In the remote communities of Darién and the Emberá-Wounaan Comarca, where travel depends on the river, women sustain life with courage and ancestral knowledge. They are traditional midwives, who accompany women during pregnancy, childbirth, and birth. They play a vital role, since reaching a health facility often involves a difficult and unpredictable journey.
— March 2026 —
Emberá midwife Yamila González (51) recounts in a calm and steady voice that her work was born out of necessity: “I had my first daughter by myself… and the second one too. I delivered them alone,” she recalls.
In her home in the community of Canaán Membrillo, without the assistance of a health professional, guided by what she had learned from observing older women in her community and traditional midwives, she found the strength to bring her children into the world. “When the pain became strong, I would go to my room and stay on my knees to give birth… that’s what I did,” she says.
Without realizing it, those solitary births marked the beginning of her path as someone who helps bring life into the world. Over time, other women in the community began to seek her help. “After I had four children, they chose me as a midwife. I helped a young woman who was having her first baby, then her second, and I helped another woman as well,” Yamila recounts. In this way, by assisting women in her community, she gradually took on this role with commitment.
According to the Pan American Health Organization (PAHO), the maternal mortality ratio in Latin America and the Caribbean remains around 65.8 deaths per 100,000 live births. In some countries, Indigenous women face a risk up to three times higher of dying during pregnancy or childbirth.
Although Panama’s national rates are lower, inequalities persist in Indigenous territories and remote communities, where distance, cultural barriers, and limited access to health services continue to put many women at risk.
With the support of the Pan American Health Organization (PAHO) and Panama’s Ministry of Health (MINSA), traditional midwives have participated in a series of activities that recognize their work and strengthen their knowledge. These trainings promote culturally safe care throughout pregnancy, childbirth, the postpartum period, and in the early days of a newborn’s life, while respecting Indigenous traditions.
Through the project Strengthening Primary Health Care for Maternal, Sexual and Reproductive Health, implemented with Panama’s Ministry of Health (MINSA) and supported by the Spanish Agency for International Development Cooperation (AECID), PAHO is working to improve maternal and reproductive health in underserved communities by strengthening the health system and promoting community participation.
The project seeks to ensure culturally safe health services that contribute to reducing maternal and neonatal mortality and strengthening women’s autonomy. To achieve this, it promotes a larger dialogue and exchange between ancestral knowledge and medical knowledge on pregnancy and childbirth. At the same time, it strengthens the capacities of traditional midwives through training and practical tools for the early detection of risks and timely referral to health services.
During the project, Panama applied for the first time the PAHO Tool for Promoting Culturally Safe Childbirth, a practical guide designed to reduce maternal mortality gaps affecting Indigenous women and other ethnic groups. Through participatory workshops, 26 traditional midwives received training on warning signs, prevention of complications, and timely referrals, integrating this knowledge with their ancestral practices, such as the use of medicinal plants, the choice of position during childbirth, and community technologies for early alerts.
More recently, traditional midwives from Darién and the Emberá-Wounaan Comarca participated in training on perinatal technologies, where they learned to use tools for monitoring pregnancy and detecting risks early. During the workshop, 24 participants were introduced to the use of blood pressure monitors to detect hypertension, pocket gestational wheels, obstetric and neonatal measuring tapes, and community flip charts for health education—tools that help identify warning signs and facilitate timely referral to health services.
Each participant received a complete kit with these instruments, strengthening their capacity to accompany pregnant women in their communities and help prevent avoidable maternal and neonatal deaths.
The workshops also included visits to the maternal and child health centers in Metetí and Santa Fe, where the perceptions of health personnel, traditional midwives, and users were gathered. These visits made it possible to observe how communication takes place between health staff and Indigenous women, whether care incorporates elements of their culture, and whether women’s autonomy is promoted during childbirth and the postpartum period.
Aspects related to infrastructure, community participation, and institutional strengthening were also analyzed. Participants also visited the site of the future Darién Regional Hospital—currently under construction—to identify opportunities to incorporate an intercultural approach to pregnancy, childbirth, and postpartum care, in accordance with the indicators of PAHO’s culturally safe childbirth tool.
One of the project’s components is promoting coordination between the local institutional health teams and traditional midwives. “We have a health assistant. When the baby is born, he cuts the cord. If something is wrong, we come to the health center,” says midwife Crilia Chango.
“This process has opened a real dialogue with communities that helps improve health care and ensure that no one is left behind. Strengthening maternal and neonatal care with an intercultural health approach is key to reducing maternal and neonatal deaths,” explains Victoria Bertolino, international consultant with PAHO’s Department of Social and Environmental Determinants for Health Equity.
In these parts of Panama, traditional midwives are often the first—and sometimes the only—point of reference for a pregnant woman seeking assistance. For them, the workshops represent recognition of their work and their knowledge. For Emberá-Wounaan mothers, it means being able to trust in a health system that respects their rights and allows them to access culturally safe childbirth, with the capacity and technology needed to prevent complications and death—for both mothers and their babies.
