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Pathways of Decision Making Among Yucatan Mayan Traditional Birth Attendants


  • Barbara A. Anderson CNM, DrPH,

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    • Barbara A. Anderson, CNM, DrPH, at the Loma Linda University School of Public Health, is a nurse-midwife and professor of public health. She chairs the Department of International Health and coordinates the maternal-child health graduate program.

  • E. N. Anderson PhD,

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    • E. N. Anderson, PhD, at the University of California at Riverside, is a professor of anthropology.

  • Tracy Franklin MPH,

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    • Tracy Franklin, MPH, at Loma Linda University School of Public Health, is an anthropologist currently pursuing a DrPH in public health.

  • Aurora Dzib-Xihum de Cen

  • Aurora Dzib-Xihum de Cen is a Yucatec Maya life-long resident of the central Yucatan. She has worked collaboratively with E. N. Anderson for many years in mapping the ethnobotany of central Yucatan.

Room 1306 Nichol Hall, Loma Linda University School of Public Health, Loma Linda, CA 92354. E-mail:


In rural, developing world communities, women are often isolated from biomedical services. Frequently, traditional birth attendants (TBAs) are the only caregivers during childbirth, both normal and complicated. Women trust their TBAs to manage their births. Globally, government and non-governmental organizations (NGOs) have sought to upgrade TBAs'skills and to encourage them to refer complications. However, most training programs have failed to change TBAs' practice substantially. Logistical barriers in reaching biomedical services in a timely manner are a key issue. Another is the difference between biomedical and traditional practitioners in the cognitive frameworks that shape decision making and management behaviors. The purpose of this study, conducted in Quintana Roo State, Mexico, was to listen to the voices of practicing Yucatec Maya TBAs (parteras) as they described decision making and management of complicated births. In-depth interviews with six practicing parteras in rural, isolated communities revealed that the parteras used traditional Maya ethnomedicine while valuing biomedical approaches. We isolated themes in decision making and mapped management of birth complications. Integrating TBAs' traditional knowledge into biomedical training programs is one way to honor their knowledge and make training relevant.