Cultural adaptation of birthing services in rural Ayacucho, Peru |
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Authors: | Sabine Gabrysch Claudia Lema Eduardo Bedri?ana Marco A Bautista Rosa Malca Oona MR Campbell J?Jaime Miranda |
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Institution: | aDepartment of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, England.;bSalud Sin Límites Perú, Miraflores, Lima, Peru.;cCentro de Salud “San José de Secce”, Red de Salud de Huanta, Ayacucho, Peru. |
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Abstract: | ProblemMaternal mortality is particularly high among poor, indigenous women in rural Peru, and the use of facility care is low, partly due to cultural insensitivities of the health care system.ApproachA culturally appropriate delivery care model was developed in poor and isolated rural communities, and implemented between 1999 and 2001 in cooperation with the Quechua indigenous communities and health professionals. Data on birth location and attendance in one health centre have been collected up to 2007.Local settingThe international nongovernmental organization, Health Unlimited, and its Peruvian partner organization, Salud Sín Límites Perú, conducted the project in Santillana district in Ayacucho.Relevant changesThe model involves features such as a rope and bench for vertical delivery position, inclusion of family and traditional birth attendants in the delivery process and use of the Quechua language. The proportion of births delivered in the health facility increased from 6% in 1999 to 83% in 2007 with high satisfaction levels.Lessons learnedImplementing a model of skilled delivery attendance that integrates modern medical and traditional Andean elements is feasible and sustainable. Indigenous women with little formal education do use delivery services if their needs are met. This contradicts common victim-blaming attitudes that ascribe high levels of home births to “cultural preferences” or “ignorance”. |
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