Remaking the Guatemalan midwife: health care reform and midwifery training programs in Highland Guatemala.

Midwifery practice and identity in Guatemala is constantly being transformed because midwives must negotiate their practices in response to changing international and national health care agendas and processes. Recently, the Guatemalan government implemented the Sistema Integral de Atención en Salud (SIAS). Framed by neoliberal processes and global reproductive health paradigms, SIAS is designed to attain the reproductive health goals outlined in the 1996 Peace Accords by reducing maternal and infant mortality rates. As the primary birthing specialists in rural areas, midwives are essential to this task. A central focus of SIAS is incorporating midwives into the national health care system through midwifery training programs. Drawing on observations of midwifery training programs and interviews with midwives in the municipality of San Martín Jilotepeque, I argue that the incorporation of midwives into SIAS is redefining the position by establishing a new model of recruitment to the role, education, and practice and authority.