The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #55500

Barbara A. Anderson, DrPH, CNM¹, E.N. Anderson, PhD², Tracy Franklin, MPH¹, and Aurora Dzib-Xihum de Cen, none³. (1) Department of International Health, Loma Linda University School of Public Health, Room 1306 Nichol Hall, Loma Linda University, Loma Linda, CA 92354, 909-558-4902, banderson@sph.llu.edu, (2) Anthropology, University of California at Riverside, 6405 N. Walnut Avenue, San Bernardino, CA 92407, (3) Anthropology, University of California, Rural delivery-Yucatan, Chunhuhub, Mexico

Globally, traditional birth attendants(TBAs)are key players in childbirth. In Mexico, an estimated 50% of babies are delivered by TBAs(parteras). Rural Mexican women prefer them even when biomedical care is available. Programs upgrading TBA skills often fail to change behaviors substantially. Curricula may not address worldviews or decision-making processes. Studies show that TBAs frequently perceive training programs as irrelevant. This study mapped decision-making processes for managing culturally defined complications of birth as described by Mayan parteras in rural Mexico. This research, based upon decision tree modeling described by Gladwin, utilized 1:1 taped interviewing in the Mayan language in five rural communities. The team included two experienced researchers with backgrounds in anthropology, nurse-midwifery and public health, a graduate student in public health and a Mayan Mexican national. Parteras described their knowledge as authoritative and perceived a strong sense of agency in decision-making. They consistently described management of culturally defined complications of childbirth. We isolated two cultural themes: hot/cold balance and body centering. Pateras were receptive to new knowledge, but timely referral and effective implementation of lifesaving skills were lacking. They perceived that training programs had not substantially changed their practice or acknowledged their existing skills. This study recommends that training programs use both biomedical and ethnomedical models and acknowledge and include the parteras' management strategies in curriculum design. Programs that support both traditional themes and biomedical lifesaving skills may provide the best hope for safe motherhood among rural Mexican women.

Learning Objectives:

At the conclusion of the session, the participant will be able to:
• Discuss the perceived agency and operational cultural themes with Yucatec Maya traditional birth attendants (parteras).
• Identify the key issues facing the parteras in actualizing safe motherhood strategies
• Describe a public health approach to engage parteras in this region in a fully interactive learning experience.

Keywords: International MCH, Midwifery

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: not applicable
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.