FAMILY PLANNING

A Fine Balance

Cultivating smaller families and healthier farms in Ecuador’s highlands.

by Marilyn Berlin Snell

The Swiss-chard fritter is to die for, as good as any chichi appetizer I’ve tried in San Francisco or New York. My host smiles shyly from under his brown fedora as I eat with my fingers, proffering a moist thumbs-up in appreciation of his gift.

Universal symbols are vital, as Alberto Yumisaca’s first language is Quichua and mine English. Spanish is our muddy middle, but with translation assistance it becomes clear that his community, carved into a steep hillside in Ecuador’s

Andean highlands, has adopted foreign notions—from leafy greens to family planning—to improve its quality of life.

Yumisaca is head of Monjas Tungurahuilla, an indigenous village of straw- and tin-roofed homes at more than 11,400 feet in south-central Ecuador’s Bolívar province. Life is as hard as the air is thin: Extreme poverty is the norm in the province; chronic malnutrition among indigenous children ages 3 to 5 is estimated at 80 percent. Infant mortality is also high, and women in rural Bolívar province are having on average 5.1 children each. (Nationwide, Ecuador has the highest population density in South America.)

But the 93 families in Yumisaca’s village are beating the statistics with an innovative program that links agriculture, health, and family planning. They have learned to space the births of their children, plant nutritional crops to keep them healthy, and maintain a fruitful and sustainable balance between population and land.

Previous efforts to promote family planning in Ecuador’s indigenous villages had usually met with failure. The Medical Center for Family Planning and Counseling, founded in 1974 by 11 Ecuadorian doctors with a mission to serve the poorest of the poor, operated urban clinics offering obstetric and gynecology care, pediatrics, and family planning. The doctors wanted to add rural services. But the Medical Center had trouble gaining a foothold in communities like Yumisaca’s, where families were suspicious of outsiders’ motives and culturally averse to discussing intimate subjects with strangers who most often couldn’t speak Quichua. Eight years ago, a healthy mix of genius and desperation led the Medical Center to team up with World Neighbors, an Oklahoma City–based organization that promotes natural-resource management and sustainable agriculture in 16 countries, including rural Ecuador.

Julio Beingolea is World Neighbors’ man on the ground. Once a professor of agronomy in Peru, before guerrilla violence forced him and his family to flee a decade ago to Ecuador, Beingolea was already working in Ecuador’s indigenous communities. At the Medical Center’s invitation, he designed a program that combined agriculture and health to help rural residents plan and provide for their families. "The way we’ve been able to get the confidence of the community is in agriculture and animal husbandry, because that’s where their income is," says the Spanish- and Quichua-speaking Beingolea, 59. "I talk about the need to space the corn for a healthy crop and can use that same metaphor with regard to children."

Beingolea and his team train volunteer "agriculture promoters" elected by the villagers in soil recovery, worm production, animal husbandry, composting, organic fertilizers, and the reintroduction of native trees for windbreaks and soil conservation. He encouraged the planting of Swiss chard in Monjas Tungurahuilla and elsewhere to help fight vitamin A deficiency.

In a coordinated effort, the Medical Center trains volunteer health promoters, usually women, in maternal and child health and family planning. Among other things, the promoters learn about sophisticated new natural methods of birth control (developed by Georgetown University with funding from the U.S. Agency for International Development, USAID), as well as tubal ligation, intrauterine devices, pills, implants like Norplant, and injections such as Depo-Provera. (Abortion is illegal in Ecuador, but estimates gleaned from hospital data on women who come in with complications arising from botched abortions indicate that 20,000 to 30,000 seek to end their pregnancies each year.)

The volunteer health and agriculture promoters cross-pollinate information at every opportunity as they venture into their own and neighboring communities. "In the field while working alongside the men, I talk to them in Quichua about health issues," says Luisa Huaman, the health promoter in Monjas Tungurahuilla. "Yesterday we talked about nutrition as we planted potatoes. People were surprised to learn that some vegetables provide better nutrition than others."

A Medical Center study, focusing on villages like Yumisaca’s where the integrated program has been established, found that in only three years the level of awareness about various birth-control methods rose from 35 to 78 percent. At the same time, the study found that the number of farmers practicing soil conservation increased from 23 to 50 percent, and the use of chemical fertilizers for corn decreased from 56 to only 7 percent. Today, 70 indigenous communities in Ecuador have integrated agriculture and family-planning programs.

But are women in these communities having fewer, healthier babies? After the fritter feast I travel an eroded and scary dirt road to Pasquazo Zambrano in the next valley over. Promoters Vicente Jarrin and María Juana Jarrin Malca are a married couple who live there. "We have 18 families and no one has more than three children," says Vicente in a rich and gravelly voice, flashing gold-rimmed front teeth when he grins. We’re standing in a plot he’s planting with spinach. The terrain is so sharply sloped I lean inward to try to keep my balance as we talk.

"Before, we didn’t know how to control pregnancy, we didn’t have the education, and people in the area were having nine or ten children," says María Juana, 33. "The health of the children and mothers has improved, and so has the spacing of babies," she adds.

The Jarrins have three children. Not only do they both work in their village on agricultural and health promotion (and farm their own plot of land), they serve 12 other communities as well. "Everyone understands the importance of family planning now," says María Juana. "But it was really hard at first. It still is, before I get to know the people. Once I get to know them it’s easier to speak of such things."

It may be getting easier to speak about family planning, but it’s about to get harder to practice. The political heat aimed at groups like the United Nations Population Fund and USAID—both of which have helped Ecuador’s Medical Center—is drying up much-needed funds.

According to Ken Farr, outgoing head of USAID’s Ecuador mission, the agency has been "in country" nearly 40 years, providing doctor and lab-technician training and contraceptives—which the Ecuadorian government, in the throes of a severe economic crisis since 1999, cannot afford to provide. Until 1998, Farr says, health and population issues were his main job. But that year the Clinton administration decided to phase out of Ecuador—partly because of USAID’s success in lowering urban fertility rates and improving health care; partly because Latin America was falling off Clinton’s map of political hot spots.

The phaseout was continued by the Bush administration, even though Ecuador’s economic crisis has rolled back most of the country’s health and family-planning gains. And Bush has gone even further, slashing funding worldwide for family-planning education and services. "There’s no more funding for family planning in Ecuador, as of 2004," says one USAID worker. "This administration just doesn’t believe in it."

Another longtime USAID employee based in Latin America is equally blunt. "There’s been a huge change in our agency; long-term development is out; health and environment issues just don’t rate. We’re now dictated to by the State Department, which focuses on tactical issues of the day. It’s like it has political attention deficit disorder." The employee adds, "People on the ground in our agency clearly see the connection between population, conservation, and political stability. It’s at the political level in Washington, where financial and ideological decisions are made, that we get into trouble."

Of course, there are still pockets of reason in Washington. From Representatives James Greenwood (R-Pa.), Joseph Crowley (D-N.Y.), and Carolyn Maloney (D-N.Y.), to Senators Patrick Leahy (D-Vt.) and Barbara Boxer (D-Calif.), members of Congress have fought to fund international family-planning initiatives like those in Ecuador. Supporters of these projects have been frustrated by a Bush administration beholden to right-wing religious groups that see abstinence as the only legitimate form of birth control. Other foes of family planning include Representative Chris Smith (R-N.J.), who spearheaded a successful attack in 2002 against the UN Population Fund. Smith accused the agency of defending "barbaric" and "anti-family" policies in China, and his amendment to the fiscal year 2004 Foreign Relations Authorization Bill stripped the agency of the $34 million the House and Senate had already allocated, even though no evidence was ever presented to substantiate his claims.

In the last village I visit, I meet Rosa Maigua. She’s been a health promoter in central Ecuador’s indigenous region for 17 years. She wears strings of glittery gold beads, a white shirt with delicate blue embroidery, a long skirt, and a black cape tied at her neck. "I remember one woman who had nine children," the 36-year-old mother of one says. "I came to visit her village and she invited me in. She said she was suffering and wanted to know how to avoid having more babies. She got her information; she got help. Now she’s a volunteer promoter." Maigua continues, "I didn’t even know what family planning was when I started! But [the Medical Center] trained me. I love my work because I see the need."

Marilyn Berlin Snell is Sierra’s writer/editor.

For more family-planning information and ways to get involved, visit the Sierra Club’s Population and Environment site at www.sierraclub.org/population.

This article has been corrected subsequent to publication.