Side by side with men in reproductive health

By Jane Godia campaign

Alice was expecting her eighth child. During a visit to the antenatal clinic she was told that she was HIV positive and asked to take her husband along the next time she visited the clinic.

Her husband, John, told her there was no way he would go anywhere near a women’s clinic. As for her being HIV positive, he said, she was the one who knew where she got the disease from. Alice is one of John’s four wives — besides two concubines that he has. She would have liked to stop having children after her fourth child, but the beating she received when she brought up the suggestion made her not to discuss the issue of family planning and contraception ever again.

Alice’s story is a replica of many African women who have no say over their sexual and reproductive health rights. Yet these rights touch the core of womanhood.

Sexual health

Sexual rights are defined as rights of all people to decide freely and responsibly on all aspects of their sexuality, including protecting and promoting their sexual health, be free from discrimination, coercion or violence in their sexual lives and in all sexual decisions, expect and demand equality, full consent, mutual respect and shared responsibility in sexual relationships. It also entails the right to say ‘no’ to sex if one does not want it.

It’s from sex that reproduction and hence procreation takes place. Reproductive health is, therefore, defined as the complete physical, mental and social well-being in all matters related to the reproductive system including a satisfying and safe sex life, capacity to have children and, freedom to decide if, when and how often to do so.

And reproductive rights are the rights of couples and individuals to decide freely and responsibly the number and spacing of their children, to have the information, education and means to do so, attain the highest standards of sexual and reproductive health and, make decisions about reproduction free of discrimination, coercion and violence.

Impact on women

As we mark International Women’s Day, faces of Alice and many other women who suffer because they have no access to sexual and reproductive health services haunt us. Since the International Conference on Population and Development (ICPD) in Cairo in 1994, it was realised that women are the greatest victims of sexual and reproductive health rights discrimination.

When sexual and reproductive health rights are infringed upon, they have a devastating impact on women’s health and social development as well.

Where a woman is not able to say ‘no’ to sexual advances when she actually has a right to say so leaves her at risk of many problems including contracting HIV and other sexually transmitted diseases. This include inability to have a say on whether her sexual partner should use a condom or not; inability to say ‘no’ to early and forced marriage; inability to say no to Female Genital Mutilation; inability to decide on a specific method of family planning; inability to determine the number of children she would like to have and within what space.

When a woman cannot say no to FGM while it is her body and sexual organs that are being interfered with in a way that will deny her ability to have sexual pleasure while at the same time making her ability to give birth without complications almost impossible, then this is a case of sexual and reproductive health rights abuse.

Rhoda Rotino, Executive Director of Pastoral Communities Empowerment Programme says FGM has been the cause of many reproductive health problems among the pastoralist communities.

"In West Pokot up to 90 per cent of circumcised girls who are 10-15 years old are forced to drop out of school into marriage while the anatomies are not fully developed for child bearing," Rotino says. "The after effect of this, among other health problems, is that most of the girls end up suffering from fistula."

Battered thoroughly

Where a woman cannot go to a family planning clinic and freely decide for herself the method she would like to use without it being dictated by her husband, partner, or community where she lives, then this is an infringement of her reproductive rights; Where a woman whose husband has multiple partners, puts her at risk of contracting HIV and other sexually transmitted diseases because she has no say on whether they can use a condom during their sexual relationship, is a clear case of sexual and reproductive health rights abuse. And it’s known that many women have been battered thoroughly merely for the fact that they said ‘no’ to their husbands’ sexual advances or demanded that their husbands use condoms.

Rosemary Muganda, Executive Director of Centre for Adolescence Health says: "A woman’s inability to negotiate for safe sex is usually due to economic dependence and this puts her at greater risk of sexual and reproductive health problems."

She adds: "A woman must have rights to family planning, the right to decide when and how often to have children; right to safe delivery; right to safe abortion when need arises and right to maternity services that support women to safe pregnancy and safe delivery."

However, Muganda says, these rights are often lacking. This leaves many women at risk. "What happens when a woman cannot access contraceptives?" she poses. "She will get an unwanted pregnancy, too many children that she cannot take care of and her health and that of her children will be in a pathetic state. She will not be able to contribute to her family or community’s development."

This usually happens when a woman lacks access to information that can lead her to making good decisions and making well-informed choices.

The fact that sexual and reproductive health rights of many women are greatly abused calls for need to look at programmes that would involve men in ensuring that women have sexual and reproductive health rights.

Since we live in a society where men have a lot of say over women’s sexual and reproductive health, it’s important that they get involved in the reproductive health agenda. Globally it’s been recognised that lack of men in sexual and reproductive health has been a big impediment to women.

"There are limited interventions that target men," says Muganda.

Equal partners in rights

According to Dr Tatua Caroline of Family Health Options Kenya (FHOK), there is still need to integrate family planning. "It works better when young adults are targeted as equal partners in sexual and reproductive health rights," she says. Already FHOK is working at having behaviour and attitude change among men in Nyando, Homa Bay and Bondo.

Tatua says: "To involve men, there is need to demystify community beliefs by getting to understand that community. Know what the problem is then involve all the stakeholders."

"In rural areas women don’t make decisions on reproductive health and it is, therefore, important that men are talked to as well."

However, since men play an important role in women’s general health, then anything on gender values must include both of them.

Muganda says: "It’s not just about giving information. It involves getting men to adopt behaviour that would avoid risk taking and use them in improving women’s health."

—Jane Godia is Deputy managing Editor, Magazines