Preventable perinatal deaths in indigenous Wixárika communities: an ethnographic study of pregnancy, childbirth and structural violence

• DOI: 10.1186/s12884-018-1870-6
• Publication Date: 2018-06-18T12:37:24Z
• Authors: Jennie Gamlin; Seth Holmes
• Keywords: Attendance

Preventable maternal and infant mortality continues to be significantly higher in Latin American indigenous regions compared non-indigenous, with inequalities of race, gender poverty exacerbated by deficiencies service provision. Standard programmes aimed at improving perinatal health have had a limited impact on rates these populations, state national statistical data evaluations services are little relevance the environments that most ethnicities inhabit. This study sought novel perspective causes solutions considering how structural, cultural relational factors intersect make women babies more vulnerable morbidity mortality. We explored structural interpersonal relationships decision-making about care seeking during pregnancy childbirth Wixarika communities Northwestern Mexico. Sixty-two were interviewed while pregnant followed-up after birth their child. Observational was collected over 18 months, producing than five hundred pages field notes. Of 62 interviewed, 33 gave home without skilled attendance, including 5 who delivered completely alone. Five died labour or shortly thereafter, we present here 3 events as case studies. identified structure provision, which providers several contiguous days off, combined poor patient-provider dynamic sometimes non-consensual imposition biomedical practices acted deterrents institutional delivery. Data also suggested men important roles play supporting partners birth. Stillbirths neonatal deaths occurring context unnecessary lone unassisted deliveries structurally generated forms violence: preventable morbidities mortalities result systematic system weaknesses. These results counter common assumption choices avoid delivery irrational, due lack education. Rather, our indicate arrangements interactions contribute deaths. Addressing issues requires important, but achievable, changes provision resource allocation addition long term, culturally-appropriate strategies.