Samuel Loewenberg, for the Pulitzer Center
I first meet Maria Francisca Mendoza on the roof deck of a woman's organization known colloquially as Casa de la Mujer, where along with five other young women she is putting the finishing touches on a vagina made out of clay. They are now starting in on a set of brightly colored Fallopian Tubes. The workshop is part of a project that trains adolescents from indigenous communities in the state of Oaxaca about maternal health and sexual and reproductive rights. The organization also provides scholarships to allow young girls to stay in school, who would otherwise be forced to drop out because they are expected to help keep up the household and provide income for their families.
Maria Francisca says she is looking forward to returning to her village, San Juan Guelavia, to start workshops for teen-agers and young women on what are normally taboo issues. "In my community there is a big divide between men and women," she tells me, as speed along the highway in the desert outside of Oaxaca city to her village, located at the foot of a mountain range. Domestic violence is common place, she says, and when men immigrate for work, they often return with STDs like gonorrhea and genital warts, which they transmit to their wives and girlfriends. I wonder what the three local men crammed into the back of the cab with us think about the conversation. They don't seem to notice.
Ethnic and gender inequalities are acute in the state of Oaxaca - and that translates directly into a number of horrific health problems, particularly for mothers. At least 778 women in the state died during pregnancy, childbirth or postpartum between 1995 and 2004, and the real figure is probably much higher because many cases go unreported. Most cases occur in rural and indigenous communities, which make up one third of the state's population. Oaxaca is Mexico's second poorest state, and there is only one hospital bed per 1,000 people, and in some areas, infant death rates are five times higher than in Mexico City. Indigenous women only go to school an average of six years, and nearly a quarter are married by the time they are fifteen. The average number of children they have is 5.6, which is more than double the national average. The probability that indigenous Oaxacan women will die from child birth is three times higher than that of non indigenous women. Overall, the rate of maternal mortality here is close to double that of the rest of the country. Cervical cancer is also a major killer. According to the Oaxaca Fund Initiative, one woman dies every forty eight hours from cervical uterine cancer.
Indigenous cultures in Oaxaca have a lot of prohibitions and taboos about discussing sex, said Whitney Duncan, an anthropologist who is studying the region. For instance, she said, there is no word for sex in many of the dialects of the indigenous language of Mixtec, instead people use a euphemism: the word for stacking baskets on top of each other. Public health efforts are often culturally inappropriate, she said. Government health educators, for instance, are often insensitive to indigenous community's concerns about modesty, or don't do a good job of explaining illness or treatments in terms that make cultural sense. An additional hurdle to public health efforts is that many indigenous women have never learned to read.
Machismo is another major problem. Jealous husbands often forbid their wives from going to doctors because they don't want their women to be examined by a man, many people do not speak Spanish and the doctors do not speak the indigenous languages, and women themselves often don't make the trip to a clinic because there is no else one to look after their children or husband. Domestic violence is the number one reason women visit the clinic in San Juan Guelavia, the doctor there tells me.