Transitions: Community Participation
Volume 14, No. 3, April 2002

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By Cecilia Moya, Clearinghouse Program Associate, International Division, Advocates for Youth

In 1995, two Peruvian non-governmental organizations, Movimiento Manuela Ramos and Centro de Investigación y Educación Popular Alternativa, began an innovative, five-year project on reproductive health and rights.^1,2 The project, ReproSalud, focused on social barriers to women's access to reproductive health services, including limited power to negotiate within sexual relationships, social isolation, domestic violence, lack of cash, and low self-esteem. It targeted the poorest, hardest-to-reach, Peruvian women, ages 15 to 49, many of whom begin childbearing by age 15 and live in urban and rural areas where health care services are underused. RepoSalud was based on an assumption that, in a more gender equitable setting, women would be more aware of their sexual and reproductive rights and more likely to demand and use quality health care services. Thus, ReproSalud aimed to improve women's sexual and reproductive health through individual and community empowerment, using participatory methods to make community education and mobilization the backbone of its efforts.

ReproSalud partnered with women's community-based organizations (CBOs) in eight of Peru's 24 departments. By December 2000, ReproSalud established partnerships with 240 CBOs in the Andean highlands and Amazon basin, which, in turn, worked with 2,300 neighboring CBOs. More than 90,000 women and 50,000 men participated in the education and training activities. ReproSalud and each partner CBO conducted a self-diagnostic workshop, allowing participants to explore their perceptions, attitudes, and experiences regarding sexual and reproductive health, community gender norms, and available health services. Workshop participants identified the priority reproductive health concerns on which they wanted to take action. Concerns included reproductive tract infections, "too many children," childbirth complications, abortion, teenage pregnancy, domestic violence, and inadequate treatment at health centers.

ReproSalud helped each CBO design and implement a strategy to address the primary reproductive health problem identified in its community, primarily through training a team of health promoters to teach other community members about sexual and reproductive health, emphasizing the selected priority concern. Because women voiced a strong interest in involving their husbands, ReproSalud also trained men as health promoters for other men. Involving men helped address important issues, such as alcoholism, violence, forced sex, and communication between partners. The interventions laid the foundation for advocacy by health promoters. In many communities, the health promoters influenced the attitudes of local health care providers and public health authorities.*

Key challenges for ReproSalud include:

• Expanding the base of beneficiaries at a low cost without losing innovative elements
• Conducting an impact evaluation
• Anticipating expenses related to community participation
• Allowing adequate time for training and community mobilization.

Surveys demonstrate significant improvements in reproductive health knowledge and service utilization. Evaluations show dramatic decreases in alcohol consumption, domestic violence, and forced sex and large improvements in contraceptive knowledge and attitudes. Evaluation is incomplete regarding behavior change; yet, interim results support this holistic model and demonstrate the inherent strength of the strategy of community participation.

References:

1. Coe AB. Health, Rights and Realities: An Analysis of the ReproSalud Project in Peru. Takoma Park, MD: Center for Health and Gender Equity, 2001.
2. Rogow D. Alone You Are Nobody, Together We Float: The Manuela Ramos Movement. [Quality/Calidad/Qualité, no.10] New York, NY: Population Council, 2000.

* In 2001, ReproSalud received a grant to continue working for five more years. Based on ongoing assessment and evaluation, ReproSalud will focus on the Andean highlands and on advocacy, linking community-based advocacy groups to form wider networks.

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Transitions (ISSN 1097-1254) © 2002, is a quarterly publication of Advocates for Youth—Helping young people make safe and responsible decisions about sex. For permission to reprint, contact Transitions' editor at 202.419.3420.

Editor: Sue Alford