by Ellen Branch
Birth is a basic female duty for the procreation and continuation of the human race. So why have institutions refused to offer all women access to peri-natal care that sustains what the World Health Organization (WHO) defines as optimal health “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity?” Many women across the globe regardless of race, class, or ethnicity lack the basic human right to appropriate medical care. Indigenous women in Guatemala experience a disproportionate burden of maternal mortality and morbidity as a result of institutional failures to respect their rights. There is a lack of awareness about normal birth resulting in interventionalist tactics that seek to medicalize a natural function, birth. But which rights must be taken into account as women prepare for birth?
A 22 year old, very pregnant Jimena Sánchez walks 8 kilometers into the Guatemala City twice a month for her pre-natal visits. When she arrives to the clinic, she waits nearly an hour to see her obstetrician. Once she is finally directed toward the exam room, she waits another 15 minutes for the obstetrician to arrive. In walks the obstetrician, in his white lab coat and scrubs, he takes her vitals, asks her if she has any questions and as swiftly as he entered he exits, leaving Jimena to trek back to her Quiche community on the outskirts of the city. In total she spent quadruple the amount of time traveling than the amount of time he spent speaking with her.
Stories like this are all too common among indigenous women in Guatemala and they illustrate the types of problems rural women across the globe have finding adequate, culturally sensitive peri-natal care. Most rural and urban women in Guatemala encounter problems finding, maintaining, and meeting the demanding requirements of the current biomedical care model. Like Jimena, many rural women have to walk to the city to get to competent care providers. Although forty percent of the population categorizes themselves as “indigenous,” these Quiche, Quetzal, Garifuna, and Mayan women find that the current biomedical model neglects anyone who does not have access to transportation and stable income. Many of these indigenous groups believe that pregnancy is natural and often a rite of passage into womanhood. It comes as no surprise that in 2012, indigenous women made up fifty-six percent of the total pregnancies in Guatemala. If indigenous women contribute over half of the population growth, then why are the institutions failing to legitimize traditional beliefs of pregnancy and labor? These rights include options for home visits, home births, access to traditional skilled-birth attendants, and finally education.
From an ethnocentric perspective many readers may wonder, how is this relevant to birth across the globe? Just as the distribution of peri-natal care is skewed in Guatemala, the same issue occurs in the United States, Canada, and India. The standard biomedical models view birth as a physical bodily disturbance and seeks medicalize it. While the indigenous view of birth is part of a holistic and personalistic system, involving moral values, social relations and the environment as well as physical aspects. In efforts to improve the culturally insensitive practices, many health care systems seek to introduce more ‘holistic’ or ‘alternative’ care to the current biomedical care model. One ethnographer in particular reinforces how medical care during pregnancy has become a feminist issue. In her ethnography of birth in a Canadian hospital, Hélène Vadeboncoeur concludes, “Whilst women are treated kindly and attention is paid to them in this hospital, there is very little respect for the birth process and the physiological nature of this event.” As a feminist issue, the biomedical care model neglects to maintain the basic human rights allotted to all people, especially women. There is a need for change on an institutional level. This change recognizes the traditional beliefs of every woman and integrates that into a revised intercultural biosocial care model. This model encompasses all the technologically advanced methods offered by the biomedical model in conjunction with educating the patient on the options for care. This is much different than the model persistent across most of the globe, where women are pushed in and out like cattle
The story of Jimena Sánchez is only the beginning, across the globe women have begun to see how the current medical model seeks to speed up the process of pregnancy and laboring. The word laboring is used for that particular reason, patience, care, and compassion must be observed in order for the female body to accept and welcome the process. All of this research would be pointless if there were not organizations like One and NOW seeking to end the disproportionate maternal health status of women in rural areas. Efforts to expand access to ambulatory services to rural areas and professionalize the work of midwives who speak the native indigenous languages are the only way to integrate tradition with mainstream medical practice and introduce a care model centered on the whole individual mind, body, and spirit.
Ellen Ashley is a women’s studies major at East Carolina University and plans to enter the field of nursing.