The maternal mortality rate in Bolivia is one of the highest in Latin America, at 229 per 100,000 live births. Approximately 620 women die each year because of complications during pregnancy or childbirth, according to Family Care International.
Many projects supported by international organizations have been implemented over the past decades with very low success in terms of maternal mortality decrease. Currently, the government is developing a new strategy based on intercultural reproductive health care approach.
In recent years, some initiatives carried out by non-governmental organizations have also explored how cultural rights can bring about changes to make access to high quality sexual and reproductive health services available for all women in multi-cultural settings.
The Government of Evo Morales, the first indigenous President of Bolivia, has given to traditional medicine an institutional relevance. Since 2006, the Ministry of Health and Sports has a Vice-Ministry of Traditional Medicine and Intercultural affairs, which is in charge of promoting, protecting and guaranteeing the conservation of traditional medicines according to the indigenous knowledge and cultures.
Officially, Bolivia’s name is "Plurinational State of Bolivia" because this Andean country has 34 aboriginal nations, which represent 55 percent of the total population. The largest ethnic groups are the Quechuas and the Aymaras, and it is estimated to be 30 percent Quechua-speaking and 25 percent Aymara-speaking people.
That is why the intercultural health approach is using the aboriginal languages, taking advantage of the regional resources and respecting the habits and traditions. Moreover, there are post-graduated programs at two Bolivian universities on Intercultural Health.
With the new Political Constitution, which came into force early this year, intercultural consciousness in reproductive health has gained in prominence. In fact, the intercultural health is also focusing to contribute to the reduction of cultural barriers related to the universal access to sexual and reproductive health care services. Cultural barriers make it difficult for indigenous women to receive qualified health care which constitutes one of the indirect causes of high levels of maternal mortality experienced in Bolivia.
Some of these barriers are the doctor’s relation which the patient, the isolation of the women in hospital because they are often separated from their families and the positions used for delivery.
The intercultural dialogue between practitioners of western and traditional medicine is currently stimulated. Nurses of various health care services and hospitals from the city of Cochabamba are assisting traditional childbirths, whereas rural midwives are been trained to improve their capacities to evaluate risks.
In Bolivia, a culture of rural midwifery known as partera, midwives speak the local language. Some of them understand the importance of evaluating risks, and for that purpose they use a sort of oracle, based in coca leaves.
Among indigenous peoples, 78 percent of children born at home and 53 percent of maternal deaths occurred also at home.
Indigenous women prefer to deliver at home because they do not feel confidence in hospitals, mainly because their customs are ignored or denied in such health services.
In traditional deliveries, women can choose the position. Most of them choose to squat, with their family around, and drink infusions of medicinal plants. Soon after the childbirth, women must keep warm and avoid contact with cold water.
Taking into account this situation, the Hospital Manuel Ascencio Villaroel in the municipality of Punata opened in August. The first delivery room in which indigenous culture and delivery habits are observed, even a kitchenette is available so they can prepare the traditional infusions.
The intercultural childbirth – as it is called- is designed in such a way that indigenous women feel confidence. All details are considered, for instance the indigenous are not forced to use hospital clothes. The hospital has also accommodation facilities for women’s relatives. The delivery is supported by a doctor, and a midwife can assist it as well.
So far, this "intercultural childbirth" has been well accepted by indigenous communities. But to be replicated, big efforts should be made in order to bridge the gap between doctors and midwives, and to get funding to build more "intercultural childbirth rooms." The Hospital Manuel Ascencio Villaroel was awarded a US$ 65.000 donation from the Japanese Agency of Cooperation.