United Nations Permanent Forum on Indigenous Issues - Parallel Event

INDIGENOUS MIDWIFERY: CULTIVATING SOCIAL AND CULTURAL

REPRODUCTION OF LIFE

CONCEPT NOTE
Date: Wednesday 18 April
Time: From 15:00 to 16:15 (UTC/GMT-4)
Location: S-2724 BR, United Nations HQ
1. Introduction
With every birth in an Indigenous community their creation story is relived and that
Nation is reborn. The value and contributions of Indigenous midwives to in their
communities cannot be overstated – they provide care in places where there is none,
they use culture, traditional plant medicines and ceremony in practice, all evidence
based practices that improve outcomes1.
✧ Indigenous Midwives are protectors: Of space, of families, of culture, of next
generations, of collective Indigenous rights
✧ Indigenous Midwives are facilitators of ceremony and cultural practice:
Cultural practices have a protective effect in health, and are a tool that creates
better outcomes
✧ Indigenous Midwives have many more skills to offer: Indigenous midwives
are not being used to their full potential and have skills that do not exist
elsewhere in the health care system. Some examples include the work
Indigenous midwives do to correctly position the baby throughout pregnancy
and how it prevents many cesareans, the ability to reach and care for people
who would otherwise receive no prenatal care – which is clear improves
outcomes.

2. Context
Midwifery is a cornerstone of every Indigenous community, however in the Americas,
the practice of traditional midwifery, the presence of Indigenous midwives, and the
ability to transmit Indigenous midwifery knowledge across generations, have all
declined significantly over the last several decades. This has had a devastating impact
both on the preservation of culture and on maternal newborn health outcomes in
Indigenous communities. In Canada it is acknowledged that, ―Aboriginal women are
suffering from the lack of equitable access to culturally appropriate midwifery, and this
is resulting in higher risks of adverse pregnancy and poorer infant health outcomes
when compared to the general Canadian population.‖ 2 In fact, it is widely
acknowledged that infant deaths in Indigenous communities are at least twice the
national Canadian average.3

1
McIvor O, & Napoleon A. (2009) Language and culture as protective factors for at-risk communities. Journal of Aboriginal Health
5(1) 6-25. & Our Health Counts Toronto. Reproductive Health Outcomes. (2018)
2
First Nations and Inuit Health. Health Canada. 2013. Available from: www.hc-sc.gc.ca
3
Midwifery and Aboriginal Midwifery in Canada, NAHO, 2004. Page 11; First Nations Inuit Health Branch, 2013
In central and south America many Indigenous midwives are criminalized. For
example, in Peru, the situation for traditional Indigenous midwives has deteriorated in
recent years, despite a policy of intercultural health, which promotes indigenous
medicine, and system integration of Indigenous midwives with Western medicine.
The oppression of Indigenous midwives and the systemic barriers created to prevent
Indigenous peoples from accessing Indigenous midwifery care are in direct
contravention to articles 24 and 25 of the Declaration of Rights of Indigenous Peoples,
and constitute a threat to the cultural survival.
In Mexico, the diminishing role of midwives in birth care is dramatic. In 1987, they
attended 43% of the deliveries while the doctors attended 38%. The rest were born
with relatives, nurses or others. Three decades later, in 2014, nine out of ten deliveries
(94.2%) in the country were attended by a doctor and only 2.9% by a midwife. The
situation is similar in Peru, where only a 1% of births are attended by midwives. This
change is not due to the preferences of women or to an increase in safety at birth. In
many rural and Indigenous areas, users of health services are threatened with losing
benefits to certain programs such as "Prospera" in Mexico or ―Juntos‖ 4 in Peru, if
traditional Indigenous midwives attend their birth.

Exclusion of Indigenous midwives from health systems, including preventing them from
registering births, issuing birth certificates also undermines the ability of a State to
properly account for their Indigenous populations creating further barriers for
Indigenous peoples to fully participate in civil society.
Today, many pregnant Indigenous women are forced to leave their communities to give
birth in large, centralized hospitals. In Canada, Mexico and Peru these women can
spend the last four weeks of pregnancy outside their communities, often alone and
without extended families for support.5 Once in these health centres, it is a common
experience to suffer discrimination and sub-standard care based on racist assumptions
and treatment.
Separation from these fundamental support systems, combined with a lack of culturally
safe pregnancy and birth care, have been linked to a range of poor outcomes including
obstetrical violence, rising caesarean section rates, low infant birth weights, and
postpartum depression. Midwifery care is a pathway that supports the regeneration of
strong Indigenous families by keeping birth close to home—by restoring the emphasis
on birth as normal, rather than approaching it as an illness in need of treatment.
Indigenous midwifery models honour Indigenous people, languages, oral cultures,
relationship to the land and spiritual traditions as well as holding birth up as a deeply
profound and sacred event. Aboriginal communities need the skills, values and
knowledge that Indigenous midwives have to share.
Midwifery is not limited to birth care or an exclusively health area. It has a direct
relationship with the physical and symbolic territory of the Indigenous peoples because
the ritual practices carried out during gestation and birth, imply the appropriation of the
territory and the sense of belonging to it. Expropriating Indigenous peoples from the
ways of receiving life and from midwives as healers and knowledgeable is another form
of territorial dispossession.

4
Conditional Cash Transfer Programs that promotes access to food, health and education services for families with fewer
resources.
5
Healthier mothers and babies. Canadian Public Health Association.

2
In the VII Continental Meeting of Indigenous Women of the Americas (Guatemala,
2015) midwives from different indigenous peoples made the following
recommendations:
1. That the recognition of the wisdom and ancestral knowledge of the medicine and
the ancestral midwifery of indigenous native peoples are public policies of the
States.
2. That the legislative power be proactive in the recognition of traditional midwifery.
3. Eliminate control mechanisms for midwives and midwives to exercise their
traditional practices.
4. Recognize and implement the right of women to give birth in the way they want.
5. Indigenous peoples must demand their rights established in the international
legal framework.
6. Strengthen the exchange and dialogue between the Indigenous peoples of
North and South America.

3. The side event

Objective of the event
- Review the current circumstance of Indigenous midwives in the Americas
- Review past recommendations regarding Indigenous midwifery
- Call for the end of criminalization of Indigenous midwives
- Discuss success strategies for supporting Indigenous midwives

Agenda
Time Theme
15:00 Opening Remarks
José Zárate
15:05 The context and value of Indigenous midwifery
Monica McKay
15:15 Perú: Wise practices in risk of abandonment.
CHIRAPAQ Centro de Culturas Indígenas del Perú

Mexico: Indigenous midwifery. Building possible futures from rights.

Kinal Antzetik DF.

Kenya: Midwifery in Kenya

Lucy Mulenkey, Indigenous Information Network (IIN) Kenya

Canada: Indigenous Midwives working in every Indigenous Community.

NACM
15:40 Recommendations
Tarcila Rivera Zea
15:50 Comments and feedback from plenary
16:10 Closing Remarks
Tarcila Rivera Zea

Language
The side event will have simultaneous translation in Spanish and English.

3
Event Organisers
NACM National Aboriginal Council of Midwives – Canada/ Office of Aboriginal
Initiatives, Ryerson University, Canada
KINAL Antzetik Distrito Federal- Mexico
CHIRAPAQ Centro de Culturas Indígenas del Perú, Peru
PWRDF The Primate’s World Relief and Development Fund - Canada