Last week I had the opportunity to observe a workshop about sexual and reproductive health and rights, with a focus on abortion. The workshop was run by the same organization, Ipas, that is funding the grant I am working on. Ipas focuses on women's health and reproductive rights, clearly. I was there partly out of personal interest but also because we will probably be integrating part of this curriculum into ours for the grant. The audience was mainly home based health workers from Mpilonhle, mostly women who don't speak a lot of English. They service homes with HIV+ learners or homes of learners who have an HIV+ person living with them. The workshop covered basic sexual and reproductive health and rights and then focused in on abortion, reviewing the legislation in place in South Africa, doing values clarification exercises, and having discussions. The challenging part for me was that most of it was in Zulu. God, what I would have given to understand what those people were saying. Clearly they were having very engaging and passionate discussions, and I could only imagine what was transpiring. This experience alone inspired me to learn Zulu. I was so curious to hear their voices on this issue that is so challenging. What is their understanding of it? What are their questions? How do they feel about it? Why? As discussed in yesterday's post, it is so valuable for me to experience an issue firsthand in order to really understand it, see it and feel it as they do, rather than assuming I know. There is a clarity that comes with personal experience that sticks with me in a way that I can't achieve no matter how many times I've read or been lectured on the material.
Though I was not able to understand much of anything being said, I was still able to achieve this enlightenment. It came through the values clarification exercises. They were particularly interesting to me because I had actually participated in some of them in similar workshops back home, like Four Corners, where a statement is read aloud and you stand in a corner designated strongly agree, agree, disagree, or strongly disagree depending on your stance. In this exercise it was interesting to observe the similarities of the outcomes to those at home, for example there was never a complete consensus with any of the statements, there was always a spectrum of opinions. The exercises were also more action based, not a lot of talking, so I could observe and understand what was going on, and the point being portrayed.
My moment of clarity came during the exercise called "Cross the line..." where a statement is read, and if it is true for you, you step over the line. The first statement was "You were raised to believe that abortion should not be openly discussed". Most people crossed the line. Not surprising. Second statement: "At some point in your life, you believed abortion is wrong". Everybody crossed the line. Again, not surprising. It's understandable that anyone would struggle with this issue and easy to believe that at some point it crosses everybody's mind that it is wrong, especially in a more conservative culture. Then the third statement: "You were raised to believe that abortion is a woman's right". Not a single person crossed the line. Not one. This is the one that got me. Sure, the response to the other two might of suggested this response, but for some reason the stillness and quiet of not a single person moving was astonishing. I wasn't expecting a lot, don't get me wrong, but at least one. A single person that had the potential to carry on the message, normalize even the idea of someone having this opinion. But, no. This message relies on outside forces, such as Ipas, to come in and provide education. It is one thing to foster a movement that has its strongholds, its another to come in and totally introduce a whole new way of thinking.
And here we run into the challenge faced by most every public health issues as well as many other issues burdening mankind, economic, political, etc, etc. I've personally been reading all about it in my research about teenage pregnancy. All these issues are complex and multi-faceted, and we must respect them as such. We have learned that trying to tackle an issue through an intervention focused solely on one aspect will quickly be overwhelmed by the influences of the other aspects involved. So, now we take a big picture approach and try and intervene on many levels. We have found that we can successfully reach individuals, communities, and even governments. But, the factor of culture remains a stronghold, the source of stigma and shared beliefs. There is no proven method to influence culture nor its stigma and beliefs. So, what do we do? Like I mentioned yesterday, we do what we can! Like Ipas coming in to initiate dialogue about abortion among rural Zulus, or Mpilonhle working to normalize HIV testing in learners by coming back year after year to these schools to do repeat screening. Does it help? Not totally sure. Culture moves and changes at its own pace. What influences it and how remains unclear. It can get frustrating, that's for sure. And sometimes I question, am I really helping/doing good if I'm having to come in and introduce an entirely new viewpoint? Or am I just inflicting my own views, my own opinion of what's right, on these people? But, then you look at the maternal mortality rates, especially those associated with botched abortions, or the HIV prevalence rates, and it's obvious something needs to be done.
With all this pondering, I was very excited to find a New York Times article on the developing field of research around the link between culture and poverty:
http://www.nytimes.com/2010/10/18/us/18poverty.html?_r=1&scp=1&sq=poverty,%20culture&st=cse
A nice tie in and definitely worth a read.
At the end of the day, I will always remember how not a single person crossed that line, and how the issues of abortion in South Africa suddenly made sense.
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