Midwives for Midwives - Creating Parterships to Strengthen Women's Healthcare

Reproductive and Maternal Health in Guatemala

Maternal mortality in Guatemala measures 200 deaths per 100,000 live births. Among indigenous Mayan women this figure may be as high as 446 per 100,000. Infant mortality is 51 per 1,000 live births.
75% of Guatemala's overall population lives in poverty; 93% of the indigenous population is poor
62% of Guatemalan women do not use a modern contraceptive method
Fewer than 3% of those use contraception choose to use condoms
Rates of sexually transmitted diseases and reproductive tract infections (RTIs) among Guatemalan women are high and are on the rise.
Abortion, which is illegal, is responsible for an estimated 30% of the high official maternal mortality rate of 248 deaths per 100,000 live births.
42% of the Guatemalan population does not have access to regular health care
Women, even those in urban areas of Guatemala, generally must visit mant different health agencies to obtain well woman care, contraception, STD/HIV prevention education, maternity care, and post-natal care, if this range of services is available at all
The majority of Guatemalan women give birth at home, with midwives attending 60-70% of all births (90% in rural areas)
Guatemalan health officials routinely exclude midwives from the formal health system in attempt to centralize medical services within hospitals
Midwifery training in Guatemala is largely centered around the identification of risk factors and transfer of patients into the hospital system, ignoring the reality that the majority of births are uncomplicated and can safely take place outside the hospital setting

According to the World Health Organization: "The person best equipped to provide community-based, technologically appropriate and cost—effective care to women during their reproductive lives is the person with midwifery skills who lives in the community. Midwives understand women's concerns and preoccupations. They accompany women through their reproductive lifespan, not only providing assistance at births, but during adolescence, pregnancy and delivery and postpartum." (1996)

Yet, instead of empowering and supporting traditional midwives by providing comprehensive and culturally appropriate training, essential equipment, and practical support, Guatemalan health officials seek to exclude midwives from the formal health system in an attempt to centralize medical services within hospitals. As a result, traditional midwives find their practices limited and their role in providing women's health care threatened.

Midwifery training in Guatemala is largely centered around the identification of risk factors and transfer of patients into the hospital system. This model ignores the reality that the majority of births are uncomplicated and can therefore safely take place outside the hospital setting. It also fails to address the cultural, logistical, and economic barriers that may interfere with transfers should a hospital birth become necessary. Meanwhile, the prevailing approach is notably weak in regard to preventive care, early detection of complications, treatment of illness, and emergency first aid. Additionally, most traditional midwives lack the equipment (e.g. gloves and fetoscopes) they need to provide even basic care.

In contrast, MFM's approach addresses these deficiencies by:

Honoring and respecting the work that traditional midwives already do;
Expanding the traditional midwives' knowledge and skills, and enhancing these with evidence-based aspects of modern midwifery theory and practice;
Involving traditional midwives and their communities in the design and implementation of our training activities;
Teaching tangible skills and providing one-on-one training to strengthen these skills;
Providing a safe space for traditional midwives to share their experiences and concerns and to mobilize and advocate to improve their profession; and working towards a model that would allow traditional midwives to learn new skills in their own communities, helping them better meet the unique needs of their constituents.