Sexual and Reproductive Health Promotion in Latino Populations:Parteras, Promotoras y Poetas:Case Studies across the Americas, edited by M. Idali Torres and George P. Cernada. Amityville, New York: Baywood Publishing Company, Inc; 2003. 352 pages, hardcover, $48.95.
This important book pulls together a wealth of multidisciplinary, multicultural, and transnational information and case studies designed for use by cultural anthropologists, public policymakers, public health experts and professionals, public administrators, researchers and program evaluators, family planning and reproductive health specialists, sexuality specialists, Latino health care workers, Latin American area students, feminist health groups, community development specialists, practitioners such as social workers, nurses and physicians, as well as social behavioral scientists and undergraduate and graduate students in diverse disciplines. The book allows us to enter the world of alternative methods of communicating health messages, through media, theater, literature, by trovadores (troubadours), cantors (street singers) and declamadores (poetry reciters), as well as radio locutores and TV reproteros.
The goal of the book is to provide readers with a far greater understanding of the results of qualitative research studies into innovative and culturally sensitive prevention, wellness, and health promotion efforts at the community level. These approaches (eg, focus groups, life history interviews, and in-depth focused thematic interviewing sessions) cut across community politics and policies, culture, and health. The focus is on heterosexual and reproductive health programming for Spanish-speaking Latin Americans migrating to the United States, which is the fifth largest Hispanic nation in the Americas. Several case studies focus on California, Massachusetts, Connecticut, Louisiana, and North Carolina. Other case studies represent research and interventions conducted in Mexico, Guatemala, Peru, and Puerto Rico. The authors selected case studies based on 3 criteria: geographic location of the work described, central topic, and the article's contribution to current debates in the field. Most authors used qualitative research methods to explore highly private and emotionally charged topics, such as sexual behaviors associated with HIV and other STDs, sexual violence and sexual assault, cervical and breast cancer, timing and experience of first sexual intercourse, birth control, pregnancy, and birth-related issues.
Section 1 looks at researching the cultural construction of sexual and reproductive health, with 8 chapters the promotion of sexual and reproductive health. Section 2 focuses on ways to promote sexual and reproductive health through popular culture, with 4 chapters on specific ways to provide information and disseminate prevention messages. Section 3 looks at ways to ensure the participation of the community in planning, implementation, and evaluation.
US Latino and Latin American populations are characterized by high rates of infant and maternal mortality, disability, hunger, and premature death. Latino women are especially vulnerable to early morbidity and mortality with disproportionate rates of HIV/AIDS, STIs, cervical cancer, and negative pregnancy outcomes. Lay health providers and promoters (parteras, promotoras and poetas) serve as cultural brokers in understanding and translating health and prevention information to the community.
Importantly, the editors include their suggestions for the kinds of future research needed: understanding transnational factors that affect partners or couples rather than the single partner of a dyad on each side of the US border; focusing on couples' relations rather than the stereotypical machismo factor; understanding the important role of radio and TV reporters in promoting prevention and well-being; and calling for much greater and more meaningful community participation in developing the research, implementation, and evaluation of programs. Most chapters also include recommendations for future community health education program planning and intervention research (for example, how to better understand the sexual negotiation dynamic or the discussion and behaviors around a sexualizing pair that determines sexual outcomes).
As several of these authors point out, most prevention and wellness programs are modeled on the needs of White, middle class, monolithic cultures and do not apply readily to the dynamic, hybrid cultures under consideration here. It is particularly important, in patient-provider relationships that personalismo (rapport) and confianza (trust) are built and maintained. So, for example, an exam is not a hasty 7-minute affair, but involves some warm interpersonal discussion beforehand on how the patient, her family, and community are doing, reports of what is new and what is going on, followed by a discussion of what symptom has brought her to the office today.
One of the most interesting chapters in the book looks at cultural factors affecting the negotiation of first sexual intercourse among Latina adolescent mothers. Teenage motherhood is a socioeconomic class phenomenon affected by race and ethnicity, and may actually be an adaptive response to serious intergenerational and socioeconomic constraints that hit adolescents of color particularly hard. Another important article looks at developing and evaluating a radio-linked telephone helpline for Hispanics, staffed by Hispanic nurses with physician supervision, to help Spanish-speaking people make decisions about their health care choices.
This book provides a wealth of information, statistics, and innovative programs. It is well formatted and clearly laid out. We recommend it highly to anyone who wants to stay ahead of the demographic curve and prepare to meet the need of diverse populations and, indeed, one of the largest and most rapidly growing segments of the American population. The editors are to be congratulated for pulling together this important and recent research in one convenient book.