Two Eyed Seeing: Decolonizing Methodologies for Reproductive Justice
This is a co-authored piece by GHC alumni Sagaree Jain and Victoria Watson (who is now the Executive Director of International Youth Family Planning Alliance (IYAFP)) and Victoria’s colleague Michalina Drejza, IYAFP’s Director of Research and Development.
Editor’s Note: As the world faces the once-in-a-century pandemic of COVID-19, it’s more important than ever that we challenge colonial ways of approaching global health. As Sarah Dalglish wrote in an op-ed in The Lancet, “The global health model is based in large part on technical assistance and capacity building by the US, the UK, and other rich countries, whose response has been sclerotic and delayed at best…The pandemic has given the lie to the notion that expertise is concentrated in, or at least best channeled by, legacy powers and historically rich states.” The below piece is part of our ongoing decolonizing global health series.
Sexual and reproductive health and rights (SRHR) are a politicized issue, wrought with misogyny and racism. These ideological underpinnings have caused the stealth attack on abortion rights this past March in the United States and the ongoing rollback of reproductive rights globally, from the United States to Poland, mobilized by “anti-choice” groups and backed by populist politicians and religious leaders. The inextricable link between colonialism, racism, and reproductive health often fails to be brought up in global health dialogue and policy, remaining an ignored part of global health history and current public policy.
This link between forms of discrimination and reproductive health informs the difference between reproductive rights and reproductive justice. Following the passage of anti-abortion morality laws like the Comstock Act in the late nineteenth century, leaders like Margaret Sanger advocated for women to have a greater range of reproductive choices, including access to birth control. The scope of reproductive rights — a largely legal term — still fails to account for the full range of life circumstances that intersect with access to reproductive care or for how race determines reproductive outcomes. The domestic term reproductive rights and the international term family planning both refer to a relatively narrow scope of rights. In particular, the right to access contraception and even abortion care is largely directed towards nuclear families rather than inclusion of people in all their diversities.
For the second half of the twentieth century, white progressive advocacy on global reproductive health was largely about limiting births and population control for national security reasons. It was about convincing, and sometimes forcing, women in the Global South to uptake birth control. U.S. foreign policy during the Cold War through USAID, as well as US global foundations, put pressure on Global South governments to implement extreme population control measures. In India, for example, international actors endorsed and encouraged compulsory sterilization in the 1970s, a policy that left more than 2,000 dead from unsafe procedures and primarily targeted Indians without class or caste privilege. In the U.S., meanwhile, sterilization in the colony of Puerto Rico was so common that a 1969 study found that 34 percent of Puerto Rican women between ages 20 to 49 had been sterilized by the medical system. These policy decisions were conducted in a top-down, technocratic fashion: powerful academics and policymakers decided on the need for population control and individual communities of color paid a high and complicated price. The implications of these oppressive policies still resonate in donor relations and among academics who, mostly based in Global North institutions, conduct research studies in low- and middle-income countries under the global health umbrella.
The reproductive justice movement arose out of a need to recognize the ways in which population policy had historically met the needs of privileged women and families, but had also been weaponized to harm and reduce populations deemed undesirable by the state. The term was founded in 1994 to take sexual and reproductive health (SRH) beyond siloed issues of abortion and family planning and address the full set of forces affecting womxn’s decision-making: issues of economic justice, the environment, immigrants’ rights, disability rights, and discrimination based on race and sexual orientation. The Black Women’s Caucus at the 1994 International Conference on Population and Development in Cairo officially recognized the term “reproductive justice” and brought it into global human rights discourse, creating a watershed moment in the SRH community’s understanding of reproductive health, oppression, and the intersectionality of women’s rights.
Reproductive justice refers to the complete physical, mental, spiritual, political, social, and economic well-being of women and girls, based on the full achievement and protection of women’s human rights. The reproductive justice framework addresses “the social reality of inequality, specifically, the inequality of opportunities,” forcing women’s rights advocates to reckon with the relationship between one’s reproductive autonomy and both the structural and normative environment constraining personal choice and freedom.
Reproductive justice relies on the well-being, self determination, mobilization, and participation of the communities policies attempt to promote. To meet community needs, global health non-governmental organizations should start by taking a decolonizing approach to their research and policy advocacy methodologies.
The “How:” Decolonizing methodologies in SRHR policy research and advocacy
We can all agree it’s time for global health organizations to consistently “walk the talk” when it comes to community participation and leadership. Many organizations — including iNGOs, philanthropists, and UN agencies— are now taking up the torch to bring a holistic roster of community-based civil society voices into the center of policy dialogue, thought leadership, and program implementation. While community engagement continues to improve, we cannot equate this rise in the inclusion of civil society with the work that remains to dismantle the top-down western-centric frameworks, productions of knowledge, and ways of seeing the world which continue to shape SRHR research.
Decolonizing methodologies in SRHR research and policy to promote reproductive justice means subverting the traditional production of knowledge and power derived through colonialism and imperialism. Colonialism has damaged and restructured societies, identities, and knowledge requiring that we center, instead, around the experiences of indigenous populations. In practice, it requires recognizing and implementing a way of analyzing, gathering, and documenting information that sees through an array of world views and frameworks — not just those favored by the Global North.
When researching in the Global South, especially with indigenous peoples or issues with a sensitive and gendered history such as reproductive justice, there are a few concrete steps researchers can take to decolonize research:
Make research responsive to community needs and concerns. Investments, research, and programming need to be dedicated in response to the community-identified needs for such interventions that explores topics of concern to the populations at hand, and is collected, analysed and disseminated in a holistic and collaborative way. Research on communities that serves questions unrelated to those communities is likely to be extractive, making use of community networks and resources without returning research conclusions and recommendations to communities.
Work with the involved communities to create culturally responsive research instruments and conduct the research itself. Incorporating the leadership and goals of researchers within the community will help guide your research towards culturally relevant and useful research. Where possible, disseminate knowledge or training among the community you are working with and let folks from within the community lead on the development of questionnaires, surveys, and analysis. Use research models and frameworks of analysis that are informed and demonstrate principles derived from cultural knowledge and practices.
Design, conduct, and analyze research in a way that doesn’t prioritize Global North knowledge and practices. One of the ongoing repercussions of colonialism is that it can undermine and/or dismiss indigenous ways of knowing as “unscientific,” assuming that epistemologies from the Global North are the only lens by which to understand problems and evidence. Not only does perpetuate negative stereotypes, but can result in ignorance towards people’s lived experiences and traditional methods of inquiry and advocacy.
Taking the Etuaptmumk (translation: two-eyed seeing) approach to research and problem analysis can help researchers lead with and express multiple perspectives, and adjust conventional methods and frameworks for indigenous knowledge. Etuaptmumk is a Mi’kmaw word meaning with one eye, we view the world through indigenous ways of knowing and with the other eye, we view the world through Global North, or Eurocentric ways of knowing.
Provide training on research fatigue and re-traumatization. Research fatigue, or over-research, describes when a community comes into contact with many researchers conducting multiple studies and begins to be disillusioned with the process of social research. The SRH research arena is becoming continuously more crowded with overlapping research agendas, Research fatigue can also be connected to re-traumatization, where individuals are asked to recount traumatic events, triggering symptoms of post-traumatic stress disorder (PTSD) or depression. Each research interview and survey interaction should be conducted with awareness of risk of re-traumatization, and should avoid traumatic topics not strictly related to the research question(s) to uphold do no harm principles.
Engage in and cultivate long-term partnerships. Building trust with communities and community leaders takes time. In order to create an environment in which one can garner honest and supportive feedback, it’s important to value partnerships with nonprofits, grassroots and indigenous research organizations, and individual respondents of the research. It should integrate an aspect of long term engagement, rather than a one-off interaction that can be exploitative or extractive.
Recognize and account for the multiple and intersecting forms of oppression and colonialism that impact the freedom to choose. In 1991, Kimberle Crenshaw coined the term “single-axis framework” as a way to describe how race and gender are often treated as mutually exclusive categories of experience. Throughout the process of researching and advocating SRHR issues, she incorporated an intersectional approach to understanding gender, race, and discrimination as well as the subsequent intergenerational issues affecting personal freedoms and the context in which we make SRH decisions.
Decolonizing research requires recognizing that foreign researchers, while experts, are not the experts in the communities they are working in. Decolonizing research approaches requires humility, deep listening skills, and a willingness to displace your own expectations in the research process.
Decolonizing methodology in action
“While we should acknowledge that there are multiple sites where the struggle against oppression and exploitation might be taken up, Indigenous peoples must set the agenda for change themselves, not simply react to an agenda that has been laid out for us by others.” — Linda Tuhiwai Smith, 2000
Decolonizing global SRHR research and advocacy continues to be a relatively new field. Here are some examples of this approach in practice:
Empowering Evidence-Driven Advocacy
In 2017, the International Youth Alliance for Family Planning (IYAFP) and the Population Reference Bureau (PRB) launched Empowering Evidence-Driven Advocacy (EEDA), a three-year research and advocacy project to evaluate the implementation of youth-friendly family planning services across Kenya, Burkina Faso, Uganda, Ethiopia, and Nigeria. Using a collaborative research model that brought together knowledge generated by specific communities of young people across each country the IYAFP and PRB supported, hired, and onboarded young researchers for the project. The youth research associates co-constructed the research methodology and conducted the full assessments on emerging adolescent and youth SRHR needs across their communities.
By engaging young people as key research intermediaries and knowledge holders, the study ensured that everything from the research question, the study protocol conceptualization, to the format and processes of both in-depth interviews and focus-group discussions were responsive to community needs and concerns, and led by the community’s learning and research paradigms. Adolescents are often marginalized and not taken as serious partners able to carry out research among their communities. The study successfully enabled the expression of indigenous knowledge and captured the intersectional barriers to access experienced by and led by young people and adolescents across each geography and setting.
Community-based Participatory Research (CBPR) in South Africa
In Cape Town, South Africa, researchers recently utilized Community Based Participatory Research (CBPR) frameworks to conduct research on cervical cancer. As there is a history of over-research in the South African context, CBPR’s approach was appropriate for the Cape Town community in question. At the outset of research, the research team formed a reference team of local health, education, and government workers to assist in conducting focus groups and project implementation.
Focus groups primarily involved high school-aged youth, but also included mothers, educators, and school support staff. Researchers emerged from the study with a concept of health as not simply something that occurs in the clinic, but an interconnected measure of the well being of a family, a neighborhood, and a community. Discussions centered around community challenges as well as “the many legacies of apartheid,” such as police brutality and community violence.
Decolonizing methodology is one of many necessary steps the international global health apparatus must make in order to make reparation for the long and brutal history of colonial approaches to reproductive health and family planning. Notably, decolonizing methodology is not only implemented for the sake of the local or indigenous communities but will provide greater positioning for researchers and academics to gain more precise and useful information in their studies. A practice of working horizontally with communities, shaping research instruments alongside valued partners, and prioritizing the needs of communities through culturally conscious listening will yield deep, long term benefits for the larger reproductive justice movement.
Victoria Watson was a 2018–2019 Global Health Corps (GHC) fellow at the Center for Health and Gender Equity in Washington, D.C. and is currently the Executive Director of the International Youth Alliance for Family Planning (IYAFP).
Sagaree Jain was a 2018–2019 GHC fellow at the Center for Health, Human Rights, and Development in Kampala, Uganda.
Michalina Drejza is the IYAFP’s Director of Research and Development.
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