Where would we be without the women in our lives? This month, we’re celebrating International Women’s Day on March 8th by asking ourselves, “how can we honor our female patients through service, especially during these difficult times?”
The answer: by ensuring the women and girls who depend on our clinic can receive the care and supplies they need through our Women’s Health Initiatives. We sat down with Sheila Cullen, the Somos Amigos board vice-chair who heads up our women’s health programming. In 2021, she says, we plan to continue our current pilot programs, in addition to offering new resources for women and men alike, including Pap/HPV co-testing, oral contraceptives and condoms, menstrual kits, menopausal care, and education resources.
Reproductive health & family planning
Family planning tools are instrumental in helping young women determine a healthy course for themselves and their families, and Somos Amigos is committed to developing programming around those resources. In a nation where 1 in 5 adolescents become pregnant by the time they’re 19 years old, access to the tools and education is even more critical. And yet, major gaps in programming exist in low-income and rural communities—precisely the communities Somos Amigos serves. We’ve been consulting with a committee of women from Naranjito, as well as female doctors, to get a sense of what kind of family planning and reproductive resources are desired and would be received well by patients and the community at large. In the Dominican Republic, issues relating to family planning and women’s health can often be overlooked or stigmatized. During our consultations we encountered numerous women who didn’t realize that they had specific health considerations when it came to their reproductive health, or who didn’t know about contraceptives and family planning.
As you may remember, it was over a year ago that we piloted our Depo-Provera program, providing birth-control to a cohort of 8 women. The pilot has proved successful, and Sheila says we’re planning to continue the Depo program, as well as continue providing oral contraceptives and education. Additionally, as of January 2021, Somos Amigos has partnered with a local lab to provide HPV/Pap Co-Testing to our patients so we can better screen for HPV and cervical cancer. Our long-term goal is to provide not only HPV testing, but also HPV vaccinations in-clinic. We also began providing menopausal care to certain patients as necessary, including Estradiol cream and counseling, ensuring our Women’s Health Initiatives are available for women of all ages.
In addition to contraceptive tools, young women in the D.R. also face a lack of access to feminine hygiene products and the stigma associated with menstruation. For many school-age young women, access to hygiene products is the difference between missing days or weeks of school each term. In 2019, Somos Amigos partnered with Direct Relief to distribute 50 reusable fabric-based menstruation kits to women of all ages in the community. The kits were gone immediately, and the women who received them were enthusiastic. Now, we’re trying to address the school-aged population through teachers in the communities, like Magaly, who are uniquely positioned in their communities to support young women’s access and learning about their reproductive health.
Guided by women, supported by research
Importantly, we are in line with a recent Dominican government study which identified specific initiatives and target audiences for such programming. In September 2020, the study “Early Union and Teenage Pregnancy in the Dominican Republic: Two Continuing Challenges” revealed not only that 20% of adolescents become pregnant before age 19, but that…
…regardless of place of residence, economic stratum, educational level and religion, the Adolescent motherhood, in the vast majority of cases, is the result of an unintended pregnancy.
Among the causes of these unplanned pregnancies, it is pointed out that it occurs due to the unmet need for family planning, a factor that affects one in 10 adolescents and one in three among those with less education. Likewise, he indicates, there is a lack of comprehensive sexuality education and the lack of effective and systematic use of contraceptive methods.
In general, according to the study, poverty continues as a determining factor for early unions and adolescent motherhood.
el Caribe, 29 Sep 2020 (Read in English, Leen en español)
Indeed, these gaps in education and access to resources are where thousands of women find themselves, and closing those gaps in access to supplies and services is only part of the solution. Our experience has shown us that family education is very important in helping someone say consistent with their care, something that our Insulin Outreach program illuminated for us. In our consultations with patients, we found that some don’t know how to use a condom, or may not know what a condom is, or may not know what purpose a condom serves in disease prevention, for instance. As a result, we’re also increasing our supply of condoms available in-clinic, as well as educating patients—men and women alike—about what condoms are, what purpose they serve, and how to use them properly. Sheila says that talking so openly about something as sensitive as sexuality with the patients can be awkward, but it’s worth it for the look on a patient’s face when they realize how much control over their own lives something as simple as a condom can provide.
Ultimately, all our Women’s Health Initiatives have been driven by local women advising Somos Amigos on what is needed in Naranjito and beyond. We take great pride in the relationship we have with our host community and patients, and they continue to help guide all that we do.