The difference between life and death: indigenous maternal mortality

MRG’s co-director, Claire Thomas, reports back from the Regional Intercultural Symposium of the Americas on the Maternal Health of Indigenous Women, hosted by the United Nations Population Fund.

Last week I had the privilege of attending a meeting of Indigenous midwives in the Americas. On the one hand, I was shocked by the stories of habitual and unquestioned racism by non-indigenous doctors and midwives to patients and even to their indigenous colleagues. We heard stories of health systems that rely on unpaid indigenous midwives to reach remote areas, speak languages that no staff member in the clinic speaks, and broker trust in institutions that nonetheless systematically disrespect and devalue the indigenous women and girls and the midwives they rely on.

On the other hand, we heard stories whereby devolving the entire holistic maternal health care system to indigenous authorities has achieved stunning results. Indigenous midwives in Nunavut, in northern Canada work in a context where referral to hospital is complicated. On a good day, the transfer by plane takes 8 hours. But if there is fog, or if a blizzard descends, an expectant mother could wait days for a plane. Despite this, with indigenous-led wrap-around care, with doctors fully supportive of that system, and careful risk assessment, the team have achieved maternal mortality rates one third of those in the UK. Nunavut’s midwives now train new medical staff in universities in Quebec.

But sadly, this is very much the exception to a tragic and deeply unsatisfactory rule.

In a pattern that will be familiar to MRG’s readership, traditional and indigenous birth practices, for example giving birth whilst standing up or squatting, were abandoned as childbirth became medicalized and almost all women gave birth lying down. Decades pass, with women suffering the consequences, until eventually the scientific community catches up with what traditional midwives always knew, which is that giving birth in a vertical position leads to better outcomes for both mother and baby. WHO now recommends this. The tragedy is that racism and undervaluing or even banning indigenous midwives, combined with the threats to indigenous communities as a whole, the loss of lands, of livelihoods, of languages, means that this knowledge is rapidly disappearing, in some cases now only partially retrievable from historical records.

We know that the ethnicity of mothers is a risk factor for pregnant women. This as true in the global north as it is in the global south. This means that tackling these disparities is critically important for indigenous and minority communities. New drugs or procedures are not going to solve this problem.

What it will take is health care practices where the women are more important than the system, where communication is key, where trust is precious, where practitioners flex and adjust to meet women where they are and not the other way around. Whilst this matters for all women, for indigenous and minority women who are pregnant, it could literally mean the difference between life and death.

Featured image: Indigenous midwife attends a workshop at San Bartolome Jocotenango, Guatemala. Credit: Tolo Balaguer / Alamy Stock Photo.