August, 2020 (CLAP / PAHO): The Pan American Health Organization´s (PAHO) Latin American Center for Perinatology, Women's and Reproductive Health (CLAP) is celebrating five decades of work in research and technical cooperation to improve the health of women and newborns.
During this half century, CLAP has been adapting its work to the needs of the countries of the Region of the Americas. The PAHO Center moved from basic research in the 1970s to public health in the 1980s and 1990s, translating data into information and then disseminating it through technical cooperation.
In this context, the Center has provided technical cooperation in all Latin American and Caribbean countries. At the same time, more than 2,000 professionals - including obstetricians, neonatologists, nurses, and midwives from Latin America the Caribbean and Europe - were trained at CLAP. Thanks to the knowledge generated at the Center, more than 2,000 publications on obstetric emergencies, maternal mortality surveillance, the audit of neonatal deaths, monitoring of birth defects, contraception, and other topics have been published in different languages.
CLAP's work has also contributed to reducing infant and maternal mortality in the Region: in the last 10 years, there has been a decrease of 14% in newborn deaths, and in five years, maternal mortality fell almost 17% in 14 countries of the region prioritized by PAHO, which represents having saved around 500 maternal lives.
Dr. Carissa Etienne, Director of PAHO, celebrates the Center's anniversary by pointing out countries´ efforts to achieve the Sustainable Development Goals, for which CLAP provides a very valuable contribution "through technical cooperation, bringing the best evidence-based practices, seeking to reach the most vulnerable populations – those who don´t have access to care, but are the ones who need it most."
Noticeable changes in five decades
Over the years, many transformations took place in how babies are born. For Bremen de Mucio, PAHO's Regional Advisor on Maternal Health, there was a positive change toward institutional delivery and medical care “by competent professionals, capable of attending a normal delivery, but also responding actively and in a timely manner to the main obstetric complications. With the clinical-physiological and technological knowledge, delivery became much safer and this had a favorable impact on the health of women and their children.” However, De Mucio also warns that these advances were accompanied by hyper-medicalization and an increase in obstetric interventionism, which transferred the focus from women and their families to the health professionals. In this regard, CLAP promotes best practices so that women can have a respected and humanized childbirth.
Newborn care has also improved substantially in 50 years. Pablo Durán, Regional Advisor on Perinatal Health, points out that advances in knowledge and technologies have greatly contributed to these improvements, as has the way they´re used for a more personal approach: “The old image of newborns in rooms full of cribs and other babies, who are met for the first by their parents, grandparents or siblings through a glass wall between them, are now relics for distant memory or photographs of those times. Newborns now are considered to have rights, which has ensured that neonatology units have gradually adapted to this view. Over time, parents have been given the opportunity to enter neonatal units, practices that weren´t necessarily the best for babies have been revised, and breastfeeding and early contact between mothers and babies have been strengthened. ” For Durán, the multidisciplinary work between nursing personnel and neonatology specialists has been crucial for these achievements.
A center created in Uruguay
It was not by chance that a center with CLAP’s characteristics was created in Uruguay. Uruguayan doctor Roberto Caldeyro Barcia was the father of perinatology and was the one who coined this term to refer to the medical discipline that deals with everything that surrounds the prenatal stage and birth. By 1947, Caldeyro Barcia and Hermógenes Álvarez had made the first record of uterine contractions, and in the 1960s they made great discoveries around childbirth in the Medical School of the Uruguayan Republic University. Fetal distress, intrauterine resuscitation, and recording of fetal heart rate were some of the discoveries that led hundreds of health professionals associated with gynecology and pediatrics to travel to Montevideo to train in research on this topic.
PAHO decided to support the development of these investigations at a time when the Region's infant mortality rate ranged between 35 and 100 per thousand live births in urban areas and between 50 and 170 per thousand live births in rural areas, according to CEPAL data. On July 28, 1970, an agreement was signed between PAHO, the University of the Uruguayan Republic and the Uruguayan Ministry of Health to create the Center. According to PAHO 2019 Basic Indicators, the infant mortality rate in the region is currently 12.3 per thousand live births.
Three seminars to celebrate
To commemorate this anniversary, the Center will host three webinars with special guests beginning in September. The first webinar will be on reducing unintended pregnancy in adolescents. A webinar will be offered in Spanish in September and one in English in October. At the end of October there will be one on "Prematurity: its assessment and implications from the perspective of quality, equity and social capital throughout the life course," and in November, there will be a webinar dedicated to "Obstetric interventionism in the future of civilization."
