Panel 2

Gender and health in African contexts

Panel organisers: Beth Maina Ahlberg and Anne Kubai, Uppsala University, Sweden

E-mail of panel organisers:

Gender is the socially constructed meaning of the differences between females and males that allocates unequally, social power and privileges to women and men and shapes their identities and perceptions, interactional practices and the forms of institutions created. In this sense gender is a key determinant of health of women and men. Differences established between tend to attribute greater importance and value to "masculine" characteristics but of course there are contextual variations in gender relations depending on legislation culture, ethnicity, age, sexual orientation, religion, etc. Gender norms and values may provoke practices and behaviours that may endanger or protect health. Gender  violence is a major cause of women’s disability and death, but it takes culturally patterned forms such as honour killing in some areas, creation of abnormalities that then require to be corrected through surgical interventions. Among these are cosmetic surgeries and female genital mutilation (FGM). In situations of war and conflict, sexual coercion and rape is a phenomenon that takes a large toll on women’s health. In the related phenomena of forced migration and human trafficking, gender violence is an important element, whereby victims are not only exposed to sexual and psychological violence; but also often sustain injuries and are at high  risk of sexually transmitted infections including HIV and AIDS, if they survive the perilous journeys across the seas and deserts

Approved abstracts Panel 2

1. Professional priorities and public health for women arriving to Scandinavia from Somalia

Author: Hannah Bradby (Uppsala University, Sweden)

There is lack of research regarding the health priorities of new arrivals to Europe in terms of their health status and their own priorities for health care (Bradby et al., 2015). Within maternity care research there is not only a preponderance of professional perspectives, but also a disproportionate focus on genital cutting, particularly with reference to Somali women in Sweden. This presentation considers the research on African migrant women’s health needs in Scandinavia to examine why particular health needs have been prioritised on the public health agenda to the exclusion of others. How processes of stigma and racialization have contributed to the absence of voice research will be addressed.

2. “Ritually bound and sold”: Understanding the role of religious beliefs and practices in human trafficking and bondage of African women to Europe

Authors: Beth Maina Ahlberg (Uppsala University, Sweden),
Anne Kubai (Uppsala University, Sweden)

Human trafficking is a growing global problem which links the origin and receiving countries. According to the UN Office of Drugs and Crime (UNODC) Global report on Trafficking in persons Nigerian Victims were found in 16 countries in Western and central Europe, making up 11% of all victims detected. Citizens of Cameroon, Ghana, Guinea and Sierra Leone, have also been identified as victims of trafficking in many European countries. In many cases, young girls and women are recruited from villages and bound through African traditional religious rituals to human traffickers and madams who received them in the countries of destination and put them to work as prostitutes in the European sex industry. In some cases, African women victims of trafficking who are bound to prostitution are warned against trying to escape by threats of violence, curses or even death as well as threats to their families at home. They are usually kept in isolation, without travel documents or money and deceived into believing that they owe an inflated debt for travel and living expenses. At the same time, they are expected to send money to their families back home in Africa.

During the last five years, large numbers of women and girls from Africa South of the Sahara, are sent to Europe by their families with the hope that they would work and send money back home. These are among the thousands of trafficked persons who have perished in the high seas crossing from North Africa to Italy and Greece. Those who survive gradually move to different countries in Europe, and some of them end up in Sweden. Therefore, in addition to the discussion of the recruitment of women for trafficking purposes, in this presentation we shall examine the role that religion, particularly African traditional religion (as well as some Pentecostal churches) plays in the trafficking of African women and girls.

This contribution is based on an on-going research project called ‘Captured in flight: experiences of violence among African women immigrants in Sweden’ funded by Brottsoffermyndigheten.

Key words: Human trafficking, religious rituals, migration, prostitution, violence

3. Communicating health in limited-media settings: Perceptions and experiences of Ugandan women

Authors: Florence Namasinga (University of Oslo, Norway)
Aisha Sembatya Nakiwala,(Makerere university, Uganda)

Over the years, African countries have focused public health efforts on making essential health information available to men and women to promote the health of the population. Health information has traditionally been communicated through the mass media, yet this still remains difficult in some areas owing to the inaccessibility to mass media. In 2002, Uganda began to depend on a community health worker programme called the village heath team (VHT) to increase access to healthcare and to essential health information in particular. Women participate highly in this programme. While the general performance of Uganda's VHT system is well documented in various studies, issues of communication of health information remain largely unaddressed. The aim of this paper is to examine the perceptions of women involved in the VHT system and accounts of their experiences of communicating about health in a limited-media setting in Uganda.

As part of a broader study, a case study was conducted in Masaka district basing on participant observation, focus group discussions and respondent interviews with six women groups and nine district health administrators. Participants were recruited through purposive sampling in places that had village health teams.

The findings revealed that health information was communicated through a network of community and local structures including schools, village meetings and community spectacles. This was reported to ease networking and sharing of informational and practical support that helped to enhance ability to negotiate barriers to health. Communication was also seen to speed up women's access and use of health services and to reduce the burden on the already overwhelmed healthcare system. However, women questioned the near exclusion of men from the Village Health Teams, insisting that it reinforced a system that puts the burden of health on women.

4. “I just sit all day, what can I do? I have nothing” A discourse analysis of women’s narratives concerning their experiences with obstetric fistula in Kassala state in Eastern Sudan

Authors: Sarah Hamed (Uppsala University, Sweden),
Beth Maina Ahlberg (Uppsala University, Sweden),
Jill Trenhom (Uppsala University, Sweden)

Obstetric fistula is a communication between the vagina and the bladder and or the rectum causing urinary and or faecal incontinence. It is often associated with child marriage, socioeconomic and gender inequalities, which influence women’s decision-making power. The affected women are often stigmatized and isolated. However, previous studies have not focused on power relations that may put women at risk for obstetric fistula as well as how they affect their experiences. Additionally, obstetric fistula has not been studied sufficiently in Eastern Sudan: an area with a very high maternal mortality rate.

The aim of the study was to explore the perceptions and experiences of women living with obstetric fistula in Eastern Sudan, in order to identify discourses that may contribute to the incidence of obstetric fistula and shape women’s experiences. A qualitative study using semi-structured interviews with nine women was conducted. Discourse analysis with a Foucauldian approach was used. Three discourses namely powerlessness, normalisation and resistance were identified.

Powerlessness indicated the existence of power relations between the women, their families, husbands and society regarding circumcision and marriage which influenced their status and experiences with obstetric fistula. Normalisation included an acceptance and internalisation of social norms as absolute truth. Subtle resistance discourse was observed as women tried to take a stand against social norms as well as harassment from the community connected to their fistula. Powerlessness, normalisation and reproduction of social and gender practices contribute to the development of obstetric fistula and the experiences of affected women. Historical, legal, political, economic and global discourses should be analysed to fully grasp the contextual effect when planning interventions to improve maternal health.

5. Exploring opportunities for enhancing adolescent girls transition pathways in Kenya

Authors: Anne Wairimu Kamau (University of Nairobi, Kenya),
Beth Maina-Ahlberg (Uppsala University and Skaraborg Institute of Research and Development, Sweden)

Transition through life stages present individuals with mixed feelings of exciting and anxiety. This is the case for adolescents. Whereas the adolescent period is presented as being characterised by storm and stress, several scholars agree that adolescent transition does not have to be problematic. Although many adolescents’ transit into adulthood with no health challenges, this period presents challenges especially for girls. The challenges of transitions through adolescence often affect girls more than boys. Early sexual debut, teenage pregnancy and the related risks of contracting sexually related diseases remain a concern for boys and girls. Further, the resultant health and social challenges affect girls more than boys. Whereas the adolescents experience these challenges at the individual level, the issue about the kind of sexuality information and services that should be provided for them is still contested for ethical and moral reasons. Thus, whereas girls are expected to remain chaste and avoid sexual engagement before marriage, few mechanisms are in place to help them attain this goal. This paper revisits the issue of adolescent girls’ transition in Kenya. The paper examines the traditional and socio-cultural settings that created pathways for transition of girls through childhood into adulthood. It examines the present approaches that are used to assist girls transit through adolescence. It furthers interrogates whether there are opportunities that could be explored and tapped to enhance pathways for adolescent girls transition in Kenya. These include peer social networks, institutionalised programmes and societal and community systems, including parental support. The paper is based on desk review and primary data obtained through research projects undertaken in Kenya among adolescents’ boys and girls.

Key words: adolescence, adolescent sexuality, transition pathways, sexual health, Kenya

6. Gender, intergenerational dynamics of ethnobotanical health knowledge and socio-spatial transformation

Author: Anne Ouma (Umeå University, Sweden);

The professional knowledge of the Traditional Birth Attendant (TBA), which is embedded in strong socio-cultural dimensions associated with fertility and childcare, is mainly transmitted from mother to daughter, but also from mother to son. A TBA combines within his/her profession other treatments for common ailments in the community. While gender is a factor in ethnobotanical health knowledge transmission, specific innate characteristics of an apprentice predominates the enabling factor for the ‘selected’ individual to acquire ethnobotanical health knowledge and later work within the community.

Gendered and generational dimensions suggest that older and some younger female knowledge holders of ethnobotanical health knowledge and products re-emphasize the values of this gift and knowledge, where it increasingly meets neoliberal processes and engages with an alternative paradigm than the gift economy. A predominance of male knowledge holders in the urban spaces and places, increasingly define the diversification of the profession as a livelihood strategy. The profession emerges into a contested Intellectual Property rights/ Access and Benefit sharing arena, where socio spatial transformations in the region continue to modify the role of male and female TBAs from that of imparting service through a gift to an owned commodity.

Based on empirical studies in the eastern Lake Victoria region, the paper discusses gender as an important dimension in intra and inter-generational ethnobotanical health knowledge transmission which is passed on between older and younger generations in different places, and in turn is influenced by dynamic and changing gender norms and gendered patterns of migration. Aspects of commercialization, commodification of this knowledge, changing health patterns, due to factors among others such as HIV/Aids are discussed.

7. Sites of resilience; Women survivors of wartime sexual violence in the Democratic Republic of Congo

Authors: Jill Trenholm (Uppsala University, Sweden) Pia Olsson, Martha Blomqvist, Ali Bitenga, Beth Maina Ahlberg.

This study is part of an ethnographic focus on the phenomena of war rape in eastern Democratic Republic of Congo. Its purpose was to explore and illuminate how women survivors of sexual violence navigate and negotiate surviving in the stigmatized margins of an already impoverished existence. The paper departs from a previous study where women expressed multiple losses and profound dispossession of identity and subsequent marginalization often with a child born of rape in tow.

The findings are based on eleven qualitative in-depth interviews with rural women of reproductive age recruited from a variety of organizations supporting women after sexual violation. Thematic analysis and Payne’s theoretical framework concerning sites of resilience guided the analysis. Findings indicated how the women exhibited agency, made proactive decisions and demonstrated resilience in severely compromised environments embedded in a larger oppressive complexity.  Faith in God, limited health interventions that challenge cultural understandings around sexuality, indigenous healing, and strategic alliances i.e. aid organizations or survival sex, supported the women in managing their daily existence in the margins. These survival strategies are identified as sites of resilience and provide vital contextual knowledge for planning effective interventions. Findings suggest that strengthening collaboration between existing networks such as the church, health care/services and indigenous knowledge/healing practices would extend the reach of health services, offering more sustainable holistic care, serving not only the needs of the violated individual but the entire traumatized community, whose function as a supportive collective is essential.

To the top