Using arts-based workshops to share knowledge on reproductive and sexual health with rural communities in Nyanza, western Kenya.
Lead Research Organisation:
University of Leeds
Department Name: School of English
Abstract
Summary
Recent work by Plastow (AHRC/MRC grant 'Maternal Mortality in East Africa; AHRC/MRC grant 'Promoting sexual and reproductive health education among adolescents through creative and youth-led practice in India, Malawi and Uganda; British Academy grant 'Engendering equality: working holistically in a Ugandan slum neighbourhood to challenge gendered inequalities, sexual ignorance and abusive sexual behaviours'; AHRC/MRC grant 'Family Planning: Fact or Fiction?') has demonstrated that poor, and especially rural, communities in East Africa suffer from an acute lack of accurate knowledge in relation to sexual and reproductive health, and that widespread myths and misinformation are stopping people being able to make good choices for themselves and their families on a range of issues in relation to these topics. We also found a great hunger for good information, which when delivered in a relevant manner, allowing time for questions and discussion, can quickly lead to significant behaviour change. Although health authorities and schools are meant to disseminate this information we have found a mixture of ignorance, embarrassment, lack of cultural sensitivity and lack of time means that people from poor rural communities have an almost universal lack of sources of reliable information. Although Kenya has excellent policies in relation to sexual and reproductive services our research found that there is a huge gulf between policy and implementation which was notably lacking in terms of both education and delivery of services in all health facilities. Numerous ills flow from this poverty of information. Maternal mortality rates are some of the highest in the world across East Africa; unwanted and teenage pregnancy is exceptionally high; many girls are missing school due to issues related to menstruation and there is a great danger of sexual exploitation due to a lack of the most basic knowledge about reproductive facts.
We have found that using a practical, embodied approach, employing local cultural vernaculars, enables communities to feel at ease and to readily take part in arts-based activities exploring their knowledge and questions about reproductive and sexual matters. When married to good clear information from public health experts; notably allowing plenty of time for debate and questions, without a preconceived moral or message-based agenda, and communicating as co-community members rather than as a health elite, a wide range of community members, from across age and gender boundaries are eager to engage and wish for knowledge that often leads to behaviour change. This creative engagement strategy facilitates strong public engagement and dissemination of relevant, accurate health education. Unexpected learning from the projects listed above was how open older members and men were to taking on board new information and changing their thinking when they could clearly see how this would benefit their wider families. We also found that, contrary to many projects which focus on a particular constituency; i.e. most commonly girls, a far more profound impact is made when the wider community is included in engagement, discussion and learning.
We also found, unexpectedly, that Traditional Birth Attendants (TBAs) and Voluntary Community Health (VCH) workers freely acknowledge that they lack good information about reproductive and sexual health. Since in rural communities these are the first line of advice for many people it is imperative that they are confident that they have good basic knowledge and know where to refer clients on. During evaluation, numerous members of these groups spoke of their desire for better education and training.
Finally, we wish to train a core group of Kenyan arts facilitators in a replicable methodology for researching and then delivering the information needed in poor communities in relation to sexual and reproductive health so that our work can be multiplied in similar settings nationwide
Recent work by Plastow (AHRC/MRC grant 'Maternal Mortality in East Africa; AHRC/MRC grant 'Promoting sexual and reproductive health education among adolescents through creative and youth-led practice in India, Malawi and Uganda; British Academy grant 'Engendering equality: working holistically in a Ugandan slum neighbourhood to challenge gendered inequalities, sexual ignorance and abusive sexual behaviours'; AHRC/MRC grant 'Family Planning: Fact or Fiction?') has demonstrated that poor, and especially rural, communities in East Africa suffer from an acute lack of accurate knowledge in relation to sexual and reproductive health, and that widespread myths and misinformation are stopping people being able to make good choices for themselves and their families on a range of issues in relation to these topics. We also found a great hunger for good information, which when delivered in a relevant manner, allowing time for questions and discussion, can quickly lead to significant behaviour change. Although health authorities and schools are meant to disseminate this information we have found a mixture of ignorance, embarrassment, lack of cultural sensitivity and lack of time means that people from poor rural communities have an almost universal lack of sources of reliable information. Although Kenya has excellent policies in relation to sexual and reproductive services our research found that there is a huge gulf between policy and implementation which was notably lacking in terms of both education and delivery of services in all health facilities. Numerous ills flow from this poverty of information. Maternal mortality rates are some of the highest in the world across East Africa; unwanted and teenage pregnancy is exceptionally high; many girls are missing school due to issues related to menstruation and there is a great danger of sexual exploitation due to a lack of the most basic knowledge about reproductive facts.
We have found that using a practical, embodied approach, employing local cultural vernaculars, enables communities to feel at ease and to readily take part in arts-based activities exploring their knowledge and questions about reproductive and sexual matters. When married to good clear information from public health experts; notably allowing plenty of time for debate and questions, without a preconceived moral or message-based agenda, and communicating as co-community members rather than as a health elite, a wide range of community members, from across age and gender boundaries are eager to engage and wish for knowledge that often leads to behaviour change. This creative engagement strategy facilitates strong public engagement and dissemination of relevant, accurate health education. Unexpected learning from the projects listed above was how open older members and men were to taking on board new information and changing their thinking when they could clearly see how this would benefit their wider families. We also found that, contrary to many projects which focus on a particular constituency; i.e. most commonly girls, a far more profound impact is made when the wider community is included in engagement, discussion and learning.
We also found, unexpectedly, that Traditional Birth Attendants (TBAs) and Voluntary Community Health (VCH) workers freely acknowledge that they lack good information about reproductive and sexual health. Since in rural communities these are the first line of advice for many people it is imperative that they are confident that they have good basic knowledge and know where to refer clients on. During evaluation, numerous members of these groups spoke of their desire for better education and training.
Finally, we wish to train a core group of Kenyan arts facilitators in a replicable methodology for researching and then delivering the information needed in poor communities in relation to sexual and reproductive health so that our work can be multiplied in similar settings nationwide
Publications
Plastow J
(2021)
A History of East African Theatre, Volume 2 - Central East Africa
Plastow J
(2021)
A History of East African Theatre, Volume 2 - Central East Africa
| Title | Hera Ockham |
| Description | This 20 minute play was for adolescents in rural Nyanza, Kenya. Building on research that showed a significant issue with multiple partners and transactional sex among adolescents in the area, the play sought to problematise the issues arising: lack of trust in sexual relationships; violence; monetary exploitation; peer pressure; danger of STDs and unwanted pregnancies. The play was shown 37 times in villages in rural Nyanza prior to a related participatory workshop where issues were further teased out and discussed. |
| Type Of Art | Performance (Music, Dance, Drama, etc) |
| Year Produced | 2021 |
| Impact | Evaluation is currently on-going |
| Title | Komo Nyuol |
| Description | A 20 minute play looking at issues and common myths in the area concerning family planning. The play was performed 40 times in 40 villages in rural Nyanza, Kenya in conjunction with a participatory workshop. The work took place because in a previous grant communities had shown how poor was their knowledge of contraception and how fearfully they looked at it, fearing it would lead to infertility. |
| Type Of Art | Performance (Music, Dance, Drama, etc) |
| Year Produced | 2021 |
| Impact | We are currently evaluating impact |
| Title | Neno Malo |
| Description | This 20 minute forum theatre production was performed 40 times in 40 villages in rural Nyanza, Kenya for adolescent girls in the community. It discussed issues of multiple sexual partners, monetisation of sexual relationships, lack of trust and girls' vulnerability. The production sought to problematise girls' experience to promote debate and reflection from the young women. |
| Type Of Art | Performance (Music, Dance, Drama, etc) |
| Year Produced | 2021 |
| Impact | Evaluation is currently on-going.. |
| Title | Rawera |
| Description | Forum theatre production for adolescent boys. This interactive piece with associate workshop problematised issues in the locality of multiple sexual partners, transactional sex, sexual violence, emotional responses to relationships and peer pressure. The show was performed 40 times in 40 villages in rural Nyanza, Kenya. |
| Type Of Art | Performance (Music, Dance, Drama, etc) |
| Year Produced | 2021 |
| Impact | Evaluation is on-going. |
| Description | This funding led to a number of key findings. 1. Building on previous work we found a great need and hunger for good information, delivered in accessible form and giving plenty of space of questions and discussion, concerning contraception. We found that fear and ignorance had been precluding people accessing free contraceptive services, but that once those fears were allayed very many wished to use these services for child spacing. 2. We found that the information needs to be made available not just to women of chid-bearing age, but to whole adult rural communities as husbands and mothers-in-law often control a woman's access to pregnancy-related services, but that once they had good information they were very often receptive to changing previous attitudes. 3. We found that Traditional Birth Attendants were still delivering many babies - probably many more than official statistics allow for, and that excluding them from acknowledgement and training is highly detrimental to rural women's health. 4. We found that Community Health Volunteers had often had poor training in relation to contraceptive services, and that many said previous lecture based, as opposed to participatory learning as we practiced, had been of limited value to them. 5. We found that our practical, illustrated and participatory methodologies were greatly valued by all the above groups who found them accessible, relevant and respectful as opposed to the limited top-down, lecture based learning previously offered. 6. We found that repeat visits to the same locations made communities much more receptive to the information on offer, more trusting and more willing to fully participate. 7. We found that among youth in rural western Kenya there are very high levels of promiscuity. For young women this is usually a matter of needing to access money as they have little or no opportunity to earn money, so the sex is generally transactional. We found that for young men there was seldom any investment in affection and that having multiple sexual partners was the norm. We found that information must be given in the local language, not in English or Swahili as is common practice as many rural dwellers have very limited knowledge of these languages. |
| Exploitation Route | The learning regarding methodology could be well used by others, and is now being adopted by NGOs in the area working on SRH following further training by us. We found that information needs to be delivered in local languages for rural populations. We found that it is insufficient to give information to young women in places where decisions are often much more of a community matter. We found that it is necessary to go to where people live rather than expecting them to come to clinics or similar centres. We found that it is important to engage Traditional Birth Attedndents as their services are still widely used. |
| Sectors | Communities and Social Services/Policy,Creative Economy,Education,Healthcare |
| Description | Our findings have directly impacted on the behaviour of many rural communities in relation to accessing contraception. We have also found that our work enabled adults to begin to talking to young people about their sexual behaviour which had previously been taboo, and that this is very important as sexual activity often begins very young. We have also built on this work to engage with local NGOs, County health authorities and Community Health Volunteers, ensuring change in methodology and language to make information sharing more appropriate and accessible. |
| First Year Of Impact | 2022 |
| Sector | Creative Economy,Education,Healthcare |
| Impact Types | Cultural,Societal,Policy & public services |
| Description | Influencing policy and practice in relation to arts-based practice |
| Geographic Reach | Local/Municipal/Regional |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | Changes are in the early stages but organisations who took the training report working in more participatory ways with community groups who are finding the sessions they attend more fun, engaging and accessible. |
| Description | ESRC Impact Acceleration Fund |
| Amount | £15,000 (GBP) |
| Funding ID | ES/T501955/1 |
| Organisation | Economic and Social Research Council |
| Sector | Public |
| Country | United Kingdom |
| Start | 03/2022 |
| End | 10/2022 |
| Description | Using arts-based workshops to share knowledge on reproductive and sexual health with rural communities in Nyanza, western Kenya. |
| Amount | £81,803 (GBP) |
| Funding ID | AH/V008544/1 |
| Organisation | Arts & Humanities Research Council (AHRC) |
| Sector | Public |
| Country | United Kingdom |
| Start | 08/2021 |
| End | 08/2022 |
| Description | Adult male consultation workshop |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Public/other audiences |
| Results and Impact | This workshop took place with 17 older men in a village in rural Nyanza. The aim was to discuss perceptions of what the group saw as constituting and good married relationship, the perceived duties of husbands and wives and the barriers to achieving an harmonious relationship. The workshop lasted some 2 hours and involved participatory activities and discussion. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Adult workshop |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Public/other audiences |
| Results and Impact | 40 workshops for 40 people each in 40 villages in rural Nyanza, Kenya. These approx 90 minute workshops followed a related play (see creative outputs) and involved audience members on participatory arts-led activities and discussion of knowledges, understandings, misunderstandings and myths relating to the use of contraception. They also engaged with the problem of parents failing to engage with adolescent children regarding issues of sexual activity despite very high levels of teenage pregnancy. The workshops responded to community requests building on knowledge from prior grant 'Maternal Mortality in East Africa. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Birth attendant workshop |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Patients, carers and/or patient groups |
| Results and Impact | This was a 2 day training workshop for Traditional Birth Attendants (TBAs) in Nyanza district, Kenya. The workshop engaged the TBAs in critical thinking and shared analysis of their methods, problems and anxieties. Best practice on delivery and advice to expectant mothers was shared and we discussed what TBAs could do if delivering mothers were experiencing difficulties that needed professional medical support. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Community Health Volunteer training |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Patients, carers and/or patient groups |
| Results and Impact | This 2 day workshop engaged with Community Health Volunteers (CHVs) in Nyanza district, Kenya. The workshop gave training in hygiene, and maternity concerns. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Consultation workshop with adolescent boys |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Public/other audiences |
| Results and Impact | This 2 hour workshop for approximately 20 adolescent males was interactive and participatory. It sought to understand the youths; understanding, anxieties and behaviours in sexual relationships. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Consultation workshop with adolescent girls |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Public/other audiences |
| Results and Impact | This arts-led participatory workshop sought to understand adolescent girls attitudes, anxieties and understandings regarding sexual relationships with men. it took place in rural Kenya for some 20 young women. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Consultation workshop with older women |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Public/other audiences |
| Results and Impact | This workshop took place with a group of 20 adult women in rural Kenya. The 2 hour event consulted women regarding their ideas of a good relationship with a male partner and the barriers to achieving this. It was interactive and participatory. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Film showing |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Undergraduate students |
| Results and Impact | The documentary film Sunset at Dawn, looking at issues in maternity services in Kenya was shown and then the groups discussed documentary production in Kenya. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Rotary Club presentation |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Supporters |
| Results and Impact | This was a short presentation in October 2021 to the Kisumu Rotary Club where synergies were explored between our work and the charitable project Rotary was supporting in the area. |
| Year(s) Of Engagement Activity | 2021 |
| Description | TfD workshop Eldoret University |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Undergraduate students |
| Results and Impact | This workshop introduced students to new ways of thinking about and creating Theatre for Development |
| Year(s) Of Engagement Activity | 2021 |
| Description | Theatre for Development actor training |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Other audiences |
| Results and Impact | This training took place over three months, working with local performers engaged with using arts in support of development activity with a number of local and national NGOs. The performers were given training in new methodologies for making performances and running arts-based community workshops. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Theatre lecture at Eldoret University |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Undergraduate students |
| Results and Impact | This lecture looked at the history of theatre in Kenya, with particular emphasis on Theatre for Development and then opened into debate with students and academics on how better to prepare students for work in this area. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Youth workshops |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Public/other audiences |
| Results and Impact | 117 workshops were held in 40 villages in Nyanza district, western Kenya. We were exploring the issue of problematic sexual relations among adolescents in these communities where sex was reported as being transactional, sometimes violent, often unprotected and very frequently with multiple partners leading to many unwanted and unsupported pregnancies. The workshops were all held in conjunction with interactive related performances. for youth aged 13-18. In the first round we included both genders and then building on this experience subsequent workshops were held separately for male and female groups. The workshops were arts-led and participatory, exploring the dynamics of sexual relationships and how and what young people might want to consider changing. |
| Year(s) Of Engagement Activity | 2021 |