Authors: I. Sarmiento, N. O'Brien, S. Paredes-Solis, N. Andersson
Indigenous communities in Guerrero, Mexico suffer from a disproportionate burden of maternal and infant mortality. Our aim was to evaluate the impact of promoting better coordination between traditional midwives and the official healthcare system. Overcoming disparities inmaternal outcomes requires adequate healthcare, particularly for obstetric complications. However, Indigenous women receive low-quality Western health services, which are often disrespectful of their traditional culture.
Between 2015 and 2017, a participatory cluster randomised controlled trial fostered the work of traditional midwives in two municipalities of Guerrero and measured its impact on maternal health . The intervention included training 17 community-appointed intercultural brokers to bridge the gap between traditional midwives and Western physicians. These local leaders worked with one to two midwives in each community. In 2016, using a narrative technique, we collected 12 stories from midwives describing the most significant changes promoted by these brokers in the last year. For the analysis, participants and staff in charge of the intervention identified the most relevant domains of change in two collaborative rounds of story selection.
The most significant change narratives identified improvements in the care coordination attributable to the intercultural broker. The broker improved interactions between physicians and midwives through basic linguistic translation, and also through facilitating intercultural interpretations. In doing so, brokers improved mutual respectover time and appreciationof both traditional and Western care providers.
Although the technique of most significant change has limitations for identifying negative impacts, these results suggest the benefits of promoting intercultural dialogue and the key role of intercultural brokers for improving care coordination and the health of indigenous communities more broadly. These resultssuggest additionalaspects of traditional midwiferyto incorporate in future culturally safe quantitative evaluations.
Safe motherhood in cultural safety: the impact of supporting traditional midwifery and intercultural dialogue in indigenous peoples in Guerrero State, Mexico.https://doi.org/10.1186/ISRCTN12397283  Davies R, Dart J. The ‘most significant change’(MSC) technique. A guide to its use. 2005 Apr.