Warning: Creating default object from empty value in /afs/ir.stanford.edu/group/womenscourage/cgi-bin/blogs/wpmu-settings.php on line 45
A success story: CARE’s FEMME Project in Ayacucho, Peru » Women's Courage

A success story: CARE’s FEMME Project in Ayacucho, Peru

February 24th, 2011 by laurah21 Leave a reply »

Statistics raise concerns about the welfare of mothers around the world. These include: “Globally, of ten maternal deaths, eight are preventable,” and, every 52 seconds a woman dies during child birth around the world highlight the importance and need to care for women before, during, and after child birth (CARE). A great example of a possibility to improve maternal mortality in developing countries is the case of Ayacucho, a rural province in Peru, where CARE’s Foundation to Enhance Management of Maternal Emergencies (FEMME) project spearheaded an Emergency Obstetrics movement that ultimately cut maternal deaths in half. In five years, Ayacucho, a highland region in the South of Peru, went from being the second worst to one of the best provinces in terms reducing maternal mortality rates. CARE is working with the Peruvian Ministry of Health to scale up this program across the country.

As mentioned previously, Peru has an approximately 240 deaths per 100,000 live births. These ratios are higher in remote highland regions, where Ayacucho and Puno are located. After implementing CARE’s FEMME initiatives in Ayacucho, a final evaluation found that, in comparison to Puno where FEMME was not implemented, the maternal deaths were reduced by fifty percent. The percentage of women with a met-need for emergency obstetric care in Puno was only 33 percent, a number similar to Ayacucho’s before CARE’s programs were implemented.

CARE provided effective “tools, systems and structures to provided appropriate management of obstetric emergencies; in creased political will; and improved staff capacities and attitudes toward women” (CARE).

CARE’s FEMME model is based on the belief that a quality system of emergency obstetric care is a necessity if we are to save women’s lives.  Eight core strategies guide their interventions (inserted in picture diagram). In Ayacucho, FEMME focused on skilled obstetric emergencies and the promotion of a rights-based approach to health care, including respect for cultural diversity. As discussed in a previous post, cultural barriers, including prohibiting vertical birthing style and inability to speak the local dialect, prevent women from seeking care. CARE’s project made sure to support women’s decision making and cultural preferences. Women and their families were taught to recognize the warning signs of obstetric complications. Now, most health workers are knowledgeable and equipped with the skills and political support for their work. In addition, CARE trained “Vigilantes de Salud,” or citizen monitors, to build trust between health providers and people in the local community. The Vigilantes are themselves women from the community who volunteer their time to support women who are already in the hospital. Vigilantes act as cultural mediators between the patients and health providers. A trusting relationship between health provider and client is key to successful interventions.

As a result of FEMME’s success, the Peruvian Health Ministry released standard guidelines and protocols for obstetric and neonatal emergencies, largely based on those developed in the FEMME model.


CARE. A Case Study: The Impact of Maternal Health in Peru. 2007 http://www.care.org/campaigns/mothersmatter/downloads/Peru-Case-Study.pdf


[related,  cool blog about women around the world http://www.philborges.com/blog/ ]


1 comment

  1. anna says:

    Laura – awesome post. It’s great to read about extremely successful interventions, especially when so often we think about how much there still is to be done! Thank you for sharing.

    I was AMAZED by the level of success FEMME had in such a short time (cutting death rates in half in 5 years – wow). This type of success story needs to be shared as it shows 1) things CAN be done and helps fight against apathy, burnout, and helplessness all too common in work in international women’s health; 2) it shows HOW interventions can be successful. For example, I was interested to note that FEMME uses community members (’Vigilantes’) to help women navigate the health care system. In seems that getting community members involved in interventions is key to their success (as you mention). I imagine this is even more important for a program like FEMME that works in rural areas where women may be less comfortable and less familiar with the formal health care system.

    You also mentioned that the Vigilantes work as “cultural mediators.” I am reminded of Anne Fadiman’s book “The Spirit Catches You and You Fall Down”, in which a Hmong family and the world of Western medical collide in treating and caring for a Hmong girl with severe epilepsy. As Fadiman portrays the story, one of the biggest reason the young girl doesn’t receive the treatment she needs to stay healthy is the cultural divide between the Hmong family and the girl’s primary physicians. Success was achieved only via the help of extremely skilled social workers who labored intensely to meet the family where they were and respect their values and beliefs while still encouraging adherence to the Western medical interventions doctors suggested. The power of reaching out and bridging these cultural divides is, in my opinion, often undervalued and underestimated. We certainly need more thoughtful, informed women like you going into medicine!

Leave a Reply

You must be logged in to post a comment.