Cultural adaptation of birthing services in rural Ayacucho, Peru.
OBJECTIVE
Maternal mortality is particularly high among poor, indigenous women in rural Peru, and the use of facility care is low, partly due to cultural insensitivities of the health care system.


METHODS
A culturally appropriate delivery care model was developed in poor and isolated rural communities, and implemented between 1999 and 2001 in cooperation with the Quechua indigenous communities and health professionals. Data on birth location and attendance in one health centre have been collected up to 2007.


METHODS
The international nongovernmental organization, Health Unlimited, and its Peruvian partner organization, Salud Sín Límites Perú, conducted the project in Santillana district in Ayacucho.


RESULTS
The model involves 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. The proportion of births delivered in the health facility increased from 6% in 1999 to 83% in 2007 with high satisfaction levels.


CONCLUSIONS
Implementing a model of skilled delivery attendance that integrates modern medical and traditional Andean elements is feasible and sustainable. Indigenous women with little formal education do use delivery services if their needs are met. This contradicts common victim-blaming attitudes that ascribe high levels of home births to 'cultural preferences' or 'ignorance'.
Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, England.
Sabine
S
Gabrysch
Claudia
C
Lema
Eduardo
E
Bedriñana
Marco A
MA
Bautista
Rosa
R
Malca
Oona M R
OM
Campbell
J Jaime
JJ
Miranda
D054521:Cultural Competency; D005260:Female; D006303:Health Services, Indigenous / Q000458:organization & administration / Q000592:standards / Q000639:trends; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008427:Maternal Health Services / Q000458:organization & administration / Q000592:standards / Q000639:trends; D008880:Midwifery / Q000458:organization & administration / Q000592:standards / Q000639:trends; D036801:Parturition / Q000208:ethnology*; D010568:Peru; D011247:Pregnancy