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[PANEL] 1101 GENDERING REPRODUCTION AND FERTILITY CONTROL IN ETHIOPIA
Organizers:
Thera MJAALAND, Independent researcher at Department of Global Public Health and Primary Care, University of Bergen, Norway
MULUMEBET Zenebe, Assistant Professor, Centre for Gender Studies, Addis Ababa University, Ethiopia
Paper presenters:
KIYA Gezahegne; Nicola JONES; ANTEHUNEGN Birhanu; Désirée ADAMI; Thera MJAALAND;
TIZITA Mulugeta; RAHWA Gebre Tesfahuney; NEGA Jibat; Astrid BLYSTAD; GETNET Tadele;
MULUMEBET Zenebe; Haldis HAUKANES
Ethiopia has implemented progressive policies on sexual and reproductive health with expanded access to contraceptives and liberalised indications for safe abortion services. But how are these new policies negotiated in practice? How does the availability of family planning and safe abortion services, impact on socio-cultural and/or religious perceptions of female and male sexuality and gendered aspects of reproduction? This panel addresses the competing moralities underlying grassroots ideas, religious norms and policy discourses on sexuality, reproduction and fertility control from a gender perspective. Theoretically, the focus of this panel is situated at the intersection of perspectives emphasising how gender shapes reproduction in different contexts (e.g. Greenhalgh), and perspectives indicating that it is (hetero)sexuality itself that shapes gender roles and relations (e.g. Pereira 2009; Miriam 2007). In this panel we are therefore particularly concerned about how gendered dimensions of power and inequality are encoded in local ideas surrounding sexuality and reproduction, with a specific focus on fertility control. We are interested in papers which address the knowledges and competing moralities that adolescent girls and women draw on to negotiate, strategize and/or cope with challenges related to their sexuality, including fertility control and abortion. We are also asking for papers that address how adolescent boys and men see their role in reproduction and their responsibility in sexual relations from the point of view of hegemonic as well as alternative notions of masculinity.
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ADOLESCENT SEXUAL AND REPRODUCTIVE HEALTH AND SOCIAL NORMS IN ETHIOPIA [Abstract ID: 1101-11]
Evidence regarding Ethiopian adolescent girls’ physical health is primarily limited to the sexual and reproductive health (SRH) behaviours of those over the age of 15, with younger girls and other health care needs (including nutrition) rarely addressed. This paper explores the extent to which very young adolescents (10-12 years) have access to health-related information and services. It also pays particular attention to the extent to which adolescent girls and boys are influenced by and able to negotiate discriminatory gender norms, which push married girls to demonstrate their fertility, limit unmarried girls’ access to contraceptives despite national policies aimed at increasing uptake, and largely preclude girls’ ability to negotiate for condom use. This paper draws on mixed methods research: a survey with 6700 adolescents and qualitative research with over 200 early (10-12 years) and older (15-17 years) adolescent girls and boys, and their peers and caregivers in 2017 in Afar, Amhara and Oromia regional states. The data collection is part of the new DFID-funded multi-country Gender and Adolescence: Global Evidence longitudinal policy research programme, which aims to better understand what works to enhance adolescent development trajectories. Our research focus on younger adolescents enables us to complement the existing evidence base on adolescent health, and suggests that very young adolescent girls in particular have highly limited knowledge about puberty, including menstruation and menstrual hygiene, and that for many girls the onset of menstruation can be a fearful experience, especially in contexts where it may be a marker of marriageability. The paper concludes by arguing that access to school-based girls clubs, ‘good brothers clubs’, and pro-active health extension workers, provide important sources of information for adolescents, especially since parents often reported feeling either unprepared or unwilling to play this role. The paper also discusses the role of programming in shaping adolescent boys’ understanding and practices of masculinity and the ways in which these shape their female peers’ SRH experiences.
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AN INTERFACE BETWEEN ABORTION PRACTICE AND COMMUNITY RESPONSE IN WOLDIA, ETHIOPIA [Abstract ID: 1101-02]
This paper examines the interface between abortion practice and community responses in Woldia Town. Despite the fact that an effort was made by the Ethiopian government to liberalize abortion laws and policies, such laws have not been enacted. This is because laws and policies do not come in a vacuum but rather emanate from the basic values and norms of society. Hence, this study employed agency structure theory so as to examine both factors of personal and structural levels in addressing the interface between the experience of women having an abortion and the community response in a given moral and sociocultural context. In this regard, the findings of this study revealed that to some extent the existing discourses and stringent normative beliefs prohibited safe abortion practices and women’s reproductive rights, decision making and access to services though Ethiopian liberalized abortion lawa. The in-depth interviews, key informant interviews and case study results mainly showed that there were always competing discourses or interests between the private arena (desires and rights to control fertility and pregnancy termination) and community responses or cultural meaning of abortion including labelling, stigma and societal reactions. The result of this study also uncovered that contextual factors such as stringent community values, healthcare providers’ conscious objections and confidentiality problems and traditionally based gender roles (male dominance) among others were the impediments of safe abortion practices in general and women’s reproductive choices in particular. Similarly, the community responses such as a belief in abortion as immoral and intolerable, societal stigma towards women as if they were murderers, violating cultural values and inciting others to do the same influenced women’s abortion decisions, created moral crises and psychological distress. Finally, this paper is interested in exploring women’s abortion experiences, negotiating strategies in abortion decision as individuals and not as passive agents, simply dominated by existing normative patterns (Giddens 1984). Loopholes in community reactions and socio-cultural pressures resulted from contextual factors in practicing induced abortion.
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CHALLENGING THE NORMS OF "PROPER" DAUGHTERS AND WIVES:THE INTIMATE LIVES OF A GROUP OF FEMALE UNIVERSITY STUDENTS IN MEKELLE (TIGRAY) AND THEIR CLAIM FOR MODERN IDENTITY [Abstract ID: 1101-07]
The wide spread of contraception in Ethiopia has separated sexuality from fertility in deeper ways. On the one hand, verginity till marriage and one-to-one intimate relationships are embodied as part of normative feminity. On the other hand, for a new generation of urban and educated young women, extramarital affairs, framing in the ideals of romantic and passionate love fostered by new media that give lively texts and depictions through which imagine the tensions between family and individual expectations, wealth and poverty, “modernity” and “tradition” (Bryce 1997; Liechty 2003), are claimed as part of a modern and cosmopolitan feminity (Hirsch, Wardlow 2006; Padilla et al. 2007; Cole, Thomas 2009).Based on ethnographic fieldwork in Mekelle (Tigray) among female university students, the in depth-intereviews with these educated women showed as the sexual practices constitute a physical and social terrain where young girls are challenging the normative expectation of respectability, transgressing the norms of “proper” daughters and wives, and a space through which negotiate a more egalitarian gender roles and new pattern of relationship.This “double standard” on female sexuality, the one that recognises the value of chastity and the one that sees sexuality.
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EPISTEMOLOGIES OF IGNORANCE: THE HYMENOCENTRIC VIRGINITY MYTH AND ITS IMPACT ON WOMEN'S SRHR [Abstract ID: 1101-08]
Not much has been written on virginity in the Ethiopian context that goes beyond stating that it continues, especially in rural areas, to be important for the girl’s marriageability and consequently for her parents’ respect in the community. Since the virginity ideal is decreasing in urban areas, a few newer studies are concerned about the possibility to strengthen it in order to reduce risky sexual behavior among youth that result in unwanted pregnancy, unsafe abortion and HIV/Aids infection (e.g. Mitike et al 2008, Meles et al 2016). No doubt this will put more pressure on girls to keep their virginity than boys who can continue to take advantage of societal sentiments that do not expect them to be able to abstain until marriage even if they are supposed to do so according to religion. Medical science has emphasized for some time now that it cannot be proven if the girl has had sex or not by inspecting the hymen (e.g. Kinkead 1887, see also Berenson et al 2002, IFEG 2015, Olson & Garcia-Moreno 2017). Despite the fact that the hymen is just an elastic mucous skin fold surrounding the vagina opening, health professionals and biology teachers continue to talk about it as if it is a seal separating outer and inner female genitalia. Virginity testing continue to be done also in Ethiopia, and virginity restoration operations has become good business in many countries. Girls continue to believe that the man can know if she is a virgin or not (which he cannot if she has not told him). Husbands and in-laws continue to expect blood on the sheet when the marriage is consummated (even if only around 50% of women bleed the first time from rifts in the vagina rather than the hymen). Based on research in Tigray this paper discusses the hard-lived myth surrounding female virginity from a comparative perspective. It asks, based on what Nancy Tuana (2004) terms ‘epistemologies of ignorance’, whose power over fertility are enhanced by ignorance and whose are suppressed by knowledge when the female virginity ideal is not questioned in a gendered sense.
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FATHER’S INFLUENCE ON WOMEN’S REPRODUCTIVE ROLE OF EXCLUSIVE BREAST FEEDING ( EBF) [Abstract ID: 1101-03]
Failure to include fathers in infant and young child feeding practices (IYCF) behavior change interventions has shown negative result on the effectiveness of exclusive breastfeeding (EBF) and challenges gender equality (Abrea, M. et al, 2017). The research on fathers’ infant and young child feeding practices and their determinants in Amhara, Oromia, SNNP and Tigray regions confirms that while men do have a general awareness of the importance of breastfeeding, few appear to have a deeper and specific understanding of the importance of breastfeeding on their infants’ development and mother’s health (Setegn, et al. 2012). This study therefore attempts to examines factors that affect fathers’ involvement in Exclusive Beast Feeding ( EBF) and its impact on women’s reproductive right and productive work. In doing so it offers an understanding of what influence Exclusive Breast Feeding and the reproductive right of mothers and its impact on their productive activity. For the sake of achieving its objective the study is conducted in Menagesha Woreda, located 15 km west of Addis Ababa, capital city of Ethiopia. The research followed a purposive sampling technique to select the Woreda, as it is very close to Addis Ababa but located in Oromia region and also serves as a place for many flower farms, where most rural women get job opportunities. The study used a qualitative research method, where in-depth interviews, focus group discussion and key informant interviews were taken as the major data collection method. A total of 30 key informants and 2 FGD participants who were selected purposely participated in the in-depth interview and FGD. Key informants from health sector and flower farms were also part of the data source. Finding showed that there is very low understanding of the concept and application of EBF among mother and father informants. However, the study identified that there is a positive impact on duration of breast feeding when fathers show emotional and financial support. Though the need for fathers support is recognized by study participants, the existence of traditional gender division of labor (men seen only as guardians or the provider of the family), lack of attention towards men’s role in EBF by health centers negatively impacted men to be change agents. In addition to this lack of EBF friendly facilities in work places, lack of legal protection and job security were also found as barriers for working women from enjoying their reproductive right of EBF, parallel to mainlining their productive work. These results suggest that men focused intervention by health centers and media, and also women’s reproductive right based adjustment in work areas may help to change the existing low rate of EBF practice and allow women to enjoy their reproductive right parallel to their productive work.
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INTEGRATING GENDER ISSUES INTO HIV/AIDS PROGRAMS: A SURVEY STUDY IN SELECTED GOVERNMENT AND NGOS OFFICES WORKING ON GENDER AND HIV/AIDS ISSUES IN MEKELLE, TIGRAY [Abstract ID: 1101-01]
HIV/AIDS and gender are closely linked issues in contemporary development planning particularly in developing countries in light of the proportion of people directly or indirectly affected by the pandemic. Gender norms play a central part in shaping the course of the HIV/AIDS pandemic because they significantly affect the attitudes towards sex and information sharing on sexual behavior, risk-taking and fidelity. The HIV/AIDS pandemic is one of the most serious threats to social and economic development particularly in sub-Saharan Africa. In Ethiopia HIV/AIDS is a major development challenge as it is taking the life of many active and productive segment of the population supposed to have a key role in the country’s development endeavor. Despite the pandemic being common to all gender and age groups; due to the low income, poor attitude and low economic empowerment, women have been the main victims. The main objective of this study deals with analysis of integrating Gender issues into HIV/AIDS Programs by assessing complementary and interrelated steps for integrating Gender issues into HIV/AIDS programs. This study conducted in Mekelle town of Tigray that was selected for its proximity to Tigray Regional Head offices. This study used both primary data via questionnaire and secondary data via literatures. The study was conducted in 100 randomly selected, via systematic random sampling technique with 79% response rate, Governmental and NGOs involved in Gender issues and HIV/AIDS programs. The collected data was processed via editing, coding and summarizing; and finally was analyzed using descriptive statistics; spearman rho correlation; and factor analysis. The findings showed that all the steps for the integration system of Gender issues into HIV/AIDS are interrelated among each other and all except using checklist to identify interventions that address female and male vulnerability and risk factors; are conducted completely in the existing system of integration. The addressing factors for their integration include: Economic self-sufficiency; promotions (publicity); counseling; and providing health care facilities. The organizations do give higher attention to counseling a reactive solution instead of promotions (publicities) proactive solutions. Thus, all stakeholders need to focus on the addressing factors and adjust the gaps.
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INVOLVEMENT OF YOUNG MEN IN FERTILITY CONTROL WITHIN NOTIONS OF MASCULINITY IN TIROAFETA DISTRICT, OROMIYAA [Abstract ID: 1101-06]
This study examines young men’s life experiences pertinent to sexuality and fertility control in Tiro Afeta. Drawing upon hegemonic masculinity as its theoretical framework and ethnographic research design, it explores the involvement of young men in fertility control including induced abortion. It investigates the articulation between dominant views and young men’s perceptions, experiences of love relations, and premarital sex and use of fertility control. It also explores sexual negotiations between young men and young women, changes and continuities in norms, and practices and expectations of masculinity. The study found that the dominant views condemn premarital sexuality, pregnancy, and induced abortion; however, these restrictive rules are practically fallible in young lives sexual and reproductive lives. Young men initiate question of love whereas young women keep it lively. Love relations are socially expected to lead to marriage without premarital sexuality, whereas many relations contradicts the rule. Young people negotiate sex; young women focus on the commitment level of the young men for marriage as men usually abandon young women when pregnancy occurs. Friends serve as channel of negotiation, and use of mobile phones has changed patterns of negotiation. The negotiation involves no or little force. Schools, streets, market, wood and water collection places are settings for dating. Women have more favorable view of using contraceptive use than men. However, fear of side effects and infertility, varying values for children, and service related challenges limit peoples’ propensity to use contraceptives. Involvement of young men in contraceptive use ranges from strongly disapproving to questioning its relevance to encouraging women to use. Service programs are not responsive to men’s reproductive concerns and interests. As a young man is expected to marry a woman he impregnates, at times, young women purposely get pregnant from young men they want to marry. Abortion service is clandestinely practiced in modern and traditional ways. Young women’s needs and interests are given priority by skilled abortion care providers. Constructive young men’s involvement in fertility control is manifested in sharing concerns and cooperating with women. Yet some avoid to involve in fertility control by refusing use of condom and embodying gender-based division of tasks.
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THE ACCESS PARADOX IN SAFE ABORTION CARE: THE CASES OF ETHIOPIA, TANZANIA AND ZAMBIA [Abstract ID: 1101-09]
Fertility control and abortion are controversial issues in sexual and reproductive health and health policy. Despite unsafe abortion being one of the easiest preventable causes of maternal mortality, moral, religious and neo-conservative political reasoning upholds or exacerbates restrictive abortion laws and hinders political commitment to secure safe abortion services globally. In sub-Saharan Africa the rate of unsafe abortions is on the rise, especially among adolescents. Through three country cases - Ethiopia, Zambia and Tanzania- we discuss access to safe abortion services in different legal contexts aiming to identify the political, economic and social processes that mitigate the effect of the law. The law regulating abortion is classified as conservative in Tanzania, semi-liberal in Ethiopia and liberal in Zambia. The law is embedded in a social, religious and health systems context where the normative discourses are played out and facilitate or inhibit access within, or at times irrespective of the law. Although high rates of unsafe abortion are - broadly speaking - linked to restrictive abortion laws the country cases demonstrate that there is an unclear and at times paradoxical association between the status of the laws and actual access to safe abortion services.
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“WE DON’T TALK ABOUT CONTRACEPTIVES”: STUDENTS' EXPOSURE TO AND ENGAGEMENT WITH SEXUAL AND REPRODUCTIVE HEALTH INFORMATION AT THREE UNIVERSITIES IN ETHIOPIA [Abstract ID: 1101-05]
Recent research indicates that male and female students at higher education institutions in Ethiopia are highly sexually active and vulnerable to risky sexual practices (eg. Moges 2014; Sendo & Melaku 2015). It has also been shown that female students lack negotiating power and are exposed to sexual coercion, unwanted pregnancy, unsafe abortion and sexually transmitted diseases (eg. Adinew 2013; Solomon 2015). Due to silence around the issue of sexuality in Ethiopia, students enter universities and colleges with very limited sexual and reproductive health information. However, after joining universities they are exposed to different information on sexual and reproductive health, including programmes and campaigns run by the universities themselves (eg. Getnet 2009). Building on a qualitative research project among students at the universities of Addis Ababa, Jimma and Mekelle on sexuality, fertility control and abortion, the current paper discusses students’ exposure to and engagement with information about sexual relationships, reproduction and contraceptives. Our findings show that students are exposed to information on sexuality and reproductive health from various sources including mass media and peers. Many factors influence the amount and type of information students obtain, such as gender, place of origin and religion. Students’ engagement with the information provided also relies on the ways they place themselves in relation to young peoples’ own norms regarding sexual relationships and practices, norms which may be quite different from those held by society at large. This should be taken into account when planning information campaigns and programs directed towards university students; the current sexuality and reproductive health programs in all the three universities seem to be inadequate not only in terms of frequency but also when it comes to content and design.