Nayeli Martínez Cruz
GFMER Coordinator for Mexico
Dr. Nayeli Martínez Cruz
Internal Medicine - Endocrinology, UMAE Hospital de Especialidades CMN Siglo XXI
Reproductive Biology, Instituto Nacional de Ciencias Médicas y Nutrición
Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”
I was born and raised in Veracruz, México and studied medicine at the Universidad Veracruzana, graduated with honours in 2004. In 2007 I traveled to Mexico, City to continue my studies; in 2011 ended the subspeciality in Endocrinology at the UMAE Hospital de Especialidades CMN Siglo XXI and later in march 2013 finalize the speciality in Reproductive Biology at the Instituto Nacional de Ciencias Médicas y Nutrición. From may to november 2012 I took the online Training Course in Sexual and Reproductive Health Research by the Geneva Foundation for Medical Education and Research. As part of my research project proposal, I have been working on the assessment of the mexican version of the Medical Eligibility Criteria Wheel for contraceptive use since in 2011, the Mexican Government undertook an adaptation of the WHO MEC Wheel taking into account the National Programme and the priorities and needs of the country.
Currently I work in the department of Endocrinology at the Instituto Nacional de Perinatología in México City and collaborate together with the Family Planning Department of the National Center for Gender Equity and Reproductive Health from Ministry of Health who is in charge of the National Family Planning Program in México and also collaborate with the Geneva Foundation for Medical Education and Research (GFMER) as country coordinator of the Training Course in Sexual and Reproductive Health Research.
Areas of interest
Family planning, contraceptive methods research, reproductive health impairment related to endocrine disorders as polycystic ovary syndrome, maternal health especially related to care of endocrine disorders in pregnancy as the gestational diabetes with the objective to reduce maternal and newborn morbidity and mortality.
- GFMER Sexual and Reproductive Rights - Fetal Rights
- Nayeli Martínez Cruz - Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico - Training Course in Sexual and Reproductive Health Research 2012
Mexican situation on the Sexual and Reproductive Health
The activities in the field of sexual and reproductive health are supported by an extensive national and international legal framework, from the Mexican Political Constitution to the Official Norms mandatory for public and private health institutions as well as by the international treaties and agreements. The national recognition of sexual and reproductive rights as human rights, has allowed important advances in this area, however, there is still much to do to implement public policies that take care of harboring and protect these human rights.
Maternal and perinatal health
In México there are important differences in rural and urban areas regarding access to reproductive health including prenatal care; The maternal mortality ratio (MMR) is 47 deaths per 100 000 live births ant the main causes of maternal mortality by May 2012 are in order, preeclampsia-eclampsia (26.7%), postpartum hemorrhage (19.5%), abortion (5.2%), puerperal sepsis, infection and pulmonary embolism which together account for 60.5% of total deaths by this date. According to data from the last years, now the demand is greater for attaining the Millennium Development Goal #5 of 2015 year, we require at least an average of 7.5 annually decrease in the MMR to reach the goal and reduce the MMR from 60 to 22 per 100.000 live births.
The proportion of women who not received medical attention during pregnancy has decreased from 7 to 2.3% for 2006. Despite significant achievements in the antenatal care coverage is still low in the following groups: women over 35 years, indigenous, illiterate and who has a very low socioeconomic status.
In Mexico the total fertility rate was 6.7 children per woman in 1970. According to estimates by the Instituto Nacional de Población y Vivienda in 2010, the total fertility rate decreased to 2.1 children per woman. This drop was possible because of the change in the General Population Law and in the fourth article of the Mexican Political Constitution. This modification recognized the equality of men and women and the right of everyone to decide free, responsible and informed about the number and spacing of children. Incorporating the concept of sexual and reproductive health proposed by the International Conference on Population and Development in Cairo to the health policy allowed intensifying programs related to this area and for 2004 with an update of the official norm (NOM 005-SSA2-1993) of the Services for Family Planning, new technologies in the contraceptive area like female condom and the emergency contraception were introduced in the country.
Adolescent Sexual and Reproductive Health
As part of the National Development Plan and with the aim of achieving the Millennium Development Goals, in 2007 was created for the first time in Mexico a program of action to address the needs of adolescents in this regard that was called "Specific Action Program 2007-2012. Sexual and Reproductive Health for Adolescents ". In Mexico, the number of adolescents from 10-19 years of age represents just over 20% of the total population. In 1995, the age group of women between 15 to 19 years began their sexual life at 17.2 years while in 2006, this dropped to 15.9 years old, according to reports in the ENADID 2006. Regarding the use of contraceptive methods, despite the high level of knowledge about contraception in adolescents there is a contrast with the little use made of them because the indicators have shown that 9 out of 10 women did not use any method of family planning on the first intercourse. Unintended pregnancy and sexually transmitted infections continue to be major challenges for our society.
Violence against women and gender inequality
In the article 1st, 3th paragraph of the Mexican Political Constitution is prohibited all discrimination motivated by ethnic or national origin, gender, age, disabilities, social status, health status or any other that threatens the dignity human and is intended to nullify or impair the rights and freedoms of individuals. The Mexican Official Norm for Health Services, criteria for the care of family violence (NOM 190-SSA1-1999) sets the criteria to be observed in the medical care and guidance provided to users who are involved in domestic violence situations.
Fetal rights and abortion
Abortion is a controversial issue in the country. The abortion proceeding in México falls under state legislation as ruled the Supreme Court in 2008. In the judgment of unconstitutionality regarding the decriminalization of abortion, the Supreme Court ruled that “In the Constitution, there is no provision for the protection directly to the product of conception, in such a way to assume the existence of a right to life of the product of conception this would be against the rights of women”.
To date, only in Mexico City was approved in 2007 the reform initiative to the Penal Code of the México City (Article 144 y 148, fraction V) and General Health Law of the México City (Article 16 bis 6 y 16 Bis 8) for the decriminalization of abortion until the 12th week of gestation.
Assisted reproductive techniques and surrogacy
Legal regulation has lagged behind scientific advances in assisted reproduction and that is why not respond to current needs. Although definition of assisted fertilization was included in the General Health Law, there is still a significant lag in terms of its regulation as e.g., embryo cryopreservation among others. It is necessary to completely restructure the Health Law and develop a Official Norm to unify the principles, operating criteria, policies and strategies for assisted reproductive techniques in the country.
GFMER past activities in Mexico
- The Oxford Evidence-based Management of Pre-eclampsia and Eclampsia Training Course in Mexico City, Mexico, 2012