Medical assistance during childbirth, especially institutional care, is one of the indicators of the effectiveness of programs aimed at extending service coverage. Its benefits are evident and are undoubtedly reflected in the decline of maternal and infant mortality rates.
However, this care may also have iatrogenic nuances. In this regard, Caldeyro-Barcia states: “One of the current problems encountered when studying parental behavior, especially during childbirth in most maternity facilities, is that modern perinatal care has distorted the behavioral patterns of the protagonists, the parents and the child, as well as those of the perinatal team, transforming a physiological act into a complex medical-surgical act.”
This situation can be corrected through the reeducation of parents and care providers, encouraging parents to participate in preparations for childbirth, promoting the adoption of a physiological posture for delivery, such as the squatting position, and encouraging continuous psychosocial interaction with the child from the moment of birth.
Malnutrition and Mental Development
Malnutrition often coexists with, and forms part of, the background of poverty. An idea that prevails in many settings, and that constitutes the hypothesis of numerous studies, is that malnutrition may cause delays in the development of children’s intellectual faculties.
However, Graham points out that “some believe the brain is especially protected against hunger and that, when higher-than-normal frequencies of failure and abnormal behavior are detected in malnourished populations, this is due to deprivation of social stimuli rather than to lack of food.”
The evidence that hunger alone can, within certain limits, alter cognitive functions is now reasonably certain to some extent. Less certain, however, is whether some behavioral abnormalities can be produced in this way.
In their conclusions, various Latin American researchers recognize the mutual influence of malnutrition and lack of stimulation as negative elements in intellectual development, especially in cognitive functions. In addition, malnutrition and lack of stimulation favor diseases with a biological background, such as infections, trauma and poisoning, whose effects on the physical structures of the child’s central nervous system can be extremely harmful.
Accidents
In most Latin American countries, accidents are among the five leading causes of death in the 1-to-24-year age group. Morbidity figures are not available, but they are estimated to be equally high.
A large proportion of accidents occurring between birth and 14 years of age take place at home and involve poisoning, trauma and burns. Numerous studies in developed countries have established a relationship between childhood accidents and lack of supervision, parents’ level of education, home safety conditions and self-medication by adults.
In Latin America, studies are needed to clarify the possible causal relationships between high accident-related morbidity and mortality among children, the psychological profile of parents and the social and material conditions of the household.
Between 15 and 24 years of age, a high number of deaths and disabilities are the result of road accidents. Rates are much higher among males and reflect the risk-seeking behavior prevalent among young people.
Physical Aggression
The social and psychological circumstances that favor the high frequency of physical aggression against young children have been studied in detail. The incidence of the so-called “battered child syndrome” is relatively high in populations of low socioeconomic status and among ethnic minorities.
Physical aggression against children by adults is frequently associated with parental alcoholism, the absence of the biological father, family disorganization and the presence of economic problems in the household.
The fact that this syndrome practically does not appear in Latin American statistics suggests underregistration, possibly because medical services are not accustomed to investigating the real causes of children’s injuries and accept in good faith the diagnosis of accidental injury.
The truth is that, in many Latin American cities, the social conditions that favor aggression against children by adults are present, and their etiological diagnosis should be made with greater rigor.
