MADRINAS OBSTETRICAS PDF

Home Spanish to English madrina. Definition of godmother in English. Elijan el atuendo para las madrinas y padrinos. La modelo Paulina Trotz fue la madrina del evento.

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How women make decisions about care-seeking during pregnancy and childbirth, is a key determinant of maternal and child health MCH outcomes. Indigenous communities continue to display the highest levels of maternal and infant mortality in Mexico, a fact often accounted for by reference to inadequate access to quality services.

A growing body of research has identified gender inequality as a major determinant of MCH, although this has rarely been situated historically in the context of major social and epistemological shifts, that occurred under colonialism.

I used a feminist ethnography to understand the structural determinants of Indigenous maternal health. These data were triangulated with structured observations and key informant interviews with healthcare providers, teachers, community representatives and family members. The associated structures of marriage, community and interpersonal relationships now operate as forms of institutionalised gender oppression, to increase Indigenous women's vulnerability, and influence decisions made about care and childbirth.

Ethnographic data analysed in historical context evidence the continuity of colonial forms of inequality, and their impact on wellbeing.

While welfare and health programmes increasingly aim to address gender inequality on social and relational levels, by rebalancing gendered household dynamics or empowering women, the historical and colonial roots of these inequalities remain unchallenged. In Latin America, the colonial political and social structures that went on to form the basis of independent nation states have not been favourable to equality between ethnicities Fisher and O'Hara, ; Valeggia, In the case of Mexico, deep inequalities established during the colonial era were strengthened throughout the process of nation-building.

During recent decades that have seen advances in Indigenous rights, these historical structures have continued to undermine the wellbeing of Indigenous people Stephens et al. Although constitutional changes have led to some advances in political autonomy for Indigenous peoples in Latin America, racial equality and social wellbeing have not followed; these remain dependent on policy and institutions at a national level. It is the continued political, social and cultural dominance of Indigenous populations by nation states that has led this relationship to be theorised as coloniality.

Throughout Latin America, Indigenous communities often evince deeply embedded gender inequalities, which combine with ethnic vulnerabilities to adversely affect health outcomes along this intersect Valeggia, The states of Chiapas MMR Infant and maternal mortality track the same fault lines, and municipalities with high infant death rates are predominantly Indigenous.

Evidence also suggests that these rates mask considerable under-reporting Gamlin and Holmes, Mexican Indigenous communities have been poorly provided for in terms of health facilities.

They are often less accessible than non-Indigenous regions, with weak transport and communication links. These are both key drivers of maternal and infant mortality on the supply side Koblinsky et al. At a global level, we know that poverty and education are important determinants of institutional delivery Freidoony et al. These are some of the findings that have informed global efforts to reduce maternal mortality. In Mexico, training traditional midwives, good surveillance in the form of the Observatory for Maternal Mortality OMM , and political pressure to ensure health budgets reach the people they are intended for, are all considered good practice for the reduction of maternal mortality Freyermuth, While there is general agreement among global health experts about the drivers of good maternal outcomes, there has been little or no consideration of the specificity of Indigenous populations, or the coloniality of care, implying that health service provision continues to operate though the imposition of a set of cultural and power structures and assumptions that are colonial in form.

This means that global health governance and national health systems determine what is best practice for Indigenous populations, or exert biopower over them, in accordance with global norms. Policies are largely defined centrally, and often in accordance with proposals, such as Universal Health Care UHC and the promotion of institutional delivery, that are defined by global health governing organisations. Non-biomedical and non-Western childbirth practices are diverse, but birthing women are usually physically supported by another individual, as was the case elsewhere before the rise of biomedicine and obstetricians Jordan, However, institutional local clinic or hospital deliveries, and in particular those where the supine position is encouraged, eradicate the role of non-medical support and few hospitals allow entry to a partner during labour Gamlin and Osrin, Institutional exclusion of men from this role is just one example of how the coloniality of global health governance is impacting on Indigenous communities.

A decolonising approach adds a new perspective to this discussion by suggesting different problematisations from which to address maternal and infant mortality. I argue that Indigenous experiences of pregnancy and birth are the afterlife of colonialism, a legacy and mingling of the colonality of gender and healthcare. By extending the idea that colonialism is an ongoing process, as opposed to a defined historical period Quijano, , Lugones describes the intertwining of race and gender that produced this system.

In this paper I re-problematise Indigenous maternal and infant mortality from the perspective of the coloniality of gender, positioning this as a structure that disrupts processes of birth and reproduction, and limits the ability of families to prevent avoidable maternal and infant deaths.

The resulting excess morbidity and mortality have become an afterlife of colonialism, as structures established under colonialism live on in the bodies of women and babies. Gender is an almost universal structure that is formed relationally, through interactions between people, and through the actions and expectations of individuals and groups.

These are supported by institutions and structures, such as the family, education system and the labour market Connell, ; West and Zimmerman, Defined gender roles and institutions then become naturalised, and are embodied in the behaviour of men and women.

In this manner the coloniality of gender has become invisible. Largely defined through cultural processes, including religious and economic organisation, Western colonial patriarchy reproduced itself within institutions such as marriage, kinship and the sexual division of labour. These institutions were then exported to colonial states, where Western structures reconfigured gendered identities in relation to those of the metropole Mies, ; Wiesner-Hanks, Race was produced as part of the same process, with the ethnicity of Indigenous people biologised and positioned hierarchically in relation to that of Europeans.

Some research has questioned why gender violence is so prevalent, and begun to explore how historical processes have influenced gender identities in Mexico. Hierarchical gender relationships then became embedded in male honour, which itself served as a cause of violence against wives Kellogg, : Mexican colonial and post-colonial history also reveals the intersection of gender and poverty.

This redefining of race and gender was central to post-revolutionary nation-building, and became reflected in cultural and social institutions — such as health, education and the family — that shaped modern Mexico. Yet while gender is a historically embedded social structure, human memory is short. The relevance of this discussion to maternal and infant mortality lies in the urgency of newly problematising longstanding and intractable problems.

Within global health, gender has overwhelmingly been addressed within neoliberal Wilson, and instrumental Gideon and Porter, development frameworks that largely reinforce structures of gender inequality.

Examining gender as part of a process of colonialism will provide pointers for critically redefining these inequalities, evidencing potential interventions and processes aimed at addressing structural gender inequality and its impact on health and wellbeing. While gender inequality has been clearly identified as a structural determinant of maternal health, its institutionalisation at a community level and articulation around coloniality is rarely expressed in relation to health.

Feminist ethnography does this by analysing personal narratives, and specifically seeks to identify how gendered power dynamics operate to impact on people's experiences.

In this case I sought to understand how gendered power influences birth outcomes. To practise this, feminist ethnography involves building up understanding by layering data gathered using different methods, and here I evidence the permanence of the past in the present, by combining ethnography with ethnohistory and using an interpretative framework for analysis that draws on the theory of coloniality.

Officially, the MD attends the clinic with a nurse from the 11th to the 30th of each month, while the SD is present from the 20th of each month for 20 days, running the clinic alone from 1st to 10th of each month. This system of healthcare provision is repeated throughout the Indigenous region. In contrast, lowland and mestizo towns have a regular and constant service. There is no tradition of midwifery, but around 60 per cent of births occur at home, with women giving birth alone, or accompanied by a family member Gamlin and Osrin, Politically, the autonomous governorship is a dependency of Mezquitic Municipality, from where services such as health, education and the Prospera welfare programme are coordinated.

Prospera is a government-run cash transfer scheme, which gives women bi-monthly cash payments for each child enrolled in school. Higher amounts are paid for female children. To be eligible women are also required to attend health promotion and exercise sessions at the local clinic.

Failure to comply with these conditions leads to payments being cut and the MD at the local clinic is responsible for enforcing the conditionality. The community has political autonomy for internal issues that are not the concern of the state. Therefore local authorities preside over cases of marital infidelities, violence or abuse and conflicts over land ownership, community residence or theft, but they have no voice in issues related to health, education or the Prospera programme.

I have worked in Xirawe since , and for this study recruited eight bilingual research assistants. We used semi-structured interviews to gather data during pregnancies and narrative interviews after the birth of their child, asking about birth experience with prompts about treatment by health providers, interventions or complications and expanding to discuss issues such as marital relationships.

In addition, I gathered observational data and conducted informal interviews with health providers 8 , teachers 3 and key community and family members approximately These were gathered in a field diary or audio recorded. At a first stage, women were recruited through the local General Assembly meeting, where we also obtained support and approval for the project. Following recruitment, the eight research assistants attended community meetings, to request the participation of pregnant women. We sought to interview all women who were pregnant during the twelve-month period of January—December A convenience sample of sixty-four pregnant women aged 13—39 mean age All women who were known to be pregnant and could be found at home at the time of the study were invited in person, to participate.

The women who did not participate may have been away from home when the interviewers called, chose not to be interviewed 8 refusals were documented , or did not disclose their pregnancy to anyone. In-depth follow-up interviews were conducted after the birth of a child. I conducted each of these interviews with the assistance of one of the eight bilingual research assistants. The sample is likely to be weighted towards women who live in the highland towns, and therefore potentially biased towards those who have greater access to education, transport and health services.

In order to achieve an accurate representation of voices, interviews were audio recorded, transcribed directly into Spanish and double-checked for accuracy by a bilingual research assistant.

These data were discussed in depth with the team of eight research assistants, who clarified and provided context for the interview data. Post-interview discussions were recorded in a field diary, together with observations, and these were transcribed directly into Word documents.

I conducted an inductive thematic analysis of all data using N-Vivo version 8, to manually generate codes and sub-themes. Following the general practice of grounded theory Strauss and Corbin, , data that were coded together included interview transcripts and observational field notes.

These were then collapsed into twelve overarching general themes so that they could be analysed individually in more detail. This enabled various simultaneous views of specific data, to illuminate the complex and multiple meanings of statements where indirect references are made to issues such as unequal partnerships.

N-Vivo also enabled analysis of data by group of informants, allowing stratification by informant type, triangulation between key informant type, post pregnancy interviews and observational data and to isolate specific interviews. In one case this provided multiple descriptions of a complex birth, in other cases I was able to compare health care provider's views with those of community members around controversial issues.

All data described above contributed to the thematic analysis and subsequent theoretical interpretation. In this paper I discuss data that relate to gender equality in intimate partnerships and within the community. Most of the women interviewed were married, some for the second time, some as second wives and some to a man who had later taken a second wife. It is rare to find a couple who have maintained a single partnership throughout their lives, this implies that women usually tolerate a string of infidelities, being one of several wives or being abandoned by the father of their children.

Marriage often occurs soon after menarche and, if the couple are still minors, subject to the approval of one or both sets of parents. Polygyny, adolescent marriage and forced marriage can each make a woman vulnerable, and often they occur together. I asked Ester why a woman would marry a man who already had a wife.

She responded by telling me her own story, of being forced to become the second wife of Obaldo, an older man:. They told me that I had gone with Obaldo to the field after the dance, and that because of this we had to end the relationship or they would make us marry. Because I was a minor I didn't have the right to say anything [at the meeting]. I began to cry and said I had done nothing, and wanted nothing to do with Obaldo.

Then my uncle spoke and said that since I had no parents, someone needed to be responsible for me, and if I had done what these people were saying, then I should marry Obaldo.

Anyway, no-one in the family could support me financially, and since this man was offering to do it, then it would be best if I went with him.

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