by Caroline Webb
Estela was born in 1994, one year my senior, and chose to undergo the surgical process of an elective tubal sterilization provided by WINGS. Already the mother of three children, Estela could not fathom having another pregnancy, birth, or child to feed, clothe, educate, and love.
As I sat by Estela’s side outside a pop-up surgical operations clinic in Chimaltenango, she breathed heavily through the nausea, a side effect of the voluntary surgical contraception (VSC), and I was humbled by her strength in the face of her decision to make a free, informed choice about her fertility and family.
Though the two of us have been circling the sun for roughly the same amount of time, our lives and responsibilities are miles apart; I have never known the weight of such a permanent, life altering choice, and due to the privileged world into which I was fortunate to be born, probably never will. Allow me to draw a comparison: as I face decisions of undergraduate majors at my fancy private school, consider potential careers, revise my resumé, or rationalize decisions because they build character and do things “for the experience,” Estela – and many of the women with whom WINGS works in Guatemala – faces decisions that ultimately determine her family’s future and reproductive path.
During my time interning with WINGS, I have been exposed to shocking truths and realities of many strong women like Estela. These will forever inspire and humble me.
As a Development Intern with WINGS, I worked primarily in the Antigua office, but was also able to assist in the field: I accompanied the incredible unidad movil to assist in a pop-up mobile cervical cancer screening/STI testing/method distribution clinic in a rural highland community, the VSC operations clinic where I met Estela, and a women’s health conference at a community hospital in Mazatenango. I assisted WINGS’ youth educator in a taller at a local school presenting to male adolescents the reality of pregnancy (complete with realistic pregnancy simulators!) and the misconceptions of gender roles. Another field experience took me to Escuintla, a region in Guatemala with high rates of AIDS and HIV, to assist in a unique charla with female sex workers, teaching about cervical cancer, HPV, different methods of contraception, and the accessibility of these options through WINGS’ services.
During these trips – replete with rutted rural roads, sunrise departures, surprise traffic obstacles (a camioneta accident ahead is not a valid excuse to arrive late to meet women waiting to take control of their reproductive health), and mara extortion – I met incredible women working toward a better future for themselves, their families and Guatemala, and witnessed firsthand the incredibly valiant yet tiring work the empathetic nurses, promotoras, and educators do to manifest WINGS’ mission.
WINGS’ vision of creating a future where all Guatemalans are capable of exercising their sexual and reproductive rights is already becoming a reality. One by one, with each IUD or subdermal implant distributed, cervical cancer screening or tubal ligation performed, and each woman, man, and youth learning and talking about sexual health and their reproductive rights, WINGS enables individuals to be their own agents of change.
Estela, like so many women I have had the privilege of knowing through WINGS, inspires me through exercising her agency to choose her fate, plan her family, and be the dueña of her body. By taking advantage of WINGS’ tubal ligation service, Estela will never again need to consider contraceptives nor worry about an expanding family to support. Thanks to WINGS’ services, Estela’s three young children may now have a better chance of transcending the vicious cycle of poverty by having access to more education, nourishing meals, better resources and special attention from their mother.
Happy Mother’s Day! Today, in celebration of all mothers who impacted our lives, we’re sharing another story from our series: 15 stories for the 15th Anniversary!
WINGS’ mobile clinics travel to remote areas of Guatemala, where access to health services is extremely limited. During the clinics, we provide contraceptive methods, cervical cancer screenings and cryotherapy treatment. In many Guatemalan communities, family planning or anything related to reproductive health is still much stigmatized, so it takes courage for women from these villages to go to our clinics. We have met strong women who have overcome many struggles, as is the case with Ana Maria.
25-year-old Ana Maria was born in Nicaragua. Both her parents died when she was a child, and without family or opportunities, she came to Guatemala, told by a prospective employer he would provide her steady work and a place to live. At just 14, Ana Maria was sold into the sex slave industry, and obligated to pay off her travel and housing debts. After 3 months living a nightmare, Ana Maria managed to escape with the help of a friend, now her husband.
A few years later, Ana Maria went to a WINGS talk about family planning and cervical cancer. The risk factors for cervical cancer really concerned her, considering her past. Ana Maria wanted to undergo a screening, but worried about the cost; her husband works on a banana plantation and some months they barely have enough money to feed their 3 children. WINGS nurse Alejandra heard Ana Maria’s concerns, and offered to waive the fee for the screening. Unfortunately, Ana Maria’s screening results came out positive for pre-cancerous cells. WINGS’ staff provided Ana Maria with immediate cryotherapy treatment that day, to prevent precancerous lesions progressing to cervical cancer. With tears running down her face, Ana Maria said: “I could never afford this treatment. Sometimes we don’t even have enough to eat. I thank God that there are organizations providing services to the poorest people.”
Ana Maria’s three children and her husband were also very grateful to WINGS. The children are still very young, and with their father busy working at the plantation during the day, Ana Maria is their main caretaker. Thanks to the cervical cancer screening and treatment, Ana Maria got the opportunity to be with her three children and see them grow up.
Ana Maria was very lucky. WINGS provided her with cervical cancer screening and cryotherapy treatment in time and she avoided developing cervical cancer. But what happens to all the women living in remote, rural area of Guatemala where access to health services is almost nonexistent? In many cases, these women have never attended a talk about cervical cancer and they don’t even realize they may be at risk. As a result, they do not get screened and there is a higher chance for cervical cancer to develop. If caught early, cervical cancer is highly preventable and treatable. It should not be the number one cause of cancer-related deaths in Guatemalan women.
This is where we are asking you to step in. We are aiming to screen almost 4,000 women for cervical cancer this year and you can help us make this happen. Join our Mother’s Day campaign today and make a donation to WINGS in the name of the mother you wish to honor. We will send you a beautiful personalized card for her, explaining the impact her Mother’s Day gift is making. Help us save lives!
In Guatemala, cervical cancer is the number one cause of cancer-related deaths among Guatemalan women. While the disease is preventable and highly treatable if detected early, in countries like Guatemala where healthcare is largely inaccessible, it’s a grim story.
Inadequate health centers, lack of knowledge, and geographic barriers make it difficult for women to get screened for cervical cancer in Guatemala. Ten years ago, WINGS developed its Cervical Cancer Prevention Program to overcome these challenges by providing visual inspection with acetic acid and immediate cryotherapy treatment for pre-cancerous cells. We continue to offer these life-saving services in stationary clinics in Sololá, Cobán and Antigua, and through our mobile clinics, which travel to the most remote areas of the country to reach underserved women. We have provided lifesaving services to improve the lives of thousands of women in Guatemala, even within our own team!
41 year old WINGS’ Nurse Rosy was born in a rural community in San Cristobal, located in northern Guatemala. Rosy travels every month with our mobile team to provide family planning information and contraceptives to the most remote areas of the country.
Like many of the girls and women we serve, Rosy has faced many challenges in her life. When she was only 15 years old, her family forced her to marry a man who turned out to be abusive. Sadly, in Guatemala it is very common for young girls to be married off without their consent. Rosy suffered through her marriage because, similar to many women in her situation, she didn’t have a say in any decisions. Although Rosy was finally able to separate from her husband, the difficulties persisted. As a single mother, Rosy had to figure out how to make ends meet so she could feed her four children and send them to school. Luckily, her former father-in-law was very supportive and encouraged her to go back to school.
Rosy and her family had never received any information about reproductive health and prior to resuming her studies, she knew very little about her own health in general. As a child, she lost her mom and aunt to cervical cancer. Neither had ever been screened and Rosy was terrified that the she would face the same health burden.
However, as an Assistant Nurse providing these important services throughout Northern Guatemala, Rosy decided to undergo a screening with our team. Unfortunately, our staff discovered abnormal cell growth which could lead to cancer, but our team treated Rosy immediately.
As Rosy shared with our team that day, “I am truly grateful to WINGS for supporting me and allowing me to keep being a mother to my children. I now have my nursing diploma and I am so proud to be able to help people who need it. I am thankful for the opportunity to work with WINGS; I love every part of my job. I give educational talks to different communities in my native Mayan language; I provide different birth control methods; and I screen women to help prevent cervical cancer. This work is so important and I hope that I can keep doing it forever.”
Like Rosy’s aunt and mother, there are thousands of women in Guatemala who do not know about the causes of cervical cancer and how to prevent it. WINGS has worked endlessly to change this and provide information and reproductive health services to Guatemalan women in need. In 2015, we surpassed our cervical cancer screening projection by 141%, ensuring that 3,062 women were able to undergo preventive screenings. And in the first three months of 2016 alone, we have already provided 496 cervical cancer screenings. Moving forward, we will continue providing these imperative services, thanks to your unwavering support.
To support women like Rosy, make a donation to WINGS today.
“Cervical cancer is a problem that not only affects women, but the entire family. There is a lot of emphasis on reducing maternal deaths, that is to say, pregnancy related deaths. But what happens to those women who die from cervical cancer? They also leave behind family, children left without a mother now even more vulnerable to violence, poverty, and malnutrition, among other things.” –Michelle Dubon, WINGS´ Medical Director
In many countries, the incidence of cervical cancer is kept low by regular screening. In Guatemala, where an effective countrywide screening program is lacking, cervical cancer is responsible for 60% of female cancer cases attended by the INCAP Cancer Institute in Guatemala City.
In fact, cervical cancer is the number one cause of cancer-related death among Guatemalan women. Risk factors such as multiple births with little spacing between pregnancies and becoming sexually active at a young age put women in greater danger of developing cervical abnormalities.
“The sad fact is that this cancer does not appear overnight; the natural course of this disease takes up to 20 years. That is why no woman should die of cervical cancer; there are so many methods to detect and treat it in time, which is why our efforts and resources should be focused on helping these women.” –Michelle Dubon, WINGS´ Medical Director
Where screening programs exist, cervical cancer mortality has been reduced by 90%.
WINGS has been providing cervical cancer detection and treatment services since 2001. Beginning with 840 Pap smears in 2001, the program has grown fivefold and now provides up to 4,000 screening tests annually, as well as needed follow-up treatment. Over the course of 15 years, WINGS has screened over 50,000 women for cervical cancer.
Through our Cervical Cancer Program, WINGS ensures that Guatemalan women living in hard-to- reach and often forgotten rural areas receive vital information, cervical cancer screenings, and follow-up treatment when problems are detected.
In 2006, WINGS started to use an alternative method of detection and treatment called VIA/Cryo or “see and treat”. This method involves using acetic acid to visually inspect the cervix and the provision of cryotherapy treatment all in one visit (VIA/Cryo). It is a very effective, low-cost technique, which allows for immediate detection of cell abnormalities and treatment if necessary, eliminating the need for women to return for results or a follow up treatment. It also presents fewer logistical and technical constraints than the Pap smear.
In 2015, Veronica, 21 years old and a mother of two, came to a WINGS clinic to get a long-term method. After listening to the information talk given by WINGS nurses, she also decided to be screened for cervical cancer. She was nervous to get screened and afterwards shared, “Before today, I didn’t know this kind of cancer existed. I had my first child at 18, so I was nervous to get tested because I learned that being sexually active at a young age is a risk factor for cervical cancer. Thankfully, my result came back negative.”
And most recently, this year 87-year-old Maria had her first screening ever. A mother of 12, she encouraged her daughters and daughter-in-laws to attend as well. In her own words, Maria “wanted to be a good example.”
As reproductive health is considered a taboo topic in Guatemala, many women are uncomfortable learning and talking about cervical cancer. During an informational talk given by our nurses in Quiché, a province in northern Guatemala, women immediately lowered their heads and stared at the ground when the nurses showed photos of a cervix with cancer and a cervix without cancer; this made them very uncomfortable. One brave woman explained that most women were not interested in getting a screening because they had heard it involved their cervix being taken out, and they were very afraid of the pain. Our nurses thoroughly explained the actual process of a cervical cancer screening and why it is so important and in the end many of the women agreed to get screened.
On the other hand, women shared with WINGS nurses during a clinic last week in Santo Tomás Milpas Altas, that they understood the importance of being screened and had in fact gone to their local health center to get screened, but three months later they are still waiting for results. Every time the women call, the health center staff say that “the results aren’t ready yet”. Sadly they are used to this; the health center is continuously behind in their work, and in the end never provide the women with the help they need. During the same clinic, a few women mentioned that when they went to get a screening in the health center near their village, they were given a toothbrush and some form of liquid, and were told to insert the toothbrush themselves. That was the extent of information and instructions they were given. Thankfully WINGS was able to provide these women with accurate information about the screening process and immediate results after using VIA/Cryo.
How can you help? Support WINGS, and your donation will allow us to reach even more women in these remote communities with cervical cancer information, screenings, and immediate cryotherapy treatment.
Your donation of $100 provides 12 women in Guatemala with a cervical cancer screening, saving lives! YOU can help us reach over 3,500 women just this year with vital cervical cancer screenings.
Elma grew up in Chiqueleu, a rural village in the highlands of Guatemala. Having grown up in a remote location with scarce access to education or health services, Elma never learned about contraceptive methods or reproductive health.
She became pregnant at a young age. It came to Elma as a big surprise, mainly because she didn’t understand how one becomes pregnant. She shared that in her community no one ever talks about sex or family planning. Even though 69% of the population in Guatemala is less than 30 years old, sexual education still hasn’t reached most public schools, and HIV prevention programs have been focused on sexual abstinence and delaying first sexual intercourse.
When Elma told her boyfriend that she was pregnant, he said that the baby wasn’t his, and disappeared from her life, never to be seen or heard from again. Elma was devastated. Sadly, this is a common occurrence in patriarchal countries where gender roles are still very traditional. Guatemala is one of the most gender unequal countries in the world. Men are not typically held accountable and many people believe that solely women are responsible for their pregnancies. In Elma’s case, most of her community and family shunned her, launching her deeper into depression.
“Once I saw the results, I couldn’t stop crying, plus my boyfriend had just left me completely alone. I honestly came close to committing suicide because I could not find a solution. Luckily, I made the right decision and I’m still here.”
Elma says that 4 years ago, nobody in Chiqueleu had access to or knowledge about contraceptive methods. Now, WINGS has impacted her community tremendously by making contraceptive methods available and providing reproductive health education. Thanks to this, Elma has had the opportunity to further her education; she only has 2 more semesters left to finish nursing school! “I am going to continue seeking advice from the WINGS volunteer promoter so that I can continue to plan my life, finish my studies and move forward”.
Did you know that 1 in 3 indigenous women in Guatemala have no access to health and family planning services? Along with that, only 14% of indigenous girls in rural areas complete primary school. Guatemala has the highest fertility rate in Latin America and the Caribbean, it has among the highest rates of adolescent pregnancies, and one of the highest rates of unmet contraceptive need. Twenty-two percent of women give birth before the age of 18. One big issue is that once adolescent girls become mothers, they are far less likely to re- enter the education system. In fact, 40% of adolescent mothers in Central America never finish their education.
Education is positively associated with contraceptive use by increasing awareness, acceptability, and utilization of family planning services. It is critical that people learn about contraceptives so they can choose if, when, and how many children to have. It is equally as important to raise awareness and increase acceptability to sexual health so that these topics stop being a taboo in Guatemala. This will result in people not being afraid or embarrassed to seek counseling and information regarding their reproductive health. Reproductive health services are important so that all Guatemalans have the opportunity to complete their education, pursue their goals, and break the cycle of poverty in this country.
To support women’s empowerment and to break the cycle of poverty, WINGS has various different programs that have a direct, cost effective impact on education, poverty, health, and gender inequality.
Though we have stationary clinics in Antigua, Cobán and Sololá, we are aware that there are many women in need who are living in very remote areas of the country. For this reason, we also have mobile clinics that go out to those areas, to provide both short-term and long-acting reversible contraception, cervical cancer screenings, and treatment for the most commonly occurring STIs. We do cervical cancer screenings and same-day cryotherapy treatment for pre-cancerous cells that may lead to cervical cancer. We also offer affordable tubal ligations and vasectomies; the donation cost is typically Q50, roughly $6, but we cover the costs for those who cannot afford it.
We offer community-based counselling and distribution of low-cost short-term methods through our network of volunteer family planning promoters, who have an intimate linguistic and cultural knowledge of the communities they serve. They provide quality counselling, low-cost contraceptive methods and referrals to WINGS for additional services.
We also train young women and men (ages 14 to 19) as Youth Leaders who provide accurate reproductive health information and service referrals to their peers through community-based activities. We improve the quality of information and services by training staff members of women’s rights and youth organizations, public health service providers, and partner organizations.
In Elma’s words, “Here in my community, we had no contraceptive methods in the past. Women here have wanted access to these methods for a long time now. It was very hard for me to tell you my story, but I thank you so much for visiting me, for the advice you have given me, and for strengthening our families through reproductive health.”
Use the arrows above to look through the image gallery from WINGS Youth Leaders’ training.
WINGS’ Youth Leaders program trains young men and women from ages 14 to 19 so they can provide accurate reproductive health information and service referrals to their peers through community-based activities. Our methodology incorporates the topics of gender equality and power.
In Guatemala, many children do not finish their education; most only go up to third grade and then start working in order to support their families. Some sell fruits and vegetables in “mercados”, some work with crops in the fields, and others shine shoes for a living. In this environment with scarce opportunities or access to schooling, children grow up knowing little about their own rights and their health. For children who do continue their education in the public school system, the picture does not get much better. Though Guatemalan legislation states that public schools must teach family planning and reproductive health topics, the culture remains very conservative and sexual health is still taboo, hence in most schools, these topics are not even mentioned. Not knowing much about reproductive health or contraception options, many girls become pregnant at 15 or earlier.
Additionally, Guatemala is a very patriarchal society where women’s voices are frequently silenced, especially in rural areas, where traditional gender roles are still very prevalent. Sadly, violence against girls and women is common. There are many pregnancies that happen as a result of rape, sometimes by girls’ own relatives.
At WINGS we believe in promoting equal rights and we know it is imperative for youth to receive an education. Unintended adolescent pregnancies can be avoided through reproductive health education and access to contraceptive methods. By informing youth about their reproductive rights, we can reduce teen pregnancies, increasing girls likelihood to continue their education, and pursue their future goals.
Just in January, we have already held two Youth Leader training sessions, one in Cobán and the other in our Antigua office. In total, we trained sixty young men and women. Both sessions were a huge success; the adolescents asked great questions, gave important feedback, and were willing to participate in all our fun activities. Even those who were shy at first warmed up to the topics and to their peers. WINGS’ staff taught the youth about the contraceptive methods we offer. To make sure that the youth understood, they got into smaller groups to make presentations about each method, with banners and demonstrations about how to use each. To keep the activities fun and dynamic, we held rallies so that the youth could run outside and play while learning. In addition to talking about contraceptive methods and how to use them, we also talked about reproductive rights, gender equality, and sexual orientation. We are aware that Guatemala is still a very traditional society, so it is important that from a very young age, our youth learn to respect all types of diversity. It was great to see that despite having been brought up in a conservative culture, the youth readily accepted these topics.
This past year, we noticed some very important numbers. Out of all the 14-19 year old adolescents we work with, 81% chose short term contraception, while only 19% choose LARCs (long-acting reversible contraception), even though the latter are the most effective.
This year we implemented the LARCs First methodology. We explain all available birth control methods in terms of efficacy: beginning with the most effective (IUD and subdermal implant) and ending with the least effective method (condom). There are numerous misconceptions about LARCs in Guatemala: it is believed that they are only meant to be used by married women or women who have already had children, some think that they can make women infertile, or that they are permanent methods. For this reason, during our training program we strongly emphasize these contraceptive methods can be used by women regardless of whether they have had kids or not, and that they can be removed after 5 years (in case of the implant) or 10 (IUD), or earlier if the person decides to.
Our Youth Leaders program is made up of many intelligent, determined youth who bring such positive energy and hope to the work WINGS does.
* Click on the “CC” button to watch with English subtitles
Here is an interview with one of our newest Youth Leaders, Samuel. Samuel talks about why youth are embarrassed to talk about sex, why adolescent pregnancies are so frequent in Guatemala, and what his dreams for the future are.
It is thanks to your support that WINGS Youth Leaders Program became reality. Please continue empowering youth in Guatemala by making a tax-deductible contribution to WINGS.