For many years, health policy-makers in Peru have tried in vain to address the subtleties and vagaries of indigenous
people’s needs. When it comes to women’s rights, especially women’s reproductive rights, cultural and religious beliefs act as
barriers that prevent women from accessing proper healthcare.
Maternal and perinatal health programs have not been able to sufficiently
increase the number of indigenous women getting prenatal and postnatal
care and delivering at health care facilities.

For indigenous women
in the Andean and Amazonian areas of the country, giving birth at health
care facilities in the presence of strangers, without their relatives, half naked and lying in a horizontal position was and still is
just unbearable. Given those circumstances they prefer to stay home
and deliver in a vertical position assisted by a midwife or a relative,
which is what they have traditionally witnessed in their communities. But this trend has had alarming consequences for women’s health
and lives because the lack
of medical assistance for any complications that can arise. A UNFPA
representative has pointed out the fact that "several women die when
they deliver at home and nobody gets to know because they live in distant
rural areas…this data is not registered."

Although health personnel
in a few departments have been assisting home deliveries in upright
positions, isolated efforts are not enough. In an attempt to reverse this tendency, the Ministry of Health decided to adapt its policies
to indigenous women’s traditions instead of imposing Western ones.
Thus, in August 2005 the "Technical Standard for Vertical Delivery
with Intercultural Adaptation"
was approved by the National Sanitation Strategy for Sexual and Reproductive
Health. It officially introduced the "vertical delivery" as
part of the maternity services in the country with a multicultural and
gender sensitive approach.

This policy aims not
only to respect indigenous women’s customs and beliefs but also to
"standardize the medical assistance on vertical delivery…adjusting
the health care services offered to women in order to increase institutional
delivery and thus, reduce obstetric complications that cause maternal
death." The latter is especially disturbing; according to Health Ministry
statistics the maternal mortality ratio is estimated to be 185 deaths
for every 100,000 live births, mainly because of bleedings.

The National Concerted
Health Plan launched in July
2007 includes as its main goals the decrease of maternal mortality to
66 per 1000,000 live births by 2015, while increasing up to 70% the coverage
of institutional deliveries in rural areas. This is particularly
important considering that the number of deliveries in rural areas has increased from 24% in 2000 to 42.5% in 2004-2005.

The Technical Standard
for Vertical Delivery emphasizes that above all, it is crucial that health personnel is technically trained
to perform the obstetric procedures needed for any of the positions
the parturient may adopt: squatting, kneeling, seated or holding rope. The standards also emphasize welcoming the patient and her
relatives, explaining to them the procedures in a simple way and, most
importantly, encouraging the patients "to express their will with
respect to the position they wish to be assisted for delivery."

In order to increase the incidence of institutional delivery, Peru has developed "waiting houses" or maternity homes, houses specifically conditioned to "shelter pregnant women
and their families coming from remote areas and keep them close to a
health care facility with basic obstetric…facilities."
This is especially crucial for vulnerable pregnant women such as victims
of domestic violence, widows, single or abandoned mothers or the ones
with complications.

A documentary on the
impact of "vertical delivery" as a standard maternity service procedure,
produced by the Health Ministry and UNFPA, shows how indigenous women
are increasingly trusting the health personnel. All the women interviewed
were satisfied with the service and mentioned that they were treated
with respect. Some of them even said they were definitely going back
to the health care facility for their next delivery and that they would
tell other pregnant women to do so.

This policy certainly
proves that access to health care services
for Andean and Amazon women can be improved simply by respecting their traditions and rights and
making reproductive health policies more inclusive, that is, bearing
in mind the multicultural nature of the country.