Midwifery: Cultural Complexities and Health Care Accessibility

Faculty:  Martha Rees, PhD

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Project Objectives
  • To respond to local community or organizations’ information needs with respect to midwifery or health
  • To describe and compare the different kinds of training and practice of midwives in Guatemala.
  • To explore the practices of different kinds of midwives.
  • To compare women’s experiences with different kinds of birthing practices (midwives, obstetricians, etc.)
  • To explore different cultural practices and perspectives about birth from women of different generations and origins.
  • To learn about the institutional structures and constraints that midwives and women experience in the birthing process.
  • To describe NGOs and governmental agencies in the birthing institutions, regulation and practice.
  • To explore access to perinatal care within human rights and social justice frameworks
 Project Activities

What are the differences in practices and outcomes of different kinds of midwives? What do women say about their beliefs and experiences giving birth? Studies of birthing show that women who give birth with midwives often report and experience (in terms of quality measures) better health and social outcomes than do those who give birth in hospitals with obstetricians. Aside from the cost and unnecessary practices (such as caesarians), women may report less pain, more autonomy and control. This project takes a rights-based approach to birthing.

The percentage of women giving birth in health facilities has increased over the period from 1998-2009, as well as the percentage of births by C-section, although the rate of home births remains at almost half of all births, however this varies widely by region and social class [http://www.who.int/maternal_child_adolescent/epidemiology/profiles/maternal/gtm.pdf]. Kinds of midwives vary, from those trained by older women, to those who study two-year programs, to university and post-graduate trained nurses. This project compares different kinds of midwives in terms of their actual activities (using a task analysis methodology), interviews with them about their training and practice, interviews with the institutional structure they are inserted in, and interviews with patients. Interview data will be analyzed. Products include a description of the cultural, social and work environments of midwives.

This project will be developed in collaboration with local Guatemalan NGOs and health services, and it builds on evaluation of midwife training and practice in Mexico.

Students will develop and implement semi-structured in-depth interviews with midwives, women and institutional representatives, in order to map the variety of practices and beliefs with respect to birthing and midwifery, taking into account the cultural and socio-economic diversity of Guatemala.  Students will gain experience in analyzing interview data, as well as in compiling and analyzing official data. The research findings will be shared with participating NGOs and other stakeholders.

Key competencies gained will include: mapping of midwifery beliefs and practices in Guatemala; understanding of the roles of different stakeholders, NGOs, medical institutions, and women in the context of the social, economic, legal and political systems operating in Guatemala today; qualitative and quantitative methods, data coding and analysis, including visual anthropology methods; report writing; and community collaboration.

NOTE: Students’ willingness to contribute to the report in the 2-4 weeks following the field school end date of June 24 is requested, in order to complete the writing, editing, and/or posting of the report.

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