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Gender, Sex and Power Inquiry

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In Phase III of the SII, six country offices engaged in an inquiry on gender, sex and power, to understand women’s empowerment, its relationship with vulnerability to HIV and the association of both to CARE programming. The study focused on CARE’s work with sex workers in Bangladesh, India, Peru and Cambodia, garment workers in Lesotho and rural women living in post-conflict Burundi.

Due to the challenges in finding beneficiaries and respondents among the sex worker community, most of the studies used convenience sampling based on who was available and identifiable for the research.

This phase of research followed three broad stages:

 Planning and Preparations

To design a framework for analysis that remained relevant across the six countries, but still could weave together to build a global story, country teams and the study's coordinators met to develop a minimum core research design framework.

Based on the contexts and interventions across each country program, all country teams agreed upon the following core elements:

Context Analysis
  1. Identify the range of vulnerability factors
  2. Identify the enablers and barriers to empowerment
  3. Identify other influences
    • Structural factors- factors beyond CARE’s influence
    • Donor modalities- how donors fund and what influence that has on your intervention
Project Intervention Strategies
  • Collectivization (solidarity groups, self help groups, etc.): Unpacking the power of these groups and what influence this has on empowering women. How they are working and what are the effects?
    • Unpacking the group dynamics and the intensity of the interventions
  • Influencing influential actors- Many of the countries engage people of power as part of their interventions ex. Pimps, madams, brothel owners, and private sector.
  • Improving relationships between couples- common in all countries are the relationships between couples and how that may make women vulnerable. 
  • Education of women and their rights- through the groups, training

Research Themes/Domains

  • Indicators of Empowerment:
    • Knowledge of rights awareness and exerting choice and decisions for self
    • Addressing stigma (including self stigma): Access to services, Seeking justice from State agencies such as the police
    • Relationships: sexual negotiations, especially safe sex with spouse/partners and clients
  • Indicators of HIV risk:
    • Use of health services. (VCT, STI, ARVs etc)
    • Control/ management over quality of services

Each areas, collectively agreed upon, were then further refined in the Global Research Design Framework for the Gender, Sex and Power developed by ICRW.

To provide continued support and guidance to each country team, each team also linked with a 'buddy' throughout the course of the study.

 Formative Research

In the first stage, teams explored participant’s perspectives on issues such as women’s empowerment and vulnerability. Further teams examined existing data through:

In Bangladesh, Cambodia, India, and Peru, the team deepened their formative research with:

facing sex workers.

 Closed/Semi-Structured Interviews

To gather data about women’s empowerment and vulnerability as well as help triangulate information, the study conducted:

This stage helped to gather demographic information and information on the core sub-domains of empowerment from the study among women and men with varying degrees of exposure to the project intervention, to provide a basis of comparative analysis.

In Burundi, the semi-structured interview guide was developed around:

In Peru, this involved the use of

Generally, semi-structured interviews covered:

  • Background demographic and socio-economic information: age, education, marital status, household situation, religion, intimate relationships, work situation, income and sources, expenses
  • Participation in intervention: duration of involvement in CARE, role within project, services utilized, membership in groups;
  • HIV awareness and testing: knowledge about HIV and how it is transmitted, knowledge about how to protect oneself against sexually transmitted infections, ability to negotiate condom use effectively, perceptions/stigma toward HIV, knowledge on where to go to get tested for HIV/STI, use of testing services in the past 12 months, knowledge of test results, use of STI/HIV treatment services, reasons for not seeking services for STIs/HIV, type of medical services accessed, satisfaction with services;
  • Decision-making in sexual relationships: frequency of condom use, reasons for not using condoms, confidence buying condoms, confidence negotiating condom use with partners, negotiation about whether or not to have sex, ability to refuse sex, domestic violence or forced sex;
  • Individual agency: Household decision-making, use of income, access to financial services, limitations in mobility, exposure to violence against women, social support network if exposed to violence, actions taken against offenders of violence, problems faced in everyday life, capability to solve problems, ability to influence husband/partner’s decision-making, ability to influence important decisions in community, aspirations for the future;
  • Group agency: Sense of group belonging, influence with community leaders/authorities, sense or respect within the group, trust in group leaders;
  • Relations: ability to negotiate with clients about services, ability to talk with influential people within the community;
  • Structures: Ability to seek justice against violence against women from police or those with power, ability to protest against perpetrators, ability to send children to school, awareness of existing services available in community, ability to pursue one’s rights/justice;
  • Gender equality beliefs: stigma and discrimination toward sex work, attitudes toward violence against women, perceptions of women’s roles and rights outside the home, beliefs toward women’s ability to lead, values toward women owning/controlling land and property, importance of women’s voices in community decision-making

From the participatory components of this study, CARE also developed a set of participatory analysis tools to understand dynamics of gender, power and decision-making over sexual relations. These have been published in:

These tools include:

  • Decision-making Tools:
    • on sexual relations and
    • negotiation of condom use
  • Body Mapping: to explore women's attitudes and feelings in regard to various types of sexual relationships.

 In-Depth Interviews

Finally, teams gathered and explored information about the relationships between the project, women’s empowerment and vulnerability to HIV through in-depth interviews. This involved:
  • Asking how women attribute changes in empowerment and vulnerability to HIV;
  • Exploring what else was happening at that time that may explain changes in women’s empowerment;
  • Gaining a better understanding of key relationships in women’s lives; and
  • Analyzing how CARE’s organizational approaches, particularly group approaches, and staff affected the planning and implementation of the project.

 Leveraging Research

From its conception, the multi-country study on group organizing approaches and their impact on HIV vulnerability and women’s empowerment aimed to influence policy-makers at global and national levels.

To link to broader policy discussions, the SII team coordinated to share findings and lessons in international forums and publications on gender and HIV/AIDS to:

Influence policy

  • Initial findings from the study where shared with organizations and professionals focused on working with HIV/AIDS at the International AIDS Conference (Mexico City, 2008)
  • Given the analysis and its findings, UNAIDS invited CARE to a working group of experts and practitioners and present its experiences with self-help groups and other empowerment interventions to address gender-based violence and HIV among sex workers. The study and key lessons were then highlighted in a UNAIDS-WHO report on promising practices in addressing violence against women and HIV/AIDS (Geneva, 2009)
  • The SII coordination team also successfully submitted an abstract to present and share lessons on migration, sexuality, vulnerability and HIV/AIDS based on the study in Lesotho at the fourth annual Sexuality and HIV/AIDS in Africa Conference (Addis Ababa, 2010).

Provide Guidance and Lessoners to Peers and Other Working in the Field 

  • In an event co-sponsored by UNAIDS, CARE partners and staff from the Bangladesh team shared their experiences and lessons learned in group mobilizing, HIV/AIDS programming and women’s empowerment at the annual Commission on the Status of Women conference held at the United Nations Headquarters (New York, 2009)
  • CARE organized a session and presented the SII research to share key findings and recommendations with researchers, professionals and practitioners at the International Association for the Study of Sexuality, Culture and Society Conference. The report was then published in the Culture, Health & Sexuality Journal for Research, Intervention and care as a resource for others working in the field (Hanoi, 2009).
  • Based on SII lessons, CARE developed a self-assessment checklist that is now part of the NGO Code of Good Practice to ensure that addressing inequities between men and women remains a foundation in interventions aimed to reduce vulnerability to HIV (www.hivcode.org).

 Lesson Learnt

This research pushed research teams to deepen their understanding of the social, political and economic dynamics – public and private – underlying women’s empowerment. The initiative challenged teams to probe into women’s attitudes around sexuality, reproduction and choice, as well as vulnerability to HIV. Findings reinforced the importance of engaging men for women’s empowerment, the fundamentality of trust and love to women’s empowerment, and the power of community-led mobilization and advocacy to support women to assert their rights.

The process of undertaking such a multi-country study also surfaced a number of lessons:

  • Prepare teams to confront assumptions, reflect on power in their own lives, and develop skills in research and analysis: Throughout this process, research teams were challenged to confront assumptions held about sex workers, HIV, power structures within society – and their own positions within these social structures. In addition, the experience challenged research teams – comprised of partners and staff – to conduct research and analysis to critically reflect on the groups with whom they work, their context, and the roles of project initiatives. Such truly reflective learning requires us as researchers to step out of routines and habits, and to be willing to expose vulnerabilities by admitting mistakes, and exploring new ideas and taking risks to try new things. This requires an organizational culture and structure that provides space for learning and rewards these qualities.
  • Monitor quality: In addition to preparation, it is critical for a lead coordinator to ensure careful quality control of the data.
  • Integrate learning as part of programming: Further, engaging staff in research, requires management of motivation for the work and the integration of research demands with project activities / responsibilities. Teams must be realistic in balancing project tasks and research initiatives. Further, team leads should be sensitive to and maintain energy levels among the team.
  • Facilitate Learning across Contexts: Participants found the cross-country learning and exchanges that comprised the research as transformative for their work and understanding. Not only did country teams learn a great deal about their own context, but the multi-country nature of the study also fostered important space for country teams to learn from one another – through weekly teleconferences, planning meetings, and visits – and build a coherent/robust framework to think about the complex and diverse dynamics around gender, sex and power.
  • Leverage learning from research: the global story and its implications on interventions served as an important resource for CARE to build visibility of key projects and frame advocacy to influence policy nationally, and globally. In addition to using the research toward influencing broader policy, CARE Burundi held meetings with participating communities to discuss the study’s findings. These meetings helped not only validate research, but also delve into deeper discussions with community members to leverage everyone’s learning about sensitive issues and factors driving them. Across country offices, key lessons highlighted that country teams must strategically plan how to leverage research and findings to inform their work and how they do programming.

 Case Studies

Gender Sex and PowerUse SHIFT+ENTER to open the menu (new window).
An impact study on women's empowerment, HIV vulnerability, and programming in Bangladesh, Burundi, Cambodia, India, Lesotho and Peru.
UCP StudiesUse SHIFT+ENTER to open the menu (new window).
A participatory learning and action exercise to understand poverty dynamics, identify impact groups and design programs. This work was developed in Bangladesh and Nepal, and replicated in Somaliland, South Sudan, Tanzania and Uganda.
Men and BoysUse SHIFT+ENTER to open the menu (new window).
This study worked with young men in the Balkans to deconstruct the definition of masculinity in terms of gender norms, socialization and attitudes toward women.
LAC Analysis for Program DevelopmentUse SHIFT+ENTER to open the menu (new window).
This inquiry explored how CARE can best influence broader change for women's rights by engaging activists on program design and strategies.

 Resources

  • CARE, with Mutengo Consulting (2009). River of Risk Toolkit. Available on: CARE India Website
  • J Iredale and D Ntacobakinvuna (2009). Gender, Sex and Power: The Implications of Empowering Women at Risk of HIV and AIDS. CARE International – Burundi. Available at CARE’s Women’s Empowerment Strategic Impact Inquiry Library: http://pqdl.care.org/sii/SIILibrary/Forms/Africa.aspx
  • CARE International – India (2008). Gender, Sex and Power: Understanding Implications of Empowering Women at Risk of HIV/AIDS. Available at CARE’s Women’s Empowerment Strategic Impact Inquiry Library: http://pqdl.care.org/sii/SIILibrary/Forms/Asia.aspx.
  • CARE International – Peru (2008). Strategic Impact Inquiry on Sexual Worker’s Empowerment. Available at CARE’s Women’s Empowerment Strategic Impact Inquiry Library: http://pqdl.care.org/sii/SIILibrary/Forms/Latin%20America.aspx.
  • M Logarta, S Heng and R Long (2008). Gender, Sex and the Power to Survive: The Impact and Implications of Empowering Women at Risk of HIV/AIDS – Project on Sex Workers’ HIV/AIDS Reduction, Advocacy, Facilitation and Empowerment (SAFE). CARE International – Cambodia. Available at CARE’s Women’s Empowerment Strategic Impact Inquiry Library: http://pqdl.care.org/sii/SIILibrary/Forms/Asia.aspx.
  • M Makoae and Z Mokomane (2008) Examining Women’s Vulnerability to HIV Transmission and the Impact of AIDS: The role of peer education/peer support in Lesotho’s garment industry. CARE International – Lesotho and Human Sciences Research Council. Available at CARE’s Women’s Empowerment Strategic Impact Inquiry Library: http://pqdl.care.org/sii/SIILibrary/Forms/Africa.aspx.
  • V Robinson (2008). Context and Power in Sex Work in Bangladesh: An inquiry into empowerment and HIV risk reduction among sex workers in Dhaka and Tangail. CARE International – Bangladesh. Available at CARE’s Women’s Empowerment Strategic Impact Inquiry Library: http://pqdl.care.org/sii/SIILibrary/Forms/Asia.aspx.
  • CARE International - USA (2007). Gender, Sex and the Power to Survive:
    Impact and implications of empowering women at risk of HIV and AIDS . Design Workshop Report. October 23-26, 2007: New Delhi, India.
  • CARE International – USA (2007). Gender, Sex and the Power to Survive: the impact and implications of empowering women at risk of HIV and AIDS, Global Research Design Framework. Available at Module 4 of CARE’s Women’s Empowerment Strategic Impact Inquiry: http://pqdl.care.org/sii/pages/methods.aspx.
  • V Robinson (2007). Life, Philosophy and Poetry: Reflection and Learning in CARE Bangladesh HIV Program. CARE International – Bangladesh.

 Gender and Analysis Contacts

Victoria Baffigo Torre
Program CoordinatorUse SHIFT+ENTER to open the menu (new window).
CARE International - PeruLatin Americavbaffigo
LeahBerkowitz Nchabeleng
ACD-ProgramUse SHIFT+ENTER to open the menu (new window).
CARE International - South AfricaSub-Saharan Africaleah.berkowitz
NabeshBohidar
Monitoring and Evaluation ManagerUse SHIFT+ENTER to open the menu (new window).
CARE Intenational - IndiaAsianbohidar
SocheatChi
Reproductive Health ManagerUse SHIFT+ENTER to open the menu (new window).
Asia
ZayidDouglas
Program Associate on Gender and HIVUse SHIFT+ENTER to open the menu (new window).
International Center for Research on WomenGlobalhttp://www.icrw.org/
MichaelDrinkwater
Senior Partner, ConsultantUse SHIFT+ENTER to open the menu (new window).
WayFair Ltd.Globalwww.way-fair.com
PaulaGleeson
Regional Technical Support Manager at Khmer HIV AIDS Use SHIFT+ENTER to open the menu (new window).
HIV/AIDS AllianceAsia
TheresaHwang
Gender DirectorUse SHIFT+ENTER to open the menu (new window).
CARE International - USAGlobalthwang
JaneIredale
ACD-ProgramUse SHIFT+ENTER to open the menu (new window).
CARE International - MaliSub-Saharan Africajane.iredale
JodiKeyserling
Policy AnalystUse SHIFT+ENTER to open the menu (new window).
CARE International - USAGlobaljkeyserling
AnthonyKlouda
International Health and Development ConsultantUse SHIFT+ENTER to open the menu (new window).
Globalhttp://www.klouda.co.uk
MercedesLogarta
Research ConsultantUse SHIFT+ENTER to open the menu (new window).
Asia
MokhantsoMakoae
Research Specialist: Child, Youth, Family and Social DevelopmentUse SHIFT+ENTER to open the menu (new window).
Human Sciences Research CouncilSub-Saharan Africa--
ElisaMartínez
Development Researcher and Advisor - Gender JusticeUse SHIFT+ENTER to open the menu (new window).
Globalhttp://www.linkedin.com/pub/elisa-martinez/4/a11/519
PalesaNdabe
Research CoordinatorUse SHIFT+ENTER to open the menu (new window).
CARE International - LesothoSub-Saharan Africapndabe
DomitilleNtacobakinvuna
Learning CoordinatorUse SHIFT+ENTER to open the menu (new window).
CARE International - BurundiSub-Saharan AfricaDomitille.Ntacobakinvuna
VictorRobinson
Conflict, Gender and Development ConsultantUse SHIFT+ENTER to open the menu (new window).
Globalhttp://www.linkedin.com/pub/victor-c-robinson/1/4b6/1b9
AndreaRodericks
Technical Advisor on Women and AgricultureUse SHIFT+ENTER to open the menu (new window).
CARE International - IndiaAsiaarodericks
XimenaSalazar
Executive Coordinator of Population ResearchUse SHIFT+ENTER to open the menu (new window).
Universidad Peruana Cayetano HerediaLatin America
Fatima JahanSeema
Learning and Impact Coordinator, Empowerment UnitUse SHIFT+ENTER to open the menu (new window).
CARE International - BangladeshAsiafatima
JoseSool
Global Health ResearcherUse SHIFT+ENTER to open the menu (new window).
Asia
ReshmaTrasi
HIV, AIDS and Development AdvisorUse SHIFT+ENTER to open the menu (new window).
International Center for Research on WomenGlobalhttp://www.icrw.org/
PennyWard
ConsultantUse SHIFT+ENTER to open the menu (new window).
MutengoSub-Saharan Africahttp://www.mutengo.co.za/
DianaWu
Learning and Analysis ConsultantUse SHIFT+ENTER to open the menu (new window).
WayFair, Ltd.Globalwww.way-fair.com