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

博士生Lucia Guerra-Reyes（匹兹堡大学）将在Kathleen M. De Walt博士的指导下进行关于文化和国家政策如何影响安全孕产的研究。她将通过分析秘鲁的跨文化生育护理政策来探索这些关系。这项政策旨在降低产妇死亡率，同时通过将安第斯家庭分娩的某些要素纳入保健服务，解决多文化政府日益关注的问题。因此，它为本研究提供了一个合适的案例研究。研究人员假设有三个相互关联的因素影响安第斯山区农村政策的实施和安全孕产的结果：区域文化差异的存在；护士助产士在实施过程中的关键地位及其对安第斯文化和跨文化的理解；以及农村地区生育妇女及其男性伴侣的经历和愿望。研究人员将通过对地区和地方领导人、卫生服务管理人员、助产士护士、妇女及其男性伴侣的深入访谈，研究这些因素及其对分娩护理的影响。研究人员还将对产前咨询进行观察，并将收集有关使用跨文化分娩服务的公开统计数据。秘鲁生育政策的案例提供了一个机会，可以更复杂地理解文化变量是如何在文化差异在政策中制度化的背景下发挥作用的。本研究的结果还将对秘鲁的政策过程如何反映和影响社会不平等现象进行批判性分析。此外，这些结果将对其他国家或地区寻求将文化作为卫生政策的关键结构的未来安全孕产政策方针具有重要意义。这项研究也将有助于研究生的教育。

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.