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, 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 communities, 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.
Promoting 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.