Traditional care during pregnancy, childbirth and postpartum in indigenous communities of Mitú, Vaupés.

Seven communities in rural Mitú were a great example for Sinergias to approach the way in which women take care of their pregnancies, childbirths and postpartum periods in the humid jungles of Vaupés. Forty-eight indigenous women from 13 communities participated in the research.

The department, which has only three health care centers registered with the Ministry of Health, has one of the highest maternal mortality rates: 175 mothers die for every 100,000 live births, which is three times the national rate of 59. Many women live in dispersed areas, which makes it difficult to access prenatal checkups: in the area it is common for indigenous women not to have access to even a single prenatal checkup, despite the fact that the law requires it. The challenge is to adapt health services so that they are friendly and appropriate to the context and to reduce the multiple barriers to access faced by this population.

Sinergias, which works in different health fields, including sociocultural and technical adaptation of public health programs for indigenous communities, under a mutual respect and equity approach, conducted a qualitative research to understand the meaning of these stages for women in the region. The research involved women between the ages of 13 and 80, who provided Sinergias with some clues and inputs to understand the meaning and care of these stages for these communities. Some of the most significant findings include:

Care during pregnancy

• Frequent complications at this stage: illnesses derived from people's “animosity” (curses, envy), traumas and falls when carrying firewood, yucca, and water, and domestic violence that sometimes leads to the loss of the baby.

• Few pregnant women go to the hospital for check-ups, because they do not see their relevance if there are no evident alterations. Prior to childbirth, they go to doctors and traditional knowledgeable people.

Care during childbirth

• Childbirth can occur at home or in the peri-domicile. A hammock or banana leaves should be placed on the floor and this place is prayed with tobacco or carayurú, as a preventive measure for the newborn. This is a very intimate moment in which women are alone, with the mother or mother-in-law. Children should not come close, because it can cause complications for the mother.

• The birthing process is accelerated by walking, scratching yucca, and drinking beverages cured by the payé.

Postpartum and newborn

• The baby is left in a hammock and once it cries, breastfeeding begins. Protective prayers are made with tobacco and/or carayurú to avoid infections.

• During the first bath in the river or the first visit to the chagra, a special preparation is made with burnt tobacco smoke to show the baby the way and to ward off “spirits” that cause psychomotor alterations or developmental delays.

The research also “revealed important gaps in the knowledge of these women, mainly in the identification of warning signs related to pregnancy risks,” says Pablo Montoya, researcher and director of the organization.

Understanding the meaning that indigenous communities give to the processes of pregnancy, childbirth and postpartum provides inputs to health service providers so that they can adapt their services according to the sociocultural context of the populations they serve.

"The WHO recommends articulating the different traditional medical systems with the health system in order to reduce mortality, morbidity and disability in vulnerable populations. This recommendation can only be effective if it is based on a principle of equity and mutual respect for different cultures, in order to bring differences closer together," adds Montoya.