Presented at FIGO (Federation for Obstetricians and Gynaecologists)
A sexual rights approach Sexual rights are human rights. A culture that espouses and observes human rights should do the same for sexual rights. The AIDS pandemic has made it pertinent that ordinary men and women, health care providers and policy-makers discuss issues around sexuality and sex. Similarly, sexual violence and other forms of violence against women have reached epidemic levels in some countries, not least South Africa. In order to address both these issues, it is essential that we address sexual rights at all levels of society.
Gender inequality is perhaps the main obstacle to individuals claiming their sexual rights. In a society in which women are subordinated to men, their power to negotiate and engage in decision-making processes is undermined. Failure to recognise this inequality has resulted in policies and intervention strategies that lack a gender focus, and thus fail to respond to women's needs. For example, women cannot effectively protect themselves from sexually transmitted diseases (STDs) including HIV because only male condoms are widely and often freely available. Female condoms are not easily accessible.
Sexual rights as a concept has not received the full attention it deserves. This is primarily because talking about sexual rights challenges historical power bases of gender inequalities that have given men an elevated socio-economic and cultural position over women.
What are sexual rights? The first attempt to describe sexual rights was at the International Conference on Population and Development (ICPD) in Cairo in 1994. Within the definition of reproductive health, is a reference to `a satisfying and safe sex life' and to `sexual health' (United Nations, 1994). Subsequent to that, the Fourth World Conference on Women in Beijing in 1995, described sexual rights as:
The human rights of women include their right to have control over and decide freely and responsibly on matters related to their sexuality, free of coercion, discrimination and violence. Equal relationships between women and men in matters of sexual relationships and reproduction, including full respect for the integrity of the person, require mutual respect, consent and shared responsibility for sexual behaviour and its consequences (United Nations, 1995).
Although the Beijing definition does not use the words `sexual rights', this is commonly referred to as the `sexual rights paragraph', and is the language most commonly understood to form the framework for sexual rights.
In an attempt to give sexuality and sex its rightful position as an issue and concept that must be tabled for the agenda at country level, an international advocacy group, Health, Empowerment, Rights and Accountability (the HERA group) described sexual rights as being,
a fundamental element of human rights. They encompass the right to experience a pleasurable sexuality, which is essential in and of itself and, at the same time, is a fundamental vehicle of communication and love between people. Sexual rights include the right to liberty and autonomy in the responsible exercise of sexuality (HERA, 1998).
The HERA group acknowledges the separate position of sexual rights from reproductive rights, and giving it space as a concept that deserves to be singled out and addressed in its own right. While the Beijing description of sexual rights emphasises control over one's sexuality, HERA emphasises enjoyment and fulfilment of the sexual experience. Thus bringing the two together highlights that in order to experience any enjoyment in an individual’s sexuality, people need to have a fair amount of control. That control can only be possible through a combination of economic, social, political and cultural power.
This approach challenges health practitioners. Whereas it is easy to see why sexual rights are a prerequisite to preventing the spread of HIV and sexual violence, health matters that health workers recognise as their responsibility, this is not enough. We need to adopt the broad World Health Organisation definition of health as, `a state of complete social, psychological and physical well-being and not merely the absence of disease' (WHO, 1986). In this approach, the inability of many people, particularly women to experience their full potential for well-being through a positive experience of their sexuality, becomes a health problem too.
This paper presents the main views around sexual rights as a concept, and discusses the opportunities engaging with sexual rights presents. It then highlights how the debates have shaped one specific framework that we are currently using in South Africa to engage issues of sexual rights.
The debates on sexual rights The high incidence of HIV infection and gender violence, has provided an opportunity to talk about sex and sexuality. Any meaningful engagement with sexual rights requires that we acknowledge and address the unequal gender relations between men and women.
At most levels of service provision, such as in health services, gender and power relations influence care and services provided, with women's needs not being adequately met. For instances when presenting at some clinics for sexually transmitted diseases, women and young girls are often instructed to bring their partners, otherwise they are denied treatment. Health care workers fail to recognise that the burden of disease, and a sexually transmitted disease in particular, is disempowering. Moreover, negotiating with the partner to go for treatment, is an extremely difficult task that is seldom successfully achieved by most women.Failure to observe women and adolescent girls' sexual rights thus renders them unduly susceptible to HIV infection and often violence.
An enabling environment that will challenge these inequalities needs to be defined. Such an environment would by necessity be one that makes possible women's social, cultural and economic independence. It would also enable women to negotiate not only for safer sex, but also for sexual enjoyment and fulfilment. Correa and Petchesky (1994) and Gupta (2000) argue that an enabling environment would give women and adolescent girls power to make choices and maximise their sexual rights.
Debates informing a sexual rights approach
Different agendas with the same goal Sexual rights are about the ability of human beings to make choices about how to express their sexuality and how to conduct their sexual lives (Freedman, 1999) and can mean different things to different people. People's differing realities and the context within which they struggle to realise their sexual rights influence how they interpret the concept. For example, while recognising that societies are heterogeneous, in most industrialised countries such as the United States of America, Europe and Australia, as opposed to developing countries, discussions about sexual rights tend to refer to seeking greater freedom for sexual expression, particularly with regard to sexual orientation. In the South the more pressing debates tend to revolve around the dynamics of how to say `No' to unwanted sexual advances or coercion, particularly for women and adolescent girls. It is about having autonomy over sexual decisions and being able to exercise that autonomy.
Sexual Rights and Reproductive Rights Sexual rights are generally subsumed within reproductive rights as defined in Cairo and Beijing. Within this framework, sex and sexuality generally are considered with regard to heterosexuality and procreation (Miller, 2000). Broad reproductive rights focus on traditional family values that focus on procreation. Women are generally considered only in so far as they play the role of conceiving.
The reproductive rights and needs of people who are not heterosexual and whose purpose in sexual intercourse is not procreation are thus generally ignored. Included in this category are older men and women, adolescents, some heterosexual men and women and homosexual men and women.
This suggests that we need to renew the debates to a more inclusive acceptance of what constitutes sexual rights.
Information
Governments in developing and developed countries have been forced to talk about safer sex, because of the challenges of addressing HIV. However, most are promoting the `A,B,C': abstain, be faithful and condomise strategy (Klugman, 2000) as an intervention and are not engaging issues of gender equality. The ‘A,B,C’ strategy has not adequately addressed HIV and AIDS because it ignores the context within which sexual relations take place. Gender inequality and unequal power relations between men and women subject women to disproportionate infection with HIV and experiences of sexual violence. Abstaining and being faithful are thus not realistic options. The South African society tends to promote a dominant masculinity that validates multiple sexual relationships for men and young boys, while insisting on femininities that disallow women to behave in this way. In addition, we live in a society that promotes a culture of daring and risk taking among men and adolescent boys as masculine where contracting a STD is perceived as a passage to manhood. In this context how can women be advised to abstain or to use a condom?
It is therefore crucial that we look at the dynamics of sexual relations between men and women that tend to be validated by our society to determine the underlying causes of the problem. We also need to look at the social interaction between men and women. Shrouding sex and sexuality in mystery and silence not only ignores the context within which sex and sexuality is experienced (Klugman, 2000; Gupta 2000), but reinforces the status quo.
Women and men need to be protected against HIV infection. While women need protective devices, they also need information in order to maximise their ability to look after themselves and to explore the choices available to them. Women need to know about their anatomy in order to understand what is going on within their bodies. They need to know how and why certain things happen so that they can be empowered to deal with the presenting conditions. They need to know about STDs and how to avoid and treat them. Adolescent girls and boys need to know about the different stages their bodies go through in order to be prepared and to make choices about how to interact and engage with their sexuality.
A female participant at a workshop said: We didn't know about female condoms. Why were we not told about them? We thought only the male ones were available. We didn't know that we could protect ourselves from sexually transmitted diseases…
Traditional patriarchal power relations and female complicity Social support is particularly important with regards to the choices women and adolescents make. The decisions they make about their sexuality and sex lives are informed by the context in which they live. Attitudes to sex and sexuality are usually determined by the norms of a group; these norms are naturalised and diffucult to challenge. A comment by a participant at a sexual rights training workshop echoes the assumptions that women are not supposed to expect sexual pleasure out of a sexual encounter or question the behaviour of their partners or husbands even if those behaviours put their lives at risk.
I complained about my husband sometimes not sleeping at home. Instead of addressing the problem, my husband called his mother and other elderly women to teach me what is expected of a wife culturally. I was told never again to question my husband's whereabouts whenever he comes home late or sleeps out. Instead I should provide him with food and sex... .
Thus taking the sexual rights campaign to all levels of society does not only expand the way in which members of society see and experience their reality, it also creates an awareness of gendered behaviour and the injustices of such issues and collectively, people start sharing a common new understanding.
An elderly woman at another sexual rights training programme said:
This training has helped me realise that my daughter in-law needs all the help and support from all of us in the family and to know that she is not a slave… . She used to do everything while we all sat, I feel so bad about it.
Economic resources An important component in making decisions about one's well-being is economic resources. Economic resources are essential for women to avoid `transactional sex' which may be the only recourse available to them to feed, clothe and educate their children and/or themselves. Because of a lack of alternatives to fulfil their basic needs, women often engage in unsafe sex, sometimes with the full knowledge of the possible consequences of their actions, but with little choice. A participant at a sexual rights training workshop said:
He has five girlfriends. But I can't leave him. I'm terrified because I don't work. He feeds, clothes and gives me shelter. I can't even talk about the condom. I'm trapped. Where will I go and what will I eat?
Most women in countries without a welfare system have to find alternative financial resources for their basic upkeep. This includes money for food, clothing, medication, housing and education for their children. Adolescents sometimes also have to finance their way through school. Mobilising different levels of society like different government sectors such as the education, health, welfare and social services, trade and industrythat can make a difference in women's economic independence is important.
Supportive norms, policies and laws
Engendering respect for the autonomy of individuals' sexual rights is necessary to build a culture of sexual rights. The environment within which women and adolescents can claim their rights needs to be supportive. The culture which promotes the belief that men's rights are more important than women's, needs to be challenged through policies and laws that promote the individuals right to information and physical protection. Government and civil society need to form partnerships to safeguard and promote sexual rights.
As stated earlier, sexual rights mean different things to different people. To some it means being able to say `No' while for others its about separating sexual rights from reproductive rights. Information on how to avoid HIV infection is another factor while the provision of social support when individuals make certain decisions about their sexuality is paramount for others. Adequate economic resources is intricately linked with sexual rights and yet to others supportive norms and policies are the only way through with they can claim their sexual rights.
From our present position therefore, the sexual rights framework is key to fighting HIV/AIDS and violence against women in our society.
Promoting or working with a sexual rights framework means that women and men should have the right to:
* Control over their bodies;
* Only have sex when, with whom and how they want to;
* Decide about their sexuality;
* Not be forced to have sex through the use of violence or non-physical force;
* Have sexual enjoyment;
* Be protected from the risk of disease such as HIV and other STDs;
* Have access to responsive services that help them deal with concerns in relation to their sexual health.
Sexual Rights Campaign in South Africa South Africa is considered to have one of the highest rates of male violence committed against women for a country not at war (Wood and Jewkes, 1997). A recent survey in the Gauteng found that young boys not yet in their teens think rape is a game and declared themselves openly in favour of sexual violence (Martin, 1998). Meanwhile an estimated 4.7 million South Africans are infected with HIV/AIDS with young women from their teens to age 30 constituting the group at greatest risk of infection (National Department of Health, 2000).
Unequal power relations between women and men render women vulnerable to coerced or unwanted sex which, in addition to the enormous psychological impacts and possible immediate physical injuries, places them at risk for contracting STDs and unwanted pregnancy. In addition, it undermines their ability to experience sex as a positive experience and a positive means of building intimate relationships.
The Women's Health Project in collaboration with seven other non-governmental organisations (NGOs) working in women's health and violence against women, adolescent health, and HIV/AIDS have jointly embarked on a drive to promote sexual rights for all South Africans through the Sexual Rights Campaign. The campaign aims to create awareness about sexual rights among South Africans to proactively address violence against women, HIV/AIDS and other STDs and poor adolescent health. While the target group has mostly been women and youth, more and more men intent on making a difference among other men are participating in our trainer of trainers workshops.
Activities of the campaign
1. Training of trainers and sexual rights workshops
NGO and community-based facilitators have been trained and are running sexual rights workshops in rural and urban areas throughout South Africa. The organisations include religious groups and traditional healers, women and youth groups, organisations of people living with HIV/AIDS, organisations of men seeking to make a positive change in relation to sexual and reproductive health, and others. After training participants produce plans of action that challenge gender stereotypes that do not recognise women's autonomy and their equality to men. The plans of action also spell out what the different groups intend to do in order to achieve their sexual rights both at individual and local levels.
In parallel to this process, an impact assessment is being undertaken to assess to what extent these workshops are leading people to take action. For example, as an outcome of a training sessions, a few months ago women took to the streets with placards and marched to a local police station and demanded that:
* Men who violate women's sexual rights be apprehended (ie that current legislation on domestic violence be properly implemented);
* Police officers who are negligent on their duties to assist survivors of domestic violence be charged with being accomplices to the perpetrator .
2. Advocacy to national and provincial politicians and decision-makers Presentations to policy- and decision-makers are made outlining how failure to observe sexual rights results in vulnerability of women and adolescents to HIV and sexual violence. The presentations highlight how mutual respect, choice and shared responsibility for sexual behaviour between men and women can help to address, and hopefully reduce domestic violence and HIV infections among women and adolescents. They put pressure on politicians and government decision-makers to publicly promote sexual rights and also to interrogate the policies and programmes of different government sectors to ensure that they promote sexual rights.
3. Identification of priority actions to promote sexual rights in different sectors National workshops of stakeholders in different sectors (ie police and justice, health, education, youth sectors) are being held to get them to commit to practical interventions. These sectors are key service providers to women and adolescents. In their service provision, issues of sexual rights and decision-making between men and women feature prominently. For instance, the Department of Education can identify and challenge all instances of sexual abuse by students and/or teachers while promoting gender equality and building life skills through the curriculum. The Department of Health can provide supportive and effective care to women, men and adolescents to address violence, STDs, HIV/AIDS, and unwanted pregnancies.
4. Public outreach Community radio stations are engaging the discourse of sexual rights by inviting trainers and members of communities that have undergone sexual rights training to participate in talk shows. Members of the public call in to ask about and debate issues around sexual rights. Posters advertising the campaign and giving contact details are also widely distributed. In addition, the campaign is monitoring how the print media reports incidents of violations of sexual rights. The overall objective is to educate newspaper editors and reporters about how the use of language in such reports can be victim-blaming, thus condoning the violation of women and adolescents' sexual rights.
5. Developing the Sexual Rights Charter (2001) In each of the above processes, participants are defining what sexual rights means to them. They are defining what they need in order to achieve sexual rights within their environment and then committing to actions they will take in order to ensure that sexual rights are observed within their specific sectors. The NGOs coordinating the Sexual Rights Campaign are collecting this information about what is needed to build a culture of sexual rights. In mid-2001 the different views that will have been gathered will be brought together and further discussed to develop a Sexual Rights Charter.
6. Dissemination of the Charter and securing commitment of to its implementation The Charter will be disseminated to different stakeholders and sectors. Signatories to the Charter will be expected to conduct their everyday business to reflect the principles contained in the Charter.
In conclusion, there is an urgent need to put sexual rights need on the agenda at local and national levels. The Campaign has illustrated how ordinary people, professionals, NGOs and inter-governmental coalitions can work together for a common cause.
* We need to talk about sex and demystify it. All people are sexual beings, yet it is very easily the least spoken about subject. We need to break the conspiracy of silence coupled with gender inequality that put women in danger. We have to look at what goes on between men and women.
* It is important to include men and actively target them for training on sexual rights because the issue of sexual rights involves both men and women. Working with only one group of people (e.g., women) when solutions lie in an agreed understanding between men and women may serve to defeat the goal. * We need to remember that gender inequality promotes the spread of physical and non-physical forms of violence and including HIV. Therefore we need to remove gender disparities;
* We need to remember that violence against women in its physical and non-physical forms is completely unacceptable
* Governments have a responsibility to uphold their citizen's sexual rights. Silence around the issue and failure to engage issues such as violence against women and the rising incidence of HIV can be taken to mean collusion with those who undermine women and young people's sexual rights.
* ALL QUOTES CONTAINED IN THE TEXT ARE FROM WORKSHOPS CONDUCTED ON SEXUAL RIGHTS CONDUCTED IN VARIOUS PARTS OF THE COUNTRY BY MBANGI DZIVHANI AND NDIVHUWO MASINDI, WHO AT THE TIME OF WRITING THIS PAPER, ARE TRAINERS AT THE WOMEN’S HEALTH PROJECT.
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