Changing Maternal Mortality in Peru

https://www.youtube.com/watch?v=a4GWl7pQIic

      This above link discusses the issues and realities of many pregnant women from rural and indigenous communities. This video not only discusses the complications that may arise for women in these communities, but also talks about a newer program in Peru which not only helps to address these problems, but also sets a model for other Latin American countries to follow.

     Throughout history, indigenous women in the Andean mountains have given birth in the comfort of their own homes with family and maybe a midwife. Many women however, develop complications at the end of their pregnancy and are days away by foot and hours by car. By then, it is too late for many. Often minimal emergency care is required to prevent these unnecessary deaths. Out of the various health outcomes that the UN has pledged to improve, reducing maternal death in child birth has been the least successful. It is important to note the key identifying factors to those who are at risk for higher rates of maternal mortality. Most of these deaths happen in remote areas and the video also mentions that 90% are in developing countries. It is clear there are a lot of health disparities and inequality among low-income populations, but even more so in low-income women populations. In relation to my practice experience, which will be me doing basic medical work (shadowing, assisting, and the like) in Peru, it would be really interesting and important to understand the root causes and history as to why high maternal mortality rates among indigenous women is the reality.  

    In response to the seemingly exponential increase of maternal mortality rates, Peru has enacted a national program to change this. Dr. Oscar Ugarte Ubillis, Minister of Health in Peru, says " the critical problems is the amount of time and distance it takes to get attention when complications arise in child birth, so we've created 450 waiting homes through the country." This video specifically talks about a pregnancy home built in small town in the mountains called Vicashuaman, for women late in pregnancy to live. This pregnancy home is a space where pregnant women can not only feel at home, as they bring their children and cook their own meal, but also allows women to have the necessary medical support to safely deliver their babies. The home tracks pregnancies in the region with a basic map and places each woman's home a long with the amount of time it takes to reach them on it. The home has radios to connect with the nearest hospital four hours away in Ayachuco when serious complications occur.

    When this program first began, it was difficult to convince indigenous women to go because they have many traditions and rituals around pregnancy and child birth. However, these programs allow women to maintain their traditions like skirts they wear for modesty while in labor, herbs and tea used to strength in delivery, and birthing in sitting position, which the obstetricians are trained to know how to do. The work in the pregnancy homes of Vicashuaman and Ayachuco, has significantly dropped mortality rate 50% from 1999 to 2005. While these programs are great, I still find myself asking questions. Although these homes give access to women in rural regions, is there enough space and resources for all the pregnant women? Do they have to apply or pay to live in these homes, or is it something the government is paying for? I also wonder how the staff stay in these regions and are incentivized enough to stay. Regardless I think this is an amazing program which many other countries could use as a model to address maternal mortality. It is clearly effective and is also an intervention from Peruvians for Peruvians, people who understand the context and culture of the situation.