When you walk through the market of San Andrés Larráinzar—a small town in the state of Chiapas, in Southern Mexico—you are likely to hear a familiar tune. You will definitely not miss it: These are the chords of La vida es un carnaval, interpreted by world-famous Cuban singer Celia Cruz. But as you start to hum the lyrics, you realize that the voice sounds a little bit different.
There is another interpreter who is singing it in Tzotzil, an indigenous language, and its lyrics are now inviting pregnant women to perform their prenatal check-ups.
The ideas behind these lyrics came from Sandra Guadalupe Trejo and Karina Pinacho, a doctor and a nutritionist at Larraínzar’s community health center. Just like Cruz's song, these women have transformed multiple popular songs into catchy tunes to promote maternal health care.
When Sandra and Karina arrived in Larraínzar in 2015, the two identified that only ten women had their prenatal exams performed before the 12 weeks mark. This definitely increased the risk of infant and maternal mortality. But, why were pregnant women reluctant to go to the doctor? One could believe that the answer was in the lack of specialists, a difficult access, or resources, but the truth is that linguistic barriers were even more determining. Larraínzar has a predominantly indigenous population, and 80% of its residents communicate in Tzotzil.
"The culture is very different. There are services that these women have trouble accepting because of beliefs they’ve had for many years. We can’t change them from night to day, but we have to work to provide them with an intercultural approach. We have to respect their worldview," says Sandra.
Here, at the IDB, we have supported and implemented this and other projects that prioritize medical examinations during pregnancy. In Larrainzar's case it was done through Iniciativa Salud Mesoamérica, a public-private partnership between the Carlos Slim Foundation, the Bill & Melinda Gates Foundation, and the governments of Spain and eight countries in Central and North America: Mexico, Belize, El Salvador, Honduras, Guatemala, Costa Rica, Nicaragua and Panama.
The second phase of this initiative in Chiapas—focused on improving care and integrally protecting maternal and child health—ended in May 2018. Through the program, more than 1,300 health workers and 800 midwives were trained. Also, nearly 800 initiatives were developed in several community centers across the region, along with the improvement of hospital processes and access to transportation. But, above all, an intercultural approach for reproductive health practices was among the program's first priorities.
“We really left our comfort zone as doctors by doing this," says Sandra . "I think it has to be a persistent job, and surely we will continue working to get better results later.”
The creative process
The idea of translating and rewriting the songs began after analyzing data coming from the health community center. The doctors—under the leadership of Sandra—identified two areas where there was room for improvement: A high number of women did not perform their prenatal exams before 12 weeks, and 11% did not do it after giving birth.
Sandra and Karina determined that the best solution to tackle these problems was to increase the number of community advocates, disseminate educational messages through mass media channels, and to create clinical teaching material.
One of the ways in which they decided to spread the messages was through these songs. Sandra and Karina chose popular tunes from well-known artists and composed the lyrics about maternal health in Spanish, then translated them into Tzotzil and recorded the songs in a professional studio. The composition was carried out in a collaborative manner: Both the medical staff and volunteers actively participated, including the person who sang in Tzotzil.
At the end of 2017, songs in Tzotzil about reproductive health worked to perfection and the initiative caused the number of women attending their exams to double compared to 2015. "As for the early recruitment of pregnant women, we are still standing. It is a job that has to be persistent over time. We have to continue trying to get patients to accept prenatal check-ups," says Sandra.
The World Health Organization (WHO) recommends that the first prenatal examination must be performed before the twelfth week, and that at least four other controls must be carried out during pregnancy. The first test has a critical role to estimate the duration of pregnancy, detect genetic or congenital disorders, identify and treat iron deficiency and anemia, diagnose sexually transmitted diseases, and understand risk factors in pregnancy, such as alcohol and drug use.
A study published in 2017 by the International Journal of Epidemiology—with data from 52 countries—estimated that following at least one of the two WHO recommendations reduces the risk of infant mortality by 32%.
Through Iniciativa Salud Mesoamérica, more than 270,000 women in the poorest municipalities of Chiapas have gained access to quality health services during their pregnancy. Between 2016 and 2018, there was a 76% of increase in the number of women who met the amount prenatal check-ups recommended by the WHO, when compared to 2015 levels.
"We really left our comfort zone as doctors by doing this," says Sandra . "I think it has to be a persistent job, and surely we will continue working to get better results later."
Learn more about this initiative here.