Women's health in northeast Thailand: working at the interface between the local and the global.

An important first step in translating global statements about women's right to health into action programs is an assessment of the interface between local health culture and public health/medical practice. In this paper, we present the findings of an ongoing research project focusing on women's sexual and reproductive health in Northeast Thailand. The project is a prototype illustrating how formative research may be used to guide intervention development as well as midcourse correction. Examples are provided which clearly illustrate why cultural understandings of gynecological health are important to consider before introducing women's health programs. One case featured describes how an iatrogenic fear of cervical cancer has emerged from public health messages and screening programs. A hybrid model of cancer has evolved from preexisting local ideas, resulting in an exaggerated sense of risk wherein women fear that a wide range of common problems may potentially transform into this fatal disease. We argue that public health needs to be held accountable for what transpires when health messages are introduced into a community. Monitoring of community response is necessary. In the second half of the paper we describe efforts to increase community understanding of women's health problems, create gender and culturally sensitive health care services, and enhance the technical and communication skills of health staff.