safe+natal — Comadrona-Designed Smartphone Checklist for Maternal Risk Screening in Rural Guatemala

In Guatemala's western highlands, comadronas — traditional Maya birth attendants — deliver a large share of babies in rural indigenous communities, but historically had no standard tool to flag which pregnancies needed a hospital referral, and low literacy in Spanish made most digital health tools unusable for them.

Starting in 2011, Wuqu' Kawoq / Maya Health Alliance and Emory University's Co-Design Lab for Health Equity worked directly with comadronas in Tecpán, Chimaltenango, to build safe+natal, a smartphone checklist app; the midwives themselves created the on-screen pictograms, with every prompt carrying audio instructions in Kaqchikel Mayan rather than Spanish.

A cluster-randomized feasibility trial followed 44 traditional birth attendants across 799 pregnancies. Referrals for high-risk pregnancies rose from a median of 20 per 100 births without app access to 33 per 100 births with it (p=0.03); when the comparison group later gained access, their rate rose to a matching 34 per 100, reproducing the effect. Since scaling from 2017, around 40 midwife partners now use the tool across more than 50 communities, covering roughly 800 births a year.

The peer-reviewed evidence covers referral behaviour in a 44-midwife trial; broader program-level claims about falling maternal deaths and rising facility births come from the implementing organisation's own reporting rather than a controlled study, and the lead academic researchers are also affiliated with the NGO, so those figures should be read as promising but not independently audited.