Objective. To assess the determining role of financial situation and gender relations on maternal mortality among Indigenous women in Chiapas, Mexico. Methods. A quantitative/qualitative study was performed by means of a survey of 158 families, as well as in-depth interviews of persons linked to cases of maternal death, community leaders from throughout the region, and focal groups composed of traditional birth attendants. Results. Decision-making surrounding women's health within the household is a critical problem because it is entirely in the hands of the husband and his relatives. In cases of high-risk pregnancy or birth, options for seeking care outside the community become limited, so that 48.7% of all obstetric cases are assisted by traditional birth attendants, 45.3% by relatives, and 6% by the mate. The problem is compounded by the high level of marginalization and very low human development index that characterize the region under study, by women's exclusion from the ownership of goods, including land, and by the fact that 97.7% of women only speak indigenous languages. Conclusions. Gender inequities within Indigenous families, together with a household economy that does not cover the basic necessities, are among the factors that keep women from receiving the necessary care during their reproductive processes. Because of the low socioeconomic status these women have, decisions surrounding care during pregnancy, birth, and the puerperium take a large toll on their health and their lives.
