Evaluation of the MacArthur Foundation’s Mexico Midwifery Initiative 2015-2018
February 20, 2019 | Evaluation | Population & Reproductive Health

Total Awarded: $17.37 million
Total Grants: 51 grants  
Evaluation Period: 2015 – 2018                                
Geographic Focus: Mexico

Background


Our Population and Reproductive Health Program in Mexico entered a final phase from 2015 – 2019. Since entering the field in 1986, we aimed to contribute to Mexico’s progress in reducing the national maternal mortality ratio. In the 1990s, we helped create and strengthen a national movement that followed two of the field’s most important international conferences for reproductive health: the International Conference on Population and Development (1994) and the Fourth World Conference on Women (1995).

Our investment focused on the growth of civil society to support reproductive and sexual health and rights. In its early years, the program contributed to a paradigm shift from population control to these rights. Our leadership and early investments contributed to catalyzing a strong and dynamic movement for reproductive health and rights that has since characterized Mexican civil society. Building on this work, in the early 2000s, we began to focus our grantmaking on maternal mortality prevention and the promotion of young people’s reproductive and sexual health and rights.

Our final initiative in reproductive health in Mexico was designed to improve maternal and reproductive health and accelerate the decline of maternal mortality and morbidity in Mexico by strengthening the primary health care system through professional midwifery. Projects began in 2015, and all grantmaking was concluded in 2018.

What We Evaluated


We contracted with Consultores Colibrí an external evaluator, to conduct the evaluation of our midwifery initiative. A baseline evaluation was completed in February 2016. It explores the landscape and baseline information related to the four thematic areas of the final phase of our work: legal and normative framework, recognition and demand, education, deployment and quality of care. And a progress report was completed in 2018. The progress report focuses on the same four areas of work: documenting knowledge and acceptance of the concept of midwifery, professional midwives who attended labor and delivery in the public health care system, evidence-based practices used in midwifery training, and the quality of care provided by midwives and physicians. Both reports represent the use of quantitative and qualitative methodologies and analysis techniques.

What We Learned


The baseline evaluation provides a snapshot of professional midwifery in Mexico and the parameters for assessing advances. Since baseline, important advances have taken place to expand the presence of professional midwives as part of Mexico’s public health system. In particular, the potential for midwifery to become a permanent feature in the country’s public health system has increased since the baseline report. As of 2018, there have been increases in the:

  • Number of students, midwives, and midwifery sites throughout the country;
  • Quantity and influence of midwifery proponents and champions in the state and federal government and advocacy groups;
  • Efforts to disseminate information and sensitize health personnel to midwifery models of care;
  • Public authorities’ awareness of and actions in favor of midwifery and an emerging dialogue among innovative state-level actors about what works.

These advances contribute to momentum for professional midwifery around the country, with the most significant progress seen in locations where the initiative’s four thematic areas, and our partners’ corresponding efforts, converged. Despite these advances, more work is needed, as professional midwifery is not yet widely understood or recognized as a viable or desirable strategy for improving maternal and neonatal healthcare on a national scale and in the Mexico health system. In particular, Mexico still lacks the appropriate policies and monetary resources needed to maintain the advances that have been made to date.


Download the full report › 
Download full report in Spanish ›
2015 Baseline Report on MacArthur’s Mexico Midwifery Initiative ›
MacArthur’s evaluation philosophy ›


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