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Excluded women: the severe limitations of access to sexual and reproductive health

Addressing the dangerous gap in sexual and reproductive healthcare in Honduras

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This year our teams have begun working with low-income communities that experience high rates of violence in Choloma, northern Honduras. In these areas, teenage pregnancy is common due to a lack of access to sexual and reproductive healthcare. 

Karen Zambrana, Médecins Sans Frontières (MSF) health promotion manager in Choloma, discusses how our teams are reaching adolescents in need.

What is the main problem regarding sexual and reproductive health in Choloma?

There is a large gap in terms of access to sexual and reproductive health for the entire community, but the need is greater for adolescents. They do not have a place where they can go and where they are treated without being stigmatised, without the influence of religion, or without an accusing finger. Adolescents do not have a point of reference for much-needed information.

So, what do adolescents do to receive help on this topic?

They don't go to health centres if they have a sexually transmitted infection (STIs), because they feel judged. They feel discriminated against and, above all, there are many medical staff who do not want to treat minors. If you are an adolescent between the ages of 12 and 16 and you want to receive sexual and reproductive healthcare or guidance, the only option is perhaps the internet – if you have access to it. This is not a reliable source of information, and that gap is widening. 

Karen Flores, from La Bueso Village, in Choloma “We appreciate the presence of MSF in the community... [Here] there is violence and medical needs. There are a lot of teenage pregnancies – a lot of absent fathers and mothers in upbringing unplanned children.”
Excluded women: the severe limitations of access to sexual and reproductive health

What does our team of community educators do in Choloma?

Community education activities are divided into three care points: the maternal and child clinic, health centres, and mobile clinics that travel to isolated rural communities. At these sites, community educators talk with people and provide information about STIs, the importance of pap smears (a procedure to test for cervical cancer in women), and the different methods of family planning.

How else does the team educate people on sexual and reproductive health?

We are working with young people, mothers, and fathers. We give talks on the prevention of teenage pregnancy and on the different types of violence, especially sexual violence. Another methodology that we have developed focuses on the changes the body goes through. This also allows us to talk about mental health issues. Through workshops, small groups are identified to focus on mental health. Once we finish our intervention, we link people with mental health professionals.

Robert López, MSF psychologist and community educator in Choloma “In Choloma, there are great needs for pregnant adolescents. We go to places where there are no doctors or nurses, and no education on sexual and reproductive health. In some communities, there is not a person who knows first aid.”
Excluded women: the severe limitations of access to sexual and reproductive health

How do you work with isolated communities who cannot easily access services?

We work with patients through mobile clinics, but we also create community connections. In addition to giving talks, we try to establish spaces to set up information points in the community for people who do not manage to get care on the day our mobile clinic arrives.

We are also working with local health committees – we want the community to get involved with health issues and the health centre to get involved with the community. What the team is doing now is promoting and motivating the creation of local health committees, and they have already been set up in four places. 


Excluded women: Lack of access to sexual and reproductive health in Honduras

MSF/Laura Aceituno
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