Reconstructing Referrals: Overcoming Barriers to Quality Obstetric Care for Maya Women in Guatemala Through Care Navigation

Guatemala has one of the highest maternal mortality rates in Latin America, a burden faced disproportionately by the majority Indigenous Maya population. Most Maya women prefer to deliver at home with traditional midwives, a practice with religious and cultural significance. However, racial discrimination, poor transportation infrastructure, and hospital resource constraints delay and prevent Maya women’s access to biomedical care during obstetric emergencies. This chapter describes ethnographic cases of rural Maya women with high-risk pregnancies seeking biomedical care at government health facilities. We illustrate how institutionalized racism and health care bureaucracy produce adverse maternal and neonatal outcomes while escalating obstetric violence against Maya women. Our analysis of hospital resource constraints and bureaucracy calls into question the sustainability of universal institutional delivery in Guatemala and other low-resource settings. Instead, we present a model of obstetric care navigation and accompaniment, deployed selectively for Maya women with high-risk pregnancies, to offer safer and more respectful institutional birth. Indigenous obstetric care navigators offer a sustainable solution that complements robust local practices of home birth and empowers Maya women and their midwives to obtain successful obstetric referrals within a severely resource-limited health system.