It is widely acknowledged in the world of sexual and reproductive health that young people require a separate, unique approach when it comes to delivering education and services. There are many barriers young people face concerning access, such as judgement from their communities, families, and/or health care providers, limited or incorrect knowledge, and cost of services/transportation. Some of their key concerns are privacy and confidentiality, followed by quick in and out service. So how do we provide youth friendly services?
First we look at the context. In Guatemala the statistics relating to youth vary from region to region and amongst different populations, such as indigenous versus non indigenous groups. Petén has the highest teenage pregnancy rate in all of Guatemala. Alta Verapaz faces the highest number of maternal deaths in adolescents, with 44% of adolescents giving birth before age 20, and 29% of those births unplanned. More astounding, nearly 50% of Guatemalan women give birth before age 20. And even though 83% of sexually active women between ages 15 to 19 have stated they do not intend on having children within 2 years, only 18% are using effective contraception. These different local situations within the same country necessitate strategies that are aware of the structural barriers and easily adaptable.
For WINGS, the strategy to ensuring adolescents have access to youth friendly services has been peer outreach with strong community support. In many rural, indigenous, and low-income communities throughout the country, few young women and men continue studying past middle school. Take the north for example, nearly 85% of adolescent girls do not complete junior high school which means their access to vital information regarding their health and their rights is extremely limited. Our Youth Leader projects in Alta Verapaz and Petén recognize the limited access to social and educational spaces and trains young women and men to be leaders in their communities who share knowledge about reproductive risk, rights and advocacy, gender inequality, and sexual identity with their peers. Youth leaders develop and offer informal talks to vulnerable peers in their communities, creating safe spaces for adolescents to address stigmatized topics, including sexual violence and ‘machista’ norms, in addition to helping their peers access our youth-friendly health promoters and mobile clinics for their specific sexual and reproductive health needs. These leaders become trusted and reliable sources of information who simultaneously build their self-esteem and become advocates for reproductive rights at the community level.
Using peer outreach this year we can reach 3,600 marginalized youth through informal talks and provide services to a minimum of 450 marginalized youth.
Early this year, WINGS hired its youngest staff members, a 17 year old and an 18 year old who are working as Assistants in the Sierra del Lacandón Park in Petén. Together Dalila and Hector support 20 youth leaders from 10 communities, promote family planning clinics, and seek new ways to engage young men and women to think about their health and their futures: “We see these young mothers and have to remember that they are still girls. Instead of toy dolls, they are now taking care of real dolls. They’re kids taking care of kids. That’s why our work is so important.”
For Dalila, this is more than just a job, it’s about her community’s wellbeing. As one of five siblings and one of the few to have stayed in her small community along the Mexican border, Daly as she’s known, has different plans. “I just started studying social work this year in Santa Elena [the provincial capital]. I want to understand the problems we face, at the root, and fix them.” Daly makes the arduous 8 hour journey to study every Saturday morning and travels daily on dirt roads between communities providing both informal and formal workshops, counselling, and support to youth leaders.
Our youth leaders and young staff members continue to awe us with their commitment to their communities and we are fortunate to have the opportunity to train more youth throughout the country. In June, we were invited by a local NGO Education for the Children Foundation to work with their high school and college scholarship students. Our team organized and led a dynamic activity during the Foundation’s Annual Sexual Education Congress on the topic of 'Responsible Parenthood'. It was a fantastic opportunity to work with a group of young men and women who all have overcome many difficulties to continue their education and break from the cycle of poverty.
WINGS is working hard to ensure young people in Guatemala have access to information and services about sexual and reproductive health that understand their needs and meet them. Moreover, we are increasingly moving towards linking sexual and reproductive health to livelihoods, in order to create long term sustainable change. We encourage our youth leaders and their peers to identify what they want for themselves, what is available within their communities, and what tools they need to fulfill their plans.
2015 is an exciting year for WINGS as we are guided by our major goal - to provide accessible, affordable, and appropriate contraception to the youth, women, and men who want to space or limit pregnancies. What the means is we began this year working with local Guatemalan physicians to provide voluntary tubal ligations and vasectomies, 30 so far, mainly women, but also one very enthusiastic man, along the Pacific Coast and in the Guatemalan highlands.
For years, we worked in partnership with a reproductive health NGO to refer women and men interested in permanent procedures to their offices and subsidize the cost of the procedures. While this partnership enabled the NGO and WINGS to ensure thousands of women and men received their method of choice, we were unable to guarantee the availability or the quality of services. So what 2015 means is that we can promise effective, quality permanent voluntary surgical contraception provided by WINGS.
In addition to our permanent procedures, we've been scaling up the number and geographic reach of our family planning clinics. Every week, our nurses and family planning educators travel throughout Guatemala to reach rural, impoverished communities and offer long-acting reversible contraception for less than $3.25. This mean for the IUD, women pay $0.32 a year for up to ten years of protection from unwanted pregnancies and for the sub-dermal implant, $0.65 for five years of protection.
Mildre chose the sub-dermal hormonal implant in our most recent clinic in the indigenous town Santa Maria Cauque. The 20 year old mother gave birth less than a year ago and decided, “We’re not ready to have another child yet. We need to make your our son has everything he needs now to be healthy and happy.” With the full support of her family, Mildre visited our day clinic with her mother-in-law who shared how proud she was of her son and daughter-in-law for thinking about their future together.
While Mildre had the support of her husband and family, we realize that for many women and even men, family planning remains highly stigmatized within their families and communities and that is why we work with young boys and men to be allies in family planning and take into account their own needs. One these young men is 19 year old Hector who began attending WINGS’ workshops over three years ago in Villa Hermosa, a community close to the Mexican border.
Hector began volunteering with WINGS in 2014 as a peer educator when he was finishing his last year of “basic” high school, comparable to 10th grade in the United States. He was happy to have the opportunity to continue learning, albeit informally, and share his knowledge about family planning with his peers. “I wanted to become a nurse but I stopped studying after básico. My father is a farmer. He had five children, but I don’t think I’ll have more than three. You just don’t have enough resources to give them food, send each one to school, make sure they grow up healthy. I had to leave school because my father just couldn’t help me.”
We were so thrilled this January to offer Hector a part-time job with WINGS working as a community educator in northern Petén and since, he’s spent the past three months travelling throughout the communities to organize talks, plan our upcoming clinics, and provide clinics. “I’m happy, you know. I have this opportunity to work and I want to use it to learn as much as possible. My favorite topics that we teach are self-esteem…and contraceptive methods of course!”
Not only is Hector doing a fantastic job helping his neighbors access the information and services they need, but he’s also now looking to his own future. “I think within a year, I will have saved enough to go back to school.” He still plans on studying nursing one day because “we have a health center that doesn’t actually provide services…no one works there. That’s why we need to be here, so that people know about family planning and can use it to their advantage.”
Working with young men like Hector alongside their female peers helps us break down the barriers to family planning and enables us to provide more services to women and men who want them but have not been able to use them due to geographic, economic, and cultural limitations.
So what’s next? This month, we are hosting two permanent contraceptive clinics as well as a series of family planning clinics for long-acting methods. We are also in the process of training 170 youth throughout the country to be leaders within their communities and help other young women and men receive information and use reproductive health services as they see fit.
What happens when we improve “access”?
When people are given access to reproductive health education and services they are able to take control of their own lives and make responsible decisions concerning their futures.
For one person, this might mean they decide against the cultural norm of marrying young and dropping out of school to start a family and instead choose to continue their education.
For one family, they might decide that 3 children is the perfect number based on their economic situation and resources, and now that they have information about different family planning methods, choose to adopt a method.
In 2014, access meant Guatemalan women avoided 6,387 unintended pregnancies and 1,387 unsafe abortions.
Access saved $155,419. Money that is now available for education, jobs, housing, nutrition, and improving overall well-being for Guatemalans.
For Marta, a 19 year old student:
I have been given the opportunity to keep studying. I already trained in baking and am now finishing my third year of secondary school. I am motivated by what I’ve learned and in the future I want to be a professional and only have two children. I don’t want to repeat my family’s history of struggling to provide for nine children.
For Marco, a 35 year old father of four and teacher:
When I see a family that decides to plan their births, I see a better quality of life. Their children have the opportunity to continuing studying, they are healthier, have more space in the home, and are more likely to pursue careers. At the community level, there is less poverty, fewer maternal deaths, and fewer malnourished children. When I got married, my wife and I didn’t know about family planning and that’s why we have four children. Recently, we started planning with the Depo-Provera injection. My wife’s well-being is important to me and I am grateful for the information we received.
For Elvira, a 26 year old teacher:
During the first WINGS workshop I participated in, I began to see my life and the world in a new light. At the time my partner was pressuring me to engage in sexual relations. I could have many children right now if I hadn’t known about family planning and the reproductive risks women face by having many children at a young age. I have a vision for my life. I want to continue studying and be a successful teacher. WINGS opened so many doors for me.
For Jose, a 38 year old father of two:
This was a great learning opportunity for us men, and for our families on family planning. If we all put family planning into practice and correctly use a method that’s right for us, we will have a better future and a better quality of life. Most importantly, family planning helps us avoid the unfortunate reality of not being able to provide for so many children. I understand now that family planning involves men as well as women.
For Linda Azucena and Linda Sucely, 16 year old twins and the youngest of 10 children:
This is really important for our lives, for reaching our goals and obtaining the quality of life we want for our future families. In our family, all our siblings are professionals and we don´t want to fall behind. It has been more than difficult for our parents to meet the basic needs of their children. We see the same pattern repeated in hardships our older siblings currently face. But we can say that our lives with be different, our lives will be better.
During September WINGS held our semiannual family planning and cervical cancer prevention clinics in El Tejar, Chimaltenango and Antigua. Each clinic lasted two days and offered both long term family planning methods, specifically the Jadelle sub dermal implant and the copper IUD, and screenings for cervical cancer at extremely subsidized costs.
Generally, WINGS offers such clinics in Alta Verapaz where the population is mainly rural indigenous, as the more urban departments in Guatemala typically have more options available when it comes to reproductive health. However, as seen by the large turnout of women that attend our clinics in Chimaltenango and Antigua, there is still great need for WINGS services in semi-urban areas.
At our Antigua clinic, we received a group of 50 women from Escuintla, who first walked over an hour to reach the nearest bus stop, many with a baby strapped to their back or a toddler in tow, and then traveled an additional 2 hours by bus to attend. Another group of 25 women came from a local nonprofit, Camino Seguro, in Guatemala City, and were so pleased with WINGS care that future collaboration is being discussed.
To begin each clinic, WINGS nurses give a short talk about the methods being offered and the importance of getting screened for cervical cancer. Women are given the opportunity to voice any concerns or questions they may have about any of the services before deciding which they would like to use. It is very common that a woman comes to the clinic looking only to use a family planning method, and decides to do the cervical cancer exam as well, or vice versa.
In total, WINGS attended to 233 women throughout the 4 clinic days.
We performed 173 rapid cancer screenings, and implanted 76 Jadelles and 10 copper IUDs.
Thankfully treatment for precancerous cells was only necessary in 2 cases.
We are encouraged that 20% of women in attendance were under 25 years of age, demonstrating interest from younger women in taking action concerning their reproductive health.
*For more photographs from our recent clinics, visit WINGS´ Facebook page.
Recently, WINGS responded to the needs of a partner institution, the Centro de Atención Permanente (CAP) which found itself in a difficult situation. CAP was holding a family planning clinic in the community Chamelco, Alta Verapaz, but only had the resources to attend to 25 people. Nearly 70 women and men arrived, many having left their homes as early as 3 a.m. to travel a great distance and attend the clinic. Very worried about turning away people in need, the Clinic Coordinator made an urgent call to WINGS, asking if we could fill the need.
WINGS’ mobile medical unit quickly responded and upon arriving, was met with applause and gratitude. WINGS staff was able to help the remaining 44 people in attendance and provided services free of charge to 11 users who lacked the economic resources to cover the subsidized cost of contraceptive methods.
One woman in particular stood out among those 11 users. Catarina timidly approached WINGS’ staff during the clinic, unsure if she would receive any help due to her economic situation. As a mother of four, 31 year old Catarina did not wish to have more children. She shared the economic hardships her family has faced with our team. Her husband´s income is unstable due to his seasonal work cultivating African palm-oil. The uncertainty of if and when he can work makes it difficult to provide for all four children, especially Catarina’s youngest daughter who is only 11 months old.
WINGS staff were truly overjoyed to tell Catarina that she would receive the Jadelle sub dermal implant free of charge. Her smile upon hearing the news was infectious and reminds us that the services we provide allow women like Catarina to achieve a better quality of life for themselves and their families.
WINGS thanks you for making our work possible and supporting Guatemalans as they make informed decisions to strengthen their families through reproductive health.
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