39 Universal health coverage programs, such as Plan Nacer, are key instruments to diminishing health disparities and improving maternal and infant health despite economic challenges, and they can serve as a model going forward. Argentina has had drastic economic fluctuations, with devastating effects on the country leading to an increase in unemployment, poverty, and health care challenges. These vicious economic cycles had an impact on population health, especially the most vulnerable, including pregnant women and infants (Wehby et al., 2017). By the late 1990s, the economy was in a state of collapse (Rubinstein et al., 2018). The resulting 2001 crisis was a consequence of several economic events, such as inflation, large foreign debt followed by a sudden stop in capital inflow, economic rigidities, currency overvaluation, and inflation. These issues, in addition to the political changes, riots, and social unrest, led Argentina to experience one of the worst market crises in history (Perry & Serven, 2003). This was a difficult period in Argentina’s political and economic history that directly impacted its health care system. Most health care products at the time were imported, and the cost of delivery increased rapidly. The social security system was in its worst shape financially, and its social and health programs lacked funding, especially those for the disabled and elderly (Fiszbein et al., 2002). Furthermore, the social security program, Programa de Atención Médica Integral (Comprehensive Medical Attention Program), began delaying payments for health care services, which led to several problems related to patient access to medical providers including pharmacies (Rubinstein et al., 2018). In 2001, both the social security health system and the private sector health services faced financial obstacles. The social security sector faced huge debts of approximately $1.8B because the prices of drugs and medical equipment had multiplied (Fiszbein et al., 2002). The private sector was undergoing a decline in income, because fewer people could afford private insurance (Fiszbein et al., 2002). These economic issues in the two sectors of health care led many to seek care in public hospitals. This diversion of patients created a strain on resources in the public sector. As a result, most hospitals began treating patients on a first-come, first-served basis until basic inputs were exhausted. Consequently, health services became very inefficient and some people were denied quality care due to limited resources. Over the next years, Argentina’s economy gradually improved, and so did its public health sector, leading a large portion of the population to continue to seek health care through the public system, rather than returning to social security or private health insurance. The Economic Crisis Deteriorates Maternal and Infant Health Argentina’s economic crisis in 2001 threw many into poverty, and more people joined the informal sector working in jobs that were not taxed or monitored by the government and thus became medically uninsured (Cruces et al., 2012). At the same time, demands for better public health necessitated the implementation of new programs, especially with more women and children coming to depend on public health. Maternal health and infant mortality became two central concerns for health care providers. In the beginning of the twenty-first century, there was a pattern of fluctuation in maternal mortality in Argentina (Dirección de Estadística e Información de Salud [DEIS], 2009). Maternal mortality is the death of a woman when pregnant or within 42 days of the termination of pregnancy. Maternal deaths can be divided into two groups: direct obstetric deaths, which are those from obstetric complications, and indirect obstetric deaths, which are those that result from a preexisting condition. Rosenstein and colleagues (2008) studied determinants of maternal mortality in Argentina based on clinical records and autopsies. The researchers found that a majority of maternal deaths were attributable to social, economic, and logistical problems within the health services. Among women who died of childbirth-related causes, 79% experienced delays in accessing care and seeking assistance. They argued that most of the deaths were due to improper access to health care or to errors in the application of available knowledge and technologies in the management of pregnancy
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