Running head: MATERNAL HEALTH AND MORTALITY IN GUATEMALA

Global Health
Maternal Health and Mortality in Guatemala
Dani Woodley
Western Washington University

MATERNAL HEALTH AND MORTALITY IN GUATEMALA

Maternal Mortality in Guatemala

Introduction
Maternal health and mortality is a major issue that continues to affect many countries
throughout the world. Guatemala, being the most populous country in Central America, is no
different. Maternal mortality rates continue to be a problem that families deal with on a daily
basis. Over the past 16 years, attempts have been made to decrease the rates of this serious issue.
Pregnancy should be the happiest and most fulfilling time in a womans life, but for many it is a
time to fear suffering, serious illness, death, or fetal complications. This paper will define
maternal health and mortality, examine the maternal health issues as well as the past and current
statistics of maternal health, and discuss the Guatemalas attempts at bettering these rates.
Demographics
Guatemala is located in Central America where it borders the North Pacific Ocean,
nestled between El Salvador and Mexico, and bordering the Gulf of Honduras (Caribbean Sea)
between Honduras and Belize. Guatemala has one of the highest populations in Central America
at an estimated 14,918,999 citizens, and has the highest fertility rate in Latin America at 3.6
children per woman. Considering the high fertility rate, Guatemala also has the highest
population growth rate in Latin America at 2.5% per year which will likely continue because of
the high birth rates, and the large reproductive-age population (Population Reference Bureau,
2011). Guatemala is also considered to be one of the poorest country in Central America with
approximately 75% of the population being estimated to live below the poverty line, and almost
58% of the population have incomes below the extreme poverty line. In Guatemala, the poverty
line is defined by an income that is sufficient to purchase a basic basket of goods, and services,
that an average Guatemalan would consider essential for survival. Extreme poverty is defined by

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insufficient funds allowing a family to purchase a basic basket of food that a family needs to
survive for one month. (The World Bank, 2016). If a family is unable to provide these basic
needs for their family, they are considered to be below the poverty line or in extreme poverty.
Defining Maternal Health
Maternal health refers to the health of women during pregnancy, childbirth and the
postpartum period (World Health Organization, 2016, p. 1). Maternal health encompasses
several areas of preparing for new life such as prenatal care, and postnatal care, to help reduce
the risk of maternal complications. In many countries, Guatemala being one of them, women
have difficulties gaining access to proper prenatal care that can help ensure a decrease in
pregnancy difficulties. In Guatemala, 42% of the population does not have access to regular
health care making proper prenatal care difficult to obtain (Midwives for Midwives International
[MMI], 2015). Because the poverty in this region is so great, and 70% of the population live in
poor rural areas, health services are beyond the means of many women (Pan American Health
Organization [PAHO], 2014).
Defining Maternal Mortality
There are many factors that could play into the mortality of a pregnant woman. The
World Health Organization (2016) defines maternal mortality as the death of a woman while
pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of
the pregnancy, from any cause related to or aggravated by the pregnancy or its management but
not from accidental or incidental causes. Worldwide, the main direct causes of maternal mortality
are hemorrhage post birth, infections, pre-eclampsia/eclampsia, unsafe abortions, and obstructed
labor. In Guatemala, more than half of the deaths are related to excessive bleeding, and other
main factors are infections, pregnancy induced hypertension, and unsafe abortions due to

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abortions remaining illegal in Guatemala. Also, in Guatemala, around 50 percent of maternal

deaths occur during deliveries at home and 50 percent in hospitals, because many women arrive
at the hospital in critical condition (Mendez, 2016).
Risk Factors
There are many risk factors that lead to maternal mortality in a poor region such as
Guatemala. In this country, maternal mortality remains high because women often hesitate to
come to clinics or hospitals to give birth. However, the main risk factor for women dying from
pregnancy complications is that there are too few medical centers in rural or semi-rural areas so
pregnant women must travel long distances to give birth safely in a hospital. Antenatal risk
factors that are associated with mortality are: inadequate antenatal care, operative or assisted
vaginal deliveries, obstructed labor, fetal malposition, antepartum hemorrhage, hypertensive
disorders, and many maternal medical treatments such as blood transfusions or antibiotics
(Bauserman et al., 2015, p. 3). The main characteristics of maternal death in the postpartum
period include seizures or convulsions, hemorrhage, anemia, hospitalization, and medical
treatments such as blood transfusions and medication errors (Bauserman et al., 2015).
Midwifery care in Guatemala
There are about 40,000 midwives that work throughout Guatemala, but very few are
associated with any type of public healthcare system. The majority of women in Guatemala tend
to give birth at home with a midwife attending 60-75% of all the births with 90% of births
occurring in a rural setting (MMI, 2015). The World Health Organization (2016) reports that the
most equipped person to execute effective pre and postnatal care are those with midwifery skills
that are living in the community, but Guatemala health officials are excluding midwives from the
public health system because they are hoping to centralize medical services within hospitals.

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Currently, the main goal of midwifery training is currently focused on the identification of risk
factors and transfer of patients into the hospital setting to correlate with the goal of centralizing
care into the hospital setting (MMI, 2015). However, this goal seems insurmountable because, as
stated earlier, many women cant make it to the hospital in time to have a safe delivery. If the
government continues to restrict the roles of midwives, this will likely result in even a further
decrease in utilization of modern obstetrical services, because they are more accessible than
many health care facilities and indigenous midwives in Guatemala will continue to provide a
large fraction of the obstetrical services among rural populations (Chary, Diaz, Henderson,
Rohloff, 2012, p. 857).
Maternal Mortality in Guatemala
In the 1990s, Guatemala had extremely high rates of maternal mortality rates at 205
deaths per 100,000 live births compared to the regions average rate of 85 deaths per 100,000
live births (PAHO, 2014). For perspective, the United States has 14 deaths per 100,000 live
births (The World Bank, 2016). These high mortality rates were a direct result of inequities in
access to health services because in 2000, one in five pregnant women had no prenatal care at all
(The World Bank, 2014). With interventions in place to decrease the risk factor of maternal
mortality, Guatemala has managed to decrease those rates currently to 88 deaths per 100,000 live
births (The World Bank, 2016). Even though the rates have improved, the numbers still remain
high. A factor that is also affecting the maternal mortality rates is that the ratio is three times
higher among the indigenous population compared to the non-indigenous. Beliefs for this
disparity focus on the indigenous peoples unwillingness and/or inability to access health care
services related to distrust of healthcare facilities and past discrimination and mistreatment by
the government during their civil war (Tanner, 2013). The following table from The World Bank

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(2016) illustrates Guatemalas decreasing trend of maternal mortality from 1990 until the most
recent estimate in 2015. However, it is believed that there may be an issue of under-reporting
related to the rural living of a substantial amount of the Guatemalan population.

Attempts to Decrease Maternal Mortality

Guatemala has struggled in the past to provide safe and effective perinatal care for the
women of the country. Attempts have been made over the past few decades to assist in
decreasing the rates of the maternal mortality. Perreira et al (2002) describes that in 1997, the
Guatemalan Ministry of Health (MOH) and MotherCare, an international maternal and perinatal
health care project, introduced interventions to four Guatemalan regions to spread awareness of
danger signs during pregnancy, delivery, and the postpartum period. These three interventions all
included focus on improving awareness of pregnancy complications: hemorrhage, swelling of the
hands and face, premature labor, premature rupture of the membranes, prior C-section delivery,
fetal mal-presentation, multiples, prolonged labor, retained placenta, abdominal pain, fever, and
foul smelling discharge (Perreira et al., 2002). The results of these interventions demonstrated

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that Safe motherhood programs can effectively increase knowledge of danger signs through
clinic and community-based educational strategies.
In the year 2000, the Ministerio de Salud Publica y Asistencai Social (MSPAS) started the
National Program of Traditional and Alternative Medicine to promote indigenous medicine, and
later a norm was issued that describes the right to receive culturally appropriate maternal
healthcare. This norm was reinforced by the 2010 Law for Safe Motherhood that reiterates that
care must be culturally appropriate, and the MSPAS began to offer its health care providers
trainings to execute this norm effectively (Dijk, Ruiz, Letona, & Garcia, 2013).
In 2001, Guatemalas Congress enacted the Social Development Act which establishes
that the lives and health of mothers and children are a matter of public welfare and that healthy
maternity is a national priority. The act calls for the creation of health care units capable of
handling obstetric emergencies to be located at strategic sites throughout the country, particularly
in places with the highest levels of maternal and child deaths (Mendez, 2016). Mendez (2016)
explains that Guatemala also has the Maternal and Neonatal Health (MNH) project that supports
the government in its aim to improve the survival of the mother and newborn. This project has an
accreditation program called CaliRed that has a framework to improve facilities that deliver
maternal and newborn care and services.
In 2005, the Guatemalan government strengthened the Extension of Coverage Program
(PEC) to help guarantee improvement of basic healthcare. The Maternal-Infant health and
Nutrition Project strongly supported the phases of the PEC and worked to improve maternal and
infant health in the region with the support of 49 million dollars loaned from the U.S (The World
Bank, 2016). These efforts found a maternal mortality decrease from 3.2% in June of 2006 to
1.24% in December of 2012 in both indigenous and non-indigenous people in the 101

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municipalities that were prioritized. Also institutional deliveries increased by 20%, from 22.3%
to 42% in the same time period (The World Bank, 2016). In 2014, the National Post-Abortion
Care Plan was introduced by the Epidemiological Research Center in Sexual and Reproductive
Health (CIESAR) whose goal is also to reduce maternal mortality by increasing access to and
quality of sexual and reproductive services.
Millennium Development Goals
In the year 2000, the United Nations made a declaration that by the year 2015, they
would partner globally to achieve 8 goals that would help decrease extreme poverty and increase
overall health. The Millennium Development Goals (MDGs) are the world's time-bound and
quantified targets for addressing extreme poverty in its many dimensions-income poverty,
hunger, disease, lack of adequate shelter, and exclusion-while promoting gender equality,
education, and environmental sustainability (Millennium Project 2006). Of the eight goals, goal
5s focus is improving maternal health by reducing maternal mortality rates by three quarters
between 1990-2015. While Guatemala did make great strides to reach MDG goal 5, and some
improvement was seen, it fell short of reaching its goal of 55 per 100,000 live births. Guatemala
still has some improvements to hopefully reach the same set goal by the secondary date of 2020.
Conclusion
While Guatemala has improved over the last few decades as it pertains to maternal health
and mortality, they still have a journey ahead of them. Guatemala must continue to improve
education to all its regions regarding family planning, contraception, and proper prenatal care. A
major barrier for Guatemala remains in limiting the scope of practice of midwives. To fully
utilize the strength of the people, they should continue to educate their midwives to assist in safe,

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healthy, and effective home births. The midwives have more access to women in all
communities, and they must not limit this valuable resource for their female citizens.

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References
Bauserman, M., Lokangaka, A., Thorsten, V., Tshefu, A., Goudar, S., Esamai, F., Bose, C.
(2015). Risk factors for maternal death and trends in maternal mortality in low- and
middle-income countries: a prospective longitudinal cohort analysis. Reproductive
Health, 12, 1-9. DOI: 10.1186/1742-4755-12-S2-S5
Chary, A., Diaz, A.K., Henderson, B., & Rohloff, P. (2012). The changing role of indigenous lay
midwives in Guatemala: New frameworks for analysis. Midwifery, 29, 852-858. DOI:
10.1016/j.midw.2012.08.011
Dijk, M., Ruiz, M., Letona, D., & Garcia, S. (2013). Ensuring intercultural
maternal health care for
Mayan women in Guatemala: a qualitative assessment. Culture, Health
& Sexuality, 15, 365-82. DOI:10.1080/13691058.2013.779026
Fleischmann, M. (2014). Guatemala improves Maternal-Infant Health and Nutrition. The World
Bank. Retrieved from http://www.worldbank.org/en/results/2014/08/07/guatemalaimproves-maternal-infant-health-nutrition
Mendez, N. (2016) Maternal Mortality in Guatemala: A preventable tragedy. Population
Reference Bureau. Retrieved from
http://www.prb.org/Publications/Articles/2003/MaternalMortalityinGuatemalaAPreventa
bleTragedy.aspx
Midwives for Midwives & Womens Health International (2015). Reproductive and Maternal
Health in Guatemala. Retrieved from http://midwivesformidwives.org/guatemala/
Millennium Project (2006). Millennium Development Goals: what they are. Retrieved from
http://www.unmillenniumproject.org/goals/

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Pan American Health Organization (2014). 11 countries in Latin America and the Caribbean
have reduced maternal mortality, new UN data show. Retrieved from
http://www.paho.org/hq/index.php?
option=com_content&view=article&id=9552%3A2014-11-countries-latin-americacaribbean-reduced-maternal-mortality-new-data-show&catid=740%3Apressreleases&Itemid=1926&lang=en
Population Reference Bureau (2011). Guatemala: Beyond the early phase of the demographic
transition. Retrieved from http://www.prb.org/publications/datasheets/2011/worldpopulation-data-sheet/guatemala.aspx
Tanner, A. (2013). Reducing Maternal Mortality: A case study of Guatemala. Social Justice,
Sociology, & Global Health. Retrieved from
https://amandactanner.wordpress.com/2013/04/28/reducing-maternal-mortality-a-casestudy-of-guatemala/
The World Bank (2016). Guatemala: An Assessment of Poverty. Poverty Reduction & Equity.
Retrieved from http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/
EXTPOVERTY/EXTPA/0,contentMDK:20207581~menuPK:443285~pagePK:148956~p
iPK:216618~theSitePK:430367,00.html
World Health Organization (2016). Maternal Health. Retrieved from
http://www.who.int/topics/maternal_health/en/
World Health Organization (2016). Health statistics and information systems: Maternal mortality
ratio. Retrieved from http://www.who.int/healthinfo/statistics/indmaternalmortality/en/

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