Beliefs and knowledge. Supply and demand in reproductive health

The reduced utilization of services in the hospitals and health centers of the rural Bolivian altiplano despite the obvious need of the population is a continuing problem for the Bolivian health system. Obstacles to full utilization of such beneficial services as vaccination and attendance at delivery are known to include economic factors and poor client treatment. The qualification of some of the health practices of the less prestigious clients as "beliefs" rather than "facts" is probably another important deterrent. Western medicine for example views bundling of the woman in labor to avoid drafts and air currents as a belief but to rural Bolivian women the practice is irrefutably beneficial and they feel insecure if deprived of it. "Beliefs" are not found only among patients. The health system itself bases many routine practices on beliefs that lack a scientifically demonstrated basis. The horizontal position during delivery routine episiotomies and the isolation of newborns in their own rooms are examples. Instead of a total lack of negotiation between the two sides a process of mutual validation in which each side accepts some but not all beliefs and practices of the other without prejudice would contribute to increased use of available services.