Integrating traditional midwives into Bolivia’s health care system to promote culturally secure births and intercultural dialogue

May 2022

Background

For years, the traditional midwives of Bolivia’s 36 nations and indigenous territories have used traditional medicine practices together with conventional medicine to bring life into the world with quality and warmth, with respect for interculturality.

Traditional medicine is an integral part of the Plurinational State of Bolivia’s Political Constitution and its National Health System. The national policy “Family Community Intercultural Health” (SAFCI) includes concepts of traditional medicine as a way of revaluing and integrating it into the public health agenda as a "new way of doing health". This model of care allows healthcare staff to reach the population with an approach which includes dialogue, respect and recognition of different sets of knowledge. The approach makes connections between bio-medical approaches and traditional medicine, thus constituting a single, universal, intercultural community and inclusive health system that addresses Bolivia’s diverse health issues.

The Bolivian government’s valuing of traditional midwives in indigenous communities contributes to universal access by providing rights-based sexual and reproductive health services that contribute to the reduction of maternal deaths and ultimately improve women's health.

The challenge

Connecting traditional midwifery with health establishments presents a challenge for health systems as there is not yet an effective coordination mechanism for integrating the two visions. While Western medicine regards childbirth as a bio-physiological process, labour represents a cosmic event for many indigenous communities. Childbirth for the indigenous woman is the confluence of all aspects of life: from social to cultural and emotional. The woman is the protagonist of the event, and the birth must take place in the most natural way possible, in total harmony with her surroundings.

Within the framework of the technical cooperation of the project “Improving the health of women and adolescents in vulnerable situations”, PAHO/WHO in Bolivia developed a plan to integrate traditional midwives in the health system in the areas where Yuracaré, Mojeño and Yuqui populations live. With funding from the Government of Canada, PAHO/WHO worked with the Directorate of Traditional Medicine of the Ministry of Health and Sports (MSD) and partners, such as the non-governmental organization Plan International, to facilitate the process of linking traditional midwives with health establishments. The midwives and the community participated in the “intercultural dialogues”. The objective of this methodology is to exchange learnings, strengthen capacities, create opportunities for empowerment and leadership of women and adolescents—all of which improves their overall health and well-being.

Results

Three products were developed to facilitate the integration of traditional midwives in the health system:

1. A guide on care during pregnancy, childbirth and the post-partum period was developed with an intercultural approach. The guide seeks to raise awareness of first- and second-level health care providers on the ancestral knowledge of traditional medicine.

2. A guide that compiles the learnings and practices of the traditional midwives from three geographical regions of Bolivia: the highlands, the valley, and the lowlands.

3. An accreditation process for traditional midwives to be officially integrated in the health system.

These interventions aimed at increasing access and coverage of sexual health and reproductive health services to offer a broad and comprehensive response. At the same time, they seek to recognize the commitment of leadership by women, adolescents, and traditional midwives, as well as their respective neighborhoods and communities.

The National Directorate of Traditional Medicine officially recognized midwives from the Yuracarés, Mojeños and Yuquis indigenous territories for the preservation of good ancestral practices in childbirth and newborn care after they participated in work sessions with the “intercultural dialogue methodology” with health personnel and community authorities.

Lessons learnt

Despite the advances Bolivia has made, the current regulations and implementation experiences are not sufficient to integrate traditional medicine with Western medicine. This is a process that needs to be further consolidated with the sustained commitment of various actors. On the one hand, health personnel must understand the importance of working in coordination with traditional midwives, to integrate their knowledge in the care of women and babies, the use of nutrition based on herbs and native foods, specific maneuvers during pregnancy, childbirth, and puerperium. On the other hand, traditional midwives must find the space in health services to complement their knowledge and seek help in case of any complication of the woman or the newborn.