Hope for a New Mayan Motherhood

As health educators in Guatemala, my husband and I are occasionally called on to present health issues in our municipality. As the saying goes, “an expert is someone from out of town”; we fit the description perfectly. This week we’re talking to community leaders about the impact of maternal mortality, since more mothers die in childbirth here than in any other place in Guatemala. It’s a topic we hardly worry about in the United States, and some even believe it’s no longer a problem at all. The reality is that it’s still a plague on women and families in developing nations all over the world, without an easy cure.

Studies show that women who are under the age of 18 or over the age of 35 and women that have four or more children are most at risk for complications during childbirth. While any woman can suffer from complications, the Population Reference Bureau reports that “…a disproportionate number of those affected live in poverty, have little education, and live in rural areas. In Guatemala, the majority of deaths are among indigenous women with little education, women who work at home, and women who have two or more children. Indigenous women have the most precarious living conditions, the highest fertility rates, and the smallest percentage of births attended by doctors or nurses.” These are the women with whom we work, and these women depend on the national health care system.

Although every nation has a moral responsibility to care for the health of its citizens, poor third-world governments like Guatemala’s often lack the proper funding. In Guatemala, health care is free, but not always available. For families in remote villages in our area, the nearest private hospital is four hours away; the nearest free, public hospital is located in the state capital, seven hours away. If a woman in labor needs emergency medical care, oftentimes the family will not take her because they can’t afford to pay the private doctor , or they can’t afford the cost of a transportation to the closest public hospital. Sometimes families make their decision too late and the woman dies during the journey.

In April of this year, our region received its first-ever ambulance, so the cost of transportation is no longer a prohibiting factor. But it’s not just about money. If all women could get to a doctor and have their baby in a hospital under sanitary conditions, then they wouldn’t die, right? International aid organizations have already pledged money to help Guatemala build more hospitals and improve its healthcare system. This might help, but it won’t solve the problem outright. There are other social, economic, cultural, and gender issues that affect the rate of maternal mortality.

In Mayan culture, birth and death take place in the home, surrounded by family and community members. Those gathered together burn candles, say prayers, and prepare their traditional foods for the occasion while the local midwife and female family members attend the birth. They feel that going to the hospital denies them the right to practice their culture. The Ministry of Health, recognizing women’s ties to their midwives and traditions, has begun a campaign to better train these local health workers to prevent deaths in childbirth. Part of this training teaches midwives to recognize danger signs and to counsel families to go to the hospital when the midwife can no longer handle the birth. Still, it’s a common belief that if a woman dies in child birth, it’s la voluntad de Dios, the will of God.

Gender figures into this argument as well. The man of the house always has the final say, whether he is the husband, father, or father-in-law of the woman in labor. He has the right to refuse the midwife’s suggestions at any time. In one local case, a twelve-year-old in labor needed a c-section because her pelvis was too small for a normal delivery, but her father didn’t want to send her to the hospital. The health center staff argued that they could use the ambulance and he wouldn’t have to pay for transport, but he insisted that the girl stay home. A frustrated health worker threatened to charge the father with murder if the girl died because she was denied medical attention. The health staff later admitted this was a bluff, but the bluff saved the girl’s and the baby’s life.

Too often it happens that girls grow up in households where their lives are not valued, figuratively and literally— the midwives even charge higher fees for delivering male babies. Traditionally, girls and women are served smaller portions of food and eat only after the men have eaten, yet they are still expected to complete physically demanding chores. Furthermore, girls are too often denied education and grow up with little self-esteem or opportunity for advancement. These malnourished, uneducated women are acquiescent to the males that dominate their lives. Unfortunately, the number of the children these men father is an indicator of their manhood, especially in rural communities. Some families even believe that contraceptives are a conspiracy to limit the indigenous population. Consequently, many women become añeras, women who give birth every year.

Where do we begin to fix these problems? Education is crucial to development. My job here is sometimes slow and often tedious, but my husband and I are working to educate people on a holistic approach to improving their health. Sometimes we feel like the locals come to our talks just to be polite, and we’re never really sure they hear what we’re saying. But the longer I’m here, the more I’m convinced that someone has to do this job. I maintain hope that if we say a thing often enough, someone will hear it. Someone might even be helped by it. Building hospitals and training midwives is easy in comparison to changing cultural beliefs about gender roles. But until we challenge these beliefs and demonstrate how everyone can benefit from feeding, educating, and empowering girls and women, we won’t get to the root of this problem. Without education in development, all the hospitals, schools, and water treatment plants in the world will never truly help the people.