Many participants also reported increased confidence in their own decisions as well as an improved ability to implement those decisions in their own households and in the community. One Level-1 Promoter indicated she gained greater power over her own body from her new knowledge of and access to family planning.
The Educadora [Level-2 Promoter] taught me how to care of myself and when to seek assistance from a doctor. Now, I can make my own decisions and to have children if I want to.
-Level-1 Promoter
The Care Group Volunteers related that, since the beginning of the Project, their confidence in their own abilities had increased, leading them to make more of their own decisions. Furthermore, they stated that they were now able to make those decisions due to their diminished fear of developing new social relationships and engagement with the community, as well as due to their new awareness of their own value acquired through the Care Group experiences. They reported they no longer feared their mothers-in-law, public speaking, or public action. One
Comunicadora (Care Group Volunteer) reported that her role made it easier for her to ask community leaders about new community activities that may benefit her and her family.
As women lost their fear, now they have seen our participation in various activities that are happening in our communities.
-Care Group Volunteer
Care Group Volunteers attributed their increased confidence in decision making and increased autonomy in their personal lives to the knowledge gained from the Project. Specifically, from what they learned through the Care Group sessions, the Care Group Volunteers and the Self-Help Group participants described comfort in making decisions regarding when to seek medical assistance during pregnancy, how to care for a sick child, how to feed their family appropriately, and how to improve the sanitation and hygiene in their homes. Additionally, some Care Group Volunteers indicated that they had adopted family planning, resulting in greater control over their own bodies and finances. Many of them also indicated that they had increased control over their lives as a result of the knowledge gained through the Care Group experience.
The truth is that we now have more knowledge and know the importance of the [family planning] topics, and there are situations in which we find ourselves now being able to make our own decisions.
-Care Group Volunteer
Yes [we have more control over our lives] because, before we were Comunicadoras [Care Group Volunteers], we would do what our elders told us to do, such as “don’t give colostrum” [to our newborns]. Sometimes our mothers-in-law were in charge of caring for our newborns and they would give them coffee or sugary drinks, but now we do not let them do this thanks to the teachings that we were given. Today our young mothers take good care of their children, and they also have knowledge about family planning.
-Care Group Volunteer
We can decide how many children we want to have, so that we can support them well.
-Care Group Volunteer
Like Level-1 Promoters and Care Group Volunteers, many Self-Help Group participants described increased decision-making autonomy and decreased domination by their male partners. According to the women, the knowledge they gained enabled them to make decisions in their households as well as in the community. Additionally, this newfound knowledge led to greater confidence in making personal decisions.
Yes, we have more [confidence] because now we are informed, and we are capable of deciding for ourselves
-Self-Help Group participant
In one interview, Self-Help Group participants noted they had gained confidence in their ability to make decisions as a result of practicing the skill of decision-making during their group sessions. The women stated that they now take ownership of their health and the health of their family. They described new experiences of standing up to mothers-in-law and husbands, and nearly every woman interviewed stated she now had more control over her own life. They also reported losing fear of participating in community meetings.
[We have] more control because now we can decide things without consulting anybody, and now we realize the importance of our own opinions.
-Self-Help Group participant
Yes, we can participate more easily because now we have lost the fear and the shame of speaking in the community meetings and activities. For example, now we only notify our husbands that we are going to a community meeting or activity [instead of having to ask for permission].
-Self-Help Group participant
Before, we participated very little. Now, we like to participate in any meeting that there might be, health-related or otherwise. We participate and they value our opinions.
-Self-Help Group participant
Regarding the source of their newly discovered confidence, Self-Help Group participants viewed the Project positively because they observed improved health outcomes, and many expressed a desire for the Care Group activities to continue. They believed their children to be sick less often, and they believed the knowledge gained through the Project was inherently valuable—for their own health and for the health of their children. According to one Self-Help Group participant:
We like it because they [the Care Group Volunteers] train us to care for our children because now they tell us which foods are good for them and also which are bad, which foods we can feed them and which ones we should not feed them, and also how we can teach them to wash their hands. Before, I would give chicharrones [deep fried pork rinds] to my children, but this is bad, and it is better to give them fruits. We like that about our group.
-Self-Help Group participant
Care Group Volunteers, most of whom had very little formal education, emphasized the importance of understanding the causes of illness and the benefits of healthy living as reasons for their behavior change. An understanding of the reasons for behavior change—as opposed to simply following the directions of the teachers—served to increase confidence in their own decisions.
Regarding changes that I have seen in my own life; before I did not give the most nutritious foods to my children. Now I do because it is beneficial to them and to me.
-Care Group Volunteer
Before we would not do what we practiced [during the Care Group meetings]. Today, we have changed. For example, as mothers, we now know the importance of colostrum, that it serves as the baby’s first vaccine, and also [the importance of] hygiene [handwashing] before eating.
-Care Group Volunteer
Self-Help Group participants understood that certain health behaviors were responsible for health improvements. Although the Self-Help Group participants expressed a basic understanding of disease causation leading them to try the new behaviors, it was the improved health of their families that convinced them to continue their new behaviors.
We now wait to feed the children [with complementary foods beyond breastmilk] until they are 6 months old to prevent disease in their lives, but before we fed them at 3 or 4 months and we saw them getting sick easily. Seeing this improvement made it easy to convince other mothers to change their feeding practices.
-Self-Help Group participant