Lima- The Peruvian Amazon still lacks infrastructure, medical staff, drugs and medical equipment to help the poor and geographically isolated rural population. The consequences are especially negative for women's health in rural areas. The most disadvantaged are the indigenous women, who suffer from economic, social and political exclusion, which in turn affects their health, above all their reproductive health.

These are some of the conclusions of a study made by Médecins Sans Frontières (MSF) in Ucayali region, after six years working in the area. "It is upsetting to confirm that, in 2001, the most frequent cause of maternal deaths are haemorrhage during birth and puerperium," declares Doris Arlt, MSF General Co-ordinator in Peru.

"This means that early detection and timely referral of pregnant women presenting alarm symptoms are insufficient." The report "Social-cultural aspects of health: women of fertile age" analyses socio-economic barriers that prevent indigenous and mixed race women getting access to health services and to quality medical care.

The report points to the benefits of community participation as a route to improve rural populations' access to health care. "The possibility of an indigenous woman going to a healthcare centre is minimal because of economic, cultural and idiomatic reasons," continues Glyn Alcock, a sociologist and the report's author.

"However, through our project in Pucallpa region, we have proved that communities are able and are ready to actively participate in proposals that improve their living conditions and their access to health care." The report concludes that a range of different forms of community participation have a significant influence on the possibilities of achieving durable changes.

At the same time, it recommends that health policies must be prioritised within development strategies, which in turn should focus on the factors and processes that help the population to rise out of poverty and social and political exclusion.

MSF is an international humanitarian organisation providing medical aid. Between 1996 and 2001 MSF has run a "Basic Sanitary Programme in Ucayali Region" to improve the indigenous and mixed race population's access to health care.