“Why don’t pregnant women go to the hospital to give birth?”

“Why don’t pregnant women go to the hospital to give birth?” is one of the questions that appears on a survey that we have been giving the parteras of the rural, mostly indigenous communities within the canton of Cayambe, Ecuador. The best translation for partera is midwife, as these women serve their respective communities by attending to partos, or births, with traditional Kichwa Kayambi medicinal practices. “We” refers to the team working on “Construyendo una Maternidad Saludable,” or “Building a Healthy Maternity,” the CARE Ecuador project that I have been lucky enough to be involved with for the past three months.

The parteras’ responses to this question are revealing, not to mention strikingly similar. Logistically, the pregnant women might be lacking the communication, transportation, or money needed to go to the hospital; more personally, they might be embarrassed, believing birth to be an ugly and exposing process, they may have no confidence in the ability of the doctors, or perhaps they are afraid because—and this is the most common answer—they are treated poorly by the nurses and the doctors.

One partera explained to me that the reason women don’t go to the hospitals is because the alternative is much more appealing: giving birth in your own comfortable home with a friendly partera who you’ve grown to trust over the past nine months and who you know will treat you with respect, allow you to make your own decisions (such as what position you want to give birth in), and keep your cultural beliefs in mind. You are an individual, a woman with dignity, and, therefore, you feel safe.

The other option? Giving birth in a bleach-white room with a doctor with cold, gloved hands who you met five minutes ago and who will treat you with indifference, subject you to his “better” occidental medicine (meaning your desire to give birth vertically will not be respected), and possibly even treat you differently because you are indigenous. You are a patient, a body without a face, and, therefore, you feel vulnerable.

These situations, of course, are not only generalizations, but extremes. That is to say that not all births given at home pass without complication, that not all doctors treat patients poorly, and, especially, that not every pregnant woman holds these points of view. However, one thing remains clear: something is keeping women from giving birth in hospitals, the implications of which are numerous. In social terms, there is a type of cultural exclusion occurring as indigenous women are fearful of seeking medical help. In medical terms, lack of treatment can mean serious health consequences, even death, for the mother or her child.

So, what’s the solution to this infinitely complex issue? CARE Ecuador has been making use of educational workshops—workshops for parteras and doctors alike, stressing the importance of a reliable emergency plan that allows women in rural communities to get hospital care; of recognizing the signs of danger during a pregnancy or birth that would require the enactment of this emergency plan; and of an intercultural, inclusive health system that people can trust.

As this system and a healthy maternity are built in Cayambe, perhaps one day the most common answer to, “Why don’t women go to the hospitals to give birth?” will be a quizzical look accompanied by a, “What do you mean? They do go to the hospitals to give birth.”