Guatemala is trying to reduce the number of women who die during childbirth by providing basic medical training to some 15,000 lay midwives in villages around the country.
More than 600 women die from complications of child birth each year in Guatemala, where midwives deliver six out of every 10 babies. These lay midwives are often the only help available to rural women, and most have no formal medical background.
President Alvaro Colom has announced a five-month program to provide them with training in the basics of gynecology and obstetrics, including how to identify complicated pregnancies and avoid preventable deaths.
"One of our biggest challenges is solving the problem of limited access to health services, and the shortage of qualified midwives in rural areas," Colom said.
For each high-risk pregnancy the midwives refer to a doctor, the government will pay them $20.
"If we're able to get these women to see a doctor, high-risk cases could be identified and we could take steps to prevent them," said Jackeline Lavidali, who directs Guatemala's reproductive health program.
Guatemala plans to enlist non-governmental organizations already in the field to do the training, using financial support from the United Nations and the U.S. Agency for International Development.
But many obstacles remain — including roads and transportation that are so poor, it is nearly impossible for women to quickly reach a doctor even if their midwives have identified problems. That's why the government is trying to create maternity houses near bigger hospitals where rural women with high-risk pregnancies can arrive days before giving birth.
Francisca Raqueq, a 65-year-old midwife, has helped deliver babies for 50 families in the last 25 years in the village of El Llano, 40 miles northwest of Guatemala City.
She said the nearest clinic is 15 miles away and it would cost $70 to rent a pickup truck to get there in an emergency during labor. That's a small fortune for farmers who make $4 a day.