July 13, 2016 |

My family legacy: delivering health and equity across generations

Her grandmother, a pioneering midwife in Peru, inspired Milka Dinev’s lifelong passion for reproductive health.
Early photo of Milka Dinev's mother and grandmother and later photo of Milka and her mother.
(Left photo) An early photo of Milka Dinev’s mother and grandmother, Julia Velando (right), a midwife who delivered hundreds of children at home. (Right photo) Today, Milka (right) with her mother Betty Dinev (left). Photos: courtesy of Milka Dinev.

Editor’s note: This is the third post in our blog series Local Brilliance: women leading global health innovation, featuring firsthand accounts from scientists and leaders who are saving lives and improving health for women and girls in their countries and communities.

As a little girl, I used to help my mother organize her closet every change of seasons, not because I wanted to do the work, but because I was curious to go over all her things: her makeup, clothes, shoes, the tiny drawers that held so many interesting things. Among those interesting things was a hardcover notebook that my mom treasured: my grandmother’s “delivery book.”

Mrs. Julia Velando, my grandmother, was one of the first professional nurse-midwives in Peru from 1920 to 1956. In her notebook, she recorded the delivery of hundreds of children at their homes, including me. She also worked in the oldest and most esteemed maternity hospital in Lima—the Instituto Materno Perinatal de Lima.

I was fascinated by all the stories in her book, the names, locations, and conditions of each delivery. My mom said when she turned 15 she accompanied my grandmother and was always awed and horrified by this wonderful event called childbirth. My grandmother would go to her patients when their birth pains started. Sometimes she would spend two to three days in their home waiting! One of the most interesting was a little girl born in 1939, who became the first Miss Universe from Peru.

Discerning a call

Portrait of Milka Dinev at 8 years old.
Milka grew up hearing stories about her grandmother’s work as a nurse-midwife delivering children. Photo: courtesy of Milka Dinev.

When I was a sophomore in high school, we were encouraged (it was mandatory really) to volunteer in a place that needed our help. I chose the Children’s Hospital in Lima, but unfortunately I was assigned to the burn unit. The experience was so heartbreaking that it discouraged me from studying medicine. So, I went on and studied engineering; however, I was always fascinated by medicine and did a lot of research. I started working with the Canadian International Development Agency (CIDA), and then with CARE managing projects from soil conservation to forestry. I also worked with Pathfinder International, mainly on reproductive health. While working at CIDA, I completed an MBA but felt I needed more background in social programs, so I graduated with a gender diploma.

As time passed I recognized a major source of pain and suffering among poor women in Peru was the inability to control their fertility, to be doomed to accept all the children that came, without being able to own their lives and be masters of their futures. Fate was responsible for all its consequences. And yet, educated women lived in a different world where they were in total control of their lives and their fertility.

It was like living in two parallel realities.

This inequitable situation drew me to work in family planning and to help ensure that sexual and reproductive rights should not be conditioned by how much you have, where you live, who you know, or how much you know.

Helping women master their own futures

A woman holds a child who is receiving an immunization.
Photo: PATH/Paul Schenkel.

The inequities I still see in Peru and in most countries in the Latin American and Caribbean (LAC) region are what move me to action. If I can touch the lives of a few women every year, make it possible for them to access quality supplies for their maternal, sexual, and reproductive health needs, then I feel I have made a real difference. But my goal is to touch the millions who are still living in vulnerable conditions and who have to walk miles to access clinical services. I want to reach those women who are victims of domestic violence, women who are afraid to go to the health facility for a contraceptive that will allow them to get a job and become financially independent, thus breaking the cycle of submission and violence.

Many LAC region countries have “graduated” into middle-income countries. This classification is based on averages—but averages hide terrible inequities. We are now faced with the Zika epidemic where those most affected are the poorest women living in vulnerable conditions. In a region where access to contraceptives is not always easy, the prospect of being pregnant and contracting Zika is very real and very dramatic. Not all governments are committed to ensuring sexual and reproductive rights to their citizens. Our work continues to be pertinent and important. Making sure that quality contraceptives are available to all within a framework of rights and informed choice.

Three women stand in front of a light blue wall.
“Not all governments are committed to ensure sexual and reproductive rights to their citizens. Our work continues to be pertinent and important.”—Milka Dinev, PATH. Photo: PATH/Mike Wang.

This is what moves me to work in the Reproductive Health Supplies Coalition (RHSC) as the regional advisor for LAC. In my job I help ministries of health, nongovernmental organizations, pharmaceutical companies, international donors, and foundations to streamline and improve their systems so we can satisfy the unmet needs for reproductive health services and supplies in my region. With the regional forum, ForoLAC, the Spanish-speaking arm of the RHSC, we deliver on the four pillars of our coalition: availability, equity, quality, and choice.

My grandmother was a trailblazer and, for me, a wonderful example of how individuals can make a profound difference in other people’s lives. I see clearly those millions of women who are still waiting for high-quality services and for the rights many of us take for granted, and I reaffirm my determination to honor my grandmother’s legacy of service. This is why my work continues.

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  • Milka Dinev is a regional advisor for the Latin American and Caribbean forum of the Reproductive Health Supplies Coalition and maternal health supplies at PATH.