Sexual & Reproductive Health & Rights Theory Of Change

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Sexual & ReproductiveHealth & RightsTheory of ChangeINCREASING BODILY AUTONOMY, AGENCYAND ENJOYMENT OF SRHRElizabete, 16, is one of manyyoung women receivingservices and support fromOxfam’s partner NAFEZAin Mozambique.Photo: Caroline Leal/Oxfam Canada

2 SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS — THEORY OF CHANGE3 SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS — THEORY OF CHANGEaccess to SRHservicesThis resource outlines Oxfam Canada’s Theory of Change for its Sexual and ReproductiveHealth and Rights programming. A theory of change shows how we expect outcomes tooccur over the short, medium, and longer term as a result of our work. In this documentwe outline how we understand SRHR; why we focus on SRHR; the ultimate aim of ourSRHR programming; our Theory of Change for our work in this area; and highlights andbest practices stemming from our SRHR programs.Contraceptionsafer sex lifeWHAT ARE SEXUAL AND REPRODUCTIVEHEALTH AND RIGHTS (SRHR)?Sexual and reproductive health and rights (SRHR) are a comprehensive, integrated, and interdependent set of civil,political, economic, social, and cultural human rights. These rights are not “new” – they are already recognizedin international human rights treaties, consensus documents, and national laws in countries around the world.1,2Among theserights3are the right of all persons to: the highest attainable standard of sexual andreproductive health (SRH), including access toSRH services; make decisions concerning reproduction andsexuality free of discrimination, coercion, andviolence; seek, receive, and share information relatedto sexuality;Comprehensive SRH services include but are notlimited to: access to a range of contraceptive methods; safe abortion and post-abortion care; freely decide whether and when to have children; prevention, detection, and treatment ofreproductive cancers; decide whether, when, and whom to marry; decide whether to be sexually active; and have a satisfying and safer sex life.maternal careEnd GBVchoose apartnerinformationsafe abortiontreatmentEnd CEFM&FGMdefine yoursexualitypreventionbodily autonomyhave childrenor not maternal care (including skilled antenatal,childbirth, and postnatal care); prevention, detection, and treatment of HIV/AIDSand sexually-transmitted infections (STIs), andof reproductive tract infections; choose one’s partner;counselling accurate, evidence-based, and non-judgmentalinformation and counselling on SRH; freely define one’s own sexuality, includingsexual orientation, gender identity, andexpression (SOGIE); bodily autonomy;decision makingpower prevention, management, and treatmentof infertility; actions to eliminate harmful traditional practicessuch as female genital mutilation and child,early and forced marriage (CEFM); and prevention and counselling of gender-basedviolence (GBV).1 UNFPA et al. (2014). Reproductive Rights are Human Rights: A Handbook for National Human Rights Institutions, p. 21. Retrieved 12 March 2020,from ghts-are-human-rights.2 Asian-Pacific Resource and Research Centre for Women (ARROW). (2016). Universal Access to Sexual and Reproductive Health and Rights in Asia:A Regional Profile, p. 9-10. Kuala Lumpur: ARROW. Retrieved 12 March 2020, from srhr-asia/.3 For a more detailed overview of the different components of SRHR and related SRH services, see: Starrs, Ann M. et al. (2018). “AccelerateProgress—Sexual and Reproductive Health and Rights for All: Report of the Guttmacher–Lancet Commission,” The Lancet (391): 2645–46.Retrieved 12 March 2020, from eproductive-health-and-rights .WHY DOES OXFAM CANADA WORK ON SRHR?At their most basic level, SRHR involve peoples’ ability toexercise meaningful decision-making power over theirhealth, bodies, and lives, as well as the wider social systemsand enabling environment necessary for them to do so.Ensuring that all people have full autonomy and agency overtheir lives and bodies is necessary for improved health andeducation outcomes, as well as their freedom to participatein all aspects of economic life.4 In this sense, realizing SRHRis fundamental to achieving gender justice, sustainabledevelopment, and fulfilling women and young people’shuman rights and wellbeing. Yet SRHR are some of the mostchallenging rights to achieve, particularly for adolescentgirls and young women. This is largely because barriers torealizing SRHR are rooted in unequal gender power relations,stigma, and entrenched social norms, with ripple effectsat individual, household, community, and policy levels.“Women’s rights are human rights.This includes sexual and reproductiverights—and the right to access safe andlegal abortions. These rights are at thecore of our foreign policy. [ ] Evidenceshows that when women and girls areeducated and have control over theirsexual and reproductive choices,maternal and child mortality ratesdecrease and families thrive.”Global Affairs Canada, Canada’s FeministInternational Assistance Policy4 Oxfam Canada. (2019). If We Want Women’s Economic Empowerment, Then Let’s Talk About SRHR. Retrieved 12 March 2020, ic-empowerment-srhr/.

4 SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS — THEORY OF CHANGE5 SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS — THEORY OF CHANGEWHAT IS THE ULTIMATE AIM OF OXFAMCANADA’S SRHR PROGRAMMING?OXFAM CANADA’S SRHR THEORYOF CHANGEPillars of WorkThrough our SRHR programming, our ultimate aim isto increase bodily autonomy, agency, andenjoyment of SRHR by those least able toclaim these rights, including women, girls,adolescents, and persons of diverse sexualorientation, gender identity and expression.This goal requires addressing power imbalances andharmful social norms regarding gender and sexuality,eliminating structural and systemic barriers, andachieving long lasting and transformative change,from a comprehensive, intersectional, and reproductivejustice approach. It also requires a focus on some ofthe most neglected areas of SRHR, such as adolescentSRHR, comprehensive contraceptive care, safe abortioncare, and advocacy for SRHR.Defining Reproductive JusticeReproductive justice is when all people havethe social, political and economic powerto enjoy their right to bodily autonomy andsexual and reproductive self-determination.It is the realization of economic, social andcultural rights and freedoms, and the abilityto make and exercise choices not limited byoppression, discrimination, stigma, coercionor violence. It aims to transform powerimbalances and achieve systemic change.55 Women’s Global Network for Reproductive Rights. Abortion Policy Paper. Retrieved 28 February 2020 from: itions/ and Joint Civil Society Statement, 42nd Session of the UN Human Rights Council. International Safe Abortion Day,28 September 2019. Personal correspondence. Also see Sistersong, Reproductive Justice, www.sistersong.net.What is Oxfam Canada’sTheory of Change forits SRHR programming?To achieve the sustainable,transformative change neededto reach our ultimate aim, ourSRHR programming is informedby the following overarchingTheory of Change comprised ofthree interconnected, mutuallyreinforcing pillars of work:PillarPillarPillar123Shifting social norms and raisingindividual and community awarenessregarding SRHR.Strengthening the provisionof comprehensive SRH informationand services.Supporting CSOs, especially WROsand YLOs, in undertaking action,advancing rights related to SRHR,and influencing related policies.Overall, our SRHR Theory of Change is grounded in the followinggeneral principles: SRHR are fundamental human rights that are essential to advancing gender justice; While comprehensive SRHR programming should address both the provision and uptake of SRH services inan environmentally sustainable manner, it also entails more than just the provision of SRH services; Promoting feminist agency (that is, women’s and girls’ autonomy and meaningful decision-making power)is integral to achieving SRHR; Collaboration, participation, and learning are key to successful outcomes; Southern-based, grassroots CSOs – particularly WROs and YLOs – are key agents of change. As such,strengthening partner capacity to effectively promote SRHR is key to long-term sustainability; Meaningful advocacy and influencing for SRHR requires a rights-based, evidence-informed approach thatplaces women and young people’s voices and leadership at its core; andSoledad in Bukidnon shares that theactivity of Oxfam’s partner PKKK was thefirst time in her 60 years that she was ableto discuss sex and sexual pleasure Advocacy efforts to advance existing SRHR laws and policies and efforts to shift attitudes, norms andbehaviours are synergistic, and potentially mutually reinforcing in driving change. As such, these effortsare best undertaken at the same time.Photo: Caroline Leal/Oxfam CanadaBuilding on Oxfam Canada’s experience of working to shift power relations, the SRHR Theory of Change takesa non-linear view of change, recognizing that work to promote, protect, and fulfill SRHR is likely to provokebacklash or attempts to push back or reverse previous gains – these results must be anticipated andmanaged.

6 SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS — THEORY OF CHANGE7 SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS — THEORY OF CHANGEO X F A M C A N A D A’ S S R H R T H E O R Y O F C H A N G EULTIMATEGOALIncrease bodily autonomy, agency, and enjoyment of SRHR by all rights-holders, particularly women, girls, adolescents, and persons of diverse SOGIE.DRIVERSOF CHANGEProgramming partners use the best available knowledge and evidence to mobilize attitudes and practices that shift social acceptance of SRHR, enable women, girls, and adolescents to safely access SRH services,and ensure that SRHR is actively and effectively sanctioned at all levels of accountability. This drives change across multiple levels (individual, community, institutional, and societal) and with key stakeholders.PILLARSPILLAR ONE: Shifting social norms and raising communityawareness regarding SRHRPILLAR TWO: Strengthening the provision of comprehensive SRHinformation and servicesPILLAR THREE: Supporting CSOS, especially WROs and YLOs in undertakingaction, advancing rights related to SRH, and influencing related policiesINTERMEDIATEGOALSStrengthen agency of women, girls, adolescents,and young people in exercising their SRHRImprove quality of comprehensive SRH information and servicesImprove effectiveness of CSOs, WROs and YLOs to advance SRHRIMMEDIATEGOALSIncreaseknowledge ofSRHR amongwomen, girls,adolescents andyoung peopleDRIVERSOF CHANGE Critical mass of influencers (including community and religiousleaders, teachers, parents and youth) promote and model positivegender attitudes and behaviours Key influencers use new knowledge to take action in supportof implementation Women, girls, and their organizations are empowered to takeleadership on SRHR Women, girls, adolescents and young people know their rightsand are empowered and supported to access quality SRH services Health facilities have the technical expertise and capacity to deliverquality, comprehensive SRH services Health service providers are sensitive to the social dimensions of SRHR,and deliver SRH information and care with skill and sensitivity Communities are exposed to public outreach on SRHR from healthservice providers Partner CSOs, especially WROs and YLOs have the skills, capacity, and resources todesign and implement effective, innovative, sustainable programs WROs and YLOs expand their sphere of influence, creating alliances to influencechange and undertake coordinated advocacy/influencing Programming mechanisms enable new knowledge and best practices to be sharedand used for continuous program improvement as well as strengthening advocacyand influencing efforts Training women, girls, men, and boys on SRHR issues throughawareness sessions, workshops, community dialogues andpeer education Strengthen women and adolescent girl leaders in communitiesto understand and claim their rights Engaging influencers (community and religious leaders, teachers,parents and youth) in behavior change communication strategies,including SRHR public awareness campaigns and advocacy Connecting women, adolescents and other marginalized groupsto SRH services Increasing capacity of health service providers to deliver quality genderresponsive, youth-friendly, comprehensive SRH services Collaborate with healthcare units/facilities to strengthen healthinformation management systems and health governance structures Supporting supply-chain management and provisionof SRH commodities Strengthening community outreach by healthcare professionals Self-directed organizational strengthening of CSOs, including WROs and YLOs, towork in SRHR and undertake advocacy/influencing Research, including participatory action research, to generate evidence, knowledgeand learning for programming, policy, and influencing, and support a community ofpractice among CSOs, WROs, and YLOs Convening and facilitating local, national, and/or international networks andalliances, both to strengthen peer-to-peer relations among CSOs, and influencestrategic decision-makers Supporting WROs and CSOs in undertaking advocacy and campaigning on SRHR Improving SRHR mobilization and activism in Canada through SRHR awarenessraising, public engagement, and promoting Southern voices in Canadian SRHRadvocacy initiatives Women, girls, adolescents and young people’s lack of accessto existing SRH services Negative social norms and stigmatization of women, girls, andadolescents by communities Political and cultural sensitivity around SRHR issues Uneven capacity and technical skills among health providers to deliverquality SRH services, including understanding of gender-responsivityand youth-inclusivity Negative social norms and stigmatization of women and adolescentsby service providers Limited resources, capacity, and availability of existing health facilities Lack of public outreach on SRHR by health care professionals Uneven capacity, technical skills and resources of local CSOs and WROs to design,implement and learn from SRHR programs Weak mechanisms for generating and sharing knowledge and learning Limited resources and opportunities for linkages and relationships acrossorganizations and alliances Weak or uncoordinated advocacy and influencing among CSOs/WROs Limited or weak implementation of SRHR laws and polices Resistance or pushback from conservative, religious and anti-rights movementsPROGRAMSTRATEGIESBARRIERSPROBLEMImprove attitudesin support ofSRHR amongwomen, men,girls, boys,and influencersIncrease ability ofproject participantsand stakeholdersto seek out SRHinformationand servicesIncrease knowledge of howto provide gender-responsive,youth-friendly comprehensive SRHservices among health serviceprovidersIncrease ability of health systemsand institutions to providegender-responsive, youthfriendly comprehensive SRHinformation and servicesIncrease organizationalcapacity of WROs, CSOs,and YLOs to delivereffective programson SRHRIncrease capacity ofWROs and YLOs togenerate knowledge toinfluence policies andpractice on SRHRImprove ability of WROs,CSOs, YLOs, and alliancesto undertake advocacyand promote SRHRissuesSRHR are human rights, though they are not universally protected, promoted, and fulfilled. The manifestations of these shortcomings include adolescent pregnancies; child, early, and forced marriage;unsafe abortions; high maternal mortality and morbidity; gender-based violence; and transmission of HIV and other STIs. These problems are compounded by age, socio-economic status, place of residence,gender inequality and lack of decision-making power, and cultural background. Despite international and national laws to protect SRHR, poor knowledge and implementation, along withdeep-rooted gender inequitable attitudes, norms, and behaviours, contribute toward shortfalls in SRHR.

8 SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS — THEORY OF CHANGEHOW DOES OXFAM CANADA IMPLEMENTITS SRHR THEORY OF CHANGE?Our SRHR Theory of Change takes an integrated and multi-faceted approach, acting on multiple levels (individual,community, institutional and societal) with diverse actors. We strive to achieve our ultimate goal throughprogram strategies undertaken with key actors and influencers, also known as drivers of change, informed bythe following assumptions:Pillar 1ProgramStrategiesAssumptionsShifting socialnorms andraisingindividual andcommunityawarenessregarding SRHR Training women,girls, men, and boyson SRHR issues Improving communities, especially women, girls,adolescents’ and persons of diverse SOGIE’s awarenessof SRHR will increase uptake of SRH services. Strengtheningwomen andadolescentgirl leaders incommunities Fostering women’s leadership potential, includingadolescent girls and young women, will support shiftstowards positive norms that model gender equality. Engaginginfluencers inbehaviour changecommunicationstrategies Connecting women,adolescents andother marginalizedgroups to SRHservices Engaging men and boys in support of SRHR can lead tochanges in attitudes, norms, and behaviours. Including menand boys also mitigates the risk of backlash to the changesin SRHR that our programming promotes. Exposing influencers to more positive gender and sexualityrelated norms, while providing opportunities to reflect onand discuss these norms with peers, will support attitudeand behavioural change. These shifts in attitudes willeventually result in a “tipping point” related to changes inthe social norms that underpin unequal access to quality,respectful SRH services and information, unmet SRHR,and broader gender inequality. Facilitating connections to services will help increasemarginalized groups’ uptake of SRH services.Pillar 1 in ActionAs part of efforts to shift norms and raise individual and community awareness, Oxfam’s Sexual andHealth Empowerment (SHE) project partners in the Philippines are undertaking trainings and stigmareduction workshops with local communities to address attitudes and/or misconceptions around genderand sexuality. This includes using activities like body mapping to identify individual sources of pride,shame, pleasure, or pain, and using these kinds of activities as an entry point to facilitate conversationsabout taboo but integral SRHR issues.9 SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS — THEORY OF CHANGEAurora works at a Rural Health Unitin Bulusan, Bicol in the Philippineswhich provides sexual and reproductivehealth information and services.Photo: Denvie Baladoy/Oxfam PhilippinesPillar 2ProgramStrategiesAssumptionsStrengtheningthe provision ofcomprehensiveSRH informationand services Increasing capacityof key healthservice providers Improving the knowledge and skills of service providers inhow to provide quality services can shift adverse attitudesand behaviours among service providers, and in turn improvethe quality of SRH service provisions. Increasing the capacityof SRH service providers will improve the health system’sability to attract and maintain service users. Collaborating withhealthcare units/facilities Supporting supplychain managementand provision ofSRH commodities Strengtheningcommunity outreachby healthcareprofessionals Providing technical assistance to health facilities regardinghealth system management and governance will in turn helpstrengthen their ability to deliver quality, comprehensiveSRH services. Increasing healthcare professionals’ public outreach willincrease awareness of and access to SRH informationand services among target populations. It will also serveto counter perceptions of health facilities as “adverse” or“hostile” for underserved groups, such as young women,adolescent girls, or persons of diverse SOGIE.Pillar 2 in ActionAcross Ethiopia, Malawi, Zambia, and Mozambique, Oxfam’s Her Future Her Choice (HFHC) project partnersare working with local healthcare professionals in project implementation sites to define “quality of care”with communities, conduct mobile outreach on contraception services, and implement community healthfairs, among other activities related to local SRH service and policy outreach.

10 SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS — THEORY OF CHANGEPillar allyWROs and YLOsin undertakingaction,advancing rightsrelated to SRHR,and influencingrelated policies Self-directedorganizationalstrengthening ofCSOs, includingWROs and YLOs Strengthening the capacities of WROs and YLOs is critical toadvancing sustainable, context-driven, long-term change.WROs and YLOs are best placed to determine what they needto improve upon to carry out more effective SRHR initiativesand work with their communities. Research, includingparticipatory actionresearch SRHR programs, advocacy, and influencing are more effectiveif these efforts are evidence-based. Increasing the spacefor and use of research, best practice, and learning inSRHR initiatives is critical for undertaking evidence-basedprojects, advocacy, and influencing for SRHR. Convening andfacilitating local,national, and/or internationalnetworks andalliances Supporting WROs,CSOS and YLOsin undertakingadvocacy andcampaigning Improving SRHRmobilization andactivism in Canada Alliance building (locally, nationally and globally) is integralto advancing and sustaining SRHR advocacy and influencingefforts (i.e. there is “strength in numbers”). Fosteringstrategic relationships with “friendly” decision-makers willalso increase the impact of advocacy and influencing efforts. Full implementation and/or advancement of SRHR relatedlaws and policies provides a more enabling context forwomen, girls, and persons of diverse SOGIE to realizetheir rights.11 SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS — THEORY OF CHANGE“I am driven to fight forreproductive health and rightsbecause for me, it’s really abasic human right for a womanto know that if she cannot assertcontrol or if she cannot makedecisions about her body, thatwill really affect her choicesin life. It will affect her future,her family, if she wants tohave a family and where shewants to go—all of that isa basic human right.”Daryl Leyesa is a Program Managerat PKKK, one of Oxfam’s partnersin the Philippines.Photo: Caroline Leal/ Oxfam Canada Ongoing resistance or pushback from conservative, religious,and anti-rights movements requires ongoing investment inadvocacy and action to protect SRHR-related gains, hold theline, and/or continue to advance SRHR in policy and practice. SRHR issues are global in nature, regardless of theincome level or strength of a country’s health system,and thus require collaborative solutions internationallyand domestically across restrictive and less restrictivesettings. Working with Canadian populations will helpincrease awareness of ongoing gaps and limitations to SRHRdomestically, and receptivity and awareness of SRHR globally,which in turn will help sustain continued Canadian fundingfor SRHR initiatives domestically and globally.Pillar 3 in ActionOxfam’s SHE partners in the Philippines are undertaking art action research initiatives, includingphotos, video documentation, poetry, paintings, and drawings as a means to creatively engage diverseconstituents on stigmatized SRHR issues, and create an evidence base from which to inform SRHRadvocacy efforts and help influence related policies.Oxfam Canada works collaboratively with Southern-based, grassroots CSOs – especially WROs and YLOs – toplan, implement, monitor, and evaluate projects. These partner organizations are key agents of change inrealizing visions of gender justice in their contexts. As such, Oxfam Canada works with them to strengthen theircapacities to manage and sustain themselves, and effectively promote SRHR, in order to ensurelong-term sustainability.We will measure our success in achieving our ultimate aim, by assessing whether there is: A change in harmful social norms, traditional practices, and taboos regarding gender and sexuality; Improved information on and access to comprehensive quality SRH services; I mproved meaningful decision-making power by women, girls, adolescents, and persons of diverse SOGIEregarding their health and sexuality; S trengthened capacity of WROs and CSOs, especially YLOs, to effectively advocate for SRHR in theircommunities, and influence legislative and policy change.

Inácia Nunes Armandois a 25 year oldactivist from Mocuba,Mozambique. She workswith Oxfam partnerNAFEZA to provide SRHRinformation and trainingto young women andgirls in 5 communities.Photo: Caroline Leal/Oxfam CanadaOxfam CanadaFor more information on Oxfam Canada’s SRHR Theory of Change, contact:39 McArthur Avenue, Ottawa, ON K1L 8L7Deborah Simpson, Manager, Program Impact atdeborah.simpson@oxfam.org1 800 466 9326info@oxfam.cawww.oxfam.caOxfamOxfamor Lara Cousins, Women’s Rights Knowledge Specialist,SRHR, at lara.cousins@oxfam.org.For more information on our SRHR programming, rk-on/sexual-reproductive-health-rights/Oxfam Canada’s SRHR programming is supported by contributions from the Governmentof Canada, provided through Global Affairs Canada, and Oxfam donors.

6 SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS — THEORY OF CHANGE 7 SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS — THEORY OF CHANGE ULTIMATE GOAL Increase bodily autonomy, agency, and enjoyment of SRHR by all rights-holders, particularly women, girls, adolescents, and perso

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