Some of the Morales administration’s most successful initiatives have been small stipends, commonly called “bonuses,” disbursed by the government for traditionally under-served sectors of the population.[i] May 26, 2011, marks the second anniversary the Juana Azurduy[ii] bonus designed to provide health and nutrition benefits to pregnant mothers and young children.
The Juana Azurduy bonus is designed to promote prenatal controls, infant checkups and increased rates of hospital births. The stipend is available to any qualified woman from the beginning of her pregnancy, until her child turns two. Mothers must attend four prenatal exams every two months, and give birth in a public hospital or health center. Babies must also receive six checkups a year. Only mothers and children without any form of insurance may benefit from the bonus, and women collecting the stipend must first complete official public registration. All public hospitals are required to provide necessary healthcare to mothers who receive this stipend.
Mothers receive up to 1,825 bolivianos over a period of 33 months, working out to about $15 every two months. Although this seems like a small amount by international standards, minimum wage in Bolivia is less than 120 dollars, and informal workers often receive less. If enlisted mothers miss their appointments they cannot receive payment for the scheduled visit. The bonus is sufficient to motivate many women to receive healthcare and teach the importance of pre- and post-natal checkups as well as maternal and child nutrition. In addition, new mothers receive dietary supplements to help prevent infant anemia.
Since its inauguration, the stipend has benefited over 131,000 pregnant mothers and children, and has helped women in all 47 municipalities in the Cochabamba department.[iii] According to the program’s director, Erick Arnéz, the bonus has helped reduce chronic malnutrition, as well as early infant mortality.[iv]
|Quick Facts About Maternal and Child Health in Bolivia|
|Lifetime risk of maternal death (2008)||1 / 150|
|Percent of births attended by skilled health personnel (2009)||71%|
|Percent of women using modern contraception (2008)||34%|
|Female life expectancy at birth (2010)||69 years|
|Children under 5 mortality rate (2009)||51 / 1000 live births|
Source: Save the Children, “State of the World’s Mothers 2011.”[v]
Bolivian mothers have long enjoyed other legal benefits, such as three months paid maternity leave, an employer-subsidized dairy product allowance and reduced schedules to accommodate breastfeeding for the first year of a child’s life, and free births in public hospitals.
Complaints and Inefficiencies
Some current and potential beneficiaries complain about excessive paperwork required to become eligible for the stipend. In a country where literacy initiatives have only enjoyed recent success, especially in poor rural areas, this can prove prohibitive. In addition, some women who could benefit from immediate approval often face delays due to errors on personal documents. To enlist in the program, other documents are necessary, such as official birth certificates and ID cards. Many rural citizens do not possess these papers, further complicating the process. Also, although the bonus provides additional income for mothers and infants, the public health care system continues to be understaffed and overloaded.
Despite some bureaucratic shortcomings, the concrete, direct benefits provided by the Juana Azurduy initiative continue to be popular. It is imperative that the Bolivian government continues to provide incentives for women’s health issues, including free HPV vaccinations and mandatory days off for Pap smear exams and mammograms. Hopefully this ongoing official encouragement will call attention to persistent challenges faced by Bolivian women, building the foundation for sustainable, equitable reform in the future.
[i] Others include the “Juancito Pinto” stipend, an incentive for schoolchildren who successfully complete the school year to help offset the high cost of school supplies, as well as the monthly pension for senior citizens who do not receive retirement pay.
[ii] The bonus was named after an important female hero in the war for Bolivia’s independence.
[iii] Mena, Maria. “Bono Juana Azurduy benefició a más de 130 mil madres y niños.” Opinión, 24 May 2011.
[v] Although Save the Children’s annual report calls attention to significant ongoing concerns, the organization also misleadingly credits USAID funding for many of the improved statistics for maternal and child health in Bolivia. This stance fails to recognize the impact of Bolivian government initiatives such as the Juana Azurduy stipend.