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.
As you may have already heard, Guatemala was the first Central American nation to adopt new World Health Organization (WHO) guidelines in late 2014 for cervical cancer which for WINGS and the thousands of women we screen and treat on a yearly basis using visual inspection with acetic acid and cryotherapy, is welcome support. The WHO guidelines recommend cryotherapy over more invasive preventative treatments and also take into account the role the human papilloma virus (HPV) plays in cervical cancer incidence. While vaccinations and tests for HPV remain cost prohibitive in Guatemala, our team of educators and nurses are making every effort possible to encourage women to get screened and get screened early, until we can incorporate HPV testing into our services.
Unfortunately, we recognize how difficult it can be for many women to ask for a screening, let alone visit a clinic or health center. That is why, throughout 2015, we will be increasing the number and geographic reach of our cervical cancer prevention clinics to ensure that Guatemalan women in indigenous, low-income, and rural communities can access information, screening, and treatment to prevent cervical cancer. In fact, we already have 7 clinics lined up for this month.
Flor dropped by one of our mobile clinics last month in Chahal, a Q’eqchi’ Maya community at the crossroads of three Guatemalan provinces. The 29 year old mother of four had been suffering from vaginal pain and wanted to undergo screening to figure out what was going on. Nurse and Project Coordinator Aury found precancerous cells and quickly provided her with cryotherapy treatment to prevent those cells from advancing into a devastating cancer. This month while we were providing follow-up support to clinic attendees, Flor told us, “I feel so much better now. The pain is gone and so is my fear of not knowing. I’ve told my sisters and neighbors that they must get screened, because I cannot imagine what would have happened to me if Aury had not been there to treat me. What would my children do?”
Flor and many women in her community have a higher risk for developing cervical cancer due in part to early child bearing – before age 17, multiple full-term pregnancies, and poverty. Flor, who first became pregnant at 15 and miscarried during her first two pregnancies due to domestic violence and injuries from a bus accident, says “Things were difficult in the past but I left him [her abusive boyfriend]. Now, I just want to be there for my children and help my husband provide them with everything they deserve.”
23 year old Ligia actually attended one of our day clinics in Chimaltenango but instead came for an IUD rather than cervical cancer screening. However, as our nurse Claudia was inserting the IUD, she noticed something abnormal and asked Ligia if she was interested in undergoing our rapid screening. Ligia, who has a one year old daughter, consented but was shocked: "I have a pap smear every year and each time, the results are normal...so I almost could not believe it when Claudia detected precancerous cells."
As worried as she was, Ligia received immediate cryotherapy treatment for those cells and could not be more relieved, “even today, Claudia and the WINGS team have checked up to make sure I am feeling fine, not just after the treatment but daily so that I can live without fear of cancer. I am so grateful that they were able to treat something that would have stopped me from watching my daughter grow up and being there for her along the way.”
We know how dedicated mothers like Ligia and Flor are to their children which is why WINGS is all the more dedicated to these women and their reproductive health. We want women throughout Guatemala to be able to lead healthy and productive futures for themselves and for their children and we believe guaranteeing them quick and quality cervical cancer prevention services is one important step towards those futures. And to make these life-saving cervical cancer screenings and preventative treatments even more accessible, we are in the process of creating a second mobile unit to travel throughout the Guatemalan highlands and southern Coast to offer daily clinics. Stay tune for our next major update in June when we have officially launched the second mobile unit!
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.