Pilar has set up SIPAM, an integrated health service for women which aims to train women to look after their own health and to put pressure on health authorities to improve existing health facilities and attitudes on behalf of the medical profession.
Pilar is an anthropologist trained at the University of Veracruz, and although she worked for a short period in anthropological research, she became involved in the citizen sector. She was a founder of one of Mexico’s most important organizations in the area of housing called Casa y Ciudad, and coordinated their research and training division. From there she became more involved in the area of health as a researcher in the University Center for Technological Education for Health, working specifically on an analysis of the Mexican health system. At the same time, she was also involved in the women’s organization of one of Mexico’s left wing political parties. She left the political movement, however, disillusioned with what she calls the “sharp and bitter ideological in-fighting.” And it was following this period that she decided to form the association Integrated Health for Women (SIPAM) combining her work on health with her concern for women and social justice. A committed feminist, Pilar is also participating in a number of publications for women at a grassroots level.
SIPAM was created by Pilar and three other women who were concerned about both the state of women’s health and by the generally poor attention which women receive in medical centers which often verges on abuse. The idea is to establish a center where women can participate in workshops where they learn not only to look after their family’s health but also the organizational skills necessary both to seek for and provide health alternatives. Pilar has devised a comprehensive training scheme focusing on three major groups that she feels have been particularly neglected in terms of medical attention: young women, pregnant women, and housewives.
Despite the fact that official statistics on health in Mexico state that 94% of the population has access to health care, recent studies have suggested that as many as 30 million people do not have access to permanent health care. With regard to women, it is worth noting that over 47% of women do not have any medical attention during childbirth, which is close to a million women. This has obvious repercussions in the area of maternal morbidity and infant survival rates. Abortion, illegal in Mexico, is still practiced however, and it is estimated that between a quarter and a half of the female population of Mexico has had an abortion at some stage in their lives. Of these, Pilar maintains that some 50,000 women die annually owing to the insalubrious conditions in which “underground” abortions are practiced. These figures are not surprising when one takes into account the fact that the National Survey on Health and Fertility found that in 1987, 64.7% of pregnant women stated that their pregnancies were not desired. The problematic nature of women’s health in Mexico is related moreover to a clear lack of quality in the health centers and clinics where these exist. Merely in terms of public spending from 1982 to 1987, spending in this area decreased from 2.6 to 1.7% despite the fact that the World Health Organization has determined that it should be 8% of the country’s gross domestic product.
Pilar is very clear on strategy and she divides it into three different levels of action: self-help, self-reliance, and social change. Each one leads into the other. By training women in self-help, they become aware of the need to organize their own resources and therefore become self-reliant. At the same time however, she claims that without social change, in this case, the democratization of medicine, in the long run nothing is going to improve. So a central strategy of SIPAM is to work with personnel within the health sector itself. In concrete terms SIPAM itself works with three specific groups: young people, pregnant women, and housewives. The young people participate in a theater for health training workshop, and Pilar is currently setting up a grant system for young people who are participating. Through the grants she hopes that the young people will gain greater self-respect and receive increased family support because of their income. SIPAM also offers what they call a “espacio joven” – a space where young people can come and talk about problems affecting them and address issues related to sexuality. A third aspect of the work with young people is vocational orientation. Here the emphasis is on stimulating young people to carry on with their studies. In SIPAM’s work with pregnant women the aim is to give not only training in natural childbirth techniques but also to foment a more positive image of maternity. With so much talk amongst feminists about the right of choice concerning abortion and the need for its legalization, the alternative choice of having children has been devalued. SIPAM seeks to recover the richness and dignity of motherhood. Finally, SIPAM’s work with housewives focuses on teaching practical skills such as dressmaking, knitting, and hairdressing. The idea is that through these informal groups Pilar can open up the women to participate in other arenas. “If you invite them to come and talk about sexuality without even knowing them, chances are they will never come. If you get to know them first and form an informal housewives group then everything else follows naturally.”Pilar Muriedas