First Lady Hillary Rodham ClintonBrother Pedro de Betancourt Hospital
Remarks at MotherCare Event
Antigua, Guatemala - November 18, 1998
Thank you very much. I am absolutely delighted to be here. I want to add my word of greetings to all who are gathered here. To Mrs. Arzu, the minister, ambassadors and all associated with this hospital. I particularly appreciate Dr. Jose del Busto and MarcoTulio Sosa, Dr. Bocaletti and Ms. Toj for the work that they have done in creating this program and in providing needed medical care for so many women and children. Thank you for the opportunity to visit thishospital and to see firsthand, as I did, the training of the midwives who are seated behind me and educated me in a very short period of time about what the difference training means to their ability to care for women.
It is very important that we recognize that here in Guatemala maternal mortality has been, and remains, a very serious issue, as Dr. Bocaletti said. You are to be congratulated for making safemotherhood a major focus of the health care proposals and programs here. The fact that the Guatemala peace accords set a goal to reduce maternal and infant mortality rates by 50 percent over the next five years is a real testament to the understanding of the leaders who devised the peace accords. Because, as I have said on several occasions already here during my visit, it is one thing to end armed combat and persuade combatants to put down their weapons, but it is an entirely different thing to make peace meaningful in the lives of people. And to a family, the loss of a member through combat or the loss of a mother to unsafe delivery is the same kind of loss. So the fact that you recognize in the peace accords that you had to do something about maternal and infant mortality is a great testament to the wisdom of the Guatemala leaders and people. You have been making progress over the past 20 years reducing mortality by 40 percent, yet it is true that Guatemala still has the highest infant mortality rate in Central America. So this is an urgent problem. As urgent, again as Dr. Bocaletti said, as the loss of life from Hurricane Mitch.
It is also clear that you have recognized that your nation's indigenous people have historically had less access to health care services than the rest of the population. As a consequence, infantand maternal mortality in rural indigenous communities is more than double the national average. And only one in three indigenous mothers can get a sick child to a formal health clinic. And only one in four receives professional prenatal care . And fewer than 20 percent have accessto family planning services. That's why what you are doing here at this hospital is so very important.
You are not only improving the health of women and children, but you're showing a sensitivity to your patients. Ensuring that the doctors, nurses and midwives who care for them can speak to them in their own language. By showing sensitivity to their customs and understandings, you are also building trust between different communities. And the most important element of the success of the peace accords, I believe, is the development of trust. I am pleased that the United States government has been your partners as you work to overcome the inequities in access to health care that keep so many women, particularly indigenous women, from receiving the integrated health and family planning services that they need to lead healthy lives.
Guatemala's health strategy builds in part on a USAID pilot program called MotherCare. MotherCare means exactly what it says -- that we have to care for mothers. And as I have been privileged to travel around the world, I have seen many different societies improve the care ofmothers. I was thinking as I watched the midwives perform their role-playing for me where the father summoned a midwife who was not trained at first to take care of his wife, the mother of his children, and then when it was clear that the untrained midwife did not know what to do, the father summoned the trained midwife, who understood immediately what the problem was and took care of the mother. I was thinking of being in a place very far from Guatemala-Nepal in theHimalayan mountains. I went to a similar occasion where the midwives there were also learning what it meant to take care of mothers. They too were practicing "mother care". And it's not all that complicated if we train midwives to recognize what they can do well and then to feel comfortable in referring patients who need medical care to a hospital in time to receive it.
Because you have been making so much progress and because of Guatemala's commitment to lowering maternal and infant mortality, I am very pleased to announce a $1.6 million contribution to the USAID-funded MotherCare project. This contribution will supportGuatemala's efforts both within the government and with NGOs to improve women's access to basic health services. I am particularly pleased that this program involves indigenous families, especially women in designing, implementing, monitoring and evaluating these efforts. I think it is important that we ask the customers of health care as we ask the customers of any other service if they are getting what they need. If they feel comfortable with their health care providers. What else could be done to improve the outcome of their health services.
I'm also very pleased to announce that we brought with us from the United States a fetal monitor. We were told that the hospital needed a fetal monitor. And this piece of machinery will help keep both mothers and their babies alive and healthy. I would like to thank General Electric Medical for this generous donation of the fetal monitor.
As the people of Guatemala make your transition, your historic transition from war to peace, you have recognized that access to education and to health care are fundamental rights of all citizens.And I congratulate everyone associated with this hospital, everyone associated with community efforts that train midwives and help provide better access, and I congratulate the government for understanding the importance of health care as a means of uplifting people's aspirations and hopes and making clear that they are valued members of a larger community. My country is committed to working with you as the health and welfare of the people of Guatemala is improved, and as you build a stronger, more peaceful, prosperous and democratic nation. Thank you very much for letting me see the progress you are making.