Efforts to integrate traditional midwives into state health systems have not succeeded in reducing perinatal mortality, but have nevertheless continued in many countries, including Mexico. The authors used ethnographic methods to examine an NGO's efforts to integrate traditional midwives into the state health system in the Sierra Madre region of Chiapas, Mexico. We found that most of the traditional midwives in the study area have little to gain by such integration, and ask whether it is possible, practical, and ethical to integrate traditional midwives into health institutions until and unless such policy is grounded in local realities.
Keywords: Birth centers; Mexico; TBA training; maternal health; traditional midwives.