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Globalizing Facts of Life

Globalizing Facts of Life - logical examinations and...

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Unformatted text preview: logical examinations and regfilar visits t'orthe physician, and who'does not have to hide contraception from her partner . . . From this perspective it can be under- stood that the pill has not found a universal aeceptance. I ‘ Interestingly. the dosages for the oral contraceptive pill were also developed on the assumption of a universal, standard female body with the same levels of es- trogen and progesterone regardless of diet, living conditions, genetic background, parity, or age. " - ' ' ‘ ‘ ' ' _ ,. .i. -.:..-, .1..- 13---)..nn STACY LEIGH PIG_G Globalizing the Facts of Life loin ality has beeh'the last domain (trailing even gender) to have'its natural, biologiz'e-d ms called into question—CAROLE utilize " 7‘ ' ' I I Iit'is April r997'and a'week-long refresher. coureefor' youth "peer educators," - ' by a Nepali nongovernmental organization {NCO} with funds aimed at er. Other-parts are harder to identifytindeedfome are organs that these-- "" ntslhave never had occasion to-consider, much less name, either be- it has never been _coneidered important to do .so or because these I_ _ 's_' are not externally visiblee—or both. The blaCk squiggles- on White; ' -' I 961:- paper are drawn from an anatomist’s or gynecologists- angle ofinspection, I and thesepeculiar renderings of the most infirn'ate-regions'of'the body do ‘ not neces's‘arily'match the landscape known tothe embodied self . _‘ When this worksheet was pas'sedtorne, 'I had a sudden flashback to the sex education courses I had sat through in church basements and in school classrooms as a teenager in Suburban Milwaukee; The worksheets whose arcane information wasconfounding the Nepali students might have been taken from-the same sex education textbook from which I-had been taught. _ ' For that teen-aged me, living some twenty-five years earlier injan American midde-class enclave coming to'grips with the so-called' sexual revolution, information about the reproductive organs, hormonal changes in puberty; the menstrual cycle, ovulation, and" fertilization was fundamentally inte- grated into my concepts of “sex,” along with "facts" about masturbation (normal), homosexuality (possibly okay but not normal}, and gendered dif- I ferences desire (girls have to be careful not to load boys on because the latter can’t contrbl themselves). I was awash in medico-rnoral discourses-on sex',buifete'd on one side by the sex-edunatlon classes taught by the gym teacher. and on the other-by my reading of Our Bodies, Ourselves, the bible of the women's health movement (with, furtive peeks at The-Joy of Sex sand: wichedin-between). I _ I ‘ ” " ' . ' 7 _ . - That Aprilin 1997, watching the Nepali students struggle withtheir work- sheets, it struck me that out-side of this training session there were few (if any) other ways that they would encounter this particular configurationof information _'about the body. I realized then just how "deeplymy-own body sense Was inforrned'by the sexual sciences. The facts of "lifeithat seemed obvious andbasic tome and that-shaped the way I handled my sexual rela- tionshipsand my _.reproduetiVe possibilities'Were not the same asthose shared by the rest of the peeple in the room that day. The formats which have encountered this information; the myriad subtle ways. it has always been echoed and reinforced my world, and the uses to which I have . - put it have made it—and the phrase itself is'telling.—"second nature".for me, Would it. become so for these Nepali students? I . Stepping Back: Sex Education ond'Persuasion ~W0rldvvide, health programs dealing-with fertility regulation,_teproduetive = health, andHIv/srn prevention are based on and actively promulgate a ~ particular set of ideas about the sexual and reproductive body; Planned- experts inpublic health and development, set up withinthe context of na tonal governments and donor-govemment-NGO relations, and tied to vi- , sions of seeial reform, these programs eventually take concrete form in the r' often inundahe activities 'ofe'ducatiori and service delivery. Some of these- activities involve concrete alterafions to the body (getting Norplant into arms condoms onto penises,- penicillin into bloodstreams', iron supplements intd gestating Women, etc.),l‘but many others intervene iii—the eocial sphere (e ‘ (,rmcreasing_'the ageof marriage for Lworhen, ‘ehCOuraging spacing of births,'-u'rging husbands and wives to'conimunicate about sexual and re. The 1ntemationaljzafion of sexology and the sexual sciences is not new}- The well-known: sexolog-ists ,of the late-nineteenth and earlthWentieth- entury Anglo-European tradition were widely translated, and contempora- utsidethe West (Dilcotter 1995; Friistiick 2000). The elaboration of these ported and parallel sexual sciences was linked to state projects of modern-- anion and, in some cases, decolonizatlon. And, for the most part it was a ourgeois elite who engaged 'with the new sciences of sex. Clearly, the sexual ‘ names have a history of being. entangled withvisions of social reform Althoughrlower socioeconomic classes and marginalized groups. have long been targeted by technological intervenfi'ons (sterilization, ‘contracep- I The education components ofsexual and repflroductive health pro- ams aim- to improve healthand autonomy by improving the knowledge I se from-which people make their decisions, but there are persistent, trou- 96I en biomedical messages and local knowledge. indeed, there find a way to strike “a balance betWeen respec’dng and ntial biomedical infor- building on what women know and giving them esse ). For instance, women are often urged to use ’ (Cornwall'zooz: 229 (such as the contraceptive pill, subderrnal or inject- able contraceptives, or the intrauterine device} with “no information at all on how the medicines or devices they are using work, or on what they do to their ' 1th workers do attempt to provide some explanation, bodies" (2.19). When hea they find that they are left to their own devi-C'es to search for metaphors that might bridge the gap between the biomedical “facts” and local knowledge. However, because women’s concerns__about the effects of these contracep- 'ndigenous understandings of reproductive tives on their bodies stem from 1 ften do not address their worries. health, even these explanations o cal knowledge into a nondorninating re feat. The educational arm 0 elf mainly to provi dical infermatio'n fails to ask bling gaps betwe is a pressing need to rnation’ invasive contraception Bringing biome'di knowledges is no easy health programs restricts its Yet an instrumental faith-in bioi-ne take on along with a biomedical view of sexuality people in different locales actually do with this info might seek from it and unintentionally derive about the processes through which people i disadvantaged circumstanCes come to have (or no ons that, in turn, medical view of their bodieséquesfi into account the various institutional stakes involved in this s dominant frame for thinking about these. issues T‘facts” with “beliefs,” “science” with '_‘values,” and “b The optimiStic hopes for achieving health via s that, on the one hand, tends to overestimate the i the world and, on the o of “'th‘efacts” to change degree to which the sexual and reproductive sciences are inextricably tangled in social issues. ' - ' hic epiphany in Nepal a r In this essay I extract from my small ethnograp series of questions about the international presenc " glornerate of ideas concerning the sexual and gnette'that opens this essay is moreithan a rhetor'i prompted me to aska series of questions about of sexuality and the history of the sexu ‘ I ' orking outwa abstract issues concerning the conceptualization Of sexuality. ' ‘ lation with local - ding basic scientific literacy. what people and reproduction; what rmation and what they from it} These are questions . r1 diverse and often severely. t to have) stakes in a bio! demand that we take ituation. The persistently iuxtaposes I iology" with “culture.” ex education sustain a- view nher‘ent, self-evident power flier, to underestimate the the relation between theories al sciences. In this study I trace some ' ‘rd from ethnographic Specificity to biological facts; and globalization. Note, however, that although I begin with observations from Nepal my aim is neither to analyze processes taking place in Nepal nor to provide a cultural interpretation of Nepalese sexuality. Rather, my goal is for this study to fimcti'on as a prolegomenon to the kind of inquiry called for sforrnations around sexuality. We livein a time when sexuality by certain tr'an gh international public health projects, is being increasingly biologized throu while, simultaneously, social theory is. prying it away from' with the physical body. Thus there is a need to reexamine the theoretical tools used for thinlng about biology andculture in relation to sexuality. 4 Biological facts elaborated through the sexual and reproductive sciences have been at the heartof the development of the concept of sex. A'historical ng of the codeveloprnent of, first, scientific objectivity with re- underStandi ing socio—moral debates concern- spect to the sexual body and, second, chang _‘ ng thatbody further confounds the self-evidence: of the separation betWeen acts and values, and points to how, on-a global scale, albiologized notion of device. Lest we become mired in a negative ex operates as a standardizing critique of science as a Western partiailarism masquerading. as a universal g the these. observations demand a robustly materialistway of envisionin ocial production of facts. . A Scientific View ,of Sexuality e .sexual and procreative body, and why is it ‘ at‘is a scientific view-of th whose headline screams: nt? consider the following news article, 5 “Epidemic Fueled by Sexual Ignorance." It sums up theca'se for I Westport, 'Ct (Reuters- Health) 'May.16'[2.ooI]——‘Sex and sexuality is at .‘ the Core of the-runs pandemicin sub-Saharan Africa and, according to a ea‘ding south Africanhe'alth ofiicial, researchers and politicians must involve the African public in amuch more frank and open discussion of human behavior if they hope to successfully combat the disease. ' '.“S.ex is regarded as a taboo Africa—youdon’t speak openly about it i' said Dr..Ma1e'gapuru William Malcgoba, president of the Medical Research council of SouthAfrica [in an address to the National institute of Allergy and Infectious Diseases in Bethesda, Maryland]. “we all know that this is a sexually-transmitted disease and that’s the bottom he said. “we’re :doing everything except focusing on the real major factor that determines whether or not you get the disease." . . . a its association _ ' ., .:.i&mufifl:3§fibzm‘cm~ L6'[ .' period. As for ideas about masculinity and eroticlongings; or about moral . cirmu'n'stancesdwell, these messy factors can be evaluated in terms ofphys- summarizing-Dr. Mal<goba's lecture leaps from a view of sexuality that could foreground'the social (and thelocal) to avie'w of sexuality that emphasizes the biological (and the universal): Makgoba anchors the call for a scien- tific approach to sexual':behavior in biological processes. 'For him, a “frank and open" public consideration of sexuality isone that makes it'an object of .medico-scientiflc knowledge, and this lqiowledge is assumed-to be objective and neutral. I ' ' ' 1 African scientific and g0vemment leaders need to recognize that the AIDS crisis in this region is not just about statistics and treatments, Dr. Makgoba said, but involfves a complex interactionjbetween science, p'oliJ tics and culture; “The challenges facing scienceand its development today ' are no longer predominantly technical but largely social.” ' " _ Research into the particular cultural backgrounds and sexual'practicesr' . of Africans is almost nonexistent; he continued, rvvith no focus being ' placed‘on combating'the sexual mythologies,'taboos, and ignorance that inform the sexual behavior of many African men and women . . . “The ' ' whole subject of human sexuality in Africa is . based on hearsay,” Dr. - Makgoba told Reuters Health. Addressing sexuality scientifically, "will make a lot of difference to people, bothiin the developed and the develop- ._ ing countries.” ' I r ' ' ‘ ‘ ' - ' “Frank and Open" in Nepal: Putting into Practice the Scientific View ofSexuality. ' “Franlme‘ss”, means speaking about in a scientific land serological way. That this is-a tautological imperative in'public health became clear to me in epal during the course of myrrglgj'research on recently established mos revenfion efforts-5- The 'main issue preoccupying the Nepali NGO leaders, ealth educators,_an'd Ains workers was how to tall: about sex in fire Nepali ontext. International donors, program planners, and technical advisers took as a given that discussions about Arias required f'iranlt” discussions of sex; barriers were to be expected but could .be overcome via. some ort of compromise between frankness and. the. socially acceptable middle :-ound. Indeed, I noticedthat AIDS workers were not simply engaging in Theposition'articulatedhere by Dr. Makgoba (himself a: prominent virolo- gist) is a'complex one. It is a plea to confront the Htv'f AIDS crisis as 'a social issue. It is also a declaration that science must Override the ‘ipolitics‘" of the (merely) social disputes over the AIDS: problem. The basis for an adequate public response to AIDS would involve the "frank and open” approach to sexuality made possible by the clarity provided by medico-scientific knowl— ‘- e'dge—a clarity that could trump narrow political interests. With his call for moreresearch on “particular cultural backgrounds and sexual practices.” Dr. M_akgoba_recognizes that interventions require reliable contextual derstandings of behavior. Here the door appears to be 'open for conduct- ing re'searchinto the contingent, complicated, and changing interactions between personhood, gender, kinship-domestic arrangements, economic strategies; and other factors that form patterns of sexual expression and sexual contacts within particularcontexts. ‘ I H 7 I " Yet, in the next breath, Dr. Makgoba introducesa universal bottom line: these “mythologies,” stemming from "ignorance,"- must be combated with facts. The sexual practices that increase the'riskrof HIV transmission can be shown to arisefrom “taboos.” which in the hard light of epidemiological risk _' can be revealed to be shadowy collective delusion_s._ A penis a vagina or anus is an opportunity for the movement of microbes from body tobody—w emehow believed that the job-merely involved managing arrivals and depar- eswhen, infect, it first involved the laying offlie tracks. . _ . ' 7 ' 7 Through [AIDS preVention prbgrains, with their attached emphasis t1 SID preventipn, sex-Wasputon the public health agenda in Nepal in new - ys (cf. Parikh, thisvolume). The early 19905 saw a major infusion of nor funding to launch these programs. Under the rubric of disease pre- tion,_newlfonns of institutional. attention to'the sexual activities and.» nsciousness of Nepalis have-emerged'within a developmentframeivork, maringpublic concern (at least on the part ofthe urban middle‘class) over . e marriages, trafficking women, prostitution, and the moral dissolution duties, coercion, and complicated goals and tra'deoffs; or. about hard life .Séd by mogermzaflon (Which has. blEd into Evil-16,1: mt qfdévelgpmem‘ . . ‘ i - - ated problems):5 - - 7 , _ . . . . . This institutional attention took several'forms. First, because AIDS pre- - lion programs revolve around changing the "ngky” practices of individ- 5, some information about sexual practices is. needed, especially infor-' ' iologicalr harm (disease) and the “pure truth"bf what we know: about the sexual function of the human-body's In a single sentence, the news article mation that is seen to be quantifiable (e.g., the average number of clients entertained per week by a sex worker; the age of first experience of sexual intercourse; the percentage of young adults who have had premarital-sexual. _ relations, etc). Surveys of this type thad'neverbeen- conducted in Nepal: demographic research in support of population control restricted its facus to married couples and asked about fertility is sues rather than sexual practices. With the new interest in AI ns ander prevention, actsbf sexual intercourse —-fr'equenc'ies, practices, and partners—came to‘be of importance informing developmentobje'ctivesf ‘ ' ' a ' 'Second, ers acquired a place on the public health agenda. Previously invisible to national health concerns, sros had been regarded as an individ- ual problem, treated surreptitioust by venereal disease specialists or (more often) on the advice of pharmacy owners. Public health programs had con- ce‘ntrate'd their attention on diarrheal diseases, malaria, tuberculosis and other respiratory diseases, and'other major problems. The issue of 'srns was introduced as a national health problem because certain STD infections can increase the risk of HIV-infection. The public health discourse on ers was new to Nepal. and in this respect Nepal's experiencedifi'ers from that of India, Malaysia, and many eastern and southern African countries where colonial authorities, who were concerned the vitality of the male labor force andthe army (and, in some places, low fertility rates), had long viewed ers as a national problem. In these countries discussionsabout AIDS have kid-“Talldflg Together; Integrating {STD/AIDS in a Reproductive Health tended to echo earlier campaigns against venereal diseases, thus buildingori HtEXi-ra Facilitator GUide for the Training of Community Health Work: already established public frameworksln Nepal, however, calls for sexual re- ‘~ ' ” {CEDPA and SC? 199'7).8-This manual was developed to help a wide I straint for the purpose of dis ease prevention took hold-with A 1 n s awareness.7- ' V ‘ Third,sex education and "sexual awarenesa training” became core pro- ‘Manuals,_curricula, and guidelines in use. elsewhere in the world provided odels for questions on. “Knowledge, Attitudes, Behavior, and Practice” ABP) surveys; outlines forum and sex education lessons; messages for IDS awareness posters and pamphlets; and groupexercises to “desensitize” participants and to enable‘them to discuss "myths rand'mismnceptions" but sex; The curricular materials included-roIe-playing exercises to “de- lop assertiveness skills," step-byvstep directions (verbal and graphic) on ow to use a condOm,-’_' and pithy handouts on “steps'to behavior change." ese materials intersperse- medical information about reproduction and sease with exercises that encourage reflexive discussions on attitudes and ues. ' I i ' 7 I I I The international.templatesalways include a statement about adapting aterials 'to-local cultural circumstances. This injunction, however, conveys t’he'neutrality—and hence natural universality—of the frameworks-and the- orniationthey contain by relegating'cultural difference to. a problem of e-t'uning information deliveernderstandin'gs, explanations, objectives, ms, and attitudes that deviate from the established norm of l‘factsf' and onjudgrnental" attitudestovvard sexuality cannot find a place in the curric- in because these are precisely the misconceptions that sex education is ant to .correct.' "Facts" arepaISed from T‘misconceptions" in subtle ways. can best be seen in the lessons found in a highly professional manual activities. For programs aimed at youth, AIDS prevention was mainly interpreted as sex education (usually carried out in schools). AWareness seminars for adults also typically included sex education modules that of- fered information on the reproductive system, the sexual maturation of the human body, er5, and exercises for expl...
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