Sisters Walking Together: A Case Study of the CASA Model of Professional Midwifery Training

Over the past three years there has been an increased focus on reducing global maternal mortality in developing countries. While substantial progress has been made, improvement remains slow in some areas. Making formal maternal healthcare services more acceptable, affordable and accessible to rural communities where the majority of maternal deaths occur, remains a considerable challenge. This study looks at the model of professional midwifery training employed at La Escuela de Partería Profesional de CASA [the CASA School of Professional Midwifery] in San Miguel de Allende, Mexico, whose aim is to train professional midwives who will provide culturally acceptable services in rural communities. It examines how the school's model reflects the development concept of community participation. This study adopted a single case study methodology to examine community participation at the CASA School of Professional Midwifery. Data collection techniques included the use of Semi-structured interviews, Focus Groups, Participant Observation and Document analysis. The study found that the CASA School included elements of participation within its model and highlights the different ways in which outsiders and insiders may arrive at implementing community participation-type processes in development initiatives. The study also finds that because of differences between the biomedical and development paradigms, the reality for many communities is that they are only permitted to participate in the maternal healthcare paradigms and models sanctioned by the state. The conclusion was that the CASA model of professional midwifery offers a new way to think about the relationship between maternal health professionals and the community, and of integrating communities back into the maternal health discourse.