Starting in the villages of southern Mexico, Diana Damián joins modern medicine and traditional beliefs to realize significant improvements in the health, and through health, the rights, of the region’s indigenous women.
The New Idea
Diana sees that the existing efforts to educate indigenous women about health and rights run into problems on one of two main fronts. On the one extreme, they target women’s rights head-on and in so doing, alienate the woman from her family and community; on the other, they adopt a strictly clinical approach to sexual and reproductive health that decries, rather than builds on, ingrained cultural views of and toward women. Working through midwives and a network of local government-sponsored “health promoters,” Diana teaches basic health to indigenous women by connecting modern approaches to care—use of contraceptives, cures for sexually-transmitted diseases, attention to maternal nutrition—to ancient, perhaps forgotten, beliefs that establish a foundation of respect for women. Rather than focusing on the individual woman (an approach which has proved ineffective in these largely communal villages), Diana involves the whole community, including village leaders and locally-appointed authorities, in addressing women’s health and related rights issues, such as domestic violence. Having begun her work in earnest two years ago, Diana is now reaching beyond the state of Chiapas and adding program elements such as sex education in secondary schools. She sees an application for her idea in indigenous communities of various traditions throughout Mexico and Central America.
Most indigenous women in Mexico are unaware of and unable to defend their sexual and reproductive rights. In Mexico’s poorest state of Chiapas, for example, where a third of the three million inhabitants are indigenous, women face several obstacles to receiving pre- and post-natal care, including few healthcare facilities, even fewer women doctors in communities that disapprove of women seeing male doctors, and hospital and clinic staff who speak only Spanish in communities where the women are primarily mono-lingual in their indigenous language. Additionally, prevailing cultural values hold women in low esteem, training them to serve others and quietly withstand family violence.
Poverty and malnourishment also contribute to poor sexual and reproductive health. Only 40 percent of the population in Chiapas receives a wage. In the highlands and jungle area of Chiapas, 80 percent of the indigenous population is undernourished, and 100 percent of indigenous women suffer some degree of malnutrition. Health and education services in the region are sparse. Women in other indigenous regions of Mexico and Central America face similar challenges.
Government campaigns against the discrimination of women do not reach this sector of the population. Public health institutions, in addition to having limited coverage in indigenous regions, tend to focus on lowering the birth rate but pay much less heed to the mortality rate. The birth control campaigns focus primarily on abstinence, rather than disease prevention and the use of condoms, much less issues of sexuality and pleasure. Efforts to encourage women to get pap smears have suffered from an insufficient number of technicians to examine the samples and an inappropriate, strictly clinical introduction of the procedure.
Health organizations have made deeper inroads into these communities, but provide primarily direct, immediate aid, with little attention to community self-organization, training and preventive medicine. The few that do work with health promoters and midwives specifically on issues of reproductive and sexual health have had little impact in the twenty years they have been doing so because the messages have not been the right ones for these traditional communities. Urban, feminist women say that a woman should make all her own decisions, but Diana knows that in an indigenous community, that is not possible because one does not live alone. The decision making of an indigenous woman is supported by the women and men around her. She consults her mother and mother-in-law, her sister and sister-in-law, and various other female and male relatives and community members.
Diana, who has indigenous roots herself, knows that many native cultures in Mexico and Central America used to teach that men and women are equal. This perspective has been lost, in part due to the penetration of a patriarchal church into these communities. Diana sees that tapping into roots and traditions offers a possibility to ground the message about health and rights in something that is familiar and instructive to men and women.
Diana uses a methodology based in these traditional beliefs as her entry point to bring sexual and reproductive rights to women in indigenous communities. Her distribution mechanism is a multiplier training process coordinated through an existing network of health promoters chosen by local communal authorities.
Diana’s methodology brings both traditional and modern health techniques to these communities by basing everything in indigenous principles of community and equality of the sexes. To cultivate this methodology and bring communities a renewed understanding of their roots, Diana’s training also includes workshops focused on using personal and family histories to recall some of the forgotten indigenous ways. She then examines the principles of indigenous culture that surface in these workshops to identify the aspects that encourage sexual and reproductive rights. For instance, using the tradition that women are sacred in their role as givers of life, health promoters and community authorities learn ways to preserve the lives of childbearing mothers rather than just accepting their death.
Diana is finding that the principles and traditions she uncovers can help communities identify and respond to domestic abuse, and to provide women with alternatives. Women who suffer domestic violence are not likely to report it to government authorities because they do not have access to health or legal services. They usually do not speak Spanish and they usually would need to make a four- to five-hour trek to a clinic or legal office. They also rarely speak to strangers about such issues. Diana’s approach, therefore, appeals not to government responses but instead to the indigenous value of community. If a woman does not want to report abuse, promoters are trained to facilitate a process in which a victim discusses the problem with her family and then her husband’s family. After discussion, the family comes to an agreement with the husband. If he repeats his actions, the family speaks to community authorities to find a solution suitable to the woman. If the abuse still continues, the entire community assists the woman to make a complaint to government authorities.
Diana is now taking this work directly to a community of one hundred fifty thousand people in a Zapatista region of Chiapas through the existing network of two hundred health promoters that serve fourteen municipalities. These promoters are important because they have already been chosen by traditional, local, non-governmental, communal authorities. They, therefore, have the official backing and the trust of the community, but have not previously had extensive training in sexual or reproductive health.
Over the last two years, Diana has been training women health promoters in issues of sexual and reproductive health. She began by doing a significant amount of lobbying herself to convince the traditional authorities to support her work. Over time, however, she has been strategically using the promoters in this network to do this convincing. For instance, in a situation in which a woman is being abused, a health promoter can get the local authorities to inform the man that he is under observation, a greater threat to him than that of any government office far away from the community.
Her direct training work with fifteen of the promoters is showing results in twelve hundred communities due to a cascade effect in which the training passes from Diana to the promoters, from the promoters to midwives and other health workers, and finally to the general public. Through Diana’s lobbying and fundraising, nine health clinics have been set up in the region that (a) incorporate traditional ways, (b) have staff that speak the local language, and (c) include at least one of the women trained by Diana. Through the clinics, each woman has her own network of promoters that she trains.
Within three years, Diana plans to have expanded the coordinating team and eventually intends to expand to the entire network of two hundred. She is also linking the promoters into the independent women’s movement at the state and national level to spread the idea beyond the region. To help this effort, she is documenting her flexible methodology for use in training others.
The model is also seeping into other parts of Mexico, Central America and farther south as Diana has sought out opportunities and also has been asked to serve as an advisor to groups in Panama, Guatemala and Colombia. A peasant group in Panama wanted nothing to do with gender work until some of its members participated in one of Diana’s workshops. After witnessing that the training comes from their own indigenous, rather than a foreign, perspective, they expressed interest in introducing it into their organizations.
Through a similar methodology, Diana’s organization is also training two hundred indigenous teachers and beginning to implement sex and reproductive health curriculum in schools. The government, which has tried and failed in this endeavor, is seeking Diana´s advice in revising its curriculum and approach.
Diana has pursued a life that joins two critical strands of social movements in Mexico: that of peasants and that of women. Experiences in her family and community, a collective farming village in the central coastal region of Chiapas, influenced her along this path. Her father was a mixture of Zoque indigenous and black, a descendant of plantation slaves and a musician who left his community for Mexico City. There, he met Diana’s mother in a student uprising in which they participated. A woman of mixed indigenous-European ancestry, she returned with him to his community, where she was initially rejected because she was not traditional.
Diana rejected two marriage proposals at ages fourteen and fifteen. Then, at age sixteen, she got pregnant and ran away to avoid being forced into marriage. Her family, however, brought her back to the community and married her off. She gave birth to her daughter, then spent years dealing with physical abuse from her husband who resented her efforts to continue studying. But Diana persisted, working, studying and raising her child until age twenty-one, when she left for the capital city of Chiapas. Thus began a period in her life that would take her to Mexico City and then, finally, back to Chiapas, where she lives today.
Her years away from Chiapas allowed her time to see organizations in action and to establish one of her own, a voluntary maternity group. In Mexico City, she found a home with various women’s groups and began working on a communication strategy for one that was just starting up. Upon returning to Chiapas, she helped start the State Council of Indigenous and Peasant Organizations, through which she worked with other indigenous women on reproductive rights. Because of her work with this organization, the Zapatista National Liberation Army invited her to participate in the peace dialogue on indigenous rights and culture, which resulted in the San Andrés Peace Accords.
Fully aware from her own experiences of the challenges to reproductive and sexual rights women in isolated areas face, Diana began to coordinate her activities with others who were implementing a health project in the highlands of Chiapas. She began devising, and experimenting with, the methodology she uses today.