Even in countries where maternal survival is improving, national statistics often mask vast inequities. In the poorest communities in Burkina Faso, for instance, less than 30% of the population receives key maternal and child health interventions (including family planning, © 2000 Liz Gilbert/David and Lucile Packard Foundation, Courtesy of Photoshare prenatal care, skilled care at childbirth, and a range of childhood immunizations), while in wealthier communities, the coverage rate is double that. In Bolivia, where overall statistics are stronger, this “coverage gap” between rich and poor is almost as striking: more than 80% of wealthy Bolivians receive the essential health interventions, compared with only half of the poor.

These gaps are not just between rich and poor. Women often don’t have access to maternal and reproductive health services because they face discrimination,  lack the funds needed to pay for health care services, or are prevented from making their own health decisions. Often, services are least accessible for people who live in rural areas, and for indigenous women for whom services often do not reflect their cultural values and needs. Many young people lack information about their sexuality or access to reproductive health services — a critical problem for working teenagers, who lose the benefits of school-based sex education just when their sexual lives are beginning. In these communities, the consequences — an unwanted pregnancy, or infection with HIV — can be fatal.

FCI works to address these gaps through a range of programs focusing on underserved and marginalized women. In several Latin American countries, we have been a leader in working with indigenous Photo credit: Karl Groblcommunities, high in the Andes and deep in the Amazon basin — empowering women leaders and other advocates, fighting for access to care, and working to make health services and providers more sensitive to cultural needs and traditions. In Africa, most of FCI’s community-based work takes place in poor and remote rural districts, where we directly engage communities in efforts to demand services and improve the quality of care. In our work with youth, we often focus on reaching young women who are out of school, and who desperately need access to information and services. To repond to local needs, FCI’s educational tools are not just in English, French, and Spanish, but also in the languages of the streets and villages — Kichwa (an indigenous language of the Andes), Haitian Creole, Swahili (East Africa), Bambara and Fulani (West Africa) — or are produced as visual flipcharts for use in low-literacy communities. 

Promoting culturally-sensitive care

In indigenous communities in the Andes Mountains of South America, maternal mortality has remained high in part because many indigenous women still prefer to labor at home rather than take advantage of free hospital care — which too often comes packaged with insensitive treatment at the hands of medical professionals, like the doctor who chided a patient for performing “dirty rituals.” FCI works to identify and address the cultural barriers that prevent indigenous women from seeking free maternal health information and services. We work with doctors and nurses to build cultural sensitivity into their practice; build bridges between health care providers and users by promoting community-wide dialogue; and work with Ministry of Health partners to establish culturally-sensitive norms for maternal health services.

Providing indigenous women with information to improve their health and well-being

Rural and indigenous women in Latin America often have little access to reproductive health care and information. Working with the Conference of Indigenous Peoples of Bolivia (CIDOB), FCI developed ¡Cuídate! (Take Care!) — a series of easy-to-use, culturally-appropriate materials — and trained health promoters to use this flipchart among indigenous communities in the Bolivian lowlands. Trained outreach workers have visited thousands of communities with ¡Cuidate!’s important messages, and it has been adapted for use by indigenous groups in Ecuador, Panama, Mexico, and other countries. FCI also works with local partners to increase awareness about national maternity health insurance, to enable communities to monitor both the quality of and access to care, and to reduce risks of HIV infection and combat stigma for people living with HIV.

In Bolivia, FCI collaborates with indigenous organizations to raise awareness about women's vulnerability to HIV and AIDS, and mobilize political will for comprehensive and culturally-respectful sexual and reproductive health policies, in line with Bolivia’s new Constitution. In Ecuador, FCI works with indigenous women's and youth groups to identify cultural factors leading to increased vulnerability to HIV, and to strengthen cultural values and tools that can help prevent HIV and its attached stigma in indigenous communities.

Educating hard-to-reach youth

In Mali, an FCI program targets young workers — who don’t benefit from school-based programs — with information on reproductive health, contraception, and HIV prevention. Because young people are most open to learning from each other, we train young people as peer educators, who then focus on the apprentices, laborers, street vendors, sex workers, and domestic workers with whom they work and live. Through these programs, FCI-trained peer educators have reached more than 22,000 young people with crucial information. We also conduct advocacy with employers and religious leaders, and have developed a curriculum to help parents talk with their children, so that these influential adults can encourage young workers to become more informed.

FCI has helped youth-serving organizations in Bolivia, Panama, and the Dominican Republic respond to the needs of rural and indigenous youth to access information and services, through a series of participatory learning tools in Spanish, including a needs assessment guide and advocacy tools.

Preventing violence against women

Since 2007, FCI has worked to help indigenous communities in Ecuador and Bolivia, which struggle with high rates of poverty and scarce social services, to address violence against women and girls. In partnership with grassroots organizations in 30 communities in the Ecuadorian province of Sucumbíos (inhabited by Kichwa peoples) and 30 communities in the Pando province of Bolivia (inhabited by the Cavinena, Tacana, Esse Ejja, Yamihuana, and Machineri peoples), we work to transform perceptions of gender-based violence in the community; ensure that laws protecting women from violence are known and understood by local authorities and community members; and raise political awareness about violence against women at the provincial and national levels. FCI also developed a flipchart in the Quechua lanugage to inform and educate community health promoters on how to manage and prevent violent domestic situations.

Photo credit: Joey O'LoughlinPromoting the emergence of indigenous women leaders

Throughout Latin America, women in indigenous communities face formidable cultural and gender-related barriers that prevent them from participating in political and policy-making processes. Because the maternal and reproductive health needs of indigenous women remain a low priority on national and local health agendas, FCI has been working on an initiative to bolster the skills of women leaders of the Continental Network of Indigenous Women to advocate for improved maternal health, reproductive health, and gender equity.

Helping rural communities improve maternal health care

In much of the developing world, services — and maternal health outcomes — in rural areas lag far behind those in cities. This is often related to poverty, but can also be an outgrowth of social and cultural barriers that keep women from seeking the care they need, or from governments’ failure to allocate the human and financial resources needed to provide accessible, high-quality care. FCI works in many countries to help local advocates fight for stronger policies and more equitable funding, to ensure access to skilled maternal health care in even remote and isolated areas, and to engage community leaders in taking real ownership of the health care services available in their villages.

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A key focus for FCI's regional program in Latin America and the Caribbean is on indigenous communities  — across multiple countries, women in these communities suffer disproportionately from maternal morality and other deficits in their reproductive health and rights. These efforts have included the development of numerous publications and tools, including the following:

¡Cuídate! , Una Guía de Salud y Bienestar (Take Care! A Guide to Health and Wellbeing), is a full color, 27-page flipchart about family life and communication, reproductive health and safe motherhood, accompanied by a set of five brochures, developed for use by health educators working in Bolivian indigenous communities (and now being used in multiple Latin American countries).

Cuidémonos para vivir bien/Alli Kawsay Kamayuk (Take Care to Live Well), is an adaptation of ¡Cuidate! for use by community health workers in indigenous communities in Ecuador, addressing issues of health and reproductive rights from the Andean worldview.

Maternal Health Cardscovering family planning, pregnancy, labor and postnatal care, breastfeeding and newborn care, infants, cervical cancer, and the Bono Juana Azurduy (a government cash transfer program aimed at improving maternal and newborn health)were designed to enable indigenous women in Bolivia to know and understand recent legislation protecting their sexual and reproductive rights.

Manual para la humanización y adecuación cultural de la atención del parto—HACAP (Manual for the humanization and cultural appropriateness of delivery care), developed in Ecuador, provides guidance for bringing together health care providers, traditional birth attendants, community leaders, and mothers to identify changes that can be made to facility-based delivery care to make institutional delivery more culturally acceptable to expectant mothers.

Camino al buen trato/Alli ñambi (The Road to Good Treatment), a partially bilingual (Spanish/Kichwa) flipchart, developed by FCI-Ecuador and partners, on management and prevention of violence against women in indigenous communities

En la intimidad del buen vivir (In the intimacy of healthful living) presents the most pressing issues related to HIV in five provinces in the coast, sierra, and Amazon regions of Ecuador, highlighting the need for HIV prevention among indigenous populations and presenting evidence to strengthen public policies

Horizontes interculturales en salud y VIH (Intercultural Horizons in Health and HIV) analyzes public policies related to HIV and indigenous populations in Ecuador from an intercultural perspective.

Mujer Indígena: Salud y Derechos (Indigenous Woman: Health and Rights) presents, in a separate booklet for each country, the process and results of participatory national workshops held in Peru, Bolivia and Ecuador in which indigenous women identified priorities for improving their health and rights, including their sexual and reproductive rights.

Mujeres indígenas: derechos sexuales y derechos reproductivos (Indigenous women: sexual rights and reproductive rights) aims to meet the demand from Ecuadorian indigenous women and organizations for information about their sexual and reproductive rights, as guaranteed by the 2008 Constitution and other laws, focusing on the indigenous perspective of “Good living” (Buen vivir), a physical, mental, social, emotional and spiritual wellness, an integrated wholeness that is not limited to the absence of sickness.

Apuntes para la incidencia en las políticas públicas sobre maternidad segura y salud sexual y reproductiva para mujeres indígenas (Notes on the impact of public policy on safe motherhood and the sexual and reproductive health of indigenous women) explains the implications of public policy and the role of civil society in shaping it, and aims to ensure that the demands of indigenous organizations translate into culturally pertinent public health policies.

Guía metodológica para la evaluación participativa de necesidades en salud sexual y reproductiva (Methodological Guide for Participatory Needs Assessment) is a tool for assessing the unmet sexual and reproductive health needs of indigenous and rural young people; results and recommendations from the application of the guide in rural communities of Panama and Bolivia are also available.

Pueblos Indígenas, ITS, VIH y SIDA (Indigenous Peoples, STIs, HIV, and AIDS) demonstrates the importance of expanding prevention efforts to underserved areas in the Amazonian District of Pando, located in the Bolivian lowlands between Brazil and Peru, and includes an assessment of knowledge, attitudes, and practices related to HIV and AIDS in five indigenous communities.




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