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Approaching Maternal Health from a Decolonized, Systemic, and Culturally Safe Approach: Case Study of the Mayan-Indigenous Populations of Guatemala

  • Anne Marie Chomat
  • Bry Kring
  • Luis Paiz Bekker
Chapter
Part of the Global Maternal and Child Health book series (GMCH)

Abstract

The Mayan-indigenous populations of Guatemala face some of the worst maternal and child health outcomes worldwide. Despite repeated assertions that reducing inequity and reaching indigenous populations is a top government priority, and despite overall reductions in maternal mortality in Guatemala, maternal mortality ratios (MMRs) remain very high in local populations, especially those living in poor, marginalized, and indigenous regions. Historical exclusion and discrimination of the Mayan populations and their sociocultural divergence from the dominant population make them an especially easy target for neglect. They are rarely consulted in decision-making processes relating to their health, and health facilities are rarely adapted to their sociocultural realities and needs. In this chapter, we explore the nature and significance of factors relating to maternal health among the Mayan populations of Guatemala. In particular, we highlight the sociocultural divide that exists in Guatemala, and the systemic failure of the formal health system to provide a culturally safe environment for indigenous women during pregnancy and childbirth. We aim to provide a framework to contextualize and improve our understanding of the root causes of maternal health inequity, and of preventable morbidity and mortality of indigenous women, looking beyond the more often faulted logistical barriers. The Mayan example clearly illustrates the importance of transcending the hegemonic biomedical health model as the only way to achieving health, emphasizing the need for maternal health to be deliberately approached from an inclusive, integral, and multidimensional understanding of health and well-being—one that recognizes the existence of diverse perceptions, concepts, knowledge, and practices.

Keywords

Indigenous women Maternal health Guatemala Pregnancy Central America Prenatal care Traditional birth attendant Midwife Maternal morbidity Maternal mortality Child mortality Herbal remedy Gender inequality Temescal Maya Comadrona Traditional midwife Legal Prevention Stigmatization Spiritual belief Obstetric death Mayan cosmovision Mayan medical system Human rights Violence Health system 

Notes

Acknowledgements

The authors would like to thank the many women, midwives, and other individuals and institutions that shared their experiences, personal stories, and ancestral knowledge over the years, and greatly informed the writing of this chapter and the points of view expressed. We extend a special acknowledgment to the women of Buena Semilla, to the midwives of the Asociación de Comadronas del Área Mam (ACAM) and to the Instituto de Salud Incluyente. We would also like to thank Dr. Lucy Manchester and Health Policy Initiatives whose invaluable research provided several of the quotes that were used to illustrate women’s experiences. Last but not least, we wish to thank our editor, Dr. David Schwartz, for inviting us to contribute to this important book.

References

  1. Adams, W. R., & Hawkins, J. P. (2007). Health care in Maya Guatemala: Confronting medical pluralism in a developing country. Norman: University of Oklahoma Press.Google Scholar
  2. Alianza Nacional de Organizaciones de Mujeres Indígenas por la Salud Reproductiva (ALIANMISAR). (2009). La salud reproductiva de la mujer indígena en Guatemala. Análisis situacional y necesidades. ALIANMISAR, Health Policy Initiatives (HPI), United States Agency for International Development (USAID). Power Point presentation to the Ministerio de Salud Publica y Asistencia Social (MSPAS), Guatemala, 17 June 2009.Google Scholar
  3. Alma Ata. (1978). Informe Final de la Conferencia Internacional sobre Atención Primaria de Salud. Alma Ata, URSS, 6–12 September, 1978.Google Scholar
  4. Anckermann, S., Dominguez, M., Soto, N., Kjaerulf, F., Berliner, P., & Mikkelsen, E. N. (2005). Psychosocial support to large numbers of traumatized people in post-conflict societies: An approach to community development in Guatemala. J Community Appl Soc Psychol, 15, 136–152.CrossRefGoogle Scholar
  5. Anonymous. (2014). Guatemala: El haz y el envés de la impunidad y el miedo: las estrategias militar-empresarial-gubernamental contra la justicia y la resistencia. Guatemala. Retrieved February 15, 2017, from http://www.albedrio.org/htm/documentos/GuatemalaImpunidadMiedo.pdf
  6. Avila, C., Bright, R., Gutierrez, J., Hoadley, K., Manuel, C., Romero, N., & Rodriguez, M. P. (2015). Guatemala health system assessment, August 2015. Bethesda, MD: Health Finance & Governance Project, Abt Associates. Retrieved February 15, 2017, from https://www.usaid.gov/sites/default/files/documents/1862/Guatemala-HSA%20_ENG-FULL-REPORT-FINAL-APRIL-2016.pdf
  7. Becerril-Montekio, V., & López-Dávila, L. (2011). The health system of Guatemala. Salud Pública de México, 53(S2), s197–s208.PubMedGoogle Scholar
  8. Berry, N. (2006). Kaqchikel midwives, home births, and emergency obstetric referrals in Guatemala: Contextualizing the choice to stay at home. Social Science and Medicine, 62, 1958–1969.CrossRefPubMedGoogle Scholar
  9. Burrell, J. (2009). Intergenerational conflict in the postwar era. In W. E. Little & T. J. Smith (Eds.), Mayas in Postwar Guatemala: Harvest of violence revisited. Tuscaloosa: University of Alabama Press.Google Scholar
  10. Cabrera LO, Rosales P, Echeverría G, Palma S, López S, Haeussler R, Calan M. Normas con Pertinencia Cultural…hacia la interculturalidad. Ministerio de Salud Publica y Asistencia Social, Departamento de Regulación de los Programas de Atención a las Personas, Guatemala, 2009.Google Scholar
  11. Callister, L., & Vega, R. (1998). Giving birth: Guatemalan women’s voices. Journal of Obstetric, Gynecologic & Neonatal Nursing, 27(3), 289–295.CrossRefGoogle Scholar
  12. Campbell, J., Dussault, G., Buchan, J., Pozo-Martin, F., Guerra Arias, M., Leone, C., et al. (2013). A universal truth: No health without a workforce. Forum report, Third Global Forum on Human Resources for Health, Recife, Brazil. Geneva: Global Health Workforce Alliance and World Health Organization. Retrieved February 15, 2017, from http://www.who.int/workforcealliance/knowledge/resources/GHWAa_universal_truth_report.pdf?ua=1
  13. Canadian Institutes of Health Research (CIHR). (2007). CIHR guidelines for health research involving aboriginal people. Canadian Institutes of Health Research.Google Scholar
  14. Chary, A., Kraemer Diaz, A., Henderson, B., & Rohloff, P. (2013). The changing role of indigenous lay midwives in Guatemala: New frameworks for analysis. Midwifery, 29(8), 852–858.CrossRefPubMedGoogle Scholar
  15. Chomat, A. M. (2016). Photovoice reveals narratives of hardship and resilience among rural Mam-Mayan women in the Western Highlands of Guatemala. In Maternal stressors impact maternal wellbeing and cortisol and infant growth in rural Guatemala: Insights from qualitative and quantitative approaches. Doctoral thesis dissertation, McGill University, Montreal.Google Scholar
  16. Chomat, A. M., Solomons, N., Montenegro, G., Crowley, C., & Bermudez, O. (2014). Maternal health and health-seeking behaviors among indigenous Mam mothers from Quetzaltenango, Guatemala. Revista Panamericana de Salud Publica, 35(2), 113–120.PubMedGoogle Scholar
  17. Chomat, A. M., Solomons, N. W., Koski, K. G., Wren, H. M., Vossenaar, M., & Scott, M. E. (2015). Quantitative methodologies reveal a diversity of nutrition, infection/illness and psychosocial stressors during pregnancy and lactation in rural Mam-Mayan mother-infant dyads from the Western Highlands of Guatemala. Food Nutr Bull, 36(4), 415–440.CrossRefPubMedGoogle Scholar
  18. Commission for Historical Clarification (CEH). (1999). Guatemala memory of silence. Report of the Commission for Historical Clarification: Conclusions and Recommendations. Retrieved February 15, 2017, https://hrdag.org/wp-content/uploads/2013/01/CEHreport-english.pdf
  19. Commission on Social Determinants of Health (CSDH). (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva: World Health Organization.Google Scholar
  20. Cook, N. D. (1998). Born to die: Disease and new world conquest, 1492–1650. New York: Cambridge University Press.Google Scholar
  21. Cosminsky, S. (2001a). Maya midwives of southern Mexico and Guatemala. In B. Huber & A. Sandstrom (Eds.), Mesoamerican healers. Austin: University of Texas Press.Google Scholar
  22. Cosminsky, S. (2001b). Midwifery across the generations: A modernizing midwife in Guatemala. Medical Anthropology, 20(4), 345–378.CrossRefGoogle Scholar
  23. Cunningham, A. (1997). Introduction. In A. Cunningham & B. Andrews (Eds.), Western medicine as contested knowledge (pp. 1–23). New York: Manchester University Press.Google Scholar
  24. Cunningham, M. (2009). Health in state of the world’s indigenous peoples. Department of Economic and Social Affairs, Division for Social Policy and Development, Secretariat of the Permanent Forum on Indigenous Issues. United Nations, New York. Retrieved February 15, 2017, from http://www.un.org/esa/socdev/unpfii/documents/SOWIP/en/SOWIP_web.pdf
  25. De Jonge, A., Teunissen, T. A., & Lagro-Janssen, A. L. (2004). Supine position compared to other positions during the second stage of labor: A meta-analytic review. Journal of Psychosomatic Obstetrics and Gynaecology, 25(1), 35–45.CrossRefPubMedGoogle Scholar
  26. Farmer, P. E., Nizeye, B., Stulac, S., & Keshavjee, S. (2006). Structural violence and clinical medicine. PLoS Medicine, 3(10), e449.CrossRefPubMedPubMedCentralGoogle Scholar
  27. Few, M. (2002). Women who live evil lives: Gender, religion and the politics of power in colonial Guatemala (pp. 1650–1750). Austin, TX: University of Texas Press.Google Scholar
  28. Fort, M. P., Grembowski, D. E., Verdugo, J. C., Morales, L. C., Arriaga, C. A., Mercer, M. A., & Lim, S. S. (2011). Implementation and progress of an inclusive primary health care model in Guatemala: Coverage, quality, and utilization. Revista Panamericana de Salud Publica, 30(3), 217–224.CrossRefPubMedGoogle Scholar
  29. Foxen, P. (2007). In search of Providence: Transnational Mayan identities. Nashville, TN: Vanderbilt University Press.Google Scholar
  30. Galtung, J. (1969). Violence, peace and peace research. Journal of Peace Research, 6, 167–191.CrossRefGoogle Scholar
  31. Gardosi, J., Sylvester, S., & B-Lynch, C. (1989). Alternative positions in the second stage of labour: A randomized controlled trial. British Journal of Obstetrics and Gynaecology, 96, 1290–1296.CrossRefPubMedGoogle Scholar
  32. Girón Mena, M. A. (1979). Itzamna y la Medicina Maya. Guatemala Indígena, 14(3–4), 26–30.Google Scholar
  33. Glei, D. A., & Goldman, N. (2000). Understanding ethnic variation in pregnancy-related care in rural Guatemala. Ethnicity & Health, 5(1), 5–22.CrossRefGoogle Scholar
  34. Godoy-Paiz, P. (2005). Obstacles to achieving mental health in post-war Guatemala: The intersection of political and structural violence. The Canadian Student Journal of Anthropology, 18(1), 34–64.Google Scholar
  35. Gómez Bravo, N. (2010). Cosmovision y ciencia de la vida del maiz. Retrieved from http://documentslide.com/documents/cosmovision-y-ciencia-de-la-vida-del-maiz.html
  36. Grandin, G., Levenson, D. T., & Oglesby, E. (2011). The Guatemala reader: History, culture, politics. Durham, NC: Duke University Press.CrossRefGoogle Scholar
  37. Green, L. (1999). Fear as a way of life. New York, NY: Columbia University Press.Google Scholar
  38. Greenberg, L. (1982). Midwife training programs in highland Guatemala. Social Science & Medicine, 16, 1599–1609.CrossRefGoogle Scholar
  39. Grupo Internacional de Trabajo sobre Asuntos Indígenas (IWGIA). (2017). Pueblos indígenas en Guatemala. Retrieved February 15, 2017, from http://www.iwgia.org/regiones/latin-america/guatemala
  40. Hogan, M. C., Foreman, K. J., Naghavi, M., Ahn, S. Y., Wang, M., Makela, S. M., Lopez, A. D., Lozano, R., & Murray, C. J. (2010). Maternal mortality for 181 countries, 1980–2008: A systematic analysis of progress towards Millennium Development Goal 5. Lancet, 375(9726), 1609–1623.CrossRefPubMedGoogle Scholar
  41. Humphrey, M., Hounslow, D., Morgan, S., & Wood, C. (1973). The influence of maternal posture at birth on the fetus. Journal of Obstetrics & Gynaecology of the British Commonwealth, 80, 1075–1080.CrossRefGoogle Scholar
  42. Hurtado, J. J. (1973). Algunas ideas para un modelo estructural en relación con la enfermedad en el altiplano de Guatemala. Guatemala Indígena, 8(1–2), 7–22.Google Scholar
  43. Hurtado, E., & Saénz de Tejada, E. (2001). In B. Huber & A. Sandstrom (Eds.), Relations between government health workers and traditional midwives in Guatemala. Mesoamerican healers. Austin, TX: University of Texas Press.Google Scholar
  44. Icú Perén, H. (2007). Revival of Maya medicine and impact for its social and political recognition (in Guatemala): A case study commissioned by the Health Systems Knowledge Network. Guatemala.Google Scholar
  45. Instancia Nacional de Salud (INS). (2002). Hacia un primer nivel de atención incluyente: bases y lineamientos. Guatemala: INS. Retrieved March 6, 2017, from https://saludjalapa225.files.wordpress.com/2016/10/hacia-un-primer-nv-de-salud-incluyente.pdf
  46. Instituto de Salud Incluyente (ISIS). (2009). El derecho a la Salud en el Modelo Incluyente de Salud. Documento Técnico. Guatemala: ISIS.Google Scholar
  47. Instituto Nacional de Estadística (INE). (2012). Caracterización Estadística de Guatemala, 2012. Retrieved February 15, 2017, from http://www.ine.gob.gt/sistema/uploads/2014/02/26/5eTCcFlHErnaNVeUmm3iabXHaKgXtw0C.pdf
  48. International Labour Organization (ILO). (2003). ILO convention on indigenous and tribal peoples, 1989 (No. 169): A manual. Geneva: ILO. Retrieved February 15, 2017, from http://pro169.org/res/materials/en/general_resources/Manual%20on%20ILO%20Convention%20No.%20169.pdf
  49. Ishida, K., Stupp, P., Turcios-Ruiz, R., Williams, D., & Espinoza, E. (2012). Ethnic inequality in Guatemalan women’s use of modern reproductive health care. International Perspectives on Sexual and Reproductive Health, 38(2), 99–108.CrossRefPubMedGoogle Scholar
  50. Kabeer, N. (2010). Can the MDGS provide a pathway to social justice? The challenge of intersecting inequalities. Institute of Development Studies, MDG Achievement Fund. United Nations Development Programme. Retrieved February 15, 2017, from www.ids.ac.uk/files/dmfile/MDGreportwebstiteu2WC.pdf
  51. Kipuri, N. (2009). Culture. In: State of the world’s indigenous peoples. Department of Economic and Social Affairs, Division for Social Policy and Development, Secretariat of the Permanent Forum on Indigenous Issues, United Nations. Retrieved February 15, 2017, from http://www.un.org/esa/socdev/unpfii/documents/SOWIP/en/SOWIP_web.pdf
  52. Kurtenbach, S. (2008). Guatemala’s post-war development: The structural failure of low intensity peace. Germany: Institute for Development and Peace (INEF). Retrieved February 15, 2017, from http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.465.4544&rep=rep1&type=pdf
  53. Macleod, M. (2013). Mayan calendrics in movement in Guatemala: Mayan spiritual guides or day-keepers understandings of 2012. Journal of Latin American and Caribbean Anthropology, 18(3), 447–464.CrossRefGoogle Scholar
  54. Medicus Mundi Navarra (MMN). (2013). Claves para la transformación de los sistemas de salud en América Latina. Bolivia, Guatemala y Perú: tres experiencias, una sola acción integral e incluyente en atención primaria de salud. Salud Integral Incluyente. Retrieved February 15, 2017, http://www.saludintegralincluyente.com/ftp/saludintegralincluyente/DOCUMENTOS/PDF/Libro/LIBROsaludintegralincluyente.WEB.pdf
  55. Medicus Mundi Navarra (MMN). (2016). Protocolo de Sistematización Avances de La Horizontalización Programática en Cuatro Países Latinoamericanos.Google Scholar
  56. Metz, B. (2001). Politics, population and family planning in Guatemala: Ch’orti’ Maya experiences. Human Organization, 60(3), 259–271.CrossRefGoogle Scholar
  57. Ministerio de Salud Publica y Asistencia Social (MSPAS). (2009). Normas con Pertinencia Cultural…hacia la interculturalidad. MSPAS, Departamento de Regulación de los Programas de Atención a las Personas: Guatemala. Retrieved March 6, 2017, from http://www.paho.org/gut/index.php?option=com_docman&view=download&alias=570-2011-normas-con-pertinancia-cultural&category_slug=sfc-salud-reproductiva-materna-y-neonatal-nacional&Itemid=518
  58. Ministerio de Salud Pública y Asistencia Social (MSPAS). (2011). Manual de adecuación cultural del parto natural/vertical y sus distintas posiciones, en el marco multicultural de Guatemala. En colaboración con la Alianza Nacional de Organizaciones de Mujeres Indígenas por la Salud Reproductiva (ALIANMISAR), Organización Panamericana de la Salud (PAHO), Population Council: Guatemala. Retrieved February 15, 2017, from http://www.paho.org/gut/index.php?option=com_docman&view=download&alias=569-2011-manual-de-adecuacion-cultural-del-parto-natural-vertical&category_slug=sfc-salud-reproductiva-materna-y-neonatal-nacional&Itemid=518
  59. Ministerio de Salud Pública y Asistencia Social (MSPAS). (2015a). Encuesta Nacional de Salud Materno Infantil 2014–15 (ENSMI). Informe Final: Mujeres. MSPAS/Instituto Nacional de Estadística (INE)/Centros de Control y Prevención de Enfermedades (CDC): Guatemala.Google Scholar
  60. Ministerio de Salud Pública y Asistencia Social (MSPAS). (2015b). Situación de la mortalidad maternal: Informe de País 2013. Guatemala. Retrieved January 26 2017, from http://www.osarguatemala.org/Archivos/PDF/201510/255_3.pdf
  61. Ministerio de Salud Pública y Asistencia Social (MSPAS)/Pan American Health Organization (PAHO). (2013). Segunda Medición de Metas Regionales de Recursos Humanos para la Salud: Informe Final. Guatemala. Retrieved February 15, 2017, from http://www.observatoriorh.org/sites/default/files/webfiles/fulltext/2013/informe_metas_2013_gua.pdf
  62. Montenegro, R. A., & Stephens, C. (2006). Indigenous health in Latin America and the Caribbean. Lancet, 367, 1859–1869.CrossRefPubMedGoogle Scholar
  63. Mumtaz, Z., Salway, S., Bhatti, A., & McIntyre, L. (2014). Addressing invisibility, inferiority and powerlessness to achieve gains in maternal health for ultra-poor women. Lancet, 383, 1095–1097.CrossRefPubMedGoogle Scholar
  64. Napier, A. D., Ancarno, C., Butler, B., Calabrese, J., Chater, A., Chatterjee, H., et al. (2014). Culture and health. Lancet, 384, 1607–1639.CrossRefPubMedGoogle Scholar
  65. PIES de Occidente. (2014). Encuentro de Comadronas: La comadrona tradicional: Obstáculo o solución a la problemática materno-infantil en regiones de pobreza extrema, exclusión y marginación? Tercera edición. Litografía de Occidente, Guatemala. Retrieved February 15, 2017, from http://asociacionpiesdeoccidente.org/assets/la-comadrona-tradicional-obt%C3%A1culo-o-soluci%C3%B3n-a-la-problematica.pdf
  66. OECD (Organization for Economic Co-operation and Development). (2015). Revenue Statistics in Latin America and the Caribbean.Google Scholar
  67. Oxorn, H. (1986). Human labor and birth. University of Ottawa, ON: McGraw-Hill Professional Publishing.Google Scholar
  68. Packard, R. M. (2013). Post-colonial medicine. In R. A. Cooter (Ed.), Companion encyclopedia of medicine in the twentieth century (pp. 97–112). New York: Routledge.Google Scholar
  69. Pan American Health Organization (PAHO)/World Health Organization (WHO). (1985). Informe del Grupo de Trabajo sobre Salud y Culturas Médicas Tradicionales en América Latina y el Caribe (p. 5). Washington, DC.Google Scholar
  70. Paul, L. (1978). Careers of midwives in a Mayan community. In J. Hoch-Smith & A. Springs (Eds.), Women in ritual and symbolic roles. New York, NY: Plenum Press.Google Scholar
  71. PIES de Occidente. (2009). Conociendo la medicina Maya en Guatemala. Asociación PIES de Occidente: Guatemala. Retrieved February 15, 2017, from http://asociacionpiesdeoccidente.org/assets/conociendo-la-medicina-maya-en-guatemala.pdf Google Scholar
  72. Radoff, K., Thompson, L. M., Bly, K., & Romero, C. (2013). Practices related to postpartum uterine involution in the Western Highlands of Guatemala. Midwifery, 29(3), 225–232.CrossRefPubMedGoogle Scholar
  73. Recino, A. (Translation Quiche to Spanish), Goetz, D., Morley, S.G. (Translation Spanish to English). (1954). Popul Vuh. The Book of the People. Los Angeles: Plantin Press.Google Scholar
  74. Roberts, C. L., Algert, C. S., Cameron, C. A., & Torvaldsen, S. (2005). A meta-analysis of upright positions in the second stage to reduce instrumental deliveries in women with epidural analgesia. Acta Obstetricia et Gynecologica Scandinavica, 84(8), 794–798.CrossRefPubMedGoogle Scholar
  75. Rogoff, B. (2011a). Born to a spiritual calling across generations: Cultural heritage and resistance. InDeveloping Destinies: A Mayan Midwife and Town. Oxford, UK: Oxford University Press.CrossRefGoogle Scholar
  76. Rogoff, B. (2011b). Ripples across generations and nations in birth destinies and postnatal care. InDeveloping Destinies: A Mayan Midwife and Town. Oxford, UK: Oxford University Press.CrossRefGoogle Scholar
  77. Rogoff, B. (2011c). Ripples across generations and nations in Mayan pregnancy and childbirth. InDeveloping Destinies: A Mayan Midwife and Town. Oxford, UK: Oxford University Press.CrossRefGoogle Scholar
  78. Rohloff, P., Díaz, A. K., & Dasgupta, S. (2011). “Beyond development”: A critical appraisal of the emergence of small health care nongovernmental organizations in rural Guatemala. Human Organization, 70(4), 427–437.CrossRefGoogle Scholar
  79. Santiso-Galvez, R., & Bertrand, J. T. (2004). The delayed contraceptive revolution in Guatemala. Human Organization, 63(1), 57–67.CrossRefGoogle Scholar
  80. Schieber, B., & Delgado, H. (1993). An intervention to reduce maternal and neonatal mortality. Guatemala City, Guatemala: Instituto de Nutrición de Centro América y Panamá (INCAP) and Pan American Health Organization (PAHO).Google Scholar
  81. Shiffman, J., & Garces del Valle, A. L. (2006). Political history and disparities in safe motherhood between Guatemala and Honduras. Population and Development Review, 32(1), 53–80.CrossRefGoogle Scholar
  82. Stephens, C., Porter, J., Nettleton, C., & Willis, R. (2006). Disappearing, displaced and undervalued: A call to action for indigenous health worldwide. Lancet, 367, 2019–2028.CrossRefPubMedGoogle Scholar
  83. Sullivan, T. (1966). Pregnancy, childbirth, and the deification of women who died in childbirth. Estudios de cultura Nahuatl (pp. 128–143). Texts from the Florentine Codex, Book IV, Folios.Google Scholar
  84. United Nations Development Programme (UNDP). (2014). Human development report: Guatemala. Retrieved February 15, 2017, from http://hdr.undp.org/sites/all/themes/hdr_theme/country-notes/GTM.pdf
  85. United Nations Organization. (2007). Declaration on the rights of indigenous peoples. UN Doc. A/61/L.67. Retrieved February 15, 2017, from http://www.un.org/esa/socdev/unpfii
  86. United States Agency for International Development (USAID). (2009). Gender assessment in Guatemala. USAID. Retrieved February 15, 2017, from http://pdf.usaid.gov/pdf_docs/Pnado177.pdf
  87. Van Dijk, M., Ruiz, M. J., Letona, D., & García, S. G. (2013). Ensuring intercultural maternal health care for Mayan women in Guatemala: A qualitative assessment. Culture, Health & Sexuality: An International Journal for Research, Intervention and Care, 15(S3), S365–S382.CrossRefGoogle Scholar
  88. Villatoro, E. (1994). La comadrona a través de la historia en las practicas obstretico pediatricas: una experiencia en el area ixil, quiché. La Tradicion Popular, 97, 20.Google Scholar
  89. Villatoro, E. (2001). Promoción de la medicina y terapias indígenas en la atención primaria de salud: el caso de los Mayas en Guatemala. Organización de Promoción, Investigación y Educación de Salud (PIES) de Occidente, Organización Panamericana de la Salud, Organización Mundial de la Salud: Washington, DC.Google Scholar
  90. Walsh, C. (2005). Interculturalidad, conocimientos y decolonialidad. perspectivas y convergencias. Signo y Pensamiento, 46, 40–50.Google Scholar
  91. Walsh, L. V. (2006). Beliefs and rituals in traditional birth attendant practice in Guatemala. Journal of Transcultural Nursing, 17(2), 148–154.CrossRefPubMedGoogle Scholar
  92. World Bank. (2009). Guatemala—Poverty assessment: Good performance at low levels. Washington DC: World Bank. Retrieved February 15, 2017, from http://documents.worldbank.org/curated/en/803331468254934801/Guatemala-Poverty-assessment-good-performance-at-low-levels Google Scholar
  93. World Bank. (2016). Guatemala country overview. Accessed 15 Feb 2017, from http://www.worldbank.org/en/country/guatemala/overview#1.
  94. World Health Organization (WHO). (1978). Promoción y Desarrollo de la Medicina Tradicional, Serie de Informes Técnicos, 622. Geneva: WHO.Google Scholar
  95. World Health Organization (WHO). (2014). World Health Statistics 2014. Retrieved February 15, 2017, from http://apps.who.int/iris/bitstream/10665/112738/1/9789240692671_eng.pdf?ua=1
  96. World Health Organization (WHO), Pan American Health Organization (PAHO). (2014). Strategy for universal access to health and universal health coverage. Retrieved February 15, 2017, from http://www.paho.org/uhexchange/index.php/en/uhexchange-documents/technical-information/26-strategy-for-universal-access-to-health-and-universal-health-coverage/file
  97. World Health Organization (WHO), United Nations Children’s Fund (UNICEF), United Nations Population Fund (UNFPA), World Bank (1990–2010). (2012). Trends in maternal mortality. WHO, UNICEF, UNFPA and the World Bank estimates. WHO: Geneva. Retrieved February 15, 2017, from http://apps.who.int/iris/bitstream/10665/44874/1/9789241503631_eng.pdf

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Anne Marie Chomat
    • 1
    • 2
  • Bry Kring
    • 3
  • Luis Paiz Bekker
    • 4
  1. 1.CIET international Guatemala (Community Information and Epidemiological Technologies)Guatemala CityGuatemala
  2. 2.Participatory Research at McGill (PRAM), Department of Family MedicineMcGill UniversityMontrealCanada
  3. 3.Asociación de Comadronas del Área Mam (ACAM)Concepcion ChiquirichapaGuatemala
  4. 4.CIET international Guatemala (Community Information and Epidemiological Technologies)Guatemala CityGuatemala

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