JITANA Una InvestigacinAccin Participativa Basada en la Comunidad
[J]ITANA Una Investigación-Acción Participativa Basada en la Comunidad en Justicia Reproductiva Liderada por Pre-adolescentes Gitanas (Proyectos I+D+i Retos de la Sociedad, Plan Estatal de Investigación Científica y Técnica y de innovación 2017 -2020)
Contenido • CESPYD • Nuestro trabajo previo con población gitana • La evaluación de la ENIPG-S en España desde una perspectiva de múltiples agentes. • ROAD 4 HEALTH. Creando capacidad para abogar por su salud en la población gitana que vive en vecindarios de exclusión (OSF) • ROMOMATTER. Empoderando el valor de las niñas gitanas que viven en riesgo de exclusión a través de la justicia reproductiva REC-RDIS-DISC-AG-2017 • [J]ITANA Capacitando a las Asociaciones Gitanas en Justicia Reproductiva. Una Investigación-Acción Participativa con Preadolescentes en Riesgo de Exclusión (Proyectos I+D+i Retos de la Sociedad, Plan Estatal de Investigación Científica y Técnica y de innovación 2017 -2020) • Papel de las Asociaciones en [J]ITANA
CESPYD: Who we are • CESPYD: Coalición para el Estudio de la Salud, el Poder Y la Diversidad. El Centro de Investigación y Acción Comunitaria de la Universidad de Sevilla www. cespyd. es
CESPYD: Investigación Acción Comunitaria • Trabajo basado en la colaboración entre investigadores académicos y las comunidades • Su finalidad es desarrollar capacidad innovadora en comunidades en riesgo de exclusión para que definan, persigan y logren sus propias metas a partir de sus necesidades y sus fortalezas. • Metodología reflexiva y colaborativa que desarrolla pensamiento y conocimiento crítico en las poblaciones y comunidades, imaginación para definir respuestas y oportunidades para lograrlas.
CESPYD: Network and sponsors
Nuestro trabajo reciente con población gitana
Contexto Andaluz Tendencia a la fragmentación social Bajos niveles de bienestar social Necesidad de desarrollar modelos que guien los esfuerzos para mejorar el bienestar de la población gitana junto a la construcción de sociedades cohesivas y respetuosas con las diferentes culturas y perspectivas.
Roma Health Integration Policy Index (RHIPEX) RHIPEX Dimensions Entitlement to healthcare Indicators • Requirements to obtaining entitlement • Health coverage and services • Co-payments Accessibility to healthcare services Responsiveness of healthcare services • • • Achieving and sustaining changes • The socio-political context of Roma health policies • Roma organizational movement, participation and collaboration • Intersectoral and collaborative work among multiple stakeholders Accessibility barriers Existing policies and strategies to overcome accessibility barriers Health inequities and challenges identified by current policies Existing policies to make services more responsive to the Roma Informal adaptations to make services more responsive to the Roma
Recomendaciones de la Evaluación de la ENIPG-Salud en España Reforzar el enfoque interseccional en la salud de la PG Cultura, edad, género, status social, nivel educativo, identidad de género Salud en todas las políticas Participación transformadora de la población gitana Participación en el diseño, implementación y evaluación de las acciones Disponer de mediadores, abogados sociales e instigadores dentro de las comunidades e instituciones Rendición de cuentas Evaluación impacto en las comunidades que lo necesitan
Lecciones aprendidas para mejorar la salud sexual y reproductiva de las mujeres gitanas • La salud sexual y reproductiva de las mujeres gitanas es un área libre de evidencias que las hace invisibles y dependientes de la buena voluntad de los profesionales y agentes sociales. • El antigitanismo es muy evidente en el análisis que se hace de los patrones sexuales y reproductivos de las mujeres gitanas a las que se acusa de aquello que son victimas. • Es necesario detectar, sistematizar y diseminar buenas prácticas para prevenir la discriminación sistémica que sufren las mujeres gitanas. • Los profesionales, los trabajadores de las organizaciones y las comunidades deben trabajar como agentes de cambio—Abogados—desde las propias comunidades • Superar las inequidades en salud sexual y reproductiva implica llevar a cabo actuaciones basadas en justicia reproductiva basadas en el balance entre equidad de genero, fortalezas culturales y basar el reconocimiento de las mujeres en la prosperidad de sus vidas asegurandole el mejor comienzo desde la infancia
The district of Poligono Sur, Seville 70, 000 inhabitants 20 -25% Roma • Unemployment ~40% • School dropout ~45% • Areas of prefabricated homes and poor housing conditions • Highest rate of drug use and dual pathologies in Sevilla
Mapping Roma visibility: Are local policies, plans and programs Roma-sensitive? Evidencefree Roma are forgotten Although awareness on inequities, adaptation of resources, integral intervention and stakeholder collaboration Institutional discrimination Homogenization of the target population No specific measures for the Roma (equality over equity) “In PS there is a comprehensive plan mainly for situations of exclusion. And exclusion affects Roma and non-Roma population. ” (Healthcare provider) Invisibilization of Roma No Roma specific Miranda, D. , Oreja-Duran, I. & Escobar-Ballesta, M. (2016). Evaluación del Componente de Salud de la ENIPG en el Poligono Sur. IOM
Mapping Roma visibility: Are health services accessible to Roma neighbors? Where do the Roma community live? They are hidden within the Poligono Sur Where are the services located? In the areas where the Roma do not reside 80% Roma http: //www. arcgis. com/apps/View/index. html? appid=820626892 ce 54 d 8 db 989 fb 187 df 4 c 05 d
Uncovering multiple discriminations: Unmuting voices of local health providers and Roma neighbors Photovoice with local Roma neighbors • Neglect from public services • Mistrust with institutions • Double discrimination – Being from Poligono Sur Focus groups with local Health Providers • Health providers don’t have institutional support • Lack of well-defined incentives • High rotation of professionals • No protocols of good practice • Health providers blame Roma neighbors • Misunderstanding of Roma neighbors
An example of institutional discrimination: The family planning program of the Primary Healthcare Center «Polígono Sur» • Sexual and reproductive health (SRH; data from 2006 and non-Roma specific) • • Teenage pregnancies 17% (+ 5% than the rest of the city) 35% of pregnancies are unplanned 1 out of three teens do not use protection 6, 6 % abortions – out of which 12% in teens, 80% in women who are already mothers, 25% already had an abortion, 50% did not use protection, 64% did not go to family planning • Since 1989, the PHC attends neighbourhoods with highest proportion of Roma (80%), exclusion, poverty and unsanitary conditions. • Family planning staff: one midwive, two general practitioners, two nurses and two nursing assistants – all of them women with experience in the PHC between 2 and 22 years.
Dismantling institutional discrimination: Steps towards Roma Health Advocacy Moving Forward • Restructuring participation by giving voice and engaging local Roma in designing and implementing local policies • Space for both providers and Roma to discuss their experiences • Rebuilding relationships of trust • Redistribution of power • Redesigning local programs, practices and policies Roma neighbors and health providers should act as Roma health advocates within community, organizations and institutions for transformative changes
Road 4 health: A multi-level advocacy framework for NRIS-H implementation in three at-risk local contexts in Sevilla • 2016 -2019 – Funded by the Open Society Foundations (129. 000$) • Goal: Generate processes that create empowering Roma settings where Roma are protagonists of change and can negotiate allocation of resources with local health providers & policymakers. • Ongoing outcomes: The need to focus on Roma maternal and child health, focusing especially on health of the teenaged age Roma children (8 -18 years old)
ROMOMATTER: Empowering at-Risk Roma Girls‘ Mattering through Reproductive Justice
ROMOMATTER: Goal and expected results • Problem • Roma teenage motherhood (RTM) in at-risk contexts is deeply at a crossroad of multiple discriminations and used by certain sectors of European society to validate the rejection of Roma • 2% of European Roma girls (10 -15 y/o) cohabit with a partner and 90% of RTM don’t complete primary school and dedicate their time to housekeeping (FRA, 2013). • Goal: To tackle gender discrimination by empowering Roma girls’ mattering to help them envision their own futures and choose motherhood only if and when they are ready. • Expected results • • • Identification of psychosocial patterns of RTM Uncover discriminatory mechanisms influencing this decision. Creation of collaborative settings among Roma girls and community facilitators Build sense of Roma community linked to values of reproductive justice among girls Development of Roma girls’ individual, relational, and collective strengths using community resources Reverse unfair RTM through an empowering process
Determinants of Roma teenager motherhood Roma patterns § Social organization based on the importance family § Strict gender roles § Strong sense of attachment and belonging (Roma identity) § Preservation of Roma community and culture through cultivating collective memory and traditions Roma teenager motherhood (RTM) Oppressive local mechanisms § § § Exposition to structural violence (blaming the victims) § Economic exploitation (unemployment, cheap labor § Cultural control (the power of Roma women is subjected to men) § Sexual control (avoiding gender identity; pressures, demands and expectations in issues like virginity and sexual behaviors) § Exclusion from the political and social spheres o A way to feel relevant o Development of a sense of mattering (recognition and influence) based on being wife, mother, caregiver. o Sense of belonging to the Roma community Violates the right of girls to be girls Impoverishes their lives Increases the risks of physical and mental illnesses Raises vulnerability to domestic violence exposure Condemns them to precarious employments
ROMOMATTER: theoretical background Mattering is the "perception that others depend on us, are interested in us, are concerned with our fate, or experience us as an ego-extension exercises a powerful influence on our actions" (Rosenberg & Mc. Cullough, 1981, p. 165). Development of sense of mattering Life Satisfaction Roma girls report worst life satisfaction compared to all other adolescents (Roma boys, and non-Roma boys and girls) Reysen et al, (2016). Journal of Applied Social Psychology, 46, pp. 426 -434 Roma identification Family vs. nationality, religion, ethnic identity (internalized stigma) Intergenerational transmission (mothers and Roma significant adults of their communities) vs. large societal influence (marginalization to survive) Dimitrova et al. (2015) Journal of Adolescence, 45, pp. 296 -306
ROMOMATTER: Embedding reproductive justice into Roma girls mattering ROMOMATTER proposes that the discrimination of at-risk Roma girls due to teenage motherhood can be reversed through an empowering process that links Roma girls’ mattering to reproductive justice. Reproductive justice is the decision-making processes and resource allocation that guarantees the right of every girl of her SRH based on the respect to their personal autonomy, gender identity and life expectations (Ross, 2007) • • • Developing critical thinking will capacitate girls to provide new meanings to their mattering and their motherhood from their cultural values and use them to imagine a thriving life. Envisioning new resources, roles and networks that will enable Roma girls to pursue their life goals. Advocating for collective actions focused on the construction of safe and healthy contexts that will allow them to decide on their mattering and choose motherhood freely.
Roma girls participatory action research (RGPAR) Opportunities Challenges • Roma girls have the talent to lead initiatives that confront their challenges • Organizations and institutions may be prejudiced or reluctant to working with them • Processes based on the collaborative alliance between Roma girls and significant adults (eg. parents, public service providers) ensure acceptation and structural changes • Roma girls—along with stakeholder facilitators —will identify their needs and strengths, design actions, implement, evaluate and provide feedback • The use of the new technologies is a determining factor in the involvement and commitment of at-risk Roma girls throughout the project • It is necessary to prevent possible rejection from family members, peers and communities. • Ensure continuity throughout the whole process
ROMOMATTER: Outcomes and Target Populations Outomes Target populations • Map psychosocial, cultural and contextual determinants • At-risk Roma girls among 10 -15 years of RTM. old • Map community assets, narratives and evidences to empower Roma girls’ mattering linked to reproductive justice. • Develop critical thinking on Roma girls • Develop recommendations to empower Roma girls’ mattering linked to reproductive justice. • Build capacity of Roma girls to advocate for their own reproductive justice • Evaluate the process, implementation and impact through empowerment evaluation. • Disseminate and promote knowledge translation and utilization of findings. • Key stakeholders: • Roma women • Providers of public services • Staff members of community organizations • Other significant adults • Policymakers
ROMOMATTER: Methodology
ROMOMATTER: Framing RGPAR to empower mattering linked to reproductive justice (TCD-Irland) 1. Building local coalitions between partners and key community stakeholders 2. Mapping community assets, Roma women narratives and scientific evidences 3. Creating a tool box for RGPAR (co-led with University of Alicante)
ROMOMATTER: Implementing RGPAR to empower mattering linked to reproductive justice (USSpain) 1. Selecting and training facilitators 2. Selecting Roma girls: 20 -25 girls between 10 -14 y/o • Selection method adapted to contextual conditions • Identify themselves as Roma, have no children, no pregnant, attending school, untapped leadership potential reflect ability to work together, national/foreign origin 3. Developing critical thinking on reproductive justice through Photovoice • Developing Roma girls capacity to articulate their own narratives to identify goals for the future • Building knowledge on Roma girls reproductive justice 4. Developing recommendations for Roma girls’ reproductive justice 5. Building capacity of Roma girls to advocate for their goals and aspirations
ROMOMATTER: Evaluating RGPAR process, implementation and outcomes (TSA-Bulgaria) 1. Developing a training guidelines 2. Training and monitoring of facilitators as evaluator 3. RGPAR evaluation activities • Process evaluation • Evaluation of implementation • Outcomes evaluation
ROMOMATTER: Dissemination and knowledge translation of outcomes and project results (UA-Spain) 1. 2. 3. 4. 5. 6. 7. Elaboration of a dissemination and communication strategy Report on dissemination and communication activities Development and maintenance of a project website Presentation of project outcomes in national and international conferences Submission of scientific manuscripts Organization of the ROMOMATTER project Final Conference Development of a tool box and policy brief on recommendations to fight against Roma teenage mother discrimination
ROMOMATTER [J]ITANA Identificar narrativas en las niñas gitanas en riesgo Identificar mecanismos de opresión que impiden a las niñas disfrutar libremente de sus decisiones Crear espacios en los que niñas gitanas identifiquen sus necesidades y deseos Promover valores de salud reproductiva en los servicios públicos y las organizaciones comunitarias Dotar los procesos desarrollados de sensibilidad a las realidades del estado español Desarrollar conocimiento de transferencia y buenas prácticas basadas en la evidencia Fortalecer la capacidad de las organizaciones gitanas en promover justicia reproductiva Universidad de Sevilla (ES) KAMIRA (ES) Universidad de Alicante (ES) FAGA (ES) Trust for Social Achivement (BU) National Network of Health Mediators (BU) University of Bucarest (RU) Policy Center for Roma and Minorities (RU) Trinity College Dublin (IR) Healthcare Leadership and Management Development Institute (HU) Universidad de Sevilla (ES) KAMIRA (ES) Universidad de Alicante (ES) FAGA (ES) Universidad de Navarra Universidad Loyola ASPCAT UNGA FAGIC GAZ-KALO
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