In continuation of our Virtual Delegation series on Women’s Rights in El Salvador, we hosted Dr. Miriam Cremer from Basic Health El Salvador to discuss her more than 12 years experience addressing women’s health issues in El Salvador. Over the years, Dr. Cremer has initiated many programs around the country to provide cervical cancer screening, reproductive health education, and training of local health professionals. In addition, she has partnered with local doctors and organizations to conduct surveys on sexual behavior, knowledge and attitudes about reproductive health services and contraception, and other related topics.
Dr. Cremer and Basic Health El Salvador lead several delegations a year, many of which focus on screening women for cervical cancer and training local health workers to conduct screenings. Because cervical cancer is the leading causes of cancer mortality among women in El Salvador, Dr. Cremer’s team stresses the importance of screening and treating women in one visit, so to avoid barriers such as transportation or day care for children from interfering with follow-up visits.
When asked about conducting surveys in El Salvador, Dr. Cremer responded that the women in the communities where they have conducted surveys are more than willing to participate, though the more sensitive the question the more conservative the answer. For example, when women are asked how many sexual partners they have had, the most common answer is one, and when women answer two they are quick to add that their first husband was killed in the war, or something of the nature. This suggests that the participants either have very few partners, or that some are not completely honest about their sexual behaviors, despite their willingness to participate. Younger women are the exception, and are beginning to report more sexual partners, either suggesting that they indeed have more partners than women of previous generations, or that they are more comfortable discussing such issues with their health care providers.
Dr. Cremer also discussed her experience with promoting methods of family planning. In El Salvador the most common form of birth control is Depro Prevara injections, though many women choose tubal ligation, even among young women under 30. In focus groups in the United States, most of the women who have a tubal ligation before the age of 30 express regret about their choice. The same is true in El Salvador, though its reliability and accessibility make it a popular option. Dr. Cremer suggested that the relative high rate of tubal ligations is also due to a lack of alternatives being offered by health care providers.
Dr. Cremer also explained that other forms of birth control, particularly oral contraceptives and injections, are used with frequency but are often less than ideal for most women because they must make frequent visits to their doctor for injections or pills, which is often difficult for women who work or have children. Given the MInistry of Health’s small budget, sometimes these forms of contraception are unavailable, meaning that women who use them are often unprotected. Considering all of these factors, Dr. Cremer has found that intra-uterine devices (IUD) are one of the most effective forms of long-term contraception. IUD insertion requires only a single visit to a health provider and is effective for a long period of time, in most cases 5-12 years. The main obstacles to greater IUD use are cultural myths and misconceptions, which could be dispelled with greater education and outreach.
Please join us next week – our panelists will include two rural health workers who will talk about their experiences providing health care to women and families in the Lower Lempa region of El Salvador. For the call in numbers and more information, please drop us a note at email@example.com.