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.