Night was closing in on the K'ekchi indigenous community in northern Guatemala's jungle-covered hills when Elvira Cuz gave birth to the first twin.

"Everything seemed normal," recalled her husband, Domingo Tot, who delivered the baby, as he had done with the couple's other children. He realised something was wrong, he said, when the second baby didn't emerge and his wife became obviously unwell.

But Mr Tot knew there was no point carrying his wife for six hours to the nearest road. Even if she survived that journey there would be no vehicle to take her to the closest hospital - one of three in the vast Petén province. So the 35-year-old farmer accepted the inevitable and watched his wife fade away by the tenuous light of a homemade kerosene lamp. The unborn child died in her womb.

The vast majority of deaths in childbirth are avoidable, which is why only four women die for every 100,000 live births in Sweden, and 13 in the UK. Women in many major Latin American cities are only slightly more at risk, and the national averages pale in comparison with many African and Asian countries, where the maternal mortality rates often top 1,000.

But the bigger picture masks the reality faced by indigenous Latin Americans. This is evident in Guatemala, where the Mayan Indian population (about half the total) is beset by extreme poverty, geographical isolation and acute and deep-rooted discrimination. "Guatemala is one of the countries in Latin America with the biggest challenges and the biggest shortfalls," said Javier Domínguez, the UN Population Fund's regional head of maternal health.

UNFPA is co-sponsoring a major international conference on maternal mortality beginning in London on October 18, in part to remind the world that it signed up to the Millennium Development Goal of reducing death in childbirth by 75% by 2015. In Guatemala nobody has any illusions that this can be achieved, despite a major campaign to address the problem in indigenous communities supported by the UN.

The strategy pivots around training traditional midwives - known as comadronas - who are responsible for most indigenous prenatal care and births. The idea is to teach them to identify potential complications early and convince them that these cases should be sent to hospital. But the midwives can face disdain, even hostility, from the medical establishment, which tends to dismiss their experience as at best inadequate and at worst actively dangerous.

At a training session in a Petén hospital, K'ekchi comadronas stood silently while they were harangued with a back-to-basics talk about foetal positions. "Lots of comadronas don't want to come to the hospital because they don't want to get told off," said midwife Rosario Botzoc. "Patients are even less willing to go, even when we say they should."

Not that timely hospital treatment comes with guarantees. Most deaths in childbirth in Guatemala are the result of haemorrhages, but only two hospitals in the Petén region have blood banks. Another problem is how few Guatemalan doctors are willing to work in the backwaters. Most doctors in the Petén are Cubans on a mission to help out, but they will not be there forever.