Good stigma, and bad

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What’s wrong with using emotional coercion as a means to achieving improved sanitation, asks this article on the Guardian’s development website, “given that the emotional coercion has been spearheaded by the local community itself?”  The author describes how, during an evaluation exercise in Karnataka, India, she had seen a range of tactics employed to get people to use toilets:

At its mildest, this meant squads of teachers and youths, who patrolled the fields and blew whistles when they spotted people defecating. Schoolchildren whose families did not have toilets were humiliated in the classroom. Men followed women – and vice versa – all day, denying people the opportunity even to urinate…

Equally common, though, were more questionable tactics. Squads threw stones at people defecating. Women were photographed and their pictures displayed publicly. The local government institution, the gram panchayat, threatened to cut off households’ water and electricity supplies until their owners had signed contracts promising to build latrines. A handful of very poor people reported that a toilet had been hastily constructed in their yards without their consent…

…Often the education campaign devolved into sensationalist scare tactics, consciously intended to shock and terrify. These included graphic media stories on the rape-murders of women, and dramas about the dangers of child-snatching, robbery and snakebites while openly defecating (all rare in the area). In one village, a Unicef-sponsored NGO had even been showing people grotesque pictures of vast tumours and conjoined twins, suggesting they were the result of poor sanitation.

Time to acknowledge the dirty truth behind community-led sanitation, 9 June 2011

Many of the comments on the article appear to agree that the end justifies the means.  Moreover, the legitimacy of the approach rests to a great extent on the fact that it comes from communities themselves: this is good old home-grown indigenous emotional coercion, not some neo-colonialist foreign-NGO imported emotional coercion.  Government agents, foreign and local aid workers involved in sanitation can sleep easy in the knowledge that they aren’t imposing their own values.

Would this article have looked the same if it had been about AIDS rather than sanitation? The narrative of the utopian democratic upsurge is also a popular one in the global AIDS movement.  And yet, the community sanitation work described in the article relies on powerful feelings of revulsion.  If this approach was used to prevent HIV, programmes would be promoting rejection of people with HIV, homophobia, mandatory testing, and even incarceration of people perceived to be at risk.  It would mean stigmatising any sexual behaviour perceived to be outside of the heterosexual, married norm, although this stigma would be disproportionately focussed on women rather than men.

In the case of AIDS, visceral feelings of revulsion make tackling it harder, not easier.  Denial, fear, and the refusal of authorities to acknowledge the realities, mean people don’t get the information and the support they need. So a more common discourse is to emphasise the links between AIDS and human rights. It is not that simple. In the context of AIDS, powerful movements in defence of gay rights and the rights of drug users have captured the imagination of policy makers and activists, but there is still ambivalence when it comes to the rights of sex workers.  At the same time the links between HIV and human rights are not always that clear. In some parts of West Africa it is the women who are the most socially marginalised who are the least affected by HIV. Even female genital mutilation and conflict are not categorically associated with higher HIV prevalence – in fact sometimes the opposite is true. 

Does this mean FGM and conflict should be ignored? Of course not, since we don’t need an association with higher HIV prevalence to tell us we don’t want them. But what it does illustrate is that responding effectively to AIDS and many other global health and development problems is a messy business, and that it is nearly impossible to do without at some stage having to question what other people believe and what you believe.

It would be nice to think development projects are always respectful of the beliefs and approaches of the people they work with, but when working on issues where inequality and marginalisation play such a major role, it’s nearly impossible not to contradict this somewhere.  I like to think that this is acceptable providing that for every person you disagree with, you are agreeing with someone else who has less of a say.  But it’s still a judgement call when all’s said and done. It’s never just about communities knowing best, and it’s never only about human rights.

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