Guayaquil, home to two million people, is Ecuador's main port city. El Guasmo is an urban settlement in the south of the city. In 1984, CEPAM, an Ecuadorian women's nongovernmental organization, began working in El Guasmo Norte, the oldest and most established area of El Guasmo. CEPAM employs an integrated approach to its work with poor urban women on health issues, legal advice, and group formation, based upon a gender analysis of life in the area. This article describes the group's work in El Guasmo Norte, explaining 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 establish their own health center. Sections cover the determinants of urban women's health, reflection and action, the health center, the concept of integration, participating in health services, and lessons learned.