| Summary: | Across the Peruvian Andes, rural women continue to die in childbirth. Since 2009, Peru's Ministry of Health has promoted a policy of parto institucional (clinically managed birth) in an attempt to lower the maternal mortality ratio (MMR) in the Sierra. Andean women have historically given birth at home, leading the Ministry of Health to position high MMR across the Andes as a 'cultural' problem. Introducing a series of intercultural health initiatives, the Ministry of Health encourages Andean women to deliver in designated health clinics. Obstetricians are instructed to respect women's cultural preferences, offering parto vertical (upright delivery) birthing techniques, whilst at the same time, the work of the community partera (midwife) is marginalised by the state. Despite a significant rise in the number of clinically managed births, MMR in the Andes remains higher than in urban areas of the country. Cultural assumptions built around historic preferences for home births have thus influenced policy measures, significantly impacting on the maternal health choices available to rural women. This thesis seeks to challenge the cultural assumptions underpinning the Ministry of Health's current maternal health policy. Rather than focusing on the 'cultural problem', this study centralises the practices and understandings of the social actors involved in maternal health. Taking an ethnographic perspective, this thesis examines maternal health encounters as they are lived out in local context by rural women and the practitioners attending to them. This thesis shows that maternal health in the Andes is not just experienced in the consultation rooms and delivery suites of obstetric departments, but also in the homes, and across the diverse and challenging geographical terrains that make up the routines and everyday lives of rural women. The difficulties of reconciling a rural, agricultural lifestyle with the demands of maternal health policy require that women travel long distances over extended periods of time to attend health clinics. Family dynamics, and pragmatic and logistical concerns are very real and pressing concerns for pregnant women in the Andes today. Situating maternal health interventions in local context, this thesis exposes the biopolitical arrangements that shape women's maternity. It shows how culture is mobilised to ensure that rural women - and the practitioners charged with their care - conform to social and institutional expectations. In order to fully understand Peru's maternal health 'problem' then, we must situate it within the local contexts and lived experiences in which it is firmly embedded.
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