Mostrando entradas con la etiqueta sexuality. Mostrar todas las entradas
Mostrando entradas con la etiqueta sexuality. Mostrar todas las entradas

sábado, 19 de enero de 2019

Gender Violence - What Cecilia Never Understood


By Marco Paulini Espinoza

She saw thirteen times the Spring to flourish. Already at mid-morning, sshe had gotten away the village too much, than her spirit felt to be free as when her mother took her hand to guide her way just some years ago.
The remembrance posessed her most intimate thougs when she suddenly felt tired, and a light dizziness made her to look for a place where to lay, while she streched Carola among her hands.
The cool wind made to collide some dry leaves against her face, awoke, and magically the Moon enlighted the prairie letting to glimpse tthe absence of the ten sheeps those were the perfect motivation and excuse of her taking-away.
Her hand slided on the grass and found the lace of Carola's dress. Within very much bad luck, a smile sketched out on her face at the time that a tear ran over her chick. as she could, she held Carola  into her arms, squeezing it, and wishing to bring back  to that day of her eight birthday when Aunt Sofía, who had years far away, came back from the city bringing the doll with its pretty smile embroidered on his little cloth face, which came in a beautiful box decorated  with a red ribbon, what would be her gift remembering the day when she born.
She got up and a strange waist pain brought her down again almost inmediatly, while  a tearing pain scream  who nobody heard at the lonely prairie escaped out from her being.
She tried to slow down when she felt a warn fluid  to run her thighs. She could not understand why she was bleeding profusely. The cold of the death took  her fragile body making her to tremble, she cried and she tried to scream for help, but she was completely alone.
Foolishly, as theatrical motion scenes, almost programmed thoughs passed through her head: What would be thinking about her at his husband Juan's house? Surely that as at her parents' hhouse "she was very pampered", she as not been accostumed to her new family. In the other hand, wwhat her father could think about of her running-away offense as the much he earned to negotiate with Juan for the town's people not to speak and realize her daughter was not virgin anymore.
As she does not arrive into home, Juan surely would despise her  and look for another girl at the lonely countryside for forcing her to make love as the habit was, because in his 22-year-old, he had it done many times, as that time when Cecilia went out from the school and the fortune, the misfortune, made to match Juan at the lonely countryside, no words crossing each other... and her destiny could change forever.
What did Juan care about doing it once again? What did Juan care about leaving Cecilia dishonored and marked lifetime?
She blamed for taking away too much because her intenttion was to feel free only but not running away, she blamed  for losing the sheeps, she blamed for being a bad daughter, she blamed for being a bad woman  and she could not understand what her body was passing through.
She did an unnatural effort  and walked as she could, almost dragging. Her body did not responsed once more time and a "My God, help me" was her ultimate reasong.
It was four in the morning wen a farmer tripped on Cecilia amid the fog, who was white as a paper and cold because of the sierra's air, but still having pulse. Rushing, he took her on his arms and covered her up with his poncho. A rampage started at the town. Juan did not want her to be addressed to the health post because it was  a villagers' habit to heal their diseased with healers and shamans.
At five in the afternoon, Don Evaristo, a very respected shaman, said he could not do anything else yet for Cecilia and bring her to the medical post.
Cecilia was evacuated and arrived into the city's hospital almost at midnight.  Half an hour later, her death was confirmed. The innocence of her years did not let her to understand she was pregnant eight weeks. The medical doctors confirmed the next day the bleeding cause was a miscarriage.

Let's denounce the machismo too ingrained inside the cultural practices. Stop the gender violence!

[Comment down next or at my Twitter account: @MarcoPaulini]

jueves, 29 de diciembre de 2016

The day-after pill - myths and the truth

Some definitions about pregnancy, contraception and SRR


When does a woman get pregnant? Do all the intercourses become creating a new being? How does emergency oral contraception work? Since August 22nd, 2016, Lima's First Constitutional Court instructed EOC to be distributed free in all health public stands, after the rule was suspended since 2009.

The problem was it actually could be sold in private drugstores, what generated unequitty in access and that is what court decision tried to balance.

But, what is all this process about? Before, I think it's necessary you understand some concepts and interpretations related to this issue in case you want to join the discussion, so you also do it under equity criteria.

Plus, I include you sources you can go deeper about this concepts (all my references are in Spanish, but you can find their equivalents in your language).

1. Reproductive cycle, ovulation and fertilization
every month, the female organism gets ready for a pregnancy. This preparation begins the first day of menstruation due to the ovaries make hormones such as estrogen and progesterone, mechanism ruled by the hypotalamus at the brain. Its objective is ova maturation, the preparation of uterus and the rest of the female sexual organs as well for a possible pregnancy.

The week after the menstruation begins, the ovaries will be the responsible for follicular maturation. As in every menstrual cycle 7 to 8 follicula start to grow, only one grows becoming mature between cycle's days 12 to 16, moment when ovulation happens. The Fallopian tube catches the mature ovum what begins its trip to the uterus, which has been preparing for a possible pregnancy swelling its endometrial layer (1). Once released, the ovum could b fertilized when joining to spermatozzoon during next 12 to 48 hours, if not it will begin to be disintegrated.

Human fertilization is intern, it happens inside the woman's body in other words, at Fallopian tubes to be exact.

Fertilization is probable if spermatozoons (male cells) are stored in the vagina by the intercourse at days 12 of 16of female menstrual cycle. Then, helped by the cervical mocus and stored in upper portion of the vagina, they start to raise to Fallopian tubes, those at the same time have gathered a mature ovum (female cell) .

For the fertilization (union of ovum and spermatozoon) to be produced, it's necessary that sexual contact (intercourse) between a man and a woman (except when artificial or assisted fertilization techniques are used) be made in a moment close to the ovulation (1).

It's actually easy to set that because this harmonious and almost timed working that female reproductive system does, the women are fertile every month during their reproductive lifetime, what begins in menarche (first menstruation) and ends in menopause. Then, her fertility or reproduction will be depend on mechanisms she and/or her partner adopts to begin or prevent pregnancies, facts those response to a biological sequence what occur cyclically in every woman, sequence that can not be unaware to take preventive measures and let them to God's fate neither.

2. Pregnancy
If spermatozzoon and owvum intercept, they will unite fusing their cores and formin one only cell, that starting in this point, will trek to the uterus, while it also begins a mitosis process, multiplying in number of cells.

3 to 4 days since the ovulation, the fertilized ovum will get the uterus, when it could last 2 to 3 days more for pinning up the endometrium, place where the new being will develop (1).

3Emergency oral contraception (EOC) and its action mechanism
The emergency oral contraception (EOC) is a method that offers an alternative to forced sexual relations or rapes, intercourses without prior contraceptive using, misusing or its failure (4). It's necessary to remark this method is effective only among 72 hours after having sex. It must not be used when this deadline is over.

It's proven the EOC works because unables the ovulation, at the same time it thickens the cervical mocus making the spermatozzoon not to go its way inside the uterus (5). So for example, Levonorgestrel emergency contraception pills prevent the pregnancy unallowing or delaying the ovulation, and avoid the fertilization due to its action on the cervical mocus, becoming it much thicky, so decreasing the spermatozzoon mobility with that, then its ability to join the ovum (4).

Thus, we support on updated scientific evidence to affirm that once the fertilization occured, the EOC doesn't interfere the process of fertilized ovam implantation and, neither it interferes the embryonic development of an already implantated ovum (4).

What it should be taken in mind is the EOC is a good method that allows preventing non-wanted pregnancies, and the protection of the woman's life in comsequence.

As I already explained, it must be paid attention to action mechanism because the EOC, as unallowing ovulation, won't display an ovum to fertilize, then there will be not a pregnancy. Also in case, that sexual relation has been happened after the ovulation, when an ovum has already been produced, this method thickens the cervical mocus as a second action mechanism, unallowing spermatozzoon and ovum encounter. So, it is proven it's not an avortive metod, bringing down the false theories which many politic authorities, influenced by their ecclesiastical colleagues, are based because here is not attempting against the life of a supposed new being, but simply conditions for the pregnancy to occur get nullified.

4. Sexual and reproductive rights (SRR) and Peruvian laws onEOC
In the other hand, each men or women has the whole right to decide on their sexuality, totally free, unattached by coercion, discrimination or violence, to decide if having kids or not, the number and spacing of them, as well as having true information with a scientific basis, and access to contraceptive methodology. In other words, to have sexual and reproductive rights (SRR), the same what were mentioned and recognized in Confference of Population and Development in Cairo, 1994, and 4th World Conference in Beijing, 1995.

Peru's Constitution doesn't mention explicitically to SRR of people, however it does recognize several rights inside or related directly to SRR of every citizen. So we find the right to dignity, free development of personality, also the right to the life, to physical and mental integrity, to fre concius, to free information, to personal intimacy for quoting someones.

Additionally on July 28th, 2005, the Family Planning technical Rule was aproved, which objective is to guarantee and standardize the attention processes on family planning inside the SRR focused from gender, setting up all person has right to enjoy the highest level of own health for allowing to enjoy own sexuality, to decide free and responsible the number and spacing of the kids, to have access with equity, without any discrimination, sexual orientation neither, to sexual health and family planning services, to the access to contraceptive methods for choosing free and volunterly, to have access to quality services of sexual and reproductive health without any type of coercion, to health institutions guard those principles to be committed.

Unfortunately, the women's SRR in Peru have not been totally recognized, as much as EOC laws have coming out behind a machismo veil, wwhich even the eecclesiastical authorities have self-allowed to give messages opposed to this contraceptive method despite Peru is a secular country, so the Church sshould not influence when ruling about issues related to sexual rights of persons.

The opposers' argument is the defense of a hypothetical being, not proven, based upon the premise of life defense.

Faith, science and machismo
despite Peruvian law fortunately begins to have a much favorable position to sexual rights, paradoxically it's still perceived there is a big number of women (not counting the men) who although recognize this contraceptive method offers a way-out before a non-wanted situation, they still see it like something attempting against the faith, prefering to accept what they had to live by God's fate, and that the woman's mission by tradition andd religion is the calling to give life despite the conditions it is given.

To us, who have a panoramic view of what happens, can affirm cathegorically this situation is just the product of the letargy and the lack of interest of Peruvian Government about recognizing and ruling on time in favor of sexual rights of people, much more women's - that the government, after paying more attention to religiosity, has come allowing laws those give to the woman a role of almost pure reproduction.

If we add disinformation to this, we have the perfect formula to continue in the chaos that non-wanted pregnancies bring themselves on. Then, we can elucidate that before such conditions, unfortunately the EOC is not an option for many of our women as a mean to protect their life, but it's not an option by own will, by pure ignorance given by the lack of information instead, because the State (almost holding hands to the Church and machismo) doesn't offer the conditions for the ownn woman to be the one who recognizes, empowers and internalizes she has sexual rights, those have not to struggle to her faith, making them to respect.

Don't lose our main focus, and this is the health of each person, translated in social health, our women's mainly, because a big amount of non-wanted pregnancies become clandestine abortion in unhealthy places those attempt against women's physical integrity, psychologic problems as well.

Let's have in mind that before rapes or any intimate relation without condom, the person exposes not only to a non-wanted pregnancy because EOC doesn't protect from sexually transmited infections nor HIV neither, due to this is not a method what avoids the contact to body secretions of the other person.

If you want to go more in-depth, I suggest go to bibliographic references I used to write this article. Remember they are in Spanish, so you can find out the equivalent in your language.
1. Saludemia. Planificación familiar. Lima: Saludemia; 2016
4. World Health Organization. Anticoncepción de Emergencia. España: Organización Mundial de la Salud; 2016.
5. Centro de la mujer peruana Flora Tristán. Anticoncepción Oral de Emergencia. Lima: Centro de la mujer peruana Flora Tristán; 2016.
8. Petrell E. Política de anticoncepción oral de emergencia: la experiencia peruana. Simposio [Serie en internet]. 2013[Citada 2016 octubre 31]; 30 (3):m [aAround 2 screens]. Available on: http://www.scielosp.org/pdf/rpmesp/v30n3/a19v30n3.pdf

viernes, 23 de diciembre de 2016

Risky teenage Love (Somewhere Piura Andes)

Risky teenage Love (Somewhere Piura Andes) By Marco Paulini

PACAIPAMPA, Peru – It seems to be a typical soap-opera scene: passion overflows two teenagers, who not worryiing about place and time, decide to make love. Around, green mountains, shiny blue sky, beautiful Andean birds tweetts are the whole romantic picture.

But that scene does not come out from the mind of a drama’s screenwriter or producer, where sex is key part of magic formula. It is a reality with risky consequences for their lives and the lives of whoever they meet or will meet.


In bellavista de Cachiaco, a village at Piura Andean Range, Peruvian Northwestern, 14-15 year-old teenagers have already started their sexual life on their romantic landscapes or when they could go beyond, “to the city”, looking for best life conditions.


But what about protection when they have sex?
  While I was working there, I asked directly san Francisco de Asis High school’s students.

We Do Not Protect
Bellavista de Cachiaco is a village 10 hours away by pick-up from Piura City, previous stop in Pacaipampa town, located deep below a valley at Andean Range, 5729 feet height. It became known because it is the birthplace of Corazón Serrano cumbia band creators, although it is also the Western gateway to enter Huarinjas lakes.

But what I look for has no magic neither mysticism. I want to know if sexually active boys and girls, at least, are protecting with a method apparently available for them – condoms.


Beginning this Annual Course, we applied a poll, being careful about informing its objective and looking for 57 both sexes teenagers to participate anonymusly and volunteeerly for free.


We found just 2 in each 25 know what a condom is and how it works, but the worst was 11 of these 25 have a negative attitude about it.


Condom is a barrier contraceptive. That means it unallows semen containing spermatozoons gets physical contact to an ovum.
No physical contact, no fecundation. So, no pregnancy.

Also, this method is suggested to avoid diverse sexual transmitted infections (STI) contagion, including HIV/AIDS.


If I Get Pregnant, It’s For Love 
Poll we applied showed that students who started their sexual life are 15 to 16 years old, in majority.

Our research also showed 64.9% of teenagers ignore they can get pregnant during penetration without condom even not having an orgasm.
Majority of this percentage are male teenagers (38.6%).
40.4% ignore they have to look for a contraceptive method before the intercourse. 52.6% does not preview neither pay attention on the possibility of a pregnancy before it happens.

54.4% assumes if pregnancy would occurs during teenage does not matter because “it’s product of love.”


Tales, Myths and Legends About Condom 
On student’s poll(males are majority), it is evident that 47.4% believes using condom threatens trust the couple has on their relationship, 52.6% thinks it limits sexual pleasure, 54.4% opine using it does not could provide them safety neither pleasure, and 64.9% believes continous using of condom causes sexual impotence in long term (.36.8% are males).

Our poll in Bellavista de Cachiaco shows 70.2% asked teenagers opine condom protects them from majority of STI, but 50.9% does not know it avoids contact to couple’s secretions during intercourse.

In doubting position, we find out 54.4% who has wrong conception that condom protects them from absolutely all STI.

50.9% does not know totally five steps proposed by World Health Organization (
WHO) to use it right, and 56.1% ignores condom does not protect if it is used just few before ejaculation, number represented in its majority by male teenagers. 23% believe wearing a condom just before ejaculation is safe.

Don’t You Have Condoms? It Doesn’t Matter! 
Data gotten in Bellavista de Cachiaco clarify 28.1% of teenagers would have sex with another one else simply “because he/she likes her/him,” even if they do not have a condom at that moment. Notoriously we observed women are who have a major negative attitude about this fact.

42.1% of this population do not pay attention before a intercourse, they must look for information to avoid STI, that they do not care using condom as protecttion if they have sex with his girlfriend/her boyfriend.


38.6% unknow they can infect from any STI during their first sexual experience if they do not use condom, and they speak it out advising their friends that it is not necessary to use it during their first sexual experience.


Conclusions
First – Evaluating knowledge on condom physiology as contraceptive method and protection against STI, more than a third part of teenagers in Bellavista de Cachiaco unknow how it works.
Second – In general terms, an elevated percentage of teenagers in Bellavista de Cachiaco unknows how to use a condom correctly, including five steps proposed by WHO.
Third – Majority of teenagers in Bellavista de Cachiaco is negatively proned to use a condom as protection against STI, as well as contraceptive method, that leads them to risky behaviors and situations turning them into a vulnerable population and –literally- unprotected before non-wanted pregnancy.
Fourth – Myths and believes before condom using are still present in more than a half of Bellavista de Cachiaco population, and unfavorable attitudes those lead on, are result of an unapproppriated information from adults, society, who are in charge of guiding and teaching teenagers.
In brief, if almost nobody knows how it is used, then almost nobody will have a possitive attitude about condoms. , It is practically unprotected sex. And this is the discussion point to empower or to improve any prevention strategy.
Do not give up on the debate.

Marco Paulini is a proffessional obsthetrician who lives in Sullana, Peru. He produced this report base don a research available in Spanish by writing at factortierra@gmail.com . Edited and translated by Nelson Peñaherrera.
© 2014, 2015-2016 Asociación Civil Factor Tierra. All Rights Reserved.

miércoles, 30 de noviembre de 2016

Let’s talk about HIV/AIDS

Pagina nueva 1
 
 
In this space we look for talking about an issue what, despite overflooded information, it is evident that campaigns to use condoms are not getting the the wished asset, what it is not achieving to create consciousness for self-protection to prevent HIV/AIDS and the other sexually transmitted infections.
Thus, it is necessary a self-reflection on unprotected sexual practices between heterosexual, homosexual and bisexual persons. This clarification is made because it makes no sense to follow accusing the gay public of HIV/AIDS infection, stigmatizing them about a dirty behavior -- it is observed an awful reality on infection does not discriminate among sexual orientation or gender (male or female), and that is gaining space because of risky sexual practices as having sex without a condom, early beginning of sexual relations not using a condom, practices which nowadays are not because a lack of information but lack of conciousness attributed due to they are practices adopted by many young and not so-young, who simply do not pay attention on the risk of acquiring HIV.
It is also observed to all this that there are still rejecting persons to HIV free testing alleging they are not men sleeping with men or women who only sleep with their husbands, when the reality has taught us if there are groups presenting more risk before infection, we all could be victims of it.
It is important to highlight that scientific researchs prove the HIV infection is detected between 16 to 24 years old. It is very known from the moment of infection until first syntomatology appearing can last from five to ten years, if we consider that the person does not test for HIV while syntomatology is not present . Then, when that person is diagnosed, we realize the cruel fact that person was infected between 13 to 15 years old, in teenage, we mean, when the majority just does not realize to be the infection-target .
 
Diana’s Tale
I met Carlos when I was 14. then, he was 16. we were classmates at high-school.
Two years later, I got pregnant. Carlos left the school,  and I went to live with him as it uses to be. Everyday , he showed me that if we were very young, he loved me and was concerned I were well. We did not have much but with few, we were going up.
Time passed and I realized Carlos started to get sick. Once more, it was too continuing that ill. Then, he was 20 years old and I was three months of my second child’s pregnancy . everybody said me I might not be worried because that would affect my baby.
Someone advised me that I should get Carlos to the health post, that there was a little free test to be applied to persons with syntoms Carlos had, and I checked in my pregnancy by the way.
My father-in-law said me it was not necessary because the test was for men who slept with prostitutes or other men. As I was not neither both, I had to be calm.
Despite, Carlos got many pills as well as available herbs but even he did not recover.
One day, Carlos could not wake up. I encouraged, went to health post . there I was diagnosed with HIV and they told me it was necessary Carlos got tested too.
A day before dying, Carlos requested me for forgiving him among tears, he said never betrayed me and I was his life love, but when he was on vacation the year before we met, he went to Aunt Aydee’s in Chiclayo, because he used to do this that year’s season.
Aunt Haydee’s sons Paco and Juan used to visit Rosa, a powerpuff girl, he had to meet for becoming a man.
Crying, he said me that if he could get the time back, he never had condemn me to his unmadurity punishment. I also answered him in tears that we both were victims and there are not anything to forgive.
Today I am taking retrovirals and waiting for the birrth. I praise God that my baby does not born infected because my first son was not lucky.
 
What is HIV/AIDS?
The HIV (Human Inmunodeficiency Virus) is a virus what attacks cellsin charge of body’s defense called CD4 co-operative lynphocites. As infection advances and CD4 lynphocites account decreases leaving the body with less defense capability, HIV-infected persons begin to get very bad infections those normally are not infected, becoming inmunodefficient.
This advanced process with other oportunist diseases already presence is called AIDS (acquired Inmuno Defficiency syndrome).
Many times, the person is diagnosed with HIV even if there are not syntoms.
When the person is infected, the virus progresses arise, and the person is unsyntomed, who does not present symtons to suspect on infection, in other words. This process can last until ten years or more, time when the person can transmit the virus to other people.
If the person is not diagnosed and receives treatment, can develop AIDS.
Persons who develop AIDS have their inmunological system so damaged that they can easily get other oportunist diseases causing them death.
 
How is it transmited?
HIV can be found in body liquids or secretions as blod, semen, pre-cum liquid, vaginal secretion and mother’s milk. All practice implying contact of these body liquids and secretions with mucus and blood flow of another person can cause infection by HIV. Pregnant women also can transmit it their child during pregnancy, at birth moment or during milk feeding.
 
Who has more risk to get HIV?
  • All person sharing Needles to inject, babies from HIV-infected mothers who did not receive treatment against the virus during pregnancy.
  • Persons having unprotected sexual relations (not using a condom), and even more if if they have HIV-positive or AIDS-developed couples with high risk behavior (promiscuos).
  • Persons who received blood or hemo-derivates transfusions without hard standards to detect the virus.
 
Which are the syntoms?
When infection is acute, they are very often similar to flu plus  diarrhea, headaches, fever, muscular sore, diverse skin eruptions, mouth wounds, cold sweatting, throatsore, inflammed lynphatic gangles.
 
Have in mind…
Today, the science advances and we fortunately have retrovirals those help for infection not to advance, and so having a good life to enjoy. However, we do not forget even when infection is treatable and can be dealed as a cronic disease, there is not a cure yet and we do not have to keep unguarded.
Also, we have to be conscious once treatment has begun, this shall continue. If not, patient only wil expose to create resistance to drugs, and while more resistance, less effectivity. That means less life possibility.
 
Marco Paulini is a Sullana, Peru-based obsthetrician. Send him your questions to his Twitter account: @MarcoPaulini
© 2014, 2016 Asociación Civil Factor Tierra (@factortierra). All Rights Reserved.
 

lunes, 31 de octubre de 2016

We save one woman, we save one community (III)



Preventing teenage pregnancy in mostly rural spaces




Teenage pregnancy is a public health important issue and its prevalence is due to social-cultural conditions, whichave determined its considerable increasing, happening mostly often in poorest social-economic sectors, although it is present in all society levels.

Many times, gender-based violence (GBV) is inside the daily life of the woman, provocating a systematic victimization effect in female gender. This is evidenced when analyzing the teenage pregnancy high rates, making the violence to go unseen, becoming a ‘ghost violence’ type, adding to its non-identification.

That’s why this intervention is committed to prevent pregnancy in teenagers inside a specific territory.
Particularly, the intervention wants to focus on:
1) Making the teenage population of the territory to be sensitive to prevent teenage pregnancy into a gender equity environment.
2) Promoting human development by life projects for teenagers.
3) Estimulating the repetition of learned contents by the teenage pregnancy prevention educative workshop’s attendants inside their educative community.

4) Developing healthy environments for teenagers by the education on teenage sexuality for parents.
In this intervention, the participants are who coordinates sexual and reproductive health (SRH) strategy at the territory under intervention’s managing office, and chiefs of every health stand inside the territory under intervention, but the space to do it would be the high-schools where the teenagers attend to.

And the logical reason is that our target are male and female teenagers who study at high-schools in the territory.
What we have to do is one educative workshopformed by five educative sessions (one monthly per every high-school) plus one repetition session (expo-fest) per every high-school.
One high-school per every health stand wil be chosen.
Every session will last two pedagogic hours and the topics are:
  • Sesion 1: Gender equity.
  • Session 2: GBV Prevention.
  • Session 3: Teenage Pregnancy.
  • Session 4: Human Development Promotion and Life Projects for Teenagers.
  • Session 5 – Intervention for Parents: Teenager’s Sexuality.
As a finale, a expo-fest to be made. Teenagers will repeat the acquired knowledge to their mates.
The monitoring of the intervention is continous and ends making a report that has to be released for verifying the indicators accomplishment and having a basis linking to future interventions.

Post-produced by Sheyla Benavente.


lunes, 24 de octubre de 2016

We save one woman, we save one community (II)


Prevention of maternal death from an integrative perspective.




InPublic Health field,  health communitarian agent has ccontributed to decreasing maternal and child deaths because of the influence over people to change attitude and behavior, form sanitary brigades, contribute to recruiting, identification, and following of risk groups, pregnants are better informed about benefits of a well-controlled pregnancy, also transfer of pregnant and risk population to increasing of vaccination coverage in rural and urban/marginal zones, etc.

That’s why this 3-month project takes advantage of communitarian agents in the territory we are intervening on - the people inside a community with leadership skills, I mean.
This agent joins a team formed by:
  • Who coordinates sexual and reproductive (SRH) strategy in the larger territory in terms of decision power.
  • Representative of the territory’s municipality where we are intervening on.
  • Delegate of a repressentative grassroot organization in the territory we are intervening on.
  • Who lead the health stands inside our territory.
  • SRH responsibles in health stands inside the territory .
This intervention looks for improving the attention by activities of health promotion through multi-sector participation and civile society commitment.
Specifically, it is focused on
1) Getting to recruit communitarian agents (CA) assuring one-per-town in the territory we are intervening at least.
2) Guaranteeing the permanent and integral training of CA.
3) Promoting the active and coordinated role of CA for the promotion of sexual and reproductive health services, identiffication of alarm signs, and users’ communitarian referral.
4) Granting non-bill bonuses for CA, enhancing their participation in the communitarian work.
5) Granting the right certification to the CA’s job.

This proposal is outlined by the multi-sector participative action. In that sense,  the reaching of the goal will be consequence of gotten sinergies among the different sectors.
It is necessary to say that Peru’s Ministry of Health has been developing successful experiences of health promotion by communitarian participation. One of those experiences has been the work with health communitarian agents, what has shown great efectiveness to face the sector’s problems.

Those agents demonstrated his commitment making actions of health prevention and promotion in their community. On this work, health stands and non-profit organizations had a singular importance, which  have contributed to improve the health communitarian agent’s skills for facing emergencies and communitarian health issues.

Post-produced by Sheyla Benavente.



viernes, 14 de octubre de 2016

Teenage Pregnancy – whose mistake?




We must start from the premise what speaking about teenage pregnancy is speaking about a risky pregnancy – it does not only imply a risk for the mother but also for her child, with a big probability of morbility-mortality for both during pregnancy, birth and/or puerperium.

We must have in mind teenage pregnancy is not only a problem of female teenager but it covers to male teenager, families of both an society itself, closing so a group of sequels repercuting on health and development of involved individuals inside this issue.

Once this anchors person to individual under-development in most cases, it has a big impact in social-economic development of population, limiting its resources.
In this point, the teenager must be considered as a changemaker for social development, investing to give him or her tools for his or her skills development; assuming, respecting and spreading their rights as persons, and creating spaces for their development as social members as well.

All this need becomes visible when reviewing the greater amounts of teenage pregnancy because of lack of information on sexual and reproductive health(SRH), which means the teenager does not know rights, rights to perform sexuality based on self-rating as a free, informed and totally regarding responsible person, and the need of sexual education that allows developing skills to postergate the beginning age of sexual relations, if they decide it so.

Why must not a teenager get pregnant?
It is known, in most cases, that teenage pregnancy is not free, informed and much less planned, having an impact on personal and social area, not taking health issues yet, limiting development opportunities, as well as their rights.

It is known the most cases of teenage pregnancy are expressed in people with few money, in poverty situation and social exclusion, people already showing access lack to education and health, bringing out individuals with low or almost nule development opportunities to the world, those are shown since early times, frustration in life plans and unadequate transition to adult life, setting up and enlarging poverty and under-development of society.
Under these criteria, we have desertion and empty schools, low-remunerated jobs, and sometimes under less than human conditions, raising gender violence indexes, broken families, among others.

In the other hand, we have all the problems around teenage pregnancy.
Here we face increasing of morbility/mortality during birth and after-birth, that is expressed in obsthetric complications due to biological inmadurity and constitutionof female teenager.
Just to mention some, we have: hypertension, hemorrages and infections, and abortion, those many times are done at unhealthy places, so they unchain a series of events attempting health, unless they finish on death.

Here we also face directly to suicide, what is very hard to draw out.
We also have malnutrition not only in the mother because it is proven that female teenagers have more probability to have a child with low weight after birth.

Teenage Pregnancy Law
Unfortunately,there are two big legal obstacles to limit the access of teenagers to sexual and reproductive health services in Peru.
In one side, we have 28704 Rule, article 173, that punishes any sexual relation between and with teenagers, including freely agreed ones, negatively impacting on teenagers’ access to SRH services because there is fear to legal fine if teenagers attend to health services without parents or preceptors.

In the other side, we have General Rule of Health, article 4, that interpretate s teenager under 18 years old as dependant on agreement and companion of parents or preceptors to access to health services, including sexual and reproductive health ones.
Under this legal context, teenager can not access to adequate information by sexual and reproductive health specialists and contraceptive supplies , absence of pre-birth attention for already pregnant female teenager , in some cases the unadequate birth attention , among others. So all this just gets the situation worst  empowering mother and just born child’s morbility/mortality because, as we said before, there is fear to legal fine.

Peruvian Government, realising this legal crack, rules a Supreme Court’s linking precedent that states as inconstitutional  the punishment of  agreed sexual relations between and with teenagers from 14 to 18 years old, propitiating  so free access  and empowering of teenagers to sexual and reproductive health. However, its application needs time to get significant changes, as well it is needed continuing with advocacy to get a better access and service related to teenager’s sexual health.

Numbers of teenage pregnancy
According to Population and Social Development Demographic Survey (ENDES in Spanish) , in Peru, in 2012, 29% of female teenagers are sexually active, 13% of female teenagers from 15 to 19 years old are already mothers and/or are already pregnant of their first child. From total amount of teennage pregnancies, the proner and more vulnerable to pregnancy are the poorest, with few education and living at rural areas.
From total amount of pregnant female teenagers, only 32% wished to get pregnant.

All this let us to see an integral reality of teenager as a sexual subject, not as someones under a false moral veil who still pretend to conceive the teenager as as not-sexed subject without need of sexual education, because as they say, to speak the teenager about  sexuality means “getting up morbidity  and leading to sin.”

What must we do?
It must invest on teenager’s integral health, creating differentiated spaces for them, assigning proffessional specialists on sexual and reproductive health with a vision to postergate the beginning of teenagers’ sexual relations who want it so, offering needed tools to strengthen decisions taking and mutual respect.

To reach articulation of education and health, getting to hire sexual and reproductive specialists to give an adequate and held training in schools, assuring teenagers the differentiate access to their integral attention at different health centers.

To give free, on-time orientation and advisory to teenagers who already have an active sexual life, getting the right use of contraceptive method to avoid teenage pregnancy.
It must understand a female teenager is not mature because she is a mother but a female teenager with all limitations this life phase carries on, having to face the world for making a child to grow up.
Let’s make the change!

Thanks Jhon Gomez for his legal advisory. Marco Paulini is a proffessional obsthetrician. Send him your questions to his Twitter account, @MarcoPaulini.
Translated by Nelson Peñaherrera for FACTORTIERRA.NET.



Gender-based Violence (GBV)







To define what is gender-based violence, first we have to understand what the violence is.
In this point we say that the violence is the behavior or omision of it proposed to harm  or wound the other person  violating so the rights of the other individual. In other words, it is an intentional behavior .


What is Gender-based Violence?

World Health Organization (who) and Pan-American Health Organization (PAHO) define it as “all act of physical or verbal power, coertion  or threatening privation for the life, addressed to woman or girl,  that causes physical or psychological hazard , humiliation, or arbitrarian privation of freedom, and that enlarges female subordination as well as it produces in public or private life.”

Many times, GBV is inserted in daily life of women , generating effect of systematic victimization in female gender, and hat does not discriminate among girls, teenagers, young, adult and elder women, causing the violence goes unseen, originating a kind of ghost violence, adding to non-identification of itself.

Here is necessary to learn the difference between GBV and other types of interpersonal or social violence, recognizing GBV’s objective is women submission before dominion of who has power and so  the control. Generally, it is inflicted by lover and/or relative , and inside home. The woman is the target of submission, I mean.
Despite in violence without gender origin, the victim can be whoever, even a male, the agressor can be a strange r or ocassional friend, and space where it is made can be wherever.

Is GBV a human rights violation?

Because it is base don unequity to women in the practice and distribution of power in society, it is proven that GBV violates human rights, and it is almost linked to violence against under legal age people.

In a more panoramic view, we can appreciate that in domestic environment , when women’s human rights are violated, also her children’s human rights are violated, so their right to live and grow up  in violenc-free environments is nullified. This way, children turn victims and witnesses of gender terror and degradation, when living with an adult with a wrong feeling or conviction of his wife’ & family members (children)’ belonging or control .

Is sexual violence a type of GBV?

Yes, it is. And it makes evident because female body is perceived, conquered and dominated as territory of male belonging and dominion. This expresses in emotional, physical, economic empowerment, blackmail or threaten for penetration or any sexual contact to women, whoever girl, teenager or adult, including cultural practices like genital mutilation, forced marriages, virginity overvaloration, among others.

Many times, culture itself justifies and legates the feeling of female body and sexuality’s conquer to their men, teaching to women for accepting themselves as male property, masking a pathological relationship of dominion and dependance that is passed from generation to generation.

Special attention must be given to marriage duty, the bad marriage principle that forces the wife to satisfy her husband’s sexual desire just because she is his wife, ignorating her desire as a woman. As it is covered under marriage or convivence veil, vilence gets impune and vigent as high as sometimes it is undetectable by the same women who experience it, assuming it is part of the normal because of the fact they are women.

Let’s see a daily example:
The mother as the only responsible of house chores.
The father as the only responsible for family and with authority for taking decisions.
It is observed here that the violence is “justified and normal.”
The most common types of GBV are childhood’s sexual abuse, domestic violence and rape.

Is GBV a public health problem?
Yes, it is. As it has a negative impact on women’s integral health, GBV repercutes on health of society. That’s why watching has to be held because it is not an isolated trend but it has origing and a negative impact around the world.
In that sense, it is a conclusion that woman’s health has to be contemplated by public policies proned to gender equity, that guarantees welfare and justice for their members, throughout elimination of carrying factors to woman’s victimization and violence because of her gender.

We, the men speak up

Many times, we, the males show violence trending to solve conflicts. Then, a question jumps automatically up: is violence necessary to solve conflicts?
There are who unavoidabily connect conflict to violence and believe that preventing the violence is necessary to prevent the conflict.

But in human reasonability, we realize that independently of male or female gender, we have different interests, aspirations, goals and values as individuals, and conflict is hard to avoid while we interact.  But depend on ourselves to learn solving them without violence by the mutual agreement that satisfies both parties through consensus and reason.

Unfortunately many times, the violent act made by the man is considered as normal and it is justified by rebelion and non-recognizement of women. Here we have cotidaneus arguments those mask GBV: “She provocates me”, “I’m the boss at home”, “She doesn’t respect on me.”

As part of this vicious circle, the male kids growing under a violent environment follow building up their manhood based on superiority granted by the machoman thinking, and they will show out in the future  turning in agressors when exercising their supossed authority, it gets threatened or questioned by women.

Within the main fears of men who were growth and masculinized under a violent environment, we have the fear of no reaching the true men standards and being humiliated or ashamed as a feminine husband, going over their empowerment and having to submit the woman as their manhood proof.
In this context, men learn since they are kids, and continously their manhood is tested by society , having to show it even violating  women and the weakest and the rest.

What can I do as a man?

We have to begin analyzing ourselves frantically about who we are as men, less competitive before the female.
This is not going to be really easy because we have growth as machomen, so this process will not happen immediately. But let’s exercise the free choosing stopping violence at home, being perseverant in our decision if we propose to change for real and for family welfare.

Anyway, we have to minimize our violent acts. Let’s remember there is not big or small violence – all types are acts to be discarded. Have in mind that nothing justifies our violence, so we are the only responsible of our violent acts. Learn to self-satisfize our needs not expecting the women do them on behalf of us because ooa superiority sense. This is key to prevent many conflicts leading to violent facts.

Learn to self-detect the syntoms when we are just ready to explode for avoiding the trigger to violence. We have to learn the skill to realize that in those conditions we can not follow a discussion because we will not able to hear and what we think or feel wil be the only important, putting on risk everything to end as a violent act. So it is better to have a time-out and step outside. Of course, stepping outside will cos tus because we will feel we are weakand we are losing in a fight, but if we are decided to change, we have to decide between continuing to argue and probably end to a violent act, or stepping us outside to get calm and agree a consensus with the couple in other moment, satysfying both.

Time-out or stepping outside is a time to be used mainly to slow down and do activities those support this objective. A good choice is walking outdoors and alone for thinking clear. Never look for friends who support you as a machoman, or alcohol ‘to solve’ the problem.

For majority of men, the fact of negotiating and conciliating  is difficult and eben more when we have benn educated to impose us or to negotiate from a perspective of top power because we are male. This does not mean it is impossible but it demands a greater commitment to our couple and other family members.

Once we get steady, it is a grateful feeling we have got it and we will on our way to mutual respect and our recognizement as true men.
As we are able to unwear that shield we are wearing sice we were child as protection mechanism , and that implies to be unsensitive before the rest and ourselves,  we could compare what we get by affective links to family is superior to we lose by dominion , making the change sustainable.

As a closure, we can say we are going to be better men as much as we start  to recuperate our sensitive and loving capability that culture and ssociety have erased.
Let’s make the change!

(Marco Paulini is a Sullana,Peru-based obsthetrician. Send your questions to his Twitter account, @MarcoPaulini)
© 2014 asociación Civil Factor Tierra (@factortierra on Twitter)
© 2014, 2016 by Marco Paulini. All Rights Reserved.
Post-produced by Sheyla Benavente.