Segment 1

VOICEOVER

Ecuador's Amazon jungle: According to a myth of the Huaorani people, pregnant women died giving birth because the only way for their babies to be born was for their husbands to cut open their bellies. But one day, the myth goes, a mouse appeared and told a pregnant woman to throw a rope over a beam in the ceiling, get down on her knees, tap her body with a palm stick, and push the baby out. This is called vertical birth. Today, indigenous women continue to follow this traditional practice at home. But home birth can be life threatening. Ecuador has 13 million people, and nearly one million are indigenous. Many live in remote areas where women face high risks of dying from complications in childbirth simply because they receive medical help too late. Alba Peralta and a group of community health promoters are on a campaign to encourage rural women to switch from home birth to hospital delivery.

ALBA PERALTA

Life experiences have taught me that it's my obligation to tell women they should go to a health center because not only are their lives in danger, but their babies' as well.

VOICEOVER

Today, they are travelling 60 miles up the Napo River to Palma Roja, one of the 500 tiny hamlets accessible only by boat. In 1998, the government passed a law providing free maternal health care to every woman, but few in rural communities know about it. In 2004, a network of health promoters known as the Users Committee was created. Supported by the UN Population Fund, or UNFPA, they are to inform and encourage women to claim their rights and benefits. Alba and her team are visiting 18-year-old Mariela Grefa to persuade her to go to the hospital. Pregnant with her first baby, Mariela is learning from her mother the traditional way of childbirth. But, despite the offer of free services, she still prefers giving birth at home.

MARIELA GREFA

I am scared to go to hospital, because I know that sometimes when women cannot give birth the normal way, doctors open you up.

VOICEOVER

For indigenous peoples, giving birth is a private and intimate family ritual. Midwives and family members are always there to give support and comfort. Modern medicine is not only unfamiliar but also frightening.

LILY RODRIGUEZ

When women arrive in hospitals, they have to go through a practice that is completely different from their culture.

VOICEOVER

Lily Rodriguez is the deputy representative of UNFPA in Ecuador.

LILY RODRIGUEZ

They are in an unfamiliar environment, and in a language they do not understand, and that's why they resist going to the hospital.

DR. ALFREDO AMORES

I asked a young mother: "Why don't you go to the hospital?" And she said, "Because we are violated."

VOICEOVER

Dr. Alfredo Amores, director of the Orellana Provincial Health Department, says women are wary of Western medical doctors.

DR. ALFREDO AMORES

If they open your legs and put their hands inside you without asking, what do you make of that? For an indigenous woman, this is tremendously offensive.

VOICEOVER

Years of campaigning by the Users Committees for more culturally sensitive services have led to a new initiative. Otavalo City, high in the Andes, where half of its 10,000 residents are indigenous, recently opened a vertical delivery room in its hospital. It's the first public health institution in the country to provide vertical birth delivery. This Otavalo model is now being replicated in other health facilities.

LILY RODRIGUEZ

What's being done is the recognition of the Declaration on the Rights of the Indigenous Peoples which says that they have the right to be taken care of according to their culture and worldview.

VOICEOVER

To inform women of their rights and birth choices is a critical role played by Alba and the Users Committees. Since they began their work, the number of pregnancy-related deaths has started to decline in Ecuador.

VOICEOVER

This report was prepared by Patricia Chan for the United Nations.