Labor and delivery service use: indigenous women’s preference and the health sector response in the Chiapas Highlands of Mexico

Abstract

BackgroundMexico has undertaken important efforts to decrease maternal mortality. Health authorities have introduced intercultural innovations to address barriersfaced by indigenous women accessing professional maternal and delivery services. This study examines, from the perspective of indigenous women, the barriers andfacilitators of labor and delivery care services in a context of intercultural and allopathic innovations.MethodsThis is an exploratory study using a qualitative approach of discourse analysis with grounded theory techniques. Twenty-five semi-structured interviews were undertaken with users and non-users of the labor and delivery services, as well as with traditional birth attendants (TBAs) in San Andrés Larráinzar, Chiapas in 2012.ResultsThe interviewees identified barriers in the availability of medical personnel and restrictive hours for health services. Additionally, they referred to barriers to access (economic, geographic, linguistic and cultural) to health services, as well as invasive and offensive hospital practices enacted by health system personnel, which limited the quality of care they can provide. Traditional birth attendants participating in intercultural settings expressed the lack of autonomy and exclusion they experience by hospital personnel, as a result of not being considered part of the care team. As facilitators, users point to the importance of having their traditional birth attendants and families present during childbirth, to allow them to use their clothing during the attention, that the staff of health care is of the female sex and speaking the language of the community. As limiting condition users referred the different medical maneuvers practiced in the attention of the delivery (vaginal examination, episiotomy, administration of oxytocin, etc.).ConclusionsEvidence from the study suggests the presence of important barriers to the utilization of institutional labor and delivery services in indigenous communities, in spite of the intercultural strategies implemented. It is important to consider strengthening intercultural models of care, to sensitize personnel towards cultural needs, beliefs, practices and preferences of indigenous women, with a focus on human rights, gender equity and quality of care.

Barriers to accessing maternal health care services in the Chittagong Hill Tracts, Bangladesh: A qualitative descriptive study of Indigenous women’s experiences

“…However, unlike these countries, no targeted intercultural health care service for Indigenous women was found in the CHT and often these women experienced discrimination (including unofficial payments and abusive treatment) from health staff, including Indigenous health staff, at the public facilities. As with previous studies, this study found that Indigenous women lacked knowledge about existing primary health facilities and about the importance of accessing MHC services [36][37][38]. These findings are supported by literature that state the importance of relatives and neighbours, may provide incomplete information regarding ANC and facility delivery [47][48][49].…”

“…Indigenous women in the CHT reported that pregnancy was a natural event. MHC services were perceived to be essential to access only if a woman was experiencing "somossya" (complications) during pregnancy and at childbirth, when situations became uncontrollable and were beyond the capacity of a TBA [36,37,48,50,51]. Otherwise, MHC services were considered a waste of time and money.…”

“…Calling a TBA to support childbirth was the first preference due to accessibility, affordability, availability [36,37] and perceived trustworthiness. The option of paying the TBA later was convenient and cost-effective for poorer Indigenous families.…”

Access to maternal healthcare services among Indigenous women in the Chittagong Hill Tracts, Bangladesh: A cross-sectional study

“…Previous studies reveal that Indigenous peoples perceived pregnancy and delivery as ‘natural events’, and would only visit health facilities if the situation becomes out of control 21 23 25 26. CHT Indigenous women with knowledge of pregnancy-related complications were more likely to access MHC services during pregnancy and delivery.…”

“…Distance to services, language barriers and cost are key barriers for Indigenous women accessing existing MHC services 20–25. The top-down nature of health intervention programmes can make services culturally unfriendly for Indigenous women in lower and middle income countries, impacting their access to available services 26.…”