In Ecuador, domestic violence is a problem clearly recognized by the government. Legislation has been passed to protect women from abusive partners, and women's police stations have been created to manage reported cases of violence against women.1 Furthermore, the Ecuadorian Ministry of Health has developed guidelines to help health facilities identify and manage cases of domestic violence.2
But qualitative research conducted in the rural Amazonian province of Orellana in 2000 demonstrates that the existence of beneficial and innovative policies does not always mean they will be implemented.3
Marked gaps between policy and practice came to light during in-depth interviews with 25 single and married women ages 19 to 57 years (13 from indigenous communities and 12 from nonindigenous communities; five from urban areas and 20 from rural areas) and 15 male and female medical and social service providers living or working in Orellana. Interviews involved the use of the qualitative research methods of "free listing" (during which women and service providers were asked to list problems that women from Orellana experience) and "pile sorting" (during which the most frequently cited problems were represented in words or pictures on cards, and community women were then asked to sort these cards into piles and explain the groupings). The validity of findings was strengthened by comparing the qualitative data from interviews with quantitative data from such sources as health statistics and civil registry data.
The qualitative methods employed in the study "allowed us to obtain a general picture in a short space of time, with little money or external support, but with the active participation of local organizations and a focus on women as active protagonists in an effort to learn what would be useful to better meet their needs," notes Isabel Goicolea, who conducted the research with support from Medicus Mundi Guipuzcoa in Spain, the Fundación Salud Amazónica (Sandi Yura), and the church of Aguarico in Ecuador.
Reproductive and sexual health issues were not specifically mentioned by investigators during the course of the study, but both women and providers frequently reported problems related to gender inequity. Domestic violence was the most commonly cited problem and, according to women, was most strongly associated with alcohol abuse by male partners.
| Kim Best/FHI |
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| A pregnant woman and her daughter in the small jungle town of Puerto Francisco de Orellana, the capital of the province of Orellana, Ecuador. |
Despite progressive national laws, policies, and protocols, "Health services in Orellana run by the Ministry of Health neither give out the necessary certificates of evidence of violence (a requirement for legal action) nor are sensitive to these problems," Goicolea says. "The same can be said of lack of sensitivity on the part of provincial government and the police. Orellana has only a small office offering legal advice to women experiencing domestic violence, run by a group of local women on a voluntary basis."
Evidence of a gap between women's family planning needs and relevant services available to them also emerged, indicating that national family planning policies are not being implemented in Orellana. The Ecuadorian constitution states that citizens have the right to decide how many children they will have,4 and the health ministry has published comprehensive protocols for delivering family planning services, including emergency contraception.5 But, Goicolea notes that other research has shown that "access is greatly restricted in Orellana. Provision is erratic and concentrated in the bigger urban areas, and the principles of quality of care are seldom fulfilled." Her own research, Goicolea says, revealed that women worried about having too many children and that pregnancies were often unplanned and unwanted. Furthermore, many of Orellana's medical service providers presented family planning in a patronizing way, telling women what to do instead of helping women and men select the contraceptive method best suited to them.
Research, in this case, was seen as a foundation on which to base interventions and "I'm happy to say that some of our recommendations have been taken into account," says Giocolea. The United Nations Population Fund (UNFPA) has included the province of Orellana in its national program for 2001-2003, and one of the organizations that led the qualitative research — the Fundación Salud Amazónica — is implementing the UNFPA program there. Objectives of the program in Orellana are to increase knowledge about reproductive and sexual rights and to improve access to reproductive and sexual health services, with special emphasis on adolescents. Giocolea, who is coordinating that work, says that other initiatives developed by groups involved in the qualitative research are under way. They include:
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Creating a health committee to improve collaboration between health and social services for women.
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Implementing sex education in the province's Hispanic secondary schools.
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Working with indigenous groups to produce appropriate sex education materials.
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Promoting reproductive health rights through a network of community health workers, primary school teachers, women's groups, and individuals.
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Creating a center where health services coexist with services for victims of domestic abuse. The Comisaría de la Mujer y la Familia de Orellana has begun working at the center, which is supported by the Ecuadorian Ministry of Health and local nongovernmental organizations that contributed to the qualitative research.
— Kim Best
References
- Mosquera Q. Estudio de la Legislación Ecuatoriana sobre la Mujer, el Niño y la Familia. Quito, Ecuador: Organización Panamericana de la Salud, 1998.
- Ministerio de Salud Pública del Ecuador. Normas y Procedimientos para la Atención de la Salud Reproductiva. Quito, Ecuador: Ministerio de Salud Pública del Ecuador, 1999.
- Goicolea I. Exploring women's needs in an Amazon region of Ecuador. Reprod Health Matters 2001;9(17):193-202.
- Mosquera.
- Ministerio de Salud Pública del Ecuador.
