Obstacles to Women’s Health: Indigenous Women’s Reproductive Health in Latin America
Alia Levine
We tend to think of health mainly as a function of biology, a measure of fitness, and/or the availability of various medical services, but the strongest determinants of health are actually the social, political and economic forces in our lives. How healthy we are depends enormously on our access to nutritious food, clean water and medical care, on the levels of violence and stress in our lives, on how much and under what conditions we work and on the opportunities we have for love, pleasure, and fulfillment.

For communities living on the edge of survival, reproductive health is only one of many unmet needs. Yet women's health is of particular importance because it affects not only their own survival, but also their children's. Around the world, women die from overwhelmingly preventable causes because of the combined impact of being women, being targets of racism and being poor. For Indigenous women in Latin America, health is inextricably tied to their rights as Indigenous Peoples. Rates of maternal mortality sharply illustrate many of the factors that interact to claim the lives of more than half a million women each year. And as the poorest and most marginalized members of every Latin American society, Indigenous women face an alarming scarcity of health services; over half of all maternal deaths result from unsafe abortions.

Improving the health of Indigenous women requires grappling with issues like land reform and income distribution as surely as offering vaccinations, contraceptives, and vitamins. Conventional wisdom about birth control and the spread of AIDS tells us that women are at risk because they do not use condoms. Yet, economic necessity is the biggest reason women enter into multiple sexual partnerships or barter sex for food and shelter. In fact, poverty and gender inequality are the primary risk factors for exposure to Sexually Transmitted Infection's (STI's). Without the resources to live independently of men, many women lack the power to even negotiate condom use (not to mention their relationships in general). User fees at privatized clinics and hospitals in Latin America, which have been implemented as a result of US-driven economic policies, mean that millions of women can no longer afford treatment. While men are also affected by privatization, women's lower status means they are less likely to have access to the little care available.

The reproductive and sexual health of Indigenous women in Guatemala, Mexico, Peru, and Nicaragua are testament to these inequalities:

Guatemalan Indigenous women bear the brunt of the poverty, illiteracy and lack of health care that are the legacy of Guatemala's decades old civil war. With only one doctor for every 10,000 rural Guatemalans, most women and girls lack even an annual medical check-up. The fertility rate is among the highest in Latin America and only about 19 percent of Guatemalan women use contraception. Unsafe, illegal abortions cause an estimated 30 percent of maternal mortality deaths in the country, and maternal mortality among Indigenous women is 83 percent higher than among non-Indigenous women. Although Guatemala's 1986 Constitution recognizes a couple's right to decide the number and spacing of their children, intervention from the Catholic Church and other conservatives has rendered family planning programs ineffectual.

In Mexico, privatization of the health care sector has left most poor Mexicans unable to afford medical care. Health problems are particularly severe in the southern state of Chiapas, where the rural Indigenous poor contend with deepening economic depression and political strife. The infant mortality rate in Chiapas is 54.5 deaths per 1,000 babies (twice the national average). Despite the existence of government family planning initiatives, reproductive health services in Mexico remain limited in scope and concentrated in urban centers. Abuses in these programs have generated deep suspicion among local communities of "outsiders" seeking to address issues of women's reproductive health. The current scourge of army harassment, which includes rape, the threat of rape and forced prostitution, has compounded this distrust while increasing the need to effectively address such issues as STI's and rape trauma.

In Peru, Indigenous communities such as those in Ayacucho province suffer from severe economic, social and cultural marginalization. In this mainly rural Andean region of Peru, people struggle to survive as small farmers in an area where only 3 percent of the land is productive. High levels of poverty and political violence drive many people to migrate to the cities. Women's sexual and reproductive health indicators starkly illustrate the unmet needs in the region. Maternal mortality looms at 185 deaths per 100,000 live births and five women a day die due to pregnancy-related complications.

The Nicaraguan Revolution made great strides in public health, improving immunization coverage, lowering infant mortality and increasing access to health care. But since the electoral defeat of the Sandinistas in 1990, many of these gains have been reversed. Women's reproductive health, in particular, is threatened by the resurgence of the Catholic Church as a force in policy making. And the racism and neglect that has long characterized government treatment of Nicaragua's Indigenous and African-descent Peoples is ongoing. The North Atlantic Coast of the country is home to most of Nicaragua's Indigenous and ethnic communities. This region has the nation's worst health indicators: almost three-quarters of the population suffer from malnutrition and the maternal mortality rate (124 deaths per 100,000 live births) is double the national average.

To address these crises, local organizations need to be able to respond at the local level to provide high-quality, respectful health services to their constituencies; at the national level to hold their governments accountable to meet people's basic needs; and in the international arena to demand macro-economic policies that respect human rights, including the right to healthcare. Organizations like MADRE (an international women's human rights organization, based in New York City) provide Indigenous, community-based women with support and trainings to develop community-based health care programs, human rights advocacy, and concrete opportunities to impact policies in the international arena as they work to promote women's health as part of the matrix of human rights.

Advocates for women's rights, including MADRE, have worked long and hard to make reproductive and sexual health and rights an important theme in international human rights legislation. Advances in the international arena have secured some commitment from both government and non-governmental development agencies to provide reproductive health programs for marginalized women. The World Bank's approach to "restructuring" health care relies heavily on non-governmental organizations like MADRE and the community-based women's groups that MADRE supports. Indeed, around the world, women's organizations are filling the role of government in creating and running community health clinics, women's shelters, AIDS-education programs, nutrition classes and more. These groups are expected to deliver the health care that governments no longer provide, and these efforts are a powerful expression of women's abilities, resourcefulness and sheer hard work. But even the best local organizations are no substitute for responsible government, nor should they have to be.

We need to target the conditions that undermine women's ability to make the best choices for their health. Having this degree of control over one's life is linked to exercising power in other realms, like land use, systems of production and the political and legal frameworks in which we live. Like other human rights, guaranteeing optimum health for women and families ultimately means maximizing women's opportunities and abilities to make decisions and play leadership roles in their families, communities, countries, and in the international arena.

As well as writing for Sexing The Political, Alia Levine is a consultant for MADRE. Founded in 1983, MADRE (www.madre.org) is an international women's human rights organization that works in partnership with women's community-based groups in conflict areas worldwide to address human rights issues including health, education, and economic development. MADRE provides resources, training and support to enable our partner organizations to promote long-term development and social justice. MADRE works with women and families who are affected by violence, poverty, racism and other violations to help them win justice and ultimately change the conditions that give rise to human rights abuses. For more information, go to www.madre.org.

A staunch lesbian/feminist/antipodean, Alia Levine moved from Aotearoa/New Zealand to her family's native New York in 1997. A Women's Studies/English Literature graduate from Victoria University, NZ, Alia worked in New York in the fields of publishing, education, and women's human rights. In 2003, after five fabulous years living in Brooklyn, New York, Alia realized that it was time to go home. As of March 2004, you'll find her back in the Southern Hemisphere's peaceful, green gateway to the world, plotting her vegetable garden and figuring out how to get around without the New York City subway.

 |  about STP  |  write for STP  |  contact us  |  links  |

text only index