Reproductive Care around the World

In 3 months Annie traveled to 6 countries to interview 70 midwives - Guatemala was her last stop.



IMG_1120Hello! My name is Annie Carson and I am an undergraduate global health student at Arizona State University. This summer I received a grant through the Circumnavigators Club Foundation to travel to 6 countries to pursue my own thesis research, and during my travels I spent 2 weeks with Wuqu’ Kawoq in Tecpan. I have always been captivated by childbirth and midwifery, and I am passionate about global maternal health. Over three months I travelled to Netherlands, Sweden, Rwanda, Bangladesh, Australia, and Guatemala to interview over 70 midwives about their roles in the community, and compare their stories across the countries.

Reproductive Care around the World: Midwives and Family Planning in Guatemala



Guatemala was my last stop on my global trip this summer. The country was so beautiful, the people so welcoming, and I learned about a very different system of health care and access than I had experienced in other countries. When I arrived in Guatemala, I was connected with Wuqu’ Kawoq and spent my two weeks with their organization in Chimaltenango learning about their important and effective mission to serve people in their own contexts and languages. The majority of medical facilities in Guatemala cater to Spanish-speaking patients, so individuals from Mayan communities who only speak Kaqchikel and are not able to read experience severe discrimination when they go to the hospitals. It was so important to work with an organization who is striving to balance the discrepancy between the urban and rural populations. Coming from the United States, where our services for indigenous people and minority populations often do not adequately provide care in culturally appropriate ways, I found this organization demonstrated an important model to follow.

the health center

During my time I was able to interview six midwives (comadrona in Spanish) with the help of a Kaqchikel translator. In Guatemala, midwives choose calling after having significant dreams and experiencing illness until they accepted the calling. One midwife realized her calling when she delivered her own child at age 17. Another graduated from the mandatory 1 year license training in just a few months because although she is illiterate, all of the answers to the questions came to her in a dream. Another midwife told me she didn’t want to become a midwife, but she continued to get violently ill until one day she helped a woman deliver her baby and instinctively knew what to do. Guatemalan midwifery callings were completely unique compared to the other midwives I interviewed around the world – who often decide to become midwives based on interest in the medical field as in Sweden and Australia, or in response to government commitments to increase the number of midwives, such as in Bangladesh and Rwanda. In Guatemala, women become midwives because of a deep sense of this vocation aligning with their identity. Hearing these stories translated back to me gave me chills as I recognized the power of such a strong calling combined with the training and infrastructure to support these midwives.

interviewing a midwife in the field

Although most Mayan midwives cannot read or write, they learn to care for normal birth through apprenticeship and health courses at the health center. While midwives are not recognized as autonomous, trained medical professionals by the official medical systems of Guatemala, they are the trusted and primary caregivers for the rural communities. Every midwife told me that a critical part of their job is referring women to the hospital and health center when complications arise. Yet the midwives said that the biggest barriers to care are convincing the women to go to the hospital, and having the hospital staff reject and discredit the midwife if she arrives. The women don’t want to go to the hospital because the staff often don’t speak Kaqchikel, they don’t inform the family of the mother’s condition, and sometimes discriminate against indigenous women. Doctors I spoke with in Guatemala told me that a big problem is that physicians don’t understand the role of midwives, so they struggle to collaborate with them. When I asked him to define a midwife, Dr. Boris Martinez beautifully responded, “A midwife is the healthcare system where there is no healthcare system. But so many doctors do not know this.”

Along with interviewing midwives, I have had the pleasure of getting to know many of the staff and volunteers and shadowing on some of the trips to the villages. I accompanied them on their diabetes project where they meet with patients and test blood sugar and provide education, as well as a women’s health teaching. All of their programs provide an educational component along with clinical care and medicinal support.

instructor (Yoli) teaches about various family planning methods

The women’s health teachings include 8 week courses where women in the community bring their children and learn about health and family planning. The week I visited, the ratio of moms to children was 2:4. It was precious to watch the women listening intently while their babies nursed and toddlers played. Family planning is a very sensitive issue in the rural communities. Many families reject family planning for religious reasons, and others have misunderstandings about how different methods work. Often, once women learn more about birth control they want to use it, but their husbands and mothers-in-law prohibit them. It was striking to learn about the strength of power dynamics in the nuclear family and to realize that comprehensive reproductive healthcare must engage many members of the community to be effective.

“The decision to use money is the responsibility of both the man and woman. Plan the number of children as well.”
women participating in an intensive health course

After the lesson, the woman to the left said that she has learned so much during the teaching. She has 7 children (the youngest sleeping on her back). She has always believed that birth control is a sin, but now she thinks differently. She says she wishes she had the opportunity to go to school and read, and she hopes that her children will have that opportunity. She said it is difficult that she cannot even read the text of the manual. Even though she thinks differently about birth control, she says that her husband will not allow her to use it. Attending this teaching made me realize the importance these kind of information sharing services. When women are not able to learn through reading, they only have access to the beliefs of their community. Without an understanding of different family planning methods they don’t even have the option of choosing one that works best for them. The intersection of knowledge and resources is so critical, and I have such respect to Wuqu’ Kawoq’s commitment to provide both of these aspects in the local language.

Travelling to radically different countries around the world, I encountered so many individuals dedicated to serve women and support families despite severe obstacles. I feel so honored that I got to spend so much time with remarkable individuals working with Wuqu’ Kawoq both in the city and community. I am so excited to watch the organization continue to grow, and I can’t wait to return in the future!

Kate and I smile for the camera