Maternal Mortality of Indigenous Women in Mexico: An Analysis from the Perspective of Human Rights

  • María Graciela Freyermuth Enciso
  • Hilda E. Argüello Avendaño
Part of the Global Maternal and Child Health book series (GMCH)


This chapter presents an analysis of maternal death among indigenous women from the perspective of human rights. It shows quantitative data of the differences in maternal mortality between different indigenous municipalities. It presents also a qualitative analysis, based on the “Three Delays Model,” of the inequalities in public health care faced by Mexican indigenous women according to personal narratives of maternal death. In this chapter, we are interested in analyzing maternal deaths among indigenous women from the perspective of human rights. In Mexico, indigenous women are twice more likely to die from maternal causes than women who live in nonindigenous municipalities. We conducted a quantitative analysis of the differences in maternal mortality between women living in indigenous municipalities (40% or more of indigenous language speakers) and women living in nonindigenous municipalities (less than 40% of indigenous language speakers) in the states of Oaxaca and Chiapas. This analysis allowed us to identify several protective and/or risk factors.


Indigenous women Maternal health Three delays model Maya Cause of death Mexico Human rights Oaxaca Indigenous pregnancy Chiapas Pregnancy disorders Maternal death Maternal mortality Pregnancy complication Abortion Preeclampsia Hemorrhage Hypertension Pregnancy deaths Hospitals 


  1. Argüello-Avendaño, H. (2018). Maternal mortality at the beginning of the 21st century in Los Altos of Chiapas, Mexico: Structural violence and care seeking, Doctoral Thesis in final review. Tarragona: Universitat Rovira i Virgili.Google Scholar
  2. Cárdenas, R. (2009). Selected indicators for the evaluation of health conditions. Mexico: Comité Promotor por una Maternidad Sin Riesgos, Asesoría Capacitación y Asistencia en Salud A.C..Google Scholar
  3. Chiarotti, S. (2006). Women and human rights: Convergences and tensions between two social movements. In A. E. Yamin (Ed.), Economic, social and cultural rights in Latin America. From the invention to the tool (pp. 85–102). Mexico: Plaza y Valdés.Google Scholar
  4. Comisión Interamericana de los Derechos Humanos (CIDH). (2010). Acceso a servicios de salud materna desde una perspectiva de derechos humanos, OEA/Ser.L/V/II. Doc.69. Retrieved March 30, 2017, from
  5. Comisión Nacional de Derechos Humanos (CNDH). (2012). International covenant on economic, social and cultural rights, and its optional protocol. México: CNDH.Google Scholar
  6. Consejo Nacional de Evaluación de la Política de Desarrollo Social (CONEVAL). (2014). Anexo Estadístico de pobreza en México 2014. México: CONEVAL. Retrieved March 31, 2017, from Google Scholar
  7. Diario Oficial de la Federación (DOF). (1981). Decree approving the International Covenant on Civil and Political Rights, opened for signature in New York City, USA, on December 19, 1966, with the interpretative declarations to articles 9, paragraph 5, and article 18, and reservations to article 13 and subsection B) of article 25, to be made by the Executive of the Union upon accession. Retrieved January 9, 1981, from
  8. Diario Oficial de la Federación (DOF). (2001). Decree approving the article by which a second and third paragraphs are added to article 1, article 2 is reformed, the first paragraph of Article 4 is repealed; And a sixth paragraph is added to article 18, and a last paragraph to the third fraction of article 115 of the Political Constitution of the United Mexican States. Retrieved from March 30, 2017, from
  9. Diario Oficial de la Federación (DOF). (2014). Special Program of the Indigenous People 2014–2018. Retrieved March 30, 2017, from
  10. Diario Oficial de la Federación (DOF). (2015). Decree to add various provisions of the General Health Law, the Social Security Law and the Law of the Institute of Social Security and Social Services of State Workers. Retrieved July 20, 2016, from
  11. Ferrer, M., Martínez, J. (2006). Population, development and human rights: A proposal for its adoption in Latin America and the Caribbean. Santiago de Chile: CELADE- División de Población de la CEPAL, Naciones Unidas. Retrieved March 30, 2015, from
  12. Freyermuth, G. (2000). To die in Chenalho. Gender, ethnicity and generation. Risk factors during maternity, PhD thesis in Social Anthropology, Mexico, Universidad Nacional Autonoma de Mexico.Google Scholar
  13. Freyermuth, G. (2010). Unequal in life, unequal to die. Maternal mortality in Chiapas: an analysis from inequality. Mexico: United Nations Development Program in Mexico, Report on Human Development in Chiapas, Working Paper 2010/1. Retrieved August 26, 2016, from
  14. Freyermuth, G., & Argüello-Avendaño, H. (2011). The premature death of women in Los Altos of Chiapas. An analysis from violence. Pueblos y Fronteras Digital, 6(10), 181–216.Google Scholar
  15. Freyermuth, G., & Luna, M. (2014). Maternal death and avoidable deaths in excess. Methodological proposal to evaluate public health policy. Realidad, Datos y Espacio Revista Internacional de Estadística y Geografía, 5(3), 44–61. Retrieved March 17, 2014, from Scholar
  16. Freyermuth, G., Argüello Avendaño, H. E., Mera, A. Z. (2014). Monitoring of sexual and reproductive health care in indigenous adolescents. Friendly Services of the State Health Institute of Chiapas and Paired Services of Asesoría, Capacitación y Asistencia en Salud, A.C., in the Tsotsil-Tseltal Zone of Los Altos of Chiapas. Mexico: CIESAS-INMUJERES. Retrieved May 14, 2016, from
  17. Freyermuth, G., Luna, M., & Muños, J. (2016a). Indicadores 2014. Mortalidad materna en México. México: Observatorio de Mortalidad Materna.Google Scholar
  18. Freyermuth, G., Luna, M., & Muñoz, J. (2016b). 2014 Indicators. InMaternal mortality in Mexico. Mexico: Observatory of Maternal Mortality.Google Scholar
  19. Freyermuth, G. (Ed.) (2017). The Right To Health Protection For Indigenous Women in Mexico. National Analysis And Cases From A Human Rights Perspective. México: Centro de Investigaciones y Estudios Superiores en Antropología Social, Comisión Nacional de los Derechos Humanos.Google Scholar
  20. Instituto Nacional de Estadística y Geografía (INEGI). (2015). Intercensal survey. Aguascalientes: INEGI. Retrieved March 31, 2017, from Google Scholar
  21. Leyva-Flores, R., Infante-Xibille, C., Pablo-Gutiérrez, J., & Quintino-Pérez, F. (2013). Persistent inequity in health and access to services for the indigenous peoples of Mexico, 2006–2012. Public Health of Mexico, 55(2), S123–S128.Google Scholar
  22. Maine, D. (1992). Safe motherhood programs: Options and issues. Nueva York: Center for Population and Family Health, Columbia University. Retrieved August 5, 2015, from Google Scholar
  23. Naciones Unidas-Derechos Humanos. (1966). International covenant on economic, social and cultural rights. New York: UN. Retrieved March 10, 2017, from Google Scholar
  24. Organización de las Naciones Unidas. (2000). Economic, Social and Cultural Rights Committee. Observation 14 The right to the enjoyment of the highest attainable standard of health (Article 12). Substantive issues addressed in the implementation of the International Covenant on Economic, Social and Cultural Rights. New York: UN. Retrieved May 11, 2016, from Ec Soc Cult.html#GEN14.
  25. Organización Mundial de la Salud (OMS). (1978). Alma-Ata 1978 primary health care. Geneva: WHO. Retrieved April 18, 2016, from Google Scholar
  26. Organización Mundial de la Salud (OMS). (2012). WHO guide for the application of CIE-10 to deaths during pregnancy, childbirth and puerperium: CIE-MM. Geneva: WHO.Google Scholar
  27. Page, J. (2002). Health policy aimed at the indigenous peoples of Mexico and Chiapas 1875–1995. Mexico: Multidisciplinary Research Program on Mesoamerica and the Southeast, National Autonomous University of Mexico, Institute of Indigenous Studies, Autonomous University of Chiapas.Google Scholar
  28. Secretaría de Salud (SSA). (2002). Action Programme: “start even in life”. Mexico: SSA. Retrieved August 18, 2016, from Google Scholar
  29. Sesia, P. (2015). Technical meetings for the promotion of maternal health in Chiapas, Guerrero, Oaxaca and Veracruz. In G. Freyermuth (Ed.), 25 years of good practices to reduce maternal mortality in Mexico. Experiences of civil society organizations and the academy (pp. 37–43). Mexico: Center for Research and Higher Studies in Social Anthropology, Observatory of Maternal Mortality in Mexico, Promoting Committee for Safe Maternity in Mexico.Google Scholar
  30. Thaddeus, S., & Maine, D. (1994). Too far to walk: Maternal mortality in context. Social Science & Medicine, 38(8), 1091–1110.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • María Graciela Freyermuth Enciso
    • 1
  • Hilda E. Argüello Avendaño
    • 2
    • 3
  1. 1.Center for Research and Higher Studies in Social Anthropology-South East UnitChiapasMexico
  2. 2.Department of Anthropology, Philosophy and Social WorkRovira i Virgili UniversityTarragonaSpain
  3. 3.Maternal Mortality Observatory in MexicoChiapasMexico

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