Safe Birth in Cultural Safety
Safe birth in cultural safety:
A cluster randomised controlled trial.
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Throughout the Americas, maternal and newborn mortality and morbidity among indigenous peoples is higher than in the overall population. Mainstream policies and programs encourage indigenous women to deliver in hospitals and clinics, with little regard for their traditions and cultural values. The Safe Birth in Cultural Safety initiative draws on both indigenous and biomedical knowledge and practices to improve maternal and newborn health without disrupting indigenous cultures. Between 2008 and 2012, a pilot study took place in Nancue Ñomndaa (Amuzgo) communities of Xochistlahuaca (Xochis), a rural indigenous community in Guerrero state, Mexico. The results suggested that women can safely give birth without having to give up their traditions in the process. We hope to demonstrate, through a larger trial in Mexico, that this culturally respectful way of doing things is not inferior than usual care in terms of mortality and serious childbirth complications and could bring additional benefits in the recovering of indigenous cultures.
Members: Sergio Paredes-Solis, Jose Legorreto-Soberanis, Neil Andersson, Iván Sarmiento
Partners:
Centro de Investigación de Enfermedades Tropicales (CIET) de la Universidad Autónoma de Guerrero
Centro de Estudios Médicos Interculturales
Grupo de Estudios en Sisteas Tradicionales de Salud de la Universidad del Rosario
Country: Mexico
Dates: 2013 to 2017
Funding: The National Council of Science and Technology of Mexico (CONACyT, PDCPN-2013-214858) funded the cluster-RCT.
McGill University funded fieldwork for middle-term evaluation of the intervention (T244294C0G).
The Quebec Population Health Research Network (QPHRN) funded fieldwork and publications.
The Fonds de la recherche en santé du Québec, the Canadian Institutes of Health Research, CeiBA fundation and the Centro de Estudios Médicos Interculturales funded one doctoral student.
Men as protagonists in improving maternal and child health:
Intervention research in marginalized Indigenous communities in Guatemala
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Guatemala has some of the worst maternal and child health (MCH) statistics worldwide, and Indigenous communities suffer a disproportionate burden of illness. Paternal distress and substance use, inequitable gender attitudes, and domestic violence are major risk factors for maternal and child morbidity and mortality and poor child growth and development. Despite research highlighting the importance of fathers in promoting MCH, few studies have evaluated interventions targeting perinatal paternal involvement. No intervention studies have addressed paternal engagement specifically in indigenous contexts. Using a participatory approach, our project was among the first in Latin America to develop a holistic, collective, strengths-based intervention for addressing the well being and positive engagement of indigenous fathers. This pilot research, to pave the way for a future larger-scale community-led cluster randomized controlled trial, aimed to create an evidence- based, feasible and locally acceptable community mobilization protocol to improve MCH through changes in gender norms, reductions in domestic violence and promotion of fathers’ wellbeing and positive engagement in MCH. Our innovative approach recognized that community engagement in designing solutions is a key component of sustainable transformation.
Members: Anne Marie Chomat, Katherine Pizarro, Anne Cockcroft, Neil Andersson
Partner institutions:
- Instituto de Salud Incluyente in Guatemala
- Distrito de Salud de Cuilco
- Distrito de Salud de Santiago Atitlán
- McGill Division of Social and Transcultural Psychiatry
Country: Guatemala
Dates: 2018-2019
Funding: Steinberg fund for interdisciplinary global health research (McGill)
Gates Seed Grant of 100,000 USD
Publications:
Pizarro KW, LeBel N, Petzey Quieju D, Yarcinio López B, Paiz Bekker L, Groleau D, Cockcroft A, Andersson N, Chomat AM. What happens when communities mobilize to promote indigenous wellbeing in Guatemala? Exploring impacts and mechanisms of change]. Global Health Night, 2 November 2020, McGill University, online. (Poster)
Pizarro KW, Chomat AM, Cockcroft A, Petzey Quieju D, Yarcinio López B, Paiz Bekker L, Andersson N, Groleau D. Participatory evaluation of a co-designed group psychosocial intervention to promote indigenous wellbeing in Guatemala. Society for the Study of Psychiatry and Culture 2020 annual meeting, online. 9 October 2020 (Poster)
Pizarro KW, Chomat AM, Paiz Bekker L, Petzey Quieju D, Yarcinio López B, Andersson N, Cockcroft A. Engaging indigenous communities in addressing men’s mental wellbeing in Guatemala: Application of Fuzzy Cognitive Mapping. Hughes Fellowship Lecture, Society for the Study of Psychiatry and Culture. April 25, 2019. (Oral presentation)
Further information:
our website – https://buena-semilla.org/
Decolonizing childbirth
Nunavik Inuit women transferred to high-risk hospitals for childbirth: a co-designed pilot intervention.
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Many Nunavimmiut women in northern Canada experience poor health in comparison with other women in Canada. This has a negative impact on their well-being in pregnancy and childbirth. To reduce the risk of health problems, pregnant Nunavimmiut women are often transferred to high-risk urban hospitals for childbirth. Research shows, however, that the policy of evacuating women for childbirth can negatively affect their health. It can also have negative effects on the health of their families and communities. It is therefore important to adapt this policy to better support the wellbeing of Nunavimmiut families. This participatory project involves Nunavimmiut families and their healthcare providers in Montreal and Nunavik. The aim of the project is to identify strategies to support Nunavimmiut families to give birth in a good way in Montreal and Nunavik, and to identify pathways and strategies to support Nunavik-based childbirth. In collaboration with participants, we will implement co-designed recommendations and examine their impact on maternal, family, and community wellbeing. The policy of evacuating Nunavimmiut women to high-risk hospitals tries to ensure their safety in pregnancy and childbirth. This policy, however, can have unintentional negative effects on the health of Nunavimmiut families. We believe that developing healthcare services in collaboration with Nunavimmiut women and families will better support their well-being in pregnancy and childbirth.
Members: Hilah Silver, Neil Andersson, Anne Cockcroft, Richard Budgell, Iván Sarmiento, Loubna Belaid
Country: Canada
Dates: 2019 to 2024
Funding: Canadian Institutes for Health Research