highest of all Central American countries in 1995, with 51 out of every 1,000 dying before the age of five. However, in the past seven years, this number has decreased to 45 out of every 1,000. In San Juan Compala, Guatemala, a young girl showed the congressional delegation her village's pharmaceutical supplies, supported in part by the ministry of health and USAID through a program called SIAS. Unique to Guatemala, the ministry of health contracts with eighty-eight NGOs to provide maternal health services, child and school-age health services, illness management, and emergency care and environmental services. Malnutrition still affects 46 percent of all Guatemalan children, however, when considering height for age. Many children are left to care for one another during the day while their parents search for work, and sometimes they do not eat until their parents return in the evening.
Ministry of health statistics indicate that 90 percent of Guatemalan children aged 12-23 months are immunized; this has risen from only 25 percent of children in 1987. Immunizations against diseases, such as measles, are an important contributing factor to Guatemala's decrease in child mortality.
 Using the Integrated Management of Childhood Illnesses program developed by the Pan American Health Organization (PAHO), Honduras has reduced child mortality by 17 percent since 1990. In the program, it is critical that children are weighed on a regular basis. At the Community Integrated Health Post in Yarumela Village, children are weighed bi-weekly and compared to growth charts to ensure that they are on track for their age groups.
The health of children in Honduras continues to suffer though, and it is estimated that 40 percent of urban children are malnourished; this statistic climbs to 60 percent of children in rural areas. This high level of malnourishment aggravates other health conditions such as diarrhea and respiratory infections resulting, in the death of an additional 25/1,000 children every year before the age of five. In the home of Efrain and Fidelian Benitez in Bacadia, Honduras, the community works together to identify and treat respiratory infections among their children using a chart developed, in part, by Dr. Nils Daulaire of the Global Health Council.
"Your health, your decision, our future," reads the motto of the reproductive health program of the Guatemala Ministry of Health. This encompassing phrase intertwines the individual, their families and their country, and its notion of personal decisions affecting the good of everyone that will continue to support the maternal and child health successes in Central America.
US Guatemalan Embassy
The Global Health Council's Congressional Delegation to Guatemala and Honduras included US Rep. Sheila Jackson Lee, D-TX. Rep. Jackson Lee was elected to the House in 1994 to represent the 18th District of Texas, which encompasses large portions of Houston. She is the founding member and chair of the bipartisan Congressional Children's Caucus, which addresses issues concerning health and well being of children. This year, the caucus expanded its focus to include global child survival issues.
Other members of the CODEL included Bryna Brennan, chief of the Office of Public Information at Pan American Health Organization, as well as staff members from the following congressional offices: Toby Croll for Sen. James Jeffords, I-VT; Craig Albright for Rep. Joe Knollenberg, R-MI; Ryan Thrasher for Rep. James McGovern, D-MA; Nisha Desai for the House International Relations Committee; Jessie Torres for Rep. Ileana Ros-Lehtinen, R-FL; Wendy Brafman and Rajah Manno for Rep. Jackson Lee, D-TX; and Charles Dujon for Rep. Jesse Jackson, Jr., D-IL.
Global Health Council staff members accompanying the delegation included Nils Daulaire, President and CEO; Carol Miller, Director of Public Policy; Michele Sumilas, Senior Legislative Associate; Claudia Daileader, editor of AIDSLink; and Gerry Ulrich, office administrator.
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