Side event: 18th session of the United Nations Permanent Forum on Indigenous Issues

Preserving the ancestral knowledge of traditional Indigenous midwives: wise practices and
challenges of implementation

Date: Monday, April 22, 2019

Time: 4:45-6:12 pm
Room: Conference Room 6-CR6

“The right of Indigenous peoples to self-determination extends to their reproductive health,

and States should put an end to the criminalization of Indigenous midwifery and make the
necessary legislative and regulatory amendments to legitimize indigenous midwives who are
recognized by their communities as health-care providers.”[1].

1. Introduction
With each birth in an Indigenous community, the history of its creation is revived and the Nation is
reborn. Indigenous midwives around the world possess knowledge and practices of to provide care
to women and infants throughout pregnancy, delivery and postpartum period. Indigenous
midwifery knowledge and practice are the collective property of Indigenous peoples, acquired and
transmitted orally, from generation to generation, and are critical pieces of Indigenous cultural
systems, where language and wise sustainable use of natural resources are combined in rituals of a
deep spiritual significance.

The 18th session of the UNPFII focuses on the generation, transmission and protection of Traditional
Knowledge of Indigenous Peoples. The Concept Note released by the UN Secretariat highlights the
important role of midwives in the communities:

28. Indigenous peoples worldwide have cultivated and maintained traditional knowledge
about healthcare and medicine that is vital for the success of their local communities.
Traditional healers play important roles in communities and are the first point of contact for
many, including those that often do not find a remedy for their ailment in Western
medicine. Indigenous midwives are often the health-care providers of choice in many
communities, due to their knowledge, skills, experience and ability to work in the local
indigenous language.

In its final report on the 17th session, the UNPFII recommended “acknowledging the cultural and
clinical knowledge of traditional indigenous midwives and their contributions to the well-being and
positive health outcomes of Indigenous peoples” (E/2018/43-E/C.19/2018/11, para. 49–51).

Preserving Indigenous understandings of birth is a commitment to the integrity of Indigenous

existence and the profound traditional knowledge of Indigenous peoples. Protecting Indigenous
midwifery is an urgent call to maintain a fundamental part of Indigenous health knowledge and
cultivate the balance of spiritual life of peoples around the world.

Answering the call of the 18th Session of the UNPFII, this parallel event will create a space to share
wise practices in relation to its transmission and preservation of Indigenous Midwifery Knowledge,
as well as to strategize implementation of international recommendations.

2. Context
Midwifery is the foundation of every Indigenous community. However, in many countries, and in
the Americas in particular, the practice of traditional Indigenous midwifery - both the provision of
clinical care by Indigenous midwives, and the transmission of knowledge and practice of Indigenous
midwifery intergenerationally, has declined significantly over the last decades due to relentless
discrimination, government policy and active oppression by state systems. This has had a
devastating impact on both the preservation of the culture and the results of the maternal and
neonatal health and well-being of the Indigenous communities.

In Canada, it is recognized that "Aboriginal women suffer from the lack of equitable access to
culturally appropriate midwifery services, and this results in higher risks of adverse pregnancy
outcomes and poorer children's health compared to the general population of Canada." [2] In fact,
it is widely acknowledged that infant deaths in Indigenous communities are at least twice as high as
the Canadian average. [3]

Large numbers of Indigenous midwives In Central and South America are criminalized. In Peru, for
example, the situation of traditional indigenous midwives has deteriorated in recent years, despite
intercultural health policies that promote traditional medicine, and the integration of Indigenous
midwives into the conventional medicine system. Today, many Indigenous pregnant women are
forced to leave their communities to give birth in hospitals located in urban centers. This is a
common experience for Indigenous women in Canada, Mexico and Peru, where women can spend
up to four weeks of pregnancy outside their communities, usually alone and without support from
their extended family. [4] Within these health institutions, it is common to experience discrimination
and a lower quality care based on implicit prejudice and racism - contributing to grave disparities in
maternal and infant health outcomes.

The exclusion of Indigenous midwives from health systems, including preventing them from
registering births and issuing birth certificates, undermines the State's ability to adequately account
for Indigenous populations, creating greater barriers for the Indigenous population to fully
participate in society and exercise their basic human rights. Separation of these fundamental
support systems, combined with the absence of culturally safe care for pregnancy and birth, have
produced devastating outcomes, including obstetric violence, an increase in cesarean section rates,
low birth weight and postpartum depression.

Indigenous midwifery models honour people, languages, oral culture, relationships with the land
and Indigenous spiritual traditions, as well as celebrate the ceremony of birth as an extremely
profound and sacred event. Indigenous communities need the skills, values and knowledge that
Indigenous midwives have to share. The oppression of Indigenous midwives and the systemic
barriers created to prevent Indigenous peoples from accessing the care of Indigenous midwives are
contrary to articles 24 and 25 of the Declaration of the Rights of Indigenous Peoples, and constitute
a threat to indigenous peoples cultural survival.

Midwifery is not limited to care at birth or exclusively to the area of health. It has a direct
relationship with the preservation of knowledge the physical and symbolic territory of the
Indigenous peoples, in particular the practices that are rooted in local spaces such as food
cultivation, medicinal plant gathering and many other practices teach Indigenous lifeways to the
next generation. In several countries of the region, Indigenous midwives collectively organize, meet,
and collaborate to strengthen their work, teach and learn, as well as strategize how to provide the
safest and best care they can with limited resources . In Canada, university training programs include
Indigenous midwifery knowledge exist, while a national Indigenous Midwifery Education Strategy is
in development. In Mexico and Peru strategies for the training of master midwives to apprentice
midwives are developed, using traditional methodology, to transmit this knowledge. In Guatemala,
Indigenous midwives have formed a large organizational structure of their own and in Colombia the
midwives of the Pacific achieved the recognition of midwifery as cultural heritage. Interinstitutional
forums are being held in various places and there is an important production of materials from the
organizations themselves.

Despite these achievements, the responses of States continue to be insufficient to protect

Indigenous midwifery and guarantee its continued practice.

3. Side event

The main objectives of this side event are:

1. Explore Wise Practices and organizational strategies of Indigenous midwifery knowledge

transmission and preservation in the Americas.

2. Review UNPFII recommendations related to traditional knowledge and midwifery, and

share examples and proposals for their effective implementation by UN member States.

Agenda

Time Themes

16:45- Opening.
16:50 The Importance of Indigenous Midwifery.
Monica McKay, Ryerson University, Canada

16:50- Block 1: Transmission of knowledge

17:20 • Peru: Learning with Indigenous midwives.
Doris Rúa Jaúregui, CHIRAPAQ Center for Indigenous Cultures of Peru

• Canada: NACM Indigenous Midwifery Core Competencies.

Cheryllee Bourgeois, Metis Midwife, National Council of Aboriginal Midwives
(NACM), Canada

• Kenia: Local experiences in knowledge transmission.

Agnes Leina. IWFI
17:20- Block 2: Preservation and Protection: The role of States and multilateral
17:45 organizations.

• Mexico: The role of State in the protection and practice of Indigenous

midwifery.
Lina Rosa Berrio. Conacyt-Ciesas / KinalDF. Mexico
• PAHO: Working with ministries of health to preserve midwifery.
Sandra del Pino PAHO / PAHO

Facilitator: Tarcila Rivera Zea

17:45- Audience engagement and participation.

18:10 Patricia Yllescas, Kinal Antzetik DF, Mexico & Raquel Garcia, CHIRAPAQ Centro de
Culturas Indígenas del Perú, Perú.

18:10- Final reflections and agreements.

18:15 Tarcila Rivera Zea, CHIRAPAQ Centro de Culturas Indígenas del Perú, Perú

The event will have simultaneous translation in Spanish and English.

Event coordinators:
National Aboriginal Council of Midwives (NACM) - Canada
Kinal Antzetik D.F.- México
CHIRAPAQ Centro de Culturas Indígenas del Perú - Perú

[1] Recommendation #50 UNPFII 17th Session Final report (2018)

[2] First Nations and Inuit Health. Health Canada. 2013. Available from: www.hc-sc.gc.c
[3] Midwifery and Aboriginal Midwifery in Canada, NAHO, 2004. Page 11; First Nations Inuit Health Branch,
2013
[4] Healthier mothers and babies. Canadian Public Health Association.