FVPF Partners With Traditional Midwives to Reduce Maternal Mortality in Mexico
Audio dramas educate “parteras” to screen for exposure to domestic violence.

“There are no formal hospitals or domestic violence agencies in the rural areas, but all of these women will see a partera (midwife) for health care during their pregnancies,” says FVPF Managing Director Leni Marin. “Midwives are ideally situated to reach out to women struggling with abuse during pregnancy, a leading cause of maternal complications, injury, and death. Activities are focused in Chiapas and Oaxaca, Mexico, where maternal mortality rates are almost double the national rates and the regional prevalence of domestic violence is estimated to affect between 30 to 40 percent of adult women.

Lively discussion furthers understanding of how to help patients face violence at home, Chiapas

Trainings address unique challenges:
The program called Reducing the Social Causes of Maternal Morbidity and Mortality in Mexico and funded by the John D. and Catherine T. MacArthur Foundation partners with a nongovernmental organization in Chiapas called ACASAC (Asesoria, Capacitación y Asistencia en Salud A.C.).

ACASAC staff came to the FVPF’s San Francisco office three years ago for an intensive training on health care and intimate partner abuse. While the parteras’ trainings in Chiapas used the FVPF’s model for screening of abuse in the health care setting, the materials were adjusted to address the distinct socio-cultural conditions where the midwives’ interactions take place. For example, the midwives, like their patients, may not know how to read or write, so they need alternative ways to report injuries and make referrals such as drawing pictures of where on the body an injury may have occurred.

Parteras listen intently to the training, Chiapas

“Our goal is to reduce maternal morbidity and mortality through early detection of abuse,” says anthropologist, Graciela Freyermuth Enciso, “and also to provide tools that empower and build the capacity of the midwives and strengthen community participation among indigenous women.”

The trainings use audio recordings of dramatic stories interspersed with instruction and guided discussion. This format has a long history in Latin America, especially for indigenous and farmworker sectors and people in inaccessible areas. “Radio programs broadcasting educational programs to small farm worker communities can be traced back to the 1940s,” says Freyermuth Enciso.

The training, called “Violence and Maternal Health in Multicultural Contexts: Improving Midwives’ Response,” is broken into four modules. Throughout each module, presenters lead listeners through the story being presented by a fellow midwife, Doña Flor, prompting discussion as different issues are raised. Participants hear the story in sections, with role-plays and other activities between segments. The modules were pilot tested in a series of meetings with midwives in Chalchihuitan in 2003-2004.

“The first module sensitizes the midwives to the prior vulnerabilities toward family violence and reproductive health risks before marriage,” says Marin. “The concept of family violence, which doesn’t exist in indigenous tongues of the regions, is also introduced.”

The remaining modules link domestic violence to obstetric health, discussing when and how to talk about the issue, as well as exploring options women have and ways to escape it. We hear Doña Flor, the midwife, talk with Maria about the violence in her life, ways she can document the abuse, find people who might help, and ultimately plan a safety plan for her and her children.

“Building the capacity of traditional midwives is a critical step in reducing maternal risks during pregnancy, protecting the lives of both the mother and child,” says Marin. “The FVPF is learning invaluable lessons from the partners and the success of these training sessions.”

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Detection and Attention to Family Violence during Pregnancy in Oaxaca, Mexico
(Excerpt from an article by Angélica Ayala Ortiz originally printed in Entre Lineas)

Considering that family violence is a frequently-occurring phenomenon, that gender inequality has an impact on women’s sexual and reproductive health, and that indigenous women are at high risk for maternal morbidity and mortality, The Rosario Castellanos Women’s Research Group—in collaboration with the Family Violence Prevention Fund (FVPF)—has developed a project entitled “Detection and Prevention of Family Violence During Pregnancy.”

Women during training, Oaxaca

The project’s objective is to make a positive impact on two severe problems: maternal morbidity and mortality, and violence during pregnancy. To reach this goal, activities have been undertaken in the Mixe and Central Valley regions of Oaxaca to train and sensitize traditional midwives, midwife apprentices, and healthcare professionals, given that these are the people in closest contact with the indigenous women of the region.

To date, several activities have been conducted to help these providers detect signs of family violence during pregnancy, implement intervention strategies both from within and from outside the community, and form alliances between healthcare providers, midwives, and community health educators in order to channel women with high risk pregnancies into appropriate healthcare services.

Both in-depth interviews with program participants and comprehensive training sessions have indicated that participants—midwives, health educators, and healthcare providers alike—all face the problem of family violence on a daily basis in their work. One of the most valuable aspects of the trainings offered through this program has been the unique opportunity for participants to reflect on this problem, exchange experiences and ideas, and learn to detect and intervene in cases of family violence during pregnancy. Program participants indicated that some advances have been made in domestic violence education and intervention, but also signaled the importance of making inroads beyond the healthcare sector to improve administrative and legal responses.

Testimonies from program participants include the following:

“In order for all of this to really be carried out, we need to start taking action. But often although the authorities try to fulfill their function, they don’t have the right tools to do so. We need to advise the legal system, train the mayor—but this never happens. What does Human Rights do? Maybe it works in offices and in the city, but out in the country it’s different.”

Healthcare providers review training material, Oaxaca

A 1997 Pan-American Health Organization study found that the major barrier preventing abused women from accessing care is the fact that they are frequently shuffled from one agency to another—both within the legal and healthcare systems—and are exposed to ridicule, silence, and blame, often without ever receiving any real assistance.

For this reason, in making the link between family violence and maternal mortality, the biggest challenge will be to establish detection and intervention strategies that enable healthcare providers, municipal authorities, and the legal system to all take a stand together to reduce the incidence of maternal mortality.

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