When Ana Luisa went to give birth at a clinic in Ayacucho, Peru, she was assigned a midwife who did not speak her native Quechan. She felt too intimidated to stay at the clinic and gave birth on the roadside on the way home.
Stories like this are not uncommon, and often end in tragedy. Every year approximately 287,000 women die before, during or just after childbirth; 99 per cent of those women are in developing countries.
Improving maternal mortality has been one of the more successful Millennium Development Goals. Maternal deaths have nearly halved since 1990, and many regions have made real progress in cutting these preventable deaths. However, indigenous women like Ana Luisa are excluded from this success story. The positive data masks the experiences of these mothers.
In being poor, female and from a minority, indigenous women face many layers of discrimination and many barriers to good health. They often lack access to health centres due to high fees and long distances to travel. Those indigenous women who do attempt to access healthcare may be intimidated, face discrimination or have difficulty communicating due to a language barrier. This means they are far more likely to die or face complications related to pregnancy. In the few places where we have the information, mortality rates can be twice as high in indigenous communities as the national averages.
Culturally appropriate health services (such as the delivery room pictured) make a huge difference. Women like Ana Luisa in rural Ayacucho in Peru faced some of the country’s highest maternal death rates. But then, after years of campaigning, health centres began to adapt and consider indigenous culture. They made provisions so that women in labour could squat and hold on to a rope rather than lie down, as indigenous women were used to, and they began hiring and training staff to speak the local language. The number of women using the clinics soared from only six per cent in 1999 to 83 per cent in 2007.
But we need to improve things for indigenous women on a larger scale, and to do this it is crucial that we get an accurate picture of the problems to be tackled. We must disaggregate data, and break it down by ethnicity as well as age and gender. This would allow us to understand how the experiences of indigenous and marginalized people are differing from the rest of the population. It would expose some of the inequities beneath the apparently good news story of the Millennium Development Goals by showing the reality for those at the edges of society. And it would enable the development of tailored solutions, like those found in rural Peru.
Indigenous women often lack a voice and this manifests itself in different ways – from being able to make decisions about their own health or about spending money, to having a political voice at the local, national or global level. Allowing the stories of indigenous women to be reflected in the data that is collected about development would allow their voices to be heard and therefore be a vital step in improving women’s health.
9 August is the International Day of the World’s Indigenous Peoples
Photos: Health Poverty Action