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Peru Eyes Innovations in Rural Maternity Health

March 31, 2010 at 12:00 AM EST
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As part of his continuing series on Peru, Ray Suarez reports on how government strategies to reduce deaths from childbirth among indigenous women who live far from health services could also help women in other Latin American countries.
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JEFFREY BROWN: Next: our second Global Health Unit report from Peru.

Tonight, Ray Suarez looks at new efforts to save lives of mothers and babies in the country’s most remote areas.

RAY SUAREZ: High in the Andean Mountains of Peru, far from the modern conveniences of a city, generations of indigenous women have given birth at home, their only help from family or a village midwife.

The longstanding tradition of childbirth at home wasn’t a problem for most women. But, in that small percentage of cases where complications developed at the end of a pregnancy, in a remote rural area, you could be days away from the nearest medical facility on foot, even multiple-hours’ drive.

And that meant the story usually had a tragic ending, like the story of Lorenzo Quispe, whose wife, Antonia, died at home three years ago, after complications arose giving birth to their sixth child.

Lorenzo described that day when his wife began hemorrhaging after delivery, when he had to leave her at home with the children to go find a doctor, and when he returned four hours later.

LORENZO QUISPE, lost wife in childbirth (through translator): I entered the house in a panic and screamed, “Wake up, wake up.” I was pleading. I touched her. And she was still warm, but the doctor said, “She is dead.”

RAY SUAREZ: Three-year-old Aldofa, the baby born that day, survived the ordeal. Lorenzo’s young children now help care for him. But caring for children, land and livestock has taken a toll on Quispe. These days, he is barely able to keep food on the table.

LORENZO QUISPE (through translator): I am in a very bad situation. Sometimes, I don’t have milk for the baby, and right now there is nothing. My children are sick. And that saddens me that I can’t afford to get my children treated for minor medical issues.

RAY SUAREZ: Doctors say Lorenzo’s wife, Antonia, died of cardiac arrest, after hours of bleeding. And they say Antonia’s death could have been prevented by minimal emergency care.

Of all the health outcomes that the U.N. has pledged to improve, reducing maternal death in childbirth has been the least successful initiative so far, so it’s become a top priority. Worldwide, half-a-million women die in childbirth each year. Estimates are that one in 10 of those deaths are preventable.

The vast majority happen in remote areas, 99 percent of them in developing countries. In Peru, a new national strategy to turn those numbers around is taking shape. And the program is being seen as a model for Latin America and the developing world.

Here, in the remote region of Ayacucho, 12,000 feet above sea level, sits the village of Vilcashuaman. Many hours from the nearest airstrip, it’s a town so remote that even the impressive Inca ruins draw few tourists.

A casa materna, or birthing home, was built for women late in pregnancy to live in as their due date nears. And it’s a centerpiece in the government’s new strategy.

Dr. Oscar Ugarte Ubillus is Peru’s health minister.

DR. OSCAR UGARTE UBILLUS, Peruvian health minister (through translator): We detected that one of the critical problems is the amount of time and distance it takes to get attention when complications arise in childbirth. So, we have created 450 waiting homes throughout the country.

RAY SUAREZ: At the casa materna in Vilcashuaman, pregnant women bring their children. They make their own meals with ingredients from a hospital garden, and live as if at home.

Twenty-nine-year-old Eulalia Centro is here with her 1-year-old daughter. Eulalia had her first child at home without complications, before the birthing home existed. But she lives in an area with no roads. It takes a full day on horseback just to get to Vilcashuaman.

So, Eulalia chose to have her second, then her third child at the birthing home.

EULALIA CENTRO, mother (through translator): Pregnant women are always dying at home, so that is why we decided to come here.

RAY SUAREZ: The birthing home is occupied nearly every day of the year. Pregnancies in the region are tracked with a simple felt map. The circles represent each pregnant woman’s home and the number of hours it takes to reach them.

Red felt represents pregnant teenagers, at greater risk for death in childbirth because their bodies haven’t fully matured. Twenty-four-hour staff are trained to deal with obstetric emergencies, like breech babies, placenta blockage, and hemorrhaging.

Josefina Montes Perez is an OB-GYN at the casa.

JOSEFINA MONTES PEREZ, casa materna, Vilcashuaman (through translator): When they gave birth in their communities, it was very common to see a woman die, and then the whole family would disintegrate. In these remote villages, the mother is the figurehead. And, once the mother dies, the family falls into poverty. The children are traumatized.

RAY SUAREZ: Two-way radios are used to notify the hospital in Ayacucho, four hours away, when complications arise.

DR. JORGE RODRIGUEZ RIVAS, medical director, Ayacucho Hospital (through translator): The protocol to deal with emergencies, we didn’t have that before. Now we do. The communities now know how to react.

RAY SUAREZ: Dr. Jorge Rodriguez Rivas is the medical director for the hospital.

DR. JORGE RODRIGUEZ RIVAS (through translator): We immediately send an ambulance out with blood. And so the blood arrives there. And, as they are bringing the woman back, they are already doing a transfusion on the road.

RAY SUAREZ: One of the early challenges was convincing indigenous Peruvian women, who have many rituals around childbirth, to come to a hospital at all.

Mothers like 25-year-old Sandra Ayasca Quilca are now able to give birth at Ayacucho’s hospital and still follow their traditional way of delivering babies, in the sitting position, called vertical birthing.

Fathers, like Solomon Parco Quicha, sit behind the mother and help in the labor process. Customary herbs and teas help with labor and its aftermath. Following traditions, laboring women are allowed to wear their headbands and their distinctive skirts, for modesty’s sake. Obstetricians are trained to delivery babies in this position.

All of this has brought in women otherwise suspicious of antiseptic hospitals. Solomon and his wife live four days away in a remote area. They were both were born at home, but they have decided to have their own children here. The couple made the journey before labor began. A healthy baby boy, this is the couple’s third child delivered this way.

SOLOMON PARCO QUICHA, father (through translator): The vertical birth means there is less suffering. It’s a tradition that we still use. Also, we give herbs and tea, the mate. This helps with pain and helps to give strength in delivery.

RAY SUAREZ: All of the efforts in the Ayacucho region have paid off. Ayacucho’s maternal mortality rate has dropped 50 percent from 1999 to 2005.

Originally launched by the international aid organization CARE, the project has become a joint effort involving local and national government officials and non-governmental organizations.

Elena Esquiche Leon from CARE says it’s an issue of human rights.

ELENA ESQUICHE LEON, CARE (through translator): We believe that maternal mortality is linked to human rights. And we are working here in Peru to mobilize the entire civil society to avoid unnecessary deaths of pregnant women. Women in Peru play an important role in our domestic economy, an important role in the health of children, in reducing malnutrition. So, losing a mother is a huge social drama.

RAY SUAREZ: Peru’s model has caught the attention of international global health experts and administration officials in the United States, who plan to make maternal health issues a top priority.

JEFFREY BROWN: Ray’s final report will look at Peru as a leader in AIDS research.