How do we fight the monster now? The women's health movement today. (Panorama).

A Shared Dream: Latin American and Caribbean Feminism

It was wide-hipped continent to the south, with an ample bosom in the north and, the envy of all, a slender Central American waist, decked out with lush tropical islands. Throughout this continent of Latinas, a marvelous multicolor Diaspora of women sung out in a polyglot of languages and tonalities. They were joined through networks of Afro-American or indigenous women, networks of young people in defense of sexual and reproductive rights, networks working for education, health, and a wide-range of rights, campaigns and conventions. They had organized in order to defend their freedom, autonomy and civil rights, in their own abused motherlands which mourned the increasing numbers of daughters suffering from hunger, unemployment, violence, discrimination and preventable illnesses.

And the situation only threatened to grow worse. One day, the women who were working for the decriminalization of abortion, sexual and reproductive rights, the prevention of HIV/AIDS and other health concerns, found themselves at a crossroads: they needed to learn how to defend themselves. And so they sought out their sisters who were experts in the issue of rights... But the monster continued to block their advances with reforms, and so women with knowledge of the economy, international banks and academia joined in the struggle... and this network of women continued to grow... until one day, they took a vacation to sunny Brazil, where they danced in a joyous carnival that clamored for an alternative world, drunk on the idea of sustainable development, the promise of a good world today and an even better one for their grandchildren tomorrow.

With all of these enriching experiences, Latin American and Caribbean women have grown even stronger and more beautiful, because now we know the songs of our indigenous peoples, chanted to the rhythm of African drums, with a chorus in Portuguese, Spanish, English, French, Chicano and an endless blend of dialects. In a crescendo to rival Ravel's Bolero, women from around the world enthusiastically shared their bread and roses with us...

...And who wouldn't be thrilled to share in this dream? What about you? Don't you want to join in the chorus?

Women's Health is Key

Health is the very best indicator of a people's well-being and a measure of society's sustainability par excellance. It is also indicates the level of our democracies' maturity and development.

But health itself is the undeniable result of a combination of numerous factors, both tangible -- nutrition, housing, potable water, basic services, education, protection, freedom from individual and social violence -- and intangible -- trust in social networks, individual and social self-esteem, a sense of belonging, expectations of justice and equity, freedom from discrimination, liberty.

Health refers directly to issues of rights, citizenship, participation and sustainable development. For this reason, few issues are as politically significant as health.

And women's health also involves another factor: the chance to exercise sovereignty over our own bodies -- a complex interaction of body-mind-citizenship.

As a result, those of us who work for health from a feminist perspective understand that we are dealing with the very heart of the patriarchy's raison d'etre, hidden behind fundamentalisms both old and new. This realization challenges us to take action based on lessons we have already learned.

Regional Realities

The history of the Latin American and Caribbean region displays a complex mesh of identities and differences. Borders have ebbed and flowed. Today's realities demonstrate a tendency to homogenization, which we see in the following crucial aspects of the current context:

1. The different applications of the neoliberal model in our countries (read, the Washington consensus) has provoked an increase in levels of poverty that has seriously affected the middle class and aggravated the already marginal conditions of our region's poor. This impact is clearly evident in:

* The economic crises which are most notorious in Argentina, Uruguay, Central America and Brazil, but which actually affect all our countries;

* Growing numbers of unemployed or under-employed professionals;

* A unprecedented number of migrants within our countries and the region as the result of economic violence (Argentina, Peru, Venezuela, Central America, etc.) and/or war, as in the case of Colombia; and

* The financial and administrative crises of the State apparatus and the proposed remedy: the folly of reducing the State to the bare minimum by selling the administration of public services to the private sector, arguing that this will guarantee efficiency, transparency and universal coverage.

2. The events of September 11 threw a spotlight on the United States' repositioning with regard to Latin America and the Caribbean. Once again, our region is being seen as the "backyard" of our northern neighbor. This wave of neo-interventionism is evident in a variety of phenomena, for example:

* The discourse against "terrorism" allows the U.S. to "penetrate" Andean countries and justify these actions with the excuse of fighting narco-terrorism, which would have been much more difficult prior to September 11. Colombia, Venezuela, Bolivia, Peru and Ecuador -- it doesn't matter if the countries are voluntary allies or if they are merely trapped by geography; the "fight against terrorism" provides a ready-made cause which can be used to justify short- or medium-term military action. The natural reaction to the dramatic events of September 11 sets the stage for support in the mass media, which sways public opinion in favor of the "fight against evil" or the against "enemies of civilization," etc.

* The political leaders in countries in economic crisis (Peru, Colombia, Mexico, etc.) -- plagued by episodes of corruption, fiscal and administrative crises and diminishing credibility -- are also relieved by President Bush's call to arms. This distraction is a real life-saver in these troubled times, and as a result, they are willing to lend any support required.

3. The New Right: Latin America and the Caribbean have not been immune from the appearance of a New Right that seems to spring from the most sincere liberalism: the protagonists are relatively young, and some are even female, a far cry from their right-wing predecessors, overwhelmingly austere men in their sixties with solid religious identifications and poor mass media appeal. The New Right is technologically savvy and comprised of younger politicians whose discourse targets a younger population. They appear to offer alternatives to corruption; they seem quite knowledgeable about economics; and to some extent, they even criticize the traditional power structures within their countries. They are excellent communicators, and several have studied at prestigious U.S. universities, such as Harvard. Many of these new power brokers are grooming themselves for the presidency, and they find their support in an disgruntled and de-politicized population that has been frustrated by years of disappointment. Clear example s are found in Peru, Brazil, Colombia, Chile and Central America.

4. The current global reorganization is evident in a number of transnational expressions: among Bush's peers in Europe and especially in Spain, gateway to Latin America and the Caribbean. At the same time, the Catholic Church has already begun to take action with renewed vigor on issues such as emergency contraception, terrorism, peace and good vs. evil, taking up its banner against gays, lesbians, "sinners," migrants, etc. The Church's discourse targeting the poor has been replaced by the commitment to "values." The pre-Cairo notion of "family" has been reestablished as central to society, and many of the gains we had achieved in the recognition of different forms of families have fallen by the wayside... Once again, the Day of the Unborn is being celebrated with the support of the New Right, and the "First Ladies" of our nations leap at the chance to take up this cause.

Ironically, the champions of "good" fail to recognize the schizophrenia of their arguments. Even as President and Mrs. Bush proclaim their support for Afghani women, they simultaneously take actions that repress the sexual and reproductive rights of all women.

5. Health Sector Reforms, solidly backed by the World Bank, are another white elephant whose failure indeed may be witnessed by the whole world. These reforms are supposed to improve quality of care, ensure universal coverage, and subsidize demand, but in reality, far from achieving

these goals, the current models are resulting in increased privatization and inequality, with a direct impact on women. Real coverage has decreased; waiting times in the public services have increased; and the traditional benefits of public health care continue to wane. Public hospitals are closing in the face of serious financial crises, and already impoverished by these global realities, health workers -- as well as the general population -- are enduring a decline in the coverage and quality of care.

The reform models evade gender equity and the concept of women's sexual and reproductive health and rights, and in some countries, we actually have seen reverses in the minimal gains we have made in these areas. This situation, in conjunction with the deterioration in the health services and the generalized impoverishment which overwhelmingly affects women, threatens us with a degrading future. The women's movement must call attention to this dreadful reality.

It appears as if health is no longer regarded as a basic human right in a people's development. In this context, the superior levels of education and health in Cuba, a country which receives no funding from the World Bank, gives us pause, especially when we consider the situation in the rest of our region.

Similar criticisms could be raised regarding the reforms being implemented in other sectors throughout our region: models seem to be passed along like so many photocopies. Perhaps the most worrying, because it is the most far-reaching, are the reforms of the State apparatus, implemented at the cost of a number of unrecognized contradictions, tax increases at even the lowest levels, and increased debts to the international banks.

At the same time, protectionism of the goods produced by the so-called "central" countries weakens the production of the "periphery." Our region is threatened as our countries are divided by the individual negotiations of the Plan Puebla-Panama, the Plan Colombia, and especially, the Americas Free Trade Agreement, which subordinates us to the protectionist interests of the United States, which defends free trade on one hand while setting limits against competition from the Latin America and the Caribbean.

For example, a new agricultural law in the United States increases subsidies to U.S. farmers by more than 80% over the next ten years. The health movement should not ignore the importance of the sensitive issues of food security, which the poor women of our region resolve through survival tactics.

6. The weakened and fragmented civil society of our region may come up with a few surprises in the search for viable alternatives. From the indigenous movement in Chiapas to the systems of exchange or barter rediscovered by Argentina and other countries, we are witnessing a variety of inventive reactions. But these strategies may never quite gain the momentum necessary to forge a clearly-expressed resistance to the imposed model of development. The efforts evident at the World Social Forum "Another World is Possible" are just beginning to gain strength, and the very diversity that enriches these expressions is, for now, their Achilles heel.

Today, the possibilities of ongoing exchange that would foster a more fluid dialogue among the civil movements of our region are being weakened by the withdrawal of international cooperation, which is currently the fundamental or principal resource.

Nonetheless, collaboration among the civil societies of our region is a challenge that must be faced. And women and the feminist movement have a significant role to play in this effort.

Learning from Our Experiences

During the past decade, the feminist movement was stimulated by the need to participate in the different United Nations summits. At these international events, and especially in Cairo and Beijing, we gave our all to ensure that the ideas of women were present. But above all, we began a process that is has yet to be fully analyzed: our development as interlocutors with decision-makers at national and international levels to a greater degree than ever before.

In every country, women organized. We shared the contents of the final documents from the conferences, and we promoted these platforms for action with varying degrees of success. In any case, our demands that our governments' meet the commitments that they signed at these conferences have resulted in poor quality interpretations that cannot be sustained over time.

Nonetheless, these ideas took wing. Around the world, many more women than ever before were joined in a common cause.

Like a pyramid, this unprecedented but tremendously significant effort gradually was focused in the most organized expressions of the women's movement. And through this process in which we learned so much, we also became aware of some serious differences within the movement, our own diversity: regional, ethnic, religious. Differences of opinion flourished and often resolved themselves in an exhausting, but very worthwhile process.

Moreover, the demands of high-level political participation did not allow us much time to analyze and incorporate these differences. Or perhaps we were not prepared to fight a battle on two fronts at the same time: the external struggle with the powers that be and the need to resolve internal differences.

In terms of health issues, some significant consensus was reached among broad sectors of the feminist movement around issues such as abortion, contraception and the very concept of sexual and reproductive rights.

The conferences also forced the movement to take a serious look at women's health in the contexts of development, macro-economic realities, the environment, etc.

Nonetheless, the follow-up meetings to the UN summits generally have lost strength or momentum over time, and regionally, such efforts have been reduced to the more-or-less sustained actions of a few networks.

The Latin American and Caribbean Women's Health Network is proud of having one of the more successful of such undertakings. Our efforts to monitor the ICPD in seven countries of the region will be available in the form of a database for use by the movement in 2003.

Women Take Action

It is tremendously encouraging to see that the movement is undertaking a number of initiatives that are not merely reactive, but proactive. One such action is the September 28 campaign to decriminalize abortion that has been promoting activities throughout the region since 1990. This important undertaking strives to decrease rates of maternal mortality, to increase the effective implementation of laws that allow abortion, to amend laws that criminalize the voluntary termination of pregnancy, and to ensure the provision of humane health care for women who choose to abort or who seek care for the complications of clandestine abortions. Organizations in 18 countries throughout our region currently take part in this annual campaign which is promoted widely by five of the most representative networks of region: CLADEM, REPEM, Catolicas por el Derecho a Decidir (the regional branch of CFFC), DAWN and LACWHN.

CLADEM is also promoting the campaign for the Inter American Convention for the Promotion and Protection of Sexual and Reproductive Rights, an initiative that resulted from the collaboration of a large number of women's organizations and networks. It is hoped that with more widespread support, the convention will be approved by the UN.

The movement also takes action on other issues through calls for solidarity, public demonstrations and international campaigns on a variety of issues, some on historically significant dates, such as May 28, International Day of Action for Women's Health, and. November 25, International Day of Action Against Violence Against Women.

Another feminist initiative is taking root within the World Social Forum, "Another World is Possible," in which the central topics of regional and global development intersect with issues essential for the full exercise of women's civil rights.

We must also recognize the important initiatives promoted by Isis Internacional which provides the headquarters for the Red Feminista Latinoamericana y del Caribe contra la Violencia Domestica y Sexual (Latin American and Caribbean Feminist Network Against Sexual and Domestic Violence) and by the group Comunicadoras del Sur (Communicators of the South) which works in collaboration CIMAC, ALAI and other regional organizations and groups.

This is just a rough sketch of the many lessons learned by the movement. It does not pretend to reach some grand conclusion, but rather to share some extremely important concerns for today. In conclusion, we should focus on the following questions:

* What are the primary political lessons that we can draw from the past that will help us confront the setbacks we envision just around the corner?

* What unresolved problems within the movement paralyze our joint actions, and what can we do about these situations?

* What are we willing to negotiate in order to unite our efforts and confront those who are themselves increasingly united in their campaigns against women's sexual and reproductive health and rights?

* Where should we focus regional political pressure?

* Can we trace a map of the actors involved that will facilitate our identification of strategies?

* How can we confront global fundamentalist policies?

This is not an unattainable dream; it is a real possibility that can be realized when regional women's networks pool their efforts to facilitate initiatives that will benefit us all, for example, by coordinating a framework for negotiation with international agencies of cooperation. At the very least, these efforts will draw attention to the role of women's health in development. When we manage to achieve this unity, the diverse emphases of our efforts will come together responsibly in a generous and complementary synergy.

RELATED ARTICLE: Final Document from the Latin American and Caribbean Discussion Group

We, the Latin American and Caribbean women present at the 9th International Women and Health Meeting, wish to share our final conclusions after analyzing the current global context which imposes multiple forms of fundamentalism: religious, political, cultural and economic.

We reject the neoliberal globalization and economic policies imposed by models of development that cause and worsen situations of poverty and social exclusion, deteriorate the environment, weaken democratic systems and threaten national sovereignty. This model dramatically affects state reforms by imposing specific legal reforms to fit its own needs. This process also has an impact on health sector reforms through the privatization of the healthcare services, decreased access to care for all women, and the elimination of systems of social security based on solidarity. As a result, the States no longer guarantee the human rights of all and especially of women, children, adolescents and youths.

Political fundamentalism and its military expressions, such as the Plan Puebla-Panama and the Plan Colombia, situations of armed conflict, and territorial occupation directly impact the lives and health of women, children and indigenous populations, worsening situations of violence and poverty. Meanwhile, religious authorities impose their particular beliefs in order to control all aspects of sexuality and reproduction, which is nothing less than the freedom to choose of all people, and above all, of women.

In this new international and national order, people's quality of life and the health and rights of all women are threatened, and the very conditions that guarantee the exercise of these rights are seriously limited. As a result, social democracy, civil autonomy and the exercise of citizenship are all weakened.

Women continue to die as the result of unsafe abortions in our countries due to restrictive and punitive laws that threaten women's health and lives. Every day throughout our region, more and more women suffer and even die due to situations of sexual and domestic violence. Increasing numbers of women endure cervical, ovarian and breast cancer at ever younger ages, die due to poverty-related illness, are infected by HIV/AIDS in a context of inadequate public policies, and experience discrimination based on gender or sexual orientation on a daily basis.

The women's health movement and the feminist movement have played a fundamental role in the struggle for women's rights and empowerment, fighting for societies that are more just, equitable and democratic. We have rejected the policies of population control imposed upon poor countries, policies that violate the right of all individuals to make autonomous and informed decisions in all matters related to their sexuality and reproduction, free from invasive technologies that damage women's physical integrity. We have identified the debate on the right to abortion as a matter of social justice and civil rights.

Strategies against Fundamentalisms and the Globalizing Neoliberal Model

* Take an explicit stand against neoliberal policies and the neoliberal model of development implemented by our governments, identifying them as devastating for the quality of life and health of women and children throughout the world.

* Systematically denounce all policies and direct attempts to colonize women's bodies and to violate our human and civil rights.

* Recover the more radical nature of the movement for sexual rights, reproductive rights and health, defining new challenges and striving for new victories.

* Review the basic concepts that nurture our efforts, enrich them, broaden them and debate them with the wider feminist movement in the search for gender justice.

* Strengthen, develop and build alliances with other groups and organizations to defend our rights and the gains we have made and to improve the situation of women's rights, democracy and citizenship.

* Confront health sector reforms and their impact on women's comprehensive health.

* Eradicate traditional practices that violate women's and girls' human rights.

Strategies for the Women's Health Movement and the Feminist Movement

* Strengthen the women's movement for health, sexual rights and reproductive rights, reverting the tendency towards internal divisions and reinforcing collaboration and communication among all the expressions of the feminist movement, including networks.

* Maintain, defend and strengthen our achievements at the national and international levels.

* Strengthen the movement's ability to take a public stand and to exercise social pressure.

* Develop complementary strategies for follow-up on national laws and international agreements that include monitoring, lobbying and actions of denunciation.

* Recover and recognize the value of women's civil participation in the different arenas of decision-making and action at national and international levels.

* Strengthen our own debates, incorporating new levels of complexity and bearing in mind the plurality, diversity and inequities in power relations among us.

* Develop policies with gender and feminist perspectives that will encourage women to become professionals in the area of science and technology and stimulate their continued education in these fields.

* Participate in and monitor the debates on biotechnology and bioethics.

* Bearing in mind that sexual rights and reproductive rights are integral aspects of human rights, strengthen alliances with the traditional expressions of the human rights movement in order to integrate women's rights and the struggle against racism, sexism and discrimination against lesbians and gays.

* Pressure States to fully assume their responsibilities as guarantors of labor, social, economic, civil and political rights.

* Design our own communications policies and defend, uphold and strengthen our communications media.

* Strengthen efforts to organize and promote our intellectual undertakings.

* Acknowledge the value of indigenous and Afro-descendant women's wisdom and knowledge in the area of health.

* Develop mechanisms to confront attacks against the medical traditions of indigenous and Afro-descendant peoples.

* Reclaim women's right to pleasure and the importance of this perspective within the women's health movement.

* Incorporate the inter-generational perspective as a fundamental element for the continuity of the movement.

* Evaluate and monitor the strategies and impact of the institutionalization of the feminist movement and the women's health movement.

* Develop new strategies in the search for economic resources which will allow us to confront the restrictive policies of financing for women's organizations in our region.

The author, the General Coordinator of the Latin American and Caribbean Women's Health Network, presented the following article at the 9th IWHM in Toronto, Canada.