[Tolerance and resistance: abortion from the point of view of traditional midwives in a rural area of Mexico]. / Tolerancias y resistencias: el aborto desde la perspectiva de las parteras tradicionales de un área rural de México.

OBJECTIVE: An evaluation of the perception, resources and practices regarding abortion of traditional midwives in a rural area in the municipality of Yecapixtla, state of Morelos, located in the central region of Mexico. METHODS: A qualitative methodology consisting of a detailed interview, focal groups and participating observation, was used. The subjects investigated were socio-cultural aspects, reproduction, sexuality and health related to abortion. Nine midwives were interviewed and a focal group was formed in which 16 midwives participated. RESULTS: The results demonstrated a profound rejection of abortion whether inducted or spontaneous. The former was considered a major sin and the latter a serious failure of a womans reproductive function. Women who abort are called "pigs", "hogs" or "bitches" and the midwives are reluctant to attend them. However, a common practice among the women in the community is to "regulate the menstruation", that is, to use substances that provoke menstruation when this is delayed. This specific practice is not considered abortive by these women. CONCLUSION: Local popular beliefs about abortion are indispensible for the construction of effective strategies, which when provided by the institutional health services, reinforce the bonds between these and the traditional midwives in such a way as to increase accessibility to the health services as well as the quality of care to women.

Traditional birth attendants in Mexico: advantages and inadequacies of care for normal deliveries.

In Mexico, traditional birth attendants (TBAs) are an essential resource for health care, especially in small rural communities where they attend approximately 45% of all deliveries. Both rural and urban women seek care with the TBAs because, amongst other things, they share the same cultural codes. In this study, qualitative and quantitative methods were used to analyze the concepts, resources and process of care during birth in rural areas of the state of Morelos. Results show that the socio-economic characteristics of the TBAs are similar to those of the patients, that they share the same precarious living conditions, and the resources to which they have access for providing care during births. When choosing a TBA as a health care provider, both the economic aspect and the importance of a shared symbolism come into play. We observed advantages in some of the traditional practices which should be incorporated into the medical system, for example protection through the massage of the perineum at the moment of expulsion. Nevertheless, there are inadequacies for which the implementation of training programs is fundamental, before articulate primary care programs using the TBAs can be promoted.

[Midwives' perception of reproductive risk factors]. / Percepción de las parteras sobre factores de riesgo reproductivo.

Midwives in rural areas of the State of Morelos are one of the most important resources used by rural women for health care of pregnancy, delivery and the puerperium. This work was aimed at identifying midwives perceptions of pregnant women's risk factors, in order to include this knowledge in reproductive health programs which articulate institutional and traditional health systems. We applied a questionnaire to all midwives in the Municipalities of Ocuituco, yecapixtla and Zacualpan, Morelos (n = 35). Four key informants were selected and interviewed. These instruments enabled us to measure variability in perception of risk factors. Knowledge of risk factors is defective among midwives. Previous training made a big difference. Sixty three per cent of midwives who attended training courses are better qualified from an academic medicine point of view. Only 28.7 per cent of non-trained midwives (43% for both groups), indicating that sociocultural aspects prevail over technical training in midwives perceptions of reproductive risk factors.

[Pregnancy, labor, and puerperium: concepts and practices of midwives in the state of Morelos]. / Embarazo, parto y puerperio: conceptos y prácticas de las parteras en el estado de Morelos.

In Mexico a combined type of care for the health-sickness phenomenon exists, where three systems interact: domestic, academic and traditional medicine. In relation to reproductive health, in the state of Morelos approximately 50 per cent of women in rural areas receive attention from traditional birth attendants, who make up one of the principal resources of traditional medicine. The goal of this study was to gather knowledge about and describe the concepts, resources and practices used by traditional birth attendants in their care during pregnancy, birth and puerperium; and likewise to determine their socio-demographic characteristics, their geographic distribution, their number and the level of training which they possess. A census based on three sources was carried out in which information about seven basic variables was sought. This information was completed with structured interviews with key informants which allowed the definition of a profile of the different types of traditional birth attendants according to the population they care for and the resources they use. The most relevant results indicate that 630 traditional birth attendants are distributed throughout the 32 municipalities of the state, with an average age of 52 years and 50 per cent having attended training courses. 17.5 per cent fall within the category of traditional birth attendant, 50 per cent are trained empiricists and 11.6 per cent are non-trained empiricists. The 20 per cent did not fit this typology. The strong social and cultural identification that exists between traditional birth attendants and their patients indicates the need to incorporate this valuable resource in rural reproductive health programs.

[An alternative to perinatal care: traditional midwives in the state of Morelos]. / Una alternativa para la atención perinatal: las parteras tradicionales en el Estado de Morelos.

In Morelos, it is estimated that about 40 percent of the births are attended by traditional birth attendants or parteras. This indicates a considerable contribution made by these health care workers. The objective of this study is to present a profile of the parteras in the state of Morelos: their concepts, resources, practices, age groups, geographic concentration, and the degree of training they possess. At the National Institute of Public Health (INSP), a census was created from three sources: data on the rural areas obtained by researchers at INSP; censuses of the parteras made by the Secretary of Health; and those made by the Mexican Social Security System. The total number of parteras found was six hundred and thirty. They are distributed in 33 municipalities throughout the state with the majority lying in the border zones of the urban centers. Most of the parteras are between the ages of 51 and 70 years, however, there exists a small number who are less than 30 years old. Approximately 60 percent knew how to read and write, and half had received training on health services. Besides this information and other studies based on this theme, the parteras have been classified as traditional, trained, and untrained. Due to secondary sources, the data has inevitable limitations in quality. However, the integration of the three sources of information and its relation to qualitative variables constitutes the beginning point for elaboration on plans and programs with this therapeutic sector.(ABSTRACT TRUNCATED AT 250 WORDS)