Rafaela Panjoj Sente grew up in a small village on the outskirts of Chichicastenango, a town in the remote Guatemalan highlands northwest of the capital, Guatemala City. Rafaela had six siblings growing up and started working at age 8, cleaning houses to help pay for her school and basic necessities. When she was in 10th grade, her mother got cancer, and Rafaela had to drop out to help support her family. “I would work during the day and go to school at night …. But we didn’t have any resources for school, so that’s why I stopped going,” Rafaela explained. She wanted to be a nurse.
At age 16, Rafaela became pregnant. Prior to becoming pregnant, she had never received any information on how to prevent pregnancy, discussed consent, or learned how protect herself from sexually transmitted infections. “Before I got pregnant, I never got any information regarding pregnancy,” she explained. Although Rafaela wanted to return to school, as a single mother, she had no choice. “When my son was three months old, I went back to work. I was lucky because the house where I used to work before took me back. So I worked there and with that money I was able to raise my child.”
Today, Rafaela lives with her husband and two children, Maria Marleni, age 6, and Elvis Edward, age 11. Rafaela and her husband sew traditional clothes and sell them in the local market to make ends meet. Rafaela does not plan to have any more children, explaining, “it requires a lot of responsibility for education and health, and to feed them well.” She uses a five-year contraceptive implant which she learned about through REDMISAR, a local NGO that receives U.S. aid to promote and monitor reproductive health, nutrition, and education in Guatemala. According to Rafaela, “The first time I found out about [family planning] was when I went to a REDMISAR training.”
Rafaela was so motivated by the information she received from REDMISAR that she decided to become a trainer herself in order to share it with other women in her community and hold providers accountable. One in five women in Quiche have an unmet need for family planning and each woman has on average four children. For Rafaela, family planning enables women to invest more not only in their children’s education – something she notes her own mother was not able to do – but also in their health and nutrition. Fifty percent of Guatemalan children suffer from malnutrition and stunting. And in the district of Quiche where Rafaela lives, that number is even higher, with 70 percent of children under age 5 suffering from malnutrition. “When we have a large family, we cannot provide for them and sometimes we might fall into chronic malnutrition or severe malnutrition,” Rafaela explained
The Guatemalan government recognized the need for better access to family planning in 2004 and passed a tax on alcohol that helps to provide reproductive health information and services for free. With assistance from the U.S. Agency for International Development (USAID), Guatemalan activists then created the Reproductive Health Observatories Network (OSAR in Spanish) to monitor the government’s adherence to their commitment.
With USAID’s support, OSAR grew into a network of 21 local organizations called REDMISAR, which have trained hundreds of women like Rafaela to provide reproductive health information and monitor provision of these services by health care providers. Rafaela explained her job, saying, “We monitor education, health, and nutrition …. We monitor seven health centers to make sure that they do have the family planning methods and that they are providing the information because people have a right to know.” This type of monitoring and reporting is critical, she notes, because “ladies have had the experience of not finding any contraceptives at the health post … There was a lady who went there … and when she went there they told her they didn’t have any family planning method, and that’s how she got pregnant.” Stock outs are a problem in some of the rural, mountainous areas of Guatemala that are difficult to reach. Rafaela pointed out that this isolation is part of the reason that “women prefer the three-month injection.”
Beyond the essential health information REDMISAR provides, Rafaela feels one of the most important things she and her neighbors have gained is knowledge of their rights and a feeling of empowerment. She shared the story of a friend who refused to leave an abusive partner, believing that his jealousy was a sign of love. Rafaela explained, “Sometimes, because we don’t have information or education, we think that is true; but thanks to REDMISAR, they have informed us that we have a right to be respected, and we don’t have to be treated that way.”
“Without REDMISAR I would never have the information I have right now,” Rafaela concluded. “Without family planning I would have five children by now,” she added, “and I may be a failure because perhaps we would have to face malnutrition because we wouldn’t have enough money.” For Rafaela, the information and empowerment she gained from USAID-supported REDMISAR has changed her life and empowered her to change the lives of hundreds of other women in her community.
All funding for family planning and reproductive health programs like REDMISAR is completely eliminated in the administration’s budget for 2018. The U.S. is the largest funder of international family planning and reproductive health programs, providing 44 percent of global aid for such programs. An elimination of U.S. funds for global family planning will have devastating consequences in the lives women like Rafaela and the millions of women and their families around the world who rely on U.S. support to plan their families, rise out of poverty, and live healthy, empowered lives.
“Before I got pregnant, I never got any information regarding pregnancy.”