In a small maternity hospital in La Paz, Bolivia, frequented by indigenous immigrants from the countryside, an Aymaran mother proudly displays her three-month-old son, Lazarus.

This Lazarus has a story not unlike that of his biblical namesake. The child's mother took him to the clinic when she thought he was dead. Somehow, the doctor revived him, calling him Lazarus--a name the mother, although she believes in mountain gods and "Pachamama," the Earth Mother, adopted.

The story of this Lazarus indicates a change in indigenous beliefs about, and confidence in, western medicine. Although about 50% of the women in the neighborhood of the hospital still deliver babies at home, many are coming to local clinics and maternity hospitals for health and family planning services. To encourage them, hospitals try to accommodate beliefs about traditional birthing practices such as squatting on the floor to deliver and burying the placenta at home.

Growing Support
Since 1989, Bolivia has been moving toward firm support of accessible, high-quality reproductive health services. The 1994&endash;1997 Declaration of Principles on Population and Sustainable Development states that reproductive health is an integral part of well-being and that men and women should have access to a broad range of contraceptive methods.

However, there is still much work to be done. A limited number of contraceptive methods is available in Bolivia. In addition, many clients and providers lack family planning information, and there continues to be a low acceptance of modern contraception.

Collaboration Underway
AVSC is collaborating with Bolivia's Ministry of Health and three nongovernmental organizations (NGOs) to expand access to family planning, to broaden the choice of methods, and to improve the quality of services. AVSC support started with a private hospital, the Fundación San Gabriel, located in a poor neighborhood in La Paz. AVSC is now expanding activities to six Ministry of Health hospitals and four NGO clinics. AVSC's work will soon include health facilities nationwide.

AVSC is providing technical support to educate doctors, nurses, and social workers in counseling and family planning methods and to train physician-nurse teams in minilaparotomy and no-scalpel vasectomy. AVSC also supports orientation sessions for all staff at the institutions to inform them about the new minilaparotomy and NSV services.

AVSC will work with the Ministry of Health to offer postabortion family planning counseling and services in hospitals. Unsafe abortion accounts for 35% of maternal mortality in Bolivia and is the leading cause of maternal death.

In collaboration with PROCOSI, an umbrella organization of 24 family planning groups, AVSC is training counselors in family planning and sexuality. From this group of trainees, PROCOSI and AVSC will select the best to become counseling trainers for other PROCOSI staff.

This work involves more than just training in family planning. It also requires an ability to deal with local cultural, economic, and geographic conditions and to face all kinds of unexpected challenges. For example, when the Fundación San Gabriel began providing motorbikes to female community health workers so they could climb the steep hills in some neighborhoods, they discovered that the women were too short to operate the motorbikes by themselves. Since then, the Fundación has provided them with sidecars and drivers as well.

In this diverse country, there are many challenges to overcome in order for the government to fulfill its commitment to women's well-being. AVSC is contributing to this effort by helping men and women make an informed choice about contraception and by enabling health professionals to offer the best quality in services and counseling they can.

AVSC's work in Bolivia has been funded by the Erik E. And Edith H. Bergstrom Foundation and the U.S. Agency for International Development.

Andrea Eschen is the assistant regional director for AVSC's programs in Latin America and the Caribbean.