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ABSTRACT
The rights to health and to culturally respectful care are inextricably linked in the documents supporting Peruvian Maternal Health Policy. Strategies of Intercultural Birthing and Maternal Waiting Houses were purported to reduce maternal deaths, while extending the right to health to marginalized indigenous women. Based on 17 months of field research in Peru, I argue that the narrow focus on achieving “good numbers” creates and sustains coercive modes of strategy applications. As a result, the on-the-ground implementation of these innovative strategies made them incompatible with right to health and culturally respectful care approaches.
SPANISH ABSTRACT
Los derechos a la salud y al cuidado culturalmente adecuado están íntimamente vinculados en los documentos de políticas de Salud Materna Peruanos. Las estrategias de Parto Intercultural y Casas de Espera Maternas proponían contribuir a reducir la mortalidad materna y, además, extender el derecho a la salud a mujeres indígenas excluidas. En este artículo, basado en diecisiete meses de trabajo de campo propongo que la estrechez del enfoque en obtener “buenos números” lleva a la creación y mantenimiento de modos coercitivos de aplicar las estrategias. El modo de implementación de estas estrategias innovadoras las hace incompatibles con los enfoques de derecho a la salud y derecho al cuidado culturalmente respetuoso.
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Acknowledgments
The protocols for this study were reviewed by institutional ethics review boards at the University of Pittsburgh and the Universidad Peruana Cayetano Heredia, Lima, Peru. I thank Maria Layme and the School of Public Health at the Universidad Peruana Cayetano Heredia for their research support.
Notes
1. In late 2000 then president, Alberto Fujimori, escaped Peru amid mounting evidence of multiple genocidal human rights violations, scandalous bribery videos, and rapid deterioration of his dictatorial grasp on power. Following impeachment and removal from office, congress called for a new general election in the year 2001.
2. The government has since created a Vice-Ministry of Interculturality, under the Ministry of Culture; however, it doesn’t have any oversight of health issues.
3. The placenta is called madri and is considered the mother of the fetus; it is given an honored place under the home hearth or family field so it can continue to nurture the family.
4. Checking-in to the Mama Wasi, meant registering the name and identity document number in the Mama Wasi ledger, showing the room, and providing a key to the lock. The ledger served for rounds every morning and was used to keep track of resident women.
5. An Ayllu is a traditional Andean communal organization, formed by several families that administer shared land and water. A communal board regulates members’ rights and responsibilities.
6. For example, the imbalance of hot/cold humors produces sobreparto, a culturally specific ailment which can manifest as strong cramps immediately after birth which can lead to death, or to a lifelong weakness. See Larme and Leatherman (Citation2003) and Kuberska (Citation2016) for more information.
7. From 22 weeks gestation to 7 days old.
8. Midwives spent almost 15 minutes per visit completing required paperwork.
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Lucia Guerra-Reyes
Lucia Guerra-Reyes, MA, MPH, PhD is assistant professor of Applied Health Science at the Indiana University Bloomington School of Public Health, and author of Changing Birth in the Andes: Culture, Policy and Safe Motherhood in Peru (2019).