Building an Equitable Response in Guatemala

Supporting Pregnant, Indigenous Women and Adolescents during the COVID-19 Pandemic

“COVID-19 has reconfigured the lives and realities of individuals and families, and resulted in the refocusing of health priorities and budgets. In Guatemala, pregnant women and adolescents have lost access to essential prenatal and preventive services or institutional delivery care, and we’ve seen an increase in home births, obstetric complications, and maternal morbidity or mortality.”

— Mirna Montenegro, Director of OSAR

As in most countries, the challenges posed by COVID-19 in Guatemala have reduced women’s access to essential services and negatively impacted the health of women and adolescents. Indigenous communities in the Western Highlands of the country have been particularly affected due to pre-existing weaknesses of the health system, which struggles to provide high quality care that responds to the needs and priorities of rural, indigenous women.

An analysis led by the Observatory of Sexual and Reproductive Health (OSAR) shows that from between 2019 and 2020, Guatemala saw decreases of 30% in prenatal care attendance, 70% in access to family planning, and 35% in institutional delivery care, with sharper decreases in indigenous and poor communities.

Maintaining essential health services for women, children, and adolescents while mitigating the pandemic’s impact represents a tremendous challenge.

Adapting support to meet the needs of indigenous pregnant women throughout the pandemic

The Healthy Mothers and Babies project — known by its local name in the Quiché language, Utz’ Na’n, — strengthens local capacity to provide high-quality, culturally respectful antenatal care (ANC) and improve indigenous women and adolescents’ use of timely and quality ANC. Implemented by Management Sciences for Health (MSH), together with local partners Asociación PIES de Occidente (PIES), OSAR, and the Ministry of Health of Guatemala, the project is working to build a more equitable and responsive health system in the departments of Quetzaltenango and San Marcos in Guatemala’s Highlands region.

Pregnant woman in Guatemala talking on the phone
Photo credit: MSH

“When COVID-19 came to Guatemala, many women were unable to travel to health facilities to attend ANC check-ups due to local lockdowns, so we helped the traditional midwives (comadronas) connect with pregnant women through other means, including WhatsApp, to provide counseling over the phone. This allowed comadronas to continue following up with pregnant mothers, answer questions about their pregnancy, and refer them to health facilities in cases of emergencies.”

— Felipe Lopez, Utz’ Na’n Project Director

Even during the pandemic, with support from our local partners and in collaboration with the Ministry of Health and a network of midwives, the project has continued to implement its innovative group ANC model, which is being scaled up to improve quality and cultural responsiveness of services. In recent months, the project has trained more than 50 facilitators in the departments of San Marcos and Quetzaltenango, who are starting to convene group ANC sessions in small groups meeting outside to respect COVID-19 safety protocols.

Including pregnant women in Guatemala’s National Covid-19 Response

In support of the government’s COVID-19 response plan, the project also advocated for including pregnant women and adolescents as a prioritized group in the national COVID-19 vaccination rollout. Partnering with the Association of Infectious Diseases of Guatemala, the Association of Gynecologists and Obstetricians, and the College of Physicians, project partners launched an advocacy strategy to use evidence-based advocacy with health officials and policymakers on a national level. Similar regional efforts were conducted by the PanAmerican Health Organisation (PAHO)/WHO providing additional validity for pregnant women’s prioritization.

“With recent data in hand, we started to advocate with both Congress and the Vice Minister of Primary Health Care for the creation of a new national office focused solely on promoting maternal and child health during the pandemic, and the allocation of sufficient resources to ensure the continuity of essential maternal health services, including for the most marginalized.”

— Mirna Montenegro, Director of OSAR

As a result of these efforts, and supported by global evidence on COVID-19 vaccine safety for pregnant and lactating women, in September 2021, the Ministry of Health of Guatemala began prioritizing pregnant women in the national COVID-19 vaccine rollout strategy.

MSH staff in Guatemala working with local partners
Photo credit: MSH

“Our efforts sharing data for decision making resulted in updates to the vaccination guidelines, informed discussions with tutors/guardians, and health personnel about the need to reach pregnant adolescent girls with the vaccine.”

— Mirna Montenegro, OSAR Director

In early September, COVID-19 vaccines became available for pregnant women, and a national communication campaign with key messages for pregnant women was launched, including differentiated campaigns in indigenous languages. In Quetzaltenango and San Marcos, the project began to monitor the implementation of the national COVID-19 vaccination plan among pregnant women; the COVID-19 vaccine supply, including in very remote health facilities; and whether accurate information about the vaccine is reaching indigenous pregnant women and their families. This strategy deliberately included young pregnant adolescents (age 12–17) in the national vaccination strategy, as more than 30% of all pregnancies in Guatemala are among adolescents.

Meeting the health needs of rural, indigenous women and adolescents throughout the pandemic and beyond, requires both a national and community approach. Utz’ Nan’n will continue to advocate for the inclusion of pregnant women in the national pandemic response. While continuing to strengthen ANC services for pregnant women utilizing trusted community health workers such as traditional midwives. Knowing that antenatal care offers an excellent entry point to provide accurate information on COVID-19 prevention and vaccine safety, the project will combine these efforts to ensure that rural, indigenous, pregnant women and adolescents are prioritized.