Power In Sexual Relationships | Page 8

this village when I first came here.
I could not go to visit anybody, was not allowed to go to weddings,
but something magical happened being part of this project. Now I
can go outside the village to the post office, local government, and
district government offices on my own to get things done. Before,
nobody taught me anything, just put restrictions on me. I was liv-
ing for the sake of living. Now I want to live like a human being.
Now I won’t like living like that, and I won’t let anyone else live
like that. People would say, “What is she going to do?” Now the
same people come to me for help. I was not much educated. Now I
have insisted that my sister get educated, and the girls in the village,
too. Now the girls have an opportunity to learn, to play. They say,
“Let’s forget the past. We are not like anybody else.” I will never
forget what the people in this program have taught me.

be seen in the case of condom promotion.
Recent research in Brazil—informed by
masculinity studies—has found that men’s
and boys’ complaints about reduced sexual
pleasure with condoms to a large degree pro-
vide socially acceptable “cover” for a deeperpreoccupation with sexual performance (i.e.,
the reasonable fear of losing one’s erection
while putting it on). Yet we have spent tens
of millions of dollars on condom promotion
campaigns which have completely overlooked
this phenomenon.
13

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The exploration of field-based efforts
began with the presentation of two
programs designed to effect change at
the level of service delivery. The first
described the necessity of addressing
providers’ own dynamics of social
power and power in sexual relationships
as a precondition to enabling them to
assist clients with their own dilemmas.
The second demonstrated that a
demand exists, as does a precedent, for
involving men in certain aspects of
reproductive health, but that providers
and service-delivery systems must adapt
their attitudes and practices to accom-
modate this demand.Empowering clients equals
empowering providers:
An example from Pakistan
(Anrudh Jain and Zeba Sathar)
4
Anrudh Jain and Zeba Sathar, of the
Population Council, described a proj-
ect in Pakistan entitled “Introducing a
Client-Centered Approach to Repro-
ductive Health Services.” The main
objectives of the intervention were to
bring about a change in providers’ atti-
tudes and behaviors, and to empower
clients to become actively involved in
their own reproductive health. The
intervention, which took place in a
poor, rural district in Punjab, heeded
previous research that linked poor
reproductive health outcomes to the
restricted mobility of Pakistani
women, their limited resources, and
their lack of power in the household.
The intervention involved training
95 community health providers work-
ing with the Ministry of Health or
the Ministry of Population and
Welfare. These women were native to
the communities that they served,
and therefore were inhibited by the
same set of constraints as the clients
they served, including limited mobili-
ty and control of their earnings—fac-
tors deemed critical to address in
the training.
WHEN DESIGNINGthe provi-
der training program, the research
team came to understand the diffi-
culty of translating the idea of
“power.” For the purpose of the
intervention, they deemed the
main components of “empower-
ment” to be:
• Knowledge
• Self-confidence
• Negotiating skills
• Awareness
• Communication skills
4For more information on this project, contact Zeba Sathar at [email protected].
FIELD-BASED EFFORTS:
SERVICE DELIVERY

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The objectives of the provider
training were:
•To raise awareness about power and
equality in the providers’ own daily
lives, in the lives of their clients, and
in their interactions with their
clients; and
•To teach them communication
skills that responded to these
power dynamics.
Exercises included mapping sources
of power, discussing alternative ways
to “open a tight fist” besides physical
power, and defining types and grades
of power. The communication skills
training emphasized the need to be
respectful, to assess clients’ reproduc-
tive health needs beyond the immedi-
ate problem (i.e., through asking open-
ended questions), and to address
clients’ domestic realities. Specifically,
providers learned to observe who in
the household held the power (such as
the husband and the mother-in-law);
to be sure to acknowledge his or her
reproductive health intentions as well
as those of the client when negotiating
an appropriate solution; and to ascer-
tain that, at the end of a visit, the
client understood and would be able
to implement the course of action
agreed upon.
From focus group interviews, feed-
back from the trainers, process stud-
ies, and visits by the presenters (the
situation analysis study results are not
yet available), it is apparent that the
training has had significant influenceon both the providers’ private and
professional lives. They report feeling
more confident about moving about
outside of their homes, becoming
more assertive in their own marital
relationships, and taking action
against domestic violence and harass-
ment at work. They also report more
patience with their own children.
Changes in their professional behav-
ior include making deliberate efforts
to be “equal” with their clients (e.g.,
sitting at the same level when they are
in their homes, avoiding one-way lec-
turing, and spending more time with
their clients). They now consider and
address other sources of power, for
example, by dealing with the hus-
band’s influence through the mother-
in-law. Finally, they generally feel
more motivated and excited about
their work.
CHANGES IN ATTITUDE AND BEHAVIOR
become apparent when listening to the women’s words:
Previously we talked in front of everybody, now we judge
who has the power of decisionmaking in the household and then
first talk with them . . . then with the