Cultural adaptation of birthing services in rural Ayacucho, Peru

Abstract

Problem Maternal mortality is particularly high among poor, indigenous women in rural Peru, and the use of facility care is low, partly due to cultural insensitivities of the health care system. Approach A culturally appropriate delivery care model was developed in poor and isolated rural communities, and implemented between 1999 and 2001 in cooperation with the Quechua indigenous communities and health professionals. Data on birth location and attendance in one health centre have been collected up to 2007. Local setting The international nongovernmental organization, Health Unlimited, and its Peruvian partner organization, Salud Sín Límites Perú, conducted the project in Santillana district in Ayacucho. Relevant changes The model involves features such as a rope and bench for vertical delivery position, inclusion of family and traditional birth attendants in the delivery process and use of the Quechua language. The proportion of births delivered in the health facility increased from 6% in 1999 to 83% in 2007 with high satisfaction levels. Lessons learned Implementing a model of skilled delivery attendance that integrates modern medical and traditional Andean elements is feasible and sustainable. Indigenous women with little formal education do use delivery services if their needs are met. This contradicts common victim-blaming attitudes that ascribe high levels of home births to "cultural preferences" or "ignorance".Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español.

Perception, Attitude and Practices of Home Birth among Mothers of Under-Five Children in a Migrant Community of Southwest, Nigeria

“…These were also reported in some studies (Mwifadhi et al, 2007, Boucher et al, 2009, Ravi, Rejoice, & Ravishankar 2014Vernon, 2007;Lily et al, 2013). Distance to the nearest health facility was identified as a factor influencing home births by Gabrysch et al (2009), Van den Broek et al (2003). However, the present study did not find distance an issue.…”

How the integration of traditional birth attendants with formal health systems can increase skilled birth attendance

“…Consistent with this, Gabrysch et al [48] presented moderate-quality evidence and Bailey et al [52] reported high-quality evidence. Lynch and Derveeuw [46] showed that the inclusion of TBAs in hospital maternity wards for prenatal care, health education, and general duties-but not delivery attendance-contributed to a 1.5-fold increase in referrals.…”

“…Gabrysch et al [48], and Skinner and Rathavy [51] reported community participation as priority for increasing compliance with TBA referrals. The integration of TBAs has been bolstered with education groups [55] and information sessions by midwife-TBA teams [50]; community committees promoting maternity care [38,42], monitoring projects [42,59], community-managed funds [44,62], and blood donation [65]; monthly meetings [60]; and women's group consultations [40].…”

“…Training health workers to collaborate effectively with TBAs and women was applied by Gabrysch et al [48] and Mullany et al [38] to increase skilled birth attendance substantially: from 37% to 95% and from 5% to 48.7%, respectively. In Guatemala, O'Rourke [49] reported a 2.8-fold increase in TBA referrals following training of hospital staff regarding standards of care and cultural practices of women and TBAs.…”

“…Goldman and Glei [41] initiated integration with registration of TBAs and followed up with inclusion at monthly health facility meetings First: delay in deciding to seek care TBA training and supervision for referral of all pregnant women, or early recognition and referral of complications SBAs have been increasingly favored with training and supervision, focusing on facility-delivery promotion [44], risk assessments [37], and referral of complications [42], with SBAs overseeing TBA-attended complicated deliveries Collaboration skills for health workers to encourage TBAs to integrate, give a sense of inclusion, and encourage women to choose SBAs Culturally appropriate SBAs and services-including manner, care, language-became respected by TBAs and well utilized [48]. Improved relationships with SBAs led TBAs to escort women and support them through birth at facilities [52] Communication systems enabling TBAs to call SBA, assess risk, and detect and manage complications Referral cards create communication between TBAs and SBAs for case management throughout pregnancy [57], ensuring women see SBAs as required Role definition for TBAs for referrals, community health activities, and promotion of services TBA roles include distributing vouchers, referring women (for which they may be paid) [59], providing maternal health, and nutrition education and services [46,60,66] Second: delay in accessing the required level of care…”