Locating Autonomy Within Women’s Reproductive Health in Chiapas, Mexico

Locating Autonomy Within Women’s Reproductive Health in Chiapas, Mexico

Elizabeth Atwood

Beginning in the 1970s, Mexico adopted changes in public services, including a more privatized, Westernized healthcare system. Mexico altered its health services to fit a global understanding of women’s reproductive care: to expand women’s reproductive health rights and reduce population levels. While perhaps wellintentioned, these policies are undergirded by a hegemonic history of Indigenous disregard and maltreatment by the Mexican government.

City street in San Cristóbal de las Casas, Chiapas, Mexico, 2019.

Elizabeth Atwood

In rural regions such as Chiapas, Mexico’s southernmost state, there is a relatively high Indigenous population of 24% (1). Moreover, the maternal mortality rate is the second-highest in the country, at 68/100,000, and the infant mortality rate is the highest in the country, at 17.9/1000 (1). Chiapas is the most impoverished state, with 74.7% of the population considered impoverished in 2012 (2). Health discrepancies such as these have developed due to inconsistencies between local medical knowledge and Western biomedicine, obstacles in accessing care, and continued discrimination by the Mexican State.

In light of this context, I set out to examine if adopting Western concepts such as the medicalization of health necessarily lead to a better healthcare system. My undergraduate thesis, as part of the University of Denver Honors Program at the Josef Korbel School of International Studies, examines women patients’ (Indigenous and non-Indigenous) perceptions of reproductive services offered by a private health clinic in San Cristóbal de Las Casas, Chiapas, Mexico called “Atención en Salud Sexual y Reproductiva para La Mujer” (AMASS) and seeks to understand if AMASS’ approach is working for and desired by patients.

To answer these research questions, my study employed a combination of survey data, a one-on-one patient interview, and participant observations from community health discussions. Twenty-two patients completed the voluntary, anonymous survey after receiving one of these services from the AMASS before, and all patients indicated that they were either “very satisfied” or “satisfied” with quality of service, quality of care, and respect. The one-on-one patient interview elucidated similarly positive responses; the patient reported that the quality of care is different at AMASS than at other clinics; patients report feeling secure, trusted, and that their autonomy is supported.

Despite possible response bias, the overwhelmingly positive trends underscore the need for clinics like AMASS. Many patients seek their services because the clinic is welcoming, flexible, and accessible. Regardless of Indigenous identity, patients were in support of AMASS’ services. This could be attributed to patient characteristics, such as being progressive and more accepting of medicalized care, or the positive results could be less about the services provided and more about the environment of care. AMASS engages in open conversations about women’s reproductive health, offers flexible prices, has female doctors who speak Indigenous languages, and respects Indigenous preferences such as keeping traditional clothing on during examinations. The quality of the care provided, as suggested in the results of my survey, seems to be the paramount concern for women seeking reproductive services.

Additionally, my research aimed to identify why women come to AMASS rather than local clinics or hospitals. As cited in the literature, obstacles to public healthcare include: location, cost, misinformation, and cultural/linguistic barriers (3,4,5). Concerns with the healthcare system include: lack of respect from practitioners, disregard for cultural health practices, invasive practices, distrust of practitioners, and unequal power dynamics (3,4,5). How is AMASS addressing these obstacles and concerns? AMASS is a private health clinic in the city of San Cristóbal, so indigenous women in rural communities may not have the means to access the clinic or may be unaware that it exists. The clinic combats cost concerns by offering low prices, working with women to pay for services over time, or finding other funding. While some staff speak Indigenous languages, there are several local Indigenous languages spoken in Chiapas and the physicians do not speak every language. AMASS aims to respect tradition and educate their patients. Family members are welcomed to attend consultation appointments to learn more about reproductive rights, for example, and AMASS only employs women because patients are more comfortable with female health professionals.

This case study presents evidence that both Indigenous and non-Indigenous women are seeking respectful reproductive care which serves to educate and empower them. Women’s reproductive health care must not be dismissive of local understandings, but actively incorporate this knowledge alongside advancements in technology offered by the Western world. As this study and many others emphasize, there is no one-size-fits-all approach to healthcare. To adopt a universal protocol is to align with global interests and to discount the complex interests of a multicultural nation.6 It is an act of blatant disregard of the histories and knowledge of different cultures within the region and around the globe.

Rather, frameworks for reproductive health must be created by local women. While autonomy should certainly be a universal goal, the means to this goal should be locally defined. Women’s reproductive health care in Chiapas may have similar characteristics to other systems, but it should be unique in the ways local Indigenous knowledge is embedded. It should not be up to international organizations or nation-states—rather, this process should manifest authentically and with respect to local culture.

The conclusions of this research are not limited to Mexico and can also be applied in the United States: a one-size-fits-all approach to reproductive care is outdated, oppressive, and ineffective at meeting women’s diverse and personalized needs.

To read the full version of the thesis or to continue the discussion, please contact Elizabeth Atwood at liz.atwood0812@gmail.com or connect with her on LinkedIn.