Behind the Unequal Risk of Birth: Why Indigenous Women Face Higher Maternal Mortality

Introduction:

It is no surprise that motherhood remains one of the most controversial topics in society today. Alongside countless stigmas and sociological problems, there is a persistent indicator of risk to global public health: maternal mortality. This situation is further exacerbated by the stark reality that, unfortunately for millions of women and girls in Indigenous communities, medical and educational advances do not reach all corners of the world equitably, especially those that for centuries have been the direct target of the complex intersection of historical exclusion, lack of access to culturally appropriate health services, institutional discrimination, and the erosion of ancestral maternal care practices. 

Displacement of Indigenous Traditions: Context and Long-Term Effects:

When we discuss maternal mortality. We are not just addressing an isolated medical problem, but a whole a mirror of social structures: 

From the perspective of the Americas before European colonization, midwifery and maternal care systems were deeply rooted in community networks in many Indigenous centers and communities. The practices in herbal medicine, upright birthing positions, and accompanying rituals that prioritized the well-being of the pregnant woman, were the main traditions in the medical area. Their methods were not solely based on spiritual rites but also on empirical observations of the body, physiology, and pain management. 

Colonization brought with it not only the collapse of their worldview and political-philosophical order, but also irreparably disrupted the health and care networks for these peoples, who were affected by coercive labor systems (encomiendas, forced labor), sexual violence, displacement, and the imposition of European medical paradigms. Now, their traditions and knowledge are completely devalued and sometimes criminalized. 

A través de la historia previa al siglo 19th, esta misma narrativa se repite en diversos contextos mundiales de las comunidades indígenas y otros grupos que actualmente aún son marginalizados, cambiando únicamente el contexto geográfico, y por lo tanto cultural y etnico. 

pre-colonial systems → colonial disruption → epistemic and institutional displacement. 

Even when colonialism ceased, the power and administration of motherhood and childbirth did not return to the hands of women, but was increasingly transferred to the state, private medical academies (at that time mainly staffed by men from privileged circles who could afford professional education), which inevitably intensified the racialized hierarchies of knowledge and treatment.

19th–mid-20th century: medical centralization, urban bias and exclusion:

The process of hospital and medical education centralization became even more centralized after urbanization and the consolidation of national health systems. However, the effects of scientific advances and industrial revolutions primarily benefited residents of the new urban areas, neglecting impoverished, rural, and indigenous communities that had no real access to that due to the economic, language and discrimination reasons. These communities, despite the establishment of medical institutions, now had to give birth far from their territories, experiencing obstetric violence, or avoiding healthcare institutions due to distrust and cultural incompatibility, rather than purely material barriers. 

Late 20th century: global targets, data and recognition of inequities:

The late 20th century, fortunately, led to a focus on social problems such as indigenous peoples and equality gaps. The post-war context, progressive-feminist movements saw the rise of interest along with the prior creation of international organizations such as the United Nations and the WHO, which fortunately led to a focus on social problems such as indigenous peoples and equality gaps. 

Maternal Mortality Rate Decline (1990-2015)s 

The rural and indigenous communities still faced high rates, the overall progress mainly happened in urban centered hospital systems. 

The early global-health approach in many cases depicted maternal mortality as a technical issue solved through biomedical intervention, prenatal checkups, emergency obstetric care, and hospital births. Interventions thus almost invariably broadened access to hospitals, but did nothing to change

the cultural and political forces that created an alienating or violent environment for Indigenous women in those institutions. 

Global Progress, Stagnation, and Renewed Vulnerabilities (2010s–2025) :

By the early 21st century, it was demonstrated that maternal mortality had become a key indicator of social development and state capability thanks to the availability, improvement and implementation of emergency obstetric care, increased professionalization, declining fertility rates and a global system of monitoring (The Millennium Development Goals 2000–2015; The Sustainable Development Goals 2015–2030). For instance, interagency estimates from WHO, UNICEF, UNFPA, the World Bank and UN DESA reveal marked decreases from the 2000s, yet a considerable deceleration after around 2016. Although there has been some successful progress in this area, global maternal mortality remained in the hundreds of deaths every day in 2023 and suggests technical capacity alone is insufficient in the absence of attention to structural inequities, rights and systemic failure. 

Rights, Power, and the Structural Drivers of Indigenous Maternal Mortality 

Indigenous women’s maternal mortality reflects clinical deficits as well as legal and political choices regarding the ability of women to achieve reproductive autonomy. This lack of abortion access for girls and women in cases of rape and life-threatening pregnancy with forced continuation of pregnancy and preventable harm has been documented in human rights cases across this region. High-profile cases in Guatemala, Nicaragua, and Ecuador show how

repressive statutes, weak enforcement of exceptions to the law, and institutional coercion combine to harm marginalized women and girls. The case law in regions like Beatriz v. El Salvador at the Inter-American Court demonstrates how the denial by the authorities of lawful therapeutic procedures leads to rights violations and loss of health; these actions contribute to the regional scope of reproductive injustice. Based on national data in Peru, reports reveal that the prevalence of maternal mortality among Amazonian Indigenous women in 2020–2023 was too high, due to limited referral capacity, culturally inappropriate service provision, and geographic barriers. Sustained patterns in Guatemala and Bolivia demonstrate that rural Indigenous towns and districts are predominantly affected by maternal deaths as they are the sites of health facilities without trained personnel, surgical capacity, blood banks, and essential medicines. This is not random, this goes without saying, these are the results of a historical and persistent political marginalisation: investment in infrastructure tends to favor urban centers, medical education excludes traditional midwives, institutions treat Indigenous patients with discrimination or obstetric violence, discouraging them from seeking care. 

Attributing higher mortality to “traditional practices” ignores the context. A number of Indigenous midwifery practices have provided community support, upright birthing positions, and effective herbal pain management. Risks arise when traditional births take place outside of sterile environments or require emergency transfers, not because the knowledge itself is inherently dangerous, but because the formal health system is not designed to integrate such traditional practitioners or to provide sustainable access to life-saving care. The leading causes of maternal mortality are structural: poverty, discrimination, underfunding, and state policies that limit reproductive rights, including those of Indigenous people, or deny Indigenous autonomy. The effects are not confined to individuals’ health. Maternal death disrupts families, heightens infant and child mortality, exacerbates poverty, and weakens cultural continuity in groups already struggling under political and environmental pressure. Indigenous women’s preventable deaths are a harbinger of grave injustice, forcing governments to grapple with the vast gulf between universal health commitments and actual access to care. The pursuit of SDG 3.1 depends not only on better hospitals, but disaggregated data, intercultural care models, and shared governance with Indigenous nations. 

Conclusions and Research Implications 

Maternal mortality should not only be understood as clinical failure or biological susceptibility of delivery. In fact, it is a historical and political process, driven by the centuries-long displacement of traditional knowledge, centralizing and exclusive medical systems, racialized social hierarchies as well as modern legal frameworks that block reproductive autonomy. Although the worldwide declines of mortality ratios have occurred since the beginning of the 21st century, the trends of stagnation, particularly since 2016, indicate that biomedical capability is by no means adequate to deliver survival in a world of structural inequities. International inter-agency reports by the WHO, UNICEF, UNFPA, World Bank and UN DESA show that daily maternal deaths continue to peak at hundreds globally, yet growth has been uneven, most acutely in rural and Indigenous communities. So these findings propose that maternal death could be re-positioned as something beyond the purely technical, and for it to function as a diagnostic tool in disclosing the political sharing of life, rights and a commitment to state capital. The pain of Indigenous women in Central and South America can let us know this story to all of them: lives deprived of preventable death are not lost simply because of a lack of awareness or undiagnosed background about the reason (e.g. hemorrhagic disease, sepsis, and hypertensive disorders) the systems do not work in all phases of life, it’s because the maternal health literature has pointed out the “three delays” which women encounter when seeking care: the decision for care, the process of getting care, and receiving adequate care. Such delays are further compounded by: 

- geographical isolation 

- language restrictions 

- underfunded health systems 

- discrimination 

- lack of protocols for Indigenous birthing techniques. 

Things are further complicated by the legal landscape: It either protects or prohibits abortion for girls and women, including rape survivors, and can then be followed with unintended pregnancies that put the health of minors in particular at risk. Documented legal processes in Guatemala, Nicaragua, Ecuador, and El Salvador attest to the reality that, when reproductive autonomy and access to treatment modalities are denied to women, rights violations, such as actual bodily harm and losses of life that could be prevented, are central to maternal death that is not reducible to a merely cited public health failure. In light of these trends, future research should shift beyond national averages into a disaggregated ethnographic method that is aware of the Indigenous nations not as marginal and/or vulnerable groups to be “integrated” into state systems, but rather as autonomous communities with knowledge systems, scientific histories, and legitimate political claims. 

This requires methodological pluralism, combining epidemiological evidence, geographical mapping and the referral pathway map of care, qualitative research into care processes and co-populating knowledge with Indigenous midwives and community leaders. It calls for giving up the grandiosity of its public-health intervention framework for an exchange of knowledge-based, interethnic systems of systems premised on knowledge parity in maternal care which allows midwives not on being tokenized in terms of symbols or tokens of support but as nodes in maternal care networks rather than assimilating. From a policy perspective, there are three implications. First, those structural investments, blood banks, surgical capacity, emergency transport teams and bilingual personnel, are core aspects of survival, not mere optional extras. Second, legal reforms to protect reproductive rights, especially for young people, and when pregnancy threatens either life or health, are critical to prevent unnecessary mortality. Third, intercultural health models will need a national scale that is in principle impossible to achieve through pilot programs and not reached by NGOs. 

Programs, although sometimes broken up, cannot undo these centuries of structural exclusion. Thus in the final analysis, there is more at stake in addressing maternal mortality for Indigenous women. In this case it is not only a question of health equity but also reparations for history of the legacies of colonialism, taking back the choice to give birth; and finally realizing that choice in a respectful, safe way. Such disparity, it can be said, must not only fall short of SDG 3.1 but also that concept of development should be redefined. 

APA 7th Edition — Reference List:

World Health Organization, UNICEF, UNFPA, World Bank, & UN DESA. (2023). Trends in maternal mortality: 2000 to 2023. World Health Organization. https://www.who.int 

Pan American Health Organization. (2023). Maternal mortality in the Region of the Americas: Regional strategy and alerts. PAHO. https://www.paho.org 

UNICEF. (2023). Maternal mortality global database and country dashboards. UNICEF Data Portal. https://data.unicef.org 

Center for Reproductive Rights. (2022). Girls, Not Mothers: Forced pregnancy in Latin America. Center for Reproductive Rights. https://reproductiverights.org 

Inter-American Court of Human Rights. (2023). Beatriz et al. v. El Salvador (Judgment). Inter-American Court of Human Rights. https://www.corteidh.or.cr 

United Nations Human Rights Committee. (2021). Decisions on reproductive rights and forced pregnancy cases. United Nations Human Rights Office. https://www.ohchr.org 

Ministry of Health of Peru. (2023). Maternal mortality data by region: Amazonian and Andean territories (2020–2023). Ministerio de Salud del Perú. 

Bolivia Ministry of Health. (2022). Maternal mortality indicators by department and Indigenous municipalities. Estado Plurinacional de Bolivia, Ministerio de Salud. 

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