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.

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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: