COLOMBIA: Wayuu Women Choose Permanent Birth Control

By IPS Correspondents Reprint | | Print |

María Isabel García

URIBIA, Colombia, Sep 2 2003 (IPS) - Esmeredith is one of 60 women from the Wayúu indigenous community, a matrilineal culture in northern Colombia, who have signed up for a family planning programme that includes sterilisation, free of charge.

”The question of children is our business. Our husbands have no say in this,” the 33-year-old mother of eight told IPS.

The family planning programme is offered by the city government of Uribia, in the northernmost Colombian department of La Guajira.

The initiative evolved out of a nutrition plan targeting the Wayúu communities, where a high prevalence of tuberculosis has been found. Most of the women heard about the family planning programme in workshops on nutrition.

Others found out about the ”apali’raja apushi” – the name of the programme in the Wayunaiki tongue – through pamphlets written in both Spanish and Wayunaiki or radio messages that the city government broadcast over local stations.

One scorching morning in August, 37 of the women who signed up for the programme, ranging in age from 26 to 42, with six to eight children each, met in the municipal hospital in Uribia to have their tubes tied – a procedure known as ”suuluja achonia” in Wayunaiki.

The operation, which costs 120,000 pesos (45 dollars), was paid for by the city government.

They had previously taken part in ”chat” groups, undergone gynecological exams, and filled out and signed application forms in which they gave their full consent to the sterilisation procedure.

The application form, in which they were asked about their medical history, ended with the following question: ”Are you aware that tubal ligation is a definitive method” of birth control?

The regional office of the Association for the Welfare of the Colombian Family (Profamilia), a private institution, is in charge of the medical aspects of the plan.

At times the assistance of a Wayunaiki-Spanish translator was necessary because although most of the residents of the town of Uribia are bilingual, many of the indigenous women living in surrounding rural areas only speak Wayunaiki.

Informational pamphlets printed in both languages were handed out, containing illustrations in which the people have Wayúu features and wear the ethnic group’s traditional dress, and explaining temporary birth control methods (”eesu supula wattawa”) as well as surgical methods (”nojorulein”).

With the exception of a few male doctors and hospital employees, only women can be seen in the corridors and outside the building.

”Men don’t meddle in these questions around here,” explained María de los Remedios García Arspushana, a member of the city government’s Social Policy Council, which is supporting the family planning programme.

Wayúu women enjoy great autonomy with respect to decision-making involving family affairs, due to the ethnic group’s matrilineal social structure. In the Wayúu culture, women are monogamous and men are polygamous. The men with the highest level of authority are maternal uncles. Names, clan membership and inheritance all pass through the mother’s side.

Family planning is not a totally foreign concept to the Wayúu. Women often drink ”tomas de jawape”, beverages prepared from the roots of different plants diluted in water or alcohol, which are supposed to act as contraceptives.

But Wayúu women have eight or nine children on average, compared to a national birth rate in Colombia of 1.28 children per woman.

García Arspushana is an adviser to the Alta y Media Guajira reservation in the municipality of Uribia, an area of 7,905 sq kms, where the largest number of Wayúu in Colombia reside.

The department of La Guajira is home to Colombia’s 150,000 Wayúu. A large number of Wayúu also live in neighbouring Venezuela.

There are an estimated 1.5 million indigenous people in Colombia, a country of 42 million.

La Guajira is located on an arid peninsula of that name that juts out over northern Colombia and Venezuela. The Wayúu can move freely across the border between the two countries, although the ”arijuna” (non-Wayúus) need visas.

”It all started with a project to identify nutritional problems” that included a count of the number of cases of tuberculosis in the region, said Belinda Gómez, who designed the programme. Gómez has been working as a nutritionist and social worker at the hospital in Uribia for 22 years.

Gómez told IPS that she believed that the fact that Uribia has a woman mayor, Cielo Redondo, had a positive influence on the programme’s social and family planning components.

According to an epidemiological report by the departmental Secretariat of Health, between 2000 and 2001 the incidence of tuberculosis rose from 67.9 to 80.6 per 100,000 population in La Guajira, while mortality rose from 1..6 to 2 per 100,000.

The report found that the main factors associated with the rise in the number of cases of the disease, which is caused by the ”tubercle bacillus”, were ”socioeconomic conditions, malnutrition, and low levels of social security coverage and access to health services.”

But in Uribia, the tuberculosis rate is even higher than the La Guajira average, standing at 147 per 100,000 population, and malnutrition is a primary cause of the spread of contagious and infectious diseases.

On visits to 28 communities, from Ipapure to Los Olivos and from Marquetalia to Orroco, 320 rural and urban families in Alta y Media Guajira were selected to receive medical, educational and nutritional assistance for three months (from July to September).

Besides detecting tuberculosis patients, ”my concern was to teach the Wayúu families about an adequate diet, since the main cause of the spread of the disease in the area is hunger,” said Gómez.

During the phase of education about nutrition, local women’s interest in family planning emerged, based on the idea that they should have ”only as many kids as they could feed and educate,” she said.

Esmeredith and other women listening to the conversation with Gómez nodded their heads in agreement.

”Children are good, but we can’t afford any more”, ”I have eight, and the youngest is the same age as my grandchildren”, ”With four boys, who have more children than girls, and three daughters, I have enough,” were some of their comments.

Besides the high birth rate, Wayúu women begin to have children early, between the ages of 14 and 16, said Gómez, who is not a member of the Wayúu community but as a resident of La Guajira is very familiar with indigenous traditions and culture.

Despite Colombia’s relatively low national birth rate, the country has a high rate of teen pregnancy. In fact, one of every three girls under 18 has been pregnant at least once. But Wayúu adolescents begin having children at an especially early age.

Family planning is considered an individual right and a duty of the state by the Colombian constitution, which also stipulates in article 43 that ”During pregnancy and after childbirth, women will receive special assistance and protection from the state, and will receive a food subsidy if unemployed or destitute at that time.”

”The state will provide special support to female heads of households,” the constitution adds.

But in La Guajira, that sounds like a pipedream. According to Gómez, malnutrition is so severe in the region that many children lack the strength to walk from their ”rancherias” – tiny hamlets of five or 10 houses – in the middle of an arid landscape to the school in Uribia, which is only partly full, and where there is a plan capable of providing school breakfasts for 13,500 students.

The nutritional programme includes the delivery of basic food items to tuberculosis patients for two months, and to their immediate families for one month.

The delivery consists of 15 non-perishable products like powdered milk, ”carve” (a soy-based meat substitute), rice, sugar, ”panelas” (raw sugar loaves), oatmeal, wheat flour, beans, lentils and pasta.

The hamlets have no electricity, and no way to refrigerate fruit and vegetables, the nutritionist explained.

Across the street from the hospital where the nurses were double-checking the information on the 37 women about to undergo the tubal ligation procedure, several adults and children made drowsy by disease and by temperatures of 38 degrees celsius in the shade killed time in the hammocks and rocking chairs of a home for tuberculosis patients.