Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 8. Impact on women’s empowerment

Abstract

Background Indigenous Maya women in the rural highlands of Guatemala have traditionally faced constraints to decision-making and participation in community affairs. Anecdotal experiences from previous Curamericas Global projects in Guatemala and Liberia have suggested that interventions using the CBIO+ Approach (which consists of implementing together the Census-Based, Impact-Oriented Approach, the Care Group Approach, and Community Birthing Centers), can be empowering and can facilitate improvements in maternal and child health. This paper, the eighth in a series of 10 papers examining the effectiveness of CBIO+ in improving the health and well-being of mothers and children in an isolated mountainous rural area of the Department of Huehuetenango, explores changes in women’s empowerment among mothers of young children associated with the Curamericas/Guatemala Maternal and Child Health Project, 2011–2015. Methods Knowledge, practice, and coverage (KPC) surveys and focus group discussions (FGDs) were used to explore six indicators of women’s empowerment focusing on participation in health-related decision-making and participation in community meetings. KPC surveys were conducted at baseline (January 2012) and endline (June 2015) using standard stratified cluster sampling. Seventeen FGDs (9 with women, 3 with men, 2 with mothers-in-law, and 3 with health committees), approximately 120 people in all, were conducted to obtain opinions about changes in empowerment and to identify and assess qualitative factors that facilitate and/or impede women’s empowerment. Results The KPC surveys revealed statistically significant increases in women’s active participation in community meetings. Women also reported statistically significant increases in rates of participation in health-related decision-making. Further, the findings show a dose-response effect for two of the six empowerment indicators. The qualitative findings from FGDs show that the Project accelerated progress in increasing women’s empowerment though women still face major barriers in accessing needed health care services for themselves and their children. Conclusion The Project achieved some notable improvements in women’s decision-making autonomy and participation in community activities. These improvements often translated into making decisions to practice recommended health behaviors. Traditional cultural norms and the barriers to accessing needed health services are not easily overcome, even when empowerment strategies are effective.

Institutionalising community engagement for quality of care: moving beyond the rhetoric

“…With respect to equitable service delivery, a 2023 mixed methods study examined knowledge, attitudes, and practices of Indigenous Mayan women in Guatemala (who are often marginalised) over three years of community engagement in a combined care group package, which sees communities identifying priorities and developing action plans along with the implementation of care groups and community birthing centres. It found significantly increased rates of participation in decision making and reported qualitative improvements in empowerment 21. Additional evidence indicates that community engagement can help make healthcare provision more people centred, by identifying and appropriately responding to community needs, for example 5.…”

Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 1. Introduction and project description

“…The other papers in this supplement describe the implementation research methods [38] as well as the effects of the Project on population coverage of key maternal and child health interventions [39], nutrition [40], mortality [41], quality of maternity care at Community Birthing Centers [42], and women's empowerment [36] and well-being [43,44]. The final two papers in the supplement concern assessments of staff and key stakeholders about the CBIO+ Approach [45] and a summary of the findings along with a discussion of the broader implications of this work [46].…”

Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 7. The empowering effect of Care Groups

“…Future research should consider interviewing indirect beneficiaries of the Care Group Approach to understand better the scope of its influence on norms, values, and behaviors. However, these groups were interviewed for the other study on women's empowerment, which follows this article in our series [10].…”

“…This article is part of a series of 10 articles that summarize the findings of an evaluation of the Project [4][5][6][7][8][9][10][11][12]. In this article we describe changes in aspects of women's empowerment, including perceived respect/social status, self-efficacy, decision-making autonomy, and formation of social capital, as reported by participants in the Care Group activities of the Project.…”