Life in Ecuador is largely characterized by instability: social unrest and strong regionalism drive a chronic political disunity, and a high occurrence of natural disasters is destructive to the agriculture sector and transportation systems in rural areas.
Such instability contributes to periods of violent crime and the presence of foreign drug mafias in Ecuador, and poverty is widespread. An economic crisis in the late 1990s spurred mass emigration to countries like the United States and Spain, and in 2005, émigrés sent more than $1 billion U.S. dollars back to their families in Ecuador.
More people in rural Ecuador are moving to urban areas, and rates of literacy, family planning use, and women in the workforce are increasing. Yet life for those who live in rural areas or in indigenous communities is still characterized by a limited access to health, education, and economic resources. On average, indigenous people in Ecuador have had just two years of schooling and nearly half are illiterate starkly different from the average nine years of schooling that those living in urban areas receive.
About 30 percent of the population — mostly poor, rural, and indigenous — has no access to even the most basic health care, and a lack of contraceptive use among adolescents contributes to nearly one in 10 adolescents giving birth each year.
Lack of access to basic reproductive health care and contraceptives is particularly dangerous for women. While over a third of all women in Ecuador report that their pregnancies are either unwanted or wanted later, restrictive abortion laws mean that many women are forced to obtain unsafe abortions that put them at a high risk for infections, complications, and even death.
In an effort to reduce the rate of unsafe abortion and unintended pregnancy, the Ecuadorian government recently launched a comprehensive sexual and reproductive health education program in secondary schools around the country. Yet much remains to be done — Ecuador has one of the lowest public health expenditures in all of Latin America, and diseases caused by poor nutrition and sanitation, especially in marginalized areas, remain serious public health issues.
PPFA in Ecuador
Since 1974, Planned Parenthood Federation of America (PPFA) has worked with partner organizations in Ecuador to reduce the rates of maternal death and disability by increasing access to sexuality education, contraception, and post-abortion care. PPFA's current work provides technical assistance to three projects with national reach: one project focuses on the integration of post-abortion care services, another project focuses on adolescent sexual and reproductive health, and our newest project focuses entirely on the needs of rural, indigenous youth aged 12-19.
PPFA assists the clinical projects in setting up client databases, formulating strategies to increase visibility, and measuring and improving the quality of care. Among its adolescent programs, PPFA has helped create innovative evaluation methods and ways to increase sustainability.
The PPFA partner CEMOPLAF, which has overseen the adolescent project for 10 years, focuses on sexual and reproductive health knowledge, access to contraceptive methods, and communication skills among adolescents at 17 sites around the country. The goal of increased adolescent knowledge is achieved through such measures as peer educator talks in both formal and informal settings, distribution of contraceptive methods, and group activities.
Through workshops for parents, peer educators, and community-wide events, the adolescent project aims to provide accurate, up-to-date information about sexually transmitted infections, healthy sexual practices, and contraceptive methods to the greatest number of people possible: an estimated 1,000 parents and 28,000 students total.
In January 2007, PPFA and CEMOPLAF launched an innovative adolescent project to address the particular reproductive health needs of rural, indigenous youth in the Chimborazo province. This population is known to face an especially high risk for unwanted pregnancy at early ages, which contributes to a cycle of low educational levels and low economic resources.
In its first year, the project is designed to determine the current knowledge, attitudes, and behavior among adolescents in the target area in order to determine specific needs; implement activities that lead to healthier attitudes and behavior related to overall health and sexual and reproductive health among the target population, including use of contraceptives and clinical services; and create a model that can be used in other areas with a similar target population in order to reach more adolescents.
PPFA expects that this project will reach adolescents with very little previous access to sexual and reproductive health information and will focus on reaching those youth who are not attending school regularly. Providing young people with these resources could have an enormous impact on community development over time as boys and girls will potentially stay in school longer, find better paying jobs, and learn skills necessary to make responsible, positive sexual and reproductive health decisions.