Link to the University of Pittsburgh Homepage
Link to the University Library System Homepage Link to the Contact Us Form

Changing Birth in The Andes: Safe Motherhood, Culture and Policy in Peru

Guerra-Reyes, Lucia (2013) Changing Birth in The Andes: Safe Motherhood, Culture and Policy in Peru. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

Primary Text

Download (2MB) | Preview


The present study analyzes the Peruvian Intercultural Birthing policy, which sought to provide culturally competent care to Andean women by changing health center birth care and incorporating elements of traditional Andean home birth. The proponents and supporters of this policy, assert that it facilitates a dialog of medical traditions on equal terms, promotes respect and cultural dialog, improves quality of care, establishes good relationships with indigenous communities, and ensures better maternal and child health. Furthermore, they contend that the use of \textit{interculturalidad} as a framework for health will not only foster cultural competence but also contribute to engage indigenous communities with the state and enable the government to address longstanding inequalities in access to health and education.

This study analyzes and evaluates these assertions, and seeks to understand why the policy was created, what factors influenced health providers to implement it, and what impact it had on patients, health providers and the overall goal of promoting Safe Motherhood in Peru.

Using a comparative case study design, I contrast two sites of implementation of the Intercultural Birthing policy: the Flores micronetwork and the Kantu micronetwork. Data was collected through formal and informal interviews at national, regional and local levels, and observations of medical visits.

The results question the assertion that the intercultural birthing policy is providing improved birth care services for indigenous women. The democratizing ideas of \textit{interculturalidad} are present only in discourse but not in the coercive and sometimes abusive birth care practice.

Additionally, the persistence of a profoundly unequal health system structure penalizes health workers charged with policy implementation, restricting their professional development and marginalizing them because they serve rural communities.
I conclude that the framework of \textit{interculturalidad} in its current iteration does not in fact change the status quo of birthing in the Andes, it does not promote intercultural dialogue, and does little to create culturally appropriate birth care. Rather it is an example of reification and appropriation of the concepts of `culture' and `interculturality' by state structures, which serves to sustain an already existing unequal health system and practice.


Social Networking:
Share |


Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Guerra-Reyes, Lucialug11@pitt.eduLUG11
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairDeWalt, Kathleenkmdewalt@pitt.eduKMDEWALT
Committee MemberAlter, Josephjsalter@pitt.eduJSALTER
Committee MemberSanabria, Harrysanabria@pitt.eduSANABRIA
Committee MemberTerry, Marthamaterry@pitt.eduMATERRY
Committee MemberDocumét, Patriciapdocumet@pitt.eduPDOCUMET
Date: 17 October 2013
Date Type: Publication
Defense Date: 25 April 2013
Approval Date: 17 October 2013
Submission Date: 16 July 2013
Access Restriction: 5 year -- Restrict access to University of Pittsburgh for a period of 5 years.
Number of Pages: 316
Institution: University of Pittsburgh
Schools and Programs: Dietrich School of Arts and Sciences > Anthropology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Date Deposited: 17 Oct 2013 21:17
Last Modified: 17 Oct 2018 05:15


Monthly Views for the past 3 years

Plum Analytics

Actions (login required)

View Item View Item