This chapter outlines the obstacles faced, and potential offered, by the post-2015 development framework for advancing the normative framework and commitments for indigenous women’s health in Latin America. An overview of the status of indigenous women’s health in the region is presented, as well as a brief analysis of current normative frameworks at global and regional levels that make reference to indigenous women´s health and the challenges of operationalising these frameworks in national legal frameworks. The chapter discusses how health goals for indigenous women may articulate with more generalized goals related to health, gender equality and women’s empowerment within the proposed new development framework to confront these challenges. It grapples with some of the complexities of including indigenous women’s health issues in the new framework in a meaningful way, as well as the particular potential offered by attention to the intersections between the goals, the related intersectoral action this implies, and the particular importance of the goals related to means of implementation, and particularly disaggregated data, for ensuring accountability.
In challenging dominant discourses on older people as vulnerable and dependent, and their health as marked by frailty and decline, the author demonstrates that stereotypical understandings of what ‘the issues’ are for older people leaves them marginalized, stigmatized and overlooked. Taking the example of neoliberal Britain and alarmist discourses of the cost of Alzheimer’s, and neoliberal India where social provision for older people is negligible and the dominant discourse classes older people as the responsibility of families, stereotypical discourses on frailty, disability, dependence and isolation are shown to marginalize other perspectives, with the result that research into old age rights (or their lack) and into later life activity and mutual interdependence across generations are framed as policy objectives rather than empirical fact. This chapter demonstrates how a focus on what older people do, that is not predetermined by ageist thinking, produces a broader understanding of what determines health in later life.
In the anticipated post-2015 development agenda many Western governments, their development agencies and a range of non-governmental organizations (NGOs) seek to advance an integrated sexual and reproductive health and rights (SRHR) framework. The SRHR framework serves as a bold new paradigm for the work of human rights-informed global health. However, the same development actors behind the SRHR framework have scarcely acknowledged the theoretical and practical tensions that their development efforts have posed for sexual rights. This chapter analyzes these tensions by asking, ‘How has the provision of sexual health impacted sexual rights?’ In answering this question, focus is placed on the logic and strategies of United States Agency for International Development (USAID)-funded HIV/AIDS interventions over ten years (2004–2014) in Ghana for ‘key populations’ (those populations most at risk to HIV). This chapter argues that Western-funded sexual health organizations, and a changing socio-political context in Ghana, facilitated a paradox between sexual health and sexual rights in Ghana. In this predicament, the strategic choices of coordinators and implementers of HIV/AIDS interventions with the aim of maximizing uptake of sexual health services among sexual minorities had the effect of: (1) co-opting sexual rights efforts; (2) silencing their public activism; and (3) incentivizing gender conformity and ‘African’ conceptions of sexuality among its clients and leadership. The chapter concludes by summarizing the findings and applying them to the SRHR framework to offer suggestions for its implementation in international development and how misconceptions of sexuality led to these problems.
Johanna Gonçalves Martín
In this chapter the author contrasts two different ways of understanding and of practicing reproduction by health professionals and by indigenous Yanomami people in Venezuela. Based on medical and ethnographic work in the Upper Orinoco and health system in Venezuela in 2003_2006 and 2009_2011, she presents the ideologies, cosmologies or theories which underlie the making of children for the Yanomami, and standard programmes of reproductive health care for the doctors. To fully understand the equivocations, and especially the troubling experiences of women when they access certain hospital-based services, it is necessary to consider some fundamental principles of the health system in Venezuela. The author describes the historical development of an approach to health that considers both gender and indigeneity, including the contradictions that have emerged at different points. It is of crucial importance to consider that while for doctors reproduction is neatly set apart into a field of conception, pregnancy, childbirth, and reproductive organs and their illnesses, and on a biological understanding of life, for the Yanomami reproduction concerns an animistic understanding of life, in which fertility is a fundamental aspect of well-being and a product of a careful management of inter-species relations in a life-ecology. The author proposes a reflection on other models of reproductive care, and ends the chapter with a call for more aware and engaged forms of interculturality in the context of care.
Very little has been written about the subjective experiences of pregnancy and childbirth among HIV positive women. In the early years of the pandemic it was assumed that very few of these women would want or be able to have children. However the rapid spread of heterosexually transmitted HIV infection in low- and middle-income countries alongside the increasing availability of anti-retroviral therapy (ART) changed the situation dramatically. Research then began on the implications of HIV for pregnancy and childbirth, but the focus was mainly on the protection of the foetus, with the needs and experiences of the women themselves receiving little attention. This chapter begins to fill that gap through a review of the biological, psychological and social challenges faced by HIV positive women in the context of reproductive decision-making and the complex processes of pregnancy and childbirth.
Lorena Núñez Carrasco
This chapter begins by referring to global trends in patterns of migration between men and women and focuses on South_South migration. It examines structural as well as subjective factors influencing women and men migrants to open up the debate on how gendered patterns of migrations impact on health. The chapter draws examples from Southern Africa to illustrate how migration is gendered and how this process is reflected on migrants men’s and women’s bodies. Through examining various phases and forms of migration and various migration settings, it explores the pathways through which mobility ‘engenders’ health risks. The chapter also highlights the invisible role of women as carers for the sick and discusses the role of the sending households and communities as carrying the burden of ill-health of returned migrants. Finally, the chapter problematizes the use of the concept of ‘vulnerability’ in the literature on migration, and debates whether the concepts of structural vulnerability or vulnerable populations are suited to address gender differentials in health and migration.
Marlise Richter and Jo Vearey
This chapter explores the complex intersection of gender and health through the experiences of migrant sex workers in South Africa, a country associated with high levels of population mobility _ both within the country and across borders _ and where sex work is illegal. Drawing on quantitative and qualitative data exploring the lived experiences of male, female and transgendered sex workers in South Africa, and a review of existing legislative frameworks, the chapter unpacks how migration and sex work are critical concerns for gender and health scholars and practitioners. It outlines the range of structural and gendered vulnerabilities experienced by migrant sex workers that are associated with increasingly restrictive immigration legislation, the criminalization of sex work, a strong anti-trafficking agenda, conservative international donor restrictions, and negative public opinion. These vulnerabilities are further exacerbated through direct violence from the police, clients and the general public. The chapter concludes by highlighting the need for structural interventions in health policy and programming by exploring the challenges that exist for health and gender scholars and activists concerned with studying and addressing the health and well-being of migrant sex workers in South Africa and beyond.
Drawing on data from China this chapter explores the linkages between gender, migration and health. The chapter argues that recognition of the diverse ways in which gendered roles and responsibilities shape the migratory process itself, as well as the employment opportunities available to women and men, is critical to understanding the links between migration and health. Evidence from China clearly illustrates the diverse ways in which gendered roles and responsibilities shape the differential health risks faced by women and men throughout the migratory process, as well as determining their access to health care services. Nevertheless, these relationships are complex and at times even contradictory and there is clearly a need for further research to fully understand the dynamics at play.
For several decades, notions of sex drives, urges and impulses have been repeatedly challenged and explored in sophisticated feminist literature on women’s sexualities. As for male sexualities, only queer theory and studies of same-sex sex can make any claim to wide-ranging, complex and nuanced treatments. It is time to ‘queer’ our dull understanding of male heterosexualities. The male heterosexual, despite and perhaps because of its hidden dominance in models of sexuality, has nonetheless too long gone overdetermined and understudied. In particular, this chapter critiques folk and scientific conceptions that would treat male sexuality as naturalized, fixed and entirely distinct from female sexuality.