• TABLE OF CONTENTS
HIDE
 Front Cover
 Introduction
 Women's lives and health: The Cairo...
 Adding color to life: Illustrated...
 Taboo talk: Reproductive health...
 Afterword
 Resume en Francais
 Resumen en Espanol
 Appendix
 About the authors
 Back Cover














Group Title: Quality/Calidad/Qualité
Title: By and for women
CITATION THUMBNAILS PAGE IMAGE ZOOMABLE
Full Citation
STANDARD VIEW MARC VIEW
Permanent Link: http://ufdc.ufl.edu/UF00088794/00001
 Material Information
Title: By and for women involving women in the development of reproductive health care materials
Series Title: QualityCalidadQualité
Physical Description: 28 p. : ill. ; 26 cm.
Language: English
Creator: Hull, Valerie J
Publisher: Population Council
Place of Publication: New York NY
Publication Date: 1992
 Subjects
Subject: Health education of women -- Case studies -- Developing countries   ( lcsh )
Women -- Health and hygiene -- Study and teaching -- Case studies -- Developing countries   ( lcsh )
Health Education -- methods -- Latin America   ( mesh )
Reproduction -- Latin America   ( mesh )
Women's Health -- Latin America   ( mesh )
Genre: non-fiction   ( marcgt )
Spatial Coverage: Egypt
Peru
 Notes
Statement of Responsibility: introduction and afterword by Valerie Hull ; case studies by Barbara Ibrahim ... et al..
General Note: Caption title.
General Note: Includes summaries in French and Spanish.
 Record Information
Bibliographic ID: UF00088794
Volume ID: VID00001
Source Institution: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: oclc - 26335997
lccn - 93241911
issn - 0873-40572 ;

Table of Contents
    Front Cover
        Front Cover 1
        Front Cover 2
    Introduction
        Page 1
        Page 2
        Page 3
    Women's lives and health: The Cairo women's health book collective
        Page 4
        Page 5
        Page 6
        Page 7
        Page 8
        Page 9
        Page 10
        Page 11
    Adding color to life: Illustrated health materials for women in Peru
        Page 12
        Page 13
        Page 14
        Page 15
        Page 16
        Page 17
        Page 18
    Taboo talk: Reproductive health videos by Pacific Island women
        Page 19
        Page 20
        Page 21
        Page 22
    Afterword
        Page 23
        Page 24
    Resume en Francais
        Page 25
    Resumen en Espanol
        Page 26
        Page 27
    Appendix
        Page 28
    About the authors
        Page 29
    Back Cover
        Page 30
Full Text


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Quality/Calidad/Qualite, a publication of the Population Council, highlights
examples of family planning and reproductive health programs that are providing
unusually high quality care. This series is part of the Council's Robert H. Ebert
Program on Critical Issues in Reproductive Health and Population which, through
scientific and practical efforts, seeks to improve and expand the scope and quality of
reproductive health care. The philosophical foundation of the program, and of this
series, is that women and their partners have a fundamental right to respectful
treatment, information, choice and follow-up from reproductive health care pro-
viders. The pamphlets reflect one of the four main thrusts of the program: enhancing
the quality of family planning programs.
Projects are selected for documentation in the Quality/Calidad/Qualit2 series
by an Advisory Committee made up of individuals who have a broad range of
experience within the field of reproductive health and are committed to improving
the quality of services. These projects are making important strides in one or more of
the following ways: broadening the choice of contraceptive methods and technolo-
gies available; providing the information clients need to make informed choices and
better manage their own health care; strengthening the quality of client/provider
interaction and encouraging continued contact between providers and clients; mak-
ing innovative efforts to increase the management capacity and broaden the skills of
service providers at all levels; expanding the constellation of services and information
provided beyond those conventionally defined as "family planning;" and reaching
underserved and disadvantaged groups with reproductive health care services.
None of the projects documented in the series is being offered as a model for
replication. Rather, each is presented as an unusually creative example of values,
objectives and implementation. These are "learning experiences" that demonstrate
the self-critical attitude required to anticipate clients' needs and find affordable
means to meet them. This reflective posture is exemplified by a willingness to
respond to changes in clients' needs as well as to the broader social and economic
transformations affecting societies. Documenting the critical choices these programs
have made should help to reinforce, in practical terms, the belief that an individual's
satisfaction with reproductive health care services is strongly related to the achieve-
ment of broader health and population goals.







Publication of this edition of Quality/Cali- Statements made and views expressed in
dad/Qualite is made possible by support this publication are solely the responsibil-
provided by the Ford Foundation, the John ity of the authors and not of any organiza-
D. and Catherine T. MacArthur Founda- tion providing support for Quality/
tion and the United Nations Population Calidad/Qualit(.
Fund (UNFPA).


Copyright The Population Council 1992


Numberel Four- 1992


ISSN 0-8734-057-2






By and for Women: Involving

Women in the Development of

Reproductive Health Care Materials

Introduction and Afterword
by Valerie Hull
Case Studies by:
Barbara Ibrahim and Nadia Farah: Egypt
Blanca Figueroa: Peru
Margaret Winn: South Pacific



Introduction
Knowledge is Power
Information is the key to understanding and coping with change. It is the basis for enhanced
self-awareness, empowering individuals to exert more control over their own lives. In the area of
health, access to information not only can provide knowledge of what services are available, but
also can expand the capacity for self-care and use of preventive measures, help people know when
external assistance is required, and build the confidence people need to effectively seek out and
use available health care. If the means of delivering information is appropriate, it can be a powerful
agent of positive change. If the message delivery is weak, the result is lost opportunities, wasted
resources, even the spread of harmful misinformation.

Women's Health: Who "Owns" the Information?
Probably nowhere is the issue of access to information more critical than in the area of
women's health-particularly women's reproductive health. In the latter half of this century, the
trend in reproductive health has been toward the expropriation of care by professionals and away
from the traditional providers of such services and practices: midwives and women themselves.
Increasingly, knowledge has become concentrated among a specialized elite, with the result that
health specialists, most of whom are male, are generally making many decisions that directly affect
the health and well-being of women-whether setting priorities for development of new contra-
ceptives, determining funding allocations among different types of health services or even estab-
lishing accepted childbirth and infant feeding practices-with women having little or no input.
Yet women are not without their own information systems; indeed, they often share health
knowledge, beliefs and fears among themselves, both between generations and among peers. Such
traditional information systems can be important components in the provision of quality health
care, fully consistent with the objectives of primary and self-care approaches. Unfortunately, the
tendency of specialists to restrict dissemination of information to lay audiences has limited the
addition of accurate knowledge about new practices into these traditional networks. Ironically,
rumors and misinformation are often more successful in filtering into these systems.

Attempts to Deliver the Message
Women have not responded passively to this situation. From the inception of the family
planning movement, women leaders in many countries around the world, have taken strong,
positive action to gain the essential right of women to control their fertility. In recent years, too,






women's health groups have become increasingly vocal and active. A landmark contribution in this
struggle is the Boston Women's Health Book Collective's Our Bodies, Ourselves. This book provides
women with a comprehensive information resource for all their health-related concerns. Partially
as a result of the success of Our Bodies, Ourselves, women's health collectives have become active
in a number of developing countries; one of the case studies in this issue describes the work of
such a group in Egypt.
Largely owing to the efforts of women working at the grassroots, provider and academic
levels, there has been a growing recognition among family planning professionals that more than
simply motivating potential clients is necessary: clients need to be provided with full and accurate
information about methods and, in addition, services must be readily available in order to foster not
only adoption but continued use of contraception. There has also been an increasing awareness
that when accurate information is presented in a form that does not realistically reflect available
services or is unintelligible or unappealing to the intended audience, it is often no more helpful
than no information at all.

Information Materials by and for Women: Some Special Challenges
So where do women come into this process? Does involvement of women in the design,
testing, production and distribution of health information materials make a difference? How can
women be involved and what happens when they are?
Development of health information by and for women faces not only common technical
problems but also more basic challenges in working in the area of women's reproductive health
care. Women, particularly poor women, are more likely to be marginalized both physically and
within society. They are also more likely than men to be nonliterate or to have lost the ability to
read through lack of practice, and they are more likely to have difficulty interpreting graphic
illustrations or even photographs. In addition, they are often intimidated by or prevented from
gaining modern information and are cut off from decision-making processes.
Another difficulty is that the field of reproductive health involves value-laden issues often
regarded as being highly "sensitive"-occasionally by the women themselves, but more often by
the male elite. This is just one reflection of the inherent communication difficulties that exist
between men and women, especially in areas such as sexuality, childbirth and domestic violence.
Hopefully, sometime in the future, men and women will all be able to discuss such issues openly,
but that is not the case today. The process of developing health materials by and for women can
provide a safe environment in which women are able to ask questions, discuss issues and share
information that would never be possible in a coeducational environment. The process also helps
to strengthen women's sense of self-esteem as they begin to see that they are not alone, that others
share their problems and concerns and can even learn from their experiences.

The Case Studies
The studies in this issue of Quality/Calidad/Qualitg describe this approach in three different
settings in the developing world. In Cairo, a women's health collective produced a comprehensive
reference book for women; in Peru, a woman's group, with the extensive involvement of their
nonliterate audience, developed a series of illustrated teaching materials; and in the South Pacific,
an all-woman production crew produced three motivation and teaching videos developed in
response to the expressed needs of Pacific Island women. Despite contrasts in the characteristics of
the intended audiences, the development process and the medium employed to deliver health
messages, the projects are all characterized by the active involvement of women at all levels and
in all stages of project development. The authors tell the story of their project, comment on
how involving women made a difference and reflect on implications for future activities. In each
case, women's involvement has resulted in a legacy of more than just a set of effective and well
utilized information materials-it has mobilized the women involved and enabled them to
help themselves.






























































































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Women's Lives and Health: The Cairo
Women's Health Book Collective


For the first time in my life, I read a book
which talks directly to me, discussing my real
problems and not the imaginary problems that
men writers think we suffer from.
Pretest Participant



The Setting
In matters that concern health, Egyptians
historically called upon an array of traditional
practitioners from within their local communi-
ties, including faith healers, bonesetters and
midwives. Increasingly, with the introduction of
modern medicine, people have entrusted their
health to doctors and to a technical system
about which they remain largely ignorant. For
women particularly, this can be a problem
because high rates of illiteracy and codes of
modesty restrict them from easy access to
health information, and ignorance leads to a
sense of helplessness rather than good health.
In addition, a current of cultural conserva-
tism in the Arab world during the last decade


has polarized viewpoints regarding women's
economic and social rights, including rights to
certain health services. Therefore, both cultural
and medical considerations have complicated
debates over issues such as the appropriateness
of modern techniques to gain control over fertil-
ity. Those women who choose to plan the num-
ber and spacing of their children have found
themselves in paradoxical situations. While, on
the one hand, they may have battled to gain
access to modern contraceptive services, such
as oral contraceptives, and have been increas-
ingly vocal about harmful traditional practices,
such as female circumcision; at the same time,
they may have serious reservations about the
unquestioning adoption of some modern medi-
cines and medical practices. As an example,
until women launched a successful public cam-
paign for its regulation, the controversial drug
Depo-provera was sold over the counter in
Egyptian pharmacies. (In many Third World
countries, as in Egypt, contraceptives and drugs
such an antibiotics are routinely sold in phar-
macies without a prescription.)




































The Collective
Concern over problems such as these led
a small group of activist women in Cairo to
begin informal discussions on issues of women's
reproductive health in Egypt. Some of the
women were familiar with the Boston Women's
Health Book Collective and its path-breaking
health guide for women, Our Bodies, Ourselves.
As they explored various options for informing
Egyptian women about health issues, it became
clear that practical health information in the
nature of a guide or reference book was virtu-
ally nonexistent in the Arabic language. The
books and magazines that were available com-
mercially were either overly technical or so sim-
ple as to be incomplete or misleading;
moreover, most existing publications contained
an implicit message that medical knowledge is a
privilege best restricted to doctors.
Based on these observations, the group
decided to take action and began planning a
women's health information project. They were
guided by three basic principles: 1) women
have a right to information about issues touch-


ing deeply on their lives and health; 2) health
information should be presented simply, clearly
and in a language that women can understand;
and 3) above all, health information should
be practically oriented, so that women are en-
couraged to become actively involved in
keeping themselves healthy and in making
informed choices.
Before deciding precisely how to proceed,
the group advertised for and selected a coordi-
nator who would devote full time to overseeing
the project. An initial task of the coordinator
was to expand the size and breadth of the origi-
nal group, which had been comprised mainly of
elite social scientists. A group of 25 women
from a variety of social classes, from all age
groups and from fields such as medicine, teach-
ing, media and development were approached
to attend a founding meeting of the Cairo Wom-
en's Health Book Collective in the Suez Canal
city of Ismailia in April 1985. Twenty-two of
the women continued with the project until
its completion.






Developing a Health Book by and
for Women
Now I can give my daughter a book that
answers all her questions scientifically, objec-
tively and without making her feel ashamed of
her own body or self
Mother of 13-year old girl
The Collective's first meeting was struc-
tured as a three-day retreat in which the women
could get to know each other and begin to
define the fundamental nature of the Collective,
as well as set priorities for action. They agreed
on the following basic points to guide their
future work:
1) They would write a health guide for
women that would reflect the culture and con-
temporary circumstances in Egypt. It would be
an original work, rather than a translation or
adaptation of an existing volume. However, they
would consult examples from other countries in
order to learn from their approaches.
2) The book would be written from the per-
spective of women, in a friendly, respectful and
accessible style. While its intended audience
would have a high-school-level reading ability,
the book would invariably reach beyond that
audience since literate women in Egypt often
live among and share what they learn with
other nonliterate female family members and
neighbors.
3) The health book would be objectively
written, not imposing any set of views on read-
ers, but instead helping women reach their own
conclusions.
4) All decisions about format, content, publi-
cation and distribution would be made through
democratic processes. The entire group would
debate any areas of disagreement so that the
manuscript would reflect the collective views of
all members, rather than the personal views of
individual writers.
The planning and production of such a
comprehensive volume required extensive dis-
cussion and collaboration, not only among the
collective members but also between the Col-
lective and outside experts and, most impor-
tant, with representatives of the intended
audience. The goal of the Collective was not
only to produce a health book by women, but
for the women who would buy and use it.


Each chapter was written by two or three
women having an interest in the subject. The
original idea was to have a technical/medical
specialist, a social scientist and a good writer
work on each chapter, but this did not prove to
be practical in all cases. The coordinator applied
for and received funding from the Ford Founda-
tion and Oxfam, U.K. in order to defray publica-
tion costs, the coordinator's salary and small
honoraria for members of the writing teams.
Over a period of two years, the Collective
met about twice a month to review draft chap-
ters and assure the collaborative character of
the manuscript. Points of disagreement were
resolved by negotiation and compromise. On
some points the medical professionals felt that
too much information could be confusing or
dangerous for lay readers. For example, in the
chapter dealing with surgical procedures such
as hysterectomy, the doctors were uncomforta-
ble with a section encouraging women to ques-
tion recommended surgery and get a second
opinion. The Collective, however, decided in
favor of a woman's right to have complete
information, to question medical procedures
and seek corroborating opinions.






Content
The book begins with a series of chapters
that take a life cycle approach to women's
experiences. To set the cultural context, an
introductory chapter discusses Egyptian wom-
en's perceptions of themselves, their status and
health. Subsequent chapters deal with the
stages of childhood, adolescence, marriage,
childbearing and rearing, menopause and old
age. Then the book shifts to address a series of
important health issues across ages, including
those which are socially determined such as
occupational health and safety. The chapters
are described in the box below.
Debates over what topics to include in the
book and how they should be handled were
numerous-not surprising given the diversity
among Collective members. The subject of vio-
lence against women, for example, aroused high
emotions. Some Collective members held to
the belief that rape is essentially a sexual act
that women invite by their inappropriate dress
or behavior. Others objected to the chapter on
the grounds that the issues of rape and wife
abuse would cast all males in a negative light
and antagonize readers. Many hours were spent
in discussion and a process of collective self-
education before these issues were resolved.
In the end, the Collective agreed to
devote a full chapter to violence against women.
Because of the sensitive nature of the material,
extra care was taken to document violence
(rape, wife beating, child abuse) from Egyptian
data and research findings. To provide balance,
the chapter addressed not only male to female
violence but female to female violence as well,
including physical abuse directed at weaker
family members and household help. Both male
and female violence are described as the result
of repressive social conditions rather than
innate qualities of either sex.
A major challenge was to find approaches
that would not offend the religious feelings of
Muslims or Christians, without sacrificing
objectivity or the pro-women nature of the
book. The Collective acknowledged the impor-
tance of religion in Egyptian society and put
forward positive interpretations of religious ten-
ets, such as Quranic quotes emphasizing the
importance of protecting women's health, high-
lighting the rights of female children and sup-
porting equal relations in marriage. Despite a


wide range of religious perspectives among Col-
lective members, they generally agreed on the
importance of reinforcing those religious values
in their society that are supportive of women.
Controversial issues were discussed at
each stage of preparation, from original outline
to subsequent drafts. In all, each chapter was
revised at least four times to take into account
suggestions by the Collective and to respond to
criticism of content or style.

Review and Revision
Now I know a lot about my own body and
self I am recommending the book to all my
friends in school and we plan to read it together
with other friends and...to the women in our
families who cannot read it on their own.
Young girl of 14
At midpoint, the Collective held a two-day
seminar to make an overall review of drafts, to
select graphics and to discuss matters relating
to consistency of Arabic tone and usage. A
group of outside reviewers was invited to partic-
ipate in this process, including a respected male










Hayat al Mara...

Women's Lives and Health in Egypt


Contents


1. Egyptian Women's Perceptions of Their Lives and Health
Describes women's perceptions of biological gender attributes, friendship and love, beauty, love and
sexual relations and multiple roles of women in society. Identifies some cultural stereotypes such as the
perception that femininity involves physical beauty and weakness.
2. Childhood: An Important Phase of Women's Lives
Discusses infant health care and traditional forms of discrimination against female children (Egypt is
one of the few countries in which female infant mortality rates are higher than male rates) and social
and psychological damage associated with female circumcision.
3. Adolescence
Reviews the physical changes in both boys and girls and emotional changes during adolescence.
Provides detailed information on menstruation and reproductive biology as well as helping women
achieve balance between desire for independence and the need for relationships.
4. Marriage and Sexual Relations
Talks about sexual relations in the context of marriage (responding to prevailing cultural values).
Emphasizes the importance of communication and need to overcome stereotypes such as a male's right
to initiate or withhold sex. Gives suggestions for improving intimate communication and mutually
agreeable sexual experiences.
5. Fertility and Infertility
Refutes the notion that women are solely responsible for infertility (which results in loss of status and
frequently divorce or abandonment). Discusses causes of infertility and methods that can help couples
with this problem.
6. Pregnancy, Childbirth and Breastfeeding
Stresses positive traditions of family involvement during pregnancy and birth, as well as importance of
medical supervision of pregnancy from an early stage; describes warning signs that demand prompt
medical attention. Reinforces tradition of breastfeeding, showing health and emotional advantages.
7. Abortion
Addresses this sensitive topic by providing information on reliable contraception and various options for
unwanted pregnancy. (Although not uncommon, induced abortion is illegal in Egypt, except when the
mother's life is threatened.)
8. Regulating Fertility: Women's Rights, When and How
Reviews all major methods of fertility regulation, giving balanced views, pro and con, of each method
and leaving the choice to each individual woman.
9. Life After Menopause
Focuses on the positive aspects of life for older women and how to cope with physical, psychological
and social changes accompanying menopause.
10. Nutrition
Presents general nutritional advice, stressing high prevalence of anemia among women and girls, its
avoidance and treatment.









































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11. Infections, Malignancies, Common Health Disorders
Recommends regular checkups (not a common practice) and overcoming reticence to seek care for
infections, observed lumps or other problems as soon as they appear.
12. Traditional Health Care
Offers a balanced view of traditional practices by reviewing scientific evidence on efficacy and noting
beneficial as well as harmful practices.
13. Women and Work
Reviews in a balanced manner risks associated with work, including health hazards in performing
household work, such as unsafe cookstoves; occupational hazards for women in agriculture caused by
use of fertilizers and pesticides; hazards in offices and factories due to unsafe materials and machinery;
and, while presenting employment for women positively, discusses the work-related stress many women
experience attempting to fulfill multiple responsibilities.
14. Violence Against Women
Covers rape, physical and psychological abuse by employers or family members, incest and abusive
treatment of servants and child laborers. Emphasizes how women can protect themselves from violence.
15. Social and Psychological Pressures
Addresses gender stereotypes and suggests how women can learn to reduce stress by seeking more
egalitarian relationships in the family; sharing problems with husbands, family members or trusted
friends; or by seeking professional help.
16. Available Health Care Services and Medical Care in Egypt
Comprehensive directory of services with special emphasis on women's health needs.


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gynecologist, a professional editor and an illus-
trator. One of the reviewers was also knowledge-
able on matters of Islamic law and traditions.
While some members were initially against
male participation at this stage, the Collective
agreed it would be useful to have the benefit of
male insights and perspectives.
Reviewers played an important role at the
seminar, making a number of suggestions that
improved the accuracy and clarity of the manu-
script. By displaying some nonsexist attitudes-
as well as a number of stereotyped responses-
the male participants gave useful feedback con-
cerning how the general public was likely to
receive the book.
Following the seminar, two chapters were
selected as a sample for protesting on an audi-
ence of Egyptian women. The pretest was car-
ried out to gauge public reaction to important
aspects of the book: language, style, format, illus-
trations and, especially, the content itself. Would
women find the presentation of sensitive mate-
rial on sexuality acceptable? Would they easily
understand the style of written Arabic? Would
they find the book's tone friendly and accessible?
One hundred women from different back-
grounds and ages participated in the first pretest.
The results were encouraging. They indi-
cated that the Collective had come up with a
book that filled a real need. Several women said
that this was the first time they had read about
vital issues in their lives from a woman's per-
spective. The pretest demonstrated that the
material was accessible even to women with
less education than originally envisioned. It also
reinforced the validity of the book's style, which
was a mixture of standard Arabic and colloquial
dialect as used in daily newspapers.
The illustrations selected by the Collec-
tive ranged from medical diagrams to photos,
line drawings to cartoons. Readers in the pretest
favored the scientific illustrations and approved
of the photos, but responded poorly to cartoons
and humorous drawings. This finding surprised
some members of the Collective who thought
cartoons were a striking way to present informa-
tion. On reflection, the Collective realized that
cartoons are typically used in Egyptian public
life to ridicule an idea or person. Unintention-
ally, the use of cartoons detracted from the seri-
ousness of health topics and cast women in a


negative light. As a result of this review, car-
toons were excluded from the book.
Following the pretest, the complete text
was revised and subjected to another review by
five women readers who had provided excep-
tionally helpful comments during the first pre-
test. Further editing ensured consistency of
syntax and a unified "voice" throughout the
manuscript, important in a book written by
many different authors. A final screening was
done to reduce any language that sounded like
"preaching" to women.


Publication and Dissemination
The final product, published in early 1991
by a woman-owned press, features clear type
and illustrations, has a durable binding and is a
size somewhere between a book and a maga-
zine, to ensure easy handling. In lieu of royal-
ties, the Collective negotiated a discount on
all orders placed through its members, thus
enabling distribution to women's associations
and other social organizations at minimal cost.
Even so, the publisher dropped most of the
illustrations planned for the book in an effort to
keep the retail price low. This decision dis-
appointed the Collective members, who will
insist on replacing the illustrations when the
book is reprinted.
The Collective hopes that the book will
be circulated widely in Egypt and other Arab
countries where women's problems are similar.
Sales in high-income Arab countries may help
subsidize editions for lower-income countries
such as Sudan, Yemen, Tunis and Morocco.


The Future
For the first time in my life, I am feeling the
depth of my deprivation as an illiterate woman. I
am going to go to literacy classes so I can read
the book on my own.
25-year old nonliterate woman
The Collective met shortly before publi-
cation of the book to plan for a public confer-
ence to include media representatives, leaders
of nongovernmental organizations, health orga-
nizations and others interested in women's
health. The meeting was held in March 1991 to

































introduce the book and its authors, with partici-
pants encouraged to disseminate information
on the book as widely as possible and to use it
in their ongoing activities. In advance of the
meeting, 200 copies were distributed free of
charge to important individuals and associations
working in the women's health field. Subse-
quently, the Cairo daily press reviewed the book
several times. Sales of the book have been
higher than anticipated, leading to a second
printing scheduled for early 1992.
With the major effort of producing the
health guide behind them, Collective members
have turned their attention to the future. Some
of the suggested activities include using the
book in health training courses; revising and
separating chapters and issuing them as pam-
phlets; and distributing the book outside com-
mercial channels such as to clinics, women's


organizations or schools. Interest also has been
expressed in training social workers in rural
areas, where women's illiteracy is high, to use
the book as a tool in literacy courses. Collective
members hope to explore other media channels,
such as video or television, newspapers and
women's magazines, to expand the educational
resources available on women's health issues.
Although the entire group no longer
meets regularly, many enduring ties have been
formed, both socially and professionally All of
the members believe that the experience of
working on the women's health guide has
enriched them and given them valuable insights
into the nature of collaboration. These experi-
ences will be important as Egyptian women
take their place in the current movement for
greater freedom of expression and participation
in national life.





L V


z
s


I,






Adding Color to Life: Illustrated
Health Materials for Women in Peru


Background
Until about 12 years ago, leaders of
grassroots women's organizations in Peru were
not interested in promoting family planning.
They associated messages about women con-
trolling their fertility with the "individualistic"
rhetoric of feminists in developed countries.
But in Peru, as in many other parts of the Third
World, leaders of the women's movement have
modified their view in recent years, realizing
that the desire to control the number and spac-
ing of children is almost universal among all
women regardless of economic or social posi-
tion. With this acknowledgment has come a
growing participation by feminists in intellec-
tual, political and practical efforts to increase
women's access to information and services
related to sexuality and family planning.

Peru-Mujer
It was within this environment that Peru-
Mujer, a nongovernmental organization, was
created in 1979 by two women researchers
interested in helping low-income women
improve the quality of their lives. Using a partic-
ipatory method of group dynamics as their
basis, Peru-Mujer began conducting workshops
on subjects such as lifetime projects, sexuality
and family planning, legal rights and small
enterprises for groups of women throughout
Peru. Special emphasis was placed on having
the women define and seek solutions to social
problems themselves. The strength of the
approach was the intense emotional response
and the sense of group identification experi-
enced by the women. The weakness, Peru-
Mujer staff were soon to realize, was that when
these inspired women returned to their daily
routine, they had few tools at their disposal
either to help them maintain their enthusiasm
or to begin to make changes in their own lives.

The Project
At just the time when the staff of Peru-
Mujer were wrestling with the problem of how


to enhance the participatory process, they were
approached by PATH, the Program for Appro-
priate Technology in Health, (then known as
PIACT, the Program for the Introduction and
Adaptation of Contraceptive Technology), to
develop a pamphlet on family planning and
another on a health issue of their choice for use
by illiterate women in Peru. Beginning its work
in Mexico in the late 1970s, PATH/PIACT
pioneered development of a methodology to
produce simple print materials easily under-
standable by illiterate and low-literate audi-
ences. Their client-centered approach involves
the training of local personnel in the materials
development process and has been used
throughout Latin America, Africa and Asia.
Peru-Mujer staff reviewed materials devel-
oped by PATH/PIACT projects in other coun-
tries and were impressed by the attitude of
respect exhibited toward cultural values. They
saw here an opportunity not only to involve
women in dialogue but to include them in the
materials development process as well.
While visual materials for primary health
did exist in Peru, they had not been tested to
determine how well they were understood or
accepted, especially by illiterates. In addition,
most of these materials reflected urban condi-
tions found in the country's coastal region.
Since Peru is a diverse country, one of the first
things Peru-Mujer decided was that a single,
national booklet on either family planning or
immunization (the health theme they chose to
promote) would not work. Rather they decided
to develop a separate version for each of the
country's three major regions: coastal, jungle,
and mountain.

Learning the Methodology
Illiterate people have their own view of
the world, a different interpretation based on
their own experiences and a legacy of oral tradi-
tion. A person with poor or nonexistent reading
skills does not view illustrations in the same way
a literate person does. The project began with a
workshop conducted by PATH/PIACT for Peru-






Mujer staff in the use of their methodology. In
this approach, the emphasis is always on the
audience (in this case local women). They are
the "experts" both in terms of what they need
to know and how the information is presented.
Thus a women-centered approach was created
that made use of the underlying knowledge and
experience women already possess, confirming
knowledge and practices that are positive and
building a basis of trust on which to begin
changing those that are negative.
One important way of doing this was to be
certain that the women could recognize them-
selves in the illustrations. Drawings of people
who seem familiar create a sense of emotional
identification and provide an opening through
which new concepts and information can be
introduced and retained. In designing materi-
als, it was also necessary to keep in mind that
a woman's ability to access and use health
technologies depends to a significant extent on
her relationships with the people around
her, including power relations within the family
and community.
Armed with the new skills they had
learned, the Peru-Mujer staff embarked on a
three-phase project: 1) talking to the women to
find out their knowledge, attitudes and values
concerning family planning and immunization;
2) based on the information gathered, develop-
ing a set of materials that present information
on these themes in a way that is understandable
and culturally acceptable; (3) testing the materi-
als with the audience to be sure the messages
are understandable and that the women iden-
tify with the illustrations.

Gathering Information
Fortunately Peru-Mujer had been con-
ducting workshops throughout the country for
several years and was well known in the differ-
ent regions, so it wasn't difficult for them to
bring together groups of illiterate women for
focus group discussions (a qualitative research
method in which a small number of respon-
dents talk about a given topic under the direc-
tion of a trained moderator) on the selected
themes. Although the women were initially reti-
cent, little by little they began to express what
they really thought about family planning or
vaccinations. The women were pleased to coop-


erate in this process, patiently explaining details
when necessary. They liked the idea that some-
one was interested in their way of life and that a
"book" was going to be done about them.

Designing the Messages
Upon completion of the focus group dis-
cussions, the information gathered was ana-
lyzed. At the same time, Peru Mujer reviewed
technical and medical information on each
topic to insure that the material was presented
accurately. The next step was to develop a set of
basic messages on each theme. In the family
planning booklets, four fundamental ideas are
expressed: spacing children allows them to be
healthier and to have more individual attention;
there are modern contraceptive methods that
can be used to space children; although plan-
ning a family is a personal issue, there are other
important community problems that need to be
resolved; and it is important for women to orga-
nize themselves and talk over their problems
as women.
Now the messages had to be translated
into pictures. Finding artists who could under-
stand the importance of reflecting the local set-
ting in their illustrations was not easy It took
several tries before the right people were found.
Once an artist had rendered an initial set of
drawings, the pictures were tested. At each site,
local women were asked to describe the ideas
conveyed by each picture. In cases where they
did not understand the message, the women
were asked how they thought the idea could be
better presented. For example, in the mountain
region, the women said that in order to show
that a man is poor, he must be shown wearing
handmade woolen pants. The women were also
adamant that the tri-colored bands that adorn
their skirts be rendered as being a particular
length and fullness and that their local hats sat
on their heads at just the right angle. Only
when at least 80 percent of the illiterate women
who saw each picture could interpret its mes-
sage correctly was an illustration considered
acceptable.
In putting the messages together, it was
decided that in order for the pictures to serve as
a "bridge" between the women's world and pre-
sentation of "new" medical information, it
would be less threatening if the messages were
































arranged so that they told a story common to
everyday life. For example, the family planning
booklet for the coastal area is called "The
Quispes Plan Their Family" Quispe is a com-
mon name among migrants living in the mar-
ginal areas around Lima and the story line is a
familiar one. The husband has no work and the
child is sick. The mother cares for the child
while the husband seeks financial assistance
from neighbors who are unable to help as they
are in the same economic situation. A neighbor
recommends that the mother take the child to
the health post. There the child receives care
and the doctor talks to the mother about con-
traception as a way to provide better care to the
couple's children. The wife returns home, talks
to her husband, and both go to see the doctor.
They choose a contraceptive method which
they later discuss with their neighbors. The
next-to-last picture shows a meeting of commu-
nity residents where they are discussing com-
mon problems. The final illustration shows the
woman at the Mother's Club looking at the
booklet and discussing family planning.
During the focus group discussions, par-
ticularly in the jungle and mountain zones,
women talked a lot about physical abuse from


their husbands. This was an emotionally
charged issue, especially as members of the
group began to realize that it wasn't just them,
that others also suffered the same abuse. For
this reason, an illustration of a drunken, irre-
sponsible husband was included. On the other
hand, in a booklet on childbirth completed at a
later date, the husband is portrayed as someone
wanting to help at the time of delivery. The goal
was not to label men as either irresponsible or
supportive but to insure first that women iden-
tify with the illustration and then that they com-
pare it with their own situation, discussing
among themselves if the behavior is appropriate
or not, if it ought to be changed and if there is
something they can do about it.


Testing the Booklets
Once all the messages had achieved a
comprehension level of 80 percent or higher,
they were compiled in booklet form and 1,000
copies of each were printed. General compre-
hension of the messages was evaluated when
they were used as material aids by health pro-
moters/community workers conducting courses
in 10 sites located within the three different






I


regions of the country. All of the health pro-
moters/community workers were natives or res-
idents of the regions where they were working
and were familiar with the local population.
Ten illiterate women from the community
were invited to attend each course, which was
always arranged with the approval of commu-
nity leaders. The women were given some sup-
port for their participation, having a choice
between cash, food, wool, and so on.
A guide for the health workers was devel-
oped to accompany each booklet. The guide
explains, picture-by-picture, how the booklets
are to be used and how to stimulate discussion.
It served as the focus for instruction during the
one-week training session each promoter
attended in Lima before going out to the field.
Additional input on family planning was pro-
vided by staff of INPPARES (Instituto Peruano
de Paternidad Responsable) and on immuniza-
tion by two pediatricians specializing in com-
munity medicine.
The testing methodology was as follows:
the women were shown the pictures one at a
time and asked to explain what they saw. If
there was no response, the promoter encour-
aged them to talk by using questions from the
guide. If a drawing introduced new information,


the women were questioned about it again later
to be sure they clearly understood the concept.
The following day, the women discussed
what they learned the previous day. No more
than five to seven illustrations were covered in
one class.



Coloring the Booklets
Each woman was given a set of colored
pencils at the beginning of the course along
with her booklet and, at the end of each day's
session, the promoter asked the women to color
the pictures covered that day. The coloring
book approach had been used by Peru-Mujer
before as part of its legal projects and was found
to hit a responsive chord.
For many poor women, particularly in the
rural areas, this was the first time they ever had
their own notebook and pencils, much less col-
ored pencils! When the women took the book-
lets home and colored the drawings, they were
often helped by their children and, at times,
their husbands. In this way the themes of family
planning and immunization entered the home
in a natural manner to be discussed by all mem-
bers of the family. Some women requested extra






booklets to share with their neighbors and
friends and, in several cases, neighbors heard
about the "painting courses" and wanted to
attend. In all cases the booklets were treated
with great care; special bags were made for
them or they were kept in plastic so they
wouldn't get dirty. At each meeting the women
would show the group the coloring they did
at home.
While asking grown women to color pic-
tures may sound naive, Pen-Mujer had learned
previously that for poor women whose lives
since infancy have been almost nothing but
hard work, the inclusion of entertaining ele-
ments in a training course is very important.
Being given a booklet and a set of pencils made
these women, who had not gone to school or
who had learned to read but forgotten, feel that
they had been shown real consideration. In
addition, on the last page of the booklet a
diploma was printed on which the name of the
participant was inscribed upon completion of
the course. The women appreciated this gesture
as it gave an added sense of accomplishment
and it also was valued by husbands and families.
Diplomas were often hung on the walls, some-
times along with the booklets.


Evaluation

Between two and four months after the
conclusion of the courses, promoters held addi-
tional sessions with the participants in seven of
the ten original sites, using focus group discus-
sions and interviews to verify if women remem-
bered what they had learned. Also, the local
health post was contacted to see whether
demand for family planning or immunization
had increased.
In terms of family planning, participants
at all sites retained an interest in the subject and
requested more courses. All of them were able
to identify problems associated with closely
spaced births. At three sites women could iden-
tify modern contraceptives well; at the remain-
ing four sites, fairly accurately. Use of family
planning had increased 80-100 percent in three
sites, 50-80 percent in another three and less
than 50 percent in one location. At six of the
sites large numbers of women had enrolled in
literacy courses following the training sessions.
Family planning facilities at two sites reported a
"considerable" increase in the use of family
planning services; four sites reported "some-
what significant" increases and one site a negli-


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gible increase. Similar results were reported for
immunization services.
In sum, the courses and booklets created
motivation to make use of services, not to a
dramatic degree, but sufficient to prove their
utility and justify the cost. Moreover, other posi-
tive results included the increased demand for
literacy courses, and in some cases the commu-
nity organized other activities, such as a "medi-
cal day" where reproductive health services
were provided.

Importance of Involving Women in
the Development of Health Materials
For most of the participants, the courses
were an important event in their lives. The
women would put on their best clothes to come
to class, even when they had to walk as far as 14
km. to reach the course site. Still they were
highly motivated and came every day because,
working as a group, they were able to share
information with others like themselves.
The participants immediately identified
with the drawings-"people like us" they said.
This recognition as being "ours" was very
important in stimulating a dialogue among the
women and also in their acceptance of the
booklets. The coloring experience made the
process even more personal: "(By) painting, we
can add color to life:'
Because the women view the booklets as
their own, they not only keep them amd put
them up on their walls, but also go over them
again and again-commenting on the drawings
they colored and sharing them with family
members and friends. Involving local women in
the process from the beginning means that they
find the content both relevant and understand-
able. And because these messages and illustra-
tions were developed and tested in each region
and show respect for local traditions and the
knowledge women already possess, the audi-
ence can identify easily with the pictures and
are more open to accepting the new concepts
incorporated in the stories.

The Future
To date, booklets have been distributed
throughout Peru in collaboration with the Divi-
sion of Community Participation of the Ministry
of Health and the Literacy Division of the Min-


~jt Sr


istry of Education. Following publication of the
first series of booklets, Peru-Mujer produced
another 19 pamphlets on subjects such as ado-
lescent health, women and violence, sexual
abuse, community organization and health.
An internal reorganization at Peru-Mujer
resulted in staff changes and a shift in emphasis
for the organization. This type of work now has
been transferred to Asociaci6n Gupo de Trabajo
Redes. Those who were more involved in this
health education project have carried their skills
and experience over to new projects and are
continuing to develop health and family plan-
ning educational materials. They are also inter-
ested in pursuing new activities such as creating
songs and games for use in adolescent programs,
developing soap operas to change attitudes
towards family planning, and identifying appro-
priate ways to promote the use of condoms.
The work in health education has tran-
scended institutional boundaries. This is due
not only to the impact of the dissemination of
materials to marginal populations, but also to
the creation of a cadre of students and commu-
nity workers who have mastered and apply the
participative methodology.






Taboo Talk: Reproductive Health
Videos by Pacific Island Women


Background
Until the mid-1980s, little was known
about women's health priorities in the South
Pacific, and few women's projects had been
funded. The minimal reproductive health infor-
mation material available was not specifically
designed for the region, and women had little
voice in developing educational materials. In
1984-85 two Australian women undertook a
study of reproductive health in the South
Pacific for the Family Planning Federation of
Australia. The researchers tapped into the
extensive network of women's groups that flour-
ish throughout the villages and towns of the
region, listening to and recording what South
Pacific women had to say about their reproduc-
tive health wants and needs.
The Pacific women had much to say, but
overwhelmingly they spoke of the need to gain
access to information, particularly about contra-
ception, pregnancy and sexually transmitted
diseases (STDs). They talked about problems of
discussing such issues with families and com-
munities, and particularly with men. They also
spoke about the problem of men not taking
responsibility for contraception or controlling
the spread of STDs.
When asked what medium would be the
most appropriate way to present information on
these topics, the women strongly favored video.
It was felt that video could present the informa-
tion in a story-telling style that was in keeping
with Pacific tradition and that this medium
could offer an acceptable way of presenting top-
ics that would otherwise be subject to cultural,
particularly sexual, taboos that often limit the
effectiveness of health education workers.
Although distribution of video equipment
within the region is uneven, the technology is
generally available and accessible.
In 1987 the Family Planning Federation of
Australia obtained funding from the Australian
International Development Assistance Bureau
to produce reproductive health videos that
would meet the needs identified.


The Project
Before undertaking the project, the basic
research study was updated to see if Pacific
women still had the same priorities they had
expressed two to three years earlier. This
brought to light a new concern: AIDS. It was
therefore decided that three videos would be
produced on the following subjects: 1) AIDS and
the South Pacific; 2) Better Safe, dealing with
sexually transmitted diseases; and 3) Taboo Talk,
a discussion of women's attitudes towards men-
struation, sex education and family planning.
The three videos differ not only in subject
matter but in style of presentation as well.
Extensive planning workshops with Pacific
women resulted in the selection of very dif-
ferent modes of presentation for each of the
three subjects.
AIDS in the South Pacific uses two well-
respected figures, a female academic and a
male physician, to present controversial mate-
rial with the voice of authority. Explicit AIDS
information was considered too sensitive to
present in any other way than a sermon-like
delivery that would give some credibility to the
messages and help overcome the general reti-
cence to discuss sexual subjects publicly.
Better Safe is a drama about sexually trans-
mitted diseases, condom use and male sexual
responsibility. The video uses actors to create a
story about a young man who moves between
his city and village girlfriends. The video tries to
expose some of the attitudinal differences
between men and women and rural and urban
areas, as well as to trigger discussion about real-
istic STD prevention options.
Taboo Talk documents a wide range of
Pacific women, young/old, urban/rural, educa-
ted/uneducated, voicing their experiences, hopes
and concerns. The tape incorporates scenes of
village life, including the singing of traditional
songs. The aim is to encourage open discussion
about reproductive health issues and to generate
an appreciation of the similarities of experience
among women throughout the region.






Producing the Videos
The Pacific island of Fiji was chosen as the
site for filming the videos because it is home to
a wide cross-section of Pacific people as well as
a number of media production facilities. In
addition, the budget could not be stretched to
include filming in more than one country.
Women administered and carried out the
entire project. Although the videos and their
use were the end-product of the project, the
process of producing them was of equal impor-
tance. Pacific women were included in all
phases from initial research to production and
distribution. The original plan was to use a
Pacific women's video film crew, but when it
became apparent that none existed, the project
was redesigned. A women's film crew was
brought from Australia with the understanding
that a component of the project would be to
train a local women's film crew as part of the
process. The selection of film trainees was
based on their past involvement in media work,
an interest and background in women's activi-
ties and the potential for future use of their
skills in other projects.
Scripts were developed but were intended
to be used only as guides that would be modi-


fied during workshops with Pacific women. The
workshops continued until appropriate lan-
guage, beliefs, values, style of presentation,
length, religious involvement and priorities
were determined. For example, due to the
important part that religion plays in the life of
Pacific people, women wanted the two principal
churches represented in the AIDS video to give
credibility and authority to the messages. And
because Pacific men don't tend to involve them-
selves in "women's business," women wanted
their STD video to focus on the need for men to
become active participants.
The project was designed to take into
account the cultural and religious sensitivities
of those involved and, because it was a video
project for women and by women, it was car-
ried out according to women's priorities.
Although women were initially reticent about
speaking on camera, they still had a strong
desire to do so. The presence of a supportive
women's film crew helped them to overcome
their reserve. In one instance, the filming trig-
gered some painful memories about a woman's
past and she started to cry. Instead of continu-
ing to shoot what could have been some sensa-
tional footage, the crew stopped and began to






share their own reproductive experiences. This
brought a realization that women's experiences
transcend nationalities and that the film could
highlight that universal experience in a positive
way, rather than dissect Pacific women's experi-
ence for its curiosity value.
The South Pacific region is racially and
culturally diverse. Although sexual taboos are
taken very seriously, they vary from country to
country. Thus it was difficult to decide whether
an explicit scene, such as that of a condom
being unrolled onto a model of an erect penis,
would be acceptable to audiences throughout
the region. After numerous discussions with
women's groups, it was decided that the scene
should be included, and no negative feedback
has resulted. This underscores the importance
of incorporating a thorough consultation about
style and content with the audience throughout
the process of materials development.



Distribution and Use
The launch of the videos was scheduled to
coincide with the Fourth Regional Women's
Conference held in Fiji in September 1988.
Scores of women from throughout the Pacific
region attended the conference. Screenings
were also held at the various sites where filming
had taken place, including in the villages. Media
representatives were invited to these screen-
ings, resulting in newspaper articles and inter-
views on Radio Fiji. Advertising broadsheets
were sent to contacts throughout the region.
All the feedback from these early contacts
was favorable.
The videos are now being distributed
through the independent, nongovernmental
family planning associations in Papua New
Guinea, Solomon Islands, Tonga, Fiji and West-
ern Samoa and are being used in 16 Pacific
countries. They are being screened by depart-
ments of health and education, women's and
youth groups, nongovernmental organizations
involved in health education and churches.
AIDS and the South Pacific and Better Safe have
been shown on national television in Papua
New Guinea and Palau and have become
"recommended videos" for regional AIDS
education curricula in high schools. A partic-
ularly innovative means of distribution was pur-


sued in Fiji, where the leading commercial
distributor of rental home videos included the
AIDS film as a "short subject" on popular
rented films. The Australian government has
also bought copies for distribution to health
workers in areas of Australia with large Pacific
Island communities.
In 1989 an evaluation of the project was
carried out to analyze both the process of video
production and the impact of the videos in
terms of distribution, acceptability, appropriate-
ness and effectiveness. The videos' ability to
encourage discussion about hitherto publicly
avoided subjects was widely applauded. Both
educators and audiences highlight two areas in
which the videos excel: their Pacific flavor and
their ability to trigger discussion.
Although the project was designed to pro-
duce educational resources for women, men
too showed an enormous interest in the repro-
ductive health subjects. Video screenings fre-
quently prompted requests by both men and
women for more videos on sexuality and contra-
ceptive methods targeted at men. When Taboo
Talk was first produced, the women were reti-
cent about Pacific Island men seeing the film,
fearing males would have a negative response to
women expressing their thoughts and feelings
in this way. As a consequence, initial screenings
of this particular film were restricted to female
audiences and non-Pacific Islander males. How-
ever, it was not possible to control viewing audi-
ences once distribution spread, so the evalua-
ation was particularly interested in learning the
reactions of Pacific men to the film. They were
found to be very positive. Men were fascinated
by the women's ability to speak out on these
subjects and wanted a chance to do the same,
especially about their views on contraception
and the male sexual role. Requests for a male
version of Taboo Talk were widespread.
Distribution remains a continuing prob-
lem in the region. Although the videos are
being widely used, their availability is uneven,
with usage dwindling the farther one moves
away from urban areas. Future distribution
would be greatly enhanced by a face-to-face
promotion tour throughout the region and by
increasing the number of distributors to include
regional organizations. Use could be further
enhanced by providing accompanying print
materials that give specific details about target


































audience, aims and objectives of each tape and
suggestions for use.
Language is another problem. English is
the only common language in the Pacific and,
therefore, if only one version can be produced
for the region, it must be in English. However,
versions in the local vernacular would be more
effective for reaching people in rural areas and
for older people. Fortunately, a follow-up proj-
ect has now been funded that will translate the
video into five Pacific languages. Development
of these translations will also be done through
community women's groups.
Recognition of the film training compo-


nent in the project could have been reinforced
by presenting the trainees with a certificate on
completion of their apprenticeship, giving
increased status to their efforts. Encouragingly,
despite the lack of formal recognition, members
of the trainee film crew have used the experi-
ence both to obtain better jobs and to broaden
the scope of their present work. All are confident
they can produce their own videos in the future.
It is a testament to the skills of all the
women involved that governments around the
Pacific are now using a nongovernment
resource produced entirely by women.






Afterword


The differences among the three projects
described here demonstrate that there is no
standard pattern for success in developing
appropriate materials and effective approaches
to reach women with health information. The
case studies can, however, stimulate us to think
about some basic principles that will be helpful
to those involved in similar efforts. Readers who
want to learn more about the individual pro-
jects can refer to the Appendix, where contact
information and other resources are listed.

No Short Cuts
Development of quality information mate-
rials takes time. Each chapter of the Cairo
Women's Health Collective's book was revised
four times, even before protesting; both the
content and the approach were discussed at
length until consensus was reached. In Peru,
painstaking attention to details, such as the
dress styles depicted in the illustrations, meant
that each picture went through several-some-
times many-versions in order to increase the
effectiveness of the message. Consultation
among the culturally heterogeneous women of
the Pacific was necessary to establish the
acceptability of potentially sensitive subjects;
production could have been faster without it,
but judging from the evaluation, the videos may
not have had the same impact.

Know the Audience
One of the most time-consuming, yet
rewarding, aspects of all three projects was the
extensive interaction with the intended audi-
ence. This was achieved in different ways-sem-
inars, meetings with women's groups, focus
group discussions-and at different stages of
the process, but in each case these consulta-
tions provided information indispensable to the
final product. Such a process is not always
applied in developing health information mate-
rials although, when women are the audience, it
is particularly crucial because they are seldom
asked about their needs and opinions.
Assumptions about what women want, or
can do, can be misleading. The producers of the
video Taboo Talk could have accepted the con-
ventional wisdom that Pacific women would not


discuss sexuality and simply produced a didac-
tic film. Instead, they invested time in talking
with women's groups throughout the region.
This gave them a completely different picture of
the situation. The result is a sensitive, moving
production that enables other Pacific women to
learn from their sisters' discussion of their
reproductive health experiences and feelings.

...and Its Variety
Although women's problems and health
needs have much in common, it is a mistake to
treat women as a homogeneous audience. In
Peru, the project had to adapt basic family plan-
ning information materials for women in each of
the three main cultural regions of the country,
and the Cairo health book had to be sensitive to
Christian as well as Muslim beliefs. The choice
of English as the language for the Pacific videos
has enabled them to be used throughout the
region but, in some cases, it has limited the
audience, with older women and those in rural
areas less likely to be reached.


Pictures, Books, Film?
The choice of which media to use is a
difficult one, and decisions once again must be
based upon knowledge of your audience. Picto-
rial material and accompanying courses
designed for illiterate people are critical in
many countries and will remain so for older
women even in countries where formal school-
ing is becoming more accessible to the young.
However, the demand for written materials
needs to be monitored as the education profile
of women changes, and consideration needs to
be given to emerging forms of the popular press
such as women's magazines. Videos also can be
appropriate where a large proportion of the
intended audience has access to the technology
and where maintenance is not a problem. As
the author of the Pacific project report dis-
cusses, the impact of the videos probably could
have been greater if they had been accompa-
nied by print material explaining their objec-
tives and use, and if they had been distributed
through a promotional tour along with face-to-
face communication.






Some Technical Lessons
Many technical problems that can arise in
producing health information materials-such
as comprehension of visual messages-may
apply equally to male and female audiences.
But because women are often less familiar with
the "outside world:' it is sometimes necessary
to make a special effort to ensure that materials
will not only reach but also be understood by
the female population. Studies often claim that
material was discussed with an undefined group
of "villagers" or "the community," but unless
special attempts were made to elicit women's
contributions, this often means male villagers
and male members of the community were con-
sulted and does not guarantee that women's
viewpoints have been represented.
Where women are the intended audience,
their involvement is essential not only to ensure
that messages are technically appropriate but
also to validate that they are relevant to women's
perceived problems and their view of the world.
In Peru, incorporating women's advice into
drawings and stories meant that the pictures
were more than just recognizable-women
identified with them.


Importance of the Process Itself
The fact that women so rarely have a voice
in decision making makes the total development
process described in these case studies a path-
breaking experience. Its value extends both to
the women who are the intended users as well
as to those involved in production. Participating
in courses and obtaining a diploma, being mem-
bers of focus group discussions, responding to
pretest material, talking about personal experi-
ences in a film-all can reinforce women's net-
works and raise individual self-esteem. For the
producers of the material, the same functions
are served through the activities involved in
implementing these projects-forming a wom-
en's collective, training in participatory metho-
dologies, taking part in discussions and
interacting with service providers. In the
Pacific, an all-women film crew was trained,
opening up new employment opportunities for
them after the project. Whether the rewards
were material, professional, social, or personal,
those involved in carrying out each project felt


that much more had been gained than just the
production of information materials.

Building on the Investment
All the projects discussed here are leading
to expanded or new activities that will make use
of the experiences and results gained, thus
broadening the impact of materials that have
been shown to be effective. Similarly, the expe-
rience gained by the participants can be drawn
upon in future activities to influence even larger
groups of people.
In Cairo, where so much time and effort
went into preparing material for the book, sug-
gestions for the future include converting indi-
vidual chapters into pamphlets, as well as
spreading the messages through other forms of
media, including women's magazines. In Peru,
too, women are considering other ways of deliv-
ering educational messages: through songs,
games and soap operas. The positive male
response to the women pictured in the Pacific
videos may lead to a related project that will
record male perspectives in reproductive
health, and the existing videos are being trans-
lated into five Pacific languages.

Links between Information and
Services
The involvement of service providers in
the process of developing and disseminating
reproductive health information for women can
yield many dividends. Links with health work-
ers can ensure that the information provided
accurately depicts available services so that
women's expectations will be realistic. While
providing technical advice on the Cairo book,
medically trained collective members and advi-
sors not only provided advice, but also had the
opportunity to engage in debate that broadened
their perspectives on women's health. The
Peru-Mujer materials were produced for use by
health promoters/community workers, who
helped to pretest the materials with women in
local communities. In the Pacific AIDS video,
the involvement of the medical establishment
helped to lend credibility to the presentation of
sensitive material and links with Pacific family
planning associations were valuable not only
during production but also for distribution of
the videos through their networks.






Health information materials developed
by and for women enable women to help them-
selves-to become more knowledgeable about
available services, more confident about using
them, and better able to mobilize to demand
improved services. In Peru the health informa-
tion courses led to increased demand for liter-
acy training and the organization of activities
such as a "medical day" where reproductive
health services were provided.


More than this, the link between informa-
tion and services is fundamental in a conceptual
sense. The current trend toward placing more
emphasis on quality of care and incorporating a
"user perspective" in service delivery extends
logically to the involvement of women in the
development of information materials. Materials
that are based on respect for the woman client-
her needs, her beliefs and her contributions-
will be those that women understand and use.


Resume enfrangais


Information est la cl6 pour comprendre et
faire face au changement. C'est la condition pour
une meilleure prise de conscience de soi-meme et
pour donner aux individus les moyens d'exercer plus
de contr6le sur leur propre vie. Probablement nulle
part ailleurs n'est la question de l'acces a l'informa-
tion aussi crucial que dans le domaine de la sant6
des femmes-particulierement en ce qui concern la
sant6 de la reproduction des femmes. Dans la
second moiti6 de ce sikcle, les professionnels de la
m6decine ont eu tendance non seulement a se sentir
propri6taire du savoir en matibre de sant6 de la
reproduction mais encore a refuser de le partager
avec les dispensateurs traditionnels de soins, c'est-h-
dire, les sages-femmes et les femmes elles-memes.
En consequence, les groupements f6minins
oeuvrant pour la sant6 des femmes sont devenus par-
ticulibrement actifs et ont commence a se faire
entendre au course de ces dernieres ann6es. Grace,
surtout, aux efforts d6ployds par les femmes travail-
lant a la base ou en milieu acad6mique ou hospitalier,
les professionnels de la planification familiale ont fini
par r6aliser que pour favoriser l'adoption et l'utilisa-
tion continue d'une m6thode contraceptive, on ne
pouvait se contenter de motiver les clients potentiels;
il fallait, en fait, leur donner des informations com-
pletes et pertinentes sur les m6thodes contraceptives
et s'assurer, par ailleurs, que les clients pouvaient se
les procurer facilement. On s'est 6galement rendu
compete que, pour 6tre utile, I'information devait etre
intelligible et attrayante pour le public vis6 et etre
pr6sent6e sous une forme qui reflbte la realit6.
Mat6riels d'information par et pour les femmes:
Quelques dfis a reliever
Le d6veloppement de mat6riels d'information
sur la sant6 par et pour les femmes se heurte non


seulement h des problemes techniques courants mais
6galement a des obstacles plus fondamentals. Les
femmes, plus particulierement les femmes pauvres,
risquent souvent d'etre marginalisees par la society.
Elles sont 6galement plus nombreuses que les
homes 'a tre analphabktes ou a avoir perdu la
capacity de lire par manque de pratique. En outre,
on les intimident ou les empechent d'avoir access a
l'information moderne et elles sont tenues a 1'cart
de toutes les prises de decisions.
Le processus de developpement de materiels
sur la sant6 par et pour les femmes peut constituer
un context s6curisant dans le cadre duquel les
femmes ont la possibility de poser des questions, de
parler de leur v6cu et d'bchanger des informations
sur des sujets qu'ils seraient impossible d'aborder
dans un environnement mixte. Un tel processus aide
6galement les femmes a se valoriser puisqu'elles s'ap-
perqoivent qu'elles ne sont pas seules, que d'autres
femmes partagent les mimes problemes et pr6occu-
pations et qu'elles peuvent apprendre de leurs exp6-
riences mutuelles.

Les etudes de cas
Proccup6es par le manque de connaissances
des femmes dans leur region sur leurs besoins en
matibre de sant6, 25 femmes du Caire, de milieu
social, de groups d'&ge et de categories profession-
nelles tres diff6rents, ont d6cid6 de former le "Col-
lectif du Caire pour l'information des femmes sur la
santO". S'inspirant de "Notre corps, nous-memes" le
fameux livre public par le "Collectif de Boston pour
l'information des femmes sur la sant6", leur intention
6tait de publier un ouvrage sur la sante qui serait
6crit exclusivement par des femmes et du point de
vue des femmes 6gyptiennes.






Le fruit de leurs efforts s'intitule "Vie et sant6
des femmes en Egypte". 11 s'agit d'un guide sur la
sant6 destiny aux femmes de la region et reflkte des
questions culturelles et des circonstances contempo-
raines particulibres A l'Egypte. PubliC en 1991, ce
guide fut d6velopp6 a travers un long processus de
n6gociations et de compromise. I1 ne s'agit ni d'une
traduction ni d'une adaptation mais d'un ouvrage
in6dit et est entierement r&dig6 du point de vue des
femmes dans un style amical et a la port6e de tous.
C'est 6galement un livre objectif puisqu'il n'essaye
d'imposer aucune vue particulibre a ses lectrices
mais au contraire de les amener a tirer leurs propres
conclusions. Le livre se vend m&me mieux que prevu
et une deuxibme impression aura lieu d6but 1992.

Peru-Mujer, ONG p6ruvienne, en collabora-
tion avec PATH (Programme de Technologie Appro-
priCe en Sante) a entrepris un project pour d6velopper
des brochures illustr6es sur la planification familiale
et la vaccination a l'intention des femmes illettr6es et
peu instruites. Les concepteurs ont adopt une
approche centre sur les femmes en faisant une utili-
sation positive des connaissances existants chez les
femmes et de leur vecu et ont cr6e un climate de
confiance propice a combattre les idWes fausses et a
faire cesser les pratiques ndfastes.
Des brochures diff6rentes ont t6 d&veloppdes
pour chacune des trois regions du P6rou et, dans
chacun des cas, les concepteurs ont pris soin de les
tester avec les femmes. Les brochures ont ensuite &te
utilisdes dans des course de formation. Lun des
aspects unique de ce project etait que les femmes (et
souvent leurs enfants et mime leurs maris!) col-
oriaient eux-mimes les illustrations avec des crayons
de couleurs qu'on leur avait donnas. Pour bien des
femmes, c'6tait la premiere fois qu'elles tenaient un
crayon de couleur entire leurs doigts; cette activity
non seulement d6veloppait l'intdrkt des femmes mais
rendaient les brochures plus valables non seulement
a leurs propres yeux mais aux yeux de la collectivit6
toute entire.


Une evaluation du project a r&v616 que l'infor-
mation avait bien &t6 m6moris6e et que le taux de
frequentation des services de sant6 et de planifica-
tion familiale avait augment. Parmi les autres r6sul-
tats positifs, il convient de noter les nombreuses
demands de participation a des course pour appren-
dre a lire et ha crire et, dans certain cas, d'organisa-
tion d'activit6s au niveau de la collectivitd.
Dans le Pacifique Sud, I'on a demand aux
femmes quels 6taient leurs besoins en matibre de
sant6 de la reproduction et quels types de mat6riels
pouvaient, selon elles, le mieux communiquer les
renseignements qu'elles souhaitaient recevoir. Le
r6sultat fut un project video entierement r6alis6 par
des femmes et du point de vue des femmes avec la
production des trois videos suivantes: 1) Le Sida et le
Pacifique Sud; 2) Mieux vaut &tre prudent, consacr6
aux maladies sexuellement transmissibles; et 3) Con-
versations tabous, une discussion sur l'attitude des
femmes envers la menstruation, l'dducation a la vie
familiale et la planification familiale.
Du ddbut a la fin, le project a 6t6 entibrement
r6alis6 par des femmes. Bien que les videos et leur
utilisation 6taient le produit final, le processus de
production 6tait d'une importance toute aussi capi-
tale. Les femmes de la region 6taient includes a toutes
les phases du project depuis la recherche initial jus-
qu'a la production et la distribution. Etant donn6
qu'aucune 6quipe de tournage feminine n'etait dis-
ponible sur place, l'on a fait venir une 6quipe austra-
lienne sous condition qu'elle formerait une 6quipe
locale dans la production de videos.
A present, les videos sont utilisees dans 16 pays
du Pacifique Sud. Une evaluation rdalisde en 1989 a
r6v6l6 que les videos sont capable de susciter des
discussions sur des sujets don't auparavant il ne fallait
pas parler ouvertement. Selon les 6ducateurs et les
spectateurs, les deux domaines dans lesquels les
videos excellent sont le fait qu'elles rendent bien
l'atmosphere du Pacifique et leur capacity a stimuler
la discussion.


Resumen en Espaihol


La informaci6n es la clave mediante la cual
comprendemos y nos adaptamos al cambio. Tambi6n
es la base sobre la cual ampliamos nuestro conoci-
miento propio y ejercemos un mayor control sobre
nuestras vidas. El problema del acceso a la informa-
ci6n es especialmente critic cuando se trata de la
salud de la mujer, y en particular de su salud repro-
ductiva. Tradicionalmente, las parteras y las mujeres
mismas se han encargado de las practices y los servi-
cios relatives a la atenci6n en salud reproductive.
Pero durante la segunda mitad de este siglo el sector
medico professional ha expropiado estas funciones,
limitando el acceso de las mujeres a la informaci6n
sobre el cuidado de sus propios cuerpos.


En respuesta a este fen6meno, los grupos de
salud de la mujer han intensificado sus actividades y
reivindicaciones en afios recientes. Gracias a los
esfuerzos de mujeres que han trabajado en los
niveles locales, institucionales y acad6micos, los pro-
fesionales de planificaci6n familiar han empezado a
reconocer que sus responsabilidades requieren algo
mas que la simple motivaci6n de posibles clients.
Es necesario ademis que la client reciba informa-
ci6n complete y exacta sobre los m6todos anticon-
ceptivos, y que existan servicios lo suficientemente
accesibles como para facilitar no s61o la adopci6n,
sino el uso continuado de la anticoncepci6n. Tam-
bidn se esti empezando a reconocer que si la infor-






maci6n exacta se present de un modo desagradable
o incomprensible, o si no refleja la realidad en cuanto
a los servicios disponibles, da lo mismo no ofrecer
informaci6n alguna.

Materiales informativos hechos por y para la
mujer: algunos desafios especiales
Ademis de presentar problems t6cnicos com-
unes, el desarrollo de materials de informaci6n
sobre salud por y para mujeres implica una series de
desafios b~sicos. Las mujeres, y especialmente las
mujeres pobres, tienden a estar marginadas tanto en
su condici6n fisica como en su posici6n dentro de la
sociedad. Comparadas con los hombres, tambi6n
tienen una mayor probabilidad de ser analfabetas o
de haber perdido la capacidad de leer por falta de
prictica. Estos factors contribuyen a que las
mujeres sean excluidas de los process de decision, y
hacen que se sientan intimidadas por la informaci6n
modern en las pocas ocasiones en que tienen acceso
a la misma.
El process de desarrollo de materials de salud
por y para mujeres permit crear un ambiente seguro
en el cual las mujeres pueden hacer preguntas, dis-
cutir temas y compartir informaci6n de un modo que
jams seria possible en un context coeducacional.
El process tambi6n ayuda a fortalecer el sentido
de dignidad de las mujeres, a media que se dan
cuenta de que no estin solas y que otras mujeres
comparten sus problems y pueden aprender de
sus experiencias.

Las experiencias
La Colectividad para Libros sobre Salud de la
Mujer de Cairo fue formada por 25 mujeres de dis-
tintas edades, classes sociales y ocupaciones que com-
parten una inquietud por la salud reproductive de la
mujer. Inspiradas por el famoso libro de la Colectivi-
dad para la Salud de la Mujer de Boston, Our Bodies,
Ourselves ("Nuestros cuerpos, nuestras mismas"), las
mujeres de Cairo decidieron producer un libro sobre
salud hecho por y para la mujer egipcia.

El resultado de sus esfuerzos se llama La vida
y la salud de la mujer en Egipto, y consiste en una
guia sobre salud para mujeres, escrita en arabe, que
refleja la cultural y las circunstancias del Egipto
actual. El libro, editado en 1991, fue desarrollado a
traves de un process de negociaci6n y conceciones.
Se lo escribi6 desde la perspective de la mujer, en un
estilo informal y accessible, y empleando s61o material
original, en vez de adaptar materials existentes. Las
redactoras tambien buscaron ser objetivas, sin
imponer un punto de vista particular, con el prop6-
sito de que cada mujer llegue a sus propias conclu-
siones. El libro se ha vendido en cantidades muchos
mayores a lo esperado, y se anticipa una segunda
tirada a principios de 1992.
Trabajando en conjunto con el Programa para
la Technologia Apropiado en la Salud (PATH), Peni-


Mujer, una organizaci6n peruana privada, emprendi6
un proyecto para desarrollar materials impresos
sobre planificaci6n familiar e inmunizaci6n para
mujeres analfabetas o de alfabetismo limitado. El pro-
yecto estableci6 una perspective centrada en la
mujer que aprovech6 de los conocimientos y la expe-
riencia que las mujeres ya poseen y cre6 una base de
confianza sobre la cual se pueda empezar a cambiar
ideas y practices negatives.
Se disefiaron folletos distintos para cada una de
las regions geogrnficas del Peri, y cada uno fue
cuidadosamente probado con mujeres locales. Poste-
riormente los folletos se emplearon durante cursos
de entrenamiento. Uno de los aspects singulares del
proyecto fue que las mujeres (y a veces sus hijos y
maridos) se encargaron de colorear las ilustraciones
de los folletos, usando lpices provistos por el pro-
yecto. Esta fue la primer vez que muchas de las
mujeres habian poseido un lipiz de color, por lo cual
la actividad no s61o estimul6 interns en el proyecto,
sino que aument6 el valor de los materials para ellas
y para la comunidad en general.
Una evaluaci6n del proyecto revel6 buenos
niveles de retenci6n de la informaci6n y un aumento
en el uso de anticonceptivos y servicios de salud.
Entre otros resultados positives se destacaron una
mayor demand por cursos de alfabetizaci6n y, en
algunos casos, la organizaci6n de actividades por
la comunidad.
En el Pacifico Sur se llev6 a cabo un levanta-
miento para determinar cuiles eran las necesidades
de salud reproductive de las mujeres locales y qu6
tipos de materials serian los mis adecuados para
proveerles la informaci6n que desean. El resultado
fue un proyecto que produjo tres videos hechos por y
para mujeres: 1) SIDA y el Pacifico Sur, 2) Better Safe
("Es mejor estar segura"), sobre la prevenci6n de las
enfermedades de transmisi6n sexual; y 3) Taboo Talk
("Temas tab6"), una discusi6n sobre las actitudes de
la mujer hacia la menstruaci6n, la educaci6n sexual y
la planificaci6n familiar.
El proyecto fue administrado y ejecutado
exclusivamente por mujeres. Aunque la difusi6n de
los videos fue el product final, el process de produc-
ci6n en si tuvo la misma importancia. Todas las etapa-
del proyecto, desde la investigaci6n inicial hasta la
producci6n y distribuci6n, incluyeron a mujeres
locales. Cuando se descubri6 que no se disponia de
un equipo femenino de filmaci6n local, se contrat6 a
uno de Australia con la condici6n de que sus inte-
grantes le ensefiaran t6cnicas de producci6n de video
a las mujeres locales como parte del proyecto.
Actualmente los videos se estin utilizando en
16 pauses del Pacifico Sur. Una evaluaci6n realizada
en 1989 subray6 la capacidad de los videos de
motivar discusiones sobre temas que previamente no
se hubieran podido abarcar en public. Tanto los
educadores como el puiblico sefialaron dos aspects
sobresalientes de los videos: su singular sabor Pac-
ifico y su capacidad para provocar la discusi6n.






Appendix
Listed below is contact information for those involved in developing the materials highlighted
in this edition of Quality/Calidad/Qualitg, along with several other organizations engaged in the
production and/or dissemination of health materials developed by and for women. Also listed are
several publications of possible interest.


Resources
Cairo Women's Health Book Collective
c/o Delta Associates
12 Muamal el Sukkar
Garden City
Cairo, Egypt
For information about the Collective or obtain-
ing the book.
Blanca Figueroa
Grupo de Trabajo Redes
Apartado Postal 1578
Lima 18, Perd
For further information on the development of
women's health materials in Peru.
Family Planning Federation of Australia
39 Geils Court
Deakin ACT, Australia
For further information about the Pacific video
project or about obtaining copies of the videos.
Boston Women's Health Book Collective
P.O. Box 192
West Somerville, MA 02144, U.S.A.
Authors of Our Bodies, Ourselves. Work with
groups in other countries to produce health
materials.
ISIS International
85-A East Maya St.
Philamlife Homes
Quezon City
The Philippines
and
ISIS International
Casilla 2067
Correo Central
Santiago, Chile
Women's information & communication ser-
vice. Publications, technical assistance & train-
ing in communication skills and management.


National Black Women's Health Project
1237 Gordon St., S.W
Atlanta, GA 30310 U.S.A.
Originally U.S. based, they now have an interna-
tional program. Extensive experience working
with disenfranchised women and helping them
take responsibility for their health care.



Publications
(Please contact publishers directly regarding
availability, cost and shipping charges, which
may be applicable.)
Developing Health and Family Planning Print
Materials for Low-Literate Audiences: A Guide,
by Zimmerman, Newton, Frumin and Wittet
Program for Appropriate Technology in Health
(PATH)
1990 "M" Street, N.W
Washington, D.C. 20036 U.S.A.
Telephone: (202) 822-0033
In Her Own Image: Films and Videos Empower-
ing Women for the Future
Media Network
39 W 14th. Street
Suite 403
New York, NY 10011 USA
Telephone: (212) 929-2663
Asian and Pacific Women's Resource and Action
Series: Health
Asia & Pacific Development Centre
P.O. Box 12224
Kuala Lumpur 50770, Malaysia
Telephone: 603-254-8088






About the Authors
Valerie Hull is a demographer with extensive experience working in developing
countries. She is currently the Director of the Women, Health and Population
Section of the Australian Development Assistance Bureau. At the time the Cairo
Health Book was being developed, Barbara Ibrahim was the Urban Program Officer
in the Ford Foundation's Cairo office; she is currently the Population Council's
Senior Representative for West Asia and North Africa. Nadia Farah is Director of the
Cairo Center for Development Studies and Coordinator of the Cairo Women's
Health Book Collective. Blanca Figueroa was one of the founders of Peru-Mujer and
continues her work on development of health materials for women as the director of
the Grupo de Trabajo Redes in Lima, Peru. Margaret Winn was involved in the
planning, implementation and evaluation of the South Pacific Women's Video Proj-
ect; she is currently a consultant on reproductive health in the South Pacific and an
AIDS educator based in Australia.


Quality/Calidad/Qualite Advisory Committee
Ian Askew Debbie Rogow
George Brown Jill Sheffield
Judith Bruce Lindsay Stewart
Ethel Churchill Kerstin Trone
Adrienne Germain Nahid Toubia
Margaret Hempel Gilberte Vansintejan
Ann Leonard Cynthia Steele Verme
Margaret McEvoy Beverly Winikoff
John Paxman Margot Zimmerman


Design:
Cover Photo:

Typography:
Printing:


Ann Leonard
Institute of Cultural Affairs,
Bayad al Arab, Egypt
Village Type & Graphics
Graphic Impressions


We invite your comments and your ideas for projects which might be included in
future editions of Quality/Calidad/Qualite. If you would like to be included on our
mailing list, please write to Ann Leonard, Quality/Calidad/Qualite, The Population
Council, One Dag Hammarskjold Plaza, New York, N.Y. 10017, U.S.A.













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