Social Science & Medicine 59 (2004) 637–651 Authorizing tradition: vectors of contention in Highland Maya midwifery Servando Z. Hinojosa* Department of Psychology and Anthropology, University of Texas-Pan American, Edinburg, TX 78541, USA Abstract In Guatemala, midwives deliver the majority of children and play an important health care role in rural areas. Maya midwives, using time-proven methods, are the chief providers of care for mothers and infants in these areas. In recent decades, however, the medical establishment has become interested in Maya midwives, and is currently engaged in training and certifying many of them. This study examines how Guatemalan health authorities have sought to change Maya midwifery, refashioning its vocational framework and retooling it in accordance with Western medical principles. I focus on the place of obligatory formal training and the use of biomedical materials in the experience of Kaqchikel Maya midwives, and consider how the health officials employ these means to undermine the midwives’ knowledge base. Encounters between midwives and formal health personnel reveal an ongoing privileging of biomedical knowledge, one that preserves asymmetrical relationships between these practitioners. This creates an environment favorable to health personnel, and helps them to extend their influence through the midwives into the community. Given this, I contend that health personnel value local Maya midwives primarily for their role in furthering the goals of biomedicine. r 2003 Elsevier Ltd. All rights reserved. Keywords: Guatemala; Maya midwifery; Biomedical change; Maternal health; Child care Introduction This article examines how formal health personnel have taken an interest in Maya midwifery in Guatemala, and how they consider it to need official control and licensure. By mandating formal midwife training and using biomedical materials as part of this control process, the health establishment has linked the legit- imating of midwives with institutional compliance. Of interest to this study is how the resulting ideological tensions and technological changes in the local health scene reveal the establishment’s efforts to undermine the midwives’ knowledge base. Health authorities have tried weakening the midwife’s confidence in her abilities and replacing her practices with biomedical ones. In doing so, they further the official view of Maya midwifery as a vehicle for reaching a wider public. Midwives and health officials of San Juan Comalapa, Guatemala, have interacted for decades, but always in an environment privileging biomedical knowledge. Nonetheless, in this municipality of some 28,380 people, divided between a town center and 27 surrounding villages and hamlets, midwives remain the chief care- givers to pregnant women. Fewer than five out of one hundred births are attended, on average, by physicians each year. Those births that are attended by physicians are usually referred by midwives. This situation has prompted physicians and other formal health workers to reassert their influence over childbirth practices in ways that have heightened existing ethnic and institutional tensions. Comalapa’s population consists almost entirely of Kaqchikel Mayas. This group is characterized locally by different degrees of Kaqchikel-Spanish bilingualism and by the wearing of woven blouses and skirts by females. Townspeople rely heavily on small-scale maize agricul- ture for meeting subsistence needs, but many also produce vegetables and textiles for export, especially to the US. Many Mayas practice a synthesis of Roman Catholic and Maya religious observances known as costumbre, a set of traditions mindful of, among other ARTICLE IN PRESS *Tel.: +1-956-316-7002; fax: +1-956-381-3333. E-mail address: hinojosas@panam.edu (S.Z. Hinojosa). 0277-9536/$-see front matter r 2003 Elsevier Ltd. All rights reserved. doi:10.1016/j.socscimed.2003.11.011