Looking Beyond the MDGs: Lessons from the Implementation of a Culturally Tailored Maternal Death Reduction Policy in Peru

Background: In 2005 a culturally tailored birthing policy was created in Peru as part of a package of maternal health improvement measures which responded to the challenges posed by the Millennium Development Goals (MDGs) to improve maternal health and reduce maternal deaths by three quarters by the year 2015. This intercultural birthing policy changed the standard birthing model by incorporating traditional Andean home birth elements. It was expected to breach longstanding inequalities in care practice, and improve access and outcomes for indigenous women. In this paper I describe challenges in the implementation of this policy, its effects on safe motherhood efforts in Peru and the lessons learned for future maternal health policies. Methods: Data was collected from 15 moths of fieldwork using a comparative case study methodology which comprised 100 interviews with health providers and community members; and 50 observations of care interactions and 10 birth processes in two sites in the Northern and Southern Andes. Cases selected represented differential support for culturally tailored policies in the area. Results: This study identified structural, organizational and community engagement challenges which limited implementation and negatively affected the safe motherhood efforts in the case study sites. Challenges relate to the persistence of discriminatory attitudes towards indigenous population, the inequality within the health system structure itself and the lack of community engagement. Conclusions: The Peruvian case highlights the need for post MDG policies to undergo a comprehensive reevaluation of the implementation of culturally tailored programs and underscores the need for revaluing community engagement.