SEATTLE — Historically, indigenous people, particularly women, have been the object of discrimination and violence in Guatemala. Indigenous people in rural regions of the country are exempt from the healthcare systems provided to those in urban areas. This type of disproportional access has devastating effects on maternal care for indigenous women in Guatemala.
Poverty Among Indigenous Populations
In Guatemala, around 41 percent of the population identifies as indigenous; this equates to around 5.9 million people. This population is the largest in the Americas after Mexico, Peru and Bolivia. In the country, 53 percent of the population is poor, yet 74 percent of Guatemalans living in poverty identify as indigenous.
Statistically, the maternal mortality rate for indigenous women is three times that of non-indigenous women. Problems arise when births are not attended by skilled medical personnel, and in 37 percent of rural Guatemala, this is the case.
Comadronas a Key Part of Maternal Care for Indigenous Women
In indigenous communities, the use of a comadrona, or an indigenous midwife, is still prevalent in 85 percent of Guatemala. Comadronas are hired by the families and help through each stage of the pregnancy process, even the weeks after birth. Their role is like that of a doula. They help deliver babies, perform massages before and after labor and use plants to lessen the pain of childbirth.
Comadronas serve important roles in the community and are crucial for the implementation of better maternal care for indigenous women in Guatemala. Comadronas have access to difficult to reach areas of the country, where most indigenous populations live. In these secluded areas, it can take hours to get to the nearest hospital by foot or car.
Social Development Act
In 2001, the Guatemalan Congress enacted the Social Development Act after recognizing the unequal access to healthcare in the country. The act establishes the lives and health of women and children as a public welfare concern and made maternal healthcare a national priority.
Presently, the Ministry of Health conducts monthly training on maternal care for indigenous women, specifically for comadronas. At these training sessions, comadronas are taught how to detect early danger signs for pregnancy, such as a baby in breech position. In such cases, the comadronas are encouraged to immediately take their patients to the nearest healthcare center.
Health Poverty Action
Various organizations exist to aid the government’s battle to strengthen healthcare throughout rural Guatemala. In 1994, Health Poverty Action began to implement maternal healthcare for indigenous women in Guatemala. Partnering with Asociacion Nuevos Horizontes, the two organizations are working to increase access to and ownership of health services in the highlands of Guatemala.
Barriers such as language, distance and discrimination are being addressed through culturally appropriate maternal and neonatal services. Health Poverty Action is training workers at the Ministry of Health facilities in vertical birth, which is the traditional position Mayan women prefer to give birth in. The program is redefining communication for mothers who speak different languages by developing translation devices for Spanish-speaking medical staff.
The empowerment of comadronas is helping to ensure that their cultural role is recognized. This means that comadronas are now able to attend births at hospitals, which previously was not allowed.
Successes of the Programs
After the adoption of these programs, statistics for maternal and child mortality rates have fallen in Guatemala. The World Bank reports that the ratio of maternal mortality of indigenous to non-indigenous women fell from 3.2 percent in June 2006 to 1.24 percent in December 2012. Additionally, the percentage of institutional deliveries increased from 22.3 percent in 2006 to 42 percent in 2012.
The infant and maternal mortality rates have significantly decreased in Guatemala since 2000. In 2000, there were 47.03 infant deaths per 1,000 live births, and in 2017, the rate dropped by about 50 percent to 21.3. Since 2005, the maternal mortality ratio has declined by 27 percent, decreasing from 120 per 100,000 births to 88.
These successes are largely the product of education throughout the country on safe practices around childbirth. Since 2009, the United Nations Population Fund has trained more than 35,000 midwives in Guatemala.
Projections show that the maternal mortality rate will continue to drop in the coming years. As knowledge of maternal care for indigenous women in Guatemala continues to spread, and facilities continue to open, more mothers and children will survive and thrive.
– Taylor Jennings