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Governments must promote midwifery
Louisa Reynolds*
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Traditional midwives are helping to reduce maternal mortality rates in some of Latin America’s poorest countries.

As a young girl, Francisca Córdoba Camacho, 54, watched with fascination and wonder while her grandmother, a traditional Afro-Colombian midwife from the Chocó department, in western Colombia, assisted women as they were about to go into labor. “‘Grandma, I want to be a midwife,’ I would tell her, and she would reply: ‘You need to wait until you grow up’,” she told Latinamerica Press with a broad smile. 

Once she grew up she fulfilled her dream of becoming a midwife and to this day she has delivered a total of 7,424 babies, whose birthdays she carefully records in a notebook, together with the mother’s name.

Before delivering a baby, Córdoba Camacho, known affectionately as Pacha Pasmo in the communities where she works, prays for the mother’s and baby’s health and tries to assuage the woman’s fears.

“I tell the mom that it will hurt but that she’ll be able to rest afterwards. I give her water or juice to keep her hydrated. Then, during the night I give her herbal infusions that help her to expel the baby,” she says.

While we talk, she shows me a handful of venturosa, one of the commonly herbs used to prepare beverages for women who are about to go into labor, that she picked from the roadside on her way to Quibdó, the capital city of Chocó. The scent given off by the handful of crushed leaves is similar to that of mint.

“Recently, in a village near the San Juan river, I attended a woman who looked very weak. I had to pull the baby out by the leg. As I’ve attended training sessions where I’ve learnt different maneuvers, I got her to lie down and I straightened out the baby’s leg. Then I pulled the other leg out. I lifted the baby’s feet so that she could expel it,” Córdoba Camacho explains. “I press my hands down like this to help the baby find the vaginal canal,” she says, illustrating each maneuver with gestures.

Women who opt for home births with a traditional midwife can choose to give birth squatting or standing — indigenous women usually prefer to squat whereas Afrocolombian women choose to lie down — surrounded by their relatives. “At home, they can cry or scream if they want and I play some music for them to relax: merengue, vallenato, whatever they ask me to play,” says Córdoba Camacho.

Violence lying in wait
For years, guerrillas and paramilitaries fought to control Chocó, a strategically important route for the trafficking of drugs, arms and contraband. As a result, today, it is the poorest region in Colombia and hosts the highest number of internally displaced people.

The signature of a bilateral ceasefire between the Colombian army and the National Liberation Front (ELN) rebel group in September this year has barely had an impact on the Chocó region, where paramilitary groups have stepped in to fill the vacuum left by guerrillas and continue to terrorize rural communities by surrounding villages and preventing civilians from leaving, a form of siege warfare known as confinamiento.

Córdoba Camacho often travels to remote rural areas where villagers would have to trek through the jungle for up to seven hours to reach the nearest clinic, and assists women who have no access to healthcare services regardless of whether they are civilians or combatants.

“Indigenous communities have no doctors and limited access to medicine. When a woman gives birth, she’s assisted by a midwife,” Diana Leivy Rojas, an advisor to the Alto Baudó community council, explained to Latinamerica Press.

According to a qualitative study carried out by Colombian NGO Sinergias, traditional midwives such as Córdoba Camacho assist 30 percent of births in impoverished rural and urban areas in Quibdó.

In an effort to recognize the value of a profession handed down through generations, in October 2016, the National Council of Patrimony included traditional midwives in the Intangible Cultural Heritage List. “Midwifery represents an ancestral tradition that is active and must be preserved,” says the Ministry of Culture’s Director of Patrimony, Alberto Escovar Wilson White.

Córdoba Camacho believes this is a step in the right direction but says the Ministry of Health should improve training programs and pay traditional midwives the minimum wage. Córdoba Camacho charges US$15-$40 for her services, which barely covers transportation costs, but in most cases the women she assists are so poor that she accepts a chicken or a bunch of plantains in lieu of payment. 

Better training leads to fewer deaths
World Health Organization (WHO) figures show a decline in Latin America’s infant mortality rate from 54 to 18 deaths per 1,000 live births as well as a decline in maternal mortality rate from 135 to 67 per 1,000 live births from 1990 to 2015.

If the region wants to continue on this path towards significantly reducing infant and maternal mortality, it needs to invest in midwifery training and education, says the United Nations Population Fund’s 2014 State of the World’s Midwifery Report. The report puts forward Midwifery 2030, a plan to develop a midwifery workforce in the 73 countries profiled in the report.

Mexico, where up to 60 percent of births in the country’s two poorest states — Chiapas and Oaxaca — are attended by traditional midwives with little or no professional training, is among the Latin American countries that are striving to improve education opportunities for its midwives.

In 1981, Mexico’s first government-accredited midwifery school was established in the city of San Miguel de Allende and in 2002, the Ministry of Health’s Department of Traditional Medicine and Intercultural Development launched a National Midwifery Program that aims to provide culturally appropriate care to indigenous women.

Bolivia, where more than half of the population is indigenous and many rural women regard midwives as family members, often referring to them as “aunts,” the Ministry of Health is striving to reduce maternal mortality rates (the third highest in Latin America, after Haiti and Guyana, according to the WHO), by training 500 midwives.

In Guatemala, where 40 percent of the population is indigenous, according to official estimates, the country’s 22,500 traditional Mayan midwives are fighting an uphill struggle for recognition. In February this year, Congress approved a law granting midwives a $400 yearly stipend and naming May 19 as National Midwives’ Day but it was vetoed by President Jimmy Morales, who argues that Guatemala’s chronically underfunded Ministry of Health lacks the resources to pay midwives a stipend. —Latinamerica Press.

*Alejandra Douat contributed to this article as a fixer. The International Women’s Media Foundation supported Louisa Reynolds’ reporting from Colombia as part of the Adelante Latin America Reporting Initiative.


Francisca Córdoba Camacho, Colombian midwife from the western department of Chocó. / Alejandra Douat
Latinamerica Press / Noticias Aliadas
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