Dying to give birth: Fighting maternal mortality In Peru
Author(s)/Editor(s): Bristol H
Publisher/Organizer: Health Affairs
Publication date: 2009; 28 (4)
“A stronger systems approach would greatly benefit Peru, a middle-income nation with annual per capita gross domestic product (GDP) of $8,400—about one-sixth that of the United States.8 Health services, at least in rural areas almost exclusively served by the national and provincial governments, are hampered by chronic shortages of trained personnel, equipment, and supplies. For maternity care, there’s also another factor: discrimination. "It’s very clear that there’s a confluence of gender discrimination and ethnic discrimination that... conspire[s] against [indigenous] women," said Alicia Ely Yamin, an instructor in law and public health at Harvard School of Public Health who has studied maternal mortality extensively, particularly in Peru.
Yamin points to contrasts between Peru and countries in sub-Saharan African. In the latter, poverty is more universal and maternal deaths more evenly distributed; in the former, the problem is more regionalized and focused on rural, indigenous populations far from the cosmopolitan capital, Lima. "Attention to education, services, and health care to these overwhelmingly indigenous rural poor populations is just very, very low," Yamin says. That shows up in the statistics: for example, the maternal death rate is 52 per 100,000 in Lima. But it’s almost seven times that—361 per 100,000—in the hardest-hit region, Puno, a highland province in southeastern Peru whose capital, also called Puno, sits on the shores of Lake Titicaca.
In addition to a general lack of services, language and culture are also barriers to good maternity care. Among Peru’s poorest inhabitants are the nearly 47 percent of the population whose first language could be the indigenous Quechua, Aymara, or one of several others, rather than the country’s other official language, Spanish.” [author]