CARACAS, Venezuela (AP) — Dr. Saturnina Clemente pulls up to the small clinic in the impoverished Caucaguita neighborhood armed with one of Venezuela's most sought-after commodities: Hormonal implants to prevent pregnancy.
In a country where contraceptives are in short supply, word in the shantytown on the outskirts of Venezuela's capital spreads quickly. The lucky get on a list run by community leaders. The less fortunate hope there will be extras.
The veteran doctor has 104 implants and there won't be enough for everyone. As a physician at the nation's largest pediatric hospital, Clemente knows firsthand that the consequences for those who don't get one are high.
"It's a sense of impotency, of frustration," she says. "You see that it's not enough, that the demand is much higher."
As Venezuela's crisis deepens, women are bearing the brunt of the nation's upheaval. Despite promises by the socialist government to provide every woman access to family planning, recent surveys and interviews with health professionals indicate access to contraceptives remains incomprehensive.
International organizations including the U.N. Population Fund have stepped in by importing tens of thousands of contraceptives this year, but their work is limited. It's an ordeal with increasingly international ramifications, as a growing number of pregnant women flee to Colombia seeking care they cannot get in Venezuela.
"Women are getting pregnant and don't have options," said Luisa Kislinger, a women's rights activist. "They're forced into motherhood."
Nicol Ramírez is 15 and already a mother. Her name is on Clemente's list, but to get an implant she needs to show a negative pregnancy test. The young mom and her older sister frantically call their mother. They need 40,000 bolivars, the equivalent of about $3, to take the simple test at a nearby laboratory.
"The situation in this country isn't one for having children," Ramírez said, balancing her baby daughter on one hip. "I'm still a girl myself."
During the late Hugo Chávez's presidency, Venezuela's government expanded services to help poor mothers by providing monthly cash transfers. Chavez lavished praise on women and hailed the "revolutionary mothers" who would help promote his vision.
The 1999 constitution he advanced guarantees "full family planning services" to women among a host of other benefits.
"The socialist revolution should be feminist," he declared.
Despite those initiatives, Chávez's government made only modest advances, at best, in improving access to contraceptives. Government data show that teenage pregnancies steadily increased during his years in power.
"There was a major advance with the constitution, with getting all these new rights and state obligations," said Rachel Elfenbein, author of an upcoming book on social programs Chávez created for women. "But when it came to implementation, if and where it happened, it was patchy."
President Nicolás Maduro has struggled to advance his predecessor's agenda amid a crippling economic contraction worse than the U.S. Great Depression. Few if any women still get cash transfers except for occasional "bonuses" equivalent to a dollar or two. Maternal death rates rose by more than 65% between 2015 and 2016.
"Under Maduro we've seen an unprecedented setback," Kislinger said.
Health professionals believe Venezuela could cut its high maternal mortality rate by one-third doing one thing: Providing contraceptives.