logo

Tag

peru

Understanding Peruvian Progress Fighting Maternal Mortality

Co-authored with Gustav Cappaert at Latin Correspondent.

Even though most maternal deaths are preventable, every day 800 women across the globe die due to complications during pregnancy and childbirth.

Peru is one of only two South American countries expected to hit its maternal mortality Millennium Development Goal, one of a set of UN-backed global poverty reduction targets that culminate in 2015. Peru today has a ratio of 67 maternal deaths per 100,000 live births, down from 265 in 1990.

The Andean nation remains behind industrialized countries like Japan (with a rate of six) but way ahead of the world’s least developed nations: in Sierra Leone, which has a maternal mortality rate of 1,100.

Help for expectant mothers

“The principal problem Peru has had is access to maternal health services,” said Mario Tavera, Health Specialist for UNICEF Peru. “Global evidence demonstrates that the reduction of maternal mortality is associated with medically-attended birth in health care centers,” he said.

Peru has made strides on this front, 80 percent of women now give birth at a medical facility, compared to just one quarter in the early 1990s. Over 90 percent attend prenatal care visits.

According to Tavera, Peru has more than doubled the number of state-run health facilities in operation, greatly increasing access to care. Some clinics operate associated casas maternas which allow women who live in remote areas to stay for up to a week as they wait to give birth.

But perhaps the most important change has taken place inside of clinics. “There’s a set of very distinct customs” in rural Peruvian communities, Tavera said. “The people were permitted to bring into the clinic customs from giving birth in their homes.” Family members were allowed into the birthing room for the first time; women were allowed to give birth sitting or on their knees; they could bring a rope to hold onto — another traditional custom.

There are wrinkles in this success story, though.

One-size-fits all?

Creating a one-size-fits-all policy is uniquely difficult in Peru. Its three major regions: coastal desert, mountainous center, and Amazon jungle each demand a different approach dictated by culture and geography.

On the traditionally wealthy coast, the average maternal mortality ratio was 56.4 between 2007 and 2011. In the poorer highland and jungle regions it was considerably higher, at 152 and 137 respectively.

“Peru is one of the most unequal countries in Latin America…Parts of Peru have European levels of mortality, other parts have African levels,” said Tavera.

In the mountains, a long history of discrimination against the majority indigenous population makes some women reluctant to visit government health posts. For one, health care providers rarely speak Quechua, the native language in most of highland Peru.

“Those that speak Spanish ignore us, those of us from the town, from the communities that come down. They humiliate us sometimes or don’t treat us well,” said Teresa Echame Vargas, a health promoter in the rural community of Huilloc.

Home births

Perhaps not surprisingly, home birth is more common in rural areas. Although official policy is to support traditional birthing methods and attend home births if possible – a practice supported by medical evidence – in reality it depends on the clinic. “We would like the health posts to attend at home, but they say they can’t,” said Vargas.

Fueling claims of discrimination is the illegal but common practice of imposing fines on women who chose to give birth at home.

Keri Baker, the executive director of the health promotion organization Ayni Wasi, recalled a patient who suffered complications during a home birth, “She hadn’t expelled her placenta all the way which can cause hemorrhaging. We saw her at that point, and she hadn’t sought medical care because of the fact that she had given birth in her home.”

A 2009 survey of women in the coastal community of Huaycan – the majority of whom had migrated from the highlands – found that 46.5 percent of women who elected home birth did so because they’d had a bad experience on a previous hospital visit or knew someone who had. A majority of women in a similar study in 2005 cited discrimination and a feeling of violation by health care providers as reasons to give birth at home.

In a jungle region like Madre de Dios, in Peru’s southeast, communities’ distance to health facilities makes professional attention a challenge. The Spanish-speaking population is transient – attracted by the lucrative business of illegal mining. Women that live in mining camps rarely make the river trip to attend prenatal visits, said Nelva Miraya, the government’s Coordinator for Community Strategy and Reproductive Health for the region.

Indigenous challenge

The area’s far-flung indigenous population of 60,000 is another challenge. Communities in Madre de Dios speak 12 different languages, and live in settlements up to three days away from the nearest hospital. The lack of government presence in these areas raises the possibility that deaths go unreported.

“(Until recently), in the entire region of La Salvación, there was only one obstetrician. She was the only one to intervene in native communities that are two, three, four days away by boat,” said a nurse in Madre de Dios’ capital of Puerto Maldonado.

Although recent progress on maternal mortality is encouraging, Mario Tavera of UNICEF warned about diminishing returns. “(Peru is) starting from a very high rate,” he said. “A country like Chile had 30 (maternal deaths per 100,000 live births). Getting to seven is more difficult.”

The Most Dangerous Place To Be An Environmentalist

DSC_1156 retouched

Published at Generation Progress. Photo: young Hondurans protest against mining.

As Al Gore and many others have said, “The future of our civilization is at stake,” due to climate change and a host of other environmental challenges. To preserve a planet worth living on, we will have to put a stop to deforestation, open pit mining, and many other destructive extractive industries. How will we do it if the loggers, miners, and destroyers are willing to kill to stay in business?

An April report from British nonprofit Global Witness shows the importance of that question. The group documented at least 116 murders of environmental activists worldwide in 2014. Global Witness tracked only confirmed cases; the real toll is likely higher.

Since its democratically elected president was overthrown in a 2009 coup, Honduras has seen over 100 killings of environmental defenders. The small Central American nation is the most dangerous place in the world to be an environmentalist.

“A white car with tinted windows and no license plate would always stop near my shop. They wouldn’t roll down the windows,” one Honduran told me when I visited the country last year. He was involved in a campaign to prevent a mine from opening in the rural community where he lived. The mine was near one of the community’s sources of drinking water, and many residents feared that it would contaminate the supply.

He asked that his name not be used due to the threats he has received for his work.

“Then the calls began. Calling me, threatening me, saying they knew where I hung out, knew where my daughter went to school. But I still kept going. From there they sent me a note telling me to shut up, that I was going to regret was I was doing,” he said.

“They said they had me well studied, the places I went, the house where I slept, and that soon they were going to pay me a visit.”

One day, he got a phone call from friends saying that mysterious men were looking for him. He fled his hometown and hasn’t been back since.

“I’ve had moments of reflection. My children are young,” he said. “My wife has asked me with tears in her eyes that I try to separate myself a little bit, because they need me. That has put me between the sword and the wall, because I feel that the need to fight is urgent. I feel a pressure inside of me, a commitment to fight, of total dedication, but I have had to slow down a little.”

If other cases are any indication, the threat is real. In the Honduran community of El Níspero, locals have reported that an iron oxide mine is destroying water sources and farmland. National police have broken up protests against the mine, and in May 2014, the body of anti-mine activist Rigoberto López was dumped in public, tongue cut out and throat slit.

In Peru, Ashaninka indigenous leader Edwin Chota asked authorities for protection after receiving threats from illegal loggers in retribution for reporting their activities. He was murdered in September 2014; a community member told a local newspaper that Chota and three others were bound and shot in front of other residents of their Amazonian village.

One month later in the Southern Philippines, anti-mining activist and indigenous Lumad leader Henry Alameda was “dragged from his house, taken to a forested area and shot dead by a paramilitary group,” according to the Global Witness report.

The damage caused by each of these crimes reverberates far beyond the Honduran highlands, Peruvian Amazon, or Philippine coast. As the killings continue, they enable the type of destructive extractive industry that is damaging all of our futures.

“It’s difficult to quantify,” said Billy Kyte, one of the authors of the Global Witness report. “But I think you can definitely draw a general conclusion” that violence and intimidation against activists is worsening environmental destruction. For every one of the 116 killings documented by Global Witness, there is an even greater amount of intimidation that doesn’t lead to violence, but still deters activism in defense of the environment.

On both ends of the equation, young people are impacted. In the developing world, one doesn’t have to be an adult to defend the environment, or to die for it. Several members of the community of Río Blanco in Honduras have been killed for their resistance to a hydroelectric dam project, among them 15-year-old Maycol Rodríguez. In the same community, the 17-year-old son of a local leader was beaten by police. Berta Cáceres, one of this year’s winners of the Goldman Environmental Prize, got her start as a student activist.

But even where young people aren’t on the front lines, these are fights over our future. Young people have a special interest in preserving both the local ecosystem services their communities rely on, as well as a healthy planet capable of sustaining life. If we’re going to put an end to problems like deforestation, it would help to make sure the deforesters aren’t killing the people who oppose them.

In the most direct sense, it’s a criminal justice problem. The people who target environmentalists are getting away with it.

“From the data we’ve found, conviction rates are unbelievably low. Of over 900 cases, we can only find ten of those in which a perpetrator has actually been tried and convicted,” Kyte said.

A lot of nations are not enforcing the laws they already have in place to protect environmental defenders, according to Kyte. Many nations are also ignoring the UN Declaration on the Rights of Indigenous Peoples, which states that indigenous communities must give prior informed consent before any development projects take place on their land.

Meanwhile, activists are working toward a binding UN treaty that would make businesses more accountable for the abuses that take place in international commerce.

“Competition for natural resources is definitely intensifying,” Kyte said, “while consumption patterns demand that we need ever more resources to feed an ever-growing economy, and our kind of obsession with growth and the growth model demands that we have ever more resources to feed that.”

If the violence is going to end, consumers in the developed world have an obligation to be part of the solution.

“As consumers, young people in the US have a responsibility to ensure they don’t fuel the rapacious activities of the mining and agribusiness companies behind much of the violence against these activists,” Kyte said. “Young consumers should check the sources of the products they buy and where possible identify companies violating human rights abuses and boycott their goods.”

Americans support the violence in more concrete ways as well. The Honduran military—implicated in many abuses against Hondurans defending their land—receives part of its funding from taxes on mining profits, but it also receives funding from the United States.

“If this reaches the ears of those who make the great contributions to the army, for weapons, for all the logistical support for our Honduran compatriots: it would be better if this help didn’t come in this form, but instead for education. Here we need help with education, here we need help with health,” the Honduran anti-mining activist in hiding said.

“We don’t want them to keep sending help to the army,” he said. “This is only bringing mourning to our poor towns, and more and more innocent blood spilled in the streets.”

Massage, Friend? Restaurant? Machu Picchu? Coke? Weed?

I wrote this blog post back in, like, January and never posted it. Better late than never:

Cuzco’s Plaza de Armas is beautiful, but walking through there as a tourist wears on your patience pretty fast.

As a gringo, you’re a walking dollar sign, constantly declining pitches for restaurants, nightclubs, textiles, trinkets, massages (or perhaps “massages”), weed, cocaine, and info about Machu Picchu.

After four months of living in Cuzco and frequently passing through the Plaza de Armas, this got pretty annoying. After a certain point I unfortunately got in the habit of avoiding eye contact and giving cold refusals, or ignoring the hawkers altogether. This was partially a deliberate tactic to minimize intrusion, but also partially just because I was past the point of containing my irritation. I’m actually frustrated with all the previous people, but today I’m taking it out on you, sir.

Of course, the sellers themselves have it even worse. To earn their paycheck, they have to repeat the same pitch over and over and over, nearly always to be rejected by rude foreigners who obviously have money to spare.

I don’t know what the solution is, but it struck me as an interesting example of how economic inequality creates an animosity that feels very personal to both parties, even though it isn’t at all.

02/26/2014 // Morning Hike // Pampallacta, Peru

pampallacta

At the Potato Park, about 14,000 feet up. Went on a walk to get a cell phone signal. The rock piles mark the border between the village of Pampallacta and nearby Chawaytire.

 

02/14/2014 // Qachun Waqachi Raymi // Chawaytire, Peru

qachun waqachi

The Potato Park is using Valentine’s Day to revive and adapt an Andean tradition. Young men demonstrate their value as potential husbands by preparing a potential field for sowing, and young women show their ability and tenderness as wives by deftly peeling a really bulbous and bumpy potato. Elders in the community judge each contest.

The Road To Machu Picchu, Traveled On The Backs Of Its Builders

The Inca Trail is the most popular hike in Peru. Four days, several hundred dollars, and limited space: tourists typically have to book months and months in advance to secure their spot on the trek to Machu Picchu. The memories, insights, and photos that hikers take from the trip are made possible by the group of local porters who carry most of their stuff, set up their camp, cook their meals, wash their dishes.

I hiked the trail in November 2013 with two friends. We had a great time, but were disturbed in a variety of ways by the inequality of the situation. My friend Gustav and I wrote about one facet, the colonial roots of the current porter system:

In 1552, Dominican friar and human rights advocate Bartolomé de las Casas wrote, “[Spanish settlers] used natives like pack animals. They have sores on their shoulders and backs, like much-abused beasts.”

Las Casas and his supporters inspired the Spanish crown to issue the New Laws, which outlawed the encomienda forced-labor system and forbade the “lading of Indians.” Although these laws were widely ignored, they reflected Spanish authorities’ uneasiness with using people as beasts of burden.

Five centuries later, Peru passed the Porter’s Law. The 2001 legislation limited loads on the trail to 20 kilograms (about 45 pounds), set a minimum wage of roughly $16 per day and required tour companies to provide porters with adequate food and clothing. A 2012 article in La Republica found that the law is routinely flouted, with porters sometimes forced to carry up to 40kg.

The whole thing at Seattle Globalist.

02/09/2014 // Pan Flutes // Puno, Peru

candelaria 3

Virgen de la Candelaria festival in Puno, Peru. Dedicated to the patron saint of Puno, Peru, a region where Christianity took hold especially strongly in the early years after Spanish conquest–the region’s Aymara population had always chafed under Inca rule and eagerly adopted the religion of their enemy’s enemy.

02/09/2014 // Virgen de la Candelaria Festival // Puno, Peru

candelaria

Days of drinking and dancing in costumes like these to celebrate the patron saint of Puno, Peru.