Intercultural Childbirth: Impact on the Maternal Health of the Ecuadorian Kichwa and Mestizo People of the Otavalo Region.

Eduardo Antônio Donadi,Edson Zangiacomi Martinez,Susana Eulalia Dueñas Matute

doi:10.1055/s-0040-1721353

Eduardo Antônio Donadi, Edson Zangiacomi Martinez + Show 1 more

Open Access

https://doi.org/10.1055/s-0040-1721353

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Abstract

Considering the increased frequency of maternal deaths reported from 2001 to 2005 for Indigenous and mestizo women from the Ecuadorian rural area of Otavalo, where the Kichwa people has lived for centuries, the objective of the present article is to describe how the efforts of the local health community and hospital workers together with a propitious political environment facilitated the implementation of intercultural childbirth, which is a strategy that respects the Andean childbirth worldview. We evaluated a 3-year follow-up (2014-16) of the maternal mortality and the childbirth features (4,213 deliveries). Although the Western-style (lying down position) childbirth was adopted by 80.6% of the pregnant women, 19.4% of both mestizo and Indigenous women adopted the intercultural delivery (squatting and kneeling positions). Both intercultural (42.2%) and Western-style (57.8%) childbirths were similarly adopted by Kichwa women, whereas Western-style childbirth predominated among mestizo women (94.0%). After the implementation of the intercultural strategy in 2008, a dramatic decrease of maternal deaths has been observed until now in both rural and urban Otavalo regions. This scenario reveals that the intermingling of cultures and respect for childbirth traditions have decreased maternal mortality in this World Health Organization-awarded program.

Highlights

Maternal mortality has been considered a serious and persistent challenge worldwide
After the implementation of the intercultural strategy in 2008, a dramatic decrease of maternal deaths has been observed until now in both rural and urban Otavalo regions. This scenario reveals that the intermingling of cultures and respect for childbirth traditions have decreased maternal mortality in this World Health Organization-awarded program
Palavras-chave ► mortalidade materna ► parto intercultural ► Kichwa ► Otavalo ► Equador ambiente político propício, facilitaram a implementação do parto intercultural, que é uma estratégia que respeita a visão de mundo do parto andino

Summary

Introduction

Indigenous peoples present poor health indicators throughout the world, characterized by inequality and inequity between Indigenous and non-Indigenous populations, which is the result of socioeconomic conditions due to the historical social exclusion of these peoples.[8] Ecuador has not been the exception, so only 30% of the Indigenous population has access to specialty care, contrasting with 80% of non-Indigenous women.[9] The Law for the Provision of Free Maternity and Child Care (in Spanish, Ley de Maternidad Gratuita y Atención a la Infancia, LMGAI) was an incremental health policy first introduced in 1994 and officially made into a mandate in 2002, as the result of the concerted effort of key stakeholders to improve health outcomes for the most vulnerable Ecuadorian women.[10] As a positive impact of the LMGAI, an increase of the number of institutional births by 39% was noted.[10] an ecological study using data for 2014 from the 24 Ecuadorian provinces showed that the MMR was higher in the provinces with the highest percentage of Indigenous population.[11]

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