Addressing Inequities in Pregnancy Care and Childbirth in Chiapas, Mexico

Andrea and Rose Jalte
Rose Molina, BWH Connors Center Global Women’s Health Fellow, and Andrea Reyes, Maternal Health Coordinator at Compañeros en Salud

By Rose Molina, MD
BWH Connors Center Global Women’s Health Fellow

The motto of every pregnancy sounds simple: “healthy mom, healthy baby.” Yet, pregnancy and childbirth remain important causes of morbidity and mortality for reproductive-age women in resource-limited settings.

While the conversation about increasing Cesarean delivery rates and “medicalization” of childbirth in the United States continues, the reality in Chiapas, Mexico, is strikingly similar yet a world apart; both under-intervention and over-intervention exist, creating significant inequities in obstetric care. In Chiapas, the lack of access to quality services remains common for marginalized women, and “medicalization” can lead to “obstetric violence,” a term used to describe disrespect and abuse during childbirth.

Obstetric violence can take the form of unnecessary Cesarean deliveries, procedures without consent such as sterilization or IUD placement, and non-dignified care. The Ministry of Health is committed to assuring that such violence does not occur in public hospitals. Respectful maternity care has become a recognized yet under-studied subject in the maternal health field; it is a critical component of effective maternal health interventions to improve facility-based childbirths.

A recent New York Times article highlighted the role of traditional midwives in attending childbirths among the indigenous population in Chiapas, Mexico. Maternal health experts have long debated how to integrate traditional birth attendants (TBAs) into health systems to reduce the unexpected catastrophic complications that can occur during childbirth, especially in remote areas without access to Cesarean deliveries, blood banks, or life-saving medications. Recently, the Ministry of Health has begun to embrace a model that includes obstetric nurses and professional midwives who practice alongside physicians for low-risk pregnancies. The evolving role of TBAs remains unclear; yet, they maintain important social status and respect in their communities and should be included in community interventions to reduce maternal and neonatal morbidity and mortality.

Partners In Health / Compañeros en Salud will soon launch a demonstration project that aims to increase facility-based births in an existing maternal center while promoting quality, respectful maternity care. The organization has strengthened the primary care system in 10 rural communities in the Sierra Madre region of Chiapas, Mexico, since 2011.

Casa Materna Revolución
The maternal center adjacent to the district hospital in Revolución, Chiapas

Over the next three years, we will work in a multi-disciplinary team of physicians, trainees, midwives, obstetric nurses, administrators and researchers to meet women’s expectations of a dignified birth experience while ensuring access to quality services during pregnancy, childbirth, and the postpartum period.

As a BWH Connors Center Global Women’s Health Fellow and an obstetrician-gynecologist, I will collaborate with the local team to provide content expertise around the project’s design and will develop a system to measure the outcomes of the demonstration project so that lessons can be shared across Chiapas and beyond.