Building Bridges: How Dialogue in Chiapas is Transforming Maternal and Child Health

GPA supports the efforts of traditional Mayan midwives to transform maternal healthcare delivery in Chiapas, placing the needs and experiences of Indigenous women at the forefront

In the southern state of Chiapas, Mexico, a state-level dialogue is paving the way for better maternal and child health outcomes for Indigenous communities. This dialogue, initiated by the Nich Ixim Midwife Movement of Chiapas, made up of more than 600 traditional midwives from over 30 municipalities, brings together midwives and health officials to share insights, tackle pressing issues, and forge agreements. It's a beacon of hope for the rural and Indigenous communities who rely heavily on traditional birthing practices yet often face stark healthcare disparities.

For many Indigenous women in Chiapas, giving birth under the care of Traditional Indigenous Midwives is not merely a preference—it's a practice deeply rooted in cultural traditions. In some regions, these midwives oversee up to 90 percent of births, providing care that aligns with the community’s worldview and practices. Indigenous pregnant women often encounter significant obstacles when interfacing with formal healthcare systems. From inadequate prenatal monitoring to delayed responses, to obstetric emergencies, the existing healthcare services fall short, exacerbated by shortages of medicines, vaccines, and medical staff. Indigenous women also face discrimination, mistreatment and at times negligent care, further discouraging them from seeking hospital care when needed. The Indigenous midwives who care for them are often met with disrespect and exclusion within health centers, hindering effective communication, and collaboration.

Recognizing these severe challenges, traditional Indigenous midwives and their communities, have worked hard to reduce the maternal and perinatal mortality rate, which is significantly higher in Chiapas than in other states in Mexico. This is a multifaceted problem involving high levels of poverty and marginalization, gender inequality, racism, and deficient state health services with a history of providing inadequate and disrespectful care to the Indigenous population.

In response to these challenges, the Nich Ixim Movement emerged in 2014, with a mission to overcome the barriers they and the Indigenous women they care for face, and fight for the right to practice in accordance with their ancestral traditions, advocate for a woman’s right to decide how, where and with whom she wants to give birth, and demand that their communities have access to quality, respectful health centers.

Their efforts led to the creation in 2023 of an ongoing series of formal state-level dialogues involving senior health and civil registry officials. These dialogues are resulting in the development of culturally-respectful strategies that put the health and rights of Indigenous women at the center. Notably, regional meetings between the Health Ministry’s IMSS Bienestar and Nich Ixim in 2024 have resulted in practical agreements, such as establishing WhatsApp groups for real-time communication between midwives and healthcare personnel to ensure no woman in obstetric emergency is turned away from hospitals. These meetings also create permanent workspaces to resolve specific issues like the refusal of government officials to issue birth certificates to children delivered by traditional midwives, and prohibitions against midwives attending births.

Global Pediatric Alliance (GPA) has played a crucial role in fostering this dialogue through two key programs. The Accompaniment of the Nich Ixim Midwife Movement of Chiapas, since 2016, together with other civil society organizations, has been instrumental in strengthening the leadership and organizational capacities of traditional midwives at local, state, national, and even international levels. Their efforts culminated in the formation of the Continental Alliance of Traditional Midwives at the United Nations Permanent Forum on Indigenous Issues in New York in April 2024. Meanwhile, GPA’s Respectful Maternal Care program has worked to raise awareness with over 2,000 health workers, a first step toward bridging gaps and fostering a more inclusive healthcare environment for rural and Indigenous communities of Chiapas.

GPA hopes that these ongoing regional meetings between traditional midwives, and healthcare civil registry, and human rights officials can help transform maternal healthcare delivery in Chiapas, placing the needs and experiences of women at the forefront. It marks a shift from a system marred by inequality and discrimination to one where traditional Mayan midwives and health officials have a respectful and equitable working relationship to ensure every mother and child receives the care they deserve. As these efforts continue, they hold the promise of a healthier, more equitable future for the women and children of Chiapas.