Fuzzy cognitive mapping and soft models of indigenous knowledge on maternal health in Guerrero, Mexico

Abstract

Background: Effective health care requires services that are responsive to local needs and contexts. Achieving this in indigenous settings implies communication between traditional and conventional medicine perspectives. Adequate interaction is especially relevant for maternal health because cultural practices have a notable role during pregnancy, childbirth and the postpartum period. Our work with indigenous communities in the Mexican state of Guerrero used fuzzy cognitive mapping to identify actionable factors for maternal health from the perspective of traditional midwives. Methods: We worked with twenty-nine indigenous women and men whose communities recognized them as traditional midwives. A group session for each ethnicity explored risks and protective factors for maternal health among the Me'phaa and Nancue ñomndaa midwives. Participants mapped factors associated with maternal health and weighted the influence of each factor on others. Transitive closure summarized the overall influence of each node with all other factors in the map. Using categories set in discussions with the midwives, the authors condensed the relationships with thematic analysis. The composite map combined categories in the Me'phaa and the Nancue ñomndaa maps. Results: Traditional midwives in this setting attend to pregnant women's physical, mental, and spiritual conditions and the corresponding conditions of their offspring and family. The maps described a complex web of cultural interpretations of disease -"frío" (cold or coldness of the womb), "espanto" (fright), and "coraje" (anger)abandonment of traditional practices of self-care, women's mental health, and gender violence as influential risk factors. Protective factors included increased male involvement in maternal health (having a caring, working, and loving husband), receiving support from traditional healers, following protective rituals, and better nutrition. Conclusions: The maps offer a visual language to present and to discuss indigenous knowledge and to incorporate participant voices into research and decision making. Factors with higher perceived influence in the eyes of the indigenous groups could be a starting point for additional research. Contrasting these maps with other stakeholder views can inform theories of change and support co-design of culturally appropriate interventions.

Bridging Western and Indigenous knowledge through intercultural dialogue: lessons from participatory research in Mexico

“…Participants described culturally coherent responses to these risks including rituals, medicinal plants, massages, midwives counselling of husbands and other care practices connected with their culture. 56 …”

“…Participants described culturally coherent responses to these risks including rituals, medicinal plants, massages, midwives counselling of husbands and other care practices connected with their culture. 56 The final statistical analysis of the randomised controlled trial, to be reported in a separate publication, will incorporate traditional midwifery knowledge as described in the fuzzy cognitive maps as prior knowledge in the statistical models, in an extension of Bayesian procedures. 57 This allows a space for Indigenous voices even in the very technical matter of effect estimation and significance testing.…”

Maternal health and Indigenous traditional midwives in southern Mexico: contextualisation of a scoping review

“…A study in the south of Guerrero included 29 Indigenous traditional midwives from the Me'phaa (Tlapaneco) and Nancue ñomndaa (Amuzgo) groups. 36 These women and two men had de facto recognition as midwives in their communities, based on their decades of service and traditional knowledge. Most used only Indigenous languages and the mapping session relied on trained intercultural brokers for translation.…”

“…The contextualisation of available evidence combined three sources of information—traditional midwives, 36 intercultural researchers working on perinatal care 33 and the available literature—to identify the influences on maternal health in Indigenous communities in southern Mexico. Traditional midwives contributed a cultural perspective grounded in Guerrero local conditions, and intercultural researchers shared their understanding of the issues, based on their years of bridging the relationships between Western institutions and Indigenous communities in their international work in America, Africa and Asia.…”

Factors influencing maternal health in indigenous communities with presence of traditional midwifery in the Americas: protocol for a scoping review

“… 57 Figure 1 illustrates a fuzzy cognitive map from traditional midwives in Guerrero state, describing their views about protective factors for maternal health. 58 …”