Obstetric Care Navigators to Improve Maternal Outcomes Among Guatemala's Rural Maya

While globally maternal mortality is declining, the most vulnerable women are still being left behind. In Guatemala indigenous Maya women are more than twice as likely to die from childbirth than non-indigenous women. Fear of public hospitals—stemming from language barriers, mistreatment by staff, institutional complexity and discrimination—leads women to refuse referral when complications arise during home births. Until this fear is overcome, interventions to better train traditional birth attendants (TBAs) who attend home births or to improve quality of care in national hospitals will be insufficient to reduce maternal and neonatal mortality. We will address this by using obstetric care navigators to help high-risk mothers get timely, quality care in public hospitals, a model we have pioneered for cancer care. Local indigenous women—incentivized via pay-for-performance—will accompany mothers and expertly navigate hospital bureaucracy, arrange transportation, provide emotional support and interpret between Mayan and Spanish languages. The approach is a low-cost way to strengthen the referral pathway, decrease referral time, and improve patient experiences and demand for services. A medical team will support the navigators, and novel embedding of rapid-cycle quality improvement techniques will ensure continuous improvements. This model is readily scalable through existing networks of TBAs and is applicable to marginalized women in many contexts.