CIAO DATE: 02/03

Crossing Cultural Borders with Our Bodies, Ourselves: Linking Women's Health Education and Political Participation in Nuestras Cuerpos, Nuestras Vidas

Ester R. Shapiro

The Ralph Bunche Institute on the United Nations

Introduction

Our Bodies, Our Selves, the ground breaking women's health information resource book, has sold millions of copy in the United States through five editions and has been translated or adapted into 19 languages, including Braille. Much more than a source of health information, Our Bodies, Ourselves (OBOS) also presents women's personal experiences of struggle and
success as the foundation for a feminist critique of health system practices. Women all over the United States and all over the world have found the book both a valuable tool for personal transformation, and a catalyst mobilizing political action in critical areas such as reproductive
health and rights, social and domestic violence, gender role and economic justice.

Typically, OBOS has been translated by groups of women's health activists working in their own countries. The approaches to translation have ranged from direct textual versions to those "inspired by" or "based on" OBOS which change the text to better address women's experiences,
needs, and political activism in diverse cultural and sociopolitical contexts. An approach which ventures beyond direct translation to cultural adaptation is especially important in the translation of feminist texts, whose purpose is to inspire consciousness of gender inequities and to mobilize processes of personal and social change.

The following paper will utilize a social developmental and participatory education approach to highlight the characteristics of OBOS as a text which mobilized personal change and political
participation among women in the United States. It will further apply this conceptual framework and review of OBOS's textual strategy to describe the process of cultural adaptation undertaken in the Latin American translation and adaptation, Nuestros Cuerpos, Nuestras Vidas (2000). The paper will conclude with suggestions for participatory women's health education in the U.S. that draws from the practice methodologies characteristic of Third World women's health activists, and that can inspire participation among U.S. communities of color in women's health and gender justice projects.

Background

Nuestros Cuerpos, Nuestras Vidas (NCNV) the Spanish translation and cultural adaptation, is the first of these projects based at the Boston Women's Health Book Collective (BWHBC) rather than in the home country of a women's health organization. A previous Spanish translation of the 383-page, 1972 English edition was published in 1976 and reprinted in 1979.
Currently outdated and lacking cultural adaptation, the 1976 translation continues to be cherished by its readers because of an enduring lack of access to such information from other sources. Work on the current translation/adaptation began in 1994, with an initial direct translation of
the 780-page, 1992 edition funded by the Noyes Foundation. An adaptation process in collaboration with Latin American women's health groups was funded by the Ford Foundation, and conducted from 1994 to 1995. The editorial process within BWHBC took place from 1995 until 1999, and incorporated changes to the text from the 1998 edition of OBOS.

The author of this essay served on an Editorial Oversight Board and as Coordinating Editor of the final manuscript. A Cuban American of Polish and Russian descent, she had intimate knowledge of the ways words are only one dimension in the construction of complex meanings mediated by language as a bearer of culture. All of us who live between languages and cultures
appreciate that words represent complex, culturally informed processes of representation. A text animates individual resonance to shared meanings connecting us to our families and communities. What does it take to go beyond words to the images and ideas capable of inspiring and sustaining personal transformation, political participation, and social change? In formulating and evaluating the complexities of the cultural adaptation process, a systematic conceptual framework offered a valuable working tool.

The author, a Professor of Clinical Psychology, has studied the process of family development during life cycle transitions, examining the conditions which help produce positive outcomes for both individuals and families (Shapiro, 1994, 1995, 2000). The author has articulated a social
developmental model, delineating the conditions that permit individuals and families to learn from experience so as to actualize individual and social change. This model regards the daily tasks of the family life cycle as the relational space where a gendered self is constructed in relationship with important others. The balance of stressors and resources in the family and social environment create the conditions within which family members can construct age appropriate relationships of mutuality and healthy interdependence. Awareness of self in social environment, including consciousness of injustice, can help individuals and families make the best use of available resources while managing stressors. Especially important in the current political and economic transitions occurring throughout the world, how do we reach beyond simplistic polarizations of individualism versus collectivism, or personal versus social responsibility, to the recognition of our human need for both self-assertion and social
responsibility?

In applying a social developmental approach to the cultural adaptation of OBOS, the work of Paolo Freire and colleagues in participatory education was especially useful. Based on critical theory and cultural studies, participatory pedagogy emphasizes that learning begins with the student's knowledge of her world derived from direct personal experience. Effective teaching transmits knowledge through collaborative processes of mutually respectful dialogue, highlighting ethical dimensions of relationships and communities, consciousness of social injustice, and shared action toward personal and social change. Such a conceptual framework, which was consistent with the narrative and political strategies embodied in OBOS, helped shape key decisions in the adaptation of NCNV. Transitional passages in the text, including all the introductions and key chapters, were re-written so as to encourage the reader's participation in the completion of a culturally appropriate text. Readers were invited to join us in the task of completing the adaptation by reading the book critically so as to evaluate both areas of connection and areas of difference within her own life and social circumstances.

Our Bodies, Ourselves as Text: A Brief History and Current Assessment

Every translator faces the challenge of transforming a text so as to convey its meanings across cultural contexts, while faithfully preserving distinctive qualities of the author's voice. Some translators believe they come to know a text better than the authors themselves, as they carefully
consider the many layers of language within which its meanings are encoded. Translators of literary texts strive to preserve structure and style as well as meaning in the original text for readers in a new language. Recent work in translation studies challenges the myth of the translator's invisibility and explores cultural assumptions and power relationships encoded within the translation (Venuti and Baker, 2000; Zlateva, 1993).

For health educators or social activists, whose goal is the reader's learning and inspiration, the work of translation becomes less the faithful representation of the original text. Rather, cultural adaptation requires an understanding of the text's purpose and impact on its original readers
and on the intended audience in the new cultural context. OBOS's success came, at least in part, from the ways it addressed the problems faced by U.S. women during the 1970's, at a time when women's economic and social roles were undergoing major transformation. While every society continues to struggle with the challenge of justice and equity for women, each does so within the distinctive sociopolitical history and current economic realities. Most women share as problematics of every day life the challenges of procuring nourishing food and potable water and safe shelter, of bearing and caring for children. Women similarly share the burdens of
deteriorating social environments all over the world, even if these burdens differ depending on economic status, political histories, and social traditions.

In taking on the task of a Latin American cultural adaptation which would go beyond translation, it was necessary to carefully evaluate the structure and rhetorical strategies utilized by OBOS. Further, OBOS is not a static volume, but has itself changed since its first through five editions, the most recent in 1998. In spite of the book's acknowledged importance in national and international feminist movements, few scholars have examined the characteristics of the text which made it such an effective tool for personal and collective change. Commenting on earlier
editions, Stein (1980) describes the book's approach as an exemplar of "clinical sociology" in its power of social transformation. He suggests that OBOS utilizes an approach to personal and social change which includes a sociological analysis of patriarchy, consciousness raising, self-help, political strategies and utopian visions of potential for change. Hayden (1997) suggests that a feminine rhetorical style and a privileging of personal experience supports a feminist epistemology, what Goldberger et al (1986) have called "Women's Ways of Knowing". Gordon and Thorne (1996) propose that the book analyzes the ways body and sexual norms are socially
constructed, offering a fundamentally feminist critique. Further, through the synthesis of technical information with women's experiential knowledge communicated through personal stories, the book offers a methodology that democratizes access to information rather than simply rejecting medical expertise. Bell (1994) uses the metaphor of "translating science to the people" to argue that OBOS serves to articulate multiple "situated knowledges" concerning reproductive health. Using the updating of the birth control chapter as a case study, she demonstrates the need to carefully separate scientific information concerning birth control technology from embedded cultural messages concerning gender.

The evolution of the book through its five editions itself presents an important area of scholarly study beyond the scope of this paper, reflecting as it does changes in the feminist movement and in women's health advocacy in the United States between 1970 and the present. When the book in English was first published in the early 1970's, the book was 383 pages long, and offered a fairly even balance between women's own stories, a women's based health and social justice critique, and information on women's medical and reproductive health. To this day, readers still report the life-changing nature of their first encounter with the book's early editions, which they read repeatedly from cover to cover and regarded as a friend and confidante.

The book's approach emerged from a shared conversation among a group of fourteen founders who encountered the profound sexism of the health care system and sought the knowledge they needed to regain control over their bodies, health, and lives. The collaborative process within the founder's group, and with a growing circle of participants, offered a distinctive approach to the "author's" voice, one which was dialogic and provisional, offering personal experiences which
illuminated both women's struggles and strengths in facing and solving real problems in daily life. The book then offered accurate information, a political understanding of patriarchy, and examples of alternative approaches to women's health both within and outside of traditional health care systems. Finally, the book included both extensive bibliographies of related readings, resource materials such as films, exemplary programs in women's health or political action, and ways to contact women working in these related areas. This distinctive approach to voice, message and content, which built both knowledge and connections, did succeed in catalyzing a transformation of health care delivery and activism for women throughout the United States, and for women's health activists throughout the world.

By the time of the 1985 edition, the book had doubled in size to over 700 pages, with the primary expansion in women's health information. Some readers reported that they no longer read the book in its entirety, but rather looked up topics in the book's table of contents or index, reading
chapters or sections as they required specific health information. While the book became more useful as a health care encyclopedia, many readers found that the book had become too long and technical to read from cover to cover. Further, the book became less accessible to those women who might feel intimidated by the density of information. The book served as a health information resource for health educators and community outreach workers, who used it as a reference for preparing their own more accessible materials. The book continued to have a strong political voice and many personal examples, but these approaches became more embedded in contrast to the growth in information content.

Critical Pedagogy and Participatory Education:
A Conceptual Framework for Translation/Adaptation of Activist Texts

The work of Paolo Freire (1970, 1985, 1994) and colleagues (Aronowitz, 1993; Macedo, 1994; Macedo and Bartholome, 2000; McLaren and Leonard, 1993; Girouox, 1992; Giroux and McLaren, 1994; hooks, 1994; Nieto, 1999) in critical pedagogy offers an especially useful model for the translation adaptation process, because it educates readers to become active, critical
participants in "completing" the text. In brief, critical pedagogy applies critical cultural studies to the area of educational practice, moving beyond critical reading of text toward intervention in real interpersonal and institutional fields. Several crucial dimensions characterize the work of Freire and his colleagues: while the teacher as expert provides the technical tools for literacy, the successful teacher enters a dialogic and collaborative relationship within which students' expertise in understanding and interpreting their own experience must be given respectful priority. Freire contrasts the authoritarian "banking" method of education, in which the expert teacher fills the student as empty vessel with knowledge, with a "problem posing" educational approach in which the student examines and learns to critically question her/his own experience
in the world, including the relationship with the teacher and other asymmetrical power relationships.

Intellectually, Freire shares with other social justice oriented third world practitioners like Frantz Fanon (Bulhan, 1985; Fanon, 1967) a recognition that oppressive social institutions become internalized and require both critical consciousness and committed social action for their
transformation (Aronowitz, 1993). Under conditions of social injustice, literacy aims to provide students with the capacity to become subjects of their own experience, rather than objects of a dominant ideology that devalues their human and intellectual contribution as a mechanism of social control. From a Freirean perspective, political analysis and action is a necessary step in an educational process, the purpose of which is the transformation of unjust social conditions. Freire's work has been banned by totalitarian governments on both the right and the left, as it offers a highly effective model for working from participant's own lived experience and identification of problems, to articulation of social conditions requiring personal and social change. Freire's approach has been embraced by community educators and activists throughout the world, not only as an effective strategy for literacy and popular education but also for health
education and economic development. Although some feminists have criticized Freire for the masculine bias of his approach, hooks (1994) suggests that Freire's own theory empowers women to enter a critical dialogue with his work so as to introduce a gender justice perspective.
The Latin American women's health movement has been strongly influenced by the work of participatory education (Gomez, 1991), as has the work in women's health among U.S. Latinas (Amaro, 1995).

In applying principles of participatory pedagogy to the cultural adaptation of OBOS as a text, we regarded the book and section introductions as opportunities to invite the reader into a shared
conversation. The introductions were crafted so as to present shared dilemmas and strategies for solutions, in a language as close to women's experiences as possible. The goal of the introductions was to invite readers to approach the text actively and critically, that is, with
attention to how her experience was both included and distinct from the text's voice. This was especially important as we thought about Spanish speaking readers of the text throughout Latin America, the Caribbean, and the United States, who would be applying their reading of the text to different countries and within each country to vastly different regional and social situations.

We followed the OBOS use of a shifting editorial "we", which in different portions of the text might refer to all women in the United States, or all women of a particular group who had contributed a portion of the text and were speaking to a particular woman's experience. The "we" in NCNV was always specified in the context of the text, but might shift from a portion of the text contributed by a particular women's organization in Argentina, or Nicaragua, or Puerto Rico, or Boston. At other times, the "we" continued to refer to the original voice in the North American translation. While the participatory education approach asks more of the reader, it safeguards her ability to use the information in the text to build her own knowledge based on her own experience and her own plan of action. The introduction to the book concludes with an invitation to the reader to contribute to the book's next edition by adding her own text and voice.

Creating Nuestros Cuerpos, Nuestras Vidas

The debate about a cultural adaptation of the book which would go beyond translation began with the publication of the first Spanish edition in 1977. A group of Boston based Latinas organized discussion groups which became formalized as ALAS, Amigas Latinas en Accion Pro-Salud (Latina Friends in Action for Health). Informed by the participatory education models of Freire and other Latin American activists, they were especially concerned with issues of methodology in making health information more accessible and useful. ALAS members found that the publication of health care information would be more useful in U.S. Latina communities if it was also supported by a community outreach process. Their work informed both the subsequent English language versions and the evolution of an adaptation process.

Work on the current volume began to be concretely planned at the Latin America and Caribbean Feminist Congress in Argentina in 1990, when it became clear that no one women's group had the resources to conduct such a major project. In 1993, the Noyes foundation funded the translation of the 1992 edition, and in 1994 the Ford Foundation funded the Latin American
adaptation phase. Starting in September 1994, Project Coordinator Rosie Mun~oz Lopez worked on identifying and recruiting the groups in Latin America most active in political as well as health content areas who could collaborate in the adaptation. Twenty women's health groups from 11 countries in Central, North and South America and the Caribbean adapted translated chapters from Our Bodies, Our Selves. Then an adaptation group based at the BWHBC reviewed the adaptations, and incorporated materials from Latin American groups and from U.S. Latinas. Veronica Nielsen Villars, an experienced medical translator and editor, worked with the manuscript word by word and line by line to ensure it had an inviting, readable voice that would make it both accessible and a pleasure to use.

In designing an adaptation process, we had to address the restructuring the book at multiple levels. We looked carefully at the book's transformation into an intimidating health care encyclopedia, in which the voices of experts had begun to crowd out the voices of the women themselves. Applying the principles of participatory pedagogy, we carefully rewrote the introductions to sections and key transitional chapters so that they would affirm women's strengths while recognizing the primary burdens women carry as we carry responsibility for others under conditions of economic, educational and legal inequality. Consistent with the approach to women's health that characterized the movement in Latin America and the Caribbean, we felt that a community based, politically and culturally informed approach had to be the foundation for the book's message. In addition, we re-structured the book to better reflect the images of family, relationship, and community would be most meaningful to Latin American women and to U.S. Latinas.

Several chapters were changed substantially to reflect very different conditions in the region. These included the chapter on abortion, since abortion is illegal in all the Spanish speaking countries of Latin America and the Caribbean except Cuba and Puerto Rico. The NCNV chapter preserved some of the information on how women in the United States won abortion rights, and some of the threats to those rights, but emphasizes the campaign to legalize abortion in Latin America. The chapter on AIDS highlights the heterosexual transmission of AIDS and the lack of focus on women's experience, including the dilemmas for married women of negotiating condom use with husbands who are likely to be having socially sanctioned extra-marital affairs. The chapter on holistic health was changed to emphasize traditional healing based on the spiritual beliefs and religious practices of Latin American and other cultures.

In a final phase of adaptation, we incorporated resource materials from Latin America and U.S. groups and adding text and sidebars as well as additional resources from both L.A. and the U.S. to make the book more culturally based. We consulted with women's health activists in Latin America, including Taller Salud in Puerto Rico; Isis international in Chile, who runs the Latin
American Women's Health Information Center and makes their data base and documents available; CIDHAL in Cuernavaca, Mexico; Red de Salud in Chile, who publishes a quarterly women's health magazine and maintains a data base of organizations in the region; and CIDEM in Bolivia who at the time were the coordinators of the campaign to legalize abortion in Latin America.

In addition to these changes in the text, we also changed the order and conceptual organization of key chapters. The book now begins with the chapters in Saber es Poder/Knowledge is Power, which in English are located at the end of the book. We began by emphasizing that contact with the health care system accounts for only 10% of health outcomes. Education, sanitation, work conditions, social support, adequate food and shelter, exercise, and other quality of life experiences determine the larger part of our health outcomes and well-being. With this recognition, women are better prepared to take care of their own health and to use the health
system wisely and critically when necessary. The first chapter offers an international perspective and makes the link between Third World women's health movements, with their greater emphasis on women's health as part of broader political movements. Although most of the groups we collaborated with work closely and directly with women, we share a view of gender justice that assumes we cannot transform our lives as women without a shared gender justice project that includes men's active participation. The second chapter, a totally rewritten chapter on health systems, emphasizes patient rights and responsibilities. The critique of health care systems emphasizes that women's first sources of health information need to be other women who offer support, and who share a vision of personal transformation linked to community and social change. The chapter on organizing for change strongly emphasizes the link between gender
justice and social justice. This section closes with the internet chapter and a section on women's health organizations by country.

The first chapter offers an introduction to feminism in both Latin America and throughout the world. We observe that the feminist movement in Latin America has become so effective in its political strategies, including alliances with United Nations human rights initiatives, that many
governments have embraced them as a way to promote national goals of economic development. Yet women throughout the world continue to work outside the home for more hours with less pay, continuing obligations to care for their families, and new burdens which come with the deteriorating fabric of society in many communities. Addressing the dilemmas of success
and "professionalization", Latin American feminists propose that women's organizations can best continue to promote gender justice by keeping close connections to a community base (Alvarez, 1998). Different groups organize their community based work to emphasize distinct priorities, such as community based advocacy, information/documentation linked to community
education, and direct health services. Latin American women's organizations providing direct services approach their work using alternative models which promote participatory health education and empowerment, promote indigenous practices promoting holistic health care,
and utilize mutual support groups which build women's capacity for self care in the context of mutual support. In the Spanish adaptation, the word "self-help" has often been translated as "mutual help", since no one takes care of themselves without the participation of others. The book in English lacks discussion of religion or spirituality, except to counter the anti-abortion movement. The Spanish adaptation features a strong statement by Catholics for Choice and recognizes the importance of religion and spirituality as sources of healing, of community bonding, and avenues to political change.

The second section of the book, "Cuidandonos/Taking care of ourselves" now begins with Traditional Medicine. Consistent with the Latin American perspective, we see a culturally and politically informed holistic healing framework as the basis for empowering women to use health information and make judgments about how to best use their resources, beginning with themselves. In this and every other section of the book, we translated the misleading, individualistic term "self'help" as "ayuda mutua" or mutual help. We believe that nobody takes care of themselves by themselves. Throughout this and other sections, we reinforced the key idea that social support and social change are essential to individual health, responsibility and empowerment.

Dimensions of an Activist Text

We feel confident that Nuestros Cuerpos, Nuestras Vidas has succeeded in offering both culturally meaningful content and ways of communicating content; a commitment to the conceptual models characteristic of Latin American and Latina women and not North American women, and an accessible quality of writing. However, we recognize that not all women can turn to a women's health encyclopedia and make the best use of its resources. We believe that the book can be made more useful to Latinas in the U.S. by making connections to other Latinas and the health education programs emerging in community based organizations. Alvarez et al (1999) have studied the way Brazilian women's health and feminists organizations used OBOS as a tool for social action. Gomez (1993) has also described the importance of OBOS in catalyzing the women's health movement in Latin America. The personal narratives, feminist analysis of health systems and social conditions of patriarchy, and examples of U.S. groups offering alternative
women's health services and political action, served to inspire political action throughout the hemisphere even though the book at the time was only a direct translation. Key elements, as activists describe the book, was its personal examples, supportive voice, political analysis, and examples of individuals and groups taking action for social change.

 

In our next steps of work at the BWHBC, we have been creating a closer link between a community outreach project for Latinas, ALAS or Amigas Latinas en Accion Pro-Salud, and the BWHBC's ongoing work on health information and education. With this approach, we are following the model offered by Latin American health information and documentation centers.
These women's health information centers are closely linked to community based education programs which offer a socially informed and culturally grounded approach to holistic health utilizing participatory health education models. We feel this model culturally and socially informed women's health education will be more inspiring and effective not only for U.S. Latinas but also for other women in communities of color. While the Latin American women's health movement has excellent resource and organizations databases, the U.S. Latina women's health movement has a more limited national resource database. We expect that the book in
Spanish will launch its own organic process, as women learn about the work of other women locally, regionally, nationally and internationally. We look forward to the publication of the book as an opportunity to initiate new conversations among women throughout the Americas. We also look forward to applying the lessons learned to support collaborations, resource sharing and networking among women throughout the world fighting for women's health and gender justice.

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