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Exploring Disrespect and Abuse in Guatemala

Photo of Indigenous midwives in Guatemala, Photoshare

Research Overview

Guatemala is home to extreme disparities between the indigenous and non-indigenous segments of the population. The indigenous population in Guatemala has disproportionately lower health outcomes when compared to their non-indigenous counterparts. These poor health outcomes can be associated with lower utilization of formal services which, specific to maternal care, can lead to higher rates of maternal mortality and morbidity. As part of an effort to understand deterrents to skilled maternal care, this project explores how experiences with disrespect and abuse affect maternal health care decisions. Findings will be leveraged to inform future efforts which work to increase the demand for formal care and improve the quality of services rendered.


Project Location

Guatemala: Ixil Health Area, Quiche Department


The Ixil Health Area in the Department of Quiche has been selected as the site for the implementation assessment because it has great need for a more efficient and effective health system and has some of the poorest education, economic and health indicators in Guatemala. Maternal mortality is estimated at 277 deaths per 100,000 births (national average being 153); infant mortality rates reach 66 deaths per 100,000 live births (national average being 471) and 82% of residents live on less than two dollars a day (52% nationwide). Furthermore, the chronic malnutrition rate for Quiche is 72.2%, and 1% of it is acute malnutrition (compared with a national average of 49.8% chronic malnutrition with 1% of it being acute).


Research Objectives

The objectives of the study are as follows:

  • Determine the manifestations, types, and prevalence of disrespect and abuse during childbirth services in both the formal and informal health system
  • Identify and explore the potential drivers of disrespect and abuse
  • Determine how disrespect and abuse influences utilization of skilled birth care
  • Understand how the contributors to disrespect and abuse are relevant to care-seeking for other illnesses
  • Contribute to global estimates and knowledge on experiences of disrespect and abuse in maternal and child health services across the formal and informal health systems 


Lessons Learned



Dissemination of Findings






Project Poster

Click on the image below to view a poster summarizing research on facility-based births and disrespect & abuse from the client's perspective. The study, titled "Using Qualitative Methods to Improve Health System Responsiveness in the Western Highlands of Guatemala," found that the majority of women in the Ixil Health Area prefer home-based births due to economic, geographic, social and knowledge barriers. Those who seek facility-based birth do so because of obstetric complications. Women who gave birth in facilities shared negative experiences and perceptions consistent with the Disrespect and Abuse Framework.

DA Guatemala Poster HSR Cape Town


Research Partners


Project Status

Country / Countries: 
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