Connecting the Dots

So I’ve shared a lot about national public health policy in Peru. You might be wondering what this could possibly have to do with my work on the ground, in an indigenous community, up in the mountains.

Policy decisions have remained regressive and are causing harm to the traditional practice of the Quechua. A few examples how:

  • A fine against home delivery
    • both the family and the midwife are subjected to such fines
    • this policy is causing the practice of midwifery to fade, as young people passionate about maternal health are studying obstetrics over midwifery because of the government’s ‘harassment’ of midwives.
    • meanwhile, practicing midwives are taking their operations ‘underground’
  • Refusal of birth certificates unless the fine for home birth is paid
    • There are serious implications associated with not having proper documentation. It restrict’s the child’s eligibility for necessary social services.
    • The internationally recognized right to personhood is violated with this practice.
  • An abortion ban, even in cases of rape or incest
    • though less severe punishments are prescribed for these situations
    • no reference to term, so the traditional beliefs of early term abortion as ‘menstrual cycle regulation’ are disregarded
  • Lacking adequate accommodations for Andean communities
    • Women hours from a facility are required to deliver in one, but they cannot come early to ensure that their transportation is covered
    • Attending in Quechua is not a routinely practiced standard of care, causing obvious communication barriers and further dividing the biomedical world from the indigenous community
    • Some facilities allow for vertical delivery, a method that’s shown to ease the birthing process and is seen as critical in the ritual of giving birth as recognized by the Quechua.
Natural birth in a vertical position is promoted, because the baby should be received close to Pachamama or Mother Earth. Other rituals take place, such as burying or burning the placenta. This event takes place in a horizontal relation between the midwife and the birthing woman.
    • Many facilities do not allow for vertical delivery, as it is a more difficult position for the doctor. It seems as though traditional handling of the placenta is even less accommodated.


The volunteer group had dinner at my house a couple of weekends ago and I shared the following Haikudeck. I covered repro history as my last entry recounts. Then I shared cultural barriers to biomedical health settings, and suggested solutions to making care more culturally appropriate. Explore my notes if you’d like, or leave a comment below if you have any questions.


Peru reproductive health policy (1990s)

I’ve been doing research on the policy around reproductive health in Peru. With some significant political instability in the last few decades came a huge shift in contraceptive policy, from neoliberalism to extreme conservatism.

In the 1990s the Fujimori government addressed reproductive health from a population control angle. Making contraceptives more widely available, legally, was highly controversial since Roman Catholicism is the dominant religion in Peru. Feminists celebrated increased options for Peruvian women to exercise reproductive health autonomy. 

In time, though, this campaign became infamous for performing sterilizations without informed consent; aggressive recruitment practices targeted at individuals in poor communities (such as the indigenous); and extremely poor quality of care in delivering those procedures.

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Health Policy, F___ Yeah!

Ladies and gents, let’s talk Obamacare.

First as a communicator:

I am sad that Obama’s PR team tried to reclaim the term Obamacare, using it in all of their own materials in response to a long period of anti-Obamacare rhetoric, just to have it blown up in their face when the American people didn’t “get it” because they weren’t paying enough attention in the first place (as displayed by Jimmy Kimmel’s brilliant and gut-wrenching man-on-the-street poll). I thought it was a such a clever campaign trick when I first saw it. Sigh.


Second, as a Public Health student:

Things I see missing in the public discourse around the ACA.

NOTE: The rest of this entry assumes you’ve been following media of a high enough quality to know the basics. 1) that it’s not a government takeover, 2) that its primary function is to provide coverage to uninsured, and 3) how the insurance exchanges are supposed to work. Need some background info? Cue: The Kaiser Family Foundation’s Health Reform site. Fueled with good data and some serious medical/public health expertise.

I see the ACA as more than a list of offerings and regulations. The thing is, health services don’t really work in free-market economics. Not with today’s system. The ACA moves the needle on this.

Think about it. You can’t really shop around for health services. If you could call around and actually get prices to compare between providers, you are one seriously determined and free-time-having person. But it’s gotten so bad, so hard to predict actual patient costs per provider/insurer/plan, that we’ve become familiar with those forms at the doctor’s office. You know, the ones that say something along the lines of “We can’t tell you what this will cost, but you’re responsible for it regardless.” This would not be an acceptable payment method in almost any other market.

Now let’s talk about the person selling you your services. Your doctor. Who is paid more for selling you the most expensive services in the highest quantity (in a fee-for-service system, at least), even if a huge cost increase does not improve your outcomes. This incentive scheme is really the same as it is for salesman Pete at your nearest used car dealership. Except in healthcare, you’re supposed to trust your doctor. You don’t have hours (days) to spend reading the latest health journals, so you don’t know that your knee replacement has been decided, pretty much conclusively, to be of insignificant benefit over vastly cheaper rehab options.

Thanks to this buyer-seller relationship (and several other factors), there is also trouble in paradise when it comes to the conventional supply-demand-prices relationship.

Another thing about free markets: they’re supposed to be inclusive. With nearly 50 million people uninsured, this is clearly not the case.

So even if we can’t fix the doctor-patient relationship (yet), maybe we can help those uninsured participate in the market to bring things one step closer. What’s been prohibiting them from participating anyway? 1) Information (this time about the insurance options and prices rather than the actual health services) and 2) costs (if you could actually find those prices in a pre-ACA world, you’d run for cover).

Answer: An accessible marketplace providing layman’s terms information on insurance options that are easily compared, with regulated minimum coverage (like Safe Auto of health care but better), and subsidies so the poorest get some help and those who are just kinda broke still get a good deal, but pay their fair share into the system.

For any kind of coverage, insurance companies need a large pool to spread risk around. Now that healthy people (who can get by on a minute clinic visit and some DayQuils each year) are incentivized by a tax penalty to get real coverage, insurance companies are competing for them. That, along with transparency and an accessible marketplace, makes for economic activity that looks a little more like free markets for the people who haven’t been so fortunate to participate up until now.

I know there are issues. Web site probs, states being jerks about medicaid expansion, etc. I want to address those later, but let’s unpack this bigger picture concept first.

In an environment where liberals are seen as pro-imposing government and shoving communism down everyone’s throats, Obamacare seems to really try making healthcare work in a way that aligns better with free market principles. It’s nothing like a single payer “socialized” system that the most left would support if given the chance. And still, Obama is being blamed for our current political jam based on refusal to compromise?



Thoughts? Questions? I’m no expert but am nerding out over this stuff ATM and am happy to discuss/research with you.