Rural parts of Ayacucho, Peru, have had some of the country’s highest death rates in pregnancy and childbirth. As in many poor countries, most of the deaths occur because women give birth at home, and those trying to help do not know how to deliver a baby safely and prevent or treat hemorrhage, infection and other deadly complications. In 1999 in the Santillana district, part of the Ayacucho region, only 6 percent of births took place at a clinic.
Health workers set out to change that. They started by asking people in the community about traditional ways of giving birth, and about what the clinic was doing wrong. They got an earful. Workers at the clinic did not speak the local language, Quechua. They treated patients brusquely, and barred husbands and other relatives from the delivery room. They forced women to wear hospital gowns instead of their own clothes, and made them give birth lying on a table instead of squatting. They threw away the placenta instead of giving it to the family to bury in a warm place.
Working with local people, members of a nongovernmental group, Health Unlimited, changed delivery services at a clinic in the Santillana district. They made sure Quechua was spoken, let relatives stay and help, set up delivery rooms so that women could squat and made other changes based on local traditions.
By 2007, 83 percent of births were taking place at the clinic. In a report in this month’s Bulletin of the World Health Organization, the authors say that the project in Ayacucho shows that indigenous women with little formal education want professional help giving birth, and will use it if they are treated with respect at clinics.
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