A woman was forced to give birth on the lawn of a medical clinic in Oaxaca, Mexico, after the clinic refused to administer her care.

Irma Lopez, of indigenous Mazatec ethnicity, walked an hour from her home to deliver her third child at the Rural Health Center in the village of San Felipe Jalapa de Diaz. Even though Lopez was reportedly fully dilated, a nurse refused to provide care, saying she was “still not ready” to deliver and that she should go outside. The health center’s director, Dr. Adrian Cruz, continued to refuse care while Lopez and her husband tried for two hours to get help. Irma eventually was forced to give birth to her third son, alone and without the aid of pain medication, on the lawn of the clinic.

A witness took a photo of Lopez squatting on the lawn in pain, her baby still attached at the umbilical cord. “The photo is giving visibility to a wider structural problem that occurs within indigenous communities: Women are not receiving proper care,” said Mayra Morales, Oaxaca’s representative for the national Network for Sexual and Reproductive Rights. “They are not being offered quality health services, not even humane treatment.”

Although health officials say Irma and her son are in good health, Oaxaca is one of Mexico’s poorest, most rural states where many women die of hemorrhaging or preeclampsia. According to the World Health Organization, hemorrhage and other complications of delivery are leading causes of death in Mexico, and women in rural areas and indigenous women are at greater risk. Mexican states with the highest indigenous population have the largest rate of maternal death by a wide margin.

The Oaxacan government suspended the health center’s director, Dr. Adrian Cruz, and officials are conducting state and federal investigations.

Media Resources: Daily Mail 10/10/13; Huffington Post 10/09/13; World Health Organization

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