There has been little attempt toevaluate traditional midwives existing knowledge, beliefs and skills. Guatemala suffers from one of the highest maternal mortality morbidity rates in Central America. The majority of poor women in Guatemala, Ladina and indigenous, continue to have little access to even basic health care. The relatively small percentage of women who can afford private care are having their babies in hospitals with physicians. Poor women are moving into public hospitals with a belief that their outcomes will improve.
Public hospitals are overcrowded, understaffed and often lack equipment.
Often medical students and inexperienced residents are in charge of care and there is an overuse and indiscriminate use of interventions. It has been recognized that hospital care for childbearing women has the potential for harm as well as good. Even with reliable, modern resources hospitals pose risks from incorrect management or un-necessary interventions in prognancy and childbirth. There exists an international debate in finding solutions to improving maternity care in developing countries. Mnay view the traditional midwife as incapale of training and having a limited role in improving women's health needs.