Despite advances made by Ecuador in developing policies on reproductive and sexual rights, implementation, and oversight remain a challenge, affecting in particular those living in the Amazon basin. This paper reports on an evaluation of sexual and reproductive health and rights (SRHR) in Orellana, Ecuador, the basis of which was the Health Rights of Women Assessment Instrument, which was altered to focus on government obligations, the reality of access and utilization of services, and the inequities and implementation challenges between the two. A community-based cross-sectional survey conducted in 2006 served to document the current status of SRHR Local female field workers interviewed 2025 women on three areas of womens reproductive health: delivery care, family planning, and pregnancy among adolescent girls age 10-19. The results suggest a reality more dismal than that of the official information for the area. Skilled delivery care, modern contraceptive use, and wanted pregnancies were conspicuously lower among indigenous women living in rural areas. Access to reproductive health services varied between rural and urban women. These significant differences in care--amongst others documented--raise concerns over the utility of national-level data for addressing inequities. The gaps evident in the validity of available information for monitoring policies and programs, and between national policy and action reveal that much still needs to be done to realize SRHR for women in the Amazon basin, and that current accountability mechanisms are inadequate.
"These initiatives are grounded in the assumption that most indigenous women desire smaller families but lack the means to achieve them. Key support for this logic comes from large-scale surveys of rural populations, during which indigenous women themselves say that they want fewer children than they already have or are likely to have, indicative of an " unmet need " for contraception (CEPAR 2004; Goicolea et al. 2008; Bremner et al. 2009). There is no question that pregnancy is particularly risky for young firsttime mothers and for high-parity older mothers; lowland indigenous populations hold relatively large numbers of both. "
Ecologies and Politics of Health, Edited by Brian King, Kelley Crews, 01/2013: chapter Vaccines, fertility and power: the political ecology of indigenous health and well-being in lowland Latin America.: pages 139-158; Routledge., ISBN: 9780415590662 (hbk : alk. paper) 9780203115527 (e-book)
"Some achievements have been noticeable: sex education is ongoing in several schools, reproductive health has been integrated to some extent into existing public health services, and sexual and reproductive rights and gender equity have been promoted within grassroot organizations and incorporated into local policies and programs. Despite those achievements, women in Orellana still lack access to adequate reproductive health care: i.e. 34% pregnancies are labeled as unwanted (43.6% among indigenous women), skilled delivery attendance still remains low (47%), and APs are common – 37.4% of girls aged 15–19 are or have been pregnant, a doubling of the national prevalence (54, 56, 57). "
[Show abstract][Hide abstract] ABSTRACT: In the Andean region of Latin America over one million adolescent girls get pregnant every year. Adolescent pregnancy (AP) has been associated with adverse health and social outcomes, but it has also been favorably viewed as a pathway to adulthood. AP can also be conceptualized as a marker of inequity, since it disproportionately affects girls from the poorest households and those who have not been able to attend school.
Using results from a study carried out in the Amazon Basin of Ecuador, this paper explores APs and adolescents' sexual and reproductive health from a rights and gender approach. The paper points out the main features of a rights and gender approach, and how it can be applied to explore APs. Afterward it describes the methodologies (quantitative and qualitative) and main results of the study, framing the findings within the rights and gender approach. Finally, some implications that could be generalizable to global reserach on APs are highlighted.
The application of the rights and gender framework to explore APs contributes to a more integral view of the issue. The rights and gender framework stresses the importance of the interaction between rights-holders and duty-bearers on the realization of sexual and reproductive rights, and acknowledges the importance of gender–power relations on sexual and reproductive decisions. A rights and gender approach could lead to more integral and constructive interventions, and it could also be useful when exploring other sexual and reproductive health matters.
Global Health Action 06/2010; 3. DOI:10.3402/gha.v3i0.5280 · 1.93 Impact Factor
"In Orellana, the percentage of pregnant adolescents is almost 40%. Forty-five percent of adolescent pregnancies are labeled as wanted, which is a high rate when compared to wanted pregnancies among other age groups in Orellana (40% for women age 20-29, and 32% for women age 30-39), but extremely low when compared to countrywide rates of wanted adolescent pregnancies (70%) [14,34]. Adolescent pregnancy in the province has sometimes been linked to sexual abuse during childhood-adolescence, poverty, parental absence, early sexual debut and lack of use of contraceptives during first sexual intercourse . "
[Show abstract][Hide abstract] ABSTRACT: Adolescent pregnancies are a common phenomenon that can have both positive and negative consequences. The rights framework allows us to explore adolescent pregnancies not just as isolated events, but in relation to girls' sexual and reproductive freedom and their entitlement to a system of health protection that includes both health services and the so called social determinants of health. The aim of this study was to explore policy makers' and service providers' discourses concerning adolescent pregnancies, and discuss the consequences that those discourses have for the exercise of girls' sexual and reproductive rights' in the province of Orellana, located in the amazon basin of Ecuador.
We held six focus-group discussions and eleven in-depth interviews with 41 Orellana's service providers and policy makers. Interviews were transcribed and analyzed using discourse analysis, specifically looking for interpretative repertoires.
Four interpretative repertoires emerged from the interviews. The first repertoire identified was "sex is not for fun" and reflected a moralistic construction of girls' sexual and reproductive health that emphasized abstinence, and sent contradictory messages regarding contraceptive use. The second repertoire -"gendered sexuality and parenthood"-constructed women as sexually uninterested and responsible mothers, while men were constructed as sexually driven and unreliable. The third repertoire was "professionalizing adolescent pregnancies" and lead to patronizing attitudes towards adolescents and disregard of the importance of non-medical expertise. The final repertoire -"idealization of traditional family"-constructed family as the proper space for the raising of adolescents while at the same time acknowledging that sexual abuse and violence within families was common.
Providers' and policy makers' repertoires determined the areas that the array of sexual and reproductive health services should include, leaving out the ones more prone to cause conflict and opposition, such as gender equality, abortion provision and welfare services for pregnant adolescents. Moralistic attitudes and sexism were present - even if divergences were also found-, limiting services' capability to promote girls' sexual and reproductive health and rights.
BMC International Health and Human Rights 06/2010; 10(1):12. DOI:10.1186/1472-698X-10-12 · 1.44 Impact Factor
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