An intercultural birthing house was established in the Highlands of Chiapas, Mexico, as an intervention to reduce maternal mortality among indigenous women. This birth center, known locally as the Casa Materna, is a place where women can come to give birth with their traditional birth attendant. However, three months after opening, no woman had used the birthing house.
This study reports on the knowledge, attitudes and practices related to childbirth and use of the Casa Materna from the perspective of the health workers, traditional birth attendants and the program's target population. Structured interviews, in-depth interviews and focus group discussions were conducted with participants from each of these groups. Data was searched for emerging themes and coded.
Findings show that the potential success of this program is jeopardized by lack of transport and a strong cultural preference for home births. The paper highlights the importance of community participation in planning and implementing such an intervention and of establishing trust and mutual respect among key actors. Recommendations are provided for moving forward the maternal health agenda of indigenous women in Chiapas.
Notes
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A report is given of a visit to an Indian village community project which is supported by a small Swedish foundation. The project was started about 40 years ago by a female relative of Mahatma Gandhi. The community is a small village of about 2000 inhabitants and consists of an irrigated agricultural project, a school through 10th grade, a small hospital, a home for 140 poor or orphan girls and a nursery. The program employs 12 community health workers who have some healthcare training. Each worker cares for 200-250 households and usually knows his/her families well. Primary emphasis is on care of children which includes help with nutrition and a vaccination program. For every 4 community health workers there is an auxiliary nurse midwife who has 3 years special training following 10th grade. The midwives check up on pregnant women once a month through the 7th month, 2 visits in the 8th month and once/week in the 9th month. Undernourishment and anemia are the most common problems of pregnancy. Children are often born in the parents' home without any trained obstetric help. In spite of this, maternal mortality is very low. Even infection from childbirth is extremely rare. The visitor was particularly impressed by the respect and affection everyone in the village showed for children and for each other.
The routine daily consultation in the health post of 1 of 10 project villages for pregnant women and children under age 5 is interrupted by a call to an emergency delivery which ends up with the birth of a baby girl weighing 2100 g who is named after the author. Under the project funded by SIDA, Stockholm, a local village committee was elected to open a dispensary which became well-attended. Due to visits to another nearby village, the number of children checked increased to 263 instead of the previous number of 147 per month. The weight status of children was worsening despite vaccination and nutritional advice, because women worked in the fields without taking a meal break for their children. After advising that several meals a day were needed, the children gained weight in the following months. A lecture by the project doctor to representatives of surrounding villages about the safety of delivery in the dispensary or the hospital elicited a positive response to send pregnant women there for delivery. The number of institutional deliveries had already increased from 249 in 1986 to 433 in 1989. Working in a developing country required preliminary preparations, French and English language study, a 4-week cultural orientation course organized by the International Child Health Unit, and reading professional books on obstetrics and gynecology in such countries.
