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For many years Peruvian Andean women used to birth their babies at home. The continuous rejection of care at health facilities is partially based on important cultural beliefs. Some of them are the exposure of female genitals in the gynaecological bed, the prohibition of familiar or traditional birth attendants (TBAs) participation in the rural clinics, and the lack of some features of traditional deliveries at home (vertical position, a rope available for pushing during uterine contractions, a belt for a sash after the baby's delivery, among others). These elements were incorporated into a rural health facility provided by the ministry of health, thus improving the rate of institutional deliveries and contributing to a decrease in maternal mortality.
The picture (taken in June 2001) represents a simulation of delivery using the culturally appropriate birth service implemented in the Aranhuay Health Post, Santillana District, Huanta Province, Ayacucho, Peru. Here appear the TBA behind the woman and a health care worker, both of them participating together.