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

摘要普拉斯托最近的工作(AHRC/MRC赠款“东非的孕产妇死亡率；AHRC/MRC赠款”通过印度、马拉维和乌干达的创造性和青年主导的实践在青少年中促进性健康和生殖健康教育；英国学院赠款“促进平等：在乌干达贫民窟社区整体工作，挑战性别不平等、性无知和虐待性行为”；AHRC/MRC赠款“计划生育：事实还是虚构？”)这表明，东非的贫穷社区，尤其是农村社区，严重缺乏与性健康和生殖健康有关的准确知识，广泛传播的神话和错误信息使人们无法在与这些主题有关的一系列问题上为自己和家人作出良好选择。我们还发现，人们对好信息的渴求非常强烈，如果以相关的方式提供这些信息，让人们有时间提问和讨论，很快就会导致重大的行为变化。尽管卫生当局和学校本应传播这些信息，但我们发现，无知、尴尬、缺乏文化敏感性和缺乏时间意味着来自贫困农村社区的人几乎普遍缺乏可靠的信息来源。虽然肯尼亚在性服务和生殖服务方面有很好的政策，但我们的研究发现，政策和执行之间存在巨大差距，在所有保健设施的教育和提供服务方面都明显不足。这种信息匮乏带来了许多弊病。整个东非的孕产妇死亡率是世界上最高的之一；意外怀孕和少女怀孕的比例特别高；许多女孩因月经问题而失学，由于缺乏关于生殖方面的最基本知识，性剥削的危险很大。我们发现，使用实际的、具体的方法，使用当地的文化方言，使社区能够感到放心，并随时参加以艺术为基础的活动，探索他们关于生殖和性问题的知识和问题。当与公共卫生专家提供的良好而明确的信息结合在一起时，尤其是在没有先入为主的道德或基于信息的议程的情况下，允许有充足的时间进行辩论和问题，并作为共同社区成员而不是作为卫生精英进行沟通，来自不同年龄和性别的广泛的社区成员渴望参与并希望获得往往导致行为改变的知识。这一创造性的参与战略促进了公众的强烈参与和相关、准确的健康教育的传播。从上面列出的项目中意外地了解到，当年长的成员和男性清楚地看到这将如何使他们的家庭受益时，他们是多么开放地接受新信息并改变他们的想法。我们还发现，与许多专注于特定群体(即最常见的是女孩)的项目相反，当更广泛的社区参与、讨论和学习时，会产生更深远的影响。我们还意外地发现，传统助产士(TBA)和志愿社区卫生工作者(VCH)坦率地承认，他们缺乏关于生殖和性健康的良好信息。因为在农村社区，这些是许多人的第一线建议，他们必须相信自己有很好的基本知识，并知道向客户推荐什么。在评估期间，这些小组的许多成员表达了他们对更好的教育和培训的渴望。最后，我们希望培训肯尼亚艺术促进者的核心小组，采用可复制的方法进行研究，然后传递性健康和生殖健康方面的贫困社区所需的信息，以便我们的工作可以在全国类似的环境中倍增

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