There is no doubt that midwives worldwide are very special people. They possess a unique ability to care for women and newborns and it takes a distinctive set of skills to qualify for the job. More than 60% of the world’s babies are helped into the world with the hands of a midwife or traditional birth attendant. In Central America, midwives are generally referred to as “traditional midwives”.



Central American traditional midwives are usually well known and respected in their community. Many traditional midwives say they felt a calling to be a midwife and learned their skills through apprenticeship and experience rather than formal training.

But Central American midwives have a tougher job on their hands than their counterparts in wealthier countries. In countries such as Guatemala, Honduras, Costa Rica, Nicaragua and El Salvador midwives can often be found working under appalling conditions, depending on how unstable their country’s health system is, and the majority of these women do not get paid for their hard work.

PAHO (Pan American Health Organization) estimates that there are about 22,000 maternal deaths per year in Latin America and the Caribbean with an aggregate ratio of 190 deaths per 100,000 births. PAHO also estimates that under-reporting in many regions can be as high as 70%.

In Central America, traditional midwives attend most of the deliveries where the maternal mortality is the highest due to poverty. The contribution of traditional midwives to the health of nations has been undervalued by governments and insufficient resources have been allocated to providing midwives with the equipment, training and medicines that they need to carry out their job safely and effectively.

In April 2004, a group of midwives from these five countries took a ground-breaking step by coming together in Costa Rica to share their experiences as midwives in their respective countries. Their tales reflect their love and devotion to their work, and their ongoing commitment to the many women they have helped through childbirth.

They tell their stories of how unjust their health systems are and share harrowing accounts of health care systems which fail its people.

Central American Midwives, the charitable organization that funded this assembly, produced a DVD depicting these women’s stories. In the documentary, one of the Nicaraguan midwives, Doña Alicia, compares the care the traditional midwives give to the impersonal care of the local hospital; “The midwife offers love and trust and confidence and she doesn’t do it mechanically like the nurses and doctors. However, I don’t mean to offend these health care workers, who do the best job they can. For example, a woman goes to have her baby in a hospital. In the room she will find a nurse, a person who cleans and another woman in the next bed to her. The doctor arrives and says "let’s see lady, open your legs", and the woman feels ashamed. On the other hand if a midwife attends this woman in the privacy of her own home, the woman experiences trust.”

Doña Alicia went on to say that she didn’t want to offend the doctors because they do offer good care when they are needed. But that they do not possess the kindness of a midwife, and often lack the patience the midwife has.

Josefa Mira, a midwife from El Salvador, explained that the midwives are constantly monitoring the progress of the labour and when a complication presents itself they organize immediate transfer to a hospital. “And we don’t only care for women of the community during pregnancy and birth”, she said. “We also look after the general health of women and their families, domestic violence and all the illnesses that are common in our communities.”

However, lack of transport is a major problem in most areas and women in high-risk conditions often cannot be moved to a hospital for medical help due to this dilemma. The same problem exists if there are not enough basic medicines to treat disease in pregnancy.

The Central American Midwives plea is to be recognized and accepted for the value of their knowledge, to work as a team with health care services, to be adequately trained and equipped, and rightfully compensated. This issue needs to be recognised as an important, pressing matter.

Let us help those who bear the hands that hold our future generations. Let us help the Central American Midwife Crisis.

Guatemalan midwife María Cecilia says; “What I would like most for our country Guatemala is health for everyone, that having a baby would become safer, that we would have safe and healthy childbirth, and that society would give importance to mothers and the work of mothers. When we are expecting our babies we should feel cared for and receive love. And the other thing I wish for is that one day midwives would really be part of the health care system and have a salary that we can enjoy.”

To order your copy of this inspirational, educational DVD or for more information on Central American Midwives, contact