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Respect for Bolivia’s indigenous mothers may help reduce high maternal mortality rates

Page history last edited by Rosemary 9 years, 2 months ago

The road up to Pocoata runs along high, barren Andean mountain slopes in southwestern Bolivia. In a field, a mother and her two daughters struggle with a plough. Down in the valley, a muddy river runs red from sludge stirred up by the region's gold diggers. Precious metals have been exported from these remote parts of Bolivia for centuries, yet this district is one of the poorest in South America.

Arminda Fuentes, who is responsible for a new midwifery training program here, taught the first class of midwives to be educated in Bolivia since the 1970s, when resistance from doctors ended the former program. "The new midwives will need to be adamant about improving care when they start working," she says.

The midwives will train at the new Pocoata hospital with head doctor Presciliano Moralez, who is well aware that many women shun hospitals because they are not comfortable with how they are treated. "They have their own traditions and many prefer getting help from friends and family or from local medicine men, who often have no training at all. In order to save patients it is necessary to combine traditional medicine with modern biomedicine.”

Moralez opens a door to a bare, tiled room with a kitchenette, designed for the new training program, where relatives can assist the birthing women by preparing herbs and traditional medicine to be offered alongside Western methods.

In Bolivia, relatives are not allowed to be present during hospital deliveries, and hospital personnel can be unfriendly. At times, pregnant women, who would traditionally move around to be more comfortable, are tied down. For first-time mothers, an episiotomy (a surgical cut in the opening of the vagina) is routinely used to speed up deliveries.

Thus, most indigenous women prefer to give birth at home in their kitchens, assisted by friends and relatives or birth attendants without formal training. But each year, more than 600 Bolivian women die in childbirth, a very high number in a population of just over nine million.

The new generation of midwives, being trained at three rural universities at the initiative of the Bolivian Society of Nurses and with support from UNFPA, could change all this. Recruited from remote local communities, the students are expected to return to their villages after they graduate, building close ties and being culturally accepted by the local women. The program teaches them technical skills to detect complications before, during and after delivery and how to perform life-saving interventions, including prompt referral to a higher level of care when necessary.

The program also rewards women in those communities who seek ante-natal care and institutional deliveries, says Jaime Nadal Roig, UNFPA representative in Bolivia.

The pilot project is part of the government's new health-care policy, which aims to end institutional discrimination against the indigenous people who make up more than half of the population. "There has been a perception that indigenous people do not really belong to society. But under the current president, Evo Morales, their culture is given more space," says Lilian Calderón of UNFPA. “We hope that the students will stay in rural areas. There, they will make a big difference."

This article is extensively abridged from a longer story by Jon Pelling, entitled Bolivia: Training Midwives to Treat Indigenous Mothers with Respect, published 30 April 2009 on the UNFPA website. For a video that includes scenes from the remote areas of Bolivia, see here. The photographs by Felipe Morales show a nutritionist providing information about the dietary needs of pregnant women (right, middle of page) and prospective midwives comparing notes (left, bottom of page).

Hopebuilding appreciates the kind permission of Jon Pelling and Felipe Morales to use this material here. Please seek their specific permission for any further use of their materials elsewhere.


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