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Comadronas at training event in Tzuzuna
Comadronas at training event in Tzuzuna.
Photo: Samantha Fien-Helfman, World Bank
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Across the world, Indigenous midwives, community facilitators, and caregivers have long played a vital role in safeguarding the health and well-being of mothers, newborns, and communities. They accompany women through pregnancy and childbirth, support families during the earliest stages of life, facilitate care for high-risk situations, and preserve knowledge passed down through generations. As trusted caregivers and community leaders, they connect families to health services while anchoring those services in the cultural knowledge and relationships that communities trust.
Yet, despite their essential role, Indigenous midwives and caregivers are rarely recognized within national healthcare systems. Much of their work takes place outside formal settings, and the knowledge they hold has not always been reflected in the policies, programs, and systems designed to improve maternal, child, and community health
This year’s International Day of the World’s Indigenous Peoples, under the theme “Honouring Indigenous Midwives: Safeguarding Life and Well-being,” offers an opportunity to raise awareness around their contributions and highlight ways to support these. The story of Indigenous midwives is also a story about work — skilled, essential, and largely uncompensated work that has sustained some of the hardest to reach communities for generations.
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A midwife’s work is sacred. It is wisdom, knowledge, practice, communication, and education. It means crossing mountains, trails, and rivers. It means walking in the darkness, in the rain, under the sun, or by moonlight, carrying a woven shoulder bag with medicinal plants or whatever is needed to welcome a new life with its first cry.
Maria Luisa Cabnal Coc,
Maya Q’eqchi’ midwife, Guatemala
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Recognition is an important first step. In Guatemala, where Indigenous Peoples make up nearly half the population, the government took a landmark step in 2015 by adopting the National Policy of Midwives to formally recognize comadronas and strengthen culturally relevant maternal health services. Comadronas assist approximately 1/3 of the births in Guatemala, and serve as community healers, pediatricians, and play a leadership role in caring for women and children. With support from the World Bank’s Crisis Response and Recovery Development Policy Loan, the Policy gained momentum through the adoption of an implementation action plan and the creation of a national registry of comadronas. Today, nearly 19,500 Indigenous midwives are registered and hold official institutional identification, helping strengthen links between the national health system and Indigenous and community caregivers. The Policy’s implementation, currently underway, has contributed to enhanced intercultural dialogue between comadronas and national health service providers, strengthened culturally relevant care in Indigenous languages, expanded support for registered comadronas through supplies and annual incentives, and helped elevate public recognition of their role, including through the establishment of the National Day of the Guatemalan Comadrona.
“The policy has positioned comadronas as an actor within the national health system, recognized by the Ministry of Health, while creating the technical and administrative conditions to support their role while respecting their traditional knowledge and cultural practices,” said Marcela Perez, Coordinator of the Indigenous Peoples and Interculturality Unit at Guatemala’s Ministry of Public Health and Social Assistance.
Beyond recognition, building capacity and enabling conditions are also critical. Investing in skills, enhancing access to equipment and supplies, and building bridges between Indigenous and national health systems can help improve the quality and reach of maternal and natal care. Small investments can make a big difference. For example, a $15,000 grant from the World Bank’s Youth Innovation Fund, supported training for comadronas in Guatemala’s Lake Atitlán region to identify and refer high risk pregnancies to hospitals and provided them with sanitary supplies. As the training was delivered in their Indigenous language and helped build trust between them and the formal health system, results were impressive. After a year of providing the training, maternal deaths in the Lake Atitlan region fell from 18 to three. At a larger scale, the World Bank-financed Crecer Sano Project has supported training for 4,500 comadronas to certify them as “friends of breastfeeding” – a critical effort given the proximity and trust between comadronas and mothers in the earliest and most foundational stages of breastfeeding – which has contributed to improved breastfeeding practices among new mothers in the community. The Project has also incorporated feedback from comadronas in the design of health facilities and carried out monthly knowledge exchanges between comadronas and health staff. The project has also established dedicated spaces for comadronas to grow traditional medicinal plants and hold knowledge exchanges.
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A Guatemalan baby is weighed at one of the health posts of the Crecer Sano project in the department of Quiché, Guatemala.
Photo: Gerson Elizondo/World Bank
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Panama, Lao PDR, and India have also been adopting similar approaches. In Panama, the World Bank financed project Support for the National Indigenous Peoples Development Plan has worked with traditional midwives across all Indigenous territories, leading to the development of the country’s first National Midwifery Training Manual and the training of more than 196 traditional midwives. In Lao PDR, the government, with support from the World Bank, Australia, Gavi, and the Global Fund, launched the Lao PDR Remote Ethnic Women’s Empowerment Initiative, training 3,250 ethnic minority women as village facilitators and equipping them with life-saving skills in nutrition and maternal and child health. In India, three World Bank-supported State Health Systems Projects have adopted innovative strategies to improve access to care in remote tribal areas. In Karnataka, auxiliary nurse-midwife training programs reserved spaces specifically for tribal women for the first time, helping create a new generation of health workers able to serve their own communities in culturally appropriate ways.
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3,250 ethnic women in Lao PDR were recruited as village facilitators to bridge the gap in maternal and child health.
Photo: World Bank
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Different countries may pursue different approaches, but the lesson is consistent: health systems are stronger when Indigenous knowledge is recognized, traditional and formal systems work together, and when service delivery empower front-line women to respond to the realities of the communities they serve
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