Data do count! Collection and use of maternal mortality data in Peru, 1990-2005, and improvements since 2005.

This paper reports on a qualitative, exploratory study in 2005, based on interviews with 15 key decision-makers from the Peruvian Ministry of Health responsible for maternal mortality prevention and officials responsible for national data and information on maternal deaths. The main aims were to find out the sources of data and information used by Ministry of Health officials for programme planning and decision-making, whether policies and programmes were informed by the data available, and data flows among central decision-makers within the Ministry and between Ministry and regional and local health centres. Information systems require staff and systems capable of collecting, processing, analysing and sharing data. In Peru, none of these conditions was fulfilled in a homogeneous way. Vertical programmes in the poorest regions had funds for information systems and infrastructure, but limited technical and human resources. Public health workers were overwhelmed with provision of services and not always trained in data collection or informatics. Thus, quality of data collection and analysis varied greatly across regions. Data collection and usage since the study have been improved, reflected in a fall in maternal mortality ratios and women's increased use of maternity services, but efforts to maintain and improve data quality must continue to ensure that initiatives to prevent maternal mortality can be monitored and services improved.

The social constructions of unwanted pregnancy and abortion in Lima, Peru.

Although modern contraceptive use in Peru has increased, many women still face unwanted or unplanned pregnancies and abortions remain high despite the illegality of elective pregnancy termination. To improve understanding of how men and women make reproductive decisions, we conducted this study in Lima. Fifty-two 18-37 year old low- and middle-income women and men participated in in-depth interviews and focus groups. Reproductive planning constitutes a worry among participants. The paradigm of contraception, pregnancy, childbearing and pregnancy termination is complex and contained within a context of contradictory pressures toward women: while women feel the need to be autonomous in all realms of their lives, they also need to meet the traditional roles associated with sexuality and childbearing and rearing. The woman, her partner and family members take part in reproductive decisions. However, participants expressed difficulties preventing unwanted pregnancies and social stigma if they resorted to abortion or, interestingly, if they continued a pregnancy when involved in a socially undesirable personal situation. Abortion-related stigma generated fear and guilt in addition to safety concerns given the unsafe, clandestine contexts in which pregnancy termination takes place. Despite these concerns, interviewees often opted for abortion for personal reasons, which were primarily economic.

Social stigma and disclosure about induced abortion: results from an exploratory study.

It is well recognised that unsafe abortions have significant implications for women's physical health; however, women's perceptions and experiences with abortion-related stigma and disclosure about abortion are not well understood. This paper examines the presence and intensity of abortion stigma in five countries, and seeks to understand how stigma is perceived and experienced by women who terminate an unintended pregnancy and influences her subsequent disclosure behaviours. The paper is based upon focus groups and semi-structured in-depth interviews conducted with women and men in Mexico, Nigeria, Pakistan, Peru and the United States (USA) in 2006. The stigma of abortion was perceived similarly in both legally liberal and restrictive settings although it was more evident in countries where abortion is highly restricted. Personal accounts of experienced stigma were limited, although participants cited numerous social consequences of having an abortion. Abortion-related stigma played an important role in disclosure of individual abortion behaviour.

Managing unplanned pregnancies in five countries: perspectives on contraception and abortion decisions.

Why is induced abortion common in environments in which modern contraception is readily available? This study analyses qualitative data collected from focus group discussions and in-depth interviews with women and men from low-income areas in five countries--the United States, Nigeria, Pakistan, Peru and Mexico--to better understand how couples manage their pregnancy risk. Across all settings, women and men rarely weigh the advantages and disadvantages of contraception and abortion before beginning a sexual relationship or engaging in sexual intercourse. Contraception is viewed independently of abortion, and the two are linked only when the former is invoked as a preferred means to avoiding repeat abortion. For women, contraceptive methods are viewed as suspect because of perceived side effects, while abortion experience, often at significant personal risk to them, raises the spectre of social stigma and motivates better practice of contraception. In all settings, male partners figure importantly in pregnancy decisions and management. Although there are inherent study limitations of small sample sizes, the narratives reveal psychosocial barriers to effective contraceptive use and identify nodal points in pregnancy decision-making that can structure future investigations.

La investigación en salud para el desarrollo y el enfoque de género en el Perú: Tendencias en la década de los 90 / Health research for development and the focus in gender in Peru: Tendencies in the 90ïs

Balance de la investigación en salud realizada desde un enfoque de género. Contiene los resultados del balance realizado en Perú. Se exploraron las áreas de salud, derechos sexuales y reproductivos, calidad y acceso a los servicios de salud, violencia contra las mujeres y salud mental