Power In Sexual Relationships | Page 4

that male involvement
often promotes reproductive health and
that both women and men seek a more
active role for male partners), there are
a number of lessons from interventions
that directly consider questions of gen-
der power.
Men who want to participate face barriers
Although both women and men gener-
ally welcome greater involvement by
male partners in reproductive health
matters, men who attempt to become
involved in women’s or children’s health
may face barriers that arise from norms
about appropriate gender roles. Other
men and family members may react
negatively. Service systems may also be
unwelcoming. Facilities may not have
space for male partners to wait, and
health workers may refuse to allowthem access to labor and obstetrical
wards or to examination rooms. In
some studies, men have reported that
they have been treated rudely or made
to feel that they have no legitimate rea-
son to be there.
Clients want to discuss issues of sexuality
There is significant evidence that clients
are usually relieved and happy to be
asked about their sexual lives by con-
cerned providers. That men and women
are willing to talk about sexual matters,
however, is not to say that they neces-
sarily find it easy. Indeed, it appears that
intensive training of providers (on
issues such as sexuality, gender, and
power) and continuous support follow-
ing training are crucial for effective dis-
cussions with clients.
Intervention models
Blanc categorized intervention approaches
that have acknowledged or attempted to
influence power relations along a con-
tinuum that ranges from the most basic
to the most ambitious:
•Providing clients with information
that explicitly recognizes the role of
partners in reproductive health
choices and outcomes;
•Improving the exchange of informa-
tion between clients and providers
and addressing the context of sexual
relations;
•Promoting peer education and com-
munication;
•Providing the client’s partner with
information and inviting him to par-
ticipate in services;
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•Integrating the dynamics of sexual
relations into services for men; and
•Seeking to change community
norms and practices.
Programmatic challenges
Those who have attempted to develop
programs that influence power rela-
tions in sexual relationships have fre-
quently faced the criticism that gender
relations are a component of “culture,”
which is seen as impermeable to—or
inappropriate for—external interven-
tion. Nevertheless, some programs that
have sensitively addressed deeply
embedded traditional practices and
beliefs have met with success.
One dilemma for programs is how
to honor the desires of women or men
who wish to use family planning in
spite of their partner’s opposition.
Providers need to recognize that legiti-
mate disagreements will exist within
couples, and the relative weight given to
the needs of individuals versus the
needs of the couple must be addressed
with careful consideration of the rights
and responsibilities of each partner.
In many settings, female family
members provide assistance, informa-
tion, and care for pregnant and recent-
ly delivered women. It is important that
there not be any weakening of positive
traditional supports. In some settings,
the extended family’s vested interest in
children can be a strong incentive to
continue childbearing, even if the cou-
ple prefers to limit their family size.
Programs that endeavor to manipulatepower relations within couples need to
acknowledge the full range of actors
who participate in decisionmaking
related to reproductive and sexual
health.
The discomfort of clinic and other
program staff with the discussion of
sensitive topics such as sex and sexual
violence is inevitable. Programs that
have incorporated training on such
topics have encountered some initial
resistance by staff, embarrassment, and
some personal biases that can inhibit
counseling. Yet many programs have
also found that provider discomfort
can be overcome, although it may take
some time and may require ongoing
support for staff.
Methodological challenges
One of the deficiencies of research to
date is the small number of rigorous
quantitative models that specify the
link between gender-based power rela-
tions and sexual and reproductive
health outcomes. Power itself is rarely
measured; thus if a desirable outcome
occurs, it is often not possible to attrib-
ute it to a change in power relations.
Studies that link an intervention to
changes in power, and then to a specif-
ic health outcome, are greatly needed.
Such research has no doubt been
inhibited by the lack of a commonly
accepted definition of power and the
absence of useful and practical meas-
ures of power relations. A number of
methodological approaches to the
measurement of power have been under-
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taken,including measures of the relative
say of partners in decisionmaking, locus
of control, women’s autonomy, and
women’s empowerment. These measures
have been shown to be related to specif-
ic outcomes in some settings. It is not
clear yet whether any of these measures
could be employed outside of the spe-
cific setting in which they were devised.
Major ethical challenges
As noted above, family planning pro-
grams unavoidably confront the issue of
partners who disagree about the use of
contraception or of particular methods,
and the desires of women to use con-
traception secretly. In the area of STI
diagnosis and treatment, partner notifi-
cation programs must consider ques-
tions of confidentiality and protection
of clients. Similarly, screening clients
for gender-based violence and providing
adequate support for those who report
violence require weighing the potential
harm versus the benefits that can be
achieved.
Future priorities
Develop interventions that directly address
the balance of power in sexual relationships
Most important (and challenging) are
the development, implementation, and
evaluation of interventions that directly
and intentionally address the balance of
power within sexual relationships. Such
interventions must include baseline and
follow-up measures of power relations,
difficult as they will be to develop and
validate.
Diversify, scale up, and document
interventions that address power
More documentation from a range of
settings