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Child survival & newborn portraits in Peru - 2018
In Yaurisque, newborn mortality rates have improved significantly, from 38 deaths per 1,000 live births (2000) to 8 per 1,000 (2017). Despite these advances, challenges remain: chronic malnutrition, long travel distances to maternal health clinics, and harsh living conditions in poor, rural villages continue to imperil newborns’ lives. A lack of running water, heating and mothers’ knowledge of common perinatal conditions, such as anaemia, haemorrhaging and preeclampsia, can be lethal. Since the 1990s, UNICEF has been working with public health officials to develop national solutions to address these challenges. Thanks to the solutions put in place by UNICEF – most notably the accommodation of vertical births – the number of women giving birth in a hospital in Yaurisque has increased dramatically, from 7 percent (2000) to 98 percent (2017). In addition, newborn mortality rates have gone down –While these numbers inspire hope and indicate that important advances have been made, at the regional level in Cusco, the newborn mortality rate at 12 per 1,000 live births remains above the national average of 10 per 1,000 (2016-2017). Yaurisque is a district in Paruro, a province of the region of Cusco, with a population of about 3,000 people. The people of Yaurisque are mainly indigenous citizens of Quechua descent. Yaurisque is located at 3,328 meters above sea level.

In Peru, some mothers live as far away as a five hours’ drive from the nearest health clinic. In the past, if their contractions started along the way, some of them did not make it in time and were forced to give birth on the road. If complications rose, some did not survive. A mama wasi, or mother waiting house, offers pregnant women a chance to wait, and rest, in a comfortable setting that reminds them of their homes before their babies come. UNICEF helped build the first mama wasis in 1999. It provided furniture, kitchen appliances to cook local post-partum dishes such as caldo de cordero, a savoury broth with lamb meat, which is believed to stimulate lactation and help mothers recover their strength. UNICEF also lobbied successfully to have the houses adopted as a public health policy across the region (it implemented 25 of Cusco’s 108 maternal waiting houses). “The whole objective is to avoid complications,” said Aragón Cuenca. “Because the mothers live in the countryside, they are at risk. If complications arise, or contractions start on their way here, they might not make it alive.” Because of the policy, maternal deaths in Cusco fell from 75 in 2009 to 19 in 2017.

While vertical births are culturally preferable and the most common in Yaurisque, conditions sometimes require a horizontal delivery: When a baby is head-up (breech), or a mothers’ pelvis is too small, a vertical birth would endanger a mother’s life. In addition, “some mothers become exhausted squatting on the floor, and they ask for a horizontal birth. We give them that option,” said Paola Yerina Aragón Cuenca, a midwife. “We don’t know how a birth will end; there are lots of cases when they start on the floor, but end up on the table.” UNICEF equipped the horizontal delivery room with a table and other appliances which ensure the survival of the baby: stoves, mattresses, beds, delivery kits, and other medical equipment.

A midwife is a caretaker, adviser and trusted confidante over the course of a pregnancy. In Peru, she does not leave her patient’s side. She visits expectant mothers at their homes to establish their health and safety. She also teaches them to recognize the most common ailments that can afflict pregnant women, such as hypertension, bleeding and fevers. She assists with deliveries that are not complicated (C-sections are performed by doctors, for example), and she continues to visit mothers at their homes to track the families’ health. “We are like confidantes; we come into the house and will see things nobody else sees,” said Aragón Cuenca. A midwife is helped by a network of women – nurses, who provide medical assistance, and community health workers, who are trained by UNICEF and are the link between mothers and their midwife. Many mothers live in mountainous areas, at least 15 kilometres from the nearest health centre, so when a fever or other dangerous symptoms arise, the health worker will call a midwife who will immediately depart for her patient. The community workers also help mothers to overcome their fears and shame. “Some women don’t want to come to the health centre,” said Adelaida Huamán Cruz, a health promoter in Incacona, a village in Paruro province, Cusco. “They are scared, or feel ashamed, but they know us, so we convince them and give them confidence.” “One woman who was in pain and about to give birth felt ashamed because she already had many children; she thought she would be judged at the health centre for failing to use contraception, but I was able to convince her to go after all. It was safer this way.” “They are our eyes when we can’t be there,” said Aragón Cuenca. In 2000, there were only 55 health workers for 12 health centres, including 6 staff at the health centre in Yaurisque (1 doctor, 2 nurses, 1 biologist and 2 technicians). Since then, the number of staff has doubled and, in some cases, tripled. Thanks to the UNICEF support and interventions, all of the province’s 55 health workers were trained in maternal and neonatal healthcare interventions. They included 8 doctors, 2 odontologists, 13 nurses, 10 obstetricians, 21 nursing technicians and 1 biologist. Furthermore, 60 community health workers (community volunteers) and 24 traditional midwives were trained; 20% of them were in Yaurisque District. Thanks to the UNICEF intervention, neonatal mortality rates dropped from 38 deaths per 1,000 live births to 8.6 per 1,000 in Yaurisque. (However, the regional average of 14.3 per 1,000 live births in Cusco remains higher than the Peruvian national average of 13 per 1,000.)

While the supplement is distributed to all 189 children under the age of three in Yaurisque District, only 30% of mothers in Cusco Region administer the supplement. This is why anaemia is a serious public health problem in children under the age of three. Many mothers in Cusco develop iron deficiency anaemia during their pregnancy. If they do not adopt a diet rich in iron (ferrous sulphate), their children will be anaemic as well. She will also run a higher risk of haemorrhaging during the delivery. UNICEF has worked with the Government of Peru to distribute supplements that contain life-saving nutrients. “The pills are crucial to a child’s mental development – an anaemic child will be tired all the time and not do well in school,” said Aragón Cuenca. In 2018, iron supplementation for children under the age of three is part of the national health policy such that all children should receive micronutrients from the age of 6 months.

In Peru, mothers keep a scorecard of their babies’ health at home. The card, introduced in recent years in Yaurisque by UNICEF and based on guidelines by the World Health Organization, is a tool that helps mothers track their babies’ health and become aware of any changes in their status. By charting an infant’s weight regularly and keeping an eye on dangerous symptoms such as fevers, vomiting, a change in skin colour and a decline in milk intake, mothers can feel more in control of their baby’s health. They feel empowered, involved and capable to call for help when their baby is sick. “To many mothers, our words and guidelines don’t mean much, but when they see a curve going up, indicating their baby is gaining weight, they understand,” said Rene Alcira Berrio Huancahuire, a nurse. “Once, a mother had trouble breastfeeding her child, and this showed on the chart. It appeared that she didn’t know how to feed him. The baby was brought in, seriously underweight. (He was born prematurely, and after 15 days, had lost 200 g. He only weighed 1.8 kg when he was brought back to the hospital.) The mother was aware of the danger of the situation – thanks to the card. She also trusted us to take care of her baby at the hospital, where he was saved. Then, I taught her a breastfeeding technique that worked well, and the baby left after one week, at 2.3 kg! It was teamwork.”
© UNICEF/UN0186354/Njiokiktjien VII Photo
Peru, 2018
[RELEASE OBTAINED] On 10 February 2019 in Peru, mother Celia Virginia Flores Mamani, 37, holds her baby...
© UNICEF/UN0197886/Njiokiktjien VII Photo
Peru, 2018
[RELEASE OBTAINED] On 10 February 2018 in Peru, mother Verónica Anchaya Huamám, 22, holds her 14-day-old...
Ilvy Njiokiktjien VII Photo
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