Cathy Vaughan

Participatory research with youth: Idealising safe social spaces or building transformative links in difficult environments?

Freire’s theory of social change informs analysis of youth-focused participatory research, with researchers describing links between participation and young people’s critical thinking. There is less analysis of how youth move from the safe social space of a participatory research project to take health-promoting action in difficult real-world contexts. This article analyses a project conducted with Papua New Guinean youth, disrupting assumptions that critical thinking inevitably leads to critical action on health. Findings suggest the need to shift the focus of participatory research from supporting ‘safe social spaces’ to supporting ‘transformative action in context’ to concretely contribute to improving youth health.

Dialogue, Critical Consciousness, and Praxis

Social psychological analyses of communication inevitably encounter the debate between those social theorists convinced of the possibility of genuine communicative exchange, and those who doubt that effective and properly equal forms of communicative exchange are practically achievable at all. However, what is often overlooked in this debate is the role of interaction between self and other in the development of persons in the first place: The psychology of self-other relations shows that while communication between self and other is indeed a difficult process, fraught with contradictory and destructive energies, it also contains a positivity without which there would be no person at all. (Jovchelovitch, 2007, p. 131) As highlighted in the previous chapter, Vygotsky posits that interactions between self and other are the basis for the development of higher cognitive functions in humans. This chapter will explore the role of self-other interaction in the construction of social worlds, and outline the foundational role of communication between self and other in efforts towards transforming those social worlds (social change).

Beyond ‘working with men and boys’: (re)defining, challenging and transforming masculinities in sexuality and health programmes and policy

In the 21 years since the 1994 Cairo International Conference on Population and Development, those working in the fields of health and sexuality have seen changing ‘men and masculinities’ as central to struggles to improve the health of women and men (Cornwall, Edstrom, and Greig 2011; Peacock and Barker 2014). Efforts to respond to men’s violence and HIV, in particular, have focused on understanding the links between masculinities and men’s health-related behaviour, and increasingly on engaging men and boys as a pathway to transforming masculinities (Jewkes, Flood, and Lang 2015; Mane and Aggleton 2001; Peacock and Barker 2014). Perhaps as a consequence of these efforts, the phrase ‘We need to work with men and boys’ has become something of a mantra dominating health and sexuality programmes. In the past few years, there have been a number of reviews of interventions that have sought to work specifically with men and boys to promote health-enhancing behaviours. These reviews have highlighted the important role that interventions engaging men and boys can have in reducing men’s use of violence against women (Dworkin, Treves-Kagan, and Lippman 2013; Jewkes, Flood, and Lang 2015), increasing access to HIV-testing (Hensen et al. 2014), reducing HIV-risk behaviours (Barker, Ricardo, and Nascimento 2007; Dworkin, Treves-Kagan, and Lippman 2013) and, more widely, enabling men to become more engaged in supporting partners and children (Levtov et al. 2015). However, these reviews also highlight that working with men and boys does not always translate to changes in their behaviour, that changing attitudes about gender does not always lead to behaviours that support gender equality and that intervention effectiveness is dependent on the approaches used and the process and context of implementation (Barker, Ricardo, and Nascimento 2007; Dworkin, Treves-Kagan, and Lippman 2013; Jewkes, Flood, and Lang 2015). Given the growth in the number of programmes and interventions working with men and boys globally, research exploring the processes involved, the challenges, problems, limitations and politics of this kind of work is surprisingly limited. The ways in which women are and could be involved in this work, so as to support and not hinder efforts at changing masculinities, has also received limited attention. It was against this backdrop that this special issue of Culture, Health & Sexuality was conceptualised. A call for papers led to 55 abstracts being submitted for consideration; reflecting on these submissions provides us with an insight into some of the wider contemporary dynamics of the field of masculinities and how this special issue could contribute, potentially stimulating new conversations, reflections and debates. First, the geographical spread of research on this topic was highly skewed towards Africa and in particular, South Africa. In total, 21 abstracts were received based on research conducted in South Africa, and a further 19 were about Africa more widely. Beyond that, 5 abstracts were submitted drawing on work undertaken in Australia, 5 more from Asia, 2 from Europe, and 1 each from Canada, Mexico and the Caribbean. What does this suggest to us? First, it would be correct to acknowledge that this partly reflects existing networks and communities of research, which are reflected in our specific geographic locations as editors in South Africa and Australia, and that English is the primary language of the journal. Second, those writing on a country are not necessarily based there (although this was only the case in the minority of submissions). However the geographical focus of submissions does reflect something wider about the global production of knowledge on masculinities at this moment in the field of health and sexuality. It highlights that much of the recent research on masculinities has emerged in the context of the immediate needs and challenges faced in the global South, particularly those associated with violence and HIV (Shefer et al. this issue). In the early years of the HIV epidemic, the global response focused on communities’ urgent, practical needs and on advocacy and activism for structural and political change (Mbali 2013). Practitioners responding to the epidemic were often informed by debates in relation to Women in Development and then Gender and Development, but less space was allocated to reflection on how gender transformation efforts could contribute to this work (Jewkes et al. this issue). However, over the last 20 years, the often hard lessons of the epidemic have seen HIV researchers and practitioners in southern Africa shift their gaze towards gendered power, masculinities and men’s violence against women. Across the Atlantic, frustration at prevailing discourses about gender equality and the limited attention paid to the struggles of young Brazilian men gave rise to the highly influential work of Program H and subsequently the work of Promundo. In a very important sense, therefore, the global South has been central to the production of knowledge in the field of masculinities, even if the process has often been mediated by the agenda of academic and development partners in the global North (Epstein and Morrell 2012). Collectively, the papers of this special issue significantly upscale existing dialogue around the processes of engaging men and boys in gender transformative work. In the rest of this overview, we highlight a number of key themes we see emerging through the papers.

W-DARE: a three-year program of participatory action research to improve the sexual and reproductive health of women with disabilities in the Philippines

BackgroundIn many contexts, women with disability have less access to sexual and reproductive health information, screening, prevention, and care services than women without disability. Women with disability are also known to be more likely to experience physical and sexual violence than women without disability. In the Philippines, health service providers often have little awareness of the sexual and reproductive experiences of women with disability and limited capacity to provide services in response to their needs. Very limited data are available to inform development of disability-inclusive sexual and reproductive health, and violence prevention and response, services in the country. This paper presents the protocol for W-DARE (Women with Disability taking Action on REproductive and sexual health), a three-year program of participatory action research that aims to improve the sexual and reproductive health of women with disability in the Philippines.DesignW-DARE is a disability-inclusive program that will use mixed methods to 1) increase understanding of factors influencing the sexual and reproductive health of women with disability, and 2) develop, implement and evaluate local interventions to increase supply of and demand for services. W-DARE will generate data on the prevalence of disability in two districts; the wellbeing and community participation of people with and without disability, and identify barriers to community; and describe the sexual and reproductive health needs and experiences, and service-related experiences of women with disability. These data will inform the development and evaluation of interventions aiming to improve access to sexual and reproductive health services, and violence prevention and response services, for women with disability. Local women with disabilities, their representative organisations, and SRH service providers will be involved as members of the research team across all stages of the research.DiscussionThis three-year study will provide evidence about factors undermining the sexual and reproductive health of women with disability in a lower-middle income country, and provide new insights about what may be effective in increasing access to services in settings of limited resources. Findings will be relevant across Asia and the Pacific. Analysis of the program will also provide evidence about disability-inclusion in participatory action research approaches.

Sexual and reproductive health services for women with disability: a qualitative study with service providers in the Philippines

BackgroundThe Philippines has ratified the United Nations Convention on the Rights of Persons with Disabilities and recently passed domestic legislation protecting the sexual and reproductive rights of people with disability. However women in the Philippines continue to report barriers to sexual and reproductive health services, and there is limited empirical evidence available to inform policy makers’ efforts to respond. This study aims to contribute to the available evidence by examining service providers’ perceptions of disability and their experiences providing sexual and reproductive health services to women with disability.MethodsThe study was conducted as part of a larger three-year program of participatory action research that aims to improve the sexual and reproductive health of women with disabilities in the Philippines. Fourteen in-depth interviews and two focus group discussions were conducted with a total of thirty-two sexual and reproductive health service providers in Quezon City and Ligao. Qualitative data were analysed to identify key themes in participants’ discussion of service provision to women with disability.ResultsAnalysis of service providers’ accounts suggests a range of factors undermine provision of high quality sexual and reproductive health services to women with disability. Service providers often have limited awareness of the sexual and reproductive health needs of women with disability and inadequate understanding of their rights. Service providers have had very little training in relation to disability, and limited access to the resources that would enable them to provide a disability inclusive service. Some service providers hold prejudiced attitudes towards women with disability seeking sexual and reproductive health services, resulting in disability-based discrimination. Service providers are also often unaware of specific factors undermining the health of women with disability, such as violence and abuse.ConclusionRecent legislative change in the Philippines opens a window of opportunity to strengthen sexual and reproductive health service provision across the country. However the development of services that are disability-inclusive will require substantial efforts to address supply-side barriers such as prejudiced service provider attitudes and limited capacity. Disability inclusion must be prioritised for the national goal of responsible parenthood and reproductive health to be realised for all.

ASPIRE: A multi-site community-based participatory research project to increase understanding of the dynamics of violence against immigrant and refugee women in Australia

BackgroundOne in three women around the world are or have been subjected to violence. This includes in Australia, where violence against women is an urgent public health and human rights issue. Immigrant and refugee women who have resettled in Australia are known to face barriers accessing services aimed at preventing and responding to family violence. However there is little evidence about the contexts, nature and dynamics of violence against immigrant and refugee women to inform appropriate responses to enhance their safety and well-being. The ASPIRE project will address this gap by identifying opportunities for the development of responsive local and community-based interventions for family violence against immigrant and refugee women, contributing to the currently limited Australian research in this area.Methods/DesignThis participatory research project will work with communities in eight geographic locations (two inner-city, three outer-suburban, and three regional) across two states (Victoria and Tasmania), to generate evidence about immigrant and refugee women’s experiences in a range of settings. The project will engage stakeholders and communities through extensive consultation prior to data collection and by facilitating community members’ participation in generating and analysing data. A mix of qualitative methods will be used to generate rich data about the family, cultural and place-based contexts that shape the prevalence and dynamics of violence against immigrant and refugee women; women’s prevention and help-seeking efforts; and community attitudes about and responses to violence across a range of cultural groups. Methods include in-depth interviews with women who have experienced family violence, key informant interviews with local community service providers, focus group discussions with men and women from predominant cultural groups that have migrated to areas covered by the research sites, and Photovoice with community leaders. Bilingual health educators will contribute to development of the research approach, the collection and analysis of data, and the dissemination of findings.DiscussionFindings from this two-year study will be disseminated to communities, service providers and policy-makers, providing evidence to inform culturally-appropriate prevention and support interventions, and building local communities’ awareness and capacity to respond to violence against immigrant and refugee women.

Exploring Australian journalism discursive practices in reporting rape: The pitiful predator and the silent victim:

This article draws on the qualitative research component of a mixed-methods project exploring the Australian news media’s representation of violence against women. This critical discourse analysis is on print and online news reporting of the case of ‘Kings Cross Nightclub Rapist Luke Lazarus’, who in March 2015 was tried and convicted of raping a female club-goer in a laneway behind his father’s nightclub in Sydney, Australia. We explore the journalism discursive practices employed in the production of the news reports about the Lazarus trial. Our analysis shows how some lexical features, quoting strategies and structuring elements serve to minimise the victim’s experience while emphasising the adverse effects of the trial on the accused. Furthermore, we demonstrate how such practices allow for the graphic representation of the attack in a salacious manner while minimising the impact of the crime on the victim by selectively referencing her victim impact statement. We found some differences between print and online news stories about this case, some of which may be attributable to the greater space available to the telling of news stories online. We conclude that in news reporting of the Lazarus case, routine journalism discursive practices, such as the inverted pyramid news-writing structure and decisions about who and what to quote, serve simultaneously to diminish the victim’s experience while objectifying her. These results build on international findings about media reporting practices in relation to violence against women and add substantially to what we know about these practices in Australia.

Sexual and reproductive health and philanthropic funding in Australia.

UNLABELLED Background Australias philanthropic sector is growing and could support efforts to improve sexual and reproductive health (SRH). However, philanthropy is often misunderstood in Australia and there is limited evidence of philanthropic support for SRH initiatives. METHODS We aimed to understand the barriers and facilitators to philanthropic funding of SRH initiatives in Australia. A qualitative approach was used and involved 13 in-depth interviews with professionals from the philanthropic sector, and from organisations and services involved in SRH. RESULTS Barriers to organisations in seeking philanthropic funding for SRH activities included insufficient resources for writing grant applications and the small financial value of philanthropic grants. Facilitators to seeking philanthropic funding for SRH included a perception that government funding is shrinking and that philanthropic research grants are less competitive than government grants. Philanthropic participants identified that barriers to funding SRH include the sensitive nature of SRH and the perceived conservative nature of philanthropy. Facilitators identified by these participants in supporting SRH initiatives included networking and relationships between grant-makers and grant-seekers. All participants agreed that philanthropy does and could have a role in funding SRH in Australia. CONCLUSIONS The findings of this research suggest that barriers to philanthropic funding for SRH in Australia exist for organisations attempting to access philanthropic funding. Philanthropic organisations could provide more financial support to Australian SRH service providers, as happens in countries such as the United States and United Kingdom. Addressing these barriers and promoting the facilitators could lead to increased awareness of SRH by Australias philanthropic sector.

Australian Media Messages: Critical Discourse Analysis of Two Intimate Homicides Involving Domestic Violence:

This study uses critical discourse analysis to examine news reporting of two cases of intimate partner violence in Australia. The fine-grained analysis of newswriting and news-editing practices focuses particularly on the lexical features and referential strategies used to represent the perpetrator and the victim, the crime, and the location of the crime. Findings show that reporting often omits social context, sensationalizes, and acts to shift blame in ways that do not increase public understanding of the nature of domestic violence. These results build on international findings and add to the evidence base about media reporting of violence against women.

Expectant fathers’ participation in antenatal care services in Papua New Guinea: a qualitative inquiry

BackgroundThe importance of engaging men in maternal and child health programs is well recognised internationally. In Papua New Guinea (PNG), men’s involvement in maternal and child health services remains limited and barriers and enablers to involving fathers in antenatal care have not been well studied. The purpose of this paper is to explore attitudes to expectant fathers participating in antenatal care, and to identify barriers and enablers to men‘s participation in antenatal care with their pregnant partner in PNG.MethodsTwenty-eight focus group discussions were conducted with purposively selected pregnant women, expectant fathers, older men and older women across four provinces of PNG. Fourteen key informant interviews were also conducted with health workers. Qualitative data generated were analysed thematically.ResultsWhile some men accompany their pregnant partners to the antenatal clinic and wait outside, very few men participate in antenatal consultations. Factors supporting fathers’ participation in antenatal consultations included feelings of shared responsibility for the unborn child, concern for the mother’s or baby’s health, the child being a first child, friendly health workers, and male health workers. Sociocultural norms and taboos were the most significant barrier to fathers’ participation in antenatal care, contributing to men feeling ashamed or embarrassed to attend clinic with their partner. Other barriers to men’s participation included fear of HIV or sexually transmitted infection testing, lack of separate waiting spaces for men, rude treatment by health workers, and being in a polygamous relationship. Building community awareness of the benefits of fathers participating in maternal and child health service, inviting fathers to attend antenatal care if their pregnant partner would like them to, and ensuring clinic spaces and staff are welcoming to men were strategies suggested for increasing fathers’ participation in antenatal care.ConclusionThis study identified significant sociocultural and health service barriers to expectant fathers’ participation in antenatal care in PNG. Our findings highlight the need to address these barriers – through health staff training and support, changes to health facility layout and community awareness raising – so that couples in PNG can access the benefits of men’s participation in antenatal care.