on polarisations and reductionism


I take words and language quite seriously. Seriously enough that the many meanings and interpretations of words are how I make my daily wage. I endlessly debate-internally as well as with other people- one word over the other, weigh political implications (everything, even a simple ‘and’ holds immeasurable weight*), and wonder about the word in context. Invariably, it drowns in jargon and specificity of the work that we do.

It is funny, then, that given my obsession and fascination with words; I still struggle to fully explain what I do. The question ‘What do you do?’ fills me with about as much discomfort as ‘where are you from?’ does.

I could respond with ‘I work in sexual and reproductive health and rights, particularly for women and young people’. I could add more details about advocacy, policy, lobbying, development agendas, negotiations, and movements but these words- taken out of context- mean nothing really. They get caught up in trying to explain themselves with more nothing-words.

I know this because the follow up question is almost always, ‘What does that mean?’.

And that poses a few dilemmas, not least because if we purport to work on these issues because ‘it impacts and influences every aspect and stage of peoples’ lives’ (that’s paraphrasing many an international consensus document); then how is it that nobody knows what I’m talking about?

In attempting to explain the concept- and when I have the time to unpack as many complexities as possible and people have the patience to hear me out, they usually do agree that it’s foundational- it falls upon me to make a decision on how to frame such a fraught political perspective with my own feminist and kyriarchal analyses and not feel as though I’ve come to some strange cop-out between SRHR as a purely health issue, or within the dreaded; über privileged framework of ‘choice’.

This reduction of a vast, complex issue into health and choice is deeply, deeply problematic. Not only does it gut the entire rights discourse behind it, it removes it from the context of autonomy, of justice, of empowerment; removes it from the context of women’s lives. This false idea of ‘choice’- ‘it’s your choice to have an abortion’, ‘it’s your choice to skip birth control’, ‘it’s your choice to have sex’ – it assumes that most women have choices, overlooks that having choices and options- even knowing that you do- are still privileges. It continues to marginalise and overlook the fact that decision-making (and especially for women and young people) is muddied by a complex set of factors: information, money, access to services, stigma, discrimination, age, caste, race, the village you live in, the gatekeepers of services and information, your marital status…

‘Choice’ is sneaky in that it positions the debates as an issue for the individual to decide on- it posits that decision-making is free of societal, historical, systemic oppressions; which is obviously false. This emphasis on the individual reduces the responsibility of the State to ensure that these are all accessible rights, that these are not privileges accessible to a select few, but are actually available to all people. Marlene Gerber Fried has an excellent piece on ‘10 Reasons to Rethink Reproductive ‘Choice’ that I think should be required reading. So the framework of ‘choice; is filled with things I don’t agree with, making it a taboo-word in the ‘What do you do?’ response-spiel.

Framing it as a purely health-specific (usually ‘public health’) concern is also limiting and tends to grate on my nerves. It is easily reduced into ‘maternal mortality and morbidity’ (hello, MDGs!) that everyone can agree on and garners enough support to make it an depoliticised issue to address. Of course women shouldn’t die when giving birth, these are all preventable deaths. The reasons for why women die/suffer serious injury due to pregnancy and childbirth related complications are more than due to direct health/medical related issues. If you can’t get to a hospital in time because it’s too far away and the roads/transportation are/is inaccessible- that’s more than just an issue of health systems. The medicalisation of our bodies also removes us from a rights perspective- it makes ‘health’ about prevention of disease (and therefore cuts out ‘optional’ procedures) rather than about well-being.

It also fits into the larger struggle within the human rights movements themselves. We all (with nary an eyeroll) agree that human rights are indivisible, interrelated, and interconnected, but when it comes down to it; there is a hierarchy of rights. Civil and political rights are seen as the ‘primary’, more important rights with economic, cultural, and social rights (the right to health being one of them) as secondary rights that we can get to in a while after we sort out this civil & political rights stuff. And I want to call bullshit! on this hideous, hideous idea. Rights aren’t optional: you don’t get to say which ones are more important and which ones are less important. You don’t get to barter one set of rights so you can achieve another set.

And ‘health’ and ‘choice’ don’t even come near talking about sex, sexuality, pleasure, orientation, identity, gender- and all these other beautiful, beautiful, beautiful words that make up our SRHR dictionary. How do I talk about breaking the taboo around these issues if I can’t even explain it to someone in the simplest, most accurate way possible? How do I talk about the spectrum of sexual orientation and gender identity, ‘fixed’ and ‘fluid’?

I have to admit that I struggle with this on a daily basis: how much do I share, how do I explain it, and which tack do I take? Given that I live/have lived in rather conservative contexts and that these are really sensitive issues that could derail years and years of work if mishandled, I try to be cautious around what I say. And no matter what I say, I feel as though I’ve betrayed this cause I believe so very much in. I feel as though I’ve wasted an opportunity to do the work I say I do: challenge the silence, challenge the taboos, challenge the misinformation, begin a discussion… and instead, I choose to cop-out by saying ‘human rights’ or ‘women’s health’. I wonder if I’m doing more damage than I am doing any good. I wonder if I’m sabotaging- not to be melodramatic- the ’cause’ because I cannot explain what I do without reducing it or creating polarisations I don’t believe in.

I have to find a better way to explain what I do, what the work that keeps me up at night is. I have to use all these beautiful, beautiful words that are- at their core- about peoples’ lives, dreams, hurts, identities, experiences, realities and not betray them for ‘convenience’, for ‘ease’, for a soundbite. How else do you shift the discourse, change the priorities if you cannot explain a concept?

*For example, there is a difference between ‘sexual and reproductive health services’ and ‘sexual and reproductive health and services’. The latter is interpreted to mean that it includes services such as access to abortion, which aren’t necessarily/always medically necessary procedures.

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Tinderbox: a pyre of women


NPR published an article and an interview with Craig Timberg; the author of ‘Tinderbox: How the West sparked the AIDS epidemic and how the world can finally overcome it’.

The piece is based in the author’s analysis of the HIV/AIDS epidemic (and the subject of his book), and it’s current state. Timberg shares some of the research and data around the beginnings of the virus, the spread to the ‘West’, and opines on prevention programmes. The article sums up the main points that he brings up over the course of the interview.

The opening quote for the article, “In vaginal sex, you can have sex with hundreds of people and not transmit [HIV], it turns out,” made me raise an eyebrow.

Understandably, I think.

All current research (as far as I’m aware) counts women’s physiology as one of the main reasons for why women are more susceptible to the virus, [TL;DR? Just CTRL+F ‘Biology’] which directly contradicts what Timberg claims in the interview.

I haven’t read the book, but going by the tone of the article and his interview; he seems to overlook several key points in his analysis of the epidemic. He doesn’t even mention something central to the current HIV/AIDS situation: women.

The feminisation of HIV/AIDS is one of the most concerning issues in the fight against HIV/AIDS. ‘According to WHOAIDS, the HIV/AIDS infection rate is constantly on the rise in women. In Africa, women represent 59% of adults living with the AIDS virus and three quarters of HIV positive women live in Sub-Saharan Africa. On a worldwide scale, 17.3 million women aged 15 years or more live with HIV, making up 48% of the world’s total. In Asia, Eastern Europe and Latin America, there is a growing number of women and girls living with HIV/AIDS’ [source]. Obviously all of this is further exacerbated by the existing gender disparity, the prevalence of violence against women, the lack of negotiating spaces, early marriage, and female genital mutilation; amongst others. The burden of dealing with the AIDS epidemic also falls on women- supporting families that’ve lost the main bread-winner to the virus, dealing with vertical transmission (mother to child),  as well as the stigma and discrimination that specifically targets women.

So I do not understand an entire interview that does not even mention how 50% of those living with HIV are women. That makes no sense to me.

In addition, I have grave objections to consistently pushing male circumcision as a magic solution to the epidemic.

He says, “The essential fact is that a man’s foreskin is a different kind of tissue than the other parts of his penis. It’s a little softer, it’s a little thinner and it’s more easily penetrated by the virus. And so a man who doesn’t have a foreskin is much less likely -70% or so less likely- to get HIV, and crucially; the man who can’t get HIV can’t give it to anyone else, can’t give it to anyone else, can’t give it to anyone else. There’s a chain of consequence when you block one infection. ”

Anyone who has read enough around male circumcision and HIV transmission, knows much; much better than to say things like ‘the man who can’t get HIV’ when talking about circumcision. That’s an idea that must not be propagated. It sounds as though I’m nitpicking, but if you listen to his repetition of the ‘can’t give it’- that’s underscoring an incredibly flawed idea. Circumcision does not stop the spread of the infection, it just lowers the possibility of infection.

While initial studies have shown a decrease in transmission, it is something that has (on the ground) shown questionable behavioural issues. After circumcision, there were reports of men refusing to use condoms because they believed that circumcision  would protect them from infection. Most importantly, the focus remains on men alone-it is about preventing the spread of infection in men. Male circumcision programmes look at reducing female to male transmissions more so than others (see the previous link)- and transmission of female to male infection is already considered less likely than male to male or male to female transmission.

These programmes do not, in any way, specifically address the needs of women and girls.- it does not give them the control over their own health/safety or the answers to an epidemic that they are physiological, culturally, and socially more vulnerable to.

In fact, all the examples he uses or references are specific to men. Even an evocative image of a radio advert that utilises a young girl to beseech/guilt her father into coming home- is about her father. It is not about that little girl, her sister, or her mother.

I’m also uncomfortable with how Timberg consistently uses incredibly disempowering imagery and language to describe socio-cultural interactions. I chafe at his use of the word prostitutes- he means sex workers, specifically in the context that he’s addressing.

This is especially true when speaking of the African context- he attempts to explain the polygamous practices, but does not delve into the socio-economic implications. He alludes to young women who have older partners who pay for their education, for example. This form of transactional sex is beyond just sex or about gifts- it is about the very particular issues of a power struggle, of access, and of a patriarchal society. This complete lack of contextual understanding of how it drives the epidemic, and specifically so for women, is shocking. I shudder to imagine how he conveys these sensitive ideas in his book, if he cannot adequately capture this in his spoken interview.

Throwing around phrases such as ‘Stay home, stay safe’ echoes a morality framework that has been proved ineffective and inefficient. While he briefly mentions the ‘abstinence based’ policies of the US government (still continuing, by the way. It did not shift under the Obama administration) and supports an open approach to sex and sexuality; again his comments are very, very specific to men.

There are a number of other issues in his interview and in that particular accompanying article; but I was also surprised that he mentioned funding and HIV/AIDS programming that is driven by the West; but did not even breathe a word about the current funding crisis, the cancellation of Round 11 (that had a particular impact on Africa), or even mention treatment and access to treatment.

I’m  a little curious to see whether he mentions the forced sterilisation and coerced contraceptive use programmes targeted at positive women as he analyses some of the disastrous HIV prevention campaigns. A little curious, but not enough to make myself read his book. Especially when he completely ignores 50% of the very people he is speaking about. The very people that Kofi Annan said, ‘The face of HIV/AIDS is a woman’s face’ about.