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Over the past 20 years, Central America (CA) has made considerable progress in improving the health status of its populations. However, in some countries, the overall health status remains below average with poor outcomes concentrated geographically among the poor and Indigenous populations. Although Indigenous people make up the second largest population in CA, these populations have less access to healthcare, and funding for initiatives to improve maternal health is scarce. In many communities across CA, women continue to rely heavily on plant-based medicines for health and well-being, and yet there is a paucity of information regarding the safety and efficacy of these therapies. Sourced from available academic, governmental, and gray literature, in both English and Spanish, this chapter reviews maternal health issues among the Indigenous, Ladino, and other ethnic women of CA, evaluates the role of traditional medicine practices and their influence on maternal health outcomes, and reviews the existing scientific evidence supporting the use of traditional (i.e., plant-based) medicines for pregnancy-related health conditions.

Ethnopharmacological relevance Antimicrobial drug resistance is a growing threat to global public health. Historical records and herbal texts relating to traditional Celtic medicine indicate an extensive pharmacopeia of plants for treating infections likely caused by microbes. However, a major barrier for successful integration of these remedies into mainstream practice is the current lack of accurate interpretation and scientific validation. Materials and methods We investigated the flora of the Isle of Arran, Scotland, via in situ targeted screening of 83 out of 138 plants identified in Meddygion Myddvai (a 14th century Welsh manuscript) to treat conditions related to microbial infections, and an additional 18 plants from modern ethnobotanical knowledge on the island (Scottish School of Herbal Medicine). In a follow-up proof-of-concept study, bioassay-guided fractionation was performed to identify bioactive constituents from two high scoring hits that inhibited Staphylococcus aureus (Gram-positive) and Escherichia coli (Gram-negative) bacterial growth. Results 67 historical plants (80.7%) and 14 modern plants (77.8%) were found to have detectable levels of antimicrobial activity when tested using Mobile Discovery kits, with human saliva as a source of bacteria for screening. Sabinene, a natural bicyclic monoterpene from juniper “berries” ( Juniperus communis L.) and alliin, a natural sulfoxide from garlic cloves ( Allium sativum L.), were isolated and confirmed as primary antibacterial leads. Conclusion Using historical medical sources such as those associated with traditional Celtic medicine to guide rigorous, evidence-based scientific investigation, provides additional leads for new and alternative bioactive molecules for combating bacterial diseases.

Lifestyle-related, non-communicable diseases, such as diabetes, hypertension, and obesity have become critical concerns in the Pacific islands of Micronesia. We investigated the relationship between the diminution of traditional lifestyle practices and the decline in the health of the population in the State of Pohnpei, Federated States of Micronesia. To assess this, our interdisciplinary team developed two scales, one to rank individuals on how traditional their lifestyles were and one to rank individuals on the healthiness of their lifestyles. Participants' locations were categorized as living on a remote atoll, living on the main island, or as a transitional population. Pohnpeians living in transitional communities (e.g. recently moved from a remote atoll to the main island, or the reverse) ranked lowest on both the tradition and health scales, rather than ranking intermediate between the remote and main island groups as we had hypothesized. As predicted, individuals residing on the remote atolls were living the most traditional lifestyles and also had the healthiest lifestyles, based on our rating system. The higher an individual scored on the tradition scale, e.g. the more traditional life they lived, the higher they scored on the health scale, suggesting the importance of traditional lifestyle practices for maintaining health. These findings have significant implications for promoting health and longevity of Micronesians and other Pacific Island peoples. We suggest the process of transition be recognized as a significant lifestyle and health risk and be given the attention we give to other risk factors that negatively influence our health. Based on our findings, we discuss and recommend the revitalization of particular traditional lifestyle practices, which may advance healthy aging among Pohnpeians.

Findings from this research contribute to the literature on Q’eqchi’ Maya ethnomedicine by associating the biological activity with the traditional remedies, subsequently further validating traditional Maya medicine and broadening the understanding of the efficacy of these plants. Documentation of traditional medical treatments aids in preserving the knowledge of these traditions and creates documents that can be used in the training of new apprentices in traditional Maya medicine, in addition to the long tradition of studying one on one with an elder traditional healer. We hope that in demonstrating the associated bioactivity in the medicines that are being used in this traditional medical system, these results will further validate and return prestige to traditional Maya medicine.

Traditional healing and herbalism practices can be very particular to the individual practitioner, and people’s knowledge is always being enhanced by experience and exposure to others’ knowledge. Traditional Q’eqchi’ Maya medicine is dynamic and continues to advance on the individual level as remedies, preparations, and treatments are refined, or newly discovered. Maya traditional medicine at the medical system level continues to make advancements as well, and research efforts such as this study make a contribution in support of this continued advancement. Plant-based remedies and other traditional treatments are supplying primary healthcare for much of the Maya world, much as they always have. It is only that with each successive generation there are far fewer practitioners and keepers of this important knowledge. Though in-depth knowledge of traditional plant-based treatments still remains in the Belizean Q’eqchi’ community, today this knowledge is mostly held by Q’eqchi’ elders, with very few young Maya apprenticing. The detailed documentation of such knowledge can be utilized in educational efforts to train Q’eqchi’ youth in traditional Maya medicine. The results of this study function as a reference to those practicing traditional medicine, those who wish to learn traditional Q’eqchi’ medicine, and biomedical practitioners who wish to take an integrative approach or provide culturally competent care to their indigenous patients. Efforts to integrate traditional indigenous medicine and biomedicine in Belize and regionally can benefit as well from thorough ethnomedical documentation and associated bioactivity verification.

Q’eqchi’ Maya women face considerable barriers to education, employment, and other opportunities to improve their livelihoods in Belize. In addition, due to a combination of sociocultural factors, women’s traditional knowledge in the Q’eqchi’ communities is disappearing at a faster rate than other areas of traditional knowledge. A retired midwife explained that women’s knowledge and knowledge of treatments for women’s health are the first to be lost. According to her, in the past there were more women healers and they specialized in women’s reproductive health. Men’s knowledge is also becoming fragmented, but less so, partially because many of their networks have stayed farther-reaching since they have not been tied to domestic obligations to the same extent as women. The knowledge of Q’eqchi’ ethnomedical treatments is highly gendered, with women knowing how to use different medicinal plant species than men. This highlights the need for the documentation and revitalization of women’s traditional knowledge.