The Peru strategy of the Bernard van Leer Foundation focuses on approximately 521,000 indigenous children aged between zero and eight living in rural areas, plus around 91,000 children of the same age range living in the urban slums of Iquitos. 49.3% of urbanites (9.6 million people) in Peru live with at least one of the deprivations that constitute living in a ‘slum’ - overcrowding, precarious house construction, no access to water, no access to sanitary services or no land tenure.
We chose Iquitos because the percentage of urban dwellers with at least one deprivation is highest in the jungle region (74.5%), and Iquitos is the city with the largest slums in the region. The National Institute of Statists of Peru (INEI) estimated that, in 2012, 91,041 children 0 to 8 lived in urban slums in Iquitos without access to drinking water. The overall theme is to ensure all children are Peru are healthy, protected and able to take advantage of Peru's progress. Our three goals in Peru are:
National increase in the percentage of indigenous, rural children under 3 with access to quality home visiting programmes that integrate birth registration, health, nutritional support and parent education
As of 2012, only 4.5% of all children under 3 (2% in rural areas) had access to early learning programmes, a figure that falls to 2.6% in rural areas. The few programmes that exist are typically center-based and urban-biased. Reaching rural children in their homes can connect them to a range of services and to help parents support their children’s learning from birth.
This is most critical for the estimated 189,355 indigenous children under 3, of whom more than 85% live in rural areas. Nearly 55% of those children live in poverty; in regions where more than a quarter of the population is indigenous, chronic malnutrition rates average 31.9%. While nine in ten indigenous children have their births registered by age three, only 56% are registered in the first year, indicating a lack of early connection with state services.
Work with rural mayors has opportunity to reach scale
On 6 December 2013, Peru’s Government created a multisectoral commission to propose an action plan for early childhood services from 2014 to 2016. The commission’s work achieved rapid results: on 31 December the Government committed 100 million PEN (26 million euros) to a fund administered by the Ministry of Social Inclusion to support early childhood services.
Among the organisations represented on the commission was Red INNOVA, which we have been supporting since 2011 in helping three municipalities in the Loreto region to obtain central government funds and create infrastructure for service delivery to rural families with children under 3. Two more municipalities were added to the project in 2013.
Short-term impact on the original three municipalities is encouraging, for example with a 59% increase in coverage of early childhood services and a near-tripling in indicators such as the number of families playing with their children and following parenting guidelines.
Red INNOVA has demonstrated that the model can work. There is now an opportunity for organisations such as the National Association of Rural Mayors (REMURPE), the Association of Regional Presidents and the Citizen Movement for Childhood (Grupo Impulsor) to promote the use of the new funds committed by the Government to contribute to scaling-up early childhood services.
A reduction in violence in families with young children living in urban slums in the city of Iquitos and indigenous, rural communities
An estimated 37.2% of women who have had partners have experienced intimate partner violence, and this is more likely to occur in homes with young children: WHO research found that 15% to 28% experienced physical violence during pregnancy and UNICEF estimates that 37% of mothers with children under 5 experience physical violence. This implies an estimated 1.75 million children aged under 8 live in homes where their mothers are beaten. Furthermore, small scale studies have found that up to 96% of Peruvian children experience physical punishment in the home, with the most common forms being ear pulling, slapping, and hitting with a belt.
We chose to target our efforts on urban slums and indigenous rural communities because they are the most under-served by public works and they live in conditions that are correlated with family violence in a wide variety of literature on the subject.
Peru starts to collect official statistics on family violence
Accurately measuring the extent of a problem is a prerequisite for tackling it effectively. In 2013, Peru’s National Institute of Statistics and Information (Instituto Nacional de Estadísticas e Información, INEI) included for the first time questions on child abuse and partner violence in the annual household survey of Peru (Encuesta Demográfica y de Salud Familiar, ENDES).
Questions on witnessing and experiencing violence are addressed individually to each child in a family, recognising the importance of children’s perspectives. Peru is the first country in Latin America to include these questions in a national statistics-gathering exercise.
The INEI’s action followed publicity for the results of the baseline studies we commissioned in 2011, which were carried out by project partner GRADE. Since El Comercio newspaper reported on GRADE’s first data release, the issue of violence in the family has gone from being a subject of private discussion to a topic of public debate.
The INEI is among several institutions which have since reached out to GRADE for information on the tools and methods used in the baseline research. The information from ENDES will be available during the first quarter of 2014 and is expected to have a direct impact on public investment, particularly for violence reduction programmes by the Ministries of Education, Social Inclusion and Women and Vulnerable Populations.
A reduction in the prevalence of gastro-intestinal and respiratory infections among young children growing up in unhealthy physical environments in urban slums in the city of Iquitos
Peru spends around 3% of its GDP on treating illnesses caused by poor water, sanitation and hygiene, and those most affected are children growing up in urban slums. In Belen, a slum area of Iquitos where 16,000 children under 8 are living, rates of acute diarrhea and respiratory infection among three year olds are 34% and 36%, while chronic malnutrition is 36%. More than half of homes (67.4%) have no sanitation and 77.3% have no potable water; 94.9% cook with carbon, wood, kerosene or dung and without a chimney, and 27.2% of homes have only one room. Given such statistics, it is not surprising that rates of acute diarrhoea and respiratory infection among three year olds are 29.8% and 24.8% respectively, and chronic malnutrition affects 27.2%.
In all, nearly half of Peru’s urban population (9.6 million people) live with at least one of the deprivations that constitute living in a ‘slum’ – overcrowding, precarious house construction, no access to water, no access to sanitary services or no land tenure – and one in five live with two or more of those deprivations. This affects all aspects of children’s lives, not only health: it limits opportunities to play, creates stress on families, and drives violence.
Improved health through better living conditions in Peru
In 2013, the Instituto de Estudios Peruanos (Institute for Peruvian Studies) completed a study of our partner TADEPA’s project, Allin Wiñapaq (‘Growing up well’ in Quechua), in Ayacucho, Peru. The study compared four similar peasant communities in the highlands of Peru, two of which took part in the project.
The study found that the project – which aimed to improve home environments – did have a positive impact on the health and quality of life of both children and their families. Improved design of kitchens, where mothers and young children spend several hours a day, reduced smoke and the incidence of respiratory and eye diseases.
Improved nutrition was observed in the project villages through ecological gardens and the introduction of refrigerators. There was also a lower incidence of gastrointestinal diseases, attributed to the project’s emphasis on boiling water and using safe containers.
There were benefits, too, beyond the goal of improving health through better living conditions: the two project villages had lower incidences of neglect and violence against children, which is related to reduced stress through the encouragement of shared family responsibilities and a more organised home environment.
Do you have comments on our goals in Peru? Please contact our Programme Officer for Peru, Leonardo Yanez: email@example.com.