[{"bbox": [85, 153, 341, 184], "category": "Section-header", "text": "## 2.2 Problem Analysis"}, {"bbox": [96, 200, 1134, 280], "category": "Text", "text": "Despite important advances over the past decades, maternal and infant health, as part of sexual and reproductive health rights, continue to be challenges in El Salvador that have significant room for improvement in particular in the most marginalised areas of the country."}, {"bbox": [96, 304, 1134, 518], "category": "Text", "text": "In 2021 there were a total of 1,805,691 women of childbearing age. Between 2007 and 2023, infant mortality in El Salvador decreased from 21.5 to 6 deaths per 1000 live births. The maternal mortality ratio for 2023 was estimated at 43 deaths per 100,000 live births, a reduction of 12.3 pct from the estimated value for 2000. Among adolescent girls from 10 to 14 years old the birth rate is 2.1 pct and for adolescent girls from 15 to 19 years old it is 50.06%, underlining the country's challenges in terms of teenage pregnancies. Adolescent girl pregnancies are linked to poverty, limited access to and availability of sexual and reproductive health information, total abortion bans and sexual violence. Two out of three women and girls over the age of 15 have experienced physical, sexual or psychological violence⁶."}, {"bbox": [96, 543, 1134, 730], "category": "Text", "text": "Women and girls with disabilities may also face increased risk of gender and disability based violence and additional challenges to see support and legal measures as survivors. Because of the stigma still attached to women and girls with disabilities, they may also face discrimination and barriers to access SRHS including maternal and child care. It is common that health personnel lack knowledge and understanding about women and girls sexual and reproductive health needs, and some may consider that women with disabilities are asexual and therefore should not have families, or they lack knowledge on how to attend women with physical disabilities, or those who are deaf or blind in a professional way."}, {"bbox": [96, 755, 1134, 863], "category": "Text", "text": "In 2022, premature birth and congenital anomalies accounted for 63% of neonatal mortality. Premature births according to the National Integrated Health System (SNIS) represent 8.1% of total live births, while congenital anomalies represent 2.1% of total live birth. Both of the conditions have a negative impact on the ability to achieve maximum neurological development."}, {"bbox": [96, 888, 1134, 996], "category": "Text", "text": "The issue of teenage pregnancy is significant as it increases the risk of premature birth and/or congenital anomalies, which currently represents a major public health problem, making it necessary, on the one hand to strengthen sexual and reproductive health and education, but also to strengthen pre- and postnatal health services and psychosocial and economic support for the adolescent mothers."}, {"bbox": [96, 1020, 1134, 1155], "category": "Text", "text": "The Salvadoran government has expressed its commitment to implement the International Conference on Population and Development (ICPD) Programme of Action of 1994 and has prioritised infant and child care in its social policies: The “Creciendo Juntos” (“Growing Together”) policy aims to promote maximum neurological development in early childhood, which requires intervention from pregnancy through the pediatric period, especially for newborns whose health has been compromised by any pathology."}, {"bbox": [96, 1180, 1134, 1472], "category": "Text", "text": "In August 2021 the “Nacer con Carino” (“Born with Love”) law was enacted. The law introduced a biopsychosocial as well as a biomedical approach, based on the “Loving and Sensitive Care Framework” promoted by UNICEF. The Law establishes that the necessary health support must be provided from the moment there is an intention to get pregnant. Therefore, preconception counselling and sexual and reproductive information is already of great importance to promptly identify risk factors, carry out the necessary evaluations and studies, and also prevent unwanted pregnancies and strengthen young girls and boys understanding about their bodies and sexual relations and rights, as well as the ideal treatment to reduce the risks on the health of the mother and child. With the approval of the \"Nacer con carino\" law, the Ministry of Health of El Salvador launched a process to analyse the needs of the Integrated National Health System, with the aim of identifying the gap between the principles, objectives, guarantees, services and rights promoted by the law and the capacity of the Integrated National Health System (SNIS) to guarantee them."}, {"bbox": [96, 1497, 1134, 1553], "category": "Text", "text": "This process, carried out in accordance with the spirit of the law from a biopsychosocial as well as biomedical approach, led to the identification of the main issues and critical moments that negatively influence the SNIS's"}, {"bbox": [85, 1620, 1012, 1646], "category": "Footnote", "text": "⁶ UNFPA (2019). https://elsalvador.unfpa.org/sites/default/files/pub-pdf/cuadernospoblacion_1_unfpa-sv.pdf"}, {"bbox": [1027, 1655, 1142, 1682], "category": "Page-footer", "text": "Page 6 of 21"}]