Reproductive Health in the Sacred Valley of Peru – July 2011

The Sacred Valley of Peru, outside of Cusco and the gateway to Machu Picchu, but so much more, is one of the last indigenous bastions of Peru. The people speak Quechua, an ancient Inca language, and make their living by farming and livestock. Men, women and children work the farms on the valley floor and high on ancient Inca terraces that climb the Andean peaks up to 4,000 meters or more. They dress in traditional clothes and live in mud brick dwellings, which the higher you go, the fewer amenities like electricity and water they have.

I spoke to some of the local women through a translator. Rosario is 47, farms and has 6 children from 27 to 14. Her first five were delivered at home; her sixth she delivered in the local hospital, because she was having a difficult pregnancy (risks in pregnancy increase with the number of deliveries). Just before she entered the hospital, her husband had an accident and injured his foot so badly that he was unable to work their farm. Because she, and her children, were now responsible for the farm without his help, she decided to have a tubal ligation after her delivery. She wanted more children but sacrificed for her living children and husband, whom she had to feed.

Her method of birth control between pregnancies? Achank’aray, a local herb grown high in the Andes. The indigenous women collect it and boil it to make tea. One cup a day prevents pregnancy. When Rosario was ready for her next child, she stopped taking the tea. As for sex ed, this is commonly done by the grandmother. Herbal recipes are passed down from generation to generation. There are no herbal contraceptives, alas, for men. There is, however, one plant that lessens male aggression. If a husband is abusive or violent, then the local women wash his underwear in a plant called tuberculo. Alternatively, they put it in his drink. After two days the husband’s libido and aggression are markedly lessened.

I then met an extended family: Mercedes, age 62 with her daughters and daughters-in-law, Florentina, Isidora and Isabella. They all live in the same small house, in the valley. Mercedes, age 62, had 8 children ages 38 to 19. These children have 2, 3 or 4 children each. Florentina, age 25, a daughter-in –law, has just two, ages 7 and 2. She does not want any more children and uses birth control injections every three months from the local health facility. She pays 10 Soles per injection, or around $3. She gets headaches as a side effect but continues, since she cannot afford to educate her children. While the tuition is free, the school uniforms, books and school supplies are not. My gifts of pens and paper were most welcome.

Isidora, age 35, a daughter, has 4 children, ages 12, 10, 7 and 4, all delivered at home except the last. She too uses injections for birth control.
Isibella, age 37, another daughter, has 3 children, ages 16, 8 and 4. She says she does not use contraception.

I passed on to a pair of women waiting to take batches of barley to the Sunday market in Pisac. Regina, age 37, has two children , ages 16 and 12. She uses the calendar method for birth control, since injections are too expensive. She lives too low in the valley to find the herbal plants.

Her friend, Modesta, age 43, had four children. After the delivery of her fourth at the local health facility, the doctor pressured her into having a tubal ligation, even though she wanted more children. She says she feels constantly sick, since she is not getting her monthly period and toxins are building up inside her body. She is angry.

None of the women tell their husbands they are on birth control. Machismo is a reality of life. Men want children and equate birth control with their wives having extra-marital affairs.

While hardly a scientific sample, these women represent the challenges of poor women in Peru. Traditional methods remain in use, but many have changed to modern methods despite the costs and side effects. The number of children per woman is declining. The concept of unwanted children is virtually unknown, rather, women want many children to farm the land. Women alone are responsible for birth control and have to use it surreptitiously. None mentioned abortion. Nor was there any infant mortality.