Abstract
This chapter offers an overview of obstetric choice in Guatemala analyzed from an anthropological and biomedical point of view. It presents recent statistics related to maternal healthcare, especially the use of healthcare facilities and consultation with skilled medical attendants, and aims to explain, both from a biomedical and public health and an anthropological point of view, the trends in utilization of hospital- or clinic-based services versus the use of services provided by midwives in the past decades. It presents an analysis of family, community, and country level factors that influence obstetric choice and impact maternal health outcomes.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsNotes
- 1.
An ecological approach or paradigm views individuals as part of a wider social context that influences their behavior and perceptions. Context includes family and peer groups and other spaces where individuals interact such as school, the workplace, church, public institutions, etc. This analytical approach requires that all elements mentioned above are considered when assessing an issue (Schensul and LeCompte 1999).
- 2.
Maternal death is defined as the death of a woman while she is pregnant or within the 42 days following the conclusion of the pregnancy, independently of its duration and state of the pregnancy, due to any cause related or worsened by the pregnancy or its care, excluding accidents or incidentals (OPS 1995, p. 139).
- 3.
The neonatal period begins at birth and ends 28 days after birth (OPS 1995, p. 136).
- 4.
Many other indicators continue to be a cause of concern. However, for the purposes of highlighting issues associated with obstetric choice, this chapter will focus on the three more closely associated to the topic: maternal and neonatal mortality and access to reproductive health services.
- 5.
According to Guatemala’s public health policies, “skilled birth attendants” include medical doctors and nurses (MSPAS et al. 2017). The terminology used to refer to midwives is more confusing because the ministry of health sometimes refers to “trained midwives” to identify “traditional” birth attendants that have received some form of training on public health standards. Because these standards have changed and been redefined and challenged over time, it is difficult to establish what “trained” means today and how midwives’ roles differ from those of other health extension workers trained in the different iterations of expansion of coverage plans. Additionally, the term “traditional” masks the heterogeneity found among Maya and Ladino midwives. For the purpose of this study, the term “lay midwife” will be used to refer to them, following King et al. (2015), p. 126, 141 recommendation.
- 6.
Auxiliary nurses have a secondary education level and have received 1 year of training as nurses (MSPAS et al. 2017, p. 3).
- 7.
PASMO is an NGO dedicated to social marketing of HIV prevention and FP products and services.
References
ACCESA. (2015). El acceso universal a la salud, algunos elementos para la discusión. Guatemala: Serviprensa. Retrieved from http://icefi.org/sites/default/files/el_acceso_universal_a_la_salud.pdf.
Adams, W. R., & Hawkins, J. P. (2007). Health care in Maya Guatemala: Confronting medical pluralism in a developing country. Norman, OK: University Oklahoma Press.
Ávila, C., Bright, R., Gutiérrez, J. C., Hoadley, K., Manuel, C., & Romero, N. (2015). Guatemala, Análisis del Sistema de Salud 2015. Bethesda, MD: Proyecto Health Finance and Governance, Abt Associates Inc..
Becerril-Montekio, V., & López-Dávila, L. (2011). Sistema de Salud en Guatemala. Salud Pública de México, 53(2), S197–S208.
Berry, N. S. (2008). Who’s judging the quality of care? Indigenous Maya and the problem of “not being attended.”. Medical Anthropology, 27(2), 164–189. https://doi.org/10.1080/01459740802017413.
Berry, N. S. (2010). Unsafe motherhood. Mayan maternal mortality and subjectivity in post-war Guatemala. New York, NY: Berghahn Books.
Bruce, J. (2016). The difficulties of “living while girl”. Journal of Virus Eradication, 2(3), 177–182.
Cazali Avila, A. (2002). Los militares en el poder: el gobierno de Carlos Arana Osorio. Universidad San Carlos de Guatemala, Dirección General de Investigación. Guatemala: Universidad San Carlos de Guatemala.
Cecchini, S., & Azócar, I. (2007). Indicadores de los Objetivos de Desarrollo del Milenio en América Latina y el Caribe: una comparación entre datosnacionales e internacionales. Santiago de Chile: CEPAL/ONU.
Cerón, A., Ruano, A. L., Sánchez, S., Chew, A. S., Díaz, D., Hernández, A., et al. (2016). Abuse and discrimination towards indigenous people in public health care facilities: Experiences from rural Guatemala. International Journal for Equity in Health, 15(1), 77. https://doi.org/10.1186/s12939-016-0367-z
Chary, A., & Rohloff, P. (2015). Privatization and the new medical pluralism. Lanham, MD: Lexington Books.
Cosminsky, S. (2016). Midwives and mothers. The medicalization of childbirth on a Guatemalan plantation. Austin, TX: University of Texas Press.
Davis-Floyd, R., Sergant, C. (1996). Introduction: The social production of authoritative knowledge in pregnancy and childbirth. Medical Anthropology Quarterly, 10(2), 111–120. Retrieved September 4, 2016, from http://www.jstor.org/stable/649323.
Fuentes, J. A., Balsells, E., & Arriola, G. (2003). Guatemala: Human development progress towards the MDGs at the sub National Level. United Nations development programme. Guatemala: UNDP.
Garces, A., Mcclure, E. M., Hambidge, K., Krebs, N. F., Figueroa, L., Aguilar, M., et al. (2015). Trends in perinatal deaths from 2010 to 2013 in the Guatemalan Western Highlands. Reproductive Health, 12(Suppl 2), S14. https://doi.org/10.1186/1742-4755-12-S2-S14
Gabrysch, S., & Campbell, O. M. (2009). Still too far to walk: Literature review of the determinants of delivery service use. BMC Pregnancy and Childbirth, 9(1), 34. https://doi.org/10.1186/1471-2393-9-34.
Ginsburg, F., & Rapp, R. (1991). The politics of reproduction. Annual Review of Anthropology, 20, 311–343.
Hemmings, J., Nieto-Andrade, B., Rivas, J. R., & Longfield, K. (2007). Bajo el poncho-Pillow talk: Relationships and sexuality among indigenous peoples in Guatemala. Results from a PEER/FoQus study. Guatemala: Options Consultancy Services Ltd and PASMO Guatemala.
ICEFI. (2012). ¡Quiero crecer con mamá! Boletín Contamos (9), ICEFI, Guatemala.
ICEFI, UNICEF. (2016). Pobreza multidimencional infantil y adolescente en Guatemala: privaciones a superar. Guatemala: ICEFI.
Kayayan, V. (2017). Principales idiomas mesoamericanos hablados hasta el siglo XXI. Proyecto Mesoamérica (poner aquí el nombre oficial del proyecto). Population Council, Guatemala [not yet published].
King, N., Chary, A., & Rohloff, P. (2015). Leveraging resources in contemporary Maya midwifery. In A. Chary & P. Rohloff (Eds.), Privatization and the new medical pluralism (pp. 125–141). Lanham, MD: Lexington Books.
Prensa Libre. (2015, November 11). El entonces resplandeciente Hospital Roosevelt. Prensa Libre.
Ministerio de Salud Pública y Asistencia Social (MSPAS). (2010). Encuesta Nacional de Salud Materno Infantil 2008 (ENSMI-2008/09). Ministerio de Salud Pública y Asistencia Social (MSPAS)/Instituto Nacional de Estadística (INE)/Centros de Control y Prevención de Enfermedades (CDC). Guatemala.
Ministerio de Salud Pública y Asistencia Social (MSPAS). (2012a). Diagnóstico Nacional de Salud. Guatemala: MSPAS.
Ministerio de Salud Pública y Asistencia Social (MSPAS). (2012b). Normas con Pertinencia Cultural. Guatemala: MSPAS.
Ministerio de Salud Pública y Asistencia Social (MSPAS). (2015). Situación de la mortalidad materna: informe de país 2013. Retrieved from http://www.osarguatemala.org/Archivos/PDF/201510/255_3.pdf.
Ministerio de Salud Pública y Asistencia Social (MSPAS). (2017). Ministerio de Salud Pública y Asistencia Social. Retrieved January 29, 2017, from http://www.mspas.gob.gt/index.php/institucional/acerca-del-mspas.
Ministerio de Salud Pública y Asistencia Social (MSPAS), Instituto Nacional de Estadística (INE), & Segelpán. (2017). VI Encuesta nacional de salud materno infantil 2014–2015. Informe final. Guatemala: MSPAS INE ICF.
Mosquera, M. T., Paredes Marín, V. H. (2008). Legislación de la medicina alternativa en Guatemala. Criterios de “validez” y “cientificidad” desde la perspectiva de los grupos étnicos en Guatemala. Universidad de San Carlos de Guatemala, Dirección General de Investigación, Instituto de Estudios Interétnicos, Programa de Investigación: Cultura, Pensamiento y Sociedad Guatemalteca, Guatemala. Obtenido de Retrieved from http://digi.usac.edu.gt/bvirtual/informes/cultura/INF-2008-052.pdf.
Mosquera Saravia, M. T. (2006). Lógicas y racionalidades: entre comadronas y terapeutas traditionales. Guatemala: IDEI-USAC Serviprensa S.A.
Pan American Health Organization (OPS). (1995). Clasificación estadística internacional de enfermedades y problemas relacionados con la salud. Washington, DC: OPS.
Pan American Health Organization (OPS) (2007, February). Health systems profile Guatemala, 2007 (3rd ed.). Washington, DC: PAHO Retrievied from http://new.paho.org/hq/dmdocuments/2010/Health_System_Profile-Guatemala_2007.pdf.
Paul, L. (1975). Recruitment to a ritual role: The midwife in a Maya community. Ethos, 3(3), 449–467.
Paul, L., & Paul, B. D. (1975). The Maya midwife as sacred specialist: A Guatemalan case. American Ethnologist, 2(4), 707–726.
Pebley, A. R., Goldman, N., & Germán, R. (1996). Prenatal and delivery care and childhood immunization in Guatemala: Do family and community matter? Demography, 33(2), 231–247.
Population Council. (2010a). Mejora de la salud materna de mujeres indígenas y garífunas a través de políticas públicas con enfoque de derechos e interculturalidad. Guatemala: Population Council.
Population Council. (2010b). Guatemala rising one girl at a time: Findings from the 2009–2010 evaluation. Guatemala: Population Council.
Rolhoff, P., & Chary, A. (2015). Introduction. In A. Chary & P. Rolhoff (Eds.), Privatization and the new medical pluralism (pp. xiii–xxxi). Lanham, MD: Lexington Books.
PRRAC 2004 (Proyecto Salud). (2004). Informe de Avances. Preparado por: Alejandra Colom. Guatemala, Guatemala.
Sacayon Sapón, C. A. (2015). Condiciones de ingreso de pacientes referidas por comadronas. Tesis Presentada ante las autoridades de la Escuela de Estudios de Postgrado de la Facultad de Ciencias Médicas Maestría en Ciencias Médicas con Especialidad en Ginecología y Obstetricia.
Schensul, J. J., & LeCompte, M. D. (1999). Ethnographer’s toolkit. Walnut Creek, CA: Altamira Press.
Segeplan. (2015). Informe final de cumplimiento de los Objetivos de Desarrollo del Milenio. Guatemala: Segeplan.
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.
Solien de Gonzalez, N. (1963). Some aspects of child-bearing and child-rearing in a Guatemalan Ladino community. Southwestern Journal of Anthropology, 19(4), 411–423.
Wikisource. (1996). Acuerdo sobre Aspectos Socieconómicos y Situación Agraria. Guatemala. Retrieved from https://es.wikisource.org/wiki/Acuerdo_sobre_aspectos_socioecon%C3%B3micos_y_situaci%C3%B3n_agraria.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
Colom, A., Colom, M. (2018). Poverty, Local Perceptions, and Access to Services: Understanding Obstetric Choices for Rural and Indigenous Women in Guatemala in the Twenty-First Century. 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_32
Download citation
DOI: https://doi.org/10.1007/978-3-319-71538-4_32
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-71537-7
Online ISBN: 978-3-319-71538-4
eBook Packages: MedicineMedicine (R0)