Skip to main content

Beyond the White Man's Burden

Alyson Zureick

What (pregnant) women want

By Alyson Zureick - 10 months ago

It's amazing what can happen when you listen to people. On Tuesday, the New York Times ran a great piece on a community health project in rural Peru that is helping women have safe and healthy births - and it's all because the health workers took the time to find out what pregnant women want.

In Peru, giving birth is often a life-threatening event, especially for poor, rural and indigenous women. These women generally give birth at home rather than at health clinics and thus do not have access to skilled medical practitioners who can address obstetric complications, a leading cause of maternal mortality worldwide. Health workers in a rural area of Ayacucho, Peru set out to find why pregnant women did not attend health clinics to give birth. They learned that many women were reluctant to attend clinics for many reasons, including because health workers did not speak Quechua, a primary indigenous language in Peru; their family and traditional birth attendants were not allowed in the delivery room; they were required to give birth lying on a delivery table rather than sitting vertically as is traditional in the area; and they were not given the placenta to bury in a warm place according to local custom. The nongovernmental organization, Health Unlimited, changed delivery services in one local clinic to address these problems, and between 1999 and 2007, the percentage of local births taking place in the clinic rose from 6 percent to 83 percent.

Health Unlimited's results demonstrate how powerful local, community-based strategies can be in promoting maternal and infant health specifically and promoting good health generally. At the same time, however, the program was not able to adequately address all barriers to care. For example, the area continued to lack a free ambulance to transfer women from the local clinic to better-equipped and staffed facilities for comprehensive emergency obstetric care services because of funding shortages for petrol. Even when changes are made in the delivery of health services at the local level, larger health system problems often continue to prevent people from accessing essential medical care.

My question to readers is: How can governments, international donors and local health workers work together to promote macro-level health system reform along with community-based health initiatives that cater to peoples' needs at the local level?

Article Rating

Average: No Rating Available (0 votes)  
Labels: Health and Social Governance, Human Rights, Latin America - Caribbean, Public Health, Public Institutions

4 Comments

 
Post #1
Haymar Win Tun Haymar Win Tun - 10 months ago

I don't know much about the situation in the West. But in the developing countries, the availability of ante and post-natal care services for pregnant women in the rural areas is very limited. One reason is the limited number of service providers (mostly midwives) who usually has reponsibility for around 10 villages. Another reason is geography; the distance of one village to another is quite far. Even if the service provider has the incentive to give efficient care, he or she doesn't have full capacity. In this case, we have to consider the role of government: to produce more efficient service providers (doctors and nurses) for the rural areas, the role of international donors: to give more assistance in providing infrastructure and the moblie clinics and the role of local health workers; to be motivated to give more efficient services. But for  motivation of local health workers, it's also related to the issue of incentive structure provided by the government. But anyway, I think there are some other things should also be factored in the issue.

 
Post #2
Alyson Zureick Alyson Zureick - 10 months ago

Thanks for the comment! I definitely agree that those all are very important and common barriers to health care in many countries. I spent a year working in Sierra Leone on maternal and child health issues, and the reasons why pregnant women did not access skilled care for delivery reflected a variety of issues related both to structural problems with the health care system (lack of transportation to health facilities, shortages of trained staff and medical supplies, etc.) as well as factors related to quality of patient care and service (women felt more comfortable accessing traditional birth attendants than clinic health staff, women had to travel long distances to reach health clinics and there was no where for them to stay before going into labor, etc.) Addressing these barriers can require different strategies but should happen in a coordinated and collaborative way to make health care more accessible, particularly to marginalized communities in developing countries.

 
Post #3
Michael Middleton Michael Middleton - 10 months ago

Hi Alyson, nice post and thank you for the insightful comment Haymar. I think the key to all of this is decentralization. Yes there needs to be national (Macro) body which promotes best practices and manages resources but local clinics must be given the necessary autonomy to adapt to the needs of their patrons. I am not suggesting cutting a blank cheque to local clinics, but, so long as the services get delivered, it should not matter how. The only concern I would have is when local customs jeopardize the safety or health of themselves or others. What do you think Allyson? Is deregulation possible in developing states which already lack infrastructure? And what happens if local practices pose a health or safety risk?

 
Post #4
sasha grate sasha grate - 6 months ago

here i love to share a blog about women health pregnancy tubal reversal

and vaginal issues

Would you like to comment?

You must be a member. Sign In if you are already a member.

Viewed 345 times