Embracing Diversity in Perspectives, by Diego Solares

Just the other day I arrived at the office to find a pile of faux-leather handbags strewn across the floor. Around the pile sat several women in Saris carefully applying brown paint onto a design printed on each bag. I picked up one of the finished products and was able to make out, underneath the fresh paint, an image of a woman holding a female condom with “Pleasure, Power, Respect” written underneath.

“Why are they painting over the design?” I asked one of my colleagues.

“Because we want to sell the bags to women in the community and they don’t like what it says. No one will buy them like this.”

“They’re embarrassed of it?” I asked.

“Huh, yes,” he responded with a smirk.

The early days of the AIDS pandemic taught us a costly lesson about the harms of sexual conservatism. Across the world, AIDS ravaged entire communities of sex workers and networks of men who have sex with men. Bureaucrats and the public alike cringed and giggled at talk of condoms and lubricant; almost as much as they condemned their lifestyles. But eventually, it was the activists, epidemiologists and health workers—tired of attending funerals and losing friends—that convinced enough people to engage in frank discussions about sex in the interest of saving lives.

It was this approach that led to significant reductions in HIV transmission in several countries. In Brazil, people dressed as enormous condoms paraded through Carnaval; and in Thailand, outdoor games that involved inflated condoms were introduced in villages. It desensitized the public to sex enough that it enabled a rise in condom use and the provision of progressive sex education.

Sex workers, however, face the additional challenges of abuse, exploitation and stigma-induced neglect. For this reason, several interventions in red light areas around the world paired discussions about sex with efforts to promote empowerment, human rights and the right to sex work. Before long, this “empowerment” model became one of many sacred cows in the field of global health; sacred cows that are, of course, never to be challenged. And so guidelines, pamphlets, t-shirts and handbags produced everywhere from Geneva and Bangkok to Washington D.C. and Stockholm were exported to red light areas in poor countries across the world. It became disadvantageous over time (especially with regards to fundraising) to resist these sorts of efforts.

I arrived in India six months ago a proponent of this school of thought. While I continue— perhaps even more than before—to appreciate the harms of sexual conservatism and moral policing, I have learned what a disservice to the community it could be to hush dissent, even when it dares to challenge a sacred cow.

Those handbags, cleansed of their provocative messages, were not the first example of this happening. Months ago, a popular organization focused on promoting the right to sex work visited Saheli to conduct a workshop on how to be more economically productive as a sex worker. The idea of promoting sex work so forthrightly horrified several of the attendees and the organization was never invited back.

Community participation is another sacred cow in global health, one that I am committed to furthering. And representativeness in programming, one of the purposes of ensuring participation, is achieved only through embracing community perspectives, diverse or unexpected as they may be.

The truth is that there are sex workers that are ashamed of what they do and embarrassed by the topic of sex. They may have been trafficked into sex work or simply pressured to enter the trade due to financial need; and because of stigma, illiteracy and debt bondage, leaving the trade is only a distant possibility.

This is why exporting empowerment in this community hasn’t worked. For one organization to represent a thousand sex workers is a daunting task, especially when where one stands on the issue is subject to an immense range of individual experiences. The controversial nature of sex work seems to have polarized debate. And when one side is poor and disenfranchised, power dynamics inadvertently silence dissent. At the end of the day, anti-prostitution arguments appear nuanced while “the sex worker perspective” appears simple.

As satisfying as it would have been to find myself at an organization committed to protecting the right to sex work, I am grateful for what I have learned at Saheli. And for all the community’s ideological divisions, it is united against AIDS. The challenge of AIDS drove the community to collectivize in 1996; and through it still lies an opportunity to improve the health and human rights of the community.

But until health and social welfare organizations discover a way to promote respect for individuals’ choices without compromising those with little choice in the matter, “empowerment handbags” will continue to be censored.

- Diego Solares

Roj Nishale Jaiye (We all go to school everyday), by Diane Coffey

Greetings from Kutch! My name is Diane and I’ve spent the past five months living and working in a rural district of western Gujarat called Kutch. Though not physically separated from India, Kutch is often compared to an island. It is cut off from the rest of the state by water and by vast expanses of salty desert. It is also isolated in terms of language; most of the people speak Kucchi, an unwritten language spoken nowhere else in India. It is common for Indian government officials posted in Kutch to consider the region a “hardship” or a “punishment” posting.

While it is true that working in Kutch has left me feeling isolated, I have found Kutch to be the friendliest and most peaceful place I’ve ever lived. In addition, the landscape and the seascape are often downright stunning. Finally, it is a fascinating place to witness a variety of development issues from migration and industrialization to agriculture, water provision and education.

One of the most disadvantaged groups in the district is the seasonal migrant workers who come from in and around Kutch in search of a livelihood. Most of Kutch’s migrant workers are engaged in salt production, though smaller groups of migrants also engage in fishing, animal husbandry and other activities. The children of migrant workers have no access to formal education during the migration period.

The NGO with which I have been placed tries to establish schools at the sites where migrants live and work. During my time in Kutch, I have been involved in a project to improve attendance at the schools. It has provided me with the opportunity to work in the area of monitoring and evaluation. There are many activities that fall under the umbrella of M & E, as it is often abbreviated; my project falls into the category of “impact evaluation.” An impact evaluation asks the question: “How is the outcome of a program different from what would have happened without the program?”

Before I get into the thick of how to do an impact evaluation, let me tell you a little about the attendance program I’ve implemented.

Considering the low level of financial and human resources of the NGO with which I work, I decided on a very simple program based on psychology. The program consists of giving each teacher a hand-made megaphone and teaching her students a song to encourage them to attend school regularly. Each day, a different student is assigned to bring the megaphone home and to sing the song into it the next morning on his way to school.

While this may seem like an unconventional idea, it makes use of the psychological principles of self-signaling and social proof to create habits and social norms around going to school when none exist. Firstly, the child who uses the megaphone is making an effort to show others that she goes to school. Often, when we exert effort for some goal, we believe ourselves to value it more. Therefore, the child who uses the megaphone and sings the song may come to believe that school is an important part of his life. Secondly, we implicitly think that the actions of other people in our community are reasonable. So if children see another child going to school they may be more likely to go also.

While the megaphone program sounds like it may work on paper, I don’t whether it will work in reality. So, I decided to build “impact evaluation” into the implementation. If the impact evaluation shows that it works, I will recommend the program, or something similar, to other NGOs working in education.

The kind of impact evaluation I am doing to test the effect of the megaphones is called a “randomized controlled experiment.” Like an experiment in the physical sciences, a randomized controlled experiment used for impact evaluation measures the difference between a control and an experimental group to estimate the effect of the program.

Therefore, I randomly assigned the NGO’s 35 schools to either the experimental or the control group, and only implemented the program in the experimental schools. Before the end of the school year, I will show up unannounced to each of the schools and take attendance. I will compare these attendance figures to a baseline measurement of attendance that I took before implementing the program. Specifically, I will try to see whether there has been an improvement in the experimental schools that did not occur in the control schools.

If the megaphone program works, it will be a low-cost way for NGOs and governments to encourage more children to attend school. It will also provide support for the idea that social norms and habits around school-going are an important missing link in the education of extremely poor children.

- Diane Coffey