Cellphones in pockets; cellphones in hands; cellphones hidden in women’s brassieres: if you take a moment to look around, you’ll notice that in Nicaragua, cellphone users are everywhere.
In fact, according to the International Telecommunications Union, in 2011 there were 4.8 million cellphone users in 151 out of the 153 municipalities of Nicaragua. That represents over 82% of the population.
But this is not a story about cellphones. This is a story about what can be done with cellphones: they can be used to empower Nicaraguans to lead healthier, safer, and more productive lives through ChatSalud, an SMS-based sexual and reproductive health hotline.
ChatSalud will harness the pervasiveness and popularity of cellphones and text messaging to connect Nicaraguans to sexual and reproductive health (SRH) education, as well as to existing healthcare services by putting those resources directly into the hands of Nicaraguans. It will deliver culturally sensitive and contextually correct information on five central themes: reproductive health, safer sex, HIVaids, STIs, and domestic violence.
While sex is a sensitive topic, it permeates every aspect of our lives in the form of relationships, self-esteem, pregnancy, health, gender dynamics, and more. There are few themes that are as vital to our health and wellbeing, yet so unequivocally difficult to discuss openly. Pena, a Spanish word closely related to embarrassment, shame, and awkwardness, is one of the biggest cultural barriers that Nicaraguans have in accessing SRH information. This means that while people are engaging in sexual activity, few are engaging in an open discourse about their sexual health.
ChatSalud’s goal is to bypass the “pena barrier” by providing a completely anonymous way for Nicaraguans to access SRH information. Think about it: whether rich or poor, urban or rural, everyone has questions about their sexual and reproductive health. Yet in developed countries, answers to those burning and potentially embarrassing questions are easy to come by anonymously: just Google it and the information is yours. How empowering.
However, in a country like Nicaragua where only 10% of the population has internet access, most people do not have that luxury. So why not use cellphones to provide Nicaraguans with that same pena-free access to information? Think of the possibilities:
Imagine, for example, that you are a 16-year-old girl living in a rural community. Your boyfriend wants to have sex, but you are not sure if you are ready. You’re too scared to ask your parents for advice, so you text ChatSalud for more information about teen pregnancy, condom negotiation, and healthy versus unhealthy relationships.
Imagine next that you are a 40-year-old man and you’re concerned that you might have HIV. You text ChatSalud and discover that your symptoms are more typical of an STI, which compels you to go to your health center for a proper diagnosis and treatment.
Now imagine that you are a woman in your mid-twenties. Your husband acts out and beats you on occasion, but then is apologetic and showers you with affection. Your close friends are tired of listening to you complain about your relationship, so you turn to ChatSalud to learn about the cycle of violence and discover resources that can assist you in your local community.
Although these scenarios are hypothetical, they are based in reality. According to the Pan American Health Organization, Nicaragua has the highest teen pregnancy rate in Central America: approximately one in every three adolescent girls will become pregnant before they reach the age of 19. In addition, the United Nations Population Fund reports that gender-based violence affects nearly 48% of women who are married or in a union. Overall, one in three women has experienced physical or sexual violence in her lifetime.
Although Nicaragua has consistently had the lowest incidence of HIV infections in Central America, the annual incidence of registered cases of HIV has tripled in the past six years. In light of these statistics, ChatSalud hopes to make an impact in Nicaragua by being a resource people can use to make informed decisions about their sexual and reproductive health.
The idea of ChatSalud was initially conceived by a group of U.S. Peace Corps Volunteers who noticed both the need for a secure source of health information and the widespread use of cellphones in their rural communities. Since its inception, the project has grown substantially. Now with the guidance and support of several local and international organizations, ChatSalud is preparing to launch at a national level. The ChatSalud team is still in process of finalizing the content, system, and evaluation tools, but be on the lookout for a launch date in late 2013.
If you are interested in the project and would like to know more, please contact us at [email protected].
Lauren Spigel just finished her Peace Corps service in Nicaragua after spending two years living and working in a medium-sized community in the department of Matagalpa. She is a founding member of the ChatSalud team. She holds a Bachelor of Science in Community Health from the University of Maryland and plans to pursue her Master of Public Health from Johns Hopkins University Bloomberg School of Public Health starting in July 2013.
Chloe Lew is a current Peace Corps Volunteer in Nicaragua and is serving in a small community in Nueva Segovia. She serves as ChatSalud’s public relations advisor. She holds a Bachelor of Science in International Relations and Anthropology from George Washington University.