Although they have different methods and foundations, traditional midwifery and institutional medicine coexist as two parallel systems which serve the same vital need: accompanying birth. Medical science does not consider traditional midwifery as a professional activity. However, maternal and infant mortality rates do not differ significantly between urban and rural areas in Mexico – thanks to the fact that traditional midwifery has not disappeared.
Traditional midwifery is an ancient activity in Mexico and many regions around the world. It pre-dates medical science from any perspective. A traditional midwife is a person with the inherited knowledge, empathy and healing qualities to accompany women during pregnancy and childbirth, as well as in the post-natal period. All of this is done on a nonprofit basis, as midwives see their service to their community as honouring a gift of life.
Traditional midwifery in today’s Mexico
Like much knowledge, midwifery has been transmitted orally. Direct contact with the women who are the custodians of the tradition has been essential to preserving it over time. Midwives learn from their grandmothers and mothers, passing on their knowledge to the next generation. Even today, among Indigenous and Afro-Mexican communities, the tradition continues within families and community networks.
Midwives understand herbal medicine, massage, temazcal baths, pain management, and healing. It is even said that they know how to turn babies in the womb when necessary. They perform prayers and rituals to bless the girls and boys who come into the world. In many remote areas of the country, where there are no public medical services, these wonderful women travel long distances to attend a birth. Their work undeniably contributes to public health.
It is not, however, considered part of public health systems. Unlike maternity services offered by state institutions, traditional midwifery does not adhere to programmes, objectives, goals or budgets. Over the last hundred years, today’s conventional medicine has established itself through policy and regulation as the exclusive way to provide health services, based on scheduled appointments, clinical examinations, and medication. It discriminates against other forms of healing, which are seen as being based on “beliefs” and “hunches” rather than science and reasoning.
Regulatory barriers and legal reform
The practice of traditional medicine is often restricted or prohibited. In the case of traditional midwifery in Mexico, obstacles began to arise indirectly through administrative procedures. Obtaining a birth certificate required the signature of a qualified health professional on a standard form available only in Spanish, not Indigenous languages. Without this certificate, there was no registration, even if the traditional midwife accompanied the parents to the registry office.
It was then decided to offer training to traditional midwives, so they could be accredited in a national register of midwives. Some decided to participate in the training and joined maternal and neonatal healthcare teams in public institutions. The register excluded traditional midwives who did not participate in the training, even though their work is recognised by the Indigenous and Afro-Mexican communities to which they belong. For many midwives, these procedures caused confusion and a loss of autonomy in the exercise of their work.
In response, I proposed a reform to the law to establish respect for traditional Indigenous medicine as a legal objective of the health system. The reform was passed, and discrimination against traditional midwives is now illegal in Mexico. They must be given the necessary support to practise in dignified conditions. Specifically, the law mandates those responsible for population records to recognise traditional midwives when issuing birth certificates.
The new law, Mexican standard NOM-020-SSA-2025[1], defines a traditional midwife as a person recognised by their community – whether Indigenous or Afro-Mexican, rural or urban – who, through intergenerational or community transmission, typical of their culture of origin, acquires the traditional knowledge and practices for the care of pregnancy, childbirth, the postpartum period and the newborn, based on their worldviews and use of their biocultural resources.
Government of Mexico. (2025) Norma Oficial Mexicana NOM-020-SSA-2025, Diario Oficial de la Federación, 4 March. Available at: https://www.dof.gob.mx/nota_detalle.php?codigo=5750807&fecha=04/03/2025#gsc.tab=0 (accessed January 2026).
The purposes of the law are to protect the free exercise of this ancestral practice, and the right of a mother to freely choose who accompanies them during childbirth. It strengthens the autonomy and self-determination of Indigenous and Afro-Mexican peoples and communities.
I hope this law sets a precedent that could inspire other governments elsewhere. However, it is only a first step forward. The issues it addresses cannot be resolved through legal provisions alone.
Ultimately, the challenges faced by traditional midwifery in Mexico, and in many parts of the world, are rooted in the perceived exclusivity of medical sciences in people’s wellbeing. Public health authorities and institutions, and above all medical professionals, must eradicate these behaviours of exclusivity and recognise traditional midwifery as an activity as valuable as their own.
