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Maternal Care in Guatemala: Problematizing Discourses of Development, Transnational Advocacy, and Indigeneity

  • Briana Nichols
  • Lisette Farias
Chapter
Part of the Global Maternal and Child Health book series (GMCH)

Abstract

This chapter focuses on the impact of development discourses of biomedical care and transnational approaches to maternal pregnancy-related care among the indigenous Maya of Guatemala. Despite efforts by the Guatemalan government and collaboration with international advocates, indigenous Maya maternal mortality rates remain a significant concern. Approaches to reducing maternal mortality have been supported by both international and national initiatives focused on “safe motherhood,” and often involve a complex assemblage of caregivers who span both state run and nongovernmental organization (NGO)-based programming. The structures of care are incredibly complicated to navigate, often forcing women and their families to incur hidden costs associated with transportation, medication, and supplies. They serve to reproduce discourses that place indigenous practices in contrast with “modernity,” and ultimately neglect the critical social role of successful home birth for Mayan women. This chapter argues that discourses of development naturalizing childbirth in Western medical settings positions indigenous birthing practices as immoral and uninformed, and obscures the larger structural issues Mayan women and communities face. Constructing Mayan women as not only uniformed but also immoral does not serve the goal of reducing maternal mortality or morbidity.

Keywords

Indigenous women Maternal health Poverty Home birth Guatemala Ladino Discrimination Indigenous pregnancy Maya Reproductive health Violence Maternal mortality Reproductive health Traditional midwife Comadrona Structural barrier Health services Education Training Birthing practice Infant morbidity Maternal morbidity 

References

  1. Angus, J., Lombardo, A., Lowndes, R., Cechetto, N., Ahmad, F., & Bierman, A. (2013). Beyond barriers in studying disparities in women’s access to health services in Ontario, Canada: A qualitative metasynthesis. Qualitative Health Research, 23(4), 476–494.  https://doi.org/10.1177/1049732312469464 CrossRefPubMedGoogle Scholar
  2. Avila, C., Bright, R., Gutierrez, J. C., Hoadley, K., Manuel, C., Romero, N., et al. (2015). Guatemala health system assessment. Bethesda, MD: Health Finance & Governance Project, Abt Associates.Google Scholar
  3. Becerril-Montekio, V., & Lopez-Davila, L. (2011). [The health system of Guatemala]. Salud Publica Mex, 53(Suppl 2), s197–208.Google Scholar
  4. Berry, N. S. (2005). Incorporating cultural diversity into health systems: An example of midwives teaching midwives. East Lansing: Women and International Development, Michigan State University.Google Scholar
  5. Berry, N. S. (2006). Kaqchikel midwives, homebirths, and emergency obstetric referrals in Guatemala: Contextualizing the choice to stay at home. Social Science & Medicine, 62, 1958–1969.CrossRefGoogle Scholar
  6. Berry, N. S. (2010). Unsafe motherhood: Mayan maternal mortality and subjectivity in post-war Guatemala. New York: Berghahn Books.Google Scholar
  7. Bhaskar, R. (2011). Reclaiming reality: A critical introduction to contemporary philosophy. London, England: Routledge.Google Scholar
  8. Bossert, T., Bowser, D., Amenyah, J., Copeland, R., & GETSA. (2003). Decentralization and integration in the health logistic system in Guatemala. Final report. Boston: Harvard School of Public Health. Arlington, VA: JSI/DELIVER, for USAID.Google Scholar
  9. Chary, A., Díaz, A. K., Henderson, B., & Rohloff, P. (2013). The changing role of indigenous lay midwives in Guatemala: New frameworks for analysis. Midwifery, 29(8), 852–858.CrossRefPubMedGoogle Scholar
  10. Cosminsky, S. (1982). Knowledge and body concepts of Guatemalan midwives. In M. Kay (Ed.), Anthropology of human birth (pp. 233–252). Philadelphia: F.A. Davis.Google Scholar
  11. Cosminsky, S. (2001). Maya midwives of southern Mexico and Guatemala. In B. R. Huber & A. R. Sandstrom (Eds.), Mesoamerican healers (pp. 179–210). Austin: University of Texas Press.Google Scholar
  12. Cosminsky, S. (2012). Birth and blame: Guatemalan Midwives and reproductive risk. In L. Fordyce & A. Maraesa (Eds.), Risk, reproduction, and narratives of experience (pp. 81–101). Nashville, TN: Vanderbilt University Press.Google Scholar
  13. Gibson, B. E. (2016). Rehabilitation: A post-critical approach. Boca Raton, FL: Taylor & Francis.CrossRefGoogle Scholar
  14. Glei, D. A., & Goldman, N. (2000). Understanding ethnic variation in pregnancy-related care in rural Guatemala. Ethnicity and Health, 5(1), 5–22.CrossRefPubMedGoogle Scholar
  15. Glei, D. A., Goldman, N., & Rodrı́guez, G. (2003). Utilization of care during pregnancy in rural Guatemala: Does obstetrical need matter? Social Science & Medicine, 57(12), 2447–2463.CrossRefGoogle Scholar
  16. Goldman, N., Glei, D., Pebley, A., & Delgado, H. (2001). Atención Prenatal en Áreas Rurales de Cuatro Departamentos de Guatemala: Resultados de la Encuesta Guatemalteca de Salud Familiar, 1995. Guatemala City: Instituto de Nutrición de Centro América y Panamá.Google Scholar
  17. Gragnolati, M., & Marini, A. (2003). Health and poverty in Guatemala. Policy Research Working Paper 2966. The World Bank—GUAPA 1. Retrieved from https://www.researchgate.net/publication/23549513_Health_and_Poverty_in_Guatemala CrossRefGoogle Scholar
  18. Hallowell, E. (2014). “Between the wall and the sword”: Reproductive governance and the technology of emergency in Guatemalan maternity care. Feminist Formations, 26(3), 100–121.CrossRefGoogle Scholar
  19. Hammell, K. W. (2006). Perspectives on disability & rehabilitation: Contesting assumptions, challenging practice. Amsterdam: Elsevier Health Sciences.Google Scholar
  20. Harvey, D. (2007). A brief history of neoliberalism. Oxford, UK: Oxford University Press.Google Scholar
  21. Hernández, A. R., Hurtig, A.-K., Dahlblom, K., & San Sebastián, M. (2014). More than a checklist: A realist evaluation of supervision of mid-level health workers in rural Guatemala. BMC Health Services Research, 14(1), 112.  https://doi.org/10.1186/1472-6963-14-11 CrossRefPubMedPubMedCentralGoogle Scholar
  22. Ishida, K., Stupp, P., Turcios-Ruiz, R., William, D. B., & Espinoza, E. (2012). Ethnic inequality in Guatemalan women’s use of modern reproductive health care. International Perspectives on Sexual and Reproductive Health, 38(2), 99–108.CrossRefPubMedGoogle Scholar
  23. McAllister, C., & Nelson, D. M. (Eds.). (2013). War by other means: Aftermath in post-genocide Guatemala. Durham, NC: Duke University Press.Google Scholar
  24. Metz, B. (2001). Politics, population, and family planning in Guatemala: Ch’orti’Maya experiences. Human Organization, 60(3), 259–271.CrossRefGoogle Scholar
  25. Nelson, D. M. (2009). Reckoning: The ends of war in Guatemala. Durham, NC: Duke University Press.CrossRefGoogle Scholar
  26. PAHO (Pan American Health Organization). (2007). Health in the Americas: Guatemala. Retrieved from http://ais.paho.org/hia_cp/en/2007/Guatemala%20English.pdf
  27. PAHO (Pan American Health Organization). (2012). Health in the Americas: Guatemala. Retrieved from http://www.paho.org/saludenlasamericas/index.php?option=com_docman&task=doc_view&gid=132&Itemid=
  28. Pena, C. L. (2013). Guatemala—Improving access to health care services through the expansion of coverage program (PEC): The case of Guatemala. Universal Health Coverage (UNICO) studies series; no. 19. Washington, DC: World Bank. Retrieved from http://documents.worldbank.org/curated/en/967411468039876158/Guatemala-Improving-Access-to-Health-Care-Services-through-the-Expansion-of-Coverage-Program-PEC-The-Case-of-Guatemala
  29. Rööst, M., Johnsdotter, S., Liljestrand, J., & Essén, B. (2004). A qualitative study of conceptions and attitudes regarding maternal mortality among traditional birth attendants in rural Guatemala. BJOG: An International Journal of Obstetrics & Gynaecology, 111(12), 1372–1377.CrossRefGoogle Scholar
  30. Ruiz, M. J., van Dijk, M. G., Berdichevsky, K., Munguía, A., Burks, C., & García, S. G. (2013). Barriers to the use of maternity waiting homes in indigenous regions of Guatemala: A study of users’ and community members’ perceptions. Culture, Health & Sexuality, 15(2), 205–218.CrossRefGoogle Scholar
  31. Sanford, V. (2003). Buried secrets: Truth and human rights in Guatemala. Berlin: Springer.CrossRefGoogle Scholar
  32. Santiso-Galvez, R., & Bertrand, J. T. (2004). The delayed contraceptive revolution in Guatemala. Human Organization, 63(1), 57–67.CrossRefGoogle Scholar
  33. Shiffman, J. (2007). Generating political priority for maternal mortality reduction in 5 developing countries. American Journal of Public Health, 97(5), 796–803.CrossRefPubMedPubMedCentralGoogle Scholar
  34. Shiffman, J., & Garcés del Valle, A. L. (2006). Political history and disparities in safe motherhood between Guatemala and Honduras. Population and Development Review, 32(1), 53–80.CrossRefGoogle Scholar
  35. Sibley, L., Sipe, T. A., & Koblinsky, M. (2004). Does traditional birth attendant training improve referral of women with obstetric complications: a review of the evidence. Social Science & Medicine, 59(8), 1757–1768.CrossRefGoogle Scholar
  36. UNICEF. (2015). The state of the world’s children 2015 country statistical tables. Guatemala. Retrieved from http://www.unicef.org/infobycountry/guatemala_statistics.html
  37. Walsh, L. V. (2006). Beliefs and rituals in traditional birth attendant practice in Guatemala. Journal of Transcultural Nursing, 17(2), 148–154.CrossRefPubMedGoogle Scholar
  38. World Bank. (2003). Poverty in Guatemala. Washington, DC: World Bank.CrossRefGoogle Scholar
  39. World Bank. (2009). Guatemala—Poverty assessment: Good performance at low levels. Washington, DC: World Bank. Retrieved from http://documents.worldbank.org/curated/en/803331468254934801/Guatemala-Poverty-assessment-good-performance-at-low-levels Google Scholar
  40. Wright, E. O. (2010). Envisioning real utopias. London, England: Verso.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of AnthropologyUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Graduate Program of Health and Rehabilitation SciencesWestern UniversityLondonCanada

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