Interview with Susana Galdos for International Women's Day, March 8, 2003

"It was amazing! These local women stood in front of the head of the hospital and told him how they had been treated by the doctors. They told him that when they came to the hospital with their babies, the doctors said, 'You have another baby? Why did you have another one? You already had five!' The women asked the hospital director, 'Why did these doctors say this to us? Why did they blame us? Why didn't they say it to our husbands?' And the hospital director had to listen, and take notes."
 
-Susana Galdos, describing a meeting in which rural women in Puno, Peru met with high-level health officials to tell them what health services they needed, and what needed to be changed.

Susana Galdos has worked to promote women's rights for over 25 years. In 1978, Ms. Galdos co-founded Manuela Ramos, an internationally-recognized NGO working toward the empowerment of women, sexual and reproductive health, and the prevention and treatment of violence. In 1995, Ms. Galdos became the director of ReproSalud, a USAID-funded project of Manuela Ramos focused on reproductive health, advocacy, and income generation for women. She joined MSH in 2001, and is currently working to develop strategies for community-based health care services. Ms. Galdos has participated in several UN conferences, has worked as a consultant to both national and international institutions, and has testified on behalf of women before the Egyptian Parliament and US Congress.

A health promoter carries a child on her back in Lake Titicha, Peru. Photo by MSH staff.

Question: Can you describe your work in Latin America? How did you become interested in women's issues?

SG: I'm Peruvian, and I belong to a generation with a strong commitment to human development—we are part of what we call the "political parties of the left." We used to work with the poor people in shantytowns. We realized that women's needs were invisible to most of society. We realized that women believed that they were born with a genetic predetermination for a particular social role: within the home, taking care of the family and children, serving the husband, being patient, and so on. This realization radicalized us, and caused us to organize ourselves as an NGO named Manuela Ramos.

So we have been working to improve women's rights, including reproductive and sexual rights, since 1978. This year, in May, Manuela Ramos will have its 25th anniversary. We began with a staff of 8, and now we have a staff of 200. Manuela has had different projects in health, political participation, income generation, and fighting against violence against women. We work at different levels: at the grass roots level, with poor illiterate people, with professionals, and with government officials. At the beginning, we worked only with women, but now we work with children and teenagers, women and men.

For the past 5 years, I conducted a project named ReproSalud, focusing on improving women's health in rural areas and establishing relationships between women's organizations and health services. The results of the first five years of the project were so positive that USAID decided to support it for another 5 years.

Two indigenous women at a market with their young children. Photo by MSH staff.

Question: What do you see as the major health problems facing women in Latin America today?

SG: It is hard to talk about all of Latin America. In Bolivia, Haiti and Peru, maternal mortality is the biggest health problem. In the Caribbean, AIDS is increasing and 50% of the infected are women and children. In rural areas, the lack of contraception services is the biggest problem. In all regions, I think violence against women is the invisible problem—which is also why I think it is one of the major problems—health services don't see it, or recognize it, as a problem. While there have been some legal advances, health workers continue to think that violence is a private issue, and don't understand how connected it is to women's health.

Question: How are these health problems related to poverty, politics and culture?

SG: I think poverty, politics and culture cause these health problems. Generally, projects try to change the consequences of health problems, but they don't address the main causes—such as women's dependency on others and their inability to make decisions about their own lives.

For example, even though AIDS is rapidly spreading among women in Africa, at the same time, many women are not able to have safe sex because they don't know how to negotiate this with their husbands. Often, they don't use contraception because their husbands don't want to. In rural areas, women need men's permission to go to the health services or to deliver a baby in the hospital.

Of course these are cultural matters, but we can change culture—culture is not static. The main question is how much projects are actually addressing this issue. How much do projects understand that behavior change should be thought about from a gender perspective in order to be sustainable?

Question: Can you tell a story from your experience about a particular problem that you were able to successfully address?

SG: Actually, I prefer to talk about our experiences as a group, or rather, as a team. For example, in ReproSalud, poor, rural, illiterate women talked with their partners about contraception, violence, and gender roles. Women discussed with the authorities of their community how to establish an exit route for high-risk pregnancies - they won a Sarah Faith award for saving a mother's life. As ReproSalud took into account women's needs and their points of view, the project included adolescents and men in the training activities. Women said: "Men can help us—the majority of them are good people, but they don't know about these things that we already know." The results were a healthy community, authorities being involved and improved health services—higher numbers of visits for family planning, prenatal visits, and sexually transmitted diseases.

Question: Are there similarities between the problems of women in Latin America and the problems of women in other parts of the world? What do you think is the greatest challenge to women's health worldwide today?

SG: Some problems are more or less the same for developing countries. For example, I was invited to Mauritania, a Muslim county in Africa, to explain ReproSalud's strategy. They loved ReproSalud because they are dealing with the same problems: women's dependency, lack of family planning, high maternal mortality, rural areas with poor services, etc. In Haiti, one NGO was working with the ReproSalud methodology, after having attended an international conference and learned some of ReproSalud's strategies for working with the community. Violence against women is a problem everywhere, even in developed countries. Here in the USA, one in five women will be a victim of rape in her lifetime.

Worldwide, the greatest challenge is for women to be visible. Women need to be in the statistics, so that health projects consider women's needs. People working in health need to hear women's voices. We already have enough literature and research from the many feminist NGOs around the world, UNFPA and UNIFEM, among others. We know what is necessary to improve women's lives—we have strategies, tools, etc.—we only need the commitment.

Question: How have women's health issues changed since you began your work? Has their situation improved or become worse?

SG: That means.30 years ago!! Oh yes. At least we have now a vision of gender equity in society, and some gender indicators for human development. The United Nations has recognized women's rights, and we have laws in many countries that punish violence against women. But it's always easy for this process to reverse itself. For example, choice as a right—issues of contraception—these are always sensitive issues.

Question: What are the greatest disparities between women in poor countries and women in wealthy countries?

SG: I think women in wealthy countries have rights—at least in the law—and government services are involved in public health. In most of the poor countries, laws and services are in the framework of religions. Poor countries have to deal with donor demands—for example, the Global Gag Rule. This restriction goes against democracy and women's rights, but because poor countries need the money for health services, they have been forced to go along with it.

A woman in Peru. Photo by MSH staff.

Question: What do you think is the key issue for women in upcoming years?

SG: Empowerment at all levels.
 
Two-thirds of the illiterates in the world are women; every minute a woman dies from pregnancy related causes; women own approximately 1 percent of the world's land. Seventy percent of people in abject poverty (living with less than $1 per day) are women. In early 2000, only nine women were heads of State or Government. Seventy-five percent of the refugees and internally displaced in the world are women who have lost their families and their homes. In both developed and developing countries, women work 35 hours more than men every week. 

Question: What do you think is the key challenge for governments, NGOs, and international agencies in helping women to overcome health problems related to poverty in the future?

SG: In general, if they can see the women, go to them, and hear them, they will know what to do. When we are working at the community level, we can see, easily, that some health problems are because of a lack of education, money and/or lack of political commitment. And most health problems are because of women's socio-economic condition and gender situation—dependency and undervaluation. I think we need to work in the framework of gender and community and try to improve health through "constellations" of possibilities—including income generation, loans, education and political participation.