Maternal mortality is a serious health issue that persists in the country of Guatemala. In the Americas, Guatemala has the fourth highest maternal mortality rate with 140 deaths per 100,000 live births (Mitchell, 2014). This statistic is higher than the regional average of maternal mortality at 85 deaths per 100,000 live births (Mitchell, 2014). These deaths unveil underlying issues relating to social, political, economic, and cultural themes in the country. The most notable determinants which contribute to the concerning maternal mortality rate are the blatant subordination of Guatemalan women through forms of violence, the lower economic standing of women, the undereducation of women, and the discrimination of the underprivileged intersectional indigenous females that experience even more risk for increased maternal mortality. Maternal mortality being a health issue wholly related to women, the feminist anthropological perspective will be ideal in analyzing the health issue and its contributing determinants.

Feminist theory centers on gender being the sole reason for difference in circumstance and how gender affects aspects of one’s life (Feminist Theory, 2019). Feminist theory can evaluate an issue, particularly the health issue of maternal mortality, concentrating on how the concept of gender can be the defining factor in the measured outcome of the instance. Feminist anthropological theory dates back to the 1850’s starting when society was particularly male-dominated and women had very little say (Dominguez et al., 2017). The second wave started to reject the concept of inherent dichotomies, more particularly, that “women stay at home” and “men go to work” (Dominguez et al., 2017). The third wave delves into a more complex concept, which is the possibility of focusing on dividing factors between women instead of the division between women and men. Variabilities between women that are being focused on in the third wave are ethnicity, status, age, etc. (Dominguez et al., 2017). This brings upon the concept of intersectionality of women who may face more than one discriminatory factor other than gender causing those who are intersectional to be more at a disadvantage and face different wavelengths of inequity and injustice. The second and third waves are still very relevant to today’s issues regarding maternal mortality in Guatemala. In looking at the determinants that contribute to maternal mortality in Guatemala, the history of feminist anthropology brings to light many issues in which Guatemalan women still face. Moreover, Guatemala’s history and possibly the root of violent treatment and undervalue of women.

Guatemala’s rich history in war and violence contribute greatly to the rampant continuum of gender inequality in the form of sexual and fatal violence against women. Guatemala’s 36-year civil war was characterized by killing solely based on gender (femicide), abductions, and sexual violence, which ultimately resulted in the loss of 200,000 lives (UN Women). About 83% of the deaths caused by the war were indigenous lives (UN Women). The violence from the long-running civil war has seeped into the current Guatemalan society. In 2013, 748 women had died from some form of violence, which was a 10% increase from the previous year (UN Women). That same year, 95 cases of femicide were heard by regular courts, but only 5 firm sentences were issued (UN Women). The Guatemalan society has deep roots of patriarchy and in that, a legal system and society that enables men. An estimated 94% of violence against women legal cases conclude with the perpetrator not having to face any consequences (UN Women). Even when judges rule in favor of the female victims, the system gives little protection as around half of the convicted perpetrators can make bail and avoid any incarceration (Carey & Torres, 2010). This barreling statistic runs mainly in favor of the male perpetrators oftentimes silencing the mass of women who have fallen victim to acts of femicide or other types of violence. Social stigma associated with domestic or sexual violence also makes many women hesistant on even speaking out. Legal action has been taken as Guatemala is creating laws in order to address women who have been victims of violence. The Law against Femicide and other Forms of Violence against Women had already been in effect since 2008 (UN Women). Laws holding men accountable for harsh acts on women are usually not enforced with many court cases allowing impunity and permissiveness of the male perpetrators. The lack of diligency to prosecute sex crimes and uphold the laws has shown as femicide and others forms of violence like sexual violence in Guatemala still shows to be prevalent with the increased rate in teen pregnancy. Guatemala has one of the highest rates of girl and adolescent pregnancy in Latin America (UN Women). Trends in pregnancy as a result of sexual violence in girls aged 10-14 years old has increased. From 2010 to 2012, the number of pregnancies in girls aged 10-14 years old increased from 1,634 to 3,644 (UN Women). There are further risks associated with pregnancy at a young age. Pregnancy achieved in one’s teenage years constitutes more overall health, social, and economic risks for the young mother (Lemon et al., 2017). In the country of Guatemala, adolescent pregnancy and childbearing has direct association with education and poverty (Lemon et al., 2017).

Guatemala has high income inequality and poverty in the country. This permits unequal opportunity to a multitude of Guatemalans and their access to much needed healthcare services. Almost half of the population is poor and 15% of the population that is in extreme poverty has neither improved nor worsened (Borzutzky et al., 2011). This is most likely from the unequal distribution of wealth in the country where the richest 20% controls about 58% of the country’s wealth, while the poorest 20% controls a little over 3% of the country’s wealth (Borzutzky et al., 2011). Women are more likely to face poverty as they are unfortunately not considered for certain higher-paying jobs likely due to inherent dichotomies and lack of education. The Guatemalan labor force is male-dominated at 83% of the workforce being males (UN Women). When women are permitted to work, they are not even in charge of their own money as a 2008-2009 Guatemalan survey stated that 67.0% of men said their wives needed to ask permission for managing the household money (UN Women). Gender wage gaps, though improving, still exist and there are even larger ones showing pure discrimination solely based on indigenous ethnicity. Impoverished incomes for women, especially indigenous, influences the amount of risk in the way that they handle their health pre- and postnatally. In the delivery room, around 59% of births in Guatemala are attended by traditional birth attendants or unskilled family members (Walsh, 2006). In rural regions populated with a majority of indigenous folks, the statistic is much higher. The traditional birth attendant is oftentimes a comadrona, which is a trustworthy community member who has a “spiritual calling” to participate in midwifery, and usually have very little education (Walsh, 2006). The common attendance of comadronas instead of medically-trained doctors may have to do with the economic factors. An appointment with a comadrona, or midwife, typically costs 10 Quetzales ($1.40) compared to an appointment with a doctor which costs 50-100 Quetzales ($7-14) (Rae & Melimpoulos, 2018). The more affordable and commonly hired comadrona may or may not have any formal education leaving them to lack in critical skills needed to properly identify and assess high-risk pregnancies. The lack of formal regulations regarding comadronas oftentimes steers the overall quality of the medical services into one of variability, which puts prospective mothers more at risk regarding their health. Disparities of wages based on gender and ethnicity also go hand in hand with education level. The most educated individuals and the least educated individuals have a wage ratio of five to one (Borzutzky et al., 2011).

Education level varies for different groups of individuals in Guatemala. The average level of education for non-indigenous women is 5.3 years, while indigenous women only account for 3 years, on average (UN Women). Men’s education is valued more as they, on average, spend more time in school. Non-indigenous men account for 5.9 years of school, while indigenous men account for 5.9 years (UN Women). Girls’ education is seemingly less valued. In Guatemala, more females than males drop out of school from early marriage, frequent childbearing, and chronic poverty (UN Women). Many indigenous Mayan children drop out of elementary and middle school to help their families (Trapp, 2011). This is usually the time that the state-sanctioned sexual education program is taught. There is a correlation between the lack of sexual knowledge in indigenous children and lack of education. In Guatemala, sexual education is a controversial subject. Cultural and social views of Guatemalans are fiercely linked to religion. Talk of sexual reproduction is forbidden and considered taboo by many religious church organizations. The Catholic church in Guatemala has even taken action against recent sex education classes being implemented in schools. The archbishop of Guatemala City, Rodolfo Quezada, has called implementation of sex education classes in school and facilitation of contraceptives immoral (Valladares, 2009). Many religions’ solution to the prevention of pregnancy is to be abstinent until marriage, but that proves to be faulty as a lot of young people do engage in sexual activity anyways. Despite the lack of comprehensive education, many Guatemalan teens are sexually active. By 20 years old, 70% of women have had their first sexual encounter and the statistic is even higher for women in rural indigenous areas (Trapp, 2011). Indigenous Mayans have less access to contraceptive services than non-indigenous individuals based on the fact that they statistically have less schooling. The lack of sexual education of women on health-related matters corresponds to elevated birth rate where 44% of women have at least one child under the age of 20 (Trapp, 2011). Lack of basic or sexual education allows for the inclination towards being unaware of contraceptive protection against pregnancy and increases the risks in even the mildest of health-related issues.

Worse health is most associated with one of the most vulnerable groups in Guatemala: indigenous women. Maternal mortality is seen at a higher rate in indigenous women than non-indigenous women. The maternal mortality ratio for indigenous women is three times larger than in non-indigenous women (Paulino et al., 2019). Additional social determinants that may contribute to this statistic is the social gradient and social exclusion. Indigenous women face a reality of blatant discrimination, which is caused by their decreased worth in society based on the underprivileged factors that they face. These factors associate indigenous women being more likely to be uneducated, illiterate, and have a low wealth index (Colombara et al., 2016). In 2011, the illiteracy rate among indigenous women was 48% compared to non-indigenous women at 19% (UN Women) being an indicator of the social exclusion that indigenous women face. With the stereotypes on their educational and economic status, discrimination against the indigenous is fueled. Discrimination can be fueled in the other direction where not only are they unjustly treated because of their underprivilege, but can be maltreated solely because of their ethnicity. Great ethnic disparity is shown with indigenous women in medical facilities like hospitals as they are sometimes treated as subordinates by their predominantly “ladino” (mixed Spanish and indigenous) healthcare professionals. This instance can be described by the lack of flowing communication between the indigenous patient and ladino health specialist. The two ethnic groups can experience difference in cultural and social customs like a language barrier. Ladinos speak Spanish and the mostly Mayan indigenous people may speak a multitude of various indigenous languages. The lack of understanding can provide lack of quality care in a health facility, the most common complaint of indigenous women who stay in hospitals (Kanako et al., 2012). Indigenous women’s hesitancy to visit medical facilities because of probable discrimination is shown by birth arrangement statistics. A 2008-2009 Guatemalan study focusing on birth arrangement showed that 36% of indigenous women delivered in medical institutions like hospitals compared to the 73% of ladina women (Kanako et al., 2012). Birth in hospitals are associated with decreased maternal death essentially associating the disproportionately higher maternal mortality rate with indigenous women who are less likely to give birth in hospitals shown by their oftentimes impoverished economic and educational background.

The alarming frequency of maternal mortality in Guatemala is a serious health issue. Inequity of gender in Guatemala supports the use of feminist perspective not only in value of the difference in gender, but intersectionally, as well. Maternal mortality is a complex issue that has entangled determinants fueling the higher statistic of intersectional women having the risk of this health issue. Starting with the displays of violence stemming from the long-running historical civil war, women in Guatemala are faced with high statistical violence against them not only domestically, but sexually fueling the subordinate and under-valued treatment of women. The evident maltreatment of Guatemalan women opens the door to a slew of factors of misfortune including less than exceptional economic standing, undereducation of girls in basic and sexual education, and especially affecting the underprivileged indigenous women in Guatemala experiencing all of these entwining factors. These determinants position women to systematically experience continued maternal mortality with no sign of improvement. With determinants being that men have more power in a patriarchal legal system and household setting which leaves women to be treated as less than, basic and sexual uneducation in women as their education is less valued, unequal economic opportunity in a male-dominated labor force and control of household finances, and indigenous women facing these realities more often and more harshly. Maternal mortality is viciously higher for indigenous women as they are more likely than any other women to die during pregnancy or childbirth. Women, especially indigenous women, need to be the center of all solutions in total attainment of the eradication of maternal mortality. Feministic efforts focused towards freedom and equality of women will drastically reduce the harsh determinants that influence the maternal mortality rate, especially pertaining to the heightened vulnerability of intersectional expectant women with rural and indigenous backgrounds.

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