In Ecuador, there are more than 2,000 community midwives, who are an axis of support for access to maternal healthcare in rural communities. According to the Interamerican Bank of Development, in Ecuador nearly 40 percent of indigenous women do not have access to basic services, such as prenatal check-ups. The lack of access is related to issues of ethnic discrimination, as well as geographic and linguistic limited access across the region. In addition, the impact of oil extraction and mining in these indigenous territories has resulted in high rates of breast and uterine cancer and abortions.
While indigenous midwives are highly respected as counselors, spiritual guides, guardians of reproduction, and experts of the natural world and medicinal plants, they’re perceived negatively by mainstream healthcare providers. Thus, their traditional knowledge and holistic cosmovision of health paired with the cultural values of the people they serve have been widely ignored—a grave disservice to maternal healthcare in Ecuador as a whole.
In this story I worked with AMUPAKIN, an organization of Amazonian Kichwa midwives working to protect the maternal health of indigenous women in Napo, Ecuador. They run a midwifery school and the first indigenous midwifery hospital in the Amazon of Ecuador. They have created a woman-centered community that cares for each other during pregnancy, childbirth and postpartum. Despite having extensive training rooted in their medicinal knowledge, many of their practices face limitations because of the distance and geographical complications of access to the communities. These 8 Kichwa women, between 60 and 80 years old, take care of a medicinal garden, hospital and make great efforts to visit nearby communities to provides their free services . Their goal is the transmission of their knowledge to younger generations. The health and well-being of future generations is crucial to ensure the survival of the Amazon, the populations that inhabit it and all of humanity.
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Sunrise on the Napo River. More than 40% of this river is home to Amazonian indigenous communities such as Cofán, Siona-Secoya, Waorani, Zapara and Kichwas. Sixty-five percent of indigenous women in this region give birth at home, attended by midwives who are respected in their communities but have a complex integration with the state health system. Ecuador constitution recognizes and guarantees traditional health systems since 2008, but in daily practice, two worlds with very different cultures, experiences and perceptions confront each other between Western medicine and traditional midwifery. Tena, Ecuador. August 2022.
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Maria Tapuy, midwife of AMUPAKIN, Association of Kichwa Women Midwives of the Upper Napo, massages the belly to accommodate the baby's position Violeta Tapuy (32), who is expecting her sixth childbirth. Violeta, like most Amazonian indigenous women, lives in a community far from the city. She assures that babies die on the way to the hospital before they are born / Archidona, Ecuador. August 2022.
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Olga Chungo and Ofelia Salazar, AMUPAKIN midwives, conduct a community prenatal check-up visit to pregnant women in the Kichwa Amazonian Sinchiwarmi community. Comprehensive intercultural maternal health care includes prenatal care, delivery, and postpartum. The check-ups performed by the mothers are visits to the women's homes, in the traditional midwifery hospital. The midwives apply natural oils, give massages and position the babies for birth. They also identify illnesses such as high blood pressure and anemia in the mothers and recommend treatment with the natural medicine that they provide. Visit communities is difficult for the midwives because of their limited resources for movilization and their advanced age. / Napo, Ecuador. August 2022.
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Mural of Amazonian women midwives at the AMAPUKIN traditional midwifery hospital. At its peak, this organization had more than 80 Amazonian midwives in Napo. At the moment, eight women support the association, they share traditional knowledge with new generations/ Archidona, Ecuador. August 2022.
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Olga Chungo, an Amazonian midwife and member of AMAPUKIN, prepares guayusa (Amazonian medicinal plant) in the kitchen of her home while waiting for a patient who will visit her for a prenatal check-up. "For me, being a midwife means taking care of pregnant mothers," says Olga, "knowing about medicinal plants for childbirth and prenatal control to give life. / Archidona, Ecuador. August 2022.
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Butterfly on the window of the AMAPUKIN midwifery hospital. Nature surrounds the midwives' hospital, providing a safe and peaceful environment for those who decide to give birth with traditional medicine. Midwives care for and lull the newborn with songs in Kichwa and accompany the mother with medicinal plants until she recovers / Archidona, Ecuador. August 2022.
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Ofelia Salazar, midwife and Amazonian Kichwa woman leader of AMAPUKIN, poses for a portrait in the medicinal plant garden of the midwives' hospital. They grow the plants and care for their medicinal garden following the knowledge of their ancestors. Ofelia learned traditional medicine from her mother. Her challenge is to ensure the intergenerational transmission of her culture and knowledge by incorporating new generations / Archidona, Ecuador. August 2022.
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Caldo de gallo with yucca is a natural food prepared by midwives after childbirth. The warmth of this food helps the woman's stability after giving birth and strengthens her body and spirit. These animals are raised organically by the midwives, and their preparation only includes the harvest from the medicinal garden / Archidona, Ecuador. August 2022.
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Edith Yumbo (34) waits for prenatal care from the midwife at her home in the community of Santa Rita. She is six months pregnant with her fifth baby. Edith has never had a medical check-up because of the distance from her community and the mobilization resources involved in going to the Hospital. The community visits made by the midwives free of charge are fundamental for the maternal health of indigenous women in the region. Holistic health in the indigenous cosmovision must integrate care of the body and protection of the spirit to prevent emotional risks for moms / Archidona, Ecuador. August 2022.
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Edith Yumbo (34) waits for prenatal care from the midwife at her home in the community of Santa Rita. She is six months pregnant with her fifth baby. Edith has never had a medical check-up because of the distance from her community and the mobilization resources involved in going to the Hospital. The community visits made by the midwives free of charge are fundamental for the maternal health of indigenous women in the region. Holistic health in the indigenous cosmovision must integrate care of the body and protection of the spirit to prevent emotional risks for moms / Archidona, Ecuador. August 2022.
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Maria Tapuy, midwife of AMUPAKIN, Association of Kichwa Women Midwives of the Upper Napo, posses for a portrait in her home. Archidona, Ecuador. August 2022.
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Olga Chungo, an Amazonian midwife and member of AMAPUKIN, makes clay utensils with her granddaughter in the kitchen of her home while waiting for a patient who will visit her for a prenatal check-up. "For me, being a midwife means taking care of pregnant mothers," says Olga, "knowing about medicinal plants for childbirth and prenatal control to give life. / Archidona, Ecuador. August 2022.
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Ofelia Salazar, midwife and Amazonian Kichwa woman leader of AMAPUKIN, poses for a portrait in the medicinal plant garden of the midwives' hospital. They grow the plants and care for their medicinal garden following the knowledge of their ancestors. Ofelia learned traditional medicine from her mother. Her challenge is to ensure the intergenerational transmission of her culture and knowledge by incorporating new generations / Archidona, Ecuador. August 2022.
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Maria Shiguango, an Amazonian midwife and member of AMAPUKIN, heads to the midwifery hospital kitchen to prepare food for one of her patients. The midwives work full two-days at the hospital to attend to the medicinal garden, patient care, medicine preparation, and natural treatments for the women. / Archidona, Ecuador. August 2022.
Sunrise on the Napo River. More than 40% of this river is home to Amazonian indigenous communities such as Cofán, Siona-Secoya, Waorani, Zapara and Kichwas. Sixty-five percent of indigenous women in this region give birth at home, attended by midwives who are respected in their communities but have a complex integration with the state health system. Ecuador constitution recognizes and guarantees traditional health systems since 2008, but in daily practice, two worlds with very different cultures, experiences and perceptions confront each other between Western medicine and traditional midwifery. Tena, Ecuador. August 2022.
Maria Tapuy, midwife of AMUPAKIN, Association of Kichwa Women Midwives of the Upper Napo, massages the belly to accommodate the baby's position Violeta Tapuy (32), who is expecting her sixth childbirth. Violeta, like most Amazonian indigenous women, lives in a community far from the city. She assures that babies die on the way to the hospital before they are born / Archidona, Ecuador. August 2022.
Olga Chungo and Ofelia Salazar, AMUPAKIN midwives, conduct a community prenatal check-up visit to pregnant women in the Kichwa Amazonian Sinchiwarmi community. Comprehensive intercultural maternal health care includes prenatal care, delivery, and postpartum. The check-ups performed by the mothers are visits to the women's homes, in the traditional midwifery hospital. The midwives apply natural oils, give massages and position the babies for birth. They also identify illnesses such as high blood pressure and anemia in the mothers and recommend treatment with the natural medicine that they provide. Visit communities is difficult for the midwives because of their limited resources for movilization and their advanced age. / Napo, Ecuador. August 2022.
Mural of Amazonian women midwives at the AMAPUKIN traditional midwifery hospital. At its peak, this organization had more than 80 Amazonian midwives in Napo. At the moment, eight women support the association, they share traditional knowledge with new generations/ Archidona, Ecuador. August 2022.
Olga Chungo, an Amazonian midwife and member of AMAPUKIN, prepares guayusa (Amazonian medicinal plant) in the kitchen of her home while waiting for a patient who will visit her for a prenatal check-up. "For me, being a midwife means taking care of pregnant mothers," says Olga, "knowing about medicinal plants for childbirth and prenatal control to give life. / Archidona, Ecuador. August 2022.
Butterfly on the window of the AMAPUKIN midwifery hospital. Nature surrounds the midwives' hospital, providing a safe and peaceful environment for those who decide to give birth with traditional medicine. Midwives care for and lull the newborn with songs in Kichwa and accompany the mother with medicinal plants until she recovers / Archidona, Ecuador. August 2022.
Ofelia Salazar, midwife and Amazonian Kichwa woman leader of AMAPUKIN, poses for a portrait in the medicinal plant garden of the midwives' hospital. They grow the plants and care for their medicinal garden following the knowledge of their ancestors. Ofelia learned traditional medicine from her mother. Her challenge is to ensure the intergenerational transmission of her culture and knowledge by incorporating new generations / Archidona, Ecuador. August 2022.
Caldo de gallo with yucca is a natural food prepared by midwives after childbirth. The warmth of this food helps the woman's stability after giving birth and strengthens her body and spirit. These animals are raised organically by the midwives, and their preparation only includes the harvest from the medicinal garden / Archidona, Ecuador. August 2022.
Edith Yumbo (34) waits for prenatal care from the midwife at her home in the community of Santa Rita. She is six months pregnant with her fifth baby. Edith has never had a medical check-up because of the distance from her community and the mobilization resources involved in going to the Hospital. The community visits made by the midwives free of charge are fundamental for the maternal health of indigenous women in the region. Holistic health in the indigenous cosmovision must integrate care of the body and protection of the spirit to prevent emotional risks for moms / Archidona, Ecuador. August 2022.
Edith Yumbo (34) waits for prenatal care from the midwife at her home in the community of Santa Rita. She is six months pregnant with her fifth baby. Edith has never had a medical check-up because of the distance from her community and the mobilization resources involved in going to the Hospital. The community visits made by the midwives free of charge are fundamental for the maternal health of indigenous women in the region. Holistic health in the indigenous cosmovision must integrate care of the body and protection of the spirit to prevent emotional risks for moms / Archidona, Ecuador. August 2022.
Maria Tapuy, midwife of AMUPAKIN, Association of Kichwa Women Midwives of the Upper Napo, posses for a portrait in her home. Archidona, Ecuador. August 2022.
Olga Chungo, an Amazonian midwife and member of AMAPUKIN, makes clay utensils with her granddaughter in the kitchen of her home while waiting for a patient who will visit her for a prenatal check-up. "For me, being a midwife means taking care of pregnant mothers," says Olga, "knowing about medicinal plants for childbirth and prenatal control to give life. / Archidona, Ecuador. August 2022.
Ofelia Salazar, midwife and Amazonian Kichwa woman leader of AMAPUKIN, poses for a portrait in the medicinal plant garden of the midwives' hospital. They grow the plants and care for their medicinal garden following the knowledge of their ancestors. Ofelia learned traditional medicine from her mother. Her challenge is to ensure the intergenerational transmission of her culture and knowledge by incorporating new generations / Archidona, Ecuador. August 2022.
Maria Shiguango, an Amazonian midwife and member of AMAPUKIN, heads to the midwifery hospital kitchen to prepare food for one of her patients. The midwives work full two-days at the hospital to attend to the medicinal garden, patient care, medicine preparation, and natural treatments for the women. / Archidona, Ecuador. August 2022.
Johis Alarcon Photography
Johis Alarcon is a female Ecuadorian photojournalist whose work is focused on socio-cultural humanitarian and gender issues, primarily in Latin America.