Background: As a coordinator at Manos Abiertas, a clinic specializing in child and maternal health in Antigua, Guatemala, Carmen Ordoñez advocates for more openness and information regarding child and maternal health in Guatemala, given the high vulnerability of low-income women. She shares her experience working with faith-inspired groups, churches, and religious communities around topics that are still considered taboo in Guatemala; however, she sees great potential for collaboration and support among secular and faith-inspired groups to support vulnerable children and women. Carmen's conversation with Andrea Arzaba Diaz, a research assistant for the Guatemala mapping project, took place in Antigua, Guatemala on February 27, 2016 as part of the Berkley Center/WFDD’s consultation on child and maternal health in Guatemala.
As background, can you tell us about Manos Abiertas?
I work for Asociación Manos Abiertas, which devotes itself to aspects of sexual and reproductive health. We serve Antigua, Guatemala and neighboring areas. I do social work, which is what I want to focus on to help Guatemala, and I seek out projects that have promise to be sustainable. At Manos Abiertas we concentrate on helping vulnerable women from rural areas. However, we also see patients who can pay more and thus help us to maintain the clinic.
What are Guatemala’s greatest difficulties in relation to sexual and reproductive health?
The lack of information, education, and supplies to be able to provide for the different communities. Also the dearth of open dialogue about sexual and reproductive health matters, because in Guatemala it continues to be a taboo subject. We need to explore it and get to know it better.
What do you mean by “taboo subject”?
In Guatemala, there is no program or venue that encourages discussions about sexual and reproductive health. Young people or teenagers gradually learn about it through experiences that others share with them. It’s not truthful, accurate information. There are many youth pregnancies. The church looks down upon contraceptive methods. Therefore, that situation creates a lack of opportunities to inform the population in any continuing manner.
I understand that Manos Abiertas is not itself a faith-inspired organization. Do you have a working relationship with any church or religion? Have you formed any alliances with religious groups?
At Manos Abiertas we work with the municipal network. There, various organizations have different viewpoints. The Catholic Church also participates through the Pastorales de Jóvenes. We also work with Fe en Práctica, another religious organization, on prevention, education, cervical cancer prevention, and rapid diagnostic tests for the different communities in the countryside.
And how do you go about prevention?
Primarily through health fairs. We give talks on education and prevention about different types of cancer, what’s available as treatment, and long- and short-term contraceptive methods. At the health fairs, we also perform rapid diagnostic tests, and follow up if any of the tests come back positive. If women are interested, we offer them long-term contraceptive methods, because it can be difficult to return to the community regularly to hand out short-term contraception.
When you go to the communities, do the women express any sort of fear or refer to some barrier that would prevent them from using the methods?
There are women who hold the view that if they use some form of contraception, it’s a sin, and they are doing something bad or wrong. Many believe that they should have as many children as God gives them, even though they might not have the resources to provide for them. And then there are those who have never received any reproductive information or health advice. They do not know even what the methods are for; they think they can use natural methods, which are not as effective, because then they end up pregnant.
But do you think that young women are open to information?
It depends on the place and the family, because the women know what their families are inclined to share with them, and not all families are amenable to conversing about sexuality. Sometimes their families have never spoken to them about reproductive or sexual health. At best, some families might be willing to talk about it, but discussing it with their sons and daughters embarrasses them. They don’t dare tell them that they should use protection, or even consider the idea that their sons and daughters might have active sex lives.
What is the relationship with the local churches?
For now we have not had any clashes; on the contrary, the Lutheran Congregation in Germany is involved. And they have supported us in our health fairs on methods and prevention. Thus, we haven’t had any confrontations; they have supported us because they know that it’s necessary work for a country that needs it.
And what about the work of religious leaders in terms of reproductive health in the areas where your organization works?
I haven’t seen any such work. I’ve only heard about the changes that Pope Francis has suggested in what he speaks about; he discusses by implication the use of family planning, because it’s not just about bringing children into the world, but it’s also about all of the needs that come along with it. We thus see a predisposition to start addressing this matter with a different focus—to educate and prevent.
And are you interested in forming more alliances with churches or faith-inspired groups?
That is something that we have not really focused on up to now. But it would be interesting to do so, because what we want is to reach more communities and more women, and to give them tools of empowerment. We aren’t trying to clash with their culture, or what people think in terms of religion. Instead, we’re trying to offer them support and honest and accurate information that they can use in their lives.
Could you tell me a little more about the teen pregnancies that you handle in the clinic?
We support the Sexual and Reproductive Health Observatory (Observatorio de Salud Sexual y Reproductiva, OSAR). They see teen pregnancies, in addition to maternal deaths. So we always refer back to or are in contact with them if there is any teen pregnancy case in our clinic. What we have seen now is that the teenagers don’t want to go to the health centers or hospitals because they fear that they won’t be able to leave or that it will cause problems with their partner, because sometimes their partners are older than they are—they are 16 and their partners may be 20 or 22 years old—and they are not looking for any trouble.
Moreover, if an older person is with a teenager, that person can be jailed. Besides that, teenage girls have a mandatory obligation to attend a consultation at one of the health centers or hospitals. We try to help them trust us during their pregnancy. And we try to educate, to give them contraception after they’ve had their first baby, so that they also consider their future. For us it’s all about education. This is why we give them tools, to help them understand that we are not trying to force them to use contraception, but that we want them to decide and understand, which in part is so that they can continue to grow later.
How many cases have you helped?
In the database we currently have 4,300 cases, but there are still cases from years ago that haven’t been updated. But yes, we’ve seen a lot of cases.
What would you like to see in the future?
To handle a large number of cases, but we must also recognize our own limits, because there are only a few of us and a few volunteers that help us. Therefore, we would love to see double the number of patients and have a full clinic, go to more health fairs, and do a lot more to benefit women. But the fact that we don’t have enough financial or human resources to be able to do this work is limiting.
Do you work with the government in any way?
We don’t receive any type of government support. But we support the government by offering contraceptive supplies when the government runs out. We give some to them. We have a price for our patients, but we sometimes give contraceptives to them at a much lower price or talk to them to see how much they can pay for the method, so that they feel at ease. We have provided continuing support to some of the patients from the health center; since they don’t go to the health center any more, they come to us. They feel more trusting about what questions they can ask. It’s not as if we oblige them to use contraception, but instead we talk about whether the method is working, if it’s good for their bodies, and if they feel well, since contraception can cause hormonal changes and be difficult for the women.
Besides giving supplies to the government, do you do any other work together?
With labor and delivery care, yes. The government has the Healthy Maternity law. We also collaborate on contraceptive methods. We work within the law and within their continual updates of regulations and law changes. But I can’t say that we work with them constantly or permanently.
On a personal level, how do you see the future?
What motivates me is when a woman leaves our consultations happy and she can express herself, she can resolve her doubts, and she realizes that she has rights. When she realizes her own self-worth and doesn't base it off of what her husband or mother says. And she realizes that her destiny in life is not just to play the role of a mother, but that she can also work and do other things independently. It inspires me to help women become more empowered—when they believe in themselves, they become agents of change in their communities; they end up telling their neighbor what they are learning and doing and what’s working and what’s changing their lives, and they tell their neighbors that they have rights too. To contribute to this change and to achieve more awareness about women’s role in society is extremely satisfying.
Additional background (from http://www.asociacionmanosabiertas.org/en/)
Manos Abiertas is one of the only women-centered, culturally and linguistically-sensitive birthing and women’s health care centers in Guatemala. It was founded by Planned Parenthood Federation of America (PPFA) in 2008 as a response to the urgent need for comprehensive health care services for vulnerable Guatemalan women. Recognizing the importance of local collaboration for long-term sustainability and impact, PPFA approached Hannah Freiwald, a professional midwife with over 15 years experience working in Guatemala, and asked her to lead the project. Hannah worked with her Guatemalan team to develop the project into a full-scale clinic that has grown to serve 3,500 women and their family members. It focuses on providing excellent health care services to women living in poor, mostly rural areas of Guatemala. Over 70 percent of Manos Abiertas’ clientele work in the agricultural sector and are of indigenous Mayan decent.
The clinic opened in 2008. Asociacion Manos Abiertas was strategically located in Ciudad Vieja, Sacatepéquez; a very underserved area, despite its close proximity to Antigua (an international tourist destination). Ciudad Vieja is serviced by most major bus lines and as such is more easily accessed by women living in remote areas. It also provides a convenient home-base for staff who travel to rural areas to provide mobile clinical services to women unable to leave their communities.
Manos Abiertas aspires to a holistic approach to women’s health care, seeking to address the sexual and reproductive health needs of women throughout their lifespan. By providing comprehensive health care services it paves the path for appropriate, specialized care during pregnancy, labor, and delivery. For many women they serve, pregnancy marks their first contact with the health care system, which provides a valuable opportunity to promote not only safe pregnancies and deliveries, but also to address other vital aspects of women’s health including family planning, HIV/sexually transmitted infections, and cervical cancer prevention and treatment. After pregnancy, the clinic aim to provide on-going services for mother and child and empower women to continue to make informed health care decisions, serving as models for their children, families and communities.