Sexual and Reproductive Health in El Salvador and Lower Lempa

Too often, youth throughout El Salvador make poor decisions regarding their sexual and reproductive health, increasing their risk of an unintended pregnancy or contracting sexually transmitted infections. For many youth, their decision-making process is driven by misinformation, myths, and cultural norms, or they simply lack the empowerment to prioritize their health over other factors. While some in the NGO and government sectors have taken steps to empower youth with information about how to care for their sexual and reproductive health, risky behavior remains the norm. Unfortunately, social, cultural, and religious barriers continue to hamper their efforts.

In the Lower Lempa region of Usulutan, public health promoters and community leaders identify sexual and reproductive health issues as one of their primary public health concerns. Though data specific to the Lower Lempa is unavailable, public health workers estimate that communities in the region are consistent with national averages for rural areas.

A 2005 USAID/CDC report found that the average woman in a rural community has her first sexual encounter at the age of 16, while the average Salvadoran male in a rural community has his at the age of 15. By contrast, the average woman in the United States has her first sexual encounter at the age of 17.4, while the average man has his at the age of 16.9, almost two years later than the average Salvadoran man. By the age of 16, 75.5% of all men in rural Salvadoran communities have had their first sexual encounter, and 60% of their women counterparts have had theirs. The survey also found that for girls who had their first sexual encounter by the age of 15, 34.6% did so with a partner more than 20 years of age. The authors of the report conclude that such an age gap suggests that the reproductive health was likely compromised and that the young women likely had little say in whether or not the sexual activity was initiated.

The same USAID/CDC study found that during their first sexual encounter, only 10.3% of young women in rural areas contracepted. Conversely, 41.7% of young men contracepted during their first sexual encounter. Among unmarried women who failed to contracept, 45.5% state that they did not know they were going to have a sexual encounter and were unprepared, while almost 20% did not know of any means of contraception.

Of unmarried women, 28.5% believed that they could not become pregnant at the time of their first pregnancy. Their reasons varied. Over 25% stated that they did not have intercourse frequently, implying a belief that they had to have sex multiple times to become pregnant. Almost 20% of such women reported that their partners said they could not become pregnant, and they believed them. Over 18% stated that it was their first time, implying a belief that they could not become pregnant during their first sexual encounter. Over 10% believed that they were not old enough to become pregnant. Another 6% of women reported that their partner opposed the use of contraception, suggesting that they were either unable to insist on contraception, or willing to take the risk of pregnancy or contracting an STI. Of married women, 37.7% did not use contraception during their first sexual encounter because they wanted to become pregnant, and 20% did not know of any means of contraception.

The survey also found that 17% of all Salvadoran women have been pregnant by their 17^th birthday, and over 46% by the time they turn 20. Of all pregnancies by women between the ages of 15-24, 40% were unintended. Even in El Salvador, which has some of the strictest prohibitions against abortion, some women with unintended pregnancies attempt to terminate their pregnancy. While the number of illegal abortions performed every year is unknown, attempts to self-abort are the second highest cause of maternal mortality in El Salvador. It does not help that Salvadoran law requires doctors to report women who seek treatment for injuries caused during an attempted termination to the police, deterring women from seeking medical care.

Sexual encounters without proper protection also place youth at risk of contracting sexually transmitted infections, such as HIV/AIDS. Between 1984 and 2005, the Salvadoran government reported 15,609 cases of HIV/AIDS. In their 2005 El Salvador Country Report, UNAIDS reports that since 2000, El Salvador has averaged 1544 new cases of HIV/AIDS every year. While over half of El Salvador’s cases of HIV/AIDS are in the capital of San Salvador, cases in rural departamentos such as Usulutan are on the rise. Data on other sexually transmitted infections is unavailable. However, with the number of cases of HIV/AIDS on the rise, it is likely that other STIs such as human papillomavirus, genital warts, syphilis, chlamydia, gonorrhea, and others are increasing as well. Health promoters and community leaders are concerned that their youth are not protecting themselves, and that even a slight increase of infections could quickly spread out of control through the region.

These reports and data highlight the issues and needs that health promoters and community leaders in the Lower Lempa are too familiar with – that youth throughout the region must have greater knowledge concerning their sexual and reproductive health, and be empowered to make healthy decisions. Unfortunately, many barriers to an informed and empowered citizenry exist. Past efforts to implement educational programs in the schools have been met with resistance by the Church and members of the Central Government, as well as some community members. For example, the Ministry of Education recently prepared materials to integrate sexual and reproductive health into the national curriculum. Representatives from the conservative government and the Church edited the materials, however, and cleansed them of any discussions of contraception and to redirect the focus on abstinence. Similarly, though the Ministry of Health receives large quantities of contraceptive materials from the international community, the donations are rarely distributed appropriately. In the Lower Lempa, for example, the government’s family planning agency only provides clinics with approximately 30 condoms per month, which is hardly sufficient. And while women around the country recognize the need for contraception, Salvadoran society continues to follow the Church’s ban on methods other than abstinence and other natural methods. Similarly, El Salvador’s “machismo” culture continues to inform young Salvadoran males that getting women pregnant and having multiple partners are signs of ones’ masculinity.

Despite these barriers, women and men alike are more aware of the issues than the generations before them. When asked, the majority of youth in rural El Salvador want to limit the number of children they have to 3, and are willing to take the steps necessary to control the size of their family. And anecdotal evidence indicates that more women are seeking out long-term contraceptive options such as “the injection” and even hysterectomies. Such options are especially important for women whose partners refuse to use protection or do not want them to use contraception (men often believe that the only reason for their partner to use long-term contraception is because they are cheating on them). In 2005, the Salvadoran Association of Public Health (ASPS, in Spanish) completed two projects in the Lower Lempa that sought to improve awareness and knowledge of HIV/AIDS and reproductive health. The projects, though limited in their scope and duration, were successful and the communities they reached experienced significant declines in unwanted pregnancies and reports of sexually transmitted infections.

In order for Salvadoran youth to have greater control over their sexual and reproductive health, government institutions, NGOs, community leaders, parents, and all others must work together to empower youth with information. They must also work together to change the culture of sexual and reproductive health, so that women are more willing and able to express an informed and empowered decision, and young men respect their decisions. Women must have greater access to a contraceptive method that suits their needs and lifestyle, and their partners must work with them to affectively plan the size of their families. And while respecting long-standing religious and moral values, Salvadorans must be free to take a realistic approach towards preventing unintended pregnancies and sexually transmitted infections. But none of this will happen until society begins talking about the situation and does not back away from open dialogue.

Sources

- Montheit R. S., Stupp, P. W. & McCracken, S. D. (2005). “Reproductive, Maternal, and Child Health in Central America, Trends and Challenges Facing Women and Children. El Salvador, Guatemala, Honduras, Nicaragua.” Atlanta, GA: USAID/DRH/CDC. (p. 55).

- Kaiser Family Foundation. “U.S. Teen Sexual Activity Fact Sheet.” 2005

- UNAIDS (2005). “Country Report: El Salvador.” 2005

Food Security in the Lower Lempa

Last week, the United Nations World Food Program made the last of three food handouts to citizens of the Lower Lempa. Severe drought followed by flooding resulted in near 100% crop failure throughout the region last year, and families needed the donations to ensure their survival until the August 2008 harvest. The World Bank defines food security as “access by all people at all times to enough food for an active and healthy life.” Last year’s crop loss and the need for food handouts highlight how far El Salvador is from achieving “food security.”

While it is easy to attribute the current food shortage in the Lower Lempa to last year’s sever weather, the region’s unstable position and the nation-wide food crisis are rooted in bad economic policy and the government’s failure to serve the interests of all Salvadorans.

Since before the civil war ended in 1992, the Salvadoran government and international community have weakened El Salvador’s food security by promoting a neo-liberal, open market system that prioritizes the industrial and service sectors over the agricultural sector. The new economic focus favors foreign investment that requires cheap labor, and permits food imports to replace domestic products. Between 1979 and 1981, which was a period of great civil unrest, El Salvador exported $552.6 million more in agricultural products than it imported. Between 1989 and 1991that number dropped to $92.6 million more in exports than imports. By 2004, however, El Salvador was importing in excess of $456 million more in agricultural products than it was exporting. While levels of agricultural exports grew between 1991 and 2004, El Salvador became more dependent on imports for their food consumption. Then President Alfredo Cristiani led the movement by lowering tariffs on imports, deregulating agricultural markets, and promoting foreign investment. At the same time that he was lowering tariffs on imports, President Cristiani also set up a agricultural import business.

Fifteen years into these reforms, agricultural production is limited to large corporate farms that produce coffee, shrimp, cereals, and sugarcane for export, and small sustenance farmers that grow enough beans, rice, and corn to sell at market and feed their family. Sustenance farmers, however, are paying 80% more to plant their crops than they did even four years ago – the result of higher prices for seeds and agrochemicals (an industry dominated by a company owned and run by ex-president Cristiani), and higher rates on the agricultural loans needed to purchase them. Many farmers that receive remittances from family members living and working in the United States have stopped planting, while others have moved to urban areas to work in the industrial or service sectors. Small farmers that still cultivate their land have to produce enough so they are able to pay off the loans they took to by seed and agrochemicals, while setting aside enough to feed their family. With exceedingly tight margins, a bad year can be devastating and jeopardize their very survival. So when the drought last year killed the first crop and floods drowned the second, families in the Lower Lempa had to turn to the World Food Program for assistance.

The decrease in domestic food production and the dependence on imports has weakened El Salvador’s food security. With almost no control over market prices, Salvadorans are now subject to the ups and downs of the international market, which has seen a lot more ups (in prices) than downs. The recent oil crisis, for example, has increased the cost to transport food imports to the Salvadoran marketplace, causing drastic increases of food prices, even those produced domestically. The high oil prices have also increased the demand for bio-fuel, resulting in increased market prices for corn, a staple in all Salvadoran diets, and the main ingredient in the national food (the famed Pupusa).

While El Salvador is wise to expand other sectors of their economy, they ought not do so at the expense of their agricultural markets and food security. Government agencies ought to take affirmative steps to strengthen food security by raising tariffs on cheap imports, subsidizing small farmers and giving them greater access to regional and national markets, lowering or suspending taxes on domestic food products, encouraging more sustainable forms of agriculture, and taking other such measures. While some solutions may be counter to the global movement towards open markets and free trade, El Salvador has to achieve a certain level of economic and social stability before it can participate in or realize the advantages of a global market.

Instead of considering some of these options or directly addressing food security, the central government has proposed a new Ley de Arrendamiento de Tierras (The Law on Renting Land). While proponents of the law claim it will increase domestic food production, many Salvadorans see it as another attempt by El Salvador’s wealthy to take their land from the poor. Their fears are well founded. Ever since land reforms of the 1980s limited the amount of land an individual could own to 245 hectors (605.4 acres), wealthy land owners have tried to retain or get back their land, while the poor have struggled hold on to the land they have.

If passed, the new law will require individuals and cooperatives to “rent” fallow or under-cultivated land to corporations or individuals so they may cultivate it. The tenants will pay the owners of the land a monthly rent or a percentage of the sale price of the crops. If the tenant makes improvements to or investments in the land, the owner of the property must compensate the tenant at the end of the lease agreement. For example, if a tenant plants lime trees and installs an irrigation system to produce export quality limes, at the end of the lease agreement the owner will have to compensate the tenant for the value of the trees and irrigation systems. If they are unable to do so, the tenant will have the right to continue farming the land indefinitely. While domestic food production is important, it is unlikely that tenants would plant the beans, corn, rice, and produce necessary to increase food security. They are more likely to plant crops for export, which will have a higher return, and require capital investments that the owners will be unlikely to compensate them for. 

Communities, organizations, and farmers in the Lower Lempa, however, are not waiting around for the Salvadoran government to alter its failed economic policies. Instead, they are organizing to promote food security within their micro-region, through communal gardens, alternative forms of agriculture, crop diversity, and improved infrastructure. In addition, they are initiating advocacy initiatives to influence policy-making at the regional and national regions.

In Community Otavio Ortiz (C.O.O.), for example, community leaders are organizing 50 families to each plant a plot of tomatoes, green peppers, cucumbers, radishes, and eggplant. With proven success in several pilot gardens around the community, this year C.O.O. is likely to meet their entire demand for vegetables and produce from their own local gardens. In doing so they are limiting the costs of production by eliminating all middlemen, transportation costs, and taxes, and significantly improving their level of food security. And though Salvadoran farmers generally do not plant in the dry season, C.O.O. will rotate four irrigation systems between dozens of plots of land, allowing farmers to continue growing corn and vegetables throughout the year and save crops they might otherwise loose during periods of drought. In addition, the Presbyterian Church in the U.S. donated an 8-ton truck to the community so they are able to transport excess products to markets outside there region, freeing them from the high costs of outside transportation.

United Communities, a local grass roots organization, is helping C.O.O and other communities in the Lower Lempa, address the flooding issue that contributed to last year’s crop failure. They are organizing community members to clean and expand the drainage system (with the help of bulldozers and excavators) that will channel floodwaters into the Bay of Jiquilisco. In addition, they are experimenting with more flood resistant varieties of crops such as rice and sesame seed. United Communities also promotes organic and alternative agriculture to break the dependence on agricultural loans and expensive agrochemicals, as well as improve the health of the farmers and their environment. With assistance from Horizons of Friendship, Voices on the Border, and others, United Communities recently began offering women in the Lower Lempa low-interest loans to purchase cattle, one of the main agricultural products in the region.

Communities and organizations in the Lower Lempa are also joining together to fight the Ley de Arrendamiento de Tierras and to prevent large corporations from taking over their land. La Coordinadora del Bajo Lempa, United Communities, representatives from directivas and other local governments, Procaris, and many others have formed the Land and Agricultural Defense movement. The group came together after the government’s recent exclusion of communities in the Lower Lempa from a program that distributed agricultural packages (fertilizers and seed) to small farmers. As with many other government programs, the aid was distributed to benefit the ARENA party’s electoral interests. Communities further east in San Augustin have also joined the movement after surveyors with armed guards appeared and began taking notes on specific plots of land. The group will also address other land use issues that threaten their agricultural community, including corporate and transnational tourism agendas, the promotion of genetically modified seeds, and the need for a national policy to support local agriculture.

So while hundreds of families picked up their supplies from the World Food Program trucks in a somewhat festive atmosphere, community leaders and organizations throughout the Lower Lempa are working hard to eliminate the need for such aide. They are augmenting and diversifying local food production, addressing infrastructural needs, organizing and informing farming families, advocating for the rights of campesinos in their communities and all of El Salvador, and other important measures. In addressing their own food security needs, they are creating a model for other regions in the country.

Voices on the Border – Introduction

Welcome to the Voices on the Border (Voices) blog we’ve titled “Voices from El Salvador.”

Voices is a non-profit, grassroots network of individuals and organizations promoting just and equitable development in the departments of Usulután and Morazán in El Salvador.

We’re launching this blog on July 3, 2008; our goal is to provide you with up-to-date information about our activities and our partner communities in El Salvador and the U.S. In doing so, we will put local issues into context by highlighting and analyzing regional, national, and international development and social justice issues.

A little about Voices…

We began our work in 1987 as a project of accompaniment with over 10,000 Salvadoran refugees in Colomoncagua, Honduras and in other refugee camps. In 1989 and 1990, Voices accompanied these refugees as they returned to El Salvador. Upon their return, many refugees founded Comunidad Segundo Montes, in the northern department of Morazán, while others moved to the Lower Lempa region of Usulután.

We have continued accompanying our Salvadoran partners for over twenty years, responding to their needs and priorities, facilitating partnerships with U.S. communities and other international organizations, advocating for justice and equality, and informing U.S. citizens of the realities in El Salvador. At any given time, we are engaged in a number of activities, including:

1. Grant making
2. Community organizing
3. Leading delegations to Salvador
4. Initiating and supporting development projects and activities
5. Advocating for social, economic and political justice
6. Other activities that further the social justice and development interests of our partners

Voices strength is in our small staff, active board, and network of individuals, organizations, and communities that partner in our activities and support our programs. As we have for over twenty years, we continue to draw our energy and inspiration from our local partners in El Salvador, who face challenges and struggles with grace, humility, and determination.

If you’re interested in more information about Voices and the work we do, please visit our website – www.votb.org. I also welcome you to write us at voices@votb.org or call our Washington D.C. office (202) 529-2912.