“Morir En Camino”: Community Narratives about Childbirth Care in Rural Chiapas

ABSTRACT

This anthropological study explores why more women in the rural Sierra Madre region of Chiapas, Mexico birth at home rather than at the hospital. Between January and May of 2014, the primary investigator conducted in-depth, semi-structured interviews with twenty-six interlocutors: six parteras (home birth attendants), nine pregnant women, four mothers, four healthcare providers, and three local government leaders. Participant observation occurred in the health clinic, participants’ homes, and other spaces in a community with a population of 1,188 people. Drawing from narrative analysis, the findings suggest that women face structural obstacles to accessing high-quality childbirth care, which lead them to give birth at home instead of the hospital. These obstacles include financial barriers in obtaining facility-based care and poor quality of care, such as mistreatment in the facility. The study highlights the importance of centreing community narratives in healthcare programming in order to bridge the implementation gap between women in rural communities, healthcare workers, and policymakers.

KEYWORDS:

• Maternal health
• childbirth care
• rural Mexico

Acknowledgements

This study was conducted with the support of Compañeros En Salud and the Harvard University Global Health Equity Options (GHEO) Scholars programme. The authors acknowledge David Carrasco, Hector Carrasco, Azucena Espinosa, Paul Farmer, Victoria Koski-Karell, Joia Mukherjee, Lindsay Palazuelos, Tilsa Ponce, and Ishani Premaratne for guiding and supporting this project.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 Doña Rosa said this after describing her daughter's childbirth in the nearby hospital.

2 National MMR figures are often unreliable due to data collection systems in which hospitals are not incentivized to report maternal deaths and women who do not obtain facility-based prenatal and childbirth care are not included. Moreover, statistics for countries with high socioeconomic disparities dilute the gravity of maternal mortality in the poorest areas, like rural Chiapas.

3 “Mestizo” refers to various peoples of mixed Indigenous, African, and European ancestries.

4 While many non-governmental organisations operate in Los Altos, only one NGO works in the health sector in the Sierra Madre health sector.

5 In order to protect the identities of participants, we use Spanish pseudonyms to refer to participants and areas in which the study was conducted.

6 Vega (2017) and El Kotni (2016) have revealed the nuances in various birth movements in Mexico that draw on “indigenous culture”, with an explicit focus on the roles of parteras.

7 In Mexico, graduating medical students are expected to complete a social service year.

8 There are doctors in the hospital on Saturdays, yet it is nevertheless important to note that some community members believe that doctors are not present on the weekends.