Maternal health and Indigenous traditional midwives in southern Mexico: contextualisation of a scoping review

Abstract

Objectives: Collate published evidence of factors that affect maternal health in Indigenous communities and contextualise the findings with stakeholder perspectives in the Mexican State of Guerrero.

Design: Scoping review and stakeholder fuzzy cognitive mapping.

Inclusion and exclusion: The scoping review included empirical studies (quantitative, qualitative or mixed methods) that addressed maternal health issues among Indigenous communities in the Americas and reported on the role or influence of traditional midwives before June 2020. The contextualisation drew on two previous studies of traditional midwife and researcher perspectives in southern Mexico.

Results: The initial search identified 4461 references. Of 87 selected studies, 63 came from Guatemala and Mexico. Three small randomised trials involved traditional midwives. One addressed the practice of traditional midwifery. With diverse approaches to cultural differences, the studies used contrasting definitions of traditional midwives. A fuzzy cognitive map graphically summarised the influences identified in the scoping review. When we compared the literature's map with those from 29 traditional midwives in Guerrero and eight international researchers, the three sources coincided in the importance of self-care practices, rituals and traditional midwifery. The primary concern reflected in the scoping review was access to Western healthcare, followed by maternal health outcomes. For traditional midwives, the availability of hospital or health centre in the community was less relevant and had negative effects on other protective influences, while researchers conditioned its importance to its levels of cultural safety. Traditional midwives highlighted the role of violence against women, male involvement and traditional diseases.

Conclusions: The literature and stakeholder maps showed maternal health resulting from complex interacting factors in which promotion of cultural practices was compatible with a protective effect on Indigenous maternal health. Future research challenges include traditional concepts of diseases and the impact on maternal health of gender norms, self-care practices and authentic traditional midwifery.

Keywords: maternal medicine; primary care; public health; social medicine; statistics & research methods.

Figure 1

Flow diagram of the selection of sources of evidence (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). (1) CINAHL, Scopus, LILACS, Medline, Embase, Google Scholar. (2) CEPAL, Repositorio FLACSO, BVS, BVS MTCI, PAHO, PAHO IRIS, Red de repositorios latinoamericanos, La referencia Dialnet, Redalyc, BDCOL, Biblioteca digital Bogotá, CLACSO, BRISA, WHO, WHO IRIS.

Figure 2

Fuzzy cognitive map of the most influential categories identified in the scoping review. To simplify the graph, we only included the 10 strongest positive and negative relationships. Online supplemental file 3 contains all the relationships on the map. Solid lines represent positive relationships and dashed lines negative ones. The numbers on the edges represent the cumulative influence of one category on another, where 1 is the strongest influence on the map. The three boxes with ticker lines also had the highest outdegree centrality or influence in the whole system.