Guatemala has one of the highest rates of maternal mortality in Central America. Mayan women living in rural areas of Guatemala are especially at risk, with a maternal mortality ratio (MMR) of 156 per 100,000 compared to a national rate of 113 per 100,000. 60% of births in Guatemala are attended by traditional birth attendants, otherwise known as comadronas, and their prevalence in these communities makes them a valuable resource to improve maternal and neonatal health outcomes. This paper evaluates a low-cost prenatal care training program for Guatemalan comadronas, founded by a non-profit called Saving Mothers, with the goal of improving maternal health outcomes in the region.

Materials and Methods

The School of PowHER, a 12-month prenatal care training program implemented in 2014, is administered to comadronas native to the Lake Atitlán region of Guatemala. Comadronas are recruited by Saving Mothers and the Guatemalan Ministry of Health. The training program consists of a four-month didactic arm and a nine-month clinical arm. Eight cohorts of comadronas were evaluated in this study (2014-2022). The learning outcomes of comadronas in the didactic phase were assessed using three tests administered at baseline and at the completion of each unit. Clinical learning outcomes were assessed at baseline and at 12 months using a WHO prenatal care checklist.

Results

123 women were recruited and enrolled in all 8 graduating classes of the School of PowHER from 2014, 2016-2019, and 2021-2022. An average improvement in didactic pre-test and post-test scores was found across all years. Additionally, a statistically significant increase in clinical abilities was found across all years analyzed (2018, 2021, 2022).

Conclusion

The School of PowHER is a low-cost, efficient, community-based model for empowering local, traditional health workers to help improve maternal health outcomes. Despite significant language, cultural, and social barriers to prenatal care education, this program proves effective at not only teaching comadronas prenatal knowledge and clinical skills, but also at promoting long term retention of these skills. The success of this pilot program could hold major implications for maternal health in Guatemala if widely applied to rural villages throughout the country.