Speakers:
Prof William Stones, Senior Lecturer in Obstetrics and Gynaecology, School of Medicine, University of Southampton
Dr Liz Watson, University Lecturer, Department of Geography and Fellow of Newnham College, University of Cambridge

Chair:

Nicola Jones, Research Fellow, RAPID Programme, ODI

1. Nicola Jones, in the chair, provided a brief background to the issues which would be under discussion:
i. How researchers can better communicate their research from the start of the project through to its conclusion.
ii. What incentive structures exist for researchers to ensure that their work has an impact on policy and practice.
iii. What role NGOs could play in taking forward changes in policy and practice as a result of research findings.
iv. Exploring the case for increased funding for knowledge management to ensure that more people have access to research findings.

2. She then introduced Prof William Stones, Senior Lecturer in Obstetrics and Gynaecology at the University of Southampton, and author of ‘Integration of HIV, Health and Family Planning Services’.


Prof William Stones

3. Prof Stones explained that time intervals between births are associated with child survival in the developing world. He asserted that it might be anticipated that the use of contraception would lengthen time intervals between births. Stones investigated the association between the use of reversible contraception and short birth intervals in sub-Saharan Africa, using logistic regression techniques.

4. He discovered that in countries where the use of reversible contraception was high, there were very small changes in the percentage of short birth intervals between survey rounds. Some countries recorded an increase in short birth intervals while others saw a decrease.

5. Stones concluded that reversible contraceptives actually play a limited role in decreasing the occurrence of short birth intervals in the developing world. Breastfeeding remains the overwhelming influence on the length of birth intervals.

6. Paradoxically, the increased use of injectable contraception is associated with greater odds of a short birth interval.

7. Stones then shifted his focus to India, where he had researched the relationship between India’s well-established family planning infrastructure and HIV awareness. The main question he asked was, ‘To what extent was the family planning infrastructure also a resource for disseminating information and services relating to HIV?’

8. His research findings indicated that:

i. Female sterilization is the most popular method of family planning in India.
ii. Sterile women no longer require the services of India’s family planning workers.
iii. Because family planning workers who disseminate information about HIV/AIDS will not come in contact with sterile women, these women are unaware of the dangers of HIV/AIDS, as well as the most effective prevention techniques.
iv. 38% of women in rural India lacked any knowledge of HIV/AIDS. These women were not in need of family planning services.
v. 58% of rural Indian women were unaware that a condom could be used to prevent the transmission of HIV/AIDS.
vi. In all, this amounted to 68 million sterilized women who no longer required family planning services, and who were unaware of HIV/AIDS as well as preventative measures that could be taken against contraction of the virus.
vii. The largest lesson learned from the research: Sterilized women in India are a major risk group.

9 . Stones then moved to his second research project, which focused on the attitudes of Nepalese men towards reproductive health and family life. The research findings indicated that:

i. Nepalese society is rapidly changing, as evidenced by the recent legalization of abortion.
ii. Age, caste, and accessibility to media were critical in formulating the attitudes of Nepalese men towards reproductive health.
iii. The biggest challenge for reproductive health advocates is to reach the large number of people who could be referred to as the ‘media underclass’, i.e. those who have very limited access to literature, news publications, or television.

10. Stones then introduced his final research project, which focused on unintended pregnancies in research contexts. Women who participate in research trials of this kind are strongly advised not to get pregnant, they receive contraceptive advice, and also go through a course about HIV prevention. A large amount of these women became pregnant anyway. Numbers of pregnancies are extremely large in West African research programmes especially, despite the efforts of research institutions. Such pregnancies have major implications for research programming. Stones offered the following suggestions to reduce this trend:

i. Maximise men’s involvement in research.
ii. Identify the ‘media underclass’ and develop specific strategies for reaching this group of people.
iii. Identify synergies between family planning and HIV prevention, but also any gaps that might exist.
iv. Focus on ‘joined-up’ systems based on the priciples of reproductive health rather than single modes of contraception.


Dr Liz Watson

11. Dr Watson examined Natural Resource Systems Programme (NRSP) projects in India and Ghana. The findings of her research indicated that there was a lack of consideration of gender issues in the NRSPs.

12. She conceded that new research on gender can be risky, and some researchers mistakenly view the issue of gender as something that has already been sufficiently ‘dealt with’ or mainstreamed.

13. To illustrate the importance of gender issues, Watson examined research completed in the so-called ‘Front-Line Demonstrations’ (FLDS) in India. The FLDS were conducted by natural scientists, social scientists, researchers, and NGO representatives from the North who were studying the farming methods of rural Indian farmers. Their collective research sought to identify technical and scientific practices that could improve the lives of Indian farmers. An important omission from the research however, was the critical role played by gender played in these Indian societies.

14. The rural Indian women tended to play more supportive roles, such as agricultural planning, planting, weeding, and harvesting, while the men did the ploughing and field operations.

15. Watson identified many problems with FLDS’s neglect of the role of gender:

i. It failed to acknowledge the importance of the complimentary nature of gender roles in that specific society.
ii. It did not recognise the variability of tasks.
iii. It did not recognise the supportive role that women played in natural resource management.

16. Watson suggested that FLDS research missed these vital insights because there were too many dissimilar agendas guiding the research. The natural scientists and social scientists especially had different perspectives concerning gender stratification, so the issue of gender was ommitted altogether.

17. Watson recommended the following changes to improve future research programmes:

i. More and better dialogue between the different disciplines of researchers involved in a research programme.
ii. More explicit discussions of the research aims with specific regard to gender issues.
iii. Programmes should seek to tackle issues that are too often dismissed as ‘too complicated', 'too political', 'matters of local tradition', or 'beyond our remit’.


Discussion

18. Comments and questions raised during the discussion included:

• The international reproductive health agenda is in decline, resulting in the serious under-use of a potentially very useful programme.
• There are serious limitations to the way gender can be incorporated into humanitarian research.
• Attention should be given to the injustices inherent in ‘subsistence existence’. Women in developing countries cannot escape the harsh realities of rural life, and as long as the economy remains dependent on agriculture, female subservience will continue. Northern institutions should consider the merits of much bigger and far-reaching societal and economic transformations so that poorer countries can industrialise.
• Gender dynamics are clearly an issue in HIV prevention. The virus disproportionately affects older men and younger women. Gender issues have to be and should be an integral component of HIV prevention efforts.