by Louise Kelly
A heavily pregnant woman is at home in rural Guatemala when she begins to go into labour. The community midwife is in attendance, as is the traditional norm, but something is wrong – the baby is in distress and the woman needs additional medical care.
An NGO volunteer who has been liaising with the community tells the woman that she must attend one of the country’s few maternity hospitals in order to ensure her safety and the welfare of her unborn child.
The woman refuses, however, stating that her husband needs to make those decisions.
When asked where her husband is so that he can be contacted as a matter of urgency, the woman replies: ‘He left me two months ago’.
As the danger for the woman – and her child – increases, her father is then called in an attempt to procure permission for her to attend a hospital. The older man, whose own wife died through complications in childbirth, informs the volunteer: ‘Her husband must make that decision.’
The strength of traditional and culture across the many principalities of Guatemala can be somewhat difficult to comprehend when it comes to situations such as these, but this recent real-life example is not the rarity.
‘You’re dealing with women who are really managing everything at home because their husbands are working in the fields,’ PCI Director Pascale Wagner tells me.
‘But something happens and there is an emergency and no decision is made until the husband comes back. There are repercussions if there a delay in looking for medical help – and this happens quite often unfortunately.’
The mountainous region of HueHuetenango is the principality with the highest rate of maternal mortality in all of Guatemala. Lack of sexual and reproductive education in some families has led to a growing number of women becoming pregnant very early or vey late in their reproductive cycle.
Other communities insist that girls marry as young as 13 and 14 – many in arranged marriages – so that these children don’t have any choice in when they start having families themselves. Even though contraception is available, it is often denied to teen girls at health centres unless they are accompanied by a man.
With limited maternity care resources nearby, not to mention a fear of hospitals and doctors located so far from the comfort of the community family, woman at risk are not receiving adequate care until it’s too late.
The Casa Materna I visited beside HueHue’s only hospital is a sort of halfway house that attempts to make the transition for these women less frightening and more accessible.
‘We wish to make sure that women at risk are referred to us as soon as possible – not to wait until the mother goes into labour – so that we can still do something about it and try to save their lives,’ says Wagner.
‘We work with them on their [sexual and reproductive] rights while they are staying with us…if they need to have a C-section, we have them visit the hospital on a daily basis so that they can get used to the doctor, get used to the atmosphere. It’s an intimidating process for any woman, not least one from such a rural background.’
Another issue in Huehuetenango is low birth weight babies and malnutrition, a result of a variety of factors including lack of vitamins and supplements taken by the mother during her pregnancy and, unfortunately not uncommon, substance abuse. With approximately four incubators in the whole of Guatemala, a more simple but nonetheless effective solution is required to try to keep these underweight, premature infants alive.
‘We teach the mother skin to skin contact with the baby so that the mother herself serves as an incubator because we know that there are never going to be enough incubators in Guatemala,’ PCI’s Huehuetenango’s director Bal Maria tells me during the visit.
‘We try to involve fathers as well as much as possible – and now grandmothers, those incredible influencers [whether positive or negative] – so they can take turns holding the baby, to try to create a more cohesive family.’
Some 13 women were attending Casa Materna at the time of my arrival: a room of teen girls, all at least 37 weeks pregnant, giggling at the idea of being on camera despite significant complications in their pregnancy that led to their stay here; a group of ‘jaded’ young women in the next room who had passed their due date and were at least two hours drive from home, all aged under 23 and had given birth at least once before.
But it was the howls of anguish from an older woman in the shelter’s lobby that reinforced the somewhat defeatist attitude that there may never be enough initiatives to assist. Maria was advised to receive hospital care when she became pregnant with twins at an age at which it was deemed unsafe to conceive, and due to pre-existing heart problems. She agreed to speak with me in her private room where I learned that her 19-year-old daughter had taken her only life only four days before. Her daughter’s husband had left her to go to the US shortly before the incident but her mother tells me that ‘God took my child away’ as she prayed for the health of her two unborn babies.
The recent Zika virus outbreak in Central and South America has brought the safety of pregnant women and those planning to become pregnant to the global media stage.
Guatemala has now been placed on the list of countries at risk from this rapidly growing epidemic, as a number of health ministries beseech their female population to delay becoming pregnant due to the virus.
Pregnant visitors worldwide are being advised to stay away from Latin American countries for the foreseeable future, but for Guatemalan women, this is simply one more concern of many that they must face.
Louise Kelly is a journalist with the Irish Independent. She was funded under the summer 2015 round to travel to Guatemala to highlight and explore gender inequality in the country and the high levels of domestic violence against women. This is the second of two blog posts that Louise wrote in Guatemala. Read the first here.