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Reviewing our history charting new roads.

In 2010, the Latin American and Caribbean Women's Health Network celebrates 26 years of promoting and defending women's health and rights. To have reached this stage--more than a quarter century of uninterrupted work--encourages us to look at the road traveled, to assess our achievements, to recognize what remains to be done and to look ahead towards the future.

This meeting is a wonderful opportunity to share our experiences as a network of diverse voices, voices that want to respond to the challenge of improving the status of all women, but especially the situation of those who suffer the greatest discrimination and violation of their rights, whether because they are poor, indigenous, black, young, old, HIV positive, differently abled, migrants, workers or women who love other women.

In this process, and as the daughters of social movements that took wing centuries ago, we have inherited the spirit of rebellion, of transgression and of looking to the future, striving to promote the socio-cultural transformations so necessary for women to no longer be abused, discriminated against and subordinated.

Today, in the important opportunity offered by the Second Members Consultation Meeting, we first invite you all to review our history, which will allow us to revise our first stage of work in the 1980s, and above all, to assess what needs to be rethought in light of the current global and regional context, so full of challenges.

But as our comprehensive history has not yet been written--a tremendous debt that we recognize and hope to settle at some point--we turn to those companeras--who have sketched out part of this history and also to our own memories.

Transgression and Rebellion

As explored in various articles by Ana Maria Portugal, Olga Amparo Sanchez and Maria Isabel Matamala, the 1980s was an era in which we saw a profound break with traditional beliefs related to women's lives and health and to their place in society. Feminist studies were essential in this undertaking and especially gender theory, which eventually led to the concept of gender perspective, today a required element of analysis applied in various disciplines, including the field of health.

As Marcela Lagarde states in Genero y Feminismo. Desarrollo humano y democracia (Gender and Feminism: Human Development and Democracy):
   In the experiences of their own lives,
   every woman and every man synthesizes
   and realizes the cultural and historical
   process that makes them, precisely,
   that man and that woman, the
   subjects of their own society, living
   through their culture, sheltered by the
   religious traditions or philosophical beliefs
   of their individual families and
   their generation, speaking their language,
   within the context of the nation
   and the class in which they were
   born ... The cultural mechanism of
   gender assignment occurs in the ritual
   of birth: at birth, with one look at the
   child's genitals, the midwife identifies
   and names at once: "it's a girl" or "it's
   a boy." Language, the word, is the distinguishing
   mark that labels the sex
   and announces the gender. And
   throughout the rest of our lives, almost
   imperceptibly, the ritual is repeated ...


Thus, gradually, by incorporating a gender perspective, there was a real breakthrough, an opening of our eyes and minds to other ways of thinking, from which we would derive new questions, new answers, new certainties.

For example, the process of health-illness began to be approached from another angle, with a closer look at gender differences: women do not get sick like men; we may live longer, but our quality of life is worse. Women often become sick with preventable illnesses. Our reproductive health has a cost, in terms of repeated, successive pregnancies, which are often imposed against our will. Motherhood, and even the desire to not be mothers, can mean that we will resort to illegal and unsafe abortions. Our mental health gives evidence of the impact of the imbalance of power, the cost of women's subordination to the desires of others, the perverse effects of gender violence, the oppressive weight of the double and triple workload. And without access to quality health care, we are discriminated against and prevented from enjoying our social rights.

In this decade, we also began to see a breakdown of the traditional, hierarchical, vertical, and patriarchal "doctor-patient relationship," which has historically subjugated women to medical authority (in parallel to their subjugation to husband, father and priest), whose declarations have been imposed on the female body for centuries.

Also, thanks to these new and freer lines of thought, the notions of health care, prevention and promotion, and participation in health began to encourage the active involvement of women themselves, who wanted to stop being "patients." Indeed, women began to learn about themselves from a position of greater autonomy in making decisions about their bodies and their lives, and they learned something that perhaps today has once again been lost in the bustle of modernity and post-modernity: to care for themselves, to treasure their bodies, to offer peer support and many other irreplaceable, breakthrough experiences.

But women knew that they needed to start being involved in major decisions, to have a voice in designing the policies that affected them, and they started demanding participation from those in power. And increasingly, they challenged the traditional public-private division, a dichotomy that has made women invisible and subordinate to men, who are "naturally" channeled towards participation and leadership in the public world. Women wanted to be in the labor market, they wanted to be in politics, they wanted laws that would protect them, they wanted to care for their health because they saw that this good health, this well-being, would reflect their progress towards being citizens, in the fullest meaning of the term. And although overwhelmingly engaged with leftist projects against the dictatorships in the political realm, women did not often find in their own male comrades a response to their demand for equal opportunities.

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In this historical process, all we remember and recognize the incalculable value of the classic book, Our Bodies, Ourselves, by which the Boston Women's Health Book Collective raised a complaint regarding the impact of the hierarchical gender system on women's health and well-being throughout their life cycle, taking charge of providing women with information about health in a way that recognized their personal stories, replete with their struggles and strengths, thereby reinforcing the value of mutual support and solidarity among women.

However, we cannot forget that this vital decade of fragmentation and change, this decade in which women increasingly recognized the exercise of autonomy over their sexuality and reproduction, this decade in which we saw increasingly visible changes in population trends (such as low fertility rates) was also a decade of profound social, political and economic crises. We remember that the 1980s has also been called the "lost decade." Indeed, the process of installing the neo-liberal development models in Latin America and the Caribbean had, and continues to have, a very negative impact on the lives of huge segments of the population. For example, the "increasing levels of poverty meant that women of the working class were not only forced to participate in the informal and formal sector, but they also had to organize in order to access health information and to attempt to autonomously solve one of the tasks assigned to women under the patriarchy: health care of the family and the community" (Matamala and Portugal, 1993).

As these authors explain, nongovernmental organizations (NGOs) became essential instruments that met these new demands placed on those women with the greatest needs, whether by socializing official or traditional knowledge in health, incorporating a gender perspective in reflection and action, facilitating the organization of the women themselves, and later by becoming allies of health professionals. Thus, throughout the decade, three main areas interacted: the grassroots women's movement; NGOs and healthcare professionals; and the feminist movement.

LACWHN was born in 1984, at a time when a rich tapestry of women's organizations working on health, quality of life, community support and the struggle for democracy simultaneously began to unfold in several countries of the region. It was a time of tremendous political power, when the human rights paradigm was increasingly evident in civil demands, and women unfurled such historic slogans as "The personal is political" and "Democracy in the country and in the home (and in bed)."

And while we are on the subject of women, let us not forget, several important milestones that led up to this decade:

* The UN Decade for Women 19751985 led to the gradual incorporation in the UN system of the new perspective proposed by feminism based on gender theory.

* Mexico hosted International Women's Year in 1975.

* In 1978, in Alma Ata, the goal of Health for All by 2000 was adopted (yet still unfulfilled today).

* In 1979, the Convention on the Elimination of All Forms of Discrimination Against Women, CEDAW, was adopted. Articles 12.1 and 12.2 assigned responsibilities to the States with regard to access and equal care for women in health services, making special reference to sexual and reproductive health care.

* Actions demanding abortion were developed in various European countries and the United States, and the debate began in some of the countries in our region, including Mexico, Puerto Rico, Peru, Venezuela and Colombia. A key trigger for this movement was the International Campaign for Abortion Rights, promoted by women's organizations in Europe.

Clearly, we were seeing an end to the invisibility of certain taboo topics related to sexuality and reproduction, voluntary motherhood, the reporting of gender violence and freedom of sexual choice, among many other issues.

This progress was significantly reaffirmed in the 1990s, when the agreements reached at the International Conference on Human Rights (Vienna, 1993), the International Conference on Population and Development (Cairo, 1994), the Social Development Summit (Copenhagen, 1995) and the Fourth World Conference on Women (Beijing, 1995) implied a profound transformation of paradigms.

As noted by Maria Isabel Matamala (2006), in the discussions at these conferences, gender was part of every debate, and the follow advances were made:

* Human rights were linked with the economy and with people's well-being.

* Population policies were no longer strictly based on demographic considerations.

* The impact of power relations between men and women on health and rights was stressed.

* Sexual and reproductive rights were recognized as human rights.

* The role of sexuality in women's health and citizenship was recognized.

* The need for "empowerment," defined as women's ability to make autonomous decisions over their own lives and destinies, was emphasized.

And in that context, feminist researchers Sonia Correa and Rosalind Petchesky advanced in the formulation of four ethical principles that are the basis of sexual and reproductive rights: bodily integrity, personhood, equality and respect for diversity.

Working and Networking

So LACWHN was born in the midst of this social revolution of the 1980s, and it grew and developed in the 1990s. In the first decade of the 21st century, the Network is in full bloom.

But to make the Network a reality, it took a group of Colombian feminists to advance in a proposal that has marked the history of the Latin American and Caribbean health movement: the first Regional Meeting on Women's Health, held in Tenza, Boyaca, Colombia, on May 28, 1984, in happy coincidence with the date that LACWHN would later propose as the International Day of Action for Women's Health.

And so, the Corporacion Regional para el Desarrollo Integral de la Mujer y la Familia (Regional Corporation for the Comprehensive Development of Women and the Family)--with the support of Colombia's Ministry of Health, the Pan-American Health Organization (PAHO), the Pathfinder Foundation and the Population Council--held this meeting, thanks in great part to the efforts of Luz Helena Sanchez, from Bogota's Casa de la Mujer.

For six days, women from diverse backgrounds--but united in the need to promote women's comprehensive health from a perspective of rights and social justice--came together in Tenza to define strategies that would address serious problems, such as violence against women (including violence from the dominant medical system), population control policies and the different forms of control over women's bodies, reproduction and sexuality, all of which had, and continue to have, a devastating impact on women's lives.

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And as a result of these reflections and rebellions, the participants decided to create a regional network of organizations and individuals committed to human rights and women's health: the Latin American and Caribbean Women's Health Network, LACWHN, whose presence in the region, and even in other continents, continues stubborn as ever, from the 1980s until this, the third, millennium. From 1984, the coordination of the Network was housed in Isis Internacional, in Santiago, Chile, until 1995, when LACWHN began to operate independently.

Strategies, Proposals, Actions

In our journey of more than two decades, a number of strategic areas have been developed to promote and defend women's right to dignified, fulfilling and happy lives, to comprehensive health and to first-class citizenship expressed in the real and daily exercise of all the internationally recognized human rights.

One of the Network's first steps was to generate a system of information and communication, which is to a large extent the reason for LACWHN's current strength and continued existence. Born under the wing of Isis Internacional, an icon in field of women's communication, the Network's area of communications continues to produce regular publications, the Women's Health Journal and the Women's Health Collection, while simultaneously exploring the realm of virtual communications.

At the same time, the Network forged a landmark alliance with the Women's Global Network for Reproductive Rights (WGNRR) based in the Netherlands at the time and now in the Philippines. From 1987 to 1996, LACWHN and WGNRR jointly coordinated the historic campaign for May 28, International Day of Action for Women's Health, which initially focused on the prevention of maternal mortality.

And from 1996 on, LACWHN began coordinating two regional campaigns: the aforementioned campaign on May 28 and another on November 25, International Day Against Violence Against Women, uniting Network member organizations around widely disseminated Calls for Action, with the aim of promoting social and political action by women in defense of their rights, particularly through the development of advocacy and lobbying of local decision makers and by raising awareness among the general public. The campaigns have highlighted a range of different concerns, emphasizing issues such as unsafe abortion, maternal mortality, adolescent pregnancy and quality of care or the cost of gender-based violence on women's lives and health.

In 1998, LACWHN launched the Itinerant University, originally the International Course on Gender Perspectives in Health, with a special emphasis on the processes of health sector reform, its impact on women's health, and ultimately, on fostering advocacy agendas created by the women participants to influence their respective realities. We should also mention, as a prior experience of training, LACWHN's support for the historic scholarship program developed by Sao Paulo's Colectivo Feminista de Sexualidad (Feminist Collective on Sexuality), with Maria Jose Araujo as the coordinator.

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Another milestone in the Network's history was the project to Monitor the Implementation of the Programme of Action from the International Conference on Population and Development, which had the support of the UNFPA. One of the most important proposals for monitoring the consensus of Cairo, this initiative was developed in Brazil, Chile, Colombia, Nicaragua, Peru, Mexico and Suriname, with the involvement of several member organizations that promoted citizen monitoring efforts. And LACWHN's commitment to the ICPD Programme of Action continues today ...

At this point, we should recognize LACWHN's involvement in the series of UN conferences on the status of women held in the 1990s. The Network played a significant role promoting the Latin American and Caribbean women's agenda in Cairo, Beijing and Copenhagen and at the UNGASS, among other opportunities.

Other recent projects developed by LACWHN have focused on reproductive health supplies (with Population Action International, PAI), training spokespersons for the decriminalization of therapeutic abortion in Chile (with the Safe Abortion Action FundIPPF) and the regional Campaign to End Violence Against Women (with Oxfam/Novib).

In terms of networking and shared experiences, LACWHN has organized several important meetings, including the First Working Meeting of the Network held with LACWHN members in Santiago in 1991. In 1992, the Network convened the Meeting on Ethical and Legal Issues in the Implementation of Abortion, in Piriapolis, Uruguay, which gave rise to the historic September 28 Campaign for the Decriminalization of Abortion, first coordinated by the Uruguayan group Catolicas por el Derecho a Decidir(Catholics for the Right to Decide). And in 1993, in preparation for the participation of Latin American and Caribbean women in the ICPD, LACWHN convened the meeting Women and Population Policies in Oaxtepec, Mexico.

We mention these few meetings, but there have been many other events, workshops, seminars and forums organized by LACWHN to share, reflect and strategize on relevant issues.

Finally, the Network takes part in numerous regional women's campaigns and coalitions, including the Campaign for an Inter-American Convention on Sexual Rights and Reproductive Rights, the Campaign Against Fundamentalisms, the September 28 Campaign for the Decriminalization of Abortion in Latin America and the Caribbean and the international campaign Women Won't Wait.

If we need to quantify what we have achieved, we can check the following list:

* In 26 years of existence, we have linked 558 national women's organizations and networks, plus 329 individual members.

* Since 1998, we have trained 800 women from 22 countries in Latin America and the Caribbean in the Itinerant University courses.

* For 14 consecutive years, we have supported 2,600 activities by LACWHN members in the context of May 28, International Day of Action for Women's Health, and November 25, International Day Against Violence Against Women.

* LACWHN has distributed 57 issues of the Women's Health Journal (in English and Spanish), 13 issues of the Women's Health Collection (in English and Spanish), has produced numerous virtual newsletters, a website and more recently, has maintained a constant presence on social networking sites.

* We have promoted hundreds of national, regional and international actions of solidarity and defense of women's human rights.

* We have developed tools for monitoring the implementation of international agreements (the Programme of Action from the International Conference on Population and Development, Cairo, 1994).

* We have created a model for social intervention to promote changes in perceptions, attitudes and behaviors towards violence against women in Latin America and the Caribbean.

* In the context of institutional strengthening and decentralization, we have established National Links and Focal Points in 20 countries in Latin America and the Caribbean.

* And we will take input from this reunion into consideration as we prepare the next Strategic Plan and for the evaluation of the current plan. These processes will also be shared with the general membership.

In qualitative terms, we turn to Olga Amparo Sanchez (1994), who explains that the network has managed to promote:

* The concept of the recovery of women's bodies as a vehicle for their own pleasure and as a space for the exercise of autonomy.

* The transformation of maternity into something desired and intended.

* The appropriation of sexuality as another act of re-creating life itself.

* The democratization of knowledge that breaks with the division between those who know and those who are ignorant.

* The denunciation of violence by the medical institution against women's bodies.

* The denunciation of the medicalization of women's life processes.

* The demand for health services that meet women's needs and serve their interests.

* The need for birth control programs that are implemented in the region to be placed within the framework of respect for women's right to freely choose the method of fertility control and the number and spacing of their children.

* The preservation of the knowledge that women have about health, the reconceptualization of medical knowledge and science, and the development of new paradigms.

Democracy and Women's Rights

In the current situation, the effective response to the urgent demands that women have been making visible during all these years is a considerable challenge. While we have made progress, the real exercise of rights is not a daily reality in the lives of women and girls. On the contrary, it appears that gender-based violence has escalated and that patriarchal discourse and action are getting even stronger.

The crisis of the 1980s, may have diminished in the 1990s, but it is still present in our region and the world, exacting a heavy price in terms of wellbeing and quality of life. In the context of neoliberal globalization, structural adjustment policies and the sway of the market, a series of phenomena have emerged that are contrary to the exercise of rights by the population in general and women in particular. Indeed, as the result of the introduction of structural reform processes by the State (whose social costs have yet to be calculated) and the weakened role of the State (which has abandoned its role as guarantor of rights), large segments of the population have less access to social goods, such as health, education, decent work, social protection, housing, culture and recreation. The privatization of public goods and services has continued in recent decades, making the aforementioned basic rights into consumer goods that are only available to a few.

This situation has led to the widening of gaps in income distribution, and access to the benefits of development is becoming increasingly unequal. In other words, the distance between the richest (a very few) and the poorest (the wide majority) continues to grow. This inequity has been consistently highlighted in recent Human Development Reports, in the Social Panorama of ECLAC and other global monitoring instruments.

In relation to matters of central importance in the lives of women, this global context has served to strengthen the discourse, action and influence of fundamentalist groups. Neoliberalism is, without doubt, another expression of the patriarchy that has led to increased violence in all its forms and expressions, in particular, gender-based violence, racism, intolerance and xenophobia. Neoliberalism has also escalated the arms race and militarism under the false argument of national security.

We could continue to list the serious social problems arising from the implementation of these development models, and it is likely that they all have a serious impact on women's lives. Indeed, women constitute the majority of the poor, most of those who are excluded from access to health, education and social welfare, and the bulk of cheap labor and flexible work in unhealthy and dangerous conditions, unprotected by labor laws and even enslaved, confronting gender violence that multiplies and grows stronger in these contexts.

Undoubtedly these phenomena constitute a threat to democratic governance, they affect the stability of institutions and threaten the enjoyment of human rights and peace itself. They also pose a barrier to civic participation, especially by traditionally and historically excluded sectors, including women, whose rights are further constrained in this regional and global context. And finally, at an individual level, they seriously alter our quality of life, mental and physical health and our ability to be happy, fulfilled and in charge of our destinies.

Does this mean that the actions of women's social movements have been unsuccessful? Does this mean that our efforts have not been effective enough to break down the unequal power structures or at least break through them?

The movements have undoubtedly been useful, but much greater effort, in coordination with other social movements, is required to advance sustained, structural changes. This reality challenges us and forces us to rethink our Network in terms of its structure, the validity of our political agenda and strategic areas, and our ability to network.

New Paths: Questions, Answers, Musings

In this quest to define new paths for the Network's future, we have repeatedly raised a number of urgent and necessary questions. This Members Consultation Meeting will be a vital opportunity to reflect on some of these issues, in relation to the Network as an organization, and with regard to our strategies and agenda. Those of us who are part of the Network's Coordination or Board of Directors are not here to present previously defined answers. On the contrary, we are here to look for them together. Some of the questions we might ask are:

Are women's networks (many of which have been in existence for decades) still valid and efficient structures for bringing together diverse, heterogeneous organizations around certain common themes? How do we build consensus around common denominators? What are the common denominators that define us and are non-negotiable?

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How do we foster more horizontal and democratic decision making in the Network? How do we ensure that the member organizations feel represented, listened to and incorporated into the daily actions of a regional office of coordination that operationalizes the programs?

How do we define LACWHN membership and the different levels of participation? How does this participation translate into a political and ideological identification and not just a formal connection to certain programs, such as publications, activism campaigns or human resources training?

How do we solve the challenge of and the urgent need for alliances with other social movements that today do not necessarily support our demands and may even detract from them?

Should we partner with other strategic sectors, such as academia, healthcare professionals, unions, students, politicians and media professionals?

Does having a relationship with the United Nations system have a negative impact on our independence, autonomy and freedom of action or does it strengthen us? What is the human cost, in terms of resources and time spent on monitoring the processes of the UN conferences, and what are the benefits? Is the complaint about the excessive institutionalization of women's health movement a well-founded criticism, and how do we respond to it?

How do we structure a political agenda that addresses current events and the challenging regional (and global) context, without leaving aside the specific issues of the countries, and how can our strategic areas promote this agenda?

Are our mission and vision possible utopias, achievable in a world wracked by violence in all its forms, inequality, exclusion and oppression, a world in which democracies seem to be too fragile and inefficient to safeguard the human rights of all and in which the benefits of development are the privileges of a few?

How do we move beyond certain key issues that traditionally have been LACWHN's priorities, in order to take up the overarching problems of the global context that today are not being addressed in our agenda and proposals for action? Are we prepared, as organizations, networks and individual women, to make that leap?

Have we analyzed and addressed women's health from a comprehensive perspective or rather in a piecemeal fashion? What are the unavoidable issues concerning women in the third millennium: poverty, race/ethnicity, gender, violence in all its forms, universal access to health, sexuality, migration, paid and unpaid work, access to education, parity in participation, conservatism, militarism? How many of these issues have been or are a part of our vision and critical action as LACWHN?

To what extent are our strategic areas still efficient and effective? Do we need a thorough revision and updating in light of current events? Who is our target audience and are we reaching them?

After reviewing these diverse questions, it should be clear that:

* LACWHN should increasingly mobilize its members around issues of particular interest to women, especially in relation to the economic, social and political crises affecting our countries and the region. In other words, the Network should strengthen its capacity to articulate proposals and introduce into the debate current structural issues in our society today, through a coherent political discourse that has an impact and generates lines of action, not only among our members, but in collaboration with other social movements sensitive to our demands.

* And, at the same time, we are confident that LACWHN should continue to work in the democratic networking of member organizations that are diverse in their interests, realities and capabilities, but which are unified around a common goal: the unconditional defense of women's and girls' human rights.

The Second Members Consultation Meeting thus begins with an invitation to all those present to engage in the urgent task of strengthening LACWHN as a regional benchmark in the defense of women's human rights, citizenship and health, in this, the third millennium.

References

Correa, Sonia and Rosalind Petchesky (1994) "Reproductive and Sexual Rights: A Feminist Perspective," In: Population Policies Reconsidered. Health, Empowerment and Rights. Boston: Harvard Center for Population and Development Studies, International Women's Health Coalition.

Matamala, Maria Isabel (2006) "Genero y Salud." Opening presentation given for the Masters in Public Health. Universidad de Valparaiso, Chile.

Matamala, Maria Isabel and Ana Maria Portugal (1993) Movimiento de salud de las mujeres, Vision de una decada. Scientific Publication 541. Geneva: PAHO.

Portugal, Ana Maria (2004) "La continuation de un vuelo: Nace la RSMLAC." Revista Mujer Salud 2-3.

Sanchez, Olga Amparo (1994) "Lo invisible y visible de la salud de las mujeres." Revista Mujer Salud 2-3.

Nirvana Gonzalez Rosa

The author is the General Coordinator of the Latin American and Caribbean Women's Health Network, LACWHN. The following was the opening presentation at the Second Members Consultation Meeting, held in Antigua, Guatemala, October 18-19, 2010.
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Author:Rosa, Nirvana Gonzalez
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Date:Oct 1, 2010
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