PAHEF provided a grant to the Population Council for a project to promote maternity waiting homes in Guatemala that can ultimately reduce maternal mortality in vulnerable populations. More women die in childbirth in Guatemala than almost any country in Latin America, and the vast majority of those deaths are preventable. In rural areas and for indigenous women, the rate of mortality can be two to three times higher than for non-indigenous women.

Benefits of Maternity Waiting Homes

In rural areas of Guatemala, many women go into labor and give birth at their homes, attended by traditional birth attendants. As the distance to the nearest hospital is often long, women with obstetric emergencies have a high risk to die on their way to the hospital. A maternity waiting home is a residential institution, located near a medical facility, which offers the possibility for pregnant women at high risk for having complications to await their delivery. Once a woman goes into labor, she is transported to the nearby hospital.

Despite saving lives, only two maternity waiting homes exist in the country after others were closed due to a lack of financial and personnel resources as well as underutilization.

Goals of the Project

Meeting at the casa materna in Huehuetenango with women, traditional birth attendants and community leaders to share information about the benefits of maternity waiting homes.

This project was co-led by Dr. Marta Julia Ruiz, a Guatemalan physician and Population Council's country representative in Guatemala, and Dr. Marieke van Dijk, a medical anthropologist and physician based in the Council's Mexico office. The PAHEF-funded project identified and proposed strategies to make the maternity waiting homes more widely used, of higher quality, and more culturally acceptable amongst indigenous women and their families.

To collect data, the investigators carried out in-depth interviews with women who had stayed in a maternity waiting home or were currently staying in one, influential family members, health personnel, and others who have contact with expecting women.

Findings

Data from the interviews revealed that many women do not recognize pregnancy complications until it is too late. Additionally, when women have complications, they may not be able to go to a hospital because:

• husbands or mothers-in-law feel it is indecent for a physician to see the woman’s body

• high cost of transportation

• distance of community from hospital

• lack of a working vehicle to take the woman to the hospital

They found that many barriers exist that prevent women from using a maternity waiting home. Cost was at the top of the list as women are expected to pay for their meals and make a voluntary financial contribution. Additionally, staff do not speak indigenous languages and women are not allowed to stay with an accompanying person, leading monolingual women to feel isolated. Traditionally, women in Guatemala give birth in a kneeling position. Once the women were transported from the waiting home to the hospital, doctors require women to birth lying down, which is foreign and uncomfortable.

Outcomes

The investigators reported their findings to health officials at the national level and via a workshop where stakeholders such as USAID, UNFPA, and various NGOs attended. During the workshop, participants devised strategies to make maternity waiting homes and laboring in hospitals more comfortable and attractive.

Strategies include:

• providing birth chairs (which allow women to labor in a sitting position)

• opening and equipping more maternity waiting homes

• developing a standardized protocol of services for maternity waiting homes and hospitals to follow

• providing more culturally acceptable care

• offering more robust education regarding contraceptive use, prenatal care, and other relevant topics