Mexico Midwifery

Politics in Midwifery

Latina Republic had the opportunity to talk with members of the Organization of Indigenous Physicians of the State of Chiapas, A.C. (OMIECH). This meeting was held with Micaela Icó Bautista, who is the Coordinator of the Women and Midwives Area of OMIECH, Dr. Susannah Daniels and Dr. Rafael Alarcón Lavín who are Advisors of the same Area. Our conversation highlighted issues related to the politics between traditional midwives and the health sector, modern medicine, traditional medicine, and the recognition of indigenous traditional midwives. 

Here we have the perspective of the interviewees about the traditional indigenous midwifery and their experiences with the health sector. The details in this article are based on OMIECH’s own discoveries and interpretations of how the arrival of professional midwifery in Mexico has affected the culture of traditional indigenous midwifery.

 

Healer & midwife Lom, Chenalhó municipality, 2010. Source: Bacilia Velazco Trejo.

 

History of the Inquisition: The Beginning of Problems

Where did the problem come from?

“In pre-Hispanic times there were no problems because the Spaniards had not come. Midwives accompanied and attended most deliveries in Mesoamerica. In the event that a midwife was not present, the women had their birth alone or helped by another woman. Since the Spanish invasion there have been changes that involved the gradual loss of traditional indigenous midwifery in Latin America and around the world. 

The problem began in Europe with matronas, especially in France. The work of the midwives in Europe was like all over the world: they dominated the environment and the map of the feminine; they treated the sufferings of women and their children; they accompanied their deliveries and cared for their newborns. Then, doctors, surgeon-barbers and apothecaries realized the power of matronas and felt envy.

These men did not adequately know the female physiology, the way of thinking of women in relation to pregnancy, childbirth, puerperium. Subsequently, this situation of envy towards the midwives of Europe was transferred to America and the doctors began to displace the midwives and take away their work.  The main purpose was to obtain financial gain from the care of women since midwives, mainly in England, for each league walked to attend a birth charged a certain amount to the pregnant woman or her family.”

 

Micaela Ico in a community workshop in Carmen Yalchuch, Huixta municipality in 2018. Source: Filiberto Ico.

 

“The struggle in Europe, between doctors and matronas, continued to erase the last of the midwives; present day, there are still professional midwives. In America, schools were set up where anatomy, physiology, biochemistry, were taught in a medical perspective that subjugated the midwives. And midwives forgot everything they had learned through the ancestral matrilineal way; the transmission of knowledge, from generation to generation, was gradually lost.

In Europe, mechanisms of persecution and physical disappearance such as the inquisition accelerated the disappearance of the original midwives; a mindset that later was exported to America. The doctors, along with the church, were the ones who started the Inquisition. In Europe they killed thousands of women and “witches.” These “witches” were women who worked with natural medicine, with herbs.

Once the Spaniards transported the Inquisition to America, the despoliation of the native midwives of the territory that is now the United States and in Canada began; later, when the French and English settled, they finished the task of ethnocide in those territories. Currently, some women in the Reservations of native peoples of these two countries, try to recover elements of the original midwifery; a situation that has been difficult to achieve.”

 

OMIECH community workshop in Carmen Yal Chuch, 2018. Source: Filiberto Icó.

 

“What has changed are the numbers of deliveries attended by traditional birthers, which have been reduced due to the repression by doctors in the health sector. For example, several deliveries attended by traditional birthers are reported by a doctor and not under the name of the midwife who treated the woman. What the health sector is doing is trying to disappear and train traditional midwives.

This situation, of control over traditional midwives in America began in the twelfth century (years 1101 to 1200) in Spain, when the Spanish Crown forced matronas to be certified, through the application of an examination of knowledge and skills, so that they could exercise their trade. This story, which happened in Spain, is being repeated in Latin America and, today, in Mexico.”

 

OMIECH community workshop in Carmen Yal Chuch 2015. Source: Mounia El Kotni.

 

“The disappearance of traditional midwives has already occurred in other Latin American countries, for example, Uruguay, Argentina, and Chile. These countries became Europeanized and the matronas, as they were known there, and who were indigenous, disappeared.

There are several institutions, such as the MacArthur Foundation, the United Nations Population Fund, the Johnson & Johnson Laboratory, among others, that want to eliminate traditional midwives in Latin America and other continents, turning them into professional midwives. By turning them into professional midwives, you lose the trust, the community and various aspects that have marked the work of traditional midwives.”

 

Training of midwives by Health Sector. Drawing used in a community workshop by  OMIECH. Source: Antonio Vazquez, 2020.

 

What events influenced the start of OMIECH and what projects have been beneficial to women and the community?

“There was a persecution of traditional doctors that intensified in the 70s and 80s of the last century. It was the result of integrationist and modernizing politics that gave rise to political and religious conflicts within communities, as well as the result of international health politics for population control. The Área de Mujeres y Parteras (Area of Women and Midwives) of OMIECH emerged because we saw that there was a lot of need, concern, sadness, and a lot of dissatisfaction of the midwives, who felt rejected and despised.

Little by little the traditional midwives and doctors of the five mandates were being put behind: healers, midwives, herbalists, mountain priests or k’oponej witz in Tzotzil (”he/she who prays to caves”) and bonesetters. When the first assembly of traditional doctors was held, more doors were opened. And so, in 1985, the organization was legally constituted with its different areas of work. In the Women’s Area, we do workshops in the communities and regional meetings at the headquarters of OMIECH in San Cristóbal de Las Casas. Our aim, above all, is to strengthen the transmission of knowledge from experienced elderly midwives to young midwives, to women, men and children.”

 

Traditional midwife teaching apprentices. Drawing used in OMIECH community workshop. Source: Antonio Vazquez,2020.

 

What is the current state of the midwives in the indigenous communities of Chiapas? 

“In the indigenous communities of Chiapas, women are still cared for by midwives in their homes. The care provided by the midwives is not limited to the care of the pregnancy, but covers other stages of the woman’s life, the health of children and the well-being of the family. There are midwives, and some girls, who are retaining the knowledge of their grandmothers or their moms. “Our midwifery is not dead,” as some say.

But the Health Sector is hurting it, it is devaluing it and dividing the midwives. So, there’s concern about what’s going to happen to our midwifery, and many young people no longer accept it when they dream of their gift of a midwife. They don’t believe it, or only those closest to their grandparents believe it.

Traditional midwives are more reliable and respect family conditions. They respect the decisions of women and their families. When there is trust on the part of the woman’s family towards the midwife, she begins to advise the husband on how to take care of his wife and baby, how to have harmony between the couple and the family and thus prevent complications in the pregnancy, childbirth and postpartum.

When the woman is going to give birth, her family is present and the session is private, unlike a hospital. When the baby is born, there is bonding with the family and the midwife. Patients of the midwives claim, from personal experience, that they prefer the care of a midwife to that of a doctor. They say there is trust, peace of mind, and a lot of patience with the traditional midwife because it’s natural the way they attend.”

 

OMIECH community workshop at Carmen Yal Church, 2018. Source: Filiberto Ico.

 

Rights of Traditional Midwives

In Mexico and over the years, how have public policies aimed at traditional indigenous midwives changed and what is the reason for these changes?

“At the moment there are many complications because there are many programs that compete to train midwives, while the traditional midwife got her gift spiritually. The traditional midwife learns through her experiences and the knowledge of other companions. If something happens to the pregnant woman or the baby, the traditional midwife has no way of defending herself against the accusations of the Health Sector. In contrast, certified midwives are more respected and are able to defend themselves through their physical certificate.

Traditional midwives are concerned about the change that takes place and that may happen with the practice of traditional midwifery, since they are not respected, there is discrimination, and inequality; they feel that their work is not valid. The Birth Certificate to prove the nationality of the newborn children is denied to the parents if the delivery is not attended by a certified midwife by the Health Sector. The value of traditional midwives is being reduced, so they feel looked down upon, as their work is not recognized by the Health Sector. But the midwives continue their work which is important for them and for the families they help.”

 

OMIECH community workshop in Lázaro Cardenas, Simojovel municipality 2008. Photo: Bacilia Velazco Trejo.

 

“By understanding the historical context, you can see this political and social process that is being raised in the legislation of Mexico. All this must be contextualized in politics of aggression and of uncertain form, commodification of the reproductive process of women. When women are cared for in a hospital, there is capital build-up for pharmaceutical laboratories with the doctor’s decision to do caesarean sections. Meanwhile, legislators make laws to subjugate traditional midwives and eliminate them.   

Government programs began in the eighties, but gained more popularity in the nineties, where financial support was offered to pregnant women on the condition that they attend talks about family care. These government programs are provided by the Mexican Social Security Institute (IMSS) and the Ministry of Health which, if pregnant women do not attend the talks and meetings they organize, will not be provided with financial support from the government.

In other words, they are obliged to attend these meetings. The same happens to traditional midwives, if they do not attend the training talks on Western medicine or allopathic medicine given by these two institutions. In order to get their financial support, pregnant women have to be cared for in a government clinic or hospital, and not with a traditional midwife.

This conditional support is where OMIECH’s midwives identify that the problem began. Maybe the relationship with the health sector has not changed, the discourse changes, but the intention, the objectives, of the health sector towards the communities has always been the same. They only change their discourse, and now what they handle is the discourse of interculturality. 

In regards to midwifery, there is a contradiction between the Political Constitution and the secondary laws. The Political Constitution of the United Mexican States is the superior law that governs the others. The General Health Law is a secondary law, where trained midwives are recognized, but not traditional non-certified midwives.

However, the Political Constitution of the United Mexican States, in its second article, says that Mexico is a multicultural, multi-ethnic nation, and all cultures must be respected. In addition, there are international treaties affirming collective and cultural rights of traditional doctors that are also valid because Mexico has signed them. 

For example, article 169 of the International Labour Organization, which talks about indigenous communities and the respect they should be given and the participation they should have in health policies in different countries. In this sense, the General Health Law goes against the Political Constitution that says that indigenous cultures must be respected and governed based on what the community decide through the application of a Consultation, broad and previously informed of the consequences of the programs and actions that the government intends to apply in regions where the inhabitants are located in the indigenous communities.

This Consultation is mandated in Article 169 of the International Labour Organization (ILO), which is also a law that is at the same level as the Political Constitution in our country. Through the use of the General Health Law, the Health Sector gets involved with us, because they think and intend to transform the customs of the indigenous people.

Medicine and biomedicine have been generated by the Global Biomedical Paradigm, which prevails and dominates over all medicines and biomedical science. Rafael Alarcón had a controversy with the famous medical anthropologist Eduardo L. Menéndez. The discussion focused on Menéndez’s assertion that indigenous traditional midwives caused maternal deaths and that they had to be replaced by professional midwives, generated in the Biomedical Paradigm. Alarcón asked Menéndez for scientific proof of what he was stating. Menéndez replied that he had no evidence of this.”

 

Analyzing abuses in the Health Sector, Reunion of midwives OMIECH 2020. Photo: Agripino Icó.

 

How does the idea of integrating midwifery into the health sector affect the principles of traditional midwifery?

“For first-world people it is difficult to understand the fundamental role of traditional midwives in the health community and the positioning of those who defend this ancestral practice, because on their lands there are no longer traditional midwives or they are not recognized. Governments and the press in these countries only highlight development politics that are positive for their country and their context, and in some cases they are beneficial.

For example, there may be new techniques that help reduce obstetric violence in one country, but not in another country. In countries where traditional midwives still exist, before implementing training and creating midwifery schools, the perspective of the communities where traditional midwifery is still practiced and the people who will be affected by such politics should be considered.

The difference between OMIECH and other civil society organizations (CSOs) working with indigenous midwives here in Chiapas, and in other states, is that the latter’s agenda is generally tailored to the development goals of international health organizations (WHO, PAHO and UNFPA, among others), for whom traditional midwives are a means to an end: the reduction of maternal death. In recent years, some of these CSOs have adopted the profile of defenders of indigenous midwifery, but the rescue, development and defense of traditional medicine is not their main objective, as it is one of the main purposes of OMIECH.

The work of these CSOs is rather framed in a feminist discourse of sexual and reproductive rights, with the exception of a few organizations. The CSOs that promote professional parteria in Mexico to the detriment of traditional midwives, start from the premise that maternal deaths in indigenous communities are due to an insufficiency in the care they are receiving at the hands of traditional midwives.

What distinguishes OMIECH is that its work is part of a positive appreciation of traditional midwifery. The workshops of Área de Mujeres y Parteras facilitate the exchange of traditional knowledge, between experienced, traditional, midwives and younger ones, in the Tsotsil and Tseltal languages. In contrast, groups such as the Nich Ixim Movement of Traditional Midwives of Chiapas, which is composed of both traditional midwives and professional midwives, insist on the need to complement the knowledge of traditional midwives with the knowledge of modern biomedicine.”

 

Midwife training by Health Sector. Drawing used in OMIECH community workshop. Source: Antonio Vazquez, 2020.

 

“The problem is that they do not want to recognize that there is a stratification of the midwifery in Mexico crossed by the power built and exercised by the Mexican State and the “altruistic” foundations (Rockefeller, MacArthur, Ford, Kellog’s, among others) and international health agencies. The ”exchange” between traditional midwives and professional/trained midwives does not happen in a void, but in a broader context marked by racism, the imposition of the biomedical model, and the consequent inferiorization of traditional indigenous medicine, which is causing the gradual disappearance of traditional midwifery.

The focus of the trainings provided by the Health Sector is no longer about them being trained in biomedicine practices, but that they know how to recognize signs of risk to channel their patients to clinics. So, it’s no longer based on them learning other types of knowledge or practices in clinical medicine to supplement, according to them, their knowledge.

Western medicine, not many years ago, discovered that any woman can have a complicated childbirth no matter if she has a previous risk or not. To avoid a complication in childbirth, the health sector sends all women to the hospital, whether they have a previous risk factor or not.”

 

OMIECH 2016 meeting midwives and healers. Photo: Agripino Icó.

 

“Right now, all the women go to the hospital, because they have already realized that a woman, with no apparent previous risk, can have a complicated childbirth. There is a growing emphasis on the fact that traditional midwives need to be able to recognize risk signs and analyze their patients and that they cannot attend any birth that presents a complication.

The conflict, if any, between traditional midwives and professional midwives was historically caused by doctors. Professional midwives are certified as doctors and have some protection from the state, while traditional midwives are not. What is verifiable is that, throughout history, the public authorities have manipulated traditional and professional midwives. “

 

Requesting a birth certificate. Drawing used in OMIECH community workshop. Source: Antonio Vazquez, 2020.

 

“At the beginning of the century in Mexico there were complications between doctors and professional midwives, to such an extent that professional midwives were disappeared. In a few midwifery schools they teach them cultural issues and respect for traditional midwives.

If there is a willingness, mainly from the Mexican government, to dialogue with the traditional midwives, if there is respect for the traditional midwives and, above all, if the government does not cause more division among the midwives themselves with their programs and projects, we will be able to move forward and stop the disappearance of the traditional midwives in Mexico. 

From 2015-2018, the MacArthur Foundation from the United States, to be in line with the policy of the Rockefeller Foundation in the forties, came up with the idea to push forward biomedical medicine. The MacArthur Foundation, in line with the WHO (World Health Organization) and some international agencies, public and private, settled in Mexico and carried out an initiative to implement professional midwifery in Mexico.”

 

Midwife training by Health Sector. Drawing used in OMIECH community workshop. Source: Antonio Vazquez, 2020.

 

“This interference of the MacArthur foundation in the national policy implies the displacement of the traditional midwives, since it intends to impose a single model of obstetric care, professional midwifery, with which the traditional midwives would disappear. While professional midwives and schools for professional midwives increase, the government “tolerates” traditional midwives.

To legislate in favor of professional midwifery, the MacArthur foundation gave money to CSO to do an extensive lobbying campaign in the chamber of deputies and senators. Many CSOs in the states of Chiapas, Oaxaca and Guerrero, the main states with indigenous populations, received money from the MacArthur to boost professional midwifery. Nich Ixim’s Traditional Midwives Movement is one of the initiatives driven by MacArthur dollars.”

 

Exchange on medicinal plants in the OMIECH community workshop in Carmen Yal Chuch, Huixtán municipality 2018. Photo: Filiberto Icó.

 

Traditional Medicine and Modern Medicine

“Traditional midwives are not against allopathic medicine or doctors, as long as it is used properly: an example might be childbirth complication. What they want is for there to be respect for their tradition, for the way in which they carry out their service to pregnant women. It is another thing for pregnant women to be respected for their decision of where and with whom they want to be taken care of.

Prenatal care by traditional midwives is an important phase in the development of pregnancy and to avoid complications in and after childbirth. The difference with institutional prenatal care is that traditional midwives are with women throughout the course of their pregnancy and applying their knowledge of traditional midwifery, which is based on the same worldview of pregnancies and the traditional indigenous midwife.

During the COVID-19 pandemic, care by traditional midwives increased due to the fear of being treated in a hospital where cases increased. This increase in women served by traditional midwives lit up the role of midwives and the importance of them in communities. “

 

Doctor forbidding the traditional sobada. Drawing used  in OMIECH community workshops. Source: Antonio Vazquez, 2020.

 

“Many CSOs have advisors who know about the matter, have spent years on the subject, and know exactly that traditional midwives are disappearing. However, several professionals sold themselves to the MacArthur foundation and “bought them” to pretend and say that traditional midwifery is supported but, deep down, they are supporting professional midwifery in Mexico. This situation has greatly influenced the displacement of traditional midwifery to such a degree that it is likely to become a complete ethnocide within a few years.”

 

Prayer meeting midwives OMIECH 2018. Photo, courtesy, OMIECH.

 

“OMIECH has already had strong experiences of defending herbalism, for example against the U.S. government’s ICBG-Maya project, which wanted to patent the knowledge of indigenous peoples here. We fought, together with the Council of Traditional Indigenous Physicians and Midwives of Chiapas (COMPITCH) and managed to get that project cancelled.”

The real problems of the disappearance of a very important part of a culture that is still alive have not been assessed. For this reason, it is important that indigenous traditional midwives continue to organize, that they raise their voices, so that the situation described above becomes visible, which will allow the public debate on the current state of traditional midwives in Mexico to deepen. 

 


Nancy Ortega | University of California, Davis

My name is Nancy Ortega and I am a current undergraduate student at UC Davis majoring in Animal Science and Spanish, but began my studies at Rio Hondo College. I am the proud daughter of two immigrants and the sister of a Dreamer. My interest in Latin America emerged due to the passion from my high school Spanish teacher. I became interested in the variety of cultures, the unique people, and the history still to be uncovered from underrepresented countries. In Latina Republic, I want to expand the beauty and complexity of Latin America and enrich my mind, as well as that of the readers, throughout this new experience. I look forward to meeting interesting individuals, hearing new stories, and coming out with a fresh mind set.