Gender power dynamics in sexual and reproductive health. A qualitative study in Chiredzi District, Zimbabwe

Sammanfattning: This thesis presents perspectives of men regarding abortion, contraceptive use and sexuality. Contrary to what we had expected, men expressed anxiety over abortion and contraceptive use, not because the issues concerned women’s health, but rather because men associated them with extramarital sexual activity they thought women were concealing. To understand the meanings of sexuality and factors shaping these meanings appeared to be a necessary step in promoting women’s health. We thus included in the study participants with different characteristics including men, women and adolescents, and used a variety of qualitative methods to explore in-depth these issues.Men’s anxiety over wives’ sexuality seemed to be exacerbated by their separation from the family through labour migration, and their inability to play the expected role of the family breadwinner. The men described using different strategies to ensure their wives did not use contraceptives. Men’s perspectives and the related dynamics seem therefore to be a manifestation of contradictory experiences of gender power within contexts of spousal separation.The thesis also illuminates the paradoxical situation of adolescents and adolescent sexual and reproductive health. As guardians, the men described how they are intolerant to premarital sex and pregnancy, which might threaten the expected bride wealth from the marriage of a daughter or sister. They therefore respond with violence. Ironically, information or service which would enable unmarried girls to prevent pregnancy is also denied. This is so in spite of the great concern by families over premarital pregnancy, and common knowledge that young girls are sexually abused by adult men. The men and boys described the pressure they exert on the girls for sex, but also how they then blame the girls for deliberately becoming pregnant in order to trap them into marriage. The boys are nevertheless anxious about pregnancy also for fear of family violence and the threat of being forced to terminate schooling. The girls expressed feeling trapped between the violence from guardians and partners, a situation which may lead to unsafe abortion.The silence, denial and violence imply the young people generally cannot discuss sexual abuse or abortion with parents, or seek health care when needed. Rather, sexually transmitted infections may be ndured or even self-treated, and abortion sought in silence. Preventive actions such as condom use are similarly difficult for the youth. The knowledge the youth may have about AIDS may also simply become a burden when room for applying it is limited.This thesis challenges public health promotion approaches that assume firstly a universal manifestation of gender power, and secondly ability of individuals to effect behaviour change once provided with information regardless of contextual factors. Whether in AIDS education or involvement of men in sexual and reproductive health, understanding social contexts and dynamics, and identities and experiences within these contexts is crucial.