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Basics
and Beyond
A Manual for Trainers
Integrating Sexuality, Sexual and Reproductive Health and Rights
- loo
p*
TARSH!: Basics and Beyond
Introduction
Anyone who has worked on contraceptive choices, HIV prevention,
sexuality education, or even the management of sexually transmitted
infections or reproductive tract infections, will agree that these issues
are interconnected. But for most part, sexuality, sexual health,
reproductive health, and their connections with each other as well as
with human rights have been addressed as separate issues and concerns.
Now, however, these connections are being articulated with increasing
authority and influence, especially after the International Conference
on Population and Development (ICPD) in Cairo in 1994, and the
Fourth World Conference on Women (FWCW) in Beijing in 1995. Still,
more than ten years later, many practitioners feel inadequately prepared
to address and integrate these issues effectively in their work. They may
not have the language to talk about them or the information and comfort
levels to discuss them confidently.
The Why and How of Basics and Beyond
Because sexuality is complex — being deeply personal yet highly socially
regulated - it can often be difficult to address. It calls for appropriate,
culturally relevant and creative training material to provide a multi
layered knowledge and understanding not just of factual information
about bodies and how they operate sexually or of how infections are
transmitted or prevented, or how contraceptives work. It also requires
developing an understanding of how these play out in a given socio
cultural context and an appreciation of how connecting sexuality to
human rights makes for better health and improved well-being.
Basics and, Beyond provides training content, tools and methods to
demonstrate and strengthen the connections between sexuality, sexual
health, reproductive health and human rights. It is based on TARSHI
trainings for practitioners on sexuality since 1999 and on trainings on
sexuality, sexual health, reproductive health and rights since 2003. Most
of the exercises in this manual have been developed and tested at these
training programmes. Some exercises have been adapted from other
sources that have been duly acknowledged. In a few cases, it has not
been possible to trace the original creator of an exercise because the
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TARSHI: Basics and Beyond
exercise had been widely used and much modified long before we
encountered it. We have received and incorporated feedback on the
contents of the manual from various experts in the field and welcome
further feedback and suggestions for improvement from users.
Who can use it
Basics and Beyond is a valuable resource on sexuality, sexual health,
reproductive health and rights for individual trainers as well as
organisations working on these issues. It provides resources to effectively
conduct a training course on these issues for participants working in a
variety of related fields. Exercises in the manual cover basic concepts
along with more complex issues. Detailed message points and
instructions for each exercise make Basics and Beyond appropriate for
both experienced as well as novice facilitators. The exercises combine
information on sexuality, sexual health, reproductive health and rights
to elicit discussion and build clarity and understanding for participants
on a variety of subjects and topics. The exercises also give participants
tools and ideas to implement these issues in thei^ day-to-day work.
Because Basics and Beyond contains a substantial number of handouts,
it can also be used as a mini-compendium of basic facts about sexuality,
sexual health, reproductive health and rights. It can therefore be used
as a resource book by individuals and organisations interested in a basic
or more complex understanding of the themes of the manual, by those
looking for new ideas on these issues, and those that want to link and
integrate these issues more effectively into their advocacy and work.
How to use Basics and Beyond
Basics and Beyond contains five modules in addition to a special section
for facilitators (Preparing To Train). It contains over 75 exercises covering
more than 70 hours of training time.
The chapters and exercises in each module have been constructed and
organised to systematically build on concepts and ideas — earlier chapters
in a module lay the foundation for a deeper and more complex discussion
in later chapters. Similarly earlier exercises in a chapter establish basic
ideas whereas the later exercises introduce more complex concepts.
The manual can be used in a variety of ways depending on the
facilitator’s goals and the level of understanding, experience and nature
of work of the participants. A facilitator can pick and choose exercises
from the modules that address issues relevant to the training group’s
needs and can tailor sessions accordingly. The manual can also be used
in its entirety to conduct a comprehensive training programme. A sample
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TARSHI: Basics and Beyond
7-day training schedule that combines a variety of the issues covered in
the manual can be found in the section Preparing to Train. This is only
an example of a training schedule to stimulate ideas on how to use the
exercises and topics. Each facilitator should evaluate the needs and level
of understanding of the group being trained and choose topics and
exercises accordingly.
The Structure of Basics and Beyond
Bastes and Beyond begins with a section for the facilitator called Preparing
to Train. This section is intended to increase the facilitator’s
understanding and capacity to train on the topics covered in the manual.
Using exercises and information handouts, this section provides a
foundation for the facilitator to become comfortable and confident about
issues of sexuality, sexual health, reproductive health and rights. In
addition, Preparing to Train includes general training tips and ideas to
give the facilitator basic tools and methods to conduct an effective and
interesting training. Whether the facilitator using this manual is
experienced or not, going through this section will ensure a more effective
and comprehensive training.
Preparing to Train is followed by five Modules. Each module has the
following components.
Module Introduction: Every Module has an overarching theme and
contains chapters that address different aspects of this theme. The
introduction includes a list of the exercises for the chapter, and
assessment options to evaluate the training session.
Chapters: Each chapter in a Module begins with an overview and
rationale for the chapter that prepares and guides the facilitator about
the main themes and messages of the included exercises. It also contains
additional resources that facilitators can explore and use to learn more
about the topics covered in the chapter.
Exercises: Every exercise outlines the objectives for the exercise along
with the materials required, duration, advance preparation and handouts
needed. It also contains the key messages the facilitator needs to
communicate, tips on how to train effectively on the topic, and how to
connect the ideas brought up in the exercise with other issues in Basics
and Beyond.
The Appendices at the end of Basics and Beyond contain Internet links
to selected relevant human rights documents (Appendix A), and a sample
listing of films that can be used to enhance the training process
(Appendix B).
3
TARSHI: Basics and Beyond
Contents
Preparing To Train
Chapter 1: Exploring Knowledge and Attitudes
Chapter 2: Tips and Tools for the Facilitator
Module 1: Basic Concepts on Sexuality
Chapter 1: Sex, Sexuality and Gender
Chapter 2: Sexual Identity and Gender Identity
Chapter 3: Sexuality Through Life
Chapter 4: Pleasure and Eroticism
Module 2: Sexual and Reproductive Health
Chapter 1: Sexual and Reproductive Anatomy and Physiology
Chapter 2: Conception, Contraception, Abortion
Chapter 3: Infertility and Assisted Reproductive Technologies
Chapter 4: HIV/AIDS, Sexually Transmitted Infections and Reproductive Tract Infections
Chapter 5: Sexual Problems
Module 3: Sexual and Reproductive Rights
Chapter 1: Human Rights Basics
Chapter 2: Understanding Reproductive Health and Rights
Chapter 3: Sexual Health and Rights
Module 4: Beyond Basics
Chapter 1: Sexuality and Power
Chapter 2: Stigma, Discrimination and Marginalisation
Chapter 3: Sexuality and Disability
Module 5: Making it Work
Chapter 1: Values and Principles
Chapter 2: Ethics in Practice
Chapter 3: Learning from Others
Appendices
Appendix A: Some Relevant International Documents Related to Rights and Ethics
Appendix B: Sample Listing of Films Related to Sexuality, Sexual and Reproductive
Health and Rights
4
Preparing to Train
PREPARING TO TRAIN
Introduction
In creating this manual, we recognise that a range of facilitators
and groups with varying levels of knowledge and skills use this
resource. With this in mind, we created this Preparing to Train
section, modelled after a ‘training of trainers’ approach. Preparing
to Train recognises that some facilitators may come to the issues of
sexuality, sexual and reproductive health, and rights for the first
time; some may want to analyse how these issues intersect with
one another with a fresh perspective; or need to brush up their
information on some aspects of these topics.
Preparing to Train increases the facilitator’s understanding and
capacity on issues of sexuality, sexual and reproductive health, and
rights. It guides facilitators through the primary issues and topics
of this manual using exercises and information handouts. When
worked through in their entirety, in the order presented, these
exercises provide a foundation for understanding basic issues and
the ability to impart training on this information.
Tips and tools are also included in Preparing to Train to enable the
facilitator to conduct an effective and interesting training session.
These include icebreakers, different training methods, and tips on
how to approach difficult training situations.
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TARSHI: Basics and Beyond
PREPARING TO TRAIN
ADDITIONAL RESOURCES:
I • CREA. INh. Adolescent Sexual
and Reproductive Health and
Rights in India. New Delhi: CREA.
• De Bruyn, M. 2002. Gender or
Sex? Who Cares? Skills-Building
Resource Pack on Gender &
Reproductive Health for
Adolescents & Youth Workers.
IPAS.
• JHPIEGO. 2003. Training Works!
What You Need to Know About
Managing, Designing, Delivering,
& Evaluating Group-Based
Training. Baltimore, MD.
JHPIEGO.
Chapters in Preparing to Train
Chapter 1: Exploring Knowledge and Attitudes
• Preparing for Module 1: Basic Concepts on Sexuality
• Preparing for Module 2: Sexual and Reproductive Health
• Preparing for Module 3: Sexual and Reproductive Rights
• Preparing for Module 4: Beyond Basics
• Preparing for Module 5: Making it Work
Chapter 2: Tips and Tools for the Facilitator
• Planning a Training
• Setting Expectations and Ground Rules for a Training
• Selection of Training Methodologies
• Ideas for Icebreakers and Energisers
■ Trouble Shooting Challenging Situations in Training
• Mertus, J., Flowers, N., Dutt, M.
1999. Local Action Global
Change. UNIFEM and The Center
for Women's Global Leadership.
■ TARSHI. 1999. TheRedBookWhat You Need to Know About
Yourself 110-14 Years/. N. Delhi.
;
I
• TARSHI. 1999. The Blue Book What You Need to Know About
Yourself115+ Years/. N. Delhi.
■ Youth Coalition. For a list of
training resources on young
people and sexual and
reproductive health and rights,
see resources section of http://
www.youthcoalition.org
• Ideas for Training Assessments
TARSKI: Rasies and Beyond
PREPARING TO TRAIN
Sample Training Schedule
Below is a sample training schedule for seven-day training session using this manual. Please note this
is only a sample and does not include all the exercises from the manual. It may not be appropriate for
all audiences or cover all essential topics required for all participants. Please use this sample as a guide
to how the manual can be used for training on sexuality, sexual and reproductive health and rights. A
blank sample training schedule can be found following this sample agenda for facilitators to fill and
plan their training.
EVENING BEFORE DAY 1: ORIENTATION TO THE TRAINING
TIME
SESSION
RATIONALE
4:00-5:00
Introductions
To introduce participants to each other the day before the training begins.
5:00-5:30
Expectations from the Training
Set expectations in order for facilitators and participants to know how the
5:30 - 5:45
Ground Rules
training will be shaped and what it will focus on.
Establishing the ground rules the day before the actual training will give
participants this foundation before beginning any exercise.
Going through the Agenda, Readings and
To have participants know what to expect and to list their expectations of the
Expectations of the Participants
training.
Tea/Refreshments
To have participants socialise in the group.
TIME
SESSION
RATIONALE
9:30-9:45
Icebreaker
To energise the group at the beginning of the day.
9:45-10:45
Guess the Value
To establish foundation for the entire training by introducing the 5 Core Values
10:45-11:00
Tea/Refreshments
5:45 - 6:30
6:30
DAY 1
that inform Human Rights.
11:05-11:50
Understanding Sexuality
11:50-12:00
Quick Energizer/Break
12:00-1:00
Why talk about Sexuality?
1:00-2:00
Lunch
To establish basics of sexuality for the duration of the training.
To continue discussion of sexuality from previous exercise and help participants
understand why it is important to address sexuality.
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TARSHI: Basics and Beyond
2:00-2:10
PREPARING TO TRAIN
Gender as Social Construct (as an
If participants have background of gender, this is only a refresher of the
Energizer)
concepts.
2:10-3:00
Varieties of Sexual Expression
To increase participants' comfort with ideas of sexuality and behaviour and
3:00-3:45
Good Sex/ Bad Sex
To follow up the previous exercise and help participants examine their attitudes
3:45-4:00
Tea/Refreshments
4:00-5:15
Human Rights Tree
5:15-5:30
Review for next day/ feedback group/
Give any assignments and readings to reinforce the day's learning/ to prepare
other instructions
for the next day's sessions
SESSION
RATIONALE
familiarise them with lesser-known forms of sexual expression.
and dis/comfort with certain sexual behaviour and expression.
An introduction to human rights and their connection to sexuality and
reproductive and sexual health.
DAY 2
TIME
9:30-9:45
Report of previous day
To refresh ideas and see if questions remain from the day before.
9:45-10:15
Freedom To/ Freedom From
To begin discussions on reproductive and sexual rights.
10:15-11:30
Speed questions on Reproductive Rights
Having begun with brief introduction to reproductive rights in previous exercise
with discussion.
now can start to relate it to personal lives.
11:30-11:45
11:45-1:00
Tea/Refreshments
Case Study on Sexuality, Sexual Health
To have more complex discussions on issues of sexual rights and apply
and Sexual Rights
theoretical concepts to a real-life situation.
1:00-2:00
Lunch
2:00-2:30
Why do we have Sex?
To begin a discussion on the importance of addressing pleasure in the context
of one's work and to make participants more comfortable before the next
exercise.
2:30 - 3:30
Pleasure Stories
3:30-4:15
Sex and Gender Identities
To make participants more comfortable with talking about sexuality and pleasure.
Now that sexual rights have been introduced, this exercise establishes that
these rights apply to people of all identities.
4:15-4:45
Tea/Refreshments
4:45 - 5:30
Who Has The Power?
5:30 - 5:45
Review for next day/ feedback group/
Give any assignments and readings to reinforce the day's learning/ to prepare
other instructions
for the next day's sessions
To introduce how people can experience less or more power and opportunities
in society depending on their circumstances, life choices, identities etc.
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TARSHI: Basics and Beyond
PREPARING TO TRAIN
DAY 3
SESSION
RATIONALE
9:30-10:15
Report of previous day
To refresh ideas and see if there are still questions from day before
10:15-11:00
Pre-test Quiz game: Anatomy, physiology,
If participants already have a background in reproductive health, this will be a
contraception, conception and abortion
review and ensure that all are at the same level of understanding.
TIME
10:30-11:15
Tea/Refreshments
11:15-12:30
Case studies on Infertility and Options
After discussing the information-based topics, the participants can begin to
analyse the social implications from a rights-based approach by discussing
surrogacy, adoption and assisted reproductive technologies.
12:30-1:30
My Views on Abortion
1:30-2:15
Lunch
2:15-4:00
HIV/AIDS Basics
To help participants clarify their own values and attitudes to abortion and to
listen to other viewpoints as well.
Some participants may have experience in HIV/AIDS related issues. This
exercise can be a review for them and provide information to participants with
little knowledge of the topic.
Tea/Refreshments
4:15-4:15
Film screening ISee Appendix B for list
4:15-5:30
of filmsl
The film can be on any of the topics discussed thus far. Films break the
monotony of a training course and are an effective way of getting ideas across/
starting discussions on a topic.
5:30-5:45
Review for next day/ feedback
Give assignments and readings to reinforce the day's learning/ to prepare for
group/other instructions
the next day's sessions
DAY 4
TIME
SESSION
RATIONALE
9:30-9:45
Report of previous day
To refresh ideas and see if questions remain from the day before.
9:45 -10:30
Stigma and Identities
To examine stereotypes related to various identities and how these can
stigmatise, discriminate and marginalise and link it to rights in the context of
sexuality and reproductive and sexual health.
10:30-11:15
Stigma Mapping
11:15-11:30
Tea/Refreshments
11:45-1:00
Abuse of Power: Sexual Violence and
To understand the link between abuse of power and rights in the context of
Harassment
sexuality and reproductive and sexual health.
After discussing HIV/AIDS and identities the previous day, participants can
discuss stigma and discrimination faced by various groups of people.
1:00-2:00
10
|
Lunch
TARSHI: Basics and Beyond
PREPARING TO TRAIN
2:00-3:00
Abuse of Power: Child Sexual Abuse
3:00-3:15
Tea/Refreshments
3:15-5:30
5:30-5:45
As an appropriate continuation of the earlier discussion on abuse of power.
Film Viewing and discussion ISee Appendix
The film can be preceded by brainstorming about a topic addressed by the film
B for list of films)
and can be followed by a discussion to make learning effective and fun.
Reading/ assignments for the day off/
Give assignments and readings to reinforce learning/ to prepare for the sessions
feedback
to follow.
DAY 5 BREAK/ OFF-DAY
DAY 6
TIME
SESSION
RATIONALE
9:30 - 9:45
Report of previous day
To refresh ideas and see if questions remain from the day before.
9:45-11:15
Disability and Sexuality Film Clips
Introduction of this topic, which may be new to participants. Film clips will help
open up discussions and increase comfort with the issue.
11:15-11:30
Tea/Refreshments
11:30-1:00
Representation in the Mass Media
To begin to discuss representation and who and how images and ideas reflect
and influence people's ideas about sexuality and gender and link this to
stereotyping and discrimination.
1:00-1:30
Lunch
1:30-2:45
Negotiating with Other Stakeholders
Continue discussions on representation and link it with freedom of expression
and the right to information
2:45-3.00
Tea/Refreshments
3:00-4:15
Case Studies on Ethical Dilemmas
Switching gears to bring together many of the training topics with a discussion
4:15-5:30
Case Studies on Campaigns for Sexuality,
To continue to apply the ideas and issues of the training to the campaign case
Reproductive and Sexual Health and
studies. Participants will continue to see how these topics play out in their
Rights
work and real situations.
of ethics in case studies based on real-lifesituations
5:30-5:45
Reading/ assignments for the day off/
Give assignments and readings to reinforce learning/ to prepare for the sessions
feedback
to follow.
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TARSKI: Basics and Beyond
PREPARING TO TRAIN
DAY 7
TIME
SESSION
RATIONALE
9:30-9:45
Report of previous day
To refresh ideas and see if questions remain from the day before.
9:45-11:15
Guiding Principles: Assessment
To evaluate how participants integrate the issues of sexuality, reproductive and
sexual health and rights into their work by having them develop guiding
principles for working on sexuality.
11:15-11:30
Tea
11:30-1:30
Parking Lot Issues
To review or discuss issues and questions left unanswered throughout the
training. Facilitator may want to conduct an exercise or have a discussion or
show a film etc to address an issue that was left out/ requires more
clarification.
1:30-2:15
Lunch
2:15-3:00
Assessment of Training
To evaluate how much the participants learned and their opinions on the
3:00-4:00
Farewell exercise and Certificate
To wrap up training with key messages - this can be done as a short slide
exercises and facilitator style.
distribution
presentation highlighting key ideas participants should be taking back from the
training.
4:00pm
Tea/Refreshments
onwards
SAMPLE TRAINING SCHEDULE
Below is a template for a one day training schedule. Depending on the focus of the training and the topics it aims to cover, the facilitator can fill in this
blank schedule with exercises from one module/chapter or in combination with exercises from other modules/chapters
9:30-9:45
Icebreaker
9:45-10:45
Exercise 1
10:45-11:00
Tea
11:00-12:00
Exercise 2
12:00-12:10
Short break/ quick energiser
12:10-1:00
Exercise 3
1:00-2:00
Lunch
2:00-2:15
Energiser/lce breaker
2:15-3:00
Exercise 4
3:00-3:45
Exercise 5
3:45-4:00
Tea
4:00 - 5:00
Exercise 6
5:00-5:30
Review for next day/ feedback group/ assessment of the day's sessions
12
TARSHI: Basics and Beyond
PREPARING PREPARING-Chapter I
Chapter 1
Exploring Knowledge and
Attitudes
This chapter is appropriate for both a novice facilitator who
wants to increase comfort and confidence in addressing
sexuality and related issues, and for a seasoned facilitator to
review key points and examine more complex topics. Sexuality,
sexual and reproductive health, and rights are complex and
dynamic issues. New aspects to these topics constandy arise
and can be approached differendy at different points in one’s
personal and professional lives, and in different contexts,
cultures and times. It is therefore important for a facilitator to
re-visit these issues from time to time in order to present them
in a relevant and comprehensive way to one’s audience. The
exercises and handouts mentioned in this chapter can help a
facilitator with this task.
This chapter refers to certain exercises that appear in the
various modules of Basic and Beyond that can prepare a
facilitator to clarify their own knowledge and views on topics
covered in the manual. It follows the same topical sequence
as the rest of the manual. For example, the first exercises and
topics referred to in this chapter correspond to Module 1: Basic
Concepts on Sexuality. Within each section of exercises, there
is first a brief description of the module the facilitator is being
prepared for, followed by references to the handouts they must
review for the module. The referenced exercises that follow
correspond to exercises in the manual that the facilitator should
look up and go through themselves. These exercises provide
information and concepts covered in the module, introduce
or refresh one’s understanding of the issues, and anticipate
participant questions and concerns.
This section can be completed all at once, or the facilitator
may want to cover the modules over a period of time. These
exercises can also be used as review/revision prior to a training
day for a particular module or chapter.
13
TARSHI: Basics and Beyond
PREPARING TO TRAIN - Chapter 1
Preparing for Module 1
Basic Concepts Related To Sexuality
At the start of any training, it is necessary to establish a sound
understanding of basic ideas and information. This module gives
participants a solid foundation before moving on to more complex
issues. The information and ideas included in Module 1 include
not just definitions for terms such as sexuality and gender, but also
exercises on language and how values and attitudes affect work on
issues around sexuality, sexual and reproductive health, and human
rights. This basic information is particularly valuable if the topic
of sexuality is new to participants. It is also useful for those who
have been working on these issues and want to review these topics.
Exercises to Prepare for this Module:
A review of the following handouts
from the module is recommended in
addition to going through the
exercises mentioned alongside. For
additional information to supplement
these handouts and exercises refer to
Additional Resources at the
beginning of each chapter in
Module 1.
It is recommended that the facilitator go through the following
exercises selected from Module 1: Basic Concepts on Sexuality to
prepare to conduct the exercises in this module effectively.
HANDOUTS:
• Introduction to Module 1: Setting the Tone
Handout 1.2
Basic Information on Sex, Sexuality
and Gender
The objective of this exercise is to describe and discuss the five
core values that act as a foundation for the discussion of sexuality,
sexual and reproductive health, and rights. Understanding the
link between values and sexuality allows for an appreciation of
the advantages of using a rights-based approach to sexuality and
sexual and reproductive health.
• Module 1, Chapter 1, Exercise 1: Understanding Sex and
Sexuality
The objective of this exercise is to understand sexuality as more
than acts of sex and comfortably discuss this with participants.
Issues of sexuality are laden with values, subjective and are not
experienced and expressed in the same way by everyone. Being
aware of these individual differences is important in order to
provide effective services that respect people’s choices and the
opportunities to lead healthier and safer lives.
■ Module 1, Chapter 1, Exercise 3: Understanding Gender
The objective of this exercise is to understand how gender is
socially constructed and relates it to sexuality as well. Social
construction of gender means that it is determined by our social,
cultural and psychological surroundings and environment.
14
What to Review
Handout 1.1
Five Core Values
Handout 1.3
Understanding Sexuality: Terms and
Definitions
Handout 1.4
Basic Information on Sexual Identity
and Gender Identity
Handout 1.5
Varieties of Sexual Behaviour and
Expression
TARSHI: Basics and Beyond
PREPARING TO TRAIN - Chapter 1
• Module 1, Chapter 2, Exercise 1: Sexual and Gender Identities
The objective of this exercise is to understand and define different
sexual and gender identities and to examine common experiences
and issues faced by different identities. Identities are fluid,
changing and personal. Every individual has multiple identities
which intersect in unique ways. For example, someone may
identify as a woman, a mother, a lesbian, a daughter, and a
nationalist. Stereotypes focus on only a single identity of an
individual and may be used to judge a person unfairly.
• Module 1, Chapter 2, Exercise 2: Varieties of Sexual Expression
The objective of this exercise is to acquire awareness of, and
comfort around the diversity and variety of sexual behaviors and
expressions and learn the appropriate terms for these practices.
Recognising the diversity of behaviours helps affirm the rights
of people to engage in consensual sex without fear of judgment
or punishment.
• Module 1, Chapter 3, Exercise 1: Experiences of Sexuality
Through Life
The objectives of this exercise are to appreciate that sexuality is
experienced throughout life and to acquire comfort around
talking about sexuality at different stages of life.
• Module 1, Chapter 4, Exercise 1: Sex for Pleasure?
The objective of the exercise is to explore attitudes and ideas
surrounding sex and pleasure. Pleasure is an important
consideration in the context of sexual health and safer sexual
practices. For example, when safer sexual practices are being
promoted, the fact that people often have sex because it feels
good must be recognised so as to find an effective and ‘userfriendly’ method of protection that does not reduce pleasure.
Talking openly about pleasure and its place in sexual experiences
can also reduce shame and guilt, allow for the expression of fears
and clarify misconceptions around this issue.
• Module 1, Chapter 2, Exercise 6: Representation in the Mass
Media
The objective of the exercise is to recognise how identities are
represented in mass media. These representations can lead to
stereotypes and discrimination. Being aware that sexuality and
sexual and reproductive health related issues are also represented
through language, images, documentation, campaigns,
advertisements, reports and brochures, and documentaries, can
help in designing effective campaigns and communication
materials.
15
PREPARING TO TRAIN - Chapter 1
TARSHI: Basics and Beyond
Preparing for Module 2
Sexual and Reproductive Health
While sexuality is not restricted to the physical body, it is largely
expressed and experienced through the body. Any discussion on
sexual and reproductive health requires a basic understanding of
body functioning. This information-based module is intended to
provide information on human sexual and reproductive anatomy
and physiology, conception, contraception, abortion, infertility,
sexual problems, sexually transmitted infections and HIV/AIDS.
Beyond basic understanding, the chapters explore attitudes and
ideas on these issues and also link them to values and rights, for
example the rights of people to have/not have children, the rights
of HIV positive people to marry, etc.
For the facilitator to be adequately prepared for this module, it is
important to review the information-based material for each chapter
and to examine and analyse the associated issues. The handouts
mentioned alongside provide the basic information for each topic,
while the exercises can help move beyond information and explore
discussions and debates around the issue.
Exercises to Prepare for this Module:
Two exercises follow: one is selected from Module 2: Sexual and
Reproductive Health and the other has been designed for the
facilitator to prepare them for issues brought up in this module
and to conduct the exercises in the module effectively.
■ Module 2, Chapter 1, Exercise 4: Sexual and Reproductive
Physiology
The objective of the exercise is to identify the differences and
similarities in sexual and reproductive physiology. Recognising
sexual functions of different parts of the body and the zones of
pleasure is important and should go hand in hand with
understanding reproductive functions.
• Module 2, Exercise for the Facilitator: Opinions and Ideas
The exercise below combines questions and exercises from all
the chapters in Module 2. The objective is to analyse and engage
in issues related to sexual and reproductive health.
What to Review
A review of the following handouts
selected from the module is
recommended in addition to going
through the exercises mentioned
alongside. For more information to
supplement these handouts and
exercises refer to Additional
Resources at the beginning of each
chapter in Module 2.
SELECTED HANDOUTS:
Handout 2.1 Facilitator Copy:
True and False Pre-test on Sexual
and Reproductive Anatomy and
Physiology
Handout 2.3 Facilitator Copy:
Diagram of the Human Sexual and
Reproductive Anatomy and its
Physiology
Handout 2.4
Participant Copy: Diagram of the
Human Sexual and Reproductive
Anatomy and its Physiology
Handout 2.6
Basic Information on Conception
Handout 2.7
Basic Information on Contraception
Handout 2.8
Basic Information on Abortion
Handout 2.9 Facilitator Copy:
Pretest on Conception,
Contraception, Abortion
TARSHI: Basics and Beyond
PREPARING TO TRAIN - Chapter 1
Look over the following statements and write responses to them.
Do you agree or disagree with them? Why? If you are unsure,
list out arguments for both viewpoints and try to analyse them
using a rights based perspective (See Module 3 for more on rights)
Handout 2.11
Basic Information on Infertility
Handout 2.12
Basic Information on Options for
Infertility
Handout 2.13 Facilitator Copy:
: Myths and Facts on Infertility and
| Assisted Reproductive Technologies
Handout 2.16
■ Basic Information on HIV/AIDS
| Handout 2.17
i Quiz on Basics of HIV/AIDS
: Handout 2.18
■ Testing, Treatment Care and Support
of HIV/AIDS
Handout 2.19
Basic Information on Sexually
Transmitted Infections (STIsI and
Reproductive Tract Infections IRTIs)
Handout 2.20 Facilitator Copy:
STIs and RTIs Pre-test
Handout 2.24
Basic Information on Sexual
Problems
Handout 4.25 Facilitator Copy:
Myths and Facts on Sexual Problems
1.
The most important thing a person can do is to have children.
2.
People should have children only if they are married.
3.
Sex-selective abortion is a woman’s reproductive right.
4.
If a woman is raped it is okay for her to have an abortion.
5.
Abortion should be a woman’s choice.
6.
Abortion should be legal and free.
7.
Mandatory HIV testing is a good policy for couples to be wed.
8.
All people entering the country should undergo mandatory
testing for HIV
9.
A doctor has the right to tell a partner of someone who has just
tested HIV positive of his/her partner’s status without the
consent of the positive person.
10.
All HIV positive women should not be allowed to have children.
11.
Infertility in a couple adversely affects the woman more than
the man.
What are some debates taking place around these issues in your
community at present? Have there been any recent legal actions,
media reports or instances related to these issues? You may want
to keep track of recent debates in your community to learn more
about these. In addition to providing examples for your training,
this information will also help you to make the concepts more
relevant to your audience from the same community.
Handout 2.28
A New View of Women's Sexual
Problems
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PREPARING TO TRAIN - Chapter 1
TARSHI: Basics and Beyond
Preparing for Module 5
Making it Work
Regardless of whether participants work in reproductive health
interventions, sexuality education programmes, or sexual health
clinics, integrating the ideas and information in this manual into
their work can make it stronger and more effective. It can be a
challenge however, to apply the ideas and concepts in this manual
to the work and advocacy we do. How have individuals/
organisations successfully accomplished this before? What lessons
can we learn from the successes and challenges of other campaigns
and programmes? What principles do we need to apply to be
effective and respectful of the people we work with?
Module 5: Making it Work, addresses these questions. It brings
together topics from the other modules and illustrates how these
can be used effectively to improve work in fields of sexuality, sexual
and reproductive health, and advocacy. To provide participants with
these tools, a facilitator should explore different advocacy methods
and how to combine the lessons learned from Basics and Beyond
into practical applications.
What to Review
A review of the following handouts
selected from the module is
recommended in addition to going
through the exercises mentioned
alongside. For additional information
to supplement these handouts and
exercises refer to Additional
Resources at the beginning of each
chapter in Module 5.
SELECTED HANDOUTS:
Handout 5.1
Guiding Principles for Working on
Sexuality
Selected Exercises to Prepare for this
Module:
Handout 5.3
Basic Information on Ethical
Principles
• Module 5, Chapter 2, Exercise 3: Ethical Dilemmas
Handout 5.4
Sample Ethical Guidelines
The objective of the exercise is to identify ethical issues in reallife situations and examine useful approaches to dealing with
issues of sexuality, sexual and reproductive health, and rights.
Crosscutting principles such as confidentiality, beneficence,
respect and non-exploitation run through the ethical concerns
of training, funding, service delivery and research. The facilitator
can go through some or all the case studies in the exercise to
familiarise themselves with the range of ethical issues and how
they can be addressed.
• Module 5, Chapter 3, Exercise 3: Campaigns for Sexuality,
Sexual and Reproductive Health and Rights
The objective of the exercise is to examine real-life campaigns
and movements on sexuality, reproductive and sexual health and
rights, analyse the successes and challenges of these campaigns
and ascertain how similar ideas and approaches can be used in
other advocacy work.
20
Handout 5.5
Ethics Case Studies
PREPARING TO TRAIN - Chapter 2
Chapter 2
Tips and Tools for the Facilitator
The purpose of this chapter is for facilitators to learn about the
kind of preparation necessary to conduct and lead an interesting
and effective training workshop and to acquire comfort with
potentially problematic training situations and assess possible
ways of overcoming them.
In the previous chapters, the focus was on learning and
preparing to be an effective facilitator in the areas of sexuality,
reproductive health, and rights. At the same time, preparation
is also essential to be an effective overall facilitator regardless
of the subject matter. Being an effective facilitator takes more
than just mastery of information; it also requires an
understanding and awareness of participants in the training,
comfort in difficult situations, enthusiasm, and the proper
application of tools and resources that can benefit and improve
training sessions for the participants as well as the facilitator.
The following sections in this Tips and Tools chapter will provide
facilitators the methods, resources, tools, techniques and
exercises to improve their overall performance. Whether the
facilitator is highly skilled with years of training experience, or
a new facilitator just starting out as a trainer, working and
reading through the sections that follow will ultimately benefit
their professional impact.
The tips and techniques in this chapter are designed to
complement the knowledge from the previous chapter
Exploring Knowledge and Attitudes so that the facilitator may
be able to effectively get the information and ideas across to
their audiences.
TARSHI: Basics and Beyond
PREPARING TO TRAIN - Chapter 2
Setting Expectations and
Ground Rules fora Training
Establishing expectations and setting ground rules during the
introduction and beginning of any training is important to set the
tone. Ground rules firmly establish respect and listening as central
to learning during the training. Expectations also guide the
facilitator to address the specific issues and questions of participants
and inform participants about the scope and focus of the training.
One way of establishing ground rules is through an interactive
exercise in which participants agree upon rules they find
appropriate and essential for the training. Since this method is
participatory and democratic, it helps participants identify with
the rules and therefore adhere to them. As another option, the
facilitator can write the ground rules beforehand. These can be
displayed in the training room or distributed as a handout to each
participant. In this case, the facilitator should read through the
ground rules with participants to ensure that they are understood
and agreed upon. Some examples of common ground rules are
given in the box alongside.
Establishing expectations may be done through individual
questionnaires. The Listing Expectations Questions below can be
copied, handed out to each participant to complete and then
evaluated by the facilitator.
Another option for setting expectations is to have each participant
write out one or more expectations on a slip of paper and post
them on a chart paper in the room.
COMMON GROUND RULES:
■ Respect the ideas, opinions and
views of the other group
members.
• Listen to other group members.
• Maintain confidentiality: whatever
is shared in this space must stay
within it.
■ There is no pressure to share
personal information.
• Punctuality.
• No insults, foul language or
cursing; no discriminatory
language or behaviour.
• No name calling, placing blame, or
making fun of other participants/
resource person/s.
• Any questions can be asked.
• Participate to your fullest capacity,
and encourage quieter participants
to do the same.
Listing Expectations Questions:
• What are your expectations from this training workshop? Please
list these.
• What specifically do you hope to learn from this training?
• What skills do you want to acquire?
• Do you have any background in sexuality, sexual and
reproductive health or human rights? If yes, describe.
■ Are you here voluntarily or are you a mandatory participant,
sent by your organisation?
22
■ Feel free to express an opinion
that is different from that of other
people.
■ Mobile phones must be switched
off during sessions.
TARSH1: Basics and Beyond
PREPARING TO TRAIN ■■ Chapter 2
Planning a Training
MATERIALS YOU MIGHT NEED:
• Participant kits - Name tags,
pens, note books, files, bags, and
reading material
• Flipcharts
• Markers
Planning training sessions require a great deal of time and
preparation: in addition to planning the content of the training, a
location must be identified; invitations extended to participants;
meals and snacks ordered; and travel arrangements and lodging
coordinated, to name a few. Once all this is in place, the facilitator
must prepare to conduct the training. Below is a checklist of basic
issues and items to be kept in mind prior to the first day of training.
Who is your audience?
• Pens, pencils
■ How many people will attend the training?
• Scrap paper, newspapers, chits of
paper
• What are the ages, genders, and religious backgrounds (if
relevant) of the participants?
• Stationary: Scissors, punching
machine, stapler, glue sticks, pins,
tape
• Materials for various exercises
including handouts, case studies,
instructions etc.
■ Are the participants coming from urban or rural areas?
• Do they all speak the same language or have the same language
fluency? Is English, or the language you will be conducting the
training in, their first language?
■ Are the participants coming from organisations or individually?
Will some know each other prior to the training?
• Equipment - film/s, projectors,
computer, screen
• Have any participants in the group attended a similar training?
Are all participants of the same level of‘seniority’?
• Camera in case you want to video
document the training
If you do not have all of this information before the training you
could do an icebreaker exercise at the beginning that will reveal
some of the information (please see the Icebreaker Section for
suggestions). It would, however, be useful to have some information
available in advance. For example, gauging participant comfort
levels with language and literacy levels is important in case
arrangements need to be made for an interpreter or exercises need
to be modified for a non-literate audience.
• Feedback/assessment/evaluation
forms for participants.
What is the training facility like?
Will there be electricity?
Will there be access to computers, overhead projectors, or video
equipment?
Is it a small room; is there space to move around?
Will people be sitting on the floor or on chairs? If participants
are on the floor throughout, it may be necessary to do additional
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PREPARING TO TRAIN - Chapter 2
TARSHI: Basics and Beyond
energising exercises throughout the training to keep the group
engaged besides providing mats and cushions for comfort.
It is preferable to have participants seated in a circle during the
training. Is it possible to do so in this training space?
How long will it take to get to the training venue from where
the participants are staying?
Is your training planned as a residential one? If yes:
Have you booked the rooms in advance?
Have you prepared a rooming list if participants are sharing
rooms?
Have you sent out instructions to participants beforehand about
how to reach the venue with a map and other directions?
Are you planning an evening of entertainment for the
participants such as a talk/ lecture/cultural show/party etc.? If
yes, do you want to invite other colleagues/organizations from
the area to the event as well?
Do you have back-up materials in case something unplanned
happens?
If you plan on using overheads do you have flipcharts, markers
and notes in case the electricity fails?
Do you have handouts and copies of power point slides if your
computer does not work?
Can you anticipate any other eventuality that you must be
prepared for?
Are you planning a field visit or are you inviting a guest speaker/
resource person to conduct sessions in your training? If yes:
Do you need to ask for permission or extend an invitation in
writing to the organisation to be visited or people to be invited?
How will participants travel to the host organisation and will
you give the speaker or resource person/s a travel allowance?
Will you give an honorarium to the host organisation or the
speaker/resource person?
Will you need to provide a profile of the participants to the host
organisation or speaker/resource person?
If the planned visit is at a facility such as a HIV/AIDS hospice,
an orphanage etc., is a quick ‘briefing’ of protocol for the visit
necessary? For example, briefing participants to avoid asking
intrusive/inappropriate questions and making false promises etc.
24
MISCELLANEOUS
• Are participants required to read
anything prior to the training? If
yes, will you be sending out the
reading material in advance?
■ Are participants required to bring
anything to the training from their
organisations like their brochures/
publications/a short presentation
on their work?
• Do you plan to have a post
training follow-up with the
participants, such as setting up an
email-group for participants and
resource persons to share their
ideas and work even after the
training process? If yes, what do
you need to prepare in advance?
TARSHI: Basics and Beyond
PREPARING TO TRAIN - Chapter 2
Selection of Training
Methodologies
People learn in different ways. Therefore using only one method
for training will not work for all participants. During any training
session, it is best to use a variety of training exercises and techniques
to keep the training interesting and address the various modes of
learning each participant may find most effective. Below are
training methods used in this manual and other methods that are
recommended.
Assessments
Written and/or participatory assessments presented in this manual
are meant to help the facilitator and participants evaluate whether
the objectives of the exercises have been met and whether
participants have learned what they were intended to. Assessments
can be done as a written form (see Sample Assessments later in
this chapter for examples), a role-play (to assess attitudinal
changes), or through developing a charter of rights/guiding
principles/curriculum for sexuality education etc.
Brainstorming
These exercises ask participants to list and propose ideas and
comments on a specific issue or topic proposed by the facilitator.
Brainstorming can foster creative thinking by the group and helps
engage quieter participants. Brainstorming allows participants to
observe the diversity of ideas and approaches to an issue and
recognise the complexities of a given issue.
Case Studies
Case studies present participants with scenarios or stories portraying
a real-life situation that they can analyse. Each case study in this
manual is accompanied with guiding questions to promote
discussion and debate among the group and match the key messages
to be conveyed to participants by the facilitator. Case study exercises
are effective in getting participants to apply an issue or theory to
real-life scenarios and learn from each other during the discussion.
Categorisation
Categorisation exercises require participants to individually write
out answers to a few separate categories of questions. The answers
to these are collected and read out to see the range of answers and
opinions on an issue. This exercise is good for topics that may
initially be uncomfortable for a group to discuss, such as what a
person considers ‘good sex’ or ‘bad sex’, since it allows for
anonymity. It can also indicate areas or questions that participants
still need clarification on.
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PREPARING TO TRAIN ■ Chapter 2
TARSHI: Basics and Beyond
Circle orientation
Seating participants in a circle can be the most effective way to
conduct a training session. This allows them to face each other
during conversations and have an open dialogue. It can also increase
comfort during conversations and is more participatory than the
conventional ‘class-room’ arrangement.
Debates
Participants are divided into groups and told to prepare arguments
that support or oppose a given topic. The groups then debate the
issue with each other. Debates promote participant understanding
of all sides of an argument or issue, and enable them to articulate
their ideas clearly.
Energisers
Energisers are quick, fun activities that can help participants regain
their energy and prepare for the next exercise, particularly when
they have been sitting in one place for a long time, are experiencing
post-lunch sluggishness, have completed an emotionally or
intellectually demanding exercise, or when the group is tired and/
or bored. A facilitator can choose to use these quick exercises
whenever required. Please see the Energiser Section in this chapter
for examples.
Film and Discussions
Showing documentaries, feature films, or television programmes
and having a discussion about it is an interesting and non
threatening way of addressing some issues contained in this
manual. It also allows participants to visually engage with an issue
making it more ‘real’ for them. For a list of selected films on related
issues please see Appendix B or visit http://www.asiasrc.org/
films.php.
Group Discussions
These are structured discussions where participants talk about a
topic or questions posed by the facilitator and subsequently hear a
variety of opinions and learn from one another. While this is an
excellent method to encourage group engagement with an issue,
the facilitator must guide the discussion by addressing and
commenting on certain points made by the group as well as
interjecting appropriate questions to spur the conversation forward.
It is important to also keep the group focused on the issue and
encourage shy or quiet group members to participate. This method
is a great tool to use after a lecturette or an interactive exercise, to
debrief from the exercise and expand the discussion.
Icebreakers
Icebreakers are meant to increase the comfort level in the group
and allow participants to get to know each other. They can be
effective if used before introducing a topic that requires talking
about personal issues, and in the beginning of each module or
training day to get participants reacquainted with one another.
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TARSH1: Basics and Beyond
PREPARING TO TRAIN - Chapter 2
JAM (Just A Minute)
Sessions
Lecturette
JAM sessions are a variation of a popular competitive event in most
school and college festivals in India. Participants sit or stand in a
circle and are given a topic to speak about in ‘Just A Minute’. When
one participant finishes the minute, stumbles or repeats the same
idea more than once, they lose their turn and the next participant
in the circle speaks for a minute on the same or different topic.
This continues through all the participants in the circle. At the
end, the facilitator and/or participants can select the best speaker.
A lecturette is a shorter version of a lecture and is used when a
large amount of information needs to be conveyed to participants
in a short period of time. This method emphasises brief and concise
presentations to avoid overburdening the facilitator or participants
with too much information. The lecturettes in this manual use
handouts to guide the facilitator. It is highly recommended that
the information provided in the handouts be presented to the
participants in its entirety. However the facilitator is free to use a
different style of presentation that will still convey all the
information from the handouts. Conducting a lecturette puts the
emphasis on the facilitator, and the following points should be keep
in mind for a lecturette:
• Speak slowly.
• Address all the points and messages on the handout.
■ Ask for questions and comments throughout the presentation
to involve the participants and make it more interesting and
interactive for them.
• Try not to make the presentation impersonal or dominate the
discussion. If you do not know the answer to a question asked
by participants, write it down on a chart that everyone can see
and return to it later once you have the correct answer.
■ You may want to use a flipchart to write down the bullet points
and important messages in the handouts.
• Information about HIV/AIDS, Assisted Reproductive
Technologies etc keep changing with new advances in science
for example. Be sure to check if the information in the Handouts
are up-to-date and make any changes if required before
presenting the lecturette.
Myth or Fact
In these exercises, participants are asked to decide whether a
statement is a myth or fact/ true or false, after which the facilitator
gives the correct answer (if not given already) with an explanation.
As an alternative, the facilitator can discuss only the myths and
ask participants why each statement is a myth. This is effective in
dispelling myths participants or their communities may have, as
well as to introduce important facts. In the end, the facilitator must
stress on the facts rather than on myths.
27
PREPARING TO TRAIN - Chapter 2
28
TARSHI: Basics and Beyond
Opinion Continuum
In a variation of the polarisation exercise (see below), participants
are asked to respond to a statement on an opinion ‘scale’ from
strongly agree to strongly disagree. A line is drawn/made using a
ribbon/rope from one side of the room that is designated strongly
agree to the opposite side designated strongly disagree. After reading
out the statement, participants are asked to stand on the line based
to their opinion of the statement. This exercise is effective for
creating discussions around contentious issues and also can be a
way of energising participants by making them move around the
room.
Parking Lot
The Parking Lot is time allotted during a training session, either
at the end or periodically throughout, for issues that cannot be
adequately discussed during an exercise or that day. This may be
due to time constraints or because the topic does not fit into the
oudine of the exercise and is taking the discussion off-track. It
may be beneficial to have chart paper up on the wall labelled
‘Parking Lot Issues’ where the facilitator can list out the issues
that need to be addressed later in the training. This will assure
participants that these topics have not been forgotten and will be
discussed later. Parking Lot can even be some time set aside in the
schedule for additional questions.
Party Games
Adapting various games like Charades and Speed Dating to suit
the objectives of your exercise is another lively and interesting way
of getting participants to address difficult issues.
Polarisation
This method has participants responding to a series of statements
read out by the facilitator, deciding whether they agree or disagree
with the statement and moving to the side of the room designated
for that response. Polarisation exercises are effective when looking
at a contentious or difficult issue to open up discussion between
differing viewpoints and opinions. Insisting participants choose a
position on the statement can also clarify ideas for them and help
them learn to effectively defend their positions.
Pre-tests
Pre-tests can come in many forms - true/false, myth/fact, short
answers etc. They are designed to help the facilitator assess the
level of understanding and gaps in knowledge of the participants.
This can help better structure the training and ensure that such
gaps are addressed.
TARSHI: Basics and Beyond
PREPARING TO TRAIN - Chapter 2
Question/Idea Box
Placing an anonymous question/idea box placed in the training
room with paper and pens is an effective way of allowing
participants to ask questions or make comments that they would
otherwise be uncomfortable about in front of the whole group or
facilitator. Participants can write questions or comments and place
them in the box. The facilitator can review additions to the box at
the beginning and/or the end of each day and can either address
the issues then or at an appropriate point in the training.
Quiz
This format is effective to cover information-based issues.
Participants are divided into teams and asked questions in a quiz
style exercise. Healthy competition between teams keeps
enthusiasm levels high. The team with the highest score is declared
the winner. This exercise may also be used as an assessment
exercise.
Role-plays
Role-plays are interactive exercises that place participants in small
groups and ask them to act out a given situation or scenario. This
method allows participants to apply their skills, ideas, and
understanding to a real-life situation. It is also stimulates discussion
and conversation in the group about the different choices and
decisions people can make in any given situation. A role-play can
also be adapted into an assessment exercise.
Small group work
This method has the facilitator dividing participants into smaller
groups to work on a given task or assignment (for example,
discussing case studies, making a charter of rights/list of guiding
principles, listing out behaviours/challenges/strategies etc.). This
is an effective way to have participants discuss an issue when there
is a limited amount of time in the session and can be especially
beneficial for those participants who are not comfortable speaking
in front of the larger group. Small groups then share their discussion
and outcomes with the larger group to maximise learning and
exchange of ideas.
Self-reflection
For this exercise, participants need to spend time individually
answering questions and thinking about an issue and their views
on it. After a personal reflection, participants can be asked to get
back together as a large group and discuss their answers and ideas
with each other. This exercise can be beneficial for working on
topics that participants may be uncomfortable with, or those they
may not have encountered before.
29
PREPARING TO TRAIN - Chapter 2
30
TARSHI: Basics and Beyond
Situational
Statements
In these exercises, participants are given a variety of statements
and must decide and discuss the validity of these statements or
what kind of situation these describe. This can be a different way
to generate conversation or discussion on a topic and present reallife situations.
Teaching the Class
In these exercises, participants are divided into small groups and
given information on a topic and then asked to create a presentation
that will ‘teach’ the larger group this information. In this manual
the appropriate and specific information to be conveyed by each
group is found in the handouts that correspond to these exercises.
Teaching the class engages the group with the material and can be
more interesting than having the facilitator lecture on a topic.
During these presentations the facilitator must ensure that the
groups cover all the points from the handouts and that no inaccurate
information is conveyed. Therefore the facilitator needs to be alert
and vigilant throughout the group presentations.
TARSHI: Basics and Beyond
PREPARING TO TRAIN - Chapter 2
Ideas for Icebreakers
OBJECTIVE:
To learn about participants'
backgrounds (gender, age, religious
affiliation etc.).
WHEN TO USE:
This is best used at the beginning of
any training because it gives the
facilitator information on the
background of the participants and
allows people to get to know one
another as well as learn about the
diversity of the group.
Get to Know One Another Groups
INSTRUCTIONS:
Read out a statement and ask participants to form groups with
people who would respond to the statement similarly. For example,
if the statement is ‘born in the same decade’, participants should
find other participants and form groups according to the decade
they were born in - there may be a group of 1950’s, 60’s, 70’s etc.
Example Statements:
Born in the same decade
Like the same kind of music/ adventure activity
Like the same type of food
Come from the same state/country
The first language you learned
The language you are most comfortable communicating in
Listening Exercise
OBJECTIVE:
To emphasise the importance of
listening during trainings.
WHEN TO USE:
This exercise is best used at the
beginning of a training session to
emphasise the ground rules. It can
also be used if the facilitator notices
that participants are not paying
attention as the training proceeds.
INSTRUCTIONS:
Divide the participants into pairs and have them decide who will
be called A and who B for this exercise.. Each pair should have A
draw a picture using only three shapes: a circle, a square and a
triangle. A draws without letting their partner B see the drawing.
Once A completes the drawing, they have to describe the
drawing in words to B who in turn should try to draw what is
being described. B may/may not be allowed to ask for questions
and clarifications of A while trying to replicate the drawing.
After they are done, they should compare the drawings. Are they
the same? Are they different? Could A have described the
picture differently or with more detail in order to have B draw a
more accurate picture? Did 5 not listen well enough to the
instructions?
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PREPARING TO TRAIN - Chapter 2
Interview another Participant
INSTRUCTIONS:
Ask participants to walk around and find someone in the room
they do not know well and have not spoken with during the
training. After everyone has a partner they should interview one
another for 2 minutes each. In the interviews they should gather
as much information as they can about one another. The questions
can be about anything: where they are from, their families, likes
and dislikes. After they have both been interviewed bring the group
back together and have each participant briefly describe what they
learned about the person they interviewed.
Names and an Adjective
INSTRUCTIONS:
Ask participants to sit in a circle and have each introduce
themselves. They have to do this by using an adjective that describes
them. The adjective should also begin with the letter that their
name begins with. (For example: ‘Hi my name is Neetu and I am
Nice’ or ‘I am Nice Neetu’; ‘Hello I am Patient Pawan’ etc.).
OBJECTIVE:
To get participants to talk to people
in the group they may not know.
WHEN TO USE:
This icebreaker is best used at the
beginning of a training, when the
facilitator notices participants are not
interacting with one another, or if
participants are inactive in the group
discussions or exercises.
OBJECTIVE:
To help the facilitator and
participants learn names and relax
the group.
WHEN TO USE:
At the beginning of a training when
people have just begun to introduce
themselves.
Two Lies and a Truth
OBJECTIVE:
INSTRUCTIONS:
Ask each participant to take a few minutes to think of three
statements about themselves: two of these should be false and one
should be true. The statements can be as personal as a participant
wants but acceptable enough to share with the whole group. Invite
participants to share their statements without revealing which are
true and which false. After the participant tells all three statements,
the rest of the group must decide which of these is true.
32
To have participants get to know
each other better and increase
comfort when sharing personal
information. This can also help dispel
myths participants may still have
about each other.
WHEN TO USE:
This exercise is best used after
participants have got to know each
other a little and have already gone
through some exercises together.
TARSHI: Basics and Beyond
PREPARING TO TRAIN-Chapter 2
OBJECTIVE:
To have participants to get to know
more about each other. To also
demonstrate how hard it can be to
define oneself when asked.
WHEN TO USE:
Your Biography in 30 seconds
INSTRUCTIONS:
Ask participants to stand in a circle. Tell them they have 30 seconds
to tell the group their life story. Begin with one participant and go
around the circle using a stopwatch to time each life story.
This exercise can be used at the
beginning of a training, before
identity exercises or exercises related
to stigma and discrimination.
OBJECTIVES:
To have participants to get to know
each other better and what is
important to each person.
WHEN TO USE:
This exercise can be used at any
time.
OBJECTIVES:
To have participants to get to know
each other better and what is
important to each person.
WHEN TO USE:
What to Save
INSTRUCTIONS:
Ask participants to take a few minutes and think about which two
items they would save from their homes if there was a fire and all
of their family, friends, pets etc were already safe. Ask them to
explain their choices.
Desert Island
INSTRUCTIONS:
Ask participants to share three things they would want to bring
with them on a lifeboat, aside from friends and family or pets, if
they were stranded or on a desert island.
This exercise can be used at any
time.
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PREPARING TO TRAIN - Chapter 2
Ideas for Energisers
Energiser exercises are short, quick ways to boost the energy and morale
of the group. It is a great idea to use energisers between modules, after
meals, after a difficult or challenging exercise, or right before leaving
for the day. They are a lively and effective way to bring people back into
the conversations. Party games can be modified for short energisers as
well. Below are some energising exercises that can be used during
training sessions.
Spell out a word
Ask participants to stand up and invite a volunteer to choose a word
(the word can be related to the theme of the training, such as pleasure,
gender, rights). Have participants spell out the chosen word using their
whole body (for example they may spell the letter ‘I’ by standing straight
with their arms raised over their heads). Do a few rounds of spelling
the word, increasing the speed with each round.
Pass a Face
Ask participants to stand in a circle. Begin with one participant making
a face (a silly face, a sad face, an angry face). The person next to this
participant must imitate that face, passing it around the circle until it
returns to the original person who made the face. Has the face changed?
Dance and Freeze
Ifyou can, put on some music. If not, you can clap or sing a song instead.
Ask the participants to dance to the music, and freeze in place when
the music stops. The last person to freeze is disqualified and must
answer a question from the group: what is their favourite movie, favourite
food, what they like best about where they live etc. After they answer
the question the music starts up again. Continue playing until there is
a ‘winner’.
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TARSH1: Basics and Beyond
PREPARING TO TRAIN - Chapter 2
Trouble Shooting Challenging
Situations in Training
Case Study i- Dealing with Difficult Group
Members
Yju have just started a five-day training workshop and you are excited.
The group you are working with seems great and well balanced: there
are equal numbers of men and women ofvarying ages and backgrounds.
The participants for the most part are respectful and kind to each other
and after the first day of exercises they are beginning to bond and become
more comfortable sharing personal details about their lives with each
other. One participant, however, is turning out to be difficult. The
participant rarely contributes to discussions, makes rude remarks,
criticises other group members and their comments, talks over other
participants, or laughs whenever sex is mentioned. You have gone over
the list of Ground Rules on the first morning of the training and it is
currently posted in the training room for all to see. Y)u keep going over
these with the group at the start of each module and even stress the rule
of respecting others and not talking over them, in the hope that the
difficult participant will understand that they are breaking these rules
and change their behaviour. But the participant continues to act out
and their behaviour becomes ruder and more inappropriate with each
passing exercise. This cannot go on for the rest of the training as it has
already begun to distract other participants. Plus you begin to notice
that the rest of the group has become more and more uncomfortable
speaking after this participant’s outbursts, and is angry at the comments
made. What should you do in this situation?
Suggestions:
■ Ask to speak to the participant privately during or after the session.
Start out by asking about the participant’s impressions of the training
and whether they have any concerns or issues with the training.
Address concerns that come up, and then explain to the participant
that ground rules have been developed to facilitate the comfort of
group members and enable them to be effective in the training, and
that by speaking out of turn etc they are not following these rules,
absorbing the training and are disrupting the process.
• The next time you observe such behaviour or at the beginning of the
next morning, announce that you feel the group is being less
participatory than usual. Give examples of how the group was more
participatory before and how they have become less participatory,
encouraging the former behaviour.
35
PREPARING TO TRAIN - Chapter 2
• Do an exercise on the ground rules to solidify them for the group.
Ask each person to take one ground rule and explain why it is
important. Emphasise that you will not tolerate behaviour that
continually breaches the code of conduct agreed upon by the group.
• Conduct another icebreaker, perhaps a trust/team building exercise.
■ Remind the group that this is a safe space to share and discuss opinions
and ideas and if they feel uncomfortable or threatened they should
express this either in front of the group or to the facilitator privately.
■ Think of what else you could do in such a situation and discuss with
a co-facilitator/ colleagues before you begin training so that you are
prepared for such an eventuality.
Case Study 2 - Equipment Breakdown
You are leading a new training this week at a facility you have never
been to before, located a couple hours from where you live. You have
heard this is a good location with friendly staff and are eager to get there
to set up for the session. You get to the training site on the first day and
go the meeting rooms to set up your equipment. You have planned to
use PowerPoint slides and overheads for almost every exercise because
you feel most comfortable using these tools to present and facilitate any
discussions. This is especially the case with the current training since
you are using definitions/statistics to go over many of the topics and
fear that the exercises will be irrelevant without them. After you arrive
and set up your equipment at the site the power dies and you are told it
will probably be down for a good portion of the day. You are unsure
about what you should do. Participants have arrived and are beginning
to register themselves before the session begins, but you are unprepared
to facilitate without these aids! At the same time you realise that you
cannot cancel or reschedule the training. What should you do? Could
this have been prevented?
Suggestions:
■ Ask the facility staff if there is a flipchart and write out the some of
the important points from the overheads and PowerPoint onto the
flipchart. Make sure that you carry a print-out of your slides so that
you do not have to spend time thinking about the points you wanted
to make.
• Conduct the training without any visual aids and when power
resumes go over your slides to make sure that there were no areas
left out. If there were, go over them at the next session.
■ Inform the group of the equipment failure, let them know it was
beyond your control and assure them that you will proceed with the
training in the best possible way.
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TARSHI: Basics and Beyond
TARSHI: Basics and Beyond
PREPARING TO TRAIN - Chapter 2
■ Write out bullet points on a flipchart for the next day in case the
power goes again.
• If it is feasible, try to get a backup generator for the next days.
■ Be prepared with possible modifications to the exercises in advance.
Case Study 3 - Refocusing the Group
You are working on an exercise on basics of sexuality. The group has
been very engaged in the topic, asking many questions and providing
insightful and thought-provoking comments. However, at one point in
the exercise a question is asked about the definition of oral sex. A variety
of comments and questions on the topic come up and the group slowly
moves away from the focus of the exercise. While this is an important
conversation to have at some point, because of links to safer sex messages
for example, the focus of the exercise and chapter is to understand the
basics of sexuality, not the varieties of sexual expression. It will also be
difficult to move forward in discussions without this basic information.
At the same time, the training in intended for the participants and their
interests and concerns must be addressed. What should you do?
Suggestions:
• Refocus the group and ask them if they can defer this discussion for
a later time. Emphasise that they will return to this discussion by
writing the issue on a flipchart where people can see it (as is done for
Parking Lot issues).
• Keep in mind that not everyone wants to have this conversation and
that it is also a disservice to those wanting to focus on the topic of the
exercise to not return to the exercise.
• Stress that a conversation on oral sex will be more meaningful after a
discussion on the basics of sexuality first.
■ Compliment the group on their engagement in the issues and quickly
paraphrase the new discussion that has ensued. Explain that while
this current discussion is important, it does not fit into this exercise
or session at the moment and can be worked on later. Discuss the
option of stopping the session to have the conversation versus tabling
it for later and how that will actually affect the agenda or flow of the
training.
• Suggest that this topic be discussed after the day’s training or at
lunchtime.
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PREPARING TO TRAIN - Chapter 2
Case Study 4 - Unmet Expectations
It is the first morning of a six-day training workshop and you ask the
participants to write down their expectations from the training. The
participants write down many points excitedly. After they have finished,
you read through them and assess that most of the expectations and
needs seem to be in line widr your own aims for the training and learning.
The next few days of the training proceed as you have planned. During
the lunch break on the fifth day of training, a participant approaches
you and tells you that although they are really enjoying the training,
one of their primary expectations for the course was to become more
comfortable and aware of issues involving older adults and sexuality
(they have a large client base in their 50s-70s and this is an area they
thinks they should be more comfortable with) and that even after these
past 5 days, they are still uncomfortable talking about these issues and
the terms associated with it. They add that while one day is left for the
training, they are not sure will be able to gain much in that time. They
are somewhat disappointed as this was their primary expectation and
goal for the training. "You thought that the training was going well for
the participants so you are a little shocked by these comments, and feel
terrible that they are not satisfied! What do you do?
Suggestions:
■ You may want to explain to participants that while expectations and
goals are important to the training and should be met, sometimes
there are areas participants need to work on independently after the
training is complete. They can continue to use the lessons and
information from the training to increase their understanding and
knowledge of an issue they may have difficulty with.
■ To avoid such surprises you may want to assess participant satisfaction
periodically throughout the training, perhaps by having a suggestion/
idea box and encouraging participants to use it. You can check this
every day and respond to the comments and suggestions. If any
suggestions are outside the scope of the training, the facilitator should
make this clear.
• Ifyou have time, you may also want to suggest meeting the unsatisfied
participant at some point in the evening to talk more about their
concerns and needs.
38
TARSHI: Basics and Beyond
TARSHI: Basics and Beyond
PREPARING TO TRAIN - Chapter 2
Case Study 5 - Silent Participants
The current training workshop that you are leading is a difficult one.
The participants are friendly and kind, but barely speak during an
exercise. This is particularly when the topic of sexuality is brought up
and you find this to be challenging. You have tried to be friendlier during
breaks with the group to increase their comfort level; you have done
initial icebreakers with them; but they are still not responding. You are
not sure whether they are reluctant or simply uninterested in
participating and speaking during the exercises. What more could you
do?
Suggestions:
■ Keep calm.
■ Choose a few participants and encourage them to speak on or
comment about an issue. Observe their reactions and see whether
you could pursue this approach with others.
• Share your concerns with the group and ask them whether you are
getting through to them. Find out how they are faring so far in the
training. Ask participants why they are quiet, and if they want to
address anything apart from the topics being discussed.
• Ask if there are any fears or doubts about the training topics.
• Because the generation of a more active discussion may take time,
you may want to reschedule or drop some sessions from the training
agenda.
• Use energisers and icebreakers liberally.
• Use the ideas box as a secret ballot and ask participants to write one
suggestion for the training each. You do not need to mention the
reason for this request.
• Raise highly debatable/contentious questions which are context
specific. This will help generate comments and reactions.
• Do small group work with participants. Sometimes this can help
people speak more openly and ‘find their voices’.
39
TARSHI: Basics and Beyond
PREPARING TO TRAIN - Chapter 2
Ideas for Training Assessments
Using assessment forms or informal assessment groups after exercises can help facilitators evaluate
how much participants have learned from the exercises and training and which areas still need attention.
Below are three sample assessment forms for a facilitator. These are only samples and can be modified
to fit the kind of group being trained and the material being covered. Assessment forms are not the
only way to evaluate the efficacy of a training and learning. The facilitator can also create a feedback
group from among the participants, whose responsibility is to get feedback from participants on the
exercises and training. Feedback can include questions such as ‘What did you feel about the sessions
of the day?’, What did you like and what could be improved upon?’, ‘What is a new piece of information
you learned today?’ This information can be given to the facilitator at the end of each training day to
evaluate the training and to give the facilitator time to modify exercises etc for subsequent days.
SAMPLE ASSESSMENT FORM 1: EVALUATION OF A MULTI DAY TRAINING
Please take a few minutes to complete the following questions
1.
Yes
Is this the first training you have attended on Sexuality, Sexual and Reproductive Health and Human Rights:
No
Comments:
What are two things you will take back to the work you do from this training?
2.
1.
2.
3.
Were the exercises:
Interesting?
Yes
No
Comments:
Effective in communicating information?
Yes
No
Comments:
4.
Was there enough time for:
The exercises?
Yes
No
Comments:
Discussions?
Yes
No
Comments:
5.
What exercises did you like the best? Why?
6.
Which exercises did you like the least? What do you suggest as an alternative?
40
TARSHI: Basics and Beyond
8.
PREPARING TO TRAIN - Chapter 2
Please check Yes or No tor each topic and give comments:
After this training do you feel you have a better understanding of:
TRAINING TOPIC
YES
NO
COMMENTS
Values and Principles
for Working with Sexuality
Sexuality
Gender
Human Rights
Sexual Identity and Gender Identity
Reproductive health and rights
Sexual health and rights
HIV/AIDS
Contraception, conception, abortion
Stigma
Sexual Harassment and Violence
Child Sexual Abuse
Disability
Pornography
Ethics
Advocacy Campaigns
9.
10.
Were there other issues/topics you wanted to discuss not addressed in the training?
Yes
No
Comments:
Do you think the facilitators were:
Effective in their presentation of the information?
Yes
No
Comments:
Effective at conducting the exercises?
Yes
No
Comments
41
TARSHI: Basics and Beyond
PREPARING TO TRAIN - Chapter 2
SAMPLE ASSESSMENT FORM 2:
ASSESSMENT FOR SPECIFIC EXERCISE(S) (FOR EXAMPLE, EXERCISES 2, 3 AND 4 , MODULE 1, CHAPTER 2)
Please circle Yes or No to the following questions.
BEHAVIOUR
DID YOU KNOW WHAT
DO YOU FEEL
THIS BEHAVIOUR WAS
COMFORTABLE
BEFORE THIS SESSION?
DISCUSSING THIS
SEXUAL BEHAVIOUR
WITH OTHERS?
Fantasizing
Yes
No
Yes
No
Anal sex
Yes
No
Yes
No
No
Oral sex
Yes
No
Yes
Peno-vaginal sex
Yes
No
Yes
No
Masturbation
Yes
No
Yes
No
Mutual masturbation
Yes
No
Yes
No
Sex talk with a partner
Yes
No
Yes
No
Sex talk with a stranger (on the phonel
Yes
No
Yes
No
Reading erotica
Yes
No
Yes
No
Watching erotic films or pictures
Yes
No
Yes
No
Chatting online about sex
Yes
No
Yes
No
Sex between two men/ two women
Yes
No
Yes
No
Group sex/ threesomes
Yes
No
Yes
No
Sex between a younger man and an older woman
Yes
No
Yes
No
Exchanging money for sex
Yes
No
Yes
No
Watching others have sex with/ without their knowledge and consent
Yes
No
Yes
No
Being tied up/whipped with consent as part of sex
Yes
No
Yes
No
Additional behaviours you learned about in this session or feel more comfortable speaking about:
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TARSHI: Basics and Beyond
PREPARING TO TRAIN - Chapter 2
SAMPLE ASSESSMENT FORM 3:
ASSESSMENT FOR CHAPTER(S) (FOR EXAMPLE, EXERCISES 1 ANO 2, MODULE 2, CHAPTER 4)
Please take a few minutes to complete the following questions
Affiliation:
1.
Yes
Is this the first training you have attended on HIV/AIDS?
No
Comments:
Please indicate whether you think the following statements are True or False:
2.
The routes of transmission for HIV are unprotected sex, infection from mother to child, contaminated blood, and through bites from
insects and animals.
True
False
Comment:
The risk of HIV can be significantly reduced with correct and consistent condom use.
True
False
Comment:
A person can test negative for HIV but actually have the virus as in the case of being tested in the window period.
True
False
Comment:
Mandatory testing for HIV can result in stigma and discrimination.
True
False
Explain why you think so:
What are two new things other than the ideas mentioned in Question 2 you learned from this session?
3.
1.
2.
4.
Do you think the facilitator was:
Effective in the presentation of the information?
Yes
No
Comments:
Effective at conducting the exercise?
Yes
No
Comments:
5.
Do you think the exercises were:
Interesting?
Yes
No
Comments:
Effectively communicated the information?
Yes
No
Comments:
6.
7.
8.
Was there enough time for:
The exercises?
Yes
No
Comments:
The discussions?
Yes
No
Comments:
Were there other issues you wanted to discuss left unaddressed?
Yes
No
Comments:
Any further comments or remarks:
43
TARSHI: Rasies and Beyond
PREPARING TO TRAIN - Chapter 2
SAMPLE ASSESSMENT 4: PEER ASSESSMENT BY PARTICIPANTS
Peer assessments help participants develop confidence and critical thinking and analytical abilities. The following assessment can be
used for the suggested modification to Exercise 1, Chapter 1, Module 5.
Guiding Principles: Group Feedback
After listening to the Guiding Principles created by the group, please fill out this assessment form. This is not a 'grade' for the group, but
a way to provide feedback and point out strengths and areas for improvement in the principles.
1.
Did the Guiding Principles presented include the core values of:
Dignity
Yes
No
Comment:
Respect
Yes
No
Comment:
Equality
Yes
No
Comment:
Diversity
Yes
No
Comment:
Non-judgmental
Yes
No
Comment:
2.
Could you use these Guiding Principles in the work you do? Would they be appropriate/applicable? Why or why not?
3.
Did the Guiding Principles:
4.
Address sexuality in a positive way? Yes
No
Comment:
Address gender in a positive way?
Yes
No
Comment:
Address the range of sexual and
gender identities
Yes
No
Comment:
Have a rights-based approach?
Yes
No
Comment:
How could these guiding principles be improved? Is there anything missing?
Additional comments:
44
MODULE 1
Basic Concepts on Sexuality
MODULE 1
Introduction
At the start of any training it is necessary to begin with basic ideas
and information. Module 1 covers basic concepts related to
sexuality. The chapters and exercises give participants a solid
foundation of knowledge related to issues and ideas addressed in
this manual. This information is particularly valuable if the topic
of sexuality is new to participants. The module is also useful as
review material for participants who have previously worked on
these issues.
Module 1 also introduces participants to values and attitudes and
their influence on personal and professional behaviour and choices.
A section called Setting the Tone follows this introduction and
includes an exercise on the values that underlie rights-based work.
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TARSHI: Basics and Beyond
TARSHI: Basics and Beyond
MODULE 1
Module 1
Basic Concepts on Sexuality
Chapter 1: Sex, Sexuality and Gender
• Exercise 1: Understanding Sex and Sexuality
60 minutes
■ Exercise 2: Why Talk About Sexuality
60 minutes
• Exercise 3: Understanding Gender
30 minutes
• Exercise 4: Talking Gender
45 minutes
Chapter 2: Sexual Identity and Gender Identity
• Exercise 1: Sex and Gender Identities
45 minutes
• Exercise 2: Varieties of Sexual Expression
45 minutes
• Exercise 3: Good Sex/Bad Sex
60 minutes
• Exercise 4: Reflecting on Sexual Expression
60 minutes
• Exercise 5: Examining Identities
60 minutes
• Exercise 6: Representation in the Mass Media
60 minutes
Chapter 3: Sexuality Through Life
• Exercise 1: Experiences of Sexuality Through Life 90 minutes
• Exercise 2: Charting our Changes
60 minutes
• Exercise 3: What we Learn from Others
60 minutes
■ Exercise 4: My Views on Sexuality Through Life
45 minutes
Chapter 4: Pleasure and Eroticism
• Exercise 1: Sex for Pleasure?
45 minutes
• Exercise 2: Creating a Pleasure Story
60 minutes
• Exercise 3: Demystifying Pleasure
60 minutes
• Exercise 4: Negotiating Pleasure
45 minutes
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TARSHI: Basics and Beyond
MODULE 1
Assessment for Modulel
Basic Concepts on Sexuality
At the end of this module the facilitator can conduct an assessment,
which will evaluate any increase in participant knowledge, changes
in attitudes, preferences for different exercises, and/or opinions on
the facilitator’s skills. For this module, an assessment can be done
using the following tools:
■ Adapting one of the sample assessment forms found in
Chapter 2 Preparing to Train.
■ Using the facilitator preparation exercises for this module
found in Chapter 1 Preparing to Train.
• Developing a new assessment depending on the type of
information the facilitator is looking to discover.
Sample Training Schedule
A blank template of a training schedule as well as a sample sevenday training schedule can be found in Preparing to Train. Depending
on the focus of the training and the topics it aims to cover, the
facilitator can fill in the blank schedule with exercises from this
module or in combination with exercises from other modules.
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TARSHI: Basics and Beyond
MODULE 1
Introduction Exercise
Setting the Tone
Module 1 focuses on basic concepts and ideas that lay a
foundation for the topics to follow in later modules and
chapters. In keeping with this objective, Module 1 begins
differently than the other modules in Basics and Beyond. It
starts with an introductory exercise called Setting the Tone.
The purpose of this exercise is to provide participants with the
initial tools and language to discuss the topics and issues
covered in this manual. To establish this language and
understanding, Setting the Tone introduces participants to values
that inform work in the fields of sexuality, sexual and
reproductive health and rights - specifically the basic values of
choice, dignity, diversity, equality and respect. These basic
values underlie the concept of human rights and affirm the
worth of all people.
What do we mean by values and why is it important to begin
any training with a discussion of values? Values are standards,
beliefs, attitudes or principles that people consider important
and worthwhile to the way they conduct themselves - whether
that be related to work they do or the personal lives they lead.
The five basic values of choice, dignity, diversity, equality and
respect are examples of such standards and principles and
discussed in Setting the Tone.
A training session using this manual should begin with the
following introductory exercise. Whether beginning with basic
exercises in Module 1 or addressing more complex issues
covered in Module 5, this exercise sets the necessary tone for
any session.
49
TARSHI: Basics and Beyond
MODULE 1
Exercise
Setting the Tone
Instructions
1.
2.
3.
Divide the participants into five groups. Distribute one core value
to each group. Give participants 15-20 minutes to create their
role-play/scenario/skit illustrating the word they received. The
aim of each scenario is to have the other groups guess the word
without it being said in the role-play/scenario/skit. For example,
if the word is Respect, the scenario could depict a doctor who is
respectful of a patient’s rights and treats them accordingly.
Bring the groups back together and invite one group at a time to
act out their scenario. At the end of each scenario ask the other
groups to guess the core value being enacted. Write down the
words and phrases that are guessed on a flipchart. Go through
each group and their word conducting the same exercise. Use a
separate flipchart page for each word. No more than 5 minutes
should be spent guessing each word.
After this, display the list of words from each flipchart and
explain that these and other ideas around Choice, Dignity,
Diversity, Equality, Respect are the foundation for this training
and for discussions and advocacy on sexuality, sexual and
reproductive health, and human rights. Ask if the participants
have questions or comments on these words and ideas.
Suggested Questions:
■ How did you feel during this exercise? Was the exercise
difficult to do or not, and why?
• Can you see how these concepts create a foundation and
opportunity to talk about issues such as sexuality and human
rights?
• Do these values of choice, dignity, diversity, equality, and
respect motivate you in your daily life and work? How do you
apply these to your own life and work?
■ Are there other words or ideas you think should be added to
these core values?
50
PARTY GAME
Purpose of the
exercise:
To describe and discuss the
five core values that act as
a foundation to discuss
sexuality, sexual and
reproductive health, and
rights.
TIME
60 minutes
MATERIALS
Sheets of paper, Handout 1.1 Five
Core Values
ADVANCE PREPARATION
Write out each of the following core
values on separate sheets of paper:
Choice, Dignity, Diversity, Equality,
Respect.
TARSHl: Basics and Beyond
THIS EXERCISE CAN BE MODIFIED
MODULE 1
Key Messages
BY:
■ Giving groups all the values
together and asking them to
create separate scenarios to enact
each one. This will allow Tor
different interpretations of the
same value/s and might be more
beneficial for groups that do not
have the vocabulary to guess the
words easily.
• The basic values of choice, dignity, diversity, equality and respect
underlie the concept of human rights. These values affirm the
worth of all people. It is important to relate them to sexuality,
sexual and reproductive health, and rights in order to work
effectively. Without these values, services and advocacy will be
ineffective and not operate in the best interests of the people it
hopes to serve. For example, affirming a person’s choice about
their sexuality means that if a person chooses to be sexually active
then they have the right to access condoms and contraceptives
irrespective of marital status. Practioners need to respect this.
MAKING CONNECTIONS:
• Practioners often use these words but may not understand their
implications in practical terms or real situations. This exercise
encourages participants to discuss the reasons why these words
are important, exactly what they mean to people and how they
relate to work on the ground. Being able to articulate the
importance of these values concretely helps put them into practice
and improves the quality of the service being provided or the
communication material being prepared.
• The core values mentioned in this
exercise underlie the principle of
human rights. For more see
Chapter 1 in Module 3.
■ Values inform ethics and ethical
principles, which can be then
codified to guide people's work.
See Module 5 for more.
TIPS FOR THE FACILITATOR:
■ Participants may be unsure how to enact a particular word or have trouble
guessing the word for some of the values, especially if they do not understand
its meaning. If the whole group cannot guess the word within 5 minutes, ask
for synonyms, give them other hints or just tell them the word and have a
discussion around it.
• Participants may be confused because of the complexity of ideas in this
exercise. Assure them that this is just the beginning, and these concepts will
become clearer and more concrete during the training.
■ Other issues and topics may emerge during group work. For example, a group
might do a skit on diversity illustrating different sexual or gender identities.This
might arouse questions from the rest of the group. Avoid addressing these in
depth at this point, and assure participants that these issues will be covered
later so that the focus remains on the values that inform one's work.
I
TARSHI: Basics and Beyond
MODULE 1
Handout 1.1
Five Core Values
ADAPTED FROM COMMON GROUND: PRINCIPLES FOR WORKING ON SEXUALITY, TARSHI 2000
There are Five Core Values that underlie the principle of Human Rights. They are:
•
Choice
•
Dignity
•
Diversity
•
Equality
•
Respect
These basic values underlie the concept of human rights and affirm the worth of all people. Choice,
dignity, diversity, equality and respect are words used frequently but what do each of them mean in the
context of sexuality?
Choice: Choices about one’s sexuality should be made freely, and with access to comprehensive
information and services. They should respect others’ rights. For example, a person can choose to be
sexually active before marriage and has the right to access condoms and contraceptives irrespective of
marital, status.
Dignity: All individuals have worth regardless of their age, caste, class, gender, orientation, preferences,
religion and other determinants of status. For example, all people have the right to information and
good quality sexual health services regardless of marital status or sexual identity (married, widowed,
separated, gay, lesbian, heterosexual etc).
Diversity: Involves acceptance of the fact that women and men express their sexuality in diverse ways
and that there is a range of sexual behaviour, identities (homosexual, bisexual, transgendered,
intersexed), and relationships.
Equality: All women and men are equally deserving of respect and dignity, and should have access to
information, services, and support to attain sexual well-being. For example, whether people have a
disability or not, are young, old or HIV positive, they should have the same access to information and
services to attain sexual well-being.
Respect: All women and men are entitled to respect and consideration regardless of their sexual choices
or identities. For example, it is important to respect sex workers’ choice of profession and give them the
consideration they deserve when they access health services.
52
MODULE 1 - Chapter 1
Chapter 1
Sex, Sexuality and Gender
Chapter Objectives for the Facilitator
1.
To have participants understand the difference between sex
and sexuality, and the difference between sex and gender.
2.
To have participants examine the connections between
gender and sexuality.
3.
4.
To dispel myths around sexuality.
To have participants talk comfortably about sexuality and
gender issues.
TARSHI: Basics and Beyond
MODULE 1 - Chapter 1
Why a Chapter on Sex, Sexuality and Gender
Sexuality is a central aspect of being human throughout life and
encompasses sex, gender identities and roles, sexual orientation,
eroticism, pleasure, intimacy and reproduction. Sexuality is
experienced and expressed in thoughts, fantasies, desires, beliefs,
attitudes, values, behaviours, practices, roles and relationships. While
sexuality can include all of these dimensions, not all of them are
always experienced or expressed. Sexuality is influenced by the
interaction of biological, psychological, social, economic, political,
cultural, ethical, legal, historical and religious and spiritualfactors.
EXERCISES IN THIS CHAPTER:
Exercise 1: Understanding Sex and
Sexuality. 60 minutes
Exercise 2: Why Talk About
Sexuality. 60 minutes
Exercise 3: Understanding Gender.
30 minutes
Exercise 4: Talking Gender.
45 minutes
(WHO draft wording definition ofsexuality, 2002)
Understanding sexuality involves more than just memorising the
definition above. It implies identifying a wide range of issues,
emotions, experiences and topics included under sexuality.
Similarly, an understanding of gender requires appreciating its
variability, its construction by society, and that sex, sexuality and
gender are not interchangeable concepts.
This chapter addresses the differences between sex, sexuality and
gender. It clarifies common misconceptions and answers questions
about these topics. For instance, that sexuality is more than the act
of sexual intercourse, that gender is socially constructed, and that
there can be more than two genders. This chapter gives participants
a broad understanding of sexuality and its connections with gender
and acts as a starting point for discussions on sexuality, sexual and
reproductive health, and rights that come up later in the manual.
MATERIALS FOR THIS CHAPTER:
Flipchart
Markers
Pens/pencils
Index cards/slips of paper of different
colours
Three containers or baskets
Tape
HANDOUTS REQUIRED FOR THIS
Key messages for this chapter
Sex and Sexuality
• Sexuality is more than acts of sex. It can mean a range of
experiences that vary from person to person — for example to
some it might mean sexual orientation, for others the freedom
to express themselves and make choices regarding their body.
These varied experiences and issues related to sexuality can
impact people’s lives in significant ways.
54
CHAPTER:
Handout 1.2
Basic Information on Sex, Sexuality
and Gender
Handout 1.3
Understanding Sex and Sexuality
TARSHI; Basics and Beyond
MODULE 1 - Chapter 1
ADDITIONAL RESOURCES:
• Bhasin, K. 2003. Understanding
Gender: Gender Basics. Women
Unlimited. India
■ Bridle, S. 1999. 'Gender Outlaw:
Interview with Kate Bornstein'.
What is Enlightenment? http://
www.wie.org/j16/kate.asp
- Point of View.1996. XX/XY:
Voices of Women And Men Living
With HIV. India
• Sexual and reproductive health decisions (for example, the
decision to have or not have children, when to have them, to get
married or not, to choose a sexual partner, or to have a husband/
wife chosen by a family or community) cannot be isolated from
issues of sexuality. This makes it even more important to
understand and address sexuality.
■ Addressing sexuality helps reduce fear, myths and
misconceptions surrounding the issue. It also enhances people’s
well-being by helping them lead safer and pleasurable sexual
lives.
Sex and Gender
• Sexuality Information and
Education Council of the United
States, http://www.siecus.org
• Gender is socially constructed, which means that it is
determined by our social, cultural and psychological
surroundings and environment. It is not innate in the same
way that our biology (sex) is believed to be. Like gender,
sexuality is also socially constructed. A person’s expressions
and experiences of sexuality are influenced and determined by
the social environment.
• Talking About Reproductive and
Sexual Health Issues.
www.tarshi.net
• Sex was considered to be constant and unchangeable until
recently. Now it can be changed through medical intervention
(sex reassignment surgery).
■ TARSHI. 2001. Common Ground:
Principles for Working on
Sexuality. India.
• Gender is variable and can change from time to time, culture
to culture, and sub-culture to sub-culture.
• San Francisco Sex Information.
http://www.sfsi.org
■ The way girls and boys are socialised to be ‘feminine’ or
‘masculine’ is called gendering.
■ Women in Action. Focus: Women
and Sexuality. 1999. Available at:
http://www.isiswomen.org/pub/
wia/wia199/index.html
■ Different cultures may value girls andJooys differently and
assign them different gendered roles, responsibilities and
attributes.
• For selected films see, http://
www.asiasrc.org/films.php and
Appendix B.
■ Sexual and reproductive health decisions can be influenced by
a person’s gender. For example, in a marital relationship, it
may be the man who has the power to decide whether to have
children or not, when, and how many.
55
TARSHI: Basics and Beyond
MODULE 1 - Chapter 1
Exercise 1
Understanding Sex and Sexuality
Instructions
Ask participants to come up with a list of words they think are
connected with sexuality. Write these words on a flipchart as
they are being called out. Be ready to prompt participants for
more words. Take 10 minutes to compile a list.
1.
After the brainstorm session, ask for questions or comjnents to
begin a 10-15 minute discussion:
2.
Suggested Questions:
■ Are any words missing, what are they and why do you think
they were left out?
BRAINSTORMING
Purpose of the
exercise:
1. To understand sexuality
as being more than acts of
sex.
2. To develop comfort
around discussions of
sexuality.
• What words had you not thought about in relation to sexuality?
• From the list, what do you understand by the term sexuality ?
How would you explain sexuality to someone who has never
heard the word before?
TIME
• Where do the words on this list come from? Are they used and
developed locally or borrowed from other cultures/societies?
MATERIALS
3.
4.
Continue the discussion by distributing Handout 1.2 and asking
participants to read through the definitions of sex and sexuality.
After this, divide participants into small groups. Ask each group
to complete the last column in the handout that asks how each
word relates to sexuality. The purpose of this is to understand
how sexuality relates to one’s personal life and why each element
of the definition is important to understanding sexuality.
Ask each group to share their examples.
Suggested Questions:
■ Do you understand sexuality differendy after this exercise? Can
you relate the definition and idea of sexuality to your life more
easily?
• The definition of sexuality appears to be long. Why is it important
to have such a long definidon ? What does this detailed definition
tell us about sexuality?
• Are there any other examples you want to add to the list?
56
60 minutes
Flipcharts, markers, pens/pencils,
copies of Handout 1.2
Understanding Sex and Sexuality
ADVANCE PREPARATION
Read through Handout 1.2
TARSHI: Basics and Beyond
MODULE 1 - Chapter 1
Key Messages
■ Sexuality is more than acts of sex. It is also different from gender,
which refers to how societies view women and men, the
differences between them, and to the roles assigned to them.
THIS EXERCISE CAN BE MODIFIED
BY:
■ Reading out the definition of
sexuality to the group, particularly
if the participants have a low
literacy level. The definition would
have to be read once completely
and then repeated line by line,
since it can be difficult for
participants to retain all the
information in one go.
Alternatively, selected words and
phrases can be discussed at length
rather than going through the
whole definition.
■ Dividing participants into smaller
groups to discuss the definition
amongst themselves before
sharing key points with the larger
group. This is useful for larger
groups but will require more time
to be allotted for this.
■ Everyone does not experience sexuality in the same way. Being
aware of these differences helps cater to individual needs and
provide effective services to people.
• Sexuality encompasses many ideas and is subjective. Any
definition of sexuality needs to reflect this diversity which is why
it would be longer and more complex than expected. The
definition of sexuality has been evolving along with our
understanding of sexuality.
■ Multiple factors are influenced by and influence our sexuality.
For example, we cannot assume that all people are motivated by
the same reasons to have sex or be in a relationship — some
people might make this choice to have children, others for
companionship.
TIPS FOR THE FACILITATOR:
• Note the kinds of words being used. Do they reflect any values of the group; are
participants shying away from sexual terms [masturbation, sex, vagina, andpenis}',
are they focusing on a particular manifestation of sexuality [heterosexual,
monogamous}', are they using 'negative' terms [rape, pain, violence, abuse} or
'positive' ones [pleasure, fun, arousal}'1
. Bring these observations to participants'
attention and ask for comments.
• Even after long discussions, it is possible that some participants may not understand
the difference between sex and sexuality. Be prepared with simpler explanations
and examples or return to this after they have had time to think over the concepts
and have more questions.
MAKING CONNECTIONS:
■ Understanding the range of issues
in sexuality can help establish its
connection to sexual rights. For
more see Chapter 3 in Module 3.
• Participants may be uncomfortable around the topic of sexuality, especially early
in the training. This can manifest as disruptive behaviour, offensiveness,
defensiveness, non-participation or use of inappropriate humour to divert attention
from their discomfort. Draw their attention to the Ground Rules (see Preparing to
Train for examples/ to remind them of the attitude of respect/ openness they had
agreed upon before the training.
■ Core values inform and shape how
we work with sexuality. For
more, see Setting the Tone in the
Introduction to Module 1.
■ As participants realise that sexuality is much more than acts of sex, they will
begin to feel more confident dealing with real or imagined opposition from their
communities. They will also begin to feel less inhibited about talking about sexuality.
57
TARSHI. Basics and Beyond
MODULE 1 - Chapter 1
Exercise 2
Why Talk About Sexuality?
GROUP DISCUSSION
Instructions
1.
Hand out three index cards to each participant. Ask them to
write answers to the questions below, each on separate cards. In
order to maintain anonymity, they should not put their names
on the cards. Tell participants that the cards will be read aloud
in the next part of the exercise. Encourage them to be as open
and honest as possible.
• Index Card 1: Write one question/concern/fear around sexuality you
had as a child.
■ Index Card 2: Write one question/concern/fear around sexuality you
had as an adolescent.
Purpose of the
exercise:
1. To explore sexuality in
the different stages of life.
2. To explore how
information on sexuality is
important to dispel myths
and improve well-being.
■ Index Card 3: Write one question/concern/fear around sexuality you
had as an adult.
For example one question/concern/fear around sexuality from
adolescence might have been: How does a woman get pregnant,
or can two men be in love or have sex with each other?
Ask participants to put each slip into the corresponding
containers - all responses to question 1 into the Childhood
container; the responses to questions 2 and 3 into the Adolescence
and Adulthood containers respectively.
TIME
60 minutes
MATERIALS
Index cards/slips of paper, pens/
pencils, 3 containers or baskets
ADVANCE PREPARATION
2.
Pass the Childhood container around and have each participant
pick one card at a time and read it aloud. After they have read
all the slips, ask for questions and comments:
Suggested Questions:
■ When in childhood did such concerns arise? Were they
addressed? By whom and when?
• Are the concerns typical of the community/culture you were
brought up in ? Do you think the responses would differ in urban
or rural communities, or from men and women?
3.
58
Now invite participants to read from the Adolescence container
followed by the Adulthood container.
Label 3 containers 'Childhood',
'Adolescence' and 'Adulthood'
TARSHI: Basics and Beyond
MODULE 1 - Chapter 1
Suggested Questions:
THIS EXERCISE CAN BE MODIFIED
BY:
• Dividing.the participants into three
groups after they have responded
to the questions and giving each
group one container. Each group
can then be asked to summarise
the key concerns raised by the
questions in their age category
and present these summaries to
the larger group.
• Compare these responses to the earlier experiences. Are they
similar or different?
■ Did you have similar questions? When did such concerns arise?
Were they addressed? By whom and when?
■ Are the responses typical of the community or culture you were
brought up in?
■ Do they think the responses would differ in urban or rural
communities, or from men and women?
4.
■ Reading a few questions aloud
randomly from each container or
all the responses from any single
category. This is useful for training
specific groups as in the case of
those who are being trained to
conduct sexuality education
sessions with young people for
example; more time can be spent
with the Adolescent category to
help them appreciate the concerns
of young people and how to
address them.
MAKING CONNECTIONS
■ Sexuality can be experienced
throughout one's life. For more
see Chapter 3 in this Module.
• All people have the right to sexual
health and well-being, to
information on their bodies, and
choices to allow them to lead lives
free from fear, pain, and
reproductive and sexual ill health.
For more see Module 2.
Finally, ask for questions or comments about the exercise.
Suggested Questions:
• Would your life have been different if you had accurate
information about sexuality at the time the questions arose?
• At what age should people receive information on sexuality?
Why?
Key messages
• Concerns about sexuality arise early in our lives. Accurate, easyto-understand sexuality education enhances the quality of
people’s lives by clarifying misconceptions and helping young
people make informed choices. These include protection from
unwanted pregnancies, infection and abuse.
• Providing information on sexuality is not the same as teaching
someone how to have sex. It includes information on sexual
anatomy and physiology, on how sexuality is related to well
being, on how one’s sexuality interacts with family or community,
how that makes one feel, talking about one’s choices in sexual
partners and identities and how they can be negotiated etc.
TIPS FOR THE FACILITATOR:
• Linking concepts of sexuality with one's personal experience while maintaining
anonymity is important. This allows for sharing and discussion of personal concerns/
issues more openly in later sessions as well.
■ This exercise is not meant to answer questions and concerns listed by participants
about their sexuality and history. Assure them that many of their queries are likely
to be addressed during the course of the training. List any questions on a flipchart
as Parking Lot Issues to be addressed later.
59
TARSHI: Basics and Beyond
MODULE 1 - Chapter 1
Exercise 3
Understanding Gender
POLARISATION
Instructions
1. Ask participants to stand in a straight line at the centre of the
room, equidistant from the labelled walls.
2. Read one statement aloud at a time from those below. After each,
ask participants to move a step towards the Society wall or the
Biology wall depending on whether they feel that the statement
is based on socio-cultural factors or has a biological basis.
Purpose of the
exercise:
To understand that gender
is socially constructed.
Statements
a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
k)
1)
m)
Girls are gentle, boys are not
Having sex with her husband is a woman’s duty
Women can get pregnant, men cannot
Men are good at logical and analytical thinking
Real men don’t cry
Women can breast-feed babies, men cannot
Women are creative and artistic
Women have maternal instincts
Men’s voices break at puberty, women’s voices don’t
Men have a greater sex drive than women
Women like to dress up and wear make up
Men should be the wage earners of a family not women
In a heterosexual relationship/marriage, the man has to
be older than the woman
3. After all the statements have been read, most people should be
closer to the Society wall since all but 3 of the 13 statements
have a social basis. Have participants discuss their views about
all the statements and explain to one another why they felt a
certain way about each statement.
4. Ask for any questions or comments.
Suggested Questions:
■ Which statements were controversial, i.e. where all of you did
not agree that it was based on biology or society? Why did
everyone not agree?
• Most of the statements above are examples of the way society
expects people to be and act based on their gender and not based
60
TIME
30 minutes
MATERIALS
Two pieces of flipchart paper,
one labelled Society and the other
Biology, tape
ADVANCE PREPARATION
Prepare the two charts and stick
them on opposite walls of the room
TARSHi: Basics and Beyond
MODULE 1 - Chapter 1
on innate qualities. Do you understand how gender is therefore
constructed or created by society? Can you give other examples
of how gender is learned by what society creates as gender roles?
Key Messages
THIS EXERCISE CAN BE MODIFIED
BY:
■ Having participants stand in a
circle and move out from the
circle if they believe the statement
is related to socio-culture
influences or into the circle if they
believe the statement relates to
biology. This modification is useful
for large groups or if the room is
too small for everyone to stand in
a line.
MAKING CONNECTIONS
■ After going over the basics of sex,
sexuality and gender, see Chapter
2 in this Module for sexual and
gender identities.
■ People often face stigma and
discrimination based on their
gender or for choosing to act
outside their gender roles. For
more see Chapter 2 in Module 4.
• It is important to distinguish between what society has
constructed/ created for each gender and what is biological.
For example, the idea that men are strong and should not cry is
created by society, versus women giving birth which is biological.
• Gender is a social construct. This means that gender roles and
attributes vary from society to society, and at different times in
history. Gender roles and behaviour are assigned by society and
are learned rather than innate.
• Recognising that gender is socially constructed and that gender
based behaviour is learned helps us to understand that behaviour
can be changed. For example, recognising that aggression in men
is often learned can help us change the way we socialise/
condition boys to be aggressive. Or that women should stay at
home and take care of children is based on social norms, and
can be countered by encouraging and supporting women if they
choose to work.
■ As with sexuality and its formal definition, gender is also
influenced by the interaction of biological, psychological, social
and historical factors.
TIPS FOR THE FACILITATOR:
■ Except statements about breastfeeding, pregnancy, and men's voices breaking at
puberty, all the statements have a social basis. How the other statements are
interpreted may differ from culture to culture, and even in the same society/
culture from a single generation to another.
• Read all statements beforehand and prepare responses to anticipated arguments.
The statements about girls being gentle and women having maternal instincts can
be contentious. Asking why people believe these statements to have a biological
basis and what negative effects these stereotypes can have may help participants
understand the importance of being aware of gender as a social construct.
• It is often mistakenly believed that all people have sexual 'instincts' and all women
have 'maternal instincts'. Help participants examine how these assumptions can
be dangerous. For example, those who believe in sexual instincts may use this
argument to absolve abusers of any responsibility by pronouncing their actions as
'beyond their control'. Common terms associated with instinct are ‘innate’,
'uncontrollable', 'need', 'urge', and 'have to be fulfilled at all costs'.
61
TARSHI: Basics and Beyond
MODULE 1 - Chapter 1
Exercise 4
Talking Gender
jam: just a minute
Instructions
1.
2.
Ask participants to form a circle. Choose 3 or 4 statements from
the list of ‘Statements for the JAM session’ below. Explain to
participants that they will be given just one minute to talk about
a topic/ respond to a statement. During that minute, they cannot
repeat ideas, and if they falter during their time, they lose their
turn and the next participant in the circle will be given the
chance to talk about the topic.
TIME
Statements for JAM session: •
MATERIALS
To be a man is...
To be a woman is...
Masculinity is...
Femininity is...
A man’s role in the family is...
A woman’s role in the family is.’..
A man’s role in society is...
A woman’s role in society is....
10 years ago a real woman/man was...
100 years ago a real woman/man was...
After the selected topics have been discussed, have a larger
discussion with the group for 20-25 minutes.
Suggested Questions:
■ How did you feel doing this exercise? What are your reactions
to the words/ideas listed on the chart?
• What do these words tell you about dominant ideas of gender in
society? Do you agree with these ideas? Why? Why not?
• What are the implications, advantages or disadvantages of
perpetuating such notions in the context of sexuality, sexual and
reproductive health and rights?
• Do you feel men are often left out of conversations that involve
62
To explore gender roles
and their connections to
sexuality.
Ask for a participant to volunteer to begin the exercise. Note
the key words and ideas being used by participants on a flipchart
to discuss later. After one minute the next person in the circle
must speak on the same topic.
a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
3.
Purpose of the
exercise:
45 minutes
Flipchart, markers
ADVANCE PREPARATION
None
TARSHI: Basics and Beyond
MODULE 1 - Chapter 1
sexuality, sexual and reproductive health and rights? How can
they be included?
THIS EXERCISE CAN BE MODIFIED
BY:
Asking participants to brainstorm
responses to some of the
statements. The ideas from this
session can be written on a
flipchart and discussed later.
■ Dividing participants into small
groups and asking them to discuss
two statements in their group
which they later share in the
larger group.
MAKING CONNECTIONS:
• Gender is closely related to power
and how individuals can
experience imbalances of power
depending on their gender or role
in society. For more see Chapter 1
in Module 4.
• While gender roles are based on
expectations a culture has of what
is appropriate behaviour for men
and women, gender identity is an
individual's sense of belonging to
the category of men or women or
neither of the two. For more see
Chapter 2 in this Module.
4.
At the end of the discussion, participants can be asked to judge
the best speaker on the basis of both content and style of
presentation.
Key Messages
■ Gender is socially constructed, which means that it is determined
by our social, cultural and psychological environment and is
not innate like our biology (sex) is believed to be.
• Gender roles relate to expectations a culture has about one’s
behaviour based on one’s biological sex. For example, women
should be mothers and stay at home to raise children, and men
should be fathers and earn the money in the family. However
these roles may not be what all individuals want or desire. Those
who move away from these gender roles may be looked down
upon by family, friends and community. This can result in stigma
and discrimination.
• Different cultures may value girls and boys differently and assign
them different roles, responsibilities and attributes.
• Gender is variable and changes from time to time, culture to
culture, and sub-culture to sub-culture. Therefore, the way that
one participant discusses a statement can differ from another.
• There is no one ‘masculinity’. The term ‘masculinities’ is more
accurate because at a given time in a given place, there can be
many forms of masculinities. There may however, be one
dominant form of (or hegemonic) masculinity that influences
the behaviour and attitudes of men and women. For example,
in many cultures, a dominant form of masculinity is that men
should be bread-earners of families. This can result in pressure
on them to fulfil this expectation and restrict them from moving
away from this gender-role.
TIPS FOR THE FACILITATOR:
• It may be difficult for participants to articulate their ideas in one minute. Emphasise that there are no right or wrong answers
and that this exercise is intended to spark discussions on gender.
■ If participants have difficulty starting, it may be helpful to begin the conversation with some examples, such as 'a real woman
wants to have children and a family'; or 'In Victorian times/100 years ago a man who had sex with another man was thought
to be practicing 'abnormal' behaviour, whereas now such behaviour is becoming more accepted.'
63
TARSHI: Basics and Beyond
MODULE 1 - Chapter 1
Handout 1.2
Basic Information on Sex, Sexuality, and Gender
Agency: The capacity, ability and tools possessed by
individuals or groups to control and make choices
in their lives and within society. Using agency,
individuals can create new realities, states of being,
and situations for themselves through the re
structuring of their realities, regardless of the
constraints that may be socially imposed upon them.
Even marginalised individuals and groups or those
without resources can have agency to create new,
acceptable situations and conditions that existing
social structures may not have allowed for. For
example, even women forced to have sex with their
husbands may use resources and skills to prevent this
from happening; they may say they are menstruating
or change their physical circumstances by placing
their child between them to prevent coercion from
their husbands.
Gender: A concept that refers to how societies view
women and men, how diey are distinguished, and
the roles assigned to them. People are generally
expected to identify with a particular gender, that
has been assigned (gender assignment) to them, and
act in ways deemed appropriate for this gender.
While gender roles are based on expectations that a
culture has of behaviour appropriate for male or
female, gender identity is an individual’s sense of
belonging to the category of men or women or
neither of the two. We attribute a gender (gender
attribution) to someone based on a complex set of
cues, which vary from culture to culture. These cues
can range from the way a person looks, dresses and
behaves to the context in which they do so and also
on their relationship with and use of power.
Patriarchy: A hierarchical social system of thinking
where a dominance of men over women in society
results in a marked inequality between them in the
political, economic and social domains, among
others. It implies that men hold power in all the
important institutions of society and that women are
deprived of access to such power. It does not imply
that women are either totally powerless or totally
deprived of rights, influence, and resources (see
Agency for more).
64
Sex: The biological difference between females and
males present at birth. These include anatomical
differences such as the presence of a vagina or penis;
genetic differences present in a person s
chromosomal makeup; or physiological differences
such as menstruation or sperm production. Sex can
also be used to describe physical acts of sex that
include, but are not limited to, penetrative penilevaginal intercourse, oral sex, anal sex, masturbation,
kissing, among others.
Sexuality: Sexuality as a concept has been examined
for many years. There are a number of definitions
that cover various components of this concept. While
there is no single agreed upon definition, the two
definitions of sexuality below promote an
understanding of sexuality.
• Sexuality is a central aspect of being human
throughout life and encompasses sex, gender identities
and roles, sexual orientation, eroticism, pleasure,
intimacy and reproduction. Sexuality is experienced
and expressed in thoughts, fantasies, desires, beliefs,
attitudes, values, behaviours, practices, roles and
relationships. While sexuality can include all ofthese
dimensions, not all of them are always experienced
or expressed. Sexuality is influenced by the interaction
of biological, psychological, social, economic,
political, cultural, ethical, legal, historical and
religious and spiritual factors.
(WHO draft wording definition 2002)
■ Human sexuality encompasses the sexual knowledge,
beliefs, attitudes, values and behaviours of
individuals. Its various dimensions include the
anatomy, physiology and biochemistry of the sexual
response system; identity, orientation, roles and
personality; and thoughts, feelings, and relationships.
The expressions ofsexuality are influenced by ethical,
spiritual, cultural, and moral concerns.
(SIECUS Report, Volume 24 #3, 1996)
Sexual identity: A concept that refers to how people
view themselves sexually in terms of whom they are
attracted to. This refers specifically to whether an
individual is attracted to people of the same gender,
a different gender, more than one gender and which
category of these identities they want to adopt for
themselves.
TARSHI: Basics and Beyond
MODULE 1 - Chapter 1
Handout 1.3
Understanding Sex and Sexuality
Sex: The biological difference between females and males present at birth. These include anatomical differences
such as the presence of a vagina or penis; genetic differences as in a person’s chromosomal makeup; or
physiological differences such as menstruation or sperm production. Sex can also be used to describe physical
acts of sex that includes but is not limited to penetrative penile-vaginal intercourse, oral sex, anal sex,
masturbation, kissing, among other acts.
Sexuality: Sexuality as a concept has been examined for many years. There are a number of definitions that
cover the various components of sexuality. While there is no single agreed upon definition, the definition of
sexuality below provides a basic and fairly comprehensive understanding of sexuality.
Sexuality is a central aspect of being human throughout life and encompasses sex, gender identities and roles,
sexual orientation, eroticism, pleasure, intimacy and reproduction. Sexuality is experienced and expressed in
thoughts, fantasies, desires, beliefs, attitudes, values, behaviours, practices, rolesand relationships. While sexuality
can include all of these dimensions, not all of them are always experienced or expressed. Sexuality is influenced
by the interaction of biological, psychological, social, economic, political, cultural, ethical, legal, historical and
religious and spiritualfactors.
(WHO draft wording definition 2002)
Please fill in the last column of this chart by thinking about how this word or phrase might relate to sexuality. For
example, people’s sexual orientation can influence how they express their sexuality. In some cases it may mean
they can express their sexual orientation openly. If they live in a community or environment in which alternative
sexual orientations such as homosexuality are not accepted, this expression of their sexuality might be limited.
TERM
DEFINITION
Sex
The biological difference between females and males present
at birth. These include anatomical differences such as a vagina
and penis and genetic differences found in a person's
chromosomal makeup or physiological differences such as
menstruation or sperm production. Sex can also be used to
describe physical acts that include but are not limited to penilevaginal intercourse, oral sex, anal sex, masturbation and
kissing, among others.
Gender
identities and
roles
Gender roles are based on expectations a culture has of
behaviour as appropriate for male or female. Gender identity
is an individual's sense of belonging to the category of men or
women or neither of the two.
Sexual
orientation
How individuals consider themselves based on whom they
are sexually attracted to, whether to people of the same
gender, a different gender, or to more than one gender and
.which category of these identities they want te-adopt for
themselves.
Eroticism,
pleasure
Feeling sexual excitement, arousal, enjoyment, and desire from
certain actions, images, ideas, etc.
Intimacy
Feeling of closeness and familiarity with another person.
HOW DOES THIS RELATE TO SEXUALITY?
65
TARSHI: Basics and Beyond
MODULE 1 - Chapter 1
TERM
DEFINITION
Reproduction
Having a pregnancy occur and bearing children
Thoughts
Ideas, opinions and beliefs
Fantasies
Images or ideas created in the mind.
Desire
A person, thing or idea that is wanted and hoped for,
whether physically, emotionally, or sexually
Beliefs
Accepting and trusting a fact, opinion, or assertion.
Attitudes
An active feeling of liking or disliking something.
Values
Beliefs of an individual or group about the standards of
what is worthwhile.
Behaviours
Actions.
Practices
To do or perform something habitually or constantly.
Roles
A function or task/position.
Relationships
An involvement or connection between two or more people.
HOW DOES THIS RELATE TO SEXUALITY?
For the following terms, think of one example that illustrates how the interaction of these terms relates to sexuality.
66
Biological
To do with the physical body.
Psychological
To do with the mind or emotions.
Social
To do with society.
Economic
To do with the financial/monetary/material requirements of
life.
Political
To do with the government, politics and the State.
Cultural
To do with the shared knowledge, experiences and values of
a particular society or community.
Ethical
To do with rules or standards governing the conduct of a
person or members of a profession based on ideas of right
and wrong.
Legal
To do with laws and legislation.
Historical
To do with how ideas, events, attitudes, and perceptions
change and can be influenced by each other as they change
through time.
Religious
To do with having faith in or practicing a particular religion.
Spiritual
To do with the soul or spirit. Religion is only part of the overall
theme of spirituality. Spirituality may include belief in
supernatural powers, as in religion, or an emphasis on personal
experiences.
MODULE 1 - Chapter 2
Chapter 2
Sexual Identity and Gender
Identity
Chapter Objectives for the Facilitator
1.
To introduce participants to the concepts of sexual and gender
identity.
2.
To familiarise participants with the variety of sexual
expression and behaviour.
3.
To help participants develop comfort when talking about
these issues.
4.
To help participants see the difference between sexual
behaviour and sexual identity.
5.
To prompt participant discussion on how common forms
of representation can affect issues of sexuality, sexual and
reproductive health, and rights.
TARSHI: Basics and Beyond
MODULE 1 - Chapter 2
Why a Chapter on Sexual and Gender
Identity
This chapter focuses on identity, particularly sexual and gender
identity, and its role in sexuality, sexual and reproductive health,
and rights. Sexual identity refers to the identity people adopt for
themselves, based upon whom they are sexually attracted to.
Specifically, this is based upon whether they are attracted to people
of the same gender, a different gender, or to more than one gender.
Gender identity refers to how people perceive their own gender whether they think of themselves as a man, woman, both, or as a
different gender.
Sexual identity is different from sexual behaviour. Sexual behaviour
refers to the sexual activity individuals engage in and not how they
identify themselves. Behaviours are not always indicative of a
particular identity. For instance, engaging in sexual activity with a
person of the same gender does not necessarily indicate
homosexuality - there are men who have sex with other men
(behaviour) who do not think of themselves as homosexual
(identity).
EXERCISES IN THIS CHAPTER:
Exercise 1: Sex and Gender
Identities. 45 minutes
Exercise 2: Varieties of Sexual
Expression. 45 minutes
Exercise 3: Good Sex/Bad Sex.
60 minutes
Exercise 4: Reflecting on Sexual
Expression. 60 minutes
Exercise 5: Examining Identities.
60 minutes
Exercise 6: Representation in the
Mass Media. 60 minutes
MATERIALS FOR THIS CHAPTER:
In many cultures and communities, there are often prescribed rules
for ‘appropriate’ sexual and gender identities and sexual behaviour.
For example it is often ‘appropriate’ to be a heterosexual woman or
man and engage in monogamous, penile-vaginal sex within
marriage. Deviation from this norm can often result in
discrimination, stigmatisation, abuse, and ridicule. However,
having the option to choose and express a gender and sexual identity
rather than conforming to external rules is necessary for our selfrespect and well-being.
At times these rules are also played out in the .way identities are
represented. Representations come in the form of language, images,
documentation, advertisements, campaigns, reports and brochures,
or documentaries and have different purposes ranging from
entertainment, to raising awareness, inviting public sympathy, etc.
With all these, the interpretation of images and their effect often
depends upon the attitudes and background of the audience they
are designed for.
In this chapter participants examine and discuss the range of sexual
and gender identities and behaviour, as well as the importance of
respecting these diverse identities and behaviour while working
on sexuality, sexual and reproductive health, and rights. The
representation of identities is also addressed and examined in order
to develop an appreciation of sexuality and related issues without
creating victims or isolating/excluding certain groups.
Flipcharts and markers
Pens/pencils
Paper
HANDOUTS REQUIRED FOR THIS
CHAPTER:
Handout 1.4
Basic Information on Sexual Identity
and Gender Identity
Handout 1.5
Varieties of Sexual Behaviour and
Expression
Handout 1.6
Sexual Expression Self-Reflections
Handout 1.7
Case Studies for Sexual and Gender
Identity
TARS HI: Basics and Beyond
ADDITIONAL RESOURCES:
• Gay Lesbian Bi and Transgender
Search Engine, http://
www.pridelinks.com
• Glossary of Sexual Terms, http://
gender.eserver.org/sexglossary.txt
■ Human Rights Violations Against
Sexuality Minorities In India-. A
PUCL-K Fact-finding Report About
Bangalore. 2001
■ Humjinsi. http://
www.indiarights.org/humjinsi/
larzish.html
• ■ Humsafar Trust, http://
www.humsafar.org
■ Media Awareness Network.
Media Stereotyping, http://
www.media-awareness.ca/
english/issues/stereotyping/
• Parents, Families, and Friends of
Lesbians and Gays, http://
www.pflag.org
• Sangini (Indial Trust, http://
www.sanginii.org
• Transgender Forum, http://
www.tgforum.com
■ S. A. White ed. 2003.
Participatory Video - Images That
Transform and Empower. United
States: Cornell University.
■ For selected films see, http://
www.asiasrc.org/films.php and
Appendix B.
MODULE 1 - Chapter 2
Key messages for this chapter
• Sexual identity and behaviour are not interchangeable concepts.
For example, a man having sex with another man need not
identify as homosexual or gay. He may identify as heterosexual;
he may be attracted to women, be married and have children
and at the same time engage in same-sex sexual behaviour.
■ Sex (whether a person has male genitalia, female genitalia, or
both/neither male and female genitalia), gender identity
(whether a person thinks of oneself as a man, woman, both, or
as a different gender), and sexual identity (being heterosexual,
bisexual, homosexual etc.) refers to different aspects of a person.
• The terms and ideas presented in this manual may not
encompass the variety and diversity of people’s experiences in
different parts of the world, including India where most of the
examples are drawn from. This is partly because of language
limitations. Exact translations from English to local languages
and vice versa are not always possible. This, however, does not
mean that these identities and experiences do not exist in a
culture. For example, the word gay/homosexual as it is
Conceptualised in the West does not translate into many local
languages. Similarly, there is no English word that can explain
the Indian fathi identity satisfactorily to a non-Indian audience.
• Every individual has multiple identities, which intersect in
unique ways to make the person who s/he is. For example,
someone may identify as a woman, a mother, a lesbian, a
daughter, and a nationalist. Identities are fluid, changing and
personal. Stereotypes focus on only a single identity of an
individual and may be used to judge the person unfairly.
• People oppressed on the basis of their sexual or gender identity
have formed groups to advocate for rights and/or support.
• Some varieties of sexual behaviour and expression go beyond
what is conventionally acceptable. Those engaging in consensual
sexual behaviour have the right to do so without fear of being
judged or punished for their activities.
■ A variety of sexual acts can be safe and pleasurable and need to
be discussed while helping people make informed sexual choices.
• Coercive' sexual behaviour of any kind, even between regular
partners such as married couples, is unacceptable.
■ Sexuality and related issues are often subject to stereotypes that
can be represented in many forms - language, advertisements,
campaigns, images, reports, brochures and documentaries.
TARSHI: Basics and Beyond
MODULE 1 - Chapter 2
Exercise 1
Sex and Gender Identities
Instructions
1.
Distribute one chit with an identity to each participant. Ask
participants to take a couple minutes to read their chits. For the
rest of the exercise they must make these identities their own.
For example if a participant is lesbian in real life, she must adopt
the identity of a transsexual if that is what her chit says.
2.
Ask participants with their assumed identities to ‘mingle’ and
create small groups with other identities with whom they have
something in common. The commonalities could be related to
a role they have in a community, a gender identity, the kind of
work they do, the choices they have etc. If you find that people
are not able to establish commonalities, raise questions to get
them started. For example, what would a gay man have in
common with a lesbian woman in terms of their expectations
or limitations in a community?
3.
After at least three small groups are formed, ask groups to discuss
what they have in common in the context of their identities and
prepare to present their discussions to the larger group. Give
the groups 10 minutes for these discussions.
GROUP DISCUSSION
Purpose of the
exercise:
1. To understand and .
define different sexual and
gender identities.
2. To examine common
experiences and issues
faced by people with
different identities.
TIME
4.
Bring the groups back together to share their discussions. First
each person in the group should introduce themselves and their
identity and then a representative from the group should
summarise their discussions. After the presentations, ask for
questions and comments.
Suggested Questions:
■ Are there any identities you do not understand or have never
heard of before? If yes, can the person with that identity read
out the definition they have?
■ Can you name any other sexual or gender identities from your
community that were not mentioned in the chits?
• Were there any stereotypes that emerged from the groups? For
example, all gay men are promiscuous, transgendered people
should only hold entertainment jobs etc.
70
45 minutes
MATERIAL
Flipchart, chits of paper, Handout
1.4 Basic Information on Sexual
Identity and Gender Identity
ADVANCE PREPARATION
Write the identities from Handout
1.4 on separate chits of paper for
each participant, for example
'lesbian', 'female to male
transsexual' etc.
TARSHI: Basics and Beyond
MODULE 1 - Chapter 2
THIS EXERCISE CAN BE MODIFIED
Key Messages
BY:
■ Using it to emphasise stigma and
discrimination rather than sexual
and gender identities. Additional
identities can be included such as
unmarried woman, married man,
or those relevant to the country/
region participants belong to, to
help participants see the effects of
stigma and discrimination at a
wider level and emphasise their
effects.
■ Sexual identity refers to how people define themselves based on
whom they are sexually attracted to; whether they are attracted
to people of the same gender, a gender other than their own, or
to more than one gender.
• Gender identity refers to whether one thinks of oneself as a man,
woman, both, or as a different gender. As with sexual identity,
many cultures and communities have prescribed rules for
appropriate gender identities based on the biological sex of a
person.
• Identities are not static. Individuals can identify in many different
ways, and can change their sexual and gender identity
throughout their lives.
• Many different individuals and identities are subjected to stigma.
and discrimination. Often the more ‘different’ a person is from
the established norm, the more discrimination they face.
MAKING CONNECTIONS
• People with disabilities are also
sexual and have a variety of
sexual and gender identities. For
more see Chapter 3 in Module 4.
■ People can experience stigma and
discrimination for their inability to
have children, or for their HIV
status, among other issues. See
Chapter 2 in Module 4 for more.
■ Stereotypes maintained by societies and communities contribute
to stigma and discrimination against certain gender and sexual
identities.
TIPS FOR THE FACILITATOR:
• Make sure participants do not mimic behaviour during the exercise, but instead
focus on the identity. For example, if they adopt gay as an identity, they should
not act effeminate or assume other similar stereotypical actions.
• If participants have difficulty finding something in common between the different
identities, give examples to help them. For instance, a woman may experience
stigma and discrimination similar to a transgendered person or hijra. Both may
have less decision-making power in a community, or be confined to certain spaces
and roles.
■ While participants may be unfamiliar with some of the defined identities or some
terms may not be relevant in their countries or communities (for example, kothi
may be relevant to individuals in Indian sub-continent and not in other areas), it is
important to be aware of the diversity of identities specific to certain regions.
71
TARSHI: Basics and Beyond
MODULE 1-Chapter 2
Exercise 2
Varieties of Sexual Expression
Instructions
1.
Divide participants into groups. Distribute flipchart paper and
markers to the groups. Instruct them to list out every kind of
sexual behaviour they have heard of, engaged in, seen, or read
about. Give them 20 minutes to complete this task.
2.
Bring the groups back together and ask representatives from
each to present their list to the larger group.
3.
After the presentations, distribute Handout 1.5 to participants.
Ask for questions and comments.
Suggested Questions:
SMALL GROUP WORK
Purpose of the
exercise:
1. To be aware of the
diversity and variety of
sexual behaviour and
expression.
2. To be comfortable
discussing a range of
sexual behaviour and
expression.
• How did you feel when you did the listing? What kinds of
behaviour did you hear about for the first time? What kinds of
behaviour do you think are common in our culture/ community?
• What kinds of behaviour would increase risk of infection or
unwanted pregnancies? Do you think these are behaviours only
engaged in by heterosexuals or also by non-heterosexuals?
TIME
45 minutes
MATERIALS
Key Messages
• People engage in a variety of sexual behaviour even if they are
not discussed openly.
• Many forms of sexual behaviour and expression can take place
between people of different genders and also those of the same
gender. For example, oral sex can take place between two men,
two women or a man and a woman.
■ While some people may prefer not to engage in a certain type of
behaviour, this does not mean it is wrong for odters to enjoy it if
it is consensual. For example, some people may find' bondage
and discipline unappealing, while others find it pleasurable. As
long as there is mutual consent, this should not be judged as
‘wrong’ behaviour.
72
Flipcharts, markers, pens/pencils,
copies of Handout 1.5 Varieties of
Sexual Behaviour and Expression
ADVANCE PREPARATION
Read through Handout 1.5 and make
sure you understand all listed terms.
Add a few of your own to the list if
you wish.
TARSHI: Basics and Beyond
MODULE 1 - Chapter 2
THIS EXERCISE CAN BE MODIFIED
BY:
■ Conducting it as a large group
brainstorm exercise. While
participants brainstorm answers,
the words can be listed on a
flipchart and discussed
afterwards.
MAKING CONNECTIONS
■ Individuals can find a variety of
sexual behaviours and expression
pleasurable. For more see Chapter
4 in this Module.
• It is important that the practice of
any kind of sexual behaviour is
with the consent of partners and
with precautions to prevent
transmission of STIs including HIV/
AIDS. For more see Chapter 4 in
Module 2.
It is important for people to be aware of different sexual activities
and their own reactions to them. This helps them to be prepared
and react appropriately when they hear about them during the
course of their work.
Certain types of sexual behaviour are sometimes considered
‘unnatural’ or against ‘nature’. This argument is simplistic
because many kinds of behaviour, such as same-sex behaviour
are practiced by animals and in ‘nature’. Moreover, creating the
label ‘unnatural’ for behaviour does not take into account the
fact that human beings engage in a number of activities that
animals do not (and therefore are ‘unnatural’) which are still
acceptable, such as wearing clothes, sitting on chairs and
travelling on wheels!
Being aware of the diversity of sexual expression can also help
design information and services to help people protect against
potential adverse effects/ consequences of these behaviours. For
example, with regard to conception, many believe that anal sex
is a safe alternative to penile-vaginal sex. They may therefore
engage in unprotected anal sex, which not only exposes them to
risk of infection, but also does not rule out the risk of conception.
TIPS FOR THE FACILITATOR:
• Be prepared for discomfort by participants, which may manifest as inappropriate
humour, silence or outbursts of anger. Let these reactions emerge spontaneously.
However, remind the group that the purpose of the exercise is for them to become
aware of behaviours to enable them to work more effectively on sexual and
reproductive health and rights.
• Pay attention to the terms listed out by the groups. Participants might include
sexual or gender identities in the list of sexual expression. Point out that sexual
behaviour or expression is different from identity. For example, homosexuality is a
sexual identity, not behaviour.
■ Make note of the kinds of words being brought up during the exercise. Do they
reflect any values of the group or individuals and/or do they focus on any particular
kind of sexuality lheterosexual, monogamous)? If so, ask participants why they
focused on these and introduce other sexual identities.
73
TARSHI: Basics and Beyond
MODULE 1 - Chapter 2
Exercise 3
Good Sex / Bad Sex
Instructions
1.
Distribute two slips of paper to each participant. Ask them to
write sexual behaviours they consider Good Sex on one slip, and
what they consider Bad Sex on the other. For example, Good Sex
may elicit responses such as penile-vaginal sex, while Bad Sex
may elicit responses such as anal sex. After participants have
written their responses, ask them to put the slips into the
appropriate containers.
2.
Collect the two containers. Pass them around and have
participants read out the responses for the Good Sex category
one by one. Write these down on a flipchart. Do the same for
the Bad Sex responses.
BRAINSTORMING
Purpose of the
exercise:
To understand and identify
personal values related to
sex and link them to
stigma and discrimination.
TIME
60 minutes
3.
Once the listing is complete, ask participants to look at them
and react/ make note of their observations. Ask for questions
and comments.
Suggested Questions:
MATERIALS
Flipchart, markers, chits of paper,
two jars/baskets one marked Good
Sex and the other Bad Sex.
■ Is there any behaviour that falls into both categories? What does
this mean?
ADVANCE PREPARATION
• Is there prejudice or discrimination associated with terms and
practices in the bad sex category? Why?
Prepare two flipcharts. Write Good
Sex at the top of one flipchart, and
Bad Sex on the other.
• Do we leave out certain people from health service delivery by
labelling their behaviour as ‘bad’ ? Can you give an example from
the given list?
74
TARSHI: Basics and Beyond
MODULE 1 - Chapter 2
THIS EXERCISE CAN BE MODIFIED
Key Messages
BY:
• Giving participants two separate
coloured slips of paper le.g. blue
and yellowl. They can be asked to
write what they consider good
sex on the yellow slips and bad on
the blue slips. Once they finish,
their slips can be pasted on a pre
prepared wall for all to read and
comment upon.
MAKING CONNECTIONS
■ Individuals have a right to practice
and experience their sexuality as
they choose. For more see
Chapter 3 in Module 3.
■ Sex should not be coercive or
forced, even between regular
partners and/or spouses. For
more see Chapter 1 in Module 4.
• All people have the right to express their sexuality freely and are
responsible for doing so in a manner that does not harm or violate
anyone else.
• One may incorrectly judge others on the basis of what they find
right/wrong or are uncomfortable with. Any sexual activity
between consenting adults is their private matter and should be
respected as such.
■ Judging people creates prejudice, and causes them to be
discriminated against. This affects their self-esteem and causes
hurt and pain. It can also deprive them of essential services and
information.
• Stigmatising people on the basis of perceived or real difference
prevents them from accessing services and help when most
needed. For example, a hospital may not treat an HIV positive
person, based on the assumption that the infection has occurred
due to Bad Sex. This neglect can make the person more
vulnerable to infection, complications or severe illness.
TIPS FOR THE FACILITATOR:
■ Some participants are likely to rate an act good while others rate the same act
bad. This difference helps people see how subjective sexual preferences and
experiences are and so cannot be judged.
■ The Bad Sex examples may leave many participants feeling awkward. An indepth discussion of this category is not essential but it is important to have
participants reflect on where these ideas of bad sex may have arisen from and
how the stigma they create can affect service-provision.
• The discussion can reveal values, judgments and prejudices that, to a large extent,
will be challenged by the participants themselves. The facilitator can step in when
required.
75
TARSHI: Basics and Beyond
MODULE 1 ■ Chaptei 2
Exercise 4
Reflecting on Sexual Expression
Instructions
1.
2.
Distribute Handout 1.6 to each participant and give them 15
minutes to read the list and fill out the chart. Encourage
everyone to be honest in listing factors that have influenced
their attitudes and factors that have helped them become
comfortable with the identities and behaviours listed. Assure
participants that this is a private exercise and they will not be
expected to share their thoughts with others unless they want
to.
After 15 minutes, invite participants to talk about how they felt
while doing the exercise. Stress that they do not need to discuss
anything they are uncomfortable sharing.
Suggested Questions:
• Are there some kinds of behaviour that are more acceptable than
others? Why? Who decides what is acceptable?
• Is there a universal standard of what is good or bad? Should
there be one? Why? Who would be given the authority to decide
what is good/bad?
• Once society or individuals determine that a sexual behaviour
is not ‘right’, does it stop people from engaging in it? Why or
why not?
76
SELF-REFLECTION
Purpose of the
exercise:
To identify opinions and
ideas about personal sexual
behaviour and expression.
TIME
30 minutes
MATERIALS
Handout 1.6 Sexual Expression Self
Reflections
ADVANCE PREPARATION
Make copies of Handout 1.6 for each
participant.
TARSHI: Basics and Beyond
MODULE 1 - Chapter 2
Key Messages
THIS EXERCISE CAN BE MODIFIED
BY:
• Asking participants to discuss how
their communities or social groups
view these kinds of behaviour and
whether there are laws, policies
or institutions that prohibit or
accept these behaviours. They can
then examine how these views
and laws came about historically
and how they can affect people's
choices and rights.
'
|
I
;
• There are different types of sexual behaviour. People’s comfort
levels and preferences for these diverse behaviours vary.
• Tolerance and acceptance of various types of sexual behaviour is
essential, whether or not we engage in any of these ourselves.
• Social, cultural, and personal factors influence each person
differently. What one person may find ‘acceptable’ may be
different from another. In other words, all people do not have
the same attitudes toward and/or practice the same sexual
behaviour. This should be respected.
• Societal values also affect our comfort level and attitudes toward
certain identities and behaviour. These may cause us to feel
unnecessary shame and guilt about our own sexual desire and
its expression, even when it is safe and consensual.
MAKING CONNECTIONS
■ Sexuality is an individual
experience that changes over time
and can be experienced in a
variety of ways. For more see
Chapter 1 in this Module.
TIPS FOR THE FACILITATOR:
■ Social and cultural factors can
influence how we express our
sexuality and the power we have
to do so. For more see Chapter 1
in Module 4.
• Participants may be uncomfortable sharing what they have written forthis exercise.
Emphasise the ground rules for tolerance and openness before the exercise begins
and reassure everyone that they do not need to share anything that makes them
uncomfortable.
77
TARSHI : Basics and Beyond
THIS EXERCISE CAN BE MODIFIED
BY:
■ Taking one or two case studies
and discussing them in a large
group rather than dividing the
cases among participants. This
may be beneficial if the group
wants in-depth focus on a
particular issue.
MAKING CONNECTIONS
■ Sexual and reproductive health are
important to overall health and
well-being. For more see
Module 2.
• Individuals have a right to choose
and practice their sexuality. For
more see Chapter 3 in Module 3.
MODULE 1 - Chapter 2
Homosexual and bisexual women and men may experience
pressure to get married. Often they do not have anyone they can
share their concerns with and may feel isolated, lonely and
depressed.
Making assumptions about people’s sexuality on the basis of
stereotypical ideas can limit choices about and access to medical
and other services. For example, an unmarried woman may be
sexually active. She may have a regular male partner, more than
one partner, or a woman partner. Any or all of these factors may
be overlooked/ignored by a healthcare professional who assumes
that she is not sexually active since she is unmarried and therefore
does not need to be checked for an STI.
Use of gender-neutral language while describing a client’s
partner will give non-heterosexual, non-monogamous clients the
message that they can speak freely without being judged.
All people have the right to express their sexuality freely and are
responsible for doing so in a manner that does not harm or violate
any one else.
TIPS FOR THE FACILITATOR:
• Participants may have very strong reactions to the case studies. Note if anyone
uses discriminatory language, if any prejudices are reflected, if certain topics create
discomfort, or if there are any significant reactions to different characters in the
case studies. Point out these instances and question their basis. This needs to be
done gently and respectfully by the facilitator to prevent participants from feeling
that they are being criticised.
■ Participants may find it difficult to discuss this topic or believe that all non
heterosexual behaviour is morally wrong. Ask why they believe this, pointing out
that morality is relative lit varies from culture to culture, generation to generation,
and even from one person to the next) and there is no single or universal standard
to live by.
79
TARSHI: Basics and Beyond
MODULE 1-Chapter 2
Exercise 6
Representation in the Mass Media
Instructions
1. Divide participants into groups. Distribute the local newspapers,
magazines and advertisements to the groups. Ask each group to
look through the material and select pictures and/or articles (the
facilitator may want to collate the material beforehand to save
time) that deal with sexuality and list out their reasons for
selecting them. For example, a group may identify a picture of
a woman in a seductive pose next to a motorcycle and explain
that a woman’s body/sexuality is being used to attract a largely
male clientele for motorcycles. Give the groups 20 minutes for
this task.
SMALL GROUP WORK
Purpose of the
exercise:
To discuss how people are
represented in the media
and its effects on sexuality
and rights.
TIME
2. Bring everyone together and have each small group share their
articles and pictures, discussions and explanations. Ask them
to tape the pictures on the wall or on a flipchart as they talk
about them. After each presentation, ask for questions and
comments.
60 minutes
MATERIALS
Local newspapers, magazines,
advertisements, scissors
Suggested Questions:
■ How did you feel doing this exercise?
• What messages do these images give about the people or groups
being represented? Are these messages accurate and/or
stereotypical? What are the advantages and disadvantages of
these messages? (For example, what is the advantage or
disadvantage of representing homemakers as efficient, perfectlydressed, always happy mothers?)
3.
After all the presentations, ask for general questions or
comments.
Suggested Questions:
■ Do you see any similarities between the types of articles and
pictures found in newspapers, magazines and advertisements?
• What do you think the role of the media is with respect to the
depiction of sexuality?
• Is there a range of identities or genders represented? For example,
do (you see people portrayed as only heterosexual? Is only
80
ADVANCE PREPARATION
Collect some local newspapers, and
an assortment of magazines and
advertisements.
TARSHI: Basics and Beyond
MODULE 1 - Chapter 2
THIS EXERCISE CAN BE MODIFIED
women’s sexuality being highlighted? Are older people or those
with disabilities represented as often?
BY:
• Asking the small groups to find
pictures and articles that relate
not just to sexuality, but also to
gender, sexual and reproductive
health. This can begin broader
discussions on connections
between sexuality, gender and
reproductive and sexual health.
■ Showing various images and
asking participants to call out
words that come to mind as they
see them. Each image can be
pasted on a separate flipchart/
made into a slide presentation.
The words can be listed on a
flipchart and this can be followed
by a discussion using the
suggested questions in the
exercise Instructions.
• Do these representations play a role in how we think about
sexuality, sex and gender roles? How? Do they perpetuate
commonly held ideas or challenge them? Give examples.
Key Messages
■ In many instances, articles and pictures found in newspapers,
magazines and advertisements reflect the way sexuality, sex, and
gender roles are perceived by a community or culture. For
example, advertisements from some communities/regions
typically show a woman as the ‘good housewife’ to sell a product;
or a man as strong and stable to support a family.
■ Images in the mass media represent some value or moral
standpoint. For example, articles that advise women on ‘How
to catch a man’ imply that all women w;tnt to be with men; do
not want to be alone or with other women; and must conform to
a particular standard to meet a man.
■ Images in the mass media can be interpreted and judged in many
ways depending on people’s perspective and attitude. For
example, a photograph of a ‘scantily-clad’ woman in an
advertisement may seem inappropriate or crude to some, but
artistic or erotic to others.
MAKING CONNECTIONS
• Some groups and identities are
usually represented in a simplistic
manner. For example, people with
disabilities, if at all represented,
are represented as victims. For
more see Chapter 3 in Module 4.
• Sexuality is usually associated
with young people. Older people's
sexuality is often underrepresented or not given positive
representation. For more see
Chapter 3 in this Module.
TIPS FOR THE FACILITATOR:
■ Participants may find it difficult to relate the pictures or articles to sexuality. If so,
give examples such as those listed above. The facilitator may also want to begin
the exercise by reviewing the definition of sexuality (Exercise 1, Chapter 1,
Module! I.
■ Participants may focus only on heterosexual roles and relationships. It is important
to introduce representations of other identities and relationships, such as samesex sexual relationships.
■ Help participants identify those people who are left out of typical representations
and the implications for public health and the well-being of those who are left out
(older people, those with disabilities or even those who do not conform to media's
notions of beautyl.
81
TARSHI: Basics and Beyond
MODULE 1 - Chapter 2
Handout 1.4
Basic Information on Sexual Identity and Gender Identity
The terms below refer to commonly used sexual and gender identities. This list is not exhaustive.
These terms and identities are constantly being discussed and examined and therefore their meanings
and how they are used as identities change over time. Some people may decide not to use any
identification, or may choose to move from one identity to another. A number of identities have been
excluded from this list because they cannot be translated into English easily. Ultimately, it is important
to understand and recognise that there is a range of sexual and gender identities.
• Asexual: An individual who feels no sexual attraction towards other individuals.
• Bisexual: An individual who is sexually attracted to people of the same gender and also to people of
a gender other than their own.
• Gay: A man who is sexually attracted to other men and/or identifies as gay. This term can also be
used to describe any person (man or woman) who experiences sexual attraction to people of the
same gender.
• Heterosexual: An individual who is sexually attracted to people of a gender other than their own
and/or who identifies as being heterosexual.
■ Heterosexism: The viewpoint that all people should be heterosexual and the assumption that this
is the ‘normal’ or ‘natural’ sexual identity people should have. This viewpoint results in bias against
other sexual identities.
• Hijra: A term used in the Indian subcontinent, which includes those who aspire to and/or undergo
castration, as well as those who are intersexed (please see definition below). Although some hijras
refer to themselves in the feminine, others say they belong to a third gender and are neither men nor
women.
• Homosexual: An individual who is sexually attracted to people of the same gender as their own,
and/or who identifies as being homosexual.
• Homophobia: An intolerance or irrational fear of homosexual people that can manifest itself in
discrimination, prejudice, disgust or contempt of homosexual people.
• Intersexed Person: An individual born with the physical characteristics of both males and females.
These individuals may or may not identify as men or women.
• Kothi: A feminised male identity, which is adopted by some people in the Indian subcontinent and
is marked by gender non-conformity. A !{othi, though biologically male, adopts feminine modes of
dressing, speech and behaviour and looks for a male partner who has a masculine mode of behaviour
speech and attire. Some believe that this is not an identity but a behaviour.
• Lesbian: A woman who is sexually attracted to other women and/or identifies as a lesbian.
82
TARSHI: Basics and Beyond
MODULE 1 - Chapter 2
Man: A person who identities as a male and may or may not have male genitalia or reproductive
organs like a penis or testes.
Queer: A person who questions the heterosexual framework. This can include homosexuals, lesbians,
gays, intersexed and transgendered people. To some this term is offensive, while other groups and
communities have used it as a form of empowerment to assert that they are not heterosexual, are
non-conformist, against a dominant heterosexual framework, and dissatisfied with the ‘labels’ used
on people who do not identify as heterosexual.
Sex reassignment: A complex range of procedures that people undergo to transform from one sex to
another. These include hormone therapy, hair transplants or removal, speech therapy and surgeries
to change one’s sexual and sometimes reproductive organs.
Transgendered Person: An individual who does not identify with the gender assigned to them. They
may or may not consider themselves a ‘third sex’. Transgender people can be men who dress, act or
behave like women or women who dress, act or behave like men. They do not, however, necessarily
identify as homosexual.
Transsexual Person: An individual who wants to change from the gender they have been assigned at
birth to another gender. Some have surgery, hormonal medication, or other procedures to make
these changes. They may or may not identify as homosexual, bisexual or heterosexual. They may be
female to male transsexuals, male to female transsexuals or choose not to be identified as either.
Transvestite: An individual who dresses in the clothing that is typically worn by people of another
genderforpurposes ofsexual arousal/gratification. Transvestites are often men who dress in the clothing
typically worn by women. They are also known as cross-dressers.
Woman: A person who identifies as a female and who may or may not have female genitalia and
reproductive organs like breasts, a vagina, and ovaries.
83
TARSHI: Basics and Beyond
MODULE 1 - Chapter 2
Handout 1.5
Varieties of Sexual Behaviour and Expressions
NAME
COMMON TERMS
DESCRIPTION
Anal Sex
Bum-fucking, buggering
Inserting one's penis, dildo, fingers or other objects into a partner's anus.
Analingus
Rimming
Autoerotic
asphyxiation
Bestiality
Sexual interaction with animals that can include various types of contact,
such as oral, anal, and vaginal intercourse.
Biting
Love, bite, hickey
Biting or sucking a partner's body (usually neckl hard enough to produce a
mark or bruise.
Bondage and
Discipline
Sexual behaviour that includes parts of sadism and masochismlsee below).
One partner is bound/restrained, submissive and is 'disciplined' or 'punished'
physically or mentally by the dominant partner. This is sexually arousing to
the partners and is mutually consensual or negotiated beforehand.
Coprophilia
Sexual pleasure associated with eating faeces.
Cunnilingus
Going down on, eating,
licking out, suck off.
Dry sex
Erotalia
A partner uses their mouth/tongue to stimulate a woman's genital area.
Increasing friction of penile-vaginal sex by drying the vagina with cloth or
herbs. The friction is said to increase sexual pleasure for the man. Also
increases the opportunity for tears and scrapes in the vagina and therefore
the possibility of contracting a sexually transmitted infection including HIV.
Talking dirty, telephone sex
Speech that is sexually arousing.
Exhibitionism
Exposure of genitals for sexual gratification.
Fantasy
Imagining things that are sexually arousing.
Fellatio
Giving head, going down on,
blow job, sucking off.
Fetishism
84
Using one's mouth to stimulate a partner's anal area.
Self-strangulation during masturbation. Partial asphyxiation cuts off air
supply to enhance an orgasm. This practice can result in accidental death.
A male/ female partner uses their mouth/ tongue to stimulate a man's
penis.
Being sexually aroused by an inanimate object, e.g. shoes, underwear,
leather etc.
Finger insertion
Fingering, finger-fucking
Inserting one's finger/s into a partner's anus/vagina.
Fist insertion
Fisting, fist- fucking
Inserting one's fist into partner's anus/vagina. This can be done gradually and
may begin one finger at a time.
TARSHI; Basics and Beyond
MODULE 1 - Chapter 2
NAME
COMMON TERMS
DESCRIPTION
Flagellation
Whipping, Paddling
Being sexually aroused from whipping a partner or from being whipped.
Frottage
Dry humping
Partners rub their bodies together for mutual sexual pleasure.
Kissing
Smooching, pash off,
suck face, tonguey
Partners use their mouths to kiss a partner's mouth or other parts of the
body.
Masturbation
Solo sex, wanking, rubbing
up, fiddling, jerking off,
playing with yourself.
Giving yourself sexual pleasure, usually by touching/ rubbing your genitals.
Can also involve fantasy, pornography and/or sex toys.
Mutual
Masturbation
Partners sexually stimulate one another's genitals, usually by touching or
rubbing with hands or sex toys. Can also refer to watching each other
masturbate.
Necrophilia
Being sexually aroused by the thought/sight of a corpse, or by touching or
having intercourse with it.
Ozolagnia
Being sexually aroused by the smell of body odour.
Pornography
Porno, stick books, blue
movies, X-rated, smut
Using movies/video, and/or reading stories of sexual acts for sexual
arousal. Often in combination with masturbation.
SadoMasochism
S&M
The sex between those who enjoy causing physical and/or emotional pain
(sadists) and those who enjoy it being directed at them (masochists). Can
involve role play, whips, bondage etc.
Sex, Sexual
intercourse.
Making love, fucking,
bonking, screwing
A male partner puts his erect penis into a woman's vagina.
It can also include any penetrative sexual activity.
Toys
Sex toys, marital aids
Toys' refers to a wide range of devices used to arouse a person or their
partner. Toys include dildos and vibrators.
When a couple performs oral sex on each other at the same time.
Sixty-nine
Tribadism
Rubbing the vulva against partner's thighs/genitals for sexual pleasure.
Troilism
Threesomes,
menage-a-trois.
Sexual activity involving three people.
Urolagnia
Golden showers,
water sports
Getting sexual pleasure from being urinated on or urinating on a
partner.
Voyeurism
Watching, peeping
Getting sexual pleasure from watching others having sex, listening to others'
sexual exploits, watching someone bathe etc.
85
TARSHI: Basics and Beyond
MODULE 1 - Chaplet 2
Handout 1.6
Sexual Expression Self-Reflections
Please look through the list of diverse sexual behaviours below. Of these behaviours, please note which
you feel personally comfortable with and which you are uncomfortable with. List the factors that
influence your attitudes and level of comfort with the various kinds of behaviour.
SEXUAL BEHAVIOURS/ EXPRESSION
COMFORTABLE
YES/NO
Fantasising
Anal sex
Oral sex
Peno-vaginal sex
Masturbation
Mutual masturbation
Sex talk with your partner
Sex talk with a stranger Ion the phone)
Reading erotica
Watching erotic films or pictures
Chatting online about sex
Any other (please add)
Any other (please add)
Any other (please add)
86
FACTORS THAT HAVE INFLUENCED MY COMFORT/ DISCOMFORT
TARSHI: Basics and Beyond
MODULE 1 - Chapter 2
Handout 1.7
Case Studies for Sexual and Gender Identity
Case study 1
A young man is being pressured by his parents to get married because now he has everything that a
married man would require: a good job, an excellent salary, a car and a house. The man is reluctant to
marry because he knows that he is not attracted to women. He has been having sex with men for a
number of years and wants to enter a long-term relationship with a man.
What issues related to sexuality and identity can you identify in this case study?
Is this young man homosexual? Explain your reasons.
Case study 2
An 18-year-old boy has been having oral sex with different men at common cruising areas in the city.
He has a feeling that one of his classmates frequents these places as well but is scared to ask him
directly.
What issues are highlighted in this case study?
Is this young man homosexual? Explain your reasons.
Case study 3
A 32-year-old woman goes to the gynaecologist for a routine check-up. She is asked to get some tests
done, including an ultrasound of her ovaries. On reading her referral form, the doctor doing the
ultrasound looks surprised and asks why she needs to come in for a test when she is unmarried. He
resists doing a vaginal scan for the same reason.
What assumptions is the doctor making about the woman’s sexuality and her health?
What issues related to gender and sexuality (and rights) can you identify in this case study?
How do you think this could affect the woman’s physical and mental health?
87
TARSHI: Basics and Beyond
MODULE 1 - Chapter 2
Case study 4
A man calls a helpline complaining that he has seen his wife and her friend, a married woman living
in the neighbourhood, in a compromising position. They were both half undressed and touching
each other ‘inappropriately’. He cannot understand why she is interested in another woman when
she is sexually satisfied with him.
What would you tell this man?
Is his wife lesbian?
Case study 5
A young man approaches a well-known lawyer to fight his case. He is angry with his brother for
accusing him of having undergone a sex reassignment surgery only so that as a male heir, he would get
an equal share to the family’s ancestral wealth. He has gone through a lot of pain and difficulty to
finally look like a man, something he knew he wanted to be even as a child when he dressed and acted
like a girl.
What issues related to gender and sexuality (and rights) can you identify in this case study?
What are your views about the brother’s actions?
Case study 6
A group in a small town has heard about transgender beauty pageants taking place in Thailand. As
people who identify as transgender, they want to hold a pageant in their small community to help
people appreciate their identity and also have fun. They go to the local community authorities to get a
permit to hold the pageant. The community authorities deny them the permit and tell them they do
not want to support such an event.
What issues related to gender and sexuality (and rights) can you identify in this case study?
How can the group advocate so as to get approval to hold the pageant?
88
MODULE 1 - Chapter 3
Chapter 3
Sexuality Through Life
Chapter Objectives for the Facilitator
1.
To describe how sexuality can be experienced throughout
one’s life, from childhood and adolescence to adulthood and
beyond.
2.
To dispel myths associated with sexuality and age,
particularly sexuality related to young people and sexuality
related to older adults.
3.
To acknowledge and recognise that sexuality can play a role
in physical development, sexual health, identity, and
pleasure through the different stages of life.
TARSHI: Basics and Beyond
MODULE 1 - Chapter 3
Why a Chapter on Sexuality Through Life
EXERCISES IN THIS CHAPTER
'My parents don’t have sex — they are too old!’
Exercise 1: Experiences of Sexuality
Through Life. 60 minutes
'My daughter is only 13, she doesn’t need to know about sex or
sexuality. ’
Exercise 2: Charting our Changes.
60 minutes
‘He became a father at the age of 68 — my, what a naughty old
man!’
Exercise 3: What we Learn from
Others. 60 minutes
These types of statements are common and reflect the ways in
which sexuality is often viewed by individuals or communities as an issue only for people of reproductive age (those between 15
and 45 years), and considered inappropriate or taboo,
particularly for people beyond reproductive age. However,
directing discussions about sexuality at a certain age group and
making age-related assumptions about sexuality - for instance
that older people do not experience sexuality, or younger people
do not need sexuality education - overlooks the reality that
sexuality is experienced throughout the course of a person’s life.
People of all ages experience sexual desire, are capable of being
sexually active, and need information on sexuality to enjoy lives
free of fear, stigma and infection.
This chapter discusses sexuality and sexual and reproductive
health through life. Participants explore their perceptions, ideas
and expectations of sexuality and sexual and reproductive health
through life, as well as the implications on health and well-being
when certain age groups are ignored in sexuality interventions.
Exercise 4: My Views on Sexuality
Through Life. 45 minutes
MATERIALS FOR THIS CHAPTER:
Flipcharts and markers
Pens/pencils
Paper
Index cards/slips of paper
Jars or baskets
HANDOUTS REQUIRED FOR THIS
CHAPTER:
■ Handout 1.8
Basic Information on Changes in
the Body Through Life
• Handout 1.9
Phrases and Words Related to
Sexuality
TARSHI: Basics and Beyond
ADDITIONAL RESOURCES:
MODULE 1 - Chapter 3
Key Messages for this Chapter
• The Boston Women's Health
Collective. 2005. Our Bodies,
Ourselves. New York: Touchtone.
• Sexuality is part of people’s lives from their youth until the end
of their lives.
■ Brick. P and Lunquist. J. 2003.
New expectations: Sexuality
Education for Mid and Later Life.
New York: SIECUS.
• Some people believe that discussing sexuality with young and
older adults is irrelevant, because they do not fall into the
reproductive age group, are perceived to be sexually inactive,
and consequently have no need for such information. However
sexuality is explored, expressed and experienced throughout life.
■ Irvin, A. 2004. Positively
Informed: Lesson Plans and
Guidance for Sexuality Educators
and Advocates. New York:
International Women's Health
Coalition.
■ Older Adult Sexuality Reference.
http://instruct 1 .cit.cornell.edu/
courses/psych431/student2000/
dp51/index.html
• TARSHI. 1999. The Red Book What You Need to Know About
Yourself UO-14 Years). New
Delhi: TARSHI.
• TARSHI. 1999. The Blue Book What You Need to Know About
Yourself115 + Years). New Delhi:
TARSHI.
■ For selected films see, http://
www.asiasrc.org/films.php and
Appendix B.
• Discussing young people’s sexuality and sexual and reproductive
health is critical, especially in those parts of the world where
child marriage is still the norm. However, it is important to
remember that a person’s first sexual encounter may not always
take place within marriage.
• Because men have a longer reproductive life span, their sexuality
receives more attention than women’s. Once women reach
menopause, they are seen as having no reproductive potential;
consequently their sexuality and sexual and reproductive health
are often ignored.
■ Physical changes that take place with ageing affect how people
experience their sexuality and its role in their lives. This does
not necessarily diminish/undermine their sexuality.
TARSHI: Basics and Beyond
MODULE 1 - Chapter 3
Exercise 1
Experiences of Sexuality Through Life
Instructions
1.
Hand out three index cards to each participant. Ask them to
write answers to each question below on separate cards. They
need not put their names on the slips in order to maintain
anonymity. Tell participants that the slips will be read aloud in
the next part of the exercise. Encourage them to be as open and
honest as possible.
• Card 1: When did you first hear about sex/sexuality and what was
the context?
■ Card 2: Describe briefly how you currently view your sexuality.
CATEGORISATION
Purpose of the
exercise:
1. To comfortably discuss
sexuality at different stages
of life.
2. To appreciate that
sexuality is experienced
throughout life.
■ Card 3: Describe briefly what you thinly your sexual experiences/
sexuality will be 20 yearsfrom now.
2.
3.
Ask participants to put each slip into the corresponding
containers - all responses to question 1 into the Past container;
the responses to questions 2 and 3 into the Present and Future
containers respectively.
MATERIAL
Index cards (or three different colour
cards), pens/pencils, 3 jars or
baskets
Suggested Questions:
ADVANCE PREPARATION
• Are the responses typical of the community you were raised/
live/work in? Do you think the responses would be different in
rural or urban communities, or if they came from women, men,
older or younger people etc.? Why or why not?
Now invite participants to read from the Present container
followed by the Future container.
Suggested Questions:
■ Compare responses of all three categories. How are they different
or similar? Did you expect these responses?
• Are the responses typical of the community you were brought
up in? Do you think the responses would be different in rural
92
60 minutes
Pass the Past container around and have each participant pick
one card at a time and read aloud. After they have read all the
slips, ask for questions and comments:
■ Are the experiences what you expected them to be? How many
of these were related to physical changes in your bodies?
4.
TIME
Label 3 jars Past, Present, and
Future
TARSHI: Basics and Beyond
MODULE 1 - Chapter 3
or urban communities, or if they were came from women, men,
older or younger people etc.? Why or why not?
Key Messages
THIS EXERCISE CAN BE MODIFIED
BY:
Dividing participants into smaller
groups to discuss the statements.
This is beneficial for participants
who are uncomfortable doing this
exercise in the large group.
After small group discussions,
participants can share their
conversations in the larger group.
MAKING CONNECTIONS
■ All people have the right to sexual
pleasure, irrespective of age. For
more see Chapter 4 in this
Module.
• Reproductive health and rights
should not focus on those of
'reproductive age' only, and is
important throughout our life. For
more see Chapter 2 in Module 3.
Sexuality is personal and subjective. It can be experienced at all
stages of life and can change over time. These changes are not
negative and do not suggest a diminished sense of sexuality.
Sexuality is not only about being sexually active and/or
reproducing. It is also related to well-being, a person’s choices
in sexual partners and identities and how they can negotiate
them, how their sexuality interacts with their family, community
or friends and how that makes them feel etc.
Different communities talk about and regard sexuality
differently; especially in the case of younger and older people.
For instance, some believe sexuality should be discussed with
young people but is unnecessary for older adults. Speaking about
sexuality is important to every person’s health and well-being.
As people grow older, they may develop comfort with their bodies
and themselves, which reflects in more satisfying sexual
experiences. For example, a woman may feel uninhibited or free
after menopause because unwanted pregnancy is no longer a
fear, and thus may be able to enjoy sex more.
TIPS FOR THE FACILITATOR:
• Participants may express shock at some of the responses, which seem different
from their own. Do not critique an experience or allow others to do so.
■ Participants may believe that with age people are likely to develop diseases that
affect their sexuality. While ageing does increase the likelihood of developing certain
medical conditions, avoid giving a message that age=disease=no sexuality.
■ Some participants may regard sexuality of older people with disapproval. Some
may be uncomfortable, laugh or make inappropriate comments when the issue
arises. Ensure that such comments do not target or disrespect older people.
• Young people may feel awkward with comments about their perceived inexperience.
Ensure that no discriminatory assumptions are made about their sexual lives.
■ Be aware of participants of different ages and experiences. Stress common factors
between these age groups (for example, the need for non-judgmental services at
all ages! as well as allow participants to highlight the differences Ifor example, the
requirements of a post-menopausal woman would be very different from a woman
going through her first pregnancy!.
93
TARSHI: Basics and Beyond
MODULE 1 - Chapter 3
Exercise 2
Charting Our Changes
Instructions
1.
Divide participants into small groups. Each group should receive
four to five of the phrases and words from Handout 1.9.
2.
Ask the groups to look over their respective phrases and words
that relate to sexuality. As a group they should decide which
category.the statements belong to: Adolescence, Mid-life, or Elder
Adults. After coming to an agreement on all the phrases and
their categories, one person from each group should write the
phrase or word on the appropriate flipchart pasted on the walls.
Let participants know that it is possible to put the words or
phrases in more than one category if they believe they pertain
to more than one category.
3.
After the groups have written all the phrases/words on the charts,
ask participants to come back together in the large group and
discuss where each phrase was placed. Begin with Adolescence-,
move to Mid-life-, then to Elder Adults. After going over each
stage, ask for questions and comments.
Suggested Questions:
■ Do you agree or disagree with where the phrases/words were
placed?
■ Would you change any of them?
• Are some of the phrases/words in all three categories? What does
this tell us about sexuality over our lifetime?
■ How can you talk about sexuality with people in these different
age groups?
■ How can you address the importance of sexuality with
communities that find it inappropriate to talk about sexuality
with certain age groups?
94
CATEGORISATION
Purpose of the
exercise:
1. To understand and
discuss the characteristics
and features of sexuality at
different stages in life.
2. To dispel myths
associated with sexuality
and safer sex over our
lifespan.
TIME
60 minutes
MATERIALS
Flipchart, markers, Handout 1.9
Phrases and Words Related to
Sexuality
ADVANCE PREPARATION
Copy Handout 1.9. On three
different pages of the flipchart write
Adolescence, Mid-Hfe, and Elder
Adult. Tape these pages up in
different areas of the room.
TARSHI: Basics and Beyond
THIS EXERCISE CAN BE MODIFIED
MODULE 1 - Chapter 3
Key Messages
BY:
• Older people can also feel pleasure and desire.
• Reading aloud the statements
from the list on Handout 1.9 to
participants, as a large group and
inviting them to say what
category each would fit into. After
each statement, the facilitator can
ask whether others agree or
disagree and if it can fit into other
categories as well.
• It is important to continue to practice safer sex at every stage of
life.
■ Although we can experience sexuality throughout our lives, there
are also physical and emotional changes that occur as we get
older that can affect how we view and experience our sexuality.
TIPS FOR THE FACILITATOR:
■ To avoid confusion, the facilitator should develop a consensus with the group at
the beginning about what age ranges would constitute the Adolescence, Mid-Ufe,
and Elder Adult categories.
MAKING CONNECTIONS
• As we age, our bodies change and
this can effect and influence our
sexuality. For more on sexual and
reproductive anatomy and
physiology see Chapter 1 in
Module 2.
• Sexual problems for some people
may occur due to changes in the
body as we grow older,
potentially increased risk for
illness or certain medications.
These problems do not necessarily
imply a diminished sexuality. For
more on see chapter 5 in
Module 2.
■ Differing backgrounds, religions, and communities of the participants can cause
disagreement over which category each word/phrase belongs in. For example,
participants from some communities may think that a discussion of masturbation
or sexual experimentation in older adults is inappropriate, while others may disagree.
The facilitator and participants should respect these differences and the conversation
should encourage the expression of varying opinions. It may be appropriate to find
out why different ideas are present and whether participants think attitudes can
or should be changed.
• Participants may focus on heterosexual, penile-vaginal sex, identities and
experiences. Encourage the discussion to include other types of relationships and
identities. For example, many participants may put the phrase 'voice deepens' in
the Adolescence category. This can, however, also occur later in life if someone
decides to have a sex change.
• Participants may make assumptions about elder adults. For example, many may
assume that all elder adults are in monogamous relationships. If participants make
these assumptions, ask about the bases for these ideas and whether nonmonogamous or non-heterosexual relationships are also possible for older people.
■ Gender differences may emerge from the discussion. The facilitator should be
alert to and focus on any comments that suggest bias/difference based on gender
and ask why these are important. For example, do people think that only men
can masturbate or should be able to at any age?
95
TARSHI: Basics and Beyond
MODULE 1 - Chapter 3
Exercise 3
What We Learn From Others
Instructions
Divide participants into three small groups. Ask each to create
a role-play in which they finish/respond to the following
statements:
1.
Group 1: ‘My mother taught me about sex...’ and/or
‘My father taught me about sex...’
Group 2: ‘My friends/peers taught me about sex...’
Group 3: ‘My community taught me about sex...’
Encourage groups to interpret these open-ended statements
broadly and creatively. For example, the role-plays can be
conversations between people, a snapshot of time, pantomime
etc. Age groups can also be added into the three statements. For
example, ‘In adolescence my mother/father taught me about
sex..‘In adulthood, my friends/ peers..About older people
and sexuality, my community taught me...’ etc. Give the groups
20 minutes to create these role-plays.
ROLE- PLAY
Purpose of the
exercise:
1. To explore how attitudes
and values on sexuality are
shaped by social and
cultural surroundings.
2. To describe how our
environment can influence
our sexual growth and
development.
TIME
60 minutes
2.
Bring the participants back together and invite each group to
perform their role-plays. After each presentation, ask the group
for comments or questions.
Suggested Question:
■ Were the experiences in the role-plays similar or different to the
messages you received from these groups (parents, peers and
society)? How were they similar or different?
3.
When all role-plays are complete, ask the group to discuss and
compare the three.
Suggested Questions:
■ What aspects of sexuality did each group stress? Were they
different or similar?
• Were the lessons learned by parents the same as those from the
community or friends?
96
MATERIALS
Paper
Pen/pencil
ADVANCE PREPARATION
None
TARSHI: Basics and Beyond
MODULE 1 - Chapter 3
THIS EXERCISE CAN BE MODIFIED
BY:
Providing possible answers to the
statements and asking participants
to create a role-play from these.
For example, 'My mother taught
me...sex before marriage is
wrong', or 'My friends taught
me...that it was okay to be a
homosexual'. This may be suitable
for groups that are uncomfortable
sharing personal experiences.
■ Asking participants to draw a
simple picture of themselves. They
should then draw all the factors in
their lives that have influenced
their sexuality. These influences
can be family, friends, society etc.
The drawing can be simple, with
stick figures and words. When the
drawings are completed,
participants can present it to the
group and discuss their influences.
Would you add other people/ groups to this list of those who
influence us about sexuality? Do these groups continue to
influence your sexuality or are your influences different now?
Key Messages
• Different groups and individuals may influence and shape
people’s sexuality differently. For example, parents may stifle
sexual expression, while some teachers might find it comfortable
discussing sexuality or vice versa.
• Influences can change over time. For example, while teachers
may not continue to influence choices and decisions made on a
daily basis for some, what was learned from teachers may
continue to impact later choices for others.
• Ideas about sexuality and how to engage with it also change
with time and circumstances, reinforcing the notion that
sexuality is fluid.
MAKING CONNECTIONS
TIPS FOR THE FACILITATOR:
■ Younger and older people can
experience stigma, discrimination
and marginalisation while trying
to access sexuality related
information and services. For
more see Chapter 2 in Module 4.
■ Participants might avoid the issue of sexuality in their role-plays by focusing on
sexual and reproductive health issues. If this happens, shift the focus or ask why
this occured. For example, a group may mention that parents generally teach a
girl about the connection between gening her period and her fertility, rather than
address her feelings and attitudes around this event Isuch as telling her that having
her period means that she has 'become a woman' and now has to be careful to
protect herself and dress differently to avoid sexual attention from menl.
• Representations in the mass
media, by NGOs etc. of younger
and older people and their
sexuality can influence our
attitudes and opinions on
sexuality. For more see Chapter 2
. in this Module.
• Participants in each group may come from different backgrounds, religions and
communities and may find creating a scenario with these questions difficult. The
facilitator should emphasise that this is an opportunity to collaborate on common
themes, involve individual experiences, and open up discussions.
• Participants may focus only on heterosexuality. Shift questions and discussion to
broaden the focus. For example, did peers teach them that it is possible to have a
same-sex relationship?
97
TARSHI: Basics and Beyond
MODULE 1 - Chapter 3
Exercise 4
My Views on Sexuality Through Life
Instructions
1.
Tell participants that you will read out a statement and they
must decide whether they agree or disagree with this. Designate
one side of the room as the Agree side and the other as the
Disagree side. Ask participants to move toward either side,
depending on how they feel about the statement. Those who
are undecided should move to a third designated spot in the
room (the Don’t Know group).
POLARISATION
Purpose of the
exercise:
1. To examine and analyse
attitudes and opinions
toward sexuality
throughout a person’s life.
Statements for My Views on Sexuality Through Life
■ Talking about sexuality with teens is unnecessary
■ Young people have the right to sexuality education
• Its normal for people over 50 years of age to be sexually active
• Its not normal for older men to fantasise about younger women
or for older women to fantasise about younger men
■ My community would support my mother talking to my children
about sexuality
• It is not necessary to talk about sexuality with most people as
they get older
■ Some cultures allow their children to explore their sexuality
openly when they are very young. They let them walk around
naked, ask questions etc. This is inappropriate
• There is a cycle to our sexuality, and with age, a person’s sexuality
diminishes
■ Older men are allowed to express their sexuality.
2.
Ask participants to share why they have chosen to be on a
particular side of the room. Discuss the issues for no more than
20-25 minutes or participants may lose interest.
Suggested Questions:
■ Why do you agree or disagree?
• Do you think you would change your opinion if the statement
reflected a specific gender? For example, is it appropriate to talk
with young women about sexuality so they will not get pregnant,
but not necessarily with young men?
98
TIME
45 minutes
MATERIALS
None
ADVANCE PREPARATION
1. Select three statements from the
listT>f 'Statements for My Views on
Sexuality Through Life'.
2. Review the statements and be
prepared to lead a discussion on the
selected topics.
3. Clear the room or part of the
room of furniture so that there is
space for participants to move
around.
TARSH1: Basics and Beyond
MODULE 1 - Chapier 3
3.
After discussing the statements, ask for general comments or
questions.
Suggested Questions:
■ Were there any issues you had not thought of before? What were
they and how did they make you feel?
THIS EXERCISE CAN BE MODIFIED
• From these statements and discussions, what are your opinions
and thoughts about sexuality through our life?
BY:
■ Eliminating the Do Not Know
option in the exercise, and
insisting that participants decide
to agree or disagree with the
statements. This can be difficult
for some statements, but
encourages participants to form
opinions and discuss the positive
and negative aspects of each.
• Choosing fewer statements and
spending more time discussing
them, particularly if participants
are having trouble grasping a
concept.
Key Messages
■ It is common for people of all ages and at all stages of their lives,
whether in a relationship or single, to feel sexual desire. Social
taboos may, however, prevent people from expressing their
desires.
• Different cultures and communities regard sexuality differently,
particularly when dealing with younger or elder people. It is
important to initiate discussions among different groups.
• Social conditioning can lead people to believe that it is wrong to
have sexual feelings unless they are young adults and in a
monogamous relationship. This can cause feelings of guilt and
shame in many, and can lead to sexual problems.
• Because of the shame and secrecy that surround sexuality, people
hesitate to seek help openly. They may therefore resort to seeking
help from unreliable sources (for example, from fake/unqualified
health practitioners), much to the detriment of their health and
well-being.
MAKING CONNECTIONS
• Sexual health and rights are
important for people of all ages.
For more see Chapter 3 in
Module 3.
• Gender and gender roles can
influence how sexuality is
expressed throughout life. For
more see Chapter 1 in this
Module.
TIPS FOR THE FACILITATOR:
■ These statements may provoke difficult questions and debate from participants.
The facilitator should emphasise respect for all ideas and opinions as laid out in
the Ground Rules {see Preparing to Train for a sample).
• Participants may all agree or disagree with statements, leaving little room for
debate. Be prepared with possible arguments and responses to statements before
undertaking this exercise. For example, participants may all disagree with the
statement that older men are allowed to express their sexuality and believe that
the problem lies with women, who do not talk about such topics. The facilitator
may ask why women don't talk about these topics, and whether it is to do with
stigma related to such conversations.
■ Polarisation exercises may discourage quieter participants from speaking. Invite
all to express their views from time to time during the exercise.
99
TARSHI; Basics and Beyond
MODULE 1 - Chapter 3
Handout 1.8
Basic Information on Changes in the Body Through Life
Physical changes occur in the body as people age. A person’s life circumstances also affect these changes (for
example, income level, nutrition, stress and responsibilities etc.). Below are some common physio ogica
changes people experience through their life.
Menarche: The onset of menstruation, which can occur as early as age 9 and as late as 15 years, but
most often around the age of 12. Nutritional standards, family history and psychological factors
determine the age of onset of periods for most girls.
Even today in many parts of the world, menarche is marked as a significant coming of age event for
girls and is often accompanied by rituals of celebration. However, even girls in urban areas are not
usually prepared by their mothers, teachers or other care-takers for menarche. Rules and restrictions
may also be imposed on girls once they reach menarche - for example who they can speak to, what they
can wear, where they can go etc. - all of which add to feelings of confusion and shame for the young
person who may not be able to share her feelings with anyone.
Menstruation: When the lining of the uterine wall, made up of blood and tissue, is shed gradually
through the vagina. This shedding occurs because the uterine lining is not required if fertilisation has
not occured. Menstruation usually occurs once every four weeks and can last between two to eight
days.
Stress, change in routine, anaemia, illness and the side effects of medicines are some of the reasons for
irregular menstruation. In certain cultures, rituals of purity are observed even today since menstruating
women are considered dirty and not fit to take part in social and religious activities.
Perimenopause: The period before a woman reaches menopause. During this time, the ovaries begin
to produce less oestrogen, a hormone that helps to regulate menstruation. Perimenopause can begin
to occur a few years prior to menopause. Within the last two years of perimenopause, oestrogen
production decreases more rapidly, which can lead to menopausal symptoms such as hot flashes, changes
in libido, and vaginal dryness.
Perimenopause and menopause are often thought of as a time when women experience diminished
sexual desire. While libido (sexual desire) might decrease, this idea may have more to do with prevailing
social attitudes that look down upon women’s expression of sexuality, after they have fulfilled their
reproductive responsibilities toward the family.
.100
TARSHI; Basics and Beyond
MODULE 1 - Chapter 3
Menopause: Menopause is the time a woman stops menstruating. The ovaries no longer produce eggs
and release less oestrogen than before. Menopause can occur naturally as women age, any time between
the ages of 40 and 60 years. It is possible for women to experience premature menopause before the
age of 40 as a result of medical interventions, such as a hysterectomy, autoimmune deficiencies that
can result from chemotherapy or HIV/AIDS, or genetic conditions. A woman is considered to be in
menopause when she experience 12 consecutive months without menstruation.
As mentioned, menopause is often thought of as a time when women experience diminished sexual
desire. While libido (sexual desire) might decrease, this idea may have more to do with prevailing
social attitudes that look down upon women’s expression of sexuality, particular those of older women.
Post menopause: The time after a woman has reached menopause until the end of her life. In the post
menopause phase, the symptoms experienced in the perimenopausal period, such as hot flashes, can
decrease. A woman can experience other physical changes primarily as a result of lower oestrogen
levels during post menopause. These include decrease of fat in the genitals, thinning and drying of the
vaginal mucous, and a decrease of firmness in the breasts.
Climacteric: When men begin to produce decreased levels of testosterone, usually around the age of 45
to 65. This has been likened with the female menopausal process. Unlike menopause in women, this
is not often accompanied by decreased sexual libido.
As both men and women grow older, physical conditions, like diabetes and hypertension, and
sometimes the use of additional medications or supplemental vitamins may have side-effects ,
which can affect sexual interest and performance.
TARSHI: Basics and Beyond
MODULE 1 - Chapter 3
Handout 1.9
Phrases and Words Related to Sexuality
■ Able to have an orgasm
• Develops breasts
• Facial hair begins to grow
• Voice deepens
■ Should use a condom for protection against sexually transmitted infections (STIs) including
HTV/AIDS
• Experiences sexual pleasure
• At risk for a sexually transmitted infection (STI)
• Experiences desire
• Libido decreases
■ Experiences menopause
• Can get pregnant
• Experiences menarche
• Experiences perimenopause
• Goes through climacteric
• Has a monogamous relationship
■ Can experience sexual abuse
• Has nocturnal emissions
• Enjoys or wants to watch/use pornography/sex toys/erotic literature
• Masturbates
• Participates in sexual experimentation
• Has fantasies
102
MODULE 1 - Chapter 4
Chapter 4
Pleasure and Eroticism
Chapter Objectives for the Facilitator
1.
To have participants identify the role of pleasure and
eroticism in sexuality and sexual health.
2.
To encourage participants to discuss sexual pleasure and
eroticism in a non-judgmental manner.
3.
To have participants recognise the importance of integrating
pleasure in safer sex messaging.
TARSHI: Basics and Beyond
MODULE 1 - Chapter 4
Why a Chapter on Pleasure and Eroticism
'I am too embarrassed to talk about whether something feels good
sexually with my partner. What if my partner laughs at me?’
‘Whether Ifeel pleasure during sex is not important, what is important
is that my husband enjoys it.’
‘Condoms don’t feel good during sex, so 1 don’t like to use them. I
would rather enjoy sex.’
‘How can Iprolong my lovemaking? I have heard ofsprays and capsules
to enhance sexual performance; are they safe to use? Ifeel afraid that
my partner will lose interest in me ifI cannot satisfy her’.
‘We engage in anal sex so that my partner does not have to use a condom
and I don’t get pregnant either. But I was told that anal sex is risky i0°
— how?’
Pleasure is often talked about as an afterthought, as something we
can ‘indulge’ ourselves in after we have taken care of disease, pain
and abuse. The topic may also elicit feelings ofdiscomfort or shame,
and may be considered inappropriate for discussion. These
common reactions to the notion of sexual pleasure indicate the
need for more dialogue and an open approach to the subject that
can help remove the guilt and shame surrounding the experience
ofpleasure. Open dialogue promotes an understanding of the range
of existing sexual preferences and creates a comfortable
environment for people to discuss sex and sexuality. It will be
particularly beneficial for people who have been discouraged from
articulating their desires, such as women, young people and older
adults.
Introducing the notion of pleasure in sexual and reproductive health
programmes will improve their efficacy and quality. It is important
that pleasure be acknowledged as a common reason people have
sex and a factor influencing their sexual choices. These choices
can sometimes increase their risk ofcontracting sexually.transmitted
infections, including HIV/AIDS, and susceptibility to sexual and
reproductive ill-health. Integrating sexual pleasure into sexual and
reproductive health programmes acknowledges pleasure as a valid
104
EXERCISES IN THIS CHAPTER
Exercise 1: Sex for Pleasure?
30 minutes
Exercise 2: Creating A Pleasure
Story. 60 minutes
Exercise 3: Demystifying Pleasure.
60 minutes
Exercise 4: Negotiating Pleasure.
45 minutes
MATERIALS FOR THIS CHAPTER:
Flipchart
Markers
Pens/pencils
Index cards/slips of paper
Assorted items from the training area
HANDOUTS REQUIRED FOR THIS
CHAPTER:
• Handout 1.10 Facilitator Copy:
Pleasure Myths, Facts and
Opinions
• Handout 1.11 Participant Copy:
Pleasure Myths, Facts and
Opinions
• Handout 1.12
Open-ended Case Study on
Pleasure
TARSHI: Basics and Beyond
ADDITIONAL RESOURCES:
• Betty Dodson Online, http://
www.bettydodson.com
■ Coalition for Positive Sexuality.
http://www.positive.org
■ Hendrix-Jenkins A; Clark S; Gerber
W; LeFevre J; Quiroga. 2002.
Games for Adolescent
Reproductive Health: An
International Handbook. Program
for Appropriate Technology in
Health (PATH).
• Improving Women's Sexual Lives.
http://www.hesperian.org/assets/
whx_8.pdf
• The Pleasure Project, http://
www.the-pleasure-project.org
• Society for Human Sexuality.
http://www.sexuality.org
■ Women's Sexual Pleasure and
Health, http://www.theclitoris.com/
• For selected films see, http://
www.asiasrc.org/films.php and
Appendix B.
MODULE 1 - Chapter 4
motivation for sex. These programmes can then educate people on
how to maintain the experience of sexual pleasure while practicing
safer sex.
This chapter engages participants in discussions on pleasure to
remove feelings of discomfort surrounding the topic. It gives them
an understanding of the role of pleasure in sexuality and in the
realization of sexual and reproductive health and rights.
Participants will discover the connection between sexual pleasure
and well-being and also understand why and how it is essential to
incorporate pleasure into programmes on sexuality and public
health.
Key Messages for this Chapter
■ Discussing pleasure and sexuality does not need to cause
discomfort. People should have the opportunity and voice to
express what does and does not feel good sexually.
• Pleasure and eroticism are individual experiences. There is no
wrong or right, better or worse in sexual feelings or preferences.
One individual may be aroused by certain touches, smells, or
thoughts while another may not.
• Different circumstances and conditions can affect or alter how
we experience sexual pleasure. For example a chronic disease
or disability can change a person’s preference or experience of
sexual pleasure. Or a woman who has been through menopause
and no longer fears pregnancy may be more relaxed and therefore
might experience sexual pleasure differently.
■ Pleasure and eroticism are important to address in the context
of sexual health and well-being in order to help people make
their pleasure seeking behaviour safe and with less risk.
■ Gender and power influence the way people seek and experience
pleasure. For example, in some communities and cultures, men
are encouraged to express pleasure and eroticism differently from
women- men have the power to negotiate and ask for what may
be sexually pleasurable, while women are expected to be more
passive and not express what feels good.
TARSHI: Basics and Beyond
MODULE 1 - Chapter 4
Exercise 1
Sex for Pleasure?
Instructions
1.
Introduce the exercise to participants by asking them to express
ideas, thoughts and opinions in response to the question: ‘Why
do you think that people have sex?’ They should be encouraged
to express whatever words/phrases/statements/ideas come to
mind. Write each statement/idea on the flipchart as they are
said. A few sample statements/ideas can also be listed on a
flipchart prior to the session. In this sample list, include
statements about pleasure such as ‘It feels good’, or ‘I like to
have orgasms from sex’ and ask participants to add to this list.
Starting with these ready statements can help participants get
comfortable with the session.
brainstorming
Purpose of the
exercise:
To explore attitudes and
ideas surrounding sex and
pleasure.
TIME
30 minutes
2.
After the group has generated a substantial list of statements
and ideas, ask for comments and questions about the list.
Suggested Questions:
■ Are there statements/comments on the list that address sex and
pleasure? Is consideration of sexual pleasure important?
• Are there any statements on the list you disagree with?
• Why is talking about pleasure and sexual practices important?
• Is talking about sex and pleasure taboo in your communities/
cultures? In what circumstances is it acceptable and why? When
and why is it unacceptable?
• Do you think this list would be the same if the exercise were
done with people from your family or community?
106
MATERIALS
Flipcharts, Markers
ADVANCE PREPARATION
None
TARSHI: Basics and Beyond
THIS EXERCISE CAN BE MODIFIED
MODULE 1 - Chapter 4
Key Messages
BY:
• Introducing a second question into
the discussion, such as: 'Is sexual
intercourse the only way to
achieve sexual pleasure?'
Once a comprehensive list of
responses is compiled, engage
participants in a discussion similar
to the previous one.
MAKING CONNECTIONS
■ Pleasure is a right not only for
adults in a certain age/ability/
health bracket. Young people,
older adults, people with
disabilities or diseases also want
and have the right to experience
sexual pleasure. For more on
sexuality through life see Chapter
3 in this Module.
■ People with disabilities can also
experience pleasure and sexuality.
For more on disability and
sexuality see Chapter 3 in
Module 4.
• Pleasure and eroticism need to be recognised as an integral part
of many sexual experiences.
• Pleasure is an important consideration in the context of sexual
health and safer sexual practices. For example, some people have
sex because it feels good, and this must be kept in mind when
safer sex practices are being promoted. If this is one of the
primary reasons people have sex, they will want a protection
method that facilitates pleasure during sex rather than one that
diminishes/ is thought to diminish sensations.
• It is okay to talk openly about pleasure and its place in sexual
experiences. Such a discussion can reduce shame and guilt and
allow for the expression of fears as well as clarify misconceptions
around this issue.
TIPS FOR THE FACILITATOR:
■ If participants exclude remarks related to pleasure or eroticism, make sure to
introduce them into the session.
• Participants may focus on reproduction as the primary reason for sex. Help them
see that sex is not only about reproduction. Sexually active people in the reproductive
age group have sex for reasons other than procreation.
• Participants may focus on heterosexual relationships li.e. man-woman sexual
interactions and/or penile-vaginal penetration). Expand this focus and introduce
other possibilities such as same sex relations.
• Participants may argue that pleasure is a 'luxury' and does not deserve attention
when more pressing issues like disease and infection exist. Remind them that
denying the role of pleasure in peoples' lives could be why disease has become
such a major issue today - if it was acknowledged that people expose themselves
to significant risk in pursuit of pleasure, public health messaging could be designed/
created accordingly.
107
TARSHI: Basics and Beyond
MODULE 1 - Chapter 4
Exercise 2
Creating a Pleasure Story
SMALL GROUP WORK
ADAPTED FROM PATH GAMES FOR ADOLESCENT REPRODUCTIVE HEALTH
Instructions
1.
Divide the participants into small groups. Give each group one
container of collected items. Ask participants to use the items
to create a story titled ‘Pleasure and Sexuality’. Every object in
the bag should be used in the story and can be used literally or
to represent something. For example, if a condom and a rock
are present among the items, the group could create a story about
a woman who wants to use a condom. Her boyfriend is stubborn
and unyielding like the rock saying he finds condoms
uncomfortable. The woman is equally stubborn and sticks
resolutely to her decision about using protection, which she
considers important.
Purpose of the
exercise:
To comfortably discuss
pleasure, eroticism and
sexuality.
TIME
60 minutes
2.
3.
Give the groups 30 minutes to create the story. Tell participants
there will be two winners: for The Most Creative Story and for
The Most Erotic Story. When telling the story they can hold up
each object being used as the story goes along.
After each story ask the other participants for reactions and
questions.
Suggested Questions:
■ How did you feel doing this exercise? How easy/difficult was it
to create a story around sexual pleasure? What was easier to
discuss and what more difficult?
MATERIALS
11 Material collected from around
the training area. These should
include a wide range of objects such
as bottles, food items, kitchen tools,
magazines, train tickets, receipts,
rocks, flowers, etc. Items can also
include forms of contraception such
as a condom. 2) Bags or containers
to store the material.
ADVANCE PREPARATION
■ Was pleasure and sexuality depicted positively or negatively in
the stories? Did the story describe situations common in your
communities?
• Would it have been easier to create a story about violence or
abuse? Why/Why not? Do we have greater ease or better
language around the issue of abuse and violence than pleasure
and sexuality?
108
Gather the items and divide them
into two to three separate
containers. Each container should
have a variety of objects laround ten
I items) and also include some form of
I contraception.
TARSHI: Basics and Beyond
THIS EXERCISE CAN BE MODIFIED
MODULE 1 - Chapter 4
Key Messages
BY:
• Instructing participants to relate
each object to pleasure in the
story rather than allowing for
metaphorical interpretations. For
example, instead of stubbornness,
the rock could represent
something the woman likes her
partner to rub on her feet for
pleasure.
■ Asking members of the group to
bring in their own materials for
the bags. Stress that these items
need not be personal.
Alternatively, people could be
asked to pick up one item from
the training area that symbolises
pleasure to them.
■ How each person understands and experiences sexual pleasure
is individual and subjective.
• What is considered ‘appropriate’ for a person or community can
affect ideas of pleasure and sexuality. For example, in some
cultures women are discouraged from speaking openly about
what feels sexually ‘good’ or ‘bad’. This makes them
uncomfortable talking about sexuality and pleasure.
• It can be enjoyable and exciting to talk about pleasure and
sexuality. However, the language around pleasure is limited.
Language that is more familiar is from popular erotic literature
and films, and is often derogatory. Since people do not discuss
sexual pleasure openly, they may find it difficult to think about
or describe it in a positive way, which may contribute to the
discomfort felt during such a conversation.
TIPS FOR THE FACILITATOR:
• Participants may be uncomfortable sharing thoughts and ideas about sexual
pleasure. In this case, do not force them to participate. Encourage them to speak
up while in the smaller groups.
MAKING CONNECTIONS
■ People may derive sexual pleasure
from a variety of sexual behaviour
and practices. Individual
preferences and practices must be
respected as long as they are
consensual and do not harm
others. For more see Chapter 2 in
this Module.
• Experiences of sexual violence and
abuse can affect how people
experience or approach sexual
pleasure. For more see Chapter 1
in Module 4.
• Participants may create stories linked only to penile-vaginal sex within marriage.
Encourage integration of other forms of sexual experiences into the discussion,
such as same sex eroticism and fantasy. Conversely, they may create stories that
describe sexual pleasure only in the context of 'illicit' behaviour. For example, a
married man has an affair or a woman decides to become a sex worker 'to fulfil
their desires'. Point out that sexual pleasure can be experienced during different
interactions and not just 'illicit' situations.
• Participants may focus on stories in which men experience more pleasure than
women, validating men's pursuit of sexual pleasure and ignoring a similar motivation
in women. Make sure these biases are avoided and there is discussion around
such judgements.
• If participants find it difficult to create a story suggest an outline or a framework
to the story.
109
TARSHI: Basics and Beyond
MODULE 1 - Chapter 4
Exercise 3
Myths, Facts and Opinions on Sexuality and Pleasure
MYTH OR FACT
Instructions
1. Distribute Handout 1.11 to the participants. Ask each participant
to read one statement from the handout aloud and respond to
it: Do they think the statement about pleasure is a fact or myth?
Or what is their opinion on the statement? After each has
responded,.ask the others whether they agree or disagree and
why. It is not necessary to let the group know immediately
whether the statement is a myth or fact. First allow for
conversation and discussion.
2. After the group discussion, tell the participants why the
statement is a myth or fact. Bring up issues that were not
introduced or talked about by the group (refer to Handout 1.10.
Have the rest of the participants read out their statements one
by one and follow the same process. After everyone has read
out the statement ask for general questions or comments.
Suggested Questions:
• Were you surprised by any of the statements? Did you believe
some to be either myths or facts and discover the opposite to be
true?
• Are there any other statements you commonly hear or wonder
about regarding sexuality and pleasure? What are these?
Purpose of the
exercise:
1. To dispel myths and
misconceptions about
pleasure and sexuality.
2. To explore opinions and
ideas about sexuality and
pleasure.
TIME
60 minutes
MATERIALS
Flipchart, markers, index cards/slips
of paper, Handout 1.10 Facilitator
Copy: Pleasure Myths, Facts and
Opinions, Handout 1.11 Participant
Copy: Pleasure Myths, Facts and
Opinions
ADVANCE PREPARATION
Copy or write he statements from
Handout 1.11 on separate index
cards. Make copies of Handout 1.11
for each participant.
110
TARSHI: Basics and Beyond
MODULE 1 - Chapter 4
Key Messages
THIS EXERCISE CAN BE MODIFIED
BY:
■ Unking it to a discussion of sexual j
problems and their medicalisation
(Chapter 5 in Module 2).
Emphasise that the sexual
response cycle is only a model and
not a set way in which each
person will or should experience
pleasure. Some questions to pose
for participants after going over
the model of sexual response
could be: Were you surprised that
the sexual response has been
studied and that there is a
'scientific' process to describe sex
and pleasure?
• Pleasure is an individual feeling. There are no rules on how to
experience sexual pleasure.
• Men and women may experience pleasure differently. It is
important to address the concerns and experiences of both.
• All individuals have the right to experience sexual pleasure and
express this in any manner they feel comfortable, as long as they
do not infringe on another’s rights.
• Pleasure can be experienced in many different ways: Through
penetrative sex, manual stimulation, hugging, kissing, lying next
to each another etc. Pleasure is experienced not only through
physical experiences, but mental and emotional ones too.
TIPS FOR THE FACILITATOR:
• Participants may want to share their own personal experiences related to the
statements. Acknowledge these contributions, but stress that each person's sexual
pleasure cannot be addressed in this exercise.
MAKING CONNECTIONS
■ People derive sexual pleasure in a
variety of ways and this must be
respected as long as this is
consensual and does not harm
others. For more see Chapter 2 in
this Module.
■ While sexuality and pleasure are
not only bodily experiences,
knowledge of our sexual anatomy
and physiology helps enhance the
experience of sexual pleasure. For
more see Chapter 1 in Module 2.
111
TARSHI: Basics and Beyond
MODULE 1 - Chaptei 4
Exercise 4
Negotiating Pleasure
Instructions
1. Distribute the case studies chosen from Handout 1.12 to each
participant. Give them 5-10 minutes to read over the case studies
and related questions.
2. Begin with one case study and invite participants to describe
what they see as the next steps for the character.
Suggested Questions:
■ Does the character have options and choices?
• What is the best choice for the character to make?
3.
Have two participants volunteer to carry out a conversation that
could develop between characters in the case study. The
conversation can be used to demonstrate how to share and
negotiate pleasurable and safe sexual practices. After the role
play ask for questions and comments:
Case Studies/Role-Plays
Purpose of the
exercise:
1. To discuss the ways in
which pleasure and
eroticism can be negotiated
in relationships or
situations.
2. To recognise the
diversity of actions and
experiences people may
find pleasurable.
3. To examine the links
between sexuality and
behaviour from a public
health point of view.
Suggested Questions:
■ Do you agree with the way the conversation unfolded? Do you
think the conversation was unrealistic? Have you had to
negotiate sexual pleasure in a similar way?
• Do you think it is necessary for us to get rid of barriers to pleasure
before we can talk about sexual pleasure? For example, address
sexually transmitted infections with people before discussing
pleasure. Why?
4.
Ask participants to consider a scenario in which die roles are
reversed.
Suggested Question:
■ Would changing gender roles allow for different choices or make
the conversation different between the characters? How?
5.
112
Move to the next case study and conduct a similar exercise with
the same questions as above.
TIME
60 minutes
MATERIALS
Handout 1.12 Open-ended Case
Study on Pleasure
ADVANCE PREPARATION
Choose 1-3 of the four case studies
from Handout 1.12 and make copies
of the case studies for each
participant.
TARSHI: Basics and Beyond
THIS EXERCISE CAN BE MODIFIED
MODULE 1 - Chapter 4
Key Messages
BY:
• Dividing participants into three
small groups and asking each
group to read one of the case
studies and present the situation
and discussions.
• Conducting fewer case studies.
This may allow for a more indepth discussion about a given
scenario and is especially useful if
there is limited time in the
session.
■ Negotiating pleasure is the process of reaching agreement on
safer and more pleasurable sexual decisions.
• Comfort around acknowledging and articulating one’s desires
is crucial to negotiating for pleasure and safety.
• Some people believe that the elimination of disease or risk of
contracting STIs including HIV/AIDS, violence or fear of
violence is essential before one can focus on sexual pleasure.
Acknowledging pleasure is however, necessary to effectively
address and balance sexual pleasure with risk.
TIPS FOR THE FACILITATOR:
MAKING CONNECTIONS
■ Sexual problems can also affect
how a person negotiates or talks
about what is sexually
pleasurable. For more see Chapter
5 in Module 2.
■ Any discussion or negotiation
about sexual pleasure should also
include safer sex practices. This
will reduce the likelihood of
acquiring a sexually transmitted
infection including HIV/AIDS. For
more on see Chapter 4 in
Module 2.
■ Participants may assume that negotiations only happen within heterosexual
relationships. Introduce other options or ask participants whether they assume
the meaning of the word 'partner' in a case study means a partner of another
gender. Does it make a difference if they assume there are only heterosexual
,
relationships?
■ If group members are uncomfortable with each another, they may feel awkward
role-playing intimate situations. Ask them to then act out the part of other members
of the family/society. This may help identify societal values and influences that
directly or indirectly influence partners and make participants more comfortable
with the exercise.
I_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
113
TARSHI: Basics and Beyond
MODULE 1 - Chapter 4
Handout 1.10
Facilitator Copy: Pleasure Myths, Facts and Opinions
• It is my right to experience sexual pleasure.
FACT: All individuals have the right to experience and express sexual pleasure in any manner they
feel comfortable, as long as they do not infringe on others’ rights.
• Women have sex for love; men have sex for pleasure.
MYTH: Individuals have sex for diverse reasons and these cannot be categorised based on gender.
Many societies have such mistaken ideas about men and women’s preference for sex as reflected in
this statement. All people have the right to choose to have sex for any number of reasons, regardless
of their gender.
■ Men can always be aroused by the idea of sex and can get an erection immediately.
MYTH: Men are not always sexually aroused. Even if they are aroused they may not get an erection
immediately. This does not mean there is something wrong or that they do not desire their partners.
■ All people feel sexual desire in the same way.
MYTH: In the same way that sexuality is an individual experience, desire is experienced differently
by each person and even for the same person at different times, depending on various factors (life
circumstances, health, stress levels, relationship issues etc).
■ Women can have an orgasm only through penetrative sex.
MYTH: Women can experience orgasms through clitoral stimulation and stimulation of other
parts of their bodies, not just through (vaginal or anal) penetrative sex.
• It is possible to sustain a marriage or relationship without sexual pleasure.
OPINION: For some people, sexual pleasure must be part of a healthy relationship. Others feel that
this is not essential to maintaining a marriage/relationship. Again, this varies for people at different
times in their lives.
■ The aim of sex is to have pleasure.
OPINION: Some people have sex to experience pleasure, while others may enjoy it for the feeling
of intimacy or power or for procreation. People can also experience sexual pleasure from acts other
than sex, for example touching each another or watching erotic films or reading sexually explicit
literature.
• You can experience pleasure only if you are monogamous or married.
MYTH: Many people experience pleasure in a variety of sexual situations., not all within a marriage
or a monogamous relationship. There should not be moral judgements imposed on these choices
and experiences.
114
TARSHI: Basics and Beyond
MODULE 1 - Chapter 4
• Pleasure is an integral part of well-being.
FACT: Pleasure is essential to well-being, whether it be sexual, emotional, physical or mental.
Sex is the only way to achieve pleasure.
MYTH: Pleasure can be experienced in many different ways: Through penetrative sex, manual
stimulation, hugging, kissing, lying next to each another etc. Pleasure is experienced not only through
physical experiences, but mental and emotional ones too.
Disease and pain must be eliminated before we can address pleasure in a public health dialogue.
OPINION: Some people believe pleasure to be a ‘luxury’ and that the elimination of disease or risk
of contracting STIs including HIV/AIDS, violence or fear of violence is essential before one can
focus on sexual pleasure. Others believe that sexual pleasure is necessary to well-being.
Acknowledging pleasure is necessary to effectively address and balance sexual pleasure with risk.
Sexual pleasure derived from causing or receiving pain during sex (such as sadomasochism) is
abnormal/unnatural.
MYTH: Sexual pleasure is experienced in different ways. Any kind of sexual activity is acceptable as
long as it is consensual and does not harm anyone. It is wrong to categorise certain sexual practices
as wrong or abnormal.
• Young people have a right to experience sexual pleasure.
FACT: Young people have the right to experience sexual pleasure and should have access to
information and contraception to protect themselves.
• The use of toys and technology is acceptable for the attainment of pleasure.
FACT: Individuals may enjoy using toys, technologies, food, or other ‘aids’ to experience pleasure.
As long as the use of these methods is consensual, there is nothing wrong in enjoying them. The
usual precautions related to cleanliness and hygiene will protect against infection and injury and
enhance the experience of pleasure.
• Pleasure can be experienced between people of the same gender.
FACT: Homosexual, transgendered, transsexual, intersexed, queer, and heterosexual people can all
experience sexual pleasure. People can choose to practice and experience pleasure differently with
people of the same or different gender.
Men need sex more than women.
MYTH: In some societies it is erroneously believed that men’s desires should be considered before
women’s and that only men should experience sexual pleasure. However, all people, regardless of
their gender can have sexual desires and have the right to express themselves sexually.
• It is acceptable to have different fantasies and notions of pleasure.
FACT: Fantasies and desires are individual and experienced differently. They are not ‘wrong’ as
long as they do not infringe on others’ space or rights in any way.
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TARSHI: Basics and Beyond
MODULE 1 - Chapter 4
People past the reproductive age should not be allowed to experience sexual pleasure and talk
openly about it.
MYTH: Older adults experience sexual desire and should have the space to discuss it. In many
cultures this is taboo and it is believed that after a certain age people should not be involved in
sexual activity. This causes many older adults to repress their desires or feel guilty for experiencing
them, to the detriment of their well-being.
Penile-vaginal sex is the only normal and acceptable way to have sex and experience pleasure.
MYTH: There are many ways to experience sexual pleasure, including oral sex, anal sex, cuddling
after sex, massaging a partner etc. .
• It is not good to have sex during pregnancy.
MYTH: Though penile-vaginal intercourse is sometimes not advisable in the first three and last
two months of a pregnancy, pleasure can be given and received through activities other than
intercourse. It is important for any sexual activity to be consensual, and also that care be taken.
Unless there are clear instructions from the doctor to abstain as in the case of a difficult pregnancy,
there is no reason a couple cannot be sexually active throughout the woman’s pregnancy. Activities
like mutual masturbation and oral sex can be engaged in until the end of term.
■ Women can experience multiple orgasms.
FACT: Some women can experience one orgasm after another if stimulation continues. However
not all women experience multiple orgasms and this is not a sign of a problem.
• Using alcohol or drugs can increase sexual pleasure.
OPINION: Some people believe that alcohol and drugs increase sexual pleasure but for many they
can lead to sexual problems. This depends on the quantity of alcohol consumed, whether the person
is a frequent drinker or not, etc.
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TARSHI: Basics and Beyond
MODULE 1 - Chapter 4
Handout 1.11
Participant Copy: Pleasure Myths, Facts and Opinions
Please state whether you think each statement is a myth, a fact, or a matter of opinion.
It is my right to experience sexual pleasure.
• Women have sex for love; men have sex for pleasure.
Men can always get aroused by the idea of sex and can therefore get an erection immediately.
■ All people feel sexual desire in the same way.
• Women can have an orgasm only through penetrative sex.
• It is possible to sustain a marriage or relationship without sexual pleasure.
• The aim of sex is just to have pleasure.
■ You can only have pleasure if you are monogamous or married.
■ Pleasure is an integral part of well-being.
• Sex is the only way to achieve pleasure.
• Disease and pain must be eliminated before we can address pleasure in a public health dialogue.
• Sexual pleasure derived from causing or receiving pain during sex (such as sadomasochism) is
abnormal/unnatural.
• Young people have a right to experience sexual pleasure.
• It is acceptable to use toys, technologies and other objects to experience pleasure.
• Pleasure can be experienced between people of the same sex.
• Men need sex more than women.
• It is acceptable to have fantasies and different ideas about pleasure.
• People past the reproductive age should not be allowed to experience sexual pleasure and talk openly
about it.
■ Penile-vaginal sex is the only normal and acceptable way to have sex and experience pleasure.
• It is not good to have sex during pregnancy.
■ Women can experience multiple orgasms.
■ Using alcohol or drugs can increase sexual pleasure.
117
TARSHI: Basics and Beyond
MODULE 1 - Chapter 4
Handout 1.12
Open-Ended Case Study on Pleasure
Case 1.
Amrita and her husband Sanjeev have been married for five years. They are happy: Sanjeev has a job
he enjoys and Amrita is content staying home for the time being and caring for their two children. The
couple has discussed having more children but have decided that this is not the right time for this.
Even though they have maintained an active sexual relationship, after the birth of their children they
have not used any kind of contraception. Now that they decided to postpone having more children,
Amrita thinks they should start using contraceptive protection. She has suggested condoms since she
is concerned that the oral contraceptive will make it hard if she wants to conceive later. Sanjeev does
not like using condoms; he feels they hurt and reduce the sensation during sex. Because of their lack of
agreement over this issue, their sexual life has turned cold. Both Amrita and Sanjeev are frustrated and
realise that something needs to change.
How can they negotiate this situation better?
What are other options?
How would you handle this situation?
Construct a role-play and dialogue between Sanjeev and Amrita.
NOTE FOR THE FACILITATOR:
■ Go through the chapter on contraception and list the contraceptive choices that exist for the couple.
■ Help participants identify the issues related to pleasure for both partners as well as options to change this situation. For example,
Amrita's fear of a pregnancy can inhibit her sexual responses and reduce pleasure. To change this, Amrita and Sanjeev need more
information, i.e. that the oral contraceptives do not affect a woman's return to fertility once she discontinues them; that there are
a variety of textured condoms that can enhance pleasure, or that they can engage in non-penetrative activities that can also be
pleasurable until they agree on a contraceptive option.
Case 2.
Andy is 23. He and his partner have a wonderful sex life. Lately however, his partner has become
distant and unresponsive in bed. Andy notices that his partner also avoids being touched as intimately
as before. Andy is not sure what to do. Should he confront his partner, try out some new moves in bed
or find someone else? He loves being in this relationship and does not want it to break up. He approaches
his friend for help.
Create a role-play between Andy and this friend.
NOTE FOR THE FACILITATOR:
■ The case study does not specify the gender of Andy's partner. Observe the attitude and assumptions participants have made
reflected in their role-play. Have they assumed that Andy's partner is a woman? Highlight the disadvantages of this assumption '
■ List out possible reasons for the change in Andy's partner's behaviour before conducting the exercise.
118
MODULE 1 - Chapter 4
TARSHI: Basics and Beyond
Case 5
Neetu has been with her partner Amit for many years and the two of them are happy. Lately, however,
Neetu has been dissatisfied with their sex-life: It feels distant and unsatisfying. She does not know
how to broach the subject comfortably with her partner. They have never really talked about sex before.
Amit is also the only sexual partner Neetu has ever had, which makes this discussion even more
difficult for her. She also wants to talk about using new types of protection and is unsure about how to
do this. She loves her partner very much but is intimidated by the idea of this conversation. How
should she go about it?
Construct a role-play and dialogue between Neetu and Amit on sexual pleasure.
NOTE FOR THE FACILITATOR:
■ Help participants discuss possible reasons for Neetu's hesitation about talking to Amit. This would include taboos about discussing
one's own pleasure; fear that he may have other partners which may be related to Neetu's desire for newer forms of protection;
fear that the current form of protection is inadequate or reduces pleasure for either of them.
120
MODULE 2
Sexual and Reproductive
Health
TARSHi : Basics and Beyond
MODULE 2
Introduction
While sexuality is not restricted to the physical body, it is largely
experienced and expressed through the body. In addition, achieving
individual health and well-being requires a full understanding of
our bodies, how our bodies work, how we can protect ourselves
from infection, and what can be done to eliminate misinformation
around these issues that lead to stigma and discrimination.
Module 2 is an information-based module that provides this basic
understanding. It includes information on human sexual and
reproductive anatomy and physiology, conception, contraception,
abortion, infertility, sexual problems, sexually transmitted infections
(STIs) and HIV/AIDS. Beyond a basic understanding of facts, the
chapters explore attitudes and ideas on these issues and also link
them to values and human rights. For example, it includes
discussions surrounding an individual’s right to have/not have
children and the rights of HIV positive people to marry.
Module 2
Sexual and Reproductive Health
Chapter 1: Sexual and Reproductive Anatomy & Physiology
■ Exercise 1: Quiz: Sexual and Reproductive
Anatomy and Physiology
15 minutes
• Exercise 2: Creating the Anatomy
60 minutes
• Exercise 3: Identifying the Anatomy
60 minutes
• Exercise 4: Sexual and Reproductive Physiology
60 minutes
TARSHI: Basics and Beyond
MODULE 2
Chapter 2: Conception, Contraception, Abortion
■ Exercise 1: Quiz: Conception, Contraception
and Abortion
15 minutes
• Exercise 2: Conception Basics
75 minutes
■ Exercise 3: Charting Contraception Choices
30 minutes
• Exercise 4: Abortion Basics
30 minutes
Exercise 5: My Views on Abortion and
Contraception
60 minutes
Chapter 3: Infertility & Assisted Reproductive Technologies
■ Exercise 1: Demystifying Infertility
45 minutes
■ Exercise 2: Infertility Basics
60 minutes
■ Exercise 3: Looking at Options: Fertility Treatments 60 minutes
• Exercise 4: Case Studies: Options To Deal
With Infertility
60 minutes
Chapter 4: HIV/AIDS, STIs and RTIs
• Exercise 1: HIV/AIDS Basics
60 minutes
• Exercise 2: HIV/AIDS: Testing, Treatment,
Care and Support
60 minutes
• Exercise 3: My Views on HIV/AIDS
60 minutes
? '■•Exercise 4: Quiz: STIs and RTIs
15 minutes
- • Exercise 5: Talking About STIs/RTIs
45 minutes
• Exercise 6: Examining Attitudes Associated
With HIV/AIDS and STIs
45 minutes
Chapter 5: Sexual Problems
■ Exercise 1: Demystifying Sexual Problems
45 minutes
■ Exercise 2: Medical Solutions, the Only Answer?
60 minutes
• Exercise 3: My Views on Sexual Problems
60 minutes
• Exercise 4: Case Studies on Sexual Problems
60 minutes
123
TARSHI : Basics and Beyond
MODULE 2
Assessment for Module 2
Sexual and Reproductive Health
At the end of this module the facilitator can conduct an assessment.
This assessment can be used to evaluate increase in participant
knowledge, changes in attitudes, preferences for different exercises,
and opinions on the facilitator’s skills. For this module, an
assessment can be done using the following tools:
• Administering the quizzes after the sessions as post-test
assessments.
• Using the facilitator preparation exercises for this module found
in Chapter 1 Preparing to Train.
■ Adapting one of the sample assessment forms found in Chapter
2 Preparing to Train.
■ Developing a new assessment depending on the type of
information the facilitator wants to uncover.
Sample Training Schedule
A blank template of a training schedule as well as a sample sevenday training schedule can be found in Preparing to Train. Depending
on the focus of the training and the topics it aims to cover, the
facilitator can fill in the blank schedule with exercises from this
module or in combination with exercises from other modules.
124
MODULE 2 - Chapter 1
Chapter 1
Sexual and Reproductive
Anatomy and Physiology
Chapter Objectives for the Facilitator
1.
To have participants identify and describe the parts and
functions of the human sexual and reproductive anatomy.
2.
To have participants explore the different beliefs associated
with sexual and reproductive anatomy and physiology.
3.
To facilitate participant discussion on mental and;emotional
health in relation to sexual and reproductive anatomy and
physiology.
TARSHI : Basics and Beyond
ADDITIONAL RESOURCES:
■ Birds and Bees, http://
www.birdsandbees.org
■ EngenderHealth. 2003.
Comprehensive Counselling for
Reproductive Health: Trainer's
Manual. New York:
EngenderHealth.
MODULE 2 - Chapter 1
This chapter gives participants an overview of the human sexual
and reproductive organs (anatomy) and how these organs work
(physiology). The chapter also explores the mental and emotional
connections people have with their bodies and links anatomy and
physiology to cultural, social and religious beliefs associated with
these topics.
Key Messages for this Chapter
■ Family Health International.
Contraceptive Technology and
Reproductive Health Series
Modules. Available at: http://
www.fhi.org/en/RH/Training/
trainmat/Modules/index.htm '
• An accurate understanding of the body and its functions
empowers people and helps them make better decisions about
their sexuality and sexual and reproductive health.
• Reproductive Health Online, a
service of JHPIEGO, an affiliate of
Johns Hopkins University, http://
www.reproline.jhu.edu
• Sexual pleasure is experienced through different parts ofthe body.
An understanding of this should go hand in hand with
understanding the body’s reproductive functions. For example,
a woman’s breasts can be used for breast-feeding, but are also a
source of sexual pleasure.
■ Irvin, A. 2004. 'Chapter 3:
Anatomy, Physiology and
Puberty'. Positively Informed:
Lesson Plans and Guidance for
Sexuality Educators and
Advocates. New York:
International Women's Health
Coalition.
• For selected films see, http://
www.asiasrc.org/films.php and
Appendix B.
• People do not always enter into sexual relationships with
reproduction in mind. The body can provide pleasure and sex
can be independent of reproduction.
■ In today’s world sexuality is equated with youth, beauty and
having a perfect body. For young people especially, the pressure
to conform to prevalent standards of beauty can be immense.
Those who do not conform may feel unattractive, and this affects
their self- and body image. This is also true for people with
disabilities.
• Body image can influence how people behave and express their
sexuality, and how they treat their bodies. For example, if a
woman feels good about the way she looks she may be more
comfortable expressing her sexuality and take better care of her
health and body.
• There is a connection between the body and emotional health.
For example, if a woman has a mastectomy (removal of her
breasts) it may impact her sexual expression and how she feels
about her body and self.
TARSHI: Basics and Beyond
MODULE 2 - Chapter 1
Exercise 1
Quiz: Sexual and Reproductive Anatomy
and Physiology
QUIZ
Instructions
1.
2.
Distribute copies of Handout 2.2 to each participant. Explain
that this quiz will not be ‘graded’ and the level of performance
has no bearing on participation in the training. The quiz will
be used to ensure that gaps in participant information are
addressed during the training. The quiz can also be distributed
the day before beginning the chapter in order to tailor the
information and chapter exercises to the needs and strengths of
the group. The facilitator can choose to give participants the
option of responding anonymously to the quiz. Give them 10
minutes to answer the questions.
Have participants return the quizzes and correct the answer
sheets during a break or while the group works on the next
exercise. Note areas of knowledge and gaps.
Purpose of the
exercise:
1. To have participants
assess their own
knowledge and beliefs
about human sexual and
reproductive anatomy and
physiology.
2. To evaluate participant
knowledge, understanding
and beliefs and to note
gaps in information and
misconceptions to be
addressed in the topics in
question.
TIME
10 minutes
MATERIALS
Handout 2.1 Facilitator Copy: True
and False Quiz on Sexual and
Reproductive Anatomy and
Physiology, Handout 2.2 Participant
Copy: True and False Quiz on Sexual
and Reproductive Anatomy and
Physiology, pens/pencils
ADVANCE PREPARATION
Make copies of Handout 2.2 for each
participant.
128
TARSHi: Basics and Beyond
MODULE 2 - Chapter 1
Key Messages
THIS EXERCISE CAN BE MODIFIED
BY:
■ Dividing participants into two
teams and conducting the exercise
like a game using the questions
from Handout 2.1. Each correct
answer can earn the team a point
and the winning team can be
given a prize at the end.
• Emphasise that this exercise is not being graded. While this does
not diminish its seriousness, participants should not worry about
any areas or questions they are unsure of and answer the
questions to the best of their ability.
• Combining this quiz with the other
true/false and myth/fact exercises
from this module into a larger quiz
that can be played at the
beginning/ end of the module.
TIPS FOR THE FACILITATOR:
■ Before handing out the quiz, participants should be given a brief introduction to the
exercise and its purpose in order to alleviate discomfort or fears about the format.
• It may be beneficial for the facilitator to give participants the quiz a few hours or
one day before starting the chapter. This way, the training can be tailored to
participant needs. For example, if the group has extensive knowledge of anatomy,
it may be best to focus on some of the attitude exercises in the chapter.
i
MAKING CONNECTIONS:
- People with disabilities also have
a right to information on sexual
and reproductive anatomy and
physiology. For more see Chapter
3 in Module 4.
- Making the quiz anonymous can reduce pressure on the participants and will still
allow the facilitator to assess the information levels of the group.
■ The quiz can be administered again at the end of the chapter to assess what
participants have learned or subjects they still need information on.
• As we move from childhood to
adulthood, our bodies can change.
These are not always negative
changes and do not necessarily
diminish our sexuality. For more
|
see Chapter 3 in Module 1.
129
TARSHI ' Basics and Beyond
MODULE 2 - Chapter 1
Exercise 2
Creating the Anatomy
Instructions
1. Divide participants into four groups. Hand out flipchart paper,
newspapers, markers and tape to the groups. Assign two groups
to use the material to construct a woman’s sexual and
reproductive anatomy and two groups to construct, a man’s
sexual and reproductive anatomy. Participants can interpret the
assignment in any way they are comfortable with: they can tape
flipchart paper and newspaper together and draw the outline of
the body of one volunteer from the group and then complete
the anatomy; they can each draw sexual and reproductive
anatomy on separate sheets of paper etc. Give the groups 20-30
minutes to complete the assignment.
SMALL GROUP WORK
Purpose of the
exercise:
1. To explore personal
attitudes and ideas about
the physical body.
2. To discuss links between
cultural and social beliefs
and sexual and
reproductive anatomy and
physiology.
2. Bring the groups back together and have participants present
their work. Ask them to share how they developed their
anatomies. After all the presentations, ask for questions and
comments.
TIME
Suggested Questions:
BO minutes
■ How did you feel doing this exercise? Uncomfortable,
embarrassed etc.?
■ How did your group choose a method to create the anatomy?
Did your approach have a connection to your comfort levels
discussing the sexual and reproductive anatomy?
• If it was a mixed group, did either the men or women dominate
the exercise? Why?
■ What are the benefits to having accurate information on how
the body works?
■ Have any individuals been left out in these drawings? What
about intersexed or transgendered people?
130
MATERIALS
Flipchart, newspapers, markers,
tape
ADVANCE PREPARATION
Review Handout 2.3 Facilitator
Copy: Diagrams of the Human
Sexual and Reproductive Anatomy
and Its Physiology (All 3 Diagrams
and 1 Key for Male Anatomyl
TARSHI: Basics and Beyond
MODULE 2 - Chapter 1
THIS EXERCISE CAN BE MODIFIED
Key Messages
BY:
j • Collecting objects from around the
I training area, such as string,
bottles, food, and clothing and
: using these to construct a model
j of sexual and reproductive
I anatomy and physiology. This can
; be good for low-literacy groups,
people in rural communities, or
i groups who only need a refresher
on this information.
MAKING CONNECTIONS
• Comfort about talking about the
body is an important part of
sexuality and well-being. For more
see Chapter 1 in Module 1.
■ Knowledge of our bodies can help
us experience pleasure. For more
see Chapter 3 in Module 1.
• It is common to experience discomfort when talking about sexual
and reproductive anatomy. Many cultures and communities may
also consider it inappropriate to have such discussions.
• The manner in which groups choose to draw the sexual and
reproductive anatomy may be significant. Drawing each organ
separately rather than outlining the body of someone in the
group may indicate the discomfort some people feel around
talking about the body.
• Silence and discomfort when talking about these issues can lead
to misinformation and perpetuate myths around conception,
contraception, sexual and reproductive health. This can affect
an individual’s mental and emotional health.
• Individuals working in the field of sexuality, sexual and
reproductive health need to be comfortable talking about sexual
and reproductive organs. This will enable them to impart
information in a matter-of-fact manner to their audience and
break through the shame and the silence around the topic.
■ Possessing certain physical characteristics is not always associated
with a particular gender identity. For example, an individual
may identify as a man but not have a penis, or may identify as
transgendered and have a penis. Individuals have a right to
express their gender identity and should not be forced to conform
to the ‘traditional’ gender categories.
TIPS FOR THE FACILITATOR:
• Participants may focus on just the reproductive anatomy, for example depicting only the vagina but not the clitoris. If this I
occurs point it out and ask groups why they think this happened.
• Men may feel uncomfortable being asked to depict women's organs and vice versa. To promote comfort, participants can be
divided into groups based on gender. Integrating the groups on the other hand, can also lead to discussions on how men represent |
women and vice versa. Facilitators can use their discretion to decide how they want to divide up the participants.
131
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MODULE 2 - Chapter 1
Exercise 3
Learning Human Anatomy
lecturette and group work
Instructions
1. Introduce the exercise, explaining that participants will be labelling
and discussing different parts of the sexual and reproductive
anatomy. While this may be a review for some, emphasise that
this exercise is intended to ensure that all participants are at the
same level of understanding.
2. Distribute Handout 2.4 (all 3 Diagrams). Begin with either the
male or female external anatomy and continue to the
corresponding internal anatomy. Go through each labeled part
in the diagrams and invite participants to name the body part.
If participants do not know the answer, tell them the name. Ask
them to label their diagrams accordingly.
3.
4.
After each part has been labelled correctly, ask participants to
describe the structure and function of each part. For example,
‘the clitoris is a tiny, pea-sized organ above the urinary opening,
hidden within the folds of the vagina, where the inner lips join.
It is extremely sensitive to touch and when stimulated becomes
firmer and slightly bigger. The only purpose of the clitoris is to
provide sexual pleasure.’ Fill in information not mentioned by
participants from Handout 2.3.
After going over the diagrams of male and female anatomy, ask
for questions and comments.
Suggested Questions:
■ What information was new to you? How does knowing about
the parts and functions of the body affect your understanding of
sexuality?
• Are there other names for parts of the sexual and reproductive
anatomy? For instance some may know other words for penis or
clitoris. What impact does using these types of words have in
discussions of sexuality and health?
• After going through this exercise, do you feel more comfortable
with the sexual and reproductive parts? Would you feel
comfortable going home and using a mirror to look at your own
genitals, if you have not done so before?
132
Purpose of the
exercise:
1. To identify and label the
parts of human sexual and
reproductive anatomy.
2. To describe the function
of each part of the human
sexual and reproductive
system.
3. To explore feelings of
self-image related to
anatomy and physiology.
TIME
60 minutes
MATERIALS
Handout 2.3 Facilitator Copy:
Diagrams of the Human Sexual and
Reproductive Anatomy and Its
Physiology (all 3 Diagrams and Key
for Male Anatomy), Handout 2.4
Participant Copy: Diagrams of the
Human Sexual and Reproductive
Anatomy and Its Physiology (all 3
Diagramsl
ADVANCE PREPARATIONS
Make copies of Handout 2.4; review
Handout 2.3.
TARSHI: Basics and Beyond
MODULE 2 - Chapter 1
5.
THIS EXERCISE CAN BE MODIFIED
BY:
Using markers and pencils to
colour the diagrams indicating
areas participants are familiar or
unfamiliar with. Unfamiliar areas
can be reviewed in a large group
and all participants can be given a
copy of the Handout 2.3 to review
by themselves.
MAKING CONNECTIONS
■ Disabled people also have the
right to information about sexual
and reproductive anatomy. For
more see Chapter 3 in Module 3.
■ As we grow older our bodies can
change. This does not however
necessarily diminish our sexuality.
For more see Chapter 3 in
Module 1.
End the session by giving participants markers or pencils and
asking them to shade in or colour parts of the body that give
them pleasure. If they are comfortable ask them to share what
they shaded or coloured and why.
Key Messages
• Having an accurate and clear understanding of the body and its
functions is empowering and valuable for a discussion on sexual
and reproductive health and sexuality.
■ Language used for sexual anatomy can be negative and
derogatory, taking away from positive feelings of sexual well
being and pleasure. For example, using negative names for a
woman’s breasts can make her feel ashamed and uncomfortable
with this part of her body and feel embarrassed by pleasure she
derives from them.
• Incomplete information or misinformation about our bodies can
sometimes lead to worry or fear. It can also make individuals
hesitant to seek help when they have health care needs that
require attention.
• Sexuality is not restricted to our bodies or to certain body parts
alone. But sexuality may be largely expressed and experienced
through our bodies, including our external/physical anatomy
where we experience pleasure and sensations.
TIPS FOR THE FACILITATOR:
j • Lecturette exercises can be information-heavy and dull. Ensure that participants
i
are engaged by asking questions and taking breaks if necessary.
L------------------ —--------------------------------------------
133
TARSHI : Basics and Beyond
MODULE 2 - Chapter 1
Exercise 4
Sexual and Reproductive Physiology
SMALL GROUP WORK
Instructions
1. Divide participants into small groups. Distribute Handout 2.5
to each group. Ask each group to discuss ways in which different
body parts function as sexual and reproductive organs. For
example, for a woman’s breasts, they can say that their
reproductive function is lactation, which allows a mother to
nurse her child. At the same time, the breasts also give and feel
sexual pleasure. Give the group 10 minutes to discuss and
identify the body parts.
Purpose of the
exercise:
To discuss the similarities
and differences in sexual
and reproductive
physiology.
2. Bring the participants back together in a large group and invite
them to share their discussions. Afterwards ask for questions
and comments.
TIME
Suggested Questions:
45 minutes
■ Are there other parts of the body you believe share a dual role of
being sexual and reproductive? Are there any parts of the
anatomy that have only a sexual function?
• Is it important to learn about sexual physiology? Why?
• Do you feel comfortable talking about sexual pleasure and parts
of the body that can give sexual pleasure with people in your
community? Is it a taboo topic? How can these discussions be
made more comfortable and less taboo?
• What if a person does not have some of these body parts? For
example, a woman who has had breast removal or mastectomy?
How does this change their sexuality, if at all or diminish their
‘womanhood7‘manhood’/‘ personhood’?
134
MATERIALS
Handout 2.5 Sexual and
Reproductive Physiology
ADVANCE PREPARATION
Make copies of Handout 2.5 for each
participant.
TARSHI: Basics and Beyond
MODULE 2 - Chapter 1
Key Messages
THIS EXERCISE CAN BE MODIFIED
BY:
■ Discussing and conducting the
discussion in a large group rather
than in smaller groups. This may
be suitable for groups more
comfortable with the topic.
:
• Mastectomies or other procedures can change sexual and
reproductive physiology. This does not necessarily mean there
is a diminished sexuality or that a person is less of a woman or
man or sexual being.
MAKING CONNECTIONS:
• There are similarities as well as
differences between sexual and
I
j
reproductive health and rights. For i
more see Chapters 2 and 3 in
Module 3.
■ Information about the body is
useful for all people: those in the
reproductive age-group, younger
and older people. All people have
the right to this information. For
more see Chapter 3 in Module 1.
■ It is important to recognise sexual functions and pleasure that
can be derived from parts of the body. This is separate from but
can go hand in hand with understanding reproductive functions
of the body.
'
j
\
■ Sexuality is not restricted to our bodies or to certain body parts.
However, sexuality is largely expressed and experienced through
our bodies, and it is therefore important to know about sexual
anatomy and physiology.
TIPS FOR THE FACILITATOR:
I ■ Participants may only focus on the reproductive functions of the body and .
i
particularly the role of women in reproduction. Emphasise that beyond this, |
the body also provides sexual pleasure. People can also choose not to reproduce i
:
and still express their sexuality and experience sexual pleasure.
i • Participants may be uncomfortable or try to avoid a discussion of the body in
I
relation to pleasure and sexuality. Introduce questions if participants continue to
|
avoid the topic, for example, 'Do you think it is wrong to talk about the sexual role
I
of the body? Why?' 'Can the body serve sexual as well as reproductive functions?'
I
;
\
■
135
TARSKI : Basics and Beyond
MODULE 2 - Chapter 1
Handout 2.1 Facilitator Copy:
Quiz on Sexual and Reproductive Anatomy and Physiology
Please write if the statement below is true (T) orfalse (F)
■ The fallopian tubes are two small tubes through which an egg travels into the uterus.
TRUE: During ovulation, an egg is released from an ovary and travels down through the fallopian
tube into the uterus.
• The primary sex gland for men is the testes.
TRUE: Testes produce sperm and male hormones called androgens. The testes are two egg-shaped
organs located in two hanging sacs called the scrotum. The scrotum is located behind the penis.
• Penile size can be increased with exercise, massage or medicine.
FALSE: Penile size cannot be increased with medicine, massage or exercise and the size and length
of a person’s penis is not an indication of fertility, sexual potential, or strength.
■ Having an erection in the morning means that a man is over-sexed.
FALSE: Many men throughout their lifespan will wake up with an erection and this does not mean
they are over-sexed. These reflex erections occur during sleep and have been observed even in infancy.
• The clitoris regulates female hormone production.
FALSE: The clitoris is a pea-sized organ in women situated above the urethra (urinary opening),
where the inner lips of the vagina join. The function of the clitoris is for sexual pleasure, not
hormone production.
• Semen is not made up of blood. The quality and quantity of semen varies in men.
TRUE: Semen is a thick, white/off-white coloured fluid that comes out of the penis and is made up
of sperm and other substances including sugar, water, enzymes and proteins, but NOT blood. The
amount and quality of semen varies from man to man, and the amount produced can vary over time
for the same man as well.
• When semen comes out of the penis at night, this is called a nocturnal emission and is a common
and normal occurrence, unrelated to sexual feelings or desires.
TRUE: Nocturnal emissions, also called wet dreams or ‘night fall’, are a normal and common
occurrence that usually begins sometime during puberty.
• A woman’s breast size can be increased with massage and massage oils.
FALSE: Massaging breasts will not increase their size. Breast size and shape can change over time
with age, with changes in weight or muscle mass, from taking certain hormonal contraceptives or
from surgery.
• The size of a woman’s breasts can indicate her interest in sex or her ability to receive or give sexual
pleasure.
FALSE: A woman’s breast size has no bearing on her interest in sex or ability to experience or give
sexual pleasure.
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TARSHI: Basics and Beyond
MODULE 2 - Chapter 1
The vulva is made up of a woman’s external genitals that include the outer lips, inner lips, mons
pubis, clitoris, clitoral hood, and vaginal opening.
TRUE. These organs are included in the vulva and vary in colour, shape and size from woman to
woman.
The G-spot is the source of a woman’s sexual pleasure.
FALSE. The G-spot is named after Grafenberg, the person who discovered it. It has been described
as a small nodule oftissue in the vagina that swells when a woman is aroused and can cause heightened
sexual pleasure. However the existence of this spot and its function is not wholly agreed upon.
Women have different sources/zones of pleasure, which may/not include nipples, clitoris and vagina.
Circumcision is a practice that removes a man’s external genital organs.
FALSE: Circumcision is a procedure performed on a man to remove the foreskin covering the
penis. This is a cultural tradition for some religions and communities and has become a commonplace
practice in many developed countries as well since it promotes genital hygiene and may decrease the
risk of infections.
• The hymen is a delicate tissue in the vaginal passage that stays intact until the first act of sexual
penetration.
FALSE: The hymen is a delicate tissue located outside the opening of the vaginal passage. It is so
delicate that it may tear in childhood during cycling or exercising. It may also tear from using
tampons, during masturbation or exercise. In some women, it can be stretched without tearing.
Some women are born without a hymen. An intact or unbroken hymen or the appearance of blood
during intercourse, are not signs of virginity.
• A hysterectomy is a surgical removal of the uterus.
TRUE: A hysterectomy is the surgical removal of the uterus and can be total (which includes the
removal of the ovaries and tubes) or partial (removal of the uterus and sometimes the cervix). If the
ovaries are removed (oophorectomy) during a hysterectomy, the woman will experience a sudden
loss of the hormone oestrogen. This can cause menopausal symptoms and is also known as ‘surgical
menopause’. Hysterectomies are sometimes performed for health reasons, for example in cases of
uterine cancers. Female to Male transsexuals may also undergo this surgery as part of the transition
process.
• It is normal for a woman’s genitals to produce fluids and have a distinctive smell.
TRUE: Fluids secreted by the vagina and cervix clean the vagina. If a woman has an infection, the
colour and smell of the fluid can change. If this happens, medical treatment is sometimes required.
• A woman is dirty when she is menstruating.
FATSE- Menstruation is the periodic shedding of the uterine lining that usually occurs once a
month if an egg has not been fertilised after ovulation. A woman can begin menstruating during
puberty and will continue to menstruate until menopause. There is nothing dirty about this process
and women should not be ashamed of it. However there are various rituals and practices among
some communities that isolate and deny women basic rights during menstruation.
• The prostate gland produces one of the fluids for semen.
TRUE- The prostate gland is located just below the bladder and is the size of a walnut. It acts as
both a reproductive and sexual organ. It secretes and stores a fluid that is part of semen. Some
derive sexual pleasure from the massaging or stimulation of the prostate gland.
137
MODULE 2 - Chapter 1
TARSHI : Basics and Beyond
• The main male hormone is testosterone and the main female hormone is oestrogen.
TRUE: The primary male hormone is testosterone, produced in the testicles. The primary hormone
in women is Oestrogen, produced mainly in the ovaries, the corpus luteum and during pregnancy
in the placenta.. Oestrogen promotes the development of a woman’s secondary sexual characteristics
like breasts, and regulates the menstrual cycle. However, small quantities of oestrogen are also
produced in the male body just as small amounts of testosterone are produced in the woman s body.
• Men can find stimulation of their nipples pleasurable.
TRUE: Both women and men can find simulation of their nipples pleasurable.
• Reproductive organs can also be sexual organs.
TRUE: Organs that are part of the reproductive anatomy can also be sexual and provide people
pleasure. For example, the prostate gland or a woman’s breasts. The prostate gland stores and
secretes a fluid that makes semen, necessary for fertilisation. At the same time, some men find its
stimulation sexually pleasurable. Similarly, breasts can produce milk to feed a baby and also provide
sexual pleasure to many women.
Please write a few lines in response to the following questions:
• Do you believe that how we feel about our body can affect our sexuality and sexual interactions?
Why or why not?
• Do you believe that women in your community are taught to hide or be ashamed of their bodies?
Do you think it is important to talk about sexual anatomy and physiology to young people? Why
or why not?
What are some words commonly used in your communities to describe parts of the anatomy?
What attitudes/values do these words reflect? How do you think these words affect the way we
deal with our bodies?
138
TARSHI: Basics and Beyond
MODULE 2 - Chapter 1
Handout 2.2 Participant Copy:
Quiz on Sexual and Reproductive Anatomy and Physiology
Please write if the statement below is true (T) or false (F)
The fallopian tubes are two small tubes through which an egg travels into the uterus.
• The primary sex gland for men is the testes.
Penile size can be increased with exercise, massage or medicine.
Having an erection in the morning means that a man is over-sexed.
The clitoris regulates female hormone production.
■ Semen is not made up of blood. The quality and quantity of semen varies in men.
• When semen comes out of the penis at night, this is called a nocturnal emission and is a common
and normal occurrence, unrelated to sexual feelings or desires.
• A woman’s breast size can be increased with massage and massage oils.
• The size of a woman’s breasts has a bearing on her interest in sex and the ability to receive or give
sexual pleasure.
• The vulva is made up of the external female genitals that include the outer lips, inner lips, mons
pubis, clitoris, clitoral hood, and vaginal opening.
• The G-spot is the source of a woman’s sexual pleasure.
■ Circumcision is a practice that removes a man’s external genital organs.
■ The hymen is a delicate tissue in the vaginal passage that stays intact until the first sexual
penetration.
• It is normal for a woman’s genitals to produce fluids and have a distinctive smell.
• A woman is dirty when she menstruates.
• The prostate gland produces one of the fluids for semen.
■ The main male hormone is testosterone and the main female hormone is oestrogen.
■ Men can find stimulation of their nipples pleasurable.
• Reproductive organs can also be sexual organs.
139
TARSHI : Rasies and Beyond
MODULE 2 - Chapter 1
Please write a few lines in response to the following questions:
• Do you believe that how we feel about our body can affect our sexuality and sexual interactions.
Why or why not?
Do you believe that women in your community are taught to be ashamed of their bodies?
Do you think it is important to talk about sexual anatomy and physiology to young people? Why
or why not?
What are some other words commonly used in your communities to describe parts of the anatomy?
What attitudes or values do these words reflect? How do you think they affect the way we perceive
our bodies?
140
TARSH1: Basics and Beyond
MODULE 2 - Chapter 1
Handout 2.3 Facilitator Copy:
Diagrams of the Human Sexual and Reproductive Anatomy and its
Physiology
A Woman’s Internal Anatomy
1.
Ovaries: Two organs each about the size of a walnut, located slightly below erither side of the uterus.
The ovaries have two purposes: to produce ova (eggs) and to produce hormones, including oestrogen,
progesterone, and testosterone.
2.
Fallopian Tubes: Connect the uterus to the ovaries. When an ovary releases an egg it travels through
the fallopian tube into the uterus. This is where fertilisation occurs.
3.
Endometrium: The uterine lining. This lining will thicken and grow during ovulation to prepare
for a fertilised egg. If there is no egg fertilised it will be shed during menstruation.
4.
Uterus: An organ in which a fertilised egg will attach and develop during pregnancy. Menstruation
occurs when the endometrium that lines the uterus sheds if the egg is unfertilised.
5.
Cervix: The opening of the uterus. During conception sperm pass through the small opening of the
cervix into the uterus to meet the egg in the fallopian tube. The cervix opens during childbirth to
allow a baby to come out.
6.
Vagina: Leads from the vulva to the uterus. It produces fluids that keep the vagina lubricated, clean
and prevent infection. It stretches during sex and when giving birth. It is a sexual and reproductive
organ. The first 2 inches of the vaginal passage has nerve endings that give pleasure during sexual
stimulation.
7.
Vaginal opening: Opening of the vagina.
141
TARSHI : Basics and Beyond
MODULE 2 - Chapter 1
Handout 2.3 Facilitator Copy:
Diagrams of the Human Sexual and Reproductive Anatomy and its
Physiology
A Woman’s external Anatomy
The vulva is made up of woman’s external genitals, that includes the outer lips, inner lips, mons pubis,
clitoris, clitoral hood and vaginal opening
1
Mons pubis (mons veneris): The hairy part of the vulva on top of the pubic bone.
2
Outer lip (labia rnajora): The fatty folds of skin that protect the inner parts of the vulva.
3
Clitoris: A pea-sized organ located above the urethra (urinary opening), where the inner lips of the
vulva join. The role of the clitoris is for sexual pleasure.
4
Urinary opening: The outer part of the urethra that carries urine from the bladder to the outside of
the body.
5
Vaginal opening: Opening of the vagina.
6
Inner lip (labia minora): Inner folds of skin that are without hair and sensitive to touch. They cover
the vaginal opening and vary in size from woman to woman.
7
Hymen (if present): a delicate tissue located outside the opening of the vaginal passage. It is so
delicate that it may tear in childhood during cycling or exercising. It may also tear from using
tampons, during masturbation or exercise. In some women, it can be stretched without tearing.
8
142
Anus: The outside opening for the intestine where stool or faeces leaves the body.
TARSHI: Basics and Beyond
MODULE 2 - Chapter 1
Handout 2.3 Facilitator Copy:
Diagrams oi< the Human Sexual and Reproductive Anatomy and its
Physiology
A man’s Internal Anatomy
1
Seminal Vesicle: Pair of glandular sacs that secrete some of the fluid that makes up semen.
2.
Rectum: Connects the colon to the anus. Receives faeces from the colon. The rectum holds the
faeces until it leaves the body.
3
Prostate: Located just below the bladder and is the size of a walnut. It acts as both a reproductive
and sexual organ. It secretes and stores a fluid that is part of semen. Some people derive sexual
pleasure from the massaging or stimulation of the prostate gland. A muscle at the bottom of this
gland prevents urine from being released during ejaculation.
■ 143
TARSHI : Basics and Beyond
MODULE 2 - Chapter 1
4.
Cowper’s gland: Two pea sized glands at the base of the penis that secrete a clear fluid before and
during sexual arousal and before ejaculation. This fluid is also known as pre-cum.
5.
Anus: The outside opening for the intestine where stool leaves the body.
6.
Vas Deferens: A tube that carries sperm from the epididymis during ejaculation.
7.
Epididymis: A pair of coiled tubes at the back of the testes that store the sperm until they are
released during ejaculation.
8.
Testes: Two egg-shaped organs located in the scrotum that are two hanging sacs located behind
the penis. Testes produce sperm and male hormones called androgens, including Testosterone.
9.
Scrotum: A sac hanging under the penis that holds the testes and protects them.
10.
Urethral Opening: The outer part of the urethra that carries urine and ejaculate (semen) to the
outside of the body. Urine and semen are carried separately.
11.
Glans penis: The head of the penis that is very sensitive to touch.
12.
Penis: The external male sexual and reproductive organ.
13.
Urethra A tube that carries urine and ejaculate through the penis out of the body. Urine and
semen both go through the urethra, usually at separate times.
14.
Bladder: An organ that stores urine. The urine leaves the bladder through the urethra.
144
TARSHI: Basics and Beyond
MODULE 2 - Chapter 1
Handout 2.4 Participant Copy:
Diagrams of the Human Sexual and Reproductive Anatomy and its
Physiology
A Woman’s Internal Anatomy
145
TARSHI : Basics and Beyond
MODULE 2 - Chapter 1
Handout 2.4 Participant Copy:
Diagrams of the Human Sexual and Reproductive Anatomy and its
Physiology
A Woman’s External Anatomy
1
2
3
4
5
6
7
8
146
TARSHI: Basics and Beyond
MODULE 2 - Chapter 1
Handout 2.4 Participant Copy:
Diagrams of the Human Sexual and Reproductive Anatomy and its
Physiology
A man’s Internal Anatomy
147
TARSHI : Basics and Beyond
MODULE 2 - Chapter 1
Handout 2.5
Sexual and Reproductive Physiology
148
MODULE 2 - Chapter 2
Chapter 2
Conception, Contraception
and Abortion
Chapter Objectives for the Facilitator
1.
To have participants understand and describe the basic
process of conception.
2.
To have participants describe current forms of contraception
and their advantages and disadvantages.
3.
To have participants understand abortion options and
procedures.
4.
To engage participants in discussions on issues of
conception, contraception and abortion, including selective
abortion, the pressure to have children, particularly sons,
as well as stigma and disapproval associated with
contraception and abortion.
TARSHI : Basics and Beyond
MODULE 2 - Chaptei 2
Why a Chapter on Conception,
Contraception and Abortion
'There was never any discussion ofhow a baby is made in my house. In
fact, it was not until I was in my early 20’s that I really understood
how pregnancy happened let alone how to prevent it. ’
EXERCISES IN THIS CHAPTER:
Exercise 1: Quiz: Conception,
Contraception and Abortion.
15 minutes
Exercise 2: Conception Basics.
75 minutes
‘My friends and people in my town don’t speal^ about how to not get
pregnant, and ifthey do it is only to mention condoms. There are not
many other options that we {now about. ’
‘I am afraid to talk^ about abortion because it is a topic everyone gets so
angry about. I am not even sure I can get an abortion in my country
legally.’
How pregnancy occurs, how to prevent it and what to do if it is
unwanted are common concerns and questions faced by people of
various genders and identities, whether they are sexually active or
not.
Exercise 3: Charting Contraception
Choices. 30 minutes
Exercise 4: Abortion Basics.
30 minutes
Exercise 5: My views on Abortion
and Contraception. 60 minutes
MATERIALS REQUIRED FOR THIS
Pregnancy has social and personal implications and plays a central
role in people’s lives in many cultures and communities. The
premium on pregnancy can perpetuate practices like withholding
information on how to prevent an unwanted pregnancy,
discouraging the provision of contraceptives for adolescents, and
unavailability of abortion options if a woman wants to end a
pregnancy. Such practices violate the rights of people to information
and sexual and reproductive choices.
And what of a woman who does not want to have a child, or has a
daughter and no sons, or ,a couple in a homosexual relationship
that wants to have children? Do they have the space and
opportunities to make these choices freely? Should and are these
choices available to them?
To answer these questions and to examine issues surrounding
conception, contraception and abortion, it is necessary to first have
basic information on how a pregnancy occurs, available methods
to prevent a pregnancy, and options to end an unwanted pregnancy.
Since this information is not easily available, many misconceptions
and myths abound. This information serves as a first step to engage
in the dialogue around issues of sexual and reproductive choices
and rights.
This chapter gives participants basic information on conception.
Arguments regarding these topics, many of which participants may
have to grapple with in the course of their work, are contentious
and may have no simple answers.
CHAPTER:
Flipchart
Markers
Pens/pencils
Index cards/slips of paper
HANDOUTS REQUIRED FOR THIS
CHAPTER:
Handout 2.6
Basic Information on Conception
Handout 2.7
Basic Information on Contraception
Handout 2.8
Basic Information on Abortion
Handout 2.9
Facilitator Copy: Quiz on Conception,
Contraception, Abortion
Handout 2.10
Participant Copy: Quiz on
Conception, Contraception, Abortion
TARSHI : Basics and Beyond
MODULE 2 - Chapter 2
ADDITIONAL RESOURCES:
■ Feminist Women's Health Centre.
http://www.fwhc.org
■ Go Ask Alice, http://
www.goaskalice.columbia.edu/
Cat7.html
• International Women's Health
Coalition. 'Chapter 3: Anatomy,
Physiology and Puberty', Positively
Informed: Lesson Plans and
Guidance for Sexuality Educators
and Advocates.
■ 1PAS. Abortion Methods, http://
www.ipas.org/english/
womensjiealth/
abortion_methods/default.asp
• The Medical Termination of
Pregnancy Act, 1971. (India).
Available at: http://
www.mp.nic.in/health/
mtp%20Act.pdf
• Planned Parenthood, http://
www.plannedparenthood.org
■ Reproductive Health Online, Johns
Hopkins University, http://
www.reproline.jhu.edu/
■ Sen, A. 2003. 'Missing Women
Revisited', British Medical Journal.
Volume 127, 6 December.
■ World Health Organization. 2003.
Safe Abortion: Technical and
Policy Guidance for Health
Systems. WHO: Geneva.
• For selected films see, http://
www.asiasrc.org/films.php and
Appendix B.
Key Messages for this Chapter
• Conception, contraception and abortion should be understood
for the integral role they play in sexuality, sexual and reproductive
health, and rights.
• Understanding the basic processes of conception, contraception,
and abortion provides a foundation for further discussion on
the social norms and pressures influencing these choices.
■ Technical/scientific language on conception should be balanced
with a cultural, social and ethnic understanding of the process
so as to be accessible to more people.
• Various contraceptive options are available to individuals, some
of which use medical interventions and others that do not. The
advantages and disadvantages of each option differ for each
person.
■ Contraception options must also be viewed in terms of sexual
and reproductive rights. Individuals have the right to information
and access to contraception options, and also the right to sexual
well-being and to determine whether and when to have a child.
• Low awareness about the legal status and availability of abortion
options can sometimes lead women to seek unsafe, illegal
abortions that contribute to high rates of maternal mortality and
morbidity.
• Often the responsibility of preventing unwanted pregnancies
falls unfairly on women. At the same time, women are often
seen only as child-bearers/reproducers and their opinions/desires
are overlooked in the reproductive decision-making process.
TARSHI : Basics and Beyond
MODULE 2 - Chapter 2
Exercise 1
Quiz: Conception, Contraception, and Abortion
QUIZ
Instructions
1.
2.
Distribute copies of Handout 2.10 to each participant. Explain
that this quiz will not be ‘graded’ and the level of performance
has no bearing on participation in the training. The quiz will
be used to ensure that gaps in participant information are
addressed during the training. The quiz can also be distributed
the day before beginning the chapter in order to tailor the
information and chapter exercises to the needs and strengths of
the group. The facilitator can choose to give participants the
option of responding anonymously to the quiz. Give them 10
minutes to answer the questions.
Have participants return the quizzes and check the answer
sheets during a break or while the group works on the next
exercise. Note areas of knowledge and gaps.
Purpose of the
exercise:
1. To have participants
assess their own
knowledge and
understanding of
conception, contraception,
and abortion.
2. To evaluate participant
knowledge and
understanding of
conception, contraception,
and abortion.
3. To make note of the
myths and misconceptions
and gaps in information to
be addressed.
TIME
I 15 minutes
MATERIALS
i Handout 2.9 Facilitator Copy: Quiz
l on Conception, Contraception,
. Abortion, Handout 2.10 Participant
■ Copy. Quiz on Conception,
; Contraception, Abortion, pens/
: pencils
ADVANCE PREPARATION
Make copies of Handout 2.10 for
each participant
152
TARSHI: Basics and Beyond
THIS EXERCISE CAN BE MODIFIED
MODULE 2 - Chapter 2
Key Messages
BY:
■ Dividing participants into two
groups and conducting the
exercise like a quiz game using the
questions from Handout 2.9. Each
correct answer can earn the group
a point. Score can be kept and the
winning team can be given a prize
at the end of the game.
• Combining this quiz with other
quizzes and myth/fact exercises
from this module into a larger quiz
game played at the start or end of
the module.
________________________ I
• Emphasise that this exercise is not a ‘graded’ test and participants
should answer the questions to the best of their ability. The quiz
should, however, be taken seriously.
TIPS FOR THE FACILITATOR:
• It may be beneficial to give the quiz a day/ few hours before starting the
chapter. That way, the training can be tailored to participant needs. For
example, if the group has extensive knowledge of contraception, it may be
best to focus on some of the perspective/attitude exercises instead.
• Making the quiz anonymous can reduce pressure on the participants and still
be useful in obtaining an idea of the group's knowledge level.
• The quizzes can be administered again at the end of the chapter to assess
what participants have learned or subjects they still need information on.
MAKING CONNECTIONS
• Basic information on human
sexual and reproductive anatomy
and physiology is required before
learning about conception,
contraception and abortion. For
more see Chapter 1 in this
Module.
• Both the right to conceive and
access to contraception are
reproductive rights. For more see
Chapter 2 in Module 3.
153
TARSHI : Basics and Beyond
MODULE 2 - Chaptei 2
Exercise 2
Conception Basics
Instructions
1.
2.
Introduce the topic of conception to the group. Spend the first
15 minutes going over the process of conception as outlined in
Handout 2.6. While this may be a review for some participants,
emphasise that a basic introduction is important to ensure that
everyone is at the same level of understanding.
After going over the basics of Handout 2.6 ask for questions or
comments.
Suggested Questions:
■ List out terms you have heard people use to describe pregnancy
or conception. Do these terms reflect social attitudes toward
pregnancy? What are the implications of using ‘slang’ terms?
For example does saying that a woman is ‘in trouble’ to describe
that she is pregnant have a moral implication?
■ How do culture, religion, and communities influence the
knowledge and understanding of conception and pregnancy?
• People often use medial terminology when talking about
conception. How can you convey technical information in an
easy manner that takes into account the socio-cultural context
of the audience?
3.
Now introduce the debate exercise. Divide the participants into
two groups. Designate one group as the ‘Agree to both
statements’ and the other group as the ‘Disagree to both
statements’. Read out the two statements:
Statement 1: The most important thing a person can do is having
children.
Statement 2: People should have children only if they are
married.
Give the groups 20 minutes to construct arguments to support
the viewpoint designated to them. Encourage participants to
use personal experiences, and/or common attitudes from their
communities in their arguments.
154
LECTURETTE AND DEBATE
Purpose of the
exercise:
1. To understand and
describe the process of
conception.
2. To analyse the role of
pregnancy and child
bearing in different
communities and social
groups.
TIME
75 minutes
MATERIALS
Handout 2.6 Basic Information on
I Conception
ADVANCE PREPARATION
Handout 2.6
I____________ I
TARSHI: Basics and Beyond
MODULE 2 - Chapter 2
4.
Now, invite each group to present their arguments in 5 minutes,
after which, open the floor for a freer debate, asking questions
and highlighting points when appropriate. Make sure that one
group/side does not dominate the discussion.
Suggested Questions:
THIS EXERCISE CAN BE MODIFIED
BY:
• Conducting the second part of the i
exercise as a polarisation rather
;
than a debate. Ask participants to
move to the Agree! Disagree side
of the room depending on their
j
opinion of the statement. Have a j
discussion on the statements
using the questions above as
guidelines.
MAKING CONNECTIONS
• Women who cannot have
children often face stigma and
discrimination. For more see
Chapter 3 in this Module.
• All people, irrespective of marital
status, whether with a disability
or not, etc. have the right to
decide whether to have children
or not, how many, and when. For
more see Chapter 2 in Module 3.
Is having children important to people in your community or
the communities you work with? Why/ why not? Do you think
or do people in your community believe there is something wrong
ifa person does not want to have children or considers adoption?
■ Do you think a man and a woman should raise a child together?
Why? What if an individual wanted to raise a child, or a
homosexual person/couple wanted to do so?
Key Messages
• Whether to have a child or not is an individual choice. All people,
irrespective of marital status, sexual and gender identity, whether
they have a disability or not have the right to make this choice.
It is their reproductive right.
■ People who choose not to have children or are unable to have
children are often stigmatised. This is particularly so with
women, who may be ostracised or regarded poorly in these
situations.
TIPS FOR THE FACILITATOR:
• Participants may experience discomfort at having to argue a side of the debate
they disagree with. Encourage them to learn to argue a side they disagree with in
order to understand their own position and the opinion of others better. It also
illustrates the difficulties experienced in arguing for reproductive rights and thinking
of how this can be done effectively.
■ Participants might get emotional during this discussion, especially if they have
experienced stigma for not having children. Be alert to this and do not push
people to speak unless they are willing to.
• Participants may ask technical questions about conception which are not covered
in the handouts. Put them in the Parking Lot for later discussion if required.
155
TARSHI : Basics and Beyond
MODULE 2 - Chapter 2
Exercise 3
Charting Contraception Choices
Instructions
1.
2.
Divide the participants into two groups. Distribute the index cards
equally between the groups. Ask participants to decide whether
the forms of contraception on the index cards should be
categorised as Very Effective, Somewhat Effective, or Taking a
Big Chance at preventing pregnancy. For each method they
should also write one advantage and one disadvantage on the
index card. For example, male condoms are highly effective for
the prevention of pregnancy and a major advantage is that they
also protect against STIs and HIV A disadvantage might be
that it disrupts spontaneity during sex. After each method has
been discussed, the groups can tape each index card to the
appropriate categories on the flipchart or walls.
When all the cards are up,-go through each category of efficacy
and read aloud the methods. With each method, first invite
participants to describe the method. After a method is described,
read out the advantages and disadvantages. Invite participants
to add to the list. Make sure to correct any misclassification of
a method. For example if condoms were put in the, Somewhat
Effective group, it should be stressed that in fact condoms are
98% effective and should therefore be in the Very Effective
category. Also, fill gaps in information on the description or
advantages and disadvantages of each method from Handout
2.7. After looking at each category ask for questions and
comments.
Suggested Questions:
■ Do you have any questions about the methods? Are there some
of these methods unavailable in your communities?
3.
After this, begin a discussion on how contraception options may
play a role in sexuality and rights.
Suggested Questions:
• Take a method from each category of efficacy. How does this
method, with its pros and cons, relate to sexuality and rights?
For example, from the Very Effective category, contraceptive pills
(OCPs) provide women with choice and the ability to prevent
156
CATEGORISATION
Purpose of the
exercise:
1. To describe
contraceptive methods and
their efficacy.
2. To discuss what
contraception options and
choices mean for sexuality
and rights.
—
TIME
60 minutes
MATERIALS
Flipchart, tape, index cards/slips of
paper with different forms of
contraception written out from
Handout 2.7 Information on
Contraception.
I
ADVANCE PREPARATION
Write out the contraception methods !
without their descriptions from
Handout 2.7 onto separate index
cards/slips of paper; create 3
flipcharts with the titles Very
Effective, Somewhat Effective,
Taking a Big Chance. Review
Handout 2.7.
TARSHI: Basics and Beyond
MODULE 2 - Chapter 2
THIS EXERCISE CAN BE MODIFIED
BY:
• Conducting this as a large group
exercise rather than in two
smaller groups. The facilitator can
go through each method and
invite participants to describe its
efficacy. A discussion of each
method and its advantages and
disadvantages can follow.
unwanted pregnancies. It can also be said, however, that a focus
on OCPs continues to put the onus on women and does not
recognise the importance of male responsibility in contraception.
Key Messages
■ Knowledge of contraception options and methods is important
for the prevention of unwanted pregnancies.
• Having contraception options allows women and men to make
choices on how they wish to have and space children, and protect
themselves against STIs including HIV
■ It is important for two people to consider the need to protect
themselves against STIs including HIV/AIDS when considering
the most appropriate form of contraception.
MAKING CONNECTIONS
• While making a contraceptive
choice, it is important to consider
that not all contraception methods
provide protection against STIs
including HIV/AIDS. For more see
Chapter 4 in this Module.
• People who want to choose
contraception should be given
information and support in a nonjudgmental manner. For more see
Setting the Tone in the
Introduction to Module 1.
• Contraception decisions are an individual preference that depend
upon the needs and comfort of each person, and should not be
forced upon anyone. Not all methods are appropriate for
everyone, as highlighted in some of the advantages and
disadvantages in the chart.
• Women are often left out of decisions about birth control. Those
with more power by virtue of their gender (men), social status
(parents-in-law) or educational background (doctors in the
public health system) can influence and control the kind of
contraception a woman uses or does not use.
TIPS FOR THE FACILITATOR:
■ Participants may put a contraceptive method in the wrong category of efficacy.
Make corrections if this happens. A copy of the Handout 2.7 should be handed to
participants at the end of this exercise for future reference.
• Participants may want to know the medical details of each method. If the facilitator
is unsure of these details, or if time is limited, put the questions in the Parking Lot
to be discussed later.
157
TARSHI : Rasies and Beyond
MODULE 2 - Chapter 2
Exercise 4
Abortion Basics
Instructions
1. Begin the exercise by giving a 15-minute presentation on the
LECTURETTE
Purpose of the
exercise:
different abortion methods and options from Handout 2.8.
2. After giving an overview of the types of abortion methods ask
1. To understand options
for abortion.
for questions.
Suggested Questions:
■ Were there any options you were unfamiliar with?
2. To discuss and debate
the issues surrounding
abortion.
• Are all these options available in the countries/areas/
communities in which you live?
Key Messages
TIME
• There are a variety of abortion options available, including
medical and surgical abortions, that can be performed depending
on how advanced the pregnancy is.
• Whether to have an abortion or not should be the woman’s
choice. However, it often depends less on her preference than
on types of options available and the wishes and opinions of her
family, peers, culture, and community.
• Even ifwomen know that abortion is legal in their country, many
opt for unsafe or ‘back-street’ abortions for fear of being identified
or judged by their community. These unsafe abortions can lead
to increased rates of maternal mortality and morbidity.
■ Having an abortion is often an unpleasant physical and
emotional experience for a woman. It is important to have
counselling for women considering abortions and for those
opting to have them. This provides them with information and
support through the decision-making process and abortion
procedure when done in a non-judgmental and respectful
manner.
158
30 minutes
MATERIALS
Flipchart, markers
ADVANCE PREPARATION
Review Handout 2.8 Basic
Information on Abortion and be
prepared to give a short lecture on
the topic. Check whether abortion is
legal in your country and what
methods are commonly available
locally.
TARSHI: Basics and Beyond
MODULE 2 - Chaplet 2
THIS EXERCISE CAN BE MODIFIED
BY:
■ Distributing Handout 2.8 and
giving participants 5-10 minutes to i
read through the handout and
formulate any questions they may i
have. They can then be asked a
series of questions about the
handout. For example: 'Were you
unfamiliar with any of the options
mentioned?' 'Are all of these
available where you live/work?'
'How can we educate others
about these abortion options?'
I
Coercive abortions take place in many parts of the world. Many
of these are performed on women to eliminate female foetuses,
on disabled women and those with learning difficulties thought
to be incapable of rearing children, teens and single women.
Such coercive methods violate women’s reproductive rights.
Abortion is a heavily debated issue with two main sides to the
debate, pro-choice (supports abortion as a right of the woman)
and anti-choice (opposes abortion as a choice for the woman to
make).
Those who are pro-choice believe in the right of a woman to an
abortion because it is her body and her right to choose whether
to have or to not have a child.
The anti-choice side of the debate opposes abortion because they
believe it is taking a life. A woman’s social, physical, mental or
emotional circumstances and reproductive rights are not taken
into consideration by this view.
MAKING CONNECTIONS
TIPS FOR THE FACILITATOR:
■ Basic information on human
sexual and reproductive anatomy
and physiology is required before
learning about abortion. For more
see Chapter 1 in this Module.
• Exercise 5 My Views on Abortion in this chapter can follow this exercise. Ask
participants to withhold comments and opinions on abortions and various options
until that exercise is complete.
• Some women who have an
abortion face stigma from their
families and communities even
though they are exercising their
reproductive rights. For more see
Chapter 3 in Module 3.
• Abortion can be a very difficult issue for discussion, and strong opinions are likely
to be expressed. Emphasise respect, listening and open discussion during this
topic.
159
TARSHI: Basics and Beyond
MODULE 2 - Chapter 2
Exercise 5
My Views on Abortion
Instructions
1. Choose at least 3 statements from the list below. Read out one
statement at a time. Designate one side of the room as the Agree
side and the other as the Disagree side. Ask the participants to
move towards either side of the room based on their opinion of
the statement. Those who are undecided should move to a third
designated spot in the room (the Don’t Know group).
Statement 1: Abortion should be the woman’s choice.
Statement 2: Abortion should be legal and free.
POLARISATION
Purpose of the
exercise:
1. To discuss opinions on
abortion, including
selective abortion.
2. To analyse stigma
associated with abortion.
Statement 3: If a woman is raped it is okay for her to have an
abortion.
Statement 4: Sex selective abortion should be a woman’s choice.
Statement 5: It is okay to have an abortion if tests indicate the
possibility that the foetus will have a disability.
Statement 6: Young people have the right to have an abortion
without parental consent.
TIME
60 minutes
MATERIALS
Flipchart, markers
2. After the participants have chosen a side, invite them to share
the reasons for this choice. Discuss the issue for no more than
20-25 minutes or participants may become uninterested.
Suggested Questions:
■ Why do you agree or disagree?
• Do you think your opinion is similar to that of your community?
3.
After going through all the selected statements, ask for general
comments or questions.
Suggested Questions:
■ Were there any issues you had not thought of before? What were
they and how did they make you feel?
• From these statements and discussions, what are your opinions
and thoughts about abortion and reproductive health and rights?
160
ADVANCE PREPARATION
None
TARSHI: Basics and Beyond
THIS EXERCISE CAN BE MODIFIED
MODULE 2 - Chapter 2
Key Messages
BY:
• Asking for reactions and
discussing fewer statements. This \
can allow for deeper and longer
I
discussions of the issues and
opinions.
• Combining two of the statements ;
and asking whether people agree
or disagree. It becomes more
difficult to take sides on a
statement when there are more
nuances to consider. Participants
will need to grapple with and
analyse their opinions around
abortion more carefully in this
situation.
■ The right to abortion is a reproductive right that all women have,
regardless of age, marital status, disability status etc.
■ Because women bear more of the physical and emotional
consequences of a pregnancy their reproductive rights are given
higher priority than those of men. The choice to have a child, or
not, or to have an abortion or not, is the woman’s to make.
■ Abortion is a heavily debated issue with two main sides to the
debate: pro-choice supporters that believe a woman has the right
to an abortion because it is her body and choice about whether
to have a child or not, and anti-choice supporters, who oppose
abortion because they believe it is taking a life. The latter view
does not take a woman’s social, physical, mental or emotional
circumstances and reproductive rights into consideration.
TIPS FOR THE FACILITATOR:
MAKING CONNECTIONS
• There are overlaps between
sexual and reproductive rights, but
also differences. For more see
Chapters 2 and 3 in Module 3.
■ People with disabilities have the
right to decide whether or not
they want to have children. For
more see Chapter 3 in Module 4.
• Participants may be uncomfortable discussing this topic or have very strong
opinions on it. Be prepared for heated arguments. Prevent participants from
attacking one another's ideas in a disrespectful manner. Encourage openness to
others' views and opinions.
• Issues of morality may come into the debate. Emphasise that morality is a
relative term. Help participants to consider the advantages of addressing abortion
as a health and rights issue as opposed to one of morality.
■ Some participants may feel it important to consider a partner in decisions about
abortion. While it is important to involve men in the decision making process,
ultimately the choice of whether to have an abortion or not is the woman's as it
is she who bears the consequences of the pregnancy. Even in marital situations,
a woman should be able to choose whether to have a child or an abortion.
161
TARSHI : Basics and Beyond
MODULE 2 - Chapter 2
Handout 2.6
Basic Information on Conception
Below are some terms commonly used when talking about conception:
■ Amenorrhoea: The absence of menstrual periods that can be caused by pregnancy, menopause,
breast-feeding, hormone imbalance, excessive dieting or exercise and stress, among other factors.
■ Conception: The moment a fertilised egg attaches itself to the lining of the uterus and pregnancy
begins.
• Embryo: A fertilised egg growing in the uterine lining becomes an embryo.
• Endometrium: The uterine lining, which will thicken and grow during ovulation to prepare for a
fertilised egg. In the absence of fertilisation, the endometrium is shed during menstruation.
■ Fertilisation: When an egg (ovum) meets and merges with a sperm in the fallopian tube.
• Ovulation: The process by which an egg (ovum) is released by the ovary. The process begins with
the growth of 10 to 20 ovarian follicles. Most of these follicles will not mature and are reabsorbed by
the body, but one follicle will produce a mature egg that will be released during ovulation. Ovulation
begins when hormones are released from the pituitary and hypothalamus glands in the brain.
■ Oestrogen: A hormone produced by the ovaries which among other things, signals the egg in the
ovary to be released.
• Ovaries: Two organs, each about the size of a walnut, located slightly below either side of the uterus.
The ovaries have two purposes: to produce eggs (ova) and hormones, including oestrogen and
progesterone, and testosterone.
• Progesterone: A hormone produced by the ovaries. Among other things, oestrogen signals the lining
of the uterus (endometrium) to thicken and grow in preparation for a fertilised egg.
• Zygote: After an egg is fertilised it changes its surface to prevent other sperm from entering. This
fertilised egg is called a zygote.
162
TARSHI: Basics and Beyond
MODULE 2 - Chapter 2
How does pregnancy occur?
Pregnancy begins with fertilisation. The process of fertilisation starts with ovulation - a woman’s ovary
releasing an egg (ovum). Just before ovulation, the uterine wall begins to thicken with tissue and blood
in preparation. After the egg is released, it travels into the fallopian tube, where it stays for three to four
days. If a woman has sex with a man during this period and he ejaculates into her, the ejaculated
semen will travel into the woman’s vagina and uterus, and head up toward the fallopian tubes. Most
sperm will die while travelling up toward the fallopian tubes, but some will make it up to the fallopian
tube and try to meet the egg. When the two meet and merge, fertilisation occurs. The fertilised egg
then travels down the fallopian tube and attaches itself to the uterine wall, which will nourish the egg
with blood and nutrients for the next nine months, and secrete increased levels of the hormone
progesterone. This is when pregnancy has occurred.
What happens if the egg is not fertilised or attached to the uterine wall?
If pregnancy does not occur the thickened uterine wall (endometrium) is not needed to nourish an egg
and is shed. This lining, composed of tissue, blood, and mucous, will come out of a woman’s vagina
little by little for a period of two to eights days. This is called menstruation.
Can a woman get pregnant from pre-cum or if a man ejaculates near her vagina?
Tfes, a woman can get pregnant any time sperm enters the vulva or is inside the vagina. This means
that ejaculation near the vagina can also lead to pregnancy. This is possible when the vaginal lubrication
(wetness) in the woman provides a medium for the sperm to swim into the woman’s body. There is no
way of knowing the probability that pregnancy will occur when semen comes in contact with the vulva
or vagina. Pregnancy can be determined using a home pregnancy test or more accurately through a
pregnancy test done in a laboratory.
163
MODULE
e Handout 2.7
The chart below outlines general information on different forms of contraception. However, this list is not exhaustive in the facts or details of each method.
Many of these methods may not be available everywhere. Often the most appropriate option for an individual should be discussed with a health care
provider. If the chart notes that efficacy is 99% this means that 99 out of 100 people using the method properly each time will not get pregnant. Because of
new developments in contraceptive technology, information can change on a regular basis. Therefore, up-to-date information on any of these and other
forms of contraception, their availability and cost should be sought from health care providers in your area.
2 -Chapter 2
Basic Information on Contraception
* For more on this and the studies associated with nonoxynol-9 and HIV transmission, please see the World Health Organization website at http://www.who.int/reproductive-health/stis/nonoxynol9.html.
** Progestin is a synthetic hormone used to affect a woman's body in the same ways as the hormone progesterone.
BARRIER METHODS
FORM OF
DESCRIPTION
EFFICACY
ADVANTAGES
DISADVANTAGES
USAGE
OTHER INFORMATION
Reusable after washing
with soap and water. Can
be inserted 6 hours prior to
intercourse and left in up to
48 hours for multiple acts of
intercourse if more
spermicide is added. Does
not interrupt intercourse.
Few side effects. Can be
discontinued at any time.
Does not affect fertility.
Does not reduce risk of STI
and HIV transmission. Some
people may have allergic
reactions to spermicides/ the
latex. May be difficult for
some women to insert. Need
a health care provider to fit
the cap (they come in
different sizes). If a woman is
at higher risk of HIV infection
using spermicides that
contain nonoxydol-9 may
increase the likelihood of
transmission.*
Before using check for
holes, tears or cracks. Apply
spermicide to the cervical
cap, and then insert it into
the vagina and place the cap
onto the cervix so the cervix
is completely covered and the
cap fits snuggly. Leave the
cervical cap in place for at
least 8 hours after sex.
Should not be used if a
woman is using other vaginal
medications, like treatments
for yeast infection, or during
a woman's menstrual period.
The cap should be replaced
every year. A woman should
also have her cap refitted if
she has had a child vaginally,
gains or loses more than 9
kgs, or had an abortion or a
miscarriage, as these can
affect the way the cap fits.
CONTRACEPTION
Cervical Cap
TARSHI : Basics and Beyond
84-91%
A thimble-shaped device
in women
made of thin soft latex
(rubber! or silicone, with a
who have
flexible rim that fits over the not given
cervix. It is a physical barrier birth. 68to block the cervix and
74%
prevent sperm from reaching effective
the egg and to hold chemical for
women
spermicide to kill sperm.
Similar to a diaphragm, the
who have
cap is smaller and can be left given
birth
in longer (up to 48 hours).
vaginally.
EFFICACY
ADVANTAGES
DISADVANTAGES
USAGE
OTHER INFORMATION
Diaphragm
A thin, circular dome with a
flexible rim made of soft
latex (rubber! or silicone. It a
physical barrier to block the
cervix and prevent sperm
from fertilising an egg and to
hold chemical spermicide to
kill sperm.
86-94%
Reusable after washing with
soap and water. Can be
inserted 6 hours prior to
intercourse and left in up to
24 hours for multiple acts of
intercourse. Few side effects.
Does not affect fertility.
Does not reduce risk of STI
and HIV transmission. Some
people may have allergic
reactions to the latex or
spermicides. May be difficult
for some women to insert.
Need a health care provider
to fit the cap (they come in
different sizes).If a woman is
at higher risk of HIV infection
using spermicides that
contain nonoxydol-9 may
increase the likelihood of
transmission.*
Before using check for tears,
cracks, or holes. Apply
spermicide to the diaphragm
and then insert it deep into
the vagina. The front rim
should be tucked behind the
pubic bone. Make sure it
covers the cervix.
Should not to be used if a
woman is using vaginal
medications such as for yeast
infection, or during her period
as it can increase the risk for
toxic shock syndrome. Must
replace after 3 years. A
woman should also have her
diaphragm refitted if she has
had a child vaginally, gains or
loses more than 9 kgs, or had
an abortion or a miscarriage,
as these can effect the way
the cap fits.
Female condoms
A polyurethane pouch that
has a flexible ring at both
ends. It is approximately 3
inches wide and 7 inches
long.
79- 95%
Reduces the risk of STI and
HIV transmission. Can be
used by those with latex
allergies. Can be inserted up
to 8 hours prior to
intercourse. Can increase
pleasure for both partners
because the rim of the outer
ring stimulates the clitoris
and testes during sex. Does
not affect fertility.
Can be expensive. There can
be a noisy/crackling sound
during intercourse. It may be
difficult to insert.
Add lubricant. Insert the
closed end of the condom
deep into the vagina to cover
the cervix. The open end
stays outside the vagina to
partially cover the labia. After
sex, remove the condom by
twisting the outer ring and
pulling it out gently to avoid
spilling any semen.
Do not use the male and
female condom together.
Recommendations for the
female condom indicate a
single usage for each
condom. However there is
research being done to study
whether disinfecting and
cleaning a female condom
can allow for multiple usage.
CONTRACEPTION
7
TARSHi: Basics and Beyond
DESCRIPTION
FORM OF
FORM OF
DESCRIPTION
ADVANTAGES
DISADVANTAGES
USAGE
OTHER INFORMATION
A sheath of latex or plastic
that is worn on the penis.
Comes rolled uo in a
wrapper.
Reduces the risk of STI and
HIV transmission (only the
latex variety!. May help delay
ejaculation. Usually
inexpensive and easily
accessible. Available in
various textures, flavours,
sizes, colours and brands.
Does not affect fertility.
May break or rip if used
incorrectly. Can disrupt
spontaneity during sex. If
stored incorrectly (in warm/
moist conditions) the condom
can begin to disintegrate if.
Some people may have
allergic reactions to the latex.
Put the condom on after the
penis is erect. Squeeze the air
out of the closed end of the
condom and place it on the
head of the penis. Hold it in
place and unroll it completely
on to the penis. Let go of the
tip when unrolled. After sex,
the man should withdraw
before the penis goes soft in
order to avoid spillage of
semen.
Necessary to check expiry
date and whether electron
ically tested. Latex condoms
should not be used with oil
based lubricants (like lotion
or oil). Using water-based
lubricants with the condom
can reduce condom failure
(such as breakage). Do not
use a male and female
condom together. Use the
condom only once.
A small, flexible device
(sometimes T-shaped)
inserted into the uterus.
There are 2 types of IUDs non-hormonal (also known as
a Copper T) and hormonal.
An IUD works at preventing
fertilisisation by altering the
uterine environment. A
hormonal IUD also contains
progestin** that thickens
cervical mucous making it
more difficult for sperm to
enter the uterus to fertilise
an egg.
The non-hormonal IUD can be
left in place for up to 10
years. The hormonal IUD can
be kept in place for up to 5
years. Does not interrupt
intercourse. The progestin**
in the hormonal IUD can help
relieve menstrual cramps and
bleeding.
Does not reduce risk of STI
and HIV transmission. In the
first few months after
insertion, some women may
experience cramps or
backaches. It can increase
menstrual bleeding, cramping
or spotting between
menstrual periods. Needs to
be inserted by a health care
provider in clean hygienic
surroundings. Increased risk
for pelvic inflammatory
disease (PID) in the first 20
days after insertion.
A health care provider will
insert the IUD. Variants are
available for different
durations - 3,5,7 or even 10
years.
If any side effects are
experienced within the first
month after insertion, a
health care provider should
be contacted. Make sure the
IUD is in place regularly by
checking the 2 small strings
that hang down from the IUD
into the upper vagina.
Fertility can return a month
after an IUD is removed.
EFFICACY
CONTRACEPTION
Intra-uterine
device (IUD) (hormonal and
non-hormonal)
I
TARSHI : Basics and Beyond
FORM OF
DESCRIPTION
EFFICACY
ADVANTAGES
DISADVANTAGES
USAGE
OTHER INFORMATION
Contain the hormones of
oestrogen and progestin.**
The combination of these 2
hormones primarily work to
prevent ovulation and thicken
cervical mucous to prevent
sperm from entering the
uterus.
92-99%
Easy to administer. There are
many types of COCs to
choose from. Reduces
menstrual flow for some
women. Can decrease the
risk of some diseases such as
PID, some cancers, or benign
breast disease. Does not
interrupt intercourse.
Increased dosages can also
be used as emergency
contraception Imore later in
this chart).
Does not reduce risk of STI
and HIV transmission. Must
be taken everyday, and
requires a regular supply. Can
cause temporary side effects
such as nausea and break
through bleeding which
usually last the first three
months.
Take one pill every day for
21-25 days depending on the
type of COC. A doctor/ health
care provider can help
determine which COC is best
for each woman and when to
start the pills.
Should not be used by
women who have blood
clots, have migraine
headaches or women over 35
years who smoke. Once
COCs are stopped, regular
fertility levels will return in
approximately 3 months. It
may take a month or two for
periods to become regular
after stopping. COCs can be
used by women who are
breastfeeding, after 6
months of regular
breastfeeding.
Small, plastic tubal implants
that are inserted under the
skin of a woman's arm.
These implants slowly
release hormones that
primarily work to thicken
cervical mucous to prevent
sperm from entering the
uterus and prevent ovulation.
99%
Lasts for 3 to 5 years. Does
not interrupt intercourse.
Does not reduce risk of STI
and HIV transmission. Some
severe side effects have been
reported. Can cause weight
gain, irregular bleeding, and
lower abdominal pain. Can be
visible through the skin.
A health care provider will
insert the implant under the
skin in minor surgery. The
implants are inserted within
the first 7 days of a
menstrual cycle.
Return to regular fertility
after the implants are
removed can take between
8-10 months.
CONTRACEPTION
Combin ed Oral
Contra eptive Pills
ICOCs)
a* ® +
J
so. IfTL os ’
® <5ftsl
J JS
Implan ts
■
TARSHI: Basics and Beyond
HORMONAL METHODS
FORM OF
ADVANTAGES
DISADVANTAGES
USAGE
OTHER INFORMATION
An intramuscular injection
contains progestin* * and is
given every 12 weeks. The
shot slowly releases the
hormone into the body. This
primarily works to prevent
ovulation and thicken cervical
mucous to prevent sperm
from entering the uterus.
97-99%
For some injectables,
protection against pregnancy
can last for 3 months. Does
not interrupt intercourse.
Decreased risk for some
cancers. Decrease in
menstrual flow and in
menstrual cramps. Can be
used for women who are
breastfeeding.
Does not reduce risk of STI
and HIV. A health care
provider must administer the
shot. Possible side effects
include weight gain, irregular
bleeding, breast tenderness,
headaches, mood swings, loss
of bone density that can
increase the risk for
osteoporosis.
A health care provider will
administer the shot in the
arm or buttocks.
On average, it takes a
woman 4 months to return
to regular levels of fertility
after discontinuing an
injectable. Some women
may stop having their period
or have large gaps in
between menstrual cycles
when on an injectable.
Mini-pill
A progestin** only pill. It
primarily works to thicken the
mucous around the cervix to
prevent sperm from entering
the uterus. Also prevents
ovulation.
87-99%
Easy to administer. Does not
interrupt intercourse. Can be
used by women who cannot
take oestrogen. Women who
are breastfeeding can use the
mini-pill.
Does not reduce risk of STI
and HIV transmission. Must be
taken at the same time
everyday. Women may have
irregular periods or spotting in
between periods.
Take one pill every day at the
same time.
Should not be used by
women who have certain
conditions or diseases such as
liver disease or breast cancer.
Fertility will return
immediately or within a few
months after discontinuing
the mini-pill.
The patch
A small adhesive patch.
It contains oestrogen and
progestin** which are
gradually released into the
blood and primarily work to
prevent ovulation and thicken
cervical mucous to prevent
sperm from entering the
uterus.
99%
Does not interrupt
intercourse. Can reduce
menstrual flow for some
women. Can decrease the
risk of some conditions and
diseases such as PID, some
cancers, or benign breast
disease.
Does not reduce risk of STI
and HIV transmission. Visible
on the skin. Can cause
possible skin irritations and
temporary side effects such as
nausea and spotting in
between periods that usually
last for the first three months
of use.
A new patch is applied each
week for 3 weeks and no
patch is worn on the 4th
week. Some studies have
shown that the patch may
increase the risk of blood
clots as compared to regular
COCs. The patch can be worn
on the lower, upper torso or
arms, abdomen, buttocks.
Women who have blood
clots, are breast-feeding,
have migraine headaches or
women over 35 years who
smoke should not use the
patch. Efficacy is also lower
for women who weigh over
90 kilograms.
Injectable
z
£ (8 R
> BS
TARSHI : Basics and Beyond
EFFICACY
2 -Chapter 2
DESCRIPTION
CONTRACEPTION
MODULE
”
FORM OF
DESCRIPTION
EFFICACY
ADVANTAGES
DISADVANTAGES
USAGE
OTHER INFORMATION
Pessaries, foams, creams,
gels, suppositories, or tablets
that are placed in a woman's
vagina. They contain chemicals
that kill sperm.
71-82%
Available in many forms.
Can be left in for 6-8 hours.
Does not reduce risk of STI
and HIV transmission. May
weaken latex condoms
making them less effective.
Can have an unpleasant taste
or smell. If a woman is at
higher risk of HIV infection
using spermicides that
contain nonoxydol-9 may
increase the likelihood of
transmission.*
Put the spermicide deep into
the vagina. Must be inserted
10-15 minutes prior to
intercourse. Leave it in place
for 6-8 hours after having
sex. Do not douche (squirt
water or other solutions,
such as vinegar, baking soda,
or douching solutions into the
vaginal after insertion.
Most effective when used in
conjunction with other barrier
methods, but used on its
own, it is better than no
contraception method.
A soft, plastic, flexible ring that
a woman inserts into her
vagina. The ring slowly
releases oestrogen and
progestin** hormones into the
body that primarily work to
prevent ovulation and thicken
cervical mucous to prevent
sperm from entering the
uterus.
92-99%
Does not interrupt
intercourse. Can reduce
menstrual flow for some
women. Decreases the risk
of some conditions and
diseases such as PID, some
cancers, or benign breast
disease.
Does not reduce risk of STI
and HIV transmission. Some
side effects can include,
irregular bleeding, breast
tenderness, headaches,
nausea, and weight gain. It
may be difficult to insert.
Insert a new ring once a
month. The ring is placed
anywhere in the vagina
during the first 5 days of the
menstrual period and remains
there for three weeks. It is
removed at the beginning of
the fourth week. A new ring
is inserted at the end of the
fourth week.
The ring should not be
removed during sexual
intercourse. Women who
have blood clots, are breast
feeding, have migraine
headaches or women over 35
years who smoke should not
use the vaginal ring.
CONTRACEPTION
Spermicides
-
Vaginal ring
MODULE 2
S NON-HORMONAL I NON CHEMICAL METHODS
FORM OF
EFFICACY
ADVANTAGES
DISADVANTAGES
USAGE
OTHER INFORMATION
Abstinence
Defined as either choosing to
abstain from any sexual activity,
or refraining from any penetrative
sexual acts (such as anal or vaginal
sex), while participating in other
sexual acts (such as oral sex).
100% if
abstaining
from any.
sexual
activity
Nothing to purchase. Can be
discontinued at anytime. Reduces
the risk of STI and HIV
transmission.
Potential to transmit some STIs,
such as syphilis if there is skin to
skin contact during sexual activity
other than intercourse.
Can include periodic abstinence,
in which an individual refrains
from sexual activity from time to
time (such as when a woman is
ovulating), or constant abstinence
in which an individual refrains
from sexual activity at all times.
Requires the cooperation of both
partners, which may not be
possible at all times.
Basal Body Temperature
A fertility awareness method
(FAM), where a woman takes her
body temperature each morning to
determine the fertile phase in her
menstrual cycle. During the fertile
period, pregnancy can be
prevented by voluntarily avoiding
sex or using other forms of
contraception.
With other
FAMs
75-99%
Nothing to purchase. Can help a
woman better understand her
reproductive physiology.
Does not reduce risk of STI and
HIV transmission. Takes time to
learn the fertile phase and requires
a commitment to checking
everyday.
Each morning as soon as a woman
wakes up, she records her
temperature with a sensitive
thermometer. A temperature rise
indicates that ovulation has
occured. The fertile period lasts for
3 consecutive days after this
increase in temperature.
Women are advised to not eat,
drink, or smoke before taking their
temperature. May be difficult to
use this method during times of
stress, illness or lack of sleep
because these factors can affect
body temperatures.
Nothing to purchase. Can be
discontinued at anytime.
Does not reduce risk of STI and
HIV transmission. Will only last
for 6 months after delivery and
only if the woman is exclusively
breastfeeding.
Requires that a woman has not
had a period since delivery. A
woman must breastfeed at least
six times a day (every four hours!
from both breasts. Protection lasts
for 6 months after giving birth.
Women who have HIV/AIDS may
be advised to not breastfeed (520% chance of HIV transmission
through breast feeding).
CONTRACEPTION
AND DESCRIPTION
TARSHI : Basics and Beyond
Breast Feeding/LAM (Lactational
Amenorrhoea Method!
Exclusive breastfeeding for the 1st
6 months after childbirth produces
prolactin, a hormone that
suppresses ovulation.
EFFICACY
ADVANTAGES
DISADVANTAGES
USAGE
OTHER INFORMATION
With
Calendar (rhythm) Method
other
A fertility awareness method
(FAM), this requires recording and FAMs
calculating the number of days in a 75-99%
woman's menstrual cycle to
determine the fertile phase in the
cycle. During the fertile period,
pregnancy can be prevented by
voluntarily avoiding sexual
intercourse or using another
contraceptive method.
Nothing to purchase. Can help a
woman better understand her
reproductive physiology.
Does not reduce risk of STI and
HIV transmission. Takes time to
learn the fertile phase and requires
a commitment to recording the
menstrual cycle each month.
Keep a written record of each
menstrual cycle, counting from the
first day of one menstrual period
up to, but not including, the first
day of the next. Keep records of 6
cycles. To find the start of the
fertile days take the shortest cycle
recorded and subtract 18. To find
the end of the fertile phase, take
the longest cycle recorded and
subtract 11.
This method may be difficult to
use for women with irregular
periods.
With
other
FAMs
75-99%
Nothing to purchase. Can help a
woman better understand her
reproductive physiology.
Does not reduce risk of STI and
HIV transmission. Takes time to
learn the fertile phase and requires
a commitment to check the
cervical mucous everyday.
Check the mucous each day for
several months. Pre-ovulation
mucous is yellow/ white, cloudy
and sticky. Ovulation secretions
are clear and slippery and can be
stretched between the fingers.
During the fertile phase (after
ovulation) the mucous is thick and
cloudy. After the fertile phase
there may be little/no mucous.
Not recommended for women
with abnormal discharge.
CONTRACEPTION
AND DESCRIPTION
Cervical Mucous Method
A fertility awareness method
(FAM)., this requires checking the
texture, colour and quality of the
mucous and secretions in the vulva
to determine a woman's fertile
phase. During the fertile period,
pregnancy can be prevented by
voluntarily avoiding sexual
intercourse or using another
contraceptive method.
Efficacy
varies.
TARSHI: Basics and Beyond
FORM OF
S’
a?
FORM OF
ADVANTAGES
DISADVANTAGES
USAGE
OTHER INFORMATION
Nothing to purchase.
Does not reduce risk of STI and
HIV transmission. Can be highly
ineffective at preventing
pregnancy because pre-ejaculatory
fluid secreted from the penis after
erection also contains sperm that
can enter the vagina during
penetration. Can interfere with sex
and make partners worry about
withdrawing 'in time'.
Before ejaculating a man will
remove his penis from the
woman's vagina. A man must be
able to anticipate and control his
ejaculation.
Requires that both partners to
cooperate.
EFFICACY
ADVANTAGES
DISADVANTAGES
USAGE
OTHER INFORMATION
Nearly
100%.
Does not interrupt intercourse.
Permanently prevents pregnancy.
Does not reduce risk of STI and
HIV transmission. Can be
emotionally difficult for women
who see it as an inability to have
more children. Complications such
as infection can occur from the
surgery. Reversal is difficult and
requires a highly skilled medical
practitioner.
There are surgical and non-surgical
options. In the surgical procedure
the fallopian tubes are cut, sewn
or tied. In a non-surgical procedure
small metal implants are inserted
into the fallopian tubes. Over time
scar tissues grows over these
implants and blocks the fallopian
tubes. The patient can leave soon
after these procedures are
completed.
Does not effect menstrual periods,
ability to have an orgasm, and nor
does it cause menopause.
EFFICACY
CONTRACEPTION
AND DESCRIPTION
Coitus Interruptus
Withdrawal method in which the
man completely removes his penis
from the woman's vagina before
he ejaculates.
PERMANENT METHODS
FORM OF
CONTRACEPTION
AND DESCRIPTION
TARSHI: Basics and Beyond
Tubectomy or Tubal Ligation
A surgical procedure that blocks
the fallopian tubes. The procedure
prevents an egg from travelling
from the ovary to the uterus and
sperm from reaching the egg to
fertilise it.
EFFICACY
ADVANTAGES
DISADVANTAGES
USAGE
OTHER INFORMATION
Nearly
100%
effective
at
preventing
pregnancy.
Does not interrupt intercourse.
Permanently prevents pregnancy.
Complications are rare.
Does not reduce risk of STI and
HIV transmission. Can be
emotionally difficult. Reversal
surgeries are not highly successful.
A health care provider will cut and
seal the two vas deferens. Can be
done by the standard method or
the no-scalpel technique (noninvasivel.The patient can leave
soon after the procedure is
completed.
Takes around 15-30 ejaculations
after the operation to clear out the
sperm already in the vas deferens
- during this time an alternative
contraception should be used.
Does not affect ability to have an
erection, ejaculation, or the ability
to have an orgasm.
EFFICACY
ADVANTAGES
DISADVANTAGES
USAGE
OTHER INFORMATION
Up to 94%
effective if
taken
within 24
hours. It is
up to 79%
effective if
taken
within 5
days.
Easy to use. The side effects are
short-term.
Does not reduce risk of STI and
HIV transmission. ECPs can only
be used up to 5 days after
unprotected sex or contraceptive
failure. Some side effects are
nausea, or vomiting, breast
tenderness, late or early onset of
the next period with heavier or
lighter flow.
A woman takes one dosage of
ECPs as soon as possible after
unprotected sex / contraceptive
failure and the second dosage 12
hours later. Dosage depends on
the type of regimen being used.
Some COCs in higher dosages can
also be used as emergency
contraceptives. A copper bearing
IUD can also be used an
emergency contraceptive.
ECPs do not cause an abortion and
should not be confused with the
abortion pill (for example, RU486I. If a woman is already
pregnant when she takes EC, it
will not interrupt the pregnancy.
If EC is taken mistakenly during a
pregnancy, it will not harm the
foetus. Taking EC will not harm a
woman's ability to become
pregnant in the future.
CONTRACEPTION
AND DESCRIPTION
Vasectomy
A surgical procedure that seals the
vas deferens preventing sperm
from getting into semen. After a
vasectomy, a man still produces
semen but there is no sperm it.
OTHER
FORM OF
CONTRACEPTION
AND DESCRIPTION
Emergency Contraceptive Pills
(ECPsI
Also known as the 'morning-after
pill'. ECPs are higher dosages of
the hormones found in regular oral
contraceptive pills. They can be
taken up to 5 days after
unprotected sex or contraceptive
failure to prevent pregnancy. EC
works to prevent fertilisation,
inhibit ovulation or alter the
uterine lining preventing
implantation of an egg.
TARSHI: Basics and Beyond
FORM OF
TARSHI : Basics and Beyond
MODULE 2 - Chapter 2
Handout 2.8
Basic Information on Abortion
What are an induced abortion and a spontaneous abortion?
An abortion is the induced or spontaneous termination of a pregnancy. A spontaneous abortion occurs
when a pregnancy terminates without any medical or surgical intervention, as in the case o a
miscarriage. Induced abortions involve surgical or medical procedures for termination of the pregnancy.
How late in a pregnancy can you have an induced surgical abortion?
Countries have different laws on abortion and up to what week certain abortion procedures can be
performed. Abortion was legalised in India over 30 years ago (see http://www.mp.nic.in/health/
mtp%20Act.pdf for the full text of the Medical Termination of Pregnancy Act, 1971). Please check the
laws in your country for information on which methods are available and till what stage in a pregnancy.
In addition, keep abreast of medical developments in the field as well as the socio-legal implications of
abortion in your region.
Up to 7 weeks
Manual Vacuum Aspiration (MVA) can be performed up to 7 weeks after a woman’s last menstrual
period. This procedure can be done under local or general anaesthesia and is safe and highly effective
(95-97% efficacy). During a MVA a speculum holds open the vagina. Small instruments called dilators
are then used to gradually open up a women’s cervix. A small tube with an attached syringe is inserted
into her uterus, which will create a vacuum. This vacuum will suction out and remove the contents of
the uterus into the syringe container. The procedure takes between five and ten minutes.
Up to 14 weeks
Dilation and Suction Curettage (D&C) can be performed between six and fourteen weeks after a
woman’s last menstrual period. This procedure is done under local or general anaesthesia and is safe
and effective. A speculum holds open the vagina after which small instruments called dilators are
gradually used to open up the women’s cervix. A small tube attached to a suction machine is then
inserted into the woman’s uterus. The machine is turned on and the tube suctions out the contents of
the uterus. Once this is over, the machine is turned off and a spoon shaped instrument called a curette
is moved along the walls of the uterus to remove any remains of the uterine contents.
Between 14 and 24 weeks
Dilatation and Evacuation (D&E) can be performed between 14 and 24 weeks after a woman’s last
menstrual period. D&E is generally a two-day procedure: on the first day the cervix is dilated and on
the second day the uterine contents are removed. To dilate the cervix, small instruments called dilators
are used and may be left inside for many hours to gradually open the cervix wide enough. After the
cervix has opened sufficiently, a small tube connected .to a suction machine is inserted into the woman’s
uterus. The machine is turned on and removes the uterine contents. Instruments are also moved
along the sides of the uterus to remove any remaining tissue from the uterus.
174
TARSHI: Basics and Beyond
MODULE 2 - Chapter 2
What are the side effects from induced surgical abortion procedures?
Patients may feel groggy from anaesthesia, and uterine bleeding and cramps are common. Sanitary
pads are needed for the bleeding. Some patients may also feel faint, or nauseous.
When can an induced medical abortion be performed?
In India, Mifepristone and Misoprostol are two common drugs sold through chemist outlets on
prescription. While the former is registered for use in the first 49 days (7 weeks) of pregnancy, the latter
has been endorsed for use for the first 56 days (8 weeks) of pregnancy.
What does an induced medical abortion involve?
A medical abortion uses a combination of two hormonal drugs - an anti-progesterone and prostaglandin,
which can be used through various routes namely by mouth, by injection intramuscularly/intravenously
or vaginally. A woman first takes the anti-progesterone (Mifeprestone), which prevents the hormone
progesterone from being produced in her body. Without progesterone the lining of the uterus will
begin to shed and is unable to hold a fertilised egg. Twenty-four to forty-eight hours after the antiprogesterone is taken the woman will take the prostaglandin (often Misoprostol). The prostaglandin
causes the uterus to contract, the cervix to open and the uterine contents to be expelled from the
woman’s body.
What are the side effects from induced medical abortions?
Cramping and bleeding are common, and are often taken to mean that the drugs are working. Other
side effects include nausea, dizziness, diarrhoea, vomiting, and back pain.
What are unsafe abortions?
According the World Health Organization (WHO) definition, an unsafe abortion is ‘a procedure for
terminating an unwanted pregnancy either by persons lacking the necessary skills or in an environment
lacking the minimum medical standards, or both.’
How many women die from unsafe or illegal abortions each year?
According to the WHO 80,000 women worldwide die every year from unsafe or illegal abortions.
175
TARSHI : Basics and Beyond
MODULE 2 - Chapter 2
Handout 2.9 Facilitator Copy:
Quiz on Conception, Contraception, and Abortion
• What is conception?
Conception is when an egg (ovum) is fertilised by a sperm.
Please define pregnancy.
Pregnancy occurs when the fertilised egg attaches to the uterine wall and begins to secrete increased
levels of certain hormones that thicken the uterine wall and cause a woman to stop having her
menstrual periods.
• What is oestrogen?
Oestrogen is a hormone produced in a woman’s ovaries and signals the ovaries to release an egg.
The release of the egg is called ovulation.
• How long can sperm live inside a woman’s body?
Sperm can live in a woman’s body for up to 6 days.
What are two options for non-hormonal contraception?
Answers can include the male condom, female condom, cervical cap, non-hormonal intra-uterine
device.
• Can a woman get pregnant ifshe has intercourse during her period?
There is a very small chance of this happening. Sperm can live up to 6 days in the cervical mucus of
a woman’s vagina and ovulation can sometimes occur soon after the last day of a woman’s period. It
is also possible for the woman to ovulate during her period, though this is not very common.
• What are an induced and a spontaneous abortion?
A spontaneous abortion occurs when a pregnancy terminates without any medical or surgical
interventions, as in a miscarriage. Induced abortions involve surgical or medical procedures to
terminate a pregnancy.
176
TARSHI: Basics and Beyond
MODULE 2 - Chapter 2
What is a medical abortion?
A medical abortion uses a combination of two hormonal drugs, an anti-progesterone and
prostaglandin, to end a pregnancy. It can be used to end a pregnancy up to 6-8 weeks of pregnancy
in India. Please check legal status and availability of this procedure in your region.
What are some side effects from an abortion?
Side effects can include cramping and bleeding, nausea, dizziness, diarrhoea, vomiting, and back
pain.
Approximately how many women die each year worldwide from unsafe or illegal abortions?
According to the WHO, approximately 80,000 women die each year from unsafe or illegal abortions.
True or false: Ifa woman has an abortion she will be unable to have children in the future.
False. If a woman has a safe abortion without severe complications, she can still get pregnant in the
future.
Name three types ofhormonal contraception options.
Answers can include oral contraceptive pills, hormonal intra-uterine device, injectables.
Are any male hormonal contraceptive pills available?
No, there are currently no male oral contraceptive pills; however there is research being done to
develop such an option.
What are emergency contraception pills?
Emergency contraceptive pills are pills with higher dosages of the hormones found in regular oral
contraceptive birth control pills. These can be taken up to five days after unprotected sex or
contraceptive failure to prevent pregnancy.
Can a woman get pregnant from performing oral sex on a man and swallowing the ejaculate?
No. A person cannot get pregnant from performing oral sex on a man and swallowing the ejaculate.
177
TARSHI : Basics and Beyond
MODULE 2 - Chapter 2
Handout 2.10 Participant Copy:
Quiz on Conception, Contraception, Abortion
• What is conception?
• Please define pregnancy.
• What is oestrogen?
■ How long can sperm live inside a woman’s body?
• What are two options for non-hormonal contraception?
■ Can a woman get pregnant if she has intercourse during her period?
• What are an induced and a spontaneous abortion?
• What is a medical abortion?
• What are some side effects from an abortion?
• Approximately how many women die each year worldwide from unsafe or illegal abortions?
• True or false: If a woman has an abortion she will be unable to have children in the future.
• Name three types of hormonal contraception options.
• Are any male hormonal contraceptive pills available?
• What are emergency contraception pills?
■ Can a woman get pregnant from performing oral sex on a man and swallowing the ejaculate?
178
MODULE 2 - Chapter 3
Chapter 3
Infertility and Assisted
Reproductive Technologies
Chapter Objectives for the Facilitator
1.
To have participants understand infertility and its possible
causes.
2.
To have participants understand treatments for infertility
and the benefits and disadvantages of options such as
assisted reproductive technologies, adoption and surrogacy.
3.
To explore attitudes about infertility and options available
to deal with infertility.
4.
To explore the attitudes and stigma associated with infertility
in the communities that participants live and work in.
TARSKI : Basics and Beyond
MODULE 2 - Chapter 3
Why a Chapter on Infertility and Assisted
Reproductive Technologies
EXERCISES IN THIS CHAPTER
Exercise 1: Demystifying Infertility.
45 minutes
'I wanted to have a child so badly and tried so hard to. I prayed, I ate
well, I did not smoke or drink- But I never could bear a child and I
know my husband blamed me and so did his family. I continue to
hope that it will happen soon, but as each day passes I worry more and
more that my husband will leave me and I will be left with nothing.
Having a child is the most important thing in my community. Without
this, you are considered incomplete and useless. ’
In many parts of the world, including India, bearing a child is
often thought of as an essential contribution to one’s family and
community. For some, a child represents an additional pair ofhands
to work and contribute to the household income, while others see
children as a means to pass on the family name and legacy. Either
way, the desire to have children and a family is common. This
emphasis put on childbearing can make it difficult for those who
have problems or are unable to have children. They endure
personal, community and family frustrations, stigma, and at times,
even abuse or violence.
According to the World Health Organization more than 80 million
people worldwide experience infertility problems and a majority
of them live in developing countries (World Health Organization.
2001. Current Practices and Controversies in Assisted Reproduction').
Men and women can be infertile for various reasons. These can
include medical conditions such as abnormalities in hormonal
productions; as a consequence of an untreated sexually transmitted
infection; or unexplained reasons.
A number of options exist for those who experience infertility,
including adoption, surrogacy, and assisted reproductive
technologies (ARTs). ARTs are treatments or procedures that use
human eggs and sperm to bring about conception with the help of
medical intervention. ARTs have been increasingly used worldwide,
including in developing countries. However, these have not erased
the stigma and discrimination that individuals, particularly women,
face when they are unable to bear a child. In fact the introduction
of ARTs and the continued emphasis on bearing children gives
rise to many issues and questions: when and how should ARTs be
used? Why is stigma associated with infertility? How can a balance
be established between efforts to provide women with reproductive
choices, and the promotion of ARTs, which have a success rate of
below 30%? Should ARTs be a priority in areas with limited
resources?
This chapter on infertility and assisted reproductive technologies
addresses some of these questions and the issues around them. It
Exercise 2: Infertility Basics.
60 minutes
Exercise 3: Looking at Options:
Fertility Treatments. 60 minutes
Exercise 4: Case studies: Options To
Deal With Infertility. 60 minutes
MATERIALS FOR THIS CHAPTER:
Flipchart
Markers
Pens/pencils
Index cards/slips of paper
HANDOUTS REQUIRED FOR THIS
CHAPTER:
Handout 2.11
Basic Information on Infertility
Handout 2.12
Basic Information on Options for
Infertility
Handout 2.13 Facilitator Copy:
Myths and Facts on Infertility and
Assisted Reproductive Technologies
(ARTsI
Handout 2.14 Participant Copy:
Myths and Facts on Infertility and
Assisted Reproductive Technologies
Handout 2.15
Case Studies on Adoption, Surrogacy
and Assisted Reproductive
Technologies (ARTs)
TARSHI : Basics and Beyond
MODULE 2 - Chapter 3
ADDITIONAL RESOURCES:
Centres for Disease Control and
Prevention. Assisted Reproductive
Technologies: Home, http://
www.cdc.gov/reproductivehealth/
ART/index.htm
• For information on Male Infertility
see Centre for Male Reproduction
and Vasectomy Reversal.
www.malereproduction.com
• Reproductive Health Outlook:
Infertility, http://www.rho.org/
html/
infertility_keyissues.htm#geographic
• Reproductive Science Centre.
http://www.rscbayarea.com/
articles/microman.html
• World Health Organization. 2002.
Current Practices and
Controversies in Assisted
Reproduction. Geneva: World
Health Organization. Available at
http://www.who.int/reproductivehealth/infertility/
report_content.htm
• For selected films see, http://
www.asiasrc.org/films.php and
Appendix B.
also addresses the attitudes, stigma and discrimination associated
with infertility in many parts of the world, and how this is greatly
affected by gender and related to reproductive rights.
Key Messages for this Chapter
• For the purposes of this manual, Infertility has been defined as
the inability to have a pregnancy occur after 12 months of
unprotected sex. The cause for this can be in the man, the woman
or in both. Primary infertility occurs when a person has never
been able to have a pregnancy occur, even after 12 months of
unprotected intercourse. Secondary infertility refers to a situation
where, people who have previously had a child are unable to
conceive again, even after 12 months of unprotected intercourse.
■ The causes of infertility vary. They can include but are not limited
to congenital conditions, consequences of untreated reproductive
tract infections (RTIs) or sexually transmitted infections (STIs),
poor reproductive health services and/or poor nutrition.
• Women may experience the negative consequences/stigma of
infertility more than men, especially in countries where
motherhood is highly valued. In such cases, women who do not
have children may suffer stress and ridicule from the'community,
and sometimes even abuse and violence.
■ Options exist for people who experience infertility, and want to
have a child. These include assisted reproductive technologies
(ARTs), adoption or surrogacy.
• ARTs can be successful in treating infertility and individuals
should have access to this option. However, ARTs can also be
misused, and have ethical and social implications.
• Individuals have the reproductive right to have children, and
should have access to ARTs should they want them. They also
have the right to not having a child if they do not want to access
any of these options.
■ Economic, cultural and social issues can affect people’s access
to health services that provide ARTs, or give them the opportunity
for adoption or surrogacy.
The use of ARTs has clashed with population control policies in
many countries around the world. It may be difficult to get
support for ARTs if there is an emphasis on population control.
Moreover, public health programmes focus more on HIV/AIDS,
STIs, diseases such as malaria, sanitation etc. Therefore resources
for the treatment of infertility may be limited. A denial of such
services and options is a violation of a person’s right to have
children and access service? enabling them to do so.
TARSHI : Basics and Beyond
MODULE 2 - Chapter 3
Exercise 1
Demystifying Infertility
Instructions
1.
2.
Distribute Handout2.14 to each participant. Give participants 5
minutes to read through the Handout and decide whether each
statement is a myth or a fact.
Review each answer separately by asking participants to share
their responses to each statement. Ask for questions or comments
and discuss each statement briefly.
Suggested Questions:
■ If the statement was a myth, do you think that people in the
communities you live or work in believe this to be a fact?
GROUP EXERCISE
Purpose of the
exercise:
1. To discuss personal
ideas and attitudes about
infertility.
2. To discuss common
myths about infertility and
facts that can be used to
dispel them.
■ How could you dispel these myths and clarify misconceptions
about infertility?
3.
TIME
After all the statements have been reviewed and discussed, ask
for general questions or comments.
i 45 minutes
Suggested Questions:
MATERIALS
■ Are there any additional ideas or statements about infertility you
need clarification on?
• How do you think myths about infertility affect women and
men who cannot have children? For example, one myth is that
a woman’s inability to get pregnant is her fault and not that of
her partner. This affects her self-esteem adversely and she may
also be excluded or punished by her community for not
conceiving.
Handout 2.13 Facilitator Copy:
Myths and Facts on Infertility,
i Handout 2.14 Participant Copy:
Myths and Facts on Infertility, pens/
pencils
ADVANCE PREPARATION
Review Handout 2.13, make copies
i of Handout 2.14 for participants
182
|
TARSHI: Basics and Beyond
MODULE 2 - Chapter 3
Key Messages
THIS EXERCISE CAN BE MODIFIED
BY:
• There are many myths related to infertility. The perpetuation of
these myths can alienate people in their communities, lead to
emotional abuse from family or community, and cause increased
stress and pressure to have children, particularly on women.
• Conducting it as a quiz game by
dividing participants into two
groups and reading out
statements from Handout 2.13.
Each correct answer can earn the
group points. Keep score and
declare the team with the higher
score as the winner at the end of
the exercise.
• Infertility is often the result of medical conditions, which may
be congenital, the consequence of poor reproductive healthcare,
or the effects of a reproductive tract infection or sexually
transmitted infection.
• A common myth is that women are responsible for infertility,
particularly if they decide to delay pregnancy with contraceptives.
■ Combine this exercise with the
other myth/fact exercises and pre
tests from this module to conduct
a larger quiz game or assessment
at the start or end of the module.
■ Women are usually more stigmatised for infertility. This stigma
falsely focuses on their ‘lack of femininity’ if they cannot bear a
child, and can result in their ostracism from society. Femininity
and motherhood are not connected: a woman may not- have a
child and still be feminine.
• Reproduction and childbearing is not the only role for a woman
in society. If a woman cannot have a child it should not affect
her status within her family or community.
MAKING CONNECTIONS
• Basic information on human
sexual and reproductive anatomy '
and physiology, as well as on
conception is required before
learning about infertility. For more I
see Chapters 1 and 2 in this
Module.
• Infertility is often caused by
uncured or untreated sexually
transmitted infections. For more
see Chapter 4 in this Module.
j
• Infertility can be a problem for people who want to have children.
However"not all people want to have children and have a right
to make this choice.
TIPS FOR THE FACILITATOR:
■ Some communities believe that faith, prayer and destiny can impact the ability
to have or not have children. Take note when these arguments are used. Ask
questions to examine these ideas, such as why and what participants think the
role of faith or destiny is; how this may alienate women and help to perpetuate
myths and negative attitudes towards those who do not have children; or
| whether such attitudes are harmful and can increase stigma for those
concerned.
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MODULE 2 - Chapter 3
Exercise 2
Infertility Basics
LECTURETTE
Instructions
1. Introduce the topic to participants, explaining that it is only a
brief overview of infertility. For some, this information may be
a review and for others it may be new. It is important to have
some basic knowledge of the issues and ensure that all the
participants are at the same level of understanding. Begin the
lecturette with the points in Handout 2.11. After the lecturette,
ask for questions or comments from the group.
Suggested Questions:
■ Are there any causes or reasons for infertility you are unclear
about? Are there any other causes that are not listed here?
Purpose of the
exercise:
1. To understand and
describe causes of
infertility.
2. To dispel myths that
may exist about infertility
the participants’
communities.
■ Did you think some of these causes were myths?
• How can awareness of the facts about infertility help you discuss
this issue with people from your community?
TIME
45 minutes
MATERIALS
Flipchart, markers, Handout 2.11
Basic Information on Infertility
ADVANCE PREPARATION
Review Handout 2.11. Copy bullet
points from the handout onto a
flipchart.
TARSH1: Basics and Beyond
THIS EXERCISE CAN BE MODIFIED
MODULE 2 - Chapter 3
Key Messages
BY:
• Combining this lesson with
Exercise 3 in this Chapter [Looking
at Options: Fertility Treatments}
and asking participants in groups
to create 'lessons' to teach each
other about infertility and options
to deal with infertility.
• Distributing Handout 2.11 to
participants and giving them 5-10
minutes to read it over before
asking them a series of questions
about the information in the
Handout. For example: 'Name 3
reasons for infertility in men';
'Name 3 reasons for infertility in
women'; 'How can we educate
others about the reasons for
infertility?'
■ Infertility is often the result of a medical condition affecting either
a woman or man, or both of them.
• Improved health services can decrease infertility among men
and women. Diagnosing and early treatment of sexually
transmitted infections (STIs) and reproductive tract infections
(RTIs), regularising a woman’s menstrual cycle, or treating a
man’s low sperm count, are some ways of doing this.
• Knowing the facts about infertility can help to dispel myths and
the stigma related to it. It can also lead to the initiation of
discussion about infertility in communities and social groups.
TIPS FOR THE FACILITATOR:
• Some participants may still believe some myths to be true. One such example
is the belief that infrequent menstrual periods are a cause of infertility.
Encourage people to share their beliefs and discuss facts that can dispel these
myths.
• Participants may find a lecture on this issue dull. Try to keep the session brief
and concise to hold the participants' attention.
MAKING CONNECTIONS
■ Basic information on human
sexual and reproductive anatomy
and physiology, as well as on
conception is required before
learning about infertility. For more
see Chapters 1 and 2 in this
Module.
• Facilitators may not be able to respond to some questions that may arise. Put
these inquiries into the Parking Lot and try to address them later after doing
research and finding answers to the questions.
• To conceive and have a child is a
reproductive right. For more see
Chapter 2 in Module 3.
185
TARSHI : Basics and Beyond
MODULE 2 - Chapter 3
Exercise 3
Looking at Options: Fertility Treatments
Instructions
1.
Divide the participants into groups. Hand each group a copy of
Handout 2.12. Explain that the handouts describe different
options to deal with infertility including assisted reproductive
technologies (ARTs). Ask groups to read over the options and
discuss them among their groups. They should also answer the
following questions:
• Was there anything that you do not understand about these
options?
• What are 2 benefits and 2 disadvantages to each of these
methods?
Give participants 20-25 minutes to create the presentations.
Ask participants to return to the larger group and have each
present their benefits and disadvantages and any questions they
may still have. Write the points up on a flipchart and answer
the questions as they arise.
2.
3.
After presentations are complete, ask for any other questions or
comments.
TEACHING A CLASS
Purpose of the
exercise:
1. To understand and
describe options for those
experiencing infertility,
including adoption,
surrogacy and assisted
reproductive technologies
(ARTs).
2. To discuss the benefits
and disadvantages of
common options for
dealing with infertility.
3. To discuss access options
that deal with infertility
and how this is related to
reproductive rights.
Suggested Questions:
■ Should people who want children consider adoption or surrogacy
if they are unable to have children biologically?
• How is access to options to deal with infertility connected to
reproductive rights?
• Would any/all of these options be available to people in your
community? Would they be accepted as good alternatives for
people who experience infertility?
TIME
90 minutes
MATERIALS
Flipchart, pens/pencils, markers,
Handout 2.12 Basic Information on
Assisted Reproductive Technologies.
ADVANCE PREPARATION
Make copies and review Handout
2.12.
186
TARSHI: Basics and Beyond
THIS EXERCISE CAN BE MODIFIED
MODULE 2 - Chapter 3
Key Messages
BY:
■ Distributing Handout 2.12 to
participants and giving them 5-10
minutes to read through it and
formulate any questions that
come to mind. A series of
questions can then be asked about
the Handout. For example: 'Name
3 types of ARTs'; 'If you had a
sister/brother who was interested
in getting one of these procedures
done what would you say to her/
him?'
• Having a longer debate about the
benefits and disadvantages of
ARTs. Participants can be divided
into two groups, one to discuss
the advantages and the other the
disadvantages. The two groups
can then debate the issue.
• People who are infertile have options ifthey want to have children.
They can consider assisted reproductive technologies, adoption
or surrogacy, if appropriate and affordable. They may consider
not having a child as an option too.
■ Adoption and surrogacy can also be used for people who are
able to bear children. These options are not just for people who
experience infertility.
• There are both advantages and disadvantages to using
reproductive technologies. Benefits include more options and
choices in reproductive health. ARTs can also be used as an
advocacy tool to promote better prenatal and women’s healthcare.
• Disadvantages of ARTs can include potential misuse for selective
abortion, adverse effects on the rights of disabled people (by
advocating for termination of a pregnancy if the child is likely to
be born with some ‘deficiency ’), or viewing the foetus as more
important than the woman who is considered only as a
‘reproducer’. In addition, these options are expensive and
therefore may be available only to people of a higher socio
economic group, leaving out those who cannot afford these
options.
MAKING CONNECTIONS
TIPS FOR THE FACILITATOR:
■ To conceive and have a child is a
reproductive right. For more see
Chapter 2 in Module 3.
■ The information in this exercise can be difficult to understand and absorb.
Keep the exercise brief and do an energiser at the end of the exercise.
■ People who cannot have children
often face stigma and
discrimination in their
communities and families. For
more see Chapter 2 in Module 4.
■ Some ART's are complex and it is important to emphasise to participants that
this exercise is intended merely to provide an overview of options for people
who want children.
• Participants should be aware of these options to deal with infertility in order to
discuss the benefits, disadvantages and consequences of these methods.
■ Participants may want to check which options that are available, accessible and
acceptable in their communities.-
187
I
TARSHI : Basics and Beyond
MODULE 2 - Chapter 3
i
Exercise 4
Case Studies: Options To Deal With Infertility
r
I
CASE STUDY
I
Instructions
1. Divide participants into three groups. Distribute one case study
from Handout 2.15 to each group. Give groups 20-30 minutes
to read and discuss the case and answer the corresponding
questions.
2. Ask participants to return to the larger group and invite each
group to give a 3-5 minute overview of the case study and their
discussion. After each presentation, ask for reactions and
questions.
Purpose of the
exercise:
To discuss attitudes to
adoption, surrogacy and
ARTs, and the implications
of these attitudes.
i
I
TIME
90 minutes
• Have you encountered any similar situations in your work/ life?
How was it dealt with?
MATERIALS
■ Would people in your communities or families feel differently
about this situation?
Handout 2.15 Case Studies on
Adoption, Surrogacy and Assisted
Reproductive Technologies (ARTsl.
ADVANCE PREPARATION
Make copies of Handout 2.15.
188
i
i
Suggested Questions:
■ Do you agree with the conclusions of the group? Would you
suggest an alternative?
1
J
TARSHI: Basics and Beyond
MODULE 2-Chapter 3
THIS EXERCISE CAN BE MODIFIED
Key Messages
BY:
■ Choosing only one case study and
reading it together as a large
group. This may benefit groups
that want to look specifically at
one option to deal with infertility.
MAKING CONNECTIONS
■ People who cannot have children
often face stigma and
discrimination in their
communities and families. For
more see Chapter 2 in Module 4.
• Options for infertility are often
available to people with money
and opportunities. For more on
power, see Chapter 1 in
Module 4.
■ Surrogacy, adoption and ARTs are options for those who
experience infertility and want to have a child. It is important
not to abuse these methods, for example using them for sex
selection. Surrogacy and adoption are also options for fertile
couples.
■ It can be emotionally stressful for people to undergo these
procedures. This includes the person receiving any of these
treatments, the partner, the possible surrogate mother, and/or
their families.
• Reproductive health decisions are not made in a vacuum and
are influenced by family, cultural, religious, social and economic
factors. Therefore making decisions on adoption, surrogacy or
ARTs can be difficult and are not just based on the wants of an
individual or couple trying to have a child.
• Adoption, surrogacy, and ARTs are not always accepted options
by communities/families/social groups and people who use these
options can be looked down upon. But it is an individual’s
reproductive right to have children and choose any of these
options.
TIPS FOR THE FACILITATOR:
• Some participants may believe that surrogacy can be an option only if the
surrogate is related to the parents. Make sure to introduce other legitimate
:
possibilities, such as using an unknown or unrelated surrogate.
• Some participants may argue that it is dangerous to adopt a child from unknown ’
parents because of unknown genetic predispositions. While there is a genetic
predisposition to certain conditions, it has not been proven that behaviour/conditions
such as criminal behaviour or alcoholism is linked to one's genes. It may be
worthwhile to point out that if participants are worried about predispositions to
disabilities or chronic illnesses, the same uncertainties would exist even if they
j
were to have their own biological child, unless they underwent some sort of
i
genetic testing beforehand.
189
TARSKI : Basics and Beyond
MODULE 2 - Chapter 3
Handout 2.11
Basic Information on Infertility
For more on statistics and details on the information found below, please see the World Hea t
Organization’s Current Practices and Controversies in Assisted Reproduction. Available at http.//
www.who.int/reproductive-health/infertility/report.pdf.
What is infertility?
For the purposes of this chapter, Infertility has been defined as the inability to have a pregnancy occur
after 12 months of unprotected sexual intercourse. The reason for this can be in the man, the woman or
in both. Primary infertility occurs when a person has never been able to have a pregnancy occur, even
after 12 months of unprotected intercourse. Secondary infertility refers to situation in which people
who have previously had a child are unable to conceive again, even after 12 months of unprotected
intercourse. Some people do not agree with the medical definition of, or even the term Infertility.
These discussions are important and need to be followed through, especially while working from a
rights perspective. However, these are new and ongoing debates and are beyond the scope of this
manual.
How common is infertility?
Infertility affects more than 80 million people worldwide. In general, one in ten couples experience
primary or secondary infertility, but infertility rates vary between countries from less than 5% to more
than 30%. Between 8% and 12% of couples around the world have difficulty conceiving a child at some
point in their lives.
What are some statisitcs on infertility?
• Approximately 80% of people succeed in creating a pregnancy in the first year of trying.
■ Approximately 10% of people succeed in creating a pregnancy in the second year of trying.
• Approximately 10% of people fail to create a pregnancy and seek assistance. From this 10%: 30% of
this are men with a problem, 30% of this are women with a problem, 30% of this are both men and
women with a problem, and in 10% of the cases the reasons are unknown.
Can infertility be treated or cured?
Infertility can be treated in some cases. For example a low sperm count can be increased with medication
or with changes in lifestyle, such as decreasing alcohol consumption or wearing looser clothing. In
cases when the cause of infertility cannot be diagnosed, treatment may not be possible.
What are some of the causes of infertility in men and women?
In the chart below are some causes of infertility in men and women. A doctor must be consulted to
know if there is a medical reason for infertility. This list is not exhaustive but has been included to
provide some reasons for infertility.
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MODULE 2 - Chapter 3
CATEGORIES OF
WHAT IS IT?
CAN BE AFFECTED BY:
Ovulation is the process by which the
ovaries release an ovum (egg), which
travels down the fallopian tube to the
uterus. This usually occurs once a month.
During this process the egg has the
potential to be fertilised by a sperm and
attach to the wall of the uterus resulting in
a pregnancy. Irregular, sporadic or no
ovulation can make it difficult for women
to conceive. As women age, ovulation can
start to decline making it more difficult to
have children.
• Abnormalities in the thyroid gland, which is a small
gland located underneath the voice box that
produces hormones.
Cervical factors impede the ability of the
sperm to pass through the mouth of the
uterus because of damage to the cervix.
■ Inadequate or inhospitable mucous in the cervix.
INFERTILITY IN
WOMEN
Ovulatory Problems
Cervical Factors
• Overproduction of prolactin, which is the hormone
leading to the production of breast milk.
■ Excess testosterone (male hormone!
■ Effects of cancer or cancer treatment
■ Physical stress
■ Psychological stress
• Lifestyle changes such as dietary changes, shifting
living situations into new time zones, and
increased alcohol consumption
■ Cervical narrowing or 'stenosis'
• Infections of the cervix from common STIs such as
chlamydia and gonorrhoea.
■ Sperm allergy where the immune system attacks
the sperm and does not allow it to travel to
fertilise the egg.
Pelvic And Tubal Factors
Uterine Factors
Unexplained
These factors include any disruption of
normal pelvic and tubal activity, such as
scarring in the fallopian tubes.
• Scar tissue or adhesions.
Unfriendly/inhospitable conditions in the
uterus that prevent sperm from travelling
up to the fallopian tubes or prevent
implantation of the fertilised egg.
■ Benign tumours called fibroids in the uterus.
• Endometriosis - where the endometrial lining
grows outside the uterus and attaches to other
organs such as the ovaries and fallopian tubes.
■ Thin or abnormal uterine lining
■ Anatomic problems such as uterine fibroids,
polyps, abnormal shape of the uterus.
Approximately 10% of women
experiencing infertility do so from
unexplained causes. This simply means
that the results of common tests to
diagnose the cause of infertility show
normal results and a cause for the
infertility is not determined.
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MODULE 2 - Chapter 3
CATEGORIES OF
WHAT IS IT?
CAN BE AFFECTED BY:
There are not enough sperm in the
semen to travel through the fallopian
tube to fertilise an egg. Normal
sperm count varies from 20 to 150
million sperm per millilitre. The
normal volume of ejaculate varies
from 1.5 to 5 millilitres.
• Swollen varicose vein in the scrotum.
INFERTILITY IN MEN
Low Sperm Count
■ Hormonal problems in the testicles or pituitary gland that
produces testosterone.
• Effects from cancer treatments such as radiation or
chemotherapy.
■ Use of tobacco, alcohol, drugs such as marijuana
■ Testicular injury, such as sports or work injury, or congenital.
• Structural problems including blocked ejaculation due to a
vasectomy, or retrograde ejaculation.
■ Short-term illness or infection in adulthood like mumps.
■ Physical stress
• Psychological stress
• Too much heat around the genitals from tight clothing,
saunas or hot tubs.
■ Medications
■ Genetic factors like Klinefelter syndrome.
■ Inexplicable reasons
Abnormal Sperm Shape
Low Sperm Motility
Unexplained
192
This happens when over 40% of
sperm in the semen have a shape
and structure different from the
usual shape (oval head, mid-piece,
and tail) that prevents them from
moving forward to the fallopian
tubes and fertilising an egg.
■ Varicocele
Refers to the inability of more than
50% of the sperm in the semen to
move forward through the vagina
and cervix to the fallopian tube to
fertilise an egg.
■ Swollen varicose vein in the scrotum.
Approximately 10% of men
experiencing infertility do so from
unexplained causes. This simply
means that common tests to
diagnose the cause of infertility show
normal results and a cause is not
found for the infertility.
• Use of drugs and smoking
■ Heat around the genitals from tight clothing, saunas or hot
tubs.
■ Infrequent ejaculation
• Infection
• Too much heat to genitals from tight clothing, saunas or hot
tubs.
TARSHI: Basics and Beyond
MODULE 2 - Chapter 3
Handout 2.12
Basic Information on Options for Infertility
What are some options for individuals who experience infertility and want to have a child?
Individuals can adopt a child, opt for a surrogate, or assisted reproductive technologies (ARTs).
What is adoption?
Adoption refers to the process whereby an individual or couple take on the guardianship of a child that
is not biologically theirs. Laws of the country usually govern eligibility and other conditions for adoption.
What is surrogacy?
Surrogacy is when a woman acts as a ‘carrier’ (or surrogate) for a person unable to conceive or carry a
child to term. The surrogate bears a pregnancy and delivers the baby for another person/couple, after
which the child would be legally adopted by the individual/couple for whom she carried the baby.
What is artificial insemination?
Artificial insemination (Al) is a general term used for assisted reproductive technologies (ARTs). Al is
a procedure in which a qualified reproductive health specialist injects sperm into a woman’s reproductive
tract. There are different types of Al: intracervical (in the cervical canal), intrauterine (in the uterine
cavity), intrafollicular (in the ovarian follicle) or intratubal (in the fallopian tubes) injections.
What is egg or sperm donation?
Egg donation is when eggs are donated, fertilised by sperm, and then placed into the uterus of a
woman who is unable to produce eggs herself. Sperm donation refers to the process by which a man
gives his sperm to be used to fertilise an egg. It is also possible to freeze embryos for future implantation.
This is often used for people who may have cancer and are on chemotherapy that can often decrease
fertility.
What are some forms of ARTs and procedures that may help a woman get pregnant?
Some common ARTs and procedures are described below. Please note that these may not be offered or
available in all countries or regions. The information here is intended to provide an introduction to
available options.
ASSISTED REPRODUCTIVE TECHNOLOGIES
lUI-intrauterine
insemination.
Sperm is concentrated and then injected into a woman's uterus. Increasing the number
of sperm injected into the fallopian tube improves the possibility of a pregnancy.
ICSl-intracytoplasmic sperm injection
Usually used when men have a low sperm count, poor sperm motility, or sperm shape
is not normal. In this process a single sperm is injected into the egg.
IVF-in vitro fertilisation
A woman's eggs are harvested, mixed with sperm and re-implanted into her uterus.
Multiple eggs are implanted.
Gamete intrafallopian tube transfer
A laparoscope is used to recover the eggs from the ovary, sperm is mixed with the
eggs, and then both are transferred back into the ends of the fallopian tube.
(GIFT)
Zygotic intrafallopian tube transfer
IZIFT) Sometimes called
Tubal Embryo Transfer (TET)
A laparoscope is used to place embryos into the ends of the fallopian tubes.
Part of the outer layer of the fertilised egg will be dissolved to enable the egg to have a
greater opportunity to attach to the uterine wall.
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Handout 2.13 Facilitator Copy:
Myths and Facts on Infertility and Assisted Reproductive
Technologies (ARTs)
Instructions for participants: Indicate whether each statement below is a Myth or a Fact. Write (M) for
a myth and (F) for a fact.
• Painful periods can cause infertility.
MYTH. Painful periods are common in many women. They are neither a sign of infertility nor an
indication that a woman will be infertile.
• Having irregular periods can cause infertility.
MYTH. Irregular menstruation does not cause infertility. Regular periods are important in that
there are more opportunities to be fertile and get pregnant, but irregular periods are not a sign of
infertility.
■ If a woman is unable to conceive, there is a greater likelihood of something being wrong with her
rather than with her partner.
MYTH. When people seek assistance for infertility, the cause can be the woman, the man, both, or
unknown. In 30% of cases men have a problem, in 30% of cases women have a problem, in 30% both
men and women have a problem, and in 10% of the cases the reasons are unknown.
• Prayer and faith can help a woman get pregnant.
MYTH. Faith and belief are important and personal aspects to many people’s lives. However with
infertility, particularly if the causes are medical or unknown (for example low sperm count or blocked
fallopian tubes), these cannot be cured solely with prayer.
• Masturbation causes a loss of semen and can prevent a man from impregnating a woman.
MYTH. Masturbation is an enjoyable and harmless activity and does not cause loss of semen that
would prevent a woman from getting pregnant. Semen that contains sperm is constantly being
produced in the testes. Production is constant, and masturbation will not deplete the supply.
■ If a woman relaxes and concentrates hard enough on getting pregnant it will happen
MYTH. Concentrating hard on getting pregnant cannot mitigate the medical causes of infertility,
which may or may not respond to treatment. Stress reduction and relaxation exercises may help the
woman/couple cope better with their situation and with any treatment they are undergoing.
• If you enjoy sex you are more likely to get pregnant.
MYTH. Sexual pleasure and ability to get pregnant are not connected.
• A woman conceives only if both she and her partner have an orgasm.
MYTH. While sexual pleasure is important, even if a man or woman does not have an orgasm and
a man ejaculates into or near a woman’s vagina, there is a possibility of pregnancy. A man’s pre-cum
also contains sperm and can cause pregnancy.
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Using any form of contraception will limit the chances of getting pregnant in the future.
MYTH. Using hormonal contraceptive methods such as oral contraceptive pills or injectables will
prevent a pregnancy. When stopped, fertility returns within a short period. The length of time to
return to normal fertility levels depends on the individual and type of contraceptive. Contraceptives
such as condoms, however, are a one-time preventative and do not affect a person’s ability to get
pregnant the next time they have unprotected sex.
Fertility and femininity are strongly linked.
MYTH. The ability of a woman to have a child is not connected to her femininity. Nor is her desire
to have a child or decision to not have a child. People have the right to choose whether they want a
child or not, regardless of gender.
A woman is fertile and able to conceive approximately 14 days prior to her next menstrual period
and 4-6 days before she begins ovulation.
FACT. This is when most women are most easily able to get pregnant.
• People who cannot conceive can face stigma and discrimination.
FACT. Stigma and discrimination can affect people who are unable to have children, particularly
women. There are cases ofwomen being emotionally, mentally or physically abused by their husbands
and families for not being able to have children, treated violently by their community, and are blamed
for the lack of children when the cause may in fact lie with her partner.
• If a woman and man cannot have a child, it is usually the woman’s fault.
MYTH. Infertility can result from the woman, the man or from both. Families and communities
often blame the woman for problems in conception, even when the cause can just as easily lie in the
man.
• Sometimes the causes of infertility cannot be determined.
FACT. About 10% of infertility cases are due to unexplained reasons.
• One of the main preventable causes of infertility is sexually transmitted infections.
FACT. Sexually transmitted infections (STIs) are one of the primary causes of infertility and can be
prevented. STIs such as chlamydia and gonorrhoea are examples of STIs that if left untreated can
cause infertility in men and women.
• When a man is infertile, this may be a result of low sperm count.
FACT. A low sperm count is one reason a man may be infertile.
• In vitro fertilisation is when a man’s sperm and a woman’s eggs are mixed together outside of the
woman’s body and inserted into the woman.
FACT. With in vitro fertilisation (IVF) a woman’s eggs are harvested (removed from her ovaries),
fused with sperm, and re-implanted into the woman’s uterus. In many cases, multiple eggs are
implanted.
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• People in same-sex relationships can use assisted reproductive technologies (ARTs) to have a
child.
FACT. ARTs, such as in vitro fertilisation or intrauterine injection, can be used by same-sex people
or single women to have a child.
• Assisted reproductive technologies (ARTs) are a simple and easy way to have a child.
MYTH. Some ART procedures can be painful and uncomfortable. Certain medications and
hormonal injections can have side effects and cause discomfort. Procedures to remove the eggs and
to re-implant them into the woman can be particularly uncomfortable and painful. Since the success
rates of such procedures are low, the stress and disappointment of a failed attempt can add to the
stress.
• Assisted reproductive technologies (ARTs) will work for everyone who tries them.
MYTH. Most ARTs and fertility procedures have a less than 30% success rate.
• Technologies to determine the sex of a child are common.
FACT. Pre-implantation genetic diagnosis can be used to determine the sex of the child. This
procedure determines if there are any genetic abnormalities by removing a single cell from the
embryo and testing it. This practice could be ethically dangerous.
■ Assisted reproductive technologies (ARTs) are usually more accessible to people in a higher socio
economic groups.
FACT. ARTs are an expensive option for people and are more easily available to people with a
higher disposable income.
• Some countries/religions/communities allow people to divorce or take another wife if the woman
cannot have a child.
FACT. Some communities place a high importance on childbearing and the burden of this falls on
a woman. Ifa woman is unable to have a child, some families and communities allow and encourage
the man to take another wife to fulfil this child-bearing function.
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• People in same-sex relationships can use assisted reproductive technologies (ARTs) to have a
child.
FACT. ARTs, such as in vitro fertilisation or intrauterine injection, can be used by same-sex people
or single women to have a child.
• Assisted reproductive technologies (ARTs) are a simple and easy way to have a child.
MYTH. Some ART procedures can be painful and uncomfortable. Certain medications and
hormonal injections can have side effects and cause discomfort. Procedures to remove the eggs and
to re-implant them into the woman can be particularly uncomfortable and painful. Since the success
rates of such procedures are low, the stress and disappointment of a failed attempt can add to the
stress.
• Assisted reproductive technologies (ARTs) will work for everyone who tries them.
MYTH. Most ARTs and fertility procedures have a less than 30% success rate.
• Technologies to determine the sex of a child are common.
FACT. Pre-implantation genetic diagnosis can be used to determine the sex of the child. This
procedure determines if there are any genetic abnormalities by removing a single cell from the
embryo and testing it. This practice could be ethically dangerous.
• Assisted reproductive technologies (ARTs) are usually more accessible to people in a higher socio
economic groups.
FACT. ARTs are an expensive option for people and are more easily available to people with a
higher disposable income.
■ Some countries/religions/communities allow people to divorce or take another wife if the woman
cannot have a child.
FACT. Some communities place a high importance on childbearing and the burden of this falls on
a woman. If a woman is unable to have a child, some families and communities allow and encourage
the man to take another wife to fulfil this child-bearing function.
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MODULE 2-Chapter 3
Handout 2.14 Participant Copy:
ths and Facts on Infertility and Assisted Reproductive
Technologies
Instructions for participants: Indicate whether each statement below is a Myth or a Fact. Write (M) for
a myth and (F) for a fact.
Painful periods can cause infertility.
Having irregular periods can cause infertility.
If a woman is unable to conceive, there is something wrong with her and not her partner.
Prayer and faith can help a woman get pregnant.
Masturbation causes a loss of semen and can prevent a man from impregnating a woman.
If a woman relaxes and concentrates hard enough on getting pregnant it will happen.
• You are more likely to get pregnant if you enjoy sex.
• A woman conceives only when both she and her partner have an orgasm.
■ Using any form of contraception will limit a woman’s chances of getting pregnant in the future.
■ Fertility and femininity are strongly linked.
• A woman is fertile and able to conceive approximately 14 days prior to her next menstrual period
and 4-6 days before she begins ovulation.
■ People who cannot conceive face stigma and discrimination.
■ If a woman and man cannot have a child it is usually the woman’s fault.
• The causes of infertility sometimes remain unknown.
• A main preventable cause of infertility is sexually transmitted infections.
• When a man is infertile, this may be a result of a low sperm count.
■ In vitro fertilisation is when a man’s sperm and a woman’s eggs are mixed together outside the body
and then inserted into the woman’s womb.
• People in same-sex relationships can use assisted reproductive technologies (ARTs) to have a child.
• Assisted reproductive technologies (ARTs) are a simple and easy way to have a child.
• Assisted reproductive technologies (ARTs) will work for everyone who tries them.
■ Assisted reproductive technologies (ARTs) can be-used to determine the sex of the child.
■ Assisted reproductive technologies (ARTs) are usually more accessible to people of a high socio
economic group living in urban areas.
Some countries/religions/communities allow people to divorce or take another wife if the woman
cannot have a child.
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Handout 2.15
Case Studies on Adoption, Surrogacy and Assisted Reproductive
Technologies (ARTs)
Case Study 1: Adoption
Deepa and Satish have been married for 7 years. They enjoy each other’s company and are happy
together. They both are also doing well financially and socially: they can afford a flat in the city, have
a small and supportive set of friends, and are at the peak of their careers
For about a year now they have been trying unsuccessfully to have a baby. They have discussed getting
some tests done, but have decided that they should be fair to each other, and avoid finding out who is
responsible for this problem. They have now decided in consultation with friends that they should
adopt a child, and have registered with a few adoption agencies.
Their request came through recently, and they will bring a baby home next week. She is a lovely,
chubby 8 month old baby. Deepa is very excited and has been telling everyone and shopping for the
baby. Satish is also really happy and is already planning a welcome party.
However, Deepa’s mother is very angry and upset. She feels the adoption is the wrong move for the
couple to make and that the decision has been influenced by their friends who have children of their
own. She thinks that both Deepa and Satish should undergo tests and take medication and that Deepa
should also go with her to an alternative religious practitioner who assures results for ‘couples like
them’. She cannot believe that Deepa will die childless and will never know the pleasure and pain
every woman must go through to become a ‘real’ woman.
Deepa had tried to convince her mother that the adoption is a good idea through constant discussion,
but without any luck. Now when she tells her that the baby is being brought home next week, Deepa’s
mother has begun a fast and is threatening dire consequences if Deepa and Satish go ahead with this
plan. She has sworn that the day the baby comes home will be the last day Deepa will see or hear from
her. Deepa is angry with her mother, has no intention of changing her plans to bring the baby home,
but is also a little scared that her mother may in fact do something to harm herself
Questions:
■ What should Deepa and Satish do? What do you think of Deepa’s mother’s reaction to the adoption?
• How can Deepa and Satish negotiate this situation?
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Case Study 2: Surrogacy
Tara is afraid. She has heard her in-laws discussing a possible second marriage for her husband Gajender
who is the only son of a rich, educated and quite liberal family of landowners. They have been married
for 6 years now, and have been unable to have a child. The liberal attitude of her in-laws has enabled
Tara to enjoy many liberties: she has not had to keep her head covered all the time and her opinion is
sought on matters of property and other such issues. She has even been allowed to call over some of the
little girls around their farm and offer them some basic literacy classes in the afternoon. Ever since the
talk of a second marriage began, Gajender even talks to her less. He keeps looking at her with a lot of
love, but also something else, perhaps sadness.
A little boy comes to study with Tara every day. His mother Namo loves Tara a lot, always praising and
thanking her profusely for tutoring her son. Tara decides she needs to take steps to prevent her husband’s
second marriage and asks Namo to be her real sister by bearing her a child: to save her life and her
marriage; to repay Tara for the knowledge and education she gives her son. In turn she will give Namo
whatever she asks. She and Gajender will send her son to school and pay for everything. They will get
Namo a small house and meet her daily living requirements for food, clothing, medication, and anything
else that is required. Tara says she will also arrange everything and no one will ever know about it. At
the beginning of the pregnancy Tara will hire Namo and she can be around the house. Later the two
of them can go off to the city where Namo can have the baby and they can tell everyone that Tara has
delivered the child. All she has to do is conceive Gajender’s baby, care for herself during her pregnancy,
and deliver the baby for Tara.
Namo is stunned: How will she ever do this? What if someone gets to know? What if it becomes
public? But Namo also feels she owes Tara a lot for the support and attention she has provided her son.
Also, Tara has offered to take care of everything during the pregnancy. Namo considers the good
blessings she will be earning by giving a child to a childless woman: in a sense it is God’s work.
Tara has spoken to Gajender, who was initially angry and resistant to the idea. He suggests they consider
adoption, but Tara is determined he must have a biological child, to take the name of the family further.
She is sure his mother will get a new wife for him otherwise. Gajender tries to reason with Tara, telling
her Namo may not get pregnant after one try and that it may take repeated tries. Tara says she is willing
to take that chance.
After some time though, Tara’s pleas and urging melt his objections. He cannot see his wife suffer like
this and he is ready to do what she says.
Questions:
■ If you were Namo would you do this for Tara? Do you think that Gajendar should go along with the
plan?
■ Does it make a difference whether Namo has sex with Ganjendar or is artificially inseminated?
• If Tara and Gajendar approached you at your local NGO and asked for advice, what would you tell
them?
• What are the pros and cons of this arrangement?
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Case Study 3: Assisted Reproductive Technologies
Manish is one of the country’s top young, upcoming executives. His charming wife, Ruchi is also a
senior executive in a consulting company. After repeated failed attempts at getting pregnant, they have
decided to go to a clinic and take tests to determine the reason for this. The tests show that Manish has
a very low sperm count. Family and friends are a little surprised: Manish is over 6 feet tall, handsome,
and seems healthy.
Ruchi and Manish make an appointment at an IVF clinic at the biggest hospital in the city. The clinic
tells them the IVF procedure is a relatively small and simple procedure: they will mix Manish’s sperm
and Ruchi’s eggs and then insert this back into Ruchi. This sounds simple enough and the couple
decide to go ahead with the plan.
They have been warned that it may take up to 6 attempts to get Ruchi pregnant. After the first time
both Ruchi and Manish have a good laugh over the entire process; it is funny how she goes for her egg,
and he puts some sperm in a cup. But after 7 months and six tries, the couple have run out of their
good humour. Manish travels a lot and is unable to keep the next appointment. The new dates clash
with Ruchi’s other travel plans. They are both feeling stressed, even though they try to keep each
other’s spirits up. Manish is also being ribbed by his friends who keep joking about him and his
infertility. Every month close friends and relatives call up to ask if there is any good news. The procedure
is also costing them a small fortune.
They are unsure about whether they want to continue this process, or try other options. Both want a
child of their own, but are aware that this might not happen. They are worried about what being
childless would mean for them in the community.
Questions
■ What should Ruchi and Manish do? Should they continue with the IVF?
• Do you agree with the choice for IVF that Ruchi and Manish made?
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MODULE 2 - Chapter 4
Chapter 4
HIV/AIDS, Sexually Transmitted
Infections and Reproductive Tract
Infections
Chapter Objectives for the Facilitator
1.
To have participants understand basic information on HIV/
AIDS including routes of transmission, prevention, care and
support and treatment.
2.
To have participants learn basic information on Sexually
Transmitted Infections (STIs) and Reproductive Tract
Infections (RTIs).
3.
To facilitate participant discussion on issues of stigma and
discrimination associated with HIV/AIDS and STIs/RTIs.
4.
To facilitate participant discussion on ways to approach and
talk about HIV/AIDS, STIs and RTIs in their communities.
TARSKI : Basics and Beyond
MODULE 2 - Chapter 4
Why a Chapter on HIV/AIDS and Sexually
Transmitted Infections (STIs) and
Reproductive Tract Infections (RTIs)
• The highest rate of new cases of STIs in the world occur among
people between the ages of 15 and 49 years in South and Southeast
Asia (Source: http://www.avert.org/stdstatisticsworldwide.htm)
■ Some 340 million curable STIs are estimated to occur worldwide
every year. Many millions of incurable viral STIs, including an
estimated 5 million HIV infections, also occur annually. (Source:
http://www.aveit.org/stdstatisticsworldwide.htm)
■ An estimated 6.7 million people live with HIV/AIDS in SouthEast Asia (2005), the second highest number of cases in the world
after sub-Saharan Africa. (Source: http:llw3.whosea.org/enl
Sectionl0/Sectionl8/Section348 _9917.htm)
• Approximately 40.3 million people around the world are living with
HIV/AIDS. (Source: http://www.avert.org/worldstats.htm)
■ The Indian National AIDS Control Organization (NACO) estimates
that 5.134 million people were living with HIV in India in 2004.
Only South Africa has more people living with HIV. (Source: http:/
/www.avert.org/indiaaids.htm)
STIs including HIV/AIDS continue to affect millions of people
around the world and impact certain regions and countries more
than others. Despite this situation, many people and communities
continue to react to these issues with indifference, discomfort, fear
and anger, and stigmatise and discriminate against infected people.
This creates obstacles to providing information for prevention of
transmission and to adequate treatment and care for people with
HIV/AIDS and STIs. Reducing the risk of transmission and
providing treatment and care for people living with these infections
is crucial to health and well-being.
This chapter gives participants basic knowledge of HIV/AIDS,
STIs, and reproductive tract infections (RTIs), including how these
infections are transmitted, and how they can be prevented and
treated. This information provides a foundation for participants
to discuss several issues including addressing social implications
like gender inequality, stigma and discrimination and denial of
rights experienced by people with HIV/AIDS and STIs, the focus
on fear and abstinence in most prevention messages, and the right
to information and access to services.
EXERCISES IN THIS CHAPTER
Exercise 1: HIV/AIDS Basics.
60 minutes
Exercise 2: HIV/AIDS: Testing,
Treatment, Care and Support.
60 minutes
Exercise 3: My Views on HIV/AIDS.
60 minutes
Exercise 4: Quiz: RTIs/STIs.
15 minutes
Exercise 5: Talking About RTIs/STIs.
45 minutes
Exercise 6: Examining Attitudes
Associated With HIV/AIDS and STIs.
45 minutes
MATERIALS FOR THIS CHAPTER:
Flipchart, Markers, Pens/pencils
Small paper bags, Candy/chocolate,
gum, sweets
HANDOUTS FOR THIS CHAPTER:
Handout 2.16
Basic Information on HIV/AIDS
Handout 2.17
Basics of HIV/AIDS Quiz
Handout 2.18
Frequently Asked Questions
Handout 2.19
Basic Information on STIs and RTIs
Handout 2.20 Facilitator Copy:
STIs and RTIs Quiz
Handout 2.21 Participant Copy:
STIs and RTIs Quiz
Handout 2.22 Facilitator Copy:
Talking About STIs and RTIs
Handout 2.23 Participant Copy:
Talking About STIs and RTIs
TARSHI : Basics and Beyond
MODULE 2 - Chapter 4
ADDITIONAL RESOURCES:
■ Avert-lnternational AIDS
Charity, www.avert.org
• The Body: The Complete HIV/
AIDS Resource, http://
www.thebody.com
• Holmes, W. 2003. Protecting the
Future: HIV Prevention, Care and
Support Among Displaced and
War Affected Populations. New
York: International Rescue
Committee.
■ Joint United Nations Programme
on HIV/AID. http://
www.unaids.org
Key messages for this Chapter
■ Knowledge of HIV transmission, prevention, treatment, and care
is important to reduce risk of transmission and spread of the
infection, and decrease the stigma and discrimination associated
with HIV/AIDS.
• Many STIs and RTIs are curable, however if left untreated they
can have a serious impact on the health and well-being of people,
by causing infertility, ectopic pregnancies or some cancers. STIs
can also increase the risk of HIV transmission.
It should not be assumed that HIV is transmitted only in certain
‘high risk groups’ (such as sex workers or intravenous drug
users). Infection can occur in people who are young or old,
monogamous or non-monogamous, heterosexual, bisexual, or
homosexual, women, men or transgendered people.
• National AIDS Control
Organization. Government of
India, http://www.nacoonline.org
• People have a right to confidentiality and privacy when they
receive health care, including counselling and treatment for HIV/
AIDS, STIs and RTIs. People also have the right to keep their
HIV status confidential. Fear of their status being revealed may
keep many from getting tested.
■ Solidarity & Action Against The
HIV Infection in India ISAATHIII.
http://www.saathii.org
• Placing blame on individuals and discovering who are the
primary ‘infectors’ of HIV/AIDS or STIs is counterproductive
and leads to stigma and discrimination.
• Welbourn, A. 1995. Stepping
Stones: A Training Package in HIV/
AIDS, Communication and
Relationship Skills. London:
ActionAid.
• Teaching-Aids At Low Cost
(TALC), http://www.talcuk.org
• WHO Regional Office for South
and Southeast Asia, http://
www.whosea.org
■ For selected films see, http://
www.asiasrc.org/films.php and
Appendix B.
■ A variety of factors cause infection: lack of information, lack of
access to condoms or other protection, and inability to negotiate
safer sex, among others.
• While the information in this chapter is current at the time of
publication, knowledge and development of HIV treatments and
recommended therapies are constantly being revised. It is
important to review the most current treatments and options
available in your country/region.
TARSHI: Basics and Beyond
MODULE 2 - Chapter 4
Exercise 1
HIV/AIDS Basics
Instructions
1. Divide participants into two or three groups/teams. Encourage
them to name their teams and write the names down in the
columns on the flipchart for scoring.
2. Explain the game and the scoring to participants. For every
correct answer, a team gets 10 points. If a team cannot answer a
question, it is passed on to the next team, which gets 5 points if
they answer correcdy.
QUIZ GAME
Purpose of the
exercise:
To understand the
difference between HIV
and AIDS, the routes and
conditions of transmission
of the virus, and
prevention.
3. Read out one question at a time and give each team time to
discuss their response before they answer. Clarify questions and
doubts as diey come up so that participants are clear about the
information.
4. Once you have gone through all the questions, announce the
winners, give the prizes to the appropriate groups, and distribute
Handout 2.17.
' TIME
! 60 minutes
MATERIALS
i
■ Flipchart, markers, Quiz questions
from Handout 2.17 Basics of HIV/
AIDS Quiz, prizes for the winners
i
ADVANCE PREPARATION
i 1. To keep score, make a column for <
each team playing the game on a
i flipchart.
I 2. Keep some prizes ready for the
I winning team and the runners-up.
| 3. Review and make copies of
Handout 2.16 for each participant,
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j
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MODULE 2 - Chapter 4
THIS EXERCISE CAN BE MODIFIED
Key Messages
BY:
■ Combining this quiz with the other
true/false and myth/fact exercises
from this module into a larger quiz
game. This can be played at the
beginning of the module Ito
determine what topics
participants need information on)
or end of the module (to review
and/or assess how much
participants have learned!.
• Knowledge of HIV/AIDS including modes of transmission,
prevention, treatment, and counselling is essential. This gives
people information to reduce the risk of transmission and spread
of the disease.
■ There are many myths and misconceptions about the modes of
transmission of HIV and its effects on the body. These lead to
fear and discrimination.
• People with HIV/AIDS often experience stigma and
discrimination. It is necessary to work to reduce this stigma in
order to reduce rates of transmission as well as to protect the
rights of people to live lives with dignity and respect.
MAKING CONNECTIONS
TIPS FOR THE FACILITATOR:
■ A basic understanding of human
sexual anatomy and physiology is
essential to understand the
mechanism of HIV transmission.
For more see Chapter 1 in this
Module.
• Make sure to review any information and handouts before starting this exercise
to have a clear understanding of HIV/AIDS and to answer questions from
participants.
■ People with HIV/AIDS are often
subject to stigma, discrimination
and marginalisation. For more see
Chapter 2 in Module 4.
■ Do not spend too much time on any single question even if you feel that clarification
is required. Participants may lose interest when the discussion focuses only on
one issue. Note areas that require more discussion on a flipchart lin a Parking Loti
and address these issues at some point during the training.
■ There may be participants in the training who work on HIV/AIDS and so have
extensive knowledge on the topic. Encourage them to contribute additional
information from the field but do not let them dominate the group. Encourage
everyone to participate in the game.
205
TARSHI: Basics and Beyond
MODULE 2 - Chapter 4
Exercise 2
HIV/AIDS: Prevention, Testing, Treatment,
Care and Support
teaching™class
Instructions:
1.
2.
Divide the participants into four groups. Assign one group
Transmission and Prevention, another Testing, the third Treatment,
and die fourth Care and Support. Give each group a copy of their
specified topic from Handout 2.18. Ask them to review their
handout and prepare a 5-10 minute presentation on the topic.
The presentation can be in the form of a role-play, a brief
lecturette, or a question answer session, as long as all the
informadon on the handout is covered. For example, the group
assigned to Testing can do a role-play in which a person visits a
clinic to find out their HIV status and learns about the tesdng
options and procedures. Presentations should not exceed 5
minutes to allow ample time for questions and comments. Give
groups 30 minutes to create their presentations.
Purpose of the
exercise:
1. To understand testing
and treatment options
available for HIV/AIDS.
2. To describe the kind of
care and support necessary
for those living with HIV/
AIDS.
Bring the groups back together and invite the Transmission and TIME
Prevention group to begin the presentations, followed by Testing,
. 90 minutes
Treatment, and ending with the Care and Support group. After
each presentation, make sure to add any information that is left
MATERIALS
out or to correct misinformation. Ask for questions and
Flipcharts, markers, Handout 2.18
comments.
Suggested Questions:
’ Frequently Asked Questions:
■ Is there any information you are still unclear about?
i Transmission of HIV and its
j Prevention; Testing for HIV/AIDS;
■ Were there any negative portrayals of HIV/AIDS in the
presentation? How could these be eliminated?
j Treatment of HIV/AIDS; Care and
Support for HIV/AIDS
ADVANCE PREPARATION
3.
After going through all presentations ask for general questions
or comments.
Suggested Questions:
■ Could you communicate this information to the communities
you work with? Would the information need to be modified in
any way and if so how and why?
• Do you think learning about HIV/AIDS testing, treatment, care
and support are important to the work you do? Why?
206
Make copies of all four sections of
Handout 2.18
TARSHI: Basics and Beyond
MODULE 2 - Chapter 4
Key Messages
New treatments and recommended therapies are constantly
changing and being revised. It is important to review the most
current treatments and options available in your country/region
in addition to laws and policies that may affect them.
THIS EXERCISE CAN BE MODIFIED
BY:
■ Conducting a four-part lecturette Prevention and Transmission,
Testing, Treatment, and Care and
Support. Each part can consist of
a 10-minute lecturette followed
by 10 minutes for comments and
questions, and another 15-20
minutes after all the lecturettes
for general questions.
There are 4 routes of transmission of HIV: 1) unprotected sex
with an infected person; 2) infected mother to child; 3) through
contaminated blood and blood products; and 4) sharing of
unsterilised infected needles, syringes etc.
There are 2 tests for HIV: the antibody test (example, ELISA)
and the antigen test (example, Polymerase Chain Reaction). The
antibody test is the more common and standard test for HIV
People undergoing testing need to understand the ‘window
period’ and the potential for a false-negative test during this time.
Antiretroviral (ARV) treatment can help stem progression of the
HIV virus. There are various free/subsidised ARV therapy
schemes available through the governments of different countries
and states.
MAKING CONNECTIONS
TIPS FOR THE FACILITATOR:
■ Stigma and discrimination often
prevent people from seeking
voluntary counselling and testing
services. Stigma needs to be
addressed before we can expect
people to come forward for
testing and treatment. For more
see Chapter 2 in Module 4.
• Some information in Handouts 2.18 overlap with information in Handout 2.16.
This is necessary to give participants complete information for the presentations.
• People living with HIV/AIDS have
the same rights as individuals who
are not HIV positive. For more see
Chapter 1 in Module 3.
• There may be participants who have extensive knowledge about HIV/AIDS. If
appropriate ask them to contribute any additional relevant information. Divide
such participants equally among the four presentation groups, and request them
to be the presenters to guarantee clear and accurate presentations.
• Information on HIV/AIDS is frequently changing, with new treatment options,
research, governments changing their policies and financial support for HIV/AIDS
related programming etc. Check that the information on the handouts is current
before starting this exercise.
■ Participants may ask questions during this exercise that are out of the scope of
the Handouts/ beyond the facilitator knowledge. Write these on a flipchart (in a
Parking Loti to return to later in the training.
207
TARSHI: Basics and
MODULE 2 - Chapter 4
Exercise 3
My Views on HIV/AIDS
Instructions
1.
Read out one statement at a time. Designate one side of the
room as the Agree side and the other as the Disagree side. Ask
participants to move toward either side, depending on how they
feel about the statement. Those who are undecided should move
to a third designated spot in the room (the Don’t Know group).
Statementsfor My Views on HIV/AIDS:
■ Mandatory HIV testing for couples getting married is a good
policy
• All people entering the country/ migrating from different parts
of the country should be screened for HIV
• A doctor has the right to tell a person their partner’s HIV status
without the partner’s consent
• HIV positive women should not be allowed to have children
• Needle exchange programmes will encourage drugs use
■ HIV positive people should be encouraged to disclose their status
for the good of odiers
■ Women are to blame for the spread of the HIV infection since
they are the ones who primarily infect men with HIV
POLARISATION
Purpose of the
exercise:
1. To identify and discuss
attitudes related to HIV/
AIDS.
2. To discuss issues of
human rights and HIV/
AIDS.
Ip———————
TIME
‘ 60 minutes
MATERIALS
' None
ADVANCE PREPARATION:
2.
After participants have chosen a side, invite them to share why
1. Select three statements from the
they have made their choice.
j list below.
Suggested Questions:
■ Why do you agree or disagree? Do you think your opinion is
similar to that of others in your community?
3.
I 3. Stick charts on opposite walls of
Conduct a polarisation and discussion with the above questions I the rooms, one saying Agree and the
for three of the statements. Afterwards, ask for general comments
; other Disagree.
or questions.
Suggested Questions:
■ Were there any issues you had not thought of before? What were
they and how did they make you feel?
• From these statements and discussions, what are your opinions
and thoughts about the connection between human rights and
HIV/AIDS?
208
i 2. Go through the key messages in
order to be prepared to lead a
| discussion on the selected topics.
TARSHI: Basics and Beyond
MODULE 2 - Chapter 4
Key Messages
THIS EXERCISE CAN BE MODIFIED
BY:
• Asking for reactions to fewer
statements, and allowing for
longer discussions.
• Complicating the statements, for
example, combining statements 1
and 2. Questions with many
issues become more difficult to
answer and participants may have
to grapple and analyse their
opinions more carefully.
MAKING CONNECTIONS
• The rights of all people must be
respected, irrespective of their HIV
status and how they got the
infection, whether through unsafe
sex or blood transfusion. For more
see Chapter 1 in Module 3.
• Stigma and discrimination also
diminish the quality of life of
people living with HIV/AIDS. For
more see Chapter 2 in Module 4.
Mandatory testing before marriage has been supported by some
groups, however this policy can be harmful: the person being
tested may be in the window period so the test result will be
inaccurate; the test does not ask for consent; it makes false
assumptions that people cannot get infected after marriage and
that it will protect women from infection (if a woman tests
positive, there may be no support systems in place to help her
afterwards); the tests can breed stigma and discrimination against
those who test positive.
Non-judgmental counselling may help people decide to disclose
their positive status to others. However, this is an individual’s
choice and needs to be respected. No third party has the right to
breach patient confidentiality. Doctors’ primary allegiance is to
their patients/clients and not to the patients’ partners. If doctors
maintain confidentiality and earn the trust of HIV positive
people, they may be in a better position to prepare positive people
to reveal their status to their partners.
The right to have children or not is the reproductive right of all
women regardless of their HIV status. While HIV positive
women need help to reduce the risk of transmission to their
children during childbirth, preventing women from choosing
to have children is a violation of their rights.
While efforts should be made to help people overcome addictions
if they want to, the detoxification/de-addiction process is a long
one. In the meanwhile, providing injecting drug users with
information about the harmful effects of sharing needles and
providing disposable syringes can help them protect themselves
from infections including HIV
Placing blame on individuals and discovering who are the
primary ‘infectors’ of HIV is counterproductive and leads to
stigma and discrimination. A variety of factors contribute to HIV
infection: lack of information; lack of access to condoms or other
protection; and inability to negotiate safer sex, among others.
TIPS FOR THE FACILITATOR:
• Try and anticipate all possible arguments for every statement before undertaking this exercise.
• Do not spend more than 10-15 minutes per statement to keep the interest of the group.
• Make note of the areas that require more discussion on a flipchart and make time to address these issues during the training.
209
TARSHI: Basics and Beyond
MODULE 2 - Chapter 4
Exercise 4
STIs / RTIs Basics
Instructions
1. Divide the participants into two or three teams. Encourage them
to name their teams and write the names down in the columns
on the flipchart for scoring.
2. Explain the game and the scoring to participants. For every
correct answer, a team gets 10 points. If a team cannot answer a
question, it is passed on to the next team, which gets 5 points if
they answer correctly.
3. Read out one question at a time and give each team time to
discuss their response before they answer. Clarify questions and
doubts as they come up so that participants are clear about the
information.
QUIZ GAME
Purpose of the
exercise:
To understand the basics of
Sexually Transmitted
Infections (STIs) and
Reproductive Tract
Infections (RTIs).
; TIME
i 15 minutes
4. Once you have gone through all the questions, announce the
winners, give them prizes, and distribute Handout 2.17.
MATERIALS
i Handout 2.20 STIs and RTIs Quiz
j Game, Prizes
ADVANCE PREPARATION:
1. To keep score, make a column for
each team playing the game on a
flipchart.
2. Keep some prizes ready for the
winning team and the runners-up.
3. Review Handout 2.19 and 2.20.
210
TARSHI: Basics and Beyond
THIS EXERCISE CAN BE MODIFIED
MODULE 2 - Chapter 4
Key Messages
BY:
■ Combining this quiz with the other
true/false and myth/fact exercises
from this module into a larger quiz
game. This can be played at the
beginning of the module (to
determine what topics
participants need information onl
or end of the module (to review
and/or assess how much
participants have learned).
■ Information about STIs and RTIs can help better protect and
prevent these infections.
• Talking about these can decrease stigma and therefore reduce
fear of accessing treatment services and increase general health
and well-being.
• STIs and RTIs have significant impact on people’s sexual and
reproductive health, particularly that of women. Some of these
infections can also increase the risk of transmission of HIV/
AIDS.
MAKING CONNECTIONS
TIPS FOR THE FACILITATOR:
• Untreated STIs can result in
serious conditions including
infertility. For more see Chapter 3
in this Module.
• Make sure to review any information and handouts before starting this exercise
to have a clear understanding of STIs and RTIs and to answer questions from
participants. .
■ Sexual and reproductive rights
include the rights of all people to
live lives free of infection, fear and
discrimination. For more see
Chapters 2 and 3 in Module 3.
• Do not spend too much time on any single question even if you feel that clarification
is required. Participants may lose interest when the discussion focuses on one
issue. Note areas that require more discussion on a flipchart (in a Parking Loti and
address these issues at some point during the training.
■ Some participants may work on STIs and RTIs and therefore have extensive
knowledge on the topic. Encourage them to contribute additional relevant
information but do not let them dominate the discussion. Encourage everyone to
participate in the quiz.
211
TARSHI: Basics and Beyond
MODULE 2-Chapter 4
Exercise 5
Talking About STIs I RTIs
Instructions
Divide participants into small groups. Distribute Handouts 2.19
and 2.23 to each group. Assign each group one of the cases and
ask them to read the case and discuss the questions. Give groups
10-15 minutes.
1.
2.
Bring the groups back together and ask them to share their
discussions and approaches to their case. After all the
presentations, ask for questions or comments.
Suggested Questions:
■ Why do you think it is important to talk about STIs and RTIs?
Are they discussed and addressed by the communities you live
in and work with?
Were there any moral judgments about the characters being made
during the case presentations? Were you making any judgments
about the people in these cases?
Were any assumptions made about the type of relationships these
characters are in? Did you assume, for instance, that they were
all in heterosexual or homosexual relationships? Did you assume
that the men/women would always be faithful in the
relationships and therefore not transmit an infection to their
partner/s? How can diese assumptions affect the attitudes about,
and treatment of STIs and RTIs?
Are there any obstacles people face to getting tested and treated
for STIs and RTIs? What might these be and how can they be
overcome? For example it might not always be possible for a
person to tell a partner that they have an infection, because of
power dynamics in the relationship, gender inequalities, or lack
of access to appropriate health services.
212
CASE STUDIES
Purpose of the
exercise:
1. To know and understand
common STIs and RTIs.
2. To examine how
discussions about STIs and
RTIs can be had with
different groups and
communities.
TIME
45 minutes
MATERIALS
Handout 2.19 Basic Information on
Sexually Transmitted Infections
(STIs) and Reproductive Tract
Infections (RTIs), Handout 2.23
I Participant Copy Case Studies of
STIs and RTIs, pens/pencils
■ ADVANCE PREPARATION
I Make copies of the handouts for
I each participant.
TARSHt: Basics and Beyond
MODULE 2 - Chapter 4
Key Messages
THIS EXERCISE CAN BE MODIFIED
BY:
■ Eliminating the cases and only
distributing Handout 2.19 to
participants and asking for any
questions or comments after they
have read through it. This may be
best for groups with an extensive
knowledge on STI/RTIs.
MAKING CONNECTIONS
■ It is important to talk about
sexuality to learn how to protect
oneself from STIs and unwanted
consequences of unprotected sex.
For more see Chapter 1 in
Module 1.
■ Comprehensive and accurate
sexuality education for young
people can help dispel myths
about STIs/RTIs. For more see
Chapter 2 in Module 5.
• Many STIs are curable with medications. It is important to discuss
STIs and RTIs because if left untreated, they can have serious
health consequences such as infertility, ectopic pregnancies and
some cancers. Certain STIs can also increase the risk of HIV
transmission.
• If a person has an STI, their partner/s also need to be treated for
the infection, or the infection can be transmitted back to the
person from their untreated partner/s (‘presumptive treatment’
to prevent the ‘ping-pong effect’).
■ While it may be important to ascertain a person’s sexual history
in order to test and treat their partner/s as well, beware of asking
intrusive and insensitive questions and making assumptions
about the person.
• It is important to avoid moral judgments about people who have
an STI or RTI. Any person, whether in a monogamous or nonmonogamous relationship, married, heterosexual, bisexual, or
homosexual, woman, man or transgender, can get infected.
TIPS FOR THE FACILITATOR:
• Emphasise that the information for this exercise is basic and meant for non
medical professionals. Stress that unless a person is a qualified medical
practitioner, s/he should not attempt to treat or prescribe medication to anyone
with a possible Sexually Transmitted Infection (STI).
■ Do not use pictures or graphic descriptions of STIs to 'put people off' from
unprotected sex and increase fear-based messages about sex. The information in
this chapter is meant to provide knowledge about the existence of such infections,
the adverse effects of these infections, and the importance of seeking treatment
and protection to reduce risk of transmission. Ultimately, however, individuals
have the right to make choices about their bodies and sexual behaviours.
213
TARSHI: Basics and Beyond
MODULE 2 - Chapter 4
Exercise 6
Examining Attitudes Associated With HIV/AIDS and
STIs
PARTY GAME
Instructions:
1. Ask each participant to take a bag. Participants should not look
at the slip of paper in the bag. Give everyone 2-3 minutes to
walk around the room and swap sweets with others, paying
attention to the people they exchange with. Participants can
interact with as many or few people as they want.
2. Ask participants to sit down and unfold their slips ofpaper. Have
the person with H on their slip stand up and go to the corner of
the room, away from other participants. This person is HIV
positive. Ask anyone who exchanged sweets with this person to
stand up.
3.
4.
5.
Now ask the person with S on their slip of paper to stand up.
This person has an STI. Ask this person to also go to the corner
of the room away from other participants. Ask anyone who
exchanged sweets with this person to stand up if they are not
already standing. At this point the majority of people should be
standing in the room.
Ask the people with C on their piece of paper to sit down. These
people have used condoms and are therefore uninfected. The
participants in the corner of the room with the original H and S
should give you their bags of sweets. They will stand there for
the rest of the exercise. Distribute the sweets from their bags to
the seated participants with C’s in their bags.
Ask for comments and questions.
Suggested Questions:
■ If this exercise represents the spread of HIV/AIDS and STIs,
what does it tell you about the spread of the disease? How can
the spread or risk be reduced?
■ How do the people standing in the corner feel about being
separated from the group? How did you feel being the person
with the STI or HIV/AIDS? Do you think people with STIs or
HIV/AIDS feel discriminated against?
214
Purpose of the
exercise:
1. Discuss the stigma and
discrimination associated
with STIs and HIV/AIDS.
2. Discuss ways in which
this stigma and
discrimination can
negatively affect people
living with an STI or HIV/
AIDS, and how to change
these attitudes.
TIME
45 minutes
MATERIALS
Small folded slips of paper for each
participant, marker/pen, 5-10 pieces
of candy/chocolate/gum, small bags/
packets
ADVANCE PREPARATION
Fold as many slips of paper as the
number of participants. On one,
write an H, on one write an S, and
on two slips write C. Leave the rest
of the slips blank. Place a folded slip
in each bag with 5 to 10 pieces of
candy/chocolate/sweets. Have as
many bags ready as the number of
participants for the exercise.
TARSHI: Basics and Beyond
MODULE 2 - Chapter 4
THIS EXERCISE CAN BE MODIFIED
• How do die people still standing feel towards those who infected
them? Do they blame those with H or S in their slips?
BY:
• Using only H as the example and
eliminating the S from the slips of
paper. This may be useful for
groups that work in HIV/AIDS.
MAKING CONNECTIONS
■ Stigma and discrimination can be
as debilitating as the infection
itself. For more see Chapter 2 in
Module 4.
• Use of condoms is one way to
protect people from HIV/AIDS and
other STIs, as well as unwanted
pregnancies. For more see Chapter
2 in this Module.
• Is there stigma associated with HIV/AIDS or STIs? If so, does
this contribute to spread of the infections or hamper prevention
strategies? How?
Key Messages
STIs including HIV can infect anyone. Unlike this game, in
many real-life situations people are able to make more informed
decisions about their choices in sexual interactions to reduce
the risk of transmission.
People with STIs or HIV/AIDS experience stigma and
discrimination in many communities. People with STIs such as
Chlamydia or Gonorrhoea may not be discriminated against in
the way a person with HIV/AIDS is, but shame and ‘unclean’
behaviour is still associated with these STIs. Because people are
afraid of being alienated or ostracised, they may avoid being
tested and treated.
Advocacy and education with correct information on HIV/AIDS
and STIs to communities can help reduce this discrimination
and stigma.
TIPS FOR THE FACILITATOR:
■ Participants may find it difficult to equate the abstract discrimination and
stigma in this exercise to real-life experiences. Emphasise that this is only a
demonstration to elicit discussions and not equal to the actual discrimination
and stigma people with HIV/AIDS might experience.
• Focus on the stigma and discrimination faced by people with STIs including HIV
more than on how the infections spread.
215
TARSHI: Basics and Beyond
MODULE 2 - Chapter 4
Handout 2.16
Basic Information on HIV/AIDS
I.
The Immune System
II.
HIV
III.
AIDS
IV
HIV/AIDS Life Cycle
V
HIV Transmission
VI.
Life with HIV
I.
The Immune system
What is the Immune System:’
The immune system is the body’s network of cells and substances that protect a person from infective
agents such as viruses, bacteria, parasites, fungi, and tumour cells. White blood cells are a major
component of the immune system. There are several different types of white blood cells: one is called
lymphocyte, which can be of two kinds- B-cells and T-cells. These two types of cells form part of the
immune response for the specific infections that the body has already experienced or developed immunity
to. This immune response is called acquired immunity.
What are B-cells?
B-cells are a variety of lymphocytes and their role is to react to a specific part of an infecting agent
called an antigen. The antigen acts like a nametag identifying the infecting agent. B-cells react by
producing antibodies, a response necessary to defend the body. In addition to attacking the infecting
agent, B-cells also create memory cells that remain in the body for years and act as a historical record
of the attack, adding to the body’s acquired immunity. For example, when children receive polio drops
or diphtheria shots, B-cells create a historical record of the infection thus immunising the body against
these infections in later life.
WZiar are T-cells?
Another variety of lymphocytes, the T-cells, like B-cells, react to antigens. It is the job of the T-cell to
attract other immune cells to the area where the infection/antigen is located to help destroy it. T-cells
help watch over the body and alert the rest of the immune system when there is an infection. T-cells
also aid in attacking the infecting agent. There are two types of T-cells, CD4 cells, also called helper
cells or T-4 cells; and CD8 cells, also called suppressor cells or T-8 cells. CD4 cells attach themselves
to the infecting agent making it easier for CD8 cells to attack that agent. HIV mainly targets CD4 cells
and as a result limits the body’s ability to protect itself.
216
TARSHi: Basics and Beyond
MODULE 2 - Chapter 4
II.
HIV
What is HIV?
HIA stands for Human Immuno-deficiency Virus. This name has been derived in the following way:
or uman, because this virus can only infect human beings; I for Immuno-deficiency, because the
virus wea -ens the body s immune system, resulting in a diminished immune response to other infecting
agents, and V for Virus, because this organism is a virus, which means that it has the ability to reproduce
itself over and over again by taking over healthy cells. In the case of HIY the virus takes control of CD4
cells and reproduces itself through these infected cells. Each infected CD4 cell can make thousands of
copies of the virus until the cell dies. A person infected with HIV creates millions of new HIV viral
particles every day. HIV by itself is not an illness and while it can lead to AIDS, this progression can
take several years. An HIV infected person can lead a healthy life for years.
What are retroviruses?
Most viruses store their genetic material as DNA. However HIV belongs to a class of viruses called
retroviruses in which the genetic material is in the form of RNA. It uses an enzyme called reverse
transcriptase to become part of the host cells’ DNA. This allows many copies of the virus to be made in
the host cells. Medicines that have been developed to inhibit HIV replication are called anti-retrovirals
(ARVs) and the treatment is called anti-retroviral therapy (ART).
III.
AIDS
What is AIDS?
AIDS stands for Acquired Immune Deficiency Syndrome. It has been named this for the following
reasons: A for Acquired because it is not a genetic condition, but rather, a disease that is contracted by
an individual through one of four transmission routes; I for Immune because it affects the body’s
immune system; D for Deficiency because it weakens the immune system; and S for Syndrome because
a person with AIDS may experience a wide range of different diseases and infections. AIDS severely
weakens the body’s defences making it possible for other diseases, known as Opportunistic Infections
(OI), to successfully manifest themselves.
IV.
HIV/AIDS Life Cycle
What happens when a person is first infected with HIV?
After a person has been infected with HIY the virus will begin to attack CD4 cells and multiply
rapidly in the body. During the first 2 to 8 weeks the immune system fights back and a person may feel
like they have the flu. Within three months of infection, the body’s immune system produces antibodies
to combat the virus. Most common HIV tests look for the presence of these antibodies. When a
person is said to be HIV positive, this indicates the presence of these antibodies in their blood.
What is the window period?
HIV tests do not look for the presence of HIV in the body; they look for the presence of antibodies
produced by the immune system when it encounters HIV It may take up to three months for the body
to produce enough HIV antibodies to produce a positive test result. This three-month period between
infection and a positive test is known as the window period. During this time a person is already
infected and capable of spreading HIV
217
MODULE 2 - Chapter 4
TARSHI: Basics and Beyond
How does a person with HIV remain healthy?
It may take up to 8 or 10 years for a person with HIV to develop symptoms. During this time the virus
weakens the body’s immune system, but the body still has a strong enough defence against Opportunistic
Infections. An HIV positive person can continue to lead a healthy life for many years by following a
proper eating regimen, avoiding harmful behaviour such as drug or alcohol use, and using anti-retroviral
treatment (ART).
How does a person go from HIVpositive to having AIDS?
AIDS is said to have occurred when HIV has damaged the immune system, leaving a person s body
vulnerable to infection and disease. A common indicator to determine when HIV has developed into
AIDS is when a person’s CD4 count falls below 200. Those with AIDS may also experience one or
more Opportunistic Infections, such as pneumonia, tuberculosis or certain cancers.
However, the definition of AIDS has changed dramatically over the years. A person may have HIV for
a long time and remain healthy, even if their CD4 count is below 200. Plus, with improved treatment,
including Anti Retroviral Therapy, and testing options, Opportunistic Infections can be treated and
the CD4 count built up, changing the earlier definition of AIDS (CD4 below 200 and one/more OI).
V.
Transmission of HIV
How is HIV transmitted?
There are four routes of transmission for HIV: 1) unprotected sex with an infected person; 2) infected
mother to child, either during pregnancy, delivery or through breastfeeding; 3) through contaminated
blood and blood products (including organ and tissue transplants); and 4) sharing of unsterilised
infected needles, syringes and other medical equipment like dentists’ instruments.
How can a person find out if they have HIV?
The most common HIV tests look for the presence of HIV antibodies in a person’s blood or saliva.
Within three months of infection with HIV the body’s immune system is able to produce a detectable
level of HIV antibodies. When these antibodies are present, a person tests positive. ELISA (Enzyme
Linked Immuno Sorbent Assay) is a commonly used antibody test.
What is a false negative test result?
If a person goes in for an antibody test in the window period - during which there are barely any
antibodies to HIV in the body - s/he may get a negative result. This is a false negative result because the
person is infected with HIV but the test does not show this. Therefore it is recommended that if a
person is not sure of their last unsafe exposure, they should get a second test done after three more
months, during which they should not expose themselves to infection.
What are the conditions for transmission ofHIV through unprotected sex?
One person must be infected with HIV to pass it to another person. Unprotected penetrative vaginal
intercourse is the most common route of HIV transmission, while anal sex - whether male-to-male or
male-to-female poses a higher risk for transmission. It is rare but possible to acquire HIV through oral
sex, particularly if the person has ulcers or sores in their mouth. Kissing and other non-penetrative
sexual activities do not pose a risk for HIV transmission.
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What can decrease the spread ofHIV through sex?
Correct and consistent use of condoms significantly reduces the transmission of HIV. At present,
condoms are the most effective method of HIV prevention through the sexual route. Treatment and
prevention of STIs can reduce the risk of HIV transmission. STIs particularly not only increase a
person s susceptibility to getting HP/ they also increase an HIV positive person’s infectivity, making
the spread of the disease easier.
What are the conditions for transmission from mother to child?
An HIV positive mother can pass the virus to her child either during pregnancy, delivery, or through
breastfeeding. Most often a foetus is protected from infection while in the uterus, but the presence of
some STIs such as syphilis can increase the likelihood of infection. Transmission between mother and
child is most likely to occur during delivery when there is a high chance of the baby’s blood coming in
contact with the mother’s blood. HIV is also present in breast milk; different studies have found
results ranging from a 5% to a 20% chance that the baby may become infected through breast milk.
When there is no healthy alternative to breastfeeding, infected mothers are encouraged to breastfeed
their children to prevent them from dying of malnutrition or water-borne diseases instead. The risks of
HIV infection through breastfeeding and the risk of death due to malnutrition need to be balanced
and carefully considered in such situations.
What can reduce the risk for transmission ofHIV from mother to child?
The primary tool to prevent transmission from mother to child is the use of antiretroviral medicines
during pregnancy and delivery. This method, combined with safe delivery practices and counselling
and support for infant feeding methods can significantly reduce the transmission of the virus between
mothers and their infants. It is crucial for pregnant women to know if they are HIV positive.
Why do people now prefer to use the term parent-to-child transmission instead ofmother-to-child
transmission ?
It has been argued that the term mother-to-child transmission puts the onus of infection of a child on
the mother, which may often not be the case. Parent-to-child transmission implies that the child could
have got infected through the father via the mother. The use of this term holds both parents responsible
for taking the necessary precautions to prevent transmission of infection to the child in case one or
both parents are FIIV positive.
How can person find out ifa baby has HIV?
Most common HIV tests do not test for the virus itself, but for the presence of HIV antibodies. Since
all infants carry their mother’s antibodies for the first several months of life, it is difficult to determine
if an infant born to an HIV positive mother has HIV All the babies of HIV positive women will have
HIV antibodies in their systems for 9 to 18 months, therefore testing infants at 9 months and again at
18 months is recommended. In addition, all infants born to HIV positive mothers should receive
regular check-ups for up to 18 months. Due to the complications in determining if the infant is HIV
positive, the infant’s health and nutrition must be carefully monitored and the use of preventative
medicines may be necessary.
What are the conditions for transmission HIV through blood or blood products?
Injection drug use, blood transfusion, and needle sticks are the primary methods of transmitting HIV
through blood or blood products. Sharing injecting needles and/or syringes for drug use is a very
effective way of transmitting HIV When infected blood is drawn into a needle while using a syringe
and that needle is than used by someone else, the second person is effectively injecting HIV directly
into his or her blood.
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Transfusion of blood infected with HIY organ or tissue transplants are all ways of getting HIV Those
subjected to needle stick injuries or blood splashes to the eyes or mouth in the healthcare setting are at
low risk of contracting HIV
What can be done to prevent the transmission ofHIV through blood or bloodproducts?
Single-use and proper disposal of syringes and needles can drastically reduce the spread of HIV among
injecting drug users. Strict criteria and testing of blood for transfusion and organ and tissue donation
can help reduce the risk of HIV transmission, as can blood safety and precautionary guidelines in
healthcare settings to avoid risk incidents.
Are there times when people with HIV are more infectious or able to transmit HIV easier?
People are more infectious when they have a greater viral load or concentration of the HIV virus in
their blood. The viral load is highest when a person first contracts HIY before the body has had a
chance to build a defence/create antibodies to the virus, and later during the progression of the virus
when the immune system weakens and displays signs of damage. A person with an STI is also more
likely to transmit HIV when they participate in unprotected sex, due to the higher concentration of
HIV in their semen or vaginal fluids, as well as other conditions that lead to higher infectivity.
Can a mosquito spread HIV?
Mosquitoes cannot spread HIV Extensive research on this question has proven this.
Is HIV a strong or fragile virus?
HIV is a fragile virus. It can only survive in moist conditions, which is why it is transmitted through
bodily fluids such as blood, semen, vaginal secretion or breast milk. It cannot penetrate through unbroken
skin and condoms. HIV is sensitive to fluctuations in temperature and the presence of oxygen. One
place that HIV has been known to survive for a long time is in drug injection syringes since these are
airtight and often contain blood from the injector.
VI.
Life With HIV/AIDS
How many people are living with HIV/AIDS around the world?
Approximately 40.3 million people are living with HIV/AIDS worldwide (2005).
Ifa person is HIVpositive, what should they do to protect their health?
Knowing one’s HIV status is fundamental to protecting a one’s health and the health of their sexual
partner/s and children. It is important to remember that a person can live a healthy, full life with HIV
if they take care of their health. This can be done by finding support networks to provide emotional
support, as well as information on nutrition, medical treatment and how to live a healthy life.
Why is nutrition so important to protecting the health ofa person with HIV?
As HIV progresses in a person, weight loss typically occurs. HIV changes the way a body processes
food in two key ways. First HIV reduces the body’s ability to absorb nutrients. Secondly, people living
with HIV mainly lose muscle weight instead of fat. When the body of a person with HIV runs out of
energy rich foods, it uses the energy stored in muscles. Healthy people access fat for extra energy when
the food stores in their bodies are diminished. The shrinking of muscles goes unnoticed initially
because the fat around the muscles is not lost. Muscles are made up of protein, and it is therefore
important that an HIV positive person eat protein rich foods.
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tiona y, it is important to eat lots of carbohydrates since the body uses a lot of energy in its fight
against
. Energy foods such as rice, bread, and potatoes and foods with fats and oils, provide what
is own as complex sugars to supply energy. If an HIV positive person does not eat enough energy
oo s an protein-rich foods, they will lose important muscles and not fat. This is called wasting,
which weakens the body and makes it more difficult to combat disease.
What is a CD4 count and a viral load test and why are they important?
Since HIV mainly targets the CD4 cells in a body’s immune system, the CD4 count indicates how
many CD4 cells are healthy, and how strong a person’s immune system is. Most people without HIV
have about 700 to 1000 CD4 cells, whereas HIV infected people are considered to have ‘normal’ CD4
counts if the number is above 500. A value below 200 could indicate that a person needs to go on ARVs
if they are not already on them.
Viral load is a measure of the active HIV found in a small sample of blood. This can range from
greater than 750,000 to less than 50 and the lower this figure, the better the health status of the person.
CD4 counts and viral load tests are used as health indicators for people with HP/ to help determine
when to take certain medicines and to gauge the progression of HIV
What are Opportunistic Infections?
HIV attacks the immune system, making it harder for a person to fight off other infections. These
infections are called ‘Opportunistic Infections’ or OIs, as they occur because of the weakened immune
system. Common OIs include Tuberculosis (TB), Pneumocystis Carinii Pneumonia (PCP),
Oropharyngeal Candidiasis (thrush), and Kaposi’s sarcoma (a form of skin cancer). The CD4 count
is a good indicator of the OIs a person may contract, so it is important for HIV positive people to
monitor their CD4 counts. Based on this, their health care providers can guide them on which OIs to
anticipate and what can be done to prevent OIs.
What medicines do people with HIV need to take?
There is presently no cure for HIV Treatment is available, however, to treat Opportunistic Infections
(OIs) and slow the progression of HIV There are three different kinds of medicines for people with
HIV Firsdy, there are prophylactic medications to prevent Opportunistic Infections such as PCP
Secondly there are medicines to treat Opportunistic Infections, and lastly there are medicines used to
slow the progression of HIY known as antiretrovirals (ARVs). Different ARVs work in different ways
to stop the spread of the virus, but they do not eliminate HIV
What is Highly Active Antiretroviral Therapy (HAART)?
HAART is a combination of anti-HIV drugs, known as antiretrovirals (ARVs), which needs to be
taken daily to slow the progression of HIV Not every HIV positive person needs to take HAART.
Health care officials use CD4 counts and viral load tests to determine when to start HAART. Once a
person begins HAART, s/he cannot stop the treatment. There are many side effects and issues of
treatment adherence and drug resistance to be taken into consideration before initiating HAART. So it
is important for a person considering HAART to talk to their health care provider and learn about
advantages and disadvantages of this treatment.
Are traditional medicines and ayurvedic treatments more effective than ARVs for combating HIV?
Traditional ways of combating disease may often provide practical tools to assist a person with HIV to
stay healthy. However they should be seen as complementary tools and not replacements for ARVs.
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Handout 2.17
Basics of HIV/AIDS Quiz
NOTE FOR THE FACILITATOR: ANSWERS TO THE QUESTIONS BELOW CAN BE FOUND IN HANDOUT 2.16. DEPENDING ON THE NUMBER
OF PARTICIPANTS AND THEIR LEVEL OF AWARENESS, YOU MAY WISH TO ADD MORE QUESTIONS AFTER GOING THROUGH HANDOUT
2.16 OR MODIFY THE ONES GIVEN HERE AS WELL.
What do HIV and AIDS stand for?
What is the difference between HIV and AIDS?
What is the immune system?
What are antibodies?
What are T-cells?
What are CD-4 Cells?
What are the routes oftransmission ofHIV?
What is the Window Period?
Can HIV infect married men and women? Please explain.
How do they test for HIV?
What is meant by ‘viral load’in the context ofHIV/AIDS?
Ifyou have sex, what is the best protection against transmission ofHIV/AIDS?
How can the risk ofmother to child transmission HIV be reduced?
Can you tell by looking at someone ifthey have HIV?
How many people are living with HIV/AIDS around the world?
You can get HIV from sharing a toilet: True or false.
Can insects or mosquitoes transmit HIV?
What are Opportunistic Infections?
Is there a cure for AIDS?
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Handout 2.18
Frequently Asked Questions: Transmission of HIV and its Prevention
ease note that the information provided in this handout is very general. Information on HIV is
continua ly changing and it is important to make sure that the information you have is current,
particularly for new treatments or drug options, laws and policies, controversies and campaigns in a
region and country. If anyone in your group is working on these issues, ask them to give you the
information they have and use in their work. Add any other information you feel is important when
you make your presentation. If you have not been working regularly on these issues, find out what is
available in your state/country/region.
How is HIV transmitted?
There are four routes of transmission for HIV: 1) unprotected sex with an infected person; 2) infected
mother to child, either during pregnancy, delivery or through breastfeeding; 3) through contaminated
blood and blood products (including organ and tissue transplants); and 4) sharing of unsterilised,
used infected needles, syringes and other medical equipment like dentists instruments.
What are the conditions for transmission ofHIV through unprotected sex?
One person must be infected with HIV to pass it to another. Unprotected penetrative vaginal intercourse
is the most common route of HIV transmission, while anal sex - whedter male-to-male or male-tofemale - poses a higher risk for transmission. It is rare but possible to acquire HIV through oral sex,
particularly if the person has ulcers or sores inside their mouth. Kissing and other non-penetrative
sexual activities do not pose a risk for HIV transmission.
What can decrease the spread ofHIV through sex?
Presently condoms are the most effective method of HIV prevention through the sexual route. Correct
and consistent condom use significantly reduces the transmission of HIV. Treatment and prevention
of STIs can reduce the risk of HIV transmission. STIs not only increase a person’s susceptibility to
getting HIV they also increase an HIV positive person’s infectiousness making spread of the disease
more likely.
What are the conditions for transmission from mother to child?
An HIV positive mother can pass the virus to her child either during pregnancy, delivery, or through
breastfeeding. Most often a foetus is protected from infection while in the uterus, but the presence of
some STIs such as syphilis can increase the likelihood of infection. Transmission between mother and
child is most likely to occur during delivery when there is a higher chance of the baby’s blood coming
in contact with the mother’s blood. HIV is also present in breast milk; different studies have found
results ranging from a 5% to a 20% chance that the baby may become infected through breast milk.
When there is no healthy alternative to breastfeeding, infected mothers are encouraged to breastfeed
their children to prevent them from dying of malnutrition or water-borne diseases instead. The risks of
HIV infection through breastfeeding and the risk of death due to malnutrition need to be balanced
and carefully considered in such situations.
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What can reduce the risk for transmission ofHIV from mother to child?
The primary tool to prevent transmission from mother to child is the use of antiretroviral medicines
during pregnancy and delivery. This method, combined with access and utilization to safe delivery
practices, and counselling and support for infant feeding methods can significantly reduce transmission
of the virus between mothers and their infants. It is crucial for pregnant women to know if they are
HIV positive.
What are the conditions for transmission HIV through blood or blood products?
Injection drug use, blood transfusion, and needle sticks are the primary methods of transmitting HIV
through blood or blood products. Sharing injecting needles and/or syringes for drug use is an effective
way of transmitting HIV When infected blood is drawn into a needle via a syringe, and the same
needle is used by someone else, HIV is injected directly into his/ her blood.
A person who receives blood infected with HIV through a transfusion, organ or tissue transplants, can
also contract the virus. Needle stick injuries or blood splashes to the eyes or mouth that often takes
place in the healthcare setting subject people to a relatively low risk of infection.
WZiar can be done to prevent the transmission ofHIV through blood or bloodproducts?
Single-use and proper disposal of syringes and needles can drastically reduce the spread of HIV among
injecting drug users.
Strict criteria and testing of blood for transfusion and organ and tissue donation can help reduce the
risk of HIV transmission as can blood safety and precautionary guidelines in healthcare settings to
avoid low risk incidents.
Are there times when people with HIV are more able to transmit HIV ?
A person is more infectious when there is a greater viral load or concentration of the HIV virus in their
blood. There is a greater viral load in the body when a person first contracts HIY before the body has
had a chance to build a defence/create antibodies to the virus, and later during the progression of the
virus, when the immune system is weakened. A person with an STI is also more likely to transmit HIV
when they participate in unprotected sex, due to the higher concentration of HIV in their semen or
vaginal fluids, as well as other conditions that lead to higher infectivity.
Can a mosquito spread HIV?
Extensive research done on this issue has proved that mosquitoes do not transfer HIV HIV cannot
survive outside the human body for long.
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Handout 2.18
Frequently Asked Questions: Testing for HIV/AIDS
Please note that the information provided in this handout is very general. Information on HIV is
continually changing and it is important to make sure that the information you have is current,
particularly for new treatments or drug options, laws and policies, controversies and campaigns in a
region and country. If anyone in your group is working on these issues, ask them to give you the
information they have and use in their work. Add any other information you feel is important when
you make your presentation. If you have not been working regularly on these issues, find out what is
available in your state/country/region.
What happens when a person is first infected with HIV?
After a person has been infected with HIV the virus will begin to attack CD4 cells and multiply
rapidly in the body. During the first 2 to 8 weeks while the immune system is fighting back, a person
may feel like they have the flu. Within three months of infection the body’s immune system is able to
produce HIV antibodies to combat the virus. Most common HIV tests look for the presence of these
antibodies. It is only when these antibodies are present in the blood that a person tests positive for
HIV
How does someone find out if they have HIV?
The most common HIV tests look for the presence of HIV antibodies in a person’s blood or saliva. It
may take several days to get the results of some tests since they have to go to labs, while other ‘rapid
tests’ can provide results in 30 minutes. Common antibody tests include ELISA (Enzyme Linked
Immuno Sorbent Assay) and Western Blot (this is also used as a confirmatory test).
What is the window period?
HIV tests look for the presence of antibodies produced by the immune system when it comes in contact
with HIV It may take up to three months for the body to produce enough HIV antibodies to show up
in the test. This three-month period between the time of contracting the infection and when a person
tests positive on an HIV antibody test is known as the window period. During this time a person is
already infected and capable of spreading HIV to another individual.
What is a false negative test result?
If a person goes in for an antibody test in the window period - during which there are not enough
antibodies to HIV in the body to show up in the test - s/he may get a negative result. This is a false
negative result because although the person is infected, the test does not show this. It is therefore
recommended that if a person is unsure of their last unsafe exposure, a second test should be done after
another three months. During this time they should not expose themselves to any additional risk of
infection.
What are VCT clinics?
These are Voluntary Counselling and Testing clinics, intended to provide confidential counselling
and testing for HIV Many communities have set up these up to encourage people to get more
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information about HIV/AIDS, determine their HIV status and get treatment if necessary. They are
also called Voluntary Confidential Counselling and Testing (VCCTs) clinics in some countries.
How can a person find out ifa baby has HIV?
The most common HIV tests do not test for the virus itself but for the presence of HIV antibodies.
Since all infants carry their mother’s antibodies for the first several months of life, it is difficult to
determine if an infant born to an HIV positive mother has HIV All infants born from HIV positive
women will have HIV antibodies in their system for 9 to 18 months, so a test is recommended for such
infants at 9 months and then again at 18 months. All infants born to HIV positive mothers should
receive regular check-ups for up to 18 months, and their health and nutrition must be carefully monitored.
Preventative medicines may be necessary in some instances.
How does a person with HIV remain healthy?
It may take up to 8 or 10 years for a person with HIV to develop symptoms. During this time the virus
weakens the body’s immune system, but the body still has a strong enough defence against Opportunistic
Infections. An HIV positive person who is otherwise in good health - through healthy eating habits,
practice of safer sex, and the use of anti-retroviral treatment (ART) - can continue to lead a healthy life
for many years.
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Handout 2.18
Frequently Asked Questions about Treatment for HIV/AIDS
Please note that the information provided in this handout is very general. Information on HIV is
continually changing and it is important to make sure that the information you have is current,
particularly for new treatments or drug options, laws and policies, controversies and campaigns in a
region and country. If anyone in your group is working on these issues, ask them to give you the
information they have and use in their work. Add any other information you feel is important when
you make your presentation. If you have not been working regularly on these issues, find out what is
available in your state/country/region.
Is there a cure for HIV/AIDS?
There is no cure yet for HIV/AIDS nor any vaccine against HIV/AIDS.
Is there any treatment to help people living with HIV/AIDS?
There are three types of medicines people with HIV can take: (1) Preventative Medications, used to
prevent Opportunistic Infections. (2) Medicines to treat Opportunistic Infections. (3) Medicines used
to slow the progression of HIY known as antiretrovirals (ARVs).
What is Antiretroviral Treatment (ART)?
Antiretroviral treatment is medication people living with HIV/AIDS can take to slow down the
progression of the virus and reduce levels of HIV in the blood and need to be taken for the rest of a
person’s life. However this treatment will not remove HIV from the blood or act as a cure.
How do Antiretroviral (ARV) medications work?
HIV is a virus that spreads through the body by infecting healthy immune system cells and replicating
itself. These replicated cells then infect new healthy immune system cells. The ARTs available consist
of drugs that work in different ways to slow down the replication of the HIV virus. These drugs are
known as antiretrovirals, anti-HIV drugs, or HIV antiviral drugs.
What is HAART?
HAART stands for Highly Active Antiretroviral Therapy and refers to treatment with a combination
of three or more anti-FIIV drugs. It has been found that the reduction of the replication of HIV over a
long period of time is more effective if a person takes more that one type of antiretroviral drug at a time.
What are the different types ofantiretroviral drugs?
There are four classifications of antiretroviral drugs that work against HIV in different ways: 1)
Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs); 2) Non-Nucleoside Reverse
Transcriptase Inhibitors (NNRTIs); 3) Protease Inhibitors; and 4) Fusion or Entry Inhibitors.
Are there many ART drugs currently available?
There are a number of different antiretroviral drugs currently available around the world. The number
of ARVs and types available vary from country to country.
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Are there any side effects from antiretroviral treatments?
Yes, most of the drugs have side effects that include tiredness, abdominal pain, constipation, fevers,
headaches, nausea, seizures, and rashes among others.
What is a CD4 count and a viral load test and why is it important?
Since HIV mainly targets the CD4 cells in a body’s immune system, the CD4 count indicates how
many CD4 cells are healthy and consequently, how strong a person’s immune system is. Most people
without HIV have about 700 to 1000 CD4 cells. HIV infected people are considered to have ‘normal
CD4 counts if the number is above 500. A value below 200 could indicate that a person needs to go on
ARVs if not already on them.
Viral load is a measure of the active HIV found in a small sample of blood. The figure can range from
higher than 750,000, to less than 50 and the lower this figure, the better the health status of the person.
CD4 counts and viral load tests are used as health indicators for people with HIV They are used to
determine when to take certain medicines and to gauge how far HIV has progressed.
When do people begin ART?
There is debate about when antiretroviral treatment should begin. Some doctors and researchers argue
that it should be when the CD4 count is at a certain level (below 200), while others believe it can begin
with a CD4 count as high as 350. It is generally believed that the viral load should be measured in the
blood before starting treatment. When CD4 tests are unavailable, other guidelines for treatment can be
used which depend on stage of the infection and different infection symptoms. There are also personal
factors to be considered like the availability of money to consistently pay for treatments, ability to
continue without ARTs etc., and each individual must decide on the best approach to their management
of HIV before beginning treatment.
What are Opportunistic Infections?
HIV attacks the immune system making it harder for a person to fight off other infections. These
infections are called ‘Opportunistic Infections’ or OIs because they strike when the immune system is
weakened. Common OIs include Tuberculosis (TB), Pneumocystis Carinii Pneumonia (PCP),
Oropharyngeal Candidiasis (thrush), and Kaposi’s Sarcoma (a form of skin cancer). The CD4 count
is a good indicator of the OIs a person may contract, so it is important for HIV positive people to
monitor their CD4 counts. Based on this, their health care providers can guide them on which OIs to
anticipate and what can be done to prevent OIs.
Is there treatment for Opportunistic Infections?
Yes, there are drugs to treat many of the common Opportunistic Infections people with HIV/AIDS
acquire. Preventative medicines and improved access to treatment can help reduce these infections
and the progression of HIV The drugs used to treat Opportunistic Infections are also used by people
with the same infection who may not be HIV positive. For example a person with TB who is not HIV
positive will receive the same medication as an HIV positive person who has developed TB.
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Handout 2.18
Frequently Asked Questions about Care and Support for HIV/AIDS
Please note that the information provided in this handout is very general. Information on HIV is
continually changing and it is important to make sure that the information you have is current,
particularly for new treatments or drug options, laws and policies, controversies and campaigns in a
region and country. If anyone in your group is working on these issues, ask them to give you the
information they have and use in their work. Add any other information you feel is important when
you make your presentation. If you have not been working regularly on these issues, find out what is
available in your state/country/region.
Ifa person is HIVpositive, what should be done to protect their health?
Knowing one’s HIV status is a fundamental tool to protect a person’s health and the health of their
sexual partners and children. It is important to remember that a person can live a healthy, full life with
HIV if they take care of their health. This can be done by finding support networks to provide emotional
support, as well as information on medical treatment, nutrition and how to live a healthy life.
Is ARV treatment available to everyone?
In many developing countries, ARV therapy is unavailable in certain areas or too expensive for many
people. Other obstacles can limit access to treatment such as lack of adequate storage facilities (it is
necessary to keep some ARV drugs at colder temperatures), lack of clean drinking water (some ARVs
require drinking litres of clean drinking water); and lack of adequate health care facilities or workers
to supply doses of the ARVs in a timely manner necessary for adherence to the drugs (failure to stick to
an ARV regimen can result in drug resistance to some of the HIV strains). It is important to note,
however, that these factors are no excuse for the failure to provide treatment options for people in all
settings and areas.
Does good nutrition play a part in HIV/AIDS?
Yes, as HIV progresses in a person, weight loss typically occurs. HIV changes the way a body processes
food in two key ways. First HIV reduces the body’s ability to absorb nutrients. Secondly, people living
with HIV mainly lose muscle weight instead of fat. When the body of a person with HIV runs out of
energy rich foods, it uses the energy stored in muscles. Healthy people access fat for extra energy when
the food stores in their bodies are diminished. The shrinking of muscles goes unnoticed initially,
because the fat around the muscles is not lost. Muscles are made up of protein, and it is therefore
important that an HIV positive person eat protein rich foods.
Additionally, it is important to eat lots of carbohydrates since the body uses a lot of energy in its fight
against HIV Energy foods such as rice, bread, and potatoes and foods with fats and oils, provide what
is known as complex sugars to supply energy. If an HIV positive person does not eat enough energy
foods and protein-rich foods, they will lose important muscles and not fat. This is called wasting,
which weakens the body and makes it more difficult to combat disease.
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Does counsellingplay a part in HIV/AIDS care and support?
Counselling is considered very helpful in the care and support of persons living with HIV/AIDS, their
families, and the communities they live in. Counselling provides social and psychological support, an
has been shown to help people cope with being HIV positive and understanding what it means to ive
with HIV/AIDS. It also helps reduce the risk of transmission to others, and other decisions that may
affect the family and community when a person has AIDS or may be close to dying.
Sex workers/intravenous drug users/truck drivers are the main carriers ofthe HIV virus, and are the
main cause ofHIV: True or False?
False. It is not a particular group, but certain types of behaviour (for example unprotected anal sex with
person/s whose HIV status is not known) that puts a person at risk for HIV/AIDS. HIV can infect a sex
worker, truck driver, married woman in a monogamous relationship or a child receiving transfusion.
Is a person living with HIV/AIDS (PLWHA) just waiting to die?
No. PLWHAs are active members of society who may live life with some challenges, but should not be
seen as ‘patients’ or ‘sick’ persons.
Can HIV/AIDS affect married men and women?
"yes, being married does not protect a person from HIV/AIDS.
Can you tell by looking at someone if they have HIV?
No. It can take up to 8-10 years before someone with HIV begins to show symptoms. Also, the ‘symptoms’
that may appear are to do with Opportunistic Infections.
Do complementary medicines and ayurverdic treatments work to treat HIV/AIDS?
Some complementary treatment and ayurvedic medicines may be beneficial to people while others
may be ineffective. Some may even be harmful. It is important to recognize that alternative forms of
healing and treatment do exist, and that communities find these beneficial and appropriate. Traditional
ways of combating disease may often provide practical tools to assist a person with HIV to stay healthy.
However they should be seen as complementary tools and not replacements for ARVs.
What is palliative care?
Palliative care is given to a person nearing the end of life. It is meant to ease the pain people experience
when they are dying. Palliative care can consist of medicinal or physical therapies that make people
more comfortable, and emotional and/or spiritual support to seriously ill people and their loved ones as
they prepare for death.
How many people are living with HIV/AIDS around the world?
Approximately 40.3 million people are living with HIV/AIDS worldwide (2005). Check local figures
from National or State AIDS Control organisations in your region. Global figures can be obtained
from the UNAIDS website (www.unaids.org) or office in your region.
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SYMPTOMS
TREATMENT
PREVENTION
CONSEQUENCES IF UNTREATED
Bacterial Vaginosis
IBVI
A RTI in women caused by an
imbalance- or overgrowth of
certain bacteria in the vagina that
disrupts the normal bacterial
balance. Not passed from person
to person, but more common
among sexually active people.
Unusual vaginal discharge that is
grey in colour and has an
unpleasant smell, it appears
particularly after sex. Some may
feel itching around the vagina and/
or burning during urination while
some report no symptoms at all.
Antibiotics and vaginal creams.
Avoid scented soaps and douching
(washing or rinsing out the vagina
by forcing water or other mixtures
of fluids into the vaginal cavity);
using a condom may lower risk
because of the effect semen can
have on bacteria in the vagina;
keep the vulva dry and clean.
Increased risk for other
reproductive tract problems such
as pelvic inflammatory disease
(PIO); if a woman is pregnant BV
has been associated with
premature labour; increases
susceptibility to HIV and other
STIs.
Chancroid
A bacterial STI that is transmitted
through contact with sores on the
vagina, penis, rectum or anus.
Small blister or sores that turn into
painful ulcers on the genitals, anus,
mouth or lips and can bleed easily.
Antibiotic treatment.
Use a condom during oral, anal or
vaginal intercourse to reduce the
risk of transmission. Avoid sexual
intercourse or contact with the
sores until they are healed and fully
treated.
The sores can rupture and drain
pus, which can be very painful; can
increase risk for transmission of
HIV.
Chlamydia
A bacterial STI transmitted
through anal, oral or vaginal sex.
Could be asymptomatic in both
men and women. If symptoms
occur it is usually discharge from
the penis, swollen testicles or pain
during urination for men.
Symptoms in women: unusual
vaginal discharge, painful
urination, pelvic pain, or abnormal
bleeding during menses or after
sexual intercourse.
Antibiotic treatment. All sexual
contacts should be screened for
chlamydia.
Use a condom during oral, anal or
vaginal intercourse to reduce the
risk of transmission; sexual
partners should also be tested and
treated so as to avoid re-infection.
Women can develop PID, ectopic
(tubal) pregnancy or infertility,. If
pregnant, chlamydial infections
can lead to premature delivery and
the infant can develop infections
like conjunctivitis or pneumonia.
Men can develop sterility and
epidydimitis which is a painful
condition of the testicles that can
lead to infertility if left untreated.
- Chapter 4
TRANSMISSION
MODULE 2
RTIISTI NAME
: Basics and Beyond
Handout 2.19
Basic Information on Sexually Transmitted Infections (STIs) and Reproductive Tract Infections (RTIs)
RTI/STI NAME
SYMPTOMS
TREATMENT
PREVENTION
CONSEQUENCES IF UNTREATED
Cytomegalovirus
(CMVI
Viral infection that spreads through
bodily fluids (saliva, blood, tears,
breast milk, semen, urine);
commonly spread from a woman
to a fetus. Though not primarily
an STI, it can also spread through
close personal contact or vaginal,
anal and oral sex. Complications
with CMV occur more often in
people with compromised immune
systems (like those with HIV, on
chemotherapy).
In healthy adults usually
asymptomatic but can transmit
the infection to others. Some
symptoms can manifest in swollen
glands, fatigue, or fever.
Once someone is infected, the
virus remains in the body for life,
but most of the time it remains
dormant. There is no cure. There
are some medications being
tested and vaccines being
developed to prevent CMV.
No direct intervention to prevent
CMV. Using a condom can help
reduce risk of transmission during
sex, but it can also be acquired
through saliva, kissing or oral sex.
Infants infected just before or after
birth can transmit the disease to
others, so proper hand washing
and diaper changing can reduce
risk.
Complications and serious
infections such as eye infections
can develop mainly with people
who are immuno-suppressed, such
as those on chemotherapy or with
HIV. Babies born with CMV can
develop serious infections or
develop blindness, deafness or
epilepsy. Often there are no long
term health consequences for
healthy adults.
Donovanosis
A bacterial STI. Found mainly in
tropical regions, like parts of South
India.
Reddish ulcers near genitals that
can bleed on contact.
Antibiotic treatment
Use a condom during oral, anal or
vaginal intercourse. Avoid sexual
contact when there are visible
sores.
Ulcers can grow together and
result in permanent scarring and
depigmentation of the genitals.
Genital Herpes
A viral STI caused by the herpes
simplex virus (HSV). There are two
subtypes: HSV-1 and HSV-2.
Herpes spreads through skin
contact with an infected individual.
The virus can be spread through
contact with blisters and sores
during an outbreak as well as
when there are symptoms.
Can be asymptomatic although
infected people can still transmit
the virus. For those with
symptoms, they include painful
blisters or sores on the genitals,
around the buttocks or thighs, or
mouth; fever, swollen glands.
There is no cure. People can
experience outbreaks of sores
that will vary in severity and
frequency from one person to
another. Symptoms can be
treated with oral or topical
medications.
Use a condom during oral, anal or
vaginal intercourse. Avoid
intercourse when one partner is
having an outbreak of sores.
Recurrent outbreaks. 1st time
infection during pregnancy can put
the woman at risk of miscarriage/
preterm labour. If 1st episode
occurs during delivery, there is risk
of herpes transmission to the baby.
In some cases, contact with sores
can lead to damage to the baby's
nervous system. People with low
immunity may suffer infections of
various organs including kidneys,
eyes, brain etc.
TARSHI : Basics and Beyond
TRANSMISSION
MODULE 2 - Chapter 4
3
SYMPTOMS
TREATMENT
PREVENTION
CONSEQUENCES IF UNTREATED
Bacterial STI that can infect the
vagina, penis, cervix, urethra, anus
or throat. It is spread through oral,
vaginal or anal sex.
If symptoms do occur they can
include unusual discharge from the
penis/vagina, pain when urinating,
painful bowel movements.
Antibiotic treatment.
Use a condom during oral, anal or
vaginal intercourse.
Increased risk of contracting HIV.In
women; PID, increased risk for
ectopic pregnancy, infertility and
chronic pelvic pain. If a woman is
pregnant it can cause spontaneous
abortion, pre-term delivery, and
blood or eye infections in the baby.
In men: epididymitis which is a
painful condition of the testicles
that can lead to infertility if left
untreated.
Hepatitis B-HBV
Transmitted though the exchange
of blood or other body fluids
including semen and vaginal fluids,
sharing needles and from infected
mother to child. Not transmitted
through kissing, breastfeeding, or
sharing eating utensils.
Yellow skin and eyes, dark urine,
severe tiredness, weight loss,
abdominal pain, loss of appetite,
nausea and vomiting.
There is a vaccine to protect
against HBV. There is no cure for
HBV. Often in healthy people it
will go away on its own in 4-8
weeks. A small percentage of
people will develop chronic HBV.
Symptoms can be treated with
medications.
Vaccination against Hepatitis B. If
infected do not donate blood.
Using a condom can reduce the
risk of transmission; also test blood
before transfusion, use disposable
syringes, find out about
immunization for mother to child
transmission.
Chronic hepatitis, liver cancer,
cirrhosis. If a woman is pregnant
Hepatitis B can be transmitted to
the foetus.
Hepatitis C-HCV
Contracted through unprotected
vaginal, penile or anal sex with
infected person, sharing infected
needles, contact with infected
blood, blood transfusions of
infected blood etc.
Yellowing of the eyes and skin,
headaches, muscle aches, dark
urine, tiredness, loss of appetite,
nausea and vomiting, generalised
itching.
There is no cure. Many people
infected with HCV become
chronic carriers. Medications and
treatments can help with
symptoms.
If infected do not donate blood,
organs, sperms, tissues. Use a
condom during oral, anal or vaginal
intercourse. Avoid sharing
needles.
Chronic hepatitis C; cirrhosis of the
liver, cancer of the liver. There is
a low risk of a pregnant woman
transmitting HCV during
pregnancy or birth.
MODULE 2
TRANSMISSION
Gonorrhoea
TARSHI: Basics and Beyond
RTI/STI NAME
TRANSMISSION
SYMPTOMS
TREATMENT
PREVENTION
CONSEQUENCES IF UNTREATED
There are four routes of
transmission for HIV-1)
unprotected sex with an infected
person; 2) infected mother to child,
either during pregnancy, during
delivery or through breastfeeding;
3| through contaminated blood
and blood products (including
organ donation and tissue
transplants); and 4) sharing/use of
unsterilised infected needles,
syringes and other medical
equipment like dentists'
instruments.
People may have no symptoms
while infected, however early
symptoms can include: rapid
weight loss over a month, swollen
glands, fatigue, skin blotches,
persistent fever, diarrhoea for
several weeks, thrush on the
tongue, persistent yeast
infections.As the infection
progresses, the immune system is
affected and the person may
experience
Opportunistic
Infections.
There is no cure. However, there
are medications that slow down
the spread of the virus and treat
common/
Opportunistic
infections that are caused by the
virus.
Correct and consistent condom use
are presently the most effective
method of significantly reducing
risk of transmission of HIV through
the sexual route. Treatment and
prevention of STIs can reduce the
risk of HIV transmission. STIs not
only increase a person's
susceptibility to getting HIV, they
also increase an HIV positive
person's infectiousness making it
more likely for them to spread the
infection.
HIV causes AIDS (Acquired
Immunodeficiency syndrome!.
AIDS is said to have occurred
when HIV has damaged the
immune system, leaving a person's
body vulnerable to infection and
disease. Please see Handouts 2.16
and 2.18 for detailed information.
HPV (Human
Papilloma Virus] &
Genital Warts
An STI caused by HPV. There are
over 70 types of HPV. Some types
may cause genital warts. These
are called low-risk types of HPV.
It is very common among people
who are sexually active. When
HPV infects the genital area, it
affects the the vulva, vagina,
cervix, rectum, anus, penis, or
scrotum. Some types may cause
cell changes that sometimes lead
to cervical and other cancers.
These are called high-risk types of
HPV. Most types of HPV seem to
have no harmful effects at all.
Genital warts are small, flesh
coloured and look like small
cauliflower florets on the genitals,
anus, and in some cases in the
mouth and/or throat. These warts
can be itchy and grow in clusters.
Many other forms of HPV can be
asymptomatic. Cell changes of
high-risk HPV strains can be
detected through Pap tests for
women.
Genital warts are oftentimes
curable, with freezing chemical
agents applied to the sores,
lasers to burn them off, or
surgery. Many forms of HPV
have no known cure or will go
away on their own. Pap tests
can detect pre-cancerous cell
changes in women.
Using a condom during oral,
anal, or vaginal intercourse can
reduce the risk of transmission.
Often many forms of HPV can be
transmitted through skin-to-skin
contact as well. Regular Pap
tests for women to check for
cellular changes in the cervix
helps identify and check the
infection in time. A vaccine to
prevent high risk HPV have been
developed and should be in the
market soon.
Genital warts if untreated can
disappear, stay the same, or grow
in size and in number. They can
cause sores and bleeding - which
can increase the risk of HIV
infection. Some forms of HPV have
links to cervical and other cancers.
TARSHI: Basics and Beyond
RTI/STI NAME
HIV-IHuman
Immunodeficiency
Virus)
SYMPTOMS
TREATMENT
PREVENTION
CONSEQUENCES IF UNTREATED
lymphogranuloma
Venereum ILGVI
Caused by a specific type of
chlamydial bacteria strain.
Transmitted through anal, oral or
vaginal sex.
Small, painless genital ulcers that
can develop between 3 to 30 days
after exposure; swelling of the
lymph nodes in the groin;
inflammation or bleeding of the
rectum.
Antibiotic treatment.
Using a condom during oral, anal
or vaginal intercourse can reduce
the risk of transmission.
Fistulas (an opening between the
rectum and the vagina), scarring
and narrowing of the rectum,
enlargement of the genitals. Can
increase the risk of HIV
transmission.
Molluscum
Contagiosum
Contracted by skin-to-skin contact.
Not necessarily through sexual
contact. In adults usually
transmitted through sexual
intercourse. Can also be trans
mitted through sharing of towels
or clothing that come into contact
with the lesions.
Small, smooth hard bumps with
a white dimpled centre that is
painless and usually around the
groin, thighs or lower abdomen,
or anywhere in the body.
Often the bumps heal and
disappear without treatment.
The bumps can also be scraped
off or treated with a topical
ointment.
Using a condom during oral, anal
or vaginal intercourse can reduce
the risk of transmission. Avoid use
of clothes or towels of infected
person.
Infection of the sores and
spreading if untreated.
Pubic Lice
Transmitted by close body contact
with an infected person. It can also
spread through sharing of bedding,
clothing or towels.
Itching in the genital area or anus,
visible tiny white eggs (nits) on
pubic hair, mild fever.
Medications and topical lotions
can eliminate the lice. Clean and
change all clothing and linens
that were in contact with
affected areas.
Every person who was in close
contact with the infected person
(family, friends, sexual partners)
should be treated.
There are rarely complications.
Scratching may make the skin raw
and increase risk of secondary
infection.
Scabies
A small mite that goes under a
persons' skin. It is spread through
prolonged skin to skin (including
sexual contactl contact with an
infected person. It can also spread
through sharing of bedding,
clothing or towels.
Sever itchiness in areas that the
mites have burrowed to lay eggs
seen as small bumps or rashes
usually around the genitals,
breasts, webs of the hands, thighs,
elbows and lower adomen.
Medications and topical lotions
can eliminate the scabies. Clean
and change all clothing and linens
that were in contact with
affected areas.
All those in close contact with the
infected person (family, friends,
sexual partners) should be treated.
There are rarely complications.
_____________
MODULE 2 -
TRANSMISSION
TARSHI : Basics and Beyond
RTI/STI NAME
”
RTI/STI NAME
TRANSMISSION
SYMPTOMS
TREATMENT
PREVENTION
CONSEQUENCES IF UNTREATED
Syphilis
A bacterial STI that is transmitted
through direct contact with sores
that the infection produces on the
vagina, penis, rectum, anus, lips
or mouth.
There are 3 stages of syphilis:
primary stage symptoms include
a painless ulcer on genitals, anus
or mouth; secondary stage
symptoms include skin rashes,
headaches, weight loss, hair loss,
malaise, and muscle aches.
Tertiary stage has no symptoms
but the infection remains in the
body. It may damage the internal
organs, including the brain, nerves,
eyes, heart, blood vessels, liver,
bones, and joints.
Antibiotic treatment. Easy to
treat in the early stages of the
infection.
Avoid sexual intercourse until the
sores are healed and fully treated.
Using a condom can reduce the
risk during anal, oral or vaginal sex.
However syphilis can still be
transmitted if the condom does
not cover the sores.
Increased risk of HIV transmission.
Complications of the nervous
system and cardiovascular system
such as heart disease. If a woman
is pregnant it can cause
spontaneous abortion, and if
passed to the foetus, the infant can
be born with damage to the brain
or heart, as well as develop
anaemia, swollen liver, fevers and
rashes.
Trichomoniasis
An STI transmitted through a
parasite and more common in
women. Transmission through
penile-vaginal intercourse or vulvato-vulva contact with an infected
partner.
Often asymptomatic but if
symptoms do occur, they are
unusual discharge, painful
urination, itching and burning in
the genitals.
Topical and oral medications can
treat and cure.
Using a condom during oral, anal
or vaginal intercourse can reduce
the risk of transmission.
In pregnant women can cause
premature labour and low birth
weight. May increase the risk of
HIV susceptibility.
Vaginal yeast
infection
(candidiasis, Candida
moniliasis!
An RTI that is caused by an
overgrowth of yeast naturally
found in the body. Occurs when
the usual environment in the
vagina changes. Often the reasons
are unknown but can be from
antibiotic use, associated with
diabetes or problems affecting the
immune system.
White clumpy vaginal discharge
that can also have an odour;
redness or burning in the genital
area; itchiness in the internal or
external genitals; vaginal pain
during intercourse; burning
urination.
Topical creams and vaginal
suppositories (medication
inserted into the vagina where
it melts) can cure the infection.
No complications are known
except for severe discomfort from
serious infections.
Avoid sexual intercourse until
treatment is completed. Avoid
scented soaps, synthetic
underwear, and douches (washing
or rinsing out the vagina by forcing
water or other mixtures of fluids
into the vaginal cavity!.
Cranberry juice and yogurt are two
foods that may help prevent the
occurrence of yeast infections and
aid in their treatment.
1
TARSHI: Basics and Beyond
MODULE 2 - Chapter 4
Handout 2.20 Facilitator Copy:
STIs and RTIs Quiz
What are RTIs?
RTI stands for Reproductive Tract Infection. RTIs refer to infections that affect the reproductive tract.
RTIs are caused by an overgrowth of organisms that are normally present in the vagina or when bacteria
or micro-organisms are introduced into the reproductive tract during sexual contact or through medical
procedures.
What are the types of RTIs ?
Three types of RTIs exist: sexually transmitted, endogenous, and iatrogenic. These often overlap in
the ways in which they are transmitted. Endogenous infections occur from an overgrowth of organisms
that are normally found in the reproductive tract. Iatrogenic infections occur when an outside
intervention (usually medical, such as insertion of an IUD or use of unsterilised equipment) introduces
bacteria or micro-organisms into the reproductive tract or pushes an infection that is already present in
the vagina into the upper genital tract. Sexually transmitted RTIs are transmitted through sexual contact.
What are STIs?
STI stands for Sexually Transmitted Infection. STIs refer to infections that are transmitted through
sexual contact.
Are STIs the same as RTIs?
No, some STIs can be RTIs, but not always. Similarly, some RTIs are also STIs but not always. In
many cases, STIs have more serious health consequences.
Name two Sexually Transmitted Infections (STIs):
There are a number of STIs that include Chlamydia, Gonorrhoea, Herpes, Trichomoniasis, and
Chancroids. Please see Handout 2.19 for a full list of possible STIs.
Are most STIs curable?
Yes, many STIs are curable using antibiotics.
Is HIV/AIDS an STI?
Yes HIV/AIDS is also considered an STI because transmissions can occur through the sexual route.
Is there a relationship between STIs and HIV transmission?
"Ves. A person with an STI has an increased risk of acquiring HIV as well as an increased risk of
transmitting HIV
How can the risk of most STI transmission be reduced?
A person can reduce the risk of STI transmission by using a condom during sex; getting screened and
tested for STIs (both if symptoms do and do not exist since many STIs can be asymptomatic); and
getting treatment for themselves and their partner/s. It is important to abstain from sexual contact
during the course of treatment and during outbreaks of some STIs such as herpes.
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TARSHI: Basics and Beyond
MODULE 2 - Chapter 4
What are two common symptoms for many STIs?
An unusual discharge, pain during urination, ulcers or sores around the genitals and skin irritations
are the symptoms of an STI. For additional symptoms please see Handout 2.19.
What does an asymptomatic STI mean?
Asymptomatic means that most people will not have symptoms if they have the STI. For example,
nearly 70% of women who have chlamydia or gonorrhoea are asymptomatic. Because people feel fine
and have no symptoms of infection, they may delay getting tested and subsequently treated for the
STI.
If a woman is pregnant an STI can cause complications: True or false?
True. If a woman is pregnant, certain STIs can cause her to go into pre-term delivery or the baby can
develop adverse health conditions such as conjunctivitis, brain damage or even death.
If untreated, what are some of the consequences of an STI?
Infertility, pelvic inflammatory disease in women, some cancers, epididymitis, and ectopic pregnancy
are some consequences. For more please see Handout 2.19.
How many new STI cases are reported each year?
According to estimates from 1999, the WHO reported 340 million new cases of curable STIs worldwide
between people of age 15-49.
Which area of the world had the highest number of new infections?
South and Southeast Asia had the largest number of new infections worldwide among people between
the ages of 15-49.
Once cured of an STI, you cannot contract it again: True or False?
False. Even if you have been treated and cured of an STI, you can contract this or any other STI again.
How can a person find out if they have an STI or RTI?
By getting tested by a health care provider. It is important to get screened and tested for STIs even if
symptoms are not present.
People who have STIs are promiscuous and lack good morals: True or false?
False. A person can get an STI from a regular sexual partner, from two partners or from twenty. The
‘moral correctness’ of a person’s life and choices should not be judged by anyone.
238
TARSHI: Basics and Bevond
MODULE2-Chapter4
Handout 2.21 Participant Copy:
STIs and RTIs Quiz
■ What are RTIs?
' What are the types of RTIs?
• What are STIs?
' Are all STIs RTIs?
• Name two Sexually Transmitted Infections (STIs):
■ Are most STIs curable?
• Is HIV/AIDS an STI?
• Is there a relationship between STIs and the transmission of HIV?
• How can the risk of most STI transmission be reduced?
■ What are two common symptoms of many STIs?
• What does an asymptomatic STI mean?
• If a woman is pregnant an STI can cause complications: True or false?
• What are some of the consequences of an untreated STI?
• How many new cases of STI are reported each year?
• Which area of the world had the highest number of new infections?
• If you have been cured from an STI you cannot contract this again: True or false?
• How can a person find out if they have an STI or RTI?
■ People who have STIs are promiscuous and lack good morals: True or false?
239
TARSHI: Basics and Beyond
MODULE 2 - Chapter 4
Handout 2.22 Facilitator Copy:
Talking About STIs and RTIs
Case Study1
Akash has been seeing Shruti for many years. They are unmarried but have been having sex since they
started dating. Recently Akash has been experiencing pain when he urinates. He is not sure why this
is happening, but thinks it may have some connection to his pants being too tight. He has never
experienced these symptoms before.
Questions:
■ If Akash approached you, what would you say to him?
• What would you recommend he do?
• Are there services in your community that Akash could use? Are they accessible? Would he be
comfortable going to these facilities?
• Would your reaction be different if Akash was below 18 years of age and approached you?
Case Study 2
Sunita started taking birth control pills a few months ago so that she and her husband can have sex
without a condom. They find sex more comfortable and pleasurable without a condom. Right before
her period, however, she developed an unusual discharge. She wonders if this is from the birth control
pills or something else.
Questions:
■ If Sunita approached you with this problem what would you tell her?
• What would you recommend she do?
• Are there services in your community that Sunita could use? Are they accessible? Would she be
comfortable going to these facilities?
■ Would your reaction be different if Sunita was below 18 years of age and approached you?
Case Study 3
Gautam is in a monogamous relationship with his lover. A few months ago they began to have sex
without a condom or other protection. Within a few weeks he developed a sore on his mouth which
went away after a week or so. Gautam forgot about the sore, but a few months later he developed a
fever and rash and began to get worried. He didn’t connect the two illnesses, but his partner is concerned.
Questions:
■ If Gautam approached you, what would you tell him?
• What would you recommend he do?
• Are there services in your community that Gautam could use? Are they accessible? Would he be
comfortable going to these facilities?
• Would your reaction be different if Gautam was below 18 years of age and approached you?
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TARSHI: Basics and Beyond
MODULE 2 - Chapter 4
Case Study 4
Twinkle usually uses protection when she has sex, but the other day she spotted some fluid-filled blisters
on her genitals and wonders if she has contracted some infection from one of her sexual partners.
Questions:
If Twinkle approached you what would you tell her?
What would you recommend she do?
Are there services in your community that Twinkle could use? Are they accessible? Would she be
comfortable going to these facilities?
• Would your reaction be different if Twinkle was below 18 years of age and approached you?
Case Study 5
Rita makes an annual trip to the doctor to get a physical examination. She has a Pap smear as a part of
this visit. Her most recent Pap test shows an abnormal result. She is upset and worried and does not
know what to tell her boyfriend.
Questions:
■ If Rita approached you what would you tell her?
• What would you recommend she do?
• Are there services in your community that Rita could use? Are they accessible? Would she comfortable
going to these facilities?
• Would your reaction be different if Rita was below 18 years of age and approached you?
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1
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1
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MODULE 2 - Chapter 4
TARSH1 : Basics and Beyond
Handout 2.23 Participant Copy:
Talking About STIs and RTIs
Case StudyI
Akash has been seeing Shruti for many years. They are unmarried but have been having sex since they
started dating. Recently Akash has been experiencing pain when he urinates. He is not sure why this
is happening, but thinks it may have some connection to his pants being too tight. He has never
experienced these symptoms before.
Case Study 2
Sunita started taking birth control pills a few months ago so that she and her husband can have sex
without a condom. They find sex more comfortable and pleasurable without a condom. Right before
her period, however, she developed a strange discharge. She wonders if this is from the birth control
pills or something else.
Case Study 3
Gautam is in a monogamous relationship with his lover. A few months ago they began to have sex
without a condom or other protection. Within a few weeks he developed a sore on his mouth, which
went away after a week or so. Gautam forgot about the sore, but a few months later he developed a
fever and rash and began to get worried. He didn’t connect the two illnesses, but his partner is concerned.
Case Study 4
Twinkle usually uses protection when she has sex, but the other day she spotted some fluid-filled
blisters on her genitals and wonders if she has contracted some infection from one of her sexual partners.
Case Study 5
Rita makes an annual trip to the doctor to get a physical examination. She has a Pap smear as a part of
this visit. Her most recent Pap test shows an abnormal result. She is upset and worried and does not
know what to tell her boyfriend.
242
MODULE 2 - Chapter 5
Chapter 5
Sexual Problems
Chapter Objectives for the Facilitator
1.
To have participants identify the different sexual problems
that people may face and the possible causes for these
problems.
2.
To dispel myths associated with sexual problems that exist
among participants and their communities.
3.
To have participants understand how to talk about sexual
problems with partners and their community.
TARSHI :■ Basics and Beyond
MODULE 2 - Chapter 5
Why a Chapter on Sexual Problems
Sexuality is much more than acts of sex. It has many components:
beliefs, attitudes, behaviours, and identities. Yet sex and sexual
activity are a part of one’s sexuality, and the physical act of sex is
comprised of a complicated set of physiological processes that occur
within thinking, feeling people. Considering this complexity makes
it easier to appreciate that sexual problems occur frequently. In
most cases, solutions to these problems exist. What makes arriving
at these solutions difficult is that talking about sexual problems whether impotence or painful intercourse - is difficult and
embarrassing for most people.
Furthermore, the focus on solutions to sexual problems and what
is often termed ‘sexual dysfunction’ has been to address physical
and physiological factors. This approach ignores important factors
beyond the physical that contribute to sexual problems. These
can include psychosocial factors like relationships, gender, religion,
ethnicity, and social environment. For instance, women often lack
the language or space to express what they enjoy sexually and what
practices they find painful - both of which can lead to sexual
problems. Poor health care services, lack of education on sexual
and reproductive anatomy and physiology can also play a part in
sexual problems.
In some instances, changes in sexual responses and needs can be
mistaken for sexual problems. For example, occasional erectile
difficulty or painful intercourse may not always signify a sexual
problem. For those with problems, however, it is vital to keep
communication open and have information and services available.
Communication helps dispel myths and misconceptions, which
prevent an easy resolution to many sexual problems. For example,
it is falsely believed that the ‘cure’ for all sexual problems is only
through medication. Those in the business of ‘curing’ sexual
problems also often assume that everyone experiences pleasure only
in penile-vaginal intercourse, which excludes and invalidates other
sexually pleasurable experiences.
This chapter explores what constitutes a sexual problem and
examines how these may stem from social and cultural
EXERCISES IN THIS CHAPTER
Exercise 1: Demystifying Sexual
Problems
45 minutes
Exercise 2: Medical Solutions, the
Only Answer?
60 minutes
Exercise 3: My Views on Sexual
Problems
60 minutes
Exercise 4: Case Studies on Sexual
Problems
60 minutes
MATERIALS REQUIRED FOR THIS
CHAPTER:
Flipchart
Markers
Pens/pencils
TARSHI : Basics and Beyond
MODULE 2 - Chapter 5
HANDOUTS REQUIRED FOR THIS
CHAPTER:
Handout 2.24
Basic Information on Sexual
Problems
Handout 2.25
Facilitator Copy: Myths and Facts on
Sexual Problems
Handout 2.26
Participant Copy: Myths and Facts
on Sexual Problems
Handout 2.27
A New View of Women's Sexual
Problems
Handout 2.28
Case Studies on Sexual Problems
ADDITIONAL RESOURCES:
• A New View of Women's Sexual
Problems, http://www.fsdalert.org
• HERA Action Sheets. Available at:
http://www.iwhc.org/docUploads/
HERAActionSheets.PDF
■ Masters, W.H., Johnson, V.E.
1966. Human Sexual Response.
Boston: Little, Brown.
• For selected films see, http://
www.asiasrc.org/films.php and
Appendix B.
environments. It also looks at current trends to medicalise sexuality
- whether by Western science or indigenous therapies - and how
these may harm rather than resolve the sexual concerns of people.
Finally, the chapter explores the connections between sexual
problems and pleasure, infertility, and sexual health.
Key Messages for this Chapter
■ Most information that people have about sexual problems is
incomplete or inaccurate. It is important to dispel these myths
and misconceptions.
• Sexual problems can be very common and discussing them need
not cause shame or discomfort.
• Shame, embarrassment and fear around sexual problems drives
people to seek help through clandestine practitioners who take
advantage of situations by prescribing expensive, ineffective or
even harmful infusions, oils, potions or powders.
• In heterosexual relationships, the reasons for sexual problems
can be found in the man, the woman or in both. Assumptions
based on prevailing ideas in society, that blame one or the other
are inaccurate and harmful. It is also possible that the problem
is not because anything is ‘wrong’ with either partner but because
of other factors such as unresolved relationship issues or past
experiences of abuse.
• Some common sexual problems include early ejaculation,
erection problems in men, painful intercourse and an inability
to experience orgasm in women.
TARSHI: Basics and Beyond
MODULE 2 - Chapter 5
Exercise 1
Demystifying Sexual Problems
Instructions
1.
2.
Distribute copies of Handout 2.26 to participants. Give them
5-10 minutes to read over the statements and write down whether
each statement is a myth or a fact.
Review each statement separately by inviting participants to
answer whether they thought it is a myth or a fact. After each
statement ask for questions or comments and make sure to
include the points mentioned in Handout 2.25.
Suggested Questions:
MYTH AND FACTS
Purpose of the
exercise:
1. To dispel myths and
misconceptions about
sexual problems.
2. To identify facts about
sexual conditions and
problems.
■ If you thought the statement was a myth/fact are there people in
your communities, social networks that think differently?
■ How could you dispel misconceptions about this statement? For
example, it is a myth that a woman is ‘frigid’ if she has pain
during sex. What can be done to dispel this myth and promote
better understanding of women’s sexuality?
TIME
< 45 minutes
MATERIALS
3.
After reviewing all the statements ask for questions or comments. i Handout 2.25 Facilitator Copy:
, Myths and Facts on Sexual
Suggested Questions:
■ Are there any additional ideas about sexual problems that you
want clarity on?
■ How do you think these myths affect women and men
differendy? (For example if a woman cannot have an orgasm is
it accepted as usual/common? Whereas if a man cannot have an
orgasm it is thought of as a problem)
' Problems, Handout 2.26 Participant
: Copy: Myths and Facts on Sexual
I Problems, pens/pencils
ADVANCE PREPARATION
; Review Handout 2.25; Make copies
| of Handout 2.26 for each participant.
L_____________
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MODULE 2 - Chapter 5
THIS EXERCISE CAN BE MODIFIED
Key Messages
BY:
■ Dividing participants into groups
to discuss the statements, rather
than asking them to fill out the
handout individually. This may
help ease discomfort since people
may find it easier to broach the
issue in a small group rather than
with all participants. After the
groups have discussed all the
statements, bring them back
together and invite participants to
share the statements they thought
were myths.
• Many ideas and a lot of the information about sexual problems
may be false. It is important to understand the basis of sexual
problems and work to dispel myths around these.
• Sexual problems can be very common and need not be a cause
of shame or discomfort.
• Not all sexual problems need medical interventions. However,
medical examination may be needed on occasion to diagnose
the cause of some sexual problems.
• In any relationship, the reasons for sexual problems can be found
in either or both partners and/or caused by factors in their
relationship. Assuming that the problem is because of a particular
partner is unfair and does not help to resolve the problem.
MAKING CONNECTIONS:
TIPS FOR THE FACILITATOR:
• Sexual problems can sometimes
affect sexual pleasure. This does
not mean that an individual is
incapable of experiencing sexual
pleasure, but may mean trying
different or new sexual behaviours
or talking about the issue with the
partner/s. For more see Chapter 4
in Module 1.
■ Discussing sexual problems may be uncomfortable for some participants.
Encourage participants to speak openly and freely and reiterate that there is
no need for shame or discomfort when discussing these issues.
• Participants may make jokes or laugh during this exercise. If necessary go
over the ground rules for the training and emphasise respect for others.
• Knowledge of sexual and
reproductive anatomy may help in
understanding sexual problems.
For more see Chapter 1 in this
Module.
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MODULE 2 - Chapter 5
Exercise 2
Medical Solutions: The Only Answer?
Instructions
1.
2.
Divide the participants into four groups. Distribute copies of
Handout 2.24 and Handout 2.27 to each participant. Assign each
group to one of the Women’s Sexual Problems sections in
Handout 2.27 (for example one group will be assigned ‘I. Sexual
Problems due to Socio-Cultural, Political, or Economic Factors’,
another group will be assigned ‘II. Sexual Problems Relating to
Partner and Relationship’ etc.). Each group should read the
handouts and create a 5-minute ‘lesson’ to be presented to the
entire group. This lesson should provide the rest of the group
with a solid understanding of the causes of sexual problems
assigned to them. Encourage groups to be creative - using
flipcharts, drawing diagrams, acting out a role-play etc. For
example a group could do a role-play of a patient going to the
doctor and learning about a problem and any available
treatments or reasons for its occurrence. They can use examples
of different sexual problems listed in Handout 2.24. Give
participants 25-30 minutes to create the presentations.
1. To learn the specific
names, descriptions and
causes of each sexual
problem.
2. To comfortably discuss
sexual problems.
TIME
60 minutes
MATERIALS
Flipchart, pens/pencils, markers
Handout 2.24 Basic Information on
Sexual Problems, Handout 2.27 A
New View of Women's Sexual
Problems.
Suggested Questions:
ADVANCE PREPARATION
■ What do you think of issues and causes of sexual problems the
group presented? Had you heard of these sexual problems
before?
After all the presentations, have the group discuss what they
have learned.
Suggested Questions:
■ Why do we talk about sexual problems as medical issues only?
Does it make it easier for us to talk about the subject?
248
Purpose of the
exercise:
Bring participants back together and invite groups to make their
presentations one by one. After each presentation, add any
information that has been left out by the group or correct any
misinformation. Following each presentation ask for questions
and comments.
■ Was there anything in the presentation you did not understand?
3.
TEACHING THE CLASS
Make copies and review Handouts
2.24 and Handout 2.27.
TARSHI: Basics and Beyond
THIS EXERCISE CAN BE MODIFIED
BY:
MODULE 2 - Chapter 5
• What are the drawbacks of making sexual problems a medical
issue? Do other factors contributing to sexual problems get
ignored? Give examples.
■ Asking participants to convey
some common myths about
sexual problems and dispel them
in their presentation.
• What are the dangers of medicalising sex and pleasure? For
example, is there any danger to thinking a pill will cure all
problems when having sex?
■ Distributing Handout 2.27 to each
participant, giving them 5 minutes
to read through it and clarifying
any questions they may have.
Then participants can be asked a
series of questions about the
handout. For example: 'Name 3
types of sexual problems'. 'If you
had a partner/ knew someone
that was experiencing one of
these problems how would you
react?'
Key Messages
• Even though Handout 121 focuses on women’s sexual problems,
men may also face problems due to similar reasons. Men often
stay silent about their sexual problems because socio-cultural
ideas of masculinity expect them to be invulnerable and imply
that they are weak if they seek help for sexual problems.
• The reason for using a manifesto on women’s sexual problems
is to highlight the specific problems faced by women in inornate
situations. These issues are not focused on/neglected by the
medical community and/or by society.
• Sexual problems are quite common and do not need to be a
cause of shame. People need to feel more comfortable and free
of stigma while discussing their sexual problems.
MAKING CONNECTIONS:
• Gender roles for men and
women can influence the stigma
and silence around sexual
problems. For more see
Chapters 1 and 2 in Module 1.
■ A sexual problem does not mean
that a person has diminished
sexuality. For more see Chapter 1
in Module 1.
TIPS FOR THE FACILITATOR:
■ Participants may be shy discussing this topic and may want to simply read out
the information from the handout during their presentation. Encourage them
to be creative and to help increase their comfort with the topic.
• It may be helpful to write the sexual problems from Handout 2.24 on a flipchart
prior to the exercise and describe them briefly before the presentations.
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Exercise 3
My Views on Sexual Problems
Instructions
Ask participants to stand in one line across the room. Designate
one end of the line as Strongly Agree and the opposite end of the
line as Strongly Disagree.
1.
Read out 3-6 statements from the list of statements below. After
each, ask participants to put themselves on the line based on
whether they strongly agree, strongly disagree or fall somewhere
in between.
2.
Statements on Sexual Problems:
■ It is okay to take medication to help improve a sexual problem
like impotence.
OPINIONS CONTINUUM
Purpose of the
exercise:
1. To examine the various
opinions and ideas about
sexual problems among
participants.
2. To discuss the
relationship between
sexual problems, society
and culture.
■ It is okay to use pleasure enhancing sprays and creams to prolong
an erection during sex.
• There is too much talk about sexual problems in the media.
TIME
• Women’s sexual problems are related to emotion and feelings
while those of men are a result of physical problems.
■ It is better to just keep trying to have sex rather than seeking a
doctor’s help with a sexual problem.
60 minutes
MATERIALS
None
• The most important part of sex is having an orgasm.
ADVANCE PREPARATION
• All sexual problems are caused by physical conditions and can
be treated by medicines alone.
Sexual problems are a part of ageing and need to be accepted as
such rather than trying to get treated for them.
After participants have moved on the line, invite them to explain
their position and why they have chosen to stand at a particular
point in the line. Spend 15-20 minutes discussing the statement
and issues that arise before moving onto another statement.
3.
250
After reading and discussing the statements ask the participants
to return to their seats and invite questions and comments on
the exercise.
None
TARSHI: Basics and Beyond
MODULE 2 - Chapter 5
Suggested Questions:
THIS EXERCISE CAN BE MODIFIED
BY:
■ Proposing fewer sexual problem
statements. This can allow for a
deeper discussion of certain topics
or be useful if time for the session
is limited.
• Dividing participants into groups,
and giving each group one of the
statements. Groups should come
up with 3-5 key points/reactions
about this statement and present
these during the large group
discussion.
MAKING CONNECTIONS:
■ Gender roles can influence the
way women and men approach
and view sexual problems. For
more see Chapter 1 in Module 1.
• Sexual pleasure is an individual
preference and can be experienced
in many ways. For more see
Chapter 4 in Module 1.
■ Did the exercise raise any new questions for you about sexual
problems?
• How can you dispel myths and increase people’s comfort in
talking about sexual problems?
• Do you think there is equal consideration of men’s and women’s
sexual problems?
Key Messages
• Taboos around discussions of sexual problems or the blame
placed primarily on women for these problems makes it harder
to overcome sexual problems and discuss them openly. A person
with a sexual problem should not be stigmatised.
• Someone experiencing a sexual problem may still be capable of
experiencing sexual pleasure since there are a variety of ways to
experience pleasure. Sexual pleasure and preferences are
individual and can change over time, similar to the way sexuality
is individual and fluid.
• Women’s sexual problems are often overlooked. Viewing them
through the framework of men’s sexual problems can make them
feel embarrassed or inhibit their ability to talk about their
problems. At the same time, cultural norms that expect men to
‘know-it-all’ and be in control also prevents them from seeking
help with sexual problems.
TIPS FOR THE FACILITATOR:
• Participants may be uncomfortable talking about sexual problems. Introduce
icebreakers before the exercise to increase comfort levels.
• Make sure that the discussion on sexual problems does not degenerate into a man
vs. woman issue where each group feels more marginalised than the other. Both
women and men face shame and guilt around sexual problems and need
consideration.
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MODULE 2 - Chapter 5
Exercise 4
Case Studies on Sexual Problems
Instructions
1. Divide participants into four groups. Give two groups Case study
1 from Handout 2.28 and the other two groups Case Study 2.
Ask the groups to discuss the case study and corresponding
questions. Give groups 20-30 minutes to discuss the case and
questions.
2. Bring participants back to the larger group and invite each group
to share their discussion. After all the groups are done, ask for
questions or comments.
CASE STUDIES
Purpose of the
exercise:
1. To analyse and discuss
sexual problems as related
to ‘real-life’ problems.
2. To examine attitudes
toward sexual problems.
Suggested Questions:
■ Were there common or similar discussions between the groups?
What were they?
• Were there any common factors that contributed to the issue
faced by the couple: cultural, gender related, class etc.?
■ How can you increase people’s comfort levels in talking about
sexual problems? How can you reduce and remove the stigma
associated with such problems?
■ How are sexual problems related to sexuality and sexual health
and rights?
TIME
60 minutes
MATERIALS
Handout 2.28 Case Studies on
Sexual Problems
ADVANCE PREPARATION
Make copies of Handout 2.28 for
each participant.
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TARSH1: Basics and Beyond
MODULE 2 - Chapter 5
THIS EXERCISE CAN BE MODIFIED
Key Messages
BY:
■ Asking participants to read
through the case studies and do a
role-play that answers questions
associated with the cases.
■ Choosing one of the case studies
and reading it in a larger group
rather than dividing participants
into smaller groups with separate
case studies. This may be
beneficial for groups
uncomfortable with the topic or
with limited time for the exercise.
■ It is important for partners to discuss their sexual problems. This
can help break down commonly held myths and misconceptions
about sexual problems and also enhance sexual pleasure.
• Gender and other socio-cultural factors influence the way sexual
problems are dealt with. For example, some women do not voice
their problems for fear that their husbands will leave them.
Others may believe that sexual pleasure is not as important as
getting pregnant and do not acknowledge their disatisfaction
when they do not feel pleasure/experience pain during sex.
• Talking about and seeking help for sexual problems helps
alleviate the problem, reduces shame and low self-esteem of those
facing the problem, and promotes the sexual well-being of
individuals and couples.
• While not all sexual problems require medical intervention,
seeing a doctor and undergoing tests helps to rule out any
possible physical causes of the problem.
MAKING CONNECTIONS:
• Sexual problems are not the
same as infertility, nor do they
cause infertility. For more see
Chapter 3 in this Module.
■ All people have the right to
sexual well-being. For more see
Chapter 3 in Module 3.
• Relationship counselling or consulting a sex therapist are other
ways of addressing sexual problems. It is important to find a
counsellor and therapist that is qualified, sensitive and nonjudgmental.
TIPS FOR THE FACILITATOR:
■ Conducting an icebreaker prior to this exercise may help reduce participant
discomfort around the discussion of sexual problems.
• Participants may feel that conversations about sexual problems between couples
should remain private, and that discussing them in this exercise is inappropriate.
Emphasise the importance of building comfort around such discussions and enabling
I
others to do the same, particularly when working on sexuality and sexual health.
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Handout 2.24
Basic Information on Sexual Problems
What are sexual problems?
A person is said to have a sexual problem when s/he is continually or repeatedly unable to enjoy either
physical or emotional sexual stimulation or experiences. This is based on an individual s own standards
of acceptable sexual response and satisfaction.
What is the cause of sexual problems?
A number of factors can contribute to sexual problems. These can include 1) emotional or psychological
factors including stress, fear, or former experiences of abuse 2) interpersonal factors such as fear and/or
poor communication with a partner or peer pressure 3) community factors including cultural pressures
or gender relationships; or 4) physiological or biological factors including medical conditions and
infections, physical injury or hormonal changes in the body. Contrary to popular belief, many sexual
problems can be successfully resolved by addressing the first three issues, and fewer people may require
medical intervention to solve their problems.
What are some kinds of sexual problems?
Below is a list of some commonly described sexual problems.
• Erectile Dysfunction/Impotence: The inability to maintain or achieve an erection. ED/impotence
can result from physical conditions such chronic illness, diseases, or aging of the body, or from
psychological causes that can range from dislike of sex or sexual partner to effects of abuse. Impotence
can occur at any age and has different manifestations.
■ Premature ejaculation: Described as ejaculation before a person wants to ejaculate with minimal
sexual stimulation and/or ejaculation very soon after penetration.
■ Retarded ejaculation: Described as the inability or involuntary delay in ejaculation after a prolonged
period of sexual stimulation. This is different from Ejaculatory Incompetence in which a man is
unable to ejaculate even after prolonged stimulation.
■ Retrograde ejaculation: A condition in which the neck of the bladder does not close properly. This
causes a man to ejaculate backwards into the bladder instead of out through the urethra. A man may
experience an orgasm but not experience the accompanying ejaculation.
■ Anorgasmia: A persistent inability or involuntary delay in reaching orgasm for women even after
prolonged sexual stimulation.
• Dyspareunia or painful sex: A condition in which women experience pain during sexual activity,
either during penetrative sexual activity or non-penetrative genital stimulation. The pain can be felt
either in the vaginal opening or deep within the vagina.
• Vaginismus: A condition in which women have difficulty allowing penile penetration during sexual
activity because they experience pain during the penetration. It is usually caused by the involuntary
contractions of the vaginal muscles.
• Inhibited Sexual Desire: A number of factors may inhibit a person’s sexual desire temporarily or in
the long term. Anyone can experience this due to stress, illness, weakness, or psychosocial factors
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MODULE 2 - Chapter 5
What is meant by the medicalisation of sexual problems?
The medicalisation of sexual problems has resulted in the creation of definitions of normalcy for sexual
activity (based in part on the sexual response cycle described below). Any activity outside these norms
is considered abnormal and needs to be ‘treated’, ‘cured’, or ‘corrected’ with medications and drugs.
For example, if men cannot maintain an erection during sexual excitement, they are prescribed
medications to ‘fix’ this problem. While Western medicine is often blamed for this medicalisation,
indigenous practitioners are also known to depend heavily on medication in the form of herbal powders
and capsules, oils and lotions to treat sexual problems.
This approach to sexual problems and sexuality ignores that people experience sexuality and sexual
activity differently, that not all people experience sexual pleasure in the same ways, and that issues of
interpersonal relationships, gender, class, religion, ethnicity, and social environment can play a role in
how sexuality is experienced. For more information see Handout 2.27 A New View of Women’s
Sexual Problems.
What is the sexual response cycle?
U.S. based gynecologist William Masters and psychologist Virginia Johnson pioneered research into
the nature of human sexual response and the diagnosis and treatment of sexual disorders and
dysfunctions from 1957 until the 1990s. The sexual response cycle is a model developed from a research
study conducted by Masters and Johnson on sexual physiology in the 1960s. The aim of the study was
to determine how people react physically to sexual experiences - which hormones in the body are
involved in sexual desire, what happens to one’s genitals and bodies during arousal and orgasm etc.
The outcome of their research was the sexual response cycle model.
The purpose of describing the stages of the sexual response cycle created by Masters and Johnson (and
supplemented since its original development) is not to suggest that sexual response in people is a
mechanical process experienced in the same way by all people, but rather to provide a background on
how sexual problems have been defined, and to emphasise that while there may be common experiences
in sexual activity, pleasure and sexuality remain highly subjective and individual.
Sexual Response Cycle:
Stage 1: Desire-. (Libido) Signs that a person finds something or someone appealing sexually.
Stage 2: Excitement: (Arousal) Physical signs include vasocongestion (rush of blood)of the vaginal
walls, increase of breathing rate, erection of the nipples, clitoral erection, vaginal lubrication, elevation
of the uterus and stretching of the vagina and changes in the colour, size and shape of the labia in
women. In men, there is penile erection, ascension of the testes, a drawing back of the foreskin, and
emission of pre-ejaculatory fluid (a transparent fluid also called pre-cum).
Stage 3: Plateau: Levels of arousal are maintained. This stage can be brief or long and people have
varying preferences for how long this phase is maintained.
Stage 4: Orgasm: This is characterised by rhythmic muscular contractions, usually accompanied by
a sense of satisfaction and release.
Stage 5: Resolution: This is the return to pre-excitement or an un-aroused state. Men experience a
Refractory Period, which is the period between return to un-aroused state and getting a second
erection. Women can have multiple orgasms if the sexual stimulation continues.
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MODULE 2 - Chapter 5
Handout 2.25 Facilitator Copy:
Myths & Facts on Sexual Problems
• Men are more sexual than women.
MY'I'H. Women are just as sexual as men.
• If a man cannot ejaculate he has a medical problem.
MYTH. If a man cannot ejaculate it may be a medical problem; however it may also happen because
of other reasons. In addition, one instance of this situation does not indicate a sexual problem.
• If a man cannot ejaculate, it is the fault of his partner.
MYTH. Sexual problems are not the fault of the person experiencing them or their partner. There
can be medical, psychological or societal reasons for them.
• Women are frigid if they cannot have sex or find it painful.
MYTH. Painful sex or the inability to have penetrative sex can be caused by medical, social or
psychological factors. Frigidity is an inaccurate description, and also has derogatory connotations of
a woman ‘being cold’ and ‘unresponsive’ sexually.
• Sexual pleasure may be reduced by focusing on performance.
FACT. Focusing on reaching orgasm or ‘performing’ well may sometimes decrease sexual pleasure
and arousal and preventing the person from reaching orgasm. In such cases, it can be defined as a
sexual problem.
■ Sex is perfect the first time it is experienced.
MYTH. The first time an individual has sex can be pleasurable, painful, uncomfortable or anything
in between. There is never any right or wrong way to experience sex and if it is a painful or
uncomfortable experience it can result from many factors.
■ Masturbation does not cause sexual problems like erectile dysfunction or premature ejaculation
in men.
FACT. Masturbation is a safe and enjoyable activity that is not harmful in any way. Both men and
women masturbate. Masturbation does not affect one’s sex life negatively. It is a legitimate sexual
activity in its own right and does not cause weakness, stunted growth, pimples, or any psychological
problems.
If a woman is not satisfied in a heterosexual relationship, it is because the man’s penis is not big
enough for her.
MYTH. If the penis is about 2 inches long when erect, a man can arouse and satisfy his partner.
This is because the first 1.5-2 inches of a woman’s vagina has the maximum nerve endings, responsible
for sensation. More than the vagina, it is the clitoris, located outside the vagina, above the urethra
(urinary opening) that is sensitive to stimulation. The length of the penis has nothing to do with a
woman’s ability to experience sexual pleasure. It is technique, not size, that matters.
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If a woman doesn’t feel pain the first time she has sex with a partner, it means that she has had sex
before.
MYTH. Often people think that women will experience pain the first time they have sex because
the hymen, a thin and highly elastic membrane present in the vagina, will rip from penetration of
the penis. The hymen may, however, tear during the course of running, cycling or exercising, or at
any point in life; not necessarily related to sexual activity. It is also possible that an intact hymen
stretches during intercourse but does not tear. Therefore the presence or absence of an intact hymen
and/or pain during intercourse does not indicate whether or not a woman has had sex before. There
is no ‘proof of virginity’ for either a woman or a man.
• The longer a man takes to ejaculate, the better, because his partner will feel more pleasure and
enjoyment.
MYTH. Sexual pleasure is subjective and cannot be generalised. Some partners may feel more
pleasure if a man takes a long time to ejaculate while others may not.
• A man’s failure to get an erection can be attributed to a combination of physical and psychological
problems.
FACT. Inability to get an erection can be because of psychological problems such as nervousness
about not being able to ‘perform’ or discomfort with a partner, as well as physical problems related
to health conditions or the side-effects of medications or drugs.
■ Women who masturbate are over-sexed and their partners will find it difficult to satisfy them.
MYTH. Masturbation is not a sign of being ‘over-sexed’. Both men and women masturbate.
Masturbation is one of the safest sexual practices, and a way of experiencing pleasure without the
risk of unwanted pregnancies or contracting STIs including HIV/AIDS. Sex therapists believe that
if one is able to have a healthy sexual relationship with one’s own body, chances are that they will
enjoy sex with a partner more.
• Women may experience pain during sex for reasons other than infections or injury.
FACT. Pain during sex can be from physical causes, and also emotional and psychological ones,
such as discomfort with a partner or the partner’s sexual technique.
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MODULE 2 ■ Chapter 5
TARSHI: Basics and Beyond
Handout 2.26
Participant Copy: Myths & Facts on Sexual Problems
State whether each statement is a Fact or a Myth and why.
• Men are more sexual than women.
• If a man cannot ejaculate, he has a medical problem.
• If a man cannot ejaculate, it is his partner’s fault.
• Women are frigid if they cannot have sex or find it painful.
• Sexual pleasure can be reduced if the focus is on ‘performance’.
• Sex is perfect the first time one has it. If not, then the man has a problem.
• Masturbation does not cause sexual problems like erectile dysfunction and premature ejaculation
in men.
■ If a woman is not satisfied in a heterosexual relationship, it is because the man’s penis is not big
enough for her.
• If a woman doesn’t feel pain the first time she has sex with a partner, it means that she has had sex
before.
• The longer a man takes to ejaculate, the better, because his partner will feel more pleasure and
enjoyment.
• A man’s failure to get an erection can be attributed to a combination of physical and psychological
problems.
• Women who masturbate are over-sexed and their partners will find it difficult to satisfy them.
• Women may experience pain during sex for reasons other than infections or injury.
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MODULE 2
Chapter 5
Handout 2.27
A New View of Women’s Sexual Problems
by The Working Group on A New View of Women’s Sexual Problems.
(From: http://www.fsd-alert.org)
Introduction
In recent years, publicity about new treatments for men’s erection problems has focused attention on
women s sexuality and provoked a competitive commercial hunt for “the female Viagra.” But women’s
sexual problems differ from men’s in basic ways, which are not being examined or addressed. We
believe that a fundamental barrier to understanding women’s sexuality is the medical classification
scheme in current use, developed by the American Psychiatric Association (APA) for its Diagnostic
and Statistical Manual of Disorders. (DSM) in 1980, and revised in 1987 and 1994. It divides (both
men sand) women s sexual problems into four categories of sexual “dysfunction”: sexual desire disorders,
sexual arousal disorders, orgasmic disorders, and sexual pain disorders.
These dysfunctions” are disturbances in an assumed universal physiological sexual response pattern
( normal function”) originally described by Masters and Johnson in the 1960s. This universal pattern
begins, in theory, with sexual drive, and proceeds sequentially through the stages of desire, arousal,
and orgasm.
In recent decades, the shortcomings of the framework, as it applies to women, have been amply
documented. The three most serious distortions produced by a framework that reduces sexual problems
to disorders of physiological function, comparable to breathing or digestive disorders, are:
1)
A false notion of sexual equivalency between men and women. Because the early researchers
emphasized similarities in men’s and women’s physiological responses during sexual activities,
they concluded that sexual disorders must also be similar. Few investigators asked women to describe
their experiences from their own points of view. When such studies were done, it became apparent
that women and men differ in many crucial ways. Women’s accounts do not fit neatly into the
Masters and Johnson model; for example, women generally do not separate “desire” from “arousal,”
women care less about physical than subjective arousal, and women’s sexual complaints frequently
focus on “difficulties” that are absent from the DSM.
Furthermore, an emphasis on genital and physiological similarities between men and women ignores
the implications of inequalities related to gender, social class, ethnicity, sexual orientation, etc.
Social, political, and economic conditions, including widespread sexual violence, limit women’s
access to sexual health, pleasure, and satisfaction in many parts of the world. Women’s social
environments thus can prevent the expression of biological capacities, a reality entirely ignored by
the strictly physiological framing of sexual dysfunctions.
2)
The erasure of the relational context of sexuality. The American Psychiatric Association’s DSM
approach bypasses relational aspects of women’s sexuality, which often lie at the root of sexual
satisfactions and problems—e.g., desires for intimacy, wishes to please a partner, or, in some cases,
wishes to avoid offending, losing, or angering a partner. The DSM takes an exclusively individual
approach to sex, and assumes that if the sexual parts work, there is no problem; and if the parts
don’t work, there is a problem. But many women do not define their sexual difficulties this way.
The DSM’s reduction of “normal sexual function” to physiology implies, incorrectly, that one can
measure and treat genital and physical difficulties without regard to the relationship in which sex
occurs.
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MODULE 2 - Chapter 5
3)
TARSHI: Basics and Beyond
The levelling of differences among women. All women are not the same, and their sexual needs,
satisfactions, and problems do not fit neatly into categories of desire, arousal, orgasm, or pain. Women
differ in their values, approaches to sexuality, social and cultural backgrounds, and current situations,
and these differences cannot be smoothed over into an identical notion of “dysfunction
or an
identical, one-size-fits-all treatment.
Because there are no magic bullets for the socio-cultural, political, psychological, social or relational
bases of women’s sexual problems, pharmaceutical companies are supporting research and public
relations programs focused on fixing the body, especially the genitals. The infusion of industry
funding into sex research and the incessant media publicity about “breakthrough” treatments have
put physical problems in the spotlight and isolated them from broader contexts. Factors that are far
more often sources of women’s sexual complaints—relational and cultural conflicts, for example,
or sexual ignorance or fear—are downplayed and dismissed. Lumped into the catchall category of
“psychogenic causes,” such factors go unstudied and unaddressed. Women with these problems are
being excluded from clinical trials on new drugs, and yet, if current marketing patterns with men
are indicative, such drugs will be aggressively advertised for all women’s sexual dissatisfactions.
A corrective approach is desperately needed. We propose a new and more useful classification of
women’s sexual problems, one that gives appropriate priority to individual distress and inhibition
arising within a broader framework of cultural and relational factors. We challenge the cultural
assumptions embedded in the DSM and the reductionist research and marketing program of the
pharmaceutical industry. We call for research and services driven not by commercial interests, but
by women’s own needs and sexual realities.
Sexual Health and Sexual Rights: International Views
To move away from the DSM’s genital and mechanical blueprint of women’s sexual problems, we
turned for guidance to international documents. In 1974, the World Health Organization held a unique
conference on the training needs for sexual health workers. The report noted: ‘A growing body of
knowledge indicates that problems in human sexuality are more pervasive and more important to the
well-being and health of individuals in many cultures than has previously been recognized.” The
report emphasized the importance of taking a positive approach to human sexuality and the enhancement
of relationships. It offered a broad definition of “sexual health” as “the integration of the somatic,
emotional, intellectual, and social aspects of sexual being.”
In 1999, the World Association of Sexology, meeting in Hong Kong, adopted a Declaration of Sexual
Rights.” [7] In order to assure that human beings and societies develop healthy sexuality,” the Declaration
stated, “the following sexual rights must be recognized, promoted, respected, and defended”:
- The right to sexual freedom, excluding all forms of sexual coercion, exploitation and abuse;
- The right to sexual autonomy and safety of the sexual body;
- The right to sexual pleasure, which is a source of physical, psychological, intellectual and spiritual
well-being;
- The right to sexual information...generated through unencumbered yet scientifically ethical inquiry
- The right to comprehensive sexuality education;
- The right to sexual health care, which should be available for prevention and treatment of all sexual
concerns, problems, and disorders.
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MODULE 2 - Chapter 5
Women s Sexual Problems: A New Classification
exua problems, which The Working Group on A New View ofWbmen’s Sexual Problems defines as
iscontent or dissatisfaction with any emotional, physical, or relational aspect of sexual experience,
may arise in one or more of the following interrelated aspects of women’s sexual lives.
I.
SEXUAL PROBLEMS DUE TO SOCIO-CULTURAL, POLITICAL, OR ECONOMIC
FACTORS
A.
Ignorance and anxiety due to inadequate sex education, lack of access to health services, or other
' social constraints:
B.
1.
Lack of vocabulary to describe subjective or physical experience.
2.
Lack of information about human sexual biology and life-stage changes.
3.
Lack of information about how gender roles influence men’s and women’s sexual expectations,
beliefs, and behaviors.
4.
Inadequate access to information and services for contraception and abortion, STD prevention
and treatment, sexual trauma, and domestic violence.
Sexual avoidance or distress due to perceived inability to meet cultural norms regarding correct
or ideal sexuality, including:
1. Anxiety or shame about one’s body, sexual attractiveness, or sexual responses.
2.
Confusion or shame about one’s sexual orientation or identity, or about sexual fantasies and
desires.
C.
Inhibitions due to conflict between the sexual norms of one’s subculture or culture of origin and
those of the dominant culture.
D.
Lack of interest, fatigue, or lack of time due to family and work obligations.
II.
SEXUAL PROBLEMS RELATING TO PARTNER AND RELATIONSHIP
A.
Inhibition, avoidance, or distress arising from betrayal, dislike, or fear of partner, partner’s abuse
or couple’s unequal power, or arising from partner’s negative patterns of communication.
B.
Discrepancies in desire for sexual activity or in preferences for various sexual activities.
C.
Ignorance or inhibition about communicating preferences or initiating, pacing, or shaping sexual
activities.
D.
Loss of sexual interest and reciprocity as a result of conflicts over commonplace issues such as
money, schedules, or relatives, or resulting from traumatic experiences, e.g., infertility or the death
E.
of a child.
Inhibitions in arousal or spontaneity due to partner’s health status or sexual problems.
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MODULE 2 - Chapter 5
III.
A.
SEXUAL PROBLEMS DUE TO PSYCHOLOGICAL FACTORS
Sexual aversion, mistrust, or inhibition of sexual pleasure due to:
1. Past experiences of physical, sexual, or emotional abuse.
2. General personality problems with attachment, rejection, co-operation, or entitlement.
3.
B.
IV
Depression or anxiety.
Sexual inhibition due to fear of sexual acts or of their possible consequences, e.g., pain during
intercourse, pregnancy, sexually transmitted disease, loss of partner, loss of reputation.
SEXUAL PROBLEMS DUE TO MEDICAL FACTORS
Pain or lack of physical response during sexual activity despite a supportive and safe interpersonal
situation, adequate sexual knowledge, and positive sexual attitudes. Such problems can arise
from:
A.
Numerous local or systemic medical conditions affecting neurological, neurovascular, circulatory,
endocrine or other systems of the body;
B.
Pregnancy, sexually transmitted diseases, or other sex-related conditions.
C.
Side effects of many drugs, medications, or medical treatments.
D.
Iatrogenic conditions.
Conclusion
This document is designed for researchers desiring to investigate women’s sexual problems, for educators
teaching about women and sexuality, for medical and nonmedical clinicians planning to help women
with their sexual lives, and for a public that needs a framework for understanding a rapidly changing
and centrally important area of life.
For more information visit: http://www.fsd-alert.org
2B2
TARSHI: Basics and Beyond
MODULE 2 - Chapter 5
Handout 2.28
Case Studies on Sexual Problems
Case 1:
Sapna married Karun a few months ago. The marriage was arranged by her family, but Sapna has
strong feelings for Karun and believes she is lucky to have him as her husband. She believes they will
be happy together and as time passes and she gets to know him better, she gets even more excited over
her chosen husband. Karun feels the same towards Sapna and is thankful his family found him a kind
and easy-going woman to share his life with. Despite their strong feelings for each other, Sapna and
Karun have been having problems in their sex life. Every time they have sexual intercourse, Sapna
experiences pain and discomfort. She is not sure what the cause of this discomfort is. Even thinking
about her genitals and ‘that part of her body’ is something she has never done before, aside from the
time of her monthly periods. Because of her discomfort, Sapna has begun to avoid sex with Karun and
when it takes place, she tries to be impassive though her body language and face reflect her pain.
Sapna thinks this problem will go away after some time and plans to avoid mentioning it to Karun.
Karun, however, has noticed the way Sapna reacts when they have sex and the way she tries to avoid
the prospect of having intercourse. At first he thought it was because Sapna was uncomfortable with
him since they were still getting to know each other, and her lack of sexual experience. But her
unhappiness and discomfort has not dissipated over the past few months and Karun has begun to
worry. He feels it is affecting him and his sexual performance. He can see how distraught Sapna is
during sex, so he ejaculates very quickly and makes sure that sex is over quickly. He does not find such
hurried and intercourse pleasurable, but thinks that if they just continue to have sex Sapna will become
comfortable and eventually enjoy it.
• What are your impressions and thoughts on this scenario?
• How can the couple deal with this situation?
• What would a discussion between the two involve? What factors may play a part in the way this
situation is discussed - for example are there psychological, cultural, or gender factors that would
influence the talk?
■ How can this situation be changed or resolved? What other issues are involved in this? Does
knowledge of the body, sexual pleasure etc. have anything to do with it?
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MODULE 2 ■ Chapter 5
TARSHI: Basics and Beyond
Case 2:
Ravi and Ritu have been together for many years. They are both in their mid-40’s and live in a
comfortable apartment in the city. Since their two children are both in college abroad, Ravi and Ritu
are alone for many months at a time. Both have important and stressful jobs that keep them out of the
house well into the evening. When they do get home they are both usually tired from the stress and
work of the day and will simply have a meal together and chat a bit before going to sleep. Lately Ritu
has been feeling anxious about their sex life. She thinks they are growing distant from each other and
have sex too infrequently. She is concerned not only because this infrequency is affecting their
relationship, but also because she likes to have sex and is disappointed when Ravi is too tired or
uninterested. He has not been initiating sex at all.
Ravi, on the other hand, knows the real reason that they are not having as much sex is because lately he
has been having trouble getting an erection. The last couple of times he and Ritu started to be intimate,
he was unable to get an erection and began to feel embarrassed. Instead of telling Ritu what was going
on, he said he was tired and turned over to go to sleep. Ravi has considered going to the doctor about
the situation, but is also scared to admit to his problem and thinks it will go away on its own. Also, he
knows if he has to take any medication for it, Ritu will need to know, and he is not sure he wants that.
■ What are your impressions and thoughts about this scenario?
• How can the couple deal with this situation?
What would a discussion between the two involve? What factors may play a part in the way this
situation is discussed — for example are there psychological, cultural, or gender factors that would
influence the talk?
• Do gender roles play a part in this situation? How?
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MODULE 3
Sexual and
Reproductive Rights
TARSHI : Basics and Beyond
MODULE 3
Introduction
In the previous two modules, Basics and Beyond focused on
examining a range of issues that constitute sexuality, followed by
information and issues concerning sexual and reproductive health.
Module 3: Reproductive and Sexual Rights now takes a look at
these topics in the context of human rights. It discusses how rights
can be used to affirm the health and well-being of people, particularly
with regard to sexuality and sexual and reproductive health.
Sexual and reproductive rights evolved from the human rights system
and are still in the process of being defined and developed.
Therefore, to understand sexual and reproductive rights, it is
necessary to first look at human rights as a framework and
understand what is meant by a rights-based approach. The first
chapter in Module 3 looks at the human rights system and
framework. It also introduces documents, treaties and conventions
that have contributed to the growth and development of human
rights over the years.
At the end of this module, participants will be able to effectively
and concretely discuss human rights, and more specifically articulate
and describe sexual and reproductive rights and relate it to their
daily work. They will also analyse and note the benefits as well as
the limitations to the human rights system, particularly in the context
of sexual and reproductive rights.
TARSHI: Basics and Beyond
MODULE 3
Module 3
Sexual and Reproductive Rights
Chapter 1: Human Rights Basics
■ Exercise 1: Human Rights Tree
90 minutes
• Exercise 2: Universal Declaration of
Human Rights
90 minutes
■ Exercise 3: Human Rights Treaties and
Conferences
60 minutes
• Exercise 4: Case Studies on Human Rights
60 minutes
Chapter 2: Understanding Reproductive Health and Rights
■ Exercise 1: My Reproductive Rights
60 minutes
• Exercise 2: Case Studies on Reproductive Health
and Rights
60 minutes
• Exercise 3: Acting Out Reproductive Health
and Rights
60 minutes
■ Exercise 4: Advocating for Sexual and
Reproductive Rights
60 minutes
Chapter 3: Sexual Health and Rights
• Exercise 1: Freedom to/Freedom from
60 minutes
• Exercise 2: Defining Sexual Health and
Sexual Rights
60 minutes
• Exercise 3: Quick Questions to Sexuality and
Sexual Rights
45 minutes
• Exercise 4: Case Study on Sexuality, Sexual
Health and Rights
60 minutes
267
TARSHI : Basics and Beyond
MODULE 3
Assessment for Module 3
Sexual and Reproductive Rights
At the end of this module the facilitator can conduct an assessment.
This assessment can evaluate increases in participant knowledge,
changes in attitudes, preferences for different exercises, and/or
opinions on the facilitator’s skills. For this module, an assessment
can be done using the following tools:
• Using the modification of Exercise 4 in Chapter 3 of this Module.
• Adapting one of the sample assessment forms found in Chapter
2 in Preparing to Train.
■ Using the facilitator preparation exercises for this module found
in Chapter 1 in Preparing to Train.
■ Developing a new assessment depending on the type of
information the facilitator is looking to discover.
Sample Training Schedule
A blank template of a training schedule as well as a sample sevenday training schedule can be found in the Introduction ofPreparing
to Train. Depending on the focus of the training and the topics it
aims to cover, the facilitator can fill in the blank schedule with
exercises from this Module or in combination with exercises from
other Modules.
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MODULE 3 - Chapter 1
Chapter 1
Human Rights
Chapter Objectives for the Facilitator
1.
To inform participants about the basics of human rights.
2.
To briefly outline the history of the human rights system
and structure including the charters, treaties, conventions,
agencies, and governing bodies included in this structure.
3.
To discuss a rights-based approach to sexuality, sexual and
reproductive health, and advocacy.
TARSHI: Basics and Beyond
MODULE 3 - Chapter 1
EXERCISES IN THIS CHAPTER
Exercise 1: Human Rights Tree.
90 minutes
Exercise 2: Universal Declaration of
Human Rights.
90 minutes
Why a Chapter on Human Rights
Everyone has the right to life, liberty and security ofperson. (Article 1
of the Universal Declaration of Human Rights)
Everyone is entitled to all the rights and freedoms set forth in this
Declaration, without distinction ofany bind, such as race, colour, sex,
language, religion, political or other opinion, national or social origin,
property, birth or other status. (Part of Article 2 of the Universal
Declaration of Human. Rights)
Exercise 3: Human Rights Treaties
and Conferences.
60 minutes
Exercise 4: Case Studies on Human
Rights.
60 minutes
MATERIALS FOR THIS CHAPTER:
These two sections from the Universal Declaration of Human
Rights (UDHR) are only a small portion ofthis landmark document
written and adopted by the United Nations General Assembly
nearly sixty years ago. Since then, the human rights system has
expanded and developed, as have the ways in which people use
and recognise human rights. This growth includes the adoption
of a number of treaties and charters, integration of human rights
into legislation and laws, the creation of civil society groups to
advocate for human rights, and discussions at international
conventions on the rights ofvarious groups and populations. While
there have been gains in human rights over the past years, a great
deal of work still needs to be done.
This chapter provides a basic understanding of human rights, why
a human rights framework can be an effective approach to health
and advocacy, how to use the human rights system and its
framework, and how to make linkages and discuss connections
between human rights, sexuality and sexual and reproductive
health.
Flipchart
Markers
Pens/pencils
Paper (coloured or white)
Tape
Scissors
Index cards/slips of paper
HANDOUTS REQUIRED FOR THIS
CHAPTER:
■ Handout 3.1
An Overview of Human Rights
■ Handout 3.2 Facilitator copy:
Universal Declaration of Human
Rights
■ Handout 3.3 Participant copy:
Universal Declaration of Human
Rights
• Handout 3.4
Human Rights Treaties and World
Conferences
• Handout 3.5
Case Studies on Human Rights
TARSHI: Basics and Beyond
MODULE 3 - Chapter 1
ADDITIONAL RESOURCES:
Beijing Conference Declaration
and Platform of Action. Available
at: http://www.un.org/
womenwatch/daw/beijing/
platform/
• Convention on the Elimination of
All Forms of Discrimination
Against Women ICEDAW).
Available at: http://www.un.org/
womenwatch/daw/cedaw/
cedaw.htm
Key Messages for this Chapter
■ Human rights as a system encompasses a wide range of rights,
from the right to health to the right to freedom from torture. All
these rights are essential to individual well-being and dignity.
• Human Rights Resource Centre.
http://www.hrusa.org/
• The creation of a human rights system is an important way of
upholding and making States accountable to respect, protect and
fulfil these rights for all people.
• International Covenant on Civil
and Political Rights. Available at:
http://www.unhchr.ch/html/
menu3/b/a_ccpr.htm
■ While human rights have been placed into a codified system,
they are not just a conceptual/ theoretical system but can be
concretely applied to each person’s life.
• International Covenant of
Economic, Social and Cultural
Rights. Available at: http://
www.unhchr.ch/html/menu3/b/
a_cescr.htm
• International Conference on
Population and Development.
Available at: http://
www.unfpa.org/icpd/
summary.htm
• For the ratification history of
various countries see, http//
www.ohchr.org/english/
countries/ratification
• The United Nations and Human
Rights, http://www.un.org/
rights/dpi1774e.htm
• For selected films see, http://
www.asiasrc.org/films.php and
Appendix B
• If the facilitator is unfamiliar with regional policies on human
rights or the human rights doctrines and treaties signed by their
respective countries, it may be useful to do research on these
issues before conducting the exercises.
TARSHI : Basics and Beyond
MODULE 3 - Chapter 1
Exercise 1
Human Rights Tree
SMALL GROUP WORK
ADAPTED FROM THE UNIVERSITY OF MINNESOTA HUMAN RIGHTS LIBRARY
(http:/Jwww.hrusa.org/workshops/1 -28-2005/T reeActivity.sht ml)
Instructions
Divide participants into small groups. Give each group scissors,
markers, tape and paper. The participants will use these
materials to construct a human rights tree. To construct the
human rights tree, first instruct participants to draw a trunk for
the tree. They should then use the paper to cut out leaves for
the trees (these do not need to be perfectly shaped). On each
leaf, ask participants to write one right necessary to lead 'lives
equal in respect and dignity. These rights can range from the
right to health to the right to own property, the right to vote etc.
Give participants 20-25 minutes to construct their tree.
1.
2.
Purpose of the
exercise:
1. To understand and
describe the concept of
human rights and relate it
to our own life and needs.
2. To understand and
discuss a rights-based
approach to health and
advocacy.
After they complete the trees, invite each group to come up and
present their tree to the large group and explain the process and
contents of their tree. After all the presentations, ask for
questions and comments.
Suggested Questions:
■ hxe. there similarities between the trees? Are some rights on all
the trees? Why? Do these common rights indicate something
about the communities, countries, and states we come from or
outgeneral needs? Would it be different for groups from another
country or region?
• Are all these rights equally important, with no single right being
more important than another? Do these rights support and have
connections with each other?
TIME
90 minutes
MATERIALS
Paper, scissors, tape, markers,
pen/pencils, Handout 3.1 An
Overview on Human Rights
ADVANCE PREPARATION
Make copies of Handout 3.1
• Should people always have these rights? What would happen if
they were taken away?
3.
272
Keep these human rights trees up on the walls throughout the
training to refer to and observe whether ideas and attitudes about
rights change or evolve during the training.
TARSHI: Basics and Beyond
MODULE 3 - Chapter 1
4.
THIS EXERCISE CAN BE MODIFIED
Distribute Handout 3.1 to each participant and read through
this with them. Ask for questions or comments.
BY:
Suggested Questions:
■ Asking participants to take the
trees back to their small groups
|
and add roots, which can
symbolise what is needed to
sustain and fulfil human rights,
such as economic stability,
universal health care etc.
Encourage participants to make
these roots personal. For example,
someone may feel that to realise
the right to health they need a
hospital or clinic closer to home
I
and a government that will build ■
such a clinic. Each group can then
share the roots and completed
tree with the larger group.
■ Do you understand these basics of human rights and how they
are organised?
■ Can you see connectipns between these rights and the rights
you wrote down on your human rights trees? Do you see how
this system can uphold the rights you wrote on your trees?
• Are there any flaws in the way the system has been defined and
set up?
Key Messages
• While human rights have been arranged into a codified system,
they are not just a theoretical framework and do apply to each
person’s life. This can be seen in the links between what is
written on the trees and the formal system outlined in Handout
3.1.
• Asking participants as a larger
group to categorise the various
rights on the trees as sexual rights
and/or reproductive rights, or to
think about which categories
these kinds of rights fit into, such
as civil rights, social rights,
economic rights etc. This can help |
participants observe overarching
themes of human rights.
• Human rights as a system encompasses a wide range of rights,
from the right to health to the right to freedom from torture.
They are all essential to individual well-being and dignity.
• Human rights are not the same as laws. Ideally, laws help to
protect and fulfil human rights, but this is not always so. For
example, some countries in South and Southeast Asia do not
have laws that recognise or provide protection against marital
rape, which violates the right of an individual to live a life free
from violence and abuse.
MAKING CONNECTIONS:
TIPS FOR THE FACILITATOR:
■ Human rights underlie the values
we apply to our personal and
professional lives. For more see
Setting the Tone in the
Introduction to Module 1.
| ■ Some participants may be quiet during this exercise particularly if they are
unfamiliar with what is meant by human rights. Encourage everyone to
j
participate, perhaps by having each member of the group articulate two rights
i
they believe should be on the tree.
■ Human rights influence guiding
principles for work and advocacy
in sexuality, sexual and
reproductive health. For more see
Chapter 1 in Module 5.
\
j
• Groups may become more concerned with the aesthetic appearance of their
trees than the content. Emphasise that the focus needs to stay on the content.
It may be useful to distribute pre-made leaves to the groups to help get them
started and to avoid this situation.
273
TARSHI: Basics and Beyond
MODULE 3 - Chapter 1
Exercise 2
The Universal Declaration of Human Rights
SMALL GROUP WORK
Instructions
1.
2.
3.
Divide the participants into 5 groups. Distribute Handouts 3.3
to each group. Assign each group 6 of the 30 Articles. The first
group should get Articles 1-6, the second Articles 7-12 and so
forth.
Ask groups to read the handout, which includes the preamble
to the Universal Declaration of Human Rights (UDHR) along
with the 30 Articles that make up the UDHR. Instruct the
groups to examine the preamble and the 6 Articles assigned to
them and discuss how each Article relates to sexuality. Give the
groups 30 minutes to discuss and analyse the Articles.
Suggested Questions:
2. To connect the Articles
in the Universal
Declaration of Human
Rights to sexuality.
; Facilitator Copy: Universal
Declaration of Human Rights,
Handout 3.3 Participant Copy:
I Universal Declaration of Human
; Rights
After all the group presentations, ask for general comments and ADVANCE PREPARATION
questions.
I Make copies of Handouts 3.3, read
Suggested Questions:
■ In what ways do you think these rights and their connections
to sexuality relate to your life?
■ Are there any Articles in the UDHR you consider particularly
relevant to your life and needs? For example, do you live in a
country with limited freedom of expression, manifesting as
interference in what newspapers publish? In this case, Article
19, which promotes freedom of opinion including the ability
274
1. To discuss and describe .
the Universal Declaration
of Human Rights.
Bring the participants back to the large group and invite each
group to present their discussions. The facilitator may want to
have groups present in chronological order: beginning with the
TIME
group that had Articles 1-6, proceeding to the group that had
I 90 minutes
Articles 7-12, and so on. During each presentation, the facilitator
may want to write out the main idea of the Article and the
MATERIALS
connection made to sexuality on the flipchart. After each
presentation, ask for comments or questions.
; Flipchart, markers, Handout 3.2
■ Do you agree with the connections the group made between
their Articles and sexuality? Can you think of other examples
that connect sexuality with the Articles presented by this group?
4.
Purpose of the
exercise:
I through Handout 3.2
TARSHI: Basics and Beyond
MODULE 3 - Chapter 1
to receive and impart information in the media, would be
particularly relevant to you.
• Are there limitations to these Articles and rights? For
example, the UDHR uses a language of male pronouns, such
as ‘this right includes freedom to change his religion or
belief’. Does this type of language limit women and
transgendered people and their ability to claim rights?
THIS EXERCISE CAN BE MODIFIED
BY:
• Giving groups fewer Articles in the
UDHR to read individually and
discussing the remaining Articles i
with the group as a whole. This
can be beneficial for groups having
difficulty with connections
between the Articles and
sexuality.
Key Messages
■ It is possible to relate sexuality to human rights. In other words,
individuals have the right to express their sexuality, so long as
they do not infringe on the rights of others.
■ While the UDHR is a formal document with formal language,
it is applicable and relevant to people’s lives.
TIPS FOR THE FACILITATOR:
MAKING CONNECTIONS
• Sexuality is more than acts of
sex. It is an important part of
being human and impacts
people's lives in significant ways.
For more see Chapter 1 in
Module 1.
• Applying human rights to
advocacy can be effective in
promoting rights for marginalised
people. For more see Chapter 3 in
Module 5.
■ Participants may be unsure about how to relate sexuality to some of the
Articles, particularly those addressing nationality and economic rights. Try to
encourage them to think broadly about the issue and how marginalised people
might benefit from this right. If they continue to struggle, refer to Handout 3.2
for examples to get the group started.
• Participants may keep connections to sexuality basic and narrow. If so, offer
suggestions for broader interpretations. For example, participants may look at
sexuality only in terms of heterosexual relationships and relate each Article in the
UDHR to that aspect of sexuality. It may help to ask whether those who desire
same-sex relationships, transgendered people or the ideas of pleasure can fit into
the Articles. Facilitators can look to Handout 3.2 for examples.
■ Participants may be overwhelmed by the amount of information and its complexity.
Assure them that this exercise is meant as a first step in understanding rights and
it will become clearer as they do further exercises in the chapter.
• Assure participants that the intention of this exercise is to spark their thinking
about the connections between rights and sexuality. Whether the State can or
should be held accountable if sexual rights are not respected, fulfilled or protected
is a larger discussion to be had later in Chapter 3.
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Exercise 3
Human Rights Treaties and Conferences
SMALL GROUP WORK
Instructions
Purpose of the
1. Divide participants into two groups. Distribute Handout 3.4 to
each participant. Assign one group to Treaties and the other to
Conferences. Ask participants to read their assigned information
on the handout and fill in the empty column with an example
of how the treaty or convention can be applied to or used in
their work. Give groups 15-20 minutes.
exercise:
2. Bring participants back together and begin with the Treaties
group. Ask the group to read the treaty and the one example of
how the treaty can be applied to their work. After the Treaties
group presentation, ask the Conferences group to do the same.
After both groups have presented ask for questions and
comments.
2. To discuss how the
codified human rights
system can be relevant to
advocacy.
1. To discuss the various
documents and
conferences that support
the human rights system.
Suggested Questions:
■ Do you understand the purpose of each of these treaties and
why governments came together in the world conferences?
• Do you see the value of these treaties when trying to apply a
rights-based approach to advocacy and work?
TIME
60 minutes
MATERIALS
• Can you give other examples from your work where you could
apply or use the ideas from these treaties or conferences?
Handout 3.4 Charters and
Conferences for Human Rights
ADVANCE PREPARATION
Make copies and review Handout
3.4 for each participant.
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THIS EXERCISE CAN BE MODIFIED
MODULE 3 - Chapter 1
Key Messages
BY:
• Asking participants to do the
exercise individually as a self
reflection. They can share
examples among the larger group
once they are done.
■ Asking the group to find out if and
when their country ratified the
various treaties. The group can
discuss the consequences and
benefits of having a country ratify
or not ratify each treaty, and how
this information can be used in
advocacy. Participants will
probably need access to computer
and Internet facilities in order to
complete this assignment.
• The creation of a human rights system is an important means for
upholding rights and making States accountable.
• There are methods for the NGO community, organisations, and
individuals to appeal against human rights violations.
• The 1994 International Conference on Population and
Development (ICPD) held in Cairo was significant in the field
of sexuality, sexual and reproductive health and rights. ICPD
emphasised a shift from population control and demography to
sustainable development. Reproductive rights and health, as well
as sexual health were included in the Programme of Action.
• The Fourth World Conference on Women in Beijing in 1995
continued to focus on the status of women worldwide and
reaffirmed that reproductive rights are human rights, and that
all women should have access and potential to realise these rights.
TIPS FOR THE FACILITATOR:
MAKING CONNECTIONS
- Applying human rights to
advocacy can be effective in
promoting rights for marginalised
people. For more on advocacy
campaigns see Chapter 3 in
Module 5 and for more on stigma
and discrimination see Chapter 2
in Module 4.
■ Groups may experience difficulty finding examples from their work that apply
to the given treaty or conferences. Encourage participants to think broadly
about the work they do, and the community they work with for examples.
• Some participants may be working with the human rights system already.
Encourage them to share their experiences for the benefit of other participants.
• Understanding reproductive rights
and sexual rights as they relate to
the treaties and conferences can
increase understanding of human
rights. For more see Chapters 2
and 3 in this Module.
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Exercise 4
Case Studies on Human Rights
Instructions
CASE STUDIES
Purpose of the
exercise:
1. Divide participants into small groups. Distribute one case study
to each group. Give groups 20-30 minutes to read the case and
answer the questions associated with it.
1. To identify human
rights issues in real-life
situations.
2. Ask participants to return to the larger group and invite each
small group to share their case study and discussion. After each
presentation, ask for comments and questions from the other
participants.
Suggested Questions:
2. To understand the
benefits of a rights-based
approach to health and
advocacy.
■ Do you agree with the conclusions of the group? Would you
suggest an alternative?
• How can a rights-based approach help to improve the situation
of the characters?
TIME
60 minutes
MATERIALS
Handout 3.5 Case Studies on
Human Rights
ADVANCE PREPARATION
Make copies of Handout 3.5 for
each participant
___________
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THIS EXERCISE CAN BE MODIFIED
MODULE 3 - Chapter 1
Key Messages
BY:
■ Choosing one or two cases and
discussing them as a single group
rather than in smaller groups.
This may be beneficial for groups
that are still unsure about human
rights or to those who want to
focus on a particular issue, such as
HIV/AIDS.
• Human rights are not just theories. Human rights can be found
in and applied to real-life experiences and issues.
■ A rights-based approach includes looking at the needs and
choices of individuals and empowering them so they can make
choices and exercise their rights.
■ All persons have the right to live without fear of coercion or
violence. In addition, they also have the right to access services,
and life in a healthy environment.
MAKING CONNECTIONS
■ The formal human rights system has its advantages and
limitations. Knowledge of the language and system of human
rights can help activists and healthcare providers plan and
implement programmes in a more inclusive and effective
manner.
■ In addition to violation of rights,
marginalised people often face
stigma and discrimination. For
more see Chapter 2 in Module 4.
• Human rights can be tools to direct governments and agencies
to provide proper services and care for its population. They are
meant as guidelines for countries to create policies and
programmes to respect individuals’ rights.
• Acceptance and understanding of
various gender and sexual
identities can reduce human rights
abuses and violations. For more
see Chapter 2 in Module 1.
TIPS FOR THE FACILITATOR:
■ Participants may find it difficult to relate human rights violations to the issues
and characters in the case studies. It may be beneficial to review the basics of
human rights prior to the exercise.
■ The facilitator may want to create case studies based on recent real-life
instances from their society/region to help participants relate human rights to
their specific contexts.
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Handout 3.1
An Overview of Human Rights
How CAN YOU DEFINE HUMAN RIGHTS?
Human rights are a kind of promise/ undertaking containing two elements: what has been promised
(for example, equality, non-discrimination, access to education) and a binding duty to respond and
make the promise a reality.
Human rights are the freedoms and standards we must have in our lives to live in dignity and respect.
They are universal, indivisible, interlinked and inalienable.
• Universal: This means that rights are not a privilege that some people have, but something all
people are entided to regardless of where they live, what caste they belong to, whether they are
female or male, etc.
• Indivisible: This means that a hierarchy of rights cannot be created where some rights are considered
more important than another. For example, you cannot claim that the right to vote is more important
than the right to health.
■ Interlinked: Rights have connections and reinforce each another. You cannot have the full potential
of one right without another. For example, in order to achieve a right to health you must also have
the right to economic stability and to earn a wage.
■ Inalienable: These rights and freedoms cannot be challenged or taken away from a person and each
person is born with the same rights.
Are THERE LIMITS TO THESE RIGHTS AND/OR HOW AN INDIVIDUAL CAN
CARRY OUT THESE RIGHTS?
In living, carrying out, or trying to achieve these rights, you cannot unfairly infringe upon the rights of
someone else.
• For example, an individual has the right to own property. However if when exercising this right an
individual unfairly takes away or steals another person’s property, s/he is now infringing on the
other person’s right to own property. Defining what a fair limit is and how far an individual or the
State can go before infringing on another person’s right, is also the subject of rights debates. For
example, governments often claim that they are protecting public morality and vulnerable people in
enforcing criminal laws against sex outside of marriage. However, the European Court of Human
Rights, an international human rights body, has told governments that using the criminal law to do
this - if no other harm, such as rape is involved - violated rights of privacy and non-discrimination.
What is a rights-based approach?
A rights-based approach considers the needs and well-being of each person, rather than the overall
outcomes of a population to assess if the approach is appropriate.
• For example: A rights-based approach to health would work to guarantee that every individual has
access to health services that respond to their needs, and will allow them to assess the right services
to use based on their needs and choices. Every person has a fundamental value which must be
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respecte in her/his decision-making and the context in which this decision is being made. This
contrasts with an approach that focuses on the population as a whole rather than the individual. In
t is case, demographic goals of a population are emphasised when providing health services, such
as reducing the rate of sexually transmitted infections or the number of births.
Human rights as a formal system in national and international law does have some limitations and
disadvantages. It can be complex for people to understand and apply effectively, especially in the
context of sexuality and reproductive health. Moreover, sexual rights are still evolving and are only
partly formalized. Even reproductive rights for that matter, are just beginning to be set into a formalized
system. Additionally, given the complex nature of sexuality, human rights applications to sexuality may
also be limited in some situations or leave further questions as to how they can be enforced and upheld.
HOW ARE RIGHTS ENFORCED AND SUPPORTED?
It is the duty of the State (i.e. the nation or Government) to respect, protect, and fulfil these rights.
Respect: This means that the State and its agents cannot violate, abuse, or deny a person’s rights.
■ Protect: This means the State must prevent a third party from violating, abusing, or denying a
person’s rights and if this happens, it must have a legal or other mechanism to respond to the harm,
including penalties to the third party for such actions.
■
Fulfil: This means the State must take steps to organize all of its structures - including budgets,
administration, legal structures etc - so that it can respond to rights needs. It will also work to
improve conditions or create infrastructure to allow for people to access a right if they are not able to
already do so.
Example: If looking at the right to vote, a State must respect that right by not preventing any person
from voting, such as women or non-landowners. To protect this right, the State must ensure that
there are no barriers against any person who is able and willing to vote: for example if one party
decides to use scare tactics and threaten people at the polls the State must prevent this from happening
and punish the party that does this. Fulfilling this right to vote means that diere must be structures
to establish who can vote and why; such as laws in place that allow for women and non-landowners
to vote, or programmes put in place that will improve the access people have to polling stations.
Can human rights be put into different categories?
Human rights are often discussed in the following categories. These categories, however, are not fixed
categories for all cases.
■ Civil and Political Rights (CP)-Civil rights may include the right to equality or to a fair trial.
Political rights may include the right to participate in government and assemble peacefully, be free
from torture, or be free to express an opinion and be equal before the law.
■ Economic, Social, Cultural Rights (ESC)-Economic rights may include the right to a decent
standard of living. Social rights can include favourable working conditions. An example of cultural
rights is the right to education.
•
Environmental and Development Rights (ED)-Environmental rights can include the right to clean
and potable water. Development rights can include the right to be free from poverty and
discrimination.
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HOW CAN HUMAN RIGHTS VIOLATIONS BE REPORTED AND MONITORED?
Human rights issues can be brought up and challenged in at least three ways: on a national/domestic
level, on a regional level, or an international level. In some cases it is necessary to begin at the national
level before moving to other human rights systems, but in general advocacy, one can use all three at the
same time.
■ National/domestic: A country’s local and national judicial system as well as special commissions
that address human rights.
• Regional: Formal human rights systems and mechanisms set up for the regions of the Americas,
Europe and Africa.
• International: The United Nations is the international system for human rights. Governments
came together to form the United Nations and following its formation agreed to set up various
standards on rights through the United Nations, along with processes and mechanisms to support
and monitor these rights. These include international treaties and laws overseen by independent
experts, as well as the Office of the High Commissioner for Human Rights that has a presence in
the United Nations, as well as offices in a number of other countries. These country-based offices
do monitoring and advocacy for human rights at the country level.
Key players in advancing rights
These entities can drive forward new issues and standards, as well as fulfil existing international laws
and standards.
■ Special Rapporteurs: These rapporteurs are independent experts on various issues (such as violence,
housing etc.) of the UN system and are mandated to 1) write general reports submitted to a
governmental human rights body; 2) go on two country missions each year to assess the rights
conditions and prepare a report; 3) take up communication and complaints and when applicable
take these up with respective governments. They can use any applicable international human rights
standard in making their case.
• Treaty Committees: These are groups of experts with oversight over each treaty on rights. The UN
system has created a number of treaties (also referred to as charters, protocols, and covenants).
Treaties, covenants and conventions are all international formal legal documents. These documents
outline agreements between States that sign them. Every country that ratifies a treaty has agreed to
the responsibilities laid out in the treaty/covenant and will make them part of their domestic legal
obligations. Every country that ratifies must also send in a report on how this treaty is being followed.
NGOs and other civil society groups can send in a shadow report to contradict or highlight areas
that may be missed in the country report. Treaty committees can also hear complaints from individuals
that claim human rights violations. For example the Committee on CEDAW can look into violations
against women in relation to particular rights. See Handout 3.5 for more information on the various
treaties.
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Handout 3.2
Facilitator Copy: Universal Declaration of Human Rights (UDHR)
en was the Universal Declaration of Human Rights adopted and what does it contain?
The Universal Declaration of Human Rights was adopted in 1948. There are 30 articles in the document
that summarise the human rights individuals have. The articles in the UDHR include:
life , liberty, security of person
no discrimination on the grounds of race, colour, politics, religion, sex, country or other status
legal rights - innocent until proven guilty
freedom of movement within country, right to leave your own country
• right to nationality
• right to marry freely, not coerced
• property ownership
freedom of thought, conscience and religion
• take part in government of country
• right to work, equal pay, vacation, rest
• standard of living for health, food, clothing, social services
• education — free at elementary and fundamental stages
PREAMBLE
Whereas recognition of the inherent dignity and of the equal and inalienable rights of all members
of the human family is the foundation of freedom, justice and peace in the world,
Whereas disregard and contempt for human rights have resulted in barbarous acts which have
outraged the conscience of mankind, and the advent of a world in which human beings shall enjoy
freedom of speech and belief and freedom from fear and want has been proclaimed as the highest
aspiration of the common people,
Whereas it is essential, if man is not to be compelled to have recourse, as a last resort, to rebellion
against tyranny and oppression, that human rights should be protected by the rule of law,
Whereas it is essential to promote the development of friendly relations between nations,
Whereas the peoples of the United Nations have in the Charter reaffirmed their faith in fundamental
human rights, in the dignity and worth of the human person and in the equal rights of men and
women and have determined to promote social progress and better standards of life in larger freedom,
Whereas Member States have pledged themselves to achieve, in co-operation with the United Nations,
the promotion of universal respect for and observance of human rights and fundamental freedoms,
Whereas a common understanding of these rights and freedoms is of the greatest importance for the
full realization of this pledge,
Now, Therefore THE GENERAL ASSEMBLY proclaims THIS UNIVERSAL DECLARATION
OF HUMAN RIGHTS as a common standard of achievement for all peoples and all nations, to the
end that every individual and every organ of society, keeping this Declaration constantly in mind, shall
strive by teaching and education to promote respect for these rights and freedoms and by progressive
measures, national and international, to secure their universal and effective recognition and observance,
both among the peoples of Member States themselves and among the peoples of territories under their
jurisdiction.
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Article 1.
All human beings are born free and equal in dignity and rights. They are endowed with reason and
conscience and should act towards one another in a spirit of brotherhood.
Example connection to sexuality: All people irrespective of sexual and gender identity (whether
heterosexual, homosexual, bisexual, woman, man or transgender etc.) can claim equal right to lives
ofdignity.
Article 2.
Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of
any kind, such as race, colour, sex, language, religion, political or other opinion, national or social
origin, property, birth or other status. Furthermore, no distinction shall be made on the basis of the
political, jurisdictional or international status of the country or territory to which a person belongs,
whether it be independent, trust, non-self-governing or under any other limitation of sovereignty.
Example connection to sexuality: 1) A woman, man, transgender, transsexual person all have
entitlement and should have access to the rights ofthe UDHR. 2) A child ofa sex worker can claim
the same rights as a child ofsomeone who is not in sex work.
Article 3.
Everyone has the right to life, liberty and security of person.
Example connection to sexuality: People with HIV/AIDS or other sexually transmitted infections
should not be excluded from these rights.
Article 4.
No one shall be held in slavery or servitude; slavery and the slave trade shall be prohibited in all their
forms.
Example connection to sexuality: A person’s sexual behaviours and identity should not put them in
a situation ofservitude or slavery.
Article 5.
No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.
Example connection to sexuality: Women should not be forced or coerced into sexual activity, even if
they are in a committed relationship or marriage.
Article 6.
Everyone has the right to recognition everywhere as a person before the law.
Example connection to sexuality: Whether woman, man or transgender, everyone has the right to
legal recourse at all times irrespective of their caste, class, socio-cultural background and choice of
profession/source of livelihood.
Article 7.
All are equal before the law and are entitled without any discrimination to equal protection of the law
All are entitled to equal protection against any discrimination in violation of this Declaration and
against any incitement to such discrimination.
Example connection to sexuality: A transgendered person is entitled to a life free from stigma and
discrimination and equal access to information, care and support services.
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Article 8.
eryone has the right to an effective remedy by the competent national tribunals for acts violating the
fundamental rights granted him by the constitution or by law.
Example connection to sexuality: Ifa hijra is beaten because ofhergender identity she has a right to
the same legal redressal, as any other individual that has been beaten or abused.
Article 9.
No one shall be subjected to arbitrary arrest, detention or exile.
Example connection to sexuality: People who practice anal sex should not be detained or harassed
by law enforcers because they are suspected to be homosexual. In India, Section 377 of the Penal
Code penalises sexual behaviour ‘against the order ofnature’. Some law enforcers have used this
section to harass and detain men ‘suspected’ ofbeing homosexual.
Article 10.
Everyone is entitled in full equality to a fair and public hearing by an independent and impartial
tribunal, in the determination of his rights and obligations and of any criminal charge against him.
Example connection to sexuality: A person’s sexual history should not be used against her/him in
the determination of her/his rights and obligations. For example, the misconception/assumption
that a prostitute cannot be raped or violated because she is always willing to have sex can lead to an
unfairjudgment in the favour ofher violator.
Article 11.
(1)
Everyone charged with a penal offence has the right to be presumed innocent until proved guilty
according to law in a public trial at which he has had all the guarantees necessary for his defense.
(2)
No one shall be held guilty of any penal offence on account of any act or omission, which did not
constitute a penal offence, under national or international law, at the time when it was committed.
Nor shall a heavier penalty be imposed than the one that was applicable at the time the penal offence
was committed.
Example connection to sexuality: A man who is homosexual shouldnot be assumed to be a paedophile
just because he prefers to have sex with men.
Article 12.
No one shall be subjected to arbitrary interference with his privacy, family, home or correspondence,
nor to attacks upon his honour and reputation. Everyone has the right to the protection of the law
against such interference or attacks.
Example connection to sexuality: 1) No one has the right to watch anotherperson bathe/dress/have
sex without their knowledge and permission. 2) A woman should not be in fear ofbodily harm or
invasion ofprivate space ofher body by other people irrespective of what she wears in public.
Article 13.
(1) Everyone has the right to freedom of movement and residence within the borders of each state.
(2)
Everyone has the right to leave any country, including his own, and to return to his country.
Example connection to sexuality: People ofalternative sexualities have a right to live in their own
country without fear ofpersecution or return to their home without fear ofpersecution for their
sexuality.
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Article 14.
(1)
Everyone has the right to seek and to enjoy in other countries asylum from persecution.
(2)
This right may not be invoked in the case of prosecutions genuinely arising from non-pohtical
crimes or from acts contrary to the purposes and principles of the United Nations.
Example connection to sexuality: A person who is beingpersecuted and tortured for being a lesbian
in one country, may be allowed to seek asylum in another more tolerant country.
Article 15.
(1)
Everyone has the right to a nationality.
(2)
No one shall be arbitrarily deprived of his nationality nor denied the right to change his nationality.
Example connection to sexuality: Transgendered, intersexedpeople should be able claim a nationality
as they have transitioned from one sex to another and do not fall into the gender categories created
by the State.
Article 16.
(1)
Men and women of full age, without any limitation due to race, nationality or religion, have the
right to marry and to found a family. They are entitled to equal rights as to marriage, during marriage
and at its dissolution.
(2)
Marriage shall be entered into only with the free and full consent of the intending spouses.
(3)
The family is the natural and fundamental group unit of society and is entitled to protection by
society and the State.
Example connections to sexuality: 1) In many countries of South and Southeast Asia including
India it is impossible for a same-sex couple, or trangender/transsexual couple, to have a marriage
officially recognized by the State. It is therefore also very difficult for them to adopt children or use
assisted reproductive technologies. 2) In many countries of the region, child marriages still exist,
which are in violation of the ‘in full age’ and ‘with full and free consent’ clauses.
Article 17.
(1)
Everyone has the right to own property alone as well as in association with others.
(2)
No one shall be arbitrarily deprived of his property.
Example connections to sexuality: 1) In some countries women are deniedproperty inheritance and
it is insteadgiven to a male member ofthe family who may be further removed from the deceased. 2)
An individual who undergoes a gender reassignment from female to male should not be falsely
accused ofdoing it for inheritance purposes.
Article 18.
Everyone has the right to freedom of thought, conscience and religion; this right includes freedom to
change his religion or belief, and freedom, either alone or in community with others and in public or
private, to manifest his religion or belief in teaching, practice, worship and observance.
Example connection to sexuality: A person has the right to think about their sexuality and how they
want to practise it in the manner that makes the best sense to them.
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Article 19.
Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions
wit out interference and to seek, receive and impart information and ideas through any media and
regardless of frontiers.
Example connection to sexuality: All people have the right to information regarding their sexual
and reproductive anatomy andphysiology and contraceptive choices irrespective ofmarital status or
nationality.
Article 20.
(1) Everyone has the right to freedom of peaceful assembly and association.
(2) No one may be compelled to belong to an association.
Example connection to sexuality: Gay pride parades and demonstrations, as well as sex workers
festivals and celebrations should be allowed without fear ofor actual prosecution.
Article 21.
(1) Everyone has the right to take part in the government of his country, directly or through freely
chosen representatives.
(2) Everyone has the right of equal access to public service in his country.
(3)
The will of the people shall be the basis of the authority of government; this will shall be expressed
in periodic and genuine elections which shall be by universal and equal suffrage and shall be held by
secret vote or by equivalent free voting procedures.
Example connections to sexuality: 1) Transgenderpeople should be allowed to holdpositions in the
government. 2) Some countries have only recently allowed women to vote. In India, ‘eunuchs’ were
granted voting rights in 1994.
Article 22.
Everyone, as a member of society, has the right to social security and is entitled to realization, through
national effort and international co-operation and in accordance with the organization and resources
of each State, of the economic, social and cultural rights indispensable for his dignity and the free
development of his personality.
Example connections to sexuality: 1) Sexuality can change with time and as a person develops. They
have a right to change the way they practise and experience sexuality throughout their lives. 2)
Individuals have the right to education irrespective ofHIV status.
Article 23.
(1) Everyone has the right to work, to free choice of employment, to just and favourable conditions of
work and to protection against unemployment.
(2) Everyone, without any discrimination, has the right to equal pay for equal work.
(3)
Everyone who works has the right to just and favourable remuneration ensuring for himself and
his family an existence worthy of human dignity, and supplemented, if necessary, by other means of
social protection.
(4)
Everyone has the right to form and to join trade unions for the protection of his interests.
Example connection to sexuality: Women should be able to work late at their employment and not
be harassed or assaulted when they leave their workplace late at night.
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Article 19.
Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions
without interference and to seek, receive and impart information and ideas through any media and
regardless of frontiers.
Example connection to sexuality: All people have the right to information regarding their sexual
and reproductive anatomy and physiology and contraceptive choices irrespective ofmarital status or
nationality.
Article 20.
(1) Everyone has the right to freedom of peaceful assembly and association.
(2) No one may be compelled to belong to an association.
Example connection to sexuality: Gay pride parades and demonstrations, as well as sex workers
festivals and celebrations should be allowed without fear ofor actual prosecution.
Article 21.
(1) Everyone has the right to take part in the government of his country, direcdy or through freely
chosen representatives.
(2) Everyone has the right of equal access to public service in his country.
(3)
The will of the people shall be the basis of the authority of government; this will shall be expressed
in periodic and genuine elections which shall be by universal and equal suffrage and shall be held by
secret vote or by equivalent free voting procedures.
Example connections to sexuality: 1) Transgenderpeople should be allowed to holdpositions in the
government. 2) Some countries have only recently allowed women to vote. In India, ‘eunuchs’ were
granted voting rights in 1994.
Article 22.
Everyone, as a member of society, has the right to social security and is entitled to realization, through
national effort and international co-operation and in accordance with the organization and resources
of each State, of the economic, social and cultural rights indispensable for his dignity and the free
development of his personality.
Example connections to sexuality: 1) Sexuality can change with time and as a person develops. They
have a right to change the way they practise and experience sexuality throughout their lives. 2)
Individuals have the right to education irrespective ofHIV status.
Article 23.
(1) Everyone has the right to work, to free choice of employment, to just and favourable conditions of
work and to protection against unemployment.
(2) Everyone, without any discrimination, has the right to equal pay for equal work.
(3)
Everyone who works has the right to just and favourable remuneration ensuring for himself and
his family an existence worthy of human dignity, and supplemented, if necessary, by other means of
social protection.
(4)
Everyone has the right to form and to join trade unions for the protection of his interests.
Example connection to sexuality: Women should be able to work late at their employment and not
be harassed or assaulted when they leave their workplace late at night.
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Article 24.
Everyone has the right to rest and leisure, including reasonable limitation of working hours and periodic
holidays with pay.
Example connection to sexuality: People who work in the ‘sex industry’, such as those who perform
in sex shows or Elms, also have the right to periodic breaks with pay.
Article 25.
(1)
Everyone has the right to a standard of living adequate for the health and well-being of himself and
of his family, including food, clothing, housing and medical care and necessary social services, and the
right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack
of livelihood in circumstances beyond his control.
(2)
Motherhood and childhood are entided to special care and assistance. All children, whether born
in or out of wedlock, shall enjoy the same social protection.
Example connections to sexuality: 1) People are able to enjoy andpractice their sexuality in manner
they choose, irrespective of marital status. 2) Right to adequate health implies that all people,
including those with disabilities have the right to access sexual and reproductive healthcare services.
3) Children have the right to be safe and free ofsexual abuse within as well as outside the home and
family.
Article 26.
(1) Everyone has the right to education. Education shall be free, at least in the elementary and
fundamental stages. Elementary education shall be compulsory. Technical and professional education
shall be made generally available and higher education shall be equally accessible to all on the basis of
merit.
(2) Education shall be directed to the full development of the human personality and to the strengthening
of respect for human rights and fundamental freedoms. It shall promote understanding, tolerance and
friendship among all nations, racial or religious groups, and shall further the activities of the United
Nations for the maintenance of peace.
(3)
Parents have a prior right to choose the kind of education that shall be given to their children.
Example connection to sexuality: Many educational systems do not support sexuality education for
young people or for people with disabilities. Nor do existent ‘life skills education’ or ‘family life
education’ programmes promote understanding, tolerance and respect for the needs of those
considered ‘different’, like people with disabilities, homosexuals, transgender people etc.
Article 27.
(1) Everyone has the right freely to participate in the cultural life of the community, to enjoy the arts
and to share in scientific advancement and its benefits.
(2) Everyone has the right to the protection of the moral and material interests resulting from any
scientific, literary or artistic production of which he is the author.
Example connection to sexuality: People who identify as homosexuals should not be denied roles in
theatre and musicals because of their sexual identity.
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Handout 3.3
Participant Copy: Universal Declaration of Human Rights (UDHR)
When was the Universal Declaration of Human Rights adopted and what does it contain?
The Universal Declaration of Human Rights was adopted in 1948. There are 30 articles in the document
that summarise human rights individuals have. As a brief summary, the articles in the UDHR inclu e.
• life, liberty, security of person
• no discrimination for race, colour, politics, religion, sex, country
■ legal rights-innocent until proven guilt
• freedom of movement within country, among countries
• right to nationality
■ right to marry freely, not arranged
• property ownership
• freedom of thought, conscience and religion
• take part in government of country
• right to work, equal pay, vacation, rest
• standard of living for health, food, clothing, social services
• education-free at elementary and fundamental stages
PREAMBLE
Whereas recognition of the inherent dignity and of the equal and inalienable rights of all members
of the human family is the foundation of freedom, justice and peace in the world,
Whereas disregard and contempt for human rights have resulted in barbarous acts which have
outraged the conscience of mankind, and the advent of a world in which human beings shall enjoy
freedom of speech and belief and freedom from fear and want has been proclaimed as the highest
aspiration of the common people,
Whereas it is essential, if man is not to be compelled to have recourse, as a last resort, to rebellion
against tyranny and oppression, that human rights should be protected by the rule of law,
Whereas it is essential to promote the development of friendly relations between nations,
Whereas the peoples of the United Nations have in the Charter reaffirmed their faith in fundamental
human rights, in the dignity and worth of the human person and in the equal rights of men and
women and have determined to promote social progress and better standards of life in larger freedom,
Whereas Member States have pledged themselves to achieve, in co-operation with the United Nations,
the promotion of universal respect for and observance of human rights and fundamental freedoms,
Whereas a common understanding of these rights and freedoms is of the greatest importance for the
full realization of this pledge,
Now, Therefore THE GENERAL ASSEMBLY proclaims THIS UNIVERSAL DECLARATION
OF HUMAN RIGHTS as a common standard of achievement for all peoples and all nations, to the
end that every individual and every organ of society, keeping this Declaration constandy in mind, shall
strive by teaching and education to promote respect for these rights and freedoms and by progressive
measures, national and international, to secure their universal and effective recognition and observance
both among the peoples of Member States themselves and among the peoples of territories under their
jurisdiction.
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Handout 3.3
Participant Copy: Universal Declaration of Human Rights (UDHR)
When was the Universal Declaration of Human Rights adopted and what does it contain?
The Universal Declaration of Human Rights was adopted in 1948. There are 30 articles in the document
that summarise human rights individuals have. As a brief summary, the articles in the UDHR include.
• life, liberty, security of person
• no discrimination for race, colour, politics, religion, sex, country
• legal rights—innocent until proven guilt
• freedom of movement within country, among countries
right to nationality
■ right to marry freely, not arranged
• property ownership
• freedom of thought, conscience and religion
■ take part in government of country
■ right to work, equal pay, vacation, rest
• standard of living for health, food, clothing, social services
• education—free at elementary and fundamental stages
PREAMBLE
Whereas recognition of the inherent dignity and of the equal and inalienable rights of all members
of the human family is the foundation of freedom, justice and peace in the world,
Whereas disregard and contempt for human rights have resulted in barbarous acts which have
outraged the conscience of mankind, and the advent of a world in which human beings shall enjoy
freedom of speech and belief and freedom from fear and want has been proclaimed as the highest
aspiration of the common people,
Whereas it is essential, if man is not to be compelled to have recourse, as a last resort, to rebellion
against tyranny and oppression, that human rights should be protected by the rule of law,
Whereas it is essential to promote the development of friendly relations between nations,
Whereas the peoples of the United Nations have in the Charter reaffirmed their faith in fundamental
human rights, in the dignity and worth of the human person and in the equal rights of men and
women and have determined to promote social progress and better standards of life in larger freedom,
Whereas Member States have pledged themselves to achieve, in co-operation with the United Nations,
the promotion of universal respect for and observance of human rights and fundamental freedoms,
Whereas a common understanding of these rights and freedoms is of the greatest importance for the
full realization of this pledge,
Now, Therefore THE GENERAL ASSEMBLY proclaims THIS UNIVERSAL DECLARATION
OF HUMAN RIGHTS as a common standard of achievement for all peoples and all nations, to the
end that every individual and every organ of society, keeping this Declaration constantly in mind, shall
strive by teaching and education to promote respect for these rights and freedoms and by progressive
measures, national and international, to secure their universal and effective recognition and observance
both among the peoples of Member States themselves and among the peoples of territories under their
jurisdiction.
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Article 1.
All human beings are born free and equal in dignity and rights. They are endowed with reason and
conscience and should act towards one another in a spirit of brotherhood.
Article 2.
Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction
of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social
origin, property, birth or other status. Furthermore, no distinction shall be made on the basis of the
political, jurisdictional or international status of the country or territory to which a person belongs,
whether it be independent, trust, non-self-governing or under any other limitation of sovereignty.
Article 3.
Everyone has the right to life, liberty and security of person.
Article 4.
No one shall be held in slavery or servitude; slavery and the slave trade shall be prohibited in all
their forms.
Article 5.
No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.
Article 6.
Everyone has the right to recognition everywhere as a person before the law.
Article 7.
All are equal before the law and are entitled without any discrimination to equal protection of the
law. All are entitled to equal protection against any discrimination in violation of this Declaration
and against any incitement to such discrimination.
Article 8.
Everyone has the right to an effective remedy by the competent national tribunals for acts violating
the fundamental rights granted him by the constitution or by law.
Article 9.
No one shall be subjected to arbitrary arrest, detention or exile.
Article 10.
Everyone is entitled in full equality to a fair and public hearing by an independent and impartial
tribunal in the determination of his rights and obligations and of any criminal charge against him.
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Article 11.
(1)
Everyone charged with a penal offence has the right to be presumed innocent until proved guilty
according to law in a public trial at which he has had all the guarantees necessary for his defense.
(2)
No one shall be held guilty of any penal offence on account of any act or omission, which did not
constitute a penal offence, under national or international law, at the time when it was committed.
Nor shall a heavier penalty be imposed than the one that was applicable at the time the penal
offence was committed.
Article 12.
No one shall be subjected to arbitrary interference with his privacy, family, home or correspondence,
nor to attacks upon his honour and reputation. Everyone has the right to the protection of the law
against such interference or attacks.
Article 13.
(1)
Everyone has the right to freedom of movement and residence within the borders of each state.
(2)
Everyone has the right to leave any country, including his own, and to return to his country.
Article 14.
(1)
Everyone has the right to seek and to enjoy in other countries asylum from persecution.
(2)
This right may not be invoked in the case of prosecutions genuinely arising from non-political
crimes or from acts contrary to the purposes and principles of the United Nations.
Article 15.
(1)
Everyone has the right to a nationality.
(2)
No one shall be arbitrarily deprived of his nationality nor denied the right to change his nationality.
Article 16.
(1) Men and women of full age, without any limitation due to race, nationality or religion, have the
right to marry and to found a family. They are entitled to equal rights as to marriage, during marriage
and at its dissolution.
(2) Marriage shall be entered into only with the free and full consent of the intending spouses.
(3)
The family is the natural and fundamental group unit of society and is entitled to protection by
society and the State.
Article 17.
(1) Everyone has the right to own property alone as well as in association with others.
(2) No one shall be arbitrarily deprived of his property.
Article 18.
Everyone has the right to freedom of thought, conscience and religion; this right includes freedom
to change his religion or belief, and freedom, either alone or in community with others and in
public or private, to manifest his religion or belief in teaching, practice, worship and observance.
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Article 19.
Everyone has the right to freedom of opinion and expression; this right includes freedom to hold
opinions without interference and to seek, receive and impart information and ideas through any
media and regardless of frontiers.
Article 20.
(1) Everyone has the right to freedom of peaceful assembly and association.
(2) No one may be compelled to belong to an association.
Article 21.
(1) Everyone has the right to take part in the government of his country, directly or through freely
chosen representatives.
(2) Everyone has the right of equal access to public service in his country.
(3)
The will ofthe people shall be the basis ofthe authority of government; this will shall be expressed
in periodic and genuine elections which shall be by universal and equal suffrage and shall be held
by secret vote or by equivalent free voting procedures.
Article 22.
Everyone, as a member of society, has the right to social security and is entitled to realization,
through national effort and international co-operation and in accordance with the organization and
resources of each State, of the economic, social and cultural rights indispensable for his dignity and
the free development of his personality.
Article 23.
(1) Everyone has the right to work, to free choice of employment, to just and favourable conditions
of work and to protection against unemployment.
(2) Everyone, without any discrimination, has the right to equal pay for equal work.
(3)
Everyone who works has the right to just and favourable remuneration ensuring for himself and
his family an existence worthy of human dignity, and supplemented, if necessary, by other means of
social protection.
(4)
Everyone has the right to form and to join trade unions for the protection of his interests.
Article 24.
Everyone has the right to rest and leisure, including reasonable limitation of working hours and
periodic holidays with pay.
Article 25.
(1) Everyone has the right to a standard of living adequate for the health and well-being of himself
and of his family, including food, clothing, housing and medical care and necessary social services,
and the right to security in the event of unemployment, sickness, disability, widowhood, old age or
other lack of livelihood in circumstances beyond his control.
(2) Motherhood and childhood are entitled to special care and assistance. All children, whether
born in or out of wedlock, shall enjoy the same social protection.
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Article 26.
(1) Everyone has the right to education. Education shall be free, at least in the elementary and
fundamental stages. Elementary education shall be compulsory. Technical and professional education
shall be made generally available and higher education shall be equally accessible to all on the basis
of merit.
(2) Education shall be directed to the full development of the human personality and to the
strengthening of respect for human rights and fundamental freedoms. It shall promote understanding,
tolerance and friendship among all nations, racial or religious groups, and shall further the activities
of the United Nations for the maintenance of peace.
(3)
Parents have a prior right to choose the kind of education that shall be given to their children.
Article 27.
(1) Everyone has the right freely to participate in the cultural life of the community, to enjoy the arts
and to share in scientific advancement and its benefits.
(2) Everyone has the right to the protection of the moral and material interests resulting from any
scientific, literary or artistic production of which he is the author.
Article 28.
Everyone is entitled to a social and international order in which the rights and freedoms set forth in
this Declaration can be fully realized.
Article 29.
(1) Everyone has duties to the community in which alone the free and full development of his
personality is possible.
(2) In the exercise of his rights and freedoms, everyone shall be subject only to such limitations as
are determined by law solely for the purpose of securing due recognition and respect for the rights
and freedoms of others and of meeting the just requirements of morality, public order and the general
welfare in a democratic society.
(3)
These.rights and freedoms may in no case be exercised contrary to the purposes and principles
of the United Nations.
Article 30.
Nothing in this Declaration may be interpreted as implying for any State, group or person any right
to engage in any activity or to perform any act aimed at the destruction of any of the rights and
freedoms set forth herein.
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TREATIES
HIGHLIGHTS
POLITICAL CLIMATE
ONE EXAMPLE
TIME PERIOD
FROM YOUR WORK:
Universal
Declaration of
Human Rights
The UDHR, the International
Covenant on Civil and Political
Rights, and the International
Covenant on Economic, Social and
Cultural Rights make up the Bill of
Human Rights.
• Adopted 1948.
• End of World War II that included
Nazi violence and the atomic
bomb. These events prompted
countries to draft the UDHR to
prevent further human rights
violations.
■ Europe struggles against Fascism.
• De-colonisation begins to
accelerate.
International
Convention on
the Elimination
of All Forms of
Racial
Discrimination
Contains a definition of racial
discrimination applicable to
employment, education and denial
of services. The definition states,
'Any distinction, exclusion,
restriction or preference based on
race, colour, descent, or national or
ethnic origin which has the purpose
or effect of nullifying or impairing
the recognition, enjoyment or
exercise, on an equal footing, of
human rights and fundamental
freedoms in the political, economic,
social, cultural or any other field of
public life.'
■ Adopted 1965, in force in 1969.
• Beginning of the Cold War.
■ The civil rights movement in the
United States is gaining power
and influence.
• Many African/Asia countries
achieve self-determination.
■ Feminist movement begins in the
United States.
International
Covenant on
Civil and
Political Rights
Meant as a supporting document
that would give legal force to the
UDHR. Stresses rights such as non
discrimination on the basis of sex,
race, among others, choice of
government, freedom of belief and
expression, freedom from torture,
equality in marriage.
• Adopted 1966, in force in 1976.
■ Start of the Cold War.
• Western nations supported civil
and political rights while
Communist nations supported
economic, social and cultural
rights.
International
Covenant on
Economic,
Social and
Cultural Rights
Meant as a supporting document
that would give legal force to the
UDHR. It stresses non
discrimination on the basis of sex
and race among others, in the right
to health care, housing, work, the
family and education.
• Adopted 1966, in force in 1976.
• Start of the Cold War.
■ Western nations supported civil
and political rights while
Communist nations supported
economic, social and cultural.
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HIGHLIGHTS
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POLITICAL CLIMATE
ONE EXAMPLE
TIME PERIOD
FROM YOUR WORK:
International
Convention on
the Elimination
of All Forms of
Discrimination
Against Women
Major document forbidding
discrimination against women. The
definition of discrimination includes
deliberate discrimination and
discrimination in public and private
life. The document also includes the
right of women to vote, to have family
planning education, right to decide the
number and spacing of children, and
have access to education and services
that allow for these decisions.
■ Adopted 1979, in force in 1981.
■ Human rights violations gain
attention through the apartheid
movement, Cambodian genocide,
and Vietnam War.
• Interpreted in 1992 to cover
violence against women.
Convention
Against Torture
and Other Cruel,
Inhuman or
Degrading
Treatment or
Punishment
Meant to further emphasise and call
for the abolition of torture that was
first laid out in the ICCPR. Contains a
clear definition of torture-'any act by
which severe pain or suffering,
whether physical or mental, is
intentionally inflicted on a person for
such purposes as obtaining from him
or a third person information or a
confession, punishing him for an act
he or a third person has committed
or is suspected of having committed,
or intimidating or coercing him or a
third person, or for any reason based
on discrimination of any kind, when
such pain or suffering is inflicted by
or at the instigation of or with the
consent or acquiescence of a public
official or other person acting in an
official capacity. It does not include
pain or suffering arising only from,
inherent in or incidental to lawful
sanctions.'
• Adopted 1984, in force in 1989.
Convention on
the Rights of
the Child
Most widely ratified treaty. Includes
protection from abuse, violence,
abusive employment, disease, famine,
sale, and abduction; freedom from
fighting in wars; right to education
and health care.
■ Tiananmen Square incident in
China, 1989.
• Fall of the Berlin Wall.
■ Marcos dictatorship ends in the
Philippines.
■ Adopted 1989, in force in 1990.
■ Many reports were published
leading up to the Convention on
children as refugees and in armed
conflicts, high rates of infant
mortality, abuse in jobs, and lack
of health care and education.
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CONFERENCES:
A number of conferences have been organised globally for governments and increasingly for NGOs, to
enforce and bring forth human rights claims for marginalised people and groups. These include those
in the chart below. These conferences have created consensus documents that are not legally binding.
CONVENTIONS
HIGHLIGHTS
YEAR
EXAMPLE OF HOW CONNECTED TO YOUR
WORK:_____________________
Conference on
Environment and
Development in Rio
de Janeiro (Earth
Summit)
Emphasis on poverty reduction and connection
between sustainable development and the
environment. Influenced other conferences to look at
the links between population, rights, women, the
environment, and development. NGOs begin to have
an impact on the outcomes of international
conferences.
1992
Conference on
Human Rights in
Vienna
The focus was to strengthen human rights instruments
and adherence mechanisms since the adoption of
UDHR. Called for a special rapporteur on Violence
Against Women and also focused on the rights of
indigenous people, migrants and children. Established
High Commissioner on Human Rights within the UN.
1993
International
Conference on
Population and
Development in Cairo
Emphasised a shift from population control and
demography to sustainable development. Reproductive
rights and health, as well as sexual health were
included in the Programme of Action, along with access
to health, immigrant policy, closing the gender gap,
and abortion.
1994
Social Development
in Copenhagen
Focus on globalisation, the world economy, poverty
and reaching nations and countries that are commonly
neglected and overlooked that face the hardest
economic situations.
1995
Fourth World
Conference on
Women in Beijing
Focus on the status of women worldwide and
reaffirming that reproductive rights are human rights
and that all women should have access and potential
to realise these rights, in development and in peace.
1995
World Conference
Against Racism in
Durban
Attention to debt cancellation for impoverished
countries as a legacy of racism. Called for special
measures to be strengthened to end race
discrimination.
2001
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Handout 3.5
Case Studies on Human Rights
Case Study 1
It took Arti three years and a lot of love and support from her friends and family to accept her HIV
status. She no longer feels the shame and hurt she felt in the early days of her diagnosis. Doctors told
Arti that there are medications she can take that can help her stay healthy longer, but she has not
followed up on that information. She now wants to know where she could get these medications since
she wants to improve her health. Unfortunately, when she returns to the clinic that diagnosed her as
HIV positive, she discovers that it has closed down. Arti lives in a fairly remote village which has only
one clinic—the one that has now closed down. She decides to ask one of her co-workers where she
could go to get the medication. When she asks the co-worker about the clinic she tells her that she is
HIV positive. The co-worker is not sure about a clinic but says she will try to find out for her.
The next day when Arti comes into work, she is asked by her supervisor to come into his office. He
informs her that they are cutting back on staff and will need to fire her. Arti is shocked and asks why
this is happening and who else is being fired. Since she is insistent, the boss tells her that only she is
being let go, because of her poor performance over the past year. Arti explains that she has always done
her job well and never received any complaints before. She also tells her boss that she needs the job to
help support her family, but her boss is unresponsive to her pleas. Arti goes home dejected and upset
and not sure what she should do next: she has no job, needs money to get the medicines she needs for
her HIV treatment, and is also unsure where to get these medicines. She feels alone and confused
about what to do.
Questions:
■ Are any of Arti’s rights being violated? Which ones?
■ What would the responsibility of the State be in the context of Arti’s rights?
• Discuss how any of the conventions or treaties of human rights may pertain to Arti’s situation.
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Case Study 2
Ahmed is a transgendered person living in a large city. While it has been difficult to identify as a
transgender, Ahmed is happy with his life and has friends and a community he is comfortable wit
and is content to remain in the city for the years to come. With this in mind, Ahmed decides to
purchase an apartment. He has set his sight on one: a modest apartment in a good neighbourhood and
is up for sale. Ahmed needs a loan to buy the flat and decides to try his luck with a local bank.
Ahmed goes to the bank with his request. The loan officer at the bank asks Ahmed to fill out the loan
application and tells him that the process of getting the Ioan should be fairly straightforward because
the loan amount is not very large. Also, Ahmed has documents to show that he will be able to repay the
loan effortlessly. Ahmed begins to fill out die form, but has a problem with the section that asks for
gender, and has only male and female as options. Ahmed does not consider himself to be exclusively
male or female and cannot tick one or the other category. Ahmed communicates his dilemma to the
loan officer and asks if he can add another category. The loan officer is confused, and tells Ahmed that
he must choose one of the gender options in order to get the loan. Again Ahmed protests and tries to
explain the situation, but the loan officer will not listen and simply tells Ahmed to make a choice or
forget about the loan.
Questions:
■ Are any of Ahmed’s rights being violated? Which ones?
• What would be the responsibility of the State be in the context of Ahmed’s rights?
• Discuss how any of the conventions or treaties of human rights may pertain to Ahmed’s situation.
Case Study 3
Bhuvana is a thirty-year-old woman who has just got married. She wants to have a child, but is in no
hurry: she and her husband would like to wait and have children once they are more settled in their
new home. She decides to go and speak to a health care worker about contraception. She goes to the
health centre that week and speaks to a nurse there. The nurse is very kind and they speak about her
hew marriage and home. The nurse asks Bhuvana about her plans to start a family. Bhuvana tells the
nurse that she and her husband plan to delay having children. The nurse frowns, and tells Bhuvana
that she is getting older and should have a child as soon as possible. Bhuvana explains again that she
wants children, but later. The nurse doesn’t look happy when she gives Bhuvana a pack of contraceptive
pills. Bhuvana starts to ask how they should be taken and whether there are other contraceptive options;
she doesn’t like to take pills and usually forgets medications - but the nurse has already left the room
and tells her to come back in a month. Bhuvana is left holding the pill pack and confused.
Questions:
■ Are any of Bhuvana’s rights being violated? Which ones?
• What would be the responsibility of the State, if any, in Bhuvana’s case?
■ Discuss how any of the conventions or treaties of human rights may pertain to Bhuvana’s situation
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Chapter 2
Reproductive Health and Rights
Chapter Objectives for the Facilitator
1.
To have participants understand what reproductive rights
mean.
2.
To have participants discuss the connections between
reproductive rights and reproductive health.
3.
To have participants examine the differences and overlaps
between reproductive health and rights, and sexual health
and rights.
4.
To shift participants from a conceptual understanding to
practical application of a rights-based approach to advocacy.
TARSHI: Basics and Beyond
MODULE 3 - Chapter 2
Why a Chapter on Reproductive Health
and Rights
'The protection of the family and of the child remains the concern of
the international community. Parents have a basic human right to
determine freely and responsibly the number and the spacing of their
children’ Proclamation 16, International Conference on Human Rights
at Teheran on 13 May 1968.
The first explicit mention of reproductive rights in a formal human
rights document can be found in the Declaration of the
International Conference on Human Rights in Teheran, Iran, 1968.
Over time, the definition of reproductive rights was refined at other
human rights conferences. Most importantly, the International
Conference on Population and Development in Cairo (1994), and
the United Nations Fourth World Conference on Women in Beijing
(1995), established reproductive rights as basic human rights
deserving of recognition. In essence, reproductive rights concern
the rights of people to reproduce, or not reproduce, free of
discrimination, coercion and violence. Reproductive rights are
meant to create the conditions in which reproduction can be
controlled by women and men. These rights are borne out of
reproductive health that emphasises the ‘physical, mental, and
social well-being in all matters relating to the reproductive system
at all stages of life’ (WHO. For more see Handout 3.6).
EXERCISES IN THIS CHAPTER:
Exercise 1: My Reproductive
Rights. 60 minutes
Exercise 2: Case Studies on
Reproductive Health and Rights.
60 minutes
Exercise 3: Acting Out Reproductive
Health and Rights. 60 minutes
Exercise 4: Advocating for
Reproductive land Sexual) Rights.
60 minutes
MATERIALS FOR THIS CHAPTER:
Flipchart
Markers
Pens/pencils
HANDOUTS REQUIRED FOR THIS
Reproductive rights and reproductive health are often discussed at
the same time as sexual rights and sexual health. While there are
overlaps, it is important that they be recognized as different
concepts. For example, individuals can choose to lead a sexual life
whether or not they want to reproduce. At the same time,
reproductive rights may merge or overlap with sexual rights, as
when making a choice to have children or not. This decision could
be influenced by the choice to be sexually active or not in the context
of a heterosexual relationship, unlike in the case of a same-sex
couple contemplating alternative reproductive technologies.
CHAPTER:
This chapter discusses reproductive health and rights. It also
highlights the overlaps and distinctions between sexual and
reproductive health and rights, and engages participants in
discussion and analysis of these topics.
• Handout 3.9
Reproductive Health and Rights
Role-play Scenarios
■ Handout 3.6
Basic Information on Reproductive
and Sexual Health and Rights
• Handout 3.7
Questions on Reproductive Rights
• Handout 3.8
Case Studies on Reproductive
Rights
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MODULE 3 - Chapter 2
ADDITIONAL RESOURCES:
• Chandiramani. R. 2005. 'Mapping
the Contours: Reproductive
Health and Rights and Sexual
Health and Rights in India'. Where
Human Hights Begin. Edited by
Wendy Chavkin and Ellen Chesler.
New Jersey: Rutgers University
Press.
• Eldis Health Resource Guide.
http://www.eldis.org/health/
■ HERA Action Sheets. Available at:
http://www.iwhc.org/
document.cfm?documentlD = 52
• international Women's Health
Coalition, http://www.iwhc.org/
■ MDGenderNet. Gender Equality
& the Millennium Development
Goals, http://www.mdgender.net/
■ Mertus, J., Flowers, N., Dutt, M.
1999. Local Action Global Change
- Learning About Human Rights of
Women and Girls. New York:
UNIFEM and The Center for
Women's Global Leadership.
• International Planned Parenthood
Federation, UNAIDS, UNFPA,
World Health Organization. 2005.
Linking Sexual and Reproductive
Health and HIV/AIDS; An
Annotated Inventory. Available
at: http://www.who.int.
■ For selected films see, http://
www.asiasrc.org/films.php and
Appendix B.
Key Messages for this Chapter:
• Individuals have the right to make reproductive choices based
on their circumstances, needs, desires and preferences.
• Individuals have the right to make their reproductive choices
free of fear or coercion from family, society and the State (for
example, as in the case of population policies).
• Reproductive rights mean having access, options, and services
related to reproduction as well as the right to choose when, how
and with whom these options and services are accessed.
■ Reproductive health and rights encompass a wide range of
services, choices and information that should be available to a
person. It is the responsibility of the State to ensure that these
services are in place.
• Do men also have reproductive rights? It is important to
remember that the rights of any single person cannot infringe
upon those of another. The reproductive rights of women are
given priority over those of men because women bear more of
the physical and emotional consequences of ;a pregnancy.
Therefore the choice to have a child or not, or to have an abortion
or not, is hers to make.
• Sexual rights can be examined and considered separately from
reproductive rights and vice versa. An individual can choose to
lead a sexual life without the intention or aim of reproduction.
At the same time, reproductive rights merge with sexual rights
in many instances. For example, the choice of when to have
children is connected to when and how a person chooses to be
sexually active in a heterosexual relationship. However, sex may
not be a consideration in the case of a same-sex couple who may
choose alternative reproductive technologies to have a child.
• Understanding the links and applications of the formal human
rights language and its concepts, including the language and
concepts of reproductive rights, is important when providing
services and making policies. For example, provisions for
contraception can apply and use the concept of bodily integrity
as outlined in the rights framework to make sure women receive
full information on the possible side effects of new forms of
contraception before they choose them.
TARSHI: Basics and Beyond
MODULE 3 - Chapter 2
Exercise 1
My Reproductive Rights
PARTY GAME
ADAPTED FROM LOCAL ACTION GLOBAL CHANGE - LEARNING ABOUT HUMAN RIGHTS OF WOMEN AND GIRLS.
Instructions
1.
2.
Divide the participants into two groups and have them stand
face to face in a line across the room. Read out one question at
a time from Handout 3.7 and allow participants 3 minutes to
discuss it with the person facing them. After 3 minutes, ask
participants from one line to move one place to their left to face
another person in the opposite line. The other line remains
stationary through the whole exercise. Read out another
question and allow new partners to discuss the questions for 3
minutes before moving onto the next question. Ideally each
participant should have an opportunity to speak to every other.
Continue moving the line and asking new questions until you
finish all questions. Have the group return to their seats to
discuss the exercise.
Suggested Questions:
• What did you learn from this exercise? What questions were
easier to discuss? Why?
• Were there any questions you had not thought of before? How
did you react when you heard them?
• In your discussions, who was considered to have a greater say in
questions related to reproduction (ie, men, women, family,
community etc.)? Why? What does this mean?
Give participants copies Handout 3.6 and have them read it
over. Ask for their reactions.
3.
Suggested Questions:
■ Can you relate the questions and answers from the exercise to
these definitions?
• Can you describe experiences in your life or any practical
examples that come to mind relating to these definitions?
304
Purpose of the
exercise:
To understand and discuss
what is meant by
reproductive rights.
TIME
60 minutes
MATERIALS
None
ADVANCE PREPARATION
Read Handout 3.6 Basic
Information on Reproductive and
Sexual Health and Rights and make
sure you understand all aspects of
the definitions.
Read Handout 3.7 Questions on
Reproductive Rights and select 7-10
questions. Think of possible
responses to the questions and how
they relate to reproductive rights as
described in the definitions.
TARSHI: Basics and Beyond
MODULE 3 - Chapter 2
THIS EXERCISE CAN BE MODIFIED
Key Messages
BY:
■ Discussing the questions as a large I
group rather than in pairs. This
■
modification works with
participants who are more
comfortable speaking openly in
the large group. It can also lead
to a deeper discussion of some
points and topics.
■ Reproductive health and rights are related to ‘lived’ experiences
of people and are not merely theories.
• Reproductive rights mean having access, options, and services
related to reproduction as well as the choices of when, how and
with whom these options and services are accessed.
• Reproductive rights also include the right to choose not to
reproduce.
• Experiences in reproductive health and rights can be different
among individuals. Varied individual, interpersonal and socio
cultural factors impact whether or not reproductive rights are
affirmed.
MAKING CONNECTIONS
■ Reproductive rights include the
rights of people to choose
whether to reproduce or not. This
includes the right to access to
information on preventing
pregnancies, how pregnancy
occurs and how to end an
unwanted pregnancy. For more
see Chapter 2 in Module 2.
There are options available for
women and men who have
trouble having a child and would
like to reproduce. For more see
Chapter 4 in Module 2.
TIPS FOR THE FACILITATOR:
I ■ Participants may find it difficult to relate their personal experiences to the ;
I
I
i
definitions of reproductive health and rights. It may help to begin the discussior.
with an example of how these definitions relate to a sample response. For
example, reproductive rights are being exercised when an un/married person
chooses to have a child or to not have one; not being allowed to make this ;
choice is a violation of their reproductive rights.
I ■ Participants may be uncomfortable discussing personal experiences with others.
Conduct an icebreaker before the exercise to encourage comfort within the group,
and emphasise that participants need to discuss only what they feel comfortable
sharing.
■ It is important to have a solid understanding of reproductive rights before conducting
this exercise. The facilitator may want to review Handout 3.6 as well as some of
the additional resources offered at the beginning of the chapter.
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TARSHI : Basics and Beyond
MODULE 3 - Chapter 2
Exercise 2
Case Studies on Reproductive Rights
Instructions
1.
Divide participants into small groups. Give a copy of one case
study to each participant, with instructions to read the case and
related questions and discuss the questions among the smaller
groups. Give groups 20 minutes.
2.
Bring the groups back together into the large group. Ask one
representative of each group to read out the case study and
questions and then summarise the group discussions.
3.
After each presentation, participants from other smaller groups
can ask questions or offer comments. Do not spend more than
20 minutes per presentation and discussion.
Suggested Questions:
■ What did you think of the case study?
■ Did you agree or disagree with the group analysis of the case?
Do you think there are other answers or issues to be raised?
4.
Go through this process with each small group. Ask for general
comments or questions at the end.
Suggested Questions:
■ Are there common themes or similarities between the case studies
and each group’s analysis?
• Are any of these cases similar to your own experiences or those
of your community?
306
CASE STUDIES
Purpose of the
exercise:
To understand issues
related to reproductive
rights.
TIME
75 minutes
MATERIALS
Handout 3.8 Case Studies on
Reproductive Rights, Handout 3.6
Basic Information on Reproductive
and Sexual Health and Rights
ADVANCE PREPARATION
Make required modifications to the
case studies based on your audience.
Make copies from Handout 3.6 and
Handout 3.8 for participants.
TARSHI: Basics and Beyond
THIS EXERCISE CAN BE MODIFIED
MODULE 3 - Chapter 2
Key Messages
BY:
■ Discussing one or two case
studies together as a large group
rather than dividing the
participants into smaller groups.
This can be beneficial for groups
that are still unsure about what is
meant by reproductive rights and
health.
MAKING CONNECTIONS
• Individuals have the right to be
free of infection and have access
to health services to ensure this
freedom. For more see Chapter 4
in Module 2.
■ It is important to discuss sexuality
and sexual rights with
reproductive rights. For more see
Chapter 3 in this Module.
■ Reproductive rights affirm the rights of men and women to have
information on and access to safe, effective, affordable, and
acceptable methods of family planning. This includes the right
to appropriate healthcare services for women in order for them
to have a safe pregnancy and childbirth.
• Sexual and reproductive rights issues are often associated with
inequalities of gender and sexuality. For example, a woman may
not have the same reproductive freedoms as a man, or liberty to
make choices about when and how to have children, because of
gender dynamics prevalent in communities. Similarly, she may
not be able to choose her partner and if, when, and how to have
sex.
• Reproductive rights give people the right to be able to make
informed choices about contraception without coercion.
■ Individuals should have access to healthcare and facilities that
allow them to realise sexual and reproductive health and rights
and also offer protection from infections that could potentially
affect their well-being.
TIPS FOR THE FACILITATOR:
■ Pay attention to the manner in which case presentations are made: Do they
use discriminatory language; do they reflect any prejudices; what are the
areas of discomfort? Make sure to address these when they come up.
• Be prepared to address queries on injectables and implants since they are
mentioned in one of the case studies. If necessary review Chapter 2 and
Handout 2.7 in Module 2.
• It is important to have a solid understanding of reproductive rights before
conducting this exercise. The facilitator should read over the handouts and
information on reproductive rights prior to conducting the exercise and may
also want to read additional resources offered at the beginning of the chapter.
307
TARSHI: Basics and Beyond
MODULE 3 - Chapter 2
Exercise 3
Acting Out Reproductive Rights
Instructions
1. Divide participants into three or four small groups. Assign each
group a scenario from Handout 3.9 and ask them to create a
short role-play that will address their scenario. Give them 1015 minutes to create the role-play.
ROLE-PLAYS
Purpose of the
exercise:
1. To understand issues
related to reproductive
rights and health.
2. Bring the groups back together and invite each to come up and
present their role-play. After each presentation ask for questions
and comments.
Suggested Questions:
■ What did you think of the portrayal and resolution of the role
play?
2. To discuss arguments
that surround reproductive
health and reproductive
rights.
• Do you agree or disagree with the central theme?
■ Do these issues or situations typically arise in your community?
TIME
3. At the end of all presentations, ask for general comments and
questions.
Suggested Questions:
• How do these scenarios and role-plays illustrate issues of
reproductive health and rights?
• How could you advocate for an understanding of reproductive
rights in your community and having people understand its value
in their daily lives?
I 60 minutes
MATERIALS
Handout 3.9 Role play Scenarios
for Reproductive Health and
; Rights, Handout 3.6 Basic
Information on Reproductive and
j Sexual Health and Rights
ADVANCE PREPARATION
Make copies of the scenarios of
i Handouts 3.9 and 3.6
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TARSHI: Basics and Beyond
MODULE 3 - Chapter 2
THIS EXERCISE CAN BE MODIFIED
Key Messages
BY:
■ Inviting two volunteer participants
to act out selected role-plays for
the large group rather than
> creating small groups. This may
be more appropriate for more
advanced groups who are
. comfortable and confident with
issues surrounding reproductive
' health and rights.
■ Having participants conduct a role
play reflecting both sides of an
: argument rather than trying to
; come up with a resolution to the
' case. This may be more
appropriate for less advanced
groups who are experiencing
difficulty in finding a resolution to
the situation.
• Individuals have the right to make choices related to reproduction
based on their circumstances, preferences, wants and needs.
■ Individuals have the right to make reproductive choices free from
fear or coercion from family, society and the State.
■ Reproductive health and reproductive rights encompass a wide
range of services, choices and information that should be
available to people and are the responsibility of the State to
provide.
TIPS FOR THE FACILITATOR:
■ Participants may find it difficult to resolve their role-play or arrive at a group
consensus. Emphasise that the resolution is not intended to illustrate the best or
most appropriate action, but rather to elicit conversation and discussion of the
situation.
• Participants may have difficulty connecting reproductive health and rights to the
scenarios and situations. If necessary, use the definitions provided in Handout 3.B
and review them with the group.
MAKING CONNECTIONS
• Knowledge of human rights basics
! can help with an understanding of
reproductive rights. For more see
Chapter 1 in this Module.
!■ Both the similarities and
differences between sexual and
reproductive rights should be
I considered. For more see Chapter
3 in this Module.
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TARSHI : Basics and Beyond
MODULE 3 - Chapter 2
Exercise 4
Advocating for Reproductive (and Sexual) Rights
SMALL GROUP WORK
Instructions
1.
2.
Divide participants into small groups. Hand each group three
pieces of flipchart paper and markers. Ask participants to
imagine they are working for the Ministry of Health in their
country or community and have been given unlimited funds
from the Ministry to expand, promote and create an ideal
situation to fulfil reproductive and sexual health and rights.
Their job is to map out the ideal plan to accomplish this task,
the specific requirements and steps they would need to take in
order to achieve this goal. In this plan they should answer three
questions and write these answers on the three pieces of flipchart
paper: What are the reproductive health and rights goals they
want to achieve and some requirements/needs to achieve them;
what sexual health and rights goals do they wish to achieve and
some requirements/needs to achieve them; and what goals can
be categorised as both sexual and reproductive health and rights.
Give groups 15-20 minutes.
When the small groups have completed their task, bring them
together and invite them to display their flipcharts. Ask a
representative from each group to read their charts and discuss
the process that led to the decision about ideal goals and the
needs to achieve these goals. After all the presentations, ask for
questions and comments from other participants.
Suggested Questions:
■ Do you agree with the goals presented here? Do you agree with
the ways in which sexual and reproductive health and rights
were categorised?
• Are there other ways these goals could be achieved? If money
were no longer an obstacle, what else could stand in the way of
your trying to achieve your objectives? For example, would it be
easy to get women and men to come forward to be checked for
sexually transmitted infections (STIs)? Would a community
outreach programme providing education on STIs help?
3.
310
After all presentations are over, highlight similar goals and needs
among them and differences in the way sexual and reproductive
rights were categorised. Ask for questions or comments.
Purpose of the
exercise:
1. To identify differences
and overlaps between
sexual and reproductive
rights.
2. To describe methods and
arguments to advocate and
promote better sexual and
reproductive rights.
TIME
60 minutes
MATERIALS
Flipchart paper, makers, pens,
Handout 3.6 Basic information on
Reproductive and Sexual Health and
Rights.
ADVANCE PREPARATION
Make copies of Handout 3.6 for
participants if they do not have it.
TARSHI: Basics and Beyond
MODULE 3 - Chapter 2
THIS EXERCISE CAN BE MODIFIED
BY:
Conducting this as a large group
exercise instead of one with small
groups.
• Focusing more on creating an
advocacy plan with specific steps
for a one-year plan to promote
sexual and reproductive health and
rights.
MAKING CONNECTIONS
■ Sexual rights and reproductive
rights sometimes overlap, but
there are also differences to
consider. For more see Chapter 3
in this Module.
• Campaigns and advocacy
movements have been successful
in improving reproductive rights
and health. For examples see
Chapter 2 in Module 5.
Suggested Questions:
■ What are the differences and overlaps between sexual and
reproductive health and rights?
• Do you think sexual and reproductive health and rights should
be dealt with separately, or addressed at the same time? What
are the advantages and disadvantages to consider?
• Is using a rights approach to health useful for advocacy? Why?
How?
Key Messages
• There are similarities and differences between sexual and
reproductive health and rights. It is important to recognise these
when advocating for the needs and well-being of communities
and individuals.
• An individual can choose to lead a sexual life without the
intention or aim of reproduction. At the same time, reproductive
rights merge with sexual rights in many instances. For example,
the choice of when to have children is connected to when and
how a person chooses to be sexually active in a heterosexual
relationship. However, sex may not be a consideration in the
case of a same-sex couple who may choose alternative
reproductive technologies to have a child.
■ The reproductive rights of women are given more priority than
those of men because women bear most of the physical and
emotional consequences of a pregnancy. Therefore they have
the right to choose whether to have a child or not.
■ Advocating for improved reproductive and sexual health rights
requires a clear understanding of individual rights and concerns
as well as the community’s perspective on these issues.
TIPS FOR THE FACILITATOR:
• Participants may find it difficult to identify the similarities and differences of sexual and reproductive health and rights,
especially if they have not been introduced to sexual rights at the time of doing this exercise. Review Handout 3.6 if required.
• Make sure that participants do not just list points from the sexual and reproductive health and rights definitions in ideal goals,
but base goals on needs of their communities and issues relevant to their lives.
Encourage participants to make arguments for advocacy that are specific rather than general/vague. For example instead of
an approach being 'talk to the community' have participants explain if this means to put up posters, create a media campaign
or hold open forums with community leaders?
311
TARSHI : Basics and Beyond
MODULE 3 ■ Chapter 2
Handout 3.6
Basic Information on Reproductive and Sexual Health and Rights
Reproductive Health is defined by the WHO as a
state of physical, mental, and social well-being in
all matters relating to the reproductive system at
all stages of life. Reproductive health implies that
people are able to have a satisfying and safe sex
life and that they have the capability to reproduce
and the freedom to decide if, when, and how often
to do so. Implicit in this are the rights of men and
women to be informed and to have access to safe,
effective, affordable, and acceptable methods of
family planning of their choice, and the right to
appropriate health-care services that enable
women to safely go through pregnancy and
childbirth.
(http://www.who.org/htmll'definition_.htm)
Reproductive Rights are the rights of men and
women to be informed and to have access to safe,
effective, affordable and acceptable methods of
family planning of their choice, as well as other
methods of their choice for regulation of fertility
which are not against the law, and the right of
access to appropriate health-care services that will
enable women to go safely through pregnancy and
childbirth and provide couples with the best
chance of having a healthy infant. (ICPD
Programme ofAction, para 7.3)
Sexuality is a central aspect of being human
throughout life and encompasses sex, gender
identities and roles, sexual orientation, eroticism,
pleasure, intimacy and reproduction. Sexuality is
experienced and expressed in thoughts, fantasies,
desires, beliefs, attitudes, values, behaviours,
practices, roles and relationships. While sexuality
can include all of these dimensions, not all of them
are always experienced or expressed. Sexuality is
influenced by the interaction of biological,
psychological, social, economic, political, cultural,
ethical, legal, historical, religious and spiritual
factors. (WHO wording definition 2002)
Sexual health is a state of physical, emotional,
mental and social well-being in relation to
sexuality; it is not merely the absence of disease,
dysfunction or infirmity. Sexual health requires a
positive and respectful approach to sexuality and
312
sexual relationships, as well as the possibility of
having pleasurable and safe sexual experiences,
free of coercion, discrimination and violence. For
sexual health to be attained and maintained, the
sexual rights of all persons must be respected,
protected and fulfilled. (WHO wording definition
2002)
The WHO 2002 definition says that sexual rights
embrace human rights that are already recognised
in national laws, international human rights
documents and other consensus statements. They
include the right of all persons, free of coercion,
discrimination and violence, to:
• the highest attainable standard of sexual health,
including access to sexual and reproductive health
care services;
• seel{, receive and impart information related to
sexuality;
■ sexuality education;
• respect for bodily integrity;
■ choose their partner;
■ decide to be sexually active or not;
■ consensual sexual relations;
• consensual marriage;
• decide whether or not, and when, to have children;
and
■ pursue a satisfying, safe and pleasurable sexual life.
The responsible exercise ofhuman rights requires
that all persons respect the rights of others.
How are reproductive health and rights
different from sexual health and rights?
Reproductive health refers to health in the context
of reproduction, not only of heterosexual people
of the reproductive age group (between 15 to 45
years), but also people who are younger, older
lesbian, gay, with disabilities and non-procreative.
Health-related issues of infertile people and those
who seek assisted reproductive technologies are
also part of reproductive health.
TARSHI: Basics and Beyond
MODULE 3 - Chapter 2
exual health refers to health around sexual
il
matters independent of reproduction, and deals
s
with issues like the prevention and cure of sexually
y
transmitted infections (STIs), including HIV/
/
AIDS, and sexual problems. Sexual health is a
a
sexual right in itself, but it is also a necessary
y
condition for the fulfilment of sexual rights.
would include attention to individual family
planning needs rather than a general focus on
demographic targets. It also emphasised gender
equity and sexuality as being essential to women’s
health rights and stated that comprehensive
reproductive health care should include
information on family planning, prevention of
STIs, prenatal and postnatal care, choice of
contraception, prevention of infertility, and
prevention of unsafe abortions.
Reproductive rights are about the rights of people»
to reproduce or not, free ofdiscrimination, coercion(
and violence. They are meant to create the,
conditions under which women and men cani 179 governments and over 1,500 NGOs from 113
control their reproduction.
countries attended the ICPD. Women’s groups
Sexual rights refer to the rights of all people to were instrumental in raising awareness of the
decide about matters related to their sexuality freely gender inequities in development and other
and responsibly. Because they deal with sexuality arenas, and worked to push forth an agenda for
independent of reproduction, they are wider in women’s empowerment and access to reproductive
their scope. In addition to safety from violence, health services as a human right. Funding
they offer the promise of a right to pleasure and estimates were given to each country and the
life enriching experiences. Because of their de ultimate objective was to have family planning and
linking from reproduction, sexual rights also reproductive health services available to people no
include the right to diverse forms of sexual later than 2015.
expression, identity and practice. Therefore sexual
rights also apply to people practicing non What is the background on the Fourth World
heterosexual and non-reproductive sexualities and Conference on Women in Beijing in 1995?
actively bring men into the picture.
The Fourth World Conference on Women (also
known as the Beijing Conference) built upon the
Why is the 1994 International Conference on
momentum created by ICPD and emphasised the
Population and Development (ICPD) that was importance of a gender perspective in policies and
held in Cairo significant in the context of
programmes. The Platform of Action for Beijing
reproductive rights?
addressed issues related to the social and political
The 1994 International Conference on Population empowerment of women, including their right to
accessible health services that included
and Development (ICPD) held in Cairo was
reproductive health services. 189 governments and
significant in the context of reproductive rights.
nearly 5,000 representatives from NGOs around
The conference was a turning point as it marked
the world attended the conference. A central focus
international recognition that a woman’s right to
for the conference was that rights are universal and
reproductive health was a fundamental human
need to be implemented by all nations. It also
right. It was also the first conference to put into
highlighted the political, social and economic
place an explicit call for women’s empowerment .
inequities faced by women around the world and
and gender equity, laying down guidelines for this
the need for change in attitudes and practices that
in its Programme of Action (PoA). The PoA
cause these inequities.
included recognition of women’s participation in
development, and the connection between this and
population growth. In the area of reproductive
health and rights, ICPD’s PoA also- included the
right of couples to plan and space their children,
non-coercive family planning, integration offamily
planning efforts into basic reproductive health
care, and a general confirmation that successful
efforts towards sustainable population growth
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TARSHI : Basics and Beyond
MODULE 3 - Chapter 2
Handout 3.7
Questions on Reproductive Rights
1.
What do you think is a good example of a ‘reproductive right’?
2.
How has a reproductive health choice impacted your life in any way? Give an example or two
if you feel comfortable sharing.
3.
What messages does your community/society give people about:
i.
Abortion
ii. Adoption
4.
Does your society/community treat women with children differently from women without
children?
5.
Do you think you/people in your community could be married and not have children?
6.
Do you think you/people in your community could stay single and have children?
7.
Do you think women and men face similar pressures to be:
i. Married
ii. Parents
8.
Who usually makes contraceptive choices: a woman, her partner, family, neighbours, any others?
9.
Reproductive health is only a concern for people in a sexual relationship: Agree or Disagree?
10.
Choosing not to have children is also a reproductive right. Agree or disagree?
314
TARSHI: Basics and Beyond
MODULE 3 - Chapter 2
Handout 3.8
Case Studies on Reproductive Rights
Case Study 1
A woman calls a helpline for advice. She has been married for 2 years and is still not pregnant. Her in
laws are unhappy about this and want her to have a medical check-up to make sure nothing is wrong
with her. Her husband constantly puts pressure on her to have sex with him and she gives in to him
against her own will frequently.
Are anyone s reproductive rights being violated here? If yes, whose and how?
What issues related to gender and sexuality can you identify in this case study?
Case Study 2
A woman married for 4 months is pregnant by accident (her husband’s condom broke during sex). She
is not ready for a child yet and wants an abortion. At first her husband agrees, but upon reflection feels
that they should go ahead with the pregnancy. The woman does not agree, but her husband threatens
to tell all their relatives and friends about the pregnancy in an effort to prevent her from having the
abortion.
Are anyone’s reproductive rights being violated here? If yes, whose and how?
What issues related to gender, sexuality and rights can you identify in this case study?
Case Study 3
The staff of a rural hospital has been given a brief introduction to a new contraceptive called Norplant.
They have also been told to encourage women who come in for a post-natal check-up or an abortion to
adopt this form of contraception. However, they were not told about the possible side effects and any
contraindications to look out for before prescribing the contraceptive.
What are the potential reproductive rights violations that women who visit this hospital may face?
How can this violation be avoided?
Case Study 4
A woman lives in a remote village. She has recently been experiencing unusual vaginal discharge
accompanied by an itching and stinging sensation. She is initially worried, but assumes it will stop by
itself After a week and a half, the symptoms are still present and she is now quite uncomfortable.
However the nearest medical clinic is 2 hours away and since she has a job during the day, getting to
the clinic will be difficult. The pressure is also on her to maintain her job, since her husband lost his
job a month back. The woman decides to wait longer and hopes that the symptoms subside.
What issues related to reproductive health and rights are highlighted in this case study?
Are there any reproductive rights being violated in this case? What are they? How can this violation
be avoided?
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MODULE 3 - Chapter 2
Handout 3.9
Role-play Scenarios for Reproductive Health and Rights
Scenario 1:
Create a role-play that addresses and responds to the statement: The responsibility for contraception is
a woman’s and hers alone. The role-play should illustrate agreement and disagreement with the
statement and should have a resolution to the scenario, in which one side of the argument wins over
the other.
Scenario 2:
Create a role-play that addresses and responds to the statement: The decision about whether and
when to have children should be exercised in consultation with one’s family (in-laws, parents etc.)
The role-play should illustrate agreement and disagreement with the statement and should have a
resolution to the scenario, in which one side of the argument wins over the other.
Scenario 3:
Create a role-play that addresses and responds to the statement: A government approach to population
control that has target numbers for population control measures (such as sterilisation) as its goal is the
best way to tackle the problem of over population. The role-play should illustrate agreement and
disagreement with the statement, and should have a resolution to the scenario in which one side of the
argument wins over the other.
Scenario 4:
Create a role-play that addresses and responds to the statement: A couple has the choice to not have
children and they can exercise this right. The role-play should illustrate agreement and disagreement
with the statement and should have a resolution to the scenario in which one side of the argument
wins over the other.
316
MODULE 3 - Chapter 3
Chapter 3
Sexuality, Sexual Health and
Rights
Chapter Objectives for the Facilitator
1.
To have participants understand the meaning ofsexual rights.
2.
To have participants understand the connection between
sexuality and sexual rights.
3.
To have participants relate sexual rights to their lives and
work.
TARSHI : Basics and Beyond
MODULE 3 - Chapter 3
Why a Chapter on Sexuality, Sexual
Health and Rights
Anjali was hesitant and fearful when she went to the doctor's office.
She did not lil^e doctors and was embarrassed about the reason for her
visit. But she summoned the courage to tell the doctor that she wanted
birth control pills. The doctor smiled at her and ashed how long she
had been married. Anjali hesitated and then told the doctor she was not
married, but she still needed birth control. The doctor looked concerned
and as^ed her what she needed birth controlfor ifshe was unmamedshe shouldn’t be in a sexual relationship ifshe was single, that was not
what ‘good women’ did. Even ifshe was married, she should be thinking
about having children. No, the doctor announced, there really was no
needfor Anjali to get birth control and ashed ifthere was anything else
she needed. Anjali left the officefeeling unsure and confused about the
visit, without the birth control pills she wanted.
Anjali’s experience is not uncommon. However situations such as
the one described above should have an entirely different outcome.
Anjali should have received information on her sexual health, been
given the opportunity to make decisions about her sexual and
reproductive choices without guilt or shame, and explore and
practice her sexuality and sexual identity. These choices and
information are part of Anjali’s sexual rights — rights that are
fundamental and will ensure her health and well-being.
Sexual rights are in the early stages of being defined, and many
uncertainities still exist on how these rights should be upheld,
defined and achieved. Sexual rights have historically been linked
to reproductive health and rights. While links between the two
frameworks exist, assuming that they are identical or
interchangeable, fails to recognise essential differences between
them. The question and challenge is to bring the discussion of
sexual rights and health together with reproductive rights and health
to highlight their similarities, and at the same time acknowledge
that all sexuality and sexual activity is not based upon reproduction.
In this chapter participants consider such questions after first
understanding what sexual health and rights mean. The chapter
also makes connections between sexual health and rights and offers
perspectives on how to include these issues in advocacy campaigns.
EXERCISES IN THIS CHAPTER
Exercise 1: Defining Sexual Health
and Sexual Rights. 60 minutes
Exercise 2: Freedom To/ Freedom
From. 30 minutes
Exercise 3: Quick Questions to
Sexuality and Sexual Rights.
45 minutes
Exercise 4: Case Study on Sexuality,
Sexual Health and Sexual Rights.
60 minutes
MATERIALS FOR THIS CHAPTER:
Flipchart
Markers
Pens/pencils
Index cards/slips of paper
Watch/timer
Tape
HANDOUTS REQUIRED FOR THIS
CHAPTER:
• Handout 3.6
Basic Information on Reproductive
and Sexual Health and Rights
■ Handout 3.10
Imagining a Right to Sexuality
• Handout 3.11
List of Phrases for Freedom From/
Freedom To
• Handout 3.12
Questions on Sexual Health and
Rights
• Handout 3.13
Case Study of Maya
TARSHI : Basics and Beyond
ADDITIONAL RESOURCES:
■ Chandiramani. R. Mapping the
Contours: Reproductive Health and
Rights and Sexual Health and
Rights in India in Where Human
Rights Begin Edited by Wendy
Chavkin and Ellen Chester, Rutgers
University Press, New Jersey,
2005
• CREA, SANGAMA and TARSHI. A
Conversation on Sexual Rights In
India. 2004
■
MODULE 3 - Chapter 3
Key Messages for this Chapter
■ While there is no explicit definition of sexual rights in any
international document (like the Universal Declaration of
Human Rights), various definitions of sexual rights have been
developed and used. These definitions include the right to sexual
and reproductive self-determination, to bodily integrity, to sexual
desires and fantasies, and to sexual relations with a chosen
partner without stigma or shame.
• Sexual rights are important to ensure sexual health and well
being.
■ Durbar Mahila Samanwaya
Committee, http://
www.durbar.org/
• Sexual rights are different from reproductive rights and health
(see Handout 3.6 for more), and there is a growing movement
to ensure that these two concepts are discussed separately even
while noting the common themes and ideas that exist between
them.
■ Eldis Health Resource guide, http:/
/www.eldis.org/health/
• Sexual health is a sexual right in itself. For the 2002 WHO
working definition of Sexual Health, see Handout 3.6
• Mertus, J., Flowers, N., Dutt, M.
1999. Local Action Global Change
- Learning About Human Rights of
Women and Girls. New York:
UNIFEM and The Center for
Women's Global Leadership.
• G. Misra and R. Chandiramani,
eds. Sexuality, Gender and Rights;
Exploring Theory and Practice in
South and Southeast Asia SAGE.
2005
• Of Veshyas, Vamps, Whores and
Women, http://
www.vampnews.org/
• For selected films see, http://
www.asiasrc.org/films.php and
Appendix B
TARSKI: Basics and Beyond
MODULE 3 - Chapter 3
Exercise 1
Defining Sexual Health and Sexual Rights
GROUP DISCUSSION
Instructions
1.
Divide the participants into four small groups. Divide and
distribute the slips of paper with the words and phrases from
Handout 3.6 equally among groups. Give 20 minutes to
participants to read over the words and phrases, define each
word or phrase, and explain its relevance and connection to
sexuality.
Bring the groups back together. Have each read aloud their
words/phrases and connections to sexuality. While this is being
read, write key points on a flipchart. Following each
presentation, ask for questions and comments.
2.
Purpose of the
exercise:
1. To understand and
define sexuality and sexual
health.
2. To describe the
connections between
sexuality, sexual health and
sexual rights.
Suggested Questions:
■ Does the rest of the group agree with the definitions presented?
• Would you add or remove any parts of the definition or include
other connections to sexuality?
After discussing all the words and phrases, introduce the WHO
working definition of sexuality on the flipchart.
3.
Suggested Questions:
■ Do you agree with the definition by the WHO? Is anything
missing from it?
• Could you use this definition for advocacy work within your
organisation/ community? How?
TIME
60 minutes
MATERIALS
Flipchart, markers, pens, slips of
paper with sexuality definition words
and phrases (see belowl, Handout
3.10 Imagining a Right to Sexuality,
Handout 3.6 Basic Information on
Sexuality and Sexual Rights
ADVANCE PREPARATION
Next, introduce the WHO working definition of sexual health
written on the flipchart.
4.
Suggested Questions:
■ Is the definition of sexual health comprehensive? Is anything
missing?
• How are the definitions of sexuality and sexual health related?
• Why do you think words in the definitions such as pleasure,
well-being, or gender identities have been included?
320
1. Copy the words and phrases from
the World Health Organization
IWHO) working definition on
sexuality onto separate slips of paper
or index cards.
2. On two separate flipcharts, write
out the WHO definition of sexuality
and the WHO working definition of
sexual health from Handout 3.6.
TARSHI: Basics and Beyond
MODULE 3 - Chapter 3
Exercise 1
Defining Sexual Health and Sexual Rights
GROUP DISCUSSION
Instructions
Divide the participants into four small groups. Divide and
distribute the slips of paper with the words and phrases from
Handout 3.6 equally among groups. Give 20 minutes to
participants to read over the words and phrases, define each
word or phrase, and explain its relevance and connection to
sexuality.
1.
2.
Bring the groups back together. Have each read aloud their
words/phrases and connections to sexuality. While this is being
read, write key points on a flipchart. Following each
presentation, ask for questions and comments.
Purpose of the
exercise:
1. To understand and
define sexuality and sexual
health.
2. To describe the
connections between
sexuality, sexual health and
sexual rights.
Suggested Questions:
■ Does the rest of the group agree with the definitions presented?
• Would you add or remove any parts of the definition or include
other connections to sexuality?
After discussing all the words and phrases, introduce the WHO
working definition of sexuality on the flipchart.
3.
Suggested Questions:
■ Do you agree with the definition by the WHO? Is anything
missing from it?
• Could you use this definition for advocacy work within your
organisation/ community? How?
TIME
60 minutes
MATERIALS
Flipchart, markers, pens, slips of
paper with sexuality definition words
and phrases (see below), Handout
3.10 Imagining a Right to Sexuality,
Handout 3.6 Basic Information on
Sexuality and Sexual Rights
ADVANCE PREPARATION
Next, introduce the WHO working definition of sexual health
written on the flipchart.
4.
Suggested Questions:
■ Is the definition of sexual health comprehensive? Is anything
missing?
• How are the definitions of sexuality and sexual health related?
• Why do you think words in the definitions such as pleasure,
well-being, or gender identities have been included?
320
1. Copy the words and phrases from
the World Health Organization
IWHO) working definition on
sexuality onto separate slips of paper
or index cards.
2. On two separate flipcharts, write
out the WHO definition of sexuality
and the WHO working definition of
sexual health from Handout 3.6.
TARSHI: Basics and Beyond
MODULE 3 - Chapter 3
5.
THIS EXERCISE CAN BE MODIFIED
Distribute Handout 3.10 to each participant. Ask for final
questions or comments.
BY:
Suggested question:
• Dividing it into two smaller
exercises to be done one after
another. This can break up the
information for participants and
allow for more discussion.
• Why is the choice of words so important in these definitions?
• Why is it important to have a definition of sexuality and sexual
health?
• Dividing the participants into small |
.
I
i
groups and distributing some
words and phrases from the
WHO definition to each group.
Ask participants to relate each
word to sexuality and present
these connections to the rest of
the group.
Key Messages
• The definition used by the World Health Organization (WHO)
is a working definition. Other organisations and groups have
additional definitions for sexual rights which can be found in
Handout 3.10
I
I_______ _ _ 1
• Each word in the WHO definition was chosen carefully so that
the definition of sexuality would be as comprehensive as possible
and could be used effectively in advocacy.
MAKING CONNECTIONS
TIPS FOR THE FACILITATOR:
■ It is important to understand the
basic human rights framework
and how sexual rights relate to
this. For more see Chapter 1 in
this Module.
■ As in the exercise on Understanding Sexuality (Chapter 1, Module 11, participants
may need to be reminded that the definition of sexual health is long and complex
because it has to include the various elements that constitute sexual health.
• For a clearer conceptual
understanding of connections and
differences between sexual and
reproductive health and rights see
Chapter 2 in this Module.
■ Participants may get confused and tired after this lengthy exercise. Take a break
in the middle or right after the session if necessary, to give people time to absorb
the information.
321
TARSHI: Basics and Beyond
MODULE 3 - Chapter 3
Exercise 2
Freedom To/ Freedom From
Instructions
1.
Distribute the cards/slips with the statements from Handout
3.11 to the participants. Try to give each person at least one
card/slip.
Go around the room and ask each participant to read the
statement on their card aloud and to describe what the statement
means to them and whether it should be categorised as a
‘freedom to’ or ‘freedom from’. For example, the term ‘Education
on Sexuality’ might mean being given accurate information on
safer sexual practices, which would be categorised as the
‘Freedom to Education on Sexuality’. The cards/slips should
then be taped to the appropriate flipchart in the front of the
room. Go through all the statements and then ask for questions
or comments.
2.
Suggested Questions:
• Are there any statements in the Freedom To... category you
disagree with? Are there any statements in the Freedom From...
category you disagree with?
• Could some of the statements be placed in both categories? For
example, sexual entertainment and material could be ‘freedom
to purchase, use and sell such material’, but also ‘freedom from
such material in the office or personal space’ if it makes a person
uncomfortable.
3.
After the statements have been discussed, explain that these
statements help define sexual rights.
Suggested Questions:
■ Considering that these statements are related to sexual rights,
should any statements be moved into another category?
• Can you make any connections or identify differences between
these statements and those found in the Universal Declaration
of Human Rights? Are these statements more specific or more
general? Why do you think this is so?
322
SMALL GROUP WORK
Purpose of the
exercise:
To understand what sexual
rights mean.
TIME
30 minutes
MATERIALS
Flipchart, markers, tape, Handout
3.6 Basic Information on Sexuality
and Sexual Rights (Chapter 2,
Module 31, Handout 3.11 List
of Phrases for Freedom From/
Freedom To
ADVANCE PREPARATION
Copy each statement from Handout
3.11 onto index cards or slips of
paper. Prepare two flipchart pages,
one with the title Freedom To... and
one with the title Freedom From...
Tape the two flip charts up at the
front of the room.
TARSHI: Basics and Beyond
MODULE 3 - Chapter 3
THIS EXERCISE CAN BE MODIFIED
Key Messages
BY:
• Following the discussion of
freedom from or freedom to
statements, with the question of
who should have access to the
rights listed on the flipcharts. For
example, who should have the
freedom to education on
sexuality? Should it only be adults
or adolescents as well?
• Reading aloud the statements
from Handout 3.11 rather than
handing them out to participants
and asking the participants as a
large group which category it
should be put into and why.
■ Sexual rights are important to guarantee all aspects of sexual
health and well-being.
■ There is no explicit consensus on a definition of sexual rights in
any international document (like the agreed upon definition of
human rights in the UDHR), but the Beijing Conference put
forth a Platform of Action on sexual rights that states, ‘to have
control over and decide freely and responsibly on matters related
to their sexuality.’ Since then there have been definitions put
out by World Health Organization, International Women’s
Health Coalition, among other advocacy and rights groups to
create a more inclusive definition. Handouts 3.6 and 3.10 discuss
some of these definitions.
• The rights found in the working definitions of sexual rights are
more specific than those found in the Universal Declaration of
Human Rights.
TIPS FOR THE FACILITATOR:
MAKING CONNECTIONS
• It is important to understand the
basic human rights framework
and how sexual rights relate to
this. For more see Chapter 1 in
this Module.
■ Sexual rights and reproductive
rights overlap, but there are also
differences that should be
considered between the two. For
more see Chapter 2 in this
Module.
• Participants' responses for the placement of cards may be predictable. The
facilitator should challenge them to consider alternative placements. For
example, the group may put the phrase 'have children' in the 'Freedom To'
category, however it can also be put if the 'Freedom From' category.
■ Participants may find it difficult to connect the statements to sexual rights
even after going through the exercise of categorising them. Ask them to give
examples of how each statement relates to sexual rights or use examples
such as those given in the instructions. Review the definitions of sexual rights
in Handout 3.6 if confusion still exists.
■ This can be a quick exercise completed in less than 30 minutes to have
participants begin to think about what sexual rights are and how to apply
them.
323
TARSHI: Basics and Beyond
MODULE 3 - Chapter 3
Exercise 3
Quick Questions on Sexual Health and Rights
ADAPTED FROM LOCAL ACTION GLOBAL CHANGE - LEARNING ABOUT HUMAN RIGHTS OF WOMEN AND GIRLS.
PARTY GAME
Instructions
1.
2.
Divide the participants into two groups and have them sit face
to face in a line across the room. Read out one question at a
time from Handout 3.12 and allow participants 3 minutes to
discuss it with the person facing them. After 3 minutes, ask
participants from one line to move one place to their left to face
another person in the opposite line. The other line remains
stationary throughout the exercise. Read out another question
and allow new partners to discuss the questions for 3 minutes
before moving onto the next question. Ideally each participant
should have an opportunity to speak to every other.
Purpose of the
exercise:
1. To become comfortable
around communicating
and listening to
experiences of sexuality.
2. To understand the
connections between
sexuality, attitudes and
sexual rights.
After going through the questions ask participants for comments
and reactions to what they learned and heard.
Suggested Questions:
■ Were you surprised by some of the comments and answers from
your partners? Were they similar or different from your own
reactions?
• After going through these questions do you see connections
between the ideas of sexual rights and your own needs and
experiences? If yes, how, and if no, why not?
■ How do you think some of the experiences relate to sexuality
and sexual rights? Give an example.
TIME
45 minutes
MATERIALS
Watch/timer, Handout 3.12
Questions on Sexual Health and
Rights
ADVANCE PREPARATION
Arrange chairs in two lines facing
each other.
_________ _______ ________________
324
TARSHI: Basics and Beyond
MODULE 3-Chapter
Key Messages
THIS EXERCISE CAN BE MODIFIED
BY:
• Choosing one or two statements
from the list, and inviting
participants to share how they
responded to this statement and
opening up discussion around it.
A good question to start with may
be, 'When was the first time you
exercised one or more of your
sexual rights, if ever?' The
answers to this question can help
indicate whether the group has
really begun to understand the
concept of sexual rights.
■ Conducting a group discussion
rather than having participants
talk to each other in pairs. Some
of the suggested questions given
in the Instructions can be used to
start to the discussion.
MAKING CONNECTIONS
• Different people express their sexuality differently. This does not
mean, however, that one person’s expression is better or more
acceptable than another’s.
■ Sexual rights and sexuality are not just theories. They can be
applied to people’s lives, experiences, and needs.
TIPS FOR THE FACILITATOR:
I
\
• Participants may be uncomfortable sharing experiences and answering questions
about sexual rights and sexuality, even with one person. It may be useful at the
start of the exercise to review the ground rules of the training, emphasising
confidentiality and non-judgmental attitudes and/or to do an icebreaker.
■ It is not necessary to ask questions in the listed order or spend the same amount
of time on each question. Use discretion and judgment of the group dynamics
and comfort levels to get discussions going and keep the attention and interest
of the group. Questions can also be modified to suit the audience.
• Participants should begin to see the connections between sexuality and sexual
rights and how these relate to their personal lives. If they are still unsure about
these connections, the facilitator needs to address the confusion. If the definition
is the cause, it may need to be reviewed. If there are difficulties adapting it to
personal experiences, the facilitator may want to take one of the statements as
an example and explain how it can relate to sexuality and sexual rights.
• Having a solid understanding of
sexuality, sex and gender is
important to understand the scope
of sexual rights. For more on these
topics see Chapters 1 and 2 in
Module 1.
■ There are similarities as well as
j
divergence between sexual and
reproductive health and rights. For j
more see Chapter 2 in this Module.
325
TARSHI: Basics and Beyond
MODULE 3 - Chapter 3
Exercise 4
Case Study on Sexuality, Sexual Health and Rights
CASE STUDY AND DEBATE
Instructions
1.
2.
Distribute a copy of the case study to each participant. Give
them a few minutes to read the case. Divide participants into
two groups: one group will argue for Maya returning to her first
husband, while the other will argue for Maya remaining with
her current husband. Each group should spend 15 minutes
constructing an argument for their side of the debate.
Purpose of the
exercise:
1. To examine potential
challenges and obstacles to
addressing sexuality and
sexual rights.
Bring the groups back together and begin the debate by giving
each side a few minutes to present their arguments. Then allow
for a more open discussion, making sure each side is given an
equal chance to defend/argue their position. After debating for
15-20 minutes, ask whether anyone has been convinced by the
other side of the argument and wants to switch sides. Allow
people to get up and move to the other side of the room.
2. To analyse the role of
sexual rights in real life
scenarios.
Suggested Questions:
TIME
■ For those who switched sides, why did you switch?
60 minutes
■ If no one switched, why not? Are the other side’s arguments
non-persuasive?
MATERIALS
Handout 3.13 Case Study of Maya
3.
Bring the group together by discussing Maya’s rights and
potential violations ofher sexual rights presented in this scenario.
Suggested Questions:
■ How does Maya’s story relate to sexual rights? Can you list any
violations of her rights?
• Does this case illustrate similar situations you have encountered
in your community or work?
• How could Maya challenge her position?
326
ADVANCE PREPARATION
Make copies of Handout 3.13 for
each participant.
TARSHI: Basics and Beyond
MODULE 3 - Chapter 3
THIS EXERCISE CAN BE MODIFIED
BY:
■ Conducting a simple polarisation
exercise by summarising the case
and asking those who believe that
Maya should return to Samar to
stand to one side of the room, and
those who believe she should stay
with Hakeem, to the other. After
discussing reasons for participants'
choices, engage in a discussion of
Maya's sexual rights.
■ Using the exercise to assess this
module by asking participants in
small groups to analyse the case
and present points on how the
case highlights various issues from
this module: gender and sexual
identity, pleasure, and sexual
rights etc. Peer and facilitator
evaluation of the presentations
can help determine whether the
knowledge and perspectives from
the modules have been acquired.
Key Messages
• Sexual rights play a role in real life situations and circumstances
such as the case study of Maya.
■ Many groups/communities place a stronger emphasis on family
and community than on the individual. In such cases, it may be
challenging for participants to understand the value of human
rights, which place the individual at the centre.
• Culture and religion can also play a role in the decisions made
by a family and community. While these must be respected, it is
also important to examine whether any single person or group’s
rights are always sacrificed in the name of a ‘higher good’ and
how interests of both communities/groups and an individual
can be preserved.
■ In some countries and states, tension exists between rights and
the strength of communal laws and customs. Discussing how
to integrate and balance these is important.
MAKING CONNECTIONS
TIPS FOR THE FACILITATOR:
• There are similarities as well as
divergence between sexual and
reproductive health and rights. For
more see Chapter 2 in this
Module.
• Sexuality, sexual rights and health
have been advocated for in various
campaigns and movements. For
more on such campaigns see
Chapter 2 in Module 5.
■ Participants may experience discomfort at having to argue a side of the debate
they disagree with. The facilitator should encourage them to learn to argue a side
they might disagree with in order to understand their own position and the opinion
of others better. It also illustrates the difficulties experienced in arguing for sexual
rights and how this can be done effectively.
■ Participants may feel strongly about the case but not focus on the sexual rights of
the characters. The facilitator should ask questions about Maya's sexual rights
and whether they are being violated. Participants need to be urged to think of
constructive solutions within the constraints of the situation.
327
MODULE 3 - Chapter 3
TARSHI: Basics and Beyond
Handout 3.10
Imagining a Right to Sexuality
Below are some definitions and declarations on sexual rights developed by various groups and international
bodies.
HERA (Health, Action, Empowerment, Rights, & Accountability)
Action Sheet on Sexual Rights, 1998
What are sexual rights?
Sexual rights are 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.
Sexual rights include:
• The right to happiness, dreams and fantasies.
■ The right to explore one’s sexuality free from fear, shame, guilt, false beliefs and other impediments
to the free expression of one’s desires.
■ The right to live one’s sexuality free from violence, discrimination and coercion, within a framework
of relationships based on equality, respect and justice.
• The right to choose one’s sexual partners without discrimination.
■ The right to full respect for the physical integrity of the body.
■ The right to choose to be sexually active or not, including the right to have sex that is consensual and
to enter into marriage with the full and free consent of both people.
• The right to be free and autonomous in expressing one’s sexual orientation.
• The right to express sexuality independent of reproduction.
■ The right to insist on and practice safe sex for the prevention of unwanted pregnancy and sexually
transmitted diseases, including HIV/AIDS.
■ The right to sexual health, which requires access to the full range of sexuality and sexual health
information, education and confidential services of the highest possible quality.
For more, see wtuw.iwhc.org/globallunlunhistorylhera.cfm
328
TARSHI: Basics and Beyond
MODULE 3 - Chapter 3
International Planned Parenthood Federation (IPPF): Charter On
Sexual And Reproductive Rights, i 995
1•
The Right to Life which means, among other things, that no woman’s life should be put at risk by
reason of pregnancy.
2.
The Right to Liberty and Security of the Person which recognises that no person should be
subject to female genital mutilation, forced pregnancy, sterilisation or abortion.
3.
The Right to Equality, and to be Free from all Forms of Discrimination including in one’s
sexual and reproductive life
4.
The Right to Privacy meaning that all sexual and reproductive health care services should be
confidential, and all women have the right to autonomous reproductive choices.
5.
The Right to Freedom of Thought which includes freedom from the restrictive interpretation of
religious texts, beliefs, philosophies and customs as tools to curtail freedom of thought on sexual
and reproductive health care and other issues.
6.
The Right to Information and Education as it relates to sexual and reproductive health for all,
including access to full information on the benefits, risks, and effectiveness of all methods of
fertility regulation, in order that all decisions taken are made on die basis of full, free and informed
consent.
7.
The Right to Choose Whether or Not to Marry and to Found and Plan a Family
8.
The Right to Decide Whether or When to Have Children
9.
The Right to Health Care and Health Protection which includes the right of health care clients
to the highest possible quality of health care, and the right to be free from traditional practices
which are harmful to health.
10.
The Right to the Benefits of Scientific Progress which includes the right of sexual and reproductive
health service clients to new reproductive health technologies which are safe, effective and
acceptable.
11.
The Right to Freedom of Assembly and Political Participation which includes the right of all
persons to seek to influence communities and governments to prioritise sexual and reproductive
health and rights.
12.
The Right to be Free from Torture and Ill-treatment including the rights of all women, men and
young people to protection from violence, sexual exploitation and abuse.
For the whole charter, see:http://www.ippf.com/ ContentController.aspx?ID—6653
329
MODULE 3 - Chapter 3
TARSHI: Basics and Beyond
World Association of Sexology Declaration of Sexual Rights, 1999
Sexuality is an integral part of the personality of every human being. Its full development depends
upon the satisfaction of basic human needs such as the desire for contact, intimacy, emotional expression,
pleasure, tenderness and love. Sexuality is constructed through the interaction between the individual
and social structures. Full development of sexuality is essential for individual, interpersonal, and societal
well being. Sexual rights are universal human rights based on the inherent freedom, dignity, and
equality of all human beings. Since health is a fundamental human right, so must sexual health be a
basic human right. In order to assure that human beings and societies develop healthy sexuality, the
following sexual rights must be recognized, promoted, respected, and defended by all societies through
all means. Sexual health is the result of an environment that recognizes, respects and exercises these
sexual rights.
1.
The right to sexual freedom. Sexual freedom encompasses the possibility for individuals to
express their full sexual potential. However, this excludes all forms of sexual coercion,
exploitation and abuse at any time and situations in life.
2.
The right to sexual autonomy, sexual integrity, and safety of the sexual body. This right involves
the ability to make autonomous decisions about one’s sexual life within a context of one’s own
personal and social ethics. It also encompasses control and enjoyment of our own bodies free
from torture, mutilation and violence of any sort.
3.
The right to sexual privacy. This involves the right for individual decisions and behaviors
about intimacy as long as they do not intrude on the sexual rights of others.
4.
The right to sexual equity. This refers to freedom from all forms of discrimination regardless of
sex, gender, sexual orientation, age, race, social class, religion, or physical and emotional
disability.
5.
The right to sexual pleasure. Sexual pleasure, including autoeroticism, is a source of physical,
psychological, intellectual and spiritual well being.
6.
The right to emotional sexual expression. Sexual expression is more than erotic pleasure or
sexual acts. Individuals have a right to express their sexuality through communication, touch,
emotional expression and love.
7.
The right to sexually associate freely. This means the possibility to marry or not, to divorce,
and to establish other types of responsible sexual associations.
8.
The right to make free and responsible reproductive choices. This encompasses the right to
decide whether or not to have children, the number and spacing of children, and the right to
full access to the means of fertility regulation.
9.
The right to sexual information based upon scientific inquiry. This right implies that sexual
information should be generated through the process of unencumbered and yet scientifically
ethical inquiry, and disseminated in appropriate ways at all societal levels.
10.
The right to comprehensive sexuality education. This is a lifelong process from birth throughout
the life cycle and should involve all social institutions.
11.
The right to sexual health care. Sexual health care should be available for prevention and
treatment of all sexual concerns, problems and disorders.
Sexual Rights are Fundamental and Universal Human Rights
For more see: http://www.worldsexology.org/about_sexualrights.asp
330
TARSHI: Basics and Beyond
MODULE 3 - Chapter 3
World Health Organization Working Definition of Sexual
Rights, 2002
Sexual rights embrace human rights that are already recognized in national laws, international human
rights documents and other consensus statements. They include the right of all persons, free of coercion,
discrimination and violence, to:
• the highest attainable standard of sexual health, including access to sexual and reproductive health
care services;
■ seek, receive and impart information related to sexuality;
• sexuality education;
• respect for bodily integrity;
• choose their partner;
• decide to be sexually active or not;
■ consensual sexual relations;
• consensual marriage;
• decide whether or not, and when, to have children; and
• pursue a satisfying, safe and pleasurable sexual life.
The responsible exercise ofhuman rights requires that all persons respect the rights of others.
For more see: http://wwtu.who.int/reproductive-health/gender/sexual_health.html
331
TARSHI: Basics and Beyond
MODULE 3 - Chapter 3
Handout 3.11
List of Phrases for Freedom To /Freedom From
■ Bodily integrity
• Sexual and reproductive health
• Confidentiality in health services
• Make decisions in reproduction free from coercion and discrimination
• Any sexual thought, fantasy or desire
• Sexual entertainment and material
• Stigma and discrimination
• Government intervention
• Education on sexuality
• Choose a partner
■ Be sexually active
• Consensual sexual relations
• Have children
• Sexual pleasure
• Violence
• Abuse
• Marriage
■ Harassment
332
TARSHI: Basics and Beyond
MODULE 3 - Chapter 3
Handout 3.12
Questions on Sexual Health and Rights
1.
When was the first time you exercised one or more of your sexual rights, if ever?
2.
Has a sexual choice impacted your life in any way? In what way?
3.
Does the community or society you live in convey any messages on pre marital sex to you?
4.
Does the community or society you live in convey any messages on non-monogamous
relationships?
5.
Do you think men and women face similar pressures of abstaining from sex until marriage? In
what other areas related to sexuality do you find similarities and differences?
6.
Do you think men and women deal equally with the expectation of being in a sexual relationship
and how so?
7.
Sexual health is about having ‘healthy’ or ‘good’ sex: do you agree or disagree?
8.
Sexual health is of concern only to those in a sexual relationship: do you agree or disagree?
9.
To avoid rape or sexual harassment, women should not dress in revealing clothes: do you agree
or disagree?
10.
Do you think marriage keeps a society together?
11.
Do you think sexual pleasure is a right? Why?
12.
Homosexuals should access separate sexual health services from heterosexuals: do you agree or
disagree?
13.
Do you think forced sexual activity is acceptable in marriage? Why or why not?
14
Transgender people also have the right to information on sexuality and sexual pleasure; do you
agree or disagree and why?
15
If a husband has sex with his wife against her wishes, it is a violation of her sexual rights; do
you agree or disagree and why?
16.
People with disabilities can and do have sexual desires; do you agree or disagree and why?
333
TARSHI: Basics and Beyond
MODULE 3 - Chapter 3
Handout 3.13
Case Study of Maya
Maya is a young woman who married Samar at the age of 18. Samar is a kind man and treats Maya
well. The two are content living together in a moderately-sized village among their friends and family.
Soon after they are married, Samar decides he isn’t earning enough money and wants to be a better
provider for Maya. He decides to take a job abroad for the next year, which will pay him more money
than his current job. The only drawback is that he will be far from home and probably unable to
return to visit until the end of the year. He reassures Maya that at least they will be able to talk to each
other once a month.
Maya is upset over Samar’s departure, but knows this is a good plan and thinks one year will go by
quickly. She can use the time to get to know Samar’s family and get used to her new home. During the
first few months of Samar’s move, he is regular about keeping in touch and they speak to each other at
the beginning of every month. He seems satisfied with his job, although it is difficult to be apart from
Maya and his family. Then one month, Samar’s call does not come. This is just the beginning of many
months of silence. Maya is worried but assumes her husband is busy or does not have the money to
call. After 6 months, however, she begins to think something is wrong. She tracks down the company
he was working with, and contacts them to ask about Samar and his whereabouts. The company is
unsure about him and take a few weeks to let her know that that Samar left with some other workers
for a site visit a couple months ago and has still not returned. According to the company, the group
travelled through a rather dangerous area of civil unrest and didn’t even show up for the site visit.
Their whereabouts are still unknown and the company has been trying to locate them by talking to
some groups and the police. They tell Maya they are confident about finding them, and that she
should just be patient. Maya is confused and upset, but decides there is no choice but to wait. Six
more months go by, and the company still has no news for Maya. There is no word from Samar either.
Suddenly, she gets another call from the company that inform her that Samar is presumed dead.
Upon hearing this news, Maya’s family decides to wait to make sure Samar does not return before they
find Maya another match — after all, she is still young and needs a family. Three years go by before they
finally decide to arrange another marriage for her. They find a suitable husband in a neighbouring
village and the couple are married within a few months. Maya likes her new husband Hakeem, who
is a good man and makes a fair wage working in a nearby factory. She is happy with her life, although
she continues to feel sadness over her previous life and the loss of Samar. Her life with Hakeem,
however, is comfortable, and within a few months she becomes pregnant. The couple is overjoyed and
eager to have their first child together. Eight months into her pregnancy, there is some surprising
news: Samar has returned home! A rebel group had held him captive for three years, but he had finally
been released and returned home.
Maya is overwhelmed by the news and unsure what to think or do. Samar wants her to return to him
and his family is also urging her to do the same. But Maya’s new husband Hakeem loves her and
because she is carrying their baby, he thinks her only option is to stay with him. People in the village
and surrounding areas also discuss the situation and advise Maya on what she must do. Some think
she should stay with Hakeem, while others say she was never truly divorced from Samar and according
to the law, is still his wife and should return to him, even if she is carrying Hakeem’s child. Yet another
group thinks Maya should return to Samar, but the child once born should be raised by Hakeem and
his family. The family and villages decide to hold a meeting to decide Maya’s fate. They will discuss
issues pertaining to the case and debate the options before coming up with a decision for Maya. Maya
is unsure what to do and feels like the decision is out of her control.
334
MODULE 4
Beyond Basics
TARSHI : Basics and Beyond
MODULE 4
Introduction
Once basic topics related to sexuality, sexual and reproductive health
and rights have been addressed and understood (Modules 1-3),
participants can begin an exploration of more complex issues and
their impact: issues of power, stigma, marginalisation, and disability,
in the context of sexuality.
The chapters in Module 4: Beyond Basics explore this complex
range of issues often overlooked in the context of sexuality. An
exploration of these topics will help to avoid stigmatising and
marginalising people and include all groups and populations in
discussions and programming.
At the end of this module, participants will be able to analyse and
examine issues of stigma and marginalisation and discuss power
and violence, and issues concerning people with disabilities in the
context of sexuality and sexual and reproductive health and rights.
TARSHi: Basics and Beyond
MODULE 4
Module 4:
Beyond Basics
Chapter 1: Sexuality & Power
• Exercise 1: Understanding Sexuality and Power
60 minutes
• Exercise 2: Who Has the Power
60 minutes
• Exercise 3: Abuse of Power: Sexual Violence
and Harassment
60 minutes
■ Exercise 4: Abuse of Power: Intimate
Partner Violence
60 minutes
• Exercise 5: Abuse of Power: Child Sexual Abuse
60 minutes
• Exercise 6: Creating Power Dynamics
60 minutes
Chapter 2: Challenging Stigma and Discrimination
• Exercise 1: Stigma and Identities
45 minutes
• Exercise 2: Stigma Mapping
60 minutes
• Exercise 3: Acting Out Stigma and Discrimination 60 minutes
• Exercise 4: Stereotyping Identities
60 minutes
Chapter 3: Sexuality & Disability
• Exercise 1: Reflecting on Disabilities
30 minutes
• Exercise 2: Debating Sexuality and Disabilities
60 minutes
• Exercise 3: My Views on Sexuality and Disabilities 60 minutes
■ Exercise 4: Including People With Disabilities
60 minutes
337
TARSHI: Basics and Beyond
MODULE 4
Assessment for Module 4
Beyond Basics
At the end of this module the facilitator can conduct an assessment.
This assessment can evaluate increase in participant knowledge,
changes in attitudes, preferences for different exercises, and
opinions on the facilitator’s skills. For this module, an assessment
can be done using the following tools:
• Using the modification of Exercise 6 in Chapter 1 of this Module
• Adapting one of the sample assessment forms found in Chapter
2,
Preparing to Train.
■ Using the facilitator preparation exercises for this module found
in Chapter 1, Preparing to Train
■ Developing a new assessment depending on the facilitator’s
requirements
Sample Training Schedule
A blank template of a training schedule as well as a sample sevenday training schedule can be found in the Introduction of Preparing
to Train. Depending on the focus of the training and the topics it
aims to cover, the facilitator can fill in the blank schedule with
exercises from this Module or in combination with exercises from
other Modules.
338
MODULE 4 - Chapter 1
Chapter 1
Sexuality and Power
Chapter Objectives for the Facilitator
1.
To have participants define and understand the concept of
power.
2.
To have participants connect the concept of power to issues
of sexuality, sexual and reproductive health and human
rights.
3.
To dispel myths and introduce facts about existing forms of
sexual violence and abuse.
TARSHI : Basics and Bevond
MODULE 4 - Chapter 1
Why a Chapter on Sexuality and Power
What do we mean by power? What are the different forms ofpower?
Is power merely to have control over something, and ifso what are the
factors contributing to this control?
Can choice and consent also be part ofpower exchanges?
Do influences beyond the individual, such as community and family
contribute to one’s power?
Answers to the questions above will differ depending on the person,
group or community being asked. This is because power is not a
rigid or simple concept. Power is changeable and complex, and
differs according to its context and relationship with the individual,
community, and larger environment.
This chapter examines power and its connection to sexuality, sexual
and reproductive health and human rights. It examines the role
and influence of power in the lives of people and communities we
work with. For example, sexual assault and abuse - whether in
the form of gender-based violence, rape, intimate partner violence,
or child sexual abuse — can be better understood through the lens
of power differentials. This lens provides an understanding of the
motives for such actions and is essential to addressing and changing
them.
However, we must recognise that power is not always abusive.
When consensual, exchanging power can also be affirmative and
contribute to sexual pleasure. Abuse occurs when a power exchange
loses the elements of consent and choice.
This chapter covers a number of concepts related to power, such as
power that comes from having certain opportunities, to power
examples in situations of gender-based violence and child sexual
abuse, among others. The notion ofpower is the common thread
connecting all these topics. The chapter also examines the ways
in which power is expressed, how power influences roles being
played out, how it can be assessed and adjusted for more equality,
and how it relates to the issues surrounding sexuality, sexual and
reproductive health and rights.
EXERCISES IN THIS CHAPTER:
Exercise 1: Understanding Sexuality
and Power. 60 minutes
Exercise 2: Who Has the Power.
60 minutes
Exercise 3: Abuse of Power: Sexual
Violence and Harassment.
60 minutes
Exercise 4: Abuse of Power: Intimate
Partner Violence. 60 minutes
Exercise 5: Abuse of Power: Child
Sexual Abuse. 60 minutes
Exercise 6: Creating Power
Dynamics. 60 minutes
MATERIALS FOR THIS CHAPTER:
Flipchart
Markers
Index cards/slips of paper
Pens/pencils
HANDOUTS REQUIRED FOR THIS
CHAPTER:
Handout 4.1
Abuse of Power: Sexual Violence
and Harassment
Handout 4.2
Intimate Partner Violence Scenario
Handout 4.3
Facilitator Copy: Myths and Facts
About Child Sexual Abuse
Handout 4.4
Participant Copy: Myths and Facts
About Child Sexual Abuse
Handout 4.5
Creating Power Dynamics Scenarios
ARSHI: Basics and Beyond
ADDITIONAL RESOURCES:
• CARE. 2005. Protecting Women's
Rights, or Protecting Women CARE's First Regional Meeting on
Violence Against Women
Bangkok.
■ CREA. 2005. Building Alliances
Globally To End Violence Against
Women - The Global Dialogue
Series
• Menus, J., Flowers, N., Dutt, M.
1999. Local Action Global Change
- Learning About Human Rights of
Women and Girls. New York:
UNIFEM and The Center for
Women's Global Leadership.
• Mezey, Gillian C.; King, Micheal B.
Ed. 1993. Male Victims of Sexual
Assault
■ The Population Council. 2001.
Power in Sexual Relationships: An
Opening Dialogue Among
Reproductive Health Professionals.
New York: The Population
Council.
• Renzetti, Claire M; Edleson,
Jeffrey L et al. 2001. Sourcebook
on Violence Against Women.
Thousand Oaks: Sage Publications.
• Tulir-Centre for Prevention and
Healing of Child Sexual Abuse.
www.tulircphcsa.org
■ Vishaka v. State Of Rajasthan
11997.08.131 (India Sexual
Harassment). Available at: http://
www.pria.org/intervention/
Supreme.htm
• For selected films see, http://
www.asiasrc.org/films.php and
Appendix B.
MODULE 4 - Chapter 1
Key Messages for this Chapter
• Power operates under many influences and is experienced in
different ways. These experiences vary with age, class, caste,
gender, educational status, disability, access to services, and HIV
status among others.
• There are many players/people who influence an individual’s
decisions and thereby hold some power in their lives. These can
be community, family, and larger political or legal systems.
■ Power imbalances are not confined to certain genders and sexual
identities. For example, women are not always the ones who
experience gender-based violence; transgendered people can also
face this form of violence.
■ Changing political climates and the people we arexonnected to
can continually alter how we view and experience the power
dynamics in our lives.
■ Power can manifest itself in inequalities, violence, and abuse.
However not all power is abusive or negative. Power exchanges
can also provide sexual pleasure. It is in non-consensual
situations that power is abused.
• Choice and power are never absolute and all choices are based
on the situations and contexts of people’s lives.
TARSKI: Basics and Beyond
MODULE 4 - Chapter 1
Exercise 1
Understanding Sexuality and Power
Instructions
1.
Divide the participants into two groups. Give the groups 15
minutes to discuss and list out answers to the following
questions:
Group 1: What do you think you have the power to do in your
life? What do you think has power over you in your life? What
gives you power?
Group 2: Where/when has power been used against you in your
life? Where/when have you used power over others in your life?
What denies you power?
2.
Bring the groups back together to present their list and ideas.
Write these on a flipchart and after all the group presentations,
ask for questions and comments:
Suggested Questions:
■ Do you agree or disagree with the comments from each group?
Do you have any comments or statements to add?
• What can you say about power from these lists? Is it always
positive or always negative? Can you define what power is from
these lists?
• Which players (people, organisations, political entities) from
these lists are involved in the power one may/may not have?
3.
After this discussion, ask participants to return to their groups
and relate their questions to sexuality. Give the groups 15
minutes to answer the following new statements:
Group 1: What do you think you have the power to do in your
life with respect to your sexuality? What/who do you think has
power over your sexuality?
Group 2: Where/when has power been used against your
sexuality? Where/when have you used your power over others
especially in the context of sexuality?
4.
342
Bring the groups back together to present their responses. Write
these out on the flipchart. After presentations, ask for questions
and comments.
SMALL GROUP WORK
Purpose of the
exercise:
1. To define the concept of
power.
2. To relate the concept of
power to sexuality.
TIME
60 minutes
MATERIALS
Flipchart, markers
ADVANCE PREPARATION
None
TARSHI: Basics and Beyond
MODULE 4 - Chapter 1
Suggested Questions:
THIS EXERCISE CAN BE MODIFIED
BY:
■ Creating examples and answers
for questions and distributing
these to the groups, rather than
having them come up with their
own: Participants can then decide
what questions these statements
answer and why.
MAKING CONNECTIONS:
• People who engage in sexual
behaviour that is not considered
the norm may feel marginalised
and experience less power than
others. For more see Chapter 1 in
Module 1 and Chapter 2 in this
Module.
■ What can you say about power and its relationship to sexuality
from these lists? Is it always positive or negative? Who are the
people involved in the power you may/may not have?
• Do you think you have more or less power when it comes to
issues related to your sexuality compared to other areas of your
life?
Key Messages
• Power can mean many things, from having access to services
(like anti-retroviral therapy or expensive infertility treatment),
to being able to express emotions, ideas and needs.
• Power is expressed and experienced in many individual ways,
can change over time and can be difficult to assess. Changing
political climates and the people in our lives can continually
alter how we view and experience power dynamics.
• Power can manifest itself in inequalities, violence, and abuse,
but not all power is abusive or negative. Power exchanges can
manifest as consensual sexual behaviour and provide sexual
pleasure. It is only when consent and choice are removed that
power is abusive.
TIPS FOR THE FACILITATOR:
• Participants may initially find it difficult to answer the questions. Giving examples ;
to get the groups going may help.
• While power disparities can contribute to gender inequality, ensure that no '
discussion becomes a man-bashing exercise. Men may also lack power, particularly I
around gender issues and sexuality.
■ Make sure ideas of gender are included in discussions and that ideas about power !
are inclusive. For example, the discussion should not centre only on a heterosexual/ :
male-female context. Ensure that the experiences of transgendered, transsexual, :
and homosexual people are also taken into account.
343
TARSHI: Basics and Beyond
MODULE 4 - Chapter 1
Exercise 2
Who Has the Power
GROUP EXERCISE
ADAPTED FROM LOCAL ACTION GLOBAL CHANGE - LEARNING ABOUT HUMAN RIGHTS OF WOMEN AND GIRLS.
Instructions
1.
Ask participants to hold hands and stand in a single line in the
middle of the room. Explain that you will read out a series of
statements one at a time. Participants should consider the
statement and follow the instruction based on their answers.
They must hold hands as long as possible.
Statementsfor Power
■ If you are married take one step forward.
■ If you are a man take one step forward.
Purpose of the
exercise:
1. To identify the role of
power in daily life.
2. To discuss how power
relates to opportunity,
equality and access to
services.
• If you are under the age of 30 take one step back.
• If you have children take one step forward.
■ If you have a daughter take one step back.
■ If you own a home take one step forward.
• If you have been seriously ill in the last year (not just a cold or
flu) take one step back.
• If you have a disability take one step back.
• If you do not have health insurance take one step back.
• If you own a car step forward.
TIME
60 minutes
MATERIALS
None
• If you have a Masters degree take one step forward.
ADVANCE PREPARATION
• If you did not go to college take one step back.
Review Statements for Power in
Instruction 1. Add or modify the
statements if required.
• If you grew up in a city or urban area take one step forward.
• If you have travelled abroad take one step forward.
• If you have ever been judged negatively for a reproductive or
sexual health choice take one step back.
2.
After reading all the statements out, ask participants to look
around at the others in the line and observe the following.
• Who is still holding hands? Who is ahead of the others in the
line? Why?
• Note where people stand: what does this tell us about power
and opportunity? What about power and equality?
3.
344
Now ask participants to run to a specified place in front of them,
such as a section ofa wall, and grab a space for themselves against
the wall.
TARSHI: Basics and Beyond
MODULE 4 - Chapter 1
Suggested Questions:
■ Who reached the wall first and why? Did the statements reflect
advantages you can have in society that allowed you to get to the
wall first or later?
THIS EXERCISE CAN BE MODIFIED
: BY:
i ■ Asking fewer questions during the
exercise and spending more time
1 on a discussion.
MAKING CONNECTIONS
■ Gender roles and how gender is
constructed in society can
contribute to the opportunities
and power an individual has. For
more see Chapters 1 and 2 in
Module 1.
• Human rights aim to give all
people the same opportunities and
allow them to be on the 'same
point on the line'. For more see
Chapter 1 in Module 3.
■ Can you see why some of the statements moved you forward,
while others moved you back? Do you disagree with any of the
instructions? For example, do you agree with the statement ‘If
you are married take one step forward’? Why or why not?
• Which statements were related to sexuality? How do you think
power and sexuality relate to one another after this exercise?
Key Messages
• Power has many influences and is experienced differently by
each person. These experiences can vary with age, class, caste,
gender, educational status, disability, HIV status and access to
services.
■ Those with greater opportunities because of their social groups
and/or their family/caste/class/race enjoy more benefits and
power to make choices in their lives.
• Those people who lack access to opportunities may be ‘left
behind’. Human rights speak of equal access to opportunities
for all people and help give people from different walks of life a
level playing field.
• Choice is never absolute. Choices are influenced by various
factors.
• People with less power in society still have agency. Agency refers
to the ability by individuals or groups to control and make choices
within the constraints of their lives in society.
• It is difficult at times to maintain equality as reflected by
difficulties faced by participants trying to hold hands through
the exercise while being pulled in different directions by those
ahead/behind them.
TIPS FOR THE FACILITATOR:
■ Make sure participants do not see this exercise as a judgement of them as
fortunate or unfortunate, but rather a chance to examine opportunities and
power people have in society.
• It may be difficult to discuss the idea of agency, as this is not an easily
understood concept, if this happens, the facilitator may want to include it
later, or go over the definition separately.
345
TARSHI: Basics and Beyond
MODULE 4 - Chapter 1
Exercise 3
Abuse of Power: Sexual Violence
and Harassment
SITUATIONAL STATEMENTS
Instructions
1. Distribute one statement from Handout 4.1 to each participant.
Invite one person at a time to read out their statement and
identify whether they believe it describes an instance of sexual
violence or harassment and why. After everyone has responded,
ask for general questions or comments. If the participants’
analyses are incomplete/incorrect, clarify according to the
information in Handout 4.1.
Purpose of the
exercise:
1. To identify and discuss
instances of sexual
violence, including rape
and sexual assault, and its
relationship to power.
Suggested Questions:
• Do you agree or disagree with the answer? Why?
■ Do you think the situation would be different if the gender of
the characters was reversed? How and why?
2. Go through all the statements asking the same questions as
2. To identify and discuss
instances of sexual
harassment in the
workplace, at school, and
its connection to power.
above. At the end, ask for general questions or comments.
Suggested Questions:
■ What do the characters feel or experience that defines the
situation as sexual violence or harassment? Are these situations
common to the communities you live in or work with?
TIME
60 minutes
• How can you advocate for change in these types of situations?
MATERIALS
Key Messages
• Sexual harassment is any unwelcome behaviour of a sexual
nature perpetrated by one individual on another. Sexual
harassment may be verbal or physical, repeated or done only
once. It can occur between people of different genders or those
of the same gender and may occur in a variety of relationships.
Sexual assault can be part of sexual harassment.
■ Sexual harassment can manifest in many forms. Two main
categories are quid pro quo harassment and hostile environment
harassment. Quid pro quo is when an employer has power to
control an employee’s benefits and demands that the employee
engage in sexual activities to get/ keep these benefits.
346
Index cards/slips of paper, Handout
4.1 Abuse of Power: Sexual Violence
and Harassment
ADVANCE PREPARATIONS
Write out the situational statements
given on Handout 4.1 on separate
pieces of paper or index cards.
TARSHI: Basics and Beyond
MODULE 4 - Chapter 1
Hostile environment sexual harassment may manifest in behaviour/
language that creates an uncomfortable, offensive, shameful, or
embarrassing environment for a particular worker through
unwelcome behaviour of a sexual nature, which may interfere
with work ability, such as through the display of inappropriate
posters, emails or computer screensavers.
THIS EXERCISE CAN BE MODIFIED
BY:
• Going through fewer statements.
This allows for a longer discussion
on specific issues of relevance to
I the group.
• Having two participants act out
the statements in role-play and
I asking the others whether they
consider these instances of sexual
violence or harassment.
MAKING CONNECTIONS
I ■ Human rights treaties and
Other important factors to take into account when determining
if a situation is harassment are whether someone has the freedom
to act, feels comfortable, and is in an equal situation of power.
Economic benefits are not always involved.
Sexual violence and harassment are not universal concepts and
people can define their individual limits/boundaries around
them. What one individual considers sexual harassment may
not be threatening to another.
To ensure respect for workers, workplaces should create
guidelines for sexual harassment, with clear definitions of
harassment, and repercussions for any breaches. A sexual
harassment committee can also be formed to address and
maintain these guidelines.
Rape is any forced genital or sexual penetration and can occur
in circumstances in which the person is either unknown, an
acquaintance, or within a relationship such as marriage.
Sexual assault and sexual abuse are used interchangeably, but
may mean different things under the law. They can include rape
or any other form of undesired sexual contact which can include,
but is not limited to forced kissing and unwanted touching of a
person’s body.
conventions have discussed
violence and violation of rights.
For more see Chapter 1 in
Module 3.
■ Sexual violence can impact sexual
and reproductive! health. For more
on see Module 2.
TIPS FOR THE FACILITATOR:
■ Be prepared for participants to disclose or share their own experiences of
abuse or harassment. Acknowledge their experience, and if possible/required,
provide them with referrals for help.
• Men are the more common perpetrators of rape and sexual harassment of
girls and women, so this exercise can create gender division and tension in the
group. Remind participants that women are also capable of committing sexual
harassment and abuse and men can also experience harassment and abuse.
347
TARSH!: Basics and Beyond
MODULE 4 - Chapter 1
Exercise 4
Abuse of Power: Intimate Partner Violence
CASE STUDY
Instructions
1.
Read aloud to the participants the scenario from Handout 4.2.
Then ask participants for questions or comments.
Suggested Questions:
• Does this case represent intimate partner/ domestic violence?
How so?
■ Would you think differently if the roles were reversed or if the
characters were two men or two women in a relationship? Did
you assume this scenario was one of married couples? Could
the characters also have been unmarried or dating?
• Is this example familiar in your community or work? How would
you define intimate partner violence?
Now, take a flipchart sheet and write the name or draw a figure
representing Sheena from the scenario in the centre of the paper.
Ask participants to describe the effects of each experience of
violence on her. Does it affect her physical health, her mental
health, and/or her sexuality? If so, how? Write responses on
the flipchart around the name/ figure. Spend 20 minutes on
this exercise.
2.
Purpose of the
exercise:
1. To identify and discuss
instances of violence in
intimate relationships.
2. To discuss the
connection between
intimate partner violence
and sexuality, reproductive
and sexual health and
rights and advocacy
approaches to improve
these circumstances.
TIME
• 6D minutes
After generating a comprehensive list of the possible effects of
intimate partner/domestic violence, ask for comments and
questions.
3.
Suggested Questions:
■ What obstacles may prevent Sheena from leaving or changing
her situation? For example, does she need support from her
family, or a safe place to live?
■ How could you advocate to change Sheena’s situation and to
stop the violence she experiences?
348
MATERIALS
Flipchart, markers, Handout 4.2
Intimate Partner Violence Scenario
ADVANCE PREPARATION
I None
TARSHI: Basics and Beyond
MODULE 4 - Chapter 1
Key Messages
—
THIS EXERCISE CAN BE MODIFIED
BY:
! • Dividing participants into small
; groups and distributing a copy of
the scenario to each. Groups can
be asked to discuss the scenario
and the suggested questions.
Bring them back together after 15
minutes to present the highlights
of their discussions.
MAKING CONNECTIONS:
Human rights treaties and
conventions have addressed issues I
of violence. For more see Chapter
1 in Module 3.
People who experience intimate
partner violence can also face
stigma and discrimination in their
communities. For more see
Chapter 2 in this Module.
Intimate partner violence can be in the form of physical, sexual,
mental or emotional abuse, or a combination of these. It is not
limited to men and women in marriage. There can be violence
in same sex relationships, and also between unmarried couples.
Intimate partner violence can cause physical symptoms like
chronic pain, illness and even broken bones. Mental health
effects can range from increased stress to thoughts of suicide.
Reproductive health effects include irregular periods or increased
incidence of spontaneous abortion. Intimate partner violence
can also affect a person’s experience and expression of sexuality.
Intimate partner violence is linked to family, community and
society. A person may be unable to leave an abusive relationship
because of lack of support from the family, pressure from the
community to stay in the relationship, or because there are no
services or opportunities for self-reliance without the partner.
Developing a safety plan for people experiencing intimate partner
violence can help them create options for dealing with such
situations. These plans can include preparing or safely storing
important documents like marriage certificates, bank account
information, medical records, passports and school records for
children, jewellery and spare keys to the house and/or bank
locker etc. In addition, identifying safe places to move to (with
relatives, friends, or an NGO) if and when the person is ready
to do so is also important.
Whether or not to leave a violent relationship is a choice to be
made by the person experiencing this violence. Those
experiencing violence are in the best position to assess and decide
if and when to leave. It can be difficult to leave a relationship;
even one that is violent. Forcing or coercing someone into leaving
before they are ready to is also a violation of their rights. People
choose to stay for a variety of reasons that may be emotional,
economic, social and familial.
TIPS FOR THE FACILITATOR:
• This exercise and topic may create discomfort among participants, particularly
if either they or someone close to them has experienced violence. Be alert to
any signs of distress/discomfort among them.
■ Some participants may consider domestic violence or intimate partner violence
a family problem, not to be interfered with. Emphasise the right of people to
live free from fear and violence.
349
TARSHI: Basics and Beyond
MODULE 4 - Chapter 1
Exercise 5
Abuse of Power: Child Sexual Abuse
MYTH OR FACT
Instructions
1.
2.
Introduce the topic to the participants. Distribute the index
cards/slips of paper with statements from Handout 4.4. Ask
participants to read their statements aloud one at a time. After
each statement, ask the group if they believe it to be a myth or a
fact. The facilitator should fill in any gaps in information and
give relevant information provided in Handout 4.3. It may be
useful to write some key points on the flipchart beforehand.
After going through all the statements, ask for questions or
comments.
Purpose of the
exercise:
1. To discuss and develop
awareness of issues
surrounding child sexual
abuse.
2. To learn facts about
child sexual abuse and
how it relates to power.
Suggested Questions:
■ Are there any other ideas about child sexual abuse you want to
share? Are these myths or facts?
• Why are there so many myths associated with child sexual abuse?
• How does child sexual abuse relate to the concept of power?
Does it imply and involve an imbalance of power in any
relationship?
TIME
60 minutes
MATERIALS
Key Messages
• Child sexual abuse exists all over the world, in different cultures
and communities.
• Child sexual abuse includes any exploitative sexual activity by a
person who, by virtue of their power over a child, due to age,
strength, position or relationship uses the child to meet their
sexual or emotional needs.
• It is important to know the signs and issues related to child sexual
abuse, to identify abusive situations, and to address them. Being
on the alert for signs of child sexual abuse, such as changes in a
child’s behaviour in school, increased aggression, bruises, STIs
or urinary tract infections, or changes in the way children interact
with adults and the way they use language can help identify
and prevent child sexual abuse.
350
: Flipchart, markers, index cards/slips
of paper, Handout 4.3 Facilitator
Copy: Myths and Facts About Child
: Sexual Abuse, Handout 4.4
■ Participant Copy: Myths and Facts
About Child Sexual Abuse
I
ADVANCE PREPARATION
Review Handout 4.3; write out each
of the statements from Handout 4.4
on separate index cards/slips of
paper.
I
TARSHI: Basics and Beyond
MODULE 4 - Chapter 1
I. ”. - .-—I
THIS EXERCISE CAN BE MODIFIED
BY:
■ Dividing participants into small
groups and asking each to go over !
a few statements and decide if
this is a myth or fact and why.
Participants can then share their
' opinions and discuss the
statements in the large group.
■ ■ Giving Handout 4.3 to participants I
to take with them rather than
' going over the topic. This may be ;
best for groups with survivors of
abuse who may not want to
discuss the issue at length or are
I already aware of the issues.
Parents should speak with children about ‘good’ and ‘bad’ touch
and make sure children are comfortable telling them if someone
touches them inappropriately. Children who have been abused
need to be reassured that the abuse was not their fault.
Incest and abuse are different. Incest is sexual activity between
individuals with familial relations. While abuse can occur
between family members, it can also occur between non-family
members.
Paedophilia and child sexual abuse are not the same. Paedophiles
are individuals who derive sexual pleasure and excitement only
from fantasising or engaging in sexual activity with children.
Child sexual abusers are individuals who have sexual
relationships with adult partners and at the same time engage
in sexual activity with children, which can include contact and
non-contact behaviour such as fondling, kissing, forcing them
to perform oral sex, or making them watch sexual acts, listen to
excessive talk about sex or pose for sexual photos etc.
MAKING CONNECTIONS
TIPS FOR THE FACILITATOR:
■ Human rights treaties and
conventions have addressed
children's rights and their
protection. For more see Chapter
1 in Module 3.
• People may react emotionally to this topic, particularly if they have experienced
sexual abuse or if they know someone who has. Be alert to this possibility and
take breaks during the exercise if necessary or allow for extra time to discuss
issues.
• Children with disabilities may be
more vulnerable to abuse because
they are in close contact/proximity
with care-providers and may not
have the ability to communicate
this abuse to anyone. For more
see Chapter 3 in this Module.
■ Some participants may be defensive about these issues and feel that this could
not happen in their communities or social groups. Point out that abuse is not
spoken about openly even though it can occur in any community. This is why
talking about CSA and doing an exercise such as this one is important.
TARSHI: Basics and Beyond
MODULE 4 - Chapter 1
Exercise 6
Creating Power Dynamics
CASE STUDIES AND
SCENARIOS
Instructions
1. Divide participants into four groups. Hand each a copy of one
of the case study scenarios from Handout 4.5. Alternatively, the
same case study could be given to all four groups to work with
(This will highlight different interpretations and manifestations
ofviolence in the same context.) Give participants 25-30 minutes
to go through their case study and create a scenario that addresses
the theme and questions given to them.
Purpose of the
exercise:
To discuss how sexuality
and power can be used to
promote improved sexual
and reproductive health.
2. Have participants return to the larger group. Ask each to present
the case created by them. After each presentation, ask for
questions and comments.
Suggested Questions:
■ What did you think of this case? Do you think it appropriately
addresses the theme?
■ Have you heard of situations like this before? Are they common
in your community? If so, what is-the common attitude towards
these types of situations?
• How can the characters in this case change their realities and
the imbalance of power?
3.
After all presentations, ask for general comments and questions.
Suggested Questions:
■ How do these cases demonstrate the use of power? Is power
used in positive or negative ways?
■ How does power relate to human rights in these cases? Are any
rights being violated?
• Is it possible for these situations to occur among people with
different genders and sexual identities? For example, if the
intimate partner violence case scenario featured a woman as
being abused by a man, could roles be reversed? Or could such
a situation exist in a same sex relationship?
352
TIME
60 minutes
MATERIALS
I Handout 4.5 Creating Power
I Dynamics Scenarios
ADVANCE PREPARATION
Make copies of Handout 4.5 for
participants
TARSHI: Basics and Beyond
MODULE 4 - Chapter 1
Key Messages
THIS EXERCISE CAN BE MODIFIED
BY:
• Power and its effects can be experienced in many different
situations and circumstances.
• Selecting only one case study
scenario and discussing it in the
large group. This can be beneficial
for groups focused on a specific
issue in their work, for example
child sexual abuse
• Power imbalances are not confined to certain genders and sexual
identities. For example, women are not the only ones who
experience gender-based violence. This can also affect
homosexual men, or trangendered people.
■ Individuals can experience multiple kinds of power imbalances
simultaneously. For example, a disabled woman in a lower caste
can experience marginalisation and a lack of power based on
her gender, disability and her caste.
• Using the exercise as an
assessment for this module. This
can be done by asking participants
in small groups to create scenarios
that incorporate the points and
questions given to them in
addition to ideas from the rest of
the module on disability, stigma
and discrimination.
• Power can manifest itself in inequalities, violence, and abuse.
However not all power is abused or negative.
TIPS FOR THE FACILITATOR:
• It may be difficult for participants to create a case study from the short description.
Reassure them that there is no right or wrong approach and the scenario should
simply address the theme and questions.
MAKING CONNECTIONS:
• Women often experience gender
based violence, but those who do
not conform to prevalent gender
norms in a society can also face
violence and lack of power. For
more see Chapter 2 in Module 1.
• Individuals in positions of limited
power also can face stigma and
discrimination. For more see
Chapter 2 in this Module.
|
’
i
j
i
■ Participants may find it difficult to find commonalities between case studies. Try
to focus on the inequality or who has control in the scenarios to illustrate different
instances of power.
■ If participants are unsure about what is meant by gender-based violence or intimate
partner violence, it may be beneficial to go over terms and definitions beforehand.
It can also be effective to forgo any definitions and encourage participants to
interpret the terms themselves, to enable them to identify their own ideas and
i perhaps misconceptions behind these terms.
353
MODULE 4 - Chapter 1
TARSHI: Basics and Beyond
Handout 4.1
Abuse of Power: Sexual Violence and Harassment
1. After lunch every day, Anuja goes up to the sink to wash her dishes. Ali always gets up at the same
time and washes his dishes standing right beside her, often touching the side of her body.
This can be considered sexual harassment ifit is unwelcome and makes Anuja uncomfortable in
her work environment. However, all depends upon Anuja’s feelings and level of comfort or
discomfort in the situation.
2. Meera walked into the meeting room one day and noticed a new calendar with scantily dressed
women up on the wall.
This may or may not be regarded as sexual harassment depending upon how Meera feels about
the calendar. Whether a situation can be considered sexual harassment or not often depends on
the individuals involved. For instance, one person may find a situation uncomfortable and
threatening while another may not. This can change from context to context.
3.
Amrindar’s sense of humour is considered unusual at his work-place. He likes to tell sexually
explicit jokes and uses explicit language while telling them.
This may or may not be sexual harassment depending on how the office workers feel about
Amrindar’s behaviour. One person may find a situation uncomfortable and threatening while
another may not. This can also change from context to context. For example, telling the same
jokes at an office party may be acceptable to Amrindar’s co-workers versus telling them during a
work meeting, which may upset them. For this situation to not be considered sexual harassment,
all ofAmrindar’s co-workers must be comfortable with his behaviour.
4.
Gautam’s schoolmates make fun of the size of his muscles and joke about the size of his penis.
This may or may not be sexual harassment depending on the context ofthis school and whether
there is a powerplay involved in this behaviour, for example, ifGautam is a new student or being
teased by older students. Young people tease each other and may also be cruel in ways that are
not sexual. Ifin the space ofa classroom, this creates an uncomfortable and hostile environment
for Gautam to function in, it would be considered sexual harassment.
5.
Chetan is Kamila’s boss and finds her very attractive. One day he tells her that the office is cutting
back on employees and if she doesn’t have sex with him she will lose her job.
This is quid pro quo sexual harassment. Chetan is using his power as an employer to force
sexual activity on Kamila and threatening to remove her from herjob ifshe does not agree.
6.
Sonal is a social worker attached to several villages in the district. Her work involves discussing
contraceptive options with women and men. A community leader approaches her one evening
when she is on her way home from a neighbouring village and tells her that her work is inappropriate
and threatens her. Though it is not openly stated, the leader makes sexually suggestive remarks
while threatening her.
Even though she is out of an office situation and works in the ‘field’, this behaviour creates a
threatening and uncomfortable atmosphere in which she has to carry out her duties. Therefore
this is sexual harassment. It also involves power dynamics (by virtue of the leader’s position in
the community and Sonal’s gender) and threatens Sonal and her work.
354
TARSHI: Basics and Beyond
7.
MODULE 4 - Chapter 1
A woman wears a new sexy outfit to go out with her friends. She dances with a man she finds
attractive most of the night. Later, he drives her home and then forces her to have sex with him.
This is rape. Regardless of what a woman wears and how she acts with a person, ifshe does not
consent to sex, it is rape.
8.
A man follows a woman walking home at night. He takes her money and then fondles her breast
and kisses her.
This is sexual assault. It is a crime and a violation against the woman.
9- A gay man works in a small office where no one knew his sexual identity until recently. Now every
day someone makes a comment or a joke about queer people whenever he is in the room.
This can qualify as sexual harassment, because it creates an environment for the worker in which
he is uncomfortable about his sexuality.
10. A woman goes out with a man and then goes home to his place. At first she says she wants to have
sex and is responsive to him. But as things progress, she changes her mind and decides she doesn’t
want to have sex after all. She asks the man to stop. The man forces her to have sex anyway.
This is rape. Even if someone originally wants to have sex, they can change their mind at any
time. Ifa person forces another person to have sex at any time, it is rape.
1 l.A man is walking home at night when two men approach him, begin to hit him and ask for his
wallet. He obliges, and then the men ask him to have sex with them. The man does not want to, but
the two men force him to have sex with them.
This is rape. Men can also experience rape and should not be made to have sex without consent.
12.
A woman is married and likes to hold hands with her husband, hug him, and kiss him. At work
lately one of her co-workers has begun to hug her when she leaves for the day and also grabs her
hand when he talks to her. She is uncomfortable with this.
Ifthe woman is uncomfortable with the touching it is sexual harassment. A person can welcome
and enjoy touching and engaging sexually with a particular person (s) and not with another.
13.
A man believes that he has the right to have sex with his wife whenever he wants and that it is her
duty to provide it. Even when she refuses, he insists on having sex with her.
Ifhe forces his wife to have sex against her will, it is marital rape. Just because they are married
does not mean that either partner can force the other to have sex. Each sexual encounter even
between spouses should be consensual. Being married or in a relationship with a person does
not mean one is always willing to have sex; there are times when they may not want to and this
should be respected.
14.
A woman goes out for a birthday party at a restaurant. A man at the party sits next to her most of the
night and gets her drinks. He laces one of the drinks with a drug that makes her sleepy and groggy.
She wakes up the next morning without her clothing and a condom wrapper lying beside her. She
doesn’t remember having sex and goes to the doctor for an examination. The doctor confirms that
she had sex that night and that there are minor tears and bruises on her body.
This is rape. There have been many cases when drugs have been used to impair a person's ability
to make decisions clearly andpeople have taken advantage ofthis impairment. This is called date
rape when two people went out with each other willingly but one was forced/ coerced/ deceived
into having sex by the other against their will or knowledge.
355
MODULE 4 - Chapter 1
TARSKI: Basics and Beyond
Handout 4.2
Intimate Partner Violence Scenario
Aryan and Sheena have been together for many years, but recently Sheena has been
having doubts about their relationship. While she thinks Aryan can be a loving partner,
the past few years have also brought out another side of his personality she does not like.
It began with criticism of her housekeeping abilities. Aryan would criticise Sheena in a
mean and hurtful way - he would say she didn’t cook well, but then eat most of the meal
and leave barely any for her; he would throw his clothes at her saying they were still dirty
just after she had cleaned and folded them; he would spit on the floor of their home
saying it was still dirty and she should clean it better. Sheena put up with his ‘moods’
and tried to improve. Then one day, Aryan came home in an especially angry mood - he
had a bad day at work and his>food was cold since he got home late. He threw the plate
and food at Sheena and then slapped her a few times across the face. This kind of hitting
continued for many months but after each episode Aryan would apologise and say he
would not do it again. He then tried to make up with Sheena by having sex, even if she
didn’t really want to.
356
TARSHI: Basics and Beyond
MODULE 4 - Chapter 1
Handout 4.3
Facilitator Copy: Myths and Facts about Child Sexual Abuse
Instructions for participants: Indicate whether each statement below is a Myth or a Fact. Write (M) for
a myth and (F) for a fact.
• Only girls are vulnerable to child sexual abuse.
MYTH. Both boys and girls are vulnerable to sexual abuse. However, since most available research
on child sexual abuse focuses on the abuse of girls, statistics show a higher number of girls are
abused than boys. Existent research on boys shows that boys tend to report abuse differently, denying
it often or behaving as though they enjoyed it. This suggests that more boys are abused than we
know, and more research is needed to get an accurate picture of the situation.
• An abuser can be someone who knows or is related to the children they abuse.
FACT: Many times an abuser can be a relative or friend of the family.
• Child sexual abuse (CSA) can include both contact and non-contact sexual behaviour.
FACT: CSA can include fondling, kissing, being forced to perform oral sex, rape or other penetrative
sex, made to watch sexual acts, forced to listen to inappropriate talk about sex, sexually fondled
while being bathed, shown sexual movies or other pornography, made to pose for sexual photos etc.
• Paedophiles and child molesters are the same.
MYTH: Child sexual abusers can belong to the categories of either paedophiles or child molesters.
Paedophiles are sexually fixated on children alone, while child molesters are people who have sexual
relationships with adult partners and at the same time engage in sex with children as well.
■ Child sexual abuse only happens in Western countries.
MYTH: This is a popular misconception. Child sexual abuse is a universal problem, affecting millions
of children across the world. Although this is a problem worldwide, more reporting and research is
available from Western countries. Presendy, extensive data on the prevalence of child sexual abuse
in India is not available but this does not mean that it does not occur in the country.
• Children with a disability can also be sexually abused.
FACT: Children with disabilities are easy targets for abusers (if they are not mobile, they cannot
move away from an abuser, for example), they may be unable to report the abuse because they
cannot communicate or be understood by their care-providers or worse still if they are being abused
by those who also care for their daily needs. Considering that almost 12 million children in India are
disabled, the possible prevalence of sexual abuse of disabled children in India is alarming. This is
even more of a problem because of societal denial of child sexual abuse, and because disabled children
are often viewed as ‘asexual’ and hence not protected from possible abuse like their non-disabled
siblings and peers may be and are denied any information on sexuality. That disabled children
cannot be abused, since abusers find them unattractive and feel sorry for them is another damaging
myth.
357
MODULE 4 - Chapter 1
TARSHI: Basics and Beyond
Handout 4.5
Creating Power Dynamics Scenarios
Case 1
Create a case study to present to the group that highlights sexual harassment and power. The case
study should address the following points and questions:
■ What is sexual harassment? Give an example of sexual harassment.
• How does sexual harassment relate to power?
• How can this relationship be changed and altered to create a more even balance of power?
Case 2
Create a case study to present to the group that highlights gender-based violence and power. The
case study should address the following points and questions:
■ What is gender-based violence? Give an example of gender-based violence.
• How does gender-based violence relate to power?
• How can this relationship be changed and altered to create a more even balance of power?
Case 3
Create a case study to present to the group that demonstrates child sexual abuse and power. The
case should address the following points and questions:
■ What is an example of child sexual abuse?
• How does child sexual abuse relate to power?
• How can this relationship be changed and altered to create a more even balance of power?
Case 4
Create a case study to present to the group that highlights domestic violence/intimate partner
violence and abuse. The case should address the following points and questions:
■ What is domestic violence/intimate partner violence and abuse? Give an example ofdomestic violence/
intimate partner violence and abuse.
• How does domestic violence/intimate partner violence and abuse relate to power?
• How can this relationship be changed and altered to create a more even balance of power?
3BD
MODULE 4 - Chapter 2
Chapter 2
Challenging Stigma and
Discrimination
Chapter Objectives for the Facilitator
1. To have participants understand issues related to stigma,
discrimination, and marginalisation in the context of
sexuality.
2. To have participants recognise the adverse effects of stigma,
discrimination and marginalisation on health and well
being.
TARSHI: Basics and Beyond
MODULE 4 - Chapter 2
Why a Chapter on Challenging Stigma and
Discrimination
Fanny Ann Eddy, 30, was found dead on the morning of September
29, 2003. She was alone late the previous night, wording in the Sierra
Leone Lesbian and Gay Association’s offices. Her assailant or assailants
apparently broke into the premises, raped and stabbed her repeatedly
and broke her neck- Eddy had founded the Sierra Leone Lesbian and
Gay Association in 2002. The group provided social and psychological
support to a fearful and underground community. Eddy herself was a
visible and courageousfigure, who lobbied with government ministers
to address the health and human rights needs ofmen who have sex with
men and women who have sex with women.
Eddy and her organization documented harassment, beatings and
arbitrary arrests of lesbian, gay and transgender people in Sierra
Leone. As Scott Long, director of the Lesbian, Gay, Bisexual and
Transgender Rights Project at Human Rights Watch said, ‘Now, she
has been murdered in the ojfices of the organization she founded, and
there is grave concern that she herself has become a victim of hatred. ’
(Human Rights Watch. http:llhrw.orglenglishldocsl2004llQ/04l
sierra9440.htm)
This account may provide an extreme example, yet it illustrates
the very real pain, persecution, violence and even death that
discrimination and stigma can cause. Unfortunately, Fanny Ann
Eddy’s experience is not uncommon; there are many such examples
of stigmatisation and hatred throughout the world. People are
subject to ridicule and hurt on a daily basis if they are seen as
different and therefore not as good as/lesser than the rest of society.
These may be disabled people, young/unmarried sexually active
people, people with more than one sexual partner, bisexuals, sex
workers, older sexually active people, intersexed people, those who
are HIV positive, people with mental illness, and a range of other
identities and practices that ‘mainstream’ society considers
inappropriate or wrong.
Besides infringing upon their rights to freedom of expression, bodily
integrity, and at times even to life, discrimination and stigma have
other implications. Stigmatised or marginalised people are often
forced'to adopt ways of living that can increase their vulnerability.
For example, transgendered people in many countries are
marginalised, resulting in restricted access to information, services
and social support. They may not receive timely medical care, and
resort to unsafe medical practices through unqualified practitioners,
jeopardising their health, well-being and even their lives.
Failure to understand and accept the range of sexual and gender
identities and behaviour perpetuates stigma and discrimination.
EXERCISES IN THIS CHAPTER:
Exercise 1: Stigma and Identities.
45 minutes
Exercise 2: Stigma Mapping.
60 minutes
Exercise 3: Acting Out Stigma and
Discrimination. 60 minutes
Exercise 4: Stereotyping Identities.
60 minutes
MATERIALS FOR THIS CHAPTER:
Flipchart
Markers
Pens/pencils
Paper
HANDOUTS REQUIRED FOR THIS
CHAPTER:
Handout 4.6
Stigma and Identities
Handout 4.7
Acting Out Stigma and
Discrimination
Handout 4.8
Stereotyping Identities Case Studies
TARSHI : Basics and Beyond
MODULE 4 - Chapter 2
This chapter increases participant awareness of diverse identities
and choices, and emphasises rights for all people regardless of their
identity or sexual behaviour. It also provides participants an
opportunity to examine the consequences of stigma, discrimination
and marginalisation and explore strategies to eliminate these
attitudes and treatment.
ADDITIONAL RESOURCES:
■ Action Plus. 2004. People's
Panchayat on Resisting Stigma
and Discrimination. New Delhi:
Action Plus.
■ Croll, E. 2000. Endangered
Daughters - Discrimination and
Development in Asia. London:
Routledge.
• Durbar Mahila Samanwaya
Committee, http://
www.durbar.org/
■ Kidd, R., Clay, S. 2003.
Understanding and Challenging
HIV Stigma: Toolkit for Action.
USA: The CHANGE Project,
ICRW.
• Of Veshyas, Vamps, Whores and
Women, http://
www.vampnews.org/
■ Stewart, C. 1999. Sexually
Stigmatized Communities Reducing Heterosexism and
Homophobia: An Awareness
Training Manual. California: Sage
Publications.
• For selected films see, http://
www.asiasrc.org/films.php and
Appendix B.
Key Messages for this Chapter
Stigma is a mark of shame or discredit to an individual or group
and can be attributed to anyone who is considered different and/
or ‘deviant’.
■ Discrimination means unfair treatment of a person or group on
the basis of their identity, practices, race, caste, appearance etc.
■ Marginalisation or the social process of becoming/being made
marginal (especially as a group within the larger society) is a
means to keep someone away from power, because of the choices
they make in their identities, practices or appearance.
• Stereotyping\s an oversimplified conception, opinion, or image
of people or things. Judging others on the basis of stereotypes
leads to prejudice, which is a precursor to stigma, discrimination
and marginalisation.
• Ethnicity, gender, class, sexual identity, caste, disability are just
some variables that can be used to stigmatise and discriminate.
■ Culture regulates the lives of all people, but it does not do this
uniformly. Some people/groups are regulated more than others.
For example people who appear ‘different’ may be more regulated
because they do not ‘fit’ into socially and culturally prevalent
norms in terms of the way they look (fair, dark, tall, fat, thin
etc.), behave or live.
• Most people engage in a variety of sexual behaviours other than
those considered conventional/normal/common even if they do
not talk about it. Those engaging in sexual behaviour with
mutual consent, without threat or coercion, have the right to do
so without fear of being judged or punished. On the other hand,
coercive sexual behaviour of any kind, even between regular
partners or married partners, is wrong and unacceptable.
• In today’s melting-pot world, we are influenced by more than
one set of cultures, traditions, and practices; we have multiple
identities. Therefore stigma can be experienced at multiple levels.
For example, a woman with a disability who loves other women
could face triple discrimination because of her gender, disability
and sexual identity.
TARSKI: Basics and Beyond
MODULE 4 - Chapter 2
Exercise 1
Identities
Instructions
1.
2.
Distribute Handout 4.6 to each participant. Ask everyone to
write the various identities listed in the handout in the concentric
circles, based on the level of stigma and discrimination they
experience in their societies/communities. For example,
identities that experience the least amount of discrimination
will fall into the inner most circle, whereas the outer most circle
will have the most marginalised identities. Give participants
10-15 minutes to fill out the handout.
GROUP EXERCISE
Purpose of the
exercise:
To examine stereotypes
related to various identities
and how these can
stigmatise, discriminate
and marginalise.
Invite participants to present their handouts and explain the
basis upon which they categorised identities. After 4-5 people
have shared their views, ask for questions or comments.
TIME
Suggested Questions:
■ Were there similarities among the least marginalised people?
The most marginalised? How does society stigmatise some of
these identities?
• What do the similarities indicate about certain identities? Are
there some groups such as married men that experience the least
stigma and most opportunities in society?
• Are there stereotypes associated with any ofthese identities ? How
would these stereotypes cause discrimination or marginalisation
of those concerned?
• Who creates these stereotypes and decides what is ‘normal’?
Why/How are these stereotypes and this marginalisation
maintained? For example, do media images of certain identities
help to perpetuate these attitudes or do laws or customs in a
community maintain this marginalisation?
364
45 minutes
MATERIAL
Flipchart, Handout 4.6 Stigma and
Identities
ADVANCE PREPARATION
Make copies of Handout 4.6 for each
participant.
TARSHI: Basics and Beyond
MODULE 4- Chapter 2
THIS EXERCISE CAN BE MODIFIED
Key Messages
BY:
• Having participants fill out the
handout in small groups. It can be
useful for large groups and those
from similar communities to
discuss how they perceive stigma
in their communities.
MAKING CONNECTIONS
• People of different sexual and
gender identities have the right to
express their sexuality free from
fear and stigma. For more see
Chapter 2 in Module 1.
• People with disabilities may
experience double stigma and
discrimination for their sexual or
gender identity as well as for their
disability. For more see Chapter 3
in this Module.
• Sexual identity refers to how people define themselves based on
whom they are sexually attracted to - whether they are attracted
to people of the same gender, a gender other than their own, or
to many genders.
• Gender identity refers to whether a person thinks of themselves
as a man, woman, or a different gender. As with sexual identity,
many cultures and communities have prescribed rules for
appropriate gender identities based on the biological sex of a
person.
• Though they are connected, stigma, discrimination and
marginalisation are different; a person can experience one
without the other. For example, a person may be stigmatised for
being a lesbian but because of other factors in her life (income,
class, caste, race) she may not be marginalised.
• Often the more ‘different’ a person appears from the ‘norm’ in
society, the greater the discrimination and marginalisation faced.
• Stereotypes maintained in society and communities contribute
to stigma and discrimination against certain gender and sexual
identities.
• Stigma and discrimination can result in violence, abuse or denial
of services and information for individuals.
TIPS FOR THE FACILITATOR:
• Participants may not be familiar with some of the identities listed. If necessary,
go through the identities beforehand and discuss any questions they might have
about the identities.
• Participants may express discomfort around some identities, especially those that
are new to them or those considered 'wrong' according to their culture/religion.
Be sensitive to this and encourage participants to participate in the exercise in the
spirit of learning and respect for people's sexual identities, even if they do not fully
understand them.
365
TARSHI: Basics and Beyond
MODULE 4 - Chapter 2
Exercise 2
Stigma Mapping
Instructions
1.
Hand out paper and pens to the participants and give them 3-5
minutes to write out answers to the following questions:
Questions 1: List three identities, preferably related to sexuality
and gender, found in the community you work or live in.
Question 2: List three words you would use to describe your
identity.
2.
3.
On the other side of the paper ask participants to draw or chart
out areas in their community or neighbourhood in which people
of different identities (including the ones they listed as responses
to both questions above) may be stigmatised or discriminated
against. For example, they may draw a local clinic where
unmarried women (seen as not sexually active) face stigma and
discrimination when they go for a routine gynaecological check
up. Give participants 10-15 minutes to map out their
communities.
Ask participants to get into pairs and discuss each other’s
drawings for 10 minutes. Then open up the discussion to the
larger group.
Suggested Questions:
■ What did you learn from this exercise? What common factors
exist between the maps and identities?
■ How do you think people who are discriminated against in these
spaces feel? How do you feel in spaces you consider
marginalising or stigmatising?
• Have you ever either intentionally or unintentionally treated
someone differently because you saw them as different from
yourself? How did they react? How do you think they felt?
366
SELF-REFLECTION
Purpose of the
exercise:
To identify and discuss
places, locations and sites
in people’s lives where
stigma and discrimination
are experienced.
TIME
60 minutes
MATERIAL
Paper, pens
ADVANCE PREPARATION
None
TARSHI: Basics and Beyond
MODULE 4-Chapter 2
THIS EXERCISE CAN BE MODIFIED
Key Messages
BY:
■ ■ Having the participants map out
i their community together. This
j may be appropriate for groups
! from the same community or
area.
• Asking participants to list out
areas in which people face stigma
and discrimination instead of
having them draw a map. A
discussion can follow the listing.
• Often the more ‘different’ a person is from the norms in society,
the greater the discrimination and marginalisation they face. For
example, migrants from North East India may face more
discrimination in any other part of the country than their North
Indian counterparts based on the superficial difference in their
looks.
• People can experience stigma and discrimination in different
places and situations, including while accessing health services
or applying for a job, for example.
■ Stereotyping of people is the first step to discrimination and
marginalisation.
• Though they are connected, stigma, discrimination and
marginalisation are different; a person can experience one
without the other.
MAKING CONNECTIONS
■ People with HIV/AIDS are
especially vulnerable to stigma
and discrimination in various
locations in a community. For
more see Chapter 4 in Module 2.
• People who experience violence or ■
abuse may feel stigmatised by
:
being wrongly blamed for the
abuse. For more see Chapter 1 in i
this Module.
TIPS FOR THE FACILITATOR:
■ Participants may use adjectives such as kind, friendly, or happy to identify
themselves. Encourage them to use words and phrases related to other aspects of
their identity, such as their gender, sexuality, caste/class, age or even nationality.
i
• Participants may find it difficult to map out their communities or may focus on the I
aesthetic appeal of their picture. Emphasise that there is no right or wrong way
to construct this map and the important part of the exercise is to identify the sites
of stigma in one's community.
______________ I
367
TARSHI: Basics and Beyond
MODULE 4 - Chapter 2
Exercise 3
Acting Out Stigma and Discrimination
Instructions
Divide participants into small groups. Distribute one role-play
scenario from Handout 4.7 to each group. Ask groups to develop
a 5-minute role-play from their scenario. Give groups 20 minutes
to do this.
1.
ROLE-PLAY
Purpose of the
exercise:
To identify stigma in dayto-day situations and
experiences.
Bring the groups back together and invite each to perform their
role-plays. After each role-play, ask for questions or comments.
2.
Suggested Questions:
• How was stigma and discrimination portrayed in the role-play?
Do you think this kind of stigma is common? Have you
experienced or observed this form of stigma and discrimination
in your community?
• What are the effects of this kind of discrimination on those
experiencing it, the community they live in, and services related
to sexuality and sexual and reproductive health?
• How can you advocate to change attitudes that cause such
stigmatisation?
3.
After all the role-plays, ask for general questions and comments.
Suggested Questions:
■ Were there any common forms of stigma and discrimination
among the role-plays?
• Why was it important to do this exercise? What did you learn
from it?
368
TIME
60 minutes
MATERIAL
Handout 4.7 Acting Out Stigma and
Discrimination
ADVANCE PREPARATION
Make copies of Handout 4.7
TARSHI • Basics and Beyond
MODULE 4
THIS EXERCISE CAN BE MODIFIED
Chapter 2
Key Messages
BY:
■ Giving participants specific
identities and asking them to
perform everyday scenes like
going to the market, visiting the
doctor, getting admission in a
school etc. using these identities.
This can emphasise the stigma
people face in daily experiences
that participants may not
recognise.
MAKING CONNECTIONS
• How sexual and gender
identities are represented can
reflect opinions and attitudes in
a community or culture. For
more see Chapter 2 in Module 1.
• Women and men who cannot
have a child can also experience
stigma and discrimination. For
more see Chapter 3 in Module 2.
• While extreme forms of stigma and discrimination resulting in
violence or abuse sometimes get public attention, day-to-day
subtle discrimination and marginalisation can also have
devastating effects. For example, if homosexuals are denied jobs
because of their sexual identity, it can have a multiple impact:
apart from diminishing their ability to be financially stable, it
can cause low self-esteem and emotional distress.
• Often people may be discriminated against unintentionally. It
is important to raise consciousness on how people can stigmatise
and marginalise others in their daily actions and environments.
■ Marginalisation often results in exclusion of those most in need
of care, information and services. For example, by refusing to
acknowledge that sexual activity is common among young people
or between men, these groups are denied information and access
to sexual health services which would help them stay safe and
healthy.
TIPS FOR THE FACILITATOR:
Look out for the underlying messages/opinions/attitudes being acted out by
the participants during the role-plays. For example, are affirmative messages
and attitudes presented or only messages of pity and disempowerment ?
Point these out and stress that even when people are stigmatised or
discriminated against they can still be strong and assertive.
Participants may create stereotypical portrayals of characters in their role
plays, such as all gay men are weak and effeminate, or all single people want
to get married. Emphasise that such labelling and stereotyping can lead to
prejudice and discrimination, particularly when people begin to act according
to such rigid characterisations.
369
TARSHI: Basics and Beyond
MODULE 4 - Chapter 2
Exercise 4
Stereotyping Identities
Instructions
1. Divide participants into small groups. Give each group a case
study from Handout 4.8. Ask participants to read their case
study and answer the questions following it. Give them 25-30
minutes to discuss the case.
CASE STUDIES
Purpose of the
exercise:
1. To discuss common
stereotypes and reactions to
these stereotypes.
2. Bring participants back to the large group. Ask each small group
to present a 3-5 minute summary of their discussion of the case.
After each presentation, ask for questions and comments.
Suggested Questions:
• Are the attitudes or stereotypes reflected in the case common in
your community?
2. To explore the origin of
these stereotypes, how
people and communities
use them and their effects
on individuals.
• What are the possible effects of this type of stereotyping? How
would you advocate to change these attitudes?
3. When group presentations are over, ask for general comments
and questions.
TIME
60 minutes
Suggested Questions:
MATERIALS
• How do these cases illustrate stereotypes in society of the roles
that men and women are expected to play? Are they positive or
negative?
i Handout 4.8 Stereotyping Identities
Case Studies
■ How do these stereotypes impact people in their day-to-day lives ?
ADVANCE PREPARATION
• How does this relate to human rights and sexuality?
Make copies of Handout 4.8
370
TARSHI: Basics and Beyond
MODULE 4 - Chapter 2
|- ---------------------- ----------------THIS EXERCISE CAN BE MODIFIED
I BY:
■ Reading through and discussing
some of the cases as a large
group rather than breaking up into
small groups. This may be useful
to focus on specific issues and for
in-depth discussions.
i
MAKING CONNECTIONS
■ There are a range of sexual and
gender identities. For more see
Chapter 2 in Module 1.
- Ethical guidelines are useful to
effectively address sexuality,
sexual and reproductive health
concerns, especially for
marginalised people. For more see
Chapter 2 in Module 5.
Key Messages
• Stereotypes of gender and sexual identities are commonly found
and used by communities who do not understand the diversity
of identities.
■ Stereotypes can lead to prejudice, fear, shame, stigma and
discrimination. They limit access to information and services to
large groups of people by assuming that they do not deserve or
require the information.
• Stereotypes and prejudice stem from lack of information about
people who are considered different from oneself; some examples
could include people with disabilities, those with different gender
identities from one’s own or those in the sex industry (sex
workers, bar dancers and performers in peep shows, live sex
shows, etc).
• In order to decrease stereotypes and allow people to live with
respect and dignity, it is important to broaden knowledge and
understanding of different identities and choices and be aware
of the rights of all people.
TIPS FOR THE FACILITATOR:
■ Participants may find some representations in the cases appropriate and
believe they do not need be challenged or changed. For example, they may
think sex work can never be a choice and should be given up for other forms
of work. Emphasise choice in all identities, and explain that discussing sex
work only in negative terms omits the role that power and choice can have in
people's lives and in their decision-making.
TARSHI: Basics and Beyond
MODULE 4 - Chapter 2
Handout 4.6
Stigma and Identities
■ Heterosexual: An individual who is sexually attracted to people of a gender other than their own
and/or who identifies as being heterosexual.
• Bisexual: An individual who is sexually attracted to people of the same gender and to people of a
gender other than their own, and/or an individual who identifies as being bisexual.
• Homosexual: An individual who is sexually attracted to people of the same gender as their own,
and/or who identifies as being homosexual.
■ Asexual: An individual who is not sexually attracted to other individuals.
• Transgendered person: An individual who does not identify with her/his assigned gender.
Transgendered people may or may not identify as homosexual, bisexual or heterosexual. For example
transgendered people can be men who dress, act or behave as women do, but do not necessarily
identify as homosexuals.
■ Transsexual: An individual who wants to change from the gender they are born as to another gender.
Surgery, hormonal treatments, or other procedures can be used to make these changes. People in
this group may or may not identify as homosexual, bisexual or heterosexual.
■ Intersexed person: An individual born with some or all physical characteristics of both males and
females. They may or may not identify as men or women.
• Lesbian: A woman who is sexually attracted to other women and/or identifies as a lesbian.
■ Gay: A man who is sexually attracted to other men and/or identifies as gay. This term can also be
used to describe any person (man or woman) who experiences sexual attraction to people of the
same gender.
• Queer: Those who question the heterosexual framework of identity and relationships. This can
include homosexuals, lesbians, gays, intersexed and transgendered people as well as heterosexuals.
To some this term is offensive, while other groups and communities have adopted it as a statement
of empowerment to assert that they are against a dominant heterosexual framework, and dissatisfied
with the labels used to categorise people on the basis of sexuality.
■ Transvestite: An individual who dresses in the clothing typically worn by people of another gender
for sexual arousal and gratification. Often transvestites are men who dress in the clothing typically
worn by women.
■ Female to male transsexual: A person born as a woman who wants to change her gender to become
a man. Surgery, hormonal treatments, or other procedures may be used to make these changes
This individual may or may not identify as homosexual, bisexual or heterosexual.
• Male to female transsexual: A person born as a man who wants to change his gender to become a
woman. Surgery, hormonal treatments, or other procedures may be used to make these
This individual may or may not identify as homosexual, bisexual or heterosexual.
■ Married woman: A woman who is in a committed relationship with another person that is
recognised by the state/country she lives in.
372
TARSHI: Basics and Beyond
MODULE 4-Chapter 2
Married man: A man who is in a committed relationship with another person that is legally recognised
by the state/country he lives in.
Unmarried woman: A woman who is not in a committed relationship with another person, which
is legally recognised by the state/country, she lives in.
• Single person: A person not married or in any committed relationship with another person.
Sexually active man: A man who engages in sexual activities.
• Sexually active woman: A woman who engages in sexual activities.
• Sex worker: A person who negotiates and performs sexual services for remuneration. Some use this
term to mean only prostitution, while others use the term to refer to those in the sex industry such
as porn actors, bar girls, striptease dancers, performers in peep shows, live sex shows etc. This is not
the social or psychological characteristic of a class of women, but an income-generating activity or
form of employment for women, men and transgendered people.
373
TARSHI: Basics and Beyond
MODULE 4-Chapter 2
Handout 4.7
Acting Out Stigma and Discrimination
Instruction for participants: highlight possible stigma and discrimination faced by characters in the
scenario/s given to you.
Role-play scenario 1
Mr. and Mrs. Sharma decide to ask their tenants to leave well before their lease expires. This is because
they have been hearing rumours that the two men are lovers.
Role-play scenario 2
Onima is a single parent with two children. She is employed by an NGO working on issues of domestic
violence. One day she sees her children fighting with some other children. When she goes to stop them
she hears the reason for the fight: one of the neighbour’s children was calling her a slut and immoral.
The child said he had heard his parents say this about her, because she is single and has children.
Role-play scenario 3
Tanya is well qualified for the job she has applied for at an agency and initial email and telephone
communication between them has been positive. After two rounds of face-to-face interviews and many
attempts to follow up, however, she has not got an affirmative response from them. Finally she is called
for a meeting with the manager who seems uncomfortable. Tanya is told that they need a ‘womanly
woman for the job, not a woman who behaves and dresses like a man. The organisation is very traditional
and cannot accommodate her ‘type’ of person.
Role-play scenario 4
Meeta has been denied admission into school because her mother is a sex worker. Representatives of
the group her mother belongs to are having a meeting with the school authorities to try and resolve the
issue.
Role-play scenario 5
Jaishree has applied for a job in a consulting firm. It appears as though her skills, however, don’t really
match the job profile. Despite this she gets the job, as well as a flexible time option because the
management wants to demonstrate their sensitivity towards her HIV positive status and support her.
At the same time, some employees are not happy with this decision.
Role-play scenario 6
Joseph is a single man from a medium sized town, and is hoping to get married soon. He has found out
that he is HIV positive and is unsure about whether he should inform his family and community
about his status.
Role-play scenario 7
Aslam is intersexed. Fie had joined a group of eunuchs (hijras) in his youth but left them a few months
ago since he did not feel a sense of belonging. He is trying to get a job now but has had no luck so far.
Role-play scenario 8
Amir is the 16-year-old son of conservative parents. His parents are sending him to live for a few
months with his relatives in nearby town to ‘toughen’ him up. They say that he is too sensitive - cries
when awful things happen to him, if his sister or parents get angry with him, and is shy and ‘weak’.
Role-play scenario 9
Sundar has a Masters in Social Work from a respected university in the country. He wants to go back
to his village and work with a local NGO on HIV related issues. He is hearing impaired.
Role-play scenario 10
Sasha is 24 and her family is looking for a suitable man for her to marry. Sasha’s father had a brief
episode of mental illness in his youth, which some people in their extended family know about
374
TARSHI: Basics and Beyond
MODULE 4 - Chapter 2
Handout 4.8
Stereotyping Identities Case Studies
Case Study 1
Rajeev is a sixteen-year-old boy living in a large city. He goes to school, spends time with his friends,
and loves spending time at home with his family. Rajeev likes to take care of himself. He is well
dressed and makes sure his nails are clean and filed and his hair is well groomed. He waxes his arms
and chest (even though he has barely any hair yet), and likes using his sister’s moisturizers and creams.
His family thinks it is funny that he spends more time grooming himself than his sister, and teases him
about his ‘effeminate’ ways, sometimes telling him that if he doesn’t change he will never get married.
Rajeev also gets teased at school for the way he looks and behaves. There are three boys who especially
pick on him, call him names and sometimes throw paper or garbage at him. They say that he is gay, a
girl, and shouldn’t be allowed in school.
Rajeev reacts strongly to the teasing sometimes, but does not want to change the way he acts or dresses.
But he feels if he doesn’t, he will always have to deal with this kind of ridicule and abuse.
Questions:
■ Does Rajeev’s behaviour mean he is gay?
• How did the stereotypes displayed by his family and school mates get created?
• Do you think Rajeev should change the way he dresses or acts in school or at home?
• What impact do these stereotypes have on Rajeev’s relationships with is family/friends and in society
in general?
■ How can these stereotypes (gender and sexual identity stereotypes) be changed?
Case Study 2
Soni has chosen a life partner in Ali. They studied together at the University and have been going out
since their first year of post graduation. Now they have decided to marry.
Soni is the daughter of a prominent, well-respected Hindu family. She has a sister, brother and a large
extended family. The girls of her family are said to be as dutiful as they are beautiful and the boys are
considered ‘real men’: strong, courageous and highly regarded in their businesses as honest and upright.
Ali comes from a Muslim family, not as wealthy as Soni’s but very well-respected in their home-town.
Soni’s parents are unhappy at her choice of husband. Her father even tells her that once she returns to
her family, away from her college, she will change her mind.
Ali’s mother is also distressed. She has heard that Soni’s family is class-conscious, and knows them to
be loud and argumentative. The family tries to convince Ali to forget the marriage, but so far it has not
worked and Ali has not changed his mind.
Questions:
■ What stereotypes are presented in this case?
■ How do the stereotypes displayed by the families of caste/race/religion get created?
• Who and what create these stereotypes/representations?
• Do you think the parents have a good reason to be concerned?
■ How do these stereotypes affect relationships and society in general?
■ How can these stereotypes be changed?
375
MODULE 4 - Chapter 2
TARSHI: Basics and Beyond
Case Study 3
Neetu is a mother of two (a daughter and son) and a sex worker. She has been in sex work for the past
ten years and finds it a good way to earn money for her children and maintain her independence.
There are other women she trusts and loves in the brothel she works in, and her Madam treats her
children and her well.
Over the past year, Neetu has begun to take her children to school in the mornings before going back
home to rest for the evening. One day she goes to drop off her children and another parent approaches
her and offers to rescue her children and her from the ‘horrible life they are living’. Neetu is confused:
she has never spoken to this parent before and has no idea who she is, or why she thinks Neetu needs
rescuing. The parent explains that her son told them what Neetu does, and says that she has seen
reports on the news and in magazines about the hard and horrible life of sex workers. She wants to
help change this. The parent offers Neetu a job in her family’s business.
Neetu thanks the parent for the offer, and tells her she is content with her work. Leaving it would
mean many other problems for her children and her. At present she wants to stay where she is. The
parent is shocked and yells at Neetu, calling her names like slut, whore, and an irresponsible parent.
She vows to rescue Neetu’s children from this situation, and tells Neetu to be prepared for this.
Questions:
■ What stereotypes are presented in this case?
• What factors contribute to the creation of these representations/stereotypes acted out by the other
parent?
• Who do you think is right in this case? Neetu or the parent?
• What effects do these representations have on the society in general?
• How can these stereotypes be changed?
376
MODULE 4 - Chapter 3
Chapter 3
Disability and Sexuality
Chapter Objectives for the Facilitator
1.
To familiarise participants with the meaning of disability.
2.
To encourage discussion about sexuality of disabled people,
and what contributes to stigma and discrimination.
3.
To familiarise participants with barriers faced by people with
disabilities that prevent them from exercising their sexual
and reproductive rights.
TARSHI: Basics and Beyond
MODULE 4 - Chapter 3
Why a Chapter on Disability and Sexuality
‘While most parentsfeel proud when their daughters reach this milestone,
I felt terrified when my daughter got her period. Since she's mentally
retarded, it means she has to learn to do one more thing — care for
herselfwhen she has her period. It also means she can get pregnant. But
I’ll worry about that later — now she’s so proud that she can manage
mostly without my help. I wish that was all she had to learn about
taking care ofherself in this world!’
This quote reflects the experience of many parents and care
providers of disabled people. Parents and other care-providers are
often anxious about coping with the sexuality of adolescents with
disabilities. Some believe that providing information on the body/
sexuality to their growing children will complicate rather than
enhance their lives. To avoid what they see as the ‘inevitable
disappointment’ associated with unfulfilled desires, care-providers
consciously ignore signs of sexuality in their wards. This leads to
the de-sexualisation of disabled people. Many parents also feel that
their children - especially their daughters - are more vulnerable to
sexual abuse, and take extra precautions to protect them.
Sexuality is often misunderstood as having to do only with sexual
intercourse. While this is a part of sexuality, it often may not be the
most compelling/important factor. Sexuality extends beyond the
physical sensations of our bodies. It is also a reflection of how people
feel about themselves and how they want to express themselves
with others. Still, these aspects of sexuality are often neglected in
the context of disabled people (who are labelled either ‘asexual’ or
‘over-sexed’), thus overlooking their sexual and reproductive
concerns and rights.
Thus, disabled people are often denied sexuality education and
their sexual concerns are deemed inappropriate/ignored. Women
with disabilities generally have fewer opportunities to explore their
sexuality. Structural barriers include lack of facilities to ease
mobility for wheelchair users, lack of familiarity with sign language
by hospital/clinic staff or a lack of sexuality education material in
Braille, and so on.
This chapter oudines some of the issues that people with disabilities
face around their sexuality. The focus is on the rights of people
with disabilities to express their sexuality, access information and
exercise choices for their sexual well-being. It emphasises that all
humans are sexual beings, regardless of whether they are sexually
active or not, have a disability or not, are young or old.
EXERCISES IN THIS CHAPTER
Exercise 1: Reflecting on Disabilities.
30 minutes
Exercise 2: Debating Sexuality and
Disabilities. 60 minutes
Exercise 3: My Views on Sexuality
and Disabilities. 60 minutes
Exercise 4: Including People With
Disabilities. 60 minutes
MATERIALS FOR THIS CHAPTER:
Flipchart
Markers
Pen/pencils
Paper
HANDOUTS REQUIRED FOR THIS
CHAPTER:
Handout 4.9
Basic Information on Disability and
Sexuality
Handout 4.10
Reflecting on Disabilities
Handout 4.11
Debating Sexuality and Disabilities
Handout 4.12
My Views on Disability and Sexuality
and Reproductive Rights
Handout 4.13
Integrating Disability Related
Concerns in Our Work
TARSHI: Basics and Beyond
ADDITIONAL RESOURCES:
■ Disability Resource Network.
http://www.drnbc.org/
• Disability World. Webzine.
Available at: http://
www.disabilityworld.org/AugSept2000/Women/MIUSA.htm
■ J. Morris. ed.199B. Encounters
with Strangers: Feminism and
Disability. London: The Women's
Press.
• Nelson, J. 1996. The Invisible
Cultural Group: Images of
Disability. In P. Lester (Ed.),
Images That Injure: Pictorial
Stereotypes in the Media, (pp.
119-1251. Westport, CT:
Praeger.
• World Health Organization. 2002.
Towards a Common Language for
Functioning, Disability, and Health.
Available at: http://
www3.who.int/icf/beginners/
bg.pdf
■ For selected films see, http://
www.asiasrc.org/films.php and
Appendix B.
M00UIF4
Chanter 3
Key Messages for this Chapter
• People with disabilities do not form a homogeneous group. For
example, those with visual, hearing or speech impairments,
intellectual disabilities, autism, restricted mobility or so-called
‘medical disabilities’ all encounter barriers of different kinds.
Different disabilities also have varying implications with respect
to sexuality.
• Words like impairment, handicap, and disability have different
connotations. The term impairment implies a physical limitation.
Visual impairment, for instance, means that a person’s eyesight
falls below the determined standard. Disability, on the other hand,
refers to the social impact on a person with any physical/mental
impairment. This includes stigma, discrimination, pity, or non
inclusion. Disability imposes a barrier to accessing spaces and
services available to others. The term handicap has a negative
connotation by focusing on what a person is ‘lacking’, as opposed
to the obstacles they encounter in a disabled-unfriendly society.
• Sexuality is often associated with youth and physical fitness.
The social definition of sexuality is narrow, and children, older
people and those with mental disabilities are typically viewed as
asexual beings. Sexual desirability is also linked to physical
appearance. This can affect the way people with disabilities
perceive their bodies and sexuality.
• While disabled people are often considered asexual, certain
groups such as the intellectually disabled are regarded as
‘oversexed’. One reason for this may be that some people with
intellectual disabilities are unable to recognise and practice
‘socially appropriate’ behaviour.
• To protect children with disabilities, parents may de-sexualise
them. Girls and women with disabilities have fewer opportunities
to explore their sexuality.
■ Disabled people can experience stigma and discrimination at
multiple levels. For example, disabled people may face additional
stigma on account of their sexuality (if they are homosexual,
bisexual, intersexed, transgendered), or HIV status.
• While it is important to highlight the additional disadvantage
women with disabilities face, this should be done in a manner
that affirms their right to speak for themselves. Otherwise there
is a risk of disempowering them even more.
• Disabled people have the right to information and services
related to sexuality, sexual and reproductive health. Involving
them in the planning and implementation of these services will
ensure better quality, effectiveness and appropriateness.
TARSHI: Basics and Beyond
MODULE 4 - Chapter 3
Exercise 1
What if...
SELF-REFLECTION
ADAPTED FROM PRICE J. 2002. SEXUALITY, DISABILITY AND RIGHTS. TEACHING NOTES FOR SEXUALITY AND RIGHTS INSTITUTE (TARSHI-CREA).
ADAPTED FROM GALLER. R. 1984. THE MYTH OF THE PERFECT BODY. IN C. VANCE (ED.) PLEASUREAND DANGER: EXPLORING FEMALE SEXUALITY.
LONDON, PANDORA PRESS.
Instructions
1.
Distribute Handout 4.10 to participants and give them 15
minutes to reflect and write down their responses.
2.
After 15 minutes, ask participants for their responses to the
questions and summarise them on a flipchart. Reassure
participants that they may share their responses only if they
feel comfortable doing so.
After going through all the questions, ask participants for
reactions to the exercise.
3.
Purpose of the
exercise:
1. To explore issues
affecting people with
disabilities.
2. To be comfortable
around discussing
sexuality of disabled
people.
Suggested Questions:
• How did you feel when you did this exercise? What was difficult
to discuss and why?
• What issues came to mind for the first time? How did these
make you feel?
• Do you think these issues are relevant to your community or
culture?
• Why was it important to do this exercise?
Key Messages
• This exercise is meant to help participants consider how they
would experience their sexuality if they had a disability. However,
an exercise of this sort can in no way capture the actual experience
of a person with a disability.
• Different types of disabilities affect people differently depending
on their personal experiences, values, and support from family,
friends and society etc.
People with disabilities are sexual beings and should be
recognised as such. They have an equal right to information on
sexuality and freedom from abuse, infection and unwanted
pregnancies as those without a disability.
380
TIME
45 minutes
MATERIALS
Handout 4.10 Reflecting on
Disabilities, paper and pens
ADVANCE PREPARATION
Review Handout 4.9; Make copies of
Handout 4.10 for participants
TARSHI: Basics and Beyond
MODULE 4 - Chapter 3
Social and cultural restrictions around sexuality are greater for
people with disabilities. For example, parents and care-providers
of disabled people often disregard their concerns around
sexuality. Where family honour is evaluated through a woman’s
sexuality, parents feel increased pressure to secure a future for
their daughters with disabilities. Paradoxically, this extra pressure
leads parents to believing it is ‘better’ or ‘easier’ to have girl
children with disabilities, as controlling a boy’s sexuality is
considered more difficult.
THIS EXERCISE CAN BE MODIFIED
Anyone can acquire a disability in the course of their life (for
example, through an accident or illness). This may or may not
change their experiences and desires regarding sexuality.
BY:
Turning the questions around and
asking participants to reflect on
their reactions to encountering a
person with a disability at a party,
wedding, in bed with another
person, in a movie theatre or
gynaecologist's office. Participants
can then be asked to consider
why disabled people are not seen
in public spaces and what societal
barriers prevent them from
accessing such spaces and
services. See handout 4.8
for more.
MAKING CONNECTIONS
■ People with disabilities face
stigma and discrimination,
especially in the context of their
sexual and reproductive lives. For
more see Chapter 2 in this
Module.
Sexuality is an individual
experience for each person younger or older, with a disability
or not. For more on understanding ,
sexuality see Chapter 1 in
Module 1.
TIPS FOR THE FACILITATOR:
• Help participants appreciate the barriers faced by disabled people in their daily
lives and see how these are related to society's prejudice and indifference.
• Pay attention to the words being brought up by the participants during the exercise.
Do they reflect pity and sympathy le.g. ‘suffering from a disability' or ‘confined to
a wheelchair') rather than a respectful recognition of the rights of disabled people?
I
Do not encourage feelings of pity towards people with disabilities.
j
■ Be prepared to deal with discomfort of some participants, which may manifest as
inappropriate humour, silence or outbursts of anger. Remind the group that the
purpose of the exercise is to build awareness of the possible experiences of disabled
people and their impact on their sexuality and sexual and reproductive health.
■ Participants may not be forthcoming in their answers with a group. Reassure
participants that they do not need to share anything that they are uncomfortable
about. This exercise is intended to help participants establish comfort with disability
j
and sexuality.
■ Note if the group is focusing on only one particular kind of disability. If so, shift the
discussion to other disabilities. Observe if there is more discomfort in discussing
I
the sexuality of people with certain disabilities.
• Make sure to refocus the conversation if participant focus is only on disabilities in
general rather than disabilities and sexuality.
!
■ Address the issue of body image and how this affects people with disabilities. This
could be linked to topics like the emotional and physical adjustments people would
have to make if they had an arm or leg amputated due to an accident/gangrene or
a breast removed due to cancer.
• Use visual images or films that focus on people with disabilities and sexuality to
increase comfort, stimulate conversations and increase understanding. See Appendix
i
B for a list of films.
381
MODULE 4
Chapter 3
Exercise 2
Debating Sexuality and Disability
Instructions
1.
Divide participants into five groups. Each group represents one
of the roles/stakeholders provided in Handout 4.11. Distribute
the description of one role to each of the groups. Ask the groups
to create a strategy that will uphold the position of their
stakeholder group and get the desired outcome indicated in the
handout. Give them 15 minutes to create their strategies.
TARSHI: Basics and Beyond
ROLE-PLAY AND DEBATE
Purpose of the
exercise:
To understand and discuss
issues surrounding
disability and sexuality.
Ask one representative from each stakeholder group to come
up to the ‘negotiating table’ to debate the issue. At the end of
—
the debate, the case must be resolved, and a final decision must
TIME
be made. Allow 20 minutes for debate and negotiation. After
the first round, invite another set of representatives from each
90 minutes
group to come up and carry out the same exercise. Each
MATERIALS
participant should have the opportunity to come up to the
negotiating table to debate.
Handout 4.11 Debating Sexuality
2.
I and Disabilities
After all the debates ask for comments and questions.
3.
ADVANCE PREPARATION
Suggested questions:
• How did you feel when you did this exercise? What did you
find difficult to discuss and why?
■ Do you think the kind of disability a person has is relevant to
their rights? For example, does a person with an intellectual
disability have the same rights as a person with a physical
disability?
■ Do you think these issues are relevant to your communities/
cultures? Why was it important to do this exercise?
Key Messages
■ The implications for people with different disabilities differ
according to factors such as gender, class, location (urban/rural)
and support systems. These also determine how two people with
the same disability navigate their lives in mainstream society.
• People with disabilities should also be recognised as sexual
beings. They have rights to information and safety from abuse,
382
Make copies of Handout 4.11
__ ___ ____ I
TARSHI: Basics and Beyond
MODULE 4 - Chapter 3
infection and unwanted pregnancies. To realize these, they must
be given age/stage appropriate information on sexuality.
Disabled people have to be taught skills to protect themselves
from unwanted sexual advances as well as communicate to their
care-providers if they are being abused.
Masturbation is a safe way of pleasuring oneself and should not
be discouraged because a person is disabled. People with
intellectual disabilities may require repeated instruction about
when, where (and maybe even how) they can masturbate. People
with a visual impairment may need to learn how to stay aware
of surroundings while masturbating so as to ensure their privacy.
THIS EXERCISE CAN BE MODIFIED
BY:
• Having only one representative
from each designated stakeholder
group take part in the role-play.
This may be more appropriate for
larger groups where time is
limited, and to have a more indepth discussion afterwards.
Disabled people can also be attracted to people of the same or
another gender. Those who are homosexual/bisexual/intersexed/
transgendered may face double discrimination.
Involving people with disabilities in the planning and
implementation of sexuality and sexual and reproductive health
services ensures that they are more effective and useful for them.
■ Debating both scenarios given in
Handout 4.10. This may take
more time, but will allow
participants to be exposed to
different issues related to
sexuality of disabled people.
TIPS FOR THE FACILITATOR:
■ Make sure that participants stick to their assigned roles and arguments whether
they agree with them or not. The objective is to help them appreciate the many
facets of an issue, the different resolutions and debates that can emerge during
discussion, and the advantages of being aware of options. Emphasise the importance
I of listening to different views rather than censoring dissenting voices.
MAKING CONNECTIONS
I
j
I
■ Be prepared to deal with discomfort of participants, which may manifest as
inappropriate humour, silence or outbursts of anger. Remind the group that the
purpose of the exercise is to increase awareness of sexual and reproductive health
concerns of disabled people and to improve the effectiveness of work in this area, i
:
• Debate 2 is complicated and may bring up previously unexplored issues. It is more j
suitable for use by an experienced facilitator, equipped to tackle the issues.
■ All people have the right to sexual I
I
• Note if the words being used during the exercise reflect values that convey pity for I
disabled people (for example ‘confined to wheelchair', 'victim of circumstance') as
well-being and the pursuit of
sexual pleasure, irrespective of
age, gender and whether they
have a disability or not. For more
see Chapter 3 in Module 3 and
Chapter 4 in Module 1.
i
I
opposed to empathy and recognition of their sexual and reproductive rights (for i
example, 'rights of wheelchair users to access abortion clinics').
■ Sexuality education for people
with disabilities often omits
' information on anatomy and
physiology, contraception or
protection against STIs, HIV/AIDS,
among other issues. Module 2 has
information on these topics.
j
j • Avoid focusing on a particular kind of disability. Introduce discussion about other
j kinds of disabilities and observe if there is more discomfort in discussing the sexuality
! of people with certain disabilities.
■ Address issues of body image and how this affects the sexuality of disabled people.
Link this to feelings and adjustments that people may have to make if they their
arm or leg were amputated due to an accident or a breast removed due to cancer.
383
TARSHI: Basics and Beyond
MODULE 4 - Chapter 3
Exercise 3
My Views on Sexuality and Disabilities
POLARISATION EXERCISE
Instructions
1.
2.
Give instructions for the exercise: Designate one side of the room
as the Agree side and the other as the Disagree side. You will read
out a statement and participants must move to one or the other
side of the room depending on whether they agree or disagree
with the statement. Those who are undecided should move to a
third designated spot in the room (the Don’t Know group).
Purpose of the
exercise:
To understand that people
with disabilities have the
same sexual and
reproductive rights as those
without disabilities.
Now, invite them to share why they have chosen to be on their
side of the room.
Suggested Questions:
■ Why do you agree or disagree?
■ Do you think you would change your opinion if the statement
did not concern a person with a disability? How? Why?
TIME
60 minutes
MATERIALS
3.
Continue the discussion until the topic has been sufficiently
discussed and analysed, but do not spend more than 15-20
minutes on a statement or participants may lose interest.
4.
After discussing three different statements ask for general
comments or questions.
Suggested Questions:
■ Based on these discussions, what are your opinions and thoughts
about disability, sexuality and sexual and reproductive rights?
• Have you thought about these issues before? If yes, have your
views changed? How?
384
Handout 4.12 My Views on
Disability and Sexuality and
Reproductive Rights
ADVANCE PREPARATION
1) Clear the room of furniture to
| make space for participants to move
: around. 2| Select three statements
: from Handout 4.12.3) Read through
j key messages so as to be prepared
| to lead a discussion on the selected
: topics.
TARSHI: Basics and Beyond
MODULE 4 - Chapter 3
Key Messages
People with disabilities have sexual desires and concerns. These
concerns must be acknowledged and addressed.
While some disabilities are more severe and may interfere with
expression of sexuality, many disabled people can and do live
full and meaningful sexual and reproductive lives. They have
the right to do so, and it is society’s responsibility to ensure that
barriers to claiming these rights are removed.
THIS EXERCISE CAN BE MODIFIED
BY:
While people with physical disabilities (visual or hearing
impairment, or the loss of /inability to use limbs) may require
assistance in performing their routine daily tasks, most are
capable of making independent decisions. These include the
decision to be sexually active, choice of sexual partner (whether
that be a person of the same or another gender), and whether or
not to marry or have children.
■ Having participants discuss
different statements in small
groups before sharing with the
larger group. This allows for a
range of issues to be discussed
and can help quieter participants
share their ideas more
comfortably in the small groups.
Those with severe intellectual disabilities may be able to perform
their daily tasks, but may be unable to participate in any
communication/ decision-making. Their desires must be taken
into consideration as much as possible if a care-provider/parent
is making decisions on their behalf.
• Eliminating the Do Not Know
option in the exercise, and
insisting that participants decide
to agree or disagree with the
statements. Though difficult at
times, it encourages participants
to clarify their own views and
discuss the positive and negative
aspects of each issue.
TIPS FOR THE FACILITATOR:
------------------------------------------------------------
■ Note language that reflects views that disabled people are incapable of making
their own decisions such as 'How can we allows person with a disability to get
married?' Challenge these ideas with examples. For instance, ask participants to
consider people with specific disabilities of varying degrees Ithose with hearing i
impairment, both hearing and visual impairment, loss of a limb, unable to use
one's legs, paralysed waist down etc.l and whether this changes their opinions.
MAKING CONNECTIONS
• All people have the right to sexual
well-being irrespective of age,
gender and whether they have a
i disability. For more see Chapter 3 :
in Module 3.
j • People with disabilities also have
reproductive health concerns and
reproductive rights. For more see
Chapter 2 in Module 3.
;
■ In addition to the facilitator, participants may also challenge one another about
whether they would marry or be sexually involved with a person with a disability.
The facilitator should emphasise respect for all ideas and opinions as laid out in
the Ground Rules found in Preparing to Train.
■ Many ideas and topics unrelated to the statement or exercise may come up during
discussions. The facilitator may want to note any that require more discussion on
a flipchart and allot time to address these Isuch as in the Parking Loti later.
385
TARSHI : Basics and Beyond
MODULE 4 - Chapter 3
Exercise 4
Including People With Disabilities
Instructions
1.
Divide the group into three groups. Assign each group one
scenario from Handout 4.13 and ask them to use the scenario
and associated questions to create a role-play. Give groups 20
minutes for this.
2.
Invite each group to present their role-play. After each role-play
ask for comments and reactions.
Suggested Questions:
■ What did you think of this role-play and how the groups dealt
with the issue?
• How did the group resolve the issue? Would you have resolved
it differently?
• Have you encountered similar situations in your work place? If
yes, what did you do?
ROLE-PLAYS
Purpose of the
exercise:
1. To discuss the barriers
faced by people withdisabilities to access
sexuality and reproductive
health related information
and services.
2. To examine how
disabled people can be
included in work related to
sexuality, sexual and
reproductive health and
rights.
After all the role-plays, ask for general question or comments.
Note some of these responses on a flipchart.
3.
Suggested Questions:
■ How realistic do you think it is to incorporate concerns of people
with disabilities in your own work?
• Do you have any disabled people working with you ? If not, why?
(Some examples: because you did not think of it; there is no one
with a disability in the community; your place of work is not
equipped for disabled people and is inaccessible to them; the
work requires a lot travel and so you need ‘able-bodied’ people
only, etc.)
• If you have people with disabilities in your work place, did you
have to make any adjustments to accommodate them? What
were these?
■ Who will you have to convince in your work place and
community before you can create programmes specifically for
people with disabilities? Who are your allies in this? What
barriers would you encounter?
386
TIME
60 minutes
MATERIALS
' Handout 4.13 Integrating Disability
I
! Related Concerns In Our Work
ADVANCE PREPARATION:
Go through the questions in Handout i
4.13 and make a note of discussion
points beforehand. Think of
examples from work contexts that
participants come from that can be :
used in the discussion.
TARSHI: Basics and Beyond
MODULE 4 - Chapter 3
THIS EXERCISE CAN BE MODIFIED
Key Messages
BY:
• Dividing participants into groups
and asking them to brainstorm
and discuss the suggested
questions above. They can then
focus on their own work and how
' to integrate information and
i services for people with
disabilities. This may be more
I appropriate for groups trying to
■
build up services for people with
disabilities.
MAKING CONNECTIONS
■ Representing people with
disabilities in advocacy campaigns
in a balanced and respectful way
is important. For more see
Chapter 3 in Module 5.
■ The experiences of people with
disabilities and the barriers they
face may change through their
life. For more see Chapter 3 in
Module 1.
• People with disabilities are often excluded from policies or
services. Examine why the rights of disabled people to sexual
and reproductive health information and services have been
overlooked.
• Some ways of including issues related to disability are simple,
cost effective and do not require policy level changes. For
example, advocacy and awareness materials could include some
information specific to people with disabilities or how people
with disabilities can access services. These materials could be
provided in a more accessible format, for example, large print,
Braille, audio tape, pictures etc.
• It is important to train all staff on the rights of disabled people
to equality and accessible information and services. For example,
if a woman with visual impairment comes to a clinic for a
gynaecological check-up, all staff, from the receptionist to the
doctors, must communicate decisions that are being made
including telling the woman what they are doing, where they
are taking her, who will be in the room during the procedure,
and any other information that sighted people take for granted.
• Do not make assumptions about the sexual concerns of people
with disabilities. For example, disabled people can be attracted
to people of the same or another gender. Similarly, it is not
essential that they be married to be sexually active.
■ Barriers faced by people with different disabilities vary and even
two people with the same type of disability will have differing
concerns. Do not generalise or put all people with disabilities
into one homogenous category.
• Not all disabilities are visible (for example a hearing impairment)
and this must be kept in mind, along with an awareness of the
kinds of assistance differently disabled people may require.
TIPS FOR THE FACILITATOR:
■ Encourage participants to come up with examples from their work and environment that would include people with many types of
i
disabilities.
• Help participants examine barriers to the provision of sexual and reproductive health services for disabled people that may have
I
been inadvertently created by them. For example, the location of a clinic on a top floor with no elevator/ramp would limit access
!
for wheelchair users.
■ Encourage participants to begin the exercise by expressing their fears and doubts, and then assist them to look for ways to
*
overcome real and perceived obstacles. Many barriers to incorporating the issues of disabled people in the work place are feari
related and are about not knowing enough about the issue, or wanting to avoid harming anyone.
387
MODULE 4 - Chapter 3
TARSHI: Basics and Beyond
Handout 4.9
Basic Information on Disability and Sexuality
People with disabilities do not form a homogeneous group, nor do they have the same experiences. For
example, those with visual, hearing or speech impairments, intellectual disabilities, autism, restricted
mobility or so-called ‘medical disabilities’ all encounter different obstacles, to be overcome differently.
The definitions of different forms of disability vary. For the purposes of this manual, we have kept to
simple and general definitions. For further clarity, facilitators may want to examine common definitions
in legal and state documents in their country/region.
Hearing Impairment refers to the full or partial loss of the ability to detect sounds. This can range
from a mild loss to complete deafness. The term ‘hearing impairment’ is preferred to the word ‘deafness’
because it includes different degrees of hearing loss.
Orthopedic Impairment's when individuals lack or lose the capacity to move themselves and/or objects
from one place to another.
Mental Impairment (also known as Mental Handicap or Mental Retardation) is a pattern of slow
acquisition of basic motor and language skills during childhood, and a significantly below-normal
intellectual capacity as an adult. It ranges from mild to severe. One common test of mental impairment
is an intelligence quotient (IQ) below 70. The preferred term for ‘mental impairment’ is ‘intellectual
disability’.
Mental Illness is different from a mental disability. It results in a disruption in a person’s thoughts,
feelings, moods, and ability to relate to others. As opposed to intellectual disability, mental illness is
generally curable or treatable and the affected person can function independendy in society.
Speech Impairment ranges from poor articulation such as slurring/stuttering, to a complete inability to
speak.
Visual Impairment means that a person’s eyesight falls below a determined standard for sight and can
range from partial to complete loss of vision.
Multiple Disabilities is a term that refers to more than a single disability in a person. An example of
this is a person with Cerebral Palsy (the result of brain damage prior to or shortly after birth), who faces
difficulties of coordination, movement, posture, speech and/or impairment of mental functioning.
There are a number of different kinds of disabilities and degrees of impairment that people may
experience (for example, Down’s Syndrome, Autism, Dyslexia, problems due to Motor Neuron Disease
Multiple Sclerosis or Spinal Cord injuries, to name a few). Describing all of them is beyond the scope
of this handout.
388
TARSHI: Basics and Beyond
MODULE 4 - Chapter 3
Words like impairment, handicap, and disability have different connotations. The term impairment implies
a physical limitation imposed on a person’s life. For example, visual impairment means that a person’s
eyesight falls below the determined standard. The term handicap connotes a deficiency and evokes
feelings of pity. This is in conflict with a rights-based approach, which advocates that people with
disabilities be treated with respect and dignity, not pity. Disability, on the other hand, refers to the social
impact that a person faces due to any physical/mental impairment. This includes stigma and
discrimination, pity or non-inclusion, and barriers to accessing the spaces and services available to
others.
Like gender and sexuality, disability is also socially constructed. This means that the social and cultural
environment disables people more than their impairment. For example, hearing impaired people are
‘disabled’ because others in ‘mainstream’ society do not know sign language and cannot communicate
with them. Most of society does not consider the need to learn sign language, reflecting the barrier of
indifference faced by a hearing impaired person and disabled people in general. This attitude prevents
them from claiming their rights.
Such attitudinal barriers also include a tendency to consider disabled people asexual and childlike.
This denies their right to privacy and bodily integrity, and prevents them from accessing information
and sexual and reproductive health services. By infantilising people with disabilities they are excluded
from decision-making processes and from being involved in planning and implementing programmes
meant for them. Conversely stereotyping all disabled people as ‘perverted’ or ‘oversexed’ perpetuates
the belief that they need to be controlled and protected.
A rights-based approach to sexual and reproductive health advocates for the recognition of each
individual as unique, with unique requirements and desires. It also calls for access to sexual and
reproductive health services to all people regardless of their dis/ability status and for people with
disabilities to be consulted in matters affecting their sexual and reproductive lives.
389
MODULE 4 - Chapter 3
TARSKI: Basics and Beyond
Handout 4.10
Reflecting on Disabilities
ADAPTED FROM PRICE J. 2002. SEXUALITY, DISABILITY AND RIGHTS. TEACHING NOTES FOR SEXUALITY AND RIGHTS INSTITUTE ITARSHI-CREA).
ADAPTED FROM GALLER. R. 1984. THE MYTH OFTHE PERFECT BODY. IN VANCE. C &.} PLEASUREAND DANGER: EXPLORING FEMALESEXUALITY.
LONDON, PANDORA PRESS.
Take 15 minutes to reflect and write down responses to the following questions:
1.
Do you know anyone with a disability? How did you feel when you first met them? How would you
feel if you were in their place?
2.
Close your eyes and imagine you have a disability. How do you see yourself going about your daily
activities with the disability? How would you feel when:
a.
Abu attend a party?
b.
Abu attend a wedding?
c.
You enter a room full of strangers?
d.
Abu were being intimate with your partner? How would you feel about your body with the
disability? How would it affect your sexual life?
3.
Would you find it easier if you were born with a disability, or if you acquired one later in life due to
an accident/infection/cancer surgery, etc.? Why?
4.
How would being a homosexual/bisexual/intersexed/transgendered person with a disability impact
your life?
39D
TARSHI: Basics and Beyond
MODULE 4 - Chapter 3
Handout 4.1 i
Debating Sexuality and Disabilities
Debate 1: Sexuality Education for Students With Disabilities
Parent 1 of a Student with a Disability
Y>u are the parent of a child with a disability who attends a school for people with disabilities in your community. It
is the beginning of a new school year and an announcement is made at the school that students will be taught a new
health/life skills curriculum. The new curriculum includes sexuality education that was not a part of the previous
curriculum. According to the school administration, this will provide a more comprehensive education for the students.
'rbu think your child should not receive this sort of education, because children with disabilities are not sexual and do
not need sexuality education. "You feel it will give children ideas they did not have before. In addition, you feel it is
your job to teach your child about sexuality, not that of the school. With the school curriculum you will have no
control over what your child learns about sexuality and it could promote ideas that you do not agree with. You fear
that this education could also lead people to abuse your child and you want to protect your child from this kind of
abuse. You decide to create a group of concerned parents and make sure that the new curriculum does not get taught.
As a concerned parent you are committed to the values and beliefs that are described above. You are scheduled to have
a meeting with a teacher, a parent who support the curriculum, a disability rights organisation, and a school
administrator.
Discuss and derive strategies for resolution of the case. Other groups may disagree with your point of view and
position. Your strategy should be formulated keeping the following considerations in mind:
• Who are your allies among the other stakeholder groups?
• Who are your opponents among the other stakeholder groups? How can you strategise to counter their objections?
■ What are your options for resolution? Are you willing to negotiate on your position, consider other options, and
agree to others’ viewpoints?
Parent 2 of a Student with a Disability
You are the parent of a child with a disability who attends a school for people with disabilities in your community. It
is the beginning of a new school year and an announcement is made that the students will be taught a new health/life
skills curriculum. The new curriculum includes sexuality education that was not a part of the previous curriculum.
According to the school administration, this will provide a more comprehensive education for the students.
You are very happy with this change in curriculum and eager for your child to receive sexuality education. You hope
that the course includes information on how children can protect themselves from infections, as well as what being a
sexual person is about, even with a disability. You think that your child and the others in the school have a right to this
education and should not be ‘protected’ from sexuality because of a disability.
As a parent who supports this curriculum you are committed to the values and beliefs described above. You are
scheduled to have a meeting with a teacher, a parent concerned over the curriculum, a disability rights organisation,
and a school administrator.
Discuss and derive strategies for resolution of the case. Other groups may disagree with your point of view and
protest against your position. Your strategy should be formulated after considering following points;
■ Who are your allies among the other stakeholder groups?
■ Who are your opponents among the other role/stakeholder groups? How can you strategise to counter their
objections?
• What are your options for resolution? Is your position negotiable; will you consider other options; and are you
rea dy to agree to other’s view- points?
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Teacher
You are a teacher in a school for people with disabilities in your community. It is the beginning of a new school year
and an announcement is made that the students will be taught a new health/life skills curriculum. The new curriculum
includes sexuality education that was excluded from the previous curriculum. According to the school administration,
this will provide a more comprehensive education for the students.
As a teacher in this school you are not very comfortable with this new curriculum. You think it will make many of the
parents uncomfortable and also force you to address issues and ideas with your students that you are not entirely at
ease discussing. You think it is more important to focus on education that will assist students to live more independently
and you are not sure that sexuality education is really part of that, especially for students between the ages of 10-14.
However, you do admit that some of your students are smart and have expressed interest in this type of information,
but are not sure they should receive it.
As a teacher in this school you are loyal to your group and committed to the values and beliefs described above. You
are scheduled to have a meeting with a parent opposed to the curriculum, a parent who supports the curriculum, a
disability rights organisation, and a school administrator.
Discuss and derive strategies for resolution of the case. Other groups may not agree with your point of view and
protest against your position. Your strategy should be formulated after considering the following points:
• Who are your allies among the other stakeholder groups?
• Who are your opponents among the other stakeholder groups? How can you strategise to counter their objections?
• What are your options for resolution? Will you negotiate on your position at all? Will you consider other options,
and will you agree to other’s view- points?
Disability Rights Organisation
It is the beginning of a new school year and an announcement is made at a school for people with disabilities in your
community that the students will be taught a new health/life skills curriculum. The new curriculum includes sexuality
education, absent in the previous curriculum. According to the school administration, this will provide a more
comprehensive education for the students.
Your organisation is thrilled that this new curriculum is being introduced. You have provided your input and consulted
with the school administrators interested in introducing this to the students. You think the curriculum will open up
discussions on sexuality in schools for people with disabilities and hopefully even initiate a broadened perspective in
the community. You think this will also ensure the right of choice and practice of sexuality among people, including
those with disabilities. You know that people with disabilities are often perceived as non-sexual, and are protected
and prevented from being sexually active. Your organisation believes that people with disabilities have a right as
others do, to information and protection against abuse, infection and unwanted pregnancies. You are therefore
committed to supporting and ensuring the use of this curriculum.
As a disabilities rights organisation you are loyal to your group and are committed to the values and beliefs described
above. You are scheduled to have a meeting with a parent opposed to the curriculum, a parent who supports the
curriculum, a teacher in the school, and a school administrator.
Discuss and derive strategies for resolution of the case. Other groups may not agree with your point of view and
protest against your position. Your strategy should be formulated keeping the following considerations in mind.
• Who are your allies among the other stakeholder groups?
• Who are your opponents among the other stakeholder groups? How can you strategise to counter their objections?
• What are your options for resolution? Will you negotiate on your position at all? Will you consider other options
and will you agree to other view-points?
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MODULE 4 - Chapter 3
School Administrator
You are a school administrator for a school for people with disabilities. It is the beginning of a new school year and an
announcement is made that the students will be taught a new health/life skills curriculum. The new curriculum
includes education on sexuality that was excluded from the previous curriculum. According to the school
administration, this will provide a more comprehensive education for the students.
As the school administrator you were initially nervous about the new curriculum, but after discussing it with others
you have decided this will be important and beneficial for the students. You have worked hard to make sure the
curriculum touches on key messages and information relevant to people with disabilities and are sensitive to the
barriers faced by such students between the ages of 10-14. You think sexuality education for people with disabilities
will help them know what inappropriate sexual advances can be made on them and what they can do to protect
themselves.
You are loyal to your group and are committed to the values and beliefs described above. You are scheduled to have a
meeting with a parent opposed to the curriculum, a parent who supports the curriculum, a teacher in the school, and
a school administrator.
Discuss and derive strategies for its resolution. Other groups may not agree with yoUr point of view and protest
against your position. Your strategy should be formed after considering the following points:
• Who are your allies among the other stakeholder groups?
• Who are your opponents among the other stakeholder groups? How can you strategise to counter their objections?
• What are your options for resolution? Is your position at all negotiable? Will you consider other options, and will
you agree to other view-points?
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TARSHI: Basics and Beyond
Debate 2: Teaching People With Disabilities About Sexual Pleasure
Man with a Physical Disability
You are a man with a disability and it has come to your attention that a local disability rights organisation is about to
begin a programme that will provide sexuality education for disabled people that also focuses on sexual pleasure. As
part of this focus, the programme will include information on masturbation as a safe and suitable way for people with
disabilities to sexually satisfy themselves. The organisation has adapted the programme to suit your community from
similar ones being run in some European countries. The organisation believes in the benefits of the programme and
to this end, they are organising a meeting to discuss it with different stakeholders in your community.
You are opposed to this new programme. Although you are a person with a physical disability you do not think there
should be promotion of masturbation. You think it is also insulting to you and others with disabilities to be viewed as
needy and unable to find sexual partners. You want to stop this programme from being introduced into your community
and decide to make your stand clear both to the disability rights organisation and community members discussing the
issue.
As a concerned person with a disability you are committed to the values and beliefs described above. You are scheduled
to have a meeting with others including people with disabilities who support the programme, the disability rights
organisation introducing the programme, a community leader, and a care-provider for a person with an intellectual
disability to discuss the issue.
Discuss and derive strategies for resolution of the case. Other groups may not agree with your point of view and
protest against your position. Before formulating your strategy, you should consider the following points:
• Who are your allies among the other stakeholder groups?
■ Who are' your opponents among the other stakeholder groups? How can you strategise to counter their objections?
• What are your options for resolution? Is your position at all negotiable? Will you consider other options and will
you agree to other viewpoints?
Woman with a Physical Disability
You are a woman with a physical disability and it has come to your attention that a local disability rights organisation
is about to begin a programme that will provide sexuality education for disabled people that also focuses on sexual
pleasure. As part of this focus, the programme will include information on masturbation as a safe and suitable way for
people with disabilities to sexually satisfy themselves. The organisation has adapted the programme to suit your
community from similar ones being run in some European countries. The organisation believes in the benefits of the
programme and to this end, they are organising a meeting to discuss it with different stakeholders in your community.
You are very excited about this new programme and think it will be a great way to teach people about sexual pleasure
and to improve the attitudes toward people with disabilities in your community. As a person with a physical disability
you find it hard to talk about your desires. You do not know how to pleasure yourself and would like to learn more
about it. You want to participate in the programme when it comes to the community. You have some concerns about
whether women will also participate in this programme and whether your family will allow you to attend.
As a person with a disability who supports the programme, you are committed to the values and beliefs described
above. You are scheduled to have a meeting with others, including people with disabilities that oppose the programme,
the disability rights organisation promoting this programme, a community leader, and a care-provider for a person
with an intellectual disability to discuss the issue.
Discuss and derive strategies for resolution of the case. Other groups may not agree with your point of view and
protest against your position. Your strategy should therefore take the following points into consideration:
• Who are your allies among the other stakeholder groups?
• Who are your opponents among the other stakeholder groups? How can you strategise to counter their objections?
• What are your options for resolution? Are you willing to negotiate on your position at all? Will you consider other
options, and will you agree to other view-points?
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MODULE 4 - Chapter 3
Care-provider for a Person with an Intellectual Disability
'ton are the care-provider for a person with an intellectual disability and it has come to your attention that a local
disability rights organisation is about to begin a programme that will provide sexuality education for disabled people
that also focuses on sexual pleasure. As part of this focus, the programme will include information on masturbation
as a safe and suitable way for people with disabilities to sexually satisfy themselves. The organisation has adapted the
programme to suit your community from similar ones being run in some European countries. The organisation
believes in the benefits of the programme and to this end, they are organising a meeting to discuss it with different
stakeholders in your community.
As a care-provider for a person with an intellectual disability you disagree with this programme and oppose its
introduction into the community. You cannot imagine a person coming into your home and telling your child about
masturbation. It is harmful to them and also unnecessary: people with disabilities, especially intellectual disabilities,
have a hard enough time trying to understand simple ideas and getting through their day without introducing
something like masturbation into their lives. You plan to gather together other care-providers and oppose this
programme.
As a care-provider you are committed to the values and beliefs described above. You are scheduled to have a meeting
with others, including people with disabilities that oppose the programme, disabled people that support it, the disability
rights organisation introducing the programme, and a community leader to discuss the issue.
Discuss and derive strategies for resolution of the case. Other groups may not agree with your point of view and
protest against your position. Your strategy must therefore take the following points into account:
• Who are your allies among the other stakeholder groups?
■ Who are your opponents among the other stakeholder groups? How can you strategise to counter their objections?
• What are your options for resolution? Are you willing to negotiate on your position at all? Will you consider other
options, and will you agree to other viewpoints?
Community Leader
You are a community leader and it has come to your attention that a local disability rights organisation is about to
begin a programme that will provide sexuality education for disabled people that also focuses on sexual pleasure. As
part of this focus, the programme will include information on masturbation as a safe and suitable way for people with
disabilities to sexually satisfy themselves. The organisation has adapted the programme to suit your community from
similar ones being run in some European countries. The organisation believes in the benefits of the programme and
to this end, they are organising a meeting to discuss it with different stakeholders in your community.
As a community leader you recognise that people with disabilities have rights and should be allowed to have the
information and services that will assist them to lead healthy and full lives. However, this programme also sounds
very radical to you and may anger many people in the community. While you personally have no problem with it, you
think it may be best to not support it. It would be wise to stay neutral on the subject as it is also an election year and
you do not want to anger any of your constituents or voters.
You are scheduled to have a meeting with others including people with disabilities that oppose the programme,
disabled people that support it, the disability rights organisation introducing the programme, a care-provider, and a
community leader to discuss the issue.
Discuss and derive strategies for resolution of the case. Other groups may not agree with your point of view and
protest against your position. Your strategy should therefore be formulated taking the following points into
consideration:
• Who are your allies among the other stakeholder groups?
■ Who are your opponents among the other stakeholder groups? How can you strategise to counter their objections?
■ What are your options for resolution? Are you will to negotiate on your position at all? Will you consider other
options, and will you agree to other viewpoints?
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TARSHI: Basics and Beyond
Disability Rights Organisation
You are part of a disability rights organisation planning to begin a new programme that provides sexuality education
for disabled people that also focuses on sexual pleasure. As part of this focus, the programme will include information
on masturbation as a safe and suitable way for people with disabilities to sexually satisfy themselves. %ur organisation
has adapted the programme to suit your community from similar ones being run in some European countries. It
believes this will be a beneficial programme and to this end is organising a meeting to discuss the programme with
different stakeholders in your community.
Your organisation thinks this is an excellent programme and has modelled it to be culturally sensitive and address the
barriers faced by people with disabilities in your specific community. You think that all people including those with
disabilities have the right to understand and express their sexuality, and this programme will help facilitate these
rights. You plan to start the programme with an orientation for parents, teachers and some adults with disabilities and
then over time offer the whole programme to those interested in participating.
Yw know that people with disabilities are often viewed as non-sexual, and are protected and prevented from being
sexually active. Your organisation believes that disabled people have a right to information on sexuality and safety
from abuse, and also that sexual pleasure can be experienced safely through masturbation. Therefore you are committed
to supporting and ensuring the introduction of this programme.
As a staff member of a disabilities rights organisation, you are loyal to your group and committed to the values and
beliefs described above. You are scheduled to have a meeting with others including people with disabilities who
oppose the programme, disabled people who support it, a care-provider, and a community leader to discuss the issue.
Discuss and derive strategies for resolution of the case. Other groups may not agree with your point of view and
protest against your position. Your strategy should therefore take the following points into account:
• Who are your allies among the other stakeholder groups?
• Who are your opponents among the other stakeholder groups? How can you strategise to counter their objections?
• What are your options for resolution? Are you ready to negotiate on your position at all? Will you consider other
options, and will you agree to other viewpoints?
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MODULE 4 - Chapter 3
Handout 4.12
My Views on Disability and Sexuality and Reproductive Rights
Designate one side of the room as theTgree side and the other as the Disagree side. Ask participants to
move toward either side of the room, depending on whether they agree/ disagree with the statement
you read out to them. Those who are undecided should move to a third designated spot in the room
(the Don’t Know group).
Read one statement at a time and allow time for discussion between those with different views before
moving on to other statements:
a)
People with physical disabilities can only marry or have relationships with other people with
disabilities.
b)
People with intellectual disabilities should not get married.
c)
People with disabilities should not be allowed to have children.
d)
Women with disabilities should be sterilised.
e)
People with congenital disabilities (disabilities they were born with) should not have children since
there is a chance that their children will also have the same disability.
f)
Genetic testing should be done during pregnancy to identify congenital disabilities, which will help
people decide whether or not to continue with the pregnancy.
g)
It is a myth that people with disabilities are more vulnerable to sexual abuse.
h)
Disabled people can be sexually attractive to both disabled and non-disabled people.
i)
People with disabilities can be heterosexual/homosexual/ bisexual/transgendered just like people
who are not disabled.
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TARSHI: Basics and Beyond
Handout 4.13
Integrating Disability Related Concerns In Our Work
Scenario 1
What situation would a person with a hearing impairment face if they went into a Government Hospital
or any facility with no arrangements for sign language?
• What barriers will there be for this person? How can these barriers be overcome?
• Whose support can be used from local organisations and the community to tackle these issues?
Scenario 2
What are the ideal conditions under which a person using a wheelchair/paralysed from the waist
down would be able to access an abortion clinic?
• What barriers will there be for this person? How can these barriers be overcome?
• Whose support can be used from local organisations and the community to tackle these issues?
Scenario 3
You are an inspector from the Ministry of Welfare assigned the task of checking whether the family
counselling centres in your city are friendly towards disabled people. What will you be checking for
and what do you find?
• What barriers for a disabled person will you be looking out for? How can these barriers be overcome?
• Whose support can be used from local organisations and the community to tackle these issues?
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MODULE 5
Making it Work
MODULE 5
Introduction
Regardless of whether participants work in reproductive health
interventions, sexuality education programmes, or sexual health
clinics, integrating the ideas and information in this manual into
their work can make it stronger and more effective. It can be a
challenge however, to apply the ideas and concepts in this manual
to the work and advocacy we do. How have individuals or
organisations successfully accomplished this before? What lessons
can we learn from the successes and challenges of other campaigns
and programmes? What principles do we need to apply to be
effective and respectful of the people we work with?
Module 5: Making it Work, addresses these questions. It brings
together topics from the other modules and illustrates how these
can be used effectively to improve work in fields of sexuality,
reproductive and sexual health, and rights. Participants finish this
module with tools to take back to their own work, including how
to incorporate values and principles into their work, ethical
considerations, lessons from successful advocacy campaigns, and
discussions on issues that affect populations around the world.
TARSHI: Basics and Beyond
TARSHI: Basics and Beyond
MODULE 5
Chapters in Module 5
Making it Work
Chapter 1: Values and Principles
• Exercise 1: Principles to Guide Us
90 minutes
■ Exercise 2: Clarifying Our Values
60 minutes
Chapter 2: Ethics in Practice
• Exercise 1: Understanding Ethics
60 minutes
• Exercise 2: What Ethics Guide you?
60 minutes
■ Exercise 3: Case Studies on Ethical Dilemmas
60 minutes
Chapter 3: Learning from Others
■ Exercise 1: Negotiating With Other Stakeholders
75 minutes
• Exercise 2: Representing an Issue in Advocacy
90 minutes
• Exercise 3: Campaigns for Sexuality,
Sexual and Reproductive Health and Rights
60 minutes
• Exercise 4: Sharing Campaign Stories
60 minutes
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MODULE 5
Assessment for Module 5
Making it Work
At the end of this module the facilitator can conduct an assessment.
This assessment can evaluate the increase in participant knowledge,
changes in attitudes, preferences for different exercises, and
opinions on the facilitator’s skills. For this module, an assessment
can be done using the following tools:
• Using the modification of Exercise 3 in Chapter 2 of this Module
• Using the modification of Exercise 2 in Chapter 3 of this Module
■ Adapting one of the sample assessment forms found in Chapter
2 Preparing to Train
■ Using the facilitator preparation exercises for this module found
in Chapter 1 Preparing to Train
■ Developing a new assessment depending on the type of
information the facilitator is looking to discover
Sample Training Schedule
A blank template of a training schedule as well as a sample sevenday training schedule can be found in the Introduction of Preparing
to Train. Depending on the focus of the training and the topics it
aims to cover, the facilitator can fill in the blank schedule with
exercises from this Module or in combination with exercises from
other Modules.
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MODULE 5 - Chapter 1
Chapter 1
Values and Principles
Chapter Objectives for the Facilitator
1. To have participants understand and explore their personal
values and principles.
2. To have participants examine some guiding principles for
working on sexuality, sexual and reproductive health, and
rights.
TARSHI: Basics and Beyond
MODULE 5 - Chapter 1
Why a Chapter on Values and Principles
Programmes and services must consider local and cultural sensitivities.
In order to be effective and accessible, the development, implementation,
and evaluation of programmes and services must be consonant with
the cultural and community context.
Different women and men have different needs, identities, choices, and
life circumstances. Therefore, all women and all men do not have the
same sexual concerns. Programmes must cater to the diversity among
and within groups ofpeople they serve.
Also, programmes need to consider that people may have special needs
based on different factors such as urban or rural location, sexual
orientation, illness, culture, age, or disability.
EXERCISES IN THIS CHAPTER
Exercise 1: Principles to Guide Us.
90 minutes
Exercise 2: Clarifying Our Values.
60 minutes
MATERIALS FOR THIS CHAPTER:
Flipchart
Markers
Pen/pencils
Sheets of paper
(from the Common Ground: Principles for Working on Sexuality,
TARSHI 2001)
Working on issues of sexuality, sexual and reproductive health, and
rights requires an awareness of social values, as both personal and
cultural values give meaning to people’s lives and shape their
behaviour and attitudes. This includes how people choose to express
their sexuality and their reproductive or sexual health choices. At
times these values influence people’s health and well-being. For
example, in many parts of the world there is a ‘culture of silence’
around talking about sexual issues. Consequently, many people,
especially women, do not seek professional help for sexual health
concerns, to the detriment of their health and well-being.
In this chapter, participants will look at personal, professional,
community, and cultural values. They will examine how these can
change over time and how they are shaped by experiences, belief
systems, and social and cultural surroundings. Acquiring clarity
about these values allows for more effective work and advocacy
and can be helpful in the resolution of value conflicts in ways that
increase the autonomy of individuals and communities.
HANDOUTS REQUIRED FOR THIS
CHAPTER:
• Handout 5.1
Guiding Principles for Working on
Sexuality
■ Handout 5.2
Case Studies on Clarifying Our
Values
TARSHI: Basics and Beyond
ADDITIONAL RESOURCES:
MODULE 5 - Chapter 1
Key Messages for this Chapter
• American Medical Student
Association. Principles Regarding
Sexuality, http://www.amsa.org/
about/ppp/sex.cfm
■ The basic values of choice, dignity, diversity, equality and respect
underlie the concept of human rights. These affirm the worth
of all people.
• TARSHI. 2001. Common Ground:
Principles for Working on
Sexuality. India.
■ It is important to relate the values of choice, dignity, diversity,
equality and respect to sexuality, sexual and reproductive health
and rights in order to be able to work more effectively in these
fields.
• For selected films see, http://
www.asiasrc.org/films.php and
Appendix B.
• For selected films see, http://
www.asiasrc.org/films.php and
Appendix B.
TARSHI: Basics and Beyond
MODULE 5 - Chapter 1
Exercise 1
Principles to Guide Us
SMALL GROUP WORK
Instructions
Purpose of the
1. Divide participants into small groups. Distribute Handout 5.1
to each group and ask them to discuss each principle in the
context of their work and answer the following questions:
• Give two to five examples of how you can use these principles
in your day-to-day work. For example, as a nurse it is essential
to have a non-judgmental approach to care in order to offer the
best treatment options to patients.
• Give two to five advantages of these principles in your day-today work.
■
Give groups 45 minutes to complete their lists.
exercise:
1. To discuss guiding
principles for working on
sexuality, sexual and
reproductive health, and
rights.
2. To identify methods and
advantages to using
guiding principles in dayto-day work.
2. Bring groups back together and invite a representative from each
to present their examples and advantages to the larger group.
After group presentations are complete, ask for questions and
comments.
TIME
Suggested Questions:
■ Were there common examples or connections to the principles
presented by the groups? What were these?
• Do these examples indicate that principles are useful in the work
you do whether this is direct health care or advocacy etc.?
90 minutes
MATERIALS
Flipchart paper, markers, and tape,
Handout 5.1 Guiding Principles for
Working on Sexuality
ADVANCE PREPARATION
Make copies of Handout 5.1 for each
participant; review Handout 5.1
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TARSHI: Basics and Beyond
MODULE 5 - Chapter 1
THIS EXERCISE CAN BE MODIFIED
BY:
• Using the exercise as an
assessment at the end of this
module. Ask participants in small
groups to develop 10 Guiding
Principles for working on sexuality
with a rights perspective. Their
Guiding Principles should
incorporate sexuality, gender, core
values, and human rights. For
each of the Guiding Principles,
groups should give at least one
example from their work which ■
they can apply to the principles.
Have groups present their
guidelines and discuss them to
determine whether the
participants have acquired
knowledge that fulfils the
objectives from the module. A
peer-assessment form can be
given to the non-presenting
groups to evaluate the other
groups. A sample evaluation/
assessment form can be found in
Preparing to Train.
MAKING CONNECTIONS:
■ Guiding principles can be
incorporated into advocacy
campaigns and movements. For
more see Chapter 3 in Module 5.
Key Messages
Because core values that underlie the human rights system can
sound abstract, it may be difficult to establish a connection
between these values and work on sexuality and/or sexual and
reproductive health. It is therefore useful to articulate some
guiding principles based on these values and how these can be
used tangibly in work situations.
Guiding principles that promote sexual well-being can be
integrated into different strategies and mechanisms to address
issues of sexuality. For instance, these can be used to develop or
evaluate curricula, policies, programmes, publications and
services on sexuality.
TIPS FOR THE FACILITATOR:
• The example of Guiding Principles in Handout 5.1 may be too abstract and
participants may find it difficult to relate them to their day-to-day work. If this
occurs, encourage them to think of the advantages and disadvantages of these
principles instead.
■ Sharing examples of how guiding principles apply to different work and advocacy
environments benefits all group members. Encourage each participant to contribute
at least one example of how the guiding principles apply to their work ■ even if
they are not working directly with issues of sexuality or sexual and reproductive
health.
• Respect for diversity and choice
creates an environment free of
stigma and discrimination. For
more see Chapter 2 in Module 4.
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TARSHI: Basics and Beyond
MODULE 5 - Chapter 1
Exercise 2
Clarifying Our Values
CASE STUDIES
Instructions
1. Divide the participants into small groups. Assign each group
three to four of the case studies from Handout 5.2. Give the
groups 20-30 minutes to read the case studies and answer the
corresponding questions.
Purpose of the
exercise:
To identify and clarify the
practical applications-of
the Guiding Principles.
2. Ask participants to return to the larger group and invite each
small group to share their cases studies and discussions. After
each presentation, ask for reaction and questions from other
participants.
TIME
Suggested Questions:
• Do you agree with the conclusions of the group? Would you
suggest an alternative?
• How did the application of the Guiding Principles help
characters in the case?
60 minutes
MATERIALS
Handout 5.2 Case Studies on
Clarifying Our Values
ADVANCE PREPARATION
Make copies of Handout 5.2 for each
participant.
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TARSHI: Basics and Beyond
THIS EXERCISE CAN BE MODIFIED
MODULE 5 - Chapter 1
Key Messages
BY:
• Choosing one or two cases to read
together and discuss as a larger
group. This can be helpful for
groups having trouble with the
concepts of the Guiding Principles
and/or to focus the group on an
issue that is pertinent to them.
■ Developing Guiding Principles before conducting a project/
program/campaign can help people work effectively in a dayto-day context.
■ Although core values can seem unconnected and difficult to
apply in daily work, principles based on them and followed by
organisations/workers can ensure that these values are carried
out in the work being done.
TIPS FOR THE FACILITATOR:
MAKING CONNECTIONS
■ Core values that underlie the
human rights system can also be
linked and applied in the context
of sexual and reproductive rights.
For.more see Setting The Tone in
Introduction to Module 1 and
Chapters 2 and 3 in Module 3.
• Participants may find it difficult to apply the Guiding Principles to the case studies.
Encourage them to read through Handout 5.2 before going through the cases.
• There are a variety of
contraception options available to
women aside from those in some
of the cases. For more see
Chapter 2 in Module 2.
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MODULE 5 - Chapter 1
TARSHI: Basics and Beyond
Handout 5.1
Guiding Principles for Working on Sexuality
BASED ON COMMON GROUND: PRINCIPLES FOR WORKING ON SEXUALITY, TARSHI 2001
Affirmative Approach to Sexuality: Sexuality is a complex, yet pleasurable and enriching part ofpeople s
lives. It can also have unwanted negative consequences and place one at risk of pain, disease, and
violence. Messages received by people about sexuality mosdy focus on its negative aspects and evoke
feelings of fear, shame or guilt. Most programmes centre only on the importance of safer sex. They
focus on unwanted pregnancy, STIs, and HIY for example, as dangerous consequences of sexuality
without acknowledging that pleasure is an equally important component of sexuality. Using a positive,
affirming approach to sexuality, rather than one based on fear, addresses both the pleasure and safety
aspects of sexuality. A perspective that affirms sexuality encourages safer sexual practices, relationships
and greater well-being.
Autonomy and Self-Determination: Autonomy means the ability and right of individuals to make
choices and decisions. Women and men have the right to make their own free and informed choices
about every aspect of their lives, including their sexuality. Making decisions on behalf of others does
not encourage autonomy.
For women and men to make informed choices, they must have complete information about options.
Responsiveness to Changing Needs: Women’s and men’s needs for information on sexuality and
services change over time and throughout their life cycles. With the social, cultural, and technological
changes that take place over time, emerging options, issues, and concerns will also differ. The sexual
concerns of people also change in keeping with corresponding physical, emotional, and social changes.
For example, an older woman going through menopause requires specific gynaecological interventions
that differ from those needed by a younger woman.
Comprehensive Understanding of Sexuality: Issues of sexuality are complex and affect many aspects
of a person’s life. Programmes and services must take this into account and integrate emotional,
psychosocial and cultural factors in planning and service delivery.
For example, people with low self-esteem may not feel entitled to negotiate safer sexual behaviour.
Improving their self-esteem will enhance their desire and capacity to take care of themselves.
Confidentiality and Privacy: Sexuality touches upon intimate aspects of people’s lives. Everyone has
a right to privacy and confidentiality. If people feel that their privacy and confidentiality are threatened
this will deter them from seeking information and services. This means that people have the right to
seek anonymity, to not feel under compulsion to share information, and also the right to demand that
information about them not be divulged to a third party. Services and programmes must ensure these
rights.
For example, counselling and health services must be provided in spaces where confidentiality is
maintained and people feel safe enough to speak about their concerns without being overheard.
410
TARSHI: Basics and Beyond
MODULE 5 - Chapter 1
ensitivity. Cultural perceptions about issues of sexuality differ among different groups and
immunities. Programmes and services must consider local and cultural sensitivities. In order to be
ctive an accessible, the development, implementation, and evaluation of programmes and services
™u.st e c°nsonant with the cultural and community context. Considering cultural practices, traditions,
e ic s an values of a community, and using culturally appropriate language enhances community
acceptance of sexuality programmes and services.
Diversity: Different women and men have different needs, identities, choices, and life circumstances.
Therefore, their sexual concerns also differ. Programmes must cater to the diversity among and within
the groups of people they serve.
Programmes also need to take into consideration the special needs of people based on different factors
such as urban or rural location, sexual orientation, illness, culture, age, or disability.
Gender Equity: Programmes based on gender equity recognise the need to provide for women and
men, girls and boys, to have equitable access to information, services and education that promote
sexual well-being. Messages and programmes must cater to needs specific to each gender, but without
perpetuating stereotypes or double standards about gender and sexuality. For example, programme
staff should be careful in their words and actions to not perpetuate the stereotype that young men
rather than women need to learn about sexuality, and also that women need to know about contraception.
Prevent Violence, Exploitation and Abuse: Many people experience their sexuality or initiation into
sexual activity in violent, exploitative and abusive circumstances. Programmes and services must
emphasise that consent and equity between partners are necessary conditions for healthy sexual
relationships. Consensual sexual relationships are based on mutual respect and concern for one’s own
and one’s partners’ physical, mental and sexual well-being.
Non-Judgmental Services and Programmes: People have different value systems, based upon which
they make sexual choices. Providers and educators must respect the values that others hold and refrain
from imposing their own values and judgements upon them. A non-judgmental atmosphere encourages
people to discuss their sexual concerns and access sexuality and sexual health information and services.
For example, both an unmarried sexually active young woman and an unmarried sexually active
homosexual older man need to be ensured acceptance and comfort before they visit a sexual health
clinic.
Accessible Programmes and Services: Accessibility entails more than availability of services. It includes
issues of quality, activity, confidentiality, staffing, and capacity to cater to a range of needs. Women and
men are more likely to use and be responsive to programmes and services that are non-threatening,
provided by skilled and sensitive staff, available at times that do not conflict with their other obligations/
schedules, and provided in safe, accessible locations. For example, a sexual health clinic for young
people is more accessible if it is located in a place well connected by public transport and known to
offer a range of services. If the clinic is known to offer only treatment for STIs, chances are that not
many young people will go there.
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MODULE 5 - Chapter 1
TARSHI: Basics and Beyond
Handout 5.2
Case Studies on Clarifying Our Values
Case Study 1
School A is well known and respected in the city. It has recently taken the decision to introduce sexuality
education for students who are 14 years and older. The school authorities have approached a local
NGO that is well respected in the community and has experience working on these issues to help with
the instruction. However, discussions between the school authorities and NGO staff have been stalled
because the school is not comfortable with the NGO’s request that school staff be absent from the
classrooms during the sessions. The NGO thinks this will help students talk freely about their concerns.
The NGO staff has also said that they will respond to any questions by the students, including those
on abortion and masturbation, and they may include a condom demonstration if the need arises.
Questions:
■ Do you agree with the NGO’s approach? Why or why not?
■ What Guiding Principles and values is the NGO trying to uphold with its policy for the school?
• How could the issue between the two be resolved?
Case Study 2
Kavita is confused about some changes in her body and decides to speak to her sister-in-law about
them. Kavita tells her sister-in-law that she has had to undergo repeated abortions because of her
husband’s refusal to use condoms and oral contraceptive pills do not suit her. After the third abortion
two years ago, she has not become pregnant again. This concerns Kavita and her husband since they
are now ready to start a family. A few months ago, she began experiencing abdominal and lower back
pain and excessive bleeding during her periods and sometimes even between her periods. When the
pain and bleeding became too difficult for her, Kavita went to a doctor who examined her and told her
that her intrauterine device (IUD) had been dislodged. The IUD had pierced the uterine wall, which
was the cause of all her problems. Kavita was confused: How could she have an IUD inside her
without knowing about it? She had never asked for one. Her sister-in-law mentions that a neighbour
had warned her that a local abortion facility was inserting IUDs into women when they came in for an
abortion. Maybe this had happened to Kavita?
Questions:
■ What should Kavita do in this situation?
• Do you think it was appropriate for the clinic to put in the IUD after Kavita’s third abortion?
• What Guiding Principles and values would help you examine this case?
Case Study 3
Dr. Goyal is annoyed with the students in his class. He has been conducting this course for the past
two decades and has had no complaints in the past. He always prepares his lessons from well-respected
medical textbooks. In the past few years, a number of students seem to be out to challenge him. Every
time he gives them some information, one of his students will confront him with some new information
from the Internet. He wonders how people can rely on the Internet? He has heard that it has so much
information from so many sources? How can anyone be sure that this information is valid and reliable?
He wonders why his students no longer take him seriously.
Questions:
• What do you think of Dr. Goyal’s situation? Do you think he needs to adapt to the changing needs
of his students?
• What Guiding Principles and values would help him in his work?
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TARSHI: Bas.cs and Beyond
MODULE 5 - Chapter 1
Case Study 4
Ruchika has been working as a healthcare worker in a government run mother and child clinic for
the past five years. She is fed up with one of her patients, Kavita, who has had two abortions in the
past six months. Why doesn’t she get that good-for-nothing husband of hers to use a condom?’ she
asks her colleague Mariam in frustration. Mariam tells her that it is not easy to talk about these
things and to persuade a husband to use condoms, but Ruchika is not convinced. She feels that
Kavita is lazy and unaware of the harm she is causing her body by going in for repeated abortions.
She has decided that the next time Kavita comes in for an abortion, she will take matters into her
own hand and fit her with an intrauterine device (IUD). After all, she has her client’s best interests
at heart.
Questions:
Do you agree with Ruchika in this case? Do you think she is violating any of the Guiding Principles
or values?
• What other options should Ruchika consider?
Case Study 5
Manoj and Meera were engaged to be married. Manoj is HIV positive. A few months before the wedding,
the hospital that had done Manoj’s HIV test disclosed his positive status to Meera’s relatives. They
were very upset and cancelled the marriage immediately. Manoj filed a complaint at the High Court
claiming that his right to confidentiality was breached by the hospital.
Questions:
■ Do you agree that Manoj’s confidentiality was breached?
■ What are the consequences to revealing information like HIV status without permission?
• What Guiding Principles and values are present in this case?
Case Study 6
Ramya, a 32-year-old woman goes to the gynaecologist for a routine check-up. The doctor on duty asks
Ramya why she has come for a check-up when she is unmarried. Ramya says that she has read that
women should undergo routine gynaecological check-ups after the age of 30 years, which is why she is
here. The doctor looks concerned and asked again why she needs a check-up if she is not married.
Questions:
■ Should the doctor be asking Ramya such questions?
• What Guiding Principles and values should the doctor think of in this situation?
Case Study 7
A 10 year-old-girl calls a telephone helpline and asks, ‘What is a condom?’ The counsellor hesitates,
unsure of how to respond. The counsellor feels that s/he has a moral obligation to prevent the caller
from engaging in sexual activity at such a young age and therefore does not provide the information
to the girl.
Questions:
■ Should the counsellor give the child the information? Why or why not?
• What Guiding Principles can help the counsellor make this decision?
• How could this situation be resolved?
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MODULE 5 - Chapter 1
TARSHI: Basics and Beyond
Case Study 8
Asha did not want to go to the doctor but since she was in unbearable pain, there was no choice. The
doctor noticed that she had bruises on her arms and that she was walking with difficulty. Asha was
then referred to another room in the hospital where the doctor gave her ample time and attention.
Asha relaxed under the doctor’s care and felt comfortable enough to answer the doctor’s questions.
Soon Asha poured out her entire story to the doctor and counsellor in the room. She told them about
the abuse she had endured throughout the three years of her marriage. After nearly two hours at the
hospital, she left feeling more hopeful than she had in a long time.
Questions:
■ How did the doctors help Asha tell her story?
■ What Guiding Principles are being used in this case?
Case Study 9
The Health Minister inaugurated the new voluntary counselling and HIV testing centre and STI
clinic last week. The clinic is situated right next to the busy interstate bus station. The entrance is near
the large cafeteria frequented by travellers and students from the college across the road. The Minister
took a personal interest in setting up the clinic and insisted on its location. He also ensured that several
discreet signboards were placed in the bus station, cafeteria and college campus about the new facility,
and had some handouts printed that provided information about the clinic’s facilities that assured
confidential and non-judgmental services. Some of his colleagues were unhappy about its proximity to
the college campus.
Questions:
■ Do you think the counselling centre should remain at its location? Why?
• What Guiding Principles and values can be discussed from this case?
• How can this case be resolved?
Case Study 10
Dilip was very nervous about going to the voluntary counselling and HIV testing centre and STI
clinic across the road from his college campus. His partner had insisted that they both go in for a
check-up. He knew that his partner had other relationships before him and was afraid of what the tests
would reveal. More than that, he was afraid of how his partner and he would be treated by the clinic
staff. Would they judge them for being there? Would they look at them strangely? Would they turn
them away saying that they were too young to be there? If the tests reveal that one or both of them have
any infection, will the clinic staff want to inform Dilip’s parents or the college authorities? His fears
were allayed when he read the information handout about the clinic and its activities. He felt reassured
enough to take a chance and visit the clinic.
Questions:
■ How should the staff treat Dilip when he goes to the clinic?
• What Guiding Principles should the staff uphold that will address Dilip’s fears?
• What in the information handouts do you think could have convinced Dilip to go to the clinic?
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MODULE 5-Chapter 2
Chapter 2
Ethics in Practice
Chapter Objectives for the Facilitator
1. To have participants understand what is meant by ethics.
2. To have participants discuss personal and professional ethics
and ethical guidelines regarding sexuality, sexual and
reproductive health and rights.
TARSHI: Basics and Beyond
MODULE 5 - Chapter 2
Why a Chapter on Ethics in Practice
The voluntary consent ofthe human subject is absolutely essential. This
means that the person involved should have legal capacity to give
consent; should be so situated as to be able to exercise free power of
choice, without the intervention ofany element offorce, fraud, deceit,
duress, over-reaching, or other ulteriorform of constraint or coercion;
and should have sufficient knowledge and comprehension ofthe elements
ofthe subject matter involved as to enable him to make an understanding
and enlightened decision. (Excerptedfrom The Nuremberg Code, 1947)
When people are questioned about ethics in their everyday practice,
they often think they have a moral compass guiding both their
personal and professional decisions, and that discussions about
ethics are unnecessary because this compass will guide them toward
just and appropriate answers. Yet, ‘moral’ ideals vary and it is often
difficult to ascertain whose compass we should follow. Moreover,
morality as a concept is often mistaken for ethics. Ethics are the
rules or standards governing the conduct of a person or of members
of a profession and are based on ideas of right and wrong. Morals
are based on personal convictions, rather than on actual evidence,
and have to do with the judgment of human action and character,
which arises from a personal sense of right and wrong. Perhaps
what is morally right for one person may not be so for another.
Ethics, on the other hand, are more formal and codified in
principles, and are thus less subjective.
But can the codes that govern ethics be applied to our personal
lives as well? Or are the ethics we follow in our day-to-day lives
different? How do our personal and professional ethics intersect,
particularly when working with sexuality, sexual and reproductive
health, and rights? Can ethical guidelines help to guide us in more
difficult/complex situations that are less black and white? In such
situations, ethical guidelines can help direct us to the answers or
options, while taking into account the highest interests of all those
concerned.
Historically ethical principles have guided professional medical
activities for centuries. The Hippocratic Oath binds all doctors by
the principle, ‘above all else, do no harm’. The Nuremberg Code
EXERCISES IN THIS CHAPTER:
Exercise 1: Understanding Ethics.
60 minutes
Exercise 2: What Ethics Guide you?
60 minutes
Exercise 3: Case Studies on Ethical
Dilemmas. 60 minutes
MATERIALS FOR THIS CHAPTER:
Flipchart
Markers
Pens/pencils
Paper
HANDOUTS REQUIRED FOR THIS
CHAPTER:
• Handout 5.3
Basic Information on Ethical
Principles
■ Handout 5.4
Sample Ethical Guidelines
■ Handout 5.5
Ethics In Practice Case Studies
TARSHI: Basics and Beyond
MODULE 5 - Chapter 2
ADDITIONAL RESOURCES:
• American Psychological
Association. Ethical Principles of
Psychologists and Code of
Conduct. Available at: http://
www.apa.org/ethics/
code2002.html
• Center for Enquiry Into Health and
Allied Themes, http://
www.cehat.org/
■ Feminist Sexual Ethics Project.
http://www.brandeis.edu/projects/
fse/index.html
■ A. Jesani, T. Barai-Jaitly. (Eds.)
2005. Ethics in Health Research A Social Science Perspective.
India: Centre for Studies in Ethics
and Rights.
■ National Association of Social
Workers. Code of Ethics of the
NationalAssociation of Social
Workers. Available at: http://
www.socialworkers.org/pubs/
code/code.asp
■ TARSHI. 2003. Guidelines for
Good Helpline Practice.
■ For selected films see, http://
www.asiasrc.org/films.php and
Appendix B.
the principle, ‘above all else, do no harm’. The Nuremberg Code
(1947), part ofwhich is quoted in the previous page, was an attempt
to continue this obligation to do no harm and prevent further
violations of human rights following accounts of doctors and
researchers performing cruel and inhumane experiments on people
in the Nazi concentration camps during the Second World War.
The Nuremberg Code, and the subsequent Declaration of Helsinki
(1964) (see Appendix A for how to access the document) began to
lay out ethical principles for medical practice and experimentation,
which include informed consent, beneficence, and the absence of
coercion. These ethical guidelines and principles continue to be
used today, and efforts have been made to make them relevant to
different aspects of life and work.
This chapter on ethics explores the nuances and grey areas of ethics
that people may be faced with, particularly when working on issues
of sexuality, sexual and reproductive health, and rights. It provides
discussion and debate as tools to recognise the fluid and dynamic
nature of ethics.
Key Messages for this Chapter
• Ethics are the rules or standards governing the conduct of a
person or the conduct of the members of a profession and are
based on notions of right and wrong.
• Ethical principles provide the foundation for specific guidelines
laid out in codes of ethics. They contain the essential values/
core concepts that can guide the resolution of ethical dilemmas.
• Crosscutting issues such as confidentiality, beneficence, respect
and non-exploitation run through the ethical concerns of
training, funding, service delivery and research.
■ Ethics are dynamic. They can change for individuals and groups
in different situations and over time. For example, as new drugs
and procedures to treat HIV/AIDS are developed, ethical
questions arise about how they should be tested, who should
get these drugs, how much they should cost, and how they should
be distributed.
TARSHI: Basics and Beyond
MODULE 5 - Chapter 2
Exercise 1
Understanding Ethics
Small Group Work
Instructions
Purpose of the
exercise:
1.
Divide participants into four groups. Give each group Handout
5.3, some flipchart paper and markers. Assign one of the
following topics to each group: research, service delivery,
training, fund-raising and funding. Ask small groups to first
define the four ethical principles below and then discuss concrete
examples of how the area ofwork given to them can be informed
by these ethical principles. Further information on these
principles can be found in Handout 5.3:
1)
Respect and protection of rights
2)
Anonymity and confidentiality
3)
Beneficence
4)
Non-exploitation
Give participants 25-30 minutes to do this exercise.
1. To understand what is
meant by ethics.
2. To discuss professional
ethics that guide work in
the areas of sexuality,
reproductive and sexual
health and rights.
TIME
60 minutes
2.
Bring groups back together and invite each to come up and
present their topic and discussion. After all these presentations
are complete, ask for questions and comments.
Suggested Questions:
■ How did the groups describe the ethical concepts in the different
areas of work (research, service delivery, training, fund-raising
and funding)? Were the approaches similar or different from
each other? For example, did every group define non-exploitation
in the same way? Did some define it only as warning people of
possible harm? Did others define it as taking steps to make sure
people were not harmed in addition to warning them of possible
harm?
• Are there similarities or differences between how these issues
relate to the topics of research, service delivery, training and
funding?
• Do you think it is important to consider these issues in the types
of work you do or in your personal life?
418
MATERIALS
Flipchart, markers, Handout 5.3
Basic Information on Ethical
Principles
ADVANCE PREPARATION
None
TARSHI: Basics and Beyond
THIS EXERCISE CAN BE MODIFIED
MODULE 5 - Chapter 2
Key Messages
BY:
■ Conducting the exercise as a large
group brainstorming exercise
rather than dividing participants
into small groups. This may be
beneficial if the group has more
experience in a particular area (for
example if all of them are involved
in training NGOs).
• Ethics are a code of conduct that guide and influence personal
and professional behaviour and actions.
• Crosscutting principles such as confidentiality, beneficence,
respect and non-exploitation run through the ethical concerns
of training, funding, service delivery and research. However,
there can be differences depending on the focus of the work
being done. For example, while confidentiality must be
maintained in all areas of work, the approach differs between
people in service-delivery and those involved in research and
more removed from direct services.
MAKING CONNECTIONS
TIPS FOR THE FACILITATOR:
• Values inform ethics and ethical
principles, and these principles can
be codified to guide people's
work. For more see Chapter 1 in
this Module.
• Participants may find it difficult to make connections between the four ethical
principles and their application in the different areas of their work. It may be
beneficial to give some examples.
• Participants may find it difficult to define the four issue areas. In this instance,
begin the exercise by defining the terms using Handout 5.3.
• Ethical principles can be applied to
day-to-day work on sexuality,
sexual and reproductive! health,
and rights. For more on guiding
principles in advocacy see Chapter
3 in this Module.
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TARSHI: Basics and Beyond
MODULE 5 - Chapter 2
Exercise 2
What Ethics Guide You?
Instructions
1.
Ask participants to stand in a circle. Give each person 60 seconds
to answer the question/s below. Responses should focus on
personal experiences and feelings about the question and not
on participants’ professional lives. Write the main points from
each participant on a flipchart. Ask these questions again using
other terms from Handout 5.3 (i.e., boundaries, being nonjudgmental etc.).
Question 1: ‘The concept of confidentiality for me means...’
Question 2: ‘I think confidentiality is/is not important in my
personal life because...’
2.
jam: just a minute
Purpose of the
exercise:
1. To identify personal and
professional ethics.
2. To discuss using
personal and professional
ethics when working with
sexuality, sexual and
reproductive health and
rights.
After everyone has completed their answers, ask for comments
or questions.
Suggested Questions:
• Were there common themes that emerged? Were there any ideas
you disagreed with?
• Can you see how ethics can be changeable and dynamic
depending on individual backgrounds and identities?
3.
Repeat this exercise asking the participants to focus on their
professional experiences and feelings about the question/s and
not on their personal lives. Write the main points from each
participant on a flipchart. Ask these questions again using other
terms from Handout 5.3 (i.e., boundaries, being non-judgmental
etc.).
Question 3: ‘The concept of confidentiality in my line of work
means...’
Question 4: ‘I think confidentiality is/is not important in my
work because...’
4.
420
After everyone has responded to the statements, ask for
comments or questions.
TIME
60 minutes
MATERIALS
Handout 5.3 Basic Information on
some Common Ethical Principles,
Handout 5.4 Sample Ethical
Guidelines, watch/timer.
ADVANCE PREPARATION
Make copies of Handout 5.4 for
participants.
TARSHI: Basics and Beyond
MODULE 5 - Chapter 2
Suggested Questions:
THIS EXERCISE CAN BE MODIFIED
BY:
• Creating a set of ethical guidelines
as a group rather than conducting
the JAM sessions. Ask
participants to brainstorm and
come up with a set of ethical
guidelines for working on
sexuality, sexual and reproductive
health, and rights. Write these
guidelines on a flipchart and place
this in front of the training room.
■ Dividing participants into small
groups and asking them to discuss
the questions among their group.
Ask the small groups to get back
together and share their
discussions.
MAKING CONNECTIONS
■ Values inform ethics and ethical
principles, and these principles can
be codified to guide people's
work. For more see Chapter 1 in
this Module.
■ The basic values of choice,
diversity, equality and respect
[Setting the Tone, Introduction to
Module 1) affirm the worth of all
people and serve to enhance
ethical guidelines. Such respect for
diversity and choice creates an
environment free of stigma and
discrimination. For more see
Chapter 2 in Module 4.
• Were there common themes that emerged? Were there any ideas
you disagreed with?
• Do you feel it is important to have guidelines for the workplace
given that different people have different personal ethics, which
may clash with professional ethics?
5.
End by distributing Handout 5.4 to participants and ask them
to read it.
Key Messages
• Ethics are a set of codes that help determine appropriate conduct
and when laid out in specific guidelines are called codes of ethics.
They contain the essential values and core concepts that can
guide the resolution of ethical dilemmas.
• Professional and personal ethics can guide people in situations
when it is difficult to know what is the ‘right’ course of action.
Since people with different backgrounds and values may work
together, it is important for organisations to have a written code
of ethics to guide people in their work. It is equally important
for all people in the organisations to be aware of why they are
expected to follow this code of ethics, in order to help them
appreciate and apply them better.
• Ethics are dynamic. They are not absolute, and can change for
individuals and groups in different situations and over time. For
example, as new drugs and procedures to treat HIV/AIDS are
developed, ethical questions arise about how they should be
tested, who should get these drugs, how much they should cost,
and how they should be distributed.
TIPS FOR THE FACILITATOR:
• It may be difficult for participants to talk about ethics in 60 seconds. Emphasise
that there are no right or wrong answers and the exercise is intended to spark a
discussion on ethical guidelines.
■ If participants have difficulty providing answers, it may be helpful to start with
some examples. Think of personal examples you can use to illustrate each of the
principles in Handout 5.3.
■ Participants may use the terms and concepts of ethics, morals and values
interchangeably. The facilitator should avoid this and work to define these terms
421
TARSHI: Basics and Beyond
MODULE 5 - Chapter 2
Exercise 3
Ethical Dilemmas
CASE STUDIES
Instructions
1. Divide the participants into small groups. Distribute Handout
5.5 and assign each small group one case study. Give the groups
20-30 minutes to discuss the cases and answer the questions
associated with them.
2. Ask participants to return to the larger group and invite each
small group to share the case study and their discussion. After
each presentation, ask for reaction and questions from other
participants.
Suggested Questions:
■ Is this a situation you have experienced in your workplace or
community? How was this resolved?
Purpose of the
exercise:
1. To identify ethical issues
in real-life situations.
2. To discuss approaches
and practices that can be
used in dealing with issues
of sexuality, sexual and
reproductive health, and
rights.
• Do you agree with the conclusions of the group? Would you
suggest an alternative?
• Did you notice the use/abuse of ethics in these case studies?
Please give examples.
3.
After discussing the case studies ask for general comments or
questions.
Suggested Questions:
■ Has discussing these cases and the ethics associated with them
helped you understand your own personal and professional
ethics better and how you would deal with certain situations?
Why or why not?
• Can discussions with colleagues and others in your field help
you in resolving your ethical dilemmas?
422
TIME
60 minutes
MATERIALS
Copies of Handout 5.5 Ethics in
Practice Case Studies
ADVANCE PREPARATION
Make copies of case studies from
Handout 5.5 for each participant.
TARSHI: Basics and Beyond
MODULE 5-Chapter 2
THIS EXERCISE CAN BE MODIFIED
Key Messages
BY:
■ Choosing one or two case studies
and discussing them as a large
group. It can be useful to
concentrate on one or two issues
pertinent to the group such as
HIV/AIDS or gender violence.
■ Giving each participant a case
study and using the exercise as an
assessment tool.
MAKING CONNECTIONS
• People who live with HIV/AIDS
can also face stigma and
discrimination because of the
myths and lack of information
about it. For more on basics of
HIV/AIDS, see Chapter 4 in
Module 2. For more on stigma see
Chapter 2 in Module 4.
■ New assisted reproductive
technologies IARTsI and infertility
options are being developed and
made available. New ethical
questions will arise with these
developments. For more see
Chapter 3 in Module 2.
■ Crosscutting principles such as confidentiality, beneficence,
respect and non-exploitation run through the ethical concerns
of training, funding, service delivery and research. However,
there can be differences depending on the focus of the work
being done. For example, while confidentiality must be
maintained in all areas of work, the approach differs between
people in service-delivery and those involved in funding and
more removed from direct services.
• Ethical obligations may differ in each specific situation. For
example, confidentiality or privacy may mean different things
to different communities - some may think privacy means having
members of the family present at medical or counselling sessions
as this increases client comfort and feasibility, while others may
not. In such a situation, a client needs to be consulted about
what is comfortable for them, and a discussion should be had
about the implications of their decision.
• Having ethical guidelines in professional work can help guide
workers in situations that are difficult to resolve.
TIPS FOR THE FACILITATOR:
• Participants may have very strong opinions about these cases and the proper way
to handle them. Allow for discussion but discourage participants from adopting
moral positions.
■ There are links between ethical
dilemmas and sexual and
reproductive rights. For more see
Chapters 2 and 3 in Module 3.
423
MODULE 5 - Chapter 2
TARSHI: Basics and Beyond
Handout 5.3
Basic Information on Ethical Principles:
Below are some common ethical principles prescribed for and used by Mental Health Professionals,
Social Workers and Doctors, among others.
• Anonymity is the expectation that information an individual has disclosed as a client, patient or
study participant has no identifiers (including names, initials, occupation etc) that can link them to
the information they have given.
• Beneficence requires providers to do what will further the patient’s/client’s interests.
■
Competence requires that individuals work within the boundaries of their abilities, based on their
education, training, supervised experience, consultation, study, or professional experience, and
continually strive to increase their knowledge and skills.
■
Confidentiality 'll not the same as anonymity. It pertains to the protection of information disclosed
by an individual in a relationship of trust with the expectation that it will not be divulged to others
without permission. Confidentiality should involve discretion and respect for a person’s privacy. It
could involve not revealing the identity of patients/clients/research subjects or their personal
information to any unauthorised person/s.
• Informed consent is a procedure to ensure that a person knows about the potential risks and benefits
of a treatment/research trial/study/procedure before agreeing to participate in it. A person can be
said to have given consent if they have full awareness and understanding of the facts and implications
of a treatment/research trial/study/procedure. A person must be in possession of all of their faculties
and judgment at the time of giving consent.
■ Non-exploitation, means not taking advantage or abusing a client or group directly or indirectly
through the use of information or power.
• Beingnon-judgmen tai means ensuring that one’s personal judgments, opinions, values and attitudes
do not impinge on and influence the work one is doing, whether it is counselling, care-providing,
advocacy or preparing information, education, or communication material.
■ Maintainingboundaries means maintaining a sense of‘separateness’ in a relationship. Those unable
to maintain appropriate boundaries in their relationships with clients may feel disturbed and upset,
lose objectivity, express sympathy rather than empathy, offer advice, become overly familiar, and
unintentionally increase the clients’ dependence on them.
■ Non-malfeasance advocates the principle to ‘do no harm’.
• Respect andprotection ofrights means that a person cannot violate, abuse, or deny another’s rights
and is also obliged to prevent a third party from violating, abusing, or denying a person’s rights
424
TARSHI: Basics and Beyond
MODULE 5 - Chapter 2
Handout 5.4
Sample Ethical Guidelines
THE FOLLOWING SAMPLE HAS BEEN EXCERPTED FROM TARSHI GUIDELINES FOR GOOD HELPLINE PRACTICE, 2003.
Remembering that the basic values ofchoice, diversity, equality and respect affirm
the worth ofall people will serve to enhance ethical guidelines
■ Confidentiality
Guaranteed confidentiality is essential to ethical obligations and ensures improved service delivery.
For example, a woman worried about the implications of disclosing her HIV status, will find' it
easier to share her concerns if she is reassured that all conversation will be kept confidential.
• Maintaining boundaries
Boundaries refer to a sense of‘separateness’ between individuals and emerge within the framework
of every relationship. It is important to maintain boundaries in any client-provider relationship in
order to prevent exploitation of the client and to maintain good quality of the service.
• Recognising capabilities
It is essential to recognise professional capabilities and limits, and refer people to other services and
assistance when necessary.
• Being non-judgmental
It is necessary to ensure that personal judgments, opinions, values and attitudes do not impinge on
and influence professional work.
• Resisting the commonsense bias
The commonsense bias refers to a belief that a certain behaviour and way of dealing with situations
is logical and sensible, or that things are obvious, irrefutable, and true until proven otherwise. This
approach is problematic and should be avoided.
■ Being aware of specific social and cultural environments
It is important to recognise that attitudes, belief systems and concerns differ across cultures and sub
cultures.
425
MODULE 5 - Chapter 2
TARSHI: Basics and Beyond
Handout 5.5
Ethics In Practice Case Studies
Case Study 1
In 1972, Japan introduced the Eugenic Protection Law Revision Bill to its legislative body. The revision
bill aimed to add onto the Eugenic Protection Law (EPL). The EPL was passed in 1948 and contains
provisions to, ‘prevent birth of inferior descendents from the eugenic point of view, and to protect life
and health of mother, as well’ (Article 1). The Revisions Bill proposed to augment the original EPL
with regard to abortion access. The bill contained a clause that allowed for selective abortion of a
foetus with severe disabilities. In 1996, this eugenic provision of the Revision Bill was repealed and the
Eugenic Protection Law was revised to allow only voluntary abortion. This part of the EPL was
subsequendy renamed the ‘Maternal Protection Law’.
For more on this topic please see, http://www.lifestudies.org/disability01.html
Questions:
■ What are the implications of this law?
■ Does this case raise any ethical issues, either with the proposed Revision Bill or the original EPL?
• Should a woman be able to abort a foetus with a disability?
• What ethical guidelines could you create to adequately address this issue?
Case Study 2
In the late 1990’s, the number of HIV/AIDS cases in Thailand was on the rise and the country began
to recognise the need to address this situation. Thus the government decided to take a number of
measures to increase awareness and accessibility to services for prevention. One of the measures was a
mandatory reporting of names of and addresses of HIV/AIDS patients. A number of NGOs and
activist groups protested against the provision and succeeded in abolishing the measure.
For more on this topic please see, http://www.avert.org/aidsthai.htm.
Questions:
■ Does mandatory reporting of HIV/AIDS patients raise any ethical issues?
• Should mandatory reporting be a means of reducing the risk of HIV transmission?
■ Would you support/protest such measures in your community? Why?
426
TARSHI: Basics and Beyond
MODULE 5 - Chapter 2
Case Study 3
n
t e Vietnamese government proposed a policy that required prostitutes, drug users, homosexuals,
and f°re’Sners wh° planned to spend more than three months in Vietnam to be tested for
• t further stated that citizens who tested HIV positive would be prohibited from getting married.
For more on this topic please see, http://www.etext.org/Politics/GLU/Library/IGLHRC/Vietnam
Questions:
■ Does this policy raise any ethical issues?
Should these groups be targeted for HIV/AIDS prevention? What about other groups affected by
HIV?
What are the implications of this policy on individuals?
■ What ethical guidelines could you create to adequately address this issue?
Case Study 4
The number of new HIV/AIDS cases reported in Singapore in 2004 showed a significant rise. As a
result, the government considered two measures to stem the increase: mandatory testing of couples
who planned to marry, and increased screening of HIV/AIDS for all pregnant women. Pregnant
women were already being offered the option of HIV testing but this new provision enforced testing all
women unless they opted out. However, it was stated that if the number of pregnant women who
opted out became too high, compulsory testing would be considered.
For more on this topic, please see http://www.avert.org/hiv-testing-pregnancy.htm or http://
www.medicalnewstoday.com/medicalnews.php?newsid=21115
Questions:
• Does this policy raise any ethical issues?
■ Should these groups be targeted for HIV/AIDS prevention? What about other groups affected by
HIV?
• What ethical guidelines could you create to adequately address this issue?
427
MODULE 5 - Chapter 2
TARSHI: Basics and Beyond
Case Study 5
A study in the late 1990’s was conducted in rural Indian villages to discover how sexual relationships
were negotiated between men and women in the village. The researchers were surprised when the
women requested that they be interviewed in the presence of their husbands and friends. This seemed
unconventional but the researchers obliged and reworked the methodology of the study to do partner
interviews.
For more on this topic, please see http://www.unescap.org/esid/psis/population/journal/2001/
vl 6n2a 11 ,pdf#search='Joshi%201997%200RG%20Marital%20Sexual%20Relationships'
Questions:
■ Does this case raise any ethical issues?
■ Do you think the flexibility of the researchers toward the people in their study demonstrated ethical
considerations? Why?
• What ethical guidelines could you create to adequately address this issue?
Case Study 6
Prior to 2002, abortion in Nepal was illegal. A doctor working in a village at the time was confronted
with a problem when a woman who had been raped came to her clinic for help. The woman was
married and her husband was away when a neighbour came to her home and raped her. The rape
resulted in a pregnancy and although abortion was illegal in Nepal, the woman decided to get one
done anyway. The doctor she spoke with agreed to perform the abortion when she heard the story. A
few days after the procedure, the woman arrived at the same doctor’s office with a fever and infection.
At the same time her neighbours had reported the woman’s illegal abortion to the police, who arrived
at the doctor’s office asking her to complete a report stating that the woman had an abortion. The
doctor decided to not give a report attesting to the abortion and told the police that the woman simply
had a bad infection and needed hospitalisation. While this report was false, the doctor felt it was
necessary to avoid a situation in which the woman would be arrested and severely punished.
For more on this topic, please see http://www.hsph.harvard.edu/Organizations/healthnet/SAsia/repro/
aruna.html
Questions:
■ Does this case raise any ethical issues?
• Although the doctor broke the law, was she acting ethically?
■ Should the doctor have reported the rape to the police? What would you have done as an
advocate had the woman approached you?
• In the light of such laws, what kind of ethical guidelines could you create to adequately address
this issue?
428
TARSHI: Basics and Beyond
MODULE 5 - Chapter 2
Case Study 7
In the late 1990s, India and a number of other Asian countries were the site of testing for a sterilisation
process that used the drug Quinacrine. Originally used to treat malaria, Quinacrine was found to be
a non-operative way of sterilizing women. Quinacrine pellets were inserted into a woman’s uterus,
causing inflammation in the uterus which subsequently permanently scarred the fallopian tubes and
prevented a woman from having children. During the height of the testing of this procedure in India,
the majority of women undergoing it were poor and from underprivileged communities. They did not
know the procedure had lasting effects and had initially gone to their health care provider for insertion
of an intrauterine device (IUD) rather than sterilisation. Researchers and health care providers involved
in the administering of Quinacrine argued that this was necessary to provide more options for safer
and less invasive sterilisation procedures and ultimately more contraceptive choices for women.
For more on this topic, please see http://www.hsph.harvard.edu/grhf-asia/suchana/9999/quinacrine.html
Questions:
■ Are there any ethical issues to be considered here?
• Do you think the testing of Quinacrine was done ethically?
■ Are there violations of human rights that need to be considered?
• What kind of ethical guidelines could you develop to address this issue?
■ Would you supporl/protest against such measures in your community? Why?
Case Study 8
A rural community trying to address the needs of girls with developmental disabilities (mental or
physical disabilities, such as cerebral palsy, autism or mental retardation that arise before adulthood
and usually last a lifetime) decided to let them receive care in an institution in the area. In the mid
1990’s, reports emerged from the institution about the kind of treatment being administered to the
girls, particularly when managing their menstruation. The institution decided to have the girls undergo
hysterectomies (surgical removal of the uterus) to avoid teaching them how to manage themselves
during their periods. Women’s groups protested against this enforced sterilisation. The institution
stopped after performing hysterectomies on 14 girls.
For more on this topic, please see http://www.biopolitics-berlin2003.org/doc_rt.asp?p=l&id=159
Questions:
■ Are there any ethical issues to be considered here?
• Do you think that the hysterectomies were a proper solutions? What else could have been done?
• Are there violations of human rights that need to be considered?
• Would you support/protest such measures in your community? Why?
429
MODULE 5 - Chapter 2
TARSHI: Basics and Bev°nd
Case Study 9
India has the lowest girl child ratio in the world. According to the 2001 census, there are 933 girls for
every 1000 boys. Many have termed this ‘the missing girls syndrome’ and attribute it to sex-selection
practices. New reproductive technologies (NRTs) such as sonogram/ultrasound (use of high-frequency
sound waves to create images of structures inside the body), and amniocentesis (analysis of a small
sample of fluid taken from the uterus through a needle inserted in the abdomen) among other
procedures, were introduced into India in the 1970s. By the 1980s these procedures, expensive in other
countries, had become considerably low-cost in cities and small villages throughout India. The tests
were marketed to help ascertain the health of the foetus and also determine the sex. In many cases, it
was the sex of the foetus that the couple wanted to determine, and if it was female, they would often
abort it. Many hospitals promoted the procedure and claimed it to be beneficial for potential parents.
For more on thins topic, please see http://www.whrnet.org/docs/otherpoints-picard-0601.html
Questions:
■ Are there any ethical issues to be considered here?
• Do you think the use of these NRTs should be stopped?
■ Are human rights being violated if NRTs are used or denied?
• What kind of ethical guidelines could you develop to address this issue?
Case study 10
An NGO in a city near many rural villages decides to start a fund to help girls in the villages receive
better education. While girls belonging to the higher classes were educated, those of the lower classes
were often denied education. The NGO decided to raise money and present it to the girls’ parents to
provide for their education. The NGO had already cultivated a relationship of mutual respect with
many of the women. After raising some money, the NGO met them and handed over the money,
intended for the education of their daughters. The women thanked the NGO and told them that they
would prefer this money go to their sons as they would be making money for the family and bringing
an improved status to them. Educating the girls, on the other hand, would not improve their position
within the community and might, in fact, be detrimental to their marital prospects. The NGO tried to
explain their position and how education would improve the situation of girls’ lives by providing them
options. But the women insisted that such a programme would cause more harm than benefit.
Questions:
■ Are there any ethical issues to be considered here?
• Do you think the NGO should still give the money for the girls, or should it go for the boys instead?
• What kind of ethical guidelines could you develop to address this issue?
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MODULE 5 - Chapter 3
Chapter 3
Learning From Others
Chapter Objectives for the Facilitator
1.
To have participants examine sexuality, sexual and
reproductive health and human rights campaigns.
2.
To understand how concepts and ideas discussed in earlier
modules can be used for advocacy, and to increase awareness
and knowledge.
TARSKI: Basics and Beyond
MODULE 5 - Chapter 3
Why a Chapter on Learning from others
‘No one told me what the injection wasfor till after they had given it to
me. It was only later that I realised it was to prevent pregnancy. I
suffered heavy bleeding, dizziness and pain for over two months before
things settled down. When it was time for the next shot, I put my foot
down and said I would not take it. Thankfully my husband supported
me and now I have an intrauterine device (IUD) which is suiting me
so far’.
‘No lesbian may have been picked up and flung into jail because of
Section 311 of the Indian Penal Code... But it is used to blackmail
lesbians, force them to consent to marriage and be invisible’.
Advocacy campaigns for the right to control one’s body, to express
and choose one’s sexuality, and to control one’s sexual and
reproductive health and choices have been successful in different
parts of the world. They have helped build public awareness,
highlighted the abuse of rights, and ensured that people from all
social groups have the opportunity to live in healthy environments
free of coercion and stigma. These campaigns have used various
approaches and tackled different issues including working toward
changing legislation, increasing the type of information given to
communities, to name just two. While not all advocacy campaigns
have been successful, they have played a role in creating awareness
and knowledge about sexuality, sexual and reproductive health and
rights, and allowed others to build upon that foundation of
awareness.
This chapter will examine and discuss different advocacy
movements and campaigns that have focused on issues of sexuality,
sexual and reproductive health, and rights. A closer look at these
campaigns will help consolidate the topics, information and
discussions in this manual, and generate ideas on how we can
improve the integration of sexuality, sexual and reproductive health,
and rights in our own work and campaigns.
EXERCISES IN THIS CHAPTER
Exercise 1: Negotiating With Other
Stakeholders. 75 minutes
Exercise 2: Representing an Issue in
Advocacy. 90 minutes
Exercise 3: Campaigns for Sexuality,
Sexual and Reproductive Health
and Rights. 60 minutes
Exercise 4: Sharing Campaign
Stories. 60 minutes
MATERIALS FOR THIS CHAPTER:
Flipchart
Markers
HANDOUTS REQUIRED FOR THIS
CHAPTER:
■ Handout 5.6
Negotiating With Other
Stakeholders
■ Handout 5.7
Representing an Issue in Advocacy
• Handout 5.8
Campaigns for Sexuality, Sexual
and Reproductive Health and
Rights
TARSHI: Basics and Beyond
MODULE 5 - Chapter 3
ADDITIONAL RESOURCES:
■ Akhtar, F. 1995. Resisting
Norplant: Women's Struggle in
Bangladesh Against Coercion and
Violence. Bangladesh: Narigrantha
Prabartana.
■ Campaign for Lesbian Rights.
1999. Lesbian Emergence, A
Citizens'Report. New Delhi:
CALERI
• International Lesbian and Gay
Association. 1999. India: The
Campaign for Lesbian Rights.
Available at: http://www.ilga.org
• SAMA. 2003. Unveiled Realities A Study on Women's Experiences
with Depo-Provera, an Injectable
Contraceptive. New Delhi.
■ S.N.D.T. Women's University
Library. Campaigning Against
Injectables. http://
www.gendwaar.gen.in/IN/
campaigns.htm
• Voices Against 377. 2004. Rights
For AH: Ending Discrimination
Against Queer Desire Under
Section 377. New Delhi.
• Women's Network for Unity.
http://womynsagenda.org/
progranfb/sexworker/SW/
swnu.html
• For selected films see, http://
www.asiasrc.org/films.php and
Appendix B
Key Messages for this Chapter
• The underlying messages conveyed by these featured campaigns
are the right of all people to bodily integrity (to control one’s
own body and the choices about one’s body with without fear,
shame, or coercion), the right to make decisions and choices
freely, and freedom from fear or any negative side effects from
these choices.
• There is no formula for a good advocacy campaign. However
there are common factors that can help guide a good campaign.
These include recognition of the basic rights issues at stake, the
audience one is trying to reach and making use ofdifferent spaces
to speak to different people about the issues.
■ Because issues of sexuality and sexual and reproductive health
can often be contentious, campaigning to successfully bring
about change can take time. Campaigns can meet a great deal
of opposition but can still result in changes and improvements.
• Because issues of sexuality and sexual and reproductive health
are sensitive and value laden, they can elicit strong emotions in
the campaigners as well as the audience. It is useful to keep in
mind the values discussed in the Introductory Exercise: Setting
the Tone in Module 1 and the Ethical Guidelines in the previous
chapter, to help guard against misrepresentation of people/groups
and violation of the principles of confidentiality, anonymity,
beneficence, respect and non-exploitation.
• Advocacy campaigns are contextual - they are influenced by the
political atmosphere, legal and economic systems in different
communities and countries, and prevalent social values.
Campaigns may therefore have to be modified to fit these
different environments and contexts.
TARSHI: Basics and Beyond
MODULE 5 - Chapter 3
Exercise 1
Negotiating With Other Stakeholders
Instructions
1.
2.
3.
4.
Divide participants into five small groups. Each group represents
one of the roles/stakeholders provided for in Handout 5.6.
Distribute one of the descriptions of these roles/stakeholders to
each small group.
Ask the groups to read the scenario and their assigned role and
give them 15 minutes to create a strategy that will best argue
their position in the given scenario and get their desired end
result. Participants should make sure they address the questions
on the handout.
Bring the groups back together and ask for one or two
representatives from each group to come to the ‘negotiating table’
to debate the issue. Have representatives from each role/
stakeholder first present their position on the case and
arguments. After each group has put forth their arguments allow
everyone to discuss and negotiate. At the end of the debate there
must be a resolution to the case and a decision must be made
to resolve the scenario. Allow 30 minutes of debate and
negotiation.
After the negotiations and resolutions, ask for general questions
or comments.
Suggested Questions:
• Was it easy or hard to argue your position? Why? Did each group
leave the negotiation with their desired solution? Why or why
not?
• Did your role reflect your point ofview or views commonly found
in your community?
• What are the benefits of examining the arguments of your
‘opposition’ prior to advocacy? What are the advantages and
disadvantages of compromise?
■ What have you learned through this exercise that you can use in
your own work/advocacy?
434
ROLE-PLAY AND DEBATE
Purpose of the
exercise:
1. To explore ways to
debate and argue an
advocacy position.
2. To understand the
importance of knowing the
tactics and arguments of
an opposing group while
engaging in advocacy.
TIME
75 minutes
MATERIALS
Handout 5.6 Negotiating With Other
Stakeholders
ADVANCE PREPARATION
Make copies of Handout 5.6
TARSH1: Basics and Beyond
MODULE 5 - Chapter 3
THIS EXERCISE CAN BE MODIFIED
BY:
• Creating small negotiating groups
that include one person from each
stakeholder group. These groups
can be created after the
stakeholder groups have spent
■ time on discussion and
formulation of a strategy. Give
participants 30 minutes for these
small negotiation groups to come
to a resolution, after which
resolutions are presented to the
larger group. This can illustrate
the different ways in which
people may negotiate and the
different approaches possible with
the same information and tools.
■ Debating both the scenarios. This
may take more time, but will
allow the participants to be
exposed to different campaign
strategies and ideas.
MAKING CONNECTIONS
• Censoring sexuality education can
include denying information on
contraception and abortion, which
is a violation of people's right to
information and reproductive
choices. For more see Module 3.
■ Sexual and gender identities are
not fixed and it is possible for
individuals to change identities
over time. For more see Chapter 2
in Module 1.
Key messages
• Having a solid rationale and arguments to support an advocacy
effort/campaign is important, particularly when discussing the
issue with opponents or people unfamiliar with the topic.
• While it may be difficult to argue a position different from one’s
own, this can benefit an advocacy effort/campaign by
understanding how to counter the arguments and positions of
the other side.
• Freedom of expression and the right to information allows for
access to books, movies, television shows, radio and other mass
media as well as sexuality education and sexual and reproductive
health information. Restrictions or limitations on this
information and the ability to use, observe, or consume products,
ideas, images, or ‘things’ runs counter to our right to information.
Limitations can also be detrimental to those it intends to ‘protect’.
For example, sexuality education in schools may be restricted or
emphasise abstinence to ‘protect’ young people from STIs
including HIV/AIDS, and unwanted pregnancy. However,
incomplete information can lead to more harm by denying young
people information to protect themselves and ensure their well
being.
■ Freedom of expression provides opportunities for all perspectives,
opinions and viewpoints on an issue to be aired, and for people
to have comprehensive information from which they can make
their own choices.
TIPS FOR THE FACILITATOR:
• Make sure participants maintain their assigned roles and arguments. While they
might not agree with their role, they need to keep to them to illustrate the many
facets of an issue. Being informed on options and opinions is crucial in a decision
making process.
435
TARSHI : Basics and Beyond
MODULE 5 - Chapter 3
Exercise 2
Representation in Advocacy
SMALL GROUP WORK
Instructions
1.
2.
3.
Divide participants into small groups. Hand each group flipchart
paper, markers, pens, and a campaign scenario from Handout
5.7.
Ask participants to read their campaign scenario and give them
30 minutes to create a piece of advocacy or information-based
material they would use in their campaign. For example they
can develop a poster, an information pamphlet, a commercial, a
song etc. Have them imagine that they have unlimited resources
and access to any spokespeople, materials, or images they may
want. Each group should create only one piece of material that
they will then present to the larger group. Their presentation
can be as simple as an oudine of what they want to do.
Bring the groups back together and invite each to share the piece
of material they created. After each presentation, ask for
questions or comments.
Suggested Questions:
■ Do you think this campaign material will be successful? Will
the audience understand the message? Would it appeal to diverse
audiences and communities?
■ How did the group present their issue and advocate for change?
Were there negative images and ideas? Did their materials use
images of ‘victims’ rather than promote empowerment?
• Was there any disagreement in the group over how to represent
these issues in a campaign?
4.
After the presentations, ask for general comments and questions.
Suggested Questions:
■ Did the groups have any common approaches toward their
campaign materials?
• In what way does representation play a part in advocacy for sexual
and reproductive health and sexuality?
436
Purpose of the
exercise:
1. To analyse advocacy
programmes on issues of
sexual and reproductive
health, sexuality and
rights.
2. To discuss whether the
methods in the advocacy
programmes are affirming
in their approach.
TIME
90 minutes
MATERIALS
Flipchart, markers, pens,
Handout 5.7 Representating an Issue
in Advocacy
ADVANCE PREPARATION
Make copies of scenarios from
Handout 5.7
TARSHI: Basics and Beyond
MODULE 5 - Chapter 3
THIS EXERCISE CAN BE MODIFIED
• What assumptions, if any, does your campaign make about a
particular group? How are these assumptions harmful/useful?
BY:
■ Conducting the exercise as a large
group activity in which the
participants discuss one or two of
the campaign scenarios and
brainstorm potential ideas and •
strategies.
■ Showing some examples of
effective as well as weak
campaigns and having participants
analyse the pros and cons of each.
MAKING CONNECTIONS
■ The human rights system and its
basic principles can help inform
successful campaigns. For more
see Chapter 1 in Module 3.
• Often certain sexual and gender
identities are represented in very
specific, limiting and stereotypical
ways. For more on see Chapter 2
in Module 1.
Key Messages
• Even ifmaterial is distributed on a smaller, community size scale
(rather than through mass media), it can still influence attitudes
and reactions to an issue. For example, to have a brochure on
rape and sexual abuse that portrays women only as victims
without any power over their lives may influence people in the
community to regard/treat them as victims without power to
make changes or make decisions about their own lives. Such
messages can have a similar impact on women who have
experienced rape or abuse.
• It is important to represent issues in sexuality, sexual and
reproductive health and rights without bias so as to avoid further
stigmatisation and discrimination. For example, representing
HIV/AIDS as an infection that only infects ‘high-risk groups’
like sex workers, women in prostitution and truck drivers can
further ostracise them in a community. This portrayal also fails
to promote safer sex among people who are not part of these
groups and so not considered to engage in high-risk behaviour.
TIPS FOR THE FACILITATOR:
■ Small groups may focus too much on the aesthetic appeal of their campaign
material rather than concentrating on the message and ideas it conveys. Stress
that just an outline will suffice and the content matters more than the design/
quality of the drawing or poster.
437
TARSHI: Basics and Beyond
MODULE 5 - Chapter 3
Exercise 3
Campaigns for Sexuality, Sexual and Reproductive
Health and Rights
CASE STUDIES
Instructions
1. Divide participants into small groups. Distribute one case study
from Handout 5.8 to each group. Ask participants to spend 2530 minutes reading the case and corresponding questions, and
preparing to come back to the larger group with a presentation
on the case. Alternatively, each group can be given Campaign
5,
which is a modification of the exercise, and asked to devise
steps and a plan for a successful campaign in their community
on the topic and issues presented in the case.
2. Bring the groups back together and invite each to present their
case. After each presentation, ask for questions and comments.
Suggested Questions:
■ What did you think of this campaign? Do you think it was/
could be successful?
• How can you use the lessons of this campaign in your own work?
3.
After the presentations are over, ask for general questions and
comments.
Suggested Questions:
Purpose of the
exercise:
1. To discuss campaigns
and movements on
sexuality, sexual and
reproductive health, and
rights.
2. To examine how
movements have advocated
for sexuality, sexual and
reproductive health and
rights.
3. To analyse the successes
and challenges of these
campaigns and how
similar ideas and lessons
from them could be used
in one’s own work.
■ Can you give an example of how you could use tools from these
campaigns in your own work?
• Are any common tools or methods used in these campaigns?
What is similar or different about the way they have been used?
■ Have you heard of similar campaigns in your community or
country? How would you modify these campaigns to suit your
community?
TIME
60 minutes
MATERIALS
Handout 5.8 Campaigns for
Sexuality, Sexual and Reproductive
Health and Rights
ADVANCE PREPARATION
Make copies of Handout 5.8
438
TARSHI: Basics and Beyond
MODULE 5 - Chapter 3
THIS EXERCISE CAN BE MODIFIED
Key Messages
BY:
■ Discussing one or two campaigns
as a larger group. This may be
beneficial if the group wants to
focus on a case study that
addresses their work specifically.
• Using the exercise as an
assessment for the module. After
each group presents their case to
the larger group, peer and
facilitator evaluation can be done.
For sample assessment forms see
Chapter 2 in Preparing to Train.
• Campaigns for sexuality, sexual and reproductive health, and
rights are varied and have different objectives - for example to
change legislation, increase awareness on an issue, or protest a
violent act against specific groups/identities.
• Successful campaigns take on a variety of forms, but are likely
to be successful if they clearly identify the goals of the campaign,
the audience for whom messages are meant, and define indicators
to measure their success.
TIPS FOR THE FACILITATOR:
• Participants may focus only on larger movements and campaigns. Emphasise that
change can successfully be brought about on a smaller, local level too, and it is
equally important to raise awareness and improve well-being, rights and health at
this local level.
MAKING CONNECTIONS
■ Often sexual and gender identities
can be stigmatised and
marginalised. For more on stigma
and marginalisation see Chapter 2
in Module 4. For more on sexual
identities see Chapter 2 in
Module 1.
• If participants have been involved in an advocacy campaign before, time can be
allotted to hear about it in the larger group, and analyse its strengths and challenges.
■ Participants may want to speak only about their own experiences with campaigns
and issues relevant to these. Emphasise that learning about other experiences can
help them learn successful techniques and approaches that can be used in their
own campaigns.
■ Various contraception options are
available and these should be
offered with proper information,
including potential side effects and
whether they reduce the risk for
transmission of STIs including HIV/
AIDS. For more see Chapter 2 and
4 in Module 2.
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Exercise 4
Sharing Campaign Stories
GROUP DISCUSSION
Instructions
Purpose of the
1. Invite participants to share personal experiences and stories from
past or current campaigns or movements they have participated
in. Initiate a discussion of experiences and lessons learned.
Suggested Questions:
• What tools were common in these campaigns?
• What tools or methods would you take from any of these
experiences?
• Were the campaigns successful or not? What contributed to this?
exercise:
1. To share personal
experiences with advocacy
or awareness campaigns.
2. To discuss tools and
lessons that can be learned
from other experiences and
campaigns.
TIME
BO minutes
MATERIALS
Flipchart, markers
ADVANCE PREPARATION
None
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MODULE 5 - Chapter 3
Key Messages
BY:
• Dividing participants into small
groups and having them discuss
experiences of campaigns.
• Discussing experiences with campaigns can improve future
efforts and campaigns.
• Common advocacy tools and methods can be used for a variety
of issues and goals.
MAKING CONNECTIONS
TIPS FOR THE FACILITATOR:
• Values inform ethics and ethical
principles. For more see Setting
The Tone in Module 1.
■ This exercise is designed to be a free-flowing conversation among participants.
However, ensure that those who want to speak and share their thoughts and
experiences are given the opportunity.
■ A rights-based approach to
advocacy will empower and
broaden the scope of a campaign
and its goals. For more see
Chapter 1 in Module 3.
• Some participants may have not participated in any large-scale campaigns, but
even small advocacy efforts can be shared and learned from.
• After training on these issues, participants may be more critical of others' campaigns.
Remind them of the ground rules and the importance of respecting all participants
who share their stories, even if they disagree with the way the campaigns were
run.
• The purpose of critically analysing campaigns is to enhance learning. It should be
done with this attitude rather than one of judgment and disapproval.
• Encourage participants to think of constructive solutions to ethical dilemmas
currently faced by them in their work.
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Handout 5.6
Negotiating With Other Stakeholders
Scenario 1: Mass Media and Censorship
Women’s Advocacy Group:
It has come to your attention that a new film has been made by a woman filmmaker and is ready to be released in
theatres. The two main characters of the film are married women who live in a fairly conservative community. After
meeting each other at a common friend’s party, they begin to have a sex with each other and develop a relationship
outside of their marriages. While the film has no nude scenes, the women do kiss often and touch each other like
lovers would.
Your organisation is very enthusiastic about the film and anxiously awaiting its release. From what you hear of the
filmmaker, she is smart and her film is very well made. You have been waiting for some movie of this kind to come to
your country and challenge conservative notions of sexual identity and sexual behaviour that can be quite oppressive.
You have heard that many women who identify as lesbians are discriminated against in their communities. You hope
such a film will open the minds of people to the rights people have to express their sexuality. You are prepared to do
whatever it takes to ensure that the film gets released and people go to see it.
As a member of the women’s advocacy group you are loyal to your group and committed to the values and beliefs
described above. You have to attend a meeting called by the government censor board to discuss whether they should
allow the film to be screened. The meeting will be attended by other stakeholders in the community including a
representative of the censorship board, the filmmaker, a parent of a young person, and an NGO that works on HIV/
AIDS prevention.
Discuss the case and derive strategies for its resolution. Other groups may not agree with your point of view and
protest against your position, so your strategy should be created keeping the following points in mind:
• Identify your allies among the other role/stakeholder groups.
• Who are your opponents among the other role/stakeholder groups? How can you strategise to counter their
objections?
• What are your options for resolution? Are you willing to negotiate on your position at all? Will you consider other
options or agree to other’s viewpoints?
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Open-minded Parent:
It has come to your attention that a new film has been made by a woman filmmaker and is ready to be released in
theatres. The two main characters of the film are married women who live in a fairly conservative community. After
meeting each other at a mutual friend’s party, the two women begin to have a sex with each other and develop a
relationship outside of their marriages. While the film has no nude scenes, the women do kiss often and touch each
other like lovers would.
Yju are very excited that such a film has been made in your country. While you do not identify as a lesbian you think
it is important to know and understand the range of sexual identities and behaviour that exists. This is especially so
for your child, who is at an impressionable age and would benefit from seeing such a film. Also, the film can give you
the chance to bring up other sensitive issues to discuss with your child. You decide to get some other parents from
your neighbourhood together to get them to see the film with their children.
As an excited parent you are loyal to your group and committed to the values and beliefs described above. You have to
attend a meeting called by the government censor board to discuss whether they should allow the film to be screened.
The meeting will be attended by other stakeholders in the community including a representative of the censorship
board, the filmmaker, a representative ofa women’s advocacy group, and an NGO that works on HIV/AIDS prevention.
Discuss the case and derive strategies for its resolution. Other groups may not agree with your point of view and
protest against your position; therefore your strategy should take the following points into account:
•
Identify your allies among the other role/stakeholder groups.
• Who are your opponents among the other role/stakeholder groups? How can you strategise to counter their
objections?
• What are your options for resolution? Are you willing to negotiate on your position? Will you consider other
options and agree to other viewpoints?
Community Health Organisation that does HIV/AIDS Prevention Work:
It has come to your attention that a new film has been made by a woman filmmaker and is going to be released in
theatres. The two main characters of the film are married women who live in fairly conservative community. After
meeting each other at a mutual friend’s party the two women begin to have a sex with each other and develop a
relationship outside of their marriages. While the film has no nude scenes, the women do kiss often and touch each
other like lovers would.
While your organisation does not have religious affiliations, it does believe that lesbianism and same-sex relationships
are morally wrong. People were born males and females and it is only natural to have heterosexual relationships.
This kind of film might give people the wrong ideas and begin to undo the work you have done to promote safer
sexual behaviour between men and women. Your organisation has a strong history of activism and decides to protest
against the film’s release. You have decided that if it is necessary, you will use violence to prevent people from seeing
the film.
As a member of the health organisation you are loyal to your group and committed to the values and beliefs described
above. You have to attend a meeting called by the government censor board to discuss whether they should allow the
film to be screened. The meeting will be attended by other stakeholders in the community including a representative
of the censorship board, the filmmaker, a parent of a young person, and a member of a women’s advocacy group.
Discuss the case and derive strategies for its resolution. Other groups may not agree with your point of view and
protest against your position; therefore your strategy should take the following points into account:
•
Identify your allies among the other role/stakeholder groups.
• Who are your opponents among the other role/stakeholder groups? How can you strategise to counter their
objections?
• What are your options for resolution? Are you willing to negotiate on your position? Will you consider other
options and agree to other viewpoints?
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Filmmaker:
You arc a woman filmmaker who has just completed a film and are ready to release it in theatres. The two main
characters of the film are married women who live in a fairly conservative community. After meeting each other at a
mutual friend’s party the two women begin to have sex with each other and develop a relationship outside of their
marriages. While the film has no nude scenes, the women do kiss often and touch each other like lovers would.
You are very proud of your film and believe you have presented a controversial issue in your country in a tasteful and
rather moderate way. Your objective was not to make a film that was extremely risque since you want people to feel
comfortable viewing it. You think the more people come to see the film, the greater the chances of people beginning
to understand different sexual identities. Hopefully, it will create greater tolerance in this conservative country. You
are not willing to change the film in any way, especially after working to ensure that it was not overtly offensive.
As a woman filmmaker you are loyal to your group and committed to the values and beliefs described above. Y>u have
to attend a meeting called by the government censor board to discuss whether they should allow the film to be
screened. The meeting will be attended by other stakeholders in the community including a representative of the
censorship board, a member of a women’s advocacy group, a parent of a young person, and an NGO that works on
HIV/AIDS prevention.
Discuss the case and derive strategies for its resolution. Other groups may not agree with your point of view and
protest against your position; therefore your strategy should be formulated taking into account the following points:
• Identify your allies among the other role/stakeholder groups.
• Who are your opponents among the other role/stakeholder groups? How can you strategise to counter their
objections?
■ What are your options for resolution? Are you willing to negotiate on your position? Will you consider other
options or agree to other viewpoints?
Government Censorship Board:
It has come to your attention that a new film has been completed by a female filmmaker and is ready to be released in
theatres. The two main characters of the film are married women who live in fairly conservative community. After
meeting each other at a mutual friend’s party, the two women begin to have a sex with each other and develop a
relationship outside of their marriages. While the film has no nude scenes, the women do kiss often and touch each
other like lovers would.
As the government censorship board, you believe it is your duty to protect the public from films that could be distasteful
and clash with the moral codes of people in your country. While many may think that love between two women is
acceptable, you do not agree, and certainly will not promote such behaviour. Therefore, after briefly viewing the film
you consider forbidding it from being released. There has been pressure however from a powerful section of the film
industry to have the film released.
As a member of the government censorship board you are loyal to your group and committed to the values and beliefs
described above. You have called a meeting to discuss whether they should allow the film to be screened. The meeting
will be attended by other stakeholders in the community including a representative of a women’s advocacy group, the
filmmaker, a parent of a young person, and an NGO that works on HIV/AIDS prevention.
Discuss the case and derive strategies for its resolution. Other groups may not agree with your point of view and
protest against your position; therefore your strategy should be formulated after taking the following points into
account:
• Identify your allies among the other role/stakeholder groups.
■ Who are your opponents among the other role/stakeholder groups? How can yon strategise to counter their
objections?
• What are your options for resolution? Are you willing to negotiate on your position? Will you consider other
options or agree to other viewpoints?
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Scenario 2: Sexuality education
Parent
t is the beginning of a new school year and an announcement is made at local schools that the students will be taught
a new health/life skills curriculum. The new curriculum includes sexuality education that was absent from the previous
curriculum. According to the principal/head of the school, this curriculum will provide a more comprehensive
education for the students.
You think that your child is too young to receive sexuality education. You also feel that it is not the job of the school to
teach your child about sexuality, but the responsibility of you and your spouse. The school curriculum could promote
ideas you do not agree with and you will have no control over what your child learns about sexuality. You decide to
create a group of concerned parents to make sure that the new curriculum does not get taught.
As a concerned parent you are loyal to your group and committed to the values and beliefs described above. You are
scheduled to have a meeting with a teacher, an official from the Ministry of Education, a representative of a youth
advocacy organisation, and a young person from the school to decide whether to introduce this new curriculum.
Discuss the case and derive strategies for its resolution. Other groups may not agree with your point of view and
protest against your position; therefore your strategy should be formulated taking the following points into
consideration:
•
Identify your allies potential among the other role/stakeholder groups.
• Who are your opponents among the other role/stakeholder groups? How can you strategise to counter their
objections?
■ What are your options for resolution? Are you willing to negotiate on your position? Will you consider other
options or agree to other viewpoints?
Teacher
It is the beginning of a new school year and an announcement is made at local schools that the students will be taught
a new health/life skills curriculum. The new curriculum includes sexuality education that was absent from the previous
curriculum. According to the principal/head of the school, this curriculum will provide a more comprehensive
education for the students.
You are unhappy with this change in curriculum because it means you must learn new information, including topics
on sexuality, and how to teach it. Plus students will probably ask questions you are not entirely comfortable answering
and make comments you may not want to respond to. Y>u already anticipate some parents being displeased with the
inclusion of sexuality in the curriculum, and expect that they will complain to you. You would prefer to use the old
curriculum and are prepared to refuse to teach the curriculum and remove yourself from any health/life skills teaching
if the management insists that the new curriculum be used.
As a teacher in the school, you are loyal to your group and committed to the values and beliefs described above. You
are scheduled to have a meeting with a concerned parent, an official from the Ministry of Education, a representative
of a youth advocacy organisation, and a young person from the school to decide whether to introduce this new
curriculum.
Discuss the case and derive strategies for its resolution. Other groups may not agree with your point of view and
protest against your position; therefore you should consider the following points while formulating your strategy:
•
Identify your allies among the other role/stakeholder groups.
• Who are your opponents among the other role/stakeholder groups? How can you strategise to counter their
objections?
• What are your options for resolution? Will you negotiate on your position? Will you consider other options or
agree to other viewpoints?
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Representative of the Ministry of Education
It is the beginning of a new school year and an announcement is made at local schools that the students will be taught
a new health/life skills curriculum. The new curriculum includes sexuality education that was absent from the previous
curriculum. According to the principal/head of the school, this curriculum will provide a more comprehensive
education for the students.
As an official from the Ministry of Education you folly support this new curriculum and you had provided funding
and input to ensure that it would be culturally appropriate to the schools and work to broaden perspective on sexuality.
You and the authors of the curriculum have worked hard to make sure it touches on key messages and important
information. You see sexuality education as essential to young people’s education and will firmly stand by the
curriculum.
As an official from the Ministry of Education, you are loyal to your group and committed to the values and beliefs
described above. You are scheduled to have a meeting with a teacher, a concerned parent, a representative of a youth
advocacy organisation, and a young person from the school to decide whether to introduce the new curriculum.
Discuss the case and derive strategies for its resolution. Other groups may not agree with your point of view and
protest against your position; therefore your strategy should be formulated after taking the following points into
consideration:
■ Identify your allies among the other role/stakeholder groups.
• Who are your opponents among the other role/stakeholder groups? How can you strategise to counter their
objections?
■ What are your options for resolution? Are you willing to negotiate on your position? Will you consider other
options or agree to other viewpoints?
Youth Advocacy Organisation
It is the beginning of a new school year and an announcement is made at local schools that the students will be taught
a new health/life skills curriculum. The new curriculum includes sexuality education that was absent from the previous
curriculum. According to the principal/head of the school, this curriculum will provide a more comprehensive
education for the students.
Your organisation is thrilled about the introduction of this new curriculum. You have provided input on it, and
consulted with the authors and the Ministry of Education. While the curriculum is not perfect, it is a first step. It will
open up discussions on sexuality in schools and hopefolly begin the process of broadening perspectives in the
communities and the idea that people have the right to choose and practice their sexuality. Without this curriculum,
students will be denied their right to sexuality education. This fact alone makes you committed to supporting and
ensuring its use.
As a representative of the youth advocacy organisation, you are loyal to your group and are committed to the values
and beliefs described above. You are scheduled to have a meeting with a teacher, a concerned parent, an official from
the Ministry of Education, and a young person from the school to decide whether to introduce the new curriculum.
Discuss the case and derive strategies for its resolution. Other groups may not agree with your point of view and
protest your position; therefore your strategy should be formulated keeping the following points in mind:
• Identify your allies among the other role/stakeholder groups.
• Who are your opponents among the other role/stakeholder groups? How can you strategise to counter their
objections?
• What are your options for resolution? Are you willing to negotiate on your position? Will you consider other
options or agree to other viewpoints?
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Young Person From the School
It is the beginning of a new school year and an announcement is made at local schools that the students will be taught
a new health/life skills curriculum. The new curriculum includes sexuality education that was absent from the previous
curriculum. According to the principal/head of the school this curriculum will provide a more comprehensive education
for the students.
At first you are excited about the new curriculum. A class about sex is likely to be more interesting than other subjects.
Also, you don’t have the opportunity or feel comfortable talking about these issues at home. You aren’t even sure what
is meant by sexuality. But after thinking about it, you suddenly decide you would rather not have this new curriculum.
Classes will probably stay the same, which means that boys and girls will have to discuss these issues together, which
makes you uncomfortable. You are also worried that you may say something that will make you stand out. Perhaps
the school should stay with the curriculum it had before.
As a young person from the school, you are loyal to your group and committed to the values and beliefs described
above. You are scheduled to have a meeting with a teacher, a concerned parent, the ministry of education, and a
representative of a youth advocacy organisation to decide whether to introduce the new curriculum.
Discuss the case and derive strategies for its resolution. Other groups may not agree with your point of view and
protest against your position; therefore your strategy should be formulated taking the following points into account:
•
Identify your allies among the other role/stakeholder groups.
■
Who are your opponents among the other role/stakeholder groups? How can you strategise to counter their
objections?
■
What are your options for resolution? Are you willing to negotiate on your position? Will you consider other
options or agree to other viewpoints?
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Handout 5.7
Representing an Issue in Advocacy
Scenario 1
In September 2000, the United Nations General Assembly convened the Millennium Summit that
brought together 189 United Nations member states. One of the notable outcomes of this meeting was
the unanimous adoption of the Millennium Declaration, a document that reaffirmed the values and
goals of the United Nations. The Declaration recognised the challenges and work that must be done
by nations around the world to improve conditions for its people and hasten development. To provide
a more detailed approach to achieving the goals oudined in the Declaration, in 2001 the UN Secretariat
and various UN agencies worked in collaboration to create what are now known as the Millennium
Development Goals (MDGs). These MDGs act as guidelines for nations to reach the goals addressed
in the Declaration, and while broad and ambitious, they give specific time-bound targets and indicators
for nations to follow.
Eight MDGs have been established. For the purpose of this exercise however, your group is an
organisation that wants to create advocacy or information-based material that only addresses one of
these MDGS: promoting gender equality and empowering women. This material is intended to
raise awareness in your community and help to achieve this MDG. You must define who your
community is (for example, a small rural village, a large city population etc.), and then create any
material you feel will appropriately address this issue for them (for example, an educational brochure,
a poster, a song etc.). In this material you should include issues of sexuality, sexual and reproductive
health and rights. Only one piece of material is needed, and you must create an oudine of what it will
specifically look like: for example, will there be women on the poster; what will the women look like;
will the women be well known or ordinary?
Scenario 2
In September 2000, the United Nations General Assembly convened the Millennium Summit that
brought together 189 United Nations member states. One of the notable outcomes of this meeting was
the unanimous adoption of the Millennium Declaration, a document that reaffirmed the values and
goals of the United Nations. The Declaration recognised the challenges and work that must be done
by nations around the world to improve conditions for its people and hasten development. To provide
a more detailed approach to achieving the goals outlined in the Declaration, in 2001 the UN Secretariat
and various UN agencies worked in collaboration to create what are now known as the Millennium
Development Goals (MDGs). These MDGs act as guidelines for nations to reach the goals addressed
in the Declaration, and while broad and ambitious, they give specific time-bound targets and indicators
for nations to follow.
Eight MDGs have been established. For the purpose of this exercise however, your group is an
organisation that wants to create advocacy or information-based material that only addresses one of
these MDGS: improved maternal health. This material is intended to raise awareness in your
community and help to achieve this MDG. You must define who your community is (for example, a
small rural village, a large city population etc.), and then create any material you feel will appropriately
address this issue for them (for example, an educational brochure, a poster, a song etc.). In this material
you should include issues of sexuality, sexual and reproductive health and rights. Only one piece of
material is needed, and you must create an outline of what it will specifically look like: for example
will there be women on the poster; what will the women look like; will the women be well known or
ordinary?
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Scenario 3
In September 2000, the United Nations General Assembly convened the Millennium Summit that
brought together 189 United Nations member states. One of the notable outcomes of this meeting was
the unanimous adoption of the Millennium Declaration, a document that reaffirmed the values and
goals of the United Nations. The Declaration recognised the challenges and work that must be done
by nations around the world to improve conditions for its people and hasten development. To provide
a more detailed approach to achieving the goals outlined in the Declaration, in 2001 the UN Secretariat
and various UN agencies worked in collaboration to create what are now known as the Millennium
Development Goals (MDGs). These MDGs act as guidelines for nations to reach the goals addressed
in the Declaration, and while broad and ambitious, they give specific time-bound targets and indicators
for nations to follow.
Eight MDGs have been established. For the purpose of this exercise however, your group is an
organisation that wants to create advocacy or information-based material that only addresses one of
these MDGS: combat HIV/AIDS. This material is intended to raise awareness in your community
and help to achieve this MDG. You must define who your community is (for example, a small rural
village, a large city population etc.), and then create any material you feel will appropriately address
this issue for them (for example, an educational brochure, a poster, a song etc.). In this material you
should include issues of sexuality, sexual and reproductive health and rights. Only one piece of material
is needed, and you must create an outline of what it will specifically look like: for example, will there
be HIV positive people on the poster; what will they look like; will they be well known or ordinary?
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Handout 5.8
Campaigns for Sexuality, Sexual and Reproductive Health and
Rights
Campaign 1
Established in 2000 by a group of sex workers in support of sex workers rights, the Women’s Network
for Unity (WNU) is a grassroots representative collective of Phnom Penh, Cambodia. WNU has
approximately 5000 members from 13 provinces and cities in Cambodia. Initially WNU used NGOs
as the primary means for conducting advocacy initiatives, but in 2003 opted to elect members of the
collective to act as representatives for the sex workers and the network directly. This allowed for
community development and self-representation.
Since its inception, WNU has been an instrument to address the challenges encountered by sex workers
in Cambodia, and ensure their right to live free of exploitation, social stigma and in safe and healthy
environments. The Network has taken on a variety of projects and initiatives that use peer education,
advocacy, and public education programmes to meet their goals. They have worked to improve attitudes
and approaches to HIV/AIDS prevention, which has resulted in one of the most successful strategies
to reduce HIV/AIDS, improve client negotiation skills, sex worker rights, and reduce violence against
sex workers.
In early 2004, WNU began a campaign against the drug trials for an HIV/AIDS drug, Tenofovir. The
drug was being tested for its efficacy in preventing HIV transmission. The Network heard reports
from its members about recruitment for the trials being directed toward sex workers. Potentially unethical
practices were involved: sex workers were being told that the drug had no side effects or minimal ones
that could be treated easily; they were not being told the name of the drugs or their mode of impact;
and recruiters were them that the drug was effective only for sex workers. In addition, many of the sex
workers reported that they were not informed that the drugs were experimental and the long-term
impact the drugs had on HIV/AIDS were unknown. The Network protested against this approach
and also requested full insurance to protect them from future illness.
In August 2004 the Prime Minister of Cambodia halted the trials, citing claims that the practice violated
human rights, and urged the people of Cambodia to refuse to participate. The announcement was
welcomed by WNU, ‘we are very happy with this order as we don’t want to take part in this drug test.
There is no safety guarantee for us,’ said the director of WNU Kao Tha.
For more on this topic see: http://news.bbc.co.Uk/2/hi/health/3562704.stm, http://womynsagenda.org/
programs/sexworker/SW/swnu.html
Questions:
■ What was the objective of this campaign? What issues of sexuality, sexual and reproductive health,
and rights is it trying to address?
• What was the message of this campaign?
• How was the campaign successful? What more could have been done to achieve its goals?
• How can you use the lessons/tools of this campaign in your own work?
- Are you aware of any similar campaigns in your community, country or other countries in your
region? How successful have they been and why?
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Campaign 2
In Mumbai, India, in December 1998 hardliners of a political party went on the rampage after the
screening of the Deepa Mehta film Fire, which portrays a lesbian relationship between two unhappy
sisters-in-law. They tore down posters, vandalised cinemas and threatened moviegoers. There were
spontaneous country-wide protests against such acts of violent discrimination and in New Delhi,
India it led to the birth of Campaign for Lesbian Rights (CALERI). CALERI was made up of a group
of individuals and organisations working in the area of human rights, women’s, gay (male homosexual)
and lesbian issues. Fire sparked the formation of CALERI, but the group’s work and activism aimed to
address broader issues and prejudices around lesbian rights. CALERI began their activist work by
developing a year long public campaign strategy that would include raising public awareness for lesbian
rights, addressing the suppression of women’s sexuality, and promoting discussion and debate on how
to articulate a space for lesbian rights into the women’s movement in India.
The first steps of the CALERI campaign began with public demonstrations protesting the attacks on
Fire. This was followed by a variety of public awareness raising and education efforts, that included
distributing leaflets, conducting and scripting street plays, writing public memoranda against laws
and policies that discriminated against lesbians in India, and conducting meetings and workshops
with women’s groups and NGOs. Members of CALERI also developed and published a bilingual
report called ‘Lesbian Emergence’ to raise public consciousness and awareness of these issues among
NGO activists and individuals. This report continues to inform people’s work in the field.
For more on this topic see: Lesbian Emergence - Campaign for Lesbian Rights. Caleri. 1999. New Delhi.
Questions:
■ What was the objective of this campaign? What issues of sexuality, sexual and reproductive health
and rights is it trying to address?
• What was the message of this campaign and how was it communicated? Who was the audience?
• How do you think the campaign was successful in raising awareness? What more could have been
done to achieve its goals?
• Would a campaign like this be successful in your region? Why or why not?
• What kind of advocacy and awareness raising approaches did the campaign use? How can you use
the lessons and tools of this campaign in your own work?
• What obstacles would you face if you had to execute a campaign like this and how could you overcome
them?
• Are you aware of any similar campaigns in your country or other countries in your region? How
successful have they been and why?
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Campaign 3
Section 377 of the Indian Penal Code reads: Whoever voluntarily has carnal intercourse against the order
of nature with any man, woman, or animal, shall be punished with imprisonment ofeither description for a
term which may extend to 10 years and also be liable to fine. As an explanation has been provided to the
section, 'penetration is sufficient to constitute... camal intercourse’, being interpreted to include anal and
oral sex.
Although the definition could also be interpreted to include married couples engaging in oral and anal
sex, this law has been used primarily to harass and threaten men who have sex with other men and
those who identify as homosexual.
Several groups have been calling for the removal of Section 377 in India. One group, the NAZ
Foundation India Trust, a well-known NGO working on HIV/AIDS related issues, petitioned the
Delhi High Court for this removal contending that penal action under Article 377 comes in the way of
its anti-HIV/AIDS campaigns. Another group is Voices Against 377 (VA377), based in New Delhi,
India, which is a coalition of individuals and organisations from a wide range of perspectives working
to raise awareness on issues related to Section 377, and advocate for the decriminalisation of adult,
consensual, same-sex desiring behaviour. VA377 has worked toward their goal in a variety of ways,
which include participating in protests against violence, conducting trainings on sexuality, and working
to build awareness with media and other social groups. The coalition launched the ‘Million Voices
Campaign’ in December 2004, which is a nation-wide campaign to collect a million expressions on
sexual rights.
In February 2006, the Supreme Court of India rejected an earlier Delhi High Court order (in response
to the NAZ Foundation petition) that homosexuality and gay relationships constituted an ‘unnatural
offence’. The Court stated that ‘Indian society was not ready for it’, and sent the matter back to the
court for reconsideration. This is seen as a positive step in the direction of reading down or repealing
of the law and ensuring that same-sex adult consensual relationships are not penalised anymore. At
the time of publication of this manual, Section 377 was still part of the Indian Penal Code, and VA377
continues to advocate for its removal and widen the awareness of issues concerning sexuality and
gender.
For more on this topic see: Voices Against 377. Rights For All: Ending Discrimination Against Queer
Desire Under Section 377. New Delhi, and http.7Zwww.sodomylaws.org/world/india/innews048.htm
Questions:
■ What is the objective of this campaign? What issues of sexuality, sexual and reproductive health
and rights is it trying to address?
• What is the message of this campaign and how was it communicated? Who was the audience?
• How successful do you think the strategies being used in this campaign have been? What more
could the campaign have done to achieve its goals?
■ Would a campaign like this be successful in your region? Why or why not?
• What obstacles would you face if you had to execute a campaign like this and how could you
overcome them?
• What kind of advocacy and awareness raising approaches did the campaign use? How can you
use the lessons/tools of this campaign in your own work?
• Are you aware of any similar campaigns in your community, country or other countries in your
region? How successful have they been and why?
452
TARSHI: Basics and Beyond
MODULE 5 - Chapter 3
Campaign 4
Norplant is a contraceptive for women. It consists of six small, plastic tubes implanted under the skin
of a woman s arm. These tubes slowly release hormones that prevent pregnancy and can be left in for
three months at a time. Norplant was set to be tested in trials in Bangladesh and other parts of South
and Southeast Asia beginning in the early 1980’s. Marketing for these Norplant trials first began in
Bangladesh in 1981 with advertisements in Bengali-language newspapers that promised sterility for
five years, reversible when the implants were removed. The advertisements mentioned nothing about
the product’s experimental nature or possible adverse health conditions associated with it.
Women’s groups were concerned over the testing of Norplant in Bangladesh, particularly because it is
such an invasive type of contraceptive and was still in the nascent stages of testing. Another concern
was that participants were not adequately informed of its possible adverse side effects. Bangladeshi
women’s groups and concerned doctors, pharmacists and health care workers protested to the Minister
of Health who subsequently postponed the trials.
In 1985, Norplant was brought back into Bangladesh, this time in the context of an explicit clinical
trial. There were no public announcements and advertising campaigns about Norplant and no details
of the trial and the participants. Bangladeshi social workers became aware of the women being recruited
from slums for the trial. The social workers had little cooperation from the organisations conducting
the trials to improve on the education and information being given to the women. As a result the
workers started to go into slum areas themselves to locate women who had the implants and discuss
their implications.
For more on this topic see: Akhtar, F. 1995. Resisting Norplant: Women’s Struggle in Bangladesh Against
Coercion and Violence. Bangladesh: Narigrantha Prabartana.
Questions:
■ What was the objective of the campaign? What issues of sexuality, sexual and reproductive health
and rights is it trying to address? How was it successful?
• What was the message of this campaign and how was it communicated? Who was the audience?
• How was it successful? What more could the campaign have done to achieve its goals?
• Would a campaign like this be successful in your region? Why or why not?
■ What obstacles would you face ifyou had to execute a campaign like this and how could you overcome
them?
■ What kind of advocacy and awareness raising approaches did the campaign use? How can you use
the lessons/tools of this campaign in your own work?
• Are you aware of any similar campaigns in your community, country or other countries in your
region? How successful have they been and why?
453
MODULE 5-Chapter 3
TARSHI: Basics and Beyond
EXERCISE MODIFICATION
Campaign 5
Until recently, abortion has been illegal in Sri Lanka, except when a woman’s life is in danger. This
has resulted in up to 1,000 illegal and unsafe abortions daily. There have been attempts to legalise
abortion since as early as 1995, such as a single introduction of legislation into the Penal Code that
would legalise abortion only in cases of rape and incest. But these all failed when legislators opposed
the initiatives, citing moral reasons.
Women’s groups and activists in Sri Lanka, including INFORM, a human rights based NGO in
Colombo, Sri Lanka have campaigned for legalisation of abortion. In 2004, a proposed bill came into
the Sri Lankan legislature called the Women’s Rights Bill, which has an indirect reference to abortion
rights: Women shall enjoy equal rights in all areas of private life including rights within the family
and their private lives, and the right to control their bodies and rights relating to child birth.’ Many
activists are hoping that the bill passes through the legislature.
Option 1
Questions:
■ What is the objective of this campaign? What issues of sexuality, sexual and reproductive health and
rights is it trying to address?
• What would you do to make this a successfill campaign in your community?
• How would the campaign meet its goals?
■ Are you aware of any similar campaigns in your community, country or other countries in your
region? How successful have they been and why?
Option 2
Plan a yearlong campaign around this issue peeping in mind the following:
• What obstacles would you face if you had to execute this campaign and how could you overcome
them?
• Who would your allies and adversaries be in this campaign?
■ What steps would you take toward your goal/s?
• Are you aware of any similar campaigns in your community, country or other countries in your
region? How successful have they been and why?
454
Appendices
APPENDICES
APPENDIX A
Some relevant international documents
RELATED TO RIGHTS AND ETHICS
Beijing Conference Declaration and Platform of Action.
http://www.un.org/womenwatch/daw/beijing/platform/
Convention on the Elimination of All Forms of Discrimination
Against Women (CEDAW).
http://www.un.org/womenwatch/daw/cedaw/
Convention on the Rights of the Child (CRC). www.unicef.org/crc
Declaration of Helsinki, http://www.wma.net/e/policy/b3.htm
International Conference on Population and Development (ICPD).
http://www.unfpa.org/icpd/summary.htm
International Convention on the Elimination of all forms of Racial
Discrimination (CERD). http://www.ohchr.org/english/law/cerd.htm
International Covenant on Civil and Political Rights (ICCPR).
http://www.unhchr.ch/html/menu3/b/a_ccpr.htm
International Covenant of Economic, Social and Cultural Rights
(ICESCR). http://www.unhchr.ch/html/menu3/b/a_cescr.htm
Universal Declaration of Human Rights (UDHR).
http://www.un.org/Overview/rights.html
TARSHI: Basics and Beyond
TARSHI : Basics and Beyond
APPENDICES
APPENDIX B
Sample listing of films related to sexuality,
SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS
Showing documentaries, feature films, or television programmes and
having a discussion about them is an interesting and non-threatening
way of addressing some of the contentious and difficult issues contained
in this manual. This also allows participants to visually engage with an
issue making it more ‘real’ for them. Using films in trainings help relieve
the boredom and monotony of sessions, makes learning fun and also
gives facilitators a break.
A sample list of English and regional language films is presented in the
following pages. Please note that this is a sample list to illustrate the
idea that facilitators can choose from a variety of films. Facilitators can
also use current television serials to illustrate particular themes. The
Internet is an excellent source for information and reviews on various.
This list is not exhaustive. Facilitators need to choose films carefully,
keeping in mind the objective of screening it, the audience and the
availability of the film in their region.
457
TARSHI: Basics and Beyond
APPENDICES
THE ACCUSED (ENGLISH), 1988
BANDIT QUEEN (HINDI - ENGLISH SUBTITLES), 1995
Director: Jonathan Kaplan, 110 minutes
Director: Shekhar Kapur, 119 minutes
The Accused takes a powerful and thought provoking look at human
nature and individual moral conscience, and a judicial process that
treats the person who is raped like a criminal. It highlights the
consequences of not only rape, but the judicial system as well.
The movie tells the story of the bandit queen Phoolan Devi who
was sent to prison in 1983 and got free in 1994. During five years
she was prosecuted by the Indian police and turned into a legend.
BENAQAAB (MARATHI AND HINDI - ENGLISH SUBTITLES), 2002
AFTER SUNSET (ENGLISH NARRATIVE AND VOICE OVER), 2000
Director: Chelam Zullani, 50 minutes
Director: Tahir Khilji, 40 minutes
Benaqaab is about the sex workers' movement in Sangli, a small
town in Maharashtra. The film unmasks the problems that sex
workers face, including exploitation, violence, and lack of access to
health and legal services, and harassment from police, madams
and pimps, as well as their strength as a collective.
The film illuminates the rarely-seen side of Lahore, that emerges
when the light of the day has faded. Massage boys talk about their
lives and their work, not always as masseurs. This film offers a
glimpse into the dynamics of a marginalized group, struggling to
survive against great social odds and health challenges.
BOUND (ENGLISH), 1996
AIMEE AND JAGUAR (GERMAN - ENGLISH SUBTITLES), 1999
Directors: The Wachowski Brothers, 1 hour/ 44 minutes
Director: Max Farberbock, 125 minutes
His girlfriend and her lesbian lover outwit a gang leader in this
gangster movie with a twist.
A story about love between two women set in 1943 Berlin, against
the backdrop of the Second World War.
BOLD BOLD (ENGLISH), 1991
ALL ABOUT MY MOTHER (SPANISH - ENGLISH SUBTITLES),
1999
Director: Pedro Almodovar, 102 minutes
Cecilia Roth overcomes her grief at the loss of her son and becomes
caregiver to a colourful extended family: a pregnant nun, a
transvestite prostitute and two troubled actresses.
Director: Gita Saxena, 30 minutes
Focusing on the South Asian community of Toronto, this video is a
tool for facilitators, educators, community workers and anyone
interested in organising around issues of health, sexuality and cultural
identity.
BOYS DON'T CRY (ENGLISH), 1999
AASTHA (IN THE PRISON OF SPRING) (HINDI - ENGLISH
Director: Kimberly Pierce, 118 minutes
SUBTITLES), 1997
Director: Basu Bhattacharya, 132 minutes
A middle class homemaker is introduced to sex work through a
chance encounter. Oblivious to her husband, she is torn between
the pleasures her new life afford her and the guilt-ridden awareness
of her sexuality.
Based on the true story of Brandon Teena, (a transgendered teen
who preferred life in a male identity until it was discovered he was
born biologically female), the film looks at the hatred that being
different can generate in small town America.
BROKEBACK MOUNTAIN (ENGLISH), 2005
Director: Ang Lee, 134 minutes
ASTITVA (HINDI - ENGLISH SUBTITLES), 2000
Director: Mahesh Manjrekar, 113 minutes
The humdrum life of a homemaker is disturbed when she is informed
of a significant inheritance from her long ago music teacher which
causes her husband to wonder if the teacher and his wife had an
affair.
458
An award-winning film based on the E. Annie Proulx story about a
forbidden and secretive relationship between two cowboys and
their lives over the years.
TARSHl: Basics and Beyond
APPENDICES
CHANDNI BAR (HINDI - ENGLISH SUBTITLES), 2002
Director: Madhur Bhandarkar, 150 minutes
This Bombay film delves into travails of Mumtaz, a small town girl,
whom circumstances forced to leave her hometown and led her to
become a bar dancer in Mumbai
CHOCOLATE BABIES (ENGLISH), 1996
EUNUCHS: INDIA'S THIRD GENDER (ENGLISH), 1991
Director: Michael Yorke, 40 minutes
This documentary looks at eunuchs and attitudes towards them in
India, where they are treated with a mixture of disgust, fear and
respect. The film contrasts the traditional mannerisms, lifestyles
and attitudes of the rural hijras, who are still regarded respectfully,
and that of their more marginalised urban counterparts.
Director: Stephen Winters, 83 minutes
A film about a group of queer men and women who launch an
assault campaign on conservative politicians who refuse to support
a hospice in their New York neighbourhood.
THE CLOSET (FRENCH - ENGLISH SUBTITLES), 2001
EVERYTIME YOU LOOK AT ME (ENGLISH), 2004
Director: Alrick Riley, 90 minutes
Chris and Nicky are two people who fall in love, though the odds are
stacked against them, in this contemporary story starring two
disabled actors in lead roles for the first time.
Director: Francis Veber, 85 minutes
Francois, a dull and lonely accountant meekly endures office jokes
and backroom whispers that he is about to be fired. Funnily enough,
a rumour that he is gay starts spreading which ends up being
advantageous for Francois.
FAREWELL, MY CONCUBINE (CANTONESE), 1992
Director: Chen Kaiage, 154 minutes
The story of two Peking Opera superstars who meet as young boys,
and who, for the next 50 years, are linked by their stage roles and
their lives are played out against social upheavals.
DANCE ME TO MY SONG (ENGLISH), 1998
Director: Rolf de Heer, 98 minutes
An uplifting story of a woman in a wheelchair, whose carer is vying
for the attentions of the same man she is interested in.
DIKSHA (INITIATION] (HINDI), 1991
FIRE (ENGLISH AND HINDI), 1996
Director: Deepa Mehta, 104 minutes
The film portrays the love between two unhappy sisters-in-law in a
New Delhi middle-class family. This film sparked off protests in India
and led to advocacy for lesbian rights and freedom of expression.
Director: Arun Kaul. 135 minutes
A story about a learned Acharya who has to find out which of his
two young disciples has 'impregnated' his widowed daughter and
to decide the daughter's fate. He does not have many choices - for
the prescribed Hindu punishment for this is death.
FISH AND ELEPHANT (CHINESE ■ ENGLISH SUBTITLES), 2001
Director: Li Yu; 106 minutes
A film about two women in a relationship, who have to deal with
one of their mothers trying to arrange boyfriends for her. And the
other woman's former girlfriend reappears, after having killed her
own abusive father.
EROTIQUE (GERMAN), 1994
Directors: Lizzie Borden, Monika Treut, and Clara Law, 90 minutes
FLESH AND PAPER (ENGLISH), 1990
Three women filmmakers examine sexuality in this anthology.
Segment 1, 'Let's Talk About Sex' is the story of an aspiring actress
whose day job is as a phone-sex operator. Segment 2, 'Taboo Parlor'
tells the story of two lesbians, who, for variety pick up a man for
sex. Segment 3 'Wonton Soup' is about an Australian-Chinese man
who tries to rekindle his affair with a Chinese woman by returning
to their roots.
Director: Pratibha Parmar, 26 minutes
In 1986, Suniti Namjoshi and Gillian Hanscombe published a selection
of poems entitled Flesh and Paper. The poems are a dialogue between
the two women as friends, poets and lovers. This film features an
interview with Suniti Namjoshi, and discussions by others about her
life and work with readings of her poetry.
459
TARSHI: Basics and Beyond
APPENDICES
FRESH KILL (ENGLISH), 1993
I LIKE YOU, I LIKE YOU VERY MUCH (JAPANESE - ENGLISH
Director: Shu Lea Cheang, 80 minutes
SUBTITLES), 1995
The story of two young lesbian parents, Shareen and Claire who are
raising their five-year-old daughter Honey in a converted garage on
Staten Island.
Director: Hiroyuki Oki, 58 minutes
A love triangle between three men in the liberal enclave of Kochi
City, Japan that forces each of the men to question his sexuality
and identity.
FRIENDS IN HIGH PLACES (ENGLISH), 2001
Director: Lindsey Merrison, Burma, 86 minutes
Guided by two lively 70-year olds, the director explores the role of
the spirit mediums of the Nat cult in Burma. The spirit mediums are
often homosexual men, who communicate with the spirits and take
on their flamboyant characteristics in ecstatic rituals.
IN THE FLESH (HINDI - ENGLISH SUBTITLES), 2002
Director: Bishakha Dutta, 53 minutes
A documentary film that provides an intimate insider's account of
what it is really like to be in prostitution by following the lives of
three people in prostitution.
FUNERAL PARADE OF ROSES (JAPANESE - ENGLISH
KAMA SUTRA (ENGLISH), 1997
SUBTITLES), 1969
Director: Mira Nair, 114 minutes
Director: Toshio Matsumoto, 105 minutes
The story set in 16th century India, centers on Maya, a servant girl
working for a princess, Tara. Maya has always been forced to subsist
on hand-me-downs from Tara, but on the eve of the princess'
wedding, she sees a chance for revenge by catching the groom's
eye.
Scandalous when it first appeared, Funeral Parade of Roses is still
seen as a sensational depiction of the gay subculture, as it existed in
the Tokyo in the late '60s. The film is about a gay son who kills his
mother and sleeps with his father in this Japanese version of the
Oedipus legend.
KHUSH (ENGLISH), 1991
GULABI AAINA [THE PINK MIRROR] (HINDI - ENGLISH
SUBTITLES), 2004
Director: Sridhar Rangayan, 40 minutes
The film pits two Indian drag queens against a westernized gay
teenager in a battle to woo a handsome hunk. Using the Bollywood
soap idiom of song, dance and drama the film also explores other
veiled issues related to the Indian gay community including HIV/
AIDS.
Director: Pratibha Parmar, 24 minutes
Khush deals with the lives of South Asian lesbians and gay men as
they negotiate their existence in Britain, North America, and India.
In their interviews, these men and women explore what it means to
be queer and of color in their particular locale.
KING OF DREAMS (ENGLISH), 2001
Director: Amar Kanwar, 36 minutes
HEATHER ROSE GOES TO CANNES, 1998
Director: Christopher Corin, 52 minutes
Heather Rose has Cerebral Palsy, uses a wheelchair and
communicates through a voice machine. She co-wrote and starred
in the feature film Dance Me to My Song, which was invited to the
Cannes Film Festival. This is the story of Heather's journey to the
festival, her struggles and her ultimate success.
460
This is a film about men and sexuality in India and explores what it
means to be a man who is sexual.
KORE (ENGLISH), 1994
Director: Tran T. Kim-Trang, 17 minutes
By focusing on the blindfold, Kore explores the eye as purveyor of
desire, sexual fear, and the fantasy of blindness.
TARSHI: Basics and Beyond
LADYBOYS (ENGLISH), 1992
APPENDICES
MANDI (HINDI - ENGLISH SUBTITLES), 1983
Director: Jeremy Marre, 60 minutes
Director: Shyam Senegal, 167 minutes
A made-for-BBC look at two teenage Thai boys as they try to escape
rural poverty by becoming successful katoi, orfemale impersonators.
This film is based on a classic Urdu short story 'Aanandi' by Pakistani
writer Ghulam Abbas. It deals with a brothel at the heart of a city,
in an area that some politicians want for its prime locality. They
rally against the brothel and its inhabitants in the name of morality,
and soon everyone in the area jumps on the bandwagon.
LAN YU (MANDARIN - ENGLISH SUBTITLES), 2001
Director: Stanley Kwan, 87 minutes
This movie tells the story of a wealthy businessman who flits from
one relationship to the next, passing time until the day comes when
he will marry and have children. Then he meets Lan Yu, a poor
student and wakes up 'the morning after' a night with him to find
that everything is different.
THE LOVER (ENGLISH), 1992
THE MAN IN HER LIFE, [ANG LALAKI SA BUHAY Nl SELYA]
(FILIPINO), 1997
Director: Carlos Siguion-Reyna, 96 minutes
Disappointed with her boyfriend who only wants sex but no 'real
relationship' nor marriage, this is the story of a woman who decides
to marry a gay man who, she is convinced, is definitely different.
Director: Jean-Jacque Annaud, 115 minutes
MANJUBEN TRUCK DRIVER (HINDI AND GUJARATI - ENGLISH
A poor French teenager engages in an affair with a wealthy Chinese
heir in 1920s Saigon. For the first time in her young life she has
control, and she wields it deftly over her besotted lover throughout
a series of clandestine meetings.
SUBTITLES), 2002
Director: Sherna Dastur, 52 minutes
On the Indian highway as a woman truck driver, Manjuben inhabits
a male world. She owns and drives a truck. A film about freedom,
about identity, and about desires.
LISTEN TO MY VOICE (ENGLISH NARRATIVE AND VOICE OVER),
2004
Director: Tahir Khilji, 15 minutes
MARKOVA: COMFORT GAY (ENGLISH AND TAGALOG - ENGLISH
SUBTITLES), 2000
A look at why a group of Pakistani men choose to have sex with
other men and the violence they subject themselves to by doing so.
MACHO DANCER (ENGLISH), 1988
Director: Lino Brocka, 136 minutes
Abandoned by his American lover, a teenager from the mountains
journeys to Manila in an effort to support his family. With a popular
callboy as his mentor, he enters the glittering world of male strippers,
prostitution, drugs, sexual slavery, police corruption and murder.
MAJMA (HINDI - ENGLISH SUBTITLES), 2001
Director: Rahul Roy, 54 minutes
Director: Gil Portes, 97 minutes
An unconventional true story of Walter Dempster Jr, otherwise
known as Markova. Escaping the torment of growing up with an
abusive older brother, he and his friends found further suffering at
the hands of Japanese soldiers, forced into sex work to survive. But
even after the war, Markova's struggle continued.
MATRUBHOOMI: A NATION WITHOUT WOMEN (HINDI), 2004
Director: Manish Jha, 98 minutes
Perhaps the first full-length feature film on female infanticide made
in India, it addresses the implications of millions of 'missing girls' in
the country.
The film explores male sexuality and gender relations in the 'instability'
of working class lives.
MA VIE EN ROSE (FRENCH - ENGLISH SUBTITLES), 1998
Director: Alain Berliner, 86 minutes
This is a film about six-year old Ludovic who believes that he was
meant to be a little girl and that the mistake will soon be corrected.
461
TARSHI : Basics and Beyond
APPENDICES
MIDNIGHT DANCERS (FILIPINO - ENGLISH SUBTITLES), 1994
PARAMA (BENGALI - ENGLISH SUBTITLES), 1985
Director: Mel Chionglo, 118 minutes
Director: Aparna Sen, 139 minutes
Three young and good-looking brothers live with and support their
parents in Manila; they dance at the male Club Exotica and work as
callboys.
This is a story about a 40-year-old married woman, who falls in love
with a younger man, an expatriate photo-journalist.
PHILADELPHIA (ENGLISH), 1993
MONSOON WEDDING (HINDI AND ENGLISH), 2001
Director: Mira Nair, 116 mins
An exuberant family drama set in Punjabi culture, where ancient
tradition and dot-com modernity combine in unique ways, this film
also address sexual abuse.
Director: Jonathan Demme, 125 minutes
One of the first and few mainstream films addressing the stigma
and discrimination of HIV positive people.
PRISCILLA QUEEN OF THE DESERT (ENGLISH), 1994
Director: Stephan Elliott, 103 minutes
NORTH COUNTRY (ENGLISH), 2005
Director: Niki Caro, 126 minutes
This is a fictionalised account of the first major successful sexual
harassment case in the United States, Jenson vs. Eveleth Mines,
where a woman who endured a range of abuses while working as
a miner filed and won the landmark 1984 lawsuit.
An Australian film about two drag queens, and a transsexual woman
driving across the outback from Sydney to Alice Springs in a large
bus they have named Priscilla.
QUILLS (ENGLISH), 2000
Director: Philip Kaufman, 124 minutes
OLIVER (MANDARIN - ENGLISH SUBTITLES), 1983
Director: Nick de Ocampo
A documentary of the life of Oliver, a male sex worker at a Manila
bar who is married with children and supports his family with his
earnings doing male-to-male sex shows.
Based on the life of the Marquis de Sade whose erotic stories whip
up all of France into a sexual frenzy, until a conservative doctor tries
to put an end to the fun, inadvertently stoking the excitement to a
fever pitch.
A QUEER STORY (CHINESE - ENGLISH SUBTITLES), 1997
Director: Shu Kei, 111 minutes.
THE OUTSIDERS/ THE OUTCASTS (MANDARIN - ENGLISH
SUBTITLES), 1986
.Director: Yu Kan-Ping, 102 minutes
The film is about teenage boys abandoned by their families because
they are gay, and the efforts of an aging photographer to provide a
home and family for them. This Taiwanese film is said to be the first
film with a homosexual theme to be licensed by the Republic of
China.
PARIS IS BURNING (ENGLISH), 1990
This Hong Kong comedy-drama chronicles the upcoming wedding
of marriage counselor. The fact that he is gay does not stop his
parents from continuing to pressure him. But marriage is only a part
of Law's problems.
SHANGHAI PANIC (MANDARIN - ENGLISH SUBTITLES), 2002
Director: Andrew Cheng, 87 minutes.
A film about the lives of four Shanghai teenagers - sexuality, drugs,
HIV and other 'panics' amongst a group of clubbing friends.
Director: Jennie Livingston, 76 minutes
A story of street-wise urban survival, gay self-affirmation, and the
pursuit of a desperate dream - to live for a brief dazzling moment in
a fantasy world of high fashion, status and acceptance.
462
SHINJUKU BOYS (ENGLISH), 1995
Directors: Longinotto and Williams, 53 minutes.
This documentary is set in the New Marilyn nightclub in Tokyo,
Japan where the hosts are women who have chosen to live as men.
They can only make their living as hosts in a nightclub with other
'wannabes' like them.
TARSHI. Basics and Beyond
SIXTH HAPPINESS (ENGLISH), 1997
APPENDICES
TALES OF THE NIGHT FAIRIES (BANGLA - ENGLISH SUBTITLES),
Director: Warris Hussein, 98 minutes
2003
Disabled activist Firdaus Kanga scripted this autobiographical British
drama based on his novel, Trying to Grow about romantic and other
challenges he faced growing up with brittle bone disease in a middle
class Bombay family.
Director: Shohini Ghosh, 74 minutes
Five sex workers - four women and one man - along with the
filmmaker/narrator embark on a journey of storytelling. The film
explores the power of collective organising and resistance while
reflecting upon contemporary debates around sex work.
STRAIGHT FOR THE MONEY (ENGLISH), 1994
Director: Hima B., 60 minutes
TRANSAMERICA (ENGLISH), 2005
Hima B. interviews eight lesbian and bisexual women in San Francisco
- lap-dancers and peep-show dancers in strip clubs - who talk about
their motivations, aspirations, and identities as queer women whose
jobs make them 'straight for the money.'
A pre-operative male-to-female transsexual takes an unexpected
journey when she learns that she fathered a son, now a teenage
runaway hustling on the streets of New York.
THE SNAKE BOY, (CHINESE - ENGLISH SUBTITLES), 2002
THE TWIN BRACELETS (CANTONESE - ENGLISH SUBTITLES),
Director: Duncan Tucker, 103 minutes
Director: Michelle Chen, Xiao Li, 60 minutes
1990
The story of a homosexual jazz musician in Shanghai, who comes to
terms with his sexuality and his music.
Director: Yu-Shan Huang, 100 minutes
SOMETHING LIKE A WAR (ENGLISH), 1991
A young woman in an oppressive Chinese fishing village seeks love
and escape in the arms of her childhood girlfriend against a backdrop
of customs and mores that treat women as property with no human
rights.
Director: Deepa Dhanraj, 60 minutes
A documentary about the Indian government's family planning
programme and the consequent violations of women's reproductive
rights.
TWINKLE [KIRA KIRA HIKARU] (JAPANESE - ENGLISH
SUBTITLES), 1992
Director: George Matusoka, 103 minutes
SPACKED OUT [MO YAN KA SAI] (CANTONESE - ENGLISH
SUBTITLES), 2000
Director: Lawrence Ah Mon, 91 minutes
A documentary style film about four teenage girls in Hong Kong,
who spend their time shopping, partying, and experimenting with
sex and drugs until trouble strikes and harsh reality sets in.
The story about a woman and a gay doctor who decide on a marriage
of convenience to satisfy their parents. The arrangement falls apart
when the doctor's student boyfriend becomes jealous, the woman
decides she wants to have a baby, and her parents find out about
her husband's homosexuality.
TWO OR THREE THINGS I KNOW ABOUT THEM (CANTONESE ENGLISH SUBTITLES), 1991
SUGAR SWEET (JAPANESE - ENGLISH SUBTITLES), 2002
Director: Anson Mak, 39 minutes
Director: Desiree Lim, 67 minutes
An experimental four-part video that deals with the issues and
concerns of an emerging lesbian community in Hong Kong.
Naomi pays the bills by directing lesbian porn. Her male bosses
think her work is 'too gay'; her friends think she's a sell out. When
she gets a chance to direct a popular matchmaking show and help a
friend suffering lesbian bed death romantic sparks fly.
463
TARSHI: Basics and Beyond
APPENDICES
UNLIMITED GIRLS (HINDI - ENGLISH SUBTITLES), 2002
WHEN FOUR FRIENDS MEET (HINDI - ENGLISH SUBTITLES),
Director: Paromita Vora, 94 minutes
2000
An exploration of engagements with feminism told through diverse
characters in a chat room. The film uses a personally reflective tone
and mixes non-fiction and fiction, to ask questions about feminism
in our lives: why must women lead double lives, being feminist but
not saying they are.
Director: Rahul Roy, 43 minutes.
The film examines views of masculinities and gender roles and
expectations through the eyes of four young working-class men in
New Delhi, India.
YANG + YIN: GENDER IN CHINESE CINEMA (CANTONESE AND
UTSAV (HINDI AND URDU), 1983
MANDARIN - ENGLISH SUBTITLES), 1995
Director: Girish Karnad, 145 minutes
Director: Stanley Kwan, 80 minutes
The film is based on the 6th century A.D. Sanskrit play The Golden
Toy Chariot' by the famous Indian playwright Bhasa. It is the story
of a palace courtesan who falls in love with a married and penniless
man while hiding from the amorous attentions of the king's brotherin-law.
This documentary shows how gender and sexuality are dealt with
in Chinese movies. The film examines male bonding and phallic
imagery; same-sex bonding and physical intimacy; and the
phenomenon of Yam Kim-Fai, a Hong Kong actress who spent her
life portraying men on and off the screen.
THE VIENNA TRIBUNAL (ENGLISH), 1994
Director: Gerry Rogers, 48 minutes
The film highlights personal testimonies at the Global Tribunal on
Violations of Women's Rights which was held in conjunction with
U.N. World Conference on Human Rights in Vienna in 1993. It makes
a powerful case for why women’s rights need to be seen as human
rights.
VIVA L’AMOUR (MANDARIN - ENGLISH SUBTITLES), 1994
Director: Tsai Ming-Liang, 119 minutes
This film is about a seductive real estate agent, a street merchant,
and their encounters in one of the thousands of vacant, anonymous
apartments that fill Taipei, Taiwan, while a shy young gay man
spies on the couple, creating a love triangle.
SOURCES:
THE WEDDING BANQUET (ENGLISH AND MANDARIN - FRENCH
SUBTITLES), 1993
www.geocities.com/WestHollywood/Heights/5010/
wfilms.html
Director: Ang Lee, 104 minutes
www.jagori.com
To satisfy his nagging parents, a gay landlord and a female tenant
agree to a marriage of convenience, but his parents arrive to visit
and things get out of hand.
www.solarispictures.com/ga.htm
www.us.imdb.com/search
www.hkmdb.com
www.bayswan.org/swfest/tales.html
http://www.imdb.com/
www.infochangeindia.org/documentary
www.longyangclub.org/denver/qac/s/qacs.html
464
TARSHI (Talking About Reproductive and Sexual Health Issuesl is a not-for-profit organization
based in New Delhi, India, that works on issues of sexuality and reproductive health. TARSHI
believes that 'all people have the right to sexual wellbeing and to a self-affirming and enjoyable
sexuality'. TARSHI works towards expanding sexual and reproductive choices in people's lives in
an effort to enable them to enjoy lives of dignity, freedom from fear, infection, and reproductive
and sexual health problems. TARSHI works towards achieving this vision through the following:
The Helpline: Provides information, counselling, and referrals on sexuality and sexual and
reproductive health issues
Public Education: Through publications, public events, campaigns and sessions in schools and
colleges, raises awareness of sexuality and rights issues
Training: On helpline counselling skills and on sexuality, reproductive health and rights issues
The Sexuality and Rights Institute: An annual two-week long conceptual course focusing on the
interface between sexuality and rights, conducted in collaboration with CREA (Creating
Resources for Empowerment in Actionl. For more, please visit www.sexualityinstitute.org
The South and Southeast Asia Resource Centre on Sexuality: Increases knowledge and
scholarship on issues of sexuality and sexual health and sexual well being in the South and
Southeast Asia region. For more, please visit www.asiasrc.org
TARSHI
Administrative office: 11, Mathura Road, 1st Floor, Jangpura B, New Delhi 110 014, India
Phone and fax: 91-11-2437 9070, 91- 11- 2437 9071. Helpline: 91-11-2437 2229
Email: tarshi@vsnl.com. Website: www.tarshi.net
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