Content deleted Content added

Inline

Latest revision as of 19:08, 4 April 2022

Background Information

The Quechua are an indigenous population who live primarily in the Andes Mountains of Peru, Bolivia, and Ecuador. This article focuses primarily on the Peruvian Quechua both because Peru is the central region and because it has the most research available.

History

The Quechua culture began in central Peru prior to 400AD^[1] . The language spread throughout the Andes Mountain’s as the lingua franca ^[1]. At that time, there were many flourishing civilizations in the Peru area ^[1]. Around 1200AD, a man named Manco Capac led ten ayllus from Lake Titicaca to Cuzco and established the Inca tribe^[2]. There, he married his sister to become the first emperor and the head of the royal blood line^[2].

In 1438 AD, the Inca civilization was attacked by a neighboring society called the Chanca^[3]. After successfully defending themselves, Pachacuti Inca Yupanqui (the 8th emperor) restructured the social and political systems of the empire^[3]. Shortly after, the Inca resolved begin their own expansion^[3]. Over the following ninety years, they conquered nearly all populations between southern Columbia and Northern Chile, including those of their Quechua forefathers^[3]. Because the Inca demanded only labor from their subjugated residents, not tribute or religious conversion, the Quechua were able to maintain their beliefs and customs while under the Incan rule^[3].

In 1525, the Inca were attacked by a civilization from Paraguay that was led by one white man, Aleixo Garcia^[2]. They succeeded in defending themselves, but the emperor and his heir died shortly afterward, presumably from a European disease^[2]. This left the emperor’s other two sons fighting for the throne, and the Incan empire descended into a civil war until one of the brothers was executed seven years later^[2]. Shortly thereafter, Francisco Pizarro and his soldiers reached the coast of Peru^[2]. They killed the current emperor and replaced him with another, under Spanish rule^[2].

The newly appointed emperor staged a revolt against the Spanish in 1536, but he was unsuccessful^[2]. The emperor and his followers were forced to retreat to the mountainous regions northwest of Cusco^[2]. With the protection that the mountains offered, the Inca were able to survive for 36 more years in the mountains of the Vilcabamba region^[2]. In 1572, the Spanish succeeded in executing Tupac Amaru, the last Incan emperor^[2].

Most of the survivors of the Inca Empire were used for forced labor, where many died from European diseases^[2]. Others were able to escape into the mountains and build homes for themselves^[2]. This isolation allowed the Quechua to keep some of their traditions alive, although they have changed slightly over generations^[2].

The oppression of the natives continued for many years, until a group of 60,000 indigenous men revolted against the Spanish rule in 1780. They were defeated in 1781, and again in another uprising in 1814^[4].

An army from Argentina overtook the city of Lima and claimed it free of Spanish rule in 1821^[4]. The residents of Peru went along with this, and with the help of various other leaders (including Simon Bolivar), all of Peru eventually gained independence from Spanish rule^[4].

Even with independence, battles between the surround countries raged on, and little changed for the Quechua^[4]. In 1924, the American Popular Revolutionary Alliance (APRA) was founded^[4]. It was the first political party to bring awareness to the plight of the indigenous population, but in doing so it was outlawed^[4]. When the APRA was able to win the election in 1936, the president ignored this and continued with his term^[4]. In 1939, elections were rigged to prevent APRA from coming to power^[4]. Many changes in power occurred over the following years, all with little effect on the Quechua^[4].

thumb|Five year old Lina Medina, 7 and 1/2 months pregnant. In 1933, Lina Medina was born in a small indigenous village^[4]. Five years and eight months later, she gave birth to a son via C-section, making her the youngest confirmed mother in medical history^[4].

In 1945, Peru was accepted into the United Nations^[4].

In 1975, Quechua became Peru's second official language^[4].

From the 1980s until 2000, there was an internal conflict in Peru between the Peruvian government, the Shining Path, and the Túpac Amaru Revolutionary Movement^[4]. Many indigenous populations were caught in the crosshairs--an estimated 3/4 of the 70,000 casualties were Quechua^[4].

From 1996 to 2000, Quechua and other indigenous women were the victims of Alberto Fujimori's population control campaign, which resulted in the sterilization of over 200,000 indigenous women^[4].

In 2006, two newly elected members of parliament (Hilaria Supa Huamán and María Sumire) took their oath of office in Quechua^[4]. Although Quechua had been an official language for nearly forty years, their oaths were not accepted^[4].

Social Structure and Organization

Largely separated from the Spanish, the Quechua communities are vastly different from the rest of Peru^[4]. The community unit is the ayllu, the same as it was during the period of the Inca. This can range from a large grouping of family members to a small village^[2].

Similar to many Spanish cultures, the Quechua surname consists of two parts^[5]. Married couples do not exchange names; their children receive a combination of their names^[5]. One receives the first of two part surname of each parent; with the mother's name first and the father's name last. Thus, the father's surname continues indefinitely while the mother's does not^[5]. One may marry someone removed by four generations^[5]. In some populations of Quechua, it is not appropriate to marry one who shares either of the last names^[5]. To do so would be considered incest, which is "a most shameful act."^[5]

There are gender roles, but they are not strict^[5]. For example, women typically rear children and cook meals, but a man preparing dinner would not be out of place^[5]. Men and women both weave, but women typically weave more intricate patterns^[5]. Men and women both take great pride in their work, so if there is work to be done, anyone available will help regardless of their sex^[5].

The youngest child remains in the parents' home to take care of them in old age^[5]. After they die, the youngest child inherits the home and their share of the land and livestock for their work^[5]. The other siblings generally receive the same amount of land and livestock as the youngest child^[5].

Political and Economic System

In Peru, indigenous people are one-and-a-half times more likely to be poor and almost three times more likely to be extremely poor than non-indigenous people. In fact, Peru ranked fourth in the world for the greatest nutritional disparities between the first and fifth quintiles in 1999^[6]. In addition, over half of Peru’s 2009 population fell under the national poverty line^[7].

The Quechua are largely subsistence farmers^[1]. They trade their excess goods with neighbors for other goods or money. They also sell woven materials in the markets to gain money for extra food, when needed^[1].

Religion

From their interactions with the Inca and the Spaniards, the Quechua developed religious practices that include aspects of the Spaniards’ Christianity interwoven with Incan duality^[8]. Their animate world is structured around appeasing their many gods in order to ensure good fortune and protection from evil spirits^[8]. The central god is Pachamama, Mother Earth, and offerings of drinks are made to her daily^[8]. Apus, the mountain gods, are also frequent recipients of offerings^[8].

Creation

The Quechua do not have a specific creation story, but various versions exist in literature^[9]. Many versions, such as the one that follows, clearly exhibit the disdain for the Spanish rule^[9]: First, there was just God (or Raol, in some versions) and other spirits of lesser power^[9]. God created the moon and earth, and then the plants, animals, and Nawpa Machu (“ancient old ones,” in Quechua)^[9]. The Nawpa Machu were humanoid, but they were more learned and powerful than humans are^[9]. During their stay on Earth, the Machu sinned and became God’s enemy^[9]. God sent his son Jesus to live on Earth^[9]. Jesus did not like the ancient old ones because they had angered his father^[9]. Jesus tried to fight the Nawpa Machu, but he was killed^[9]. When God asked the Nawpa to explain what had happened, they would not speak to him^[9]. God punished them with a rain of fire^[9]. They ran to the mountain caves and rivers for protection, but the fire destroyed all but their spirits, some of which were released into the wind^[9]. To prevent the revival of the Nawpa Machu, He created the sun^[9]. He made it light the Earth for his new creation, a human named Arran^[9]. Arran lived in a wonderful, fertile garden, but after seeing birds mating, he felt lonely and asked God for a mate^[9]. While Arran slept, God made Iwa from Arran’s dreams^[9]. Seeing the gifts that God gave Arran (and subsequent humans) made the Nawpa spirits jealous, so they kill them by making them sick when they have the opportunity^[9].

Physical Environment

Herds of llamas and alpaca on the Ausangate Mountain hillside.

See Geography of Peru for more detail.

In Peru, there are four areas: The coast, inland low elevations, the jungle, and the Andes. When the Spanish arrived, the indigenous populations moved to the less inhabitable areas to avoid persecution. These are, primarily, high in the Andes and deep in the jungle. There, they started communities separated from outside contact. This allowed the Quechua language to develop into numerous dialects--some so varied that they are unable to communicate with each other. The Quechua focused on for the purpose of this article are those in the Andes in the southern half of Peru.

The Andes provide a formidable terrain for the Quechua to live. The temperature and humidity decrease as the altitude increases, and the central section in Peru is quite dry. The snow line in the southern Andes is around 4,800-5,200 meters. Due to the terrible climate, potatoes are the main crop grown at higher altitudes, and they make up the majority of the Quechua diet. In fact, they have found a way to freeze dry them by leaving them outside overnight to freeze, then pressing the water out^[10] . In this form, they are able to be consumed throughout the year. Llama and Alpaca, which live in the mountains, are used by the Quechua as beasts of burden when needed, but more frequently for their fur. They are shaved in the Spring each year, and their hair is used to make wool for weaving. Since women sell their woven products in the market, these animals are more valuable for their hair than their meat, so they are not eaten. The money gained from weaving is used to purchase other food products.

Health and Illness Theories

As discussed in the Religion section, the Quechua live in an animate world full of good and evil spirits. Illness is caused by an imbalance in that world^[11]. If, for example, a person did not pay proper respects to the Apu, then the Apu will not protect them from the Nawpa Machu^[11]. The Nawpa can attack a person in various ways, each resulting in a different illness. This supernatural origin of illness is sometimes called “Pahu.”^[11] The Quechua may also become sick if there is disharmony among the people^[11]. For example, in “Wiruti,” an illness is caused by the negative thoughts of others^[11]. “Unkuy” is the most natural of illness causes: excess of natural elements, such as wind or water, manifest themselves through illness^[11]. It is important to note that one disease can be the result of any combination of Unkuy, Pahu, and Wiruti^[11].

Health Statistics

In 1996, children in the poorest 20% of the population was 4.96 times more likely die before their fifth birthday than children in the wealthiest 20%^[12]. By 2000, this rate had actually increased to 5.26 times^[12]. Both years, Peru had the greatest mortality ratio discrepancy between upper and lower quintiles in the world^[12].

People from indigenous groups are more likely to be poor, and in Peru they are less likely to complete their secondary education (23 percent of poor indigenous children compared with 36 percent of the poor non-indigenous children)^[13]. This translates to lower incomes and malnutrition^[13]. Malnourished women are less capable of enduring long labors, and have an increased risk for retained placenta. Maternal death is a frequent result^[14].

Child and Maternal Health

Peru has the second highest maternal mortality rate in South America^[15]. A 2009 study estimated the maternal mortality in Peru at 240/100,000 women^[16]. That places a woman's lifetime risk of death from maternal causes at 1 in 140, a rate that twice the regional average^[16]. Of the thousands of health centers in Peru, only 25 combine the use of traditional and western medicine^[15].

Stunting, or reduced growth rate, often begins during pregnancy as a consequence of malnutrition^[6]. The low birth weight infants that result are significantly more likely to die within thirty days of birth than are normal birth weight infants^[6]. Infants that are stunted tend to be stunted as adults, which causes substantial risks for the women during childbirth^[6]. Stunted women are much more likely to die during childbirth as a result of obstructed labor^[6]. Those that survive tend to have low birth weight infants, thus increasing the effects of stunting over generations^[6].

The top five causes of maternal death in Peru are hemorrhage, pre-eclampsia, infection, complications following abortion, and obstructed labor^[17]. The majority of pregnancy related deaths do not occur during the birth: 46% occur in the six weeks following birth, 27% occur during pregnancy, and 26% occur during labor^[17]. Due to their forced geographic isolation, fifty-nine percent of the indigenous communities do not have access to a health care facility^[17]. Of the communities that do have a facility, forty-five percent have only first-aid, forty-two percent had a health post (one of the most basic health facilities), and only ten percent had an actual health center^[17]. As a result, the maternal mortality rate of indigenous women is significantly higher than their Spanish counterpart^[17].

Statistics for all of Peru can be deceptive, since the rural areas where the Quechua live (and even their cities) have significantly worse outcomes than Spanish populated areas.

The table below illustrates the differences in care between the urban areas where the Spanish live (Lima) and the rural areas where the Quechua live (Huancavelica). The "urban" Cusco, which is primarily Quechua, is also included for comparison.

	Lima	Cusco	Huancavelica	Rural	Urban
Perinatal Mortality	13.8 (5.6, 8.2)	45.1 (13.1,32.0)	22.9 (8.6, 14.3)	29.3(11.1, 18.2)	16.4 (6.9, 9.5)
% teens pregnant with first child	2.3	1.6	4.9	3.9	1.0
% births with skilled attendant	91	39	19	42.9	89.1
C-section rate	16	4	2	5.7	23.3

Perinatal mortality: Rates per 1000 women. Given as Total (stillbirth rate, early neonatal death rate).

Source: http://www.who.int/making_pregnancy_safer/events/2008/mdg5/countries/final_cp_peru_19_09_08.pdf

Pregnancy Behaviors and Beliefs

Prenatal Care

Quechua women typically have “prenatal care,” but it less frequently provided by a doctor than in the urban areas.

The table below illustrates the differences in care between the urban areas where the Spanish live (Lima) and the rural areas where the Quechua live (Huancavelica). The "urban" Cusco, which is primarily Quechua, is also included for comparison.

	Lima	Cusco	Huancavelica	Rural	Urban
% Women receiving no prenatal care	0.8	1.6	2.7	1.6	5.1
% Women with prenatal care who learned symptoms of pregnancy complications	91.8	82.8	88.8	86.4	90.7
% Women who gave urine sample as part of prenatal care	96.9	76.6	65.2	69.9	94.2
% Women who gave birth at home in the past five years‡	3.4	18.9	32.6	41	5.4
% Women who had no postnatal care	1.5	7.5	7.1	17.7	2.9

‡ or not in a health establishment

Source: http://www.measuredhs.com/pubs/pdf/FR242/FR242.pdf

Local View (conceptualization) of Pregnancy and Infertility

Pregnancy Causes

The Quechua believe that there are multiple causes of pregnancy. The Napo Runa believe that rather than a sperm fertilizing an egg, the man leaves a small portion of his “energy” inside the woman’s womb^[18]. There, the woman nourishes the child until it is born^[18].

The Chilihuani have a similar belief, though the woman also has “energy.”^[14] If the woman’s energy is stronger, the child will be a girl; if the man’s energy is stronger, it will be a boy^[14].

It is also possible to become pregnant by more ominous means: If a woman is alone in the presence of a rainbow and strong, warm wind, she will become pregnant^[19]. The resulting child will be born with a physical defect, and it will only take its mother’s surname^[19]. Alternatively, a Nawpa Machu may impregnate a woman while she dreams^[20]. As the child grows, it draws blood away from the woman’s husband until he wastes away^[20]. The husband will die when the child is born^[20]. Similarly, if a woman is in a spring or a stream that flows from one, a Nawpa Machu may enter her vagina in the form of a snake, resulting in her becoming pregnant^[20].

Treatment for Infertility

Infertility has multiple treatments, including the following:

Phallcha flowers, as a symbol of fertility, can be made into tea and drank^[5]
Incense of Chutarpu or Sutarpu can be burned^[21]
Albahaca Negra (Ocimum micrantum) is mixed with mallow and sued to wash the vagina^[22]

Pregnancy Prevention

To prevent pregnancy, many traditional methods are still used. Modern methods are frequently not accessible or affordable, but younger generations may use them if available^[14]. Older women have a distrust for birth control suggested by the government due to the forced sterilization campaign from 1996 to 2000 that affected up to 300,000 indigenous women^[14]. Instead, the following methods may be used:^[14]

Drink Descurainia titicacensis tea three times a day during menstruation.
Drink parsley juice for breakfast for the first two days of menstruation.
Eat guinea pig soup three times one day after giving birth (this lasts for several years)
Drink Tropaeolum tuberosum tea frequently
Abstinence (not well adhered to)

Preparation for Birth

In some areas, a mode of transportation such as a horse or canoe is acquired prior to labor, in case there are any complications that require transport to the nearest city^[18].

Extrinsic Factors

Air, water, food, and drink

During pregnancy, Quechua women do not increase the amount of food that they consume^[10].

Sleep and wakefulness, rest, activity, and movement

In general, women do not change their daily activities due to pregnancy^[14]. A common Quechua belief is that the thoughts of a woman are transferred to her fetus^[14]. Therefore, she should not think of anything unsettling^[14]. A woman should also avoid spinning or weaving while pregnant to prevent the fetus from becoming entangled in the umbilical cord^[14]. To dispel malevolent air that could harm the fetus, the woman may tie black and white wool threads around their wrists, ankles, or waist^[14].

Sexual activity

Sexual activity among the Panao generally begins shortly after puberty, with the majority of girls having sex by the age of 14 and boys by the age of 15^[8]. While sex outside of marriage is not frowned upon, it should not be known publicly (indeed, kissing or holding hands in public would be quite distasteful)^[8]. Sex should occur with only one partner and continue until the parents allow the couple to marry^[8]. Pregnancy without marriage will cause one to lose some esteem, but having a second child outside of marriage is significantly more detrimental^[8].

Among the Napo Runa, there are two beliefs regarding sexual activity during pregnancy^[18]. The first is that sexual activity is needed to help the fetus to develop and should be continued throughout pregnancy to make the child grow strong^[18]. The alternate believe is the exact opposite: the mother should not have sex while pregnant because the man’s “energy” will steal from the child, making it grow weak^[18].

Emotional behavior and Personal behavior

During pregnancy, women are at an increased risk of becoming sick from interactions with evil spirits^[8]. To avoid certain diseases, extra precautions must be observed.

"Caught by the air of fetuses" This malady is transmitted by breezes along water sources that are near buried single mothers, fetuses, or placentas^[23]. If a woman bathes in the river during the evening, or washes clothing in the river at any time, she will develop small itchy bumps on her body where the water touched^[23]. In the more serious form, purulent eruptions form^[23].

Another disorder, similar to the previous disease, is caused by air from buried fetuses^[24]. In this case, the fetuses are aborted and not buried deeply enough^[24]. It frequently occurs outside of cemeteries, but it can occur at any location where one is buried^[24]. It results in cone shaped papules erupting from the skin, primarily on the face and limbs^[24]. They are not typically itchy, and they are filled with clear liquid. It also causes goose-bumps^[24].

"Mancharisqa" This disease is also contracted near burial grounds, and results in trembling, wasting of the extremities, seizures, bipolar feelings, and uncontrollable depression^[24]. It is most common in children and pregnant women who have sustained a significant fright^[24]. Luckily, this disease can be cured by a special healer called a Layqa^[24].

Labor

Where Should Labor Take Place?

Most women continue their daily activities while in labor; the walking helps to accelerate the birth^[15]. Eventually, they return to their home and labor in the kitchen/family room (most homes are two rooms: a bedroom and a kitchen/family room)^[14].

More recently, waiting houses called Mamawasi have been created. The woman travels to the waiting house at eight months pregnant and stays there until she goes into labor. This ensures that the woman will not have her child at home or on the way to the hospital^[15].

Beliefs of Cause of Labor, Onset, and Length of Labor

Labor usually occurs naturally, but if the woman appears to be getting too large, it can be induced^[18]. Llama placenta is used to help or induce labor, or they use the cooking of moqomoqo and feverfew^[21]. Moqomoqo is either a plant with sap to stop bleeding or a general term for a lizard.

A drink made with shavings of giant armadillo claws is used to help the baby slide out easily^[18].

Extrinsic Factors

Air, water, food and drink

Women are particularly susceptible to evil spirits while in labor, and therefore specific precautions must be taken^[8]. Women must be shielded from the cold air by being fully clothed and by being in a warm room, preferably heated by fire^[8]. Only hot liquids are consumed during labor^[8].

Nettle tea is consumed to warm the body and speed the birthing process^[14]. Incense are burned to ward off evil spirits. Meat broth is made at the beginning of labor to keep the woman strong^[14]. The woman may be covered with saltpeter to purify her and keep her safe^[14].

Sleep and wakefulness, rest

No sources discussed rest during labor, but keeping strength was important. From this, one can assume that resting to gain strength would be appropriate.

Activity and movement

Women frequently change positions and walk to help relieve pain and speed up labor^[14]. They are quiet; they may moan during the most painful contractions, but they do not scream^[14]. The husband of the woman in labor is usually positioned behind her while she is squatting to relieve some of the effort she has to exert^[15].

Sexual activity

Modesty is extremely important in the Quechua culture^[8]. During labor, the woman wears her own clothes, and the vagina remains covered^[8]. If someone has to see the vagina (i.e., the doctor in a hospital setting), it should not be visible to any family members^[8].

Emotional behavior and Personal behavior

Napo Runa believe that newborns are born “soft,” and must be shaped into a human by their parents and family^[18]. Because newborns are so malleable, they only the mother can hold them for the first month^[18]. If anyone else holds the child, it will become “twisted;” that is, the child will cry incessantly, and it and its feces will turn black and green^[18]. After the first month, if someone is to hold the infant, they must first ritually pass it head first through their legs (the first time that they hold it) to prevent it from becoming twisted^[18].

Pain and Pain Management, Touch

The mother of the birthing woman may massage her stomach or place pressure on her spine to help relieve pain^[14].

Attendants During Labor

In the early stages of labor, the woman does not have an attendant^[15]. Once it progresses further, the mother of the woman in labor acts as the birth attendant^[14]. Occasionally, the father of the child will be the birth attendant, but this removes him from his typical support position behind the laboring woman^[15]. Alternatively, it is possible to have a woman who lives nearby serve as a midwife^[14]. If no other options are available, any child over the age of twelve is typically able to help during uncomplicated births^[14].

Supportive Behavior

The husband gives verbal encouragement during the labor, as does the midwife, if present^[14]. The husband also provides physical support by helping to woman to remain in a squatting position, which allows gravity to speed the birthing process^[14].

Birth

Birth Attendant and Assistants

In general, the help of a midwife or professional is only sought if there are complications such as obstructed labor^[14]. There is a traditional birth attendant (midwife) or a traditional healer in some villages, but the majority do not^[14]. When they are present, they are either centrally located in the village or operate out of their home (which could be 10 or more miles away from the village center)^[14]. With unpaved roads and few vehicles, it is unlikely that a woman would be able to access a healer, midwife, or health station in case of emergency during childbirth^[14].

Status of Birth Attendant

Healers of various types are highly esteemed among the Quechua^[25]. However, a 2006 study of forty Quechua communities found that 75% of traditional healers are completely illiterate, and the remaining 25% did not complete primary school^[25]. Among traditional birth attendants, the statistics were not significantly better: 41.9% are illiterate, 52.8% didn’t finish primary school, and only 1.8 percent had graduated high school^[25].

Midwives who are more experienced and thought to have “special knowledge” may be asked to come from a neighboring village if a labor is not progressing^[14]. For this, they may be paid the equivalent of two US dollars^[14].

There are three common ways to become a midwife^[26] :

1. Apprenticeship of another midwife in the family, usually beginning at a very young age

2. Being asked to assist births in a community because of previous experience (perhaps helping a family member through a difficult birth), and ultimately gaining the reputation of midwife

3. During a dream, receiving a call from Nature where one is told to become a midwife

Locus of Decision Making Power

Women are generally able to make decisions, or at least have some input, on their care. Only 16% of Peruvian women reported that their husband made all decisions regarding health care^[16].

According to some studies, the woman makes all of the choices regarding prenatal care, labor, and birth^[26].

Where Birth Takes Place

In Peru, 82% of births take place in a medical setting^[27]. However, there are huge disparities between the urban and rural populations, with the former using health facilities 93.4% of the time and the latter using them only 59.0% of the time^[27]. Additionally, there was a direct correlation between the percentage of women giving birth in a health center and income level: women in the lowest quintile of income used health facilities on 51% of the time, with the following quintiles being 78.0%, 93.7%, 97.3%, and 97.3%, respectively^[27]. Also of note, the INEI study cited above does not separate births occurring at health posts from births occurring at hospitals; both are considered health facilities^[27]. However, a rural peasant is significantly more likely to reach a health post than a hospital^[27].

Birth Position

Quechua women change positions frequently, from kneeling to squatting to walking^[8]. Rarely, if ever, do the women recline while in labor or during birth^[8]. Of utmost importance is that the woman be touching Pachamama, with her bare feet on the ground, when the child is born^[8]. This will ensure that Pachamama will watch over the child and help protect it from evil spirits^[8].

Pain

Specific relief for pain during birth was not discussed, but it is likely that the pain relief during labor (certain herbal remedies and massage) are continued throughout the birthing process.

Placental delivery and practices

Some healers use Brack Egg to disinfect the umbilical cord before cutting it, but most are not concerned with the possibility of infection^[14]. There was no discussion of disinfecting whatever tool is used for cutting, although there are numerous beliefs about what tool to use^[14]. Some cut the umbilical cord with broken earthen ceramic or sharp tile piece because cutting with a sharp object such as a knife or scissors will cause the child to wear through clothes very quickly, or possibly become an assassin^[14]. Others prefer to use a knife or scissors to make their child “sharp,” instead of ceramic or tile which will make the child “dull.”^[14]

In some Quechua villages, such as Chillihuani, the placenta is washed within a day of being expelled and then burned^[14]. The ashes can be spread over livestock or land to make it more fertile, or they can be mixed with blessed water and drank to bestow immunity against the "malevolent wind."^[14] If the placenta is not washed before it is burned, it will cause the mother intense pain, and the child will "turn dark."^[14]

In other villages, it is more common to bury the placenta near the home in a warm place to keep it safe from the cold, which is associated with evil spirits^[8].

Extrinsic factors

Air, water, food, and drink

Keeping the woman safe from cold air remains important throughout the birth.

Sleep and wakefulness, rest, activity, and movement

During the actual birth, it is very important that the woman be touching Pachamama^[8]. The typical position for the birth is squatting, holding onto a hanging rope for balance^[8]. The husband sits behind the woman to give her support^[8].

Emotional and Personal behavior

Emotional behaviors during the actual birth were not discussed.

Behavior for complications, abnormalities

Obstructed Labor

A midwife may use her hands or a technique called blanketing to adjust the fetus’ placement in the womb^[14]. This is done with the intention of assisting the fetus into the birth canal^[14]. Lafeber and Voorhoeve stated that during blanketing, “a shawl or sheet is placed under the back of the woman, who is lying on her back^[14]. Then the midwife takes the two ends of the shawl and rubs rhythmically and slowly in to dorsal and iliac areas, going up and down various times.”^[14]

Hemorrhage

The Quechua use many different methods to combat hemorrhage. Clay can be used to cover deep tears to stop bleeding, or one can eat fresh dove heart^[21].

One method for combating a slow hemorrhage, or recovering from blood loss, is to rub a mixture of steeped herbs and animal fat onto the woman’s entire body, place nettles on her belly button, then wrap her in blankets^[14]. The feet should be rubbed with the same mixture with the addition of chewed coca, and then heated tiles should be pressed against them^[14]. This should be done on the first, third, and fifth day following the birth^[14].

Low Milk Supply

Shrimp or chicken broth is given to increase milk production^[21]. To induce milk production, Quinua (Chenopodium quinua’’) is used^[21].

Any of the following herbs, if taking for the duration of lactation, will help ensure an ample supply:^[24]

Achupalla
Ajo
Brezo
Habas
Hinojo

Perineal Tears

Some Quechua women recommend placing a cloth over the tear for the first day, and on the following day, a cream made of Grindelia boliviana, Rosmarinus officinalis, unuka, and Senecio rhyzomatosus is applied^[14]. Alternatively, the thin white membrane from the inside of an egg shell can be placed over the tear^[14].

Use of technology

Given the low percentage of births that occur in a health facility, it is unlikely that instrumental births occur. In cases of emergency, the C-section rate among the rural Peruvians is still quite low in comparison to those in the urban areas.

Postpartum

When Does It Begin and End?

Discussion of when the postpartum period begins and ends was elusive; however, one can assume that the postpartum period ends when the mother and father stop observing post-birth activities. For example, the Chillihuani postpartum period appears to last for eight days (Bolin, 1998, page 156), the Napo Runa’s two months ^[18], and the Panao three to four months^[8].

Where Does It Take Place?

Mothers of the Chillihuani must remain in her home for eight days following the birth of a child^[5].

Rite of Passage to Announce Status

The modest clothing of the Quechua easily hides pregnancy, and women do not mention anything about the child until after it is born^[8]. This is because childbearing is a dangerous process, so the announcement does not come until the mother and child are both healthy after the birth^[8].

Different Behaviors for Primiparous vs. Multiparous

Among the Chillihuani, tradition says that if the firstborn child is a female, its family will experience good luck and economic well-being^[14]. If the firstborn child is a boy, the family will struggle to make a living. The sex of all subsequent children is inconsequential^[14].

Extrinsic Factors

Air, water, food, and drink

Following the birth of the child, the mother cannot eat salt for one to three weeks because it will injure the womb^[14]. Women of Puno do not eat white food of any kind for a period following the birth of the child, unless it will stimulate milk production. ^[10]. This is a very restrictive diet, considering that the staple of the Quechua diet is the potato^[10].

Both women and men of the Napo Runa observe a two week period of restrictions after the birth of their child^[18]. During this time, they do not consume any nocturnal game for fear that the child will take on its characteristics and stay awake at night^[18]. They also avoid heavy physical activity and sex, either of which will negatively affect the child’s development^[18]. The child might grow “crooked,” turn different colors, or become very sick with diarrhea^[18].

Sleep and wakefulness, rest, activity, and movement

The mother must remain in her home for eight days following the birth of a child^[5]. Some believe that getting out of bed early will cause air to enter the vagina, which will result in itching, listlessness, lack of appetite, and severe swelling and pain^[23].

Sexual activity

The Napo Runa observe a two week period of abstinence following the birth of a child. This restriction helps to spiritually feed the child^[18].

Smith notes that Panao Quechua women typically abstain from sexual relations for three to four months following the birth of a child^[8].

Emotional behavior and Personal behavior

Napo Runa believe that newborns are born “soft,” and must be shaped into a human by their parents and family^[18]. Because newborns are so malleable, they only the mother can hold them for the first month^[18]. If anyone else holds the child, it will become “twisted;” that is, the child will cry incessantly, and it and its feces will turn black and green^[18]. After the first month, if someone is to hold the infant, they must first ritually pass it head first through their legs (the first time that they hold it) to prevent it from becoming twisted^[18].

Newborn

When newborn period begins and ends

The newborn period begins at birth and ends when the child is one month old^[21].

Rites of passage

There are no immediate right of passage for newborn^[28]. Sometime between their first and fourth birthday, the first haircutting ceremony (Rutuy, which literally translates to "to cut the hair") occurs^[28]. At this time, the baby becomes a child and one or two people who are special to the family accept the honor of being the child's godparents^[28]. The male godparent is the padrino and the female is the madrina^[28]. Rutuy is a celebration of life^[28]. Friends and family come with gifts of clothing, livestock, or most frequently, money to aid in the child's upbringing^[28]. The child's parents provide food and drink for all who participate. At the beginning of the ceremony, an unkuna cloth is placed on a table under a plate^[28]. An unkuna cloth is a special cloth for rituals that generally holds coca leaves^[28]. For Rutuy, the unkuna holds the scissors until the haircut begins^[28]. The godparents begin the ceremony by each cutting a section of the child's hair and placing it on the plate. On top of the hair, each godparent places a gift of money^[28]. Then the hug the parents and allow the next person to cut hair while they drink^[28]. Each person has a turn cutting the child's hair, placing it on the plate, and donating money. When everyone has had a turn, the godparents finish the haircut and count the money^[28]. The money is presented to the parents for the child's future needs^[28]. The hair is placed inside the unkuna cloth while the celebration continues^[28]. Once it is dark, the unkuna is burned as an offering to the mountain god, but the celebration may continue until dawn^[28].

Some Quechua do a pseudo-Baptism ceremony when the infant is between 2 and 7 days old^[14]. They receive a godparent during this ceremony, but its main purpose is to keep the child safe in case they pass away before their actual baptism, which some Quechua have a few months later^[14].

Caregiver

While the mother is the primary care giver, the father is also very involved in the children's upbringing^[28]. The godparents become involved in the raising of the child after the Rutuy^[28].

Other women of the village are also involved in the rearing of children^[18].

Extrinsic Factors

Air and water

Sources vary regarding the actions immediately following birth. However, all share the common theme of protecting the child from the cold. According to Graham, the children of Puno are quickly rinsed in warm water and wrapped in multiple cloths to avoid contact with the cold ^[10]. The Napo Runa also follow this practice^[18].

Bolin, on the other hand, states that children of Chillihuani are covered with qollpa, a substance similar to salt-peter, before being wrapped in cloths^[14]. The qollpa is used for purification and protection against the malevolent wind. He goes on to state that the child will not be bathed until the umbilical cord has fallen off^[14].

Some Quechua give their child an amulet to keep them safe from spirits (particularly the mountain spirit, which is known to take children’s souls)^[8]. The amulet, which is a small woven pouch, is filled with garlic and other potent herbs to make the spirits uninterested^[8].

Food and drink

The first breast milk (colostrum) is expelled and thrown away^[10]. It is believed to be spoiled because it has stayed in the breast for the duration of the pregnancy^[10]. The majority of infants begin breastfeeding within 24 hours of birth, and nearly all have begun by 48 hours^[10].

Children are allowed to play with and suck on adult food as soon as they are able to grab it, which is usually before they develop teeth ^[10]. The child dictates the types of food that it wants to try; the parents do not attempt to compel it^[10].

Newborns are fed breast milk, as they feel it is the ideal nourishment for the baby^[18].

Quechua women do not use formula^[10]. While discarding colostrum, the infant is fed anise or some other herbal tea^[14]

Sleep and wakefulness

Where baby sleeps

At night, the baby sleeps in the same bed as its mother, which facilitates breastfeeding more easily. The child also sleeps while strapped to its mother’s back during the day^[18].

Where is it when awake

During the day, the mother caries the baby in a wool wrap strapped to her back^[18]. If the mother is performing physical labor, she will place two stakes in the ground and attach the aparinga to make a hammock for the child^[18]. If this is done in the forest, mothers are very careful to remove and hide the stakes afterward^[18]. If she does not, the forest spirit (supai) will sense a child's prescience and hurt them during the night^[18].

Promotion of sleeping, position

The Quechua keep infants in close contact with the mother’s body^[18]^[14]. This keeps them warm and promotes sleep.

Rest, activity, and movement

Infants are very limited in the amount they are able to move due to being tightly wrapped^[14]. First, an amulet is placed around the child’s neck, and then the infants are wrapped in multiple cloths and blankets to keep them warm^[8]. Next, narrow woven strips are tightly wrapped around them^[8]. The infants stay in this position unless they are having their diaper changed, in which case they are re-wrapped as quickly as possible to prevent being touched by the cold^[8].

Evacuation and retention

What is normal

The Quechua, with their impressive weaving skills, weave diapers for their children^[8]. They are generally ankle length skirts, attached at the waist by a thin cloth belt^[8]. Once out of diapers, boys will urinate in public until roughly ten years old, while girls will guard their modestly closely by age six^[18].

Meconium

One source mentioned the Quechua rubbing meconium on their face as “pregnancy freckle marks.”^[15] However, no other sources verified this information.

Handling of feces and urine, diapers

The woven diapers are changed quickly, but no sources noted what is done with the dirty diapers.

However, bodily fluids are considered unclean, particularly feces. Urine of young boys, in some cases, may be consumed to relieve stomachaches^[8].

If the diapers are washed, they should not be twisted during the process. This could result in injury to the child^[18].

Emotional behavior

Crying and Expected Expression

Among the Napo Runa, infants are not expected to cry ^[18]. In general, the mother anticipates the infant’s hunger. If the child cries for milk too frequently, the mother may punish it by placing Capsicum pepper on her nipple before the next feeding ^[18].

Older children, both male and female, are punished also for crying. The extent of the punishment could vary from teasing or a slap on the hand to having pepper thrown in one’s eyes ^[18].

Beautification

No sources noted beautification practices among the Quechua. In older girls, attractiveness is seen through the quality of weaving; weaving so fine that it is almost translucent shows a very skilled weaver^[8].

Circumcision

There are little, if any, publications regarding circumcision among the Quechua. However, since neither male nor female circumcision is common in South America (other than among migrant populations and one Amazonian, non Quechua indigenous tribe), it can be assumed that the Quechua do not practice circumcision of any kind.

References

^[26] ^[2] ^[1] ^[4] ^[3] ^[23] ^[25] ^[16] ^[21] ^[15] ^[27] ^[19] ^[24] ^[5] ^[14] ^[10] ^[9] ^[18] ^[28] ^[22] ^[20] ^[17] ^[29] ^[30] ^[8] ^[11]

^ ^a ^b ^c ^d ^e ^f Encarta Encyclopedia Standard (2004). "Quechua". Microsoft Corporation. {{cite web}}: |format= requires |url= (help); Missing or empty |url= (help)
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p Encarta Encyclopedia Standard (2004). "Inca Empire". Microsoft Corporation. {{cite web}}: |format= requires |url= (help); Missing or empty |url= (help)
^ ^a ^b ^c ^d ^e ^f Encarta Encyclopedia Standard (2004). "Native Americans of Middle and South America". Microsoft Corporation. {{cite web}}: |format= requires |url= (help); Missing or empty |url= (help)
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q ^r ^s ^t Encarta Encyclopedia Standard (2004). "Peru". Microsoft Corporation. {{cite web}}: |format= requires |url= (help); Missing or empty |url= (help)
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q Bolin, I (1998). Rituals of respect: The secret of survival in the high Peruvian Andes. Austin, TX: University of Texas Press.
^ ^a ^b ^c ^d ^e ^f "The progress of nations 1999" (PDF). United Nations Children's Development Fund. 1999.
^ Mendoza, R., Rees, N. (2009). Infant mortality during economic downturns and recovery (PDF). New York, NY: United Nations Children's Fund.{{cite book}}: CS1 maint: multiple names: authors list (link)
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q ^r ^s ^t ^u ^v ^w ^x ^y ^z ^aa ^ab ^ac ^ad ^ae ^af ^ag ^ah ^ai ^aj ^ak Smith, T (2008). With one heart: The Panao Quechua way of life. Lima, Peru: Instituto Linguistico de Verano.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q ^r North, C (1992). There is always mal: the cultural construction of the illness experience among Quechua Indians in Peru. Ann Arbor, MI: University Microfilms International.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l Graham, M (1991). Dimensions of malnutrition and hunger among children in an Andean community. Ann Arbor, MI: University Microfilms International.
^ ^a ^b ^c ^d ^e ^f ^g ^h Roumy, V., Garcia-Pizango, G., Gutierrez-Choquevilca, A. -., Ruiz, L., Jullian, V., Winterton, P., . . . Valentin, A. (2007). Journal of Ethnopharmacology. 112 (3): 482–489. doi:10.1016/j.jep.2007.04.009. {{cite journal}}: Missing or empty |title= (help)CS1 maint: multiple names: authors list (link)
^ ^a ^b ^c The Department of Economic and Social Affairs (2009). "Implementing the millennium development goals: Health Inequality and the role of global health partnerships" (PDF). United Nations Children's Funds.
^ ^a ^b Bird, K (2007). "The intergenerational transmission of poverty: An overview" (PDF). Chronic Povery Research Center.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q ^r ^s ^t ^u ^v ^w ^x ^y ^z ^aa ^ab ^ac ^ad ^ae ^af ^ag ^ah ^ai ^aj ^ak ^al ^am ^an ^ao ^ap ^aq ^ar ^as ^at ^au ^av ^aw ^ax ^ay ^az ^ba ^bb ^bc ^bd Bolin, I (2006). Growing up in a culture of respect: Rearing children in highland Peru. Austin, TX: University of Texas Press.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ Rivas, R (2006). At highest risk: Maternal health care in the high Peruvian Andes. Watertown, MA: Documentary Educational Resources.
^ ^a ^b ^c ^d United Nations Children's Fund (2008). "The state of the world's children 2009: Maternal and newborn health" (PDF). {{cite web}}: Unknown parameter |month= ignored (help)
^ ^a ^b ^c ^d ^e ^f Amnesty International. "Peru: Maternal health and mortality—Facts and figures & case studies".
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q ^r ^s ^t ^u ^v ^w ^x ^y ^z ^aa ^ab ^ac ^ad ^ae ^af ^ag ^ah ^ai ^aj ^ak Uzendoski, M (2005). The Napo Runa of Amazonian Ecuador. Chicago, IL: University of Illinois Press.
^ ^a ^b ^c Sumar, H (1985). "La medicina traditional en la sierra centro sur: Ayacucho" (PDF).
^ ^a ^b ^c ^d ^e Allen, C (1982). "Body and soul in Quechua thought". Journal of Latin American Love. 8 (2): 185.
^ ^a ^b ^c ^d ^e ^f ^g Cavero, G (1998). Supersticiones y medicina Quechuas (in Spanish) (2 ed.). Lima, Peru: Consejo Nacional de Ciencia y Technologia.
^ ^a ^b Rengifo, V (2003). La vision Quechua lamas de las plantas medicinales (in Spanish). Lima, Peru: Proyecto Andino de Tecnologias Campesinas.
^ ^a ^b ^c ^d ^e Sumar, H. Cuadernos de medicina tradicional: "Wayrasqa" o "Wayra Qapisqa" (PDF) (in Spanish). Lima, Peru: Instituto Nacional de Medicina Tradicional.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j Avendano, A (2000). Antawaras (ed.). Medicina popular Quechua: La rebelion de los mallkis (in Spanish) (2 ed.). Lima, Peru.{{cite book}}: CS1 maint: location missing publisher (link)
^ ^a ^b ^c ^d Brown, A (2006). "En la primera línea de la atención primaria de salud: el perfil de salud de la comunidad en las comunidades rurales quechua en el Perú". Human Resources for Health. 11 (in Spanish). 4 (11). {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
^ ^a ^b ^c División de Desarrollo de Sistemas y Servicios de Salud (2001). Promoción de la medicina y prácticas indígenas en la atención primaria de salud: El caso de los Quechua del Perú (PDF) (in Spanish). Cusco, Peru: Organización Panamericana de la Salud.
^ ^a ^b ^c ^d ^e ^f Instituto Nacional de Estadística e Informática (2010). "Peru: Encuesta demografía y de salud familiar- Visíon nacional y departamental" (PDF) (in Spanish). Lima, Peru: Instituto nacional de estadística e informatica. {{cite web}}: Unknown parameter |month= ignored (help)
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q ^r Heckman, A (2003). Woven Stories. Albuquerque, NM: University of New Mexico Press.
^ Backman, G., Hunt, P., Khosla, R., Jaramillo-Strouss, C., Fikre, B., Rumble, C., Pevalin, D., Páez, D., Pineda, M., Frisancho, A. (2008). "Health systems and the right to health: An assessment of 194 countries". Lancet. 372 (9655): 2047–2085.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Physicians for Human Rights. "Deadly delays: Maternal mortality in Peru- A rights based approach to safe motherhood" (PDF).

[Quechua-1] ^ ^a ^b ^c ^d ^e ^f Encarta Encyclopedia Standard (2004). "Quechua". Microsoft Corporation. {{cite web}}: |format= requires |url= (help); Missing or empty |url= (help)

[Inca_Empire-2] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p Encarta Encyclopedia Standard (2004). "Inca Empire". Microsoft Corporation. {{cite web}}: |format= requires |url= (help); Missing or empty |url= (help)

[Native_Americans-3] ^ ^a ^b ^c ^d ^e ^f Encarta Encyclopedia Standard (2004). "Native Americans of Middle and South America". Microsoft Corporation. {{cite web}}: |format= requires |url= (help); Missing or empty |url= (help)

[Peru-4] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q ^r ^s ^t Encarta Encyclopedia Standard (2004). "Peru". Microsoft Corporation. {{cite web}}: |format= requires |url= (help); Missing or empty |url= (help)

[BolinA-5] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q Bolin, I (1998). Rituals of respect: The secret of survival in the high Peruvian Andes. Austin, TX: University of Texas Press.

[Progress-6] ^ ^a ^b ^c ^d ^e ^f "The progress of nations 1999" (PDF). United Nations Children's Development Fund. 1999.

[Downturns-7] Mendoza, R., Rees, N. (2009). Infant mortality during economic downturns and recovery (PDF). New York, NY: United Nations Children's Fund.{{cite book}}: CS1 maint: multiple names: authors list (link)

[Smith-8] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q ^r ^s ^t ^u ^v ^w ^x ^y ^z ^aa ^ab ^ac ^ad ^ae ^af ^ag ^ah ^ai ^aj ^ak Smith, T (2008). With one heart: The Panao Quechua way of life. Lima, Peru: Instituto Linguistico de Verano.

[North-9] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q ^r North, C (1992). There is always mal: the cultural construction of the illness experience among Quechua Indians in Peru. Ann Arbor, MI: University Microfilms International.

[Graham-10] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l Graham, M (1991). Dimensions of malnutrition and hunger among children in an Andean community. Ann Arbor, MI: University Microfilms International.

[Roumy-11] ^ ^a ^b ^c ^d ^e ^f ^g ^h Roumy, V., Garcia-Pizango, G., Gutierrez-Choquevilca, A. -., Ruiz, L., Jullian, V., Winterton, P., . . . Valentin, A. (2007). Journal of Ethnopharmacology. 112 (3): 482–489. doi:10.1016/j.jep.2007.04.009. {{cite journal}}: Missing or empty |title= (help)CS1 maint: multiple names: authors list (link)

[Implementing-12] The Department of Economic and Social Affairs (2009). "Implementing the millennium development goals: Health Inequality and the role of global health partnerships" (PDF). United Nations Children's Funds.

[Bird-13] Bird, K (2007). "The intergenerational transmission of poverty: An overview" (PDF). Chronic Povery Research Center.

[BolinB-14] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q ^r ^s ^t ^u ^v ^w ^x ^y ^z ^aa ^ab ^ac ^ad ^ae ^af ^ag ^ah ^ai ^aj ^ak ^al ^am ^an ^ao ^ap ^aq ^ar ^as ^at ^au ^av ^aw ^ax ^ay ^az ^ba ^bb ^bc ^bd Bolin, I (2006). Growing up in a culture of respect: Rearing children in highland Peru. Austin, TX: University of Texas Press.

[Rivas-15] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ Rivas, R (2006). At highest risk: Maternal health care in the high Peruvian Andes. Watertown, MA: Documentary Educational Resources.

[UNICEF-16] United Nations Children's Fund (2008). "The state of the world's children 2009: Maternal and newborn health" (PDF). {{cite web}}: Unknown parameter |month= ignored (help)

[Amnesty_International-17] ^ ^a ^b ^c ^d ^e ^f Amnesty International. "Peru: Maternal health and mortality—Facts and figures & case studies".

[Uzendoski-18] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q ^r ^s ^t ^u ^v ^w ^x ^y ^z ^aa ^ab ^ac ^ad ^ae ^af ^ag ^ah ^ai ^aj ^ak Uzendoski, M (2005). The Napo Runa of Amazonian Ecuador. Chicago, IL: University of Illinois Press.

[Sumar-19] Sumar, H (1985). "La medicina traditional en la sierra centro sur: Ayacucho" (PDF).

[Allen-20] Allen, C (1982). "Body and soul in Quechua thought". Journal of Latin American Love. 8 (2): 185.

[Cavero-21] ^ ^a ^b ^c ^d ^e ^f ^g Cavero, G (1998). Supersticiones y medicina Quechuas (in Spanish) (2 ed.). Lima, Peru: Consejo Nacional de Ciencia y Technologia.

[Rengifo-22] Rengifo, V (2003). La vision Quechua lamas de las plantas medicinales (in Spanish). Lima, Peru: Proyecto Andino de Tecnologias Campesinas.

[SumarB-23] Sumar, H. Cuadernos de medicina tradicional: "Wayrasqa" o "Wayra Qapisqa" (PDF) (in Spanish). Lima, Peru: Instituto Nacional de Medicina Tradicional.

[Avendano-24] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j Avendano, A (2000). Antawaras (ed.). Medicina popular Quechua: La rebelion de los mallkis (in Spanish) (2 ed.). Lima, Peru.{{cite book}}: CS1 maint: location missing publisher (link)

[Brown-25] Brown, A (2006). "En la primera línea de la atención primaria de salud: el perfil de salud de la comunidad en las comunidades rurales quechua en el Perú". Human Resources for Health. 11 (in Spanish). 4 (11). {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

[Promocion-26] División de Desarrollo de Sistemas y Servicios de Salud (2001). Promoción de la medicina y prácticas indígenas en la atención primaria de salud: El caso de los Quechua del Perú (PDF) (in Spanish). Cusco, Peru: Organización Panamericana de la Salud.

[INEI-27] ^ ^a ^b ^c ^d ^e ^f Instituto Nacional de Estadística e Informática (2010). "Peru: Encuesta demografía y de salud familiar- Visíon nacional y departamental" (PDF) (in Spanish). Lima, Peru: Instituto nacional de estadística e informatica. {{cite web}}: Unknown parameter |month= ignored (help)

[Heckman-28] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q ^r Heckman, A (2003). Woven Stories. Albuquerque, NM: University of New Mexico Press.

[Backman-29] Backman, G., Hunt, P., Khosla, R., Jaramillo-Strouss, C., Fikre, B., Rumble, C., Pevalin, D., Páez, D., Pineda, M., Frisancho, A. (2008). "Health systems and the right to health: An assessment of 194 countries". Lancet. 372 (9655): 2047–2085.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[Physicians_for_Human_Rights-30] Physicians for Human Rights. "Deadly delays: Maternal mortality in Peru- A rights based approach to safe motherhood" (PDF).

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]

[13]

[14]

[15]

[16]

[17]

[18]

[19]

[20]

[21]

[22]

[23]

[24]

[25]

[26]

[27]

[28]