Using arts-based workshops to share knowledge on reproductive and sexual health with rural communities in Nyanza, western Kenya.

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SummaryRecent 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