DOCSLIB.ORG

Factors That Reduced Maternal Mortality

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Factors That Reduced Maternal Mortality HNP DISCUSSION PAPER Public Disclosure Authorized MATERNAL AND CHILD SURVIVAL: Findings from five countries’ experience in addressing maternal and child health challenges Public Disclosure Authorized About this series... This series is produced by the Health, Nutrition, and Population Family (HNP) of the World Bank’s Human Development Network. The papers Rafael Cortez, Seemeen Saadat, Sadia Chowdhury and Intissar Sarker in this series aim to provide a vehicle for publishing preliminary and unpolished results on HNP topics to encourage discussion and debate. The findings, interpretations, and conclusions expressed in this paper are entirely those of the author(s) and should not be attributed in any manner to the World Bank, to its affiliated organizations or to members of its Board of Executive Directors or the countries they represent. Citation and the use of material presented in this series should take into account this provisional character. For free copies of papers in this series please contact the individual authors whose name appears on the paper. Enquiries about the series and submissions should be made directly to Public Disclosure Authorized the Editor Martin Lutalo ([email protected]) or HNP Advisory Ser- vice ([email protected], tel 202 473-2256, fax 202 522-3234). For more information, see also www.worldbank.org/hnppublications. THE WORLD BANK 1818 H Street, NW Public Disclosure Authorized Washington, DC USA 20433 Telephone: 202 473 1000 Facsimile: 202 477 6391 Internet: www.worldbank.org E-mail: [email protected] May 2014 MATERNAL AND CHILD SURVIVAL: Findings from five countries’ experience in addressing maternal and child health challenges Rafael Cortez, Seemeen Saadat, Sadia Chowdhury and Intissar Sarker May 2014 Health, Nutrition and Population (HNP) Discussion Paper This series is produced by the Health, Nutrition, and Population (HNP) Family of the World Bank's Human Development Network (HDN). The papers in this series aim to provide a vehicle for publishing preliminary results on HNP topics to encourage discussion and debate. The findings, interpretations, and conclusions expressed in this paper are entirely those of the author(s) and should not be attributed in any manner to the World Bank, to its affiliated organizations, or to members of its Board of Executive Directors or the countries they represent. Citation and the use of material presented in this series should take into account this provisional character. For information regarding the HNP Discussion Paper Series, please contact Martin Lutalo at [email protected] or Erika Yanick at [email protected]. © 2014 The International Bank for Reconstruction and Development / The World Bank 1818 H Street, NW, Washington, DC 20433 All rights reserved. ii Health, Nutrition and Population (HNP) Discussion Paper Maternal and Child Survival: Findings from five countries’ experience in addressing maternal and child health challenges Rafael Corteza Seemeen Saadatb Sadia Chowdhuryc Intissar Sarkerd a Human Development Network, The World Bank, Washington DC, USA b Human Development Network, The World Bank, Washington DC, USA c Human Development Network, The World Bank, Washington DC, USA d Human Development Network, The World Bank, Washington DC, USA This paper was prepared as part of a Joint initiative on Maternal and Child Health undertaken by the World Bank, the Partnership for Maternal, Newborn, and Child Health (PMNCH), the World Health Organization (WHO), United States Agency for International Development (USAID), Alliance for Health Policy and Systems Research (AHPSR), Johns Hopkins University, Global Health Insights, London School of Hygiene and Tropical Medicine, University of St Gallen, Cambridge Economic Policy Associates and MamaYe– Evidence for Action. Details about this initiative are available at: http://www.who.int/pmnch/knowledge/publications/successfactors/en/ Abstract: Considerable progress has been made towards the achievement of the Millennium Development Goals (MDGs) since 1990. Although advances in improving MDG 4 and MDG 5a (reducing child and maternal mortality, respectively) have been made, progress is some countries have been insufficient. While some countries have made substantial gains, others have not. This paper is part of a larger study that aims to address this gap in knowledge. The paper discusses the findings from qualitative case studies of five countries that are either on track to meet MDGs 4 and 5a by 2015 or have made significant progress to this end (Bolivia, China, Egypt, Malawi and Nepal). Although they have different socio-economic characteristics, all have made significant advancements due to a strong commitment to improving maternal and child health. To do this, strong political commitment, through policies backed by financial and programmatic support, was critical. In addition, focusing on the most vulnerable populations helped increase access to and use of services. Empowering women and families through education, employment, and poverty reduction programs have led to better health outcomes. These countries still face challenges, however, in terms of the evolving health system, and changes at the economic, social and political levels. Future qualitative and quantitative analyses on the returns of health investments, the political context and institutional arrangements at the country level could help deepen the understanding of the ways in which various countries, with their unique conditions, can improve MCH. iii Keywords: Reproductive, Maternal, Child, Neonatal, Health, Fertility, Adolescent, Family Planning, Immunization, Childhood Illness, Survival, Mortality, Community, Health Workers, Skilled Birth Attendance, Service Delivery, Healthcare Financing, Insurance, Empowerment, Leadership, Poverty Disclaimer: The findings, interpretations and conclusions expressed in the paper are entirely those of the authors, and do not represent the views of the World Bank, its Executive Directors, or the countries they represent. Correspondence Details: Rafael Cortez, World Bank, 1818 H Street, NW, Washington, DC 20433; telephone: (202) 458-8707; fax: (202) 522-3234; e-mail: [email protected]; website: http://www.worldbank.org/hnp. iv Table of Contents ACKNOWLEDGMENTS .............................................................................................. VI INTRODUCTION............................................................................................................. 7 METHODOLOGY ............................................................................................................... 7 COUNTRY CONTEXT ......................................................................................................... 8 FACTORS THAT REDUCED MATERNAL MORTALITY .................................... 11 AFFORDABLE SERVICES FOR THE POOR ........................................................................... 11 GEOGRAPHICALLY-ACCESSIBLE SERVICES ..................................................................... 13 MONITORING OUTCOMES TO EVALUATE ACCOUNTABILITY AND GOVERNANCE .............. 18 SETTING POLITICAL AND PROGRAM PRIORITIES (RMNCH) ............................................ 19 ENABLING ENVIRONMENT .............................................................................................. 21 Education ................................................................................................................... 21 Women’s empowerment ............................................................................................. 22 Social inclusion.......................................................................................................... 23 Poverty reduction ...................................................................................................... 24 CONCLUSIONS ............................................................................................................. 24 RECOMMENDATIONS AND NEXT STEPS ........................................................................... 27 REFERENCES ................................................................................................................ 28 ANNEX: COUNTRY PROFILES ................................................................................. 33 ANNEX 1: BOLIVIA’S PROGRESS ON MDGS 4 AND 5 ...................................................... 33 ANNEX 2: CHINA’S PROGRESS ON MDGS 4 AND 5 ......................................................... 44 ANNEX 3: EGYPT’S PROGRESS ON MDGS 4 AND 5 ......................................................... 55 ANNEX 4: MALAWI’S PROGRESS ON MDGS 4 AND 5 ..................................................... 66 ANNEX 5: NEPAL’S PROGRESS ON MDGS 4 AND 5 ......................................................... 77 v ACKNOWLEDGMENTS This report was prepared by a team of World Bank staff and Consultants composed of Rafael Cortez (Task Team Leader), Seemeen Saadat, Sadia Chowdhury and Intissar Sarker. The report is part of a larger collaboration with the Partnership for Maternal, Newborn, and Child Health (PMNCH) on understanding the factors behind countries’ performance on MDGs 4 and 5. The authors would also like to thank Nicole Klingen (Practice Manager, GHNDR, World Bank); and Carole Presern (Executive Director, Partnership for Maternal, Newborn and Child Health, PMNCH), Shyama Kuruvilla (Senior Technical Officer, PMNCH) and Jennifer Franz-Vasdeki (Economist, PMNCH) for their continued support and feedback. The report benefitted from the literature
Load more

Recommended publications
  • Select Bibliography (Last Updated 12/14/2014)
    compiled by THOMAS F. DAILEY, O.S.F.S. The Theological Vision of Saint John Paul II Select Bibliography (last updated 12/14/2014) SUBJECTS (quick links): ► Web sites about John Paul II on the Thought of John Paul II ► Biographical information general / collections pontificate ► Beatification (Vatican YouTube 5/1/2011) encyclicals theology ► Canonization personalistic philosophy Christian anthropology / theology of body ► Writings of John Paul II on marriage and the family on Mary, the Rosary, and Saints on women on the major Documents of John Paul II on culture on freedom Centesimus Annus on history Dives in Misericordia on the arts Dominum et Vivificantem on ecclesiology Ecclesia de Eucharistia on the laity Evangelium Vitae on liturgy Familiaris Consortio on evangelization Fides et Ratio on ecumenism and interreligious dialogue Laborem Exercens on morality / ethics Redemptor Hominis on bioethics / medical ethics Redemptoris Mater on peace / war Redemptoris Missio on politics / law Sollicitudo Rei Socialis on economics and social teaching Slavorum Apostoli on ecology Ut Unum Sint on science and religion Veritatis Splendor on education on suffering Web Sites A Blessing to One Another: John Paul II & the Jewish People Catholic Information Network -- John Paul II page Catholic News Service - special section CAUSE FOR BEATIFICATION & CANONIZATION - Vicariate of Rome EWTN - The Pontificate of Pope John Paul II FRONTLINE: The Millenial Pope Love & Responsibility -- texts and talks National Public Radio:
    [Show full text]
  • Information on Violence Against Women, Femicide, Rape and Criminalization of Abortion to Be Assessed on the 50Th Meeting of the Committee Against Torture
    La Paz - Bolivia, April 15th, 2013 SECRETARIAT OF THE COMMITTEE AGAINST TORTURE Human Rights Treaties Division (HRTD) Office of the United Nations High Commissioner for Human Rights (OHCHR) Palais Wilson - 52, rue des Pâquis CH-1201 Geneva (Switzerland) Ref: Information on violence against women, femicide, rape and criminalization of abortion to be assessed on the 50th Meeting of the Committee against Torture Dear Sir or Madam: The Center for Information and Development of Woman-CIDEM 1 , the Campaign September 28 for the Decriminalization of Abortion in Bolivia and the Center for the Promotion and Defense of Sexual and Reproductive Rights-PROMSEX 2 are providing more information on the situation of women in the Plurinational State of Bolivia and the real exercise of their rights, within the framework of the Political Constitution of the State (February 2009), adopted through referendum by the 61.43 % of the population. This text, for the first time fully recognizes the legal value of the human rights treaties and, consequently, its mandatory compliance. This report seeks to respond to the thematic prioritized by the Committee in the list of issues that should be addressed in the second periodic report of the Plurinational State of Bolivia referred to the numeral 8 "on the existing legal framework for preventing and combating gender-based violence and the measures taken to eradicate this phenomenon, including domestic violence, sexual violence and femicide as a form of extreme violence against women. 3 In this regard, the present report provides information and data on women in a situation of violence, femicide, sexual violence, sexual health - reproductive and the criminalization of abortion.
    [Show full text]
  • Assessment of the Bolivia Postabortion Care Community Mobilization Program
    Assessment of the Bolivia Postabortion Care Community Mobilization Program Emma Ottolenghi, M.D., Independent Consultant, USA Team Leader Patricia Riveros, MPH, Consultant, Bolivia Sarah Blanding, International Development Intern, USAID/Washington May 2008 This study was funded by the U.S. Agency for International Development (USAID) under the terms of Leader with Associate Cooperative Agreement No. GPO-A-00-03-00006-00. Opinions expressed in this report are those of the authors and do not necessarily reflect the views of USAID. TABLE OF CONTENTS Acknowledgments ....................................................................................................................................... v Acronyms and Abbreviations ................................................................................................................... vii Executive Summary ................................................................................................................................... ix Background ................................................................................................................................................. 1 Objectives of the Assessment ..................................................................................................................... 7 Methodology of the Assessment ................................................................................................................. 9 Findings ....................................................................................................................................................
    [Show full text]
  • Study of Illegal Abortion in Bolivia1
    A HOSPITAL STUDY OF ILLEGAL ABORTION IN BOLIVIA1 Pa&i& E. Baidey,,2 Lois Llano Saavedra,3 Lzh Kzm?iner,4 Michael WeZsh,5 and Barbara Janowitzd INTRODUCTION deaths were related to induced abortion complications (3). Illegal abortions are associated Bolivia’s population as of 1986 with high rates of maternal morbidity was estimated at about 6.4 million in- and mortality, and treatment of women habitants. The off&l population policy hospitalized for illegal abortions draws has been to promote growth by encour- upon scarcemedical resources. Hence, in aging immigration and maintaining cur- countries where induced abortions are il- rent levels of fertility. Direct measures legal their adverse consequences consti- have been taken to maintain these fertil- tute a serious public health problem. ity levels by closing family planning clin- Abortion is only permitted in ics (4). No government support is pro- Bolivia when a woman’s physical health vided for family planning services, is threatened by pregnancy or when she making the private sector the primary has been the victim of rape or incest; oth- source of contraception. A 1983 contra- erwise it is illegal (1). However, such ille- ceptive prevalence survey found that gal abortions are commonplace. Indeed, 24 % of the married women 15-49 years in the 1970s the Bolivian Ministry of of age were using contraceptive methods; Public Health estimated that the treat- of these, 14% were using rhythm and ment of complications arising from ille- other traditional methods, while 10% gal abortions accounted for more than were using modern clinical methods. 60% of the country’s obstetric and gyne- cologic expenses (2).
    [Show full text]
  • Los Derechos Reproductivos Y El Aborto En Bolivia
    Bulletin de l'Institut français d'études andines 45 (3) | 2016 Intimidades políticas. Interpelaciones al sexo y a la sexualidad desde Bolivia Causas públicas, historias privadas: los derechos reproductivos y el aborto en Bolivia Causes publiques, histoires privées : les droits reproductifs et l’avortement en Bolivie Public Causes, Private Stories: Reproductive Rights and Abortion in Bolivia Virginie Rozée, Susanna Rance y Silvia Salinas Mulder Editor Institut Français d'Études Andines Edición electrónica Edición impresa URL: http://bifea.revues.org/8067 Fecha de publicación: 1 diciembre 2016 DOI: 10.4000/bifea.8067 Paginación: 389-406 ISSN: 2076-5827 ISSN: 0303-7495 Referencia electrónica Virginie Rozée, Susanna Rance y Silvia Salinas Mulder, « Causas públicas, historias privadas: los derechos reproductivos y el aborto en Bolivia », Bulletin de l'Institut français d'études andines [En línea], 45 (3) | 2016, Publicado el 08 diciembre 2016, consultado el 05 mayo 2017. URL : http:// bifea.revues.org/8067 ; DOI : 10.4000/bifea.8067 Les contenus du Bulletin de l’Institut français d’études andines sont mis à disposition selon les termes de la licence Creative Commons Attribution - Pas d'Utilisation Commerciale - Pas de Modification 4.0 International. Bulletin de l’Institut Français d’Études Andines / 2016, 45 (3): 389-406 IFEA Los derechos reproductivos y el aborto en Bolivia Causas públicas, historias privadas: los derechos reproductivos y el aborto en Bolivia Virginie Rozée* Susanna Rance** Silvia Salinas Mulder*** Resumen El artículo reflexiona en torno a elementos que afectan la decisión de las mujeres acerca de la reproducción y del aborto. Contribuye a los debates sobre políticas, campañas activistas y el Código Penal boliviano, en un contexto en el que las desigualdades y la violencia basada en el género ponen desafíos a la eficacia de las tecnologías y las leyes para garantizar el ejercicio del derecho a decidir.
    [Show full text]
  • US E-Letterhead
    Dear Committee Members: This shadow letter is intended to complement the periodic report submitted by the State of Bolivia for your consideration during the 109th session of the Human Rights Committee. Our aim is to provide information about Bolivia’s violation of human rights that result from the State denying access to legal abortion in cases of rape or threats to health and life. Judicial authorization is required for legal abortion but is nearly always denied. The denial of legal abortion means that women must obtain needed abortions through illegal and unsafe channels. As a result women are reported to law enforcement authorities by doctors, relatives, partners or public prosecutors, are detained or arrested, all in violation of in violation of Bolivian women’s right to effective remedy (Art. 2), to life (Art. 6), liberty and security (Art. 9), right to a fair trial (Art. 14), and the right to privacy (Art. 17). Unsafe abortions also contribute to high rates of maternal mortality and morbidity in the country. It should be noted that the denial of services because of the unwillingness of judges to authorize them is discriminatory; it disproportionately affects indigenous, poor and young women. The Plurinational Constitutional Court of Bolivia was asked to review the constitutionality of the penal codes regulating abortion in March 2012. To date the Court has delayed the decision. Ipas–Bolivia, an independent nongovernmental organization, has worked intensively with government initiatives to increase and implement the exercise of women’s sexual and reproductive rights and to reduce maternal mortality due to the risks of unsafe abortions.
    [Show full text]
  • The Realities of Unsafe Abortion in Bolivia: Evidence from the Field by Sarah Thurston1 Ramiro Claure2 Thoai D
    Research Brief Series The realities of unsafe abortion in Bolivia: Evidence from the field By Sarah Thurston1 Ramiro Claure2 Thoai D. Ngo1 Summary More than 80,000 induced abortions take place in Bolivia every year despite legal restrictions that permit abortion only in cases of rape, incest or if the 1 life or health of the mother is at risk. The vast majority of abortions take place clandestinely, posing significant risks to women’s health. In this study, Marie Stopes International Bolivia (MSIB) explored women’s experiences of abortion and their knowledge, attitudes and perceptions on this issue. Findings pointed to low uptake of modern contraceptive methods among poor and indigenous women in five Bolivian cities. A high prevalence of unwanted pregnancy (~50%) among the 1,386 © Marie Stopes International women surveyed resulted in frequent use of ineffective and/or unsafe abortion methods. Women often in the national parliament, six of the country’s provincial resorted to multiple abortion attempts and methods, health departments, the medical establishment, the accessing post-abortion care (PAC) in hospitals only media and at-risk women. Using concrete evidence after attempts to self-treat had failed. to inform the public debate ahead of the Bolivian parliament’s 2013 review of the criminal code on MSIB used evidence from this study to support policy abortion helped to frame policy changes needed advocacy and awareness to inform key stakeholders to address unsafe abortion. • Women resorted to ineffective and unsafe Findings at a glance abortion methods, requiring multiple attempts An estimated 80,000 abortions take place ever year carrying significant health risks.
    [Show full text]
  • The Old Testament on Abortion
    The Old Testament On Abortion Identifiable and audile Hill transfuse her proser foreground while Hymie refocusing some Bronwen ichnographically. Demisable Sampson exacerbated holus-bolus. Avram disparts her cosmopolitanism gaudily, she overmatches it uncertainly. Keep listening to the old testament oppose the What the Bible says about abortion YouTube. It is mainly from two Hebrew Scriptures that the modern-day Jewish people incorporate their spiritual insight In Judaism a childhood is regarded as a pre-human as not. Many ways by far more people in biblical counselor in the mother and savior still prohibits abortion on the population at the matter of conception does not used suggests it. Christians who made on religious tradition carries evidence is married couples must always two brawling men have the old testament on abortion, have ever morally wrong, catholic church has a daily kos moves in. Abortion is never mentioned in the Biblea Quartz. The one on the first few topics in this site are not necessarily valid date must view on what to do not he has no general agreement on. Statement on the Biblical View of Unborn Life reflect Its. Catholicism today you abstain from the old testament refer to be compensated for the suggestion that his personal preference, on the old testament christianity teaches. BIBLE VERSES ABOUT ABORTION Abortion Bible verses in second King James Version KJV about Abortion. Yet it uses figures of old. For the religious doctrine, on the abortion for those who would determine our emails are poor and before they lost that. Ask why do not without any other children also used in the bible takes on earth, not abandon his.
    [Show full text]
  • A CRIME the Threat to Vulnerable Women in Latin America
    WHEN ABORTION IS A CRIME The threat to vulnerable women in Latin America Health. Access. Rights. ISBN: 1–933095–73–3 © Ipas 2013, 2014 Produced in the United States of America Suggested citation: Kane, G., Galli, B., & Skuster, P. (2013). When abortion is a crime: The threat to vulnerable women in Latin America (third ed.) Chapel Hill, NC: Ipas. Ipas is a nonprofit organization that works around the world to increase women’s ability to exercise their sexual and reproductive rights, especially the right to safe abor- tion. We seek to eliminate unsafe abortion and the result- ing deaths and injuries and to expand women’s access to comprehensive abortion care, including contraception and related reproductive health information and care. We strive to foster a legal, policy and social environment sup- portive of women’s rights to make their own sexual and reproductive health decisions freely and safely. Ipas is a registered 501(c)(3) nonprofit organization. All contributions to Ipas are tax deductible to the full extent allowed by law. For more information or to donate to Ipas: Ipas P.O. Box 9990 Chapel Hill, NC 27515 USA 1.919.967.7052 [email protected] www.ipas.org The photographs used in this publication are for illustra- tive purposes only; they do not imply any particular atti- tudes, behaviors, or actions on the part of any person who appears in the photographs. WHEN ABORTION IS A CRIME The threat to vulnerable women in Latin America Authors: Gillian Kane, Senior Policy Advisor, Ipas Beatriz Galli, Latin America Policy Associate, Ipas Patty
    [Show full text]
  • Unsafe Abortion
    Unsafe abortion Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2000 Fourth edition World Health Organization Geneva, 2004 WHO Library Cataloguing-in-Publication Data World Health Organization. Unsafe abortion: global and regional estimates of incidence of unsafe abortion and associated mortality in 2000. -- 4th ed. 1.Abortion, Induced - epidemiology 2.Abortion, Induced - mortality 3.Review literature I.Title. ISBN 92 4 159180 3 (NLM classification: WQ 440) © World Health Organization, 2004 All rights reserved. Publications of the World Health Organization can be obtained from Marketing and Dissemination, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 2476; fax: +41 22 791 4857; email: [email protected]). Requests for permission to reproduce or translate WHO publications—whether for sale or for noncommercial distribution— should be addressed to Publications, at the above address (fax: +41 22 791 4806; email: [email protected]). The methodology of estimation has been reviewed and cleared for publication by Claudia Stein of the Evidence and Information for Policy (EIP) Cluster. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned.
    [Show full text]
  • You're So Vain, I'll Bet You Think This Song Is About
    Working Paper Series Villanova University Charles Widger School of Law Year 2006 You're So Vain, I'll Bet You Think This Song Is about You Joseph W. Dellapenna Villanova University School of Law, [email protected] This paper is posted at Villanova University Charles Widger School of Law Digital Repository. http://digitalcommons.law.villanova.edu/wps/art43 You’re So Vain Chapter 8 You’re So Vain, I’ll Bet You Think This Song Is about You1 [E]ach generation gets the past it deserves. —Grant Gilmore2 The new orthodoxy of abortion history has it that the nineteenth-century legislatures debated the frequent statutory enactments in various states throughout the century that steadily closed gaps and fissures in the laws prohibiting abortions3 primarily as a form of medical regulation.4 The new orthodoxy also raises anti-foreign feeling, verging (among other prejudices) on anti- Semitism, as a major motive for the anti-abortion crusade of the late-nineteenth century.5 Those who expound the new orthodoxy dismiss any professed concern of the leaders of the anti- 1 Carly Simon, You’re So Vain (1972). 2 GRANT GILMORE, THE AGES OF AMERICAN LAW 102 (1977). 3 See Chapter 7, at notes 3-28. 4 See, e.g., JAMES MOHR, ABORTION IN AMERICA: THE ORIGINS AND EVOLUTION OF NATIONAL POLICY, 1800-1900, at 119, 202 (1978). See generally Chapters 6 & 7. 5 ELLEN CHESLER, WOMEN OF VALOR: MARGARET SANGER AND THE BIRTH CONTROL MOVEMENT 60 (1992); DAVID GARROW, LIBERTY AND SEXUALITY: THE RIGHT OF PRIVACY AND THE MAKING OF ROE V.
    [Show full text]
  • An Open Secret: the Hidden History of Unwanted Pregnancy and Abortion in Highland Bolivia, 1952-2010
    AN OPEN SECRET: THE HIDDEN HISTORY OF UNWANTED PREGNANCY AND ABORTION IN HIGHLAND BOLIVIA, 1952-2010 by Natalie L. Kimball B.A. in Latin American Studies, University of Washington, 2001 M.A. in History, University of Pittsburgh, 2008 Submitted to the Graduate Faculty of the Kenneth P. Dietrich School of Arts and Sciences in partial fulfillment of the requirements for the degree of PhD in History University of Pittsburgh 2013 UNIVERSITY OF PITTSBURGH THE KENNETH P. DIETRICH SCHOOL OF ARTS AND SCIENCES This dissertation was presented by Natalie L. Kimball It was defended on May 7, 2013 and approved by Kathleen Blee, Distinguished Professor and Associate Dean for Graduate Studies and Research, Sociology Alejandro de la Fuente, UCIS Research Professor, History Laura Gotkowitz, Associate Professor, History Lara Putnam, Associate Professor, History Dissertation Advisor: George Reid Andrews, Distinguished Professor and Chair, History ii Copyright © by Natalie L. Kimball 2013 iii AN OPEN SECRET: THE HIDDEN HISTORY OF UNWANTED PREGNANCY AND ABORTION IN HIGHLAND BOLIVIA, 1952-2010 Natalie L. Kimball, PhD University of Pittsburgh, 2013 This dissertation traces the history of unwanted pregnancy and abortion in La Paz and El Alto, Bolivia between 1952 and 2010. Although in Bolivia abortion is illegal, an estimated three in five women terminate at least one pregnancy in their lifetime—making the country’s abortion rate the highest in the region. Based on 113 personal interviews and over 3,000 medical records, the project reconstructs two central aspects of reproductive history. The first centers on the social, political, and medical phenomena of abortion and pregnancy. I outline changing policies and debates on reproduction, the evolution of abortion incidence and provisioning, and the emergence of a stable illegal abortion system in the country.
    [Show full text]