Silvia Diez Urdanivia

Silvia Diez has developed an effective solution to a widespread problem in Mexico that is only now coming to light: violations of women's personal rights by medical personnel who provide services without first obtaining informed consent. She trains women to know and assert their rights, and helps medical providers develop models of informed consent for regional hospitals and clinics.

The scattered data available suggest that violations of personal and reproductive rights of women by medical personnel are not infrequent in Mexico. Service providers recount stories of women who visited a local clinic with a cold, for example, but left implanted with an intrauterine contraceptive device; or women who had tubal ligations without their knowledge after giving birth. Silvia tackles these violations by bringing information and education to both women and health care providers. Rather than emphasizing the education and empowerment of women as a means to penalize the violators, thus creating further rancor and hostility, she engages both parties in a constructive dialogue aimed at creating mechanisms for preventing future violations.

Infringement in women's sexual and reproductive rights is not uncommon in many areas of México, though there are no official statistics to prove this point. When doctors, nurses, and hospital staff act without consulting the patient they seem to do so because they do not understand and respect reproductive rights, not because they intend to do harm. Women need to know their rights and, even more important, feel entitled to exercise their rights and demand good healthcare.

Sexual and reproductive rights are particularly important in Oaxaca and other rural areas, where the population is young and fertile. More than 62 percent of Oaxacans are under twenty-four years of age, and women tend to marry early and have more than three children on average. Oaxaca has some of the highest maternal and infant death rates in the country. Of all women's deaths, 63 percent are directly related to obstetric complications.

Silvia's program takes place in two stages, beginning with documentation and discussion among women. In this stage, Silvia takes advantage of her nine years of work organizing centers for the nutritional rehabilitation and training of rural and indigenous women in Oaxaca. In these centers, women's groups meet regularly with local nutrition and health specialists to discuss, analyze, and create alternatives to improve their nutrition and reproductive health.

Silvia's program for medical rights includes a specialist in sexual and reproductive rights who participate in each group. The specialists work together toward the goal of better health by coordinating issues and tracking clients' health and progress. Each specialist is a local woman whom Silvia has trained in nutrition and reproductive health, or sexual and reproductive rights. The women who receive training in sexual and reproductive rights also receive instruction on how to interview friends and document violations. Because this is such a sensitive area, Silvia provides interview guidelines and forms. At this stage, where the goal is to record violations and develop an understanding of what is happening, information is used only within the groups, as a means to opening discussion.

In the second stage, Silvia holds workshops that focus on the rights abuses uncovered in stage one. She invites personnel from local clinics to participate. The workshops focus on education and awareness but also include strategies to insure that informed consent becomes an integral part of every medical encounter. Her goal is to help each institution create an informed consent model that is applied during every client visit.

Since reproductive rights and informed consent are vital concerns in every clinic and hospital that serves women, Silvia has plenty of opportunity to expand her efforts. She began her project with support from the Center for the Integral Training of Community Promoters (CECIPROC), which she founded in 1995 with a colleague as a way of bringing nutrition and educational programs to rural communities. She also has the support of the Oaxaca Community Fund. Silvia is a member of several regional and national associations working on women's reproductive rights issues, including Informed Consent, a study group of academics and representatives from the Ford Foundation, the Population Council, and other organizations.

After graduating from university in the early 1980s with a degree in nutrition, Silvia became a researcher in Oaxaca, where she wrote extensively on nutrition. She returned to school for a master's degree in rural development, which she completed in 1990. The next year, she received a grant from the Kellogg Foundation to investigate nutrition training in rural Mexico. This work showed her the enormous problems faced by indigenous communities, as well as the generosity she encountered among them. Unsatisfied to simply do research, she co-founded CECIPROC as a training center. The impetus for her personal rights program came out of the daily interactions and frustrations of her work there, which made her aware of the need to improve not only women's nutrition but also their health care and self-esteem. As part of her transition from nutrition to health and leadership work, Silvia created and now directs a department within CECIPROC that manages the program and integrates it with the organization's other programs.