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

Abstract

ObjectivesCollate published evidence of factors that affect maternal health in Indigenous communities and contextualise the findings with stakeholder perspectives in the Mexican State of Guerrero.DesignScoping review and stakeholder fuzzy cognitive mapping.Inclusion and exclusionThe scoping review included empirical studies (quantitative, qualitative or mixed methods) that addressed maternal health issues among Indigenous communities in the Americas and reported on the role or influence of traditional midwives before June 2020. The contextualisation drew on two previous studies of traditional midwife and researcher perspectives in southern Mexico.ResultsThe initial search identified 4461 references. Of 87 selected studies, 63 came from Guatemala and Mexico. Three small randomised trials involved traditional midwives. One addressed the practice of traditional midwifery. With diverse approaches to cultural differences, the studies used contrasting definitions of traditional midwives. A fuzzy cognitive map graphically summarised the influences identified in the scoping review. When we compared the literature’s map with those from 29 traditional midwives in Guerrero and eight international researchers, the three sources coincided in the importance of self-care practices, rituals and traditional midwifery. The primary concern reflected in the scoping review was access to Western healthcare, followed by maternal health outcomes. For traditional midwives, the availability of hospital or health centre in the community was less relevant and had negative effects on other protective influences, while researchers conditioned its importance to its levels of cultural safety. Traditional midwives highlighted the role of violence against women, male involvement and traditional diseases.ConclusionsThe literature and stakeholder maps showed maternal health resulting from complex interacting factors in which promotion of cultural practices was compatible with a protective effect on Indigenous maternal health. Future research challenges include traditional concepts of diseases and the impact on maternal health of gender norms, self-care practices and authentic traditional midwifery.

Self-care interventions for preconception, antenatal, intrapartum and postpartum care: a scoping review

“…Last but not least, we found no eligible studies on traditional and Indigenous self-care practices. While important qualitative research has been conducted on this topic,39 40 we hypothesise that there is a relative lack of studies exploring the health effects of these types of self-care practices. Future research on these topics could also provide new opportunities for improving cultural safety of maternity care services.…”

Impact-Oriented Dialogue for Culturally Safe Adolescent Sexual and Reproductive Health in Bauchi State, Nigeria: Protocol for a Codesigned Pragmatic Cluster Randomized Controlled Trial

“…The analysis will give the knowledge of adolescent girls and boys at least equal weight to that of other stakeholders. We will compare maps of different stakeholder groups and maps from stakeholder groups with the map from the scoping review [ 62 ]. Causes of adverse ASRH outcomes identified on the maps will inform the contextualization of the survey instruments.…”

“…Supported by a specialist librarian, we will conduct a scoping review of quantitative and qualitative studies of factors associated with ASRH outcomes in low- and middle-income countries. In addition to a standard reporting of the review, we will create a fuzzy cognitive map (see as follows) of factors related to ASRH outcomes, marking the strength of associations as odds ratios or regression coefficients, and compare the literature map with stakeholder-created maps [ 62 , 64 , 65 ].…”

Toward a contextualized understanding of well-being in the midwifery profession: An integrative review

“…However, westernized forms of regulation and standardization are not inclusive and disregard accumulated knowledge from Indigenous midwifery practices. For example, a recent study exploring maternal health and midwifery in Southern Mexico demonstrated that western health institutions and practices created culturally unsafe care for birthing families (Sarmiento et al 2021). This was evidenced by negative attitudes toward traditional midwifery, preference for colonial languages and worldviews, and a general disdain for Indigenous culture.…”

“…While it might be expected that most research would focus on work-related determinants of midwives' well-being-given that being a midwife is, after all, a form of paid work-we posit that the almost exclusive focus on work-related factors stems from a false assumption: namely, that other aspects of midwives' lives are less important to their well-being. As discussed earlier, midwifery is a gendered, medicalized, and colonized profession (Clesse et al 2018;Kemp et al 2021;Sarmiento et al 2021). Therefore, the assumption that proximal work-related antecedents are the primary factors shaping midwives' well-being discounts the importance of broader structural elements such as gender, culture, and labor legislation.…”