BACKGROUND:
Maternal mortality remains a pressing issue worldwide, despite global improvements. Indigenous people have disproportionately worse health outcomes compared to their non-Indigenous country peers. The Rarámuri, or Tarahumara, are an Indigenous group living in the Sierra Madre mountains of northern Mexico. They are one of only a few groups in the world that have no system of native midwives to help women during childbirth. Women have traditionally gone into the woods alone to give birth. Similar to other Indigenous groups in Mexico, the Rarámuri are more likely to live in poverty and have very limited access to Western healthcare. Consequently, the region’s maternal mortality rates are extremely high.

OBJECTIVES:
This study explores the reciprocal relationship between cultural and social forces and how they affect Rarámuri maternal health knowledge and practices.

METHODS:
Research was conducted in five communities spanning 240 km/150 miles with varying degrees of cultural assimilation and distance to healthcare centers. Data was collected through semi-structured interviews and analyzed through an interpretive, inductive phenomenological approach.

RESULTS:
The results validated that both cultural and social factors impact pregnancy, birth, and postpartum knowledge and practices. The following themes emerged: (a) cultural traditions, (b) fatalism, (c) time orientation, (d) health literacy and orality, and (e) being caught in the middle. The results also highlight how structural violence and persistent discrimination perpetuate adverse health outcomes.

CONCLUSIONS:
In order to improve health outcomes for the Rarámuri, both interpersonal and systemic changes need to be made. On the interpersonal level, healthcare providers working with Indigenous populations should practice cultural humility, value diverse worldviews, adapt interventions to local culture, and acknowledge the consequences of historical trauma on the acceptance of Western medicine. At the systemic level, investments in education, road infrastructure, and healthcare services in rural areas are imperative to improving Indigenous health outcomes.

KEY MESSAGE:
. Poster session 4 (Group B)