by Kayla Beare
Contraception has improved the lives of countless since entering the mainstream in the 1960s. However, like most facets of sexual and reproductive health, contraception is imbued in a history of colonialism. As someone who was born and raised in a previously colonised country, the presence of colonial legacies in global health have been a point of tension and discomfort for me. The growing consciousness about racism and the extent to which our current social structures produce and maintain racism has made the topic even more salient in my mind. It would be difficult, if not impossible, to talk about racism today without engaging in conversations around colonialism. Sexual and reproductive health interventions are just one set of examples that allow us to explore how racism, colonialism and global health interact. Coming from South Africa, a country that is often referred to as an extreme in the realm of global health due to high rates of HIV/AIDS and sexual violence, into an international, UK-based university has caused me to ask questions about current health policies and how they exacerbate or mitigate the scars left by colonialism.
Below are some of the questions I have found myself asking in my own personal journey into the web of colonial legacies and global health. It is my responsibility, as a white person, to unpack my ideas of global health and their ties to colonialism. I do not pretend to have the answers to these questions, but pose them as a means of continuing the important conversations around decolonising health care.
- What role should previously colonizing countries have in the provision of sexual health care in previously colonized countries?
Given the history of colonialism and the way in which our current world is often centred around the West, it is unsurprising that the majority of global health organisations and initiatives are often situated in, or funded by, previously colonizing countries. It seems fitting that there should be some form of resource redistribution back into previously colonized countries who do not have enough resources to address sexual health concerns like the spread of HIV or access to safe and reliable contraception. That being said, the act of previously colonizing countries inserting themselves to provide knowledge and resources has distinct colonial implications. How do we navigate this dynamic? We may ask ourselves: surely it’s better that we do something instead of nothing? But how we go about it is what determines the impact of the work.
- How do we decolonise our approach to sexual health interventions?
The South African #FeesMustFall movement began in 2015, calling for the education system to be decolonized. Decolonization is a term to describe the process of actively challenging and deconstructing colonial legacies in order to prioritise the narratives, experiences and knowledge of South Africans, in this case, over the imperial model of the curriculum that is currently in place in most tertiary education institutions. The process of decolonisation is nuanced and complicated, but entirely necessary. So how do we go about decolonising the ways in which we intervene in sexual and reproductive health spaces?
I have learnt that before I begin planning any intervention, I need to be asking myself questions like: What kind of power do I hold, as a white person who is a descendent of colonisers? How does this power affect the goals that I have? Am I treating my knowledge, as someone leading the intervention, as better or more important than the knowledge of the people I am aiming to help? Am I respecting that I am not the expert on the needs and attitudes of the people I am working with? Do I understand that local health care professionals are experts in their own right? Am I projecting my Western understanding of health and wellbeing onto someone who does not share this issue?
One of the best ways to acknowledge and combat colonial legacies in health care provision is to work collaboratively with the people for whom we aim to care. For example, many of the best researchers on the topic of provision of care for women with HIV note that the most effective and impactful care is provided when women with HIV are given a seat at the table. There is vital work being done into the practice of decolonising health care, and I believe that it is my responsibility, as an individual in this field, to make use of the resources available to unpack my own preconceptions that are invariably informed by a global history of colonialism. If I do not so, my attempt to combat the effects of colonialism may in fact maintain the very colonial legacies I wish to contribute to dismantling.
- Are we doing more harm than good?
It is difficult to equate the perpetuation of colonial legacies with the provision of sexual and reproductive health care because they do not share many easily measured factors. Initiatives that provide PrEP, PEP, contraception, safe abortions and support during pregnancy and childbirth all offer a great deal of value to the people that need them. But if the value is dependent on warped power relations between those providing them and those receiving them and this power discrepancy serves to reaffirm colonial-style relationships, then there is conflict. An intervention aiming to help also has the capacity to harm. How to navigate this? Are we ensuring that we are working with people, not on them? (Once again, the importance of inclusion of local expertise). Are we working to ensure that we leave the community better equipped to function independently than when we arrived? Are we engaging with topics of anti-racism? Are we calling out ourselves and our colleagues when racist or colonial-style attitudes arise?
I do not have the answers to these questions, but there are remarkable organisations and researchers that are tackling these issues head on. Engaging with their work has provided me with guidance and information when I ask these uncomfortable questions. This discomfort is necessary in order for me to understand how to address the impact of colonialism on my ideas of global health. Only by doing so can I work on both decolonization and providing health care.
Visit the author’s Sexual Consent instagram account here: @sexual_consent_conversations