Academic journal article Bulletin of the World Health Organization

Cultural Adaptation of Birthing Services in Rural Ayacucho, Peru/Adaptation Culturelle Des Services D'accouchment Dans l'Ayacucho Rural, Au Perou/Adaptacion Cultural De Los Servicios De Maternidad En El Ayacucho Rural, Peru

Academic journal article Bulletin of the World Health Organization

Cultural Adaptation of Birthing Services in Rural Ayacucho, Peru/Adaptation Culturelle Des Services D'accouchment Dans l'Ayacucho Rural, Au Perou/Adaptacion Cultural De Los Servicios De Maternidad En El Ayacucho Rural, Peru

Article excerpt

Introduction

Most obstetric complications occur around the delivery period and often cannot be predicted. Therefore, skilled attendance at delivery and access to emergency obstetric and neonatal care are crucial for decreasing maternal mortality (1) and neonatal mortality. (2) There are enormous disparities in skilled attendant use within low- and middle-income countries, disadvantaging poor people and those living in rural areas. (3) Many of these disparities stem from differences in geographic and financial access to services but, in some settings, barriers created by cultural differences are important.

Cultural background influences beliefs, norms and values in relation to childbirth and health service use; furthermore, certain ethnic groups experience discrimination by health staff, causing them to avoid services. (4) Several Latin American studies find that indigenous women are much less likely to have skilled attendants at delivery than other population groups. (4-6)

Setting

Ayacucho, in the south-central Andes, is one of Peru's regions with the highest maternal mortality ratios. In 2000, the maternal mortality ratio was around 50 per 100 000 live births in Lima but more than 300 in Ayacucho. (7) Three-quarters of Ayacucho's population are indigenous and speak mostly the Quechua language. Poverty is extreme, educational levels are low and illiteracy is widespread, especially among women. The region was hit hard during the internal conflict between the Shining Path guerrilla group and the military in the 1980s.

In 1997, the international nongovernmental organization, Health Unlimited, started working in isolated communities in Ayacucho, initially by building links between local communities and the health system through training volunteer community health agents. (8) In response to high maternal mortality, the plight of indigenous women with problems during labour and the lack of contact with the government health system, an intervention study that introduced culturally appropriate delivery services was initiated in Santillana (Huanta province) in 1999.

Santillana district had 6158 inhabitants in 1993 and 7305 inhabitants in 2005. (9) Most people live in dispersed communities and work as subsistence farmers. Transport is mainly by foot, with public transport running once weekly from the district capital to some communities. The project involved the government health centre of the district capital with its catchment area of 17 villages.

The objective of the project was to increase delivery service use by building trust between health-care providers and communities and by making services responsive to the communities' needs. The accompanying study aimed to document the implementation process for future replication and to evaluate the project's impact.

Methods

The project of cultural adaptation of delivery services was conducted in four phases over 2 years starting in October 1999: (i) detailed formative research, (ii) design of a new culturally adapted delivery model, (iii) implementation of this model, and (iv) evaluation of implementation and impact. A fifth, post-project phase of monitoring and data collection is still ongoing, giving over 7 years of follow-up to date (Box 1).

Results

Design of the intervention

The intervention to make delivery services culturally appropriate involved 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. Table I summarizes selected findings from the first, formative research phase and how each of these translated into the new delivery model. All proposed solutions were implemented, except for the improvements in referral systems and retention of health professionals.

Satisfaction levels

After the new culturally adapted vertical delivery model was implemented in the health centre of San Jose de Secce in 2000, it was chosen by most women delivering there. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.