1. INSP National Institute of Public Health, Mexico B. Pelcastre; M. Márquez; S. Meneses; M. Ruiz; C. Amaya; Y. Gómez Ethical Issues on Indigenous Communities’ Reproductive Health and Gender Violence: The Experience of Casa de la Mujer Indígena * * Funding provided by SALUD-2005-02-14445

2. INSP Mexican indigenous communities 12.7 million total indigenous population in Mexico At least 62 native languages are spoken by over 7.6 million of them 60% live in municipalities with high degree of marginality 80% live with less than US$8 a day 25.5% are illiterate XII Census 2000/CONAPO/INI Presidencia de la República, Plan Nacional de Desarrollo 2007-2012, Gobierno de los Estados Unidos Mexicanos, Presidencia de la República, México, 2007: 200-202

3. INSP Health services Health services for indigenous population: lag behind 72.5% do not have access to health insurance schemes Triple discrimination: ethnicity, gender, and social class Infant mortality rate: 58% higher Reproductive risk: three times higher (CDI, 2000)

4. INSP Health National average Indigenous Life expectancy75 years old69 years old Maternal mortality51/100 000283/100 000 Infant malnutrition17.7%44% Anemia in pregnancy and breastfeeding women 26.4%40% CDI,2000/*Guerrero, Oaxaca 120, Chiapas 110

5. INSP Background: Casa de la Mujer Indígena Its goal is to implement a culturally appropriated model of attention to sexual and reproductive health, including gender violence, for indigenous women First established in 2003 Now its number has grown to five Houses in four states : Chiapas (1), Guerrero(1), Puebla (1) and Oaxaca (2)

6. INSP Location of Health Houses Guerrero Puebla Oaxaca Chiapas

7. INSP

8. INSP Organizational Structure Coordinator Areas of attention: psychological, legal and medical Health services Municipal authorities Local institutions 6-8 female workers (violence and maternal health) CDI-National Commission: development for indigenous groups (Budget) NGO (formal networks) External counselor

9. INSP Activities and Services Attention Delivery (by midwives) Pap test References Company (counselors) Translators Psychological Legal Medical Prevention Workshops Promotion Radio Brochures Sexual and reproductive health Violence

10. INSP Actors Indigenous women Indigenous men Indigenous female workers Local authorities Ethnic and gender identity between suppliers and users Share of language and cultural symbols Gender inequities are acceptable Threat perception

11. INSP Ethical Issues How could we continue with the indigenous women's empowerment process? How do we include men in the process (refuse informed consent and avoid threaten behavior from them)? What must we protect? (health women/traditional social values)

12. INSP Thank you!! bpelcast@correo.insp.mx San Cristóbal de las Casas, Chiapas