Open the bedroom window: Achieving gender justice in sexual and reproductive health

By Jon Hopkins and Seri Wendoh
International Planned Parenthood Federation

In conversations with women in a rural community in Zambia a few years ago one of the women said “we have all these workshops and talk about opening the window and shining a light on this and that, but why does nobody ever talk about the ‘bedroom window?” In this one sentence she captured the essence of the inherent power dynamics that determine who controls the relationship and the resulting repercussions. In a British context, the teasing question “who wears the trousers in your relationship?” shows the same recognition of power in relationships.

It may seem a little crass to talk about relationships as a “power struggle” of one person against another, but in the world of sexual and reproductive health, this is key to understanding many of the problems brought about by gender inequality.

The excellent blog from February 11 on ‘engendering accountability’ by the ATHENA Network clearly outlined what achieving gender justice should look like and the role that everyone has to play in achieving this through meaningful partnership and accountability. Nowhere more than in the arena of sex, relationships and having children are the consequences of a lack of gender justice in this world magnified.

For a long time sexual and reproductive health has been the sole responsibility of women, particularly as women face a disproportionate burden for using contraception as well as child bearing and child rearing. As a consequence, women who want to avoid pregnancy lack access to effective contraception and there were over 300,000 maternal deaths in 2014. Moreover, more than two out of three new HIV infections are among women in sub-Saharan Africa; and as the February 11 blog pointed out, gender-based violence is predominantly suffered by women mainly committed by men.

Clearly there needs to be an equal and shared responsibility taken by men and women in all areas of sexual and reproductive health. This requires working at different levels with varying partners to address the policies and norms that undermine access and enhance gender inequality. At the International Planned Parenthood Federation (IPPF) – which sees 69 million clients a year in more than 170 countries across the globe – here are five areas where we see efforts need to be stepped up:

• Increase and improve sexual and reproductive health (SRH) service provision for men: Accessible and targeted sexual and reproductive health services need to be provided to all, including men in all their diversity, while ensuring that any changes to services do not have unintended negative consequences on the quality and/or availability of services provided, especially for women and girls. Data commissioned for a recent high level consultation on Men and HIV convened by UNAIDS, Sonke Gender Justice and IPPF showed that whilst HIV transmission is higher among women, anti-retroviral therapy (ART) coverage is lower and AIDS-related deaths are much higher among men [more info here]. Access to a broad range of sexual and reproductive health and HIV services therefore needs to be improved. This can be done by adapting existing services to remove identified barriers and make them more attractive and responsive to men’s needs, and expand those services. To support this, a Platform for Action from the Men and HIV consultation will be released by UNAIDS soon, and IPPF and the UN Population Fund (UNFPA) are in the process of developing a Global Package on SRH services for men and adolescent boys to provide information on this which will be ready in the next few months.
• Get out of the clinic: When men do not have access to services, this is harmful to them, harmful to their partners and harmful to their families. It is critical that policies include more focus on reaching men and adolescent boys with innovative service delivery methods in workplaces, places of worship, sports gatherings and other community venues. Similar approaches should also be used to challenge harmful gender norms that lead to men’s unwillingness to seek healthcare services and gender-based violence.
• Promote shared responsibility: more messaging should be provided to men and adolescent boys on the shared responsibility they have for decisions around contraception, preventing HIV or other sexually transmitted infections, pregnancy and child birth, and as parents and caregivers. The 2015 State of the Worlds Fathers Report provides further information, analysis and recommendations in this area.
• Advocate to change harmful laws and policies that affect access to sexual and reproductive health and right (SRHR) for both men and women: these include laws that prohibit access to safe abortion and comprehensive sexuality education and criminalise key populations and the transmission of HIV. It is also important that there be supportive laws in place that criminalise sexual and gender based violence, rape within marriage and female genital mutilation and where these laws exist their implementation needs to be ensured.
• More evidence and research needed building on programmes that work: a more concerted effort needs to be made at all levels to collect, analyse and disseminate data that is disaggregated by both sexes and can be used to understand how gender relations and other dynamics of power shape sexual and reproductive health, including HIV. We should also ensure that we are building on programmes that are proven to work such as SASA! and Stepping Stones which recently published a newsletter with a focus on engaging men and boys [here]. One area of medical research that needs increased focus and more resources is developing new male led reversible contraceptive methods beyond male condoms, for example in developing a “male pill”.

Cross-cutting all of the above is the need to actively promote women’s empowerment – this can be supported through partnering with women’s rights networks and organisations and promoting women’s leadership, in particular through mentorship programmes with young women and girls.

There is no magic bullet to achieving gender justice in sexual and reproductive health and perfecting the above five areas and having an explicit focus on women’s empowerment will not automatically lead to an end of gender inequality – far from it. But working together in an accountable partnership with everyone in the gender justice movement, it will be possible to readdress some of the complex power relations of the bedroom. We need to open the bedroom window wide, bring in fresh air and so all who live in it can breathe and make their own choices! Wouldn’t it be great if to the question ‘Who’s wearing the trousers?’ the answer is ‘we don’t need trousers, it’s much more fun without them!’