We carried out the follow-up survey of the Safe Birth in Cultural Safety pilot study in February 2012, both in Xochistlahuaca (Xochis) and Tlacoachistlahuaca (Tlacos).

Unable to measure mortality over a short span, we evaluated birth problems as the primary outcome. We focused on other important contributions to maternal health in indigenous communities, such as not giving birth alone or choosing birthing position, as secondary outcomes. For this, we took into account births of children under the age of two years at the time of the follow-up survey in February 2012.

We compared women attended by our midwives and community health promoters with those who were not exposed to the intervention in control sites. We made this comparison at two different levels: a) between Nancue Ñomndaa (Amuzgo) population in intervention and control sites within Xochis, with exclusion of other ethnic groups; b) between the intervention group in Xochis and all control sites, including other ethnic groups, in both Xochis and Tlacos.

The findings confirmed that support for traditional midwives is no less effective as a means of reducing maternal and newborn mortality than channelling pregnancy and delivery through government health services. Among other things, there were no significant differences in pregnancy and birth complications between women exposed to the intervention in Xochis and those who were not exposed in Xochis and Tlacos.

Of great important to those living in remote rural communities, women in the intervention group were less likely to give birth alone, without a medical doctor or a traditional midwife by their side.

Moreover, culturally safe maternal care adds value through reduced surgical interventions, reduced infections, reduced costs, and increased choices. There were some key findings in this regard:

• Women in our intervention sites in Xochis were more likely to choose their birthing position than those in the control communities in Xochis and Tlacos.
• They were less likely to get cuts (episiotomies) while giving birth.
• They were less likely to get infected vaginal wounds.
• And they paid less (M$216) than those in the overall control (M$870 for all ethnic groups in both Xochis and Tlacos).

For more details about the pilot study, including methodology and results, please download a brief summary of the intervention.