ALTA VERAPAZ, Guatemala – For Estela Santiago, studying to become a professional midwife involved travelling six hours each week from her home in Nebaj to Huehuetenango, making several bus transfers along the way, all of it fuelled by the goal of supporting women and girls.
Now a university graduate with a degree in midwifery, Ms. Santiago, 24, works at the Permanent Care Centre in San Miguel Tucurú, in the highlands of Alta Verapaz. There she supports women during pregnancy, childbirth and the postpartum period, in areas where receiving timely medical care is a constant challenge.
“What inspired me most to study midwifery was being able to reach remote communities, where many women don’t have access to quality care,” she told UNFPA, the United Nations Population Fund, which is the UN’s sexual and reproductive health agency.
Ms. Santiago is also dedicated to countering damaging gender biases; too often, she explained, “Gender inequality means women don’t have the right to seek out healthcare. It’s the man who decides whether or not the woman goes to a consultation.”
In many such communities, becoming a mother still carries needless risks. Stark inequalities are visible in the higher rates of maternal and neonatal mortality and adolescent pregnancy, especially for indigenous women. And although most births take place in health facilities, geographic, economic and cultural barriers often limit access to quality services.
“We were trained to respect the beliefs and customs of each patient,” said Ms. Santiago. She is part of a new generation of professionals who are breaking down barriers that have prevented many women from accessing culturally sensitive care.
“It's something we have to put into practice [...] because if we don't treat them with respect for their culture, they won't feel comfortable with us.”
Midwives at the centre of healthcare
UNFPA supports the health centre by providing midwifery training, essential supplies and advocacy on the crucial role of midwives within the broader health system.
Mario García, who leads the reproductive health department at the centre, confirmed that midwives can often be key in filling health worker shortages. “The staffing gap is significant – at times we don’t have a doctor, and support staff have many responsibilities to fulfill. However, the midwives help us provide specialized care for maternal and neonatal cases – from the onset of labour, through childbirth, and into the postpartum period.”
UNFPA data show that educating, training and retaining 1 million more midwives offers the single most effective way to save millions of mothers’ and newborns’ lives in the next ten years. For every US$1 invested in improving access to antenatal care, safe childbirth and postnatal support, midwifery services can assure as much as a 16-fold return through social and economic gains.
In this context, midwifery graduates can make a real-world difference in the health system.
“They allow essential maternal and reproductive health services to reach where they are most needed and strengthen intermediate-level care facilities, especially in contexts where doctors are not always available,” said Alejandro Silva, a sexual and reproductive health officer for UNFPA in Guatemala. “Where integrated services are available, maternal and neonatal deaths can be significantly reduced.”
Beyond the statistics, the impact of their work is evident in true stories. Vilma Chiquín remembers her pregnancy as a supported process. She attended all her prenatal appointments with Ms. Santiago, who provided constant follow-up and instilled confidence in her.
“I had the care I needed. It was a little complicated, but thank God everything turned out well,” Ms. Chiquín told UNFPA. “She oversaw all my prenatal care and was also there on the day of my delivery, just as I had hoped.”
Thanks to that close and respectful support, she was able to experience the birth she desired.
Comprehensive support is key
![At a medical reception area, a female health worker in a dark red top and white trousers smiles as she interacts with a woman in a flowery top and blue jeans, holding a small child in a dark green flowery top and standing beside a wooden bench. Behind them is a dark blue and white front desk with a man in a dark blue top and glasses standing behind it]](/sites/default/files/inline-images/Untitled%20design%20-%202026-05-05T120944.411.png)
One case Ms. Santiago remembers most is a patient who arrived at her appointment in terror. “You could see on her face that she was sad. I started asking her why, and it turned out her medical history was difficult. She had suffered three miscarriages before – her husband was also afraid.”
The clinic doesn’t have an ultrasound machine, but Ms. Santiago arranged for lab tests, sought additional support, and maintained constant follow-up. She visited the patient in her community and called her every week.
“We made it to nine months. Then her husband called me, very grateful, to tell me that their baby had been born. Now the child is nine months old, and that makes me feel like I’m doing my job well,” she said.
