This week was a refreshing culmination of a lot of work in our class. I had been so curious about what my classmates were finding and putting together for their final projects. I found that a lot of the information my group found about maternal health and mental health in Nicaragua overlapped with other health interested groups. For example, I can imagine that a comprehensive study of maternal mental health would be influenced by traditional medicine practices, substance abuse, nutrition, Zika, and the status of women. I thought that the presentations actually helped to round out my understanding of maternal mental health from my research.
The presentation on Substance Abuse confirmed a lot of what I had read the previous week for the post about the rising prevalence of non-communicable diseases, particularly among women. I was particularly interested in the overlap between alcohol dependency and mental health. Based on their presentation research, such high rates of alcoholism would be indicative of prevalent poor mental health. I believe they said that that Michael Boudreau had said in an interview that people know that life is hard in Nicaragua, and unfortunately from a young age people know that the easiest thing would be to forget about it all and pick up the bottle. Alcohol use strongly correlates with mental health. I was also interested in how women are thought to typically find other ways of support. In a culture that starts with a government that says almost too easily in my opinion “we’ve done everything we can” and turns away from alcohol abuse, where are women finding the alternative? And what is the role that family and society play for individuals?
A second particularly applicable presentation was that on traditional medicine. The presenters talked about the special place of casa maternas attempting to bridge traditional medicine and biomedical practices. They talked about many of the same barriers to institutionalized resources that I had found in my research, such as social stigmas, expectations of being good deliverers, discomfort with male doctors, financial barriers, and ignorance among healthcare workers. I was interested in the possible solution they talked about with URACCAN nurses studying traditional medicine and being more receptive to healing practices. I am curious if they have put this in place in the Casa Materna and look forward to speaking with the parteras (midwives) there about it.
The third particularly interesting and applicable presentation was the one on Status of Women in Nicaragua. The presentation brought attention to the large gender disparity in healthcare. They had found that healthcare access is fairly equal between males and females, although my research had seemed to indicate that women (mothers in particular) received healthcare attention less frequently due to their caregiving and often more self sacrificial role. Some facts that I want to share from their presentation that are particularly interesting to my research on Nicaragua are:
- 55% of women in rural areas give birth at home
- Nicaragua has the #1 adolescent fertility rate in the world
- According to my interview with Eva, this is largely due to the abortion ban, little to no sexual education, a machismo culture that carriers forward this expectation of girls, and that pregnant girls are expelled from school
- 1/3 third of all maternal deaths are teenagers
- 27% of Nicaraguan women report physical abuse and 13% report sexual abuse
- An important statistic when considering possible mental and physical health consequences
- 30-45% lack direct access to the public health system
- 7% seek out preventative health care
- This is incredibly low for having so much primary care work provided by foreign aid/ NGOs and other forms of nonprofit work
Overwhelming themes from the presentations were a prevalent biosocial approach to health (health being much more than just bodily problems and medications), so much more work needing to be done, improved access to healthcare by communication, and further ethnographic research to find answers to the many questions that are just starting to be asked.