Approaching Maternal Health from a Decolonized, Systemic, and Culturally Safe Approach: Case Study of the Mayan-Indigenous Populations of Guatemala

Abstract

The Mayan-indigenous populations of Guatemala face some of the worst maternal and child health outcomes worldwide. Despite repeated assertions that reducing inequity and reaching indigenous populations is a top government priority, and despite overall reductions in maternal mortality in Guatemala, maternal mortality ratios (MMRs) remain very high in local populations, especially those living in poor, marginalized, and indigenous regions. Historical exclusion and discrimination of the Mayan populations and their sociocultural divergence from the dominant population make them an especially easy target for neglect. They are rarely consulted in decision-making processes relating to their health, and health facilities are rarely adapted to their sociocultural realities and needs. In this chapter, we explore the nature and significance of factors relating to maternal health among the Mayan populations of Guatemala. In particular, we highlight the sociocultural divide that exists in Guatemala, and the systemic failure of the formal health system to provide a culturally safe environment for indigenous women during pregnancy and childbirth. We aim to provide a framework to contextualize and improve our understanding of the root causes of maternal health inequity, and of preventable morbidity and mortality of indigenous women, looking beyond the more often faulted logistical barriers. The Mayan example clearly illustrates the importance of transcending the hegemonic biomedical health model as the only way to achieving health, emphasizing the need for maternal health to be deliberately approached from an inclusive, integral, and multidimensional understanding of health and well-being—one that recognizes the existence of diverse perceptions, concepts, knowledge, and practices.