title: Labor and delivery service use: indigenous women's preference and the health sector response in the Chiapas Highlands of Mexico.
abstract: BACKGROUND
  Mexico has undertaken important efforts to decrease maternal mortality. Health authorities have introduced intercultural innovations to address barriersfaced by indigenous women accessing professional maternal and delivery services. This study examines, from the perspective of indigenous women, the barriers andfacilitators of labor and delivery care services in a context of intercultural and allopathic innovations.
  
  
  METHODS
  This is an exploratory study using a qualitative approach of discourse analysis with grounded theory techniques. Twenty-five semi-structured interviews were undertaken with users and non-users of the labor and delivery services, as well as with traditional birth attendants (TBAs) in San Andrés Larráinzar, Chiapas in 2012.
  
  
  RESULTS
  The interviewees identified barriers in the availability of medical personnel and restrictive hours for health services. Additionally, they referred to barriers to access (economic, geographic, linguistic and cultural) to health services, as well as invasive and offensive hospital practices enacted by health system personnel, which limited the quality of care they can provide. Traditional birth attendants participating in intercultural settings expressed the lack of autonomy and exclusion they experience by hospital personnel, as a result of not being considered part of the care team. As facilitators, users point to the importance of having their traditional birth attendants and families present during childbirth, to allow them to use their clothing during the attention, that the staff of health care is of the female sex and speaking the language of the community. As limiting condition users referred the different medical maneuvers practiced in the attention of the delivery (vaginal examination, episiotomy, administration of oxytocin, etc.).
  
  
  CONCLUSIONS
  Evidence from the study suggests the presence of important barriers to the utilization of institutional labor and delivery services in indigenous communities, in spite of the intercultural strategies implemented. It is important to consider strengthening intercultural models of care, to sensitize personnel towards cultural needs, beliefs, practices and preferences of indigenous women, with a focus on human rights, gender equity and quality of care.
authors.affiliation: Centre for Health Systems Research, National Institute of Public Health, Avenida Universidad # 655, Colonia: Santa María de Ahuacatitlán, CP: 62100, Cuernavaca, Morelos, Mexico. midiam.ibanez@insp.mx.
authors.forename: Midiam
authors.initials: M
authors.lastname: Ibáñez-Cuevas
authors.affiliation: Centre for Health Systems Research, National Institute of Public Health, Avenida Universidad # 655, Colonia: Santa María de Ahuacatitlán, CP: 62100, Cuernavaca, Morelos, Mexico. ileana.heredia@insp.mx.
authors.forename: Ileana B
authors.initials: IB
authors.lastname: Heredia-Pi
authors.affiliation: Regional Centre for Public Health Research, National Institute of Public Health, Tapachula, Mexico. sergio.meneses@insp.mx.
authors.forename: Sergio
authors.initials: S
authors.lastname: Meneses-Navarro
authors.affiliation: Centre for Health Systems Research, National Institute of Public Health, Avenida Universidad # 655, Colonia: Santa María de Ahuacatitlán, CP: 62100, Cuernavaca, Morelos, Mexico. blanca.pelcastre@insp.mx.
authors.forename: Blanca
authors.initials: B
authors.lastname: Pelcastre-Villafuerte
authors.affiliation: Centre for Health Systems Research, National Institute of Public Health, Avenida Universidad # 655, Colonia: Santa María de Ahuacatitlán, CP: 62100, Cuernavaca, Morelos, Mexico. miguel.gonzalezblock@gmail.com.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: González-Block
mesh_terms: D016550:Birthing Centers / Q000706:statistics & numerical data*; D005260:Female; D017144:Focus Groups; D019981:Health Care Sector / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data; D008800:Mexico; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D057240:Patient Preference; D044382:Population Groups / Q000706:statistics & numerical data*; D011247:Pregnancy; D036301:Qualitative Research