Using the results from the 2008 baseline survey, we conducted a participatory design of the intervention in March 2009. This process involved meetings, focus group discussions and further interviews with everyone involved in the project: traditional midwives, apprentices, indigenous community members, community health promoters and health officials. They provided feedback and suggestions for the intervention based on the survey results.

We set up the intervention as a randomized controlled trial. From our interviews with women of childbearing age in Xochis, we identified 16 traditional midwives (out of 48) who had attended a sizable number of births. We randomly assigned these midwives and their communities to two waves of intervention, with 8 midwives each. In 2009, the intervention began in the first group of communities: Llano del Carmen, Cerro Bronco, Arroyo Grande and Xochis cabecera (the city of Xochis, seat of the municipal government). Control sites will be part of the second wave of intervention.

Intervention components

We designed interventions to support traditional birth culture in Xochis. At the request of traditional midwives, we built simple birth houses, where they could train new apprentices, assist pregnant women, and attend births. In other words, we improved the basic material conditions necessary to attend their clients and teach their trade. Indigenous health promoters supported midwives in caring for mothers and newborns.

We also trained government health staff to better deal with birth emergencies and to be more sensitive to indigenous practices and views. And we engaged municipal authorities and owners of public transportation vehicles to help improve transport conditions in cases of obstetric emergencies.

To learn more about the different people and activities involved in the intervention, visit the links below:

In February 2012, indigenous fieldworkers carried out a follow-up survey to evaluate the intervention impact. Based on the results, we will undertake the intervention in the control sites.