In Latin America, there are strong migratory flows, both within countries and from one country to another. Most internal migration is driven by economic reasons: families change residence in search of better employment and more favorable living conditions. Another important motivation is the desire to seek better opportunities for the cultural development and academic advancement of children.
Migration between countries used to follow similar reasons in the past. Today, however, the displacement of large human groups is increasingly frequent as a result of war and conditions of political insecurity. In both cases, the immediate consequence is uprooting. Families lose their ties with their communities of origin; children are deprived of their friends and separated from their areas of interest; and the entire family group is subjected to strong psychological tensions caused by insecurity, unfamiliarity with the new environment and the greater vulnerability of the newcomer.
Behavioral maladjustments and emotional disorders are frequent among children from migrant families, and even more so when they are refugee children separated from their parents.
The maternal and child primary health worker must not only be able to identify risk factors, but also, on many occasions, intervene in their modification. Of course, there are conditions such as poverty, low sociocultural level, attitudes and beliefs on which the worker cannot act directly and can only report the facts and, when appropriate, refer patients to the public and private agencies concerned with welfare, education and public services.
But there are other aspects in which the worker can play a more active role: the dissemination of information, the convening of meetings, the promotion of self-help groups, the strengthening of social support networks, or dialogue and coordination with other agents of change in the community.
For example, the worker can work with groups of young mothers to encourage the abandonment of alcohol and tobacco use during pregnancy; can promote the creation of “parents’ schools” where couples are trained in matters related to household economics, children’s study habits, psychological preparation for childbirth, follow-up of immunization schedules, compliance with medical treatments and many other practices.
In addition, these skills must be taught systematically and continuously, not according to momentary inspiration. Moreover, primary health workers must receive support and guidance from the rest of the system.
Secondary and tertiary care, for the same reasons stated above, must incorporate the psychosocial component both when planning and when executing their actions. Otherwise, the actions initiated in primary services would remain incomplete and without continuity.
Consequently, decision-making levels must vigorously adopt the new approach, and training centers for personnel at all levels must incorporate the study of psychosocial factors and techniques for modifying them as an important element of their curricula.
Women’s Nutrition
New approaches in relation to motherhood. This work focuses on women’s nutrition and, rather than offering an exhaustive review of current knowledge on nutrition and reproduction, on which very extensive information already exists, it seeks to suggest new approaches to the problem of women’s nutrition in order to improve motherhood.
Risk Approach
The starting point is the recognition of risk factors in the process of motherhood, which assume different relative weight depending on circumstances, including the timing of interactions among the host, the agent and the environment.
Another starting point is the concept that each risk factor, or set of risk factors, should in principle give rise to corrective actions whose impact is the prevention of harm. Ideally, the elimination of the risk factor achieves an effect that lasts beyond a single reproductive event; that is, it has a preventive effect for future reproductive events.
There is ample evidence that the risk of an unsatisfactory outcome in a woman’s reproductive process, pregnancy and lactation, is greater when one or more of the following circumstances are present:
Biological Risk Factors
- Maternal height and head circumference in the lower percentiles of the normal distribution; these measurements may be even more reduced. In developing countries and marginalized populations, both characteristics suggest early alterations in women’s growth.
- Low pre-pregnancy weight in absolute terms, kilograms, and in relation to height, kilograms per centimeter of height. The risk is greater if low weight persists during pregnancy and is associated with insufficient weight gain, for example, weight gain of less than 3 kg by week 30 of pregnancy. If pre-pregnancy weight is normal or high, both in absolute and relative terms, the importance of weight gain during gestation is relatively lower.
- Low lean body mass before or during pregnancy, or in both periods, indicating lower protein mass, predominantly muscle mass.
- Short interval between pregnancies.
- Parity greater than five.
- Pregnancy before age 17 or after age 35.
- Pregnancy complicated by infections, hyperemesis, hemorrhage, toxemia, severe anemia, various severe nutritional deficiencies, drug addiction, emotional disturbances and other pathological processes, such as diabetes.
- Uterine growth, or fundal height, below the 10th percentile of accepted standards.
- Multiple pregnancy.
- Previous history of disorders in reproductive function, including previous births of low-birth-weight children.
- Sexual activity during the final weeks of pregnancy.
- “Excessive” physical activity.
