For the country of Guatemala and its citizens, daily life is far from easy. With many concerns of poverty, numerous sicknesses, hunger, and violence, turmoil has been common in the small communities of Guatemala. However women in this country face an added struggle against them: infant and maternal mortality rate due to inadequate care. In Guatemala, women who are pregnant are hard-pressed to find pre-natal and post natal care for both themselves and their baby. Often times only just over 50% of women have a skilled attendant at their birth, leaving out half of the expectant mothers with little to no over-seeing support, drastically increasing the mortality risk (UNICEF, 2008-2012). Alarmingly, Guatemalan women also only receive antenatal care one or two times before birth. To put that into perspective, women in the United States often visit a doctor between 15 and 20 during the duration of their pregnancy (U.S Department of Health and Services, 2015). The World Health Organization noted that out of 1,000 live births, 23 children died before the age of 5, and 15 died as infants and newborns (WHO, 2014). These numbers although high, could be reduced with the help of proper and equal care to both mother and child. Various social, political, economic, and cultural determinants come into play and influence the issue of infant and maternal mortality rate in Guatemala, including the practice of Comadronas, the idea of a patriarchal society, lack of money for health care services and education to health care workers, and a host of other factors. The theory of Critical Medical Anthropology takes a closer look at the inequalities that encompass the economic, political, and social powers that directly affect the high mortality rate. It also focuses on the grasp of social inequality and how it can determine a person’s health, something clearly seen among the society and communities in Guatemala (Singer & Erickson, 2011).
When assessing the factors that have caused such high mortality rates in Guatemala, it is clear there is not simply one “cure all” or “quick fix” due to the numerous intertwining ways each of these numerous determinants effect expectant mothers and their children’s care. One of the largest debilitating factors that maintain these high rates is the poor economic situation the entire country is under. Guatemala is crippled by poverty, with many families, especially in rural communities, unable to pay for basic necessities, let alone proper health care, receiving under $1.25 per day for their family (UNICEF, 2008-2012). With these shockingly low wages, mothers are unable to receive the proper pre and post care needed to have a healthy pregnancy and birth. The lack of money and resources results in a lack of people getting an education, which then directly affects how many people receive a medical education in order to treat people in the country of Guatemala, which is why 59% of deliveries are over seen by unskilled friends or family members with little to no proper education in pregnancy, labor, and delivery (Walsh, 2006). Without escaping this vicious cycle of poverty and lack of education among the economy, it will be nearly impossible to bring the infant and maternal mortality rates substantially down.
Guatemala has many small rural communities among its fewer and larger urban towns, resulting in an unequal balance of health care based on demographics, especially for women and mothers seeking care. Families located in rural areas have a much more difficult time accessing and reaching medical treatment, and few medical professionals travel to such distant small towns. This issue is partially synonymous with economic status due to economic status directly effecting where families live in Guatemala. “The Public Health Ministry acknowledged that Guatemala continues to have reproductive health problems, with higher mortality rates than those in most other Latin American countries,” noted a scholarly article from Guatemala City, (michiganelibrary.org) going on to discuss how these health problems and mortality rates are even higher in the extremely rural areas of Guatemala as already discussed. It is important that whether leaving in a rural or urban environment, that Guatemala does its best to decrease this determinant, and provide equal and adequate resources for both locations in an effort to reduce the mortality rates among the people living there. Improving the education of medical professionals, the number of health care facilities, and reaching out to the mothers and families in the desolate areas of Guatemala can greatly help reduced the number of deaths that occur each year as a result of a lack of medical care.
Similarly to the economy, politics play an increasing large role in the treatment of all women and the care they receive. Guatemala is a Patriarchal society, with men holding the power above women, with the idea that men are superior and more privileged than women. In their country, the men of the household are in authority, working and earning to provide for the family while the mother stays home and tends to the children and house. Representative of U.N women in Guatemala, María Machicado Terán, mentions, “80% of men believe that women need permission to leave the house, and 70% of women surveyed agreed,” (Guinan, 2015). This statistic is just one example of how men hold power of women, and determine how and what kind of health care they receive. In a series of research that took place in 2009, researchers found that many women didn’t or couldn’t seek treatments or care due to fear. “Women’s decisions to seek care were often associated with their sense of self-worth and self-esteem,” noted the article posted to midwiferyjournal.com via google scholar. Guatemala also has a history of violence and abuse against women, and causes women to be particularly vulnerable because of a deep-rooted gender bias and culture of misogyny which could be another factor in women not getting the proper pre natal care they need for themselves and their baby, therefore increasing the risk of death. Many times women become pregnant as a result of rape, including from their own family members, and are killed in order to hide the shame of the incident. Just last year alone, 759 women were murdered, with an increase of 7% from the year before (Bessler, 2014). Politics in Guatemala need to be altered, a Patriarchal society in which men control women is unethical and is another leading reason women are not able to access the proper care they need, especially when pregnant or after giving birth.
While Guatemala’s economic and political situation directly ties in with the health issue at hand, it is Guatemala’s social and cultural framework that is the leading cause of maternal and infant deaths in their country. Rarely is a doctor present during births, and just as rarely women are taken to hospitals to give birth or receive pre/post natal care. Rather than a skilled medical professional attending the birth, often times a comadrona comes to assist. A comadrona is much like a midwife, however has little to no actual proper education or training other than her experiences during deliveries. Comadronas are often seen as wise women who are trusted that arrive to pray with the mother and hopefully deliver a healthy baby in the home after they accept their call to midwifery. Without the help of comadronas, mortality rates among mothers and their children would be even higher than they currently are, however because these rates are so high, comadronas are often wrongfully to blame. Often times they are scrutinized for their actions due to their lack of education, as well as their gender. An article posted from the University of San Francisco noted that “they are commonly devalued by those in the formal health care system, and comadronas are often the scapegoat for the high mortality rates in the country,” (Walsh, 2006). The Guatemalan culture is based primarily on nature and the spiritual world much less than it is based on the biomedicine aspect, so women often describe a series of sacred callings, knowledge, and rituals through dreams or visions with God before accepting the call to be a comadrona. One mentioned in an interview,
Nobody taught me how to do an examination, no one told me how, but I dreamed how to do this type of examination on women . . . how to measure them with a finger [points to knuckle on her finger that she uses to assess station of the pre- senting part] and when it gets smaller up here, that’s a sign that they are going to give birth. (Walsh, 2006).
Another woman spoke of symbols and signs that allowed her to know how the delivery would result, either easily or with numerous complications. “Because knowledge acquisition and the somatic signs are seen as communication from God, the knowledge gained in this way was believed to be sacred,” concluded the article from the University of San Francisco. These interviews of the comadronas help researchers better understand the culture and how it plays a vital role in the successes or failures of pregnancy and birth in the country. This mindset of counting on dreams or visions to guide the delivery and pregnancy has resulted in many professionals and researchers to believe this is one of the major determinants of the high maternal and infant mortality rates because medicine is much more education based and science based than dreams, visions, or spiritual practices.
Upon looking at the country of Guatemala and the health issue of infant and child mortality, the theory of Critical Medical Anthropology assesses the social inequalities that create numerous difficulties for women trying to get adequate care before after and during the birth of their child (lecture 1.4). Without this medical assistance, the social inequality effects can cause a host of complications for the mother and newborn baby, which is often the cause of a high number of mortalities rates. Because of the unequal treatment of men and women, women are seen as inferior and unable to receive basic medical treatment or education in medicine as a result of pressure from society’s impression on them, cultural traditions, or oppressive men in their lives. The negative viewpoint on women in Guatemala’s society and social structure directly correlates with the infancy and maternal mortality rates. It is obvious men are benefiting more so than women are in their country, reflecting in the outcomes of the various sets of people, including mothers. The fact that social inequality can so greatly determine the life and health of someone is saddening, as if the lack of ability to pay for medical expenses and care wasn’t enough for the people in Guatemala. The theory of Critical Medical Anthropology clearly helps explain the reasoning of the high number of infant and maternal deaths in a way that puts the blame on aspects of economic, social, and various inequalities present in the country (McElroy, 2002).
Guatemala has a long road ahead if they hope to cut down on the high number of maternal and infant deaths in its own country, however success is possible. Changes in the society and government can bring about new opportunities for Guatemalan men and women to change their way of life and receive the health care they need and deserve for their families and themselves, especially for expectant mothers and their newborn babies. With the help of the government and each community, it is possible to branch the gap between the unequal treatment between men and women, as well as the inequalities among the economy, politics, and society as best seen through the Critical Medical Anthropological Theory that affect expectant mothers and their children. Various determinants in Guatemalan culture and the economy, as well as its social structure and cultural traditions also play a large role against reducing these numbers, and proper action needs to be taken to ensure equal and good care for all in order to improve on the high numbers of maternal and infant mortality in Guatemala, something that if not fixed, could cause a series of other issues for the people living in this country.
Walsh, Linda V. “Beliefs and Rituals in Traditional Birth Attendant Practice in Guatemala.” Journal of Transcultural Nursing (2006): 148-54. Wunrn.com. Apr. 2006. Web. 17 July 2015. <http://www.wunrn.com/news/2006/07_03_06/070906_guatemala_beliefs.pdf>.
“Statistics.” UNICEF. N.p., n.d. Web. 24 July 2015. <http://www.unicef.org/infobycountry/guatemala_statistics.html>.
“EPublications.” Prenatal Care Fact Sheet. U.S Department of Health and Services, n.d. Web. 20 Aug. 2015. <http://womenshealth.gov/publications/our-publications/fact-sheet/prenatal-care.html>.
“Country Cooperation Strategy at a Glance – Guatemala.” World Health Organization (2014): n. pag. Apr. 2014. Web. 31 July 2015. <http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_gtm_en.pdf>.
“Guatemala’s Maternal, Infant Mortality Rates Drop.” Michiganelibrary.org. EFE World News Service, 28 Mar. 2003. Web. 31 July 2015. <http%3A%2F%2Fgo.galegroup.com.proxy2.cl.msu.edu%2Fps%2Fi.do%3Fp%3DITOF%26u%3Dmsu_main%26id%3DGALE%257CA99276639%26v%3D2.1%26it%3Dr%26userGroup%3Dmsu_main%26authCount%3D1>.
Hemphill, Margaret, and Copeland. “The Comadrona and Response to Obstetrical Emergencies: Maternal Mortality in Highland Guatemala.” Msulibraries. ProQuest, UMI Dissertations Publishing, Jan. 2011. Web. 31 July 2015. <http://msulibraries.summon.serialssolutions.com/?l=en&ho=t&q=guatemala+maternal+mortality#!/search?ho=t&l=en&q=guatemala%20maternal%20mortality>.
*Singer, Merrill, & Pamela I. Erickson. A Companion to Medical Anthropology. Chichester, West Sussex: Wiley-Blackwell, 2011.
Guinan, Julie. “Guatemala: Gender-based Violence at Epidemic Levels – CNN.com.” CNN. Cable News Network, n.d. Web. 30 July 2015. <http://www.cnn.com/2015/04/02/world/iyw-guatemala-gender-violence/>.
*Lecture: 1.4. Introducing Theory 3: Critical Medical Anthropological Theory (5 min)
“Why The World Should Care About The War Against Guatemalan Women.” ThinkProgress RSS. N.p., 20 June 2014. Web. 30 July 2015. <http://thinkprogress.org/world/2014/06/20/3450611/guatemalan-girls/>.
*McElroy, A. Medical Anthropology. Amsterdam: Gordon and Breach., n.d. 21 Jan. 2002. Web.
Schooley, Janine, Christine Mundt, and Pascale Wagner. “Factors Influencing Health Care-seeking Behaviours among Mayan Women in Guatemala.” Midwiferyjournal.com. Elsevier Inc, Aug. 2009. Web. 17 July 2015. <http%3A%2F%2Fwww.midwiferyjournal.com%2Farticle%2FS0266-6138(07)00092-7%2Fabstract>
* used to identify sources for my anthropological theory among my work cited listing.