Safe motherhood in historical perspective: Guatemalan midwifery during the 20th century

The purpose of this presentation is to describe the history of the now defunct Midwifery School that functioned as part of the Medical School at Guatemala's San Carlos University during the early 20th century. In so doing, the presentation contextualizes the current debate regarding the training of traditional birth attendants (TBAs) in Guatemala and other poor countries. Despite WHO, USAID, and government attempts to train TBAs, Guatemalan maternal and infant morbidity and mortality remain high, prompting doubts about the trainings' efficacy. By relying on archival material from the San Carlos University, the Guatemalan Ministry of Health, and the U.S. National Archives and Records Administration, as well as extensive interviews with retired professional Guatemalan midwives, this presentation describes the origins of today's TBA debates. Furthermore, it illustrates the interconnection between reproductive health and international politics. Indeed, the midwifery school was a product of Guatemala's 19th century Liberal Reforms, and although it was ordered closed in 1940, it was reopened in 1946, during the country's ten years of democracy and “spiritual socialism” (1944-1954). Shortly after the CIA-backed coup in 1954, the University was instructed to close the school, this time due to numerous factors rooted in U.S. political and medical hegemony. Cold War-era anti-communism pervaded all aspects of Guatemalan life, and the USAID precursor, the Institute of Inter-American Affairs, promoted the education of U.S.-style nurses and obstetricians, rather than midwives. With the closing of the midwifery school, Guatemala lost an important component of its never-adequate reproductive healthcare system. Thus the history of Guatemalan professional midwifery is significant and instructive; it not only puts the TBA debate in proper context but also provokes a critical analysis of U.S. political and public health interventions in poor countries. The photo below depicts Miriam Portillo receiving her midwifery diploma from the Dean of the Medical School in 1959; she was one of the final students to graduate.