Midwives are helping to reduce maternal mortality
EL ALTO, Bolivia — Mariana Limachi left the hospital in this high Andes city in tears after a doctor told her she needed a C-section because the umbilical cord was wrapped around her 8-month fetus.
Instead, she turned for help to a highly respected figure among Bolivia’s indigenous women: the midwife. A few weeks later, midwife Ana Choque, an Aymara woman, delivered Limachi’s first son at her home using sunflower oil, paper napkins and coca leaves.
After decades of shortages of trained people to help in deliveries, the role of midwives has been growing in recent years in Bolivia, which joined international efforts to improve the skills of midwives and bring them into closer contact with the medical community.
Aymara and Quechua indigenous groups make up a majority of the country’s population, and many indigenous women like Limachi distrust hospitals and cesarean births. They prefer to rely on traditional midwives, whom they often refer to as “aunt.”
Led by Bolivia’s first indigenous president, Evo Morales, the government has tapped into this strong cultural bond to train about 500 midwives and improve their medical skills. It is incorporating them into the health system as it strives to lower Bolivia’s maternal mortality, which is the highest in South America and among the highest in the Western Hemisphere.
The current program officially began in 2013 after Bolivia passed a law recognizing traditional indigenous medicine, including midwifery. But training has accelerated in recent months as more midwives have joined the staff at clinics and have been allowed to certify births when they deliver babies in distant rural areas.
Their lessons include dealing with emergency situations such as how to disinfect wounds or the best way to prepare a woman to be safely taken to a hospital in case of an uncontrollable hemorrhage.
Bolivia long tried to convince women about the need to get prenatal care at health clinics and give birth at hospitals.
Despite that, authorities say, the number of maternal deaths remained practically unchanged, around 206 per 100,000 live births in 2015. Only Guyana and Haiti have a higher rate of maternal deaths in the hemisphere, the U.N. Population Fund says.
Maternal deaths in Bolivia are concentrated among poor, rural indigenous women, who are among the most vulnerable. Critics say Bolivia’s public health centers and hospitals in rural areas often lack beds, doctors and medicines.