Traditional Midwifery in the Americas: Bridging Intercultural Health and Maternal Wellbeing

Traditional midwifery preserves ancestral knowledge, respects women’s insights into their bodies and life cycles, and supports cultural identity and health rights. As key agents in both rural and urban settings, traditional midwives facilitate culturally appropriate childbirth care, requiring equitable, respectful relationships between birthing persons and healthcare providers.

From a global health framework, the World Health Organization (WHO) established through its Fortaleza Declaration that informal perinatal care systems, such as traditional midwives, must coexist with formal healthcare systems, fostering collaboration that benefits mothers. The WHO also underscores respecting and incorporating cultural practices during childbirth. Its Guidelines on Intrapartum Care emphasise the need for respectful care that upholds dignity, privacy, and informed choice, ensuring freedom from mistreatment and continuous support. These guidelines further recommend effective, culturally appropriate communication between healthcare providers and women in labour.

Along the same line, WHO has identified the right to have a labour companion, underscoring the cultural importance of support during childbirth. Whether a community member, health worker, or doula, such companions provide emotional and physical assistance and ensure respectful care. The Organization also highlights the importance of honouring cultural practices and integrating cultural practices into postnatal care so that the needs of women and babies are met within a well-resourced health system that respects cultural contexts. This extends to providing culturally sensitive dietary recommendations, appropriate screening tools for postpartum mental disorders, and making adaptations to avoid the reproduction of health inequities.

In Latin America, it is estimated that there are at least 800 Indigenous peoples, representing a population of around 58 million. Due to the region’s cultural diversity and the enduring presence of ancestral practices in everyday life, there have been significant debates and regulations concerning the role of traditional midwives.

The Inter-American human rights system advocates integrating traditional birthing practices into healthcare. The Inter-American Commission on Human Rights 2010 report highlighted cultural barriers to maternal health and, in 2014, recognised the lack of culturally appropriate care as obstetric violence, particularly for Indigenous women. In 2024, the Commission strengthened this position and called on States to improve mechanisms ensuring access to culturally appropriate and intersectional reproductive health services for women, girls, and adolescents in rural areas, particularly indigenous and Afro-descendant populations. The Commission stressed that States must identify and incorporate measures that recognise traditional midwives' perspectives and knowledge to ensure health services reflect diverse cultural practices and worldviews around childbirth.

Advances integrating traditional childbirth practices have grown locally in several Latin American countries. For example, Colombia's Law 1751 of 2015 recognises interculturality in health, legitimising traditional and alternative practices. In 2022, the Constitutional Court affirmed midwifery’s role in cultural plurality and reproductive rights, supporting women’s autonomy. Along the same line, Law 2244 of 2022 further promotes respectful childbirth, emphasising cultural diversity and midwife training.

Mexico has also advanced midwifery integration in the healthcare system. In 2001, the Constitution acknowledged the country’s pluricultural composition, upholding Indigenous rights to traditional medicine, reinforced by the Ley General de Salud, which mandates expanding healthcare while incorporating traditional practices. In 2024, reforms explicitly included Indigenous medicine, including midwifery, in the National Health System’s objectives. The Guide on Care for Women During Pregnancy, Childbirth, and Puerperium further legitimises midwifery, promoting a humanised, intercultural, and safe maternal healthcare approach.

The Constitution of Ecuador recognises and guarantees ancestral health practices, promoting respect for and the use of their knowledge, medicines, and instruments. Additionally, the Organic Health Law defines ancestral and traditional medicine practitioners. In 2020, the Ministry of Public Health introduced the Code of Ethics for Ancestral-Traditional Medicine of the Nationalities and Peoples of Ecuador, which aims to strengthen the articulation and complementarity between ancestral and Western medicine. Furthermore, in 2023, the Manual for the Articulation of Practices and Knowledge of Ancestral Traditional Midwives was introduced to strengthen the integration of midwives’ practices and knowledge within healthcare.

Bolivia has integrated traditional medicine into healthcare through its constitutional recognition. Also, Law No. 459 acknowledges traditional healers, including midwives, as legitimate healthcare providers. This is operationalised through the Family Community Intercultural Health strategy and Ministerial Resolution No. 0496. For instance, the Health Ministry’s Technical Guide for Pregnancy and Childbirth Care incorporates traditional midwives’ knowledge into healthcare protocols. However, integrating traditional midwifery into healthcare remains a challenge. PAHO/WHO Bolivia is implementing projects promoting intercultural dialogue, midwifery practice guides, and accreditation for integrating traditional midwives into health systems to address this.

Brazil’s traditional midwifery integration varies by region. In the Amazon, where midwifery is an ancestral practice, the Ministry of Health implemented the Traditional Midwives Working Program to reduce maternal and neonatal mortality. Since 2002, the program has trained over 1,755 traditional midwives across different states. Additionally, the Ministry established the Prenatal and Birth Humanization Program, prioritising maternal care by expanding state networks for high-risk pregnancies, increasing funding, and supporting traditional midwife training initiatives.

In conclusion, integrating traditional midwifery into national healthcare systems is crucial for ensuring culturally appropriate, respectful, and effective maternal care. Recognised by both international human rights bodies and national legal frameworks, traditional midwives play a key role in preserving indigenous knowledge, reducing maternal mortality, and mitigating obstetric violence. While significant progress has been made in several countries, challenges remain in fully integrating traditional midwifery within formal health systems. Strengthening intercultural policies, ensuring legal recognition, and fostering collaboration between traditional and biomedical practitioners are essential steps toward equitable and inclusive maternal healthcare.

Laura Dragnic (she/her) is a LL.M. candidate in national and global health law and a research assistant at the O'Neill Institute. Originally from Chile, she is dedicated to advancing social and reproductive justice through the application of international human rights frameworks.

Paulina Macías (she/her) is a LL.M. candidate in National and Global Health Law at Georgetown University, researching reproductive rights at the O’Neill Institute. Her work focuses on human rights litigation and advocacy within the Inter-American and Universal Systems, with a gender perspective.

Guillermina Pappier (she/her) holds a Law Degree from Universidad Torcuato Di Tella in Buenos Aires and an LL.M. in Global Health Law from Georgetown University Law Center. She is currently a Fellow at the O’Neill Institute for National and Global Health Law, specialising in reproductive rights and biotechnology.