Parteras de Cuscatlan: training midwives in rural El Salvador
Abramsky, D.; Swietnicki, C.
Birth Gazette 10(4): 17-19
1994
ISSN/ISBN: 0890-3255 PMID: 7827527 Document Number: 531052
140 women in El Salvador die giving birth for every 10,000 live births in the country. Poor sanitary conditions, the lack of sufficiently trained birth attendants, inadequate transportation, malnutrition, closely spaced and numerous pregnancies, and the lack of prenatal care therefore combine to make giving birth a real danger for most Salvadoran women. In 1993 there were 750 registered births in the rural communities surrounding the Guazapa volcano in the Department of Cuscatlan, El Salvador. Almost 70% of these births occurred in the home. Most were attended by community midwives; other women birthed alone. The International Medical Relief Fund (IMRF) Midwifery Training Project was launched June 1993 with the goal of training enough midwives and health promoters so that a qualified person is available to attend each birth. To be chosen for the training program, a woman must be actively working as a midwife or health promoter in her community, have her community's respect, have a strong commitment to the work, and be motivated to learn. The trainee must then be able to balance her generally unpaid community activities with those which are necessary for her family's survival. The IMRF provides trainees with a stipend to cover family expenses and missed work while they are in class, as well as their lodging and food in Suchitoto where classes are held. An in-country technical advisory committee helped develop the basic curriculum on sexual anatomy and physiology; prenatal, intrapartum, and postpartum care; family planning; sexually transmitted diseases, including AIDS; and an introduction to the subject of domestic violence against women and how to respond. Ten midwives graduated from the first class in Fall 1993, and 14 additional trainees from 14 different communities graduated in Spring 1994. The women are aged 24-63 years, and their level of formal education ranges from none to grade six. The Spring 1994 course was held for one week each in February, March, and April, avoiding the planting and harvesting seasons when almost everyone works in the corn, bean, and sugar cane fields. The IMRF subsequently provides each midwife with a birth kit containing scissors, clamps, a bulb syringe, a small pot for sterilizing instruments, disposable sterile supplies and gloves, and towels and sheets. One of the biggest challenges faced by the midwives is getting to the births given the outspread nature of the communities and the lack of readily available, efficient transportation.