1. Carol Underwood, Zoé Hendrickson, and Ron Hess
Gender, power, and communicative action: Qualitative findings from selected Nepali communities
Carol Underwood, Zoé Hendrickson, and Ron Hess
Nepal HC3 Project
February 2016

2. Presentation Outline Background and context
Integrating communication and gender theory
The Nepal HC3 Project
Methods
Findings
Significance and implications

3. Background and context: Nepal
International and domestic attention to contraceptive availability, accessibility, and utilization in Nepal1,2
Contraceptive use remains lower among the young married cohort, migrants, rural populations, and couples from marginalized and disadvantaged groups3,4
Image from:
The modern contraceptive prevalence rate (CPR) is lowest, and unmet need highest, among the young married cohort (14.4% CPR for CMWRA aged 15–19; 23.8% CPR for CMWRA aged 20–24; 39.8% CPR for CMWRA aged 25–29), migrants (52.9% CPR husband and wife live together; 22.5% CPR husband lives away), rural populations (42.1% vs. 49.8% in urban areas), and marginalized and disadvantaged groups (MDAGs) (22.8% CPR Muslims; 40% CPR Dalit).

4. Background and context: Family planning decisions in Nepal
Role of communication: Greater partner communication and joint decision-making associated with greater contraceptive use3,5-8
Gender norms, gender preferences, and expectations of women’s roles also influence reproductive decision-making9-12

5. Habermas and communication
Strategic communication vs. communicative action12,13
Communicative action as the pursuit of consensus
Image from: Habermas, 1974; Jacobson & Storey, 2004

6. Connell and the theory of gender and power
Three organizing dimensions of gender relations in the family/household14
Labor: “Allocation of particular types of work to particular categories of people” (p. 99)
Power: “Relations of power that act as a pattern of constraint on social practice” (p. 107)
Cathexis: Structure organizing emotional attachments to people, particularly relations between men and women and masculinity/femininity

7. Integrating communication and gender theory
Communicative action provides a lens that moves beyond labor, power, and cathexis to examine how mutual understanding and consensus construct and/or reconstruct gender relations in a family or household

8. The Nepal HC3 Project Multi-component, four-year project (2013-2017)
Intervention includes integrated media, social media, community events

9. Map of districts in Nepal
Humla
Darchula
Bajhang
Mugu
Baitadi
Bajura
Dadeldhura
Jumla
Doti
Achham
Kalikot
Dolpa
Kanchanpur
Mustang
Dailekh
Jajarkot
Kailali
Rukum
Manang
Surkhet
Myagdi
Bardiya
Salyan
Baglung
Gorkha
Rolpa
Kaski
Lamjung
Parbat
Rasuwa
Banke
Pyuthan
Gulmi
Syangja
Dang
Arghakhanchi
Tanahu
Nuwakot
Sindhupalchok
Palpa
Dhading
Kathmandu
Dolakha
Formative research districts
Bhaktapur
Kapilbastu
Nawalparasi
Solukhumbu
Kavrepalanchok
Sankhuwasabha
Taplejung
Rupandehi
Chitawan
Lalitpur
Makwanpur
Ramechhap
Okhaldhunga
Sindhuli
Parsa
Khotang
Terhathum
Bhojpur
Panchthar
Bara
Sarlahi
Rautahat
Udayapur
Mahottari
Dhankuta
Ilam
Dhanusa
Siraha
Sunsari
Saptari
Morang
Jhapa

10. Formative research methods
Sixty in-depth interviews on attitudes, norms, experiences, and processes that influence contraceptive use
Participants:
Unmarried women and men,
Married women and men
Mothers-in-law
Migrants
Health workers and FCHVs
Influential community members

11. Analysis methods
Multi-national research team (US- and Nepal-based individuals) worked to develop coding framework using a priori and inductive coding
Thematic analysis of English transcripts performed in ATLAS.ti

12. Findings: Sexual division of labor
“Wife makes the decision related to raising the children She takes decision right from their care to every other thing. I only bring the materials to the house.” (Married man, Banke) “My wife does household work I take such decisions [on expenditures for children] according to my judgment, not spending extravagantly.” (Man from disadvantaged group, Siraha) “The female is similar to that of the male. She can engage in a job and make her career. She has the right; and she is not here just to have babies and cook and take care of the family.” (Migrant man, Banke)

13. Findings: Power inequities
A: “In my experience, it is the husband who decides. It is the husband who gives either trouble or happiness “If [women] worked according to their own interest, husband comes with the stick and punishes them.” (Male health worker, Banke)
“Whatever husband says, wife does accordingly [regarding contraception].” (Unmarried woman, Siraha)
“In my home I have a job so I have more rights. But in some houses there are women working more than men. In some houses the women will have more rights.” (Married man, Banke)

14. Findings: Power equity
“In our Muslim community if the matter between them comes to a conclusion and they both are positive for the conclusion, then they can do that thing, otherwise they can’t do it… We have that rule in our religion.” (Migrant man 1, Banke)
“[Decisions are] not only taken by husband now. Now most of the wives are understanding, and it happens through agreement. In the past men used to tell their wives to do. Males did not [use contraception]. But now if the woman is weak [so cannot use contraception], she tells her husband to do. Everything is based on agreement.” (Influential man, Syangja)

15. Cathexis
“What kind of [husband]? (Laughing). One who fulfills my needs and wants, understands me, cooperates, and makes decision together.” (Unmarried woman, Syangja)
“If both husband and wife suggest to each other, they can live with happiness and love throughout the life.” (Influential man, Banke)
“There should be trust between husband and wife. If we lose that trust, we lose our wealth, we lose our home, and we lose everything.” (Migrant man, Syangja)

16. Findings: Communicative Action
“If I do so on my own [make a decision] it would hurt my wife. It would be a forceful and one-sided decision. That’s why we decide collectively in everything not only in the matter of children.” (Migrant man, Siraha) “There is good understanding. If he finds anything good, he shares with me, and vice-versa. . . There is good agreement with my husband. We work in coordination. What else?” (Woman from disadvantaged group, Banke) “Taking the decision together helps to keep the couples happy and see other options of the subject as well.” (Man from disadvantaged group, Syangja)

17. Summary of Findings Mutual trust, understanding, and empathy
Accounts of decision-making often varied
Gendered divisions of labor and power were reported, but participants’ emphasized that joint decisions and communication about family planning and other topics with partners was increasingly important

18. Significance and implications
We often assume that household gender dynamics are characterized by strategic action and driven by power imbalances and unequal divisions of labor that perpetuate inequities between men and women
Our findings from select communities in Nepal suggest that although gendered divisions of power/labor exist, partners are motivated to achieve mutual understanding and agreement regarding family planning and reproductive decisions

19. Namaste!

20. References
Shrestha, D. R., Shrestha, A., & Ghimire, J. (2012). Emerging challenges in family planning programme in Nepal. Journal of Nepal Health Research Council.
FP2020. (2015 March 16). Nepal: Commitments, Progress & Transparency. Retrieved from
Ministry of Health and Population (MOHP) [Nepal], New Era, and ICF International Inc. (2012). Nepal Demographic and Health Survey Kathmandu, Nepal: Ministry of Health and Population, New ERA, and ICF International, Calverton, Maryland.
Khanal M.N., Shrestha D.R., Panta P.D., and Mehata S. (2013). Impact of male migration on contraceptive use, unmet need and fertility in Nepal. Further analysis of the 2011 Nepal Demographic and Health Survey. Calverton, Maryland, USA: Nepal Ministry of Health and Population, New ERA, and ICF International.
Link, C. F. (2011). Spousal communication and contraceptive use in rural Nepal: an event history analysis. Stud Fam Plann, 42(2), 83-92
Yue, K., O'Donnell, C., & Sparks, P. L. (2010). The effect of spousal communication on contraceptive use in Central Terai, Nepal. Patient Educ Couns, 81(3), doi: /j.pec
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21. References, continued
Asian Development Bank (ADB). (2010). Overview of Gender Equality and Social Inclusion in Nepal. Mandaluyong City, Philippines: Asian Development Bank.
Rai, P., Paudel, I. S., Ghimire, A., Pokharel, P. K., Rijal, R., & Niraula, S. R. (2014). Effect of gender preference on fertility: cross-sectional study among women of Tharu community from rural area of eastern region of Nepal. Reprod Health, 11(1), 15.
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Basnyat, Iccha, & Dutta, Mohan J. (2011). Family planning (re)defined: how young Nepalese women understand and negotiate contraceptive choices. Asian Journal of Communication, 21(4), doi: /
Habermas, J. (1984). The theory of communicative action, Vol. 1: Reason and the rationalization of society. Boston: Beacon Press.
Jacobson, T. L., & Storey, J. D. (2004). Development communication and participation: Applying Habermas to a case study of population programs in Nepal. Communication Theory, 14(2),
Connell, Raewyn. (1987). Gender and power : society, the person, and sexual politics. Stanford, Calif. : Stanford University Press.