[National health policies and local decisions in Mexico: the case of an intercultural hospital in Cuetzalan, Puebla]

Prioritizing women's choices, consent, and bodily autonomy: From a continuum of violence to women-centric reproductive care

Obstetric violence is a product of medical institutions' failure to prioritize women-centric reproductive care. Through interviews with local activists and leaders in Oaxaca, Mexico, as well as analysis of primary and secondary sources, we find that women-centric reproductive care is hindered by three barriers that are a part of a continuum of violence. These barriers include the cultural and religious norms surrounding reproductive care, the medical community and medical profiteers' opposition to combatting obstetric violence, and the state's resistance to women's human rights policy changes. Shifting to a women-centric reproductive care model requires: the life of the woman to be prioritized in reproductive care, the criminalization of obstetric violence, improved training for the medical community, reduced monetary incentives for unnecessary cesarean sections, and the respectful inclusion of indigenous and midwife knowledge and practices. Our study's theoretical and empirical contributions add to the scholarly research regarding the systemic causes of obstetric violence and the care ethic required for transformative change. Our recommendations can be applied across contexts with locally developed and culturally inclusive models of women-centric reproductive care.

[On specialized oversights: biomedicine as an intrinsic part of life for indigenous peoples]

The vast majority of studies on traditional medicine disregard the existence of biomedicine and alternative and complementary medicines in the lives of the indigenous peoples of Mexico and Latin America in general, despite the fact that these populations increasingly make use of biomedical knowledge more and more intensively. In this text I have attempted to elucidate this expansion of biomedicine and the decline of traditional medicine, through ethnographic information related to different indigenous groups. This expansion of biomedicine takes place despite the various negative consequences it generates due to different factors such as its comparative effectiveness, which is evidenced in the use of and demand for pharmaceuticals, biomedical services, and in particular the construction of hospitals in their communities. The indigenous population combines the uses of traditional medicine and biomedicine with a tendency to increasingly utilize biomedicine, even on the part of traditional healers.

[A critical examination of public policies related to indigenous health, traditional medicine, and interculturality in Mexico (1990-2016)]

Over the last 26 years, the Mexican government has developed a number of activities and discourses around what has been called "intercultural health," directed especially at indigenous peoples in Mexico (some 62, according to linguistic criteria). In this way, the government has built health care institutions (rural centers, clinics, and hospitals) in states like Puebla, Nayarit, Oaxaca, Chiapas, Queretaro, and Jalisco, proposing the implementation of cultural pertinence indicators (which are minimal and inadequate). Nevertheless, the health conditions among indigenous populations and the quality of health care provided by public institutions continue to be precarious in terms of human and material resources (health personnel, drugs, etc.) and discriminatory with respect to the form and content of the provided services. This paper describes some of the governmental interventions that purport to be institutional improvements in the field of interculturality, but that actually represent the continuity of arbitrary and exclusive policies.

Issues on Luck Egalitarianism, Responsibility, and Intercultural Healthcare Policies

This article analyzes the criteria for the distribution of healthcare services through different justice theories such as utilitarianism and liberalism, pointing out the problems that arise when providing services to a culturally diverse population. The international epidemiological setting is a favorable one for discussing personal responsibility and luck egalitarianism; however, some provisions have to be made so that healthcare institutions do not treat ethnic, cultural, religious, and linguistic minorities unfairly. The article concludes by proposing that accommodations and culturally sensible attention should be provided when possible, without affecting the equal opportunity of others to access these services.

Labor and delivery service use: indigenous women's preference and the health sector response in the Chiapas Highlands of Mexico

Background

Mexico has undertaken important efforts to decrease maternal mortality. Health authorities have introduced intercultural innovations to address barriersfaced by indigenous women accessing professional maternal and delivery services. This study examines, from the perspective of indigenous women, the barriers andfacilitators of labor and delivery care services in a context of intercultural and allopathic innovations.

Methods

This is an exploratory study using a qualitative approach of discourse analysis with grounded theory techniques. Twenty-five semi-structured interviews were undertaken with users and non-users of the labor and delivery services, as well as with traditional birth attendants (TBAs) in San Andrés Larráinzar, Chiapas in 2012.

Results

The interviewees identified barriers in the availability of medical personnel and restrictive hours for health services. Additionally, they referred to barriers to access (economic, geographic, linguistic and cultural) to health services, as well as invasive and offensive hospital practices enacted by health system personnel, which limited the quality of care they can provide. Traditional birth attendants participating in intercultural settings expressed the lack of autonomy and exclusion they experience by hospital personnel, as a result of not being considered part of the care team. As facilitators, users point to the importance of having their traditional birth attendants and families present during childbirth, to allow them to use their clothing during the attention, that the staff of health care is of the female sex and speaking the language of the community. As limiting condition users referred the different medical maneuvers practiced in the attention of the delivery (vaginal examination, episiotomy, administration of oxytocin, etc.).

Conclusions

Evidence from the study suggests the presence of important barriers to the utilization of institutional labor and delivery services in indigenous communities, in spite of the intercultural strategies implemented. It is important to consider strengthening intercultural models of care, to sensitize personnel towards cultural needs, beliefs, practices and preferences of indigenous women, with a focus on human rights, gender equity and quality of care.

The acceptability and feasibility of an intercultural birth center in the highlands of Chiapas, Mexico

Background

An intercultural birthing house was established in the Highlands of Chiapas, Mexico, as an intervention to reduce maternal mortality among indigenous women. This birth center, known locally as the Casa Materna, is a place where women can come to give birth with their traditional birth attendant. However, three months after opening, no woman had used the birthing house.

Methods

This study reports on the knowledge, attitudes and practices related to childbirth and use of the Casa Materna from the perspective of the health workers, traditional birth attendants and the program’s target population. Structured interviews, in-depth interviews and focus group discussions were conducted with participants from each of these groups. Data was searched for emerging themes and coded.

Results and conclusions

Findings show that the potential success of this program is jeopardized by lack of transport and a strong cultural preference for home births. The paper highlights the importance of community participation in planning and implementing such an intervention and of establishing trust and mutual respect among key actors. Recommendations are provided for moving forward the maternal health agenda of indigenous women in Chiapas.