Participation, Power & Social Change blog will no longer be updated but you can read all the latest opinions from the IDS community on our website

11/12/2014

This will be the last post to be published on this blog. The Institute of Development Studies now publishes all our members’ and guest bloggers’ posts directly onto our website.

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Voices Loud, Clear and Diverse at the Cutting Edge of Sexuality Research and Activism: Reflections on ILGA2014

10/12/2014

Cheryl OversOvers blog 1 dec 14

The theme of the Annual Global Conference of the International Gay and Lesbian Association conference in Mexico City was ‘decolonising our bodies.’ Five hundred activists, academics and policy makers talked about forms of colonisation and how to identify, resist and defy it. I followed sessions that reflected areas of work of the Sexuality Programme, economic challenges and resiliencies in LGBTI communities and legal aspects of the struggle for LGBTI rights in the global south. I also visited discussions about immigration, digital security and gender identity which are some of the ascendant issues that reflect important shifts in thinking within queer spaces.

The Year of Conchita

I first heard the term SOGI, Sexual Orientation and Gender Identity, from the UN so I was prejudiced against it. I am disillusioned by social movements and community actions being instrumentalised by institutions and it is often heralded by a new acronym. But at this conference I realised that SOGI is well used which suggests it better describes the conversation than ‘Lesbian and Gay’ plus the various letters that have been added as history has unfolded. I was also surprised to rarely hear ‘queer’ but perhaps that’s because it’s done its job of making way for gender identities to be liberated from the binary idea that there are men and women and that transgenders and intersex people must become one or the other.

For many people their first view of contemporary challenges to binary gender identity was Conchita Wurst, winner of Eurovision 2013. Predictably some people across all sexualities were mystified, having understood the categories gay men, lesbian women and trans people as settled. But here the importance of freeing minds and bodies from binary sexuality and gender categories in the overall aim of decolonisation of queer bodies were discussed throughout the conference. As well as arguments about how and why law, medicine and anthropology should shift away from gender binaries and heteronormativity, gender activists also called for the process to begin in LGBTI communities and ILGA itself. Given the historical context in which inclusion of lesbian, trans and bisexual and intersex peOvers blog 2 dec 14ople in ILGA has itself been an evolution, this process is clearly still underway. The outward signs of this shift were the familiar sites of gender contestation – clothing and bathroom designation. Beards and frocks were all over the place at ILGA 2014 and the two bathrooms became three. But the third bathroom was not marked “T” in reference to binary transpersons.

“It’s not the same to be a gay person with means as it is to be a gay person without means.”

Fundamental human rights to life, freedom of assembly and speech, non-discrimination and access to justice are rightly at the top the SOGI agenda. But in view of the number of people at the conference from middle and low income countries I was surprised at the lack of content on economic rights in the Global South.

Micro Rainbow’s research in Brazil is also an interesting exception. It shows that lesbian, gay and transgendered people are more likely to become and/or remain poor due to the stigma, prejudice and discrimination they face on the basis of their sexual orientation and/or gender identity. LGBT people who live in poverty in Rio de Janeiro often deal with verbal, physical and sexual violence, and other abuses motivated by homophobia and transphobia. It argued that the lack of social and legal recognition of LGBT people, coupled with heteronormative, exclusionary policies on poverty provide a context that maintains the invisibility and structural marginalization of LGBT people living in poverty. I hope we see more research like this and that it drives demand for redress.

The World Bank provided an opportunity to engage with development policy and it was very well attended by Global South delegates. The Bank has recognised that to fulfil its mission of poverty reduction, sustainable development and shared prosperity the development process must fully respect the dignity, human rights, economies, and cultures of gender and sexual minorities; that gender inequalities and differences expose LGBTI to various forms of risk and that LGBTI communities play a vital role in sustainable and inclusive development. It convened the meeting at ILGA2014 to discuss ways in which LGBTI groups can be involved in the process of ensuring that Bank financed projects avoid negative impacts on sexual and gender minorities and promote gender and SOGIE equality. A consultation with LGBT organisations will be taking place over the coming months to develop policy including a Gender and SOGI Plan/Planning Framework that will inform the appraisals or impact assessments of Bank funded projects. Bank staff were keen to hear suggestions about how to do that. ‘Be very careful not to do harm” was the loudest suggestion and perhaps after that ‘Don’t necessarily believe what our governments tell you about how they treat us.’ The session was convened by Chad Dobson of The Bank Information Centre which is monitoring and critiquing this process.

A recurring idea about the economic consequences of homophobia and gender was that it pushes people into poverty which forces them to sell sex. Thus sex work was uniformly cast as unsatisfactory, tragic or worse. I was musing during a coffee break about the inadequacy of this discourse with a Canadian woman. Sex workers rights were fresh in her mind because of debates in Canada where sex work has recently been further criminalised (see Pivot Legal Society). She was Helen Kennedy and the next day she was elected as Co Secretary General of ILGA which bides well for more visibility for queer sex workers at the next conference.

Although quite a lot is known about the issues facing LGBTI migrants, refugees and asylum seekers there has been little attention to SOGI issues more generally in disaster relief and humanitarian aid. In the case of outbreaks of illness sexual minorities are often blamOvers blog 3 dec 14ed for causing epidemics or making them worse. Gorma Togbah Kollie from Liberia said this is happening in relation to Ebola for gay, lesbian and transgender communities and people living with HIV in West Africa.

I was unsure if my impression about lack of economic and development content was correct until the European Parliament Co-President Ulrike Lunacek mentioned it as she presented the ‘Go Visible’ award to Galang, an organization of lesbians in the Philippines which Lunacek said stands out because it addresses economic issues. Some years back Susie Jolly wrote an article with the self-explanatory title, “Why is Development Work So Straight?” and other work at the Sexuality Programme of IDS argued that ‘development theory and practice impose reproductive heterosexuality (heteronormativity) both as the only functional form of sex for its policies and as the ruling norm subjective experiences of pleasure, desire, and identity claims.’ It would be useful to ask the converse now -why is LGBTI activism not more focussed on development?

Liberation and the Law

Activists from several countries where homosexuality is illegal spoke about their experience with law reform advocacy and strategic litigation. Stephen Chukwumah from Nigeria was one of several activists that spoke about the strain legal processes place on communities and about the challenge of ensuring that potential benefits are distributed. Others spoke about putting energy into different legal processes. Ian McKnight of J-Flag Jamaica spoke about the impact of intense police liaison and a clear directive by senior police against homophobia in law enforcement. He said that although miracles don’t happen there has been real change. Similar stories came from Fiji. This serves as a reminder that ending police negligence, violence and misbehavior doesn’t have to be complex or long term. A particularly heartening story came from SMUG Uganda. An activist is suing a US evangelical church in a US court for the damage it has caused in his life.

Several delegates spoke about the confounding logic and sheer complexity of law. Some groups have been fortunate to have skilled pro bono lawyers but even then law is a maze. I was pleased to be able to share IDS Sexuality Programme’s contribution to addressing that problem, the Sexuality and Justice Toolkit.

Sonia Correa of Sexuality Policy Watch shared her thoughts about sanctioned sexuality and commented very frankly that while the law reform process must go ahead, anyone who thinks that the law or legal reform will liberate the sexually and gender transgressive is deluded. Sonia Corrêa and Akshay Khanna have recently compiled essays that explore and reflect on the limitations and possibilities of law reform and legal processes.

The technology paradox

Several activists spoke about digital security and the paradox that networked technologies have bought joyful, rich and lifesaving opportunities at the same time as posing serious threats. Governments are increasingly taking a keen interest in the use of this space by dissidents in general and sexual dissidents in particular. Homophobic oppression is thus disguised as fighting terrorism, pornography, trafficking and child sexual exploitation. Another threat is on-line violence which causes both direct harms to targeted individuals and indirect harm by turning people away from activism. However in the context of low income counties lack of access to high speed internet remains the most pressing problem. I was delighted to see Tactical Tech at ILGA 2014. It does great work producing internet tools to help activists overcome some of these problems.

The amazing potential of citizen controlled technology was evident in the films, photography and websites on show at ILGA2014. I managed to see the beautiful photography of Chouf, Tunisia (who also won a Go Visible award); No Easy Walk to Freedom about the Naz Foundation’s challenge to Indian anti sodomy law; three short films about the work of BeLong Ireland with asylum seekers and “The Son I Never Had” about the experience of an intersex person.

Cheryl Overs is a Senior Research Fellow at The Michael Kirby Institute of Human Rights and Public Health at Monash University Melbourne Australia and is a visiting research fellow at IDS.

Previous blog posts by Cheryl Overs:


Looking beyond prosthetics? Including people with disabilities in emergency relief efforts

03/12/2014

Brigitte RohwerderBrigitte_Rohwerder200

The disproportionate impact of emergencies on people with disabilities

In all wars and disasters, it is persons with disabilities that are first to die; persons with disabilities that are the first to get disease and infection; and it is persons with disabilities who are the last to get resources and medicines when they are handed out. They get treated at the bottom of the pile” (Stubbs in WRC 2008: 6).

Given in 2007, this quote still resonates with the humanitarian crises we see today. As the new rapid response briefing on “Including people with disabilities in emergency relief efforts” from IDS shows, emergencies have a disproportionate impact on those already marginalised by society, including people with disabilities and their families. For example, people with disabilities are often left behind in responses to the current Syrian crisis and Ebola epidemic.

Why is this the case? Lack of awareness, negative attitudes and physical barriers

  • Discriminatory attitudes, poverty and structural inequalities, the loss of assistive devices and support networks, and lack of accessible information or emergency evacuation procedures result in people with disabilities being left behind, losing their independence, being vulnerable to abuse, and at disproportionate risk of death or injury.
  • Lack of awareness of their needs, discriminatory attitudes, and physical inaccessibility mean people with disabilities often face challenges in having their basic needs and rights to food, shelter, health, and security met in emergency relief efforts.

One size does not fit all – people with disabilities have diverse needs

Having conducted research on one of the most invisible groups of people in humanitarian emergencies, people with intellectual disabilities, I really appreciate the briefing’s recognition of the diversity of disability. That, for example, a person using a wheelchair or on crutches may be visible in a crowd, but someone with hearing or learning difficulties may go unnoticed. Or that women with disabilities may be treated differently than men with disabilities. Often it seems that if people with disabilities’ needs are considered, it has been to meet short-term needs in relation to physical impairments acquired as a result of the emergency. While providing prosthetics is vitally important, so is creating an inclusive and accessible environment which overcomes all the other barriers which disable people and prevent people with different disabilities accessing education or livelihoods or even emergency food and non-food items.

How can we make emergency relief efforts more inclusive?

Thankfully awareness is increasing and some progress is being made. Article 11 of the UN Convention on the Rights of Persons with Disabilities relates to situations of risk and emergencies. The newest edition of the Sphere Standards has disability as a cross cutting issue. Donors are introducing disability inclusive policies and NGOs have created manuals on inclusive humanitarian action. However, as the rapid response briefing makes clear, much more needs to be done, especially when it comes to implementation. As it recommends:

  • People with disabilities should be involved across the humanitarian cycle, including in long-term reconstruction.
  • It is important to follow a twin-track approach, having both accessible mainstream responses as well as dedicated responses for specific needs.
  • There should be training to develop awareness, skills and competencies on disability inclusion for humanitarian practitioners, policymakers and donors.
  • There needs to be an agreed set of meaningful indicators for identifying needs and capacities of people with different types of disabilities to ensure they are included.

Following these recommendations would help enable more inclusive emergency relief efforts – ones that fully recognise the rights and needs of all people with disabilities.

Brigitte Rohwerder is a Research Officer at IDS working on governance, social development, humanitarian response and conflict issues, and providing support to DFID, DFAT and EC advisors.


Happy World Toilet Day!

19/11/2014

Blog Speech BubbleJamie Myers

Today, on 19 November 2014, we are celebrating the fourteenth World Toilet Day, an international day aiming to draw attention to the dire global sanitation problem, inspire action and celebrate the work taking place across the world.

Currently, 2.5 billion people do not have access to sanitation facilities that hygienically separate human excreta from human contact. Out of those 2.5 billion people, 1 billion people practice open defecation.

This problem has been framed in a number of different ways. Rates of diarrhoea, the second highest cause of death amongst children under five, are often discussed. Improved sanitation has been estimated to reduce cases of diarrhoea by more than 33 per cent. When including hand washing with soap this reduction rate is even larger. The United Nations Environmental Programme has claimed that the uncontrolled disposal of human waste is a major source of global water pollution. The Water and Sanitation Program runs the Economics of Sanitation Initiative which highlights the economic burden; it has shown that the lack of access to sanitation costs the world US$260 billion a year. In 2010, the United Nations General Assembly recognised that clean drinking water and sanitation are a human right. Lack of access to sanitation interferes with a person’s right to life, health, education and dignity. The recent rape cases in India have highlighted the specific negative repercussions and dangers that lack of sanitation carries for women. Lack of privacy for defecation, urination and menstrual hygiene, and the shame of being seen, are major gender discriminations in South Asia and elsewhere. And lack of sanitation impacts on school attendance and thus education, especially for girls. It is now also becoming increasingly evident how lack of adequate sanitation impacts the nutrition and the physical and mental development of young children. This month my colleague Robert Chambers, along with Gregor von Medeazza from UNICEF, highlighted the links between inadequate sanitation and undernutrition. In an IDS Working Paper they show how open-defecation leads to stunting due to environmental enteropathy, other intestinal infections and parasites, all of which have been previously overlooked.

CLTS latrine_Malawi_PB

A better understanding of the multiple problems associated with the access and use of improved sanitation has led to the expansion of the sanitation and hygiene field. We now have sociologists, engineers, epidemiologists, behavioural change experts, doctors, religious leaders and even actor Matt Damon, putting in efforts to trying to solve this depressing issue.

This commitment by so many is excellent news. It brings the efforts of more people and different perspectives. However, we also need to make sure that we work together to try and establish a common language. Bringing together people who are traditionally trained separately is not an easy task and will take some time.

Expanding our awareness of the problem does not answer any of the difficult questions we are facing. It adds to the complexity of the issue and calls for conversations between different and sometimes conflicting points of view. However, it can make the answers easier to find. As more work emerges linking the sanitation crisis to a range of devastating problems affecting certain countries, this once hidden issue is brought up the priority list. The numerous reframing’s force policy makers and those in power to put time and effort into dealing with this tragedy. Additionally, it highlights to us, and by us I mean the WASH (water, sanitation and hygiene) community, the need to synergise our work in order to integrate the many different sectors and actors involved. If we are able to leave behind the professional silos we are all comfortable in and co-create multidisciplinary action orientated work, new possibilities and creative solutions may emerge.

So today on World Toilet Day 2014 I expand the call. Visit our website at www.communityledtotalsanitation.org, follow us on twitter @C_L_T_S and join the discussion.

Jamie Myers is a Research Officer at the Institute of Development Studies working on Community-led Total Sanitation.


Getting under the skin of patriarchy: how change is happening in oppressive gender orders

17/11/2014

Thea ShahrokhThea Shahrokh

The Delhi Global Symposium on Men and Boys for Gender Justice (November 2014) provided a space for an unconventional dialogue between social movement activists, thinkers and policy makers engaged in the Gender, Power and Sexuality programme hosted by IDS. This was a conversation that cut across contexts, genders and identities and provides insights on the changing nature of patriarchy and how different constituencies are challenging oppressive gender orders for gender justice. This article captures key points from this exciting and oversubscribed session which saw participants fill all seats, floor space, aisles and walls to engage in discussion and debate.

Manifestations of patriarchy and evolving forms of oppression

Patriarchy is reproduced and reinforced through complex political, social and economic processes that work to constrain equity and justice for men and women of diverse gender, ethnic, racial, class and ability based identities. Of note Alan Greig argued for the recognition of a deep-rooted interlacing of male supremacy, white supremacy and capitalism. Through this form of intersectional analysis it is argued that patriarchy and supremacy are bound up together in their origins, they work together racialising masculinities and power hierarchies. The situation of ‘angry young men’ was highlighted by Carolina Wennerholm as a manifestation of complex processes such as these; however, the issue is not recognised within development policy. By not engaging, are we enabling the roots of patriarchy to grow deep into the lives of boys and young men manifesting as violent and repressive performances of masculinity?

Darkening international contexts and geopolitical strategies was an important strand of oppression highlighted in this dialogue. Emily Esplen argued how the growth of conservatism and religious fundamentalism is a significant force playing out from local to global levels driving a fierce backlash on women’s sexual and reproductive health rights, and using tradition and culture to promote control and oppression of women within a protectionist framing. akshay khanna argued that sexuality has been cynically appropriated into the centre of geopolitics and the political strategies of the nation state to construct norms of personhood and national identity that valorise heteronormative and specific class, caste and religious identities against a subordinate, and criminalised other.

Marcos Nascimento emphasised the role of national policies in controlling gendered norms and identities through the case of a male gay couple in Brazil being granted maternity leave as the system could not reconstruct the norms of maleness that limit paternity leave to five days (versus six months for maternity). Care work is invisibilised, and misconstrued in the dominant patriarchal economic model also as a result of the value of market growth in macroeconomic policy, not people, and not their economic and social wellbeing. Valentina Utari highlighted how policies that identify unpaid care of women within families and communities are necessary to ensure that development programmes recognise the importance of caring activities in women’s lives – both in terms of how care restricts opportunities, and also the value of care to human and social relationships.

Alexandra Kelbert spoke to the rapidly changing, food insecure contexts perpetuated by the global economic crisis and related shocks driven by capitalist macro-economic policies. Poor and marginalised women are pushed into new forms of work and more work, having to be more creative to gain food on a smaller budget whilst retaining their unpaid care roles. In parallel, a poor man’s patriarchy is evolving, where the pressures of provision within the home cannot be met, in turn masculine norms are challenged and men find themselves in crisis. She asks however is this a possibility for transforming gender relations and building solidarity between men and women for redistribution of gendered roles within the family?

Strategies for getting under the skin of patriarchy

In order to penetrate the skin of patriarchy the duty bearers and the institutions in which the structures of patriarchy are perpetuated and secured need to be transformed. Satish Singh and Phil Otieno highlighted the significance of engaging men in the critical reflection of power in institutional settings. This relates significantly to the resources necessary for gender transformation – can we release resources from the clutches of patriarchy to invest in men’s engagement for gender equality? Alan Greig asked however that where state and societies are satiated with racism and capitalist intent, is the state a legitimate source of justice?  He outlined that we also need to understand alternative modes and mechanisms of justice in our communities. There is potential for transformative justice in communities that are bound by geography and identity, and men can play a critical role in this.

Julia Hamaus highlighted research on gender justice in social movements working to transform the systems of oppression that patriarchy enables.  She asked how to create critical engagement and reflection of repressive gender orders within and across social movements in order to address the hidden hierarchies that exist. Cross-movement dialogues between women’s and wider social justice movements represent an opportunity to challenge patriarchal structures. Involving men in dialogues to reflect on internalised notions of masculinity is a critical approach to interrogate gendered division of labour, leadership, decision-making and other barriers to women’s active participation. Alan Greig takes this line of introspection further, asking us to recognise the socialisation of our oppression or privilege within our own bodies and that our bodies can channel the change we want to see. Where we may have built a discourse of social justice, it is critical to hold our bodies to account in recognising their response and reflecting on the meaning of this in a process of healing and personal transformation.

Transformation in oppressive gender orders

Unlikely dialogues enable us to get under the skin of patriarchy and understand oppressive power as a living entity that adapts aggressively to changing contexts. Patriarchy is finding new ways to subjugate and constrict our humanity. We need strategies for social transformation that get under the skin and disrupt, dismantle and deviate from the privilege and control that patriarchy prescribes.

This is a continuous process that enables new trajectories to grow, through critical engagement and reflexivity. Mobilising men and women for gender justice in institutional settings is not seen as a one-off project, but a process of constructing new norms of gender equality. This goes beyond adopting the right jargon and the introduction of policies for gender equality. It involves finding allies across spaces and levels including those unlikely alliances which will enable greater momentum for changing deeply entrenched structures of inequality. Joint monitoring by rights holders and institutions can ensure that accountability is demonstrated in the upholding of these new norms as they translate into behaviours and practices. The work of social movements was also expressed as an ongoing struggle for political and social change, where strategies evolve and transformative potential is deepened over time. However as new rights claims are made and achieved, and our understanding of patriarchy is enlightened we need to continue to revise our tools of engagement and strategies for change, ensuring they are specific to people, place, and the contextual drivers of poverty, inequality, and gender injustice. Carolina Wennerholm emphasised the important role that donor governments can play in resourcing this work, enabling strategies for change that work across structures and systems. However Jerker Edstrom – moderator of this discussion – concluded by arguing the very real way in that patriarchy is embedded in the aid business and how a fundamental shift is needed in the positivistic tyranny of donor systems and related reductive, target-driven approaches that we all engage in.

Success as outlined by a number of the panellists will mean building alliances across civil society movements, nationally, regionally and globally, building solidarity by identifying common ground in terms of social justice that responds to gender inequalities in an increasingly violent, conservative, fundamentalist and market oriented global context. It is important to draw the connection between various forms and systems of oppression and realise that they all follow the rules of patriarchy. Getting under the skin of patriarchy means to engage in a deep reflection through continuous and persistent dialogue, redefining concepts of gender identities and social justice.

Thea Shahrokh is a Research Officer at IDS.


Why we need to improve the lives of Ebola survivors as part of prevention

12/11/2014

Pauline OosterhoffPauline profile

The world is paying plenty of attention these days to Ebola infections and deaths. It is paying much less attention to helping Ebola survivors recover and reintegrate. This is a mistake, not just because survivors need help (they do), but because helping survivors is one of the most important tools for preventing the further spread of the disease. As West African Ebola survivors return from medical facilities into society, they report to their friends and families on what they have experienced there, on the quality of treatment and terminal care for the dying. Their testimonies affect the willingness of others to seek care in these facilities. If people in the broader community hear stories of inadequate treatment and neglect from survivors, or if survivors are ostracised on their return, then the community will resist public-health efforts, hide infected family members and refuse to cooperate with medical institutions. This helps the virus spread.

In other words, decent treatment of Ebola victims when they are in medical facilities, and helping survivors to reintegrate and regain their livelihoods afterwards, are critical to slowing the epidemic. But in the traumatised, fearful communities struck by the disease, Ebola survivors are often stigmatised and destitute when they return. Many are plagued by survivors’ guilt and depression. Their social support networks may be damaged by the deaths of caregivers, relatives and friends. Neighbours, or even their own children, are scared of them. Their houses, utensils and even their food reserves have sometimes been burned in efforts to destroy the virus. The interrelated effects of stigma, fear and poverty are highlighted in Alain Epelboin’s film “Ebola is Not a Laughing Matter”, about his experiences working with Red Cross workers from Congo.

How can organisations help Ebola survivors reintegrate?

A number of ideas are being mooted. One international organisation has tabled the idea of giving survivors jobs burying the dead. Given the stigma they already suffer from, this idea clearly has some risks. Another idea is to get survivors to play the crucial role of donating their convalescent blood and plasma products, which may have antibodies that can help others survive. But in areas long rife with rumours of organ trading, this raises issues as well.

Anthropologists, with their expertise in how cultures, institutions and physical phenomena interact, can help answer these types of questions. But surprisingly few anthropologists have worked recently in the West African countries most affected by Ebola. Some of the most detailed ethnographic literature on daily life in these countries dates back to the colonial era; more recently, participatory observations and fieldwork have been hindered by decades of instability and conflict. But health professionals need anthropologists’ expertise on highly specific aspects of daily life, such as burial practices and managing bodily fluids, in order to provide clear and practical advice on the outbreak and build locally appropriate interventions.

The concept of giving survivors a livelihood by employing them for burial ceremonies was recently raised at the UK-based Ebola Response Anthropology Platform (ERAP). Survivors’ immune systems are more likely to be resistant to contracting Ebola from otherwise highly contagious corpses, improving prevention. Besides income, the job would give survivors an important new role in their old communities. This idea is apparently particularly popular among some of the religious organisations working on the ground in West Africa. Employing stigmatised survivors to bury Ebola casualties sounds like a great idea. But as any anthropologist student can tell you, ideas that make perfect sense from one perspective can make less sense from a different one.

Exploring ideas from all perspectives 

When I invited members of ERAP to contribute their views, it became clear that this potentially innovative idea still needed quite a bit more thought. Medical burial teams have already antagonised many communities through culturally unacceptable burial methods: cremation, improper handling of the dead, concealing the dead person’s face, and so on. James Fairhead, of the University of Sussex, pointed out that given these tensions, the proposal would be “giving an already ostracised group (i.e. Ebola survivors) the role of burying others in what is often a highly disapproved-of way. The question arises: is this likely to (a) add to the stigma of that group, and (b) add to the negative image of the ETCs (Emergency Treatment Centres)… One needs to avoid as much as possible negative attitudes to ETCs (or the more decentralised units) as it is going to become so important that people come to them voluntarily to seek health.” Organisations can engage with communities to overcome these contradictions, but that may or may not work. Community engagement on the employment of survivors in burial ceremonies has to take these perceptions into account, and not be dismissed as “stigma”.

Paul Richards and many other anthropologists have pointed out that “community myths” or “misperceptions” are often grounded in reality, or in incomplete information. That semen is still infective up to 90 days after recovery makes Ebola also a sexually transmitted disease. Campaigns have not focused on the sexuality of Ebola survivors or on breastfeeding mothers. Breast milk also has to be avoided up to 90 days after recovery. The Ebola Survivor who was said to have ‘Infected his Wife to Death’ is likely to have done this through sexual contact. People unaware of these transmission vectors who then witness wives or children of survivors contract Ebola and die may come to fear all interactions with survivors. Avoiding people who have contracted a disease can be perfectly rational behaviour if you lack accurate information on how the disease is communicated. It is important to avoid exoticising or pathologising such behaviour, and to instead obtain a factual comprehension of the behaviours or situations that result in survivors being stigmatised. In some cases, social avoidance of survivors may have nothing to do with Ebola, but with the fact that survivors are destitute, needy and miserable, and people want to avoid feeling guilty. This is quite similar to the widespread social rejection experienced until recently by child soldiers or cancer and HIV patients.

Employing survivors to bury the dead with dignity has powerful emotive and spiritual resonances; it is easy to see why the idea appeals to religious organisations. But as Fairhead points out, one can “appreciate religious institutions as compassionate towards the ostracised,” while also recognising that some of the practices they find appealing may be divisive. Before deploying suggestions for reintegrating Ebola survivors in West Africa, it is important to have a sense of how these initiatives will actually be received in the local cultural context, in the midst of a raging epidemic. And getting the recovery and reintegration of survivors right, and making them allies in prevention efforts, is crucial to the effort to stop the spread of the disease.

Pauline Oosterhoff is a research fellow at the Institute of Development Studies and a member of the Ebola Response Anthropology Platform

The Ebola Response Anthropology Platform is a joint effort of the London School of Hygiene & Tropical Medicine, the Institute of Development Studies, the University of Exeter and the University of Sussex

Previous blog posts by Pauline Oosterhoff:


Empowerment, Citizenship and Redemption? Economic programmes and policies for female sex workers

28/10/2014

Cheryl Overs

All sides in the complex and frequently fiery debates about female adult sex work acknowledge links between sex work and economic disadvantage, injustice and inequality. My recent work has explored economic programming and policies that affect female adult sex workers in Ethiopia. As in other low income countries a significant percentage of Ethiopian women live in chronic, acute poverty and the links between poverty and sex work are at their least ambiguous – it causes more women to sell sex than there is demand for sexual services which means that the sex industry is a ‘buyers’ market’ from which most women can only find subsistence livelihoods. In very low income countries sex work does not offer women a ladder out of poverty as it can in wealthy and middle income countries. In this context it is crucial to work out what ‘economic empowerment’ of sex workers means, identify the policies and programmes that can achieve it and get them in to place at scale. We also need to know which ones are a waste of time or money.

Basket weave your way out of prostitution

The first time I heard about rehabilitation programmes for sex workers was at an AIDS conference in 1988. I whispered to my friend, ‘What? Basket weave your way out of prostitution?’ He whispered back ‘if it’s that easy, why not get everybody to weave baskets?’. Six years later when I was researching Making Sex Work Safe: a guide for field workers, programme managers and policy makers’ I noticed accounts of sex worker rehabilitation in developing countries coming in alongside the first data from targeted HIV interventions. I included pieces in the book about a programme aiming to help sex workers earn income from other sources in Kenya and about social workers in the Philippines who were disappointed and puzzled because women who had said they desperately wanted another job had abandoned the programmes they’d set up for them.

Since then thousands of HIV projects for sex workers have developed and many sex worker groups have formed, some of which have established and sustained strong economic empowerment projects. In most places, rich and poor, HIV programmes for sex workers include some training or support to help women out of sex work. I have visited several and slowly formed the impression that they are frequently a side event to the public health work operated by an unregistered community based organisation while the funded HIV work is done by a ‘parent’ NGO. I was often told by NGO staff that their rehabilitation or ‘exiting’ programme was a kind of window dressing to help reduce opposition to programmes that might be seen as encouraging immorality because they advise about safe sex and distribute condoms. At the same time some more dynamic initiatives seemed to be emerging from NGOs that had been formed to respond to HIV economic empowerment programmes like that of the Usha Co-operative in Kolkata and VAMP Maharashtra India. Most recently anti-trafficking initiatives have spawned hundreds of projects that aim to rehabilitate exploited or trafficked women. Often called ‘aftercare’, these have burgeoned with the increases in anti-trafficking funds and they are operated by a variety of religious, military, feminist and development organisations such as the International Justice Mission, and Restore International.

Policy on the rehabilitation of sex workers has also developed although not always smoothly. In 2007 UNAIDS recommended rehabilitation as one of three strategies for preventing HIV among sex workers (the others were preventing women and girls becoming sex workers and ensuring that those that were not rehabilitated could access condoms and HIV tests) but replaced this in 2009 after criticism about its reliance on the possibility of relocating significant numbers of women into other occupations or reducing the total number of commercial sexual transactions. Several governments have introduced policy to support women to leave sex work, most notably in India where a Supreme Court decision obligated States to offer rehabilitation services to sex workers.

They tried to make me go to rehab but I said no, no, no

Sex workers activists have been consistently critical of rehabilitation and developed a catalogue of serious human rights abuses associated with it across the world. Several anti-rehabilitation campaigns have called for rehabilitation to be abandoned in favour of rights based approaches to increasing economic options. Because sex work is posited as a valid occupation activists reject both the ideology of ‘rescuing’ women from prostitution and the human rights violations associated with coercive or moralistic programmes. They argue that money would be better spent on increasing sex workers access to justice, education, safe workplaces, finance, housing, health care and other building blocks of fulfilled lives. The sewing machine has been used to symbolise rehabilitation and it has been accompanied with slogans opposing ‘raid and rescue’ such as ‘Save us from Saviours’; ‘Not Your Rescue Project’ and ‘With Rights I can Rescue Myself’. I think everyone’s favourite was created by Cambodian sex workers – ‘Don’t talk to me about sewing machines, talk to me about workers rights’. It encapsulates that position perfectly.

sewing machine logo for Cheryl's blog oct 14

Logo of the Asia Pacific Network of Sex Workers

But although the damage associated with ‘bad rehab’* has been well documented, it can’t be ignored that many sex workers want a livelihood that enables them to absorb economic shocks, access resources and services or to retire or escape from violence, criminality and abuse associated with sex work, which frequently also affects their children. Logically, the poorer the country, and therefore the less profitable the sex industry, the more women will want development agencies to work on giving them this option. This raises the question, what is ‘good rehab’ in a low income country?

I began to answer that question in 1994 in Making Sex Work Safe by distinguishing between moralistic services that aimed to ‘save’ women by setting them up to earn an alternative income and those that aimed to help sex workers by:

  • reducing the discrimination which bars access to economic opportunities
  • developing supplementary income
  •  career development within the sex industry.

I argued that the former were disempowering and the latter empowering – which were fresh and fashionable words in 1994! Since 2011 I have been revisiting this issue, reviewing the relevant literature and conducting field work over several trips to Ethiopia.

The written word

When I looked at the literature to catch up on progress in economic programmes for sex workers I was disappointed to find that few are documented and that there is still no overall map of them and that research and guidance is scarce. I was alarmed that the picture I had painted two decades earlier of two essential approaches seemed to be intact but not much further articulated or evaluated. It appears that most programmes aim for women to abstain from commercial sex completely and a few aim to expand sex workers economic options and power in the way I had previously outlined. The latter seem to be more ethically sound and popular with sex workers and there are signs that they benefit more women than abstinence based programmes which, even where they haven’t violated human rights, don’t appear to deliver the sustainable, new livelihood streams they promise. But I am deliberately using vague words like ‘appears’ and ‘seems’ because there is not enough information to make a call here.

Almost no data is available from any of the HIV projects about outcomes – how many women they caused to leave sex work or what impact that has had on HIV, and which industries and types of programmes (microcredit, training etc) are best. The focus on a narrow scope of alternative occupations is striking. In a margin I scribbled, ‘isn’t it unlikely that there is sufficient market demand for hairdressers to justify training whole groups of sex workers in hairdressing?’ There is even less information about the outcomes of ‘aftercare’ and religious programmes for trafficked persons and/or sex workers and/or victims of exploitation. Much is written about the potential for women to find new livelihoods after various short trainings and small loans but most are anecdotal ‘success stories’, typically about the redemptive transformation of a sex worker into hairdresser, or internal evaluations written by the operators of programmes. We don’t know if sex workers leave the sex industry at all and, if they do, whether they are replaced. We don’t know which sex workers benefit from which kind of program or who qualifies for micro-credit. Nor do we know what impact rehabilitation programmes have on the sex workers who don’t participate – which is important because most programmes can only offer places to a tiny percentage of the total number of candidates.

Methodologies, and the questions of scale and coverage that are usually central to development and public health programming remain unaddressed. No-one has identified how many sex workers would need to earn how much alternative or supplementary income to reduce the overall number of women selling sex or to drive shifts in the number and pattern of commercial sexual transactions/networks sufficient to impact on an HIV epidemic, the incidence of gender based violence, or any other outcome.

This lack of information needed to make the call about what constitutes good or bad ‘rehab’ is alarming because a large amount of money is spent on economic programmes for sex workers, much of which comes from large agencies that would normally require solid evidence before they support specific approaches. Rigorous research here is sorely needed. Why it hasn’t happened already is a mystery.

What is sure is that every day, with all I do, I always have less than I need

Over four years I conducted interviews with adult female sex workers, NGO workers and policy makers in three Ethiopian cities. The work explored the impact of the laws against sex work (minimal because they are not enforced); the incidence of coercion and violence (low compared to other places but still serious enough); mobility (the vast majority of sex workers live and work away from their place of origin); underage prostitution (far too much and few efforts to stem it); trafficking into the sex industry (it happens but is minimal because poverty ensures a steady flow of recruits); police corruption (bribes are not paid) and exploitation (yes, but how much depends on the benchmark of non-exploitative work). Freelancers can work independently but women who depend on third parties often suffer poor conditions and are overcharged for services and accommodation. I also asked lots of questions about the dynamics of income generating projects and visited several. I was trying to sort out ‘window dressing’ from useful projects and work out how to identify, measure and encourage ‘good rehab’.

In the process I ate the Ethiopian staple, injera which has been produced for many years by a self-funding sex worker collective; watched football in a crowded café run by HIV positive sex workers; helped at a 24 hour ‘hole in the wall’ condom kiosk and saw a sex worker catering collective providing lunch at a police training workshop. I also had a wonderful coat made for a great price (but within my benchmark of exploitation!). I heard some bad things too. One NGO told me about funds they had for a ludicrous silk production scheme that might save a handful of ‘fallen women’ years down the track but which, in the meantime, was covering the salaries of a gaggle of project officers with an office and shiny Land Rover. I talked with women who were working very hard to sew goods that they are only permitted to sell at an NGO market that’s mainly patronised by foreigners. They couldn’t work out why they sold so little. Sadly, I was able to figure it out with a glance at the colours and designs.

I was curious about which sex workers did, and didn’t, attend the income generating projects or enrol in trainings or join savings and loans groups. I asked focus groups and individual interviewees “Who joined?” “Who stayed?” “Who dropped out and why?” One woman answered the ‘why’ with a lesson in basic arithmetic:

To support my family and live with any kind of dignity would cost 100 birr [about 3 pounds] per day. I make between 20 and 70 birr from sex work, but only on some days. I can get 20 to 50 [from the income generating project] and sometimes I can make a few birr in another way. What is sure is that every day, with all I do, I always have less than I need.

As those words illustrate, broader economic conditions mean that multiple strategies are needed because every available strategy is weak and highly likely to fail at some stage and welfare safety nets are non-existent or unreliable. It also illustrates the need for daily income and thus why schemes that require a women to invest time and money before she has any return may not be suitable for sex workers.

sewing at the Sisters Project cheryl overs blog oct 14

Sewing at the Sisters Project

Another important motivation to attend the income generating projects emerged from my interviews that surprised even their operators. By enrolling in an income generating programme sex workers can obtain the address and supporting documentation they need to obtain a government identity document. These ID cards are needed to conduct any economic activities, travel or access services in Ethiopia, similarly to ration or voting cards that Indian sex workers have also struggled to obtain. This is especially important for mobile sex workers (as already mentioned, the majority) because the cards are recognised locally not nationally.

I asked everyone I spoke to about women exiting the sex industry as a result of NGO economic empowerment programmes. Most said they didn’t know any young women who had gained a new occupation as a result of the programmes yet but that some were on the way in that they were trained and/or had received a loan. Some said that they had heard of older women who had attended NGO projects or joined traditional local income generating groups (Idars) stopping sex work permanently. Mothers said they can take their children to the income generating projects that produce and sell goods (usually injeras) on a daily basis and provide lunch. Several older women said they benefit from even tiny amounts of money when they cannot earn much from selling sex.

From all this I could see evidence that for Ethiopian sex workers, NGO economic empowerment programmes are a strategy for dealing not only with low income but with discrimination and lack of access to various services, commodities, spaces and to citizenship itself. I argued that the neo liberal ideals that place enterprise as a central element of development are not serving sex workers well and that programmes would almost certainly work better if they were targeted and planned rather than rolled out to a frankly tired formula. But I also suggested that improvement is unlikely without more resources, some evaluation and better accountability.

Revisiting Soloman

After writing and talking about sex work and poverty in Ethiopia over the years I visited in mid-2014. I was wondering if any of my arguments about the potential benefits of sustainable, rights based economic empowerment initiatives for sex workers had fallen on fertile ground.

My first stop was the Addis Ababa sex worker group Nikat. Since my last visit its economic empowerment project had been funded by the Dutch organisation that I had urged to adopt the idea of developing careers within, without and alongside sex work. The programme is called Stepping Up Stepping Out and the women in it are dedicated to their studies of trades by day and they don’t need to make it a secret that they still sell sex – ‘but not every night and not until late like I used to’ said one women in the programme. The bad news is that the programme is miniscule. At best it reaches tens of women in a place where it needs to reach tens of thousands. Hopefully it is a pilot and a larger donor will pay for rapid and significant scale-up.

I was delighted to hear that the NGO Timret, who had shown me around its centres, had conducted a successful campaign in its 34 centres across the country to obtain ID cards for sex workers in response to my observation that lack of them drove sex workers vulnerability. Hundreds of women became ‘legal people.’ I was even more pleased to hear that Timret found most local authorities to be more co-operative than they had expected. The bad news is that most of those centres will close or be scaled right back due to funding cuts.

The EU Delegation to Ethiopia asked me to advise about how they might be able to support ‘good rehab’ through their work with local authorities. ‘No need for me’ I said, ‘Come to Nikat’. A traditional coffee ceremony and an excursion to talk to women in sex work shanty towns were quickly arranged. The Nikat leadership held forth on issues around poverty and their vision of ‘rights based’ policies and programmes to alleviate it. The women in the shanty town explained that while talk about becoming a shopkeeper or a hairdresser was good for a select few, it isn’t relevant to the thousands of women living in huge slums without sanitation, basic health care, education or child protection. Their points about what ‘economic advancement’ and ‘access to services’ meant were underlined by there being a newborn baby on virtually every bed. They explained that their babies stay there while their mothers service clients and the toddlers play outside amid open drains and live electricity cables. As well as the visible conditions which were shocking enough, the women provided eye popping facts about how much they pay to live in tiny leaking huts and what it takes to earn it. The EU delegation is supporting local government to improve services in slums and I left confident that some excellent information had been shared and that there would be follow-up that explored how to make sure those benefits extend to these slums.

I had yet another pleasant surprise when I visited the office of the President’s Emergency Plan for Aids Relief, (PEPFAR) at the US Embassy in Addis. USAID’s PEPFAR programme is the major donor for HIV services for sex workers in Ethiopia. I asked what its policy is in respect of helping women get out of the sex industry. Those who know about US HIV policy will know that PEPFAR has favoured abstinence and required the organisations it funds agree to oppose prostitution and that this has caused much gnashing of teeth. The Ethiopia PEPFAR director began defensively. He is clearly used to this enquiry coming from people who want or expect US funding to be used to reduce sex work. ‘It is not realistic to try to get all the sex workers in Ethiopia into new jobs. It’s also moralistic and that alienates them. Now our programmes are focussed on helping expand options which includes human rights, access to services and better living conditions and generating income that supplements sex work which allows women to work less or refuse clients that don’t want to use a condom.’ I resisted the impulse to make a wisecrack about how a lot of time and money could have been saved and HIV prevented if USAID had have listened two decades ago. Later I shared this with a colleague who had contributed all those years ago to Making Sex Work Safe. “We can sure rack that up as a belated success” she chuckled.

Conclusion

It’s clear that economic empowerment for sex workers in poor countries matters – it must work if human rights, public health and development goals are to be reached. My work on poverty alleviation and sex work is limited and it asks many questions as well as making some recommendations based on the evidence I gathered. It supports one solid conclusion above all others – that more research is needed to drive better conceptual frameworks and practical guidance to identify what policy and programmes should be scaled up and how. Now I know, I know – all researchers call for more research – but I am confident that if anyone doubts my assertion about lack of reliable data or thoughtful modelling about economic empowerment for adult female sex workers they will find the information abyss of which I have spoken.

*Sex workers made a film about abuses associated with rehabilitation named Bad Rehab

Cheryl Overs is a Senior Research Fellow at The Michael Kirby Institute of Human Rights and Public Health at Monash University Melbourne Australia and is a visiting research fellow at IDS.