After decades of shortages of trained people to help in deliveries, Bolivia is now training traditional midwives to help lower Bolivia’s maternal mortality.
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Bolivia has long tried to convince women about the need to get pre-natal care at health clinics and give birth at hospitals. In 2009, the government even offered pregnant women a US$247-a-year financial incentive.
Despite that, maternal death rates in Bolivia remained one of the highest in the hemisphere, with around 206 per 1000,000 live births in 2015, according to the U.N. Population Fund. By contrast, Finland recorded three deaths per 100,000 births in 2015, and the United States had 14.
Maternal deaths in Bolivia are concentrated among poor, rural Indigenous women, many of whom distrust hospitals and cesarean births. They prefer to rely on traditional midwives, who they often refer to as “aunts,” for deliveries.
The World Health Organization says that “decades of neglect of the role of midwives, either because of the over-medicalization of pregnancy care or a lack of resources, has left a legacy of high rates of maternal and newborn mortality in developing countries.”
“Midwives are already saving lives,” said Fernando Leanes, a WHO official in Bolivia. “But we could reduce the number of maternal deaths at home if more of them arrived to other homes knowing how to do their jobs right.”
The most recent investigation carried out by Bolivia’s health ministry in 2011 said about 42 percent of the country’s maternal deaths happen in home deliveries. One of the top causes is that women are aided by untrained people, including their partners or family members, it said.
Led by Bolivia’s first Indigenous president, Evo Morales, the government has tapped into this cultural practice by training about 500 midwives and improving their medical skills. The training program is partially financed by the U.N. Population Fund, which has supported similar initiatives in Bolivia previously.
Their lessons include dealing with emergency situations such as how to disinfect wounds or the best way to prepare a woman to be safely taken to a hospital in case of an uncontrollable hemorrhage.
Ana Choque, an Indigenous Aymara woman, is one of 22 women among the group who have so far passed an exam to get officially qualified by the health ministry.
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The 58-year-old midwife learned the trade from her grandmother when she was 15. In the four decades since, she has delivered more than 3,000 babies.
“I saw the miracle of life and that turned me into a midwife,” Choque said.
In recent months, the government’s midwifery training program has accelerated as more midwives have joined the staff at clinics and have been allowed to certify births when they deliver babies in distant rural areas.
German Mamani, deputy minister for traditional medicine, said the program takes into deeply rooted cultural traditions and the value of women who travel to distant areas that lack hospitals or doctors.
“There are very remote places where it could take them (medical professionals) days to arrive,” Mamani said. “But a midwife is on site, saving lives.”