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Professional Midwifery: Learning from the Past and Present to Inform the Future of Maternal Health Services in Guatemala
- Summer, Anna Leigh
- Advisor(s): Guendelman, Sylvia
Abstract
Guatemala has an unacceptably high maternal mortality ratio (MMR) of 140, and
improvements in this area have been slow. Furthermore, gross inequalities in health
outcomes exist within its population, with over 70% of maternal deaths in Guatemala
occurring among indigenous Mayan women. Mayan communities have been historically
marginalized, and most Mayan women prefer the services of traditional birth attendants
(TBA). As such, a disconnect exists between the formal and traditional health sectors in
Guatemala, contributing to poor maternal health outcomes. It is widely agreed that
professional midwifery is an important component of safe motherhood strategies that can
reduce maternal morbidity and mortality. Today the Guatemalan Ministry of Health is
reintroducing midwifery for the first time since 1960. Given the potential professional
midwifery has to address the obstetric care needs of Mayan women and bridge the gap
between the health sectors in Guatemala, formative research is needed at the outset to
inform the design and implementation of this program.
This dissertation aims to inform future directions for professional midwifery in Guatemala
by assessing and analyzing historical policies and current perspectives and presenting
context-specific recommendations for the future. The first paper looks to the past to
consider how international and society-centered forces influenced the creation of policies in
Guatemala regarding birth attendance since the signing of the Peace Accords in 1996 up to
the reintroduction of midwifery. Next, the second paper elucidates the misperceptions,
attitudes and expectations about the addition of midwifery to the healthcare system by
Guatemalan physicians, nurses, midwives and TBAs today, identifying potential threats and
facilitators to this strategy’s success in Guatemala. Finally, the third paper proposes
recommendations for the future, considering identified impediments to midwifery’s capacity
for sustainability. This dissertation provides findings that can improve the design,
implementation, monitoring and evaluation of the professional midwifery strategy in
Guatemala, and can inform program and policy decisions to implement this strategy in
Guatemala, Latin America and beyond.
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