In the 2009 edition of its flagship publication, The State of the World’s Children, UNICEF addresses maternal mortality – which it qualifies as one of the most intractable problems for development work – and points to successful strategies developed by Peru to reduce child deaths and to adapt maternity services to rural cultures.
“Peru, a lower-middle-income country where 73 percent of the population lives in urban areas,” reads UNICEF’s report, “has made enormous progress in reducing child deaths and adapting maternity services to eliminate barriers between the staff at health facilities and mothers who have deeply rooted cultural traditions for childbirth.”
Child deaths in Peru have fallen from 1 in every 6 children in 1970, to 1 in 50 by 2006. And, according to UNICEF, between 1990 and 2007, the country’s under-five mortality rate dropped by 74 percent – the fastest rate of decline in the entire Latin American and Caribbean region for that period.
Peru has had less success, UNICEF reports, in the area of maternal health. Its maternal mortality ratio, estimated at 240 maternal deaths per 100,000 live births in 2005, is among the highest in the region. Moreover, Peruvian women face a life-time risk of maternal mortality estimated in 2005 at 1 in 140, twice the regional average of 1 in 280.
According to the Peruvian Ministry of Health, women in rural areas are twice as likely as those in urban areas to die from causes related to pregnancy. A skilled attendant was present at just 20 percent of deliveries in rural communities in 2000, compared to 69 percent in urban areas.
“Like other Latin American and Caribbean countries, Peru’s challenge for improving maternal and newborn health – and greatest potential for progress – is to address disparities due to ethnicity, geography and extreme poverty,” reports UNICEF. “Part of the challenge is to adapt current health services, often facility-based or outreach, to the customs of the communities currently underserved by the health system.This will require delivering quality services to women and infants in or near their places of residence and providing integrated routine and emergency maternity and newborn care.”
Following tradition and cultural practices, rural women may prefer to give birth at home in an upright position, under the guidance of traditional birth attendants, rather than in a health centre delivery room. And when some mothers do decide to seek formal care, distance to a health facility, language barriers and cost of services might deter them.
To address these issues, the Ministry of Health and UNICEF-Peru have developped a maternal health project that includes key strategies such as establishing maternal waiting houses to resolve problems posed by geographic distance from health services. These maternal waiting houses, known locally as “Mamawasi,” are located on grounds owned by health centers or hospitals. There are currently 400 in Peru, mainly in the highland departments of Apurímac, Ayacucho and Cuzco.
“Pregnant women from near and distant communities can stay in the waiting rooms until they deliver,” reports UNICEF. “Women from remote villages may stay for weeks or months. The Mamawasi is designed to resemble a typical indigenous family home in a farming village.”
According to UNICEF, childbirth remains one of the biggest health risks for women worldwide. Approximately 1,500 women die while giving birth every day, or half a million per year.
