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:

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.


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.

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.


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.



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.

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.


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.


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.



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