Initiatives for Social Inclusion Programme - Peru

Interventions are carried out by health care workers from public health facilities with the participation of community-based organisations, local governments, promoters and birth attendants, schools, and youth groups. These interventions are based on developing institutional and community mechanisms that permit women and their families to make appropriate decisions about women's health, reducing women's dependence on their husbands. For the promotion of a new culture in favour of maternal health, a widespread process of social mobilisation that includes local authorities and the family, especially the parents, has been developed through advocacy and community participation. The project also promotes the participation of traditional birth attendants so that their actions complement those of the health establishment.

Project activities include the following:

• Training of health care workers in the adequate treatment of obstetrical and perinatal emergencies and provision of required medical supplies and equipment. Implementation of changes in pregnancy and childbirth service delivery in the health centres to assure respect for users' cultural beliefs.
• Training of women to recognise complications of pregnancy and childbirth and maternal self-health care. Health care workers, non-governmental organisations (NGOs), and school-teachers are involved in this effort.
• Development of social communication campaigns for the formation of community groups making use of mass media, cultural animation, and interpersonal communication.
• Advocacy activities with local authorities and opinion leaders in the form of meetings to raise awareness and develop inter-sectoral local plans to promote safe motherhood.
• Training and promotion of participation of men (partners) in maternal health care.
• Implementation of Casas de Espera or "Maternal Homes" close to the health centre where women from distant communities can stay during the last month of pregnancy. This is to overcome the geographic barrier in rural areas.
• Training of traditional birth attendants in home "clean births," in the timely handling of obstetrical and neonatal emergencies, and in when to bring women to the health centre during pregnancy and childbirth.

Children, Rights, Women, Health.

This project complements the National Maternal-Child Insurance Programme initiated in 1999, which aims to eliminate economic barriers to access to health services in rural areas, especially in the economically poorest areas of the country.

The intervention addresses people in parts of Peru where the population is mainly indigenous. The Third Demographic and Family Health Survey (ENDES III) carried out in 2000 registered a maternal mortality rate of 185 women for every 100,000 live births. In poor communities with limited access to health care, organisers say, the rate is more than double. Despite the fact that in Peru, during the last decade, the number of public health services has increased by 60%, almost half of the deliveries take place at home attended by traditional birth attendants or family members in poor sanitary conditions. In areas with the greatest concentration of indigenous people, only 10% to 20% of births take place in health centres. Ministry of Health (MoH) authorities say that the death of a mother (from haemorrhaging, infection, or toxemia), which is in some cases due to the lack of proper care, is often related to gender inequality in society and in the family. The death of a mother means greater impoverishment for the family. When the mother dies, mortality rises among small children, the children's school attendance declines, and life conditions in general deteriorate. Despite these problems, cultural, economic, geographic, and other factors mean a limited demand for maternity care services.