Cosmopolitical obstetrics: some insights from the training of traditional midwives

In most countries of the third world, strategies for development in the health sector include efforts to upgrade the skills of village level health care workers, including traditional birth attendants (TBAs). In spite of several decades of experience, training programs for TBAs have not been particularly successful. Drawing on data from several years of ethnographic fieldwork with Maya midwives in Yucatan and on participation in government-sponsored training courses for indigenous midwives, this paper examines some of the reasons underlying this failure. Paramount among these are differences in world view and the misapplication of didactic modes of teaching in situations where learning in the apprenticeship mode is more appropriate and culturally customary.