Kristin Elizabeth Yarris, UCLA School of Public Health and Latin American Studies
“Women’s Health and Structural Adjustment in Matagalpa, Nicaragua”

The aim of this paper is to place the health of women residing in Matagalpa, Nicaragua in the context of its social, cultural, political, and economic determinants. As has occurred elsewhere in Latin America, during the past two decades Nicaragua has become increasingly indebted to international financial institutions and has been forced to participate in "structural adjustment" programs in order to continue to receive financial assistance from the IMF, World Bank, and other international lenders. Macro-level economic policies that have decreased public investment in health and social infrastructure, and privatized many formerly-public services, have negatively impacted the health of marginalized rural communities such as Matagalpa and have made the role of non-governmental organizations (NGOs) working in these communities even more important. After reviewing the results of a study of women’s health conducted in seven communities of Matagalpa during the summer of 2003, the approach used by Acción Médica, a Nicaraguan NGO, to address the broad determinants of health and improve the lives of women in these communities will be described. The study included interviews with a convenience sample of 89 women between the ages of 15-60 using a questionnaire within both open-and closed-ended questions. In addition, focus groups were conducted with young women 15-20 to access their perceptions of health and well-being. Preliminary results reveal the multiple barriers to health and well-being faced by women in Matagalpa. Most do not complete primary school and have very limited economic resources. The majority initiate childbearing by the age of 16 and bear more than five children by their mid-30s. Although most women have knowledge of modern contraceptive techniques, many do not use them due to lack of access and intimidation by their male partners. Women commonly experience health problems such as aches and pains and gastrointestinal distress, however most live one hour or more walking distance from their nearest health post. Young women commonly identify lack of educational opportunities and gender discrimination as barriers to their well-being. Despite these barriers, Acción Médica is actively working with young and adult women in Matagalpa to address the broad range of determinants of health. This NGO is implementing programs to improve women’s access to education and economic opportunities, to promote leadership development and empowerment, and to increase access to health services.