Partnering with traditional birth attendants to reach Afro-descendant and indigenous women in Colombia

BOGOTA, Colombia – “Colombia is a multicolored country, with varied customs, practices and celebrations... Within that level of inclusion, we need to add traditional midwifery,” said Ledy Manuela Mosquera Moreno, a nurse and the executive director of the Association of the Interethnic Network of Midwifery Practitioners of the Department of Chocó. 

Such efforts are important in Afro-descendant and indigenous communities. The maternal death rate in Colombia has been falling for years, yet many of these gains have not been seen by Afro-Colombian and indigenous communities, where maternal death rates are two to four times higher, according to the health ministry; this situation has worsened under the COVID-19 pandemic. 

There are many barriers to high-quality maternal health care in these communities, including challenging geography, economic marginalization, limited presence of health institutions and services able to meet the needs of the population, as well as cultural hurdles, such as fear of Caesarean sections, shame at seeking help outside the community and challenges with language. This is where traditional birth attendants and midwives can help.

“Traditional midwifery goes beyond assisting with a delivery,” said Ms. Mosquera. Her organization works with UNFPA in the Partera Vital project, which equips Afro-Colombian and indigenous birth attendants and community health workers with modern skills and tools. “It is advising, accompanying, guiding women, families and the community in all matters of sexual and reproductive health.” 

Respect and trust

UNFPA is also working with traditional birth attendants in the Inter-agency Strategy for Reducing Maternal Mortality in Indigenous Populations, as part of the Global Action Plan for Healthy Lives and Well-being for all, also known as the GAP.

The GAP is a collaboration with three other UN agencies, the health ministry and local authorities. Through this partnership, the Pan American Health Organization is working with health systems to improve maternal health and health systems; UNICEF is mobilizing resources to improve training standards for health teams and traditional practitioners; and the World Food Programme is working to strengthen food and nutritional security in remote communities. UNFPA’s contribution is training community workers and traditional birth attendants in the indigenous Arhuaca and Wayuu communities, and helping health facilities and practitioners embrace an intercultural and human rights-based approach to health care. 

This approach made all the difference to María Cambar, who was reluctant to go to the nearby Dusakawi maternity clinic in northern Colombia – even when she was in active labour. But a community health worker, Leyla Yadira González, reassured her that her indigenous traditions and perspective would be respected if she were to accept medical assistance. Ms. Cambar felt she could trust Ms. González, who was not only a nurse trained in western medicine but also a member of the community honoured by elders of the Wayúu matriarchal society as a traditional practitioner.

Ms. Cambar was taken by ambulance to the clinic, where she had access to an interpreter and even slept in a bed similar to the hand-woven hammocks, 'chinchorros', she used in her home. There, she gave birth to a healthy baby boy.

Working together

Through the GAP programme, which was launched in 2015, these collaborations between health systems and indigenous communities are being scaled up throughout northern Colombia.

And UNFPA’s other partnerships, such as with Afro-Colombian leaders like Ms. Mosquera, are also having an impact.

“Why is it important? Because this allowed and still allows a link between ancestral knowledge and all actions that in one way or another are articulated within the health services,” Ms. Mosquera says.

She gives a lot of credit to community members themselves, who are working hard to bridge gaps, like “the midwife who considers herself trained from the ancestral perspective yet with the necessary skills and techniques to adequately assist a delivery.”