Imagine you're a woman in labour and the midwife refuses to or cannot speak to you in your own language. Not only that, but she won't allow you to give birth in a position you prefer. That is if you can make it to the health centre in the first place: it might be many miles from your home, with no affordable transport available.
In many countries this is the stark reality facing countless women and a reason why so many do not seek professional assistance even when they encounter complications during pregnancy or childbirth. Worldwide, approximately 1,000 girls and women die in pregnancy or childbirth every day, most of them unnecessarily. Many of them are from indigenous or other marginalised ethnic communities.
"We sometimes say that pregnant women have a foot here and the other in the cemetery because anything can happen during labour," says Patricia Zacarias, an activist from the Miskitu people in Nicaragua.
By 2015, the UN's Millennium Development Goals (MDGs) aim to reduce the maternal mortality ratio by three-quarters and the under-five mortality rate by two-thirds (relative to the rates in 1990). Progress is being made. But as the UN's Secretary General Ban Ki-moon highlighted upon publication of this year's MDG report in July: "Progress tends to bypass those who are lowest on the economic ladder or are otherwise disadvantaged because of their sex, age, disability or ethnicity."
Indigenous peoples are often among the poorest and most marginalised communities. In Guatemala, for example, the estimated maternal mortality ratio in the year 2000 was 153 per 100,000 live births - but the figure for the indigenous population was three times higher than for the rest of the population (the UK has 12 deaths per 100,000 live births). The rate of chronic malnutrition among Mayan (indigenous) children under five in Guatemala is nearly twice that of non-Mayan children. Meanwhile in Peru, half of all of deaths among the indigenous people of the Amazon occur before the age of 40 - which is 20 years earlier than the national average.
Despite these vast health disparities most governments do not have a clue about the extent of these inequalities. They do not collect data which is broken down by ethnicity. On the occasion of the International Day of the World's Indigenous People [9 August], British charity Health Poverty Action's Head of Campaigns, Elizabeth Muggleton, said: "Indigenous peoples are off the health radar. Already-appalling national health statistics hide far worse health problems faced by indigenous communities. Governments must start collecting better maternal health statistics and correlate ethnicity to the most important health indicators, such as access to health facilities during birth."
But it is not only a question of access to health facilities. Discrimination against indigenous peoples and ethnic minorities is rife. "The way doctors treat us here and in any place - we are discriminated against because we are Miskitu", says Ms Zacarias. With some simple measures indigenous women may feel less intimidated at health centres. Health care providers can make birthing facilities more culturally appropriate by recruiting nurses and midwifes that speak the local indigenous language or by providing for vertical birthing (standing up) where this is the usual form of child delivery.
In 1999, only six percent of births in Peru's Santillana district of Ayacucho took place at a health clinic. Once a programme of introducing culturally-appropriate facilities had been introduced in the clinic, allowing women to squat rather than lie down as well as having health staff speak the local language, this figure had soared to 83 percent of births by 2007.
Two weeks ago, three mayoral candidates in Guatemala's second city, Quetzaltenango, pledged to improve access for indigenous women to culturally-appropriate public health services by introducing vertical delivery in hospitals. Their promise to push for the disaggregation of health data by linguistic community will hopefully enable the government to better track the needs of indigenous women.
With only four years to achieve the MDGs and with most of the health-related goals off-track, it is approaches like this that will help us to assess progress more realistically. "Reaching the health-related [Millennium Development] Goals is not about national averages. It is about reaching the poor," said the World Health Organisation's Director General, Margaret Chan, in May 2010, " who are almost invariably the hardest to reach. This is the challenge, and the measure of success."
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