Nearly a decade after being launched, a program that sends mobile health units down some of Bolivia’s most remote roads is continuing to deliver much-needed basic reproductive and maternal health care to thousands of indigenous girls and women. Because most indigenous girls and women are unable to travel to cities to receive the reproductive care they need, the International Planned Parenthood Federation—Western Hemisphere and Bolivia-based Center for Investigative and Educational Services’ (CIES) Sexual and Reproductive Health Clinic use these mobile health units to bring maternal health care to women who are the hardest to reach.
Although Bolivia has one of the highest maternal mortality rates in Latin America—with 180 deaths for every 100,000 births—the number of women who die because of pregnancy related complications in rural areas is far worse. According to some estimates, the maternal mortality rate for rural Bolivia is more than 600 deaths for every 100,000 births. While Bolivia has made progress in reducing its maternal mortality rate since adopting the Millennium Development Goals in 2000, the overall and rural mortality rates remain shockingly high.
But it’s not just the geographical differences that contribute to Bolivia’s high maternal mortality in rural areas. It’s also long-standing discrimination against indigenous peoples, who account for 71 percent of the nation’s population. Most hospitals with perinatal care units are located in cities and far from the reach of rural women. Many indigenous women also face challenges to receiving proper medical care because of language differences and poor education and literacy.
In an effort to bring services to those women who can’t or won’t visit hospitals, a small team of doctors, registered nurses, drivers, and educators reach more than 100,000 Bolivians, many of who are young women and girls in need of maternal and reproductive health care. Reaching these patients means driving across rocky and unpaved roads, mountainous cliffs, and flooded valleys for 36 weeks per year—all while carrying critical medical supplies and equipment, such as a stretcher, oxygen tank, intravenous kits, pocket-sized ultrasound machines, and medications.
Although many people initially visited the mobile health units to receive general medical care, across the years more women have started seeking sexual and reproductive health care. Most of the services the units provide are Pap smears, pelvic examinations, treatment of sexually transmitted infections, contraceptive services, and prenatal screenings. Recognizing that the mobile health units cannot address all medical needs, CIES works closely with the Ministry of Health to refer high-risk cases, such as pregnancy related complications, to public medical health centers.
In addition to the proximity, indigenous women and girls continue to seek care at the mobile health units because they face fewer cultural barriers than conventional medical clinics. Every staff member speaks the Guarani language—the most commonly spoken language in Bolivia’s rural region. CIES educators also ensure they deliver educational talks promoting health behaviors reflect the socio-cultural needs of both indigenous women and men. These talks cover basic reproductive health, basic anatomical information, contraceptive methods, sexually transmitted diseases, including HIV/AIDS, women’s rights, and violence against women.
Getting frequent care and becoming better educated about reproductive health is having an impact. According to one local health promoter, the regular arrival of mobile health units is leading to greater use of family planning methods and families choosing to have fewer children.