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Birth Plans Help Ensure Healthy Babies
FrontLines - March 2010
By Angela Rucker
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Health promoter Dinora Hernandez (standing) explains how she cared for Sophia Nunez during her recent pregnancy with daughter, Carla. Hernandez works closely with the local health unit as part of a USAID-backed effort to ensure healthy pregnancies for both mothers and infants in her community.
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SACACOYO, El Salvador - In 17 years, Dinora Hernandez has come along way from a bundle of nerves to a confident health promoter in her rural community.
In that time, she has helped scores of expectant mothers deliver babies and provided advice and counseling to ensure the infants grow healthy and strong in their first months and years of life.
She uses a birth plan provided by USAID and the Ministry of Health that has helped address infant and maternal health problems. Statistics have shown dramatic improvements by using the plan but women who live in rural communities still have a 50 percent higher chance of dying during or shortly after pregnancy than do women who live in urban communities.
The World Health Organization says that between 1990 and 2006, the infant mortality rate-the number of deaths per 1,000 births-dropped dramatically from 47 to 22.
Great news. But not good enough for Dr. Astrid Lissette López Palacios. She runs Unidad de Salud de Sacacoyo, a small clinic in the Department of La Libertad with patients taking up nearly every seat in the sunny waiting areas.
Along the walls are dozens of posters with health messages for adults and children, many of them designed and paid for by USAID.
Palacios also points out a large map of her district. Neighborhoods are marked with colored pins, each showing where her female patients live and if there is a birth plan in play.
Each birth plan is a step-by-step guide for expectant mothers, their partners, and families. It starts with routine checkups for the expectant mother and ends by ensuring vaccinations for babies and follow-up care for the new mother.
Expectant mothers must arrange for transport to the nearest hospital, a difficult task in poor, rural communities where most roads are unpaved and public transportation is spotty. They must also create a savings plan, even if that means borrowing from relatives or devising a moneymaking plan they can complete while pregnant. Women have to secure the support of family members, even when the pregnancy may have disappointed and antagonized their kin.
Even the smallest assignment is logged by hand. The unit has just one computer-and a staff with little time to key in reams of data-so color-coded maps and meticulously kept record books serve as databases.
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Dr. Astrid Lissette López Palacios runs Unidad de Salud de Sacacoyo, a small health clinic in the Department of La Libertad in El Salvador.
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Keeping track of expectant women and following through on benchmarks has proved key to healthy pregnancies.
"In the end, what we hope to achieve is a healthy baby and a healthy mother," Dr. Palacios said.
Health promoters take up where health unit personnel leave off. Promoters have at least a ninth grade education, come from the communities they serve, and receive training backed by USAID on basic health care and counseling.
Margarita Lobo, USAID's manager of health projects at the El Salvador office, said health promoters are a bridge between the health units and the communities where they are often well known and respected. "They're the first line," she said.
At her home down a rocky, one-lane dirt road a short distance from Dr. Palacios' health unit, Hernandez has her own map in the tiny one-room clinic USAID helped outfit with an examination bed, scale, desk, stethoscope, and other medical instruments. She is one of four health promoters assigned to this particular health unit.
Her clinic doesn't get a lot of use because Hernandez, who is 45 and has raised four children, makes house calls using her color-coded map and knowledge of her community to guide her.
Hernandez has known Sophia Nunez, 16, since she was a little girl and began caring for Sophia when she became pregnant. She made monthly visits to check on Sophia and the baby girl she was carrying. In the end, baby Carla, now 7 months old, was delivered in hospital and healthy.
Hernandez, who remembers the days without birth plans when pregnancies could mean a mad dash to get to the hospital on time, believes the plans have made a huge difference in delivering healthy babies in her community. "It wasn't like before," she said, adding, "I feel satisfied to help people through my job."
The birth plan program has been in place since around 2004.
"We have seen a difference," said Dr. Palacios. "Maternal deaths have decreased. Patient knowledge of what are the risk signals-not only the pregnant women but the family-has increased."
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