Irma Lopez

Irma Lopez, 29, with her newborn son, Salvador, at a clinic in Jalapa de Diaz, Mexico. Mexican officials suspended two hospital directors after Lopez, an indigenous woman, was denied entry and was forced to give birth on the lawn. (Chema Alvarez / Associated Press / October 6, 2013)

MEXICO CITY — Irma Lopez, a Mazatec Indian, waited to receive attention at a medical clinic in Oaxaca, but her labor pains became overwhelming. Spurned by the nurses, she retreated outdoors — and abruptly gave birth to a baby boy on the hospital lawn.

A few days later, it was revealed that two other pregnant indigenous women had also been turned away from Oaxaca hospitals, one of whom also delivered on the lawn, and that a fourth woman had been forced to have her baby on the reception floor at a hospital in Puebla.

On Oct. 6, yet another woman, Susana Hernandez, of the indigenous Tzotzil community in Chiapas state, died after childbirth in what relatives and maternal rights advocates say may have been medical negligence.

The cases have underlined the inferior treatment often given to Mexico's indigenous communities, especially women. They have prompted new demands for greater access to healthcare, especially for Mexico's poor, and, unusually, have resulted in punishment for several hospital managers.

"The right to health protection is a fundamental right … especially for pregnant women," Mexico's human rights ombudsman, Raul Plascencia, said. He opened investigations in the Oaxaca and Puebla cases. "The vulnerability of indigenous communities is worse for women, who suffer a lack of basic material needs and services."

Mexico's maternal mortality rate is twice that of the United States but below the average for Latin America, according to the World Health Organization. However, the statistics for indigenous women in Mexico are dire: Childbirth and infant deaths are highest in states with the largest indigenous communities, according to Mexico's Maternal Mortality Observatory, exacerbated by poverty, isolation and abysmal educational systems.

According to the most recent data from the national statistics institute, 72.3% of indigenous Mexicans live in poverty (about 8.2 million people), compared with 42.6% of the non-indigenous (43.1 million people). The poorest states are Chiapas, Oaxaca and Guerrero.

Lopez, 29, had arrived at the hospital in San Felipe Jalapa de Diaz in Oaxaca state early in the morning on Oct. 2. Labor pains had already started, she later said, but the nurse refused to admit her. After about an hour and a half, and without having been attended to, Lopez stepped outside. And there her baby was born.

The hospital then admitted her, charging her for medicines, supplies and even the bed she recovered in, Lopez said.

The case received considerable attention because someone took a photo of Lopez giving birth on the lawn, and the picture made the rounds of social media, horrifying many Mexicans.

But it turned out that such treatment was far from unique. Oaxaca officials reported that two other women in the last six months had been refused attention at local hospitals and were forced to give birth outside.

Initially, authorities at Lopez's hospital offered several excuses, at one point saying she didn't speak Spanish and couldn't make herself understood. In fact, as she proved in interviews with reporters, she speaks perfectly intelligible Spanish.

A week after the incident, two top directors of the hospital were suspended.

"It's good for everyone to see how these nurses and doctors act," Lopez said.

In the Puebla case, the woman was of modest means but not indigenous. Maria del Carmen Oceguera, 21, was ignored by hospital administrators even as her labor pains increased, her family told reporters. When she could no longer resist, the baby was born on the reception area floor.

The state government fired the director of that hospital after a video of the birth was circulated.

Hernandez, the Tzotzil woman, checked into the women's hospital in San Cristobal de las Casas, one of the main cities of Chiapas state, on Oct. 4, already in labor, according to her family and a coalition of maternal rights groups. Doctors delivered her baby by caesarean section on Oct. 6, and she died shortly afterward.

The family contends they were not informed of the complications that apparently put Hernandez in danger, nor did they give permission for several medical procedures that were performed along with the cesarean, including the tying of Hernandez's tubes. Her father was quoted by the rights groups as saying he felt they were treated "like animals."

"There is a general problem in Mexico with the handling of women" by the medical establishment, said Estefania Vela, a health law expert at a Mexican think tank. "Then with indigenous women it becomes what is often called double discrimination. It becomes also a problem of class, of marginalization. "

wilkinson@latimes.com