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ORIGINAL ARTICLE
Open Access

Casas Maternas in the Rural Highlands of Guatemala: A Mixed-Methods Case Study of the Introduction and Utilization of Birthing Facilities by an Indigenous Population

Ira Stollak, Mario Valdez, Karin Rivas and Henry Perry
Global Health: Science and Practice March 2016, 4(1):114-131; https://doi.org/10.9745/GHSP-D-15-00266
Ira Stollak
aCuramericas Global, Raleigh, NC, USA
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Mario Valdez
bCuramericas/Guatemala, Calhuitz, Guatemala
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Karin Rivas
cCentro Universitario de Occidente, Quetzaltenango, Guatemala
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Henry Perry
dJohns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Figures & Tables

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  • FIGURE 1.
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    FIGURE 1.

    Location of Study Communities in the San Sabastian Coatán Municipality of the Northwestern Highlands of Guatemala

    ⍟ Partner communities with a Casa Materna in operation (Calhuitz and Santo Domingo).

    Embedded Image Partner communities in close geographic proximity to a Casa Materna.

    ▴ Non‐partner communities.

  • FIGURE 2.
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    FIGURE 2.

    Percentage of Health Facility Deliveries by Women’s Education Tercilea and by Type of Community

    95% confidence intervals shown.

    a Bottom education tercile, no education; middle tercile, 1–3 years of education; top tercile, 4+ years.

  • FIGURE 3.
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    FIGURE 3.

    Percentage of Health Facility Deliveries by Women’s Household Wealth Quintile and by Type of Community

    95% confidence intervals shown.

  • FIGURE 4.
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    FIGURE 4.

    Percentage of Health Facility Deliveries by Distance of Women’s Household to the Nearest Casa Materna and by Type of Community

    95% confidence intervals shown.

    Closest tercile is <4 km from the Casa Materna; middle tercile is 4 to <8 km; farthest tercile is ≥8 km away.

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    TABLE 1 Framework for Qualitative Data Analysis
    ThemeDescription
    Decision about birth placeComments about how the location of birth was selected
    Sub-codes:
    • Influence of others on delivery location

    • Cultural traditions

    • Previous birth experiences

    • Perception of distance to the facility and availability of transportation

    • Influence of costs on birth location

    Birth experienceComments related to the actual experience of giving birth
    Sub-codes:
    • Cultural traditions

    • Opinions about the care received at home or at a facility

    RecommendationsSuggestions for improving labor and delivery services at the Casa Materna
    • View popup
    TABLE 2 Demographic Characteristics of Survey Respondents (N = 275), by Type of Community
    Demographic CharacteristicAll Respondents (N = 275)Partner Communities (n = 189)Non-Partner Communities (n = 86)P Valuea
    Age of mother, mean, years25.225.325.0.93
    No. of persons in household, mean6.86.96.6.76
    No. of children in household, mean3.23.43.0.12
    Living with spouse/partner, %87.389.981.4.049
    Speak Chuj, %98.998.998.8.94
    Speak Spanish, %24.727.019.8.20
    Principally housewives, %95.395.295.3.71
    Family received remittances in past 3 months, %20.420.619.8.87
    Reported food insecurity in past 6 months, %21.821.722.1.94
    Family owns a vehicle or motorcycle, %14.514.315.1.72
    No. of years of education of mother, mean2.72.82.6.66
    PCA asset score of household, mean0.970.961.00.55
    Distance of mother's community from nearest Casa Materna, mean, km5.44.18.3<.01
    • Abbreviation: PCA, principal components analysis.

    • ↵a Comparing partner communities with non-partner communities. Values shown in boldface are statistically significant at P<.05.

    • View popup
    TABLE 3 Location of Deliveries During the Study Period (April 1, 2013–March 30, 2014) in the San Sebastian Coatán Municipality, by Type of Community
    Location of DeliveryAll Respondents (N = 275)Partner Communities (n = 189)Non-Partner Communities (n = 86)
    Non-health facility deliveries117 (42.5)57 (28.1)60 (69.8)
     Home of interviewee or of another person116 (42.1)56 (29.6)60 (69.8)
     En route in ambulance1 (0.4)1 (0.5)0 (0.0)
    Health facility deliveries158 (57.5)132 (69.8)26 (30.2)
     Hospital18 (6.5)13 (6.9)5 (5.8)
     MPHSW health center20 (7.3)14 (7.4)6 (7.0)
     Private clinic2 (0.7)2 (1.1)0 (0.0)
     Casa Materna  Calhuitz74 (26.9)59 (31.1)15 (17.4)
     Casa Materna Santo  Domingo44 (16.1)44 (23.3)0 (0.0)
    • All data shown as No. (%).

    • Abbreviation: MPHSW, Ministry of Public Health and Social Welfare.

    • View popup
    TABLE 4 Thematic Analysis of Factors Affecting Decision About Birth Place
    First-Order ThemesSecond-Order ThemesThird-Order Themes
    Barrier: Too many people involved in the decision-making processInfluence of others on delivery locationDecision about birth place
    Facilitator: The role of comadronas
    Facilitator/barrier: The role of husbands
    Barrier: Tradition supports giving birth at homeCultural traditions
    Facilitator: The role of the comadrona
    Facilitator/barrier: Effects of previous birth experiences on subsequent delivery locationPrevious birth experience
    Barrier: Casa Materna perceived as being located far away by somePerception of distance
    Facilitator: Casa Materna perceived as being nearby by others
    Barrier: Perceived high cost of facility birth compared with home birthCost of childbirth
    Facilitator: Perceived low cost of Casa Materna for facility birth compared with private facilities
    Facilitator: Comadrona is part of the team during delivery processCultural traditionsAssessment of birth experience
    Facilitator: Woman is attended to in her own language and with respect for long-standing traditions
    Barrier: Home perceived as safe place to give birthPerceived quality of care
    Facilitator: Home perceived as an unsafe place to give birth.
    Facilitator: Casa Materna perceived as providing high-quality care
    Facilitator: To have more equipmentSuggestionRecommendations for improving care at the Casa Materna
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Global Health: Science and Practice: 4 (1)
Global Health: Science and Practice
Vol. 4, No. 1
March 21, 2016
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Casas Maternas in the Rural Highlands of Guatemala: A Mixed-Methods Case Study of the Introduction and Utilization of Birthing Facilities by an Indigenous Population
Ira Stollak, Mario Valdez, Karin Rivas, Henry Perry
Global Health: Science and Practice Mar 2016, 4 (1) 114-131; DOI: 10.9745/GHSP-D-15-00266

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Casas Maternas in the Rural Highlands of Guatemala: A Mixed-Methods Case Study of the Introduction and Utilization of Birthing Facilities by an Indigenous Population
Ira Stollak, Mario Valdez, Karin Rivas, Henry Perry
Global Health: Science and Practice Mar 2016, 4 (1) 114-131; DOI: 10.9745/GHSP-D-15-00266
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