Barbara Klugman

Balancing means and ends -- population policy in South Africa.

South Africas population trends reflect differences in power education and wealth. The white fertility rate is 1.9 and the African fertility rate is 4.6. Apartheid and labor policies which limit the movement of the African population affect fertility behavior. Social practices which ensured child spacing declined. Population policy was directed to the reduction of the African population which has been forced into 13% of the land. This critique of South African population policy is stated from a feminist perspective and suggests that relations of power are important between partners and between people and society; equitable access to political decision making. Society has an obligation to provide general education and population and health information. In 1983 the Science Committee reported to the President that water resources were sufficient to support 80 million people; this figure was never corroborated but nonetheless was sufficient justification for the formation of a Population Development Program (PDP). PDP aimed to promote community development and to facilitate links between people in order to achieve the development goals. IEC aimed to promote population education or the notion that rapid population growth could not keep pace with the availability of resources. A summary description of the PDP program and its cooperation.

The politics of contraception in South Africa

Abstract This article discusses the social relations surrounding the use of contraception amongst Africans in South Africa. It argues that women are oppressed by the opposing forces of apartheid and capital, interlocked as they are, on the one hand, and patriarchy on the other. The government population control programme seeks to limit the number of children that women have, in an effort to reduce the African population growth rate, as part of the overall strategy to maintain white political and economic domination. Capital to some extent colludes in this process in its desire for a stable workforce and its antagonism towards protective legislation, such as maternity rights, for women. Men, in contrast, tend to be antagonistic towards contraception and to resent the reproductive control which contraception affords women. This article suggests that the double-bind that women experience in this context can only be resolved if gender oppression is addressed within the process of antiapartheid politics so that the struggle for social change does not retain its patriarchal character.

Mainstreaming gender equality in health policy

The health sector has benefited from early policy development and some positive experiences. However, BARBARA KLUGMAN warns, policy is only as good as the capacity to implement it

Developing women's health policy in South Africa from the grassroots

Abstract The Womens Health Conference in South Africa in December 1994 aimed to identify womens health needs and translate them into policy proposals. The process was inclusive and bottom up and cut across barriers of race, class and ideology. Prior to the conference, policy groups developed draftproposals on major areas of womens health, while provincial networking got input from the grassroots. The conference gave women space to talk about their experiences and finalise the proposals. Work on implementation has now begun; some proposals are being used by a number of provinces and by the Ministries of Health and Welfare and the Reconstruction and Development Programmes Gender Commission. In light of the proposal on abortion, the current abortion law is being reviewed by a Parliamentary Select Committee.

Considering Strategic Litigation as an Advocacy Tool: A Case Study of the Defence of Reproductive Rights in Colombia

Abstract Women’s Link Worldwide developed a test to determine when an environment is conducive to social change through strategic litigation. We first present our understanding of strategic litigation, and then discuss four conditions for successful and sustainable change using strategic litigation: (1) an existing rights framework; (2) an independent and knowledgeable judiciary; (3) civil society organizations with the capacity to frame social problems as rights violations and to litigate; and (4) a network able to support and leverage the opportunities presented by litigation. Next, we present examples from our work in Colombia that show how analysis of these conditions informed our litigation strategy when confronting a powerful public official who opposes reproductive rights. Two litigation strategies were adopted. The first case was not successful in the courts, but allowed us to introduce our message and build support amongst civil society. The second case built on this momentum and resulted in a victory. Strategic litigation is a powerful tool to advance rights as well as hold governments accountable and ensure compliance with human rights obligations. The strategies developed can be adapted for use in other contexts. We hope they inspire others to protect and promote reproductive rights through strategic litigation when women cannot fully enjoy their rights. Résumé Women’s Link Worldwide a conçu un test pour déterminer quand un environnement est propice au changement social par le biais de litiges stratégiques. Nous présentons d’abord notre conception des litiges stratégiques, puis examinons quatre conditions d’un changement réussi et durable avec eux : 1) l’existence d’un cadre de droits ; 2) un système judiciaire indépendant et compétent ; 3) des organisations de la société civile capables de traduire les problèmes sociaux en violations des droits et d’engager une action en justice ; et 4) un réseau capable de soutenir et d’exploiter les possibilités offertes par les litiges. Nous présentons ensuite des exemples de notre travail en Colombie qui montrent comment l’analyse de ces conditions a guidé notre stratégie de litige face à un puissant fonctionnaire opposé aux droits génésiques. Deux stratégies ont été adoptées. La première affaire n’a pas eu gain de cause devant les tribunaux, mais nous a permis de présenter notre message et de mobiliser un soutien parmi la société civile. La deuxième affaire s’est servie de cet élan et a abouti à un succès. Le litige stratégique est un outil puissant pour faire progresser les droits ainsi que pour demander des comptes aux autorités et garantir l’application des obligations relatives aux droits de l’homme. Les stratégies élaborées peuvent être adaptées à d’autres contextes. Nous espérons qu’elles inciteront d’autres personnes à protéger et promouvoir les droits génésiques par les litiges stratégiques, quand les femmes ne peuvent pas jouir pleinement de leurs droits. Resumen Women’s Link Worldwide creó una prueba para determinar cuándo un ambiente es propicio para el cambio social mediante el litigio estratégico. Primero presentamos nuestro entendimiento del litigio estratégico, y luego explicamos las cuatro condiciones para el cambio exitoso y sostenible utilizando el litigio estratégico: (1) un marco de derechos; (2) una judicatura independiente y bien informada; (3) organizaciones de la sociedad civil con la capacidad para plantear los problemas sociales como violaciones de derechos y para litigar; y (4) una red capaz de apoyar y aprovechar las oportunidades presentadas por el litigio. A continuación, presentamos ejemplos de nuestro trabajo en Colombia, que muestran cómo el análisis de estas condiciones informó nuestra estrategia de litigio para confrontar a un funcionario público influyente que se opone a los derechos reproductivos. Se adoptaron dos estrategias de litigio. El primer caso no fue exitoso en las cortes, pero nos permitió presentar nuestro mensaje y fomentar apoyo en la sociedad civil. El segundo caso se basó en este impulso y fue victorioso. El litigio estratégico es una herramienta poderosa para promover los derechos y para imputarle a los gobiernos la responsabilidad de cumplir con sus obligaciones relacionadas con los derechos humanos. Las estrategias formuladas pueden ser adaptadas para utilizarse en otros contextos. Esperamos que inspiren a otras personas a proteger y promover los derechos reproductivos por medio del litigio estratégico cuando las mujeres no puedan disfrutar al máximo de sus derechos.

WHO guideline for brief sexuality-related communication: Implications for STI/HIV policy and practice.

Abstract Brief sexuality-related communication (BSC) aims to identify current and potential sexual concerns and motivate those at risk to change their sexual behaviour or maintain safe sexual behaviour. BSC in primary health care can range from 5 to 60 minutes and takes into account biological, psychological and social dimensions of sexual health and wellbeing. It focuses on opportunistic rather than systematic or continuous communication and can be used in conjunction with already established prevention programs. The informational and motivational techniques of BSC enable health care providers to communicate more effectively with their patients, encouraging them to take steps to avoid HIV and sexually transmitted infections. The WHO Department of Reproductive Health and Research, following a review and assessment of existing evidence with regards to BSC, has recently published the guideline on Brief Sexuality-Related Communication: Recommendations for a Public Health Approach. Résumé La communication brève liée à la sexualité (CBS) vise à identifier les préoccupations sexuelles présentes et potentielles et inciter les personnes à risque à changer leur comportement sexuel ou maintenir un comportement sexuel sûr. Dans les soins de santé primaires, la CBS peut prendre de 5 à 60 minutes et tient compte des dimensions biologiques, psychologiques et sociales de la santé et du bien-être sexuels. Elle se centre sur la communication opportuniste plutôt que systématique ou continue et peut être utilisée en association avec des programmes de prévention déjà établis. Les techniques informatives et motivationnelles de la CBS permettent aux prestataires de soins de santé de communiquer plus efficacement avec leurs patients et de les encourager à prendre des mesures pour éviter le VIH et des infections sexuellement transmissibles. Après un examen et une évaluation des données disponibles concernant la CBS, le Département de santé et recherche génésiques de l’OMS a récemment publié un Guide sur la communication brève liée à la sexualité : recommandations pour une approche de santé publique. Resumen La comunicación concisa sobre sexualidad (BSC, por sus siglas en inglés) procura identificar actuales y posibles inquietudes sexuales y motivar a las personas en riesgo a cambiar su comportamiento sexual o mantener un comportamiento sexual seguro. La BSC en el primer nivel de atención puede durar de 5 a 60 minutos y toma en cuenta las dimensiones biológicas, psicológicas y sociales de la salud y el bienestar sexuales. Se enfoca en comunicación oportunista, y no sistemática o continua, y puede utilizarse en combinación con programas de prevención ya establecidos. Las técnicas de BSC informativas y motivadoras les permiten a profesionales de la salud comunicarse de manera más eficaz con sus pacientes y aconsejarles que tomen medidas para evitar el VIH y las infecciones de transmisión sexual. El Departamento de Salud Reproductiva e Investigación de la OMS, después de revisar y evaluar la evidencia relacionada con la BSC, recientemente publicó la guía Brief Sexuality-Related Communication: Recommendations for a Public Health Approach (Comunicación concisa sobre sexualidad: recomendaciones para un enfoque en salud pública).

Remobilising civil society for sexual rights: The establishment of SHARISA

abstract This Profile focuses on a consultation process that began in 2010 and has resulted in the establishment of a new organisation, the Sexual Health and Rights Initiative – South Africa (SHARISA) in 2011. The aim of the consultation was to explore why civil society mobilisation around sexual and reproductive health and rights (SRHR) has declined in the last decade. A total of 53 organisations were interviewed nationally and two consultative meetings were held to review the findings of the interviews and options to take forward recommendations of those interviewed. What surfaced was many different groups, each working on different aspects of SRHR (violence, abortion, sexuality education, sexual orientation, gender identity, gender relations), but no mechanisms to bring them together around shared goals to hold government accountable, and to build a new generation of activists, in a context of declining quality of services, and little effort to shift public opinion in favour of SRHR, except in relation to HIV. The consultations resulted in a decision to establish a new organisation, SHARISA to promote sexual health and rights in South Africa. This Profile describes the process of consultation and the issues which emerged regarding current weaknesses of the SRHR movement that motivated the decisions to launch SHARISA.

Complexity versus the technical fix or how to put sexuality back into sexual health

These reflections consider the failure of the public health establishment to invest in evaluations of interventions that support community groups to shift individual and community behaviours in favour of sexual well-being, sexual rights and sexual satisfaction. This article queries the willingness to invest substantially in researching technical interventions without simultaneously assessing their potential unintended consequences for sexual health well-being; the associated lack of will to invest in social research is also queried. The paper proposes that part of the challenge is the research paradigm that fears complexity, despite growing recognition that sexuality and sexual health are products of a complex intersection of factors, and they require research and evaluation methodologies that recognise such complexity. The paper argues that given the wide-ranging efforts to promote shifts in community norms and practices in relation to sexuality, an opportunity is being lost due to the failure to use ongoing process and outcome evaluations to inform interventions that would provide implementers and groups in communities with resources and ideas to strengthen the quality of their efforts in different contexts, thereby failing to meet the promise of the International Conference on Population and Development.