Abstract
CEPAM is an Ecuadorian women's NGO, which has an integrated approach to work with poor urban women on health issues, legal advice, and group formation, based on a gender analysis of life in the area. This account of its work in a poor urban settlement in Guayaquil describes how women came to understand that their health and well-being were determined by their status as poor urban women, and that as a result, they decided to set up their own health centre.