Jenevieve Mannell

Conceptualising the agency of highly marginalised women: Intimate partner violence in extreme settings.

How is the agency of women best conceptualised in highly coercive settings? We explore this in the context of international efforts to reduce intimate partner violence (IPV) against women in heterosexual relationships. Articles critique the tendency to think of women’s agency and programme endpoints in terms of individual actions, such as reporting violent men or leaving violent relationships, whilst neglecting the interlocking social, economic and cultural contexts that make such actions unlikely or impossible. Three themes cut across the articles. (1) Unhelpful understandings of gender and power implicit in commonly used ‘men-women’ and ‘victim-agent’ binaries obscure multi-faceted and hidden forms of women’s agency, and the complexity of agency-violence intersections. (2) This neglect of complexity results in a poor fit between policy and interventions to reduce IPV, and women’s lives. (3) Such neglect also obscures the multiplicities of women’s agency, including the competing challenges they juggle alongside IPV, differing levels of response, and the temporality of agency. We outline a notion of ‘distributed agency’ as a multi-level, incremental and non-linear process distributed across time, space and social networks, and across a continuum of action ranging from survival to resistance. This understanding of agency implies a different approach to those currently underpinning policies and interventions.

Women's responses to intimate partner violence in Rwanda: Rethinking agency in constrained social contexts

This paper explores instances of agency in womens responses to intimate partner violence (IPV) in Rwanda. The literature on womens responses to IPV conceptualises agency primarily as an individuals capacity to take action by reporting violence or leaving a relationship, obscuring other ways women may respond to violence in contexts where reporting or leaving are unlikely. We aim to replace this narrow conceptualisation of agency with a social constructivist focus on the meanings women attribute to possible IPV responses. We draw on data from a study of IPV in Rwanda, which includes semi-structured interviews with women experiencing violence and four focus group discussions with women community members (n = 39). Our findings highlight sociocultural, economic, political-legal and historical constraints that shape womens actions in this context. In relation to these constraints, women describe four possible responses to IPV: reporting the violence; seeking emotional support; ‘fighting back’ against violence; or remaining silent. While reporting and leaving violent relationships are identified, women also discuss the social constraints that make these actions extremely difficult. In designing effective strategies, we conclude that public health strategies need to consider womens understandings of their own actions, particularly in social contexts where certain actions may be constrained.

Gender mainstreaming practice: considerations for HIV/AIDS community organisations

Abstract Gender is well recognised as a critical consideration for HIV/AIDS organisations. Since the 1990s, HIV/AIDS policy-makers, donors, non-governmental organisations and transnational corporations have adopted gender mainstreaming as the process for integrating gender into development programmes and institutions. There is an increasing body of literature on the successes and challenges of practicing gender mainstreaming within organisational environments, however, little has been said about this practice within HIV/AIDS-specific organisational environments. As a contribution to this gap, this reflective paper aims to generate debate about some of the considerations for gender mainstreaming practice in HIV/AIDS organisations. It draws on the authors experience conducting a gender mainstreaming review with a southern African HIV/AIDS capacity-strengthening organisation, as well as a review of the development literature on gender mainstreaming. The paper looks at three key issues facing gender mainstreaming: (1) donor requirements on disaggregating data by sex; (2) connecting gender mainstreaming with the priorities of community HIV/AIDS organisations; and (3) the role of resistance to gender mainstreaming as neo-colonial. Preliminary understandings of these issues suggest that current approaches to gender mainstreaming may not be flexible enough to consider the multiple ways gender and HIV/AIDS interact in different sociocultural contexts. There is an urgent need for further debate and in-depth research into these issues, given the challenge they pose for HIV/AIDS organisations and donors that have chosen to make gender mainstreaming a criterion for HIV/AIDS funding.

The inclusion of women, girls and gender equality in National Strategic Plans for HIV and AIDS in southern and eastern Africa.

Abstract The global HIV and AIDS epidemics disproportionately affect women, particularly young women in southern and eastern Africa. UNAIDS, amongst other actors, has singled out National Strategic Plans for HIV and AIDS (NSPs) as a critical platform for ensuring that women and girls are meaningfully included in national HIV and AIDS responses. Despite this, there is little evidence as to how or whether NSPs integrate responses to women and girls. Using a collaboratively developed framework, we assessed how 20 countries in southern and eastern Africa integrated women and girls in their NSPs. We identified that in general there is poor inclusion, apart from access to post-exposure prophylaxis in the case of sexual violence and access to vertical transmission services. Drawing on Mosers distinction between womens practical and strategic interests, we suggest that overall women and girls are poorly included in NSPs, and where there are policies and programmes, there is an overwhelming focus on womens practical interests, without any consideration of womens strategic interests. We argue that this limits the potential of NSPs to be platforms for national responses that meaningfully seek to transform gender relations.

Evaluating social outcomes of HIV/AIDS interventions: a critical assessment of contemporary indicator frameworks

Contemporary HIV‐related theory and policy emphasize the importance of addressing the social drivers of HIV risk and vulnerability for a long‐term response. Consequently, increasing attention is being given to social and structural interventions, and to social outcomes of HIV interventions. Appropriate indicators for social outcomes are needed in order to institutionalize the commitment to addressing social outcomes. This paper critically assesses the current state of social indicators within international HIV/AIDS monitoring and evaluation frameworks.

Patient neglect in 21st century health-care institutions: A community health psychology perspective

Despite the technological and organisational advances of 21st century health-care systems, care scandals and burgeoning complaints from patients have raised concerns about patient neglect in hospitals. This article reviews the concept of patient neglect and the role of community health psychology in understanding its occurrence. Patient neglect has previously been conceptualised as a problem associated with hospital staff attitudes and behaviours, with regulation and training cited as solutions. Yet, a community health psychology perspective shows that the wider symbolic, material and relational aspects of care are crucial for understanding why patient neglect occurs and for outlining new solutions to augment existing interventions.

Adopting, manipulating, transforming: Tactics used by gender practitioners in South African NGOs to translate international gender policies into local practice

This paper looks at what is lost and gained through the process of translating international policy from a global to a local space. It does this by sharing results from a multisite ethnographic study of gender practices in foreign-funded South African health organisations. This study identifies a number of tactics used by practitioners to deal with the funding constraints and unique knowledge systems that characterise local spaces, including: using policy to appeal to donors; merging gender with better resourced programmes; and redirecting funding allocations. These tactics point to how practitioners are adopting, manipulating and transforming international policies in order to suit their everyday working realities.

Conflicting policy narratives: Moving beyond culture in identifying barriers to gender policy in South Africa

This paper explores barriers to gender policy implementation arising from the narratives framing gender as a policy issue. Through examining the influence of gender policy narratives on practitioners, it challenges those who represent policy failures as the result of unsupportive cultural contexts. The paper draws on Fraser’s (1995, 2005; Fraser and Honneth, 2003) conceptualisation of recognition and redistribution to highlight tensions between three different gender policy narratives: (1) gender as instrumental for development; (2) gender as women’s rights and empowerment; and (3) gender as relations of power requiring personal transformation. Interviews with 32 gender practitioners in 26 South African non-governmental organisations and observations of meetings between these organisations show how these narratives lead to unhelpful conflicts between practitioners. These conflicts inhibit both the uptake of gender policy recommendations and collaboration between practitioners in ways that undermine efforts to address gender inequalities in the South African context.

Cisgender male and transgender female sex workers in South Africa: gender variant identities and narratives of exclusion

Abstract Sex workers are often perceived as possessing ‘deviant’ identities, contributing to their exclusion from health services. The literature on sex worker identities in relation to health has focused primarily on cisgender female sex workers as the ‘carriers of disease’, obscuring the experiences of cisgender male and transgender sex workers and the complexities their gender identities bring to understandings of stigma and exclusion. To address this gap, this study draws on 21 interviews with cisgender male and transgender female sex workers receiving services from the Sex Workers Education and Advocacy Taskforce in Cape Town, South Africa. Our findings suggest that the social identities imposed upon sex workers contribute to their exclusion from public, private, discursive and geographic spaces. While many transgender female sex workers described their identities using positive and empowered language, cisgender male sex workers frequently expressed shame and internalised stigma related to identities, which could be described as ‘less than masculine’. While many of those interviewed felt empowered by positive identities as transgender women, sex workers and sex worker-advocates, disempowerment and vulnerability were also linked to inappropriately masculinised and feminised identities. Understanding the links between gender identities and social exclusion is crucial to creating effective health interventions for both cisgender men and transgender women in sex work.

Women’s Ideas about the Health Effects of Household Air Pollution, Developed through Focus Group Discussions and Artwork in Southern Nepal

Household air pollution is a major cause of ill health, but few solutions have been effective to date. While many quantitative studies have been conducted, few have explored the lived experiences and perceptions of women who do the cooking, and as a result are those most exposed to household air pollution. In this study, we worked with groups of home cooks, and sought to use art as a means of engaging them in discussions of how household air pollution from cooking affects their lives. In the Terai district of southern Nepal, we held four focus groups that included 26 local women from urban and peri-urban areas, as well as six local artists. The women then met approximately weekly over four months, and produced images related to air pollution. Transcripts from the focus groups were reviewed independently by two authors, who initially categorised data deductively to pre-defined nodes, and subsequently inductively reviewed emergent themes. Women identified a number of health effects from air pollution. The main physical effects related to the eye and the respiratory system, and women and young children were seen as most vulnerable. The psychosocial effects of air pollution included reduced food intake by women and lethargy. Suggested solutions included modifications to the cooking process, changing the location of stoves, and increasing ventilation. The main barriers were financial. The lived experiences of women in southern Nepal around the problem of air pollution offers a more nuanced and context-specific understanding of the perceptions and challenges of addressing air pollution, which can be used to inform future interventions.