By Giselle Alemán
El Palmital, Nueva Segovia. February 10, 2012. Nestled in the Segovian forests over 1,000 metres above sea level is a small farm surrounded by wind-ruffled coffee bushes. The tranquillity of a typical morning is broken by crying of small children carried down by mothers who have walked through rain and mud. They are determined not to miss the monthly visit with nurses and doctors from Quilalí who come to visit El Palmital.
The health team comes to visit El Palmital to monitor the 0- to 2-year-old children and pregnant women there. They’ve already counted the patients: 29 children and three pregnant women to have their height and weight measured in order to detect any problem with their growth or pregnancy.
Among those attending the clinic is 16-year-old Feldi Ferrera, who is legally still a minor but is already a mother holding a three-month-old baby whom she breastfeeds as we talk. We noticed similar case as her; another 28 adolescent mothers were sitting on benches or standing with their babies. They are girls lulling their children to sleep. It is a sad situation, but a common phenomenon in this country, especially in rural areas where the pregnancy rate among 15- to 19-year-old girls is 139 per 1,000. This also has a negative impact on the average duration of schooling among those adolescent girls, which is 7 years. Most of the young mothers here waiting their turn have already left school to put them on the responsibilities of raising children.
But good news is that nationally, the maternal mortality dropped from 76.5 per 100,000 live births in 2007 to 60.5 in 2010, thanks to a number of different interventions implemented by the Ministry of Health, supported by UNICEF, such as the Community Health and Nutrition Programme (PROCOSAN). The monthly antenatal care and well-baby visit organized in El Palmital is a part of this programme.
“When I was pregnant I came here and they looked after me,” recalls Feldi. “They told me what I had to eat and the things that I should do to protect myself and my baby. So I felt really good because I could see that my child was growing healthy as my pregnancy progresses.”
The success of the medical visits depends on the work of the community leaders, women and men who receive no wages and whose only reward is “the satisfaction of bringing benefits to the community” and “saving mothers’ lives,” in the words of René Antonio Sierra, a community leader from El Palmital.
The community leaders visit every house, gathering information. They are responsible for conducting the “census of pregnant women” with objective of providing health personnel with information on the number of women in the area, which is under the responsibility of the Family and Community Health Teams (ESCFs). It responds to a model implemented by the Minister of Health, which objective is to improve health conditions in to the community and families. They also identify women with a risk factor, including any woman who is pregnant, puerperal, or in the postnatal period who has not been to the reproductive health services. This process guarantees that they will be sought out and monitored by medical team, and will receive counselling and family planning services.
The community-based programme on nutrition, pregnancy care and family planning has a long-term positive impact, improving the quality of life of these young women and their children. In 2011, this strategy has earned the Nicaraguan government and the Ministry of Health’s “the Americas Award” for its contribution to the reduction of maternal mortality and to the Millennium Development Goal 5, with participation of community leaders, midwives and the population.
However, there is still a long way ahead of these communities to save every single young pregnant woman like Feldi, and new-born baby. In 2010, nationally 27 out of every 100 pregnant cases fell into adolescent girls 15-19 years old. In collaboration with the Ministry of Health and communities, UNICEF’s new Country Program 2013-2017 aims at saving the lives of 7,569 adolescent pregnant women, by bringing this community-based strategy operational n the 24 most deprived municipalities in Nicaragua.