At a training for midwives and community health volunteers, the three women in the picture asked me this popular question. I provided my typical response and then asked them how many children they each have. One has 10, the other 12, and the third has 8. That’s an average of 10 children each!
Nicaragua has one of the highest fertility rates in Latin America. Little to no access to contraceptives, difficulty accessing health services, lack of available sexual reproductive education, machismo, and religious beliefs, are all contributing dynamics to the high fertility rates these three women have experienced.
After her initial response, the woman in the pink shirt corrects herself and states that she has given birth to 14 children, two of which did not live for long.
Nicaragua not only has high fertility rates, but also has high maternal, prenatal and infant mortality rates. Extreme poverty is the leading cause. Nicaragua is one of the poorest countries in the Western Hemisphere, with 48% of the population living below the poverty line.
We live in the RAAS department, where maternal and infant mortality rates are hit the hardest, mainly due to the large concentration of rural communities throughout the department. How has the Ministry of Health (MINSA) confronted this problem? They have trained thousands of volunteers!
Parteras (midwives), brigadistas (community health volunteers) and promotoras (community health promoters) all receive several months of training provided by MINSA, which prepare them to work as an extension of the health services in Nicaragua throughout the rural communities.
Typical responsibilities include providing community-based education and health outreach, home visits to pregnant women, conducting community census, promoting family planning methods, as well as administering antimalaria medication and providing follow-up. Until recently, the midwives were also handling home births.
With the high mortality rates, MINSA has moved to an institutionalized birthing model and has trained their community volunteer health workers in this respect. Putting this new model into practice, Nueva Guinea has not experienced any maternal deaths in the last three years!
Several of the midwives are stationed at the three birthing houses located throughout Nueva Guinea…more on that subject in an upcoming post. -Caressa