Cultural Competence in Childbirth in Multicultural Ecuador: Lessons for Evaluation Open Access
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Despite Ecuador’s increased public health spending and improvement in health outcomes, the Maternal Mortality Rate (MMR) in the country is high and has been increasing in tendency in the past decade. Furthermore, there is a clear gap in the proportions of institutional births between indigenous and non-indigenous women. Given the implementation of culturally adequate childbirth services in public hospitals in Ecuador, which occurred mostly after the Ministry of Public Health published technical guidelines for the cultural adaptation of childbirth services in 2008, this dissertation sought to assess the extent to which the availability of culturally adequate childbirth services affects the proportion of institutional deliveries and maternal mortality rates. After reviewing the main theoretical frameworks regarding the importance of culture in access to health care, this dissertation used a mixed-methods approach to analyze the determinants of institutional deliveries, and the effects of culturally adequate services on maternal health outcomes. In addition, this dissertation builds on the experience evaluating the impact of cultural competence in childbirth services to reflect on the need for culturally responsive intercultural evaluation.