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Family Planning Stories From the Field: Ecuador
As advocates for international family planning assistance, the Global Population and Environment Program works to bring family planning stories from abroad home to our activists. It is imperative that we understand the intrinsic connections between women’s health and the health of the environment so that we can better advocate for the U.S. government to keep its promise to support family planning and reproductive health programs. World Neighbors
Over ten years ago, World Neighbors formed a unique partnership with CEMOPLAF to implement an integrated program in Guaranda, in the Bolivar Province. CEMOPLAF expanded their quality reproductive health and family planning services to rural Quichua indigenous populations. These services were complementary to the sustainable agriculture and natural resource management activities supported through the existing World Neighbors program.
In 1993, operations research was undertaken in Guaranda, in the Bolivar Province, to compare the increase in family planning rates between programs which offer "health only" services and those which offer "integrated" (health and agriculture) services. The research design included comparison of 6 "health only" and 6 "integrated" programs. The results of the research indicated that the integrated communities – which included reproductive health with an emphasis on family planning, community health, food security, sustainable agriculture and natural resource management – led to a greater adoption rate of family planning methods, use of reproductive health services and improved well-being for the rural families.
The most recent program evaluations, conducted in 2002, demonstrate continued success. The contraceptive prevalence rate has increased from 30% to 40% in both integrated and health-only communities. Maternal health service use has increased 50%, demand for prenatal care has increased from 5% to 12%, and post-natal care has increased from 2% to 16% in the integrated programs. A key factor in the success of the program was abiding by the principle that program acceptance is dependent on positive interpersonal relationships between community members, promoters and program staff. The integrated approach should consider the human being as the principal factor of development, and define the process as a coherent set of closely related activities. Relating the indigenous concept of the appropriate treatment of care of "mother earth" to women’s reproduction has been an effective way to link agricultural and reproductive health themes in training processes with participants (e.g.- in both cases, the need for adequate nutrition, protection, spacing). Other organizations are taking notice of the proven success of this integrated approach for working in rural areas. The Bolivar Provincial Health Directorate, through its Indigenous Peoples Health Department, is adopting the same approach and has hired agronomists to support the integrated outreach and work at the community level. Plan International has also been influenced, leading to a donation of a building for a new clinic in Guaranda. In addition, the Guaranda Integrated Program has negotiated collaboration with UNFPA, CARE, and the Georgetown University’s Institute for Reproductive Health. As the program continues to strengthen and improve the technical outcomes of its current programs, capacity-building goals aimed at increasing the breadth and sustainability of the integrated approach will become a focus of future program planning. At the community level, World Neighbors and CEMOPLAF will seek more effective approaches to strengthening community capacity for self-development. At the national level, they will work towards increasing and strengthening coordination with the Ministry of Health on providing health services, especially assisting in deliveries, as well as seeking strategic alliances to promote potable water systems to help prevent diseases.
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In the central mountains of Ecuador, World Neighbors and its partner, the Medical Center for Family Planning and Orientation (CEMOPLAF), work with remote, indigenous communities. These communities are composed of Quichua-speaking people who practice subsistence agriculture; soil erosion in these areas is severe and food production generally does not meet family needs. The men routinely migrate to urban areas 1-2 months a year to gain additional income. This male migration is leading to changing roles for women at both the family and community levels. Social indicators are predictably lower than the national averages in these rural zones. In Bolivar Province, the area where the program was initiated, the illiteracy rate is 19% (twice as high for women as men); the infant mortality rate is 62 per 1,000; and the fertility rate is 5.12.
Agriculture was not originally a focus of CEMOPLAF programs, however, due to the proven success of introducing reproductive health into communities through integrated programs, community members were receptive to this process. There has been a marked interest in adopting vegetable gardens, use of organic fertilizers (including worm composting and cover crops), animal health, and improvement of guinea pig stock and production. Additionally, incomes have increased, especially of women, through promotion of activities such as artisanry, including traditional weaving,raising guinea pigs, and vegetable gardening.
Based on the results of this operations research, CEMOPLAF and World Neighbors decided to expand the integrated program approach to other clinic sites in rural indigenous areas, starting in 1998 with Cajabamba, in Chimborazo Province. With the support of the Bill and Melinda Gates Foundation in 2000, the program was further expanded in the Guaranda and Cajabamba sites, and was initiated in new sites at Salcedo and Otavalo, and later in Pillaro in 2001. 