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Coopa-Roca, empowering women

November 30th, 2012

In this class, we’ve learned about many of the tragedies and hardships women face everyday around the world. Sex-selective abortion, gender-based violence, disparities in educational opportunities, sex trafficking, gender-specific cultural expectations/burdens, child marriage, maternal/reproductive morbidity–the list goes on. One of the most important ideas I’ve learned from this class is how the most successful and effective solutions for ameliorating these kinds of issues are those that are community-led and inherently empowering for affected individuals. For my last post, I’d like to highlight one more such solution. Although not directly related to women in post-war situations, it does provide another example of an opportunity (like Mushrooms with a Mission) valuable under any circumstances (post-war or not) which gives women the flexibility to provide monetarily for their families while also being able to stay home to care for their children and other dependent relatives.

One of the largest slums in the world, Rocinha is situated in the foothills surrounding Rio de Janiero and is estimated to be home for over 100,000 people. Like most other women around the world, mothers who live in the “favela” (as slums are called in Brazil) have few opportunities for employment and respect outside the home.

In the late 70’s, Maria Teresa Leal–a highly educated woman living in Rio–did what many middle and upper-class Brazilians would never do. She dared enter the favela, visiting the home of her housekeeper. During the visit, Leal was struck by the women of Rocinha, how skilled they were in sewing and yet how undervalued and underappreciated their abilities were. From that experience, Leal conceived the idea for Cooperativa de Trabalho Artesanal e de Costura da Rocinha Ltda, which was established in the heart of Rocinha in 1981.

Coopa-Roca, as the organization is nicknamed, is a cooperative jointly owned and run by women from Rocinha. The 150+ artisans employed by Coopa-Roca use traditional Brazilian techniques such as drawstring appliqué, crochet, knot work and patchwork to transform fabric scraps into elegant and sophisticated clothing pieces and home accessories like pillows, quilts, and lamp shades. The women–many of whom are single mothers–are able to work flexibly from home, only visiting the cooperative office to drop off finished pieces and pick up more fabric. They contribute to their family’s finances without having to neglect childcare and domestic responsibilities.


In the mid-90’s, the cooperative began producing pieces for the high-fashion catwalks of Brazil, garnering media coverage not only in the fashion world but also in human rights circles as an excellent example of the social integration and enterprise of low-income communities. More importantly, Coopa-Roca also offers programs to supplement its members’ vocational skills, teaching the women more about the process and trends of the clothing business and equipping them with the know-how to collectively make all decisions regarding the co-op and to share all responsibilities for production, administration and publicity. More recently, the organization initiated a professional training course for younger girls, aged 16-21, covering topics from artisanal techniques, general academic subjects, dance, cooperativism, and sexual health–particularly important considering the high rates of teen pregnancy in Rocinha.

Coopa-Roca has rightly earned the reputation of being an organization that goes beyond merely producing high quality, unique pieces that marry traditional Brazilian craftsmanship with elegant, couture fabrics–a feat in and of itself. It is a prime example of how women can help each other help themselves, of the far-reaching good that comes when women are accorded the self-esteem, respect, empowerment, and autonomy they deserve.




The Global Fund for Women

November 30th, 2012

In the course of this blog we’ve seen NGO’s grow out of unique visions, yet the overarching theme that connects them all is a dedication to women’s empowerment. We have come to understand that the most effective and sustainable change stems from the women in the communities that each NGO reaches out to, and the most prolific intervention involves women gaining capacity and a voice within society. The Global Fund for Women grew out of the same vision, and set out to provide resources for numerous organizations and women’s groups to allow them to achieve their goals. In Paradigm Found: Leading and Managing for Positive Change Anne Firth Murray described her view of the GFW’s work: “In the course of my time with the Global Fund for Women, I came to see our work as not just giving funds to women’s groups but as working with them to include and strengthen marginalized people in order for them to participate fully in their societies’ structures of power and governance.” [1]. As Murray describes, much can be learned from the poor and marginalized who are at the bottom of the existing hierarchy, thus the Global Fund for Women recognizes the central role that women play in development.

The largest women’s fund in the world today has origins that “are remarkably similar to those of the thousands of grassroots organizations that it serves around the globe — a small handful of women finding empowerment by working together toward a mutual vision of social change” [2] and it achieves that social change by supporting groups in six themes. The GFW categorizes their efforts into:

  • Advancing Health and Sexual Reproductive Rights
  • Building Peace and Ending Gender-Based Violence
  • Ensuring Economic and Environmental Justice
  • Expanding Civic and Political Participation
  • Access to Education
  • Fostering Social Change Philanthropy

From her time working with the William and Flora Hewlett Foundation, Murray understood the importance of general support grants and intended for the majority of the GFW grants to fall under this category. [2] The GFW awards grants ranging from $500 to $20,000 annually. [2] General Support gives the women leading these organizations flexibility in allocating the funds granted to them, which allows them to distribute the funds in the way they see fit. This not only increases the efficiency of the grants, but also builds trust with the organizations.

The GFW has awarded $8.9 million in grants this year, adding to a cumulative total of $93 million awarded since 1987. An advisory council of over 100 informs the GFW’s grant making process and builds on a foundation of networking and knowledge-sharing. The application for grants is available through the GFW website in five languages, with accommodation for other languages, which makes it convenient and easily accessible for women’s groups to access the grant making process. With over 10,000 donors, the GFW has helped their grantees achieve incredible ends. In their “Top 10 Wins for Women’s Movements”, some success stories include the UN recognizing the human rights of LGBTI people, Uruguay on the cusp of legalizing abortion, and gender equality in the Moroccan Constitution. [2] These are just a few examples of the incredible work in the five geographic regions across the globe in which the GFW works.

The GFW attempts to make the grantmaking process as accessible as possible, defining the different grants available to women’s groups, and outlining clearly the steps to apply, including a fundraising handbook. In the initial year of the GFW, Murray recognized that with support, an organization gains confidence and momentum. Once resources are within reach plans begin to take form and the women leaders who are pioneering these organizations can begin to realize their potential for social change. As we’ve seen throughout this blog, women are key to sustainable change.  Support of women’s rights brings about paradigm shifts within society, which in turn can have profound effects on every sector, whether it be health or financial independence. The Global Fund for Women and all the other NGOs we have examined in this blog are excellent examples of interventions from the ground up, ensuring that women take the lead in their own advancement. In this way, change is not only possible, but in fact certain.

  1. Murray, Anne Firth. Paradigm Found: Leading and Managing for Positive Change. Novato, CA: New World Library, 2006. Print.
  2. “The Global Fund for Women — Reshaping Philanthropy along Feminist Lines.” Global Giving Matters. The Synergos Institute, May-June 2006. Web. <http://www.synergos.org/globalgivingmatters/features/0607gfw.htm>.
  3. “Global Fund for Women.” Global Fund for Women. N.p., 2012. Web. Nov. 2012. <http://www.globalfundforwomen.org/index.php>.

Buddhism Revisited

November 30th, 2012

Last week, I blogged about Buddhism’s teachings on the treatment of women. My feedback was very helpful in clearing up aspects of Buddhism’s hierarchical structure that I wasn’t aware of, as well as making me more curious to understand what Buddhism is about. I’d like to revisit this topic and expand it in this post.

The true aim of Buddhism is to reach a state where suffering is over-enlightenment. As the Buddha traveled through India, he was appalled at the cycles of suffering, as well as terrified that we’d live through these experiences again and again in different lives. His set out on a journey to end suffering and went through many “trials” before getting to the state that he was seeking. He deprived himself of food and drink, gave up every treasure, tortured his body physically, until he found rest in meditation. [1]

That’s just an fyi! I really want to clear up some statements that I made in my previous post. I said that, “Buddhism has the potential for gender equality that is not found in many religions.” I said this because I felt that the teachings of the Buddha are not particularly concerned with gender differentials. Rather, it is a world-view concerned with the escape of suffering and the cycles of life and death.

However, this argument can be applied to many different religions. Christianity is not concerned with the difference between how God relates to men and women or how the genders should practice the religion. Instead, it is concerned with the salvation of the soul-male and female-through the redemptive work of Christ. Hinduism is concerned with the holistic, inter-connectedness of all beings. Islam is concerned with moral day-to-day living, as well as the steps one must take to be close to God and get to heaven.

Just like these other religions-a gendered religious structure emerges from the societal constructs into which the teachings are applied. As I’ve said throughout the quarter, the applications of the religions vary, but the worldviews and sotereology, (doctrines of salvation) do not. Each religion that I’ve explored has the potential for gender equivalence, which is not necessary equality, but a concept that the message of the religion applies to both genders equally.

Back to Buddhism.. As Kat mentioned, the Buddha was not enthused about women entering the monastic order, though he believed they could reach enlightenment. When nuns were allowed, the Buddha made a clear hierarchy that out the monks as the higher authority through seven rules:

  1. Nuns must always defer to monks, regardless of seniority.
  2. Nuns cannot spend the rainy season in a place without monks.
  3. Nuns must conduct their biweekly rituals under the direction of monks.
  4. After rainy seasons, nuns must report to monks.
  5. A nun who has broken a monastic rule must be punished by both monk and nun.
  6. Both monks and nuns are necessary for nun ordination.
  7. Monks can’t be abused or reviled in any way by a nun.
  8. Nuns can be reprimanded formally be monks, but not the other way around. [2]

Things are changing, and a more androgynous spiritual environment is emerging in theory in Buddhism, though in practice it remains largely hierarchical. [2]

All this to say, Buddhism does not have an advantage over any religion with regard to its treatment of women. In light of new societal constructs surrounding gender, I’d like to see each religion re-evaluate its view on women. It would be amazing to see religions focus on whether or not the underlying themes are true instead of focusing on the layers of rules that we’ve added throughout the years!


1. The life of the Buddha Full BBC Documentary. http://www.youtube.com/watch?v=CeQoeNH70fk

2. Cabezón JI. Buddhism, sexuality, and gender [Internet]. 1992;[cited 2012 Nov 30] Available from: http://search.ebscohost.com/login.aspx?direct=true&scope=site&db=nlebk&db=nlabk&AN=7437


NGOs as Intermediaries and Policy Advocates

November 30th, 2012

Over the quarter I’ve been using this blog to highlight different NGOs and how they use their resources to address a variety of problems and issues in women’s health that we have spent time learning about in class. For this last blog post, I wanted to sum up the different intervention tactics and programs that have been covered and take a broader look at the impact and importance of NGOs in providing solutions to different issues in international women’s health. As we know, NGOs can provide a variety of services to address a variety of issues, from human trafficking, to disaster relief, to policy advocacy.

Throughout these blogs, I have attempted to focus on NGOs that expand their intervention programs away from general monetary aid or relief programs and actively work towards implementing laws and policies on either the national or international level. In developing countries or in countries with lower state capacity, NGOs can play an integral role in helping to solve the pressing health issues that the existing system may be unable to. In particular, NGOs are helpful and integral in implementing new health programs and services because NGOS “provide important links between the community and government,” “[exhibit] a special capacity to work to work within the community in response to expressed needs,” and “have a flexibility and freedom to respond in innovative and creative ways to a wide range of requests and situations.” [1] With this in mind, NGOs are sometimes necessary and effective as a mediator or middle-man between the government and the community. Given that sometimes governments are limited in their resources and funding, or even fall victim to corruption, an independently funded agency such as an NGO is able to not only provide the necessary services, but can work to help create infrastructure and policies with the government to better serve the people.

The NGO Code of Conduct for Health Systems Strengthening

Even with all the benefits, there are also potential drawbacks from NGO intervention. Recently, NGOs have been able to benefit from increased funding, but with that funding comes some consequences as well. For example, oftentimes donors “pressure NGOs to produce short-term gains in a limited population, creating conflict with the longer-term and more difficult task of building strong, high-quality national health care systems able to provide comprehensive health services to an entire population for decades to come.” [2] The result is often inequitable health care coverage or a lack of comprehensive care and programs in the regions that need it the most.

Recognizing this and other potential problems, a coalition of NGOs came together and drafted The Code of Conduct for Health Systems Strengthening aimed at providing standards for the types of interventions and actions that NGOs can do in order to maximize benefits and minimize consequences. For example, two rules (of six) for NGO behavior in advocacy and promotion state:

  1. NGOs will strengthen and support, not supplant, the role of government in making policy. NGOs will support efforts to involve indigenous civil society voices in the policy arena by encouraging their participation in developing policy and setting funding priorities.
  2. NGOs pledge to advocate for removal of political, ideological and financial barriers to the expansion and improvement of public health systems, including unnecessarily restrictive fiscal and monetary policies, and wage bill caps imposed by the international financial institutions. [3]
With 57 current signatories, this code of conduct is a step in the right direction. While NGOs are definitely one of the best independent ways to enact change in something as crucial as public health and public health services, it is necessary to make sure that the benefits of NGOs outweigh the costs.

[1] “Non-Governmental Organizations and Primary Health Care.” World Federation of Public Health Associations. http://www.wfpha.org/tl_files/doc/resolutions/positionpapers/global/NGO&PrimaryHealthCare.pdf

[2] “Code Origins.” The NGO Code of Conduct for Health System Strengthening. http://ngocodeofconduct.org/background/code-origins/.

[3] “Article VI. NGOs will advocate for policies which promote and support the public sector.” The Code for Health Systems Strengthening. http://ngocodeofconduct.org/code-articles/advocacy-and-promotion/.

Microfinance and Decision Making

November 29th, 2012

Microfinance is generally heralded as empowering women. There are many reports in the popular press and in academic literature of microfinance loans having a transformative effect on women’s financial independence, health, and political engagement (1-3). However, in academic research there have also been a number of studies suggesting that microfinance lacks a positive impact on women’s empowerment. In particular, one key metric for women’s empowerment at the household level – decision making agency – has shown mixed results (4). A review of data from South India analyzed how different types of microfinance interventions affected decision making agency and found a striking variation in impact.

Nathalie Holvoet’s study focused on two types of microfinance interventions that have been found to be particularly impactful in women’s empowerment. The first intervention is delivering microfinance loans through a group of peers, rather than a direct relationship between a lender and bank (4). A group is particularly helpful if it functions as a social and information resource, rather than simply as a formal entity (4).  The second intervention Holvoet noted, but did not explore as fully, is bundling of services, such as financial education and skills training, along with loans (4).

Holvoet’s study compared changes in decision-making agency between women (as well as men) who participated in different types of microfinance interventions. She found that women that participated in group-based microfinance programs participated in an increased amount of leadership in home decision making (4). In contrast, women who received loans without a group structure did not change in decision making agency. An additional trend indicated that the longer women participate in microfinance groups, the more leadership they assume (however, this trend did not reach statistical significance) (4).



1. Syed Ahmed et al. “Customized Development Interventions for the Ultra Poor.” 2005: BRAC Research and Evaluation Division.

2. Wahid, Abu. “The Grameen Bank and Women in Bangledash”. Challenge: 1999.

3. PATH. “Microfinance and women’s health: What do we know?”. Outlook. August 2011.

4. Holvoet, Nathalie.  “The Impact of Microfinance on Decision-Making Agency: Evidence from South India.”  Development and Change: 2005.


Cell phones: Surprising Consequences for Sex Work in India

November 29th, 2012

Earlier this week, I came across an interesting article in the New York Times titled “Cellphones Reshape Prostitution in India, and Complicate Efforts to Prevent AIDS.” I was intrigued. My readings and research into cellphones in women’s health has overall been positive. While there are certain obstacles that need to be overcome, there have been many beneficial interventions in women’s health using cellphones. This article, however, highlights the opposite.

The article discusses how the rise of cellphones among prostitutes has led to an increase in freedom but a decrease in safety. In the red light districts of India, prostitutes were largely concentrated in brothels and any business was conducted there. However, with the expansion of cell phones, prostitutes have the freedom and mobility to seek their customers away from brothels and “madams.” Furthermore, the prostitutes can keep all the money that they earn as well as set their own rules, giving them more autonomy and financial freedom.

While the economic ramifications of this might be positive for the prostitutes, the health one are not. India has been a surprising success story in regards to AIDS. In 2002, the CIA predicated that India would have 25 million AIDS cases by 2010. India now has about 1.5 million. The amazing result is largely due to efforts by NGOs, who targeted high-risk groups such as sex workers. While brothels can be very abusive and have many issues in themselves, at least they provided a localized area. Additionally, as the article states, “Studies show that prostitutes who rely on cellphones are more susceptible to H.I.V because they are far less likely than their brothel-based peers to require their clients to wear condoms.” Through the early and late 2000s, NGOs and the Indian Government focused their efforts on distributing condoms and educating sex workers in red-light districts about STDs. These concentrated efforts were more effective than nation-wide broadcasts about safe sex. However, with this scattering of sex workers, these efforts will have to be re-strategized.

In addition, mobile phones seem to be expanding the sex marketplace. More women are entering part-time sex work and more men have access to these women. Cellphone-based massage and escort services are burgeoning in India. Mobile phones have made these services less public and have increased the number of clients.

While this article is not particularly uplifting, it shows the benefits and detriments that are inherent in any technology. I’ve mentioned many positive cellphone interventions in the last few weeks: mobile platform for recording data, maternal health cellphone messages, advice and reminders, mobile financing of health, connecting medical practitioners to rural villagers and the overall expansion of a health network. These interventions are great and I’ve grown more excited over the last few weeks as I’ve read about them. There are so many possibilities. While we don’t know the limitations or bounds of technology yet, we also may not have come across all the problems. As an engineer and a person who is passionate about social change and innovation, I look forward to the increase of technology in women’s health, but, as this article reminds us, am also aware of the rapid paradigm shifts that it can bring

UNESCO’s Global Advisory Group on Sexuality Education

November 29th, 2012

During the past couple of weeks, my posts have been focusing on the state of sexual education in developing countries: why a comprehensive approach is important, recommendations given to various countries, and interventions that are taking place for the sake of improving the information provided to young individuals. I have put all of this information out without introducing some of the very important people behind these efforts to provide youth their sexual education rights. One of the most recent intervention publications, UNESCO’s International Technical Guidance on Sexuality Education, was widely distributed and recommended to countries around the world in hopes of providing guidance for comprehensive programs. Therefore, for this last post, I’d like to introduce some of the individuals behind these efforts. UNESCO’s Global Advisory Group on Sexuality Education consists of ten people with very diverse backgrounds each with high expertise in various fields. Because there are many of them, I have decided to only present three who form part of the advisory group.

Ishita Chaudhry is the founder and present CEO of The YP Foundation (TYPF); a youth led organization in New Delhi, India. TYPF supports young people to create programmes and influence policy in the areas of gender, sexuality, health, education, the arts and governance, reaching out to over 300,000 young people in India. Ishita works with youth communities in India on developing leadership skills and enabling young people’s access to comprehensive sexuality education. She has worked with 5,000 young people in the last 8 years to set up more than 200 projects in India, training young advocates at regional and international forums.[1]

Elizabeth Mataka is the United Nations Secretary-General’s Special Envoy for AIDS in
Africa. She is also the Executive Director of the Zambia National AIDS Network (ZNAN) and represents non-governmental organizations from developing countries on the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria, and serves as the Board’s Vice-Chair. She pioneered peer education in Zambia through the facilitation of the formation  of over 2,000 school/community based Anti-AIDS Clubs. She also pioneered work on mitigating the impact of HIV/AIDS on children by initiating the Children in Distress (CINDI) project in 1990. This was the first community based response to the increasing number of orphans and vulnerable children.[1]

Alice Welbourn is a freelance social development adviser, writer, trainer and activist
on participatory approaches to gender, sexual and reproductive health and has worked
in international development since 1984. She is founder of Stepping Stones, a training package in gender, HIV/AIDS, communication and relationship skills. She was diagnosed HIV positive in 1992, and is former Chair of ICW, the only international network of HIV-positive women, which campaigns for  the sexual and reproductive rights of HIV positive women and girls. Dr. Welbourn is now co-chair and a founding member of SOPHIA, the UK-chapter of the UNAIDS led Global Coalition on Women and AIDS (GCWA). She is also a member of the leadership council of the GCWA.[1]

Works Cited

1) http://www.unesco.org/pv_obj_cache/pv_obj_id_083D59BCBAE3684DD05BB25B02118D58F99F0000/filename/hiv&aids_global_advisory_group_en.pdf

Microfinance and Victims of Rape

November 29th, 2012

Out of all the weeks this quarter, the issues that touched me most were the mental health consequences of rape and sexual trauma.  These long-term effects include depression, PTSD, anxiety, and other psychiatric morbidities as well as physical trauma or injury, disability, STIs, and pregnancy.  To compound these factors, victims of rape are frequently shunned by spouses, family members, and communities—leaving many with few options and no social network.

I wanted to focus today’s blog on an intervention that takes a unique approach to treatment of rape victims with good initial success results.  In the Democratic Republic of Congo, mass rape has become commonplace, even in times of relative peace.  Since therapy or psychological treatment may be next to non-existent or highly stigmatized in much of the developing world, many women are unable to access any mental health treatment after enduring sexual violence or trauma.  In this particular program, female victims of rape have been connected with local microfinance programs to help them become financially independent.

The interventions have worked with resounding success.  Researchers from Johns Hopkins reported positive results on the physical, mental/emotional and social well-being of participating individuals in several villages in the Walungu Territory in South Kivu.  The intervention tackles the social disadvantages associated with being a stigmatized victim of rape; it has the added benefit of also relieving psychological stress or lessening the effects of rape-related depression, PTSD, etc.  Once financed, these women once more became functioning members of society; they were able to purchase food or medicines, provide for their children, and start small businesses.  Suddenly, cast-out members of society became empowered and were often reaccepted into their families, especially if they were able to bring an added financial benefit to the family.  A reduction in stigmatization was noted on a community-wide scale.

In addition, researchers found that the women’s sense of self-worth increased and chronic stress associated with isolation decreased.  Unsurprisingly, in addition to better mental health, these women experienced improvements in overall health as they were better able to provide for themselves and became less emotionally burdened.

Whether this intervention leads to thriving businesses or long-term employment is unexplored.  As researchers noted, the goal of these interventions is not to maximize economic gain, but rather to maximize positive influence in the lives of these newly empowered women.  And it appears to be working.  As one Jina Moore writes, “Micro-credit programs were doing the kind of work usually attributed to psycho-social counseling. They restored women’s sense of self-worth. They bolstered women’s respect in the community. They returned women, in their own homes, to productive partners in their families.”

I particularly like this intervention because it takes a creative approach to fulfilling a need. Right now, the psychiatric support/infrastructure needed to heal the psychological wounds of mass rape is not adequate. However, a simple intervention like micro finance can serve a similar function for the time being. Does it fully address the psychological trauma of rape and stigmatization? Probably not, but its ability to empower women and return them to their communities speaks volumes.




Employment Opportunities for Disabled Women

November 29th, 2012

For the final post of this blog, I would like to address one of the key components of empowerment: financial independence and employment. Disabled women face discrimination on many grounds that prevents them from achieving their goals. One of the harmful stereotypes that women with disabilities face is the idea that they are economic burdens on their families and communities. Helping disabled women to find employment is one of the most effective strategies for empowering this subordinated group.

There are many ways to approach the goal of incorporating disabled individuals into their communities’ labor markets. The Bureau of Labor Statistics within the United States Department of Labor publishes the Monthly Labor Review, a journal that documents key changes in international labor markets. The Review featured an article by Melvin Brodsky in 1990 entitled “Employment programs for disabled youth: an international view” that summarizes the main policy strategies for empowering disabled people through employment. These approaches include labor quotas that dictate the proportion of disabled people that must be represented in large companies’ workforce and penalize non-compliers; programs that work to enrich the skill set of disabled people through counseling, job placement, and training; changes in work environments to support disabled employees; government wage subsidies to incentivize the employment of disabled individuals and to reimburse employers for lower productivity; and efforts to create jobs specifically for people with disabilities [1].

Another strategy comes not from the realm of public policy, but rather from community organizations and individuals. The International Development Research Center (IDRC) and researchers from the University of Calgary collaborated to study initiatives working to “foster economic independence and employment opportunities among persons with physical and cognitive impairments” [2]. This analysis yielded a list of 76 programs in 36 countries in Latin America, Asia, and Africa and focused primarily on self-directed employment. Aldred Neufeldt, the leader of the project and associate professor of rehabilitation studies at the University of Calgary, reported the following findings: “There are a number of strategies persons with disabilities can pursue in income generation programs,” he says. “The use of support services and mechanisms, the pursuit of skills and management training, access to credit or subsidies and the application of sound business practices are all crucial steps” [2]. One of the organizations studied stands as a model for other self-employment programs: MicroLink is an umbrella organization that supports 13 cooperatives of disabled workers in the Philippines. MicroLink provides services including training, business consulting, and administrative assistance to its members. In exchange, its members must invest some of their profits in a fund that will support their future development with the goal of their independence after five years. USAID and other agencies fund MicroLink’s work, which, so far, has yielded two independent businesses. This model for supporting self-generated employment is especially powerful because of its sustainability: it aims to foster lasting opportunities for disabled individuals of which they have ownership. Programs like MicroLink empower disabled people by helping their communities to appreciate the value of their contributions.

In general, a multi-pronged, holistic approach is the most effective way to approach any form of social change. I believe that organizations working to improve the health of disabled women must acknowledge and support efforts from other realms and philosophies. Instead of competing for awareness, funding, and prestige, the various programs I have highlighted in this blog must collaborate to achieve lasting improvements in the health of disabled women around the world.

[1] Brodsky, Melvin. “Employment programs for disabled youth: an international view.” Monthly Labor Review. 1990: 50-53.
[2] Harris, Craig. “Self-Employment of Disabled People in Developing Countries.” IDRC Reports. Accessed through Disability World at http://www.disabilityworld.org/11-12_03/employment/selfemployment.shtml

Antenatal mental health: psychosocial intervention in Latin America

November 29th, 2012

For this final blog posting, I would like to shift my attention within the topic of antenatal care to an issue that is not talked about often enough: mental health. During pregnancy, a period of time during which a woman is undergoing many physical, hormonal, and emotional changes, her mind may also be susceptible to major changes, and she should be cared for in this way. Just as the purposes of antenatal care (ANC) is to provide risk assessment, education, and support for health concerns, we should be sure to include management and prevention of common mental disorders such as antenatal anxiety (AA) and antenatal depression (AD). Looking more closely at Latin America, a few studies examine more closely the relationship between mental health and pregnancy, attempting to quantify prevalence, detail experiences, and suggest solutions. Overall, with mental disorders such as AA and AD at substantial levels during pregnancy, one intervention on behalf of antenatal care includes additional psychosocial support in the form of medical staff visiting pregnant women in their homes four to six times offering services.

Rates of mental disorders during pregnancy are substantial, though estimates vary widely. One systematic review focused on over 700 articles on observational studies, surveys, structured interviews, and screening instruments to estimate the prevalence of antenatal depression, coming at a conclusion of between 7% and 13%.[1] This estimate alone suggests around 1 in 10 women are affected. Shifting focus to Latin America, a separate study performed a cross-sectional examination of over 400 women in Osasco, São Paulo, Brazil aiming to estimate the prevalence of both antenatal depression and anxiety. With pregnant women with no past or present history of depression, psychiatric treatment, alcohol or drug abuse and no clinical and obstetric complications,”(25) results showed a prevalence of state and trait AA of 59.5% and 45.3%, respectively; the prevalence of was 19.6%.[2] According to the study, some of these conditions were associated with lower women’s education level, not being married, lower income, not being white, lower couple’s incomes, and previous abortions. Knowing that this prevalence exists, especially among women of low SES, what role could antenatal care have in this?

An intervention would be to expand psychosocial services to pregnant women in the home extending from health care centers.  One randomized control trial carried out at four Latin American research sites (Rosario, Argentina; Pelotas, Brazil; La Habana, Cuba; and Mexico City, Mexico) designed an intervention that provided this psychosocial support to pregnant women. The intervention by female specially trained nurses and social workers included four components: reinforcement of social support networks (4-6 home visits with a patient, “her supporting person,” and the visitor), emotional support, knowledge about pregnancy and delivery, and reinforcement of adequate health services utilization.[3] Health workers during home visits would most often discuss normal bio-psycho-social changes to expect, stress reduction during pregnancy, maternal diet and weight, hygiene during pregnancy, possible complications during pregnancy, and emergencies and use of health services. Covering important concepts also covered during antenatal care visits, this intervention meets women inside their homes and acknowledges mental health and stressful factors. The control group in the study only had an ANC visit for a 36 weeks evaluation, then an evaluation postpartum, and a last evaluation after 40 days. Though this paper did not detail conclusions compared to the control group, a literature review they included referenced that “women enrolled in the social support programs were less likely than those in the control group to feel unhappy, nervous and worried during pregnancy, were more likely to have good communication with medical staff, felt a greater sense of control during delivery and were more satisfied with antenatal care” (497).

This intervention appears to be a more psychosocial form of ANC taken out of the clinic and to women’s homes. It emphasizes the overall wellbeing of the patient with the change of setting, meaning the visit is not strictly a medical, physical evaluation. As this approach seems to have promise for mental health and wellbeing, another paper on this same randomized control trial talks about how little difference between the control and intervention groups about perinatal health outcomes, such as frequency of low birth weight or maternal complications.[4] This surprises me, as I’d assume that more frequent social support and health education, both forms of ANC, would improve success of delivery. This may implicate that the affects on mental, social, and physical wellbeing are all separate. Or, perhaps the fact that these women were all getting access to ANC at all was enough to improve the success of their pregnancies.

Like my last post, I admire the act of quality healthcare services being expanded beyond the hospital walls. It seems more similar to work by traditional health members of societies, midwives, or traditional healers. In Latin America where home remedies and alternative health personnel are options, the centralized healthcare in a hospital may seem so separate from some traditions. So if health workers are travelling to people’s homes, my hope is that women would be more comfortable. Another positive point is that all the nurses and social workers involved in the interventions were women, which empowers women professionally and hopefully extends support when it comes to mental health and social wellbeing during pregnancy.

My criticisms or questions about this intervention have to do with the privacy, feasibility, and ability to replicate. Some questions I have that readers may answer in blog comments is if one would think this is an invasion of privacy for health workers from hospitals to regularly conduct these house visits in these patients homes. Would this ability vary from place to place, and are women comfortable with this approach? Also, in terms of feasibility, the intervention study made the case that training health workers could conduct these visits works, as they successfully covered the important topics they were trained to cover. However, are there enough health workers to visit homes rather than being in the clinic? Would this type of intervention be possible to replicate in other parts of the countries, outside of big cities like La Habana, Cuba?

To conclude, the work of these studies taking psychosocial healthcare service outside the clinic and into homes is noble. As a result of this approach, more women are reached with services that address their mental health and wellbeing, hopefully decreasing the prevalence of antenatal depression and anxiety that is known to possibly occur with pregnancy. Expansion of these types of services still have not been replicated with every clinic or standard-of-care, but I believe that this additional step to take ANC interventions outside of the home is a promising way to reduce perinatal morbidity and mortality.

[1] Bennett, Heather A. et al. “Prevalence of Depression During Pregnancy: Systematic Review.” Obstetrics & Gynecology 103.4 (2004): 698-709. Web. 29 Nov 2012.

[2] Faisal-Cury, A. and P. Rossi Menezes. “Prevalence of anxiety and depression during pregnancy in a private setting sample.” Archives of Women’s Mental Health.10.1 (2007): 25-32. Web. 29 Nov 2012

[3] Langer, Ana et al. “The Latin American Trial of Psychosocial Support During Pregnancy: A Social Intervention Evaluated Through an Experimental Design.” Social Sciences and Medicine 36.4 (1993): 495-507. Web. 29 Nov 2012.

[4] Villar, José, M.D. et al. “A Randomized Trial of Psychosocial Support during High-Risk Pregnancies.” The New England Journal of Medicine 327 (1992): 1266-1271. Web. 29 Nov 2012.