Doctoral project: Safe birth in cultural safety


Bridging western and indigenous knowledge to promote safe birth in cultural safety in Guerrero, Mexico

Culturally safe actions promote health without further undermining the culture of patients, which contributes to better interaction between indigenous and Western health systems. This interaction leads to intercultural dialogue, in which both parties collaborate on the solution to health needs. Several interventions have explored training traditional midwives in Western birthing skills, but there is little research focused on supporting them, on their own terms, recognizing their knowledge and enhancing their interface with the official health system.

This thesis included the analysis of a cluster randomized trial, which was part of an ongoing partnership with academics at the Centro de Investigación de Enfermedades Tropicales (CIET) and four indigenous groups in Guerrero, Mexico (Nahua, Na savi/ Mixteco, Me’phaa/Tlapaneco, and Nancue ñomndaa/Amuzgo). The parallel-group cluster randomized controlled trial aimed to test the non-inferiority of maternal and neonatal health outcomes with an intervention to support traditional midwifery. Cognitive mapping of stakeholder knowledge contextualized a literature review to refine participatory theories of change to promote maternal health. A narrative mid-term evaluation identified mechanisms of change triggered by the intervention and additional domains of positive change.

2022 Sarmiento I., Paredes-Solís S., García A., Maciel-Paulino N., Meneses-Renteria A., Amaya C., Cockcroft A., & Andersson, N. (2022). Traditional Midwifery Contribution to Safe Birth in Cultural Safety: Narrative Evaluation of an Intervention in Guerrero, Mexico. Community Health Equity Research & Policy, 0(0), 1-12.
2022 Sarmiento I, Paredes-Solís S, Legorreta-Soberanis J, Serrano-de los Santos RF, Zuluaga G, Cockcroft A, Andersson N. Safe motherhood in cultural safety in southern Mexico: a pragmatic non-inferiority cluster-randomised controlled trial. BMC Pregnancy and Childbirth 2022;22:43.
2022 Sarmiento I, Cockcroft A, Dion A, Paredes-Solís S, DeJesus-Garcia A, Melendez D, Chomat AM, Zuluaga G, Meneses-Rentería A, Andersson N. Combining conceptual frameworks on maternal health in indigenous communities — Fuzzy cognitive mapping using participant- and operator-independent weighting. Field Methods 2022;34:1-17.
2021 Sarmiento I, Paredes-Solís S, Dion A, Silver H, Vargas EM, Cruz MP, Pimentel J, Zuluaga G, Cockcroft A, Andersson N. Maternal health and Indigenous traditional midwives in southern Mexico: contextualisation of a scoping review. BMJ Open. 2021;11(12):e054542.
2020 Sarmiento, I., Paredes-Solís, S., Loutfi, D., Dion, A., Cockcroft, A., & Andersson, N. (2020). Fuzzy cognitive mapping and soft models of indigenous knowledge on maternal health in Guerrero, Mexico. BMC Medical Research Methodology, 20(1).

(Versión en español)

2020 Sarmiento, I., Zuluaga, G., Paredes-Solís, S., Chomat, A. M., Loutfi, D., Cockcroft, A., & Andersson, N. (2020). Bridging Western and Indigenous knowledge through intercultural dialogue: Lessons from participatory research in Mexico. BMJ Global Health, 5(9).



Centro de Investigación de Enfermedades Tropicales (CIET) de la Universidad Autónoma de Guerrero

Centro de Estudios Médicos Interculturales <link:>

Grupo de Estudios en Sistemas Tradicionales de Salud de la Universidad del Rosario

Country: Mexico

Dates: 2016 to 2021

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.
TheFonds de recherche du Québec – Santé (FRQS) , the Canadian Institutes of Health Research (CIHR), CeiBA foundation and the Centro de Estudios Médicos Interculturales funded the doctoral student.