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Changing Birth in the Andes
Culture, Policy, and Safe Motherhood in Peru

Author(s): Lucia Guerra-Reyes

In 1997, when Lucia Guerra-Reyes began research in Peru, she observed a profound disconnect between the birth care desires of health personnel and those of indigenous women. Midwives and doctors would plead with her as the anthropologist to "educate women about the dangerous inadequacy of their traditions." They failed to see how their aim of achieving low rates of maternal mortality clashed with the experiences of local women, who often feared public health centers, where they could experience discrimination and verbal or physical abuse. Mainly, the women and their families sought a "good" birth, which was normally a home birth that corresponded with Andean perceptions of health as a balance of bodily humors.

Peru's Intercultural Birthing Policy of 2005 was intended to solve these longstanding issues by recognizing indigenous cultural values and making biomedical care more accessible and desirable for indigenous women. Yet many difficulties remain.

Guerra-Reyes also gives ethnographic attention to health care workers. She explains the class and educational backgrounds of traditional birth attendants and midwives, interviews doctors and health care administrators, and describes their interactions with local families. Interviews with national policy makers put the program in context.

Biography of Author(s)

Lucia Guerra-Reyes, a Peruvian medical anthropologist, is an assistant professor of applied health science in the School of Public Health at Indiana University Bloomington.


  • "Guerra-Reyes' penetrating analysis of the reasons for the failure of the Peruvian government's intercultural birth policy is a landmark study and a significant contribution to the anthropological literature on birth."
    Sheila Cosminsky, professor emerita of anthropology in the Department of Sociology, Anthropology, and Criminal Justice, Rutgers University–Camden, and author of Midwives and Mothers: The Medicalization of Childbirth on a Guatemalan Plantation
  • "In this accessibly written ethnography, Lucia Guerra-Reyes offers an incisive analysis of Intercultural Birth in Peru, one example of the broader Latin American trend to decrease maternal mortality and provide respectful care to indigenous women. In often riveting detail, the book describes the many and various consequences of the gaps between policy and practice for women, their families, and communities, as well as their health care providers. This outstanding book is a must-read for anthropologists and anyone interested in global health, maternal health, and the politics and pragmatics of health care policy."
    Eugenia Georges, professor and chair of the Department of Anthropology, Rice University, and author of Bodies of Knowledge: The Medicalization of Reproduction in Greece