Case Study: Manuela Ramos Engages Community-based Women’s Groups in Peru to Better Serve their Needs
Manuela Ramos launched ReproSalud in 1995 as a USAID-funded rural reproductive health programme. ReproSalud used a form of participatory rural appraisal, by working with community-based women's groups (such as mothers' clubs) to identify women's reproductive health needs through "auto-diagnosis workshops." Following these workshops, they held community meetings to design strategies to address the needs that women identified. ReproSalud ultimately responded to a range of health, social and economic concerns. Domestic violence and forced sex within marriage repeatedly emerged as themes and became a focus of many activities, including workshops for women and men on gender. ReproSalud also established a microcredit programme for women. By 2002, ReproSalud had reached over 123,000 women and 66,000 men.
Evaluators gathered baseline and midpoint data in 70 intervention sites and 25 control sites, including: a) baseline and midterm surveys among a random sample of households (baseline n =4,099 women, 3,192 men; midterm n = 3450 women, 3193 men); b) service utilization statistics at local health facilities; and c) semi-structured interviews with women, men, youth, village leaders, health officials, and local authorities. The evaluation measured individual-level, family-level, and community-level "empowerment outcomes." Family level outcomes included changes in levels of domestic violence, satisfaction regarding sexuality, shared decision-making, and women's social and geographic mobility. Quantitative findings were complemented with extensive qualitative data.
The survey found that gender-equitable attitudes and practices increased significantly in both intervention and control communities (14 out of 15 indicators versus 12 out of 15 indicators). The use of reproductive health services also rose 100-400% during a one-year period in intervention sites, compared to 39-51% in control communities. Evaluators noted that the project coincided with a period of strong investment by the Ministry of Health, which made it difficult to isolate the effects of the project. However, differences between the intervention and control sites were more pronounced in the qualitative data. Those findings suggested that ReproSalud had produced dramatic changes in social relations and men's behaviour through the communities. Respondents spoke at length about decreased alcohol consumption, domestic violence, and forced sex in all intervention villages studied.
Source: excerpted from Morrison, Ellsberg, and Bott, 2004, and also accessed through Bott, n.d.
Example: The International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR) and the Asociacion Civil de Planificacion Familiar (PLAFAM) in Venezuela used three strategies to address violence against women and girls within their reproductive health services. The first strategy was training staff. Providers were trained to ask questions to assess a survivor’s current safety and assist with the development of a safety plan. Additionally, clinicians were trained to: recognize signs of violence through examining marks on the body; be responsive if a woman decides to disclose that she is being abused; and to provide related counseling and referrals. The second strategy was developing materials for clients on violence and sources of support, including the Institutional Directory of Gender-based Violence Service Providers. The third and final strategy was collaborating with community alliances to create a law outlawing violence against women.
The systematic screening practices revealed that over one-third of new clients were identified as having experienced abuse compared to only 7 percent previously (Guedes et al./Population Council, 2002b).
PLAFAM has been recognized by the World Health Organization in 2000 and IPPF in 2003 and 2010 for its technical assistance to three Latin American countries working to integrate services for survivors of gender-based violence in sexual and reproductive health.
See the full report in English.
2. Maternal and child health programmes
Example: Midwives Break Cultural Taboos Surrounding Rape (Mauritania)
Midwives and imams have helped break cultural taboos about the discussion of rape in Mauritania. Prior to 2003, survivors of rape in Mauritania were thrown in jail while the perpetrators went free. Correcting that gross injustice—and getting society to recognize the problem of rape at all—began with the grass-roots efforts of four Mauritanian midwives, who could no longer ignore the stories they were hearing from their clients. With UNFPA support, the first statistics on sexual violence in Mauritania were collected, and a centre was established to respond to the multiple needs of survivors. Breaking the taboos surrounding the discussion of rape was the first step in addressing the problem. Local imams lent their support to the effort, convincing government officials, judges, the police and members of the community that protecting women and easing the suffering of those who are most vulnerable was a religious obligation.
See a short video on this initiative.
Source: excerpted from UNFPA, 2006. Ending Violence Against Women: Programming for Prevention, Protection and Care, p. 72.
Example: Reducing the Social Causes of Maternal Morbidity and Mortality in Chiapas, Mexico
The Family Violence Prevention Fund and Asesoria, Capacitacion y Asistencia en Salud partnered to develop a coordinated health response to abuse during pregnancy in order to reduce morbidity and mortality of both pregnant women and their babies. Strategies to achieve this goal include: training regional health care providers and traditional birth attendants to identify and assist women abused during pregnancy; producing a culturally and linguistically accessible training module and video for indigenous women in Mexico; facilitating linkages between formal health care facilities and local lay health care providers; producing and implementing a protocol for screening and responding to abuse during pregnancy; and identifying and evaluation promising practices that could be replicated in other regions beyond Mexico.
For additional information, see the website.
Source: excerpted from: Guedes, A., 2004. “Addressing Gender-Based Violence from the Reproductive Health/HIV Sector: A Literature Review and Analysis.” Washington, DC: USAID Interagency Gender Working Group, pg 43.
Abuse during Pregnancy: A Protocol for Prevention and Intervention, 2nd Edition (McFarlane, J., Parker, B. and Cross B., 2002). This module is targeted to nurses and nurse midwives to enable them to prevent abuse, interrupt existing abuse and protect the safety and well-being of pregnant women. Available in English.
Tools for Improving Maternal Health and Safety (Family Violence Prevention Fund). The website includes access to information on the dynamics of domestic violence; implementing a domestic violence programme in health care settings; training resources; educational materials and links to other resources in English and Spanish.
Violence and Maternal Health in Multicultural Contexts (Asesoría, Capacitación y Asistencia en Salud; Centro de Investigaciones y Estudios Superiores en Antropología Social, Mexico). See the power point and access the tools and audio recordings on the Family Violence Prevention Fund's Website.
“Basta!” (International Planned Parenthood Federation/Western Hemisphere Region). Videos and tools on gender-based violence for health care providers primarily in sexual and reproductive health services. Available in English and Spanish.
Addressing Gender-based Violence from the Reproductive Health/HIV Sector: A Literature Review and Analysis (Guedes, A., 2004). Washington, DC: USAID, Bureau for Global Health. Available in English.
Reproductive Health Services and Intimate Partner Violence: Shaping a Pragmatic Response In Sub-Saharan Africa (Watts, C., and Mayhew, S., 2004). International Family Planning Perspectives 30, no. 4: 207-13. Available in English, French and Spanish.
Delivering Post-rape Care Services: Kenya’s Experience in Developing Integrated Services (Kilonzo N, Theobald SJ, Nyamato E, Ajema C, Muchela H, Kibaru J, Rogena E, Taegtmeyer M., 2009). Bulletin World Health Organization 87, no. 7: 555-9. Available in English.
The Refentse Model for Post-Rape Care: Strengthening Sexual Assault Care and HIV Post-Exposure Prophylaxis in a District Hospital in Rural South Africa (Kim, J.C., Askew, I., Muvhango, L., Dwane, N., Abramsky, T., Jan, S., Ntlemo, E., Chege, J. and Watts, C./Population Council, 2009). Available in English.
Violence, Pregnancy and Abortion - Issues of Women's Rights and Public Health (De Bruyn/Ipas, M. 2003). IPAS. Available in English.
An Evaluation of Interventions to Decrease Intimate Partner Violence to Pregnant Women (McFarlane, J., Soeken, K. and Wiist, W., 2000). Public Health Nursing, Vol. 17, No. 6, 443-451. Available in English.
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