Exploring women's needs in an Amazon region of Ecuador.

This study broadly explored women's perceptions of their most pressing problems and needs in the mostly rural Amazonian province of Orellana in Ecuador in mid-2000. In-depth interviews with community women and health and social service providers used two rapid structured, qualitative methods--free-listing and pile-sorting--to explore the 'insider's' perspective, with the participation of local organisations, and generated discussion on the emerging issues, giving an opportunity for action aimed at improving women's situation. Unequal gender relations, subordination of women, economic problems, men drinking too much and domestic violence were identified as the most pressing concerns. Several reproductive and sexual health problems were also identified and information about others elicited. This paper describes the methodology used in the research, reports on the 20 most cited problems and looks more closely at the findings in relation to violence against women, lack of access to contraception and ambiguities arising from the need to resort to clandestine abortion. Despite the existence of innovative national policies related to domestic violence and reproductive health, there is a scarcity of resources and poor infrastructure in Orellana. Patronising attitudes on the part of health service staff also greatly limit women's access to reproductive and sexual health services.