An Interview with GPA's Mexico Office Director Martha Moreno on the Challenges Pregnant Women in Distress Face in Mexico

GPA's Mexico Office Director Martha Moreno, center, with Clara Rubio (pictured left), GPA's M&E Director, and GPA Board President Kate Kentfield-Kessner

Recently we sat down with GPA’s Mexico Office Director Martha Moreno to get her perspective on how GPA’s work addresses preventable maternal mortality in the country’s Indigenous communities.

In the rural Indigenous communities of Chiapas, an obstetric emergency can become deadly long before a woman reaches a doctor. Martha Moreno has been with Global Pediatric Alliance for 14 years. As director of GPA's office in Mexico, she coordinates programs that work alongside Indigenous midwives, communities and health personnel to prevent maternal and neonatal deaths.

In Mexico, maternal deaths are twice as likely among Indigenous women as among non-Indigenous women. One in three women in Mexico experience obstetric violence while giving birth in hospitals, and nearly half of hospital births in the country end in C-sections, well above global health recommendations. In rural areas of Mexico, Indigenous midwives attend 50 to 90 percent of all births.

"GPA's mission is to prevent maternal and neonatal death," Moreno says. "And for that, you have to focus on the delays in responding to emergencies that cause these deaths." She identifies four, and shares how GPA's programs respond strategically to each of them.

The first delay depends on recognizing an emergency in time. In Moreno's words, this means helping a midwife to recognize signs of an obstetric or neonatal emergency. To give the midwife the capacity to say, "I can't do any more. To help the woman, she has to get higher-level care." In GPA's midwifery program, midwives and GPA staff exchange knowledge and practices in skill-enrichment workshops that help midwives recognize warning signs.

The second delay is community-based. Before a woman can leave for the hospital, her family needs an emergency plan: money, paperwork, someone to care for the children, a vehicle or taxi, and a driver. "These things determine whether or not women will go to the hospital," Moreno says. GPA's community program, Women Caring for Women, works with families and communities to help them prepare for emergencies, as well as address barriers like gender-based violence or the lack of knowledge of women’s rights.

The third delay begins at the hospital door. Pregnant women are often "bounced around" from one facility to another and turned away by health staff who say, "there's no bed here, go back." "In all that bouncing around, she may die," Moreno says. Some hospitals also refuse to let midwives accompany the women in their care, an issue that GPA is addressing through its support of the Nich Ixim Midwives Movement of Chiapas.

The fourth delay lies within health institutions that treat Indigenous women without dignity or respect, when staff don’t recognize the cultural and linguistic characteristics of the population they’re supposed to serve. When word of such treatment reaches the community, pregnant women avoid hospitals altogether. GPA's Respectful Maternal Care program works with health personnel to reduce racism, respect women's rights and provide culturally-safe care.

Asked what makes her proud of GPA's work, Moreno says, "the Movement." The Nich Ixim Midwifer Movement of Chiapas grew out of GPA's midwifery program when midwives began asking for help. Moreno recalls how the midwives would come to her and say, "Look, they won't let us deliver babies anymore, and they're telling us that if we do, they'll put us in jail. Can you do something?" 

With the support of GPA and other organizations, the midwives organized so they could speak with the health system directly, not through GPA as an intermediary, but "as Indigenous women and traditional midwives."

Midwifery has long been solitary work, Moreno said. Through the movement, it has become something shared. "The midwives in the movement feel strong, supported, and know they can count on each other." When a clinic doctor harasses a midwife, the movement's spokeswomen respond with public statements or advocacy meetings with health authorities.

In the municipality of Tila, Chiapas, midwives met with the municipal president and the civil registry to press for acceptance of their birth certificates, so the children they deliver can be registered. This respects children’s fundamental right to an identity and a woman’s right to determine when, where and with whom she wants to give birth.

Nearly 10 years after its founding, the Movement works at the national level. It also helped form a Continental Alliance of Indigenous Midwives of the Americas, from Alaska to Patagonia, that brings their demands to the UN Permanent Forum on Indigenous Issues.

Moreno, a social anthropologist, says GPA's approach starts from the knowledge midwives already hold, an approach she deeply respects and reproduces in her work. In workshops, "we build on that and enrich both their own knowledge and ours." She contrasts this with organizations that "arrive and tell people what to do," or that measure success by output alone.

She reminds the GPA team every day that the organization belongs to them. "GPA isn't some organization out there. We are GPA. If someone calls you at 3 in the morning, you pick up the phone. This isn't just any job. This is different."