A Maternal Health Update from Mexico

Have you ever had one of those afternoons where you stop trying to halt the random questions that pop into your head and simply let your mind wander?

 

I love the rare chance to do this.

The questions that emerge are so grandiose that I often find myself diving into several hours of research to try and find some answers.

Since moving to Playa del Carmen in July 2013, these questions often have to do with local issues.

 

Understanding the social and historical context of my community is important to me.

 

And as a maternal health professional, the questions usually revolve around…drumroll please…maternal health…I know, predictable!

In April 2015 I was invited to an event in Tulum, Mexico, that left me with plenty of questions about the local maternal health context to ponder on those mind-wandering sessions.

The event was the Regional Forum of the Mexican Midwifery Association (AMP in Spanish).

The forum was focused on current issues in midwifery practice, certification, and education.

A full report out from the event is featured on the blog of The Maternal Health Task Force at the Harvard T.H. Chan School of Public Health.

 

The questions I left with after the forum were related to history.

I dug into the archives and discovered the fascinating historical context behind the current challenges of the midwifery workforce in Mexico.

And, of course, I had to share! 

 

Here’s a quick and dirty lesson in Mexican midwifery from 1750-1960.

 

Spanish law for midwifery licensure was enacted in 1750 and extended to all Spanish territory, including Mexico.

The Spanish model for training midwives was adopted at the Pontifical University in Mexico in 1833.

The first professional midwife trained in this model graduated in 1841.

From 1841-1888, 140 midwives graduated from the rigorous program.

However, in 1887, the first gynecology specialty program began at the same university.

In 1892 the government issued a statement strongly suggesting all births be attended by gynecologists.

The statement also relegated midwives to the role of referring women to these newly trained gynecologists.

Notably, the gynecology program was not as rigorous as the midwifery curriculum.

There are documented decreases in quality of care and maternal health outcomes during the period in which gynecology is established as the government-backed standard for maternal health care.

Don’t get me wrong – I love my OB/GYNs – but the evidence makes for a controversial discussion.

 

It was very interesting to see the differences in how the two professions were taught to treat women – and how that affected outcomes.

 

From 1889-1932, another 627 midwives graduated from the program.

But changing policies began to lead to the slow and steady demise of the profession.

In 1911, it became a prerequisite that to study midwifery in the program mentioned above, you had to first hold a nursing degree.

This systematically slowed enrollment.

In 1944, the Mexican Institute of Social Security (public insurance system – IMSS) was created.

 

The IMSS became the largest employer of nurse-midwives — but only if they agreed to abandon outside care, and serve exclusively within the system.

 

In 1957 the IMSS froze midwifery hiring, and in 1960 prohibited midwives from attending births.

By this point, there were very few professional midwives practicing in community-based environments.

Those that were part of the health system were no longer able to do their life’s work.

 

Within the span of 200 years, midwifery in Mexico was built as a profession very quickly, and then marginalized equally quickly.

 

It was a question worth looking into for me, and certainly contextualized the contemporary issues.

So what’s the current status of the profession?

Check out the Maternal Health Task Force post here

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