WHEN Jenny Rodriguez attended her first hospital ante-natal checkup, health workers invited her to participate in classes for expectant mothers. 'We learn about the baby, we learn exercises and how to relax', she says enthusiastically. Rodriguez, from one of the shantytowns that ring Peru's capital Lima, is confident that trained and supportive carers will help her cope with labour and deliver a healthy baby.
A common-place event for a pregnant woman, you might think. Not in Peru, where studies have shown many women experience discrimination and abuse by punitive health workers offering sub-standard care. The scope of ill-treatment has been well documented. In 1999 the Latin American and Caribbean Committee for the Defence of Women's Rights (CLADEM) and the US-based Center for Reproductive Law and Policy produced evidence of widespread physical and psychological violence against women in public health facilities, including maternity wards.
Many labouring women endure verbal and physical abuse from judgmental health workers who equate childbirth with punishment for having sex. 'The nurses and technicians yelled at me', one woman told CLADEM researchers. 'Who forced you to have kids? What were you expecting? If you open your legs to your husband, get ready for birth'. Another recounted how a nurse 'told me I should push. At that moment I couldn't. I cried out. The nurse slapped me
Women, some as young as 19 years old, have even been sterilised without their consent after a first child. Haemorrhaging women needing emergency obstetric services have been turned away when they were unable to pay hospital fees. Fees for some drugs and services even in government hospitals are an expensive option in Peru where, according to the World Bank, almost half the population lives on less than $2 a day.
CLADEM'S findings along with two reports by Peru's Ombudsman's Office, an official department dealing with citizen complaints about government policy, revealed that such ill-treatment is meted out to those women who are also most likely to die as a result of pregnancy. That means the young, urban and rural poor and Amerindians.
While maternal deaths dropped from 265 per 100,000 live births in 1996 to 185 in 2000, the national average is still the region's highest. The figures can also be misleading: in the rural districts of Ayacucho, Huancavelica and Puno, the ratio can be as high as 400 to 600 deaths per 100,000 live births compared to 40 in Lima.
'Rural women say they don't go to the hospital, first because they're mistreated, and second because they have to pay', says Dr Raquel Hurtado, a community health paediatrician researching maternal deaths.
Indigenous women complain that health workers are verbally abusive and make them undress for delivery, which is unacceptable in their culture. 'Most indigenous women avoid the [government] health system at all costs', says Mary Elizabeth Bathum, a family nurse practitioner and Catholic missionary who runs a small health clinic in Puno, southern Peru.
Rocio Villanueva, who heads the women's rights section at the Ombudsman's Office, says that while the government wants women to give birth in local, government-run health centres in order to lower maternal deaths, the system offers 'only one way of viewing childbirth'.