Traditional midwifery

In most indigenous, Afro-descendant and Roma populations living in the countries of the Americas, there are people (usually women) – called traditional midwives, sobadoras or comadronas – who provide support, care and advice to women during pregnancy, labour and after childbirth, as well as taking measures to prevent and detect complications in the mother and the newborn (1). This work responds to millennia of knowledge passed down to women from generation to generation, and is framed within the traditional model of health care (2). 

In 1979, the World Health Organisation defined a traditional birth attendant (TBA) as “a person (usually a woman) who assists the mother during childbirth and who initially acquired her skills by attending births herself or by working with other traditional birth attendants” (3). Later, in the joint declaration with UNFPA and UNICEF in 1993, it defined the traditional midwife as “the person who assists the mother during childbirth and who has acquired her initial midwifery skills by herself or by apprenticeship with other traditional midwives” (4). On the other hand, WHO has promoted the rapprochement of institutions with traditional midwives as a strategy to reduce maternal and perinatal mortality among populations considered vulnerable, such as the ethnic peoples of the Americas (5).

Thus, in some countries of the Region, the importance of traditional midwifery and the work of midwives as part of traditional medicine has been recognised and valued by institutions.

In Bolivia, the Ministry of Health and Sports grants licenses to midwives, who traditionally attend to women’s health during pregnancy, childbirth and postpartum, to work as providers of traditional medicine services within the Single Health System (SUS) (6). https://youtu.be/NMTa6AAKO6g

In Colombia, the Knowledge associated with Afro midwifery in the Colombian Pacific (Midwifery, ancestral knowledge and living practice | La Red Cultural del Banco de la República (banrepcultural.org) was included, in 2016 by the Ministry of Culture in the Representative List of Intangible Cultural Heritage, as a measure to safeguard and strengthen the knowledge and techniques possessed by traditional midwives (Afro-descendant, Indigenous and peasant) in this area of the country (7). Resolution 1077 of 25 April 2017, issued by the Ministry of Culture, states that the knowledge of these midwives includes knowledge and techniques related to the care of the body and the use of medicinal plants, to attend to the reproductive cycle of women, to diagnose and treat diseases; knowledge acquired through daily observation and experimentation and considered part of a traditional medical system that is transmitted from generation to generation (8).

In Ecuador, there is a methodology for the cultural adaptation of obstetric care, in which traditional midwives are the facilitators of these processes, and in order to participate in the care of women during childbirth in health facilities, they must be certified (accredited) to do so (9).

In Guatemala, midwives are called comadronas and are responsible for the care of women during pregnancy, diagnosis, prognosis, childbirth and postnatal care, as well as for illnesses suffered by women and children up to the age of nine months, and in some cases up to three years. “In the area of preventive health, they advise the whole family on women’s health, the care and education of children, good family relations and, above all, the couple. They advise on how many sons and daughters a family should have, the family’s diet, especially that of children and pregnant women” (10).

In Mexico, traditional midwives are recognized by the legal framework and are considered community health agents who are part of traditional indigenous medicine and attend to women during pregnancy, childbirth and the puerperium, as well as the newborn (11), and a National Agenda for the Defense and Promotion of Traditional Midwifery is being developed (12).

Despite this progress, a regional mapping of the organisations and experiences of traditional indigenous midwives in the Americas ((https://bit.ly/ParteriaIndigenaMapaInicial), carried out in 2022 by the Centre for Indigenous Cultures of Peru – CHIRAPAQ, found that even in many countries, health services do not promote maternity care by traditional midwives, on the contrary, their knowledge is not recognised, This has led to a reduction in the care provided by traditional midwives and a gradual loss of their knowledge, which has led to a crisis in the continuity of the practice, as the new generations do not acquire this knowledge (12).

Nevertheless, the study shows that traditional midwifery organisations and the health systems of the countries of the region have come closer together, creating processes of visibility and promotion of the work of midwives. In the case of Brazil, midwives have managed to organise themselves at national level with the “National Midwives’ Meeting”, promoted by Cais do Parto, which has been held every two years since 1996. While in Guatemala there is the National Movement of Grandmothers Midwives Nim Alaxik, which brings together the 22 departments of the country and registers 22,100 associated midwives (12).

1. National Administrative Department of Statistics DANE, and United Nations Population Fund – UNFPA. Traditional Midwifery and its incorporation in Colombia’s vital statistics. Statistical Note No. 3 of 2023. 58 pp

https://colombia.unfpa.org/es/publications/analisis-de-parteria-tradicional-y-su-incorporacion-en-estadisticas-vitales

2. Almaguer González, José Alejandro, Vargas Vite, Vicente and García Ramírez, Hernán José García. Interculturality in health. Experiences and contributions for the strengthening of health services. [Internet]. 2014. Programa Editorial del Gobierno de la República; 3rd ed. Available at: https://pesquisa.bvsalud.org/portal/resource/pt/biblio-968759?lang=es.
3. World Health Organization WHO. A practical guide for the training, assessment and articulation of traditional midwives in health services 1979. Offset Publications No. 44, 109 pp. Available at: 9243700448-spa.pdf;sequence=1 (who.int)
4. World Health Organization WHO Traditional Birth Attendants. Joint WHO/UNFPA/UNICEF statement, 1993. Available at: Traditional birth attendants: joint WHO/UNFPA/UNICEF statement (who.int).
5. García Ana Julieth, Cortina Navarro Carolina, Pabón Varela Yadira, Brito Ferreira Karen Daniela and Freyle Brito Yeraldin Loresmi. Traditional midwifery. 2018. (Internet) Cuban Journal of Nursing. 34(2):384-393. Available at: CLINICAL AND PATHOLOGICAL SCIENCES (sld.cu).
6. Gonzales Liendo, Mary O. Traditional midwives as part of the intercultural public health system in Bolivia. Research. Bolivia, 2010. 92 pp. Available at: las-parteras-tradicionales-como-parte-del-sistema-de-salud-publ_DSp30Dl.pdf (bvsalud.org).
7. Ministry of Culture. Representative List of Intangible Cultural Heritage. Available at: https://www.mincultura.gov.co/areas/patrimonio/patrimonio-cultural-en-Colombia/Documents/LRPCI%20ACTUALIZADA%202022.pdf,
8. Ministry of Culture. Resolution 1077 of 2017. Available at: https://www.mincultura.gov.co/prensa/noticias/Documents/Patrimonio/20-Parter%C3%ADa%20afro%20del%20Pac%C3%ADfico%20-%20Resoluci%C3%B3n.pdf
9. Villanueva Hernández, Ollinca I. and Freyermuth Enciso, Graciela. Traditional midwifery in the normative framework of four Latin American countries: from recognition to ambiguity. In: Midwifery in Latin America. Different territories, same battles/ Georgina Sánchez Ramírez and Hanna Laako, editors. [Internet] 2018. El Colegio de la Frontera Sur. First edition in electronic format, pp 215-238. Available at: https://www.academia.edu/37727952/PARTER%C3%8DA_TRADICIONAL_EN_EL_MARCO_NORMATIVO_DE_CUATRO_PA%C3%8DSES_LATINOAMERICANOS_DEL_RECONOCIMIENTO_A_LA_AMBIG%C3%9CEDAD
10. Ministry of Public Health and Social Assistance, General Directorate of Regulation, Surveillance and Control of Health, Department of Regulation of Care Programs for People, Traditional and Alternative Medicine Program. Manual de adecuación cultural del parto natural/vertical y sus distintas posiciones, en el marco multicultural de Guatemala. 2011. Available at: https://www3.paho.org/gut/dmdocuments/2011%20MANUAL%20DE%20ADECUACION%20CULTURAL%20DEL%20PARTO%20NATURAL%20VERTICALversion%20modificada%2024%20enero.pdf
11. Ministry of Health. Guía para la autorización de las parteras tradicionales como personal de salud no profesional. Available at: https://www.gob.mx/cms/uploads/attachment/file/38480/GuiaAutorizacionParteras.pdf
12. Center for Research and Higher Studies in Social Anthropology (CIESAS). Outreach journal focused on anthropology, social sciences and humanities, Ichan Tecolotl, year 35, number 375, September 2023. ISSN 2683-314X. México. Available at: https://ichan.ciesas.edu.mx/una-experiencia-de-mapeo-de-la-parteria-tradicional-indigena-en-las-americas/.