The school attendance rate in Guatemala is lower for girls than it is for boys, with a significantly higher drop-out rate for girls than for boys. In rural areas, 66% of girls who enroll in first grade drop out of school before they complete the third grade. The Guatemalan Association for Girls' Education in cooperation with different social and economic sectors of Guatemalan society as well as with nongovernmental and international organizations has therefore promoted a number of actions to strengthen formal primary education for girls based upon a national needs assessment and plan of action. The association has promoted the development of research, communications, advocacy, projects, and educational materials. Educational materials were developed to respond to the educational needs of Guatemalan girls, especially those of Mayan origin, and are comprised of a teacher's packet including a manual, flipchart, posters, books, and worksheets, as well as a collection of storybooks which all complement each other. The versatile materials were developed with the input of parents, community leaders, teachers, and boys and girls, and highlight the value of girls while encouraging the development of their self-esteem. The materials focus upon the ways in which the education of girls contributes to personal, family, and community well-being. Their versatility allows an emphasis to be placed throughout school curricula on girl's education.
In a study on anemia in adolescent girls living in slum areas, 105 girls, aged 10 to 18, participated in qualitative (focus group discussions; open ended, in depth interviews) and quantitative (structured survey and hemoglobin estimation) research activities before and after intervention. Perceptions of mothers were also surveyed. The qualitative methods were used on selected subsamples in order to represent all age and ethnic groups and geographic areas of the slum. Quantitative methods were used on all 105 girls. The prevalence of anemia was 98%. The patterns of responses were similar for the focus groups, interviews, and surveys. Mothers and their daughters believed the girls were healthy (" one who ate well, worked without tiring easily and did not fall sick often"). There was no major connection made between menstruation and health, or between present and future health. Most of the girls were unaware of the Gujarati term for anemia, pandurog, which is used in awareness campaigns. The girls described symptoms (weakness = kamshakti) associated with anemia and knew these could be remedied with green leafy vegetables, fruit, milk, meat, tonics from the doctor, and iron tablets (shakti ni goli). Based on these results, a puppet show, using local terms and events, was developed that covered the causes, symptoms, treatment, and prevention of anemia. The term, pandurog, was introduced and reinforced. The girls were encouraged to have their blood tested and to take iron tablets. The hemoglobin levels of the girls were taken after the show and after an iron supplement program lasting three months. Compliance with the supplementation program was monitored biweekly. Group discussions with flash cards reinforced the information in the puppet show. Results from the last hemoglobin level showed a significant increase; however, the prevalence of anemia was 87%. About half of the girls consumed at least 60% of the tablets; one-fifth consumed 80%. Forgetfulness and fasting during Ramzaan were cited as reasons for noncompliance. There was a significant increase in awareness of the term, pandurog; the symptoms of anemia; the importance of diet in preventing pandurog; and the role of menstruation in increasing iron needs and contributing to pandurog.
The Tanzania Media Women's Association (TAMWA) is a nongovernmental organization of female journalists who wish to better the status of Tanzanian women via the mass media, particularly radio and television. Their main objective is to promote and disseminate information on women's health. 51% of the population of Tanzania are women. These women are the main producers of food and cash crops. Women, even during pregnancy, work 18 hours a day in the field; men work 3 to 6 hours. Since male children are given preference for food, girls are often underdeveloped when they reach puberty and about 80% of pregnant Tanzanian women are anemic. Health programs are geared for mothers only. TAMWA uses mainstream media to remedy these problems. Mazungumza baada ya habari, a 5-minute editorial program on Radio Tanzania, is often used to discuss women's issues. Sauti ya Siti, a magazine, is produced by TAMWA to educate women about health issues and strategies to improve their daily lives. Brochures containing information on reproductive health are distributed to villages, schools, and colleges. In association with the Medical Women's Association of Tanzania (MEWATA), TAMWA holds an annual (May 28) community meeting of women, experts, and politicians to discuss problems in women's health and possible solutions. The results of these meetings are later published by TAMWA. An ongoing research program monitors the incidence of rape, abortion, maternal mortality, and other issues of interest. A major review of laws affecting reproductive health is underway. Since the media is male oriented and prohibited from taking an assertive public policy role, traditional structures need to be challenged to advance the status of women in Africa. Public opinion, as well as the law, must change.
The Comite Tecnico de Apoyo a la Lactancia Materna (COTALMA), the Technical Breastfeeding Support Committee, was founded in Bolivia in 1989. It is financed by the United States Agency for International Development (USAID) and the United Nations Children's Fund (UNICEF). It is administered in coordination with the Ministry of Health (MOH). MOH and UNICEF choose the hospitals, who send teams that include a pediatrician, a gynecologist, a nurse, and a nutritionist. The first phase of the course (5.5 days) covers the scientific background of breastfeeding. A baseline study is then planned and conducted at each hospital. 2 to 3 months later, the second phase takes place during which data is presented and breast feeding programs are developed for each hospital. Communication, training, counseling, and planning and evaluation are covered. Practicums are conducted at hospitals. Trainers are usually members of COTALMA. The person in charge of maternal and child health services at MOH lectures on national health policies concerning mothers and children. Training includes use of the national health card, breastfeeding and child survival, and breastfeeding as a family planning method. Culturally appropriate course materials, which are in Spanish, are adapted from those developed by Wellstart International. Articles by COTALMA members and others are added. Participants are encouraged to train all staff at their institutions.
Safe motherhood training may be undertaken for different purposes: 1) increasing the awareness of safe motherhood concepts among policymakers; 2) improving the job performance of maternal health care providers; 3) expanding the responsibilities of midwives and traditional birth attendants (TBAs); and 4) mobilizing new maternal health workers for the delivery of maternal care. The main functions of community pregnancy monitors (CPM) are to: identify pregnant women as early in pregnancy as possible; monitor pregnancies and postpartum periods, recording problems and events; look for and educate family members to look for danger signs in pregnant and postpartum women and newborns, and refer same; measure maternal nutritional status, weight gain, arm circumference, and check for anemia; insure pregnant women receive care not available in the community: maternal tetanus toxoid immunization; iran folate tablets and family planning supplies; promote self care, healthy nutrition, breast feeding, and safe, hygienic birth. Primary health care workers, TBAs, and midwives should be trained to perform emergency obstetric care in a timely and culturally sensitive manner. Safe motherhood activities involve women, community members, and health care providers in the development of strategies and materials; create awareness among policymakers, planners and the medical community about the need to expand the role of midwives; and strengthen the linkage between TBAs and modern health care providers.
