More Than Just a Midwife: How PROPEL Health is Supporting Indigenous Communities in Guatemala
By Stephanie Mork
In Guatemala, midwives are so much more than just a health professional. Comadronas, or Indigenous midwives in Guatemala, are essential to their communities. They provide education, guidance, and person-centered, empathetic care for women and their families.
Comadronas are highly respected and trusted individuals in the community and are often the link between pregnant women in rural communities and primary health care systems. They often act as a beacon for women of reproductive age who are intimidated by or unfamiliar with a formal hospital system to support women who want to give birth with the help of modern medicine and prefer to express themselves in their native language.
“As a midwife, I talk to the women and walk them through their treatments. When they get pregnant, I ensure they go to a health center for their prenatal appointment and that they get to the health center for their treatment.” — Mayan Midwife
It is estimated that there are nearly 8 million Indigenous peoples with 24 different languages in Guatemala — making the country one of the most ethnically diverse in Latin America (National Institute of Statistics, Guatemala).
Indigenous communities in Guatemala often face discrimination — resulting in barriers to accessing quality health care, education, and employment opportunities, leading to gaping health and income disparities between Indigenous and non-Indigenous communities. For example, the maternal mortality ratio for Indigenous women in Guatemala is more than twice the maternal mortality ratio for non-Indigenous women (International Journal of Health Equity, 2023).
To address some of the health disparities among Indigenous communities in Guatemala, PROPEL Health, funded by the U.S. Agency for International Development, conducted consultations with comadronas to learn more about the challenges and opportunities to improve their relationship with the health system.
During these consultations, the comadronas shared their experiences of discrimination in the health system, noting that formalized health systems often do not take midwives into account. The comadronas emphasized the need for more respect for Indigenous customs, language, and traditions, and personnel in health facilities who speak Indigenous languages.
The Guatemalan state has recognized the importance of comadronas through a legal framework to help address the health disparities and improve maternal health outcomes through intercultural practices, but efforts to implement policies to include comadronas in the formal health system have been fraught with challenges. One such effort is the establishment of a system to register comadronas and distribute a ‘Carnet de Comadrona’ or a registration card that facilitates access to health centers and registrations of all the births that they attend.
To obtain a ‘Carnet de Comadrona’ from the Guatemalan Ministry of Health, comadronas must be recognized in their community for the care of women during pregnancy and childbirth and must participate in knowledge exchanges or training sessions that are provided by the health system. But, as many comadronas commented during the PROPEL Health consultation sessions, this card is often difficult to obtain and maintain.
“In the health center they wanted to take away my card because I received my training and supplies in another center.” — Mayan Midwife
The project also conducted a legal analysis of the laws that protect the work of midwives and found that one of the laws, which assigned an annual payment, was only applicable for one year. PROPEL Health is working with the Indigenous Peoples Unit of the Guatemalan Ministry of Health to promote compliance with the legal framework that recognizes midwives and the need to improve relationships between midwives and the health system.
Marisela De La Cruz, Deputy Director of Equity and Quality for PROPEL Health Guatemala commented on the critical importance of the work with comadronas:
“Midwives remain a central element for community health care and are perhaps the only service provider of the traditional system that has relationship with the Western service system as a link.”
By supporting the Guatemalan comadronas, PROPEL Health can help bridge the gap in health disparities for Indigenous communities across Guatemala and provide mothers and families with the critical health care services that they need.
To learn more about PROPEL Health’s work with Guatemalan comadronas, see our video on “Honoring Guatemalan Midwives.”
Stephanie Mork is a Communications Manager at Palladium.
