Pueblo a Pueblo’s Maternal Child Health program launched the Family Planning Champions project last year to help break the silence surrounding sexuality and reproductive health among rural women in Guatemala. But what began as informal one-on-one conversations between our trained community educators and their neighbors has now grown into widespread community discussions held in public and private institutions.
Over the past few months, our Champions have begun to collaborate with new partners to provide more local opportunities for women to learn about key topics in women’s health. Their first outreach events were held in collaboration with the coordinator of the Municipal Office for Women. Twenty-four women of all ages from Santiago Atitlan attended the trainings, which focused on reproductive health, family planning techniques and how to ensure a safe and healthy pregnancy. Later in the month, Champions also led two workshops for the employees of the Rxiin Tnament health clinic on similar topics.
The most exciting opportunity for our Champions, however, was to provide sexual and reproductive health classes to adolescents in Chukmuk’s high school. In September three Champions led sessions for boys and girls across three grade levels, all aged 13 through 17 years old. They spoke about the physiology and anatomy of male and female reproductive systems, sexually transmitted diseases, and what steps to take to prevent health risks like cervical cancer.
Discussions like these are both unprecedented and of critical importance. In Guatemala, particularly in rural areas, topics related to sexual health are often avoided, and there is no nationwide curriculum to discuss health or sexual education within schools. As a result, the country has the one of the lowest rates of contraceptive usage and one of the highest fertility rates in Latin America.
Here at Pueblo a Pueblo, we are excited to expand our Family Planning Champions project and to use every outreach event as an opportunity to break the local silence on reproductive health issues.
In June and July our " Family Planning Champions" – 19 local women committed to providing women in their communities with information and access to services on family planning and sexual and reproductive health – held their first ever community discussions.
While typically Champions seek out at-risk women between the ages of 15 to 29 in their own neighborhoods, often holding small informational sessions in kitchens and backyards, this summer they were contacted by the government’s Municipal Office for Women (OMM) to engage larger groups of women at pre-scheduled trainings on job opportunities in the region.
The first two discussions – ‘charlas’ in Spanish – took place with separate groups of 12 women. At each discussion different Champions talked about natural and artificial family planning techniques, as well as general tips on how to ensure a safe and healthy pregnancy.
And right now, this work is more important than ever.
Over the next few months, as government institutions usually tasked with spreading information on women’s health near the end of their annual budgets, our Champions will become the only culturally-appropriate resource for women in these communities seeking advice and support.
It happens every year. Last October through November, the number of activities held and referrals made by Champions went up significantly, in large part because alternative sources of information had dried up and closed their doors.
We expect this year to be no different, and we’re incredibly proud of how our Champions are rising confidently to the task.
In just the past three months, our Maternal Child Health (MCH) Project has graduated 3 women; 35 women have received brand new sets of pots and pans; and one woman, Isabela, has decided, despite her pregnancy, to continue her education and commit to completing high-school!
Needless to say, it’s been an exciting month.
Those who recently graduated the MCH project meet the future with increased knowledge about information and reproductive services that are available to young women and mothers in their communities. Although we’re sad to see them go, we’re eager to see how they spread messages about family planning and reproductive health to their friends and family members.
We’d like to highlight our partnership with CEMACO, a large supermarket chain in Guatemala, which provided a generous donation of key supplies for our beneficiaries’ homes. It’s easy to take kitchen resources for granted, but many of these women cook every day for up to 10 family members with cracked pots and pans over broken stoves. Just this small contribution will make their lives much easier.
Finally, we’ve been inspired in particular by Isabela, the most recent addition to our Maternal Child Health Project. Despite her family’s traditional expectation that she would leave school when she became pregnant, she has made it clear that motherhood won’t supplant her education. Now she’s dually enrolled in our MCH and Education Scholarships Projects and looks forward to walking the stage for her high school diploma in November.
Work doesn’t stop here, though. Over the summer we’ll be enrolling three new mothers for the MCH Project as well as providing three trainings this month for our current group. As always, we’ll be sure to keep you updated!
Pueblo a Pueblo’s Family Planning Champions (FPC) project, which is beginning its second year of implementation – builds on our Maternal Child Health project by including local women in the dissemination of best practices in family planning and reproductive health. We anticipate another exciting year of progress as we add 10 beneficiaries to our existing group in 2014. Also, now that staff is able to draw from lessons learned over the pilot year, we expect record growth in both community outreach and project efficacy.
Behind the scenes few people have put as much effort into the project as Wilma Mendoza Sosof, Pueblo a Pueblo’s standout social worker. Starting with a series of home interviews with potential participants, she recruits the most willing and able women around Santiago to be the project’s new champions for family planning. Her leadership in a four-day intensive course on the benefits of family planning and female reproductive health – provide knowledge that these women will later transmit to their peers by way of informal monthly meetings in their communities.
These monthly meetings serve to open dialogue on issues like spousal communication, reproductive health, family planning, sexually transmitted diseases and strategies on how to avoid them. In addition, each champion is tasked with identifying five new women for the FPC project each year; in this way, the scope of the project grows organically.
According to Wilma, “although we have faced some challenges, for example initial lack of female participation, machismo culture, and a widespread belief that bigger families are better, we are now seeing real success. Both women and men are participating, and through their engagement they are building a strong understanding of these issues.”
“And in 2014,” she finishes, “it doesn’t seem to be slowing down. When we started last year nobody wanted to participate, and now our levels of interest and participation are increasing rapidly. It’s exciting to think where we might be at this point next year.”
From the outside, Juana’s home is almost identical to the other white cement houses topped with red tin roofs and evenly arranged in ChukMuk - a nascent town built for survivors of the 2005 mudslides that devastated communities living in Panabaj. As you enter, it’s easy to spot newspaper clippings of cartoon characters and purposefully arranged stuffed animals that adorn two bright, clean rooms. On the left hand side of one room three drawings hang, one made by each of Juana’s daughters. Each is entitled “Things we are thankful for on earth.” Underneath, carefully constructed figures appear- a big orange sun, a grouping of blue stars, a purple house, water droplets, a pink doll, and a mother.
These concepts of gratitude seem simple and even similar to things most five-year-olds might envision. But these drawings are, in fact, incredible testaments to the work being done here in Guatemala to combat maternal and infant mortality. In 2011, nearly 7 million children died before reaching their fifth birthday, two-thirds of which occurred from preventable infectious diseases. Guatemala is a country struggling with one of the highest infant and maternal mortality rates in the region. According to UNICEF’s 2011 State of the World’s Children, Guatemala ranks 65th in the world for highest under-five mortality rate- one of the highest in Latin America; it also has the highest total fertility rate and one of the lowest rates of contraceptive use in the Western Hemisphere. 24 out of 1,000 babies will die during their first year of life and for every 100,000 live births 120 mothers will die from pregnancy related causes - many of which are easy to prevent or treat.
As we consider these harrowing statistics, Juana and her three daughters embody the ideal, and how it could be for many more families living Guatemala and worldwide.
Juana first sought help from Pueblo a Pueblo’s Maternal and Child Health (MCH) program when her daughter became ill. High medical care costs often prohibit families like Juana’s from bringing their children to the doctor; a doctor’s visit and medicine to treat a simple ear infection may cost one week’s income. The MCH program combats maternal and infant mortality by employing doctors, nurses, peer educators, and midwives to deliver modern medical care that respects the Tz’utujil culture. Mothers and children who participate in the MCH program receive access to reproductive health educational services, prenatal and postnatal care, medical checkups and sick visits for their children through age five - seeing them through their most vulnerable period.
Through the MCH program, Juana’s daughter received medical care and is now an active and well-integrated member of our program. Although Juana only sought medical care, she soon discovered and took full advantage of other critical aspects of the program. She participates in monthly classes and learns about family planning methods, health and hygiene, nutrition, preventive medical care and First Aid. Juana is also a Family Planning Champion (FPC), which is a project that falls under the MCH program and seeks to promote culturally appropriate, accessible and sustainable reproductive health services by engaging communities, local leadership and peer-based educators.
In Juana’s case, the results are as astounding as they are encouraging.
Soon after entering the program, Juana recognized “the care needed for [her] children, body, and home hygiene, which [she] did not understand before this program. . .” Her children are healthy and growing; she began using a birth control method; and she is a mentor who teaches other women about reproductive health and contraceptive methods. Juana takes pride in her work with MCH’s sewing program where women learn embroidery techniques as part of an economic sustainability goal. These products may then be sold in local markets to supplement the family’s income.
Looming economic and cultural obstacles often confront reproductive healthcare and access to contraception. In Santiago Atitlán, most women and men of reproductive age are unaware of family planning methods and dialogue about these topics among couples and families is rare. If reproductive health education and resources become available, these methods are seldom used. When these social barriers are coupled with a weak local health care infrastructure, combating infant and maternal mortality remains complex. Government clinics are distant, poorly equipped, and understaffed. Furthermore, most health providers lack culturally appropriate outreach to provide quality reproductive health and family planning services to rural indigenous women or couples in their native languages.
Recently, Juana met with a young woman as part of her mentor role with FPC. Juana shared her story and explained how birth control works. This seems simple. But, open and fact-based conversations about reproductive health are often considered taboo in rural Guatemala - even among sisters and close friends. This brave step taken by Juana and the other Family Planning Champions underscores Pueblo a Pueblo’s community work in action.
Juana recognizes people will “refuse to take this advice, but, [she] feel[s] good knowing [she] is transmitting the information [so] that they have the knowledge to make a decision.” With Juana’s recent mentee, the young woman happily received Juana’s story - and she even invited her own mother to listen. The young woman’s mother appreciated Juana’s help, acknowledging “the difference [Juana] made by providing her very young daughter with the knowledge” to plan her pregnancies.
This is why Juana’s story is especially hopeful - it illustrates the slow but definite progress achieved by Pueblo a Pueblo’s community-based approach to addressing the social stigmas as well as economic and political barriers surrounding reproductive health. Combating infant and maternal mortality and increasing knowledge about sexual and reproductive health is not insurmountable if we employ the help of many - those both far and close to the communities themselves. Thank you for supporting us. It makes stories like Juana's possible.
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