1. Callister, Lynn Clark PhD, RN, FAAN

Article Content

This spring in one large South American maternity hospital, childbearing women were placed in three lines in a cavernous room, some on stretchers. One line of women had just had a spontaneous abortion or were waiting to have an induced abortion, one line of women was waiting to have a cesarean birth, and one line was made up of women in active labor anticipating a vaginal birth. These women would be unmedicated, unsupported, and alone, attended only by a medical student. The hospital rooms, bleak and cold, had no sheets, and the women's "pillows" were packages of sanitary napkins for use after giving birth. As you envision this scenario, consider these compelling words on the cover of a 2007 issue of The Lancet, "Since the human race began, women have delivered for society. It is time now for the world to deliver for women." What an incredible thought!!

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

The achievement of Millennium Development Goal #5 (to reduce maternal mortality to 66 per 100,000 live births by 2015) is being aggressively pursued in rural health centers in Peru. According to a 2007 report by Physicians for Human Rights ("Deadly delays: Maternal mortality in Peru"), critical time periods that add to birth complications include delays in recognizing warning signs at home, making the decision to seek healthcare, reaching healthcare facilities, and providing appropriate healthcare that would save the mother's life. These problems, so apparent in remote areas of the Andes Mountains, contribute to the estimated 300 maternal deaths per 100,000 live births each year in Peru; in many of these cases women in active labor either give birth at home or walk many kilometers on steep mountain roads to access healthcare.


Because of concern about high maternal mortality rates, nearly two decades ago the United Nations Family Population Agency (UNFPA) and other international aid agencies collaborated with the Peruvian health ministry and other nonprofit organizations to improve healthcare for childbearing women. Despite these efforts, indigenous women did not seek care in the cold, aseptic environment of most healthcare facilities; they preferred to give birth in the comfort and security of their own dimly lit homes, drinking herbal tea, enjoying the support of other women, and squatting to give birth. In recognition of these facts, cultural adaptations were made when 390 Mamawasis (which in the Quechua dialect means "mother's house") were developed adjacent to health centers or hospitals. Some of these Mamawasis included freestanding birthing centers designed to provide housing for indigenous women and their families before and after birth. In these centers, women could give birth vertically, squatting on wooden stools or standing, in a culturally "friendly" environment that simulated home. Because a dramatic increase in the use of such facilities has occurred, it is projected that 500 such "mother houses" will be in operation by the end of 2008.


Initiatives such as the one described here are being extended to urban clinics, such as the Belen Pampa Health Center in Cusco, Peru. A portion of their obstetric unit has been adapted to provide this same type of culturally appropriate housing for childbearing women and their families. An assistant representative of UNFPA in Peru suggested that "the issue of maternal deaths is a social justice issue. The causes of maternal mortality are known, but the solutions have not been made available to all women" (Fraser, 2008, p. 1234). This innovative Peruvian initiative is a great example of a creative way to provide birthing experiences that demonstrate respect for the sociocultural context of women's lives and honor their birthing preferences. It is time now for the world to deliver for women!!



Appreciation is expressed to Heather MacArthur Trane for her assistance in the preparation of the manuscript.




Fraser, B. (2008). Peru makes progress on maternal health. The Lancet, 371, 1233-1234. [Context Link]