Indigenous midwifery and what it means for social development

On 9 August 2026, the United Nations (UN) marked the International Day of the World’s Indigenous Peoples under the theme Honouring Indigenous Midwives: Safeguarding Life and Wellbeing. The theme puts birth, and the women who attend it, at the centre of discussion about Indigenous knowledge systems, health rights and development. This post sets out what the UN and its agencies said about Indigenous midwifing, what the evidence from Africa and elsewhere shows, and what the theme asks of social development and social work. It also considers what an Ubuntu lens adds.

The 2026 International Day of the World’s Indigenous Peoples

The UN General Assembly established the Day through resolution 49/214 in December 1994, and the date of 9 August recalls the first meeting of the UN Working Group on Indigenous Populations in 1982. Because 9 August fell on a Sunday this year, the main observance was held online on Monday 10 August 2026.

The UN framed the theme around Indigenous knowledge systems. It described these systems as grounded in worldviews that link territory, spirituality, community and ways of life, and it presented Indigenous midwifery as one expression of them, carrying knowledge between generations and sustaining cultural identity. It also noted that the practice continues to face structural barriers and discrimination that limit its recognition in formal health systems and restrict access to culturally appropriate care.

The scale of what is at stake is significant. The UN estimates there are 476 million Indigenous Peoples across 90 countries. They are less than 6 per cent of the world’s population but at least 15 per cent of the poorest, and they speak most of the world’s estimated 7,000 languages.

The commemoration and the Secretary General’s message

The online commemoration was organised around two dialogues, the first on Indigenous midwives as knowledge holders and the second on moving from recognition to action through policy reform and implementation of international commitments. Africa was represented in the second dialogue by Agnes Leina from Kajiado County in Kenya, a Maasai area, who founded Il’laramatak Community Concerns and serves as Gender Coordinator of the Indigenous Peoples of Africa Coordinating Committee (IPACC).

In his message for the Day, the UN Secretary General, António Guterres, noted that complications and deaths among Indigenous mothers and infants are far more common than in the wider population. He said evidence shows Indigenous midwives improve outcomes for mothers and babies, build trust in health systems and support continuity of care, while also keeping languages and values alive. He called on governments to collect the data that currently leaves Indigenous patients invisible, to invest in training for midwives and natal care, and to uphold the right of Indigenous women to make informed decisions about their own bodies.

Indigenous midwives as knowledge holders

Indigenous midwifing is much wider than the moment of birth. In Guatemala, Indigenous midwives in rural communities often stay with a woman from the first month of pregnancy through the birth and the weeks after it, usually without pay. Rosa Marina Chex, who has attended births for 36 years, describes midwives as holding many roles at once, including nurse, counsellor and source of moral support.

The way this knowledge is acquired also differs from formal training. Chex describes learning through dreams, at home, and alongside another woman who already held the knowledge. The ceremonial opening of the UN commemoration was led by María Herminia Quiñelen Martínez, a Mapuche Lawentuchefe (medicine woman) and Puñeñelchefe (master of ancestral Mapuche childbirth), who has accompanied more than 1,300 births and belongs to the eighth generation of a lineage of Mapuche healers.

In many African communities the same pattern holds. Birth involves the family, elders and the wider community, and the people attending a woman are often relatives as well as practitioners. A study in Limpopo, South Africa, for example, treated birth attendants and family members together as the people providing Indigenous postnatal care.

Maternal health in Africa and the place of Indigenous midwives

The theme has particular weight for Africa. An estimated 260,000 maternal deaths occurred worldwide in 2023, and Africa south of the Sahara accounted for 70 per cent of them. In the World Health Organization (WHO) African Region, the maternal mortality ratio fell from 727 to 442 deaths per 100,000 live births between 2000 and 2023, but at the current pace the region is projected to reach close to 350 by 2030, five times the Sustainable Development Goals (SDGs) target of fewer than 70. The 37 countries classified as affected by conflict or institutional and social fragility accounted for 64 per cent of maternal deaths.

Indigenous midwives remain central to how many women in Africa experience pregnancy and birth. In South Africa, around half of women still consult Indigenous birth attendants as their first choice, even where maternal and child health services are available. In one rural district of Ghana, birth attendants were responsible for around 65 per cent of births. In Nigeria, health experts have noted that birth attendants are often the first point of contact for pregnant women where hospitals and skilled personnel are scarce, and have called for integration through training and referral networks.

Evidence from Uganda, South Africa and Ghana

Research from three African settings shows what happens when the relationship between Indigenous midwives and health services is neglected, and what changes when it is built.

Among the Karamojong of north eastern Uganda, Indigenous midwives had been reluctant to refer women to the hospital serving their area because of maltreatment by biomedical staff. A partnership model was then designed together with the midwives and hospital staff, and the authors argue that bringing the two systems together is essential to meeting the needs of Karamojong women.

In Limpopo, registered midwives showed negative attitudes towards family members, birth attendants and women from diverse cultures, and there was no teamwork between them. Midwives imposed their own health beliefs at discharge without involving families or birth attendants, which the study linked to poor postnatal care, complications and rising maternal mortality. The study recommended including Indigenous practices in the midwifery syllabus so that registered midwives understand them.

In rural Ghana, a safe motherhood project took the opposite approach. Its evaluation found that integrating birth attendants into the health system improved their practice and morale, alongside better communication, support for rural midwives and greater community involvement.

Barriers, discrimination and the limits of recognition

Lessons from Guatemala

Guatemala shows that legal recognition is a starting point rather than an end point. Indigenous midwives there reported being called dirty by doctors, being made to speak Spanish, and being forbidden to use medicinal plants in state health centres. The Nim Alaxik National Movement of Midwives took the matter to the Constitutional Court and won an amparo (constitutional protection ruling), which was followed by a law recognising their dignity and a national day on 19 May.

Seven years after the judgment, the Office of the United Nations High Commissioner for Human Rights (OHCHR) has documented limited awareness of it among health staff and continuing reports of discrimination. Chex estimates that practice has shifted by perhaps 40 per cent, adding that “paper puts up with anything”. The midwives also told OHCHR that accreditation tools, such as the midwife card and state training, have in practice become mechanisms of control, and they regard a new university technical qualification in midwifery as a threat of dispossession of their knowledge.

OHCHR technical guidance on maternal mortality recommends community based approaches in rural areas, formal recognition of Indigenous midwives, and decent working conditions for them.

Lessons from Latin America more broadly

The Pan American Health Organization (PAHO) offers a model based on dialogue. Since 2021 it has worked with more than a thousand midwives from Bolivia, Colombia, Ecuador, Honduras and Peru through training and knowledge dialogues, with community plans prioritised by communities rather than imposed by the health sector. In Otavalo, Ecuador, midwives are now allowed to accompany women into delivery rooms.

Saving lives by combining ancestral and western medicines

In rural and remote communities of Latin America, where geographical barriers and cultural differences can hinder access to healthcare centres, the practical and spiritual support of Indigenous midwives can make the difference between life and death. More stories

The pattern across Guatemala, Uganda and South Africa is similar. Where health systems treat Indigenous midwives as subordinate or as a temporary substitute until hospitals arrive, trust breaks down and women delay or avoid care. Where midwives are treated as partners, referral improves and women feel respected.

Ubuntu and the ethics of birth

Ubuntu, captured in the saying “a person is a person through family, community, society, environment and spirituality”, offers a useful way of understanding why Indigenous midwifing matters. Birth is the moment a new person enters a web of relationships with parents, extended family, community, ancestors and the land. The midwife holds a place within those relationships. She is known to the family, often related to it, and answerable to the community long after the birth.

A health system that sees only the clinical event of delivery will miss most of this. A woman deciding where and with whom to give birth is weighing family expectations, the advice of elders, spiritual obligations around birth and the placenta, the language she will be spoken to in, and how she was treated last time. Indigenous midwives work within all of these. Health workers who dismiss them are dismissing the structures women rely on.

The San Code of Research Ethics, with its instruction to come through the door, not the window, applies here as well. Accreditation schemes, registers and training programmes designed without Indigenous midwives enter through the window. Coming through the door means approaching midwives through their own associations and community structures, agreeing purpose and benefit with them, and remaining accountable to them.

Recognition backed by budget and implementation

The Guatemalan experience shows that laws and court rulings change little unless they are translated into plans, budgets and staff at local level. Social development policy should treat recognition of Indigenous midwives as an implementation task with timelines and resources, consistent with the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP), which affirms the right of Indigenous Peoples to their own medicines and health practices.

Partnership rather than regulation

Integration has too often meant training Indigenous midwives to become referral agents for hospitals, or replacing them altogether. The Karamojong and PAHO examples point instead to partnership, where both systems learn from each other, referral pathways are agreed jointly, and midwives can accompany women into facilities. Social development practitioners can broker these arrangements between communities and health services.

Data that makes Indigenous mothers visible

Indigenous women are often absent from maternal health statistics, a point the Secretary General made directly. In Africa, where the term Indigenous is applied unevenly across countries, this gap is wider still. Disaggregated data on births attended by Indigenous midwives, and on outcomes for the women they serve, is needed to plan services and to make the contribution of midwives visible in national reporting.

Decent work and livelihoods

Much Indigenous midwifing is unpaid, and most of it is done by older women in rural areas. Social protection, stipends, recognition in community health worker schemes, and support for midwives’ associations are development measures that sustain the practice and value women’s work. Without them, the knowledge is likely to decline as older midwives stop practising.

Knowledge, language and education

Midwifing is a form of knowledge transmission. At least 40 per cent of the world’s estimated 7,000 languages are endangered, and the UN has declared 2022 to 2032 the International Decade of Indigenous Languages. Birth knowledge is held in Indigenous languages, and supporting midwives supports those languages. Midwifery, nursing, medical and social work education should include Indigenous birth knowledge, taught with and by the midwives who hold it.

Fragile and conflict affected settings

Given that conflict affected and fragile countries account for most maternal deaths, Indigenous midwives are often the only birth attendants who remain when facilities close or roads become unsafe. Preparedness planning in these settings should include them from the outset, rather than turning to them only once formal services have collapsed.

Social workers in maternity units, primary health care and family support can play a direct role. This includes involving Indigenous midwives and family members in discharge planning and postnatal care, recording and challenging obstetric violence and discrimination, supporting women to make informed choices about where and with whom they give birth, and mediating between midwives and health services when conflicts arise. Community development work with midwives’ associations, of the kind Nim Alaxik has built in Guatemala, is also within the scope of social work, and similar associations in Africa deserve the same support.

Looking ahead

The 2026 theme gives the UN system, governments and the professions a clear agenda: recognise Indigenous midwives as knowledge holders, work with them as partners, pay and protect them, and count the women they serve. For Africa, which carries most of the world’s maternal deaths and where many women still turn first to Indigenous birth attendants, this agenda is central to meeting the SDGs. Social development and social work bring the skills needed to build these partnerships: community engagement, advocacy, attention to family and community systems, and respect for Indigenous knowledge.

Sources:

Use the form below to subscibe to Owia Bulletin.

Table of Contents