In this season, we are speaking with guests who are applying an intersectional lens to their work in sexual and reproductive health. In this first episode, we started out by asking our guests to define the term "intersectionality" so we can all begin on the same page.
www.knowledgesuccess.org/inside-the-fp-story
From Knowledge SUCCESS and VSO, this is Season 5 of Inside the FP Story—a podcast developed with the family planning workforce, for the family planning workforce.
Each season, we hear directly from implementers and decision makers from around the world on issues that matter to our programs and services. Through these honest conversations, we learn how we can improve our family planning programs as we work together to build a better future for all.
I am Sarah Harlan, Partnerships Team Lead with the Knowledge SUCCESS project. I am pleased to introduce our narrator, Charlene Mangweni-Furusa.
Narrator: Welcome to Season 5 of Inside the FP Story. This season, we are exploring the reasons why an intersectional lens is necessary for sexual and reproductive health programs, including family planning. Our guests will also introduce tools and resources that can help us ensure that policies, programs, and services are more inclusive and accessible to all.
Narrator: As we have covered in previous seasons of this podcast, achieving and sustaining universal access to sexual and reproductive health care requires a multitude of social and structural factors—from supportive policies to trained health providers to well-functioning supply chains. And because the factors that influence sexual and reproductive health access are wide-ranging, our solutions must also address this complexity.
At the same time, we also need to recognize the various identities that individuals and groups hold—for example, class, education, race, ethnicity, gender identity, sexual orientation, income, and disability—and how they intersect to influence a person’s ability to access and receive quality health care.
One approach that can help us understand how these identities relate is called “intersectionality.” While this terminology is not new—and we will hear more about its origins from one of our guests later—it is starting to gain more recognition in our field. Using this approach can help us ensure that everybody, including those who are most underserved and vulnerable, can realize their sexual and reproductive health rights.
Sexual and reproductive health rights—or SRHR—are human rights that allow people to make informed decisions about relationships, their bodies, family planning, sexuality, and well-being. And importantly, people need to be able to access services free from stigma, discrimination, and violence. SRHR includes access to a full range of sexual and reproductive health services, including: antenatal and maternal care; STI prevention, detection, and treatment of STIs, including HIV/AIDS; choice of safe and effective contraceptive methods; sexual and gender-based violence prevention and response; and inclusive, affirming comprehensive sexuality education.
This season, we spoke with guests who are applying an intersectional lens to their work in sexual and reproductive health. We started out by asking them to define the term “intersectionality” so we can all begin on the same page.
Caroline Wambui works for VSO and is based in Nairobi, Kenya. She is the Innovations Manager and Deputy Team Lead for a program called Make Way, which we will discuss more throughout this season of the podcast. Here is Caroline’s definition of “intersectionality.”
Caroline Wambui: In a simple sentence, I would say intersectionality is the overlapping of identities. It's looking at an individual, not just from one identity, but their different identities and how these identities interact to create either opportunities or discrimination. I'll give an example.
For instance, I am not just a woman. I am an African woman. I am a black woman. I am an educated woman. I'm employed. And so if you were to look at me, you wouldn't just look at me as just one identity. You have to look at me as a whole, and you have to look at how my identities interact and whether those interactions then lead to me being discriminated upon, or either getting privilege. Intersectionality for me is about looking at a person's social identities, how they overlap and what opportunities they create and specifically what opportunities do they create when that person, when new identities interact with instruments of power—that is the policy makers, the leaders, the government and the people who make decisions in your locality or in your nation. So for instance, if I was a young black woman who is also disabled and also a sexual minority, maybe I am a lesbian, that would look very differently when I try to access services from my nation or from my locality, as opposed to if I was a young white educated woman. So intersectionality means you move away from looking at a human being as just one identity or looking at human beings as homogeneous groups, to looking at social identities and what kind of interactions they create when they interact with power or decision makers.
Narrator: Myria Koutsoumpa also works on the Make Way program. She is a Global Health Advocate at Wemos, based in the Netherlands. We asked her the same question—what does “intersectionality” mean to you? She shared a similar definition, and also discussed the concept of “leaving no one behind.”
Myria Koutsoumpa: So for me, intersectionality, really practical and really simply means leaving no one behind. So as people, we all have combinations of different identities, right? Like age, gender, sexual orientation, disability—all these different characteristics that make us who we are. And all these characteristics overlap and create new barriers for people on the one hand, but they can also create power and privilege. For example, let's say that I am an adolescent girl with a disability, I'm living in a rural area, and I'm also a lesbian. So all these different characteristics come together and they create a compounded vulnerability, create a new reality for me that makes me vulnerable or creates barriers for me to reach, let's say, and realize my SRHR.
And important thing to note is that vulnerability and power are not static, but they change over time and over context. So, for example, a Somali doctor might have had power and privilege as an educated woman in her community in Somalia, but not the same while living as a refugee without access to resources in a refugee camp in Kenya.
So it doesn't mean that how we start is how we end up. And intersectionality makes you more aware of these overlaps. So it helps you remove these barriers that are created because of the compounded vulnerabilities, because of these overlapping characteristics.
Narrator: As Myria discussed, intersectionality recognizes not only the complex and compounding nature of different identities, but also the way that this changes over time. It is never static.
As both Myria and Caroline highlighted, intersectionality invites us to first identify the different identities that a person holds and then consider how these identities intersect. It is also important to consider the gender and social norms that govern institutions, policies, and services. These norms—not the identities themselves—shape and influence an individual’s ability to access and receive quality care.
Myria also discussed the origins of the term “intersectionality.”
Myria Koutsoumpa: The concept of intersectionality is not new. The term was conceptualized and coined by the African-American feminist Kimberlé Williams Crenshaw back in the 80s. And it came out of Black feminism. So we did not reinvent the wheel by focusing on intersectionality. But yes, we made a conscious decision to really, really use it and make it operational in our advocacy work.
Using an intersectional approach to your thinking, to your programming, it can help you recognize differences and understand how these differences shape also our experience in the world. So it makes us aware of power and privilege—who has it and who does not. So it serves as a starting point for truly inclusive work on equity and justice. So within a program that is based on partnership, this is actually the first step, and this is something that we also did to our own assessment as individuals, organizations, and ask the difficult questions and explore and realize our own privilege, biases, and challenge that. So then by having this basis, we can move on to plan our work ahead and do our work planning and our theories of change and and set our goals.
Narrator: As Myria stated, program designers—particularly those with more power and privilege—need to look inward first. We will talk a bit more about that later as we make recommendations for programs and services. But first, we will further explore why intersectionality is necessary to achieve and sustain equitable and inclusive access to FP and SRH.
Narrator: We asked Caroline to describe how the intersectionality lens can be applied to FP and SRH programs.
Caroline Wambui: Sexual and reproductive health is an integral part of human life and you cannot say that you are a human being who has access to their right if you do not have access to sexual and reproductive health rights. So it is a very integral way of life. It is a gateway towards who you will be in the future.
And so intersectionality and SRHR are very important because intersectionality helps us to understand who has been left behind in access to sexual reproductive health rights. You cannot say that a person has access to their rights or they have a fulfilling life if they do not have access to SRHR.
Intersectionality provides for us a very good framework to be able to understand who has been left behind and what experiences do these people have when they try to access [SRH] services. So for instance, looking at maybe a young person in Kenya who has a disability and is also a teenage person, a teenage girl who has a disability. They have different experiences when they try to access sexual and reproductive health services when in their locality or in their countries. And so it's important to incorporate the intersectionality lens to be able to see these experiences and to be able to see who has been left behind. So it is not just important. It's not just as easy as saying that universal access to SRHR is important. It's also important to look at who is not accessing these services. And intersectionality then provides that lens to be able to see who has been left behind and what kind of experiences they have.
Narrator: Caroline and Myria described why it is important to apply an intersectional lens to FP and SRH programs. However, especially because this approach involves looking at issues with a deeper lens, it is important to anticipate and plan for challenges. We asked Caroline to explain the main barriers she faces in doing this innovative work.
Caroline Wambui: As the Intersectionality Consortium, having implemented with an intersectional lens for the last two years, one of the challenges that we have is that intersectionality is a fairly new term in this part of the world.
And so we cannot confidently call ourselves experts in this area. And so we are learning as we go. The challenge would be how we are learning. Sometimes it slows down our expectations in terms of program implementation. Looking at it from a program implementation angle, the successes may not look like what we anticipate in a conventional program, even in a conventional donor funded program. So sometimes things slow a bit because we are learning. We want to go back and document our lessons. We want to also go back and be able to see did we actually showcase intersectionality in part. So this requires a lot of flexibility on our end.
And also we have realized that, especially for Sub-Saharan Africa and specifically for the countries that we work in for the Make Way program, is that we do not have enough research to be able to support our cause. So we don't have research that is out there that we can rely on. We are going to need to create evidence on intersectionality as a program, and that requires funding.
The first challenge is that it's new. We are not experts. It slows things a bit. And then the second one is that we, there's not enough research out there for us to be able to rely on. And it requires funding, a lot of funding is required to be able to bring on board this evidence and research that will help other people who also want to learn and to work with an intersectional lens.
Narrator: Myria also discussed the challenges of applying intersectionality. First of all, organizations are so used to working with “key populations”—or defined groups of people who are particularly vulnerable—but talking about intersecting identities is not as comfortable.
Myria Koutsoumpa: I think a challenge in this work is that sometimes intersectionality is seen as another way to do programming around key populations—so about different identities—and not realizing that we need to focus on how identities interact with each other. And as NGOs, we are not used so much to doing that, to looking at the compounded vulnerability, so we end up with parallel programs. So the challenge is to really, really grasp intersectionality and include it by default in your programming as an NGO. And that requires some self-assessment as well to look internally on how to challenge your privilege, your power, and do your programming.
And of course, as always, with SRHR programs, because SRHR implicates education, religion, culture, politics, and this is all that makes SRHR interesting, but is also what makes it really, really complex and often sensitive.
Narrator: Myria also named some of the opportunities of using an approach like intersectionality in our field.
Myria Koutsoumpa: These challenges of having an intersectional lens that really unmasks systemic issues —links to education infrastructure, access to medicine—this leads really to also opportunities to understand the linkages and and really address them in your programming and in your lobby and advocacy. So, yeah, something that can be a challenge can really lead to an opportunity as well.
Narrator: We asked Myria and Caroline to describe the Make Way program, which applies an intersectional approach to SRH programming in Ethiopia, Kenya, Rwanda, Uganda, and Zambia—as well as at the global level. Here is Myria.
Myria Koutsoumpa: We are now having a new program, started in January 2021, that is focusing on intersectionality and SRHR. And it's called Make Way, embracing Intersectionality for Health, Equity, and Justice. And it is funded by the Dutch Ministry of Foreign Affairs. It's a partnership of some consortium partners. So these are Akina Mama Africa, the Circle of Concerned African Women Theologians, the Forum for African Women Educationalists, Lilane Foundation, VSO Netherlands, and Vemos—my organization.
So I'm the coordinator of the regional and global team of Make Way. Make Way is an advocacy and strengthening civil society program, and our aim is to ensure that people and youth in all of their diversity can fully realize their SRHR. So we promote an intersectional approach to address SRHR issues, which means to make the overlapping vulnerabilities visible and understand the effects of these overlapping vulnerabilities on people's lives and SRHR.
Narrator: Caroline also described her role on the program team.
Caroline Wambui: As the innovations manager for the Make Way program, my work involves supporting the country teams who are implementing the Make Way program to put intersectionality into practice. So basically we implement an SRHR program focusing on ensuring that young people have access to sexual and reproductive health and my role then involves putting that into practice. How do we showcase intersectionality? How do we build capacity of local organizations or national organizations to do the same, to put intersectionality into practice and how do we lobby and advocate for duty barriers to be able to also put intersectionality into practice within their role. That means the policy making process—how do we ensure that this also translates at the country level, at the policy level?
So my work is to support the countries to be able to put that into place and to come up with innovative ways to showcase intersectionality. And our intention is that our decision makers will be able to always have intersectionality at the back of their mind as they implement and put into place policies that ensure that no one is left behind.
Narrator: The Make Way program, led by the Intersectionality Consortium, applies an intersectional lens to reveal barriers and challenges to accessing and using SRH services among young people. Here is Caroline.
Caroline Wambui: Our intention is that all young people, regardless of their race, sexual identity, sexual orientation, [or] age, will be able to access their SRHR services in their countries without discrimination.
Our intention is that by incorporating an intersectional lens, then we are going to uncover systemic discriminations experienced by young people who are trying to access SRHR services, and that this will then help us to be able to remove those barriers and ensure that they access services. So the intersectional lens will help us to ensure that young people are able to access their services.
Narrator: Myria talked about specific tools that the Make Way program has developed and used to design and implement activities that integrate intersectionality. Specifically, she described the Make Way SRHR Toolkit, which we will link to in the notes for this episode.
Myria Koutsoumpa: What we try to do within the Make Way program is really to find ways to put intersectionality into practice. So what we did is—again, we did not reinvent the wheel—but we looked out and we found existing tools and we adapted them with an intersectional approach. And we built also new tools based on existing knowledge again. So what is this toolkit about? It has different tools that can help you really put intersectionality into practice.
And what do I mean by that? By putting intersectionality into your policy analysis or in your budget analysis or using intersectionality when you are engaging with youth, or in youth leadership. And we also have tools that have to do with accountability—so an intersectional community scorecard.
So, if I would focus on one of these tools just to make it a bit more practical, is the intersectionality-based policy analysis tool. Again, that was existing, but we adapted it for our program. And it's really an analytical tool, like a questionnaire that you can use when you analyze a policy and it helps you understand really in this policy the environment where this policy was developed, who was developed, how it was developed, who was there when it was developed.
Which population does it address? Which population does the policy leave behind? What happens with monitoring and evaluation, with accountability? So it really asks the difficult questions to see under this policy, which are the underlying power dynamics? Who is left behind in this policy?
And this can be let's say a law. It can be a bill. It can be a strategy of a development partner. It can be really adaptive. It can be used in many, many cases, but it really helps you understand deeply the power dynamics underlying the policy development process. So we have already used it quite a few times and it's really, really helpful to then build the right advocacy messages that are focusing on intersectional SRHR.
Narrator: Practically speaking, an intersectional lens helps FP and SRH programs determine what activities to prioritize to ensure that their programs serve a wider range of clients. For example, after using an intersectional approach, programs may use more inclusive language to make sexual and gender minorities feel welcome at clinics. Programs also could expand clinic hours to be more inclusive of youth, advocate for policies that address the needs of indigenous communities, or add communication devices and ramps that are accessible for people with disabilities.
Caroline also discussed the practical tools developed and used by the Make Way program.
Caroline Wambui: For VSO in the Make Way program, we have developed an intersectional community scorecard, a social accountability tool that helps to bring out the voices of the community and gives them a platform to interact with people who are mandated to offer services within their country, within their locality, maybe its health services, education services or any other services.
So our intersectional community scorecard has been implemented in two countries so far—in Kenya and Zambia—and what we have done is to be able to bring marginalized young people who are not conventionally brought on board when conversations about health and reproductive health are being conducted. One of the things that we learned in Zambia is that even though the country has these policies that talk about access to sexual and reproductive health rights for all access to contraceptives, especially for anyone who comes out and says they're sexually active, we find that people like teenagers, teenage girls and teenage boys are not accessing these services. When they go to facilities, they're turned back because there is this knowledge or this notion that the health workers have that young people shouldn't be coming to get contraceptives. We also found out that when they go to facilities to give birth, if they're teenage mothers, they're not treated the same as other mothers. Sometimes they feel mistreated. And that is one of the things that they got an opportunity through the intersectional community scorecard to stand up and say, when we go to these facilities, we are mistreated. And these are some of the things that we are trying to change.
And It's not just having the service, it's also that you are treated as a human being. You are treated with dignity, and you are able to receive a service that really responds to your needs. So I would say that is one of the ways that we have been able to put intersectionality into practice.
One of the things that I've been proud of is creating a platform through this intersectionality program for very marginalized people who have never been included in policy processes or decision making processes, being able to stand together with their leaders and telling them, “These are our experiences when we go to access services.” I think even though some of the experiences were not good experiences, it's a major thing for them to be able to be included, for them to have a platform where they are heard. And for me, that's a proud moment.
Narrator: We will discuss this newly-launched scorecard more in Episode 3 of this season—including what makes it intersectional, and how it can be used in programs.
Narrator: The intersectionality tools they described help ensure that this approach is put into practice. We asked Caroline what success looks like—in other words, what are some of the indicators that the Make Way program is achieving its outcomes and goals?
Caroline Wambui: The first thing is, creating a critical mass of people who understand and implement with an intersectional lens. So basically us being able to diffuse and create another group of people who are not in the Make Way program, also working on an intersectional lens.
That will be the first success for us. We would be glad to have other people join us in this course. And then the second one is to be able to convince duty bearers in these countries is another success area—that they can be able to go back to their budgets and wonder if I have allocated this amount towards sexual and reproductive health in this country. Does that mean that even the most vulnerable, even the person who is not usually brought into the room, are they going to access services? So to help them, if we convince even two duty bears to be able to implement or to create policies that have an intersectional lens, that will be a success story.
And also definitely if we are able to see more and more young people speaking out on their rights and be able to access SRHR services without discrimination. That would be also a very successful thing for us.
And it takes quite a bit of time but we are just starting to bring on board more people. We are hoping that then we will start the journey to be able to diffuse their knowledge.
Narrator: In our third episode this season, we will talk more about specific tools and techniques that can help resolve power imbalances unearthed when we use the intersectional lens in our programs.
Narrator: We asked Myria what recommendations she would have for programs interested in adopting an intersectional approach for their FP and SRH programs.
Myria Koutsoumpa: I would start first by looking internally. If you're an organization that wanted to work on intersectionality, first do your own assessment and ask the difficult question to explore and realize your privilege and your biases and really challenge that. So I think that's a first step. And then it's really important to listen to voices that are different from your own and learn from them. And educate yourself on the different discriminations that marginalized groups face and make space for people to speak for themselves really. So sometimes you might need to take a step back.
Narrator: Everyone involved in program development and implementation can look inward to examine their own privilege and biases—it is also important to explore power among local stakeholders and clients as well. In doing so, we can better understand and adapt programs to meet clients’ needs for FP and SRH services. These conversations can also help communities challenge harmful social norms that may impact certain groups more than others—for example, child marriage, gender-based violence, and more.
Myria also encouraged programs to pay close attention to data.
Myria Koutsoumpa: And finally, another important recommendation is to ask for disaggregated data. And advocate for that. And that's because most quantitative data that we use as advocates in our work lacks important information on the people who are most left behind. So we need data that is disaggregated beyond gender and age categories to understand who is minoritized and how, and who is left behind and which are the people that are falling between the cracks and are not counted, so then they are, their SRHR or other health needs and rights are not addressed and are not programmed for. So that is really important. And remember that intersectionality is really a way to understand and explain the complexity in the world, in the people and in the human experience. And only by putting on your intersectionality glasses, let's say, you will be able to ensure that no one is left behind.
So it's a way of thinking. It can become, let's say, a second nature to look towards SRHR, but also global health overall through an intersectional lens.
Narrator: Caroline echoed these ideas, and also recommended looking internally.
Caroline Wambui: The first one would be to do a value clarification, because the first thing about intersectionality is looking inwards. What are your biases? What do you believe in that creates the lens through which you look at the world? So for instance, how you have been brought up and your experiences and who brought you up actually your experiences in life create biases.
So you can look at a person and decide who they are even before they speak or they tell you about yourself. So intersectionality first helps us to look inwardly and look at our biases and be able to see how that then, if we were in a position of power or if we were in a position of making decisions, how we make decisions.
So that is the first thing I would ask the person who wants to learn about intersectionality is to look at yourself and also to look at your organization. Who makes decisions, how are they made and when, and who is involved in decision making. And that then helps you to start off the intersectionality journey looking inward.
Narrator: The intersectionality approach recognizes how diverse social and structural factors shape and influence access to and quality of care according to intersecting identities held by people. Both Myria and Caroline see its potential for achieving and sustaining universal access to FP and SRH. Here is Myria.
Myria Koutsoumpa: The traditional approach to SRHR that we use tends to focus on the type of discrimination or on the type of oppression in silos. So they address specific concerns or address the symptoms of power inequalities instead of tackling the issues at the root. So if we see SRHR issues intersectionally, then we see the structural problems and we will confront and change the power structure itself.
So the intersectional approach to SRHR requires that we work to transform systems of oppression at the very root, so then everyone can live and enjoy their rights, no matter who they are and where they are located in society. And, this is the important part as well, that we center the voices and the experiences of the minoritized and vulnerable first.
Narrator: Caroline also emphasized this approach as one that asks us to center the voices and experiences of the most vulnerable communities. This is done by shifting the power structures and ensuring that people belonging to these communities actively participate in the decision making process.
Caroline Wambui: I see an opportunity to actualize universal access to SRHR as stipulated in their strategic development goals. And so if we incorporate this lens, I see opportunities for countries to be able to ensure that no one is left behind and we are able to implement in a way that then brings them to the table. Ideally incorporating intersectionality in SRHR helps us to bring people who are marginalized, who are not usually thought about even when discussions and policies are being formulated. And so this gives an opportunity for that to happen and it gives them an opportunity for people who are in decision making positions to be able to listen to the most marginalized and implement with them in mind.
Narrator: Ultimately, exploring ways to apply intersectionality within FP and SRH programs will help countries and communities better realize their goals—including FP2030 goals, Sustainable Development Goals, costed implementation plans, and more—by providing a framework to challenges and bringing everyone into the conversation.
This first episode of the season introduced the concepts of intersectionality. We presented the key challenges and opportunities—and we examined the Make Way program’s innovative application of intersectionality to global FP and SRH programming. Myria and Caroline provided us with a high-level overview of the topic, including recommended tools and practices.
Join us for our next episode, where we will hear from community members about the impacts of applying intersectionality to family planning and sexual and reproductive health programming at the grassroots level.
Season 5 of Inside the FP Story is produced by Knowledge SUCCESS and VSO. This episode was written by Sarah Harlan and edited and mixed by Elizabeth Tully. It was supported by an additional team, including Brittany Goetsch, Danette Wilkins, Cariene Joosten, Polly Walker, Marjorie Mbule and Tienke Vermeiden.
Special thanks to our guests Myria Koutsoumpa and Caroline Wambui.
To download episodes, please subscribe to Inside the FP Story on Apple Podcasts, Spotify, or Stitcher; and visit knowledgesuccess.org for additional links and materials.
The opinions in this podcast do not necessarily reflect the views of USAID or the United States Government.
If you have any questions or suggestions for future episodes, feel free to reach out to us at info@knowledgesuccess.org.
Thank you for listening.
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