Safe Motherhood: A Review - Family Care International

Bolivia
2002–2007. During this period, the Universal
Maternal/Child Health Insurance Law (Seguro
Materno Infantil or SUMI) was implemented,
as well as a range of processes within the
broader context of decentralization, including:
• strengthening the decisionmaking power of
primary health care networks;
• building bridges between health care
providers and social networks;
• improving the clinical and communication
skills of providers at the health
care level; and
• promoting community mobilization
strategies and individual, family, and
community empowerment schemes.
During this period, policies focused on the
need to address obstetric emergencies
and incorporate evidence-based clinical
protocols—by improving the referral system,
strengthening transport and communication
networks, and developing strategies to
promote community mobilization and
advocacy in response to gaps in service. Also,
the National Government adopted a set of
goals including: reducing maternal mortality
by 40% by 2008 and 75% by 2015 (based
on 1990 levels); reducing infant mortality
by 10% by 2008 in relation to the ENDSA
2003 (National Survey on Demographics and
Health); and increasing the number of births
assisted by skilled attendants by 24%.
Family planning has been an implicit and
explicit component of national policies,
especially in the 1998–2003 National Program
for Sexual and Reproductive Health, and in
the current 2004–2008 program, which adopts
a strong rights-based approach. Ministry of
Health efforts have focused on strengthening
the availability of contraceptives; the
introduction of Depo Provera has been a key
factor in increasing contraceptive coverage.
According to the 2003 ENDSA survey, in
the last five years modern contraceptive
method use among women in union has
increased from 25.2 to 34.9%. For the first
time, the increase in rural areas (from 11.3
to 25.0%) was higher than the increase in
urban areas, due in large part to an increase
in use of Depo Provera. The Ministry of
Health considers that the higher contraceptive
prevalence rates, resulting from the increase
in availability of services and of modern
methods, have helped result in a decrease in
maternal deaths in Bolivia.
Programmatic Priorities
Technical shifts in programmatic
approaches and priorities reflect the
changes occurring at the international and
regional levels: a shift from the risk approach
to evidence-based practice; from training
traditional birth attendants to promoting
the use of skilled attendants and of the
care they provide; from an emphasis on
the mother and child to a more integrated
approach that focuses on sexual and
reproductive health more broadly. For
example, since 1983, the risk approach was
developed and implemented as a longterm
strategy, staunchly supported by the
Ministry of Health. From 1983 until 1994,
other program strategies were put forward
to complement the risk approach, including
the promotion of prenatal and delivery care,
and care during the postpartum period.
Although the risk approach has not been
completely abandoned, it became outdated
with the enactment of Resolution 0496,