Across the world, Indigenous midwives, community facilitators, and caregivers have long played a vital role in safeguarding the health and well-being of mothers, newborns, and communities. They accompany women through pregnancy and childbirth, support families during the earliest stages of life, facilitate care for high-risk situations, and preserve knowledge passed down through generations. As trusted caregivers and community leaders, they connect families to health services while anchoring those services in the cultural knowledge and relationships that communities trust.
Yet, despite their essential role, Indigenous midwives and caregivers are rarely recognized within national healthcare systems. Much of their work takes place outside formal settings, and the knowledge they hold has not always been reflected in the policies, programs, and systems designed to improve maternal, child, and community health.
This year’s International Day of the World’s Indigenous Peoples, under the theme “Honouring Indigenous Midwives: Safeguarding Life and Well-being,” offers an opportunity to raise awareness around their contributions and highlight ways to support these. The story of Indigenous midwives is also a story about work — skilled, essential, and largely uncompensated work that has sustained some of the hardest to reach communities for generations.
Recognition is an important first step. In Guatemala, where Indigenous Peoples make up nearly half the population, the government took a landmark step in 2015 by adopting the National Policy of Midwives to formally recognize comadronas and strengthen culturally relevant maternal health services. Comadronas assist approximately 1/3 of the births in Guatemala, and serve as community healers, pediatricians, and play a leadership role in caring for women and children. With support from the World Bank’s Crisis Response and Recovery Development Policy Loan, the Policy gained momentum through the adoption of an implementation action plan and the creation of a national registry of comadronas. Today, nearly 19,500 Indigenous midwives are registered and hold official institutional identification, helping strengthen links between the national health system and Indigenous and community caregivers. The Policy’s implementation, currently underway, has contributed to enhanced intercultural dialogue between comadronas and national health service providers, strengthened culturally relevant care in Indigenous languages, expanded support for registered comadronas through supplies and annual incentives, and helped elevate public recognition of their role, including through the establishment of the National Day of the Guatemalan Comadrona.
“The policy has positioned comadronas as an actor within the national health system, recognized by the Ministry of Health, while creating the technical and administrative conditions to support their role while respecting their traditional knowledge and cultural practices,” said Marcela Perez, Coordinator of the Indigenous Peoples and Interculturality Unit at Guatemala’s Ministry of Public Health and Social Assistance.
Beyond recognition, building capacity and enabling conditions are also critical. Investing in skills, enhancing access to equipment and supplies, and building bridges between Indigenous and national health systems can help improve the quality and reach of maternal and natal care. Small investments can make a big difference. For example, a $15,000 grant from the World Bank’s Youth Innovation Fund, supported training for comadronas in Guatemala’s Lake Atitlán region to identify and refer high risk pregnancies to hospitals and provided them with sanitary supplies. As the training was delivered in their Indigenous language and helped build trust between them and the formal health system, results were impressive. After a year of providing the training, maternal deaths in the Lake Atitlan region fell from 18 to three. At a larger scale, the World Bank-financed Crecer Sano Project has supported training for 4,500 comadronas to certify them as “friends of breastfeeding” – a critical effort given the proximity and trust between comadronas and mothers in the earliest and most foundational stages of breastfeeding – which has contributed to improved breastfeeding practices among new mothers in the community. The Project has also incorporated feedback from comadronas in the design of health facilities and carried out monthly knowledge exchanges between comadronas and health staff. The project has also established dedicated spaces for comadronas to grow traditional medicinal plants and hold knowledge exchanges.
READ MORE: https://www.worldbank.org/en/news/feature/2026/08/10/honoring-indigenous-midwives-in-family-and-community-care
