Linking Research, Policy, and Practice to Critical Creativity by frammenti.mi

FRA(M)MENTI & SHARE-NET NETHERLANDS PRESENT

linking research policy and practice to critical creativity

ng arch po ractice tical creativ

olicy e About.

This is a one-issue-only magazine on the 9th Annual Conference by Share-Net on Linking Research, Policy and Practice in which a platform is given to young researchers in the field of SRHR.

What we hope to achieve with this magazine is to, first and foremost, highlight the researches and voices of the young researchers who presented their exciting work, but also to transform theory into praxis into what we like to call critical creativity. Academic research and data will be entangled with poetry and illustrations, with photography and prose, with loud slogans and subtle colors liberating the noise and messiness of art whilst maintaining a critical approach to the ways in which we can imbue the world with meaning.

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Share-Net Share-Net Netherlands is the Dutch knowledge platform for Sexual and Reproductive Health and Rights (SRHR) and one of the country hubs of ShareNet International. Share-Net is hosted by the KIT Royal Tropical Institute and has 31 individual

members and 32 organisational members from sectors including NGOs, universities, knowledge institutes, governmental and private sector which work in lowand middle- income countries and in the Netherlands with a focus on SRHR.

Fra(m)menti Fra(m)menti (from the Italian “fragments”, but also “among minds”), is a transfeminist queer artistic collective based in Milan. We operate both online and offline, organizing cultural and educational events discussing intersectional feminist issues through artistic practices, for we

believe them to be incredible sites for critical creativity. The collective currently counts 16 people, all invested in creating a free, safe(r) and participated space where we value pluralism, celebrate differences, practice mutualism and inclusivity, and suspend all judgement.

table of contents

01 02 03 04 menstrual, vulva & obstetric care

social, cultural & organizational norms change

reproductive care & SEHR services

sexuality, sexual pleasure & LGBTI health

what does it mean?

ANC CSE ED EMR FP GBV GGR HF HW MHM MYP OOP OV PPP RMC SDG SRHR STI UHC WPVH

Antenatal Care Comprehensive Sexual Education Emergency Department East Mediterranean Region Family Planning Gender-Based Violence Global Gag Rule Health Financing Health Workers Menstrual Health Management Meaningful Youth Participation Out-Of-Pocket (Insurance) Obstetric Violence Public-Private Partnership Respectful Maternal Care Sustainable Development Goal Sexual and Reproductive Health and Rights Sexually Transmissible Infections Universal Health Coverage Workplace Violence in Healthcare

Moderator

Dinu Abdella, Global Health Advisor at KIT Royal Tropical Institute

1st Session Menstrual Vulva and

Artwork by Silvia Bocchero

n: l, d

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CHAPTER 01 â&#x20AC;¢ CONFERENCE 01

“It’s like a knife plunged into me”

How good care is done for chronically painful vulvas. By Maya Lane (she/her), medical anthropologist and dancer, interested in the daily practices of those living with non curable diseases. Vulvodynia is a condition that can affect people’s lives in a variety of ways: it can affect the sexual sphere (penetration, touch, etc.), menstrual care (tampons insertion), but also mundane activities (wearing jeans, cycling, walking). The research wants to investigate how good care is done for vulvodynia, how people do good care and how biomedical professionals do good care by also showing the nuance of conversation on care by speaking directly with those affected by this condition.

Vulvodynia is a chronic vulva pain condition. There is no cure, no official set of guidelines within the biomedical discourse to help patient care; this condition has a tremendous effect on people’s emotional, mental health as well as physical wellbeing.

N.B. It’s important to remember that the findings of this research are to be situated within a heteronormative phallocentric cultural and societal context that privileges penetrative sex.

Invitation to make care better. Good care is complex, is not straightforward, and it is relational. Lane encourages to move away from the idealized notion of what good care is for chronic pain and to embrace the messiness and specificity of care, especially for a condition that is still relatively under researched in medical discourse.

RECOMMENDATIONS

car pra

r ac 01

First set of care practices:

It’s hard work. pain fluctuates, it’s hard work and hidden care to make life livable. Hidden care. Negotiating within context between good care practices short term and good care practices long term (sometimes the two do not correspond).

“You know, it’s so much admin just to be able to do normal stuff. The work of care is just to make life liveable.”

Sex-work as good care. Obviously vulvodynia affects sexual relations. Sex-work can be defined as the communication practices, the physical practices and the emotional practices used to manage desire. What do these involve? ‡ Managing expectations of partners: A: “When I meet new people I tell them straight up: I can’t have penetrative sex, that’s never going to happen” B: “I’m always going to wear my underwear in bed”

‡ Avoiding sex. ‡ Trying to work out from someone’s Tinder profile whether or not they are going to be open to non-penetrative sex. ‡ Researching for lubricants that do not sting. ‡ Ignoring pain during sex could also be good care for some people with vulvodynia, focusing on something else in order to have penetrative sex with their partner, which they see as a practice that brings them closer together, and then dealing with aftermath of the sex (heat pack, ice pack, bath, etc). ‡ Pretending to overly-enjoy oral sex due to the guilt of not being able to have penetrative sex (while actually not really enjoying either).

Second set of good care practices: Relaxation practices. Specific to the Netherlands (vulvodynia is seen as stemming from pelvic floor tension.) Doctors will advice a variety of practices, Lane focused on two types: ‡ Active relaxation practices (massage, dilation, breathing tecniques) with the goal of having penetrative sex. These are good care but they cause so much pain. Informants were reporting dread at the prospect of having to do these practices.

‡ Traditional idea of relaxation, calming, personal ways to deal with a general stress and tension (drinking wine, smoking weed, going on a picnic, having a bath). Often this idea of good practice risks minimizing and gaslighting the actual gravity of the pain people with vulvodynia experience on a daily basis. “The doctor told me I need to do a Zumba class to relax” at a point when she was not able to work, she had to move back in with her parents and her whole life was subsumed by pain.

FINDINGS

Niki de Saint Phalle

Hon, 1966 © Niki Charitable Art Foundation

“I often wished that more people understood the invisible side of things. Even the people who seemed to understand, didn’t really.” ― Jennifer Starzec, Determination CHAPTER 01 • EXTRAS & TIPS

“The doctor told me I need to do a Zumba class to relax” ― Tina,

at a point when she was not able to work, she had to move back in with her parents, and her whole life was subsumed by pain.

Being oppressed means the absence of choices” ― bell hooks

Front page of the HON catalogue. Niki de Saint Phalle, Photo by Annika Öhrner

“It’s like a knife plunged into me”

How good care is done for chronically painful vulvas. By Maya Lane (she/her), medical anthropologist and dancer, interested in the daily practices of those living with non curable diseases.

Podcast tip

Tight Lip

https:/

“It has a name, this condition of mine: Vulvodynia. Rolls nicely off the tongue, doesn’t it? To me it sounds like bouncing on velvet cushions (“dyna” meaning “cushion” in my native language). It should have a name more similar to “acid in my pants”. I hope to see the day they change its name, mostly because “Vulvodynia” means “vulvar pain” in Latin. Thus, once you get your diagnosis your doctor merely repeats what you have told them. “My vagina hurts,” you say. “Aha!” The doctor replies. “A typical case of ‘Your knickers are on fire’!” But what’s in a name if the name cannot do more than telling you something you already know? [...] C H A P T E R 0 14 •• ECXOTNR FAES R &E NT C I PE S 0 1

After a summer of unexplained agony I have finally been told: ‘There’s nothing we can do. Computer says no.’ This is where my vagina and I form a new sort of relationship. We detest each other at this point, but we realise that we are bound by blood and bones and therefore have to work on a way to live with each other. [...]

pped

//www.tightlippedpod.com/about

Pink is the

Colour of Pain Margareta Garbe, 1971, The Stockholm Review of Literature

It may sting, it may bolt, it may ache. The pain takes different shapes and forms each day. But mostly it’s not the kind of pain that makes you scream or cry. It’s just bearable. The problem is that it is always present. [...] Unexplainable pain is never just pain. It’s a ticking clock, a message your body sends out to tell you that something is wrong. It’s a broken pipe that will soon lead to water damage. No one knows why it’s there, so no one knows what it can do. “It could be a damaged nerve,” one of my GPs says one afternoon. It could be a lot of things. Each doctor or gynaecologist has their own theory.” 19

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CHAPTER 01 â&#x20AC;¢ CONFERENCE 02

A gate to research & practice

Exploring menstrual health management among adolescent girls in Egypt

By Hadir Barbar (she/her), SRHR activist and advocate, Project Manager and Qualitative Researcher

Within the Egyptian context, there is a lack of structured formal or informal Comprehensive Sexual Education (CSE) and factors such as poverty, social and cultural norms, the influence of community members and healthcare systems aggravate the problem. This research aims to analyse the individual experiences of menstrual health management (MHM) among adolescent girls in Egypt, analyse some key influencing factors to MHM, and offer recommendations to relevant stakeholders.

N.B. Importance of digital storytelling as a tool: “The Unspoken Period: Digital Storytelling Video” and “Menstruation Shouts Project Storytelling video 1” and of uplifting the voices and stories of menstruating adolescent girls and healthcare workers.

FINDINGS

COMMON FINDINGS:

Inadequate MHM is a multidimensional health issue that requires a multisectoral approach. There is a remarkable knowledge gap about menstruation and MHM in Egypt but the diversity of the country demands for a more in depth exploration of adolescent girls’ menstrual experiences and persisting challenges. There is a crucial need for more accurate, accessible and trusted information on menstruation through online platforms. The surrounding community including peers, sexual partners and family members have a great impact on girls’ attitude towards their menstruation. The menstrual experience and challenges at school were only tackled through literature but not through the website, which brings the attention to further explore the actual causes.

CHAPTER 01 • CONFERENCE 02

‡ Social and cultural norms play a key role in the inclusion of girls in the community while girls themselves are resistant to social inclusion during their menstruation fearing social stigma; ‡ Even within the healthcare system practices and discourse, menstruation is not prioritized as a topic as much as other relevant adolescent SRHR issues as child marriage, early pregnancy and contraception use

‡ Establish more online platforms that offer revised and up-to-date information about menstruation and relevant SRHR to encourage body autonomy while ensuring their monitoring and evaluation by expertise ‡ Strengthen the Healthcare System through building the of the healthcare providers especially those present at schools ‡ Further research to study the variance between different geographical areas, menstrual experiences among different socio-econmic classes and essentially the linkage between menstruation and sexual activity among adolescents; ‡ Foster the establishment of adolescentled networks taking the successful examples of youth-led network as a leading model; ‡ Advocacy through existing SRHR activists and advocates (putting menstruation on the agenda of SRHR policies) ‡ Continue the advocacy effort to formulate formal comprehensive sexual education curricula at the Egyptian schools

RECOMMANDATIONS

‡ There is a manifested desire by adolescent girls for receiving further information on menstruations to overcome the taboo that surrounds them and to feed up their curiosity about their bodies; ‡ Menstruating girls are not allowed to do religious practices which reflects the influence of culture on the menstruators; ‡ Also by religion, sexual activity during menstruation is prohibited;

m me

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The absence of education about menstruation and the widespread misconception about enstruation heighten the risk of suffering egative psychological consequences and crease the chances of oor menstrual health practices 23

Zineb Sedira, 1997 Quatre Générations de Femmes.

The Hotham Street Ladies, 2014 You Beaut, Bakehouse Studios on Punt Road

Gaby Garcia

The Poetry of Periods

“

Despite the constant silence and hidden nature of periods, not all of us are afraid of our blood when we are alone with it—after all, we have to touch it, smell it, wring it from our clothing in the bathroom sink. I was someone new upon getting my first period,

and it had nothing to do with becoming a “woman” (whatever that means) and everything to do with the tireless rituals I realized would follow me for as long as I menstruated: the salty smell of blood and girlish insides, that color scheme of reds and how they become perpetual signals of the state of the body, a coded language. Darkest, I learned, meant the lining had been there longer, lighter, newer. Crimson would never be the same.”

Montana Kitching, ‘Ammunition’ CHAPTER 01 • EXTRAS & TIPS

I PREFER TO MAKE ARTWORK THAT CAUSES PEOPLE TO THINK AND NOT JUST MORE PRETTY PICTURES Day 2

Day 1

Jennifer Weigel

Menstruation Series, 2005 Courtesy of the artist

Day 3

“First thing each morning during the week of my monthly period, I pressed my menstrual vagina to the watercolor paper to make these prints.

It seems to me that, in regards to the topic of menstruation, a lot of people would rather simply look the other way and not have to think about it or be confronted by it. I think that’s part of why I’m finding it difficult to show some of these works, because they’re controversial even though they really shouldn’t be. I create other sorts of artwork as well, but I prefer to make artwork that causes people to think and not just more pretty pictures.”

Ilaria Mazzoletti - Midnight cramps

The poetry of periods ― Gaby Garcia “Why was the body made? How does it torture? People of all genders with uteri are reminded on a monthly, and sometimes entirely unpredictable, basis that our bodies contain a world of pain. [...] I remember sneaking tampons from the front pocket of my backpack up my sleeve when I left to go to the bathroom so that no one saw. It was not so different from the way I snuck poems into the margins of my notebook and went to great lengths to be sure that no one ever saw them. [...] And so the cyclical, ritualistic nature of the period remains inherently poetic, following a rhyme scheme equal parts wild and steady, pushing the body onward and inward. It propels the menstruating person toward themselves with abandon—are you going to have a child? You can, you know. You forgot to. Are you still breathing? What are you waiting for? [...] Like the poem, we wait for the period to come through our bodies—to hit us in the gut and then purge forth. It both does and does not belong to us. It forces eyes to stare, hands to work, brains to jolt. It is disruptive, a scandal. It punctuates and molds time into a soft narrative, just as writing does. It resists heavy control. In fact, it is almost entirely uncontrollable, just like its sister, poetry. It is an experiential transcription of the body’s secrets.”

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CHAPTER 01 â&#x20AC;¢ CONFERENCE 03

Exploring obstetric violence in the Eastern Mediterranean Region By Merette Khalil (she/her) birth doula, childbirth educator, and founder of YourEgyptianDoula

Obstetric Violence (OV ) is a form of gender-based violence (GBV ) which comprises a range of violations and abuses, targeting laboring and childbearing women. OV is institutional and systemic and exists at the intersections of health systems and socio-cultural norms. Obstetric Violence is underreported in SRHR literature (even more so in regards to the Eastern Mediterranean Region)

The EMR (Eastern Mediterranean Region) comprises 22 countries and is characterized by diversity: socioeconomic and healthcare system fragility affects health services delivery and maternal health indicators.

and womenâ&#x20AC;&#x2122;s voices and experiences on the subject are insufficiently represented. Mentions of OV are to be found in 2010 in B&H mistreatment landscape analysis, only reaching the UN and WHO in 2019.

obst etric vio-

W T O

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Obstetric Violence in the Eastern Mediterranean Region is expressed by the provision of hierarchical, technocratic, overmedicalized care with many routine interventions pushed on women often without their consent.

WHAT IS THE THREE BODIES APPROACH OF ANTHROPOLOGY? The intersections three bodies of include individual these the abuses AND the body (embodied the social body,and power dissonanceself), between providers and the political patients due tobody. patriarchal socio-cultural norms ENABLE:

Normalization of OV and passive normalization of human-rights violations by policymakers

Objectification and violation of womenâ&#x20AC;&#x2122;s bodies by health workers

Dis-empowerment of women in childbirth

Failure of recognition of violence, acceptance and underreporting

Right base care & cen voices of w are essenti combat obs violence.

‡ Advocacy for RMC at highest levels ‡ Action plans and national policies and plans to eliminate OV ‡ Accountability: Strengthening information systems: routine data collection of both qualitative and quantitative data to operationalize and measure the implementation of RMC

What’s the Policy? CHAPTER 01 • CONFERENCE 03

‡ Awareness raising, Childbirth education, Advocacy (when women know their rights, they are able to recognize the abuses).

HEALTH SYSTEM AND FACILITY LEVEL ‡ Health workforce (multidisciplinary approach, pre/in-service training,

Need for integration of OV in medical education across the Region Sensitization and training of health workers on SRHR and rights-based care Evidence generation for prevalence comparisons inter and intra-regionally Qualitative studies on provider and community attitudes on OV, sociocultural enablers and interventions and, Studies on the costs and implications of trauma and OV.

cultural - competency / gender sensitivity): invest in doulas and childbirth educators, scale up and scope change to midwives; training sensitization on SRHR/rights-based care; better HR management. ‡ Service delivery (infrastructure, strengthening gate-keeping, accountability/quality assurance mechanisms, implementation of WHO guidelines): implementing evidence based clinical guidelines; investing in birth centers; allowing women to select their birth positions; reducing routine interventions; accountability for abuses, quality assurance mechanisms to report from patient and provider sides.

PRACTICE

INDIVIDUAL AND COMMUNITY LEVEL

RECOMMENDATIONS

The recommendations and interlinkages between research, policy, and practice provide pathways to begin reduce the overwhelming prevalence of OV in the EMR, and ensure that every woman achieves her right to health and birth in a dignified, respectful, and empowered manner. RESEARCH

ed ntering women ial to stetric

To eliminate OV a paradigm shift is required involving infrastructural changes, education, empowerment, advocacy, health system strengthening, and policy development.

c o S

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f Materna o y t lC i l e

ul Matern f t al c e p

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Ev i

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Disrespect & Abuse in Childbirth

OV Obstetric Violence

CHAPTER 01 â&#x20AC;¢ CONFERENCE 03

/04 Looking at indigenous populations such as the Quichua, in Ecuador the mortality rate per 100,000 births is 175, more than three times the national average. In the Ayacucho region, where more than 75% of the population is indigenous, the data shows that the mortality rate raises to 300.

CHAPTER 01 â&#x20AC;˘ CONFERENCE 04

Repositioning birth:

Conjugating the biomedical and intersectional feminist paradigms to investigate birth positions among the Quichua communities of Ecuador and Peru

By Maddalena Giacomozzi (they/ them) researcher, SRHR advocate and activist, Masters student in medicine The national averages of both countries have achieved the sustainable development goal of maternal mortality per 100,000 births. However, looking specifically at indigenous populations such as the Quichua the data shows that in Ecuador the mortality rate per 100,000 births is 175, more than three times the national average and in the Ayacucho region, where more than 75% of the population is indigenous, the data shows that the mortality rate raises to 300. A variety of studies have tried to investigate the reasons for such a health disparity between indigenous and non-indigenous populations; in 2014 one of the studies reported that in Ecuador 37% (about 4/10) indigenous women do not access public health services because of difference in beliefs and culture. The study looked into birth positions, which are known to be culturally coded. In many indigenous communities vertical births are traditionally preferred to horizontal births. N.B. Maternal mortality is just one of the many indicators we can take to assess reproductive health.

INTERSECTION OF OPPRESSION 01.

Objectives: the study looks into maternal health in indigenous communities of Ecuador and Peru by analysing how birth positions can be a potential barrier for Quichua women to access healthcare and contribute to the negative health outcomes.

02.

Methodology: scoping review of nine sources.

03.

Framework: conjugation of biomedical and intersectional lenses looking at key axes of discrimination (gender, class and race) and at their intersection.

• SOCIAL AND POLITICAL MARGINALIZATION • TOP DOWN APPROACH

• Disrespect and abuse in childbirth • Objectification of female bodies • Sexualization of labor

gender

• Masculinization of obstetrics • Male normalization • Feminization of poverty

• •

Obstetric Violence • Affordability of health care • Poor quality of public health services • Asymmetries between health care providers and patients • Stigmatization of poverty

class • Geographical barriers • Financial barriers • Medical education inaccessibility

design / framework by Giacomozzi based on Kelly (2009) and Mullings & Schulz (2006

04.

Findings: obstetric violence is extremely prevalent. To deny the patient freedom of movement during labo(u)r and birth is a form of obstetric violence. A study by Brandão et al. uncovered that only 45% of all patients in Quito chose their birth position, while 36% did not choose and 15% did not even know they could choose. Another study by MontesinosSegura et al. carried out in Peru (2017) asked specifically about birth positions and discovered that 97% of patients had experienced at least one form of obstetric violence. Disaggregated data on race are unfortunately not available but qualitative studies report that there are major cultural barriers for Quichua people to access health care. N.B. Different axes of discrimination do not just add up but their effects multiply creating a distinct context-specific form of oppression

05.

Disempowering rucu mama Control of notnormative bodies and their reproductive processes

race

Recommendations: Denying patients the freedom of movement during labor and birth is an act of obstetric violence. Labor and birth should be facilitated in every kind of position and this can be done by training healthcare workers to assist the birth vertically but also to provide delivery rooms where this is possible (obstetric chair, rope, bars, etc.). Additionally, appreciation of Quichua birth knowledge is crucial to the reempowerment of these communities.

• Cultural barriers • Colonial legacy • Racism and ethnic discrimination

Gender:

Obstetric violence is a form of genderbased violence. Female bodies are considered deviant from the male norm. “Labor is perceived as potentially opposing to femininity - violence is thus necessary to dominate them, restoring their ‘inherent’ feminine submission and passivity [...] to re-feminize and reobjectify the body.” (Sadler er al., 2016)

Race:

Every person that is giving birth might have specific needs related to the birth position they would like to assume but there is a cultural and ethnical specificity to consider and in this case the Quichua do have a history of vertical birth positions which clashes with the Western biomedical paradigm of horizontal birth. “Discrimination is systematically embedded in an intrinsic component of the clinical encounter, contributing to differential health outcomes, not only as a stressor, but as a result of poor quality of care or outright neglect.” (Castro et al., 2015)

Class:

The most underresearched axis of the three axes of discrimination. Most research assumed an homogeneity of class, in particular of poverty status among the Quichua women, an assumption that clearly stems from the colonial gaze. However, Montesinos-Segura et al. (2017) asked directly to the interviewees: “Do you think you would have been treated differently if you had more economic resources?”. And from their research emerged that 1 in 3 women answered “Yes, I think I would have been treated differently having had more economic resources”.

Dani Marie Bordignon - itstimetotalk

Matilde Cesareo - Bleeding

bleeding while trans ― Cass Clemmer

“

‘Y’all know I’m trans and queer, And what that means for me all around, Is something that’s neither there nor here, It’s a happy, scary middle ground. So when I talk gender inclusion, And I wrote these rhymes to help you see, I’m not tryna bring up something shallow, Periods are honestly pretty traumatic for me. See my life is very clearly marked, Like a red border cut up a nation, A time before and a time beyond, The mark of my first menstruation. So let me take you back, To the details that I can still recall, Of the day I gained my first period, And the day that I lost it all. I was 15 and still happy, Running around, all chest bared and buck, Climbing trees, digging holes, And no one gave a single f***. I mean I think my ma was worried, So I went and grew out my locks,

A sign I was normal, still a girl, A painted neon sign for my gender box. So, the day I got my period, My god, a day so proud, This little andro f***ed up kid, Had been bestowed the straight, cis shroud. The relief got all meshed up in my pain, In that moment, I sat down and cried, Just thanking god I was normal, While mourning the freedom that had died. Everyone told me my hips would grow, I looked at them and couldn’t stop crying, “What’s wrong with you? You’ll be a woman!” They kept celebrating a child dying. See my body had betrayed me, That red dot, the wax seal, On a contract left there broken, A gender identity that wasn’t real. Most people deal with blood and tissue, And yet my body forces me to surrender, Cause every time I get my cycle, Is another day I shed my gender. My boobs betray me first, I feel them stretching out my binder, I send up questions, “am I cursed?” And wish to god that she was kinder. The five days it flows, I try to breathe, I dissociate, While my body rips outs parts of me, Leaving nothing but a shell of hate. The blood drips from an open wound, Of a war waging deep inside my corpse, The battle between mind and body, Immovable object; unstoppable force.

Rachelle Chadwick

Bodies that Birth: Vitalizing Birth Politics

Book tip

“No crisps, no chocolate bars, no straws. …No whispers of encouragement. No, in the end, I have no clue. What spewed you out into the blue. I was there, in the dark of night. Like a witness, just out of sight.” ― poetry from Passage, Mila Oshin

Judy Chicago, Birth Trinity from the Birth Project, 1983. Photography © Donald Woodman / Artist Rights Society, New York. Collection of Elizabeth A. Sackler. © Judy Chicago / Artist Rights Society, New York.

― Kascha Semonovitch

Descartes and Doulas https://theaccountmagazine.com/article/semonovitch-18

When I went into labor, my doula asked me to think of a mantra—something I could repeat—for the early part of the process. For this phase, my doula said, I needed something that took a little concentration, took a little of my mind because I would not yet be all body.

“Some people liked to look at pictures or sing or dance. Or repeated a poem or a prayer. Just repeating om om or humming would work for when, honestly, it just doesn’t matter what you’re thinking because you’ll probably just be making nail marks in your partner’s shoulders or shitting yourself. But for this part I needed a little phrase to say and say again to keep the mind busy. She thought maybe I could recite a piece of poetry I had memorized. This horrified me. Instead, I choice to recite the structure of Descartes’s Meditations as laid out in the synopsis. In retrospect, I can see how I sound like an arrogant academic. But it was honestly the best thing I could think of at the time: it was something I had memorized while teaching to the point of entirely internalizing

CHAPTER 01 • EXTRAS & TIPS

it so that I could think it even while distressed. “Distressed” in reference to active labor is one of those awesome euphemisms only childbirth educators would use. If you’re “distressed” in labor it is in the way that distressed fabric has been beaten or dyed until it changes structure. It will never look the same. [...] As a parent one abdicates the right to privacy for many years; laboring takes away that privilege entirely. Practically, especially in the U.S., you simply are not allowed to be alone when laboring. I chose to have my husband and doula with me for comfort; at the hospital, the nurses had to stay within

earshot and at least with those partners. I shat myself over and over in front of at least three people. It could have been a city; I don’t know. Privacy was not an option. [...] But existentially as well, I was not alone. I was not; the single letter “I,” standing there alone, does not refer to the pregnant body. The pregnant body is not isolated. It is not a container for two minds or a stack of mind-body Russian dolls. The pregnant body is a variation on all bodies; mind a flower on the stalk and seed of body. In labor, it isn’t possible to wonder if you are alone: the imminences of a force that is not you ruptures your sense of self along with your labia.

Birth Tear/Tear from the Birth Project, 1985. Macramé over drawing on fabric. Macramé by Pat Rudy-Baese. 46 × 55.5 in. Photography © Donald Woodman / Artists Rights Society, New York. Collection of Through the Flower, New Mexico. Courtesy of theartist; Salon94, NewYork; and Jessica Silverman Gallery, San Francisco. © Judy Chicago /Artists Rights Society, New York-

Moderator

Tomas Chang Pico, Global Programme Officer at Voice

2nd Sessio Social, cul and organ

on: ltural nisational

Artwork by Silvia Bocchero

/05

CHAPTER 02 â&#x20AC;¢ CONFERENCE 05

Made in Vietnam:

A critical investigation into the implementation of menstrual related labor legislation in Vietnam’s garment factories By Juliana Mee (she/her), International Development MA graduate

“Menstruation-related legislation” sounds very progressive, wellintentioned and considerate. It means that people, organizations, and governments are starting to understand the weight of menstruation and its sociocultural baggage in women’s everyday life as a critical concern towards gender equality. But is it truly as progressive as it sounds?

Art. 155 of the Labour Code of Vietnam states that women are entitled to 30 minutes paid break during their heavy days of menstruation. Despite how progressive this legislation might appear, research showed that laws like this one had paradoxical outcomes and produced more negative effects than positive ones.

N.B. Vietnam is one of the countries that implements menstruation-related labour laws, as it is commonplace in Southern and East-Asian nations. However, little to no research has been done on the effects of these genderspecific labour policies.

Introducin gender-spe legislation as breaks not be don without lo further int socio-cultu norms tha menstruat and gende inequality. CHAPTER 02 â&#x20AC;˘ CONFERENCE 05

One interviewee reported that although she would have liked to take this break she would have risked her jvob or to be put in a part of the factory where she did not want to work. The research showed that menstruationrelated legislation is not intended to subvert gender norms, on the contrary, it aims to reinforce the stereotypical role of women as belonging in the domestic sphere and menstruation as a private or potentially contaminating matter.

Introducing gender-specific legislation such as breaks should not be done without looking further into the socio-cultural norms that tie menstruations and gender inequality in general. Socio-political structures have to shift and evolve before implementing such legislation, which, behind a facade of progressiveness, hides deep-rooted stereotypical and damaging gender norms.

FINDINGS

METHO -DOLOGY

A series of interviews was conducted with NGO members, factory workers, political stakeholders and experts on related matters. Partnership with an NGO based in Hanoi, Vietnam, who works to implement labour rights in garment factories.

Data showed that women do not take these lawfully sanctioned breaks due to the negative consequences associated with them such as the risk of lowering the productivity and consequently losing money; the risk of being punished by supervisors, etc.

RECOMMENDATIONS

ng ecific n such should ne ooking to the ural at tie tions er .

/06

CHAPTER 02 â&#x20AC;¢ CONFERENCE 06

Assessing Meaningful Youth Participation in Share-Net International By Carys Stirling (she/her), Share-Net intern between April and July 2020, Master student and youth advocate

MYP: Meaningful Youth Participation. Young people are the most affected by SRHR programmes and practice, but often do not have the means to do anything about it. The involvement of young people into the processes of decision-making, education and youth-friendly programmes is called MYP. Helping programs tailor to actual rather than perceived needs.

ShareNet International is eager to understand the status of Meaningful Youth Participation (MYP) within its organisation where are the strengths, where are the gaps? How can commitment to MYP be improved? This research seeks to convey key lessons learned from this internal assessment.

CHAPTER 02 â&#x20AC;¢ CONFERENCE 06

illustration by Federico Candiani, based on a model by Choice For Youth and Sexuality

What is MYP and why is it important? “Nothing about us without us”: no policy, program or initiative should be designed without the direct and diverse involvement of the people concerned.

How can you assess MYP in your organisation? Tool of the “flower of participation” by CHOICE for Youth and Sexuality: it uses the metaphor of a blooming flower to illustrate the necessary conditions for MYP to flourish. (And that there is no one perfect way of doing MYP - it can take many forms).

N.B. It is important t not completely erase differences between youth and adults, remembering that youth participation to be effective has t be meaningful. There is the need to create safe spaces that you people can access w differences are value and celebrated and where their voices a heard. CHAPTER 02 â&#x20AC;˘ CONFERENCE 06

to e n

to e e ung where ed

are

Key lessons learnt from this internal assessment

Commit to MYP strategically and personally

Youth friendliness Ask - what are the barriers to diverse youth involvement? Money? Timing? Language? Young people are asked to volunteer their time but this is an obstacle to diversity inclusion (being able to volunteer is a privilege). Paid internships or fundraising training can be tools to improve diversity.

Understand MYP Youth friendly SRHR or research about youth SRHR is not MYP, unless young people are meaningfully involved. Shared understanding of MYP is crucial for organisations to do MYP consistently and effectively.

Often there is a consideration for young people but no strategy to meaningfully involve them. Therefore, structures and clear commitments need to be in place - e.g. in organisational policies, theories of change, governance structure - implemented by committed individuals. Mainstreaming MYP requires a significant organisational culture shift, which only takes place with sustained commitment and time.

Safe spaces MYP challenges the typical relationship between youth and adults. This can be difficult in spaces where age/gender hierarchies are strong. One participant shared that in their experience, there can be a real tendency among young people to simply â&#x20AC;&#x153;agreeâ&#x20AC;? with the adults present. This limits the utility of their input and the potential innovation they have to offer, and tokenises their involvement. So are there ways to create safe spaces where young people feel comfortable sharing their honest views? E.g. anonymised input, youth dominated spaces? These look different in different contexts.

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CHAPTER 02 â&#x20AC;¢ CONFERENCE 07

Global insights with focus on India:

Occupational violence against health workers By Gopukrishnan Pillai (he/him), Old Age medicine and Medical Law Dual masters degree graduate and a distinction MPH

Workplace Violence in the Healthcare Sector (WPVH) has adverse consequences for health workers, patient safety and health system functioning. Health Workers are as much as 16 times more likely to experience client-perpetrated violence than other service professions globally. Nearly 70 â&#x20AC;&#x201C; 80% of occupational

Governments, such as in India, have passed stringent legislation targeted to deter violence towards Health Workers (HW). However, the criminal justice system is reluctant to act against perpetrators.

violence in the healthcare sector is not reported officially. Nearly 70% of Health Workers (HW) globally face some form of violence or harassment at work every year (verbal, psychological, physical or sexual).

Investigating the causes of WPVH and the interventions shown to be effective. Individual-level determinants: Younger and less-experienced workers; women face more verbal violence and men more physical violence. Young males under influence of alcohol are most likely to be perpetrators in Emergency Departments (ED). Older men (65 years and above), people with behavioural issues are other high risk groups.

Wider Societal and Value context: Zooming out, there are more environmental and societal factors, here are some examples. Normalisation of incivility and bullying, rising rates of violent crime in society. Lack of Universal Health Coverage leading to catastrophic health expenditure. Growing corporatisation of healthcare and erosion of trust in society. Inefficiencies in policing and criminal justice system. Cultural norms and values about patient-privilege. Gendered nature of health systems and intimate care services. Interventions: Organisational culture and work arrangements, Environmental Modification, Training, Post-incident support.

CHAPTER 02 • CONFERENCE 07

WPVH is a complex phenomenon that threatens patient safety as well as the health system functioning. Most incidents can be prevented by an improved Health System management. Prevention is important, because WPVH has longterm impact on HW and Health Systems. Unfortunately though, not all incidents can be prevented even with precautions. WPVH is a sign of a larger problem of the breakdown of trust in society.

RECOMMEN -DATIONS

Organizational and environmental risk factors: Mismatch between expectations and perceived quality of care, long waiting lines, non-availability of medicines, perceived neglect or unfairness, improper communication. Less trained, overworked staff, working afternoon and evening shift, especially working alone. Hierarchy-oriented organisational culture, lack of management support.

‡

CONCLUSIONS

OBJECTIVE & FINDINGS

W p threatens well as t functionin can be improv

‡ ‡ ‡ ‡

Multi-point comprehensive organisational strategy Training and post-incident response should be strengthened Sector-wide approach for prevention (not HRM) Whole of Society and Whole of Government approach More research is needed, including in High Income Countries

WPVH is a complex phenomenon that s patient safety as the health system ng. Most incidents e prevented by an ved HealthSystem management.

Aruna Shanbaug, a 25-year old nurse in Mumbai, was left in a permanent vegetative state for 42 years after aggravated sexual assault at her place of work by a co-worker in the year 1973.

Violence is always personal 63

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The politics of abortion care in Buenos Aires

Understanding abortion care practices within a context of political debate to legalize abortion

By Zina Jorna (she/her), MA Medical Anthropology In Argentina abortion is illegal unless the life or the health of the pregnant person is at risk or in case of sexual violence. Nonetheless, abortion still has a very high incidence rate: an estimated 370.000-530.000 abortions are performer per year (with 3040 women dead in 30 years).

There is still strong aborti stigma, but th to feminism and feminist organizations Buenos Aires are now some of interpretin law to be able abort safely CHAPTER 02 â&#x20AC;˘ CONFERENCE 08

How is abortion care governed? There are three key factors: ‡ ‡ ‡

Coloniality (which implies christian values being spread); Heteropatriarchy (gender norms and women’s bodies are controlled for reproduction); Obligated motherhood.

Unfortunately there is still a strong abortion stigma towards both aborting people and abortion providers within argentinian society. However, thanks to feminism and feminist organizations in Buenos Aires, there are now some ways of interpreting the law to be able to abort safely and some form of counseling is available for people who choose this option.

RECOMMENDATIONS

s in s, there e ways ng the e to

METHO -DOLOGY

a ion hanks

It’s important when developing policies to consult already existing networks of abortion caregivers to learn from them, also and especially in countries where abortion is illegal. It is important to develop and implement an interdisciplinary outlook (intersecting with mental health, politics, sociocultural structures, etc.)

Shoutyourabortion.com

SHOUT YOUR ABORTION Abortion is normal. Our stories are ours to tell. This is not a debate. “Shout Your Abortion is a movement working to normalize abortion through art, media, and community events all over the country. Following the U.S. Congress’s attempts to defund Planned Parenthood in 2015, the hashtag #ShoutYourAbortion

became a viral conduit for abortion storytelling, receiving extensive media coverage and positioning real human experiences at the center of America’s abortion debate for the very first time. SYA quickly evolved into a grassroots movement, which has inspired countless individuals to share their abortion stories through art, media, and community events all over the country.”

ABORTION IS ESSENTIAL

An Open Letter to the Protesters Outside the Planned Parenthood by Elizabeth Acevedo An open letter to the protesters outside the planned parenthood near my job who stuck a cross in my face and told me, “abortions are the largest genocide of black people, God won’t forgive you for having one”: I’m not sure how I became the finger to pull the trigger of your mouth. That’s a lie. I know exactly what turned my lunch break into a firing range and why this clay pigeon of a body attracted your aim— Tell me more, how you care about “this largest genocide of black people” when I’ve never seen you and your signs at a Black Lives Matter protest. Tell me, did you mourn Tamir &

Aiyana & Jordan, as hard as you celebrated the shooting of a clinic in Colorado? Do you know how often I’ve walked by your markers, megaphones, and mantras? Your pickets signs and prayers that you cock like pistols as I clench half a millennium of horror between my teeth? You don’t know my god. You and mine ain’t on speaking terms. My god understands the choices black women have needed to make in the face of genocide. My god understands how slave women plucked pearls from between their legs rather than see them strung up by the neck. My god doesn’t condemn us who when faced with taking claim of our bodies do so with our chins unchained to the ground. My god understands how for generations bodies like mine were the choice for someone like you to make. Do you know how many years, women like me lived equally afraid of both hangings and hangers? Yet we’re still here, everyday carrying ourselves.

Moderator

Lucy Kaluvu, Guest Junior Researcher at the UMC Utrecht

3rd Sessio Reproduct & SRHR se

on: tive care

Artwork by Silvia Bocchero

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CHAPTER 03 â&#x20AC;¢ CONFERENCE 09

Health system factors influencing access and utilization of sexual and reproductive health services in conflict settings: Yemen By Haifa’a H. M. Al-Wajeah (she/her), MPh graduate, medical doctor with wide humanitarian experience ‡ The coverage of maternal health services was around 60% ANC (Antenatal Care) and only 45% deliveries are attended by skilled providers. ‡ Maldistributed services: there is around 63-77% of the population who live in rural areas and are not covered by HF (Health Financing). ‡ SRH (Sexual and Reproductive Health) services are limited to less than 50% in different levels of HFs.

Analyse the core three functions (governance, financing and service delivery) of the Yemeni health system which influences access and utilization of reproductive health services. In order to give recommendations to decision-makers in Yemen for health system strengthening.

‡ The conflict brought a shortage in health providers, infrastructure and medical supplies.

RECOMMENDATIONS

‡ Improve oversight and accountability through enforced regulations, laws and standards of health staff, procurement process, quality of services. ‡ Improve intergovernmental and intersectoral collaboration with community empowerment ‡ Ensure the current SRH policies and strategies are implemented. ‡ Health Financing: establish PublicPrivate-Partnership (PPP) to strengthen health financing and increase service provision.

CHAPTER 03 • CONFERENCE 09

‡ Ensure the provided services are with quality standards through timely supervision visits. ‡ Ensure availability of pre-services and in-services training programs for health providers with equitable involvement of all providers in Yemen. ‡ Strengthen the current supply chain system and ensure its implementation to reduce the stock-out of SRH commodities.

Untilted Poem from “War and Love” by Sana Uqba

The sun rose and pushed them one by one Onto the ageing bus Fresh bread, a little butter And some cheese That’s all it took Oh and some tea A whole lot of singing And laughter; that’s a perfect day At the beach

“With the war, finding food became the priority, not talk about rights” Suha Basharen ―

CHAPTER 03 • EXTRAS & TIPS

Nada Jalal Al-Saqaf Pain & Hope

“Pain & Hope” is a typography portrait designed by Nada Jalal Al-Saqaf. Al-Saqaf is a lecturer at the Lebanese University, a trainer at GIPS Institute, and a partner at Trigon Design for printing and designing. “The painting embodies the resilience of women during the war, as we know that the burden of war and its aftermath falls on women”

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CHAPTER 03 â&#x20AC;¢ CONFERENCE 10

Infertility in Zambia in narratives & numbers:

Producing babies, producing knowledge By Sydney Howe (she/her),MA in Cultural and Social Anthropology graduate with extensive experience in SRHR intercultural communication Zambia experiences both high fertility and high infertility rates which negatively impact quality of life for infertile men and women of the country. In Zambia in order to have children it is necessary to be considered a full adult: as a sign of respect, people are called by the name of their children

This research is extensively narrated in the article titled â&#x20AC;&#x153;The social and cultural meanings of infertility for men and women in Zambia: legacy, family and divine interventionâ&#x20AC;? that was just published in Facts, Views, and Vision in OB-GYN.

(Mother of Child X) instead of their names; this cultural aspect is exemplary of why infertility can have such a negative impact on the environment around Zambian people.

OBJECTIVEMETHODOLOGY

Surveys produce data that are scalable, transferable, and comparable in a way that qualitative research simply does not. Surveys will continue to be useful for health policy decision-making. However, surveys often do not work as intended in cultural contexts that are different from the context in which they are developed. The study presented here attempts to both bridge that gap and add qualitative understandings of infertility back into the data. This ethnographic survey methodology could impact policy by making surveys both more useful and adding nuance back into the discussion.

FINDINGS

Ethnography of surveys. The questionnaire and social practices of survey-taking impact people’s responses to the survey, and therefore, the survey data.

In other cases, surveys helped people talk about their feelings rather than their experiences thus clarifying that participants in abusive relationships often did not see the abusive behavior as a problem and, consequently, did not report it in the survey when asked about a “negative experience”.

CHAPTER 03 • CONFERENCE 10

‡

‡ ‡

When combining surveys and interviews new data can be created, in order to produce knowledge that is useful to adapt the surveys to the cultural context they are targeted to and to understand how participants answer the questions. Having a scale for emotional responses allows people to answer the surveys in a more nuanced way. Although the research was conducted with a relatively small number of people, maybe this approach can be adapted to bigger populations too.

CONCLUSIONS & RECOMMENDATIONS

In the example below it’is clear that the question Q7 about jealousy is not formulated well, because it does not take into account that in Zambian society jealousy is a very negatively nuanced sentiment to have due to the prevalence of Christian values among the population. Because jealousy is considered an unChristian emotion and infertile women in particular are often perceived to have caused their own infertility through immoral behavior, answering positively to this question may not have been just “socially-acceptable” but an attempt to stay right with God.

c use po maki survey wor in cult that from in w

Surveys will continue to be eful for health olicy decisioning. However, ys often do not rk as intended tural contexts t are different m the context which they are developed. 81

CHAPTER 04 • CONFERENCE 01

Francesca Distefano - I can’t

Dani Marie Bordignon - Infertility

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Ideas and encounters:

Perceptions and experiences of young Dutch women with a Turkish or Moroccan background regarding contraception

By Masha Zee (she/her), Medical Anthropology and Sociology graduate, Junior Researcher at VU Medical Center Women with a Turkish or Moroccan background are using less contraception than most Dutch women. Perceptions: not much research on second and third generations. Unique perspectives when dealing with different cultures.

Taking into account the lack of research on second and third generations, the study aims to investigate how to improve clinical encounters for young Dutch women with a Turkish or Moroccan background by analysing what perceptions and ideas women take with them to such clinical encounters.

‡ ‡ ‡ ‡

Interviews; participants recruited through friends and family and social media platforms. 14 women were interviewed; Second or third generation ; Age group: 20 - 32 years old; Clinical encounters with GP’s.

FINDINGS

METHO -DOLOGY

‡

The perceptions of the interviewed women on contraception were: ‡

‡

Not natural: there is a different perception between hormonal and non-hormonal contraception, as hormonal contraception is viewed as less natural. The goal seems to be a natural, balanced body, where a regular menstruation is natural and a sign of good health. Bad for you: eight women of the interviewed women quit their hormonal contraception due to side effects. From experiences and stories heard from other women, we can perceive a general fear of infertility as a side effect. The pill: there is a significant lack of knowledge about other kinds of contraceptives that are not the pill or are not even hormonal. The pill is common but many women don’t know anything else. N.B. When searching for information, a form of “embodied knowledge” seems to be just as important as formal knowledge. Women trust their bodies first, they actively search for experiences of other women (especially on the internet) and they prefer healthcare professionals to be women.

CHAPTER 03 • CONFERENCE 11

During clinical encounters, women experience: ‡

‡

Lack of information: in particular, women experience a lack of information about side effects, different contraceptive options and sexuality (and virginity) in general. “I would have liked it if the doctor talked to me about my wedding night, since I don’t really want to discuss it with someone else.” Lack of questions: women experience a lack of questions about experiences, perceptions, preferences and worries. It seems that healthcare professionals are not really invested in knowing more about the life of patients. “When I look back, I think the doctor could have asked: ‘How do you feel about contraception? Do you have any ideas about it?”

RECOMMENDATIONS

‡ During medical practice it is important to improve questions about wishes, preferences, perceptions or worries, and information about different contraceptives, side effects and sexuality. ‡ There is more research to be done especially referring to: ‡ What are the experiences of Dutch women from other cultures? ‡ What is actually happening in the clinical encounter about contraception? ‡ How do we deal with this dominant pill culture? ‡ How can we change what is happening in the doctor’s office? There is the need to educate students and doctors to focus on asking more questions, actively listening, and to look into the overall (cultural) perceptions of their patients.

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CHAPTER 03 â&#x20AC;¢ CONFERENCE 12

A literature review

Contraception & safe abortion trends 2015-2020 By Chandreyi Guharay (she/ her), safe abortion advocate and researcher, passionate about inclusion in international development spaces Literature review conducted for Share-Net with a focus on contraception and abortion trends on a global scale as well as regionally (Latin America and the Carribean, South Asia and Sub-saharan Africa), on the international policy and on funding landscape (especially

Unsafe abortions and the prevention of unwanted pregnancies are major public health concerns in various parts of the world (especially Sub-saharan Africa). Moreover, it is estimated that unsafe abortion is one of the leading causes of maternal mortality (costituting between 8 and 11% of maternal mortality).

how the Mexico City Policy, the â&#x20AC;&#x153;Global Gag Ruleâ&#x20AC;?, impacts vulnerable populations such as adolescents, LGBTQI+ people and sex workers), and promising practices and recommendations.

‡ ‡ ‡ ‡

Facts and Figures: ‡ ‡

‡

218 million women in developing regions have an unmet need for modern contraception. Adolescent women (15-19 yo) account for 6% (14 million) of all women in reproductive age with an unmet need for modern methods. An estimated 56 million abortions take place each year: approximately 31 million are safe, 17 million less safe, and 8 million least safe. Almost all less safe and least safe abortions (97%) take place in developing regions.

What is the Global Gag Rule? The global gag rule prohibits foreign NGOs who receive American global health assistance from providing legal abortion services or referrals, while also barring advocacy for abortion law reform—even if it’s done with the NGO’s own, non-U.S. funds. The policy allows access to abortion only in cases of rape, incest, or when a woman’s life is at risk. President Ronald Reagan first enacted the global gag rule—also known as the Mexico City Policy—in 1984.

Policy and funding landscape: On one hand, there is a revived interest (especially in EU countries and Canada, who have taken a leading role) in working towards safer and more accessible abortions with: ‡ Pledges and commitments to FP2020, Global Financing Facility and SheDecides ‡ The EU donor community has been a champion for inclusion and monitoring of SRH/FP in the SDGs, especially within the framework of UHC. On the other hand, there is a challenging and complex landscape due to: ‡ Anti-SRHR growing sentiment (far-right and conservative leaders, groups and governments growing in popularity) ‡ Reinstatement of the Mexico City Policy

CHAPTER 03 • CONFERENCE 12

However, there are also promising practices for increasing contraception use and uptake such as political and economic commitments from country governments, communitybased provision of contraceptive services. Similarly promising are the practices aimed at increasing access to safe abortion, such as an increasing access to telemedicine abortion, the implementation of Safe Abortion Hotlines (to give guidance and support for women, especially in countries where access is very restricted), developing and strengthening safe abortion advocacy groups and networks (feminists, feminist groups, advocates, politicians).

FINDINGS

METHO -DOLOGY FINDING

‡

Research and knowledge ‡ ‡ ‡ ‡ ‡

Understanding women’s reasons for non-use of contraceptive methods (context informed) improve and expand research: adolescents (particularly young adolescents, age 10-14) Data collection on abortion estimates and rates Monitor, document and publish impacts of GGR Research new developments in contraceptive technologies

03 Practice: ‡

‡ ‡

Policy: ‡

‡ ‡

‡

Addressing funding gaps among different actors (collaborations between national governments, NGOs, donors and the individuals receiving care) Political support with the aim of ending the GGR through the Global Health Act Donor governments have to include SRHR as part of international aid policy and funding (“there is no UHC without SRHR”)

Tackling the stigma around contraception and abortion at a societal level but also among health providers Findings avenues to advocate in partnership with other initiatives Prioritize programmes, initiatives and services that benefit underserved and vulnerable populations. Within Share-Net strategies and work from the different CoPs, including strategies to ensure that the most vulnerable groups can access these services.

Future directions and recommendations 91

CHAPTER 04 â&#x20AC;¢ CONFERENCE 01

Dani Marie Bordignon, Condom

Dani Marie Bordignon, Dentaldam

Moderator

Rineke van Dam, Senior SRHR Policy Advisor at Ministry of Foreign Affairs

4th Sessio Sexuality, Sexual Ple

easure

Artwork by Silvia Bocchero

on:

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CHAPTER 04 â&#x20AC;¢ CONFERENCE 13

Complicating Comprehensive:

A critical feminist discourse analysis of Dutch sexuality education By Alexandria Albertson (she/her & they/them), MSc, Sociology: Gender, Sexuality, and Society, University of Amsterdam The research analyses Long Live Love, an evidence-based sexuality education program in the Netherlands intended for implementation in secondary schools for youth aged 13-14 years, with the aim to uncover how distinct discourses and scripts of sex, pleasure, and identity are

The Netherlands is a public health success when it comes to youth sexuality. Required comprehensive sexuality education combined with a progressive sexual culture have contributed to Dutch youth being among the top users of birth control.

constructed by comprehensive sexuality education (CSE) and illuminating how theoretical qualitative analysis can lead to concrete policy recommendations.

“I Went to the cinema with a boy. In the dark he put his hand on my leg. I didn’t like that but didn’t want to make a big deal of it. Everyone was quiet, of course, so I couldn’t say loudly ‘I don’t want this’. Later I thought: I could have pushed his hand away, no one would have noticed.”

LINDA AGE 14 “I once persuaded a girl to have sex with me. Afterwards I thought: I didn’t really worry about whether she wanted to. Now I try to do that by simply asking. If you both want to, it’s much better.”

DAVID AGE 17 LONG LIVE LOVE STUDENT MAGAZINE, P. 21

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01 EXTRA

TESTIMONIES_ TEENAGERS TALK

Throughout the student magazine, there are examples of youth navigating “drawing the line.” These examples illustrate the challenges and triumphs of communicating boundaries. However, the research found that there are several examples that perpetuate gendered discourses of victim blame and perpetrator sympathy in a breach of vaguely undefined consent. In example one, it is Linda’s responsibility to “draw the line” rather than the responsibility of the boy she was with to consider consent, while David gets to figure out consent as he goes along. Further, by not calling this breech of consent wrong, it perpetuates the notion that consent is not essential to sex, rather it “makes it better”.

Overall the program is sex-positive sexual plea key point. H there is no mention of consent. Freely Given Reversible Informed Enthusiastic Specific Unintoxicated/sober

What is Consent? CHAPTER 04 â&#x20AC;˘ CONFERENCE 13

Overall the program is a sex-positive one: sexual pleasure is a key point. However there is no explicit mention of consent. Some of the points made hinting towards consent are, for example, “If you don’t like something, say it.” or “Only have sex if you really want to. Don’t do it when you don’t feel like it!”or “Draw the line”. Nonetheless, there is no definition of consent given in Long Live Love. N.B. We cannot discuss pleasure with youth without also defining and discussing consent because explicitly defined consent is integral to pleasure.

RECOMMENDATIONS

a very e one: asure is a However explicit f

FINDINGS

This research made clear that the statistical sexual successes of a program is not an equitable measuring tool for understanding the implications of discourses of sexual acceptability and values as they intersect with sexual behavior and identity. ‡ Long Live Love is a sex positive program which constructs youth as active agents of sexual decision making; ‡ The lack of information on certain identities (trans and nonbinary youth) and definitions (sex, gender, and consent) must be cleared up, defined, explicited and discussed; ‡ Programs must be evaluated comprehensively both for clear outcomes (quantitative) as well as their scripting/framing of identity and behavior (qualitative).

101

Federico Candiani - Mirror

Sex Ed: A Guide for Adults Book tip

By Ruby Rare

TV Series tip

Sex Education On Netflix CHAPTER 04 â&#x20AC;¢ CONFERENCE 13

abstractart_isy

“Shaming is one of the deepest tools of imperialist, white supremacist, capitalist patriarchy because shame produces trauma and trauma often produces paralysis.” bell hooks

“They say the way to a man’s heart is through his stomach. There is no proverb about the way to a woman’s heart. The way into her is more important.” Jenesis Fonseca, The Way to a Woman’s Heart” (CUPSI)

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A LITERATURE REVIEW

LGBTI HEALTH

By Jennifer Sawyer (she/her & they/ them), Gender Equality and Social Justice advocate, wide experience in international development This is a literature review conducted for Share-Net with a focus on LGBTI health, particularly on the questions: what is â&#x20AC;&#x2DC;LGBTI healthâ&#x20AC;&#x2122;? What are the dimensions of LGBTI health? There is growing evidence to support the idea that LGBTI people face unique health risks and a global health burden, ranging from poor overall health status to heightened incidence of specific health conditions. At the same time it is important to remember that this is a highly heterogenous group of varying sexual and gender identities with diverse health needs.

105

FINDINGS

The research is biased towards men and, to some extent, transgender women, and towards sexual and mental health. Furthermore, research is geographically focused predominantly in the global north, although research in other contexts appears to support the findings. There are multiple areas of health where LGBTI people face specific risks, they include general health, sexual health, reproductive health, mental health with the related discrimination and violence and, lastly, substance use.

RECOMMENDATIONS

Social determinants, such as the violence, stigma, and discrimination that LGBTI people face, may impact their overall health, and may result in unhealthy behaviours and treatment avoidance, however, the causalities and potential intersectionalities are poorly researched. For example, the higher rates of substance

‡ There is a need for disaggregated data from around the world; ‡ Specific research into specific LGBTI groups, especially transgender men and intersex, their experiences and their sexual health and pleasure, is needed to fill significant evidence gaps; ‡ LGBTI health is a social justice issue which requires changes in health policy and practice in order to improve LGBTI health and access to treatment and care; ‡ More research is needed on LGBTI health beyond the global north; ‡ Engage the LGBTI community to represent their own health concerns.

CHAPTER 04 • CONFERENCE 14

use by LGBT individuals, which start in youth and continue through their lifetime, are often linked to minority stress (the idea that the distinct stress factors experienced by sexual and gender minorities have negative impacts on their mental health and wellbeing). Some of the health disparities reflect behavioural choices and increased risk tasking, which could be influenced by minority stress. Further research is needed to understand and substantiate this. Furthermore, it should be recognized that lifelong discrimination may place a “stress burden” on the mental and physical health of those affected and influence health seeking behaviour.

Ge repr mental he related dis su

LGBTIQ+ Health

There are multiple areas of health where LGBTI people face specific risks

eneral, sexual, roductive and ealth (with the scrimination), ubstance use. 107

t a h t s y a d e â&#x20AC;&#x153;Th h t e r a l u f i t u a be d i a r f a t s o m m a v l e s r u o e b â&#x20AC;&#x153; o t t , y l e s o l c n e t s i l : e c n e t n e s that n u m e h t e k ma

- Alok Vaid-Me

t s o m l e e f I I t a h t s y a d he s u l l e t y e h T . d u o y f i t u b ” ves, o t e r o m s ’ e r e th u o y l i t n u . . : “. ” . e l b a t r o f m nco

enon, Beyond the Gender Binary 109

Transcendental Love - Nuées

“I am proud of you for being queer, I am proud of you for staying present to the meaning of your beliefs and to the consequences of your actions even when they were crashing into each other everyday. I am proud of you for letting the tide of your revolutionary heritage grind your fear of failure and lack to sand. I love you… ― Octavia Brood, Evidence

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Noemi Parente

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Women & Sexual Pleasure:

The experience of sex, intimacy, and pleasure of adult women living with physical disabilities in the Netherlands. By Joy Dekker (she/her), International youth program trainer, MCs medical anthropology and sociology graduate, aspiring sexologist.

The research looks at the experience of sex, sexual pleasure and intimacy of women living with a physical disability. Their voices express the struggles, the needs and

Seventeen Dutch adult women selfidentified as living with a disability were interviewed, the majority of whom are wheelchair users. The research theoretical framework followed the three bodies approach of anthropology.

the joys of experiencing sex and of re-discovering their bodies as locuses of pleasure in an ableist socio-cultural environment.

115

-the 3.bo iesth eory

W T O

T b a

CHAPTER 04 â&#x20AC;¢ CONFERENCE 01

e od h y

WHAT IS THE THREE BODIES APPROACH OF ANTHROPOLOGY? The three bodies include the individual body (embodied self), the social body, and the political body.

The individual body is how the psyche or soul relates to the physical body, how the lived self is experienced.

The social body is how an individual reflects the ideologies of the culture.

The third body, the political body, deals with integrating cultural ideologies and the health system to achieve overall community health.

117

int erv iew

t v w

The Political Body Looking into the structural limitations of living with a disability in the Netherlands.

Knowledge and education in healthcare: Emma (interviewee) brought up the point of the failings of sexual education for differently bodied individuals. “I am spastic, so my body really does work differently than a healthy one. Everything I saw or read was about normal functioning bodies. But that is not what I have! The sex education I got was quite useless, I know how everything works practically, but I know very little about my own body.”

Perpetuating the idea of disabled people as a-sexual, not having the capacity (mental or physical) to engage in sexual activities (idea that imbues the medical system as well).

Lack of privacy in rehabilitation center and assisted living. Emma lives in assisted living and eplained how she explored her sexuality through solo-sex with the use of sex toys while also having limited mobility in her limbs. “To me sexuality remains something personal, and I don’t like the idea that they [personal carers] know when I masturbate.”

02 d.

The Social Body A-sexuality and infantilization is an issue that comes up both from a structural point of view but also from a social point of view, from potential partners as well as family members.

03 Embodied Self Looking into contextualised experience of intimacy and sexual pleasure (taking into account the COVID-19 pandemic). Reconnecting with the body through pleasure. Britt (interviewee), describing the first time she experienced an orgasm in her late 20s. While for many disabled women their body can be a source of pain and discomfort, sexual activity holds the power to allow them to experience their bodies in new, different and pleasurefilled ways.

“What the fuck is my body capable of? It was a revelation. I was surprised by the power my body holds. It was so strange to have such an intense experience and feel muscles you have never felt before! It changed the relationship with my body – before it was just a piece you dragged along.”

Self-esteem and empowerment “My relationships gave me more self-confidence and a drive to try out more things. [...] We bought a strapless (a two- sided dildo), that is our new favorite! It includes a bullet vibrator, amazing!”

“That [relationship] ended because of my disability. His parents could not imagine having a handicapped daughter in law. They had their own company and thought that it wouldn’t fit with the ‘appearance of the firm’.’’ Veroni (interviewee)

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Dani Marie Bordignon, Limit

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Martina Martonskj - Discovering

“

What the fuck is my body capable of? It was a revelation. I was surprised by the power my body holds. CHAPTER 04 • CONFERENCE 15

RECOMMANDATIONS

CONCLUSIONS &

Through the idea of the “three bodies”, it became clear how women are agentic, despite and because of the non-disabled context they live in, and how, during sex, the body becomes a locus of pleasure and empowerment. Sexuality can be an important & enjoyable part of women’s lives and should be more accessible and celebrated. ‡ Inclusive sex education and healtcare practices ‡ Improvement of cohabiting and rehabilitation ‡ De-stigmatization of disability and sexuality

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“Exercising”,Thomas Pringle, watercolor and charcoal on paper

PODCAST TIP Disability After Dark - Andrew Curza

OUR RECOMMENDATIONS

“FORCED INTIMACY - AN ABLEIST NORM”

MIA MUNGUS -2017 “Forced Intimacy” is a term I have been using for years to refer to the common, daily experience of disabled people being expected to share personal parts of ourselves to survive in an ableist world. Forced intimacy is a cornerstone of how ableism functions in an able bodied supremacist world. Disabled people are expected to “strip down” and “show all our cards” metaphorically in order to get the basic access we need in order to survive. We are the ones who must be vulnerable—whether we want to or not—about ourselves, our bodyminds and our abilities. Forced intimacy was one of the many ways I learned that consent does not exist for my disabled asian girl bodymind. People are allowed to ask me intrusive questions about my body, make me “prove” my disability or expect me to share with them every aspect of my accessibility needs. I learned how to simultaneously shrink myself and nonconsensually open myself up as a disabled girl of color every damn day.”

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Federico Candiani, Macedonia

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Cultural Norms, Embodiment and Agency

An anthropological study on sexuality among Dutch women of Turkish descent By Simay Cetin (she/her), MA student in cultural anthropology and development sociology, interested in feminism and sexuality The research tries to answer how Dutch women with Turkish migrant backgrounds negotiate contradictory expectations and frameworks with regards to sexuality, how they form romantic partnerships and establish intimacy, how they understand,

Investigating how subjective interpretations of culture shape Turkish Dutch womenâ&#x20AC;&#x2122;s experiences with sexuality.

relate to and make sense of their own sexuality and what constitutes safe spaces for discussing matters related to intimacy.

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‡ CULTURE: a human-made phenomenon that gets diffused through smaller social units such as friends and family; it can be perceived as an imposition as well as a resource;

‡ AGENCY: an instrument that can manifest itself under different relational and social circumstances in the form of active participation or abstinence, as well as disobedience or acquiescence.

CHAPTER 04 • CONFERENCE 16

FRAMEWORK

‡ SEXUALITY: an embodied experience that is shaped by discursive (linguistic), institutional (such as religion and marriage), normative (cultural and social) practices;

FINDINGS & RECOMMENDATIONS

METHO -DOLOGY

The data was collected on online forums and dating apps. Narrative interviews were also conducted in person or online, inviting participants to draw a colored timeline of their sexual history thinking about the question: “In what ways have your experiences with sexuality (if any) given direction to your life?”

Real-life case studies to increase representation and visibility

Interpretations of Islam and sexuality (different interpetations drastically change perception and actions); Peer education as a health promotion strategy

The role of friends and intimate partners as informal educational networks. How can we mobilise more these social networks so that people can more easily access reliable information on SRHR and how can we also use that to prevent the dissemination of misinformation? Less focus on reproductive functions of sex, more on consent, pleasure and emotional safety.

The body as a site of knowledge production and the importance of discussing and destigmatizing female pleasure. In the classroom setting there is too much focus on reproductive functions and STIs prevention, and too little focus on consent, pleasure and emotional safety. The notion of the “buddy” or “sister” comes back in this setting as a site of knowledge production to share experiences that are more pleasure and experience-based.

Rights based approach and culturally sensitive lens

N.B. A purely rights-based approach on SRHR issues may not always create engagement with ethnic and religious minorities and not because there is a lack of agreement with the premises of such an approach but because it may not be able to present the complexity of their experiences. Simay Cetin stressed that, although some of the findings of her research could resonate with different social groups or could be applied potentially in different local contexts, adopting a more culturally sensitive lens instead of assuming a universalist approach could be more beneficial for promoting visibility of the sexual experiences of ethnical and religious minorities.

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Sexualtastes, Caterina Recaldin

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Photos by Jessica Felicio p. 12-13 Dom Aguiar p. 23 Velizar Ivanov p-30-31 Pelayo Arbués p. 33 Velizar Ivanov p. 34 Mustafa Omar p. 37 Ella Jardim p. 38-39 Hadis Safari p.50-51 Engin Akyurt p. 52 Sammie Vasquez p. 54-55 Paula Bronstein p. 60-61 Engin Akyurt p. 63 Noah Buscher p. 64-65 Melissa Westbrook p. 66 Marcus Neto p. 72 Akash Buaa p. 78-79 Oladimeji Odunsi p. 81 Reproductive Health Supplies Coalition p. 84-85 Priscilla Du Preez p. 88-89 Les Anderson p. 96-97 Mia Harvey p. 100 Brian Kyed p. 104-105 Sharon Mccutcheon p. 107 Stanley Dai p. 108 Jana Sabeth p. 117 Malvestida Magazine p. 122-123 Dainis Graveris p. 128-129 Becca Tapert p. 130 Editing by Fra(m)menti

Original illustrations by Caterina Recaldin, Federico Candiani, Silvia Bocchero, Ilaria Mazzoletti, Dani Marie Bordignon, Matilde Cesareo, Martina Martonskj, Montana Kitching, Noemi Parente, Nuées, Francesca Distefano, @abstractart_isy

Researches and base texts by Maya Lane, Hadir Barbar, Merette Khalil, Maddalena Giacomozzi, Juliana Mee, Carys Stirling, Gopukrishnan Pillai, Zina Jorna, Haifa’a H. M. Al-Wajeah, Sydney Howe, Masha Zee, Chandreyi Guharay, Alexandria Albertson, Jennifer Sawyer, Simay Cetin

Editors Matilde Cesareo, Elena Ascione Art Direction by Silvia Bocchero Graphics and illustrations by Dani Marie Bordignon, Silvia Bocchero, Federico Candiani Contacts frammenti-m.com frammenti.mi@gmail.com @frammenti_m

FRA(M)MENTI & SHARE-NET NETHERLANDS 2020