Intercultural Childbirth: Impact on the Maternal Health of the Ecuadorian Kichwa and Mestizo People of the Otavalo Region

Abstract Objective Considering the increased frequency of maternal deaths reported from 2001 to 2005 for Indigenous andmestizo women from the Ecuadorian rural area ofOtavalo,where the Kichwa people has lived for centuries, the objective of the present article is to describehow the efforts of the local health community and hospital workers together with a propitious political environment facilitated the implementation of intercultural childbirth,which is a strategy that respects the Andean childbirth worldview. Methods We evaluated a 3-year follow-up (2014-16) of the maternal mortality and the childbirth features (4,213 deliveries). Results Although the Western-style (lying down position) childbirth was adopted by 80.6% of the pregnant women, 19.4% of bothmestizo and Indigenous women adopted the intercultural delivery (squatting and kneeling positions). Both intercultural (42.2%) and Western-style (57.8%) childbirths were similarly adopted by Kichwa women, whereas Western-style childbirth predominated among mestizo women (94.0%). After the implementation of the intercultural strategy in 2008, a dramatic decrease of maternal deaths has been observed until now in both rural and urban Otavalo regions. Conclusion This scenario reveals that the intermingling of cultures and respect for childbirth traditions have decreased maternal mortality in this World Health Organization- awarded program.

摘要：
研究目的：厄瓜多尔奥塔瓦洛（Otavalo）乡村地区的奇楚瓦（Kichwa）族群已在此定居数百年，该地区原住民（Indigenous）与麦士蒂索（mestizo）女性的孕产妇死亡率在2001至2005年间呈上升趋势。本文旨在阐述当地卫生社群、医院医护人员的共同努力，结合有利的政治环境，如何推动了跨文化分娩（intercultural childbirth）实践的落地——这一策略尊重安第斯分娩世界观。
研究方法：本研究对2014至2016年共3年的孕产妇死亡率及分娩特征（共计4213例分娩案例）进行了随访评估。
研究结果：尽管80.6%的孕妇采用了西式分娩（仰卧位），但仍有19.4%的原住民与麦士蒂索女性选择了跨文化分娩（蹲位与膝位）。奇楚瓦女性对跨文化分娩（42.2%）与西式分娩（57.8%）的采用率较为均衡，而麦士蒂索女性则以西式分娩为主（94.0%）。自2008年跨文化分娩策略实施以来，奥塔瓦洛乡村与城市地区的孕产妇死亡率均出现了显著下降，且这一趋势持续至今。
研究结论：本研究结果表明，文化融合与对分娩传统的尊重，降低了该项目的孕产妇死亡率——该项目为获世界卫生组织（World Health Organization, WHO）认可的项目。