Reducing Maternal Mortality among Repatriated Refugee Populations

Project activities include non-surgical family planning, maternal and child health services, and IEC activities. Organisers explain that the latter component was developed only after considering local cultural and linguistic frameworks. Locally appropriate materials were developed; they included:

• a blanket which shows the menstrual cycle and the fertility period
• two drawings of female reproductive organs
• a life-sized drawing of a pregnant woman
• drawings of monthly foetal development
• drawings illustrating signs of high-risk pregnancies and labour
• flipcharts and boards featuring different FP methods
• informative posters on "Emergency Plan for Labour Complications"
• dolls, cloth placentas, and umbilical cords for training workshops on labour management.

Community meetings and gatherings were used as a venue for participatory educational talks on SRH issues; they also served as a means of fostering interpersonal interactions and informal gatherings around SRH issues. Educational talks were directly translated by a traditional midwife into the local language (Kanjobal) to ensure understanding and participation.

With an eye toward project sustainability, a key programme strategy was the training of health promoters and traditional midwives. The idea is that these personnel will be able to serve as agents of information and referral for their local communities, hopefully continuing to support improved access to and awareness of SRH services beyond the project period. To that end, the project team developed a training plan that included 26 SRH topics. Training was based on SRH in the community context, safe motherhood, FP, and sexually transmitted infections (STIs). Weekly interactive and participatory training workshops were conducted for health promoters and traditional midwives within the 22 communities.

Sexual and Reproductive Health, Women, Gender.

According to MS Mexico, Guatemala has had a long and violent history of internal conflict. Complex social inequalities have been exacerbated by the effects of civil war. After peace accords were signed in Mexico in December 1996, Guatemalan refugees were repatriated to areas lacking in health services and basic infrastructure. These refugee communities dispersed to places that were not their areas of origin; they therefore continued to be displaced within their own country, and were relabelled as internally displaced persons (IDPs).

Organisers share the following figures, which provide context for - and explain the motivation of - this project. Over half of the population of Guatemala lives in extreme poverty; within the rural areas this rises to 91%. Almost 40% of this population is aged below 18 years. The maternal mortality ratio for indigenous women is three times higher (211 per 100,000 live births) than for the non-indigenous group (70 per 100,000 live births), according to the Baseline Maternal Mortality study for 2000. More than half of maternal deaths are due to excessive bleeding. Others are due to infections, hypertension induced by pregnancy, and unsafe abortion. Among indigenous women, the contraceptive prevalence rate is 10%, whereas the national figure is 27%. While 52% of urban women use a contraceptive method, only 27% of rural women and 10% of indigenous women do so. According to UNAIDS, Guatemala has the second highest prevalence of HIV/AIDS infections in Central America, with a rate of 1% of the population aged 15 to 24.