This originally appeared in FrontLines, November/December 2012 issue.
Trinidad Hernández lives in a wood-panel house with a zinc roof and a dirt floor in La Patriota, Nicaragua, a small rural village near the center of Nicaragua. The 39-year-old is a cattle farmer and volunteers as a health promoter. He enjoys the respect his community gives him as a person of authority who helps solve some of the health problems they face. He is part of a community-based family planning program that has been supported by USAID since 2003 and has been integrated into the Nicaraguan Government’s national health strategy.
Maryuri Arellano gives a health talk on adolescent pregnancy prevention. Photo Credit: Kimberly Cole, USAID
Today, more than 1,000 men and women like Hernández are involved in the country’s ambitious community-based efforts to improve health by helping parents decide the size of their families. These community health promoters educate and supply contraceptives to their neighbors who live in the most remote villages. Buttressing the approach is a USAID-sponsored 2011 study (PDF) indicating that, when men are involved as partners and community members, there are lasting improvements in reproductive health.
The number of male family planning promoters in Nicaragua has grown dramatically since 2006. Hernández reports that “the women in my community have confidence in me because I offer all of the [family planning] methods that are available and I give them enough information so that they can choose the method that is right for them. And then I make sure to always have their next supply ready.”
Programs like this, which are part of the USAID graduation strategy in countries like Nicaragua, gradually prepare them for the Agency’s departure. The goal is to maintain the successes achieved with assistance both during and after graduation. Nicaragua is an especially successful case in a region where improved education for women, greater economic opportunity and increased availability of family planning have reaped enormous benefits overall, say USAID/Nicaragua officials.
In Nicaragua, specifically, increased use of family planning has coincided with a reduction in maternal mortality by almost a third since 1980.
From Six to Two
In the 1960s, the average woman in Latin America had six children and many died in childbirth. Back then, most women in remote areas didn’t have access to family planning or know that they could space or limit their pregnancies.
Today, most women have between two and three healthy children.
Infant mortality has fallen faster in Latin America and the Caribbean than anywhere else in the world, declining by 70 percent since the 1960s. Child mortality has declined by 57 percent and the region’s maternal mortality ratio has dropped by 41 percent since 1990.
According to Marianela Corriols, USAID/Nicaragua’s project development specialist for health, this is not a coincidence. “There is strong evidence that the dramatic expansion of family planning services during this period was a major factor in saving these lives, by giving couples the ability to space their children’s births, and limit their family size, according to their own desires,” says Corriols.
While USAID has been the world leader in family planning funding since the 1960s, Corriols notes that the Agency was mostly an outside facilitator of country plans. “It is the leadership of host country governments and civil society that have led to these stunning results,” she says…[continued]
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