For many years, health policy-makers in Peru have tried in vain to address the subtleties and vagaries of indigenous people's needs. When it comes to women's rights, especially women's reproductive rights, cultural and religious beliefs act as barriers that prevent women from accessing proper healthcare. Maternal and perinatal health programs have not been able to sufficiently increase the number of indigenous women getting prenatal and postnatal care and delivering at health care facilities.

For indigenous women in the Andean and Amazonian areas of the country, giving birth at health care facilities in the presence of strangers, without their relatives, half naked and lying in a horizontal position was and still is just unbearable. Given those circumstances they prefer to stay home and deliver in a vertical position assisted by a midwife or a relative, which is what they have traditionally witnessed in their communities. But this trend has had alarming consequences for women's health and lives because the lack of medical assistance for any complications that can arise. A UNFPA representative has pointed out the fact that "several women die when they deliver at home and nobody gets to know because they live in distant rural areas...this data is not registered."

Although health personnel in a few departments have been assisting home deliveries in upright positions, isolated efforts are not enough. In an attempt to reverse this tendency, the Ministry of Health decided to adapt its policies to indigenous women's traditions instead of imposing Western ones. Thus, in August 2005 the "Technical Standard for Vertical Delivery with Intercultural Adaptation" was approved by the National Sanitation Strategy for Sexual and Reproductive Health. It officially introduced the "vertical delivery" as part of the maternity services in the country with a multicultural and gender sensitive approach.

This policy aims not only to respect indigenous women's customs and beliefs but also to "standardize the medical assistance on vertical delivery...adjusting the health care services offered to women in order to increase institutional delivery and thus, reduce obstetric complications that cause maternal death." The latter is especially disturbing; according to Health Ministry statistics the maternal mortality ratio is estimated to be 185 deaths for every 100,000 live births, mainly because of bleedings.

The National Concerted Health Plan launched in July 2007 includes as its main goals the decrease of maternal mortality to 66 per 1000,000 live births by 2015, while increasing up to 70% the coverage of institutional deliveries in rural areas. This is particularly important considering that the number of deliveries in rural areas has increased from 24% in 2000 to 42.5% in 2004-2005.

The Technical Standard for Vertical Delivery emphasizes that above all, it is crucial that health personnel is technically trained to perform the obstetric procedures needed for any of the positions the parturient may adopt: squatting, kneeling, seated or holding rope. The standards also emphasize welcoming the patient and her relatives, explaining to them the procedures in a simple way and, most importantly, encouraging the patients "to express their will with respect to the position they wish to be assisted for delivery."

In order to increase the incidence of institutional delivery, Peru has developed "waiting houses" or maternity homes, houses specifically conditioned to "shelter pregnant women and their families coming from remote areas and keep them close to a health care facility with basic obstetric...facilities." This is especially crucial for vulnerable pregnant women such as victims of domestic violence, widows, single or abandoned mothers or the ones with complications.

A documentary on the impact of "vertical delivery" as a standard maternity service procedure, produced by the Health Ministry and UNFPA, shows how indigenous women are increasingly trusting the health personnel. All the women interviewed were satisfied with the service and mentioned that they were treated with respect. Some of them even said they were definitely going back to the health care facility for their next delivery and that they would tell other pregnant women to do so.

This policy certainly proves that access to health care services for Andean and Amazon women can be improved simply by respecting their traditions and rights and making reproductive health policies more inclusive, that is, bearing in mind the multicultural nature of the country.