The Consequences of Social Inequality: Maternal Morbidity and Mortality in Honduran Miskito Communities

  • Shahna ArpsEmail author
Part of the Global Maternal and Child Health book series (GMCH)


This chapter examines maternal health in coastal Miskito communities using an anthropological perspective. Miskito women who live in Gracias a Dios, the least populated and least developed department in Honduras, contend with multiple obstacles to safe motherhood, including infectious and noninfectious disease, economic insecurity, limited emergency obstetric care, poor transportation infrastructure, and high fertility. Ethnographic data collected during participant observation, four community discussions, individual interviews with 218 women and five midwives, 314 health assessments, and a maternal mortality survey are used to identify and explain the risks indigenous women encounter during pregnancy and childbirth. As in other vulnerable populations, poverty, inadequate health care resources, gender inequality, and young maternal age contribute to maternal morbidity and mortality in Miskito communities. These factors affect women’s health both directly and indirectly by influencing whether they experience complications and if they are able to withstand and recover from complications. Local beliefs about sorcery and witchcraft also affect health-related behaviors, including whether women seek prenatal care at health centers or travel to hospitals to give birth. Designing and carrying out effective interventions to prevent maternal morbidity and mortality depend on understanding local conditions and women’s complex social realities.


Indigenous women Maternal health Honduras Pregnancy Central America Prenatal care Nicaragua Obstetrics Maternal morbidity Maternal mortality Verbal autopsy Surveillance Miskito Cause of death Pregnancy complication Maternal mortality ratio Obstetric death Traditional midwife Midwifery Gender inequality Sorcery Witchcraft 


  1. Alauddin, M. (1986). Maternal mortality in Bangladesh: The Tangail district. Studies in Family Planning, 17, 13–21.CrossRefPubMedGoogle Scholar
  2. Arps, S. (2009). Explaining fertility patterns among women in an Amerindian population: Childbearing goals and perceptions of risk. Paper presented at the Human Biology Association Annual Meeting, Chicago, IL, April 1–2, 2009.Google Scholar
  3. Associated Press (AP). (2012, May 16). DEA admits to role in deadly Honduras helicopter shooting. CBS News. Retrieved September 15, 2016, from
  4. Berry, N. S. (2006). Kaqchikel midwives, home births, and emergency obstetric referrals in Guatemala: Contextualizing the choice to stay at home. Social Science & Medicine, 62(8), 1958–1969.CrossRefGoogle Scholar
  5. Brock, J. H. (1999). Iron and the immune system. In J. J. Bullen & E. Griffiths (Eds.), Iron and infection (pp. 289–325). New York: John Wiley and Sons.Google Scholar
  6. Castellanos, M., David, V., & Ochoa, J. C. (1990). Mortalidad de mujeres en edad reproductiva y mortalidad materna. Tegucigalpa, Honduras: Ministerio de Salud Pública.Google Scholar
  7. Castro, A., Savage, V., & Kaufman, H. (2015). Assessing equitable care for indigenous and afrodescendant women in Latin America. Revista Panamericana de Salud Pública, 38(2), 96–109.PubMedPubMedCentralGoogle Scholar
  8. Chapman, R. R. (2003). Endangering safe motherhood in Mozambique: Prenatal care as pregnancy risk. Social Science & Medicine, 57(2), 355–374.CrossRefGoogle Scholar
  9. Chi, I., Agoestina, T., & Harbin, J. (1981). Maternal mortality at twelve teaching hospitals in Indonesia—An epidemiologic analysis. International Journal of Gynecology & Obstetrics, 19(4), 259–266.CrossRefGoogle Scholar
  10. Danel, I. (1998). Maternal mortality reduction, Honduras, 1990–1997: A case study. Washington, DC: World Bank.Google Scholar
  11. Danel, I., & Rivera, A. (2003). Honduras, 1990–1997. In M. A. Koblinsky (Ed.), Reducing maternal mortality: Learning from Bolivia, China, Egypt, Honduras, Indonesia, Jamaica, and Zimbabwe (pp. 51–62). Washington, DC: World Bank Publications.Google Scholar
  12. Dennis, P. (2004). The Miskitu people of Awastara. Austin: University of Texas Press.Google Scholar
  13. Dennis, P., & Olien, M. (1984). Kingship among the Miskito. American Ethnologist, 11, 718–737.CrossRefGoogle Scholar
  14. Dodds, D. (1994). The ecological and social sustainability of Miskito subsistence in the Río Plátano biosphere reserve, Honduras: The cultural ecology of Swidden horticulturalists in a protected area. Doctoral dissertation, University of California, Los Angeles. University Microfilms International, Ann Arbor.Google Scholar
  15. Dodds, D. (1998). Informe preliminar sobre demografía de tres pueblos indígenas en la Reserva Biósfera del Río Plátano. Working paper 98-1, Population Institute for Research and Training, Indiana University, Bloomington.Google Scholar
  16. Gaynor, T. (2014, June 23). Honduran indigenous groups caught in crosshairs of global drug trade. Al Jazeera America. Retrieved September 15, 2016, from
  17. Gracey, M., & King, M. (2009). Indigenous health part 1: Determinants and disease patterns. The Lancet, 374(9683), 65–75.CrossRefGoogle Scholar
  18. Hale, C. (1994). Resistance and contradiction: Miskitu Indians and the Nicaraguan State, 1894–1987. Stanford: Stanford University Press.Google Scholar
  19. Heath, G. R. (1913). Notes on Miskuto grammar and on other Indian languages of Eastern Nicaragua. American Anthropologist, 15(1), 48–62.CrossRefGoogle Scholar
  20. Helms, M. W. (1969). The purchase society: Adaptation to economic frontiers. Anthropological Quarterly, 42(4), 325–342.CrossRefGoogle Scholar
  21. Helms, M. W. (1971). Asang: Adaptations to culture contact in a Miskito community. Gainesville: University of Florida Press.Google Scholar
  22. Helms, M. W. (1977). Negro or Indian? The changing identity of a frontier population. In A. Pescatello (Ed.), Old roots in new lands: Historical and anthropological perspectives on black experiences in The Americas (pp. 157–172). Westport, CT: Greenwood Press.Google Scholar
  23. Helms, M. W. (1983). Miskito slaving and culture contact: Ethnicity and opportunity in an expanding population. Journal of Anthropological Research, 39, 179–197.CrossRefGoogle Scholar
  24. Herlihy, P. H. (1997). Indigenous peoples and biosphere reserve conservation in the Mosquitia rain forest corridor, Honduras. In S. Stevens (Ed.), Conservation through cultural survival (pp. 99–129). Washington: Island Press.Google Scholar
  25. Herlihy, L. H. (2002). The mermaid and the lobster diver: Gender and ethnic identities among the Río Plátano Miskito peoples. Doctoral dissertation, University of Kansas, Lawrence.Google Scholar
  26. Herlihy, L. H. (2006). Sexual magic and money: Miskitu women's strategies in northern Honduras. Ethnology, 45(2), 143–159.CrossRefGoogle Scholar
  27. Herlihy, L. H. (2007). Matrifocality and women's power on the Miskito Coast. Ethnology, 46(2), 133–149.Google Scholar
  28. Herlihy, L. H. (2012). The mermaid and the lobster diver: Gender, sexuality, and money on the Miskito Coast. Albuquerque, NM: UNM Press.Google Scholar
  29. Instituto Nacional de Estadisticas (INE). (2001). Censo de Población y Vivienda 2001. Tegucigalpa, Honduras: INE.Google Scholar
  30. Instituto Nacional de Estadisticas (INE). (2013). XVII Censo de Población y VI Vivienda. Tegucigalpa, Honduras: INE.Google Scholar
  31. Janes, C. R., & Chuluundorj, O. (2004). Free markets and dead mothers: The social ecology of maternal mortality in post-socialist Mongolia. Medical Anthropology Quarterly, 18(2), 230–257.CrossRefPubMedGoogle Scholar
  32. Jorge, M. (2013, April 23). Time for Honduras to end scuba diving for lobster. National Geographic Voices. Retrieved September 15, 2016 from
  33. Kandoi, A., Bhatia, B. D., Pandey, L. K., Pandey, S., Sen, P. C., & Satya, K. (1991). Cellular immunity status in anaemia in pregnancy. Indian Journal of Medical Research, 94, 11–14.PubMedGoogle Scholar
  34. Koblinsky, M. A. (1995). Beyond maternal mortality–magnitude, interrelationship, and consequences of women's health, pregnancy-related complications and nutritional status on pregnancy outcomes. International Journal of Gynaecology and Obstetrics, 48, S21–S32.CrossRefPubMedGoogle Scholar
  35. Lewis, M. P., Simons, G., & Fennig, C. D. (2016). Ethnologue: Languages of the world (19th ed.). Dallas, TX: SIL International. Retrieved from Google Scholar
  36. Llewellyn-Jones, D. (1965). Severe anaemia in pregnancy (as seen in Kuala-Lumpur, Malaysia). Australian and New Zealand Journal of Obstetrics and Gynaecology, 5(4), 191–197.CrossRefGoogle Scholar
  37. Locklear, T. D., Perez, A., Caceres, A., & Mahady, G. B. (2013). Women’s health in Central America: The complexity of issues and the need to focus on indigenous healthcare. Current Women's Health Reviews, 9(1), 30–40.CrossRefGoogle Scholar
  38. Mason, J. A. (1973). The native languages of Middle America. In C. L. Hay, R. Linton, S. Lothrop, H. Shapiro, & G. Valiant (Eds.), The Maya and their neighbors (pp. 52–87). New York: Cooper Square Publishers.Google Scholar
  39. McCarthy, J., & Maine, D. (1992). A framework for analyzing the determinants of maternal mortality. Studies in Family Planning, 23(1), 23–33.CrossRefPubMedGoogle Scholar
  40. McSweeney, K. (2004). The dugout canoe trade in Central America’s Mosquitia: Approaching rural livelihoods through systems of exchange. Annals of the Association of American Geographers, 94(3), 638–661.CrossRefGoogle Scholar
  41. Meléndez, J., Ochoa Vasquez, J. C., & Villanueva, Y. (1999). Investigación sobre mortalidad materna y de mujeres en edad reproductiva en Honduras: Informe final correspondiente al año 1997. Tegucigalpa, Honduras: Ministerio de Salud.Google Scholar
  42. Miller, S., Sloan, N. L., Winikoff, B., Langer, A., & Fikree, F. F. (2003). Where is the “E” in MCH? The need for an evidence-based approach in safe motherhood. Journal of Midwifery & Women's Health, 48(1), 10–18.CrossRefGoogle Scholar
  43. Montenegro, R. A., & Stephens, C. (2006). Indigenous health in Latin America and the Caribbean. The Lancet, 367(9525), 1859–1869.CrossRefGoogle Scholar
  44. Nietschmann, B. (1973). Between land and water: the subsistence ecology of the Miskito Indians, Eastern Nicaragua. New York, NY: Seminar Press.Google Scholar
  45. Offen, K. (1999). The Miskitu Kingdom. Landscape and the emergence of a Miskitu ethnic identity, Northeastern Nicaragua and Honduras, 1600–1800. Ph.D. dissertation, Department of Geography, University of Texas.Google Scholar
  46. PAHO. (2004). Maternal and child mortality among the indigenous peoples of the Americas. Bulletin of Indigenous Health, 1, 1–3.Google Scholar
  47. Paxton, A., Maine, D., Freedman, L., Fry, D., & Lobis, S. (2005). The evidence for emergency obstetric care. International Journal of Gynaecology and Obstetrics, 88(2), 181–193.CrossRefPubMedGoogle Scholar
  48. Prevention of Maternal Mortality Network (PMMN). (1992). Barriers to treatment of obstetric emergencies in rural communities of West Africa. Studies in Family Planning, 23(5), 279–291.CrossRefGoogle Scholar
  49. Razzak, J. A., & Kellermann, A. L. (2002). Emergency medical care in developing countries: Is it worthwhile? Bulletin of the World Health Organization, 80(11), 900–905.PubMedPubMedCentralGoogle Scholar
  50. Roth, D. M., & Mbizvo, M. T. (2001). Promoting safe motherhood in the community: The case for strategies that include men. African Journal of Reproductive Health, 5(2), 10–21.CrossRefPubMedGoogle Scholar
  51. Schwartz, D. A. (2013). Challenges in improvement of perinatal health in developing nations—Role of perinatal pathology. Archives of Pathology & Laboratory Medicine, 137(6), 742–746.CrossRefGoogle Scholar
  52. Shahidullah, M. (1995). A comparison of sisterhood information on causes of maternal death with the registration causes of maternal death in Matlab, Bangladesh. International Journal of Epidemiology, 24(5), 937–942.CrossRefPubMedGoogle Scholar
  53. Shiffman, J., Stanton, C., & Salazar, A. P. (2004). The emergence of political priority for safe motherhood in Honduras. Health Policy and Planning, 19(6), 380–390.CrossRefPubMedGoogle Scholar
  54. Thaddeus, S., & Maine, D. (1994). Too far to walk: Maternal mortality in context. Social Science & Medicine, 38(8), 1091–1110.CrossRefGoogle Scholar
  55. United Nations Development Programme (UNDP). (2003). Desarrollo humano y capital social en Gracias a Dios: La necesidad de una perspectiva multicultural. In UNDP (Ed.), Informe sobre desarrollo humano: Honduras (pp. 101–133). Tegucigalpa, Honduras: PNUD.Google Scholar
  56. Valeggia, C. R., & Snodgrass, J. J. (2015). Health of indigenous peoples. Annual Review of Anthropology, 44, 117–135.CrossRefGoogle Scholar
  57. Wall, L. L. (1998). Dead mothers and injured wives: The social context of maternal morbidity and mortality among the Hausa of northern Nigeria. Studies in Family Planning, 29(4), 341–359.CrossRefPubMedGoogle Scholar
  58. WHO. (2005). The World Health Organization Annual Report for 2005. Make every mother and child count. Geneva: World Health Organization.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Sociology and AnthropologyUniversity of ToledoToledoUSA

Personalised recommendations