Doctoral Dissertation Improvement Grant: Culture, Policy, and Safe Motherhood

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Doctoral Student Lucia Guerra-Reyes (University of Pittsburgh), under the supervision of Dr. Kathleen M. De Walt, will undertake research on how culture and national policy affect safe motherhood. She will explore these relationships through analysis of the Peruvian policy of intercultural birth care. This policy seeks to reduce maternal mortality and at the same time to address the increasing concerns of a multicultural government by incorporating selected elements of Andean home birth into health service care. Thus it comprises an appropriate case study for this research. The researcher hypothesizes that three interrelated elements impact both policy implementation and safe motherhood outcomes in the rural Andes: the existence of regional cultural differences; the key position of nurse-midwives in the implementation process and their own conceptions of Andean culture and interculturalidad; and the experiences and desires of birthing women and their male partners in rural areas. The researcher will examine these elements and their effects on birth care through in-depth interviews with regional and local leaders, health service administrators, nurse midwives, and women and their male partners. The researcher will also conduct observation of prenatal consultations and will collect publicly available statistical data regarding use of intercultural birthing services.The case of the Peruvian birth policy represents an opportunity to provide a more complex understanding of how cultural variables come into play in a context where cultural differences are institutionalized in policy. The results of this study also will provide a critical analysis of how the process of policy in Peru reflects and impacts social inequalities. Additionally these results will be significant for the future policy approaches to safe motherhood in other countries or regions that seek to use culture as a key construct for health policy. The research also will contribute to the education of a graduate student.