Applying rights-based approaches to policy-making to reduce maternal mortality: A case study from Peru

Methods: In this ongoing ethnographic research, in-depth case studies of maternal deaths and cases in which women have survived obstetric emergencies are coupled with detailed policy and systems analysis, including examination of relevant national and local data.

Results: Research has found, inter alia: variable resource capacity of different health centers; disparities and difficulties in access to transportation, the adequacy of referral networks; difficulties relating to training and staffing policies; and inequities in financing mechanisms.

Discussion: All of Maine et al's three delays are present in Peru and contribute to maternal deaths: the delay in the decision to seek care; the delay in arriving at care; and the delay in receiving care when at a health facility. Although Peru's social insurance scheme has reduced some economic barriers to access, financing mechanisms need to be restructured to rationalize reimbursement for care and transfers. Rationalization of use of medicines and staffing is also critical to reducing maternal mortality in Peru. Health sector restructuring loans have shaped the priorities and programs of the health ministry in addressing maternal mortality.

Conclusions: A human rights approach to policy-making can (1) provide specific recommendations to ensure availability, accessibility, acceptability and quality of care; (2)highlight the importance of participation, non-discrimination and accountability; and (3) links health status improvements with broader understandings of health as a matter of citizenship through e.g. providing identity cards to all rural inhabitants so that they can exercise political influence over local decisions to locate health facilities and spend health-care resources.