Adapting to poverty and dealing with gender: a comparative perspective on teenage pregnancy in the Peruvian Amazon.

Teenage pregnancy rates in the Peruvian Amazon are double the national average and among the highest in Latin America. Peruvian women living in rural, underserved and Amazon areas are more likely to become teenage mothers but the factors contributing to this socio-demographic trend are unclear. Thirty-one interviews and ethnographic observations of teenage and adult mothers living in the Peruvian Amazon were conducted to examine how social class and gender impacted their motherhood experiences. Despite preconceptions concerning the undesirability of teenage pregnancy, results show that teenage and adult mothers have similar experiences of motherhood. Both groups of women lack career and educational opportunities and are therefore economically dependent on men. This, combined with the cultural valorisation of motherhood, pushes them toward pregnancy and motherhood. In other words, pregnancy is a response to a lack of career and educational opportunities and not vice versa. The one difference found between teenage and adult mothers is that the former have less agency over reproductive decision making. In conclusion, motherhood among teenage and adult mothers in the Peruvian Amazon is an adaptive mechanism that gives women protection and fulfilment but is also the result of gender and class constraints that limit their life choices.

Providing culturally competent and universal health care in the Peruvian Amazon: The role of medical authority.

Peru's Ministry of Health promotes the provision of culturally competent and universal health care. To do so they have implemented policies aimed at addressing indigenous peoples' social, geographic, and financial barriers to health care as well as cultural gaps between them and (bio)medical providers. While scholars argued that these policies have fallen short, their explanations have ignored the role that medical providers' professional authority plays in implementing these policies. This study examined how medical providers aim to provide culturally competent care and facilitate patients' use of medical services while protecting their professional authority. This includes preserving control over their space of work and their capacity to legitimately diagnose, treat, and prognosticate medical problems. Ethnographic observations and 50 interviews conducted between May 2017 and February 2018 show that to facilitate the provision of culturally competent and universal health care, medical providers engaged in non-clinical tasks, trespassed bureaucratic rules, tolerated and integrated the use of traditional medicine, and expanded the time and place of their practice. To advance these strategies, medical providers sacrificed aspects of their social authority (e.g., their autonomy over their work) and their cultural authority (e.g., their ability to define treatment). However, providers also asserted aspects of their professional authority such as the ability to give patients instructions and advice and control over the use of traditional medicine. The latter had the potential of deterring some women from having institutional births, thus reproducing some of the constraints that indigenous people face in accessing health care.

Home birth preference, childbirth, and newborn care practices in rural Peruvian Amazon.

Home birth is very common in the Peruvian Amazon. In rural areas of the Loreto region, home to indigenous populations such as the Kukama-Kukamiria, birth takes place at home constantly. This study aims to understand the preference for home births as well as childbirth and newborn care practices among Kukama-Kukamiria women in rural Loreto. Following a case study approach, sixty semi-structured, face-to-face interviews were conducted with recent mothers who experienced childbirth within one year prior to the interview, female relatives of recent mothers who had a role in childbirth, male relatives of recent mothers, community health workers, and traditional healers. We found that for women from these communities, home birth is a courageous act and an intimate (i.e. members of the community and relatives participate in it) and inexpensive practice in comparison with institutional birth. These preferences are also linked to experiences of mistreatment at health facilities, lack of cultural adaptation of birthing services, and access barriers to them. Preparations for home births included handwashing and cleaning delivery surfaces. After birth, waiting for the godparent to arrive to cut the cord can delay drying of the newborn. Discarding of colostrum, lack of skin-to-skin contact as well as a range of responses regarding immediate breastfeeding and immediate drying of the baby were also found. These findings were used to tailor the educational content of the Mamas del Rio program, where community health workers are trained to identify pregnancy early, perform home visits to pregnant women and newborns, and promote essential newborn care practices in case institutional birth is not desired or feasible. We make recommendations to improve Peru's cultural adaptation of birthing services.