Maternal mortality in Sololá, Guatemala: Factors influencing the utilization of health care

It is estimated that in the Central American country of Guatemala two women lose their lives every day while giving birth. Worldwide, maternal mortality (MM) most often affects the poor and in Guatemala, the poor are most often indigenous. Midwives safely attend to the majority of births in Guatemala, yet there are situations when advanced medical care is necessary to save the life of mother and child. Many social and cultural factors contribute to maternal mortality. The purpose of this ethnographic study was to explore the factors influencing women's use of pregnancy-related health services, particularly during emergencies, in the Guatemalan highland town of Sololá. The data collected was part of a six-week ethnographic field study in Guatemala sponsored by the North Carolina State University from May 28th to July 8th, 2006. Methods used to gather data for this study included semi-structured interviews, participant observation, and a review of existing literature. Interviews with over 40 health providers, midwives, traditional healers and women and observations in clinic waiting rooms, hospitals, and health promoter and midwife visits informed the investigation. The study yielded issues relating to the lack of quality and poor service of the hospitals and doctors, lack of decision-making ability of women, and the traditional use of midwives to be factors influencing health care utilization. Based on the findings from this study, decreasing maternal mortality in Guatemala will require more than changes to the health care delivery system, but must address the many influences on women's health utilization decisions.