Tijuana, Mexico – Ximena Rojas drives through the streets of Tijuana, Mexico, at the wheel of an old station wagon that can become an ambulance if necessary.
She often gets lost, but she always arrives where she needs to be.
Rojas has just turned 35 years old. She wears her long hair tied in a braid and speaks in a soft tone.
She is native of Veracruz, a port city located along the Gulf of Mexico, but she studied nursing and obstetrics at the National Autonomous University of Mexico in Mexico City and began assisting home births in 2010.
In 2013, she moved to Baja California, a Mexican state on the US border, to study sex education and she decided to stay.
“The border attracts me,” she tells Al Jazeera. “It is a complex area, but also very vital,” she says.
Rojas is a “partera”, a midwife, and her role is to accompany mothers during their pregnancy and to stand by their side when they give birth.
Midwifery was only officially recognised as a profession in Mexico in 2011, but Rojas says midwives are still not typically allowed to accompany their patients in the delivery room. In public hospitals, women are often not allowed to have anyone, not even a family member, present with them while they give birth.
But Rojas, who is determined to help those most in need, has assisted in more than 350 births.
She primarily helps Mexican women who decide to give birth in their homes to avoid public hospitals in Tijuana and the obstetric violence she says pregnant women often face.
But she also has found that Haitian women who wait along the border in the hopes of getting to the US are in much need of care.
In Tijuana’s public hospitals, women in labour are put in a large room, often with up to 11 other women. On busier days, as many as 20 women are put into a single room.
These women are first taken to an “expulsion room”, and after a baby is born, they are taken to the “post-birth” room.
Six hours after giving birth, and provided there are no complications, the mother is usually discharged from the hospital.
“I have lived out the obstetric violence,” Rojas says, referring to what the World Health Organization (WHO) calls the “abusive” and “dehumanising” treatment of pregnant women and their bodies.
“I had a vaginal birth when I was 16 years old, and they did not even allow my mum to accompany me,” she says.
“Routine procedures are made to all women every day in the public hospitals, such as episiotomy, scraping of the uterus, induction,” she adds.
According to a national survey, ENDIREH, released last year, 33.4 percent of women between the ages of 15 and 49 who had given birth in Mexico suffered from obstetric violence from 2011-2016.
As a midwife, Rojas offers women a choice to avoid both the public hospitals and the often expensive clinics where she says doctors try to convince women to have unnecessary cesarean sections (c-sections) to earn more money.
The pressure on women by private doctors to have c-sections is not uncommon throughout Latin America.
Mexico has one of the highest cesarean birth rates in the world. About 45 out of every 100 women have the procedure, according to the latest Secretariat of Health statistics gathered in 2015.
The rate in Mexico is three times the maximum rate recommended by the WHO.
It is not known how many of these procedures are necessary, but Rojas says that doctors often point to issues like obesity, hypertension, and diabetes as reasons why a c-section must be performed.
ENDIREH 2016 also found that of the 3.7 million women who had a cesarean, 10.3 percent were not informed of the reason for the procedure and 9.7 percent said they were not asked by their health provider for permission to perform it.
Monica Maldonado Millan, a paediatrician who works in a clinic at the Mexican Social Security Institute in Tijuana, said that, of the average 300 births at the clinic each month, “120 are c-sections”.
She told Al Jazeera that “this reflected a poor prenatal supervision”, adding that “Mexico should invest more in preventive medicine, but it does not”.
In her work, Rojas is accompanied by Bianca Tema Mercado, a 34-year-old of Mexican origin who was born in the United States and is resident in Chula Vista, San Diego County.
“When I started to practise as a midwife,” Mercado recalls, “I worked at the Birth Roots Women’s Health and Maternity Center in San Diego, [California], the first one across the border.”
She says that many of the women she served at the centre are from Tijuana, and had initially turned to private clinics thinking they were doing the right thing for their pregnancy. But, Mercado says, these women often found doctors who recommended c-sections early in the pregnancy when it is often hard to determine the necessity of the procedure.
“These mums had therefore decided to go to the United States where the caesarean rate is 30 percent, which is always high, but still lower than in Mexico.”
Mercado and Rojas define themselves “frontier midwives” because they take care of women who cross borders daily.
The two women don’t just help future Mexican mothers, but also dozens of Haitian women who, since May 2016, have arrived in Tijuana in hopes of reaching the US.
In the last couple of years, many Haitians have arrived in Tijuana from Brazil, where they had moved after the devastating 2010 earthquake, according to Brazilian media.
At that time, Brazil was preparing to host the World Cup in 2014, and the Olympics in 2016 and it needed labourers to built infrastructure.
But last year, the boom ended, and Brazil faced a new political-economic crisis.
Many Haitians decided to leave, crossing seven countries on foot or by bus, paying thousands of dollars to human traffickers, with the dream of starting over in the US.
While Haitians were granted Temporary Protected Status (TPS) in the US after the 2010 earthquake, increased restrictions have left many stranded on the border.
According to Soraya Vazquez, a lawyer and president of the Comite Estrategico de Ayuda Humanitaria (Humanitarian Aid Strategy Committee), a group of citizens and activists sprang into action in late 2016 to help Haitians with getting temporary permission in Mexico that would allow them to work.
“People welcomed them with generosity,” she says to Al Jazeera. “We had never seen such a positive reaction.”
Despite the welcome, those in need of medical attention, including pregnant women, faced many obstacles to getting the healthcare they required.
Recognising this, Mercado and Rojas saw a void they believed they could help fill.
“We started in September 2016,” Mercado recalls. “When I became aware of the situation of the stranded migrants at the border, I thought that among those people there must have been pregnant women and newborns and I also thought of the shortcomings of the Mexican healthcare system,” she says.
Many of the Haitian women they meet speak only Creole or French, sometimes Portuguese and a little Spanish.
This becomes an obstacle for most as there are no interpreters at the general hospital in Tijuana.
With the support of small donations, collected through social media and word of mouth, the two women came up with the idea to become frontier midwives.
They created Parteras Fronterizas, a charity that cares for mothers and pregnant women who are neglected by the public health system in Mexico.
The organisation pays for blood tests and ultrasounds.
Mercado and Rojas also invite the women to eat after the exams, which often require them to fast, and provide them with items like medicine and sanitary products.
“At first, we have seen many cases of miscarriage in pregnancy already advanced, as in the fifth or sixth month,” Mercado says. “These are things that with prenatal attention could have been avoided.”
In data provided by the federal delegate of the Instituto Nacional de Migracion of Baja California, Rodulfo Figueroa Pacheco said that at the end of August, there were 1,425 Haitians registered in Tijuana. Among them were 12 pregnant women.
Six of these women were or are currently being helped by Mercado and Rojas, who have conducted about 200 prenatal visits for about 50 women since May.
“They like to do group visits because maternity is not experienced as something private,” Rojas explains.
“This is good because there is always someone among the girls who speaks Spanish better and helps us to translate.”
The women the ‘frontier midwives’ help
Marie* was among the women Mercado and Rojas took care of last summer.
The 34-year-old Haitian woman spoke Spanish and acted as an intermediary between the midwives and other Haitian women.
She lived in a wooden hut in Zona Norte, close to the Juventud 2000 shelter where she was welcomed when she arrived in Tijuana.
It is an unsafe area, known for homelessness, prostitution and drug addiction. Many Haitians live here because they have no means of going any place else.
According to Rojas, Marie’s husband was often violent towards her and destroyed all of her medical records during her pregnancy.
“They are strong women who are experiencing what should be a happy time in hard conditions,” Rojas said, referring to women like Marie.
“Often, they change their home; sometimes it is difficult to reach them on the phone and, despite being worried about their pregnancy, they cannot cure themselves as it would be necessary.”
Marie welcomed a baby boy in October and is now living with her family in Miami.
Francois Andrelie, 34, was also in Marie’s group and she, too, spoke Spanish.
She arrived in Tijuana in early December 2016 after a three-month journey from Sao Paulo, where she had moved in May 2016 to stay with her boyfriend.
“The trip was dangerous,” Andrelie recalled.
“We climbed mountains; we crossed jungle and rivers,” she said.
“It was very scary.”
In July, when she was three months pregnant, Rojas and Mercado accompanied her to an ultrasound appointment at a popular downtown clinic in Tijuana.
Rojas and Mercado said they were following her pregnancy closely because she often experienced strong headaches.
“Every time I lie down, I feel the room tremble, as if I were on a truck, as if there was an earthquake,” Andrelie told Al Jazeera.
“When I realised I was expecting a child, I did not feel happiness,” Andrelie admitted.
“Here, I’m living a life that I do not like, I do not know if we can give this baby what it needs,” she added.
After the visit by Rojas and Mercado, Andrelie’s husband, Mezac, waited with a serene smile at the couple’s home.
She showed him the first picture of their future child and explained that everything would be fine.
For Rojas and Mercado, it is moments like this that makes the difficult times in their job as frontier midwives worth it.
“We do not know if, in the end, these children will grow in Mexico or if their mothers will succeed to move to the United States as they dream,” Mercado says.
“What we can do is make them come to the world in the best possible way, and it’s already a good start.”
*Names have been changed to protect the individual’s privacy.
The International Women’s Media Foundation supported Claudia Bellante and Meghan Dhaliwal reporting from Tijuana as part of the Adelante Latin America Reporting Initiative.