Recipient Aisling Walsh was supported to examine maternal mortality rates in Guatemala, a country with some of the highest rates in Latin America. She examined the risks facing women who cannot access services and potential solutions to the crisis. In this blog, she offers further insight into her project. To view a gallery of photography from Aisling’s project, click here.
Almost as soon as I moved to Guatemala five years ago the world of pregnancy, birth and maternal health care became a central focus of my life in this tiny Central American republic. During my first year I trained to be a doula and began accompanying women, both friends and strangers, through pregnancy and birth, in public and private hospitals and alongside midwives and obstetricians.
I was so inspired that I put a halt to my fledgling career in the development sector to explore the possibilities of becoming a midwife. I saw it as a practical, hands-on way of advocating for greater rights and greater choice for women in all aspects of pregnancy and birth. Six months in to my three year technical diploma in midwifery in Guatemala City, I realised that as much as much as these processes fascinated me, my real passion was actually for writing. I did another about turn and decided to focus on journalism rather than midwifery.
When my colleague Naomi Elster and I were notified last December that we had been awarded a Simon Cumbers Media Fund grant to report on access to maternal health care in Guatemala, I was delighted I would finally be able to unite my dual passions for writing and accompanying women through pregnancy and birth. As I round up 10 days of traveling around Guatemala and interviewing gynaecologists, traditional and professional midwives, activists, politicians, women’s human rights defenders, spiritual guides, and other health care practitioners all playing their part to improve maternal health outcomes in Guatemala, I feel like I came full circle.
With a minimum of two interviews per day over almost ten days, it is hard to summarise in one short blog all that we saw and learned. Guatemala faces a diversity of challenges in terms of improving maternal health care and meeting the Sustainable Development Goal of reducing the maternal mortality ratio (MMR) to less than 70 per 100,000 live births. While Guatemala’s national ratio (88) appears close to meeting this goal, the MMR among indigenous women is almost twice as high with three times greater at 138 per 100,000 live births. In fact, indigenous women represent 68.4% of all maternal deaths.
The people we spoke to commented on the a lack of funding for essential public health care and a lack of political will to implement basic improvements, the impact of discrimination and racism towards indigenous women in accessing quality healthcare, the reduced access to contraception and the criminalisation of abortion as factors that contribute to this situation.
We also saw many examples of innovative responses to these challenges including university level midwifery programmes for young women, professional training for traditional midwives and progressive public policies around maternal health care and access to family planning. The passion and the drive of those working on the front lines of maternal care was clear in all our interviews.
Of all the people we spoke to Graciela Velazquez, comadrona (traditional midwife) and human rights defender, is perhaps the interview that stands out most in my mind. We had originally arranged with her to attend the comadronas‘ assembly in her home town of Totonicapan. That meeting was postponed, however, and instead Graciela invited us to interview her at home. We met her mid-morning as she walked way back from a temazcal (Mayan sauna) where she had been providing post-partum care to one of her patients. She welcomed us in to her home with a simple invocation, inviting us to light a candle each and place it by the altar in her front room, for as well as being a comadrona, Graciela is a “keeper of time,” a Mayan spiritual guide.
Once we had set our intentions for the meeting and thanked our host, Graciela told us how being a comadrona is a don that she inherited from her grandmother and great grandmother, both of whom were also comadronas. Like many other comadronas who are born with this don, she has accompanied births from a young age, 13 in her case, learning from her elders until she was ready to accompany women alone. She accompanies her patients from the beginning of pregnancy through to the 40 days post-partum period. Comadronas generally provide comprehensive accompaniment that includes, in Graciela’s words, gyneachological, pyschological, nutritional, and paediatric care.
It is a vocation that requires her to give much of her time and energy and there are few rewards beyond the personal and spiritual satisfaction of her work. The families she accompanies are from rural areas and often impoverished. They pay what they can, sometimes that is a chicken or another kind of exchange. Comadronas rarely, if ever, charge what private hospitals or clinics charge for pre-natal care and birth, and while they attend anywhere between 34% and 80% of births in rural areas there is little recognition from the State of the essential care they provides in their communities.
While there is still much to digest and much to write following our ten day whirlwind through Guatemala, it is clear that one vital step that could be taken to improve maternal health outcomes in Guatemala would be to end the exclusion and discrimination of comadronas such as Graciela and her colleagues from the public health service.
According to Dr. Linda Valencia, gynaechologist and obstetrician, the comadronas “continue to play a vitally important role in maternal health care in Guatemala, particularly in their communities where many women still prefer to give birth at home. We cannot keep excluding them, on the contrary, we should recognise that they are an important human resource for Guatemala.”