LATIN AMERICA
IWHC has supported the Latin American women's health movement for 10 years. The movement encompasses a vibrant network of women working to confront political, social, and economic obstacles that prevent the majority of women from exercising their sexual and reproductive health and rights. This year, the Latin America program focused its resources primarily on two countries within the region -- Brazil and Chile. Bolstered by the recent successes in Cairo and Beijing, our colleagues continued to tackle difficult issues, including:
- abortion law and practice;
- quality of care in reproductive health services;
- sexuality and sexual rights, which includes men's roles and responsibilities and women's empowerment.
Over the years, the women's health movement in Latin America has become increasingly skilled at launching media campaigns; educating the public; providing training to a variety of audiences (health care providers, teachers, parents, community groups); and influencing decision-makers. Grant-making is only one way in which IWHC provides support to the Latin American women's health movement. We also facilitate information exchange between groups throughout the region, lend moral support and solidarity during difficult times, and provide assistance on organizational and programmatic development.
CHILE
IWHC has been supporting our Chilean colleagues since 1991. Our grants are modest but strategic, enabling our colleagues to develop techniques to educate the press and the public, influence policy-makers, empower poor women and improve the quality of reproductive health services. The complex nature of Chile's return to democracy in 1989 after 17 years of dictatorship, with the military and the right still wielding considerable power, has posed challenges to the strengthening of civil society. Furthermore, Chile's recent rapid economic growth at the macro-level has prompted many international donors to turn to more "needy" countries, even though this growth has been accompanied by increasing income disparity. As a result, many community groups and NGOs have had to downsize or close altogether. Within this fragile civil society, the women's health movement remains marginal and is primarily concentrated in the capital, Santiago. Despite these obstacles, a small group of committed women's health advocates has made progress in bringing important, often controversial, issues to the fore and improving health services in recent years.
Abortion Law and Practice
Chilean society is extremely conservative in matters relating to the family, gender roles, reproduction, and sexuality. It is one of the few countries in the world in which divorce remains illegal. Abortion is one of the most hotly contested issues. Within the past year, two bills have been introduced in the Chamber of Deputies that would increase the penalties for women convicted under the abortion law, which since 1989 has criminalized abortion without exception. Notwithstanding its legal status, the incidence of abortion in Chile is one of the highest in Latin America, with the abortion to birth ratio estimated to be as high as one abortion for every two births. Despite these challenges, our colleagues have consistently worked to keep abortion on the national agenda.
- An IWHC colleague organization provides information and technical assistance on reproductive health and rights to legislators, policy-makers, the press, and other actors involved in policy decision-making in Chile. This NGO has forged a working relationship with several congresspeople interested in the implications of the Cairo and Beijing platforms for Chilean law regarding abortion and reproductive health services. With IWHC support, the organization is providing technical assistance to parliamentarians on formulating legislation to reduce the number of unwanted pregnancies and to meet the unmet demand for reproductive health services and information. It is hoped that this assistance will contribute to informed debate within Chilean society and lead to the adoption of policies that guarantee reproductive rights.
- IWHC has supported a coalition of NGOs involved in reproductive rights in Chile since its inception in 1991. Over the past five years, this group has grown and matured into a leader in sexual and reproductive health and rights in Chile. Among its main achievements has been to keep the issue of abortion "alive" in the public's awareness. Accordingly, IWHC has supported this coalition to plan abortion-related strategies, including advocacy and public education.
Quality of Care in Reproductive Health Services
Despite the trend towards privatization, a majority of Chileans rely on the public health system, which is primarily staffed by women (70 percent). Health workers, as those in other parts of the world, are not encouraged to provide emotional support and counseling. Nor are clients encouraged to learn about their health or ask questions about their bodies. Our colleagues have sought to address the poor treatment of women in the health system through training for providers on improving quality of care from a gender perspective. Their strategy has involved participatory workshops where providers are encouraged to recognize and then overcome their own biases.
- An IWHC colleague organization in Chile develops and implements training courses for health care providers on quality of care, improving client-provider relations, and post-abortion counseling, all from a gender perspective. They sensitize health care professionals to the factors that influence the way they offer treatment to women and help them to develop specific skills that will improve quality of care. The end result will be to contribute to a positive change in the quality of care provided to women in maternity wards, and to develop new approaches to training providers from a perspective that recognizes gender inequities. The project includes education of policy-makers regarding the need for this kind of training, so that it can be replicated and expanded.
Women's Empowerment
In Chile, few organizations work on reproductive and sexual rights with poor women at a local level. Without the common enemy of the dictatorship to fight and with the drastic reduction in external support, community organizing has declined in general. Thus the majority of women in Chile have not yet been exposed to a reproductive and sexual rights discourse. Some of our colleagues have developed expertise in working in "poblaciones" -- urban shantytowns -- training neighborhood women as volunteer health promoters. These programs empower poor women to organize and get involved in protecting their communities' health, which has proven to be a powerful way of building a social movement to transform women's lives.
- Another IWHC-supported organization educates and mobilizes women in poor communities of Santiago on reproductive and sexual health and rights. As a part of this project, trained health promoters create educational materials on reproductive and sexual rights based on the Cairo and Beijing platforms. Designed by and for poor, urban women, these materials are created in an easily accessible format and language. The women create one bulletin each month featuring a different sexual and reproductive health right and distribute them to neighborhood women with an invitation to attend a monthly meeting on the featured theme. With a greater awareness of the issues, these women can contribute to the strengthening of a movement which can pressure the Chilean government to act on its stated commitments, while gaining a greater awareness of their rights. This is one example of how our colleagues are communicating international principles at the local level.
Men's Roles and Responsibilities
Our colleagues increasingly recognize that men's contribution is essential to ensuring sexual and reproductive health and rights for all. Yet, in Chile, there is little documentation on how men experience or view sexuality and their own sexual lives.
- IWHC supports an NGO that has initiated background research on reproductive health and masculinity in Chile as part of a World Health Organization-funded research project. As a part of this initial background research, they are developing an annotated bibliography on existing research on masculinity and reproductive health in Chile and creating a theoretical framework to ground their future study. It is hoped that this study will contribute to the development of new sexual and reproductive health programs that involve men in true partnerships with women in family planning, HIV/STD prevention and other related matters.
BRAZIL
The women's health movement in Brazil serves as a worldwide model of successful reproductive and sexual rights organizing, creating strategies and programs with far-reaching political impact. During 1996, IWHC continued its strategy of helping to broaden and deepen the sexual and reproductive health and rights movement in Brazil through support to newer organizations outside of urban centers as well as to established leading feminist organizations. Over the past year, the newer organizations have grown in strength and capacity, creating greater diversity and breadth in the national movement. The older groups have continued to work on timely and controversial issues with national impact.
Brazil leads the region in income disparity -- the richest 20% earn 32 times what the poorest 20% earn -- one of the largest gaps in the world. Poor women lack even basic health care services. Often desperate to control their fertility, women turn to sterilization -- the most common method in Brazil -- sometimes at a young age, or they buy pills over the counter without screening or instructions. Brazil has the fourth highest number of reported AIDS cases in the world. The rate of HIV infection has increased dramatically among women; in 1984, the ratio of women to men with HIV was 1:100; today it is estimated at 1:3. Brazilian women find it very difficult to convince partners to use condoms or other barrier methods --- this emphasizes the need not only to integrate and improve reproductive health services, but also to tackle the root issues of gender relations and women's status.
Abortion Law and Practice
Under current Brazilian law, abortion is legal in only two circumstances -- in cases of rape and when a woman's life would be endangered through pregnancy and birth. Despite these restrictions, abortion is a common practice in Brazil. Conservative estimates suggest 1 - 1.5 million women have abortions per year, often leading to morbidity or mortality due to unsafe conditions. Even for women who have been raped or have life-threatening pregnancies, access to abortion services is very limited. During this past year, however, there have been signs that the climate is becoming increasingly open to change, in law and practice, on the issue of abortion. The number of hospitals openly providing services for legal abortion has increased recently from only one in Sao Paulo, to two in that city, and two others in Rio de Janeiro and Recife. Despite this progress, our colleagues must remain constantly alert to efforts to further restrict abortion.
- A coalition of feminist reproductive health and rights activists recently educated the public and law makers about the likely impacts of a proposed amendment to the Brazilian Constitution that would have guaranteed life from the moment of conception. The amendment would have made abortion totally illegal, even under the two conditions currently allowed within Brazilian law. The feminist network requested a grant from IWHC to educate policy-makers, the media and the public about the deleterious effects that such a measure would have on women's health and rights. These organizing efforts were met with resounding success -- the proposed amendment was stopped in its tracks.
- Another organization that IWHC supports works for the implementation of services for legal abortion in their state in midwestern Brazil. In 1993, this NGO organized a symposium on abortion, which led to several other events, including a well-attended 1994 seminar on abortion at the local medical school and a discussion of the issue at the city council. This group then worked with a city council member, who had participated in their 1993 seminar, on passing a resolution to require public hospitals to provide services for abortion that are defined as legal in Brazil, which was eventually passed and approved by the mayor in October 1995. The group now plans to ensure that services are indeed implemented in accordance with this new municipal legislation, to improve media coverage on abortion, and to serve as principal NGO in a committee formed by the state Secretary of Health.
Quality of Care in Reproductive Health Services
Since the transition to democracy in the mid-1980s, the women's health movement in Brazil has persuaded legislators to sign progressive policies --- the greatest difficulty lies in implementing these policies. Despite the need to improve primary health care, especially in poor urban and rural areas, per capita public spending on health has declined and care is increasingly medicalized. (Brazil has the highest cesarean rate in the world.) We support projects in Brazil that address the need to improve the quality of reproductive health services within a system severely constrained by limited resources and insufficient political will.
- An IWHC-supported NGO is developing a course for health professionals in sexuality, reproductive rights and women's health. They organized a training course for health care professionals in their local public health system on reproductive rights and quality of care, with a special emphasis on sexuality and gender. The training stimulated ongoing interest and activity among the participants, who will implement changes and organize new trainings in their work places. This also helped the relatively new and inexperienced group to develop their expertise and credibility with health professionals in their area.
Movement-Building for Policy Change
The Brazilian women's health movement is one of the strongest in the world; it provides inspiration for and examples of innovative approaches to movement-building and policy change. At the national, state, and municipal levels, Brazilian women's organizations are working to make the principles of Cairo and Beijing a reality in women's lives. IWHC places a high priority on supporting this work for policy change. For example, since its birth in 1992, one reproductive health and rights organization has grown to 100 individual and organizational members and become an international example of effective coalition-building. An illustration of their capacity is the national campaign they mobilized against an attempt to amend the Constitution to guarantee life from the moment of conception, cited above.
- An IWHC colleague organization promotes the implementation of the ICPD (Cairo) Programme of Action (POA) through legislative action in Brazil. They track legislative proposals related to women, keep women's organizations informed about the legislative process, and educate legislators about women's rights. Their work has contributed to a recent increase in the number of laws passed which support women's rights. In 1995, with IWHC support, this NGO produced an analysis of the POA, designed to help women and parliamentarians understand its implications. In 1996, IWHC made a second grant to enable them to keep up the momentum on this important advocacy work through public education, identifying and promoting legislation that is consistent with ICPD principles, and providing information to parliamentarians on reproductive health and rights.
- Another NGO that IWHC supports held its fourth national meeting in 1996. This year's annual meeting provided an important opportunity to exchange information and ideas, and to make political decisions about the NGO and related concerns. Meeting participants developed strategies for working nationally to change abortion policy and to increase women's participation in defining health policies. This year's event also devoted time to planning the Eighth International Women's Health Meeting, in Rio de Janeiro in March 1997.
Men's Roles and Responsibilities
The field of reproductive health and rights is giving increased importance to working with men on gender and power issues. New health education programs are sensitizing men to their roles in preventing unwanted pregnancies, transmission of STDs/HIV, and sexual violence. Despite such efforts, there is a dearth of practical experience in mobilizing men. Several IWHC-supported organizations are including men's programs in their work in the women's health movement.
- An IWHC-supported NGO has begun its second year of work with men on reproductive health, male sexuality, and gender roles in Brazil. In 1995, they encountered reluctance among men to meet in groups to discuss issues related to reproductive health, but nonetheless succeeded in forming several small groups of men. In 1996, the NGO expanded the program by reaching out to men from unions, community and church groups, and through mailings and informal gatherings. The men's groups address male sexuality, family planning, domestic violence, and HIV/STDs. The program organizers recognize that they are working in an area in which there is little accumulated experience. Other groups, interested in expanding on this innovative project, have begun to use the program as a resource.
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