“Where a life beats, a story is born”: Mónica’s commitment to maternal health – UNFPA América Latina y el Caribe

Report on Maternal Healthcare Challenges and Progress in Bolivia in the Context of the Sustainable Development Goals

Introduction: Aligning Local Efforts with Global Goals

This report examines the state of maternal healthcare in remote regions of Bolivia, specifically the Beni department, through the experiences of gynecologist-obstetrician Dr. Mónica Noelia Rojas Villarroel. The challenges and interventions discussed are critically linked to the achievement of the United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), SDG 5 (Gender Equality), and SDG 10 (Reduced Inequalities).

Dr. Rojas’s work in Trinidad highlights the persistent barriers that prevent universal access to quality maternal care, directly impacting Bolivia’s progress towards SDG Target 3.1: reducing the global maternal mortality ratio.

Barriers to Achieving SDG 3 and SDG 5 in Maternal Health

Dr. Rojas’s professional experience has identified several critical barriers that contribute to preventable maternal and neonatal mortality, undermining key SDG targets.

Geographical and Infrastructural Obstacles

The vast and remote geography of the Beni department creates significant impediments to accessing timely healthcare, a fundamental component of SDG 3.

• Extreme Distances: Women often undertake journeys of many hours, including a documented case of a 36-hour canoe trip, to reach a health facility.
• Transportation Delays: The difficulty of travel frequently turns manageable obstetric issues into life-threatening emergencies.
• Inequality in Access (SDG 10): These geographical barriers create a stark inequality in health outcomes between urban and remote rural populations.

Socio-Cultural and Informational Deficits

Socio-cultural norms and a lack of information create delays in seeking care, which directly conflicts with the aims of SDG 5 to empower women and ensure their health rights.

• Lack of Knowledge: A critical deficit exists in recognizing obstetric danger signs during pregnancy, childbirth, and the postpartum period.
• Normalization of Complications: There is a tendency to normalize pain or adverse symptoms, with justifications such as, “the same thing happened to my mother.”
• Gender-based Delays (SDG 5): Women’s autonomy in health decisions is often compromised, with delays attributed to “waiting for my husband to arrive” or having “no one to leave my children with.”

Case Studies Illustrating Systemic Failures

Case 1: Emergency C-Section Following a 36-Hour Journey

A 30-year-old woman with a twin pregnancy delivered her first baby at home. Complications with the second baby, which was in a transverse position, necessitated an urgent C-section. The patient only reached the hospital after a 36-hour canoe journey. This case exemplifies how a lack of accessible local emergency obstetric care directly endangers lives and hinders progress on SDG 3.

Case 2: Stillbirth Due to Unrecognized Danger Signs

A mother from Rurrenabaque arrived at the hospital with a 37-week pregnancy and a stillborn baby. She was suffering from severe anemia, but the danger signs were not recognized in time, leading to a fatal delay. This highlights the urgent need for community-level health education to achieve the targets of SDG 3.

Strategic Interventions and Progress Towards SDG Targets

Collaborative efforts are underway to address these challenges, demonstrating a commitment to SDG 17 (Partnerships for the Goals).

National and International Collaboration (SDG 17)

Initiatives led by the Bolivian Ministry of Health and Sports, with support from the United Nations Population Fund (UNFPA), are crucial for advancing maternal health.

1. Capacity Building: Strengthening the skills of health personnel to manage obstetric emergencies effectively.
2. Improving Quality of Care: Enhancing the standards of care provided in health facilities.
3. Addressing Social Norms: Working to eliminate gender-based barriers that prevent women from accessing care, in line with SDG 5.
4. Policy Commitment: Bolivia’s signing of the Andean Policy for the Prevention and Reduction of Maternal Death signifies a high-level commitment to SDG 3.

Measurable Progress on SDG Target 3.1

These concerted efforts have yielded significant results. According to the UN Inter-agency Maternal Mortality Estimation Group, Bolivia has made substantial progress towards SDG Target 3.1.

• The maternal mortality ratio was reduced from 287 deaths per 100,000 live births in 2000 to 146 in 2023.
• This represents a reduction of nearly 50%, demonstrating the impact of targeted health interventions.

Conclusion: The Role of Healthcare Professionals in Localizing the SDGs

The work of professionals like Dr. Mónica Noelia Rojas Villarroel is fundamental to translating national policies and global goals into tangible outcomes. Her dedication underscores that preventing maternal mortality is possible with timely, quality, and empathetic care. Continued investment in strengthening health systems, empowering women with information, and addressing socio-cultural barriers is essential for Bolivia to fully achieve its commitments under SDG 3, SDG 5, and SDG 10.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article primarily addresses issues related to health, gender equality, and inequalities in access to services, connecting directly to the following Sustainable Development Goals (SDGs):

• SDG 3: Good Health and Well-being: The central theme of the article is the prevention of maternal mortality, ensuring safe childbirth, and providing quality healthcare for women and newborns. The experiences of Dr. Mónica Rojas Villarroel, the challenges of obstetric emergencies, and the efforts by UNFPA and the Ministry of Health to reduce maternal deaths are all core components of SDG 3.
• SDG 5: Gender Equality: The article highlights how unequal social norms and gender-specific barriers affect women’s health. Reasons for delaying care, such as “I was waiting for my husband to arrive” or “I had no one to leave my children with,” point to underlying gender inequalities that limit women’s autonomy and access to essential health services. The focus on comprehensive care for women and eliminating these barriers is aligned with SDG 5.
• SDG 10: Reduced Inequalities: The article emphasizes the disparity in healthcare access between urban and rural populations. The significant challenges faced by women in remote communities in Beni, who must undertake long journeys like a “canoe journey of more than 36 hours” to reach a hospital, illustrate the deep inequalities in access to essential services based on geographic location.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the issues discussed, the following specific SDG targets can be identified:

1. Target 3.1: By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births.
   • The entire article is framed around the goal of reducing maternal mortality. It explicitly mentions Bolivia’s progress in this area, stating that the country “has reduced the maternal mortality ratio from 287 deaths per 100,000 live births in 2000 to 146 in 2023.”
2. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services… for all.
   • The article describes the severe “barriers to accessing health services” for women in remote areas. The stories of patients arriving after long delays and with critical complications underscore the lack of universal access to “timely and quality care,” which this target aims to address.
3. Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights.
   • The work of the gynecologist-obstetrician in providing “comprehensive care of women” and the need to “spread information about danger signs during pregnancy, childbirth, and postpartum” are directly related to ensuring women have the information and services necessary for their reproductive health, which is a key component of this target.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article mentions one explicit indicator and implies several others that are crucial for measuring progress:

• Explicitly Mentioned Indicator:
  • Indicator 3.1.1: Maternal mortality ratio. The article directly provides data for this indicator, stating the ratio in Bolivia was “287 deaths per 100,000 live births in 2000” and has been reduced to “146 in 2023.” This is a direct measure of progress towards Target 3.1.
• Implied Indicators:
  • Proportion of births attended by skilled health personnel (related to Indicator 3.1.2): The story of the woman who “had been attended by her mother in her community” and gave birth to her first twin at home implies a lack of skilled birth attendance. The call to “train qualified personnel” suggests that increasing this proportion is a key goal.
  • Geographic accessibility of health facilities: The “canoe journey of more than 36 hours” and the “vast distances” are powerful descriptions of a major barrier. Measuring travel time to the nearest health facility with emergency obstetric care would be an implied indicator of progress in achieving universal access (Target 3.8).
  • Women’s knowledge of obstetric danger signs: The doctor’s assertion that it is “essential to spread information about danger signs” and the case of the mother with severe anemia whose “danger signs were not recognized” imply that measuring women’s health literacy is a critical indicator for preventing maternal deaths.

4. Table of SDGs, Targets, and Indicators

Source: lac.unfpa.org