Doctors do get respect!: Gendered inequality in the Peruvian rural health workforce and its effects on maternal health policy

Background: In Peru young, recently graduated, female health personnel undertake the main frontline tasks for the reduction of maternal and infant mortality. However they are also affected by the gender biases and discrimination inherent in the health system. Previous research has shown increasing levels of stress and job dissatisfaction. However limited research has described the effects on policy implementation.

Methods: Over six months I shadowed clinical personnel at two Andean health centers charged with the implementation of the Peruvian Intercultural Birthing Policy (IB); a maternal death reduction policy which entailed extensive changes in birth protocol to make it culturally relevant to Andean women. I conducted in-depth interviews (6), and observed patient care encounters (50). Interviews and observations were thematically analyzed and assessed the experiences of health workers and their attitudes towards policy implementation.

Results: Findings indicate that female rural health personnel involved in IB experienced increased discrimination. They were treated as less capable for working in a rural environment, and as traitors to the profession for accommodating to Andean traditions. This represented a significant loss in career expectations which negatively impacted their willingness to implement the policy, and enhanced the health system’s problems with community engagement.

Conclusions: Preexisting gendered biases in the Peruvian health care system limit the ability of your female health workers to fully engage with a policy designed to reduce maternal deaths among indigenous women. Findings suggest the need to consider the structure and culture of the health system to enhance community engagement and policy implementation.