On August 11, Knowledge SUCCESS hosted Expanding Inclusion: An intersectional lens on FP/RH services for People With Disabilities, Indigenous peoples, and LGBTQI+ communities within Asia. Featuring speakers from Nepal and the Philippines, the webinar explored key insights and lessons learned on what works and what doesn’t when providing inclusive family planning and reproductive health (FP/RH) services in different contexts, and how service delivery changes when identities intersect.
Gayo started the webinar with an introduction and overview of the concept of intersectionality. Intersectionality was originally coined by legal scholar and civil rights advocate Kimberlé Crenshaw in 1989. Originally, Crenshaw created the framework to describe how feminist and antiracist theories and policies relative to the time were not inclusive of Black women’s experiences because they faced discrimination that was unique to them. Over time, people began to share how the term captured their own overlapping identities and experiences. Participants discussed how disability, race, sexual orientation, ethnicity, gender, citizenship, and socioeconomic status can also be reflected within this framework.
Today’s definition: “Intersectionality is […] a metaphor for understanding the ways that multiple forms of inequality or disadvantage sometimes compound themselves and create obstacles that are often not understood within conventional ways of thinking about anti-racism, feminism, or other social justice advocacy structures we have.”
– Kimberlé Crenshaw, Columbia & UCLA Law Professor & Civil Rights Advocate
Marcus Swanepoel from Roots of Health began his presentation with an overview of factors affecting young people’s and indigenous people’s abilities to make healthy and desirable sexual and reproductive health (SRH) decisions in Palawan, an island in the Philippines. As the only SRH organization in Palawan for the last 11 years, Roots of Health has gained a rich understanding of issues affecting both these groups and has applied innovative solutions to meet their needs. Both young people and indigenous people in Palawan face provider discrimination, lack of access, negative perceptions, and misinformation. In addition, young people also face embarrassment, confidentiality concerns, and lack of awareness when it comes to SRH information and services.
To address these barriers, Roots of Health has employed an iterative process that continually incorporates feedback from women and adolescent girls. The organization also considers observations from program implementation to reach underserved communities with SRH information and services. Since its inception, Roots of Health has conducted significant SRH outreach to indigenous communities living in geographic isolation. The program began by training community health workers (CHWs) such as nurses to reach these communities, later incorporating trainings for government health workers as well. Roots of Health found that while these communities were isolated and myths and misconceptions surrounding SRH were common, women and adolescent girls wanted accurate knowledge and accessible services. However, a critical demographic was missing from this outreach: single young women.
To address this, Roots of Health first tried to train young CHWs to encourage young single women to attend information sessions. But when this didn’t work, Mr. Swanepoel and his team decided they needed to go to the source and talk to the women themselves. They found that many of them feared judgment and a perceived lack of confidentiality in speaking with the CHWs. To address this, Roots of Health trained even younger health workers (HWs) who had been teenage mothers themselves. This approach showed promise, and pregnancy rates initially dropped. However, providers continued to discriminate against young single women trying to access services. These findings led Roots of Health to have honest and open conversations with staff about behavior change and practices in health clinics, intentionally ensuring that providers were hired who supported the fundamental human right to contraceptives and SRH information and services. The team also opened clinic spaces specifically for young people and instituted an appointment system that minimized their chances of being seen by waiting patients.
Roots of Health didn’t reach its current operating model without learning and adapting along the way, but the services offered today are significantly more impactful and valued thanks to the journey. Mr. Swanepoel concluded his presentation by recommending that programs listen to their stakeholders and work with them to develop solutions to their challenges.
“If you see something that is not going to work because of an assumption, don’t be afraid to pull the plug. It’s just as important to stop doing the things that don’t work as it is to keep doing the things that do. Adjust and repeat until you find something that works.”
– Marcus Swanepoel, Executive Director, Roots of Health
Ramchandra Gaihre illustrated how people with disabilities experience health and SRH information differently and how the Blind Youth Association Nepal (BYAN) has responded to these needs. He also highlighted how different identities intersect for people with disabilities. Having a disability is a nuanced and multi-dimensional experience, which may include identifying as someone with a cross-disability: for instance, someone might be both visually impaired and deaf. He also mentioned that religious beliefs, being young, and other intersecting identities can have significant impacts on people with disabilities in terms of community acceptance and FP/RH service access. Furthermore, he mentioned that people with disabilities can face a language barrier in accessing information, such the lack of specific sign language signs for SRH or challenges with fully conveying the meaning behind identities within the LGBTQI+ community. Finally, similar to other underserved populations, people with disabilities face the question of when and how to share their intersecting identities and the negative or harmful consequences of that honesty.
Mr. Gaihre shared several ways in which BYAN is addressing these intersectionalities and recommendations for others looking to create more inclusive SRH service environments for people with disabilities. For instance, BYAN has decided to include different categories of disability under one umbrella, allowing for cross-sectionality within programming. Peer groups support young people with disabilities throughout learning sessions on SRH and beyond, in addition to one-on-one learning in which young people receive individualized attention. Furthermore, BYAN also adapts its materials for different disabilities, including creating braille versions for people who are visually impaired, audio versions for people who are hearing impaired, and easy-to-read, highly visual materials for people with intellectual disabilities. BYAN also advocates for increased recognition and accessibility for people with disabilities at the national, subnational, and local levels across Nepal, strengthening the capacity of people with disabilities to demand SRHR services.
Mr. Gaihre concluded his presentation by recommending that those working with people with disabilities, as well as those looking to ensure that their programs are more inclusive, deliberately strengthen the capacity of organizations of people with disabilities to prepare them for donor partnerships. He also encouraged every organization to do an accessibility audit to assess if, when, and how it includes people with disabilities.
“As we say in this work, we make the road by walking.”
– Ramchandra Gaihre, General Secretary, Blind Youth Association Nepal
The webinar concluded with a Q&A period in which Mr. Swanepoel responded to several comments in the chat related to work in schools and peer educators, as well as what hasn’t worked in Roots of Health’s programming. He mentioned several innovative and iterative approaches that Roots of Health is implementing, including communicating data effectively with teachers, expanding and ensuring interactive duties for peer educators, and being mindful of continued challenges around engaging adults on adolescent and youth sexual and reproductive health.
Mr. Gaihre mentioned several tools that the Blind Youth Association Nepal has developed in Nepali in order to perform an accessibility audit.
Mr. Swanepoel shared an evaluation planning tool that helps a user visualize logic models and how pathways of change can be mapped out while designing, implementing, monitoring, and evaluating a program. In addition, you can read more about Roots of Health’s programming and access resources intended for Filipino-speaking audiences on Malaya Ako, as well as specific materials for health workers.