Remaking the Guatemalan Midwife: Health Care Reform and Midwifery Training Programs in Highland Guatemala

Abstract

Midwifery practice and identity in Guatemala is constantly being transformed because midwives must negotiate their practices in response to changing international and national health care agendas and processes. Recently, the Guatemalan government implemented the Sistema Integral de Atención en Salud (SIAS). Framed by neoliberal processes and global reproductive health paradigms, SIAS is designed to attain the reproductive health goals outlined in the 1996 Peace Accords by reducing maternal and infant mortality rates. As the primary birthing specialists in rural areas, midwives are essential to this task. A central focus of SIAS is incorporating midwives into the national health care system through midwifery training programs. Drawing on observations of midwifery training programs and interviews with midwives in the municipality of San Martín Jilotepeque, I argue that the incorporation of midwives into SIAS is redefining the position by establishing a new model of recruitment to the role, education, and practice and authority.

Key Words:

• Guatemala
• health care reform
• Kaqchikel
• midwifery

ACKNOWLEDGMENTS

This research was funded by a Fulbright Institute for International Education Fellowship from 2002–2003. The author is grateful to Barbara Scheiber and the staff at Behrhorst Partners for Development for their assistance and support in conducting this research. He is also grateful to the three anonymous reviewers for their helpful comments and suggestions for improving this manuscript.

Additional information

Notes on contributors

Jonathan N. Maupin

JONATHAN MAUPIN is a research associate in the Department of Anthropology at Vanderbilt University. His current research focuses on examining patterns of inter- and intracultural variation in folk medical knowledge among Hispanic migrants in Nashville, Tennessee. He may be reached at VU Station B #356050 2301 Vanderbilt Place, Nashville, TN 37235-7703. E-mail: [email protected]