Mainstreaming gender and sexuality in CARE’s work

Improving lives of women through social change: Mainstreaming gender and sexuality in CARE’s work

Suman Bisht

In country after country, CARE’s experience has shown that investing in women reduces overall poverty. It makes perfect sense when women who represent more than fifty per cent of the world’s population are equipped to make decisions about themselves and their families. Most than often it means engaging with gender based unequal power relations, social norms and ideologies, especially around their sexuality which seeks to undermine their worth and relegates them to a low social position.

The silence around these issues often perpetuates conditions of poverty and social injustice. In order to bring about meaningful change in the lives of individuals, especially women, it is important that strategies to address these factors are systematically integrated into any program. This was the genesis of the Inner Spaces Outer Faces Initiative (ISOFI).

The Journey Begins…
ISOFI, is a novel project, which focuses on gender and sexuality as important factors that influence reproductive health outcomes. CARE’s Sexual and Reproductive Health (SRH) team evolved strategies for integrating gender and sexuality into reproductive health interventions in technical collaboration with International Centre for Research on Women (ICRW) and with financial support from FORD Foundation in India.

ISOFI, Phase I, was developed on one simple principle: “To effectively address gender and sexuality factors in programmes, it is necessary that personal beliefs (inner spaces) of the staff need to be in line with their professional duties (outer faces)”.

In its first phase ISOFI focused on organizational transition through personal change by looking at CARE staff as agents of social change. It proposed organizational change strategy by promoting deep personal learning among CARE staff to bring about a significant shift in how they implement the reproductive health programme. The approach focused on facilitating safe and non-judgmental space for the RACHNA staff to explore culturally sensitive issues relating to gender and sexuality, normally considered taboo for discussion even in professional settings, and then unpack their personal biases. Through regular staff reflective practice; participatory learning approach (PLA); and personal learning narratives the CARE staff was encouraged to become agents of social change and not just implementers of programmes.

ISOFI I resulted is a set of processes and tools that identify, explore, and challenge the social construction of gender and sexuality in the lives of project staff, project participants, in programme interventions and within CARE as an institution. Building on the lessons learned in the first phase, ISOFI moved into its second phase of ISOFI. The initiative has now moved beyond the focus on health services and behaviour change to influence reproductive health outcomes, by meaningfully addressing inequities around gender and sexual behaviour to ensure reproductive rights to women.

ISOFI II: 2007 – 2009 From personal change to programmatic innovation
ISOFI II is an operations research designed to gather evidence of the health impact associated with interventions aimed at improving knowledge, attitudes and behaviour related to gender equity and sexuality. The hypothesis is that by addressing gender & sexuality as an integral part of routine maternal and neonatal health interventions will lead to better maternal and neonatal health.
The platform for operations research is the implementation site of Sure Start, a project implemented by CARE India, in Rae Bareilley and Barabanki districts of Uttar Pradesh. The project is funded by Melinda and Gates Foundation and managed by PATH and aims to reduce new born and maternal morbidity and mortality in the states of UP and Maharashtra. The planned Sure Start interventions are based on technical best practices and evidences that have shown to improve maternal and newborn health at the community level and feasibility of their intervention at scale.

As part of Operations research, the brief of ISOFI II is to conduct baseline survey in the two sites, layer gender and sexuality interventions in experimental site onto ongoing Sure Start programme, and finally conduct an endline survey to assess the success of ISOFI interventions in the experimental site, Barabanki as compared to Rae Bareilley.

The ISOFI experiment in Barabanki In Barabanki, where Sure Start is being implemented, ISOFI II addresses some of the social and discriminatory factors around gender and sexuality that have direct impact on the lives of pregnant and lactating women and indirectly on the lives of newborn. Primary among them being lack of decision making power that affects the health of pregnant women as they are not able to take decisions related to seeking timely health care in time of emergency, deciding on place of birth and determine practices around delivery, and family planning.

Restricted access and control of women over resources like money, information, or food negatively impacts their ability to save money, procure medicines, or nutritious food. For example, it is often believed that it is normal for women to have Reproductive Tract Infections (RTIs) and other related diseases, pains and discomforts during pregnancy.

Restricted mobility of women impacts their utilisation of health services
including immunisation, participation in Anganwadi Centre[1] activities, seeking medical help during emergency. Unequal division of labour that women are burdened with has bearing on lack of adequate rest during and after pregnancy besides affecting the growth and all round development of the girl child.

Violence in all forms, from physical from beating and enforced sex during pregnancy to emotional and psychological violence related to son preference or pressure to give birth to a male child often leads to miscarriages or other complications during pregnancy. Availability of appropriate services is of no use if women are not able to utilise them.

Gender enforced roles of men restrict their involvement in care for women and
children: it is believed that in many instances husbands and fathers are willing
to get involved in care for women and children.

However, the socio-cultural set-up that defines the roles, responsibilities and authority for men and women, restricts the involvement of men in ‘domestic’ and ‘family’ issues; it negatively affects the family and community based care for mothers and children.

Increasing Communication between couples Couples meet were organised to involve men in maternal and neo natal health. Through interactive sessions and games, couples were encouraged to learn about each other and acknowledge the importance of communicating with each other. Men learnt about the changes that a woman’s body and mind go through during the process of child birth and the basic requirements for safe delivery and neo natal health.Therefore, ISOFI interventions included innovative strategies at the community level to build women’s agency, organise women for community level action, and to promote inter-spousal communication around reproductive health issues. The ISOFI team organised many innovative outreach activities to bring about normative changes around son preference, early age at marriage, promoting women’s mobility, participation in local governance as well as community decision making to create a more enabling environment for women to seek their own choices and rights.

These outreach activities included increased communication between couples. Men’s group meeting especially with new fathers and husbands of pregnant women were organised in those villages where routine maternal health services were unavailable. Besides sensitising men on maternal health issues, their role in ensuring adequate nutrition and rest for their wives, importance of consensual sex, as well as their involvement in child care was also stressed.

Through an intensive campaign, the community was sensitised to focus on maternal and the health of the new born. Through magic shows, puppet shows, film screenings and street plays messages on gender discrimination and equity as well as maternal and child health, were given to the community. Issues of domestic violence, preference for male child, and forced sex within marriage as well as sexual exploitation of women were also raised through these shows. This campaign was organized in twenty specific villages over a period of four months.

The frontline health service providers were put through intensive gender and sexuality training to help them identify the social causes of poor maternal health and address these in their regular work. They were also encouraged to reach out to counsel husbands and other family members on maternal health.

The endline survey of ISOFI II begins in April 2009 and will provide concrete evidence that greater self-esteem of women, increase in women’s personal autonomy and decision making, supportive environment at household level positively affect maternal and neo natal health besides reducing gender disparities.

[1] Government run day care centre with health services for pregnant women

Suman Bisht is Manager Gender Equity and Diversity in CARE India. She has done her doctorate at the Department of Sociology, Delhi School of Economics. She has been involved in research and training on gender and health issues. She has co-authored ‘From Thought to Action: Building strategies on violence against women’. She has also compiled a resource document on reproductive and sexual health and rights of women titled Networking for Rights.