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Sexual and Gender Diversity in SRHR Towards Inclusive Sexual and Reproductive Health & Rights Through Mainstreaming

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Sexual and Gender Diversity in SRHR Towards Inclusive Sexual and Reproductive Health & Rights Through Mainstreaming Arthur van Schendelstraat 696 3511 MJ Utrecht P.O. Box 9022 3506 GA Utrecht The Netherlands +31(0)30 231 34 31 [email protected] www.rutgers.international www.rutgers.nl BIC ABNA NL 2A IBAN NL18 ABNA 0496 3238 22 Utrecht, December 2018 Authors: Jantine van Lisdonk, Joline Schelfhout, Aida Bilajbegovic, Bouko Bakker Project number: AA3047SE © Rutgers 2018 Sexual and gender diversity in SRHR Towards inclusive sexual and reproductive health & rights through mainstreaming Index 2 1 Mainstreaming as a pathway to change 3 2 Homophobia, heteronormativity and diversity 5 3 SOGIESC: Concepts and prevalence 9 4 Sexual and reproductive health of LGBTQI+ people, MSM and WSW 13 5 Possibilities of mainstreaming sexual and gender diversity in our programmes 18 6 Strategies to mainstream sexual and gender diversity 21 7 Ways to address sexual and gender diversity in various contexts 25 8 Conclusion 29 References 30 Rutgers 2018 in diversity SRHR gender and Sexual 1 Mainstreaming as a pathway to change The term sexual and gender diversity refers to the broad variation in sexual orientations, gender 1 identities, gender expressions and sex characteristics, also abbreviated as SOGIESC . These 3 variations are of all times and societies (Herdt 1997). Not everyone feels attracted to another sex or prefers another sex partner. Not everyone feels comfortable with the sex assigned at birth or with the expected gender role behaviour for men and women in their society. Not everyone is born with bodily sex characteristics that are wholly female or male, according to the norms in society. Since many societies are homophobic and transphobic, or at least share a societal norm of privileging heterosexuality, LGBTQI+ people are vulnerable to being stigmatised, marginalised and excluded. LGBTQI+ is the acronym for lesbian, gay, bisexual, transgender, queer, intersex and other marginalised sexual and gender orientations/identities that is becoming commonly used in progressive international NGO contexts. Heteronormativity, the norm of heterosexuality, can impact on LGBTQI+ people’s sexual and reproductive health and impede their full access to services, information and support. It can limit their opportunities to choose and live with their preferred partner(s), which ultimately prevents them from living to their full potential. Rutgers upholds the right of everyone to enjoy a healthy sexual and relational life and to experience their own sexuality in a positive, safe way, free of coercion, discrimination, stigma and violence. We believe that people should be free to make sexual and reproductive choices, respecting the rights of others, in supportive societies.2 Due to homophobia and heteronormativity, LGBTQI+ people can experience a lack of sexual and reproductive rights, specific sexual health problems and limited access to information and services. Attention must be paid to SRHR in relation to sexual and gender diversity. We aim for equal rights, opportunities and access to enjoy sexual and reproductive health Rutgers 2018 in diversity SRHR gender and Sexual and its related information and services for all people, respecting SOGIESC. This also includes freedom of partner choice and acknowledging relational diversity. There are two pathways of change to improve SRHR respecting SOGIESC (Figure 1). The first pathway centres on empowering and equipping LGBTQI+ people and their communities and organisations to improve their sexual and reproductive health. The second pathway focuses on transforming mainstream societal, organisational and professional environments from homophobic, transphobic, heteronormative spaces into enabling environments that are open to and support and serve people respecting SOGIESC. We recognise the importance of both pathways of change and their complementarity. Figure 1 Theory of change for equal sexual and reproductive health respecting SOGIESC 1 Paraphilias are not comprised in the concept of sexual and gender diversity. Paraphilias are atypical sexual interests or preferences for specific activities or erotic goals or objects. Examples are BDSM, voyeurism, fetishism and paedophilia. 2 Rutgers’s strategy for 2017-2020 (https://www.rutgers.nl/sites/rutgersnl/files/PDF/20170726_Rutgers- Strategie_NL_LR_DEF.pdf). Internal and external mainstreaming are twin strategies to create enabling environments. Mainstreaming sexual and gender diversity refers to the integration of a sexual and gender diversity perspective as a cross-cutting issue into the preparation, design, implementation, monitoring and evaluation of SRHR policies, regulatory measures, programmes and budgetary decisions, with the 4 aim of promoting equality and inclusiveness on SOGIESC and combating discrimination. Internal mainstreaming focuses on organisations’ policies and staff attitudes, behaviour and knowledge. External mainstreaming can be applied in programmes, research or advocacy in order to meet the needs and rights of all people respecting SOGIESC.3 Successful mainstreaming focuses on organisations and programmes as well as sensitised professionals. Rutgers is an SRHR organisation that combines a) programme implementation aimed at professionals and local partner organisations, b) research and c) advocacy. Because of our core principles of inclusivity and equality and our focus on professionals and organisations, our expertise lies in the second pathway of change: mainstreaming sexual and gender diversity to create enabling environments that are inclusive to all people. According to Rutgers, mainstreaming as a pathway to change will lead to SRHR programmes, information and services that provide inclusive SRHR, respecting SOGIESC, which is beneficial to the sexual and reproductive health of LGBTQI+ people. Rutgers aims to mainstream sexual and gender diversity through integrating the needs and rights of LGBTQI+ people in research, comprehensive sexuality education, service provision, community mobilisation, lobby and advocacy programmes. One strength of mainstreaming is that it targets structural and fundamental change at the environmental and societal level while addressing both majority and minority people at the same time. However, we also acknowledge the risk of ‘awaystreaming’: when mainstreaming is not structurally embedded and is perceived as a mere technical process, the political processes that Rutgers in diversity SRHR gender and Sexual potentially transform existing (heteronormative|) power structures can remain untouched to avoid hostile or dissenting voices (Charlesworth 2005; Frobisher 2016). Despite the fact that many SRHR 2018 organisations feel sympathetic towards principles of inclusivity, equality and diversity, the practice of creating enabling environments through mainstreaming requires explicit attention. In this paper, we first address the variety of legal and cultural contexts in relation to SOGIESC. Strategies to mainstream sexual and gender diversity will be different in societies with state- sponsored homophobia and transphobia compared to societies that promote legal equality. In the current global climate where the acknowledgement of sexual and gender diversity can be a sensitive issue, the use of concepts and language is important and evolves rapidly. Therefore, our paper presents up to date language used by international NGOs and provide the basic concepts on SOGIESC and related evidence-based prevalence. Subsequently, we present the most important themes on the sexual and reproductive health of LGBTQI+ people. The positive health model is useful to offer a positive and holistic view on health that acknowledges the relationship between health and environment. The impact of harming and non-inclusive environments on sexual and reproductive health is further elaborated by the concept of minority stress. We provide strategies for mainstreaming sexual and gender diversity in SRHR programmes and organisations that have been shown to be effective and we present examples based on our international and national work. Successful mainstreaming requires being sensitive to contexts and cultures and we introduce six ways to address sexual and gender diversity to create attention for inclusive SRHR, realise LGBTQI+ people’s SRHR and mobilise support for mainstreaming sexual and gender diversity. 3 The definitions of mainstreaming build upon previous Rutgers programmes and contributions in Share-Net Netherlands (2018) and SRHR Alliance (Bakker, Reinders, & Hofs 2016). 2 Homophobia, heteronormativity and diversity Promoting inclusive SRHR through mainstreaming focuses on creating enabling environments. It is important to take into account that legal and cultural contexts relevant to sexual and gender diversity 5 vary greatly. For example, sensitising healthcare professionals requires different messaging in an environment where homosexuality is criminalised or pathologised compared to an environment where homosexuality is legally accepted, yet remains marginalised. Mapping the environment is an essential first step in mainstreaming sexual and gender diversity in SRHR programmes. This requires knowledge about the legal context, existing cultural attitudes and norms (see Knowledge file Culture, Religion and SRHR), understanding the difference between homophobia, heteronormativity and diversity and recognising intersectionality. Legislation Legislation on SOGIESC can be divided into criminalisation, protection and recognition (Carroll & Mendos 2017). The mapping of ILGA World on the legal situation of countries shows the following picture (October 2017
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