Traditional midwives and members of the CIET team gather after a meeting in Xochis

There are currently several articles in preparation by members of the research team. A doctoral student wrote his doctoral dissertation in the context of the Safe birth in cultural safety study. The list of academic publications emerging from the project includes:

De Jesús García A, Paredes Solís S. Complications from homebirth and institutional deliveries in indigenous communities. Article in preparation.

Objectives: To estimate the occurrence of and factors associated with perineal tearing, episiotomy and infection of the episiorrhaphy among women giving birth at home or at a medical institution in two indigenous municipalities in Guerrero state, Mexico.

Methods: Survey of 1,637 women with a record of childbirth in the three years prior to the interview. We asked about the place where they received care, the woman’s position during childbirth, attending staff, perineal injury or episiotomy and infection of childbirth wounds. Associated risk factors were identified through multivariate analysis.

Results: Fifty-six percent of births took place at home and were attended by traditional midwives, while 44% took place at a medical institution. Fourteen percent of women reported perineal tearing. Childbearing position was associated with perineal tearing. Vertical position was a protective factor (OR 0.70, IC95% 0.52-0.94). There were episiotomies in 31% of physician-attended births. Primiparous women were at higher risk of episiotomy (OR 1.75 IC95% 1.23-2.48). The rates of perineal tearing and infected episiorrhaphy were 20% and 15% respectively for physician-attended births and household deliveries with traditional midwives. Perineal lesion infections were less likely to occur in household births (OR 0.40, IC95% 0.15-0.86). Episiotomy incisions in hospitals carried 2.5 times the risk of infection compared to those performed in household deliveries (IC 95% 1.05-25.1).

Conclusions: There is lower risk of perineal tearing and infection of the incision in traditional midwife-attended childbirth. There is an overuse of episiotomy among health services. A considerable proportion of episiorrhaphies become infected, mainly if they are performed at a public hospital.

Meneses Renteria A. Traditional Nancue Ñomdaa (Amuzgo) midwives knowledge and handling of complications during pregnancy. Article in preparation.

The cumulative experience of Nancue Ñomndaa (Amuzgo) midwives from the State of Guerrero, Mexico, allows them to identify abnormal developments during pregnancy. In this text we describe the most common biomedical complications traditional midwives face during their professional practice. Even when they are not the only complications that can arise during pregnancy, it is worth noting that they are among the main causes of maternal death reported in the literature. The midwives describe how in some cases they have to face these contingencies with their own resources, as well as cases in which they need to resort to a hospital to save the lives of the mother and her child.

Meneses Renteria A. Cultural syndromes that complicate pregnancies among the Nancue Ñomdaa (Amuzgo) in the State of Guerrero, Mexico. Article in preparation.

Concepts of disease are influenced by social relationships, customs and traditions. A people share not only a language and a way of understanding life, but also their interpretation of diseases and their cures. The Nancue Ñomndaa (Amuzgo) people from the State of Guerrero, Mexico, are not an exception. In this article we state the main syndromes with a “cultural etiology” that complicate pregnancy. The most frequently mentioned “cultural syndromes” were antojos (cravings), espantos (frights), and nahual disease (in many indigenous Mesoamerican cultures, each person is believed to share soul matter with an animal or nahual; a person can take ill when something bad happens to his or her nahual). Midwives consider that certain signs and symptoms, like bleeding, are present both in biomedical and cultural complications of pregnancy and childbirth. When Nancue Ñomndaa medicine is not enough, midwives recommend consulting a physician.

Laucirica J. Key dimensions and ideological implications of safe motherhood discourse in a rural indigenous community in Mexico. Ottawa: University of Ottawa; doctoral dissertation, 2010.

Over the decade following 2000, the Mexican government tried to reduce maternal mortality, mostly through coercive use of poverty relief programs, health surveillance policies, and health communication campaigns to institutionalize maternal and newborn care, particularly in communities with indigenous populations. As a result, a growing proportion of pregnant women went for prenatal check-ups and turned away from homebirth assisted by traditional birth attendants. However, most kept using both traditional and biomedical resources and many continued to give birth in their homes.

This study was nested in a broader research initiative to improve maternal and newborn health among indigenous populations, without marginalizing their cultures. The author explores the interactions between health risk discourse, safe motherhood discourse, and indigenous discourses about maternal care in Xochistlahuaca, a rural community in Guerrero State. He shows how institutions and individuals draw from existing discourses, adopt them, reject them, and reshape them to make meaning according to their own circumstances and aspirations. He discusses how these interactions explain and affect maternal and perinatal care among the majority Amuzgo population. He also analyzes the ideological implications of government and indigenous discourses in a context of unequal power relations.

The author analyzes data from government health promotion materials and interviews with health officials, government health staff, and men and women in the communities, using a theoretical and methodological framework based on critical discourse analysis, social semiotics, systemic functional linguistics, and multimodal approaches. The findings reveal “discursive synergies” and contradictions between government safe motherhood discourse and traditional orders of discourse. They also shed light on how people make coherent construals of risk, blending their own experiences with multiple, often conflicting discourses in an unequal multiethnic environment, with competing authority claims. These findings should be of interest to a range of stakeholders working to prevent maternal and perinatal death in intercultural contexts.

Laucirica J. Building safe motherhood discourse, risk identities, and indigenous women’s responsibility into a perinatal health card in Mexico. Article in preparation.

Reducing maternal mortality has been a top public health priority over the last decade in Mexico. Most efforts have gone into the institutionalization of pregnancy and childbirth, particularly among indigenous populations. Public health communication has played an integral role in this regard, channeling safe motherhood tenets and risk identities, and reproducing unequal power relations, in the context of a political ideology that holds women responsible for their own health, for the survival of their newborns and for giving their children an even start in life. Using a critical discourse analysis approach that draws from systemic functional linguistics, social semiotics, and multimodal analysis, the author shows how these discursive constructions materialize through the generic articulation of a health promotion leaflet, a clinical record, and an identity card in the form of a perinatal health card issued by Mexico’s Health Secretariat, which all pregnant women must use whenever they request assistance from government health facilities.

In particular, the author explains how Embarazo Saludable (Healthy Pregnancy), the official title and main topic of the perinatal card, is construed as a variant of mainstream safe motherhood discourse, a specific type of contemporary public health risk discourse articulated around conceptual dimensions like risk awareness, danger/threat, individual agency and responsibility, choice, self-control, guilt and blame, medicalized control of maternal health, trust in government, and subordination to biomedical staff. He also discusses how government communicators have merged safe motherhood discourse with other types of discourse and orders of discourse, pointing to specific ideological implications of this discursive engineering.

Laucirica J. “Heed the messages of your body”: Merging safe motherhood discourse and risk identities with indigenous views in an edutainment video film in Mexico. Article in preparation.

Reducing maternal mortality has been a top public health priority over the last decade in Mexico. Most efforts have gone into the institutionalization of pregnancy and childbirth, particularly among indigenous populations. In this article, the author analyzes a video drama aiming at early detection of pre-eclampsia and eclampsia -two stages of a severe medical condition associated with hypertension-, which has been used across Mexico since 2007, with a focus on health districts with higher rates of maternal mortality.

Using a combination of narrative theory, film theory, multimodal analysis, and systemic functional linguistics, the author shows how the producers of the video film draw from a rich Mexican edutainment tradition of telenovelas for social change to undermine traditional views of pregnancy and childbirth and to create a new mythical narrative of maternal and perinatal health. In this new narrative, health risk discourse, safe motherhood discourse, and cognitive behavioural constructs are coupled with elements from traditional and religious orders of discourse, in an attempt to turn pregnant women and their husbands away from indigenous practices and expertise regarding pregnancy and childbirth, towards government control and biomedical views and authority. The video film sets up a moral framework for individual, familial, and collective responsibility concerning maternal health, confronting or embracing commonsense knowledge, traditional practices, gender roles, power relations, and ideas of human agency, fate, and divine intervention to fit the immediate goals and the overarching re-educational purpose.

Laucirica JO. Pregnancy and childbirth risk discourse constructions among the Nancue Ñomdaa (Amuzgo) of Xochistlahuaca, in Guerrero state, Mexico. Article in preparation.

In this article, the author explores how Nancue Ñomndaa (Amuzgo) indigenous women and men use, reshape, or reject key dimensions of government safe motherhood discourse, as well as elements from different orders of discourse (e.g., family, community, religion, traditional health care) to make meaning in relation to pregnancy and childbirth risks. Data come from in-depth interviews with women of childbearing age and men in Xochistlahuaca, Guerrero state, Mexico.

The author explores the risks that people perceive, what they do to make sense of them, and what discourses they use in the process. As a result, different views of risk emerge, each one with multiple discursive articulations. In particular, the author shows how discursive dynamics reveal tensions and articulations between traditional and biomedical views, as well as struggles around stability and change at the level of sociocultural practices.

The notion of maternal risks is very much present among the Nancue Ñomndaa. Women and men construe pregnancy as a debilitating state that exposes the mother and her baby to physical and ritual threats, particularly at childbirth. Many of them spontaneously refer to risk factors and at-risk groups in ways that resemble the logical thinking of modern epidemiology –i.e., the correlational rather than causal link between a risk factor and a health problem-, but their interpretation of risk factors, alarm signs, and obstetric complications not always matches biomedical concerns. Women and men were particularly worried about the position of the baby inside the womb, Nancue Ñomndaa cultural syndromes, miscarriage and abortion, and female lack of strength during labour and delivery. All of this undermines the idea that indigenous peoples do not follow biomedical advice because of an inherent, cultural unawareness or disregard of maternal risks, which is often voiced by government officials and government health staff.