Global Partners: Asociación Manos Abiertas

The Woman Behind the Clinic

After Hannah Freiwald came to Guatemala from Germany over 35 years ago, she had two babies in quick succession. Her first birth, in 1989, was via emergency c-section due to excessive uterine contractions caused by the too-high dose of Pitocin (a synthetic hormone used to start or speed up labor) given to her by the attending doctor. Her anesthesiologist mother, not her attending doctor, noticed the life-threatening emergency.

Her second birth was at home in Antigua with a traditional midwife, or comadrona. It was such an amazing experience, she went to El Paso, Texas, to complete her certification as a direct-entry midwife. After returning to Guatemala, she owned two birth centers before being approached by Planned Parenthood Federation of America (PPFA) with a request to help them open a reproductive health clinic. She was excited at the prospect of being able to reach even more women with patient-centered, evidence-based, holistic reproductive health and obstetric care.

The Women Who Run the Clinic Now

Asociación Manos Abiertas (AMA) was founded in Antigua in 2008. Over the past 16 years, the clinic has grown and now employs several midwives and nurses, all women, many of whom are of Mayan descent. Often, AMA staff are the first in their families to complete a formal education, and some of them have done so while working at Manos Abiertas. Several staff, for example, completed primary, secondary, and nursing school while simultaneously working in maintenance roles at AMA, before being trained to become practitioners by the organization’s midwives.

Diana S. Freiwald started following Hannah, her mother, around when she was eight years old, attending patient appointments and becoming intimately familiar with the field of midwifery. It’s no surprise that Diana followed in her footsteps, receiving her official midwifery certification in Mexico, and is now the Executive Director and Senior Midwife at AMA.

A Focus on Patient-Based Care

One of the goals of the practice is to empower women through autonomy, giving patients all of the information about their health status and letting them make decisions about the care they would like to receive based on a comprehensive explanation of their options. This is in stark contrast to the care women tend to receive in government hospitals, which is often brash, rigid, and disrespectful, according to Diana. “Obstetric violence” is reportedly common, with patients being ignored, shushed, yelled at, and denied requested care such as tubal ligations.

AMA provides reproductive health care from puberty through menopause, offering contraceptive services, cancer screenings, perinatal and delivery care, c-section prevention (95% of deliveries at private Guatemalan hospitals and 65% at public hospitals are via c-section, according to Diana), lactation support, and even pediatric care. In a typical year, AMA provides the following care to patients: 24 family planning day clinics, 270 short term contraceptive methods, 500–900 long-acting reversible contraceptive (LARC) methods, 305 gynecological consultations, 100 STI tests, 250 cervical cancer screenings, 52 post-abortion consultations, 270 prenatal check-ups, 20 vaginal deliveries, and 50 pediatric consultations. All women, regardless of their ability to pay, receive care.

The funding model at AMA is a combination of scaled fees for services and grants from organizations like Population Connection and PPFA.

AMA travels within a three-hour range, bringing its mobile clinic to marginalized communities in the departments of Guatemala, Sacatepéquez, Chimaltenango, and Escuintla. Sometimes, a mobile clinic sees only two or three patients, and sometimes it draws up to 75!

Partnerships Among our Global Partners

As of this year, Eleanor Unsworth, a Population Connection board member and the Executive Director at WINGS, one of our longest standing Global Partners, is on the board of AMA. The two organizations sometimes work together to bolster each other’s efforts, along with Maya Health Alliance, yet another of our Global Partners. Learn more about these amazing organizations here and watch the recording of a recent virtual event featuring Diana here.

Email Marian: mstarkey@popconnect.org

Thank you to all of our generous donors who make our Global Partners program possible! Without you, we wouldn’t be able to support the incredible work of the 19 small but impactful organizations currently benefiting from your contributions.