Articles about Antigua

Jeanira, 37, is a doctor’s assistant and has two young children aged two and 12. She has been a member of Famia Planea Aruba (FPA) for many years but only recently learned that FPA provides healthcare for all ages and stages of life – particularly young people.  “I am a mother of two wonderful children, a two-year-old boy and an almost twelve-year-old girl. As any parent does, I have to accept that my little girl is no longer so little and growing much faster than I am ready to accept. I do however try my best to be very open on accepting of her growth and changes in the hopes of helping her become her best self. About a year ago I had begun researching the best way and time to start talking to my daughter about her upcoming body changes, sexuality, and puberty in general”, Jeanira says.  Provision of sexual and reproductive healthcare for all, regardless of age, is at the core of FPA’s work. Over the years FPA has developed different information packages specifically aimed at reaching and supporting young people, families, and educators.   “There is of course endless information on the internet, but this is not always the most helpful since I now had the difficult task of filtering out what I saw as appropriate or not, as well as choosing trustworthy sources”, explains Jeanira. “During my search, a family member mentioned that she had seen a video on social media about puberty that was in our native language. After finding the video on FPA’s Facebook page and watching it myself first, I was over the moon. The video is fun, educational, featured local professionals, and related to my daughter’s age. I love the fact that I could introduce the video to her and let her watch it in her own comfort zone, just in case she was not in the mood to talk to me about the topic at hand or have me stare at her while she learned some of the most impactful changes heading her way. At the end, it did stimulate conversations and questions for a few days after and I truly made it easier for us to talk about some of the topics that can sometimes be a little hard to approach.”   Jeanira encouraged her 11-year-old daughter to use FPA’s OPEN program. “When my mom first told me she found a video for me to watch about puberty I was a bit scared. I do talk to my friends about some stuff, but talking to my mom sounded a bit awkward. My mom and I do talk a lot but I was still worried that it might get too deep. I didn’t think the video would be so funny”, Xiqiën remembers. “My favorite part was to be able to recognize some changes that I am going through right now. There are some changes that I would like to skip but I know it’s all part of the growing up process.”  “I’m so thankful that FPA had the idea to make such a fun video for us to learn from. There was some stuff that I already knew, but I also learned some new things. I did ask my mom a lot of questions after the video, mostly because they said that everyone is different and I really wanted to know how my mom is different from me. I don’t feel quite as worried to talk to my mom about these things anymore, I know that she will try to help.”  

“I am a volunteer promoter by inheritance. First, my mother volunteered with Pro-Familia for 15 years, she resigned because she had to go to the United States. I learned to volunteer since I was little because I saw how my mother did it”, Alicia recalls. Alicia Hernández Monge, 43, remembers that with her mother leaving the country, the community spent some years without a volunteer health promoter. In those years, women came to her to encourage her to re-establish contact with Pro-Familia so the program would resume in the Santo Domingo village, one and a half hours outside of San Salvador.  In the absence of a local public health facility, Alicia decided to become a volunteer health promoter to support her community. “When my mother left, I agreed to collaborate just to promote the cervical screening clinic, but Pro-Familia suggested that I be a volunteer, like my mother, and I accepted. Today, it’s been two years. They have trained me at home on sexual and reproductive health issues, counseling, home visits, and the use of brochures, and I also learned to inject, with all that I do a better job in my community, especially with women”, says Alicia. Alicia is an entrepreneur with a strong spirit of care towards her family and community. Every day she attends her small business that provides the community with basic products.  “I help change people's lives; the women are happy and grateful because they no longer go to Guazapa to buy contraceptive methods. Pro-Familia trains me and I coordinate with other institutions in the community, such as the church, to help people”, she says.  Alicia says that counseling is the most important part of her work. “Counselling is very important, women learn to use (contraceptive) methods and stop thinking that it is a sin, I help them to understand that family planning is a right. (…) I had a case of a client where the husband was the one who decided which method to use and make her changed very often (contraceptive method) because he wanted her to lose weight; one day I explained to him about the benefits of using only one family planning method, the effects of changing very often on her menstruation and that she had the right to decide whether or not to change, and that the weight could be due to other reasons. He understood and thanked me for taking the time to speak to him; from that day on the client keeps one family planning method and the husband respects her decision,” she says. Alicia dreams of having a larger place for her clients, or have a table to administer the injectable, but despite the limited space, she enjoys her work. "I like it and I am happy to know that I can help, many users come at night to pick up their methods because they work out of the house and I take care of them with great pleasure, when they miss their appointment, I look after them, I speak to them by phone or I send them a WhatsApp message", she ends. They prefer her for the confidence she brings Ruth Séfora Manzano has known Alicia for several years before she had children. “I like Alicia because she is a respectful person, she likes to help people, she gives me confidence, and you can trust your personal things to her because she doesn't tell anyone, she looked after me when I got pregnant and she also cares about my daughter, she guides me on how taking care of myself and the baby, she is a kind person, that's why I plan with her, and if I need other medicines I also buy them from her. I also like it because it is close to my house, she gives me the shots, and I don't have to go elsewhere, I am grateful for her help and Pro-Familia´s."

Manuela was sentenced to 30 years in prison for aggravated homicide after suffering an emergency that resulted in pregnancy loss. She died imprisoned 2 years later, after receiving inadequate medical care. Manuela fue condenada a 30 años de prisión por homicidio agravado tras sufrir una emergencia que le hizo perder el embarazo. Murió encarcelada 2 años después, tras recibir una atención médica inadecuada. 

“I started as a Pro-Family Health Promoter (PSP, in Spanish) 30 years ago. I received a visit from Pro-Familia staff on several occasions, I was very interested in what I could do to help in my community as a volunteer. I was trained in sexual and reproductive health issues, and in the technique of injecting (contraceptives)”, says Juana Margoth. Through the community-based Pro-Family Health Promoter program, the Salvadoran Demographic Association (ADS / Pro-Familia) has been providing sexual and reproductive healthcare to local communities since 1974. Today, the program currently has around 900 health promoters across El Salvador. Reaching under-served communities with contraceptive care and information lies at the heart of the program’s mission. In the absence of healthcare from the Ministry of Health in Hacienda El Edén, Sonsonate, Juana provides care to four villages in the surrounding area. “I make visits in the communities to the clients I already have, to see if they are okay with the (contraceptive) method and to receive new clients, sometimes even the same clients tell me that there is someone who needs a visit. I like that they look to me to help them. I give confidence to the clients, to their partners too, I have clients since 2, 5 or 6 years ago. (…) There is a lot of need, so I am here, until God wants it”, she says. Juana receives a quarterly supply of contraceptives that she distributes at low prices to the women in her community. “I like that women know that I am here to help them, also to give advice and understand each people's problem; (to help them) to plan their family, and I like the fact that they want to do it with me,” she says. Providing counseling to clients on contraceptive methods so that they understand the different types and can make an informed choice is a crucial part of her role. “In other places - she says - they only give the contraceptive methods to women and do not explain (it’s use)”. In addition to the community-based program, Pro-Familia supports the network of promoters to help respond to emergencies. When natural disasters occur, Pro-Familia conducts a survey of needs and responds with support for reconstruction and food supplies. “I have a lot to thank Pro-Familia for, I have learned and continue to learn with them, they are always there when I need to know something when I run out of contraceptives and without medications (for the program); I am also grateful because I have my prefabricated house thanks to Pro-Familia who helped me when the earthquake of 2001 happened”, she says. I feel confident with her Yaneth Aguilar knew Juana Margoth and felt confident in choosing the injectable as her preferred contraceptive method. “With my husband, we agreed to put myself in control with her, she is kind, and she pays attention. If she were not here, I would surely have two more children. I feel confident with her. I don't like going to the health unit, because I have to spend the whole day, and sometimes they don't treat me well." Veronica Moran also received contraceptive care and information from Juana. “Margoth has changed our life, mine and my family’s, I have been planning with her for 8 years, she is kind and always has the method I use. When I have doubts, I ask her with confidence, without shame, and I can go to her house at any time, she is always there. I don't like going to the health unit, because I spend a lot (of money), and sometimes they don't have contraceptives; nowadays, with the pandemic, we have her close and she never stopped treating me, it is very helpful in our community." Brenda Martinez has been a client of Juana’s for two years. “She is the person that we know has (contraceptive) methods in the community, where Pap tests to prevent cancer are done, where we buy medicines, where you can always ask. When I was born, she was already a promoter; I couldn't be in another place planning, she is a very good person, kind, and she is always helping us in whatever way.”

When Blanca started as a volunteer, she committed to her new role with enthusiasm, thinking about how the women of La Loma village would benefit from being able to access contraceptive methods close to home. “Many women walk up to an hour and a half from the villages of the Guazapa hill, to receive family planning services or to receive counseling,” Blanca Edith Mendoza Ramos, 61, says proudly. Her house is a cozy and special place for the clients. “I have been a Pro-Familia volunteer for 29 years, when I started, I had already had my five children, I was busy at home, but when the Pro-Familia staff explained to me about working in my community, I trusted It was important to support women. I have learned a lot and I continue to do so, I have received training that helps me to be a better person, to have knowledge and to give good advice; I have received many people from Pro-Familia in these years, and always with great responsibility”, she says. To ensure her clients’ confidentiality, Blanca has created a private room with a sofa where she provides counseling and administers injectable contraceptive methods. By creating a private space, Blanca has built up trust in the community and women prefer to go to her for contraception and advice. “I am proud to help in my community, I visit clients to see if they have any side effects when they do not come to receive their method, or to know if they are well or to recruit new clients who are encouraged to use a family planning method because their families are already very large”, comments Blanqui, as she is known in her community. The public health facility provides free healthcare, however, women from other local communities prefer to see Blanca because she is closer and offers confidential personalized care. “The Health Unit is not close, so women prefer to plan with me, they come with confidence to apply their method. On their first visit, I ask them a few questions about their health, and if everything is okay, they plan with me. I think that family planning is important for the spacing of the children and that it is not only the use of methods but also communication with the couple”, reflects Blanca. The poverty and patriarchy in these communities present many challenges, including domestic violence, multiple partners, and miscarriage that require a sensitive approach to provision of healthcare and information. Volunteers like Blanca are supported to deal with these challenges through training provided by the Community-Based Program staff. Volunteers develop skills to use referral systems, coordinate with local institutions, such as the Ministry of Public Health, other NGOs, such as the Feminist Women's Collective, the Institute for Research, Training, and Development of Women (IMU), which provide support for cases of violence or care in cases of miscarriage. This approach is integral to the provision of healthcare and support in the communities. The team of volunteers helps to reduce violence and femicides in order to improve the quality of life for women and families. “People in the community tell me that they are grateful for the care I give them, and I will continue to change what I can to improve people's lives. I will continue to make home visits, give counseling because it is a need, women need someone that understands them and helps them. Pro-Familia is part of my life, being a volunteer is something special, I have learned a lot, and the most important thing is that I can help others”, says Blanca. Respect and comfort Blanca is often recommended by her clients. María Ofelia, or Felita, as she likes to be called, comments that “a friend from the community recommended that I visit the Blanqui, I already had two children, one 4-years-old and another 11-year-old. I still remember with deep sadness the moment I looked for her, it was my last pregnancy, and I lost my daughter. Blanqui received me with affection, respect, and comfort, she understood what I was going through, she guided me, and I made the decision to plan until now. I’ve been using the two-month injection for 4 years." María Ofelia says that although she can go to the social security check-up, she prefers to go to Blanca because of the confidence she gives her, “she always takes care of me, and the prices are low, I can pay it, because in other places the methods (contraceptives) are more expensive.”

The prohibition of abortion in El Salvador is an example of a direct legal barrier to SRH access. However many of the barriers are indirect, resulting from: conflicting interpretations and perceptions of the law relating to age of consent, parental consent and provision of services prevailing cultural norms, stigma, shame, and taboo around youth sexuality  lack of confidence in confidentiality myths about contraception and lack of accurate education about sexuality lack of positive legal protection of young people’s rights and LGBT rights discretionary and therefore uneven implementation of those protective and facilitative laws that do exist the culture of machismo, gender discrimination and the prevalence of gender-based and sexual violence Includes: Implications for law and policy on a broad range of factors impacting access