“They called us animals.”
In the highlands of Guatemala, in the department of Quiché with towns like colorful Chichicastenango, hundreds of traditional midwives – comadronas – are at work. They not only fight to bring children into the world and save lives, but also to defend their ancestral knowledge against discrimination and prejudice. Their struggle is tough – they have even been called “animals” and shut out from the country’s hospitals.
High in the Guatemalan mountains, in the vibrant town of Chichicastenango, a group of Maya women carry both new lives and old tradition in their hands. Here, among cobblestone streets, bustling markets and churches where Maya rituals meet Catholic prayers, the traditional midwives – the comadronas – fight to save lives, defend their rights and preserve knowledge that is more than a thousand years old.
One of them is Esther Morales Morales, Vice President of Chichicastenango’s Midwives’ Council. We meet her at a small farm stead in the village of Chupol. She represents 600 midwives in 92 villages and, together with her colleagues, assists with around 3,200 births each year – often in people’s homes, since 80 per cent of Maya women give birth outside hospitals.
“Being a midwife is a calling. I saw in a dream that this was what I should devote my life to. If I do not do my work, I fall ill,” she says.
A lifelong task without pay
In Guatemala, traditional midwives rarely receive a salary. Families may give a symbolic gift, often around 300 quetzales (about 430 SEK), as thanks. Many comadronas therefore support themselves through small side projects – Esther makes and sells candles. Through IM’s partner ASECSA, she participates in savings and loan groups and has received training in embroidery, sewing, human rights and indigenous women’s rights.
“I have learnt my value as a woman and our value as health workers. I know when I am being discriminated against – and I fight back,” she says.
Knowledge that is not respected
The midwives’ knowledge is inherited, not academic. According to Maya tradition, a midwife is a kind of “grandmother” to every child she helps bring into the world. They rely on dreams, intuition and natural medicine – something often dismissed or disregarded by the formal health system.
Esther recalls one occasion when she saw in a dream that a pregnant woman would experience complications. When she warned the hospital, they did not believe her. The complications nevertheless occurred.
“I know what I know. But doctors do not understand our knowledge,” she says.
Language barriers make the situation even harder. Most doctors speak Spanish, while many mothers and midwives speak only the Maya language K’iche’. Imagine giving birth surrounded by medical staff who do not understand a word you say – and who look down on you for your origins.
A place for life and ritual
We accompany Esther to her tuj – a traditional sauna where she often assists women in labour. It stands on the edge of the courtyard, in a small brick-and-clay building. Inside are two rooms, and in the innermost one, two rectangular openings lie close to the floor. Above the left-hand one, marks from flames climbing upwards have blackened the wall.
Esther gets down on all fours to show how she enters the sauna. We follow, crawling into the darkness. Inside, it is pitch black, filled with the scent of fire and medicinal herbs. The ceiling is so low that we must sit hunched forward on the low ledge by the hearth. The walls and ceiling are coated with soot from years of use. The air is thick and warm, and in the stillness each breath feels part of something ancient.
Here, Esther explains, she helps women give birth. She uses herbs and traditional Maya rituals to relieve pain and provide comfort. For an outsider, the thought of entering this place heavily pregnant may seem daunting – yet once inside the warmth, a strange sense of safety emerges, almost like being enclosed in a womb.
When we crawl back out, the light from the lamp in the outer room feels blinding. The contrast evokes that moment when a child leaves the darkness and warmth to enter the world.
Organisation brings strength
The midwives of Chichicastenango are unique in Guatemala. They have organised themselves into a council, recognised by the Ministry of Health, and obtained their own ID cards – the only such example in the country. A decisive breakthrough came in 2022, when Congress ruled that all approved midwives in the area should receive an annual grant of 4,000 quetzales to purchase equipment.
In Chichicastenango town we meet the council’s president, Rafaela Ventura de Ventura. We sit together in a small, hot, cramped office inside a municipal building that also houses public authorities and the town library. This is the organisation’s headquarters.
Rafaela recalls the resistance the midwives faced when they first began to organise and demand their rights.
“We were called animals by a local official. But we had him dismissed, and his replacement was a Maya woman,” she says proudly.
The council is led, alongside Rafaela and Esther, by two other midwives. When they meet, they bring out four ancestral staffs, which carry symbolic power, as well as la vara, a ceremonial pouch containing seeds from a sacred plant, stones and other symbolic items. Every meeting begins with traditional Maya rituals, and contact with ancestors and spirits guides their decisions.
ASECSA and IM – support in the struggle
Since 1978, ASECSA – a network of 58 local health organisations – has worked to improve healthcare in marginalised communities. Through training, legal support and community organising, it strengthens the position of midwives. IM supports ASECSA’s work on organisational development and education.
Together they fight for a shared goal: zero maternal deaths. But the road is long. Indigenous women still face widespread vulnerability and discrimination, and sexual and reproductive health remains a taboo. Several midwives have trained as legal advisers through ASECSA, enabling them to provide legal support to women who have suffered different forms of abuse.
“All women here have experienced some form of violence – physical, sexual or economic,” says Esther. “We try to help them understand that they can report it, and we accompany them to hospitals if they need care and to legal authorities. We also mediate with their husbands – the men respect us and listen to what we say.”
Bearers of a living cultural heritage
In Chichicastenango, the struggle for life is also a struggle for culture and respect. The midwives are not only carers – they are bearers of a living cultural heritage.
And as long as women like Esther and Rafaela continue to organise, hope remains.
Text and photos: Malin Kihlström
By: Malin Kihlström