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Speaker 1: It's ninety degrees out and I'm covered in bug spray,

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Speaker 1: lying on the dirt floor of a hut with a

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Speaker 1: roof made of palms. A woman is pressing hard on

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Speaker 1: my stomach. She's telling me something is wrong. Look here, hey,

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Speaker 1: hap happy? The woman forcefully massaging my belly is She's

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Speaker 1: a a kind of traditional healer in the Yucatan region

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Speaker 1: of Mexico. Pregnant women come to her from nearby to

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Speaker 1: make sure that the whole childbirth experience is safe, kind

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Speaker 1: of like a duela. The massage she's giving me is

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Speaker 1: one of the sort of services she performs for her clients.

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Speaker 1: It does a bunch of things, including putting the baby

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Speaker 1: in a head down position for labor or calming the

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Speaker 1: client's nerves. Okay, that this massage, though it did not

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Speaker 1: exactly call my nerves while massaging me, tells me that

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Speaker 1: something of mine called isn't where it should be. This

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Speaker 1: probably isn't a body part you've ever heard of, but

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Speaker 1: in my own culture, here is an organ believed to

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Speaker 1: be found in your mid section. After you have a baby,

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Speaker 1: a time where your organs are really shifted around. You're

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Speaker 1: supposed to come back twelve days after delivery to get

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Speaker 1: a massage from someone like During that she makes sure

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Speaker 1: that your sto is where it should be and massages

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Speaker 1: it back into place if it isn't. The belief here,

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Speaker 1: though it isn't backed up by modern medicine, is that

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Speaker 1: with it out of place, you can experience back pain,

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Speaker 1: stomach issues, and anxiety. They believe you can pass along

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Speaker 1: some of those issues to your baby if you breastfeed too.

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Speaker 1: I'm way past that twelve day mark. How to baby

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Speaker 1: a year ago? So why am I hair exactly? I'm

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Speaker 1: Kelsey Butler, a reporter on Bloomberg's A Quality Team. When

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Speaker 1: I got pregnant in the middle of the pandemic, I

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Speaker 1: was living in New Jersey. The state was one of

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Speaker 1: the highest maternal mortality rates in the US, and the

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Speaker 1: numbers were the worst for women like me, who are black.

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Speaker 1: The death rate was made even scarier by the prospect

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Speaker 1: of getting COVID, which I knew made the chances of

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Speaker 1: complications for both me and my baby even higher. I

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Speaker 1: thankfully had a mostly complication free birth. My son turned

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Speaker 1: one last month, but it got me thinking about maternal health,

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Speaker 1: and when I started looking into it, I found an

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Speaker 1: even more shocking statistic, just a little bit south. For years,

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Speaker 1: maternal mortality had been improving in Mexico. Then the pandemic

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Speaker 1: hit and the rate for maternal deaths climbed over sixty.

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Speaker 1: So I jumped on a plane to Mexico to find

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Speaker 1: out what happened. Jobless claims coming in, I mean really

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Speaker 1: jumping from the week before, pretty brutal. Three point to

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Speaker 1: a million records. Six point six million Americans filed for

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Speaker 1: unemployment last week. Indian working women were the worst impacted

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Speaker 1: by the pandemic. If so divid like Umia, Well, now

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Speaker 1: to the billionaire boom. According to Bloomberg's super yacht charters

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Speaker 1: are up over three hut and a billionaire was created

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Speaker 1: every twenty six hours during this pandemic. It is time

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Speaker 1: for a wealth tax in America. Welcome back to the paycheck.

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Speaker 1: I'm Rebecca Greenfield. Among the many things that have determined

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Speaker 1: how a country has fared economically during the pandemic is

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Speaker 1: how government's decided to manage the virus that's off. Some

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Speaker 1: places opted for a COVID zero strategy, going to extreme

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Speaker 1: lengths to keep the virus out of their borders. Others

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Speaker 1: had more of a letter rip strategy, keeping the economy

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Speaker 1: and businesses open with little regard for the virus itself,

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Speaker 1: and many places where somewhere in between. Each approach comes

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Speaker 1: with costs, though some are much higher than others. Mexico

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Speaker 1: is a country that chose its economy over everything else.

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Speaker 1: A few months into the pandemic, the government slowly started

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Speaker 1: lifting restrictions. That's my colleague Andrea Navarro. She's a reporter

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Speaker 1: in Mexico City. We were one of the few places

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Speaker 1: in the world where we never really had any travel

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Speaker 1: restrictions of any kind. So things went back to normal

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Speaker 1: relatively quickly. Here Andrea usually covers Mexico's economy, but for

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Speaker 1: the last two and a half years she's been covering COVID.

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Speaker 1: She told me as early as before vaccines, Mexico is

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Speaker 1: open for business. To understand this approach, Andrea says, you

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Speaker 1: have to understand Mexico's president. Andrea's Manuel Lopez Obrador, who's

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Speaker 1: known more colloquially as Amlo. Amlo can be described as

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Speaker 1: a populist, and what that means is that he will

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Speaker 1: basically say and do anything that he says will be

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Speaker 1: popular with his base, which is very big. Am Lo

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Speaker 1: caters to Mexico's poorest people, many who work in the

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Speaker 1: informal and service economies, the people who run things like

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Speaker 1: street cards, and if they aren't allowed to operate or

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Speaker 1: all their customers are stuck in quarantine, they can't earn

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Speaker 1: a living, and unlike richer countries, Mexico didn't have the

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Speaker 1: money to just pay people to stay home. Plus, am

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Speaker 1: Low hates debt, so he basically let COVID run free

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Speaker 1: and the hopes that the economy would survive. Andrea says

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Speaker 1: the strategy allowed Mexico to keep a balanced budget. The

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Speaker 1: paso has also remained relatively stable, and there are no

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Speaker 1: worries about the country defaulting on its debt. But it

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Speaker 1: also had some nasty knock on effects, particularly on Mexico's

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Speaker 1: health care system. It's safe to say that the healthcare

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Speaker 1: system collapsed, Andrea says. During the worst wave, ambulances would

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Speaker 1: circle all night looking for empty hospital beds. So far,

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Speaker 1: Mexico has lost three people to COVID, which is high

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Speaker 1: enough on its own, but it lost another five hundred

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Speaker 1: thousand people to what are known as excess deaths, people

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Speaker 1: who shouldn't have died but couldn't get the care they

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Speaker 1: needed due to COVID, and among those were many pregnant

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Speaker 1: and childbearing women. Before the pandemic, Mexico's maternal mortality rate,

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Speaker 1: while still high, had been moving in the right direction.

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Speaker 1: Over two decades, it had dropped by half. The pandemic

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Speaker 1: erased most of those games. About two thousand women have

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Speaker 1: died in childbirth or soon after Mexico since the start

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Speaker 1: of the pandemic. My colleague Kelsey went down to Mexico

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Speaker 1: to investigate back to her for the story. I ended

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Speaker 1: up in Mexico after I heard the story of getting

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Speaker 1: Viejo Costito in January getting checked into a hospital in

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Speaker 1: Baja California to have her second baby. She was a healthy,

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Speaker 1: thirty one year old woman getting had a c section.

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Speaker 1: They're common generally speaking, but they're especially popular in Mexico,

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Speaker 1: which has one of the highest c section rates in

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Speaker 1: the world, and during the pandemic, the c section rate

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Speaker 1: jumped even higher. Hospitals were too maxed out and short

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Speaker 1: on time to let labor happen on its own. The

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Speaker 1: rates in the first year of the pandemic were more

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Speaker 1: than three times what the World Health Organization recommends. Because

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Speaker 1: c sections, though life saving and necessary in some cases,

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Speaker 1: carry greater risk of complications like infections or blood cloths

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Speaker 1: then giving birth the old fashioned way. It's also major

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Speaker 1: surgery and recovery is tougher to Just after gett in

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Speaker 1: c section, her family was sent home and told to

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Speaker 1: come back later. Everything seemed fine. They were told she

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Speaker 1: just needed some rust. But when Gatton's family returned, she

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Speaker 1: was dead. Her sister, Anna Maria Vaejo found her in

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Speaker 1: her hospital room. I talked to Anna on the phone

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Speaker 1: about this, which she described was heartbreaking. Anna says that

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Speaker 1: when she went to touch her sister, Gaydon was freezing.

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Speaker 1: Her arms dropped to her side, completely limp. It was

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Speaker 1: as if she had been dead for hours. The official

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Speaker 1: cause of death was listed as a hemorrhage or excessive bleeding,

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Speaker 1: one of the top causes from maternal death in Mexico

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Speaker 1: right now, just ahead of COVID. But Getton's family didn't

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Speaker 1: understand how things went so wrong. So quickly Anna told

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Speaker 1: me she asked the doctors how in the world that happened.

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Speaker 1: The family filed an official complaint, which triggered an autopsy,

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Speaker 1: but when her body was delivered to the medical examiner,

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Speaker 1: they were told they wouldn't be able to give the

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Speaker 1: family any answers because her organs were already removed from

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Speaker 1: her body. That's really odd. An official at the Medical

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Speaker 1: Examiner's office said it was the first time he had

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Speaker 1: seen something like that. The hospital, meanwhile, said it followed

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Speaker 1: protocol and removing Giddon's organs during its own autopsy. The

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Speaker 1: family wonders if doctors were trying to cover something up.

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Speaker 1: News outlets started picking up the story getting by that

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Speaker 1: is Eli. The story went viral locally. The pictures of

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Speaker 1: getting from her social media accounts put a face to

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Speaker 1: the brutal details. Women shared their own stories of mised appointments, negligence,

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Speaker 1: and bad treatment during their pregnancies. In February, people protested

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Speaker 1: in the streets. So that's almost gidding. We are all gidding.

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Speaker 1: Maternal mortality was already high in Mexico, but a perfect

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Speaker 1: storm of bad decisions made by the government during the

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Speaker 1: pandemic created a nightmare scenario for giving birth. The problem

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Speaker 1: started in the months before the pandemic. Mexico's President m

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Speaker 1: Low decided to overhaul the country's healthcare system to eventually

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Speaker 1: make it entirely free for everyone. Plar. The move couldn't

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Speaker 1: have come at a worse time. The news system wasn't

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Speaker 1: up and running, were fully funded. When the pandemic overwhelmed

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Speaker 1: Mexican hospitals, chaos ensued. There were drug shortages and not

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Speaker 1: enough hospital beds, and then one really bad decision made

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Speaker 1: it all worse. So when the pandemic started, there was

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Speaker 1: something called reconversion, hospital re conversion, and I think it

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Speaker 1: was not the best idea. That's Mina Mendez Dominguez, a

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Speaker 1: physician and researcher who studies maternal health in Mexico. She's

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Speaker 1: based in Mediva, a city of one point two million

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Speaker 1: people on Mexico's You've Got Them Peninsula. But I first

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Speaker 1: met her at a conference in New York in April.

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Speaker 1: Nina told me to deal with the influx of COVID patients,

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Speaker 1: the government decided to convert many big hospitals around the

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Speaker 1: country into COVID only facilities, meaning no one could be

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Speaker 1: treated for anything else, not heart attacks, not gunshot wounds,

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Speaker 1: not even childbirth. It was Nina and her colleagues research

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Speaker 1: that uncovered that first statistic that really shocked me, that

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Speaker 1: there had been a sixty jump in the maternal mortality

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Speaker 1: rate in Mexico during the pandemic. Other countries in Latin America,

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Speaker 1: like Brazil and Peru also had big jumps. Those COVID

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Speaker 1: only hospital conversions played a big part in the deaths.

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Speaker 1: She told me. What happened was that non essential medical

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Speaker 1: consultations were not available, but also nurses and oldest staff

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Speaker 1: were moved from certain hospitals to other hospitals. In other words,

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Speaker 1: even the hospitals that would see pregnant women were short

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Speaker 1: staffed because their staff had been sent to deal with COVID.

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Speaker 1: This led to a lot of problems for people with

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Speaker 1: all kinds of health emergencies, but it was particularly dangerous

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Speaker 1: for pregnant women, especially pregnant women who lived far away

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Speaker 1: from a hospital. Outside of the big cities, the only

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Speaker 1: nearby hospital or health clinic was reserved just for COVID patients.

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Speaker 1: In the remote region of you got done. Where I

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Speaker 1: saw someone in labor could be hours from the nearest

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Speaker 1: place that could deliver a baby or even do standard

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Speaker 1: pre and postnatal care. The first contact in rural areas

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Speaker 1: were not priority because they treat very small amount of people,

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Speaker 1: so then they stopped all the maternal consultations, and women

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Speaker 1: feared to travel to the urban areas and then go

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Speaker 1: to the hospital because they knew there were patients that

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Speaker 1: were sick over there already. Basically, pregnant women who already

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Speaker 1: lived far from medical care might now be even further

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Speaker 1: from somewhere that would treat them, and they also might

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Speaker 1: be scared to go there because there was more risk

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Speaker 1: of catching COVID. Henny Carrillo, a professor at Texas A

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Speaker 1: and M University who worked with Nina on the research,

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Speaker 1: put it bluntly, so what happened pregnant women did not

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Speaker 1: attend the routine checobs. All these decisions had a repel

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Speaker 1: effect henn He says not all paternal dates in Mexico

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Speaker 1: were directly related to COVID inflation, but rather to uncontrolled

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Speaker 1: conditions during pregnancy due to the limited hay care availability

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Speaker 1: that these women had to face. Nina told me about

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Speaker 1: one case while doing her research that's stuck with her.

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Speaker 1: She told me about a young woman who showed upbout

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Speaker 1: a remote hospital with a rare, life threatening pregnancy complication

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Speaker 1: called help syndrome. The first facility she went to didn't

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Speaker 1: catch it. By the time she got to the next

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Speaker 1: it was too late. She started bleeding internally and was

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Speaker 1: taken to surgery. The end result was tragic. She just

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Speaker 1: passed away, and it was so sad because her family

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Speaker 1: came after and she was already gone. It's these kinds

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Speaker 1: of cases that stick with Nina because they're part of

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Speaker 1: a common pattern unnecessary roadblocks that make it hard for

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Speaker 1: people to safely have babies. Emergencies were especially dangerous for

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Speaker 1: women in the thick of COVID because it took so

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Speaker 1: long for them to get to treatment and be seen

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Speaker 1: by doctors. It became so difficult for a woman, for

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Speaker 1: a pregnant woman to move from her house to find

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Speaker 1: medical attention that it ended up so bad. You get

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Speaker 1: done where Nina is based, so the highest level of

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Speaker 1: maternal deaths and more than a decade, it's a problem

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Speaker 1: that is leaving too many women behind. She says, pregnancy

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Speaker 1: should be a very positive experience. Bringing children to life

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Speaker 1: should be such an important event that we should all

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Speaker 1: enjoy this process and it should be equal for all

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Speaker 1: women in all the world. But at a virtual event

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Speaker 1: in February, Zoe Lejano, head of the Mexican Institute of

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Speaker 1: Social Security, said the country. Strategy had been quote very

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Speaker 1: very focused on hospital reconversion unquote, so that doctors wouldn't

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Speaker 1: be forced to decide which COVID patients lived and which died.

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Speaker 1: He went on to say, quote Mexico's model was growing

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Speaker 1: the capacity for care, so there were zero rejections unquote,

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Speaker 1: and barras or midwives are stepping in to fill some

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Speaker 1: of these gaps in a health care system they say

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Speaker 1: isn't working for women, but they can't fix everything. I

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Speaker 1: called one of these women who has been delivering babies

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Speaker 1: for over thirty years. Her name is Guada up She's

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Speaker 1: the president of the Association of Professional Midwives in Mexico City. Joe,

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Speaker 1: I have been delivering babies for more than thirty years

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Speaker 1: outside of hospital settings, in homes or in birthing centers,

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Speaker 1: under very strict protocols to ensure the security and safety

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Speaker 1: of both mother and baby. Told me she was afraid

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Speaker 1: to treat women early in the pandemic, leaving another gap

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Speaker 1: in the system for rural women. That wasn't the case

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Speaker 1: for Guada Lupe, who, during the height of COVID saw

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Speaker 1: double or triple the number of women she normally does.

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Speaker 1: That's because people either couldn't get care or we're scared

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Speaker 1: to go to traditional care facilities. See, so it was

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Speaker 1: very difficult imagine the situation running out of options and

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Speaker 1: filling on certain women began calling professional meadwifes. Now, she says, fortunately,

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Speaker 1: the maternal mortality numbers are in a much better place.

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Speaker 1: The latest government figures show the rate of maternal deaths

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Speaker 1: is at about thirty one for every one hundred thousand

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Speaker 1: babies born. That's down from fifty three deaths for every

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Speaker 1: one hundred thousand berths at the end of last year.

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Speaker 1: That's in large part because the chaos of the earliest

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Speaker 1: days of the pandemic and those hospital conversions are in

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Speaker 1: the past for now, but there's still work to do.

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Speaker 1: In two thousand, the country committed to decreasing the maternal

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Speaker 1: mortality rate to twenty two deaths for every one hundred

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Speaker 1: thousand live births. That's higher than many developed countries, but

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Speaker 1: lower than the United States rate right now. One way

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Speaker 1: to achieve eve that, Guada Lupe says, would be to

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Speaker 1: integrate midwives like herself into the health care system in Mexico.

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Speaker 1: We think that's what should happen here in Mexico. For starters,

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Speaker 1: they should insert professional midwives in the multidisciplinary team with

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Speaker 1: a budget to pay them well to stop treating them

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Speaker 1: in a denigrading way. There's evidence to back that up.

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Speaker 1: Researchers say addressing a shortage of global midwives would prevent

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Speaker 1: two and eighty thousand deaths per year by and the

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Speaker 1: World Health Organization recommends increasing education for midwives to reduce

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Speaker 1: maternal and infant deaths. Gualla Lupe says that there should

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Speaker 1: be more education for women about options outside the traditional

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Speaker 1: health care system to a system that is overwhelmed just

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Speaker 1: can't provide care to pregnant women the way they deserve.

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Speaker 1: Prenatal visit with an O B G y N that

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Speaker 1: has eighty women to see in a date, you can't

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Speaker 1: ask for quality of care, not even to give proper

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Speaker 1: advice or guidance. It's not that they don't want to,

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Speaker 1: it's that they can't. Right now, one thousand pregnant women

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Speaker 1: die each year in Mexico. Zoom out, and there are

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Speaker 1: three hundred thousand more around the world. One of the

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Speaker 1: lessons of the season for me has been that there's

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Speaker 1: no escaping the pain of the last two years. Some

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Speaker 1: places have felt that pain more than others, and in

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Speaker 1: more traumatic ways through unimaginable death tolls. But even countries

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Speaker 1: that manage the virus well couldn't fully insulate themselves from

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Speaker 1: the global shock of COVID. Next week, on The Paycheck,

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Speaker 1: we had to a place with one of the lowest

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Speaker 1: death rates in the world, where more and more people

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Speaker 1: are feeling economic pain. It strikes against the singaple pledge. Right.

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Speaker 1: We pledge ourselves to developer justin equal society. If we

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Speaker 1: don't hold that, then there's something problematic. Thanks for listening

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Speaker 1: to The Paycheck. If you like our show, please head

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Speaker 1: on over to Apple Podcasts or wherever you listen to

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Speaker 1: podcasts to rate, review and subscribe. This episode was hosted

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Speaker 1: by Me Rebecca Greenfield and reported by Kelsey Butler. It

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Speaker 1: was edited by Kristin V. Brown with help from Francesca Leavy,

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Speaker 1: Janet Paskin, Rocksheeta Sluja, and Me. We also had editing

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Speaker 1: help from Daniel Balby, Shelley Banjo, Gilda to Carly, Nicole Flato,

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Speaker 1: Elissa McDonald, and Kai Schultz. This episode was produced by

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Speaker 1: Gildada Carly and sound engineered by Matt kim Our original

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Speaker 1: music is by Leo Sidron. Special thanks to Magnus Hendrickson, McKinnon,

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Speaker 1: Da Kuyper, Margaret Sutherland, and Stacy Wong. The voice actor

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Speaker 1: you heard was Veronica Colloe. Francesca O Leevie is Bloomberg's

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Speaker 1: head of podcasts. See you next week. H