In Cotacachi, ancestral midwives are defending home birth as Indigenous knowledge, bodily autonomy, and political resistance, challenging Ecuador’s medical system while training a new generation to protect women from obstetric violence and cultural erasure.
Birth as Territory and Rebellion
In the Andean communities of Cotacachi, in northern Ecuador, birth is not only a private family event. It can also be a quiet act of political defiance, a way of saying that the body, like land, has memory, borders, and rights. According to an EFE report, ancestral midwife Martha Arotingo describes home birth today as “a political act,” one in which a woman says she is deciding for her territory, for the body that will give birth.
That phrase carries the weight of a much longer history. In these communities, childbirth sits at the crossing point of Indigenous knowledge, women’s autonomy, state power, religion, and Western medicine. Arotingo, who learned midwifery from her mother as a child and has accompanied births in her territory for more than twenty years, argues that women’s bodies have long been controlled by the state, the Church, and the medical system. For her, the first step is for a woman to recognize her body as her first territory.
EFE reports that Arotingo is now vice president of the Indigenous Council of Ancestral Medicine Hampik Warmikuna, which is promoting the country’s first ancestral midwifery school, Unanchu Mamakuna. The project addresses a simple but urgent problem: midwives are aging. Arotingo says the youngest traditional midwives among her companions are between fifty-six and sixty years old, and many have stopped attending births even though their work remains essential for Indigenous women.
This is not nostalgia dressed as medicine. It is a struggle over who gets to define safety, knowledge, and care. For many women in Cotacachi, the home is not a backward space but a protected one, surrounded by family and community. Arotingo told EFE that a woman should be able to decide what she wants to do, where, how, and with whom she wants to give birth. Choosing home birth, she argues, should not be treated as a criminal act. The woman is simply deciding.
In Latin America, the word ‘deciding’ has rarely been simple for Indigenous women. The region’s history is full of institutions that claimed to civilize, modernize, save, or discipline Indigenous bodies while dismissing their own systems of care. What is unfolding in Cotacachi is therefore not only a debate over childbirth. It is a debate over whose knowledge counts as science, whose pain counts as evidence, and whose way of life is allowed to survive.
Obstetric Violence Leaves a Long Shadow
Arotingo’s defense of ancestral midwifery is also shaped by what many women experience in hospitals. According to EFE, she says midwives do not attend births by staring at the clock or forcing the woman into institutional time. They observe how the mother is doing and adapt to her rhythm and needs. That difference matters in places where medical authority has often treated Indigenous women as subjects to be managed, not people to be heard.
The numbers in the notes are stark. In Ecuador, forty-eight percent of women have suffered at least one act of gynecological-obstetric violence in their lifetime, according to the National Survey on Family Relations and Gender Violence against Women from the National Institute of Statistics and Census. Among Indigenous women, the figure rises to nearly seventy percent. That gap explains why home birth, in this context, becomes political without needing a banner.
The issue is not whether hospitals can save lives. The issue is what happens when an entire system makes Indigenous women afraid, ashamed, rushed, ignored, or mistreated at the moment when they are most vulnerable. A health system can have technology and still fail at dignity. It can have protocols and still lack respect. It can speak in the language of risk while refusing to recognize the risk of humiliation.
For Arotingo, defending midwifery means defending territory and the rights of Indigenous women. That link is crucial. In many Latin American struggles, territory is not only land. It is water, language, food, plants, ceremony, body, and memory. To say the body is territory is to reject the idea that institutions may enter without consent and reorganize life according to outside hierarchies.
The school founded by the Indigenous Council of Ancestral Medicine in Cotacachi seeks to address that challenge through continuity. Arotingo told EFE that it is the first ancestral midwifery school at the national and, as she understands it, global levels, where knowledge is taught by wise women. The school is free for women from the communities and has already trained nine midwives who now accompany births in different local territories.
That detail matters because many communities are far from hospitals and health centers. Distance is physical, but it is also emotional and cultural. EFE reports that some women avoid those services because they have been mistreated, violated, or poorly treated. Arotingo says there is a lack of trust. Trust, once broken, cannot be rebuilt with new buildings or official language alone. It requires recognition.
A School Against Erasure
The fight for ancestral midwifery is also a fight against persecution. Arotingo told EFE that midwives had to accompany births in silence for years. After helping a woman give birth, they sometimes asked mothers not to mention their support because they feared persecution or criminalization. That silence is its own archive of discrimination.
The discrimination, she says, is also tied to formal education. Midwives have an education within their own system, but the Western system does not recognize it. This is one of the oldest colonial wounds in Latin America: knowledge exists, works, heals, and is transmitted, but because it does not pass through the approved institution, it is treated as superstition, informality, or danger.
Carmen Morán, president of the Ancestral Medicine Council and a student at the midwifery school, told EFE that midwives faced discrimination in hospitals for many years and that some were even detained. Yet they remained the only support for many women in distant communities. She also noted that their work has historically been voluntary, without any remuneration.
That unpaid labor reveals another layer of the story. Women preserve knowledge, attend births, hold families together, and protect community health. Yet, their labor is often treated as a natural duty rather than skilled work. The same society that depends on them can still deny them recognition.
For María Piñán, also a student at the school, the way people are born shapes the society they later build. EFE reports that she connects childbirth with emotional care, food, the community environment, pregnancy, and postpartum life. Her view widens the issue beyond delivery itself. Birth becomes the beginning of a social relationship, not just a medical episode.
In Cotacachi, where communities live amid great biodiversity, medicinal plants remain part of healthcare and pregnancy support. These practices, transmitted by mothers and grandmothers, continue to live not because they are frozen in the past, but because communities still need them. Morán told EFE they do not want this knowledge to disappear because their grandparents healed with it.
Ecuador’s debate over ancestral midwifery is therefore not a choice between past and future. It is a demand for a future where Indigenous women do not have to abandon their culture to receive care, where hospitals are not allowed to confuse authority with violence, and where home birth is not treated as backward simply because it refuses institutional control.
In Cotacachi, the act of accompanying a birth has become a way to defend life from erasure. A woman gives birth in her home, with her people nearby, and the gesture says more than any policy paper. The body remembers. The community remembers. And the knowledge that survived in silence is now learning to speak in public again.
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