Midwives Tapped to Reduce Maternal Mortality Rates in Guatemala

Most indigenous women seek the assistance of a midwife during their pregnancy and the Guatemalan government has tapped these women to help reduce maternal mortality rates. The midwives, called comadronas locally, employ ancestral practices from Mayan cultures. Government workshops, which aim to help comadronas learn things such as detecting complications, are part of a global effort to improve the health of pregnant women.

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Midwives Tapped to Reduce Maternal Mortality Rates in Guatemala

Brenda Leticia Saloj Chiyal, GPJ Guatemala

“Comadrona,” the term for a midwife in Guatemala, meet every month at the Health Center in Sololá municipality to receive training on best delivery and maternity care practices.

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SOLOLÁ, GUATEMALA – Light beams through a yellow sheet covering a bedroom window. Inside, Santa Morales walks to the side of the bed where a woman stares up at her, pregnant belly exposed.

Morales, 58, rubs the woman’s stomach, her freshly oiled hands moving up and down in calculated strokes. Morales’s entire body, even the long black braids that drape her back, moves with her hands.

In 2000, the United Nations established the Millennium Development Goals (MDG), which gives specific targets for countries to improve conditions in their country in eight areas, including poverty levels, health access and universal primary education by 2015. One goal called for a 75 percent global reduction in maternal mortality rates. Guatemala has made progress in reaching that goal.

García says cultural trust influences local women’s preferences for comadronas.

In a neighboring community, an estimated 63 percent of women who participated in a study gave birth outside of healthcare facilities, mostly at home, according to research published in 2014 by the Bulletin of the World Health Organization. Sixty-two percent delivered in the presence of a traditional birth attendant.

Since there is no official register of midwives, it is impossible to know exactly how many there are in the region, says Carmen Alvarado, an educator specializing in maternal health who organizes the workshops.

In line with the MDG targets, Guatemala had committed to reducing the number of maternal deaths for every 100,000 live births from 219 to 55, according to Guatemala’s Reproductive Health Observatory. However, Guatemala would likely not reach that goal until 2028, not 2015, according to the Guatemalan government’s Third Report on the MDG, published in 2010.

Guatemala did not meet its MDG target for reducing maternal mortality, but it did reach a threshold required for inclusion in Countdown to 2015, a multi-disciplinary collaboration that tracked 75 country’s progress in the areas of child mortality and maternal mortality. Guatemala was down to 140 maternal deaths per 100,000 live births in 2013, according to Countdown.

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Brenda Leticia Saloj Chiyal, GPJ Guatemala

Santa Morales, a comadrona in Sololá, attends to a woman in Morales’ home. Morales is one of more than 40 women who participate in the government training programs.

Integrating training for comadronas over the last two years is part of the country’s overall strategy to reduce maternal mortality and meet the target, García says.

“The job of a midwife is not taught, nor can be easily learned, rather it is a special gift that is carried in the veins, in the blood,” she says.

“Life does not give you the doctor, nor the hospital, nor a nurse,” she says. “Rather life is a gift from the one above, the supreme being. Everything I do with my patients has a lot to do with each woman’s life. It depends on the way one behaves, that will be the way of giving birth.”

The comadrona also dedicates a great part of her time to advising women on specific pregnancy issues, as well as issues of general behavior.

Midwives charge approximately 2,500 quetzales ($328) for all the care, including sobadas, temascal baths and childbirth, Morales says.

More than half of the population in Guatemala lives under the poverty line. This means that much of the population can’t buy the contents of a hypothetical food basket commonly used by economists to determine cost of living. That basket, as of October 2015, was 3,508 quetzales ($461) a month for a family of 5.38.

With the comadronas, it’s something difficult to cut the routines they make. They are strong, and those who give the talks should be careful with what they say. Because the comadronas know a lot because they have experience.

Morales, however, says she believes the government trainings are a positive initiative to help reach the MDG targets. It’s good, she says, that the government is concerned about maternal deaths in Sololá.

Ana Saloj gave birth in September. During her pregnancy, Saloj visited Morales whenever she had concerns, such as if there were potential complications with the baby’s position. Morales adjusted the baby, says Saloj, adding that she believes Morales has a divine gift.

“The gift is given by God and she must be respected as she should be, with values and principles,” she says.

Saloj preferred to be assisted by Morales rather than going to a hospital, because she felt it was consistent with her Mayan culture.

“For me, well, neither the hospital is necessary, nor the physician,” she says. “A great comadrona is in our community.”

Morales wants to help other women learn to be midwives.

“I am an unselfish person and I wish these ladies who start with their work can learn with me, because the experience is worth more than someone only explaining things to you,” she says. “I may not know many great and scientific things, but I do what I do with the will to do well for others.”

Morales believes Guatemala can continue to reduce maternal mortality if local comadronas do their part.

“It can work if the comadrona women intend to attend the talks as many times as necessary,” she says. “With the comadronas, it’s something difficult to cut the routines they make. They are strong, and those who give the talks should be careful with what they say because the comadronas know a lot because they have experience.”


Ana Saloj is not related to GPJ reporter Brenda Leticia Saloj Chiyal.