In August 2011, maternal health was confirmed as a human right by the UN CEDAW. According to their historic ruling, governments have a human rights obligation to ensure that all women are able to access timely, appropriate, and non-discriminatory maternal health care. For maternal health advocates, this ruling gave voice to an accepted norm within the field; women had a right to proper maternal health care. It’s more than a moral imperative- it’s a human right. Meeka, a fourth year UC Berkeley student, explains how Peru is using this new perspective to better address the needs of pregnant women:
Efforts to achieve maternal health as a human right have been a particular focus of the international community in light of Millennium Development Goal 5, which seeks to decrease Maternal Mortality Ratios (MMR) by 75% by 2015. Efforts to decrease MMR focus on different ‘delays’: delay in the decision to seek care, the delay in transportation to the facility, and the delay in receiving adequate care. This approach has led to a variety of programs in areas where MMR is the highest.
In Peru, rural areas with mainly indigenous populations have an MMR that is significantly higher than the national average. With a MMR of over 240 per 100,000, indigenous populations in rural Peru have one of the highest maternal mortality ratios in the Western hemisphere. Peru’s high rates of maternal mortality have been recognized as a consequence of geography, discrimination and inadequate systems of healthcare. For historical reasons, a deep distrust exists between the Peruvian government and indigenous peoples. This has made indigenous women less willing to use available health services. Many health programs try to focus on the first delay, the decision to seek care. In 1999, an international NGO called Health Unlimited partnered with local health organizations to produce ‘culturally appropriate delivery services.’ The current approach in maternal health in areas where trust in the government is low is this new system of culturally adapted maternal health.
These culturally adapted health services were instituted to help bring more indigenous women into health centers to give birth, increasing the chances of a healthy delivery and preventing unnecessary deaths. They seek to build trust between health professionals and women as well as increase levels of comfort in the hospital setting. These services include things such as a rope and a bench for women who prefer to give birth in the traditional squatting position common to many indigenous cultures. Another aspect of these new health services is the allowance of family members alongside the birth attendant in the delivery room. This has been said to increase levels of comfort for the women giving birth. The use of culturally adapted health services has increased the use of services and the number of indigenous women seeking skilled birth attendance by a notable amount.
Despite the advantages of these new services, there are still obstacles. In theory, the system is innovative and a great step for maternal health in Peru. However, the willingness of women to use this new health system depends on the quality of care given by providers. Health providers often will only speak Spanish, which makes it difficult to communicate with women who usually only speak their native indigenous language. Additionally, there is often a lack of cultural understanding and humility among health providers, leading to an environment that can be intimidating and ineffective. Thus, the next focus of culturally adapted services in Peru should be to target the quality of these services in terms of cultural competence.
While the success of ‘interculturality’ in health systems is growing, there are still obstacles to be overcome. Much more time, effort and money will have to be invested in order to spread culturally appropriate health services across Peru and throughout the world. In the case of Peru, a huge part of instituting these changes was recognition of maternal health as an issue worth paying attention too. The first step of incorporating interculturality into health systems worldwide is recognition of maternal health as a human right by governments and other institutions. This, in part, is dependent upon a realization of cultural rights as well as maternal health rights. The advocacy, education and collaboration needed for this awareness is a huge task that will require the participation of governments, non-governmental organizations, individuals and a diversity of bodies. While culturally adapted health services represent a critical step in the right direction for indigenous mothers, there is a still a long way to go for mothers everywhere.Meeka Gandhi is a fourth year undergraduate at the University of California, Berkeley. She is majoring in Peace and Conflict Studies while pursuing a pre-medical track. She has sought to bring these two areas together by concentrating her studies in Women’s Health and Human Rights. Meeka is a Guest Contributor to the NotEnoughGood.com blog. Pallavi Trikutam is an undergraduate at the University of California, Berkeley. She is a psychology and political science double major, with a minor in public policy.During her time with the SISGI Group, Pallavi researches maternal, infant, and child health issues.