Community-based Methods to Address Social Inequities in Sexual and Reproductive Health

This slide presentation for the Global Health Council 2006 Annual meeting explains applying methods to address social inequities that affect reproductive health (RH). It lists possible determinates of RH in two groups: 1) information and health services; and 2) personal or economic safety, social success or failure, personal identity, and social or cultural survival. The presentation defines social inequities and gives statistics to support the fact that lower-ranking individuals and groups suffer more negative health consequences.

The presentation describes the following tools for analysing and addressing social inequities:

1. Power and vulnerability body mapping - illustrated as a full-body drawing created at a Vietnam workshop designed to build agency and self esteem, as well as explore issues of power and vulnerability related to sexuality;
2. Process of challenging inequities - exemplified by the Maternal Health in Malawi programme. This programme uses dialogue/discussion for preparing staff to move from the personal transformation of learning to facilitate challenging dialogues to the external function of choosing challenging topics for discussion and transforming the stakeholder community into change agents.
   
3. Interactive forum theatre - illustrated through a description of this theatre format as it was used in the Republic Georgia which explored the topic of abduction and rape of girls.
   

The presenters discuss social dynamics that represent a shift in what is considered "normal" - as evidenced in changes in personal perspectives and public willingness to discuss "taboo" topics and increased tolerance for behaviour that defies harmful norms. The presenters conclude that:

• Equity can serve as an entry point for discussion on social determinants of health;
• Iterative learning cycles focusing on personal and external change are critical;
• There are inherent risks to challenging cultural norms; and
• The internal/external cycle takes longer, needs systemic and sustained effort, and can't happen without personal relationships, but shows promising local results.