We, the women of nineteen Brazilian states working in the field of health, have come together in the First Meeting on Women's Health to present the public with an indictment of the current social, political and economic crisis, in addition to the health crisis, that afflicts Brazil today, and to make proposals to overcome the problems that exist specifically in the field of women's health.

I. THE BRAZILIAN CRISIS

1. The general crisis

We live in country with a dependent economy in which the majority of the population has no access to nourishment, housing, transport, work, land, health, rest and pleasure, generating a situation of borderline subsistence dominated by poverty, unemployment, violence, low life expectancy, high infant death rate, and social, sexual and racial (black and indigenous) discrimination that severely limits the quality of life of the majority of our country's population.

2. The crisis of the health system

We have had a health system imposed upon us that favors both the privatization of the medical system and excessive medicalization, and which fails to have the preventive and educational character necessary for an adequate health system for the Third World. With the present deepening of the crisis, this already precarious system is being severely damaged, with the following effects:

a) Closing down of medical schools in countless Brazilian universities.

b) Growing reduction of the number of beds in hospitals and Social Security emergency services, with very serious consequences for the health situation of the population at large and resulting in the illegal enrichment of clinics having an agreement with INAMPS (National Social Security and Medical Services Institute).

Regarding the specific situation of women, we denounce these conditions:

- gynaecological attention is not given priority in polyclinics;

- poor women do not have access to knowledge about their bodies or to contraceptive devices and information on the use of contraceptive methods;

- only 2% of women have access to a preventive examination of the cervix, and an even smaller percentage to the detection of breast cancer;

- maternity hospitals are overcrowded and lack the necessary conditions to attend to all needs;

- illnesses contracted through deplorable working conditions and accidents at work are given no attention.

Women are considered as mere reproducers by our health system, as there are no specific programmes for the periods of adolescence, menopause and old age. However, even reproduction does not receive the necessary attention, reflecting the technocratic, dehumanized character of our sociopolitical and economic health system.

We denounce also the false solution of implementing family planning programmes as the means to eliminate poverty in our country. Poverty in Brazil, as in all Third World countries, is not the result of "population explosion" but the product of an economic model that concentrates wealth in the hands of a few. We reject programmes currently in force, such as mass sterilization of men and women and eugenics campaigns like those proposed by Air Force General Waldir de Vasconcellos, Chief of Staff of the Armed Forces, which are aimed at reducing the country's population growth through the creation of a National Population Council that would control family planning as a matter of national security.

II. PROPOSALS

1. Our concept of health

The current concepts of conventional health practices are centered on the individual and the illness, emphasizing an impersonal biological interpretation with no historical or social dimension. To us, health is something dynamic that takes into account the personal characteristics of the human being, interacting with social, sexual and class characteristics. An understanding of the process of health and illness must take into account people's working conditions and the general conditions of their lives.

The sexual and reproductive role imposed by society on women has excluded women from decision-making power over their own bodies. This results in specific illnesses. For these reasons we demand an integrated health programme for women that takes into account all their biological cycles: childhood, adolescence, youth, maternity, menopause and old age, concentrating on their sexual specificity (menstruation, contraception, pregnancy, childbirth, lactation, infertility, sexually transmitted diseases, prevention of breast and uterine cancer, mental health and common illnesses), together with the prevention and treatment of work-related illnesses, be it as worker or as housewife.

2. Changes are needed to ensure:

- a space for collective knowledge, centered on education;

- sex education for the whole population, without strengthening stereotyped values and roles;

- recovery of popular and individual knowledge that has been destroyed by excessive medicalization, unnecessary surgery and useless examinations. These must be challenged and more value placed on natural ways of life.

In addition, we propose a review of the legislation on the codes of medical ethics regarding women's sexuality and health, including abortion and contraception. We must not forget the struggle , to eliminate prejudices against marginalized women:

- Lesbians: fight to change code 302.0 of the International Classification of Diseases of the World Health Organization, adopted by the federal government, that classifies homosexuality as an illness. We fight against behavioral aversion therapies and against discrimination at all levels of medical and psychiatric services that impose compulsory heterosexuality.

- Indigenous women, whose physical and mental health is affected by the unstable situation of their land and work and by the threat of extinction of their culture.

- Black women, who have been the most affected by the mass sterilization being implemented in this country.

- Prostitutes: respect for their physical, mental and human integrity and the right to hospital attention.

- Women prisoners.

- Women in youth detention centers.

- Women with physical and mental disabilities

III. AIMS

1. Encouraging people's organizations:

- to pressure the official bodies in each state to work for an improvement in women's health conditions;

- to stimulate other people's organizations, such as trade unions, neighborhood groups, political parties and the church to work for the popular and democratic control of the implementation of the Integrated Women's Health Care Programme (PAISM) that the government is carrying out on a federal, state and local level;

- to demand that the Ministry of Health and Social Security legalize, conduct research, and manufacture nationally both contraceptive devices for men and women and the necessary equipment and medicine to produce and publish suitable educational material.

2. Make demands on government bodies:

- to assure the participation of organized women's groups in the conception, execution and supervision of programmes related to women's health;

- to assure the involvement of and supervision by women's groups of private family planning services established with government permission;

- to make it possible for health professionals to share their technical knowledge, as well as to rethink their relationship with women, with the aim of assuring a space for us in medical services;

- to incorporate the experiences of alternative groups in the training of extension workers in the field of health.

- to assure decent, non authoritarian health services for the whole population;

- to incorporate women's theoretical and practical knowledge into official channels, through extensive publication of national and foreign works produced by alternative groups and through providing research centers, schools and libraries with a basic feminist bibliography;

- to stimulate an extensive discussion of women's health in the mass media; - to regulate and supervise the research currently being carried out in Brazil on contraception and sterilization, most of which is unethical.

We women also wish to take part in both the development and implementation of health programmes to ensure that the specific needs of women will be incorporated in them (adequate provision for hygiene, breast-feeding rooms, day-care centers, etc.).

We women wish to take part in programmes in the field of computers and information science m order to include data and information specific to women - for example on acts of domestic and sexual violence and the public-private health system.

Reasserting the complete autonomy and independence of the women's and independence of the women's movement in the struggle for these demands, we believe that an extensive publication of this document would help build awareness among the population and government and especially among Brazilian women.