Critical Observance of Women's Grassroots
Health Advocacy in Action:

A Cervical Cancer Prevention Experiment in Peru

Results
Results of this investigation reveal levels of participation and satisfaction with an experimental Cervical Cancer screening exam in high jungle communities where a previous project concentrated efforts aimed at increased use of available Reproductive Health services by local women. Qualitative data elicited through in-depth interviews and group discussions with professionals and community members in the Department of San Martin provide important evidence of the effectiveness and short-comings of the participatory approaches applied to transform preventive health practices and health-seeking behaviors in contexts of international interventions among poor and marginalized women in Peru.

Context
This investigation analyzes the impact of community participatory research and education methodologies designed to influence behavior change among Peruvian women in contexts of reproductive health (RH). From 1996 to the present, the USAID-funded ReproSalud Project (managed by the Peruvian feminist NGO, Movimiento Manuela Ramos) has taken an innovative approach towards promoting women's health and empowerment among underserved populations in eight regions of the country. ReproSalud works with women's Community Based Organizations in rural and periurban centers to identify RH problems by applying the community participatory investigation instrument, the Autodiagnosis (originally developed by MotherCare/Save the Children in Bolivia). Once local RH needs are prioritized, project participants are trained to transfer information to neighboring women's organizations through education programs, and to take appropriate civic actions to resolve their problems. A key component of the project, aimed to guarantee sustainability over the long term, is the formation of women's health advocates, called Defenders of Women's Reproductive Rights.

Problem
In 2000 ReproSalud completed its project in the Peruvian jungle, leaving in place women's health advocates to continue to promote preventive practices and use of services by articulating actions with the Ministry of Health (MOH). Concurrent with the termination of ReproSalud in the Department of San Martin, is the implementation of a Cervical Cancer Prevention (CCP) Demonstration Project developed by the Pan-American Health Organization (PAHO) as part of the Alliance for CCP (funded by the Gates Foundation). In coordination with the MOH, the project recruited the Defenders of Women's Reproductive Rights to help organize the department-wide cancer screening campaign targeted at 75,000 women between the ages of 25 and 49. 

This investigation was supported by a grant from the W.K. Kellogg Foundation. Research results were presented at the conference of the American Psychological Association, Enhancing Outcomes in Women's Health:Translating Psychosocial and Behavioral Research into Primary Care, Community Interventions and Health Policy. Session: Lay Health Advisors and Peer Education in Community Interventions. Washington, DC. February, 2002.

Bibliography

• Bishop, Amie et al.
  1995 Cervical Cancer: Evolving Prevention Strategies for Developing Countries. Reproductive Health Matters 6:60-71.
  

• Castro Gómez, Julio
  1997 Interacciones oferta-demanda en atenciones para la prevención del cáncer ginecológico. Lima: REPROSALUD.
  

• Cullins, Vanessa, et al.
  1999 Cervical Cancer Prevention Using Visual Screening Methods. Reproductive Health Matters 7(14):134-143.
  

• JHPIEGO Cervical Cancer Project/Univ. Zimbabwe
  1999 Visual Inspection with Acetic Acid for Cervical Cancer Screening: Test Qualities in a Primary Care Setting. The Lancet 353(9156):869-873.
  

• Population Council
  1998 Hombres como Socios en la Salud. Lima: Population Council. 
  

• Population Council
  1998 Cambios en las Percepciones de las Comunidades sobre los Servicios de Salud Reproductiva y Reducción de la Necesidad Insatisfecha en La Sierra del Perú. Federico León, Investigador Principal. Lima: INOPAL III.

For the project proposal, work plan, budget and final presentation contact:
phammer@wayna.rcp.net.pe