Post by Giulia McPherson, Advocacy Alliances Manager, CARE USA

As a member of CARE USA’s policy and advocacy staff, I spend a lot of my time speaking with fellow advocates and elected officials about our programs and how the U.S. can impact real change in the developing world. Earlier this month I had the opportunity to see some of these programs first hand and better understand what “global advocacy” really means.

CARE has been in Ecuador since 1962 and implements a variety of maternal health, education and environmental programs. We also place a special focus on advocacy by working in solidarity with social movements, influencing attitudes concerning poverty and injustice, empowering local community organizations to engage in advocacy and bringing communities and elected officials together to address policy issues.

On February 8, I had the pleasure of visiting one particular program near the town of Otavalo in the Andean highlands. CARE Ecuador has been working closely with the Municipal Government of Otavalo, the Ministry of Public Health and the Provincial Department of Indigenous Health to implement an Ecuadorian law called the “Free Maternity and Child Health CARE Act”. Although this law called for universal access to healthcare for all Ecuadorian citizens, many indigenous communities were still experiencing high levels of maternal death. Since the majority of indigenous women give birth at home, several areas of concern were identified including an inability to recognize signs of maternal and neonatal risk, the lack of access to transportation in case of an emergency and the resulting delay in emergency care.

When CARE first began to assess this problem, it became clear that healthcare personnel were overlooking certain issues that were of concern to indigenous women. CARE worked closely with the indigenous community and local and federal government to ensure that pregnant women would feel comfortable delivering their babies in a hospital setting, if necessary.

As a result, CARE worked to implement certain changes in how healthcare was administered:

  • Most indigenous women are accustomed to being surrounded by their families when delivering their babies so CARE helped build a ‘Casa Materna’ (or Maternal House) to house families traveling many miles from remote communities.
  • The hospital now trains traditional midwives so that they are certified to both work in the hospital and preside over home births.
  • CARE worked to ensure that women who give birth at home still have access to emergency care if needed by setting up a radio communication system.
  • A garden was planted so that hospital staff could use medicinal herbs to treat labor symptoms.
  • The hospital now offers several indigenous birthing techniques including vertical birthing rooms.
  • Hospital staffs are now trained to speak the local Quichua language to accommodate women who do not speak Spanish.

This innovative program has since been replicated in other hospitals throughout Ecuador. By working closely with the government and local indigenous communities, CARE was able to influence real change and save the lives of women. As the Hospital Administrator reported during her presentation, there were no maternal deaths in this community in 2009 – and with such a dedicated team of doctors, midwives and community leaders the prospect for healthy women and healthy deliveries remains bright.

What does all this mean for CARE’s global advocacy work? It means that while goals like ending maternal mortality and extreme poverty huge undertakings, sometimes all it takes is small changes to empower a community –and women– to meet their own needs.

To learn more about CARE’s maternal health programs visit It’s also not too late to buy tickets to CARE’s International Women’s Day event, Half the Sky LIVE, taking place this Thursday at 7:30 pm EST in theaters nationwide.


Presentation by Hospital Director

Casa Materna for families and recovering patients

House with a radio tower

Garden for indigenous medicinal herbs

Medicinal herbs used in birth room