If women are not valued, they do not receive equitable care
Inequities in health care are often associated with lack of access (perhaps due to geography or poverty) or outright discrimination based upon ethnicity, religion, and perceived “otherness”. It is important to keep in mind, however, that the causes of inequity are not always clear cut. If a woman feels uncomfortable in a clinic due to her cultural traditions, is not confident that she will receive respectful treatment from health workers, or has heard stories from other women in her community that have experienced disparaging treatment in the hospitals, she is less likely to give birth in the facility. Even if she develops potentially life threatening complications, she may avoid or delay seeking care where she feels unwelcome. Creating a safe, welcoming environment where a woman’s cultural traditions are respected is extremely important to developing equitable care, particularly for an experience as significant and personal as giving birth. As Article V of the Universal Rights of Childbearing Women states, “Every woman has the right to equality, freedom from discrimination, and equitable care.” The bottom line is if women are not valued, they do not receive equitable care.
This inequity is particularly prevalent in post conflict countries; even years after accords are signed. Guatemala is a generation away from more than three decades of internal conflict, and the indigenous Mayan communities still struggle with its effects as well as the accumulated oppression of their culture. Social and economic power differences continue to add to existing ethnic tensions.
A few years ago, I visited a small Mayan town in Guatemala where the local population had suffered heavy local losses during the conflict. They had also experienced a long history of disrespectful care from the health care professionals, who were largely non-Mayan and from urban areas. Many of the indigenous women did not speak Spanish and strongly adhered to Mayan traditions. They did not feel welcome or respected in the facilities and generally preferred to give birth at home in keeping with their customs. In an effort to reduce maternal mortality and increase the number of women that opted to give birth in the small hospitals, the hospitals recruited comadronas, traditional midwives, to serve as doulas in the maternity unit. This displayed recognition of the importance of the comadrona ‘s role in the community, particularly with birth, and provided a cultural and language-appropriate liaison to the community. The comadronas acted as translators and cultural guardians for women during a time of great vulnerability.
Similarly, we can see this concept implemented in the Maternal and Child Health Integrated Program (MCHIP)-supported Center for Human Services (CHS) project in the remote and mountainous province of Cotopaxi, Ecuador. The rate of home births among the total population in this region was 46.5%, but it was 71.4% for the indigenous population. CHS determined that “cultural differences were a primary cause of the low rate of facility births among the indigenous population. Instead of making efforts to change traditional cultural practices in the community, the project decided to improve cultural responsiveness of institutional health services” (read report). The project is working to bring together community members, government officials, and health care workers to strike a balance of cultural respect and increased facility care in the community.
Integrating underserved representatives into the health care system is crucial to creating more equitable care. The integration gives credence to the population’s traditional cultural values, and develops healthier women in stronger communities, because “every woman has the right to equality, freedom from discrimination, and equitable care” (Article V).
Click the image below to see all seven articles of the Respectful Maternity Care Charter: The Universal Rights for Childbearing Women.