Bridging worlds: A Bolivian midwife blends traditional practices with modern medicine for safer childbirth

LA PAZ, Bolivia – Having witnessed first-hand women dying in childbirth, midwife Ana Choque understands the critical need for timely health decisions.

“Many times, even though the danger signs are clear, the family is reluctant to take the woman to a health centre,” she told UNFPA, the United Nations sexual and reproductive health agency. “I see it every day: The husband, the mother-in-law, the relatives – sometimes they say it’s not necessary [to go to the hospital], that the situation is ‘normal’.”

A champion of maternal health in Bolivia, Ms. Choque works with UNFPA to train midwives and advocate for the use of modern medical practices, together with traditional knowledge.

“I must have attended more than 4,000 births,” she said. With over four decades of experience in midwifery and a deep knowledge of her country’s ancestral practices, she empowers her patients to advocate for themselves. “I tell them: 'It's your body, you are the mother – you decide.’”

But Ms. Choque is not only a midwife, she's also a guardian of traditions. Growing up in the Luribay Municipality within the department of La Paz, she learned the art of healing and assisting pregnant women from her grandmother, who was a traditional birth attendant. By the age of eight, she was already accompanying her on long journeys to attend births.

“Before she started, my grandmother would offer gifts to Pachamama (Mother Earth), such as sugar, incense, copal and animal fat,” Ms. Choque recalled. These rituals were woven into her knowledge of traditional medicine and formed the foundation of her practice, which included carefully handling and analysing the placenta to assess the newborn's health, and integrating herbs to ease labour pains and promote postpartum recovery. Thanks to Ms. Choque and other dedicated midwives, it’s wisdom that continues to thrive in Bolivia today.

Combining traditional and modern medicine 

Bolivia currently has one of the highest maternal death rates in Latin America. Although the numbers dropped from 187 deaths per 100,000 live births in 2000 to 160 per 100,000 in 2020 – a more than 40 per cent reduction – since 2011, progress has more or less stagnated.

Haemorrhaging, hypertension and complications from unsafe abortion are among the leading direct causes of maternal death in Bolivia, as highlighted by the 2011 National Post-Census Maternal Mortality Study. 

These worrying figures show the need for a different approach. Daniel Rojas, head of UNFPA’s maternal health division in Bolivia, said it is essential to encourage the use of modern medicine together with traditional practices. “This requires a collaborative effort – rooted in cultural understanding – between healthcare providers, communities and midwives, to achieve safe and healthy motherhood for all Bolivian women.” 

The combination of the two systems would allow women to access more comprehensive and culturally-sensitive care, he added. Ms. Choque currently works at the Ventilla Health Centre in El Alto, where she acts as a bridge between patients and doctors, explaining medical procedures in a way that respects cultural beliefs and eases anxieties.  Where necessary, she refers complex cases to a hospital in the capital La Paz. “Many women don't want to see a doctor because of the way they are treated,” she explained.

One of the greatest challenges she faces is reaching pregnant women in remote areas. Journeys can take hours by motorcycle or horseback – a delay that can quickly become life-threatening, especially in emergencies. Facilities in these areas also often lack essential equipment and trained staff, limiting access to rapid, quality care.

Empowering women: From mothers to midwives

UNFPA supports the Ventilla health centre through a project funded by the Korean Government, aimed at promoting gender equality and improving the sexual and reproductive rights of adolescents. 

Ms. Choque’s commitment to empowering women extends beyond her individual patients to her leadership role in the midwifery community as a whole. In Bolivia, traditional midwives have long played a vital role in spurring greater uptake of skilled maternal health support, particularly among rural and indigenous communities. 

Yet their contributions have often been overlooked and undervalued by the formal healthcare system. To counter these biases, Ms. Choque leads the Association of Midwives of La Paz, a collective of more than 180 midwives in the region. 

“Before, we were invisible, we were not recognized. We suffered discrimination.” Unity, she said, is essential. “Organizing ourselves, making alliances – this is the only way to build strength and change things.”