Maternal health and Indigenous traditional midwives in southern Mexico: contextualisation of a scoping review (original) (raw)
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The changing role of indigenous lay midwives in Guatemala: New frameworks for analysis
Objectives: to examine the present-day knowledge formation and practice of indigenous Kaqchikel-speaking midwives, with special attention to their interactions with the Guatemalan medical community, training models, and allopathic knowledge in general. Design/participants: a qualitative study consisting of participant-observation in lay midwife training programs; in-depth interviews with 44 practicing indigenous midwives; and three focus groups with midwives of a local non-governmental organization. Setting: Kaqchikel Maya-speaking communities in the Guatemalan highlands. Findings: the cumulative undermining effects of marginalization, cultural and linguistic barriers, and poorly designed training programs contribute to the failure of lay midwife-focused initiatives in Guatemala to improve maternal-child health outcomes. Furthermore, in contrast to prevailing assumptions, Kaqchikel Maya midwives integrate allopathic obstetrical knowledge into their practice at a high level. Conclusions and implications: as indigenous midwives in Guatemala will continue to provide a large fraction of the obstetrical services among rural populations for many years to come, maternal-child policy initiatives must take into account that: (1) Guatemalan midwife training programs can be significantly improved when instruction occurs in local languages, such as Kaqchikel, and (2) indigenous midwives' increasing allopathic repertoire may serve as a productive ground for synergistic collaborations between lay midwives and the allopathic medical community.
The Changing Roles of Indigenous lay midwives in Guatemala: New frameworks for analysis
2013
Objectives: to examine the present-day knowledge formation and practice of indigenous Kaqchikel-speaking midwives, with special attention to their interactions with the Guatemalan medical community, training models, and allopathic knowledge in general. Design/participants: a qualitative study consisting of participant-observation in lay midwife training programs; in-depth interviews with 44 practicing indigenous midwives; and three focus groups with midwives of a local non-governmental organization. Setting: Kaqchikel Maya-speaking communities in the Guatemalan highlands. Findings: the cumulative undermining effects of marginalization, cultural and linguistic barriers, and poorly designed training programs contribute to the failure of lay midwife-focused initiatives in Guatemala to improve maternal-child health outcomes. Furthermore, in contrast to prevailing assumptions, Kaqchikel Maya midwives integrate allopathic obstetrical knowledge into their practice at a high level. Conclusions and implications: as indigenous midwives in Guatemala will continue to provide a large fraction of the obstetrical services among rural populations for many years to come, maternal-child policy initiatives must take into account that: (1) Guatemalan midwife training programs can be significantly improved when instruction occurs in local languages, such as Kaqchikel, and (2) indigenous midwives' increasing allopathic repertoire may serve as a productive ground for synergistic collaborations between lay midwives and the allopathic medical community.
Safe Birth and Cultural Safety in southern Mexico: study protocol for a randomised controlled trial
Trials, 2018
Background: Indigenous women in the southern Mexican state of Guerrero face poor maternal health outcomes. Living as they do at the very periphery of the Western health system, they often receive low-quality care from health services that lack human and financial resources. Traditional health systems remain active in indigenous communities where traditional midwives accompany women through motherhood. Several interventions have explored training birth attendants in Western birthing skills, but little research has focussed on supporting traditional midwives by recognising their knowledge. This trial supports traditional midwifery in four indigenous groups and measures its impact on maternal health outcomes. Methods: The study includes four indigenous populations in the State of Guerrero (Nahua, Na savi/Mixteco, Me'phaa/Tlapaneco and Nancue ñomndaa/Amuzgo), covering approximately 8000 households. A parallel-group cluster-randomised controlled trial will compare communities receiving usual care with communities where traditional midwives received support in addition to the usual care. The intervention was defined in collaboration with participants in a 2012 pilot study. Supported midwives will receive a small stipend, a scholarship to train one apprentice, and support from an intercultural broker to deal with Western health personnel; additionally, the health staff in the intervention municipalities will participate in workshops to improve understanding and attitudes towards authentic traditional midwives. A baseline and a final survey will measure changes in birth and pregnancy complications (primary outcomes), and changes in gender violence, access to healthcare, and engagement with traditional cultural activities (secondary outcomes). The project has ethical approval from the participating communities and the Universidad Autónoma de Guerrero. Discussion: Indigenous women at the periphery of Western health services do not benefit fully from the attenuated services which erode their own healthcare traditions. Western health service providers in indigenous communities often ignore traditional knowledge and resources, inadvertently or in ignorance, disrespecting indigenous cultures. Improved understanding between midwives and the official healthcare system can contribute to more appropriate referral of high-risk cases, improving the use of scarce resources while lowering costs of healthcare for indigenous families.
Midwives in the Mexican health system
Social Science & Medicine, 1993
The health care system in Mexico was built upon a western model in which curative rather than preventive medicine is emphasized. However, the incorporation of indigenous midwives into maternal and child care and family planning programs by several public health agencies is an exception to the governmental health policies. An analysis of midwife preferences among rural women indicates that primarily poor illiterate women with children, living in remote areas with difficult access, rely on midwives. The continued reliance on midwives by this sector of the population makes the government programs most important.
Medical Anthropology Quarterly, 1996
Physiological and anatomical concepts about reproduction held by traditional midwives in Southern Oaxaca differ considerably from those of biomedicine. Government training courses for traditional midwives disregard these deep-seated differences, and also the underlying conceptual rationale of ethno-obstetrics. These courses constantly reinforce and actively promote the biomedical model of care. But rural midwives, despite these training courses, do not substantially change their obstetrical vision and ways. The strength of their own authoritative knowledge, fully shared by the women and men of their communities, allows them to continue their traditional style of care, despite pressures to conform to biomedical values, beliefs, and practices. Suggestions for a mutual accommodation of biomedical and midwifery approaches to prenatal care include training medical personnel in ethno-obstetric techniques and rationales, teaching midwives basic medical interventions, addressing in intervention programs all social actors participating in reproductive decision making, and adopting an interdisciplinary approach that includes nonmedical aspects of maternal care. [authoritative knowledge, ethno-obstetrics, traditional midwives, prenatal care, maternal health, Mexico] n the state of Oaxaca, as in many other Mesoamerican regions, traditional and empirical parteras (midwives) continue to attend the great majority of births (
Revista panamericana de salud pública = Pan American journal of public health, 2014
To obtain background information about maternal health and health-seeking behaviors among indigenous mothers living in rural Mam-Mayan communities of Quetzaltenango, Guatemala. A cross-sectional analysis of 100 pregnant and breastfeeding women in four communities was performed to determine prevalence and determinants of service utilization. Extreme poverty, poor education, and poor access to basic resources were prevalent. Out of 100 women 14-41 years old, 33% did not use the formal health care sector for antenatal care; the majority consulted a traditional birth attendant. Only 13% delivered in a hospital. Lower socioeconomic status, lack of fluency in Spanish, and no ownership of a motorized vehicle were associated with the highest likelihood of poor utilization of services. A variety of factors affect utilization of maternal health services by indigenous women in rural Quetzaltenango. These include socioeconomic disparities, ethnic and linguistic differences, and poor access to b...
Important advances have taken place since baseline to expand the presence of professional midwives providing high-quality obstetric and neonatal care as part of Mexico’s public health system. The potential for midwifery to become a permanent feature in the country’s public health system seems greater today because of the growing number of students, midwives and midwifery sites throughout the country; a larger and more influential community of midwifery proponents or champions; multiple collaborative efforts to disseminate information and sensitize health personnel to midwifery models of care; increased awareness and action by public authorities; and an emerging dialogue among innovative state-level actors about what works. These advances contribute to momentum around the country, with the most significant progress seen in locations where the Initiative’s four thematic areas, and the corresponding efforts of its partners, have converged. In addition to confirming the importance of synergy among the four areas of support, as envisioned in the Theory of Change, the findings point to several factors or elements that may enhance success: • A few states invested significant effort in preparing the terrain through sensitization of health care officials and medical personnel to foster greater acceptance of their midwifery programs. As a result, they encountered fewer difficulties related to referrals and collaboration with other providers. The Initiative recognized the importance of sensitization and supported numerous efforts to enhance acceptance among public officials and health system personnel in targeted states. • The best maternal health outcomes are seen in integrated models where midwives are part of a larger team of practice with clear and complementary roles, and they are also best in primary and intermediate levels of care. In addition, the data show that quality of care is highest in midwifery sites where there is an enabling clinical setting, meaning committed leadership, commitment to evidence-based practices, good training, supportive staff, and continuing education. The Initiative did not prioritize a particular model of practice or health care level. Rather, it encouraged emerging models through support for learning, information exchange, and recognition of best practices. • Mexico is a highly diverse nation both culturally and geographically. This diversity is marked, however, by extreme inequality of income and education linked to ethnicity, gender, and geography. In order for midwifery to be accepted in regions that need it most, this asset of diversity—in the context of inequality—needs to be honored by training diverse midwives who are prepared to work where they are most needed. The Initiative recognized the importance of diversity and fostered this through grants to organizations representing multiple approaches and voices.
BMC Pregnancy and Childbirth
Background Available research on the contribution of traditional midwifery to safe motherhood focuses on retraining and redefining traditional midwives, assuming cultural prominence of Western ways. Our objective was to test if supporting traditional midwives on their own terms increases cultural safety (respect of Indigenous traditions) without worsening maternal health outcomes. Methods Pragmatic parallel-group cluster-randomised controlled non-inferiority trial in four municipalities in Guerrero State, southern Mexico, with Nahua, Na savi, Me’phaa and Nancue ñomndaa Indigenous groups. The study included all pregnant women in 80 communities and 30 traditional midwives in 40 intervention communities. Between July 2015 and April 2017, traditional midwives and their apprentices received a monthly stipend and support from a trained intercultural broker, and local official health personnel attended a workshop for improving attitudes towards traditional midwifery. Forty communities in t...