THE EMBEDDED CULTURE OF MACHISMO

Four out of ten reproductive health promoters in Nicaragua are men.
Photo: Cathy Becker

THE EMBEDDED CULTURE OF MACHISMO

by Alex Marshall

Matasana Diary -- The mother had carried her sick baby for two hours over steep, rutted roads. Now she could only stand by as the doctor sounded the child’s chest. Pneumonia, said the doctor at last. There was nothing to be done, unless she could get the baby into hospital straight away.

The health team found space for mother and child in their four-wheel drive. By evening, after a bumpy ride to the provincial capital and an anxious hour waiting for a bed, Rosa Alba del Socorro, six months, was in intensive care. Her mother, Gregoria, waited outside, alone. She was just 17, and this was her second time in the city.

She was lucky. Health care can be a hit or miss affair in the isolated hamlets of north-eastern Nicaragua, where armed bands still roam and transport is infrequent and uncertain: but this community is close enough to Matagalpa, the provincial capital, to have a regular visit from a health team. Matagalpa has a well-organised women’s collective, which manages both the team and a network of health promoters and midwives in the area. The collective is supported by the national Centre for Social Study and Action, which in turn gets support from the United Nations Population Fund.

Dr. Alba Alvarado is the project’s national coordinator. She explains to a group of visitors how it operates, leaning against a wall out of the hot sun, arms folded, lifting her tired, humorous eyes from time to time. She is a paediatrician who took up this work after seeing what happened to children like Rosa Alba.

And to their mothers. A third of all births in these villages are to girls under 19, some of them as young as 12. Nationally, four out of ten girls have been pregnant by the time they are out of their teens. Most of them know little or nothing about their sexuality; early pregnancy and marriage are what they expect. They may even welcome it: research by the national university shows that motherhood offers a poor, uneducated teenage girl identity and recognition she can acquire in few other ways.

But she may pay a high price, especially in these remote hills, far from modern facilities. Girls of Gregoria’s age are not ready for pregnancy. They suffer terribly in childbirth, from convulsions, haemorrhage, obstructed labour and infection. Mothers under 18 run a risk of death twice as high as their older sisters.

Young men do not concern themselves with these matters. Gregoria is not living with the father of her child, but with her own parents. If she were married, she might be no better off—marriage does not automatically come equipped with housing and employment. Young and old cram themselves into two-room cinder-block houses or wooden shacks and try to make a living from raising coffee and bananas and maybe a couple of cows.

Dr. Alba has seen many young mothers like Gregoria. By the time she is 30 she may have five or six surviving children from eight or nine pregnancies. To avoid another she might have sought an illegal, dangerous abortion. Like three out of four women in these hills, she will have experienced occasional or regular beatings from her husband. She will be old before her time, worn out from the strain of trying to keep her children clothed, fed and healthy.

Can Gregoria change her fate? Yes, says Dr. Alba. Yes, say the village health promoters who are part of the Matagalpa Women’s Collective network. Yes, says the 75-year-old midwife, who says she has attended 500 births, and now has the collective’s training to help her. Gregoria can learn how to space her pregnancies and look after her and her children’s health. Maybe the network cannot do much about the poverty and crowded conditions out of which violence grows, but workers will reach out to her husband and try to persuade him to leave his wife alone.

Four out of ten of her health promoters are men, says Dr. Alba. The embedded culture of machismo, male power, is slowly beginning to give way. Nicaragua’s long struggle for democracy brought a new emphasis on human rights—including rights for women, who played their full part in the struggle. Groups like the Matagalpa collective are using that as a lever to promote women’s empowerment. One of Dr. Alba’s workers, Antonio Concepcion, 28, says that if he is tactful he can talk to men about many things—using condoms to avoid pregnancy and infection, for example; the idea that husbands’ rights do not include the right to assault their wives; even that men should show their sons an example of responsibility and caring for the family’s welfare.

The children of these villages have rights too, including a new adolescents’ charter that declares their right to freedom from violence and abuse, and the right to protect themselves from disease and unwanted pregnancy. The collective’s activities include vivid pieces of folk theatre using puppets and dramatic reconstructions to show how these rights work in practice. Today, the community house is packed with children, laughing and shouting along with the action. It may be optimistic to talk about human rights in these conditions, but it does not seem fanciful. To the collective, protecting the rights of women like Gregoria is a real and practical aim.

At the end of the show a tide of children comes swirling out of the community house, ready for the lunch their mothers have been preparing. The naked eye confirms national statistics—nearly half the nation is under 15. Perhaps when they come to be parents themselves they will be able to rely for health care on something better than the occasional visiting doctor.

For Gregoria it is enough for the time being that Rosa Alba will be safe: after two days the baby is out of intensive care, and mother and child will soon be able to leave the hospital. Dr. Alba has given Gregoria money from her own pocket to take a bus to the end of the rough country road. There she will wait, until someone gives her a lift back home.