1. Truths and Myths about Obstetrical Care Along the US-Mexico Border
Myles Stone, MD, MPH
University of Arizona Family Medicine Residency, South Campus

2. Activity Disclaimer ACTIVITY DISCLAIMER
It is the policy of the AAFP that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflicts of interest (COI), and if identified, conflicts are resolved prior to confirmation of participation. Only those participants who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity.
Myles Stone has indicated he has no relevant financial relationships to disclose.

3. Objectives
Describe challenges particular to obstetrics on the US- Mexico border that are not seen in the interior of either country
Discuss medical implications of cross-border pregnancies
Discuss how the political complexities of the US-Mexico border can affect medical care

4. Border Region Baja California Sonora Chihuahua Coahuila Nuevo Leon
Tamaulipas

5. Arizona-Sonora Border

6. Arizona-Sonora Border

7. Arizona - Sonora Nogales, Arizona 20,000 people
Four land border crossings
Major port of commerce, particularly produce and manufactured goods
One hospital
Nogales, Sonora
220,000 people
Four hospitals
Medical and dental tourism

8. Pregnancy-related Infections
HIV
Mexico national incidence down 17% last decade, up 13% along border, up 94% in Sonora
US national incidence up 19%, down 10% along border
Tuberculosis
Mex: Down 10% nationally, up 2-3% along the border, Sonora up 36%
US: Down 30% nationally, most new cases in CA

9. Zika Virus Cases as of 8/8/16: Baja California: 0 Sonora: 0
Chihuahua: 0
Coahuila: 1
Nuevo Leon: 6
Tamaulipas: 0
Cases as of 8/12/16:
AZ: 21
Phoenix: 14
Travelers: 20

10. Breast Feeding 60% along the border (at 6 months) 49% in US
14% in Mexico
Disconnect from health services, since Mexico only recently banned free formula samples in Hospitals

11. Cesarian Sections Border State Total: 32.1% Border Regions: 37.9%
Non-border Regions: 30.9%
Cultural factors
Sterilization
Private vs. public hospitals
Most stark differences in Texas and New Mexico
Higher rates in Mexico, but medical risk factor rates aren’t higher
Cultural factors (delivery w surgical sterilization)
Higher rates at private and for-profit hospitals (majority of TX border hospitals are for-profit)
More out-of-hospital births in Mexico

12. First Trimester Prenatal Care
US Border Region: 68.4%
Non-Border Region: 73.9%
Mex Border Region: 69.2%
Non-Border Region: 78.5%
More state to state variability in US
In Mex, Health Policy set at federal level

13. Infant Mortality
Mex: Down 30% nationally last decade, down 14% along border. (absolute: 11/1,000)
US: Down 4% (6/1,000)

14. Geography is Secondary
Goodman, et. al. Helicobacter pylori Infection in Pregnant Women From a U.S.–Mexico Border Population
US: 56% prevalence, Mex: 74% prevalence
Crowding, education, # of bathrooms in home, # of children, municipal sewer connection much better predictors than location
Looked at women from both sides1

15. Immigration Status Rhetoric doesn’t match reality
“All the data suggests that people come here to work”
Demographics of undocumented immigrants
Foreign nationals giving birth here tend to be affluent and have resources
Politifact: “[Graham] uses inflammatory rhetoric to obscure legitimate policy questions”
Far fewer pregnant and childbearing age women than in either country
$13,000 package from China
TMC has $3K birth plan
Politifact quotes federal data and Pew studies

16. References
"World Bank Open Data." Data. Accessed August 14,
Healthy Border 2010/2020 Strategic Framework Report. El Paso, TX: United States-Méxcio Border Health Commission, 2010.
USA. Arizona Department of Health Services. Office of Border Health. Zika Virus Case Location Report.
Mexico. SECRETARIA DE SALUD. DIRECCIÓN GENERAL DE EPIDEMIOLOGÍA. Casos Confirmados De Enfermedad Por Virus Del Zika.
Goodman, Karen. "Helicobacter Pylori Infection in Pregnant Women From a U.S.–Mexico Border Population." Journal of Immigrant Health, July 2003, Accessed August 14, 2016.
Mcdonald, Jill A., Octavio Mojarro Davila, Paul D. Sutton, and Stephanie J. Ventura. "Cesarean Birth in the Border Region: A Descriptive Analysis Based on US Hispanic and Mexican Birth Certificates." Maternal and Child Health Journal Matern Child Health J 19, no. 1 (2014): doi: /s
Mcdonald, Jill A., Brittany Argotsinger, Octavio Mojarro, Roger Rochat, and Anup Amatya. "First Trimester Initiation of Prenatal Care in the US-Mexico Border Region." Medical Care 53, no. 8 (2015): doi: /mlr
McDonald, J.A., Mojarro, O., Sutton, P.D. et al. Matern Child Health J (2015) 19: 128. doi: /s
"Fact-checking the Claims about 'anchor Babies' and Whether Illegal Immigrants 'drop and Leave'" Politifact. Accessed August 14, birthright/.