THEME SECTION 73 23 PLA Notes

37 (February, 2000) on sexual 37 (February, 8 PLA Notes 16 on health (July, 1992), 16 on health (July, 37, Edstrom, Cristobal, de Soyza and Sellers Cristobal, de Soyza and 37, Edstrom, RRA Notes PLA Notes In …scaling up capacity-building and participatory processes • sexuality, poverty and development; sexuality, • and gender; and participation, sexuality • in ? whose agenda counts • and community-based HIV prevention Participatory work care Since to HIV/AIDS (June, 1995) on participatory approaches and programmes and reproductive well-being were published, we have seen well-being were and reproductive worse beyond our the scale of the HIV epidemic increase fears with devastating impact (see Welbourn, section 9, this long- issue). In some countries, this has shifted the focus from term to crisis interventions. Donors, impa- more development organisations and communities are tient with lengthy participatory mobilisation and planning out rolled and results and want to see interventions processes to achieve maximum coverage as rapidly as possible. (2000) point out that may be more important than scaling up ‘intervention pack- ages’. It is a common mistake to assume that it is the result- ing strategies which need scaling up to achieve an impact, Participatory Learning and we were struck by the continuing relevance of the relevance struck by the continuing we were

In this piece, we pick up a series of key issues in partici- crisis; pation in sexual and reproductive well-being and rights, pation in sexual and reproductive looking at lessons learnt exploring ways in which prac- and up by the new challenges thrown addressing titioners are issues we will focus on The key the changing environment. are: of work in a time and care participatory HIV prevention • editorials and lessons learnt work on sexual and repro- from in described ductive well-being and rights. If the programmes actively if they them continue to be developed and spread; integrated with services; and are involve those most affected allows people of enabling environments and if the creation disease or to enjoy sexual intimacy without fear of pregnancy and sexual choices, and be supported in their reproductive much would change. Much has been gained with the use of well- and reproductive in sexual participatory approaches being and rights work. But an enormous amount still needs to be done. One of the most fundamental values in participatory work is One of the most fundamental values in that of supporting people to gain the confidence and capac- change their realities. analyse and act to ity to recognise, back copies of Reading through Action, by GILL GORDON and ANDREA CORNWALL ANDREA by GILL GORDON and and rights reproductive well-being Participation sexual and in 8 74

THEME SECTION Gill Gordon and Andrea Cornwall PLA Notes Illustration from coverof tries. Butpoverty limitstheimpactofinterventions that inequality havedeepenedsince 1995inmostAfricancoun- determinants ofpovertyand healthstatus.Povertyand named structural,economic andpoliticalinequalitiesas The PrimaryHealthCare DeclarationofAlmaAtain1978 development sexualandreproductive healthand Poverty, those whoknowthesespaceswellare abletoidentify. risk thattakeaccountofthecomplexityfactorsonly spaces, andworkingwithpeopletoexplore waystoreduce – schoolsare oneexample,seeBox1–mightbe seenasrisky of thisisunderstandingbetterhowparticularenvironments creatively findthebestapproach toimplementingthem.Part local peopletoselectinterventionsknownworkand sites andcultures. Participationthenbecomes working with bringing tothetablenewideasandperspectivesfrom other outsiders share theirdifferent knowledge,withtheoutsider and lefttofacetheconsequenceswithoutfollow-upsupport. sured tospeakcourageouslyinpublicaboutcontestedissues opinions ofthepowerful.Vulnerable peoplemaybepres- easily leadtotokenparticipationandplanningbasedonthe cascade trainingmodelusingafixedsetofPLAtoolscan the processadopted. when successfulstrategiesusuallyderivetheirsuccessfrom What’s neededisanapproach inwhichinsidersand Rolling outparticipatorycommunityassessmentsina 37: Sexual and

Cartoon: adapted by Paul Mincher with acknowledgement to Regina Faul-Doyle Many havetoconsider usingtheirsexualassets tomeettheir Young peopleare atriskofHIVbecause theirpoverty. activitiesortheystayawaytosurvive. or skills-basedlearning people needsomematerialassistance toattendPLAsessions funding forcommunity-level work.Themostvulnerable approaches, which require long-termadequatelevels of to weedtheirmaize. in theirdistricts.Theyare poorandneedmoneytopayothers have thebicyclesandincentivestoreach theremote villages sex, distributecondomsandrefer tohealthservicesdonot peer educatorswhoare trainedtoteachskills-basedsafer structural adjustmentpolicies.Thecommunityworkersand they havesex.Thehealthservicesare severely weakenedby communities donothavethecashtobuythemeverytime free condomsare oftennotavailableandruralfarming transmitted infection(STI)treatment askeyinterventions.But voluntary counsellingandHIVtesting(VCT)sexually example, communitiesdemandcondoms,sexeducation, province ofZambia,for barrier toaccess.IntheEastern health (SRH)interventions,povertycontinuestobeamajor agencies workingonsexualandreproductive health. proposed bycommunitiestoaddress povertyare ignored by to exercise control overtheirlives.Alltooofteninterventions personal powermighthaveonwomen’s andmen’s abilities ignore theveryreal effects thatalackofeconomicand o :Schoolsasriskyspaces Box 1: aimed atcreatingasafeenvironmentforteachingsexuality. sexual abuseandfedintothedevelopmentofaninitialsetlessons whichshowedhighlevelsofsexualactivityand questions andstories, This producedawealthof and puttheminaboxtheclassroom. storiesandproblemletters Pupilswroteanonymousquestions, safely. life-skill lessonsandgavesuggestionsonhowitcouldbetaught theyexpressedtheirhopesandfearsaboutsexuality For example, analyse thesituationwiththemandgettheirideasonhowtorespond. usingmanyofthesametoolsto participatory assessmentwithpupils, They thenfacilitateda of sexualabuseandmadeplanstoaddressit. Teachers acknowledgedtheproblem find ways toaddressthecauses. hot-seating tounderstandtheirmotivations andtheMargoliswheelto to explorehowteacherscontributeHIVtransmissionandpregnancy, dramaandrole-play They usedmappingtoshowriskyplaces, school. and sexualityissuesroleinsexualriskpreventionthe gender reproductive, participatory processtoexploretheirownHIV, The teachersareengagedina what theycandotopreventit. are high-riskplacesforHIVtransmissionandunwanted pregnancyand teachers andpupilsinbasicschoolsZambiatoanalysewhy Zambia (PPAZ) andtheMinistryofEducationareworkingwith PlannedParenthood The InternationalHIV/AIDS Association of Alliance, Poverty affects opportunitiesforusingparticipatory Even where communitiescallforsexualandreproductive Participation in sexual and reproductive well-being and rights 8 HM SECTION THEME Box 2: Responding to poverty Box 3: Mapping bodies In 1998 Care Zambia conducted a participatory study with young Body maps, described in PLA Notes 16, have been used in a wide people in peri-urban Lusaka to explore issues around their sexual and range of creative ways by people working in sexual and reproductive health and generate a community response, which was reproductive health to explore bodily processes, risks and reported in PLA Notes 37. The range of participatory methods used, and pleasures. Annie George (personal communication) used them with the richness of the learning they generated inspired others working women in Bombay to open up discussions about sex and sexuality. with young people. Local adults reading the report were shocked at, Kim Batchelor describes in PLA Notes 37 how HIV prevention for instance, the extent to which girls bartered their bodies to meet workers at a workshop in Dallas and New Mexico mapped their most basic needs. Young people were trained to counsel and sell erogenous zones, organs associated with the birth process, and condoms to their peers. In a participatory evaluation, some years later, those affected by sexually transmitted infections (STIs), and used peer counsellors reported on their distress when poorer young people them to discuss the effects of body image on vulnerability to STIs. did not have cash to buy condoms and they were obliged to send them In a powerful example of how body maps can be used to enable away empty-handed, or when they could not afford effective STI people to reclaim their own knowledge about their bodies, treatment. The evaluation resulted in peer educators exploring the Jonathan Morgan worked with South African HIV positive women nature of commercial sexual activity in the compounds and condom using body maps to explore and share their experiences of using and STI treatment accessibility further, and developing proposals to anti-retrovirals (see http://web.uct.ac.za/depts/cssr/body_maps. continue the project further in their own compounds. (Source: Flyer on html). Ann Sturley (2000) shares her experiences of using body Participatory Ethnographic Evaluation and Research (PEER), Options mapping with men to explore their anxieties about vasectomy, in and CDS, Swansea.) PLA Notes 37. most basic needs. Jill Lewis, whose contribution to PLA Notes be de-linked from relationships, caring and compassion. In 37 showed an inspiring example of work with young people rich countries, this contributes to low self-esteem and self- that is sensitive to issues of identity and difference, argues, harming behaviour. In poor countries, some have sex to The limitations of the living conditions of people inhibit acquire the material goods that identify them as attractive, ongoing, sustained outreach. I dream of work that, with modern and successful. Take, for example, the advertise- blocks of five years’ funding, resources the local trained ments for a hair product that are to be seen in rural districts people to initiate and mount in turn their direct work with in various African countries. They show an African woman people... with straight shiny hair, and the slogan is along the lines of Barriers to addressing poverty effectively include: ‘be yourself’. • funding focused on short-term HIV interventions; Think, though, of the other ways this slogan could be • lack of expertise in economic intervention and credit; used to give young women (and men) a stronger sense of • difficulties in achieving multi-sector collaboration; their potential and capacities. ‘Be yourself’ is a good way of • small projects that generate too little income to make a thinking about what empowering sexual and reproductive difference; and well-being and rights work can do. Rather than tell people • no linking up of local issues to advocacy for national and what they ought to do – whether encouraging them to do global level changes. what others do and follow norms, or set themselves apart As well as action at a local level, those involved in sexual from the crowd by doing things that others don’t do – ‘be and reproductive well-being need to ally with movements for yourself’ could be about enabling people to become more social and economic justice. They need to advocate for action fully the person they are. It is about the freedom to be, the at the national and macro level to release the wealth needed freedom to have the kind of relationships that bring happi- by poor people to be capable of meeting their basic needs ness and the kind of sex that brings pleasure. and planning their own action to manage their sexual lives Working with participation in addressing sexuality and safely. gender is not the same as participation in work with natural resources or water supplies and the like. Sexuality and gender Participation, sexuality and gender are intimate, private and emotionally loaded. They link into Globalisation and the commoditisation of sexuality in adver- deeply held beliefs and feelings. For many societies, talking tising and media have contributed to a culture which pres- about sexuality is restricted to very specific and private situa- sures young people to achieve the norm of attractiveness tions and going outside these boundaries willy-nilly can lead through buying clothes, shoes, cosmetics, mobile phones and to harm in ways that outsiders may be unable to anticipate. the like: ‘I shop, therefore I am’. Sexual activity has come to Public participation in discussions on intimate aspects of sexu-

75 8 76 THEME SECTION Gill Gordon and Andrea Cornwall stereotypes orknowncategories outsidethestereotype, ity mayoffer informationwhichlimitsthediscussionto in guidesonparticipatoryapproaches togenderandsexual- own experience.Information provided bytrainersorfound that picture, wesoon realise thatitdoesn’t really capture our asked aboutthemeninourown livesandwhethertheyfit is easyenoughtofindastereotype tofit.Butwhenwe’re norms. Ifwe’re askedwhata‘typicalman’thinks ordoes,it media andpopularculture, create a setofstereotypes and and whatwehearfrom society, thechurch, ourparents, the about whathasbeendoneelsewhere andsucceeded. provide newknowledge,challengeharmfulbeliefsandtalk ality andgenderinfluencesexualsafety. Heorsheneedsto a more nuanced,complexandauthenticpicture ofhowsexu- to challengeeachother, ‘peelingtheonion’untiltheyreach we maynoteverquestionorchallenge,toreflect andbegin people togetthrough layersofnormativeassumptionsthat men. Insuchsettings,thefacilitatorhasakeyrole inenabling will keepquietwhenhomosexualityisvilifiedinagroup of for safety. Menwhoare attractedtoothermen,forexample, in communitydiscussionsevenifgroups are carefully setup that there isalimittothevalueofdemocracyandconsensus things are unmentionableanddeeplystigmatised.Thismeans desire, sexualpreference, relationships andpractice.Some normative pictures ratherthanthereality andcomplexityof and explore theirownpersonalfeelings. leaving littlespaceforindividualstoexpress theirdifference tricky issuesbutcanresult inthe tyrannyofconsensus, the useofdiagrammingtools.Thesecanservetoopenup from HIVmightcreate amore intimatespaceforsharingthan helping peoplereflect andfindwaystoprotect themselves relaxed conversationwithafacilitatorwhoiscommittedto which maybringoutstereotypes and norms.Asmallgroup more helpfulforreflection thanlineardiagrammingtools Participatory narrativeandperformingartsactivitiesmaybe too muchondiagrammingandpublicgroups are needed. able tospeakabouttheirreality. Processes whichdonotrely people’s storiesanddiscourseschangeovertimeastheyfeel and caringare neededforcontinuingconversationsinwhich and respond inarespectful andenablingway. trust Time, areas are verystrongly heldandthatmakesitdifficult tolisten way thatotherareas oflifemaynot.Ourvaluesaround these ways foundtotalk. it isnotcarefully andsafe plannedwiththegroups concerned ality maybedangerous forparticipantsandthefacilitatorif What we’re taughttothinkaboutsexualityand gender Discussions ofsexualityinpublicgroups oftengenerate Sexuality, genderandHIVaffect allofusverydirectly ina ering anddidactic asanylecture. Also,thesemessages are expect pleasure, drives theepidemicandare asdisempow- pleasure, andthat womenare submissivevictimsanddonot Africa are promiscuous, rough andindifferent tofemale sexuality. Forexample,thewidespread messagesthatmenin rather thangivingusasenseof thecomplexityofgenderand o :Innovativemethodstoexplore sexuality Box 4: o :Theimportanceofsexualpleasure Box 5: ovninllalt rpses(asn 2002). conventional leafletsorposters(Hassen, of communicatingthathadabetterchancereachingpeoplethan othersstillchoseotherways anothercreated arapsong, themselves, whichtheyscriptedandfeaturedin produced aphotonovella, Onegroup thought wouldmake itmostappealingandaccessible. andthemediumthatthey interesting andusefultotheirpeers, to findoutwhatkindofinformationtheythoughtwouldbemost Hassenandcolleaguesworked withgroupsofyoungwomen Nazareth, de InPorto Alegre inBrazil, condoms (personalcommunication). and engagedinquiteadifferentway aboutthepossibilityofusing enhanced theirsexualpleasure?’ The menwereamazedatthisidea Lewis asked ‘Has anyoneeverspoken withyouabouthowcondoms Jill InsuchadiscussionwithmeninRwanda, expressing groupnorms. theyare Many ofthesemenhavenotpersonallyusedacondom, womenwant tofeeltheirejaculation andsoon. sex islessenjoyable, Groupsofmenoftenagreethatcondomsfeelcold, don’t usecondoms. Participatory toolsareoftenusedtoexplorethereasonswhypeople sexual safetyandpeoplebecomereallyengagedataneffectivelevel. intimacyandlove arepartofthediscussion Spirits liftwhenpleasure, which Ineverdidbefore’. on anewlifeofpleasurewithmywife–Iamnowabletosatisfyher, oneparticipant reportedon ‘embarking enjoyable andsafersexuallife; peoplereportedamore Inanevaluation sixmonthslater, exploration. about sexualpleasureandintimacyraisedissuesforfurther This methodcombinedwithbody-mappingresulted indetailedtalk outside andlistenedtotheanswerswithoutspeakingvisa-versa. and answeredthemen’s questionswhilstthemensat aroundthe formed a ‘fishbowl’ (see Tips Women for satinthemiddle Trainers). They exchangedquestionsanddiscussedtheiranswersalonethen that theyhadalways wanted toasktheoppositesexaboutsexuality. Men andwomenteachersinZambiathoughtaboutallthequestions important areasforparticipation. up ofnewpossibilitiesforpleasurewithfreedomtoexperimentare The righttopleasureandtheopening and howtosatisfytheirpartners. Many menandwomenarekeen totalkabouthowbeagoodlover sex eroticmoviescoulddomorethanalltheleafletsbeingdistributed. Safer they hadallreachedorgasmthroughjustwatching abluemovie. movies' asmuchboysandfivemiddle-agedwomenlaughedthat Girlsgoto'blue teach girlshowtomasturbateinruralZambia. Localpubertyteacherstraditionally to askforitintheirownways. shows thatwomenandgirlsareinterestedinsexualpleasureable Participatory workwithruralcommunitiesandinschoolsZambia 77

8 THEME SECTION Photo: © 2001 Nrityanjali Academy, Courtesy of Photoshare of Courtesy Academy, Nrityanjali 2001 © Photo: Participation in sexual and reproductive well-being and rights and well-being reproductive sexual and in Participation A health worker how to use demonstrates a condom for a small of men on a crowd in India village road and about forms of pleasuring that they may never have tried. pleas- the epidemic that places intimacy, to This is an approach for the rights and needs of sexual partners at and respect ure time as respecting at the same the heart of HIV prevention – rather than treating right to pleasure and men’s women’s them as the owners of bodies that must be better controlled. Whose agenda counts? Whose All community mobilisation and participatory planning involves sharing of ideas and negotiation between different might be initiating the planning process The group groups. organisation or a of activists or an outside an insider group will have an process of both. Whoever initiates the mixture agenda and boundaries in mind, based on needs, resources the and values. The agenda might be focused as in preparing of a new STI treatment community for the introduction as described package of interventions package or a broader above. At times, the mobilisation and participation is similar the organisation wishes where to social marketing research, to understand people's knowledge, attitudes and practices to make a persuasive market- in order an intervention around ing campaign. Gender inequality does result in norms that give men in norms Gender inequality does result power over women’s sexuality and entitle them to satisfy their sexuality and entitle them to satisfy power over women’s expected who are at whatever cost to women, sexual desires to be submissive. These norms make both men and women vulnerable to sexual ill-being and they need to be addressed. But this should not be the only discourse. Imagine a sex-posi- satisfaction seen as with sexual intimacy and tive culture essential to the well-being of men and women. This culture discussions in Zambia and Ghana when can be seen in group men and women feel comfortable to talk outside – often with for sexual pleasure Christian – norms, about their search a partner or alone. Participatory workshops on how to be a ring to them than those better lover have a very different disease – but may serve the teaching people how to prevent Using techniques such as purpose just as well, if not better. turn-onsbody mapping to explore and turn-offs – as Lucy Shillingi taught us some years ago – and to allow women and men to learn zones about their own, and others’, erogenous based on possibly racist, feminist, elitist assumptions that diversity and blame and deny people their complexity, don't always want to be assertive, and Women humanity. men can feel very vulnerable. 8 78 THEME SECTION Gill Gordon and Andrea Cornwall lence of20-35% inwhichmostsexualencounters are risky for thosewhobelieveinchoice toenablethishappen. information andaccesstocondoms, andincreasingly difficult prove ofyoungpeoplebeing sexually activetodenythem tion makesiteasierforleaders andlocalpeoplewhodisap- context ofchoiceswhichincludecondoms.ThePEPFAR posi- important inreducing HIVtransmissioninAfrica, butinthe and reducing numbersofsexualpartnershave bothbeen buying andsellingofsex.Delayingthestartsexualactivity condoms for'highrisk'groups suchasthoseinvolvedinthe and isheavilypromoting fidelityinmarriageand reserving third ofprevention fundingfor‘abstinenceonly’programmes, Plan forAIDSRelief(PEPFAR), forexample,hasearmarkedone progressive TheUSPresident’s ofgovernments. Emergency countries, withanimpactthatextendseventothemost which resonate withthoseofconservativeleaders insome increasingly subjecttoconditionalitiesrelated toagendas tively harmful. nity’ whattheywouldlikeisnotenough,andmaybeposi- vulnerability ofparticulargroups. Simply‘askingthecommu- of arightsbasistoparticipatoryworkifitisaddress the reproductive rightsmakesapowerfulcasefortheimportance adolescents betteraccesstocondoms.Work insexualand sex workerstohavesaferworkingconditionsorthatgive likely tofindcommunitiescallingformeasures thatenable never appearonaPRA‘communityactionplan’,norisit without discrimination,molestationorsexualviolencemay supply smallercondoms? are willingto But then,howmanydonorsandgovernments in order tostopAIDS,astheyare toosmalltofitcondoms. can't control theirsexualfeelingsinearlyteensmarry Zambia, someeldersthinkitbestthatboysandgirlswho stick tochastiseboysandgirlswhoare outandabout.In successful action.Shegoesaround thevillageatduskwitha qualified tobeateacherandthechiefwasproud ofher severely. Thegirlstoppedherrelationship andisnownearly ter hadaboyfriend,shesenthertotheteacherbebeaten example, explainedhowwhensherealised thatherdaugh- good behaviourinyoungpeople.AchiefGhana,for nities favourtheuseofdisciplinarymeasures topromote nity strategiesoutlinedbelow. Manyolderpeopleincommu- values. Manyoutsiderswouldnotacceptthetwocommu- by communitymembersare acceptable,partlyrelated totheir ning willplaceboundariesonwhichinterventionsfavoured To applysuch anapproach incountrieswithanHIVpreva- Donor fundingforsexualandreproductive healthis The rightsoftransgendered peopletolivetheirlives All thoseinitiatingandfacilitatingcommunity-basedplan- leaders are denouncing condomsandfidelity ispromoted as who dohavesexmakesthemmore problematic still.National needs. Theimpactofsuchprogrammes onprovision forthose future activityor the widespread exchangeofsexforbasic aboutsafesexfor desire, theneedfor youngpeopletolearn promotion doesn't takeintoaccountthereality ofsexual risky sex,butsimplycannotafford tobuythem.Abstinence rather beabletousecondomsthanhaveunprotected and succeed. Itisjustasdistressing totalkthose whowould are aware oftherisksandtryhard toabstain,butdon’t tion (Grunseit become sexuallyactive,theyare more likelytouseprotec- does notresult inearliersexualactivityandwhen peopledo tion, includinginformationoncontraceptionandsafesex, (Kirby, 2002:6).Andevidenceshowsthatsexualityeduca- sexual debutoritsconsequences,onewaytheother evidence thatabstinenceonlyprogrammes haveaneffect on tently risingHIVrates–ishighlyproblematic. There isno rates ofteenagepregnancy, soaringadolescentSTIsandinsis- countries,withtheirproblems ofhigh – letaloneinnorthern o :Realisingrightsandensuringjustice... Box 5: monitor theproceedingstoensurejusticewas done. whosattoobservetheconductofjudgeand fellow women, respected bythelawweresupportedincourtsalargegroupof Women pressingfortheirrightsto be more fairlybythecourts. andtobetreated enabling womentohavebetteraccessjustice, powerful thattheymovedthewomentodevelopastrategyfor The diagramswereso to exploretheirexperienceofgenderviolence. usedparticipatorydiagrammingtoolswithwomen YWCA ofZambia, workingwiththe AnnSutherlandandFelicia Sakala(2002), women. ensuring theaccountabilityofjudicialsystems–especiallytopoor Another key dimensiongoesbeyondenhancingaccesstojustice example tobodilyintegrityandlife-savinginformation. for a dramashowingtheconsequencesofdenyingthemtheirrights, rights educationwerechallengedbytheyoungpeoplepresentthrough Participants whothoughtthatyoungpeoplewerebeing ‘spoilt’ by young peopleshouldhaveinformationonandaccesstocondoms. forexampleofwhether and resultedinchangetheparticipants, This isanopportunitytoshareknowledgeandvalues points ofview. statements relatedtotherightsandthenexplaineachothertheir contentious issueswherepeopleareasked toagreeordisagreewith Usefultoolsincludedavalues clarificationon implementation. communication andmake anactionplantopromotetheir identifychannelsof assess theirimplementationandbarrierstothis, organisations andyoungpeopletodiscussexistingpoliciesrights, civilsociety communityandreligiousleaders, service providers, governmentandtraditional holding workshopswithpolicy-makers, PPAZ andthe Alliance are InZambia, to informationabouttheirrights. A key aspectofrights-basedworkisensuringthatpeoplehaveaccess It isdistressing totalkwithyoungpeopleinAfrica who et al ., 1997). 79

8 THEME SECTION Photo: © 2002 Elizabeth Serlemitsos/CCP, Courtesy of Photoshare of Courtesy Serlemitsos/CCP, Elizabeth 2002 © Photo: Participation in sexual and reproductive well-being and rights and well-being reproductive sexual and in Participation For some, a rights-based approach goes beyond currently For some, a rights-based approach As the examples in Box 5 illustrate, participatory methods A community in Kapata, Zambia identifies the HIV- affected households – those with widows, orphans, or ill patients chronically use of them on their content and benefits, promote their promote use of them on their content and benefits, implementation and demand that they be upheld. existing legal rights to embrace a way of doing development and claim their that focuses on enabling people to recognise to them – not just those closest entitlements, including from 1998; Cornwall and Welbourn, the state (Petchesky, from we think of participa- the way in which 2002). By reframing rights- tory work on issues like sexuality and having children, the importance of make us think about based approaches enabling everyone to enjoy the right to make their own choices, the right to safe and satis- sexual and reproductive to choose when and and the right fying sexual relationships work also has an Rights-based whether to have children. to have different to play in enabling people important role regarding and with the judiciary, with providers relationships them less as those who give favours than those who are . and fulfil everyone’s protect obliged to respect, of the rights they perceptions people’s can be used to explore of the rights awareness have, to help people to gain greater they might claim – turning a sense of unfairness into a more into a demand for there active sense of entitlement, and from rights – and to enable people to organise collectively to demand Rights-based approaches: new directions, new possibilities? much that has moves that threaten Despite the retrogressive been gained in the last decade or so, the last decade has seen and in what is being in human rights an explosion of interest to development (Nyamu- called a ‘rights-based approach’ Musembi and Cornwall, forthcoming). Many countries have (Convention to Eliminate All Forms of signed up to CEDAW and CRC (Convention on the Discrimination Against Women) to full the basis for rights Rights of the Child), which provide sexuality and repro- information about and comprehensive and sexual health services, duction, and to reproductive punishment and abuse, early marriage etc. from freedom by These documents have been drafted and promoted work is outside donors and signed by urban elites. More needed to educate the people who might make the most safe, in countries where sexual culture, sexualised media and sexual culture, safe, in countries where – of sexual circulation norms show the frequency relational multiple and parallel partners, high with serial monogamy, number of men buying rates, and a not insignificant divorce being cut supplies are re-stigmatised, being sex. Condoms are and advocacy to make them widely available in large numbers order. is facing challenges of a different 8 80 THEME SECTION Gill Gordon and Andrea Cornwall sexual andreproductive rightsandwell-being,participatory devise locallyownedandappropriate strategiestorealise pleasure, tobuildsolidaritythrough shared experienceorto and supporttobreak thesilenceonissuesofsexualityand Used withsensitivityandtheappropriate follow-through Conclusions and mentorealise theirsexualandreproductive rights. formations inpracticethatcanreally begintoenablewomen tions ofparticipatorymethodologiestobringaboutthetrans- participation inSRHthefuture istousethesenewapplica- what isrightfullytheirs.Thechallengeforthoseworkingwith ment withhealth policy processes. tion indevelopment,andoncitizen engage- current research isonthehistory ofparticipa- in sexualandreproductive health,andher approaches inthehealth field,andespecially worked asapractitionerusingparticipatory opment Studiesasaresearch fellow. Shehas and currently worksattheInstituteofDevel- isasocialanthropologist,Andrea Cornwall a guideforyoungpeople. materials including author ofseveralpopularbooksandlearning HIV/AIDS Alliance.Gillistheauthorandco- 1998 andcurrently worksfortheInternational She joinedtheReproductive HealthAlliancein address issuesofgender, sexualityandequity. choices andchange,withyoungpeopleto ing arts,includingSteppingStones,toexplore and evaluation.Gillhasworkedusingperform- health educationandpromotion, monitoring using participatorymethodologiesforplanning, programmes. Gillhasalsoalotofexperiencein intotheir range ofsexualhealthconcerns ciations around theworldtointegrateabroad Prevention Unit,assistingFamilyPlanningAsso- years. ShehelpedtoestablishtheIPPFAIDS and primaryhealthcare inruralGhanafor10 Gill Gordon hasworkedinhealthpromotion ABOUT THEAUTHORS Email: [email protected] Fax: +441273621202; Tel: +441273606261; United Kingdom. University ofSussex,Brighton,BN19RE, Institute ofDevelopmentStudies, Andrea Cornwall, Email: [email protected] Fax: +441273718901; Tel: +441273718900; Brighton, BN13XF, UnitedKingdom. Queensberry House,104–106QueensRoad, HIV/AIDSAlliance, The International Gill Gordon, CONTACT DETAILS Talking AIDSandChoices– health’ (Eds.)‘SexualandreproductiveA. Welbourn and southwest UnitedStates’.InA.Cornwall methods toHIVprevention workersinthe Batchelor, K.(2000)‘Introducing participatory REFERENCES and donotreflect thoseofourorganisations. draws. Anyviewsexpressed here are ourown and ,onwhichthisarticle tion Group’s workonparticipationinsexual and SDCfortheirsupporttotheIDSParticipa- and Andrea wouldliketothankDFID,Sida whose projects are represented inthispiece; HIV/AIDSAlliance,someof the International inspiration. Gillwouldliketoacknowledge forcomments,and and AliceWelbourn We’d liketothankJillLewis,Robert Chambers ACKNOWLEDGEMENTS Notes IIED (1992)‘ApplicationsforHealth’, ductive well-being, transforming approachestosexual and repro- (Eds.), wall andA.Welbourn ment withyoungpeopleinBrazil’. In A.Corn- a participatoryapproach tomaterialsdevelop- ‘Making senseofsexualityandreproduction: Hassen, M.anddeNazareth A.(2002) grunskme.pdf. Accessed7May2003. publications/documents/children/schools/ Available onlinefrom www.unaids/ young people:areview update’.UNAIDS/97. health educationonthesexualbehaviourof Slutkin (1997)‘ImpactofHIVandsexual Grunseit, A.,Kippax,S.,Aggleton,Naldoand London: IIED reproductive health’ (Eds.)‘Sexualand andA.Welbourn Cornwall beyond individualbehaviourchange’.InA. and Sellers,T., (2000)‘Ain’t misbehavin’: Edström, J.,withCristobal,A.,deSoyza,C. Zed Books sexual andreproductivewell-being, Realizing rights:transformingapproachesto (Eds.)(2002), A.andWelbourn Cornwall, 16, London:IIED. PLA Notes 37, 81–83.London:IIED London: ZedBooks PLA Notes these approaches really canmakealife-affirming difference. with respect andfeeling.Butwhenusedsensitivelywell, reproduction, great care isneededtousetheseapproaches something aspersonalandhighlychargedsexuality and, insomecontexts,theirverylives–jeopardy. Andin values andnormsthatputwomen’s andmen’s well-being– reinforcing existingpowerstructures andshoringupthevery ects. Thetokenisticuseofparticipatoryprocesses canendup ping listofsolutionsorrubberstampalready-intended proj- can easilybecomeaquickfixandbeusedtogenerateshop- As inotherareas ofdevelopmentwork,participatorymethods approaches are apowerfulweaponinthestruggleforrights. Realizing rights: 37, 22–27. London: RRA ductive well-being, transforming approachestosexualandrepro- (Eds.) and A.Welbourn gender violenceinZambia’.InA.Cornwall visual techniquestoinitiatediscussionson Sutherland, A.,andSakala,F. (2002)‘Using Notes (Eds.) ‘Sexualandreproductive health’ andA.Welbourn vasectomy’. InA.Cornwall Sturley, A.(2000)‘Mappingtheeffects of Rights, Petchesky, R.(1998) development agencies’, all about?Perspectivesfrom international coming) ‘Whatisthe‘rights-basedapproach’ (forth- Nyamu-Musembi, C.andA.Cornwall 100–105. London:IIED. and reproductive health’ (Eds.)‘Sexual andA.Welbourn A. Cornwall givens’.In torelearn Lewis, J.(2000)‘Learning nancy, Washington DC. National CampaigntoPrevent Teen Preg- people andreduce teenagepregnancy?’ delay theinitiationofsexamongyoung Kirby, D.(2002)‘Doabstinenceonlyprograms PLA Notes IIED (2000)‘SexualandReproductive Health’, Notes Approaches toHIV/AIDSProgrammes’, IIED, (1995)‘SectiononParticipatory 37, 83–86. 23, London:IIED. London: ZedBooks. 37, London:IIED. London: ZedBooks. Negotiating Reproductive Realizing Rights: IDS Working Paper. PLA Notes 37, PLA PLA