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Maternal Death and Pregnancy-Related Morbidity Among Indigenous Women of Mexico and Central America pp 483–511Cite as

Approaching Maternal Health from a Decolonized, Systemic, and Culturally Safe Approach: Case Study of the Mayan-Indigenous Populations of Guatemala

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Part of the book series: Global Maternal and Child Health ((GMCH))

Abstract

The Mayan-indigenous populations of Guatemala face some of the worst maternal and child health outcomes worldwide. Despite repeated assertions that reducing inequity and reaching indigenous populations is a top government priority, and despite overall reductions in maternal mortality in Guatemala, maternal mortality ratios (MMRs) remain very high in local populations, especially those living in poor, marginalized, and indigenous regions. Historical exclusion and discrimination of the Mayan populations and their sociocultural divergence from the dominant population make them an especially easy target for neglect. They are rarely consulted in decision-making processes relating to their health, and health facilities are rarely adapted to their sociocultural realities and needs. In this chapter, we explore the nature and significance of factors relating to maternal health among the Mayan populations of Guatemala. In particular, we highlight the sociocultural divide that exists in Guatemala, and the systemic failure of the formal health system to provide a culturally safe environment for indigenous women during pregnancy and childbirth. We aim to provide a framework to contextualize and improve our understanding of the root causes of maternal health inequity, and of preventable morbidity and mortality of indigenous women, looking beyond the more often faulted logistical barriers. The Mayan example clearly illustrates the importance of transcending the hegemonic biomedical health model as the only way to achieving health, emphasizing the need for maternal health to be deliberately approached from an inclusive, integral, and multidimensional understanding of health and well-being—one that recognizes the existence of diverse perceptions, concepts, knowledge, and practices.

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Notes

  1. 1.

    The official figure of 41% (INE 2012) is heavily contested and most experts agree with a prevalence closer to 60% (Montenegro and Stephens 2006; IWGIA 2017).

  2. 2.

    Of note, this health worker density is only about one-half of the 22.8 per 10,000 population ratio that the WHO recommends as the minimum for a functioning health system, and much lower than the estimated 59.4 per 10,000 required to reduce maternal deaths to less than 50 per 100,000 live births (Campbell et al. 2013).

  3. 3.

    A cosmovision refers to how a culture perceives, interprets, and explains the world. It is a collection of presumptions and assumptions (i.e., ideas, symbols, myths, religion) that a group sustains, practices, and maintains on the world and how it was, is, and will be (Macleod 2013).

  4. 4.

    Where not otherwise indicated, personal communications are from our respective experiences working with indigenous populations in Guatemala, and are from a variety of sources over a significant range of time up to the present.

  5. 5.

    Mayan women’s preference for a vertical birth is not unfounded. The choice of labor and birth positions plays a critical role in a mother’s comfort level during birth and how quickly and effectively her labor progresses. Research has shown that vertical positions increase both the force of gravity and the diameter of the pelvic outlet, facilitating the baby’s descent through the mother’s pelvis, and are associated with reduced back pain, reduced pain during pushing, fewer perineal tears and need for episiotomies, and overall easier pushing (Gardosi et al. 1989; Roberts et al. 2005; De Jonge et al. 2004). Furthermore, the risk of fetal distress is reduced by avoiding compromising major blood vessels and interfering with fetal oxygenation (Humphrey et al. 1973). Finally, most women feel that they have more strength and force in a vertical position, and greater control over the birth process.

  6. 6.

    Monocultural health systems are based on a concept of society being homogeneous, and privileging the dominant national culture over all other cultures, without the systematic participation or consultation of indigenous communities. Health issues that are determined by gender, socioeconomic class, or ethnicity may not be recognized, and training of health practitioners is based on a biotechnological approach that ignores the contributions of indigenous cultures and does not prepare them to work in multiethnic contexts (Cunningham 2009).

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Acknowledgements

The authors would like to thank the many women, midwives, and other individuals and institutions that shared their experiences, personal stories, and ancestral knowledge over the years, and greatly informed the writing of this chapter and the points of view expressed. We extend a special acknowledgment to the women of Buena Semilla, to the midwives of the Asociación de Comadronas del Área Mam (ACAM) and to the Instituto de Salud Incluyente. We would also like to thank Dr. Lucy Manchester and Health Policy Initiatives whose invaluable research provided several of the quotes that were used to illustrate women’s experiences. Last but not least, we wish to thank our editor, Dr. David Schwartz, for inviting us to contribute to this important book.

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Authors and Affiliations

  1. CIET international Guatemala (Community Information and Epidemiological Technologies), Guatemala City, Guatemala

    Anne Marie Chomat M.D., Ph.D., M.P.H.

  2. Participatory Research at McGill (PRAM), Department of Family Medicine, McGill University, Montreal, QC, Canada

    Anne Marie Chomat M.D., Ph.D., M.P.H.

  3. Asociación de Comadronas del Área Mam (ACAM), Concepcion Chiquirichapa, Guatemala

    Bry Kring B.A.

  4. CIET international Guatemala (Community Information and Epidemiological Technologies), Guatemala City, Guatemala

    Luis Paiz Bekker M.D., M.T.M.

Authors
  1. Anne Marie Chomat M.D., Ph.D., M.P.H.
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  2. Bry Kring B.A.
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  3. Luis Paiz Bekker M.D., M.T.M.
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Editors and Affiliations

  1. Medical College of Georgia, Augusta University, Augusta, Georgia, USA

    David A. Schwartz

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Chomat, A.M., Kring, B., Bekker, L.P. (2018). Approaching Maternal Health from a Decolonized, Systemic, and Culturally Safe Approach: Case Study of the Mayan-Indigenous Populations of Guatemala. In: Schwartz, D. (eds) Maternal Death and Pregnancy-Related Morbidity Among Indigenous Women of Mexico and Central America. Global Maternal and Child Health. Springer, Cham. https://doi.org/10.1007/978-3-319-71538-4_25

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  • DOI: https://doi.org/10.1007/978-3-319-71538-4_25

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