A Project of:

Planned Parenthood Ottawa, the Ottawa Coalition to End Violence Against Women, Canadians For Choice, and the Canadian Federation for Sexual Health

Bridging Services For Women

A three-phase, cross-sectoral project by four partnering agencies

• Project Goal To increase service provider knowledge and capacity to respond reproductive coercion through

training

, and

knowledge-sharing

across sectors.

VAW & SRH: Linked Issues

• • • • • 1 in 12 women abused during pregnancy Coerced or “Forced Sex” (sexual assault) Higher rate of STI’s Likelihood of pregnancy increases Appears across sectors

*Image & Statistics from the Colorado Coalition To End Sexual Assault

“Reproductive Coercion” describes a cluster of coercive or abusive behaviours that interfere with a person’s ability to make free sexual & reproductive health choices.”

• • Deliberate exposure to/transmission of STI’s Refusal to use or negotiate safer sex practices • • • Refusal to use condoms/not allowing her to use birth control Birth Control Sabotage Forced Pregnancy or Termination

Bridging Services For Women Project Phases:

Phase 1: Community Needs Assessment (2012)

Phase 1 Project Goal

Phase 2: Design Training (2013) Phase 3: Implement Trainings & Sustainability Model (2014) To consult with service providers in both the VAW and SRH sectors to learn about their shared and distinct training needs.

What’s Wrong With This Picture?

VAW Sector SRH Sector

There’s some people missing!

SRH VAW Other Service Providers • • Many providers delivering services to women experiencing violence do not fit in strict VAW & SRH categories Clients seek services in other kinds of sites • Particularly true for communities experiencing intersecting oppressions and/or barriers

Focus Groups

Methods

Interviews On-line Survey Training Needs Literature & Resource Review

Literature & Resource Review

RC is in its infancy in Canada Bulk of RC literature is coming the U.S.

• Dr. Elizabeth Miller (Ob/Gyn) • Multiple studies Futures Without Violence (California) • YouTube clips, Media, fact sheets, resources interviews, partnering Almost no Canadian sources of information & no comparable projects that we could find Our consultations would be introducing a new concept for many people

Challenge!

Getting people to tell you what they need to know about a subject they’ve never thought about before is tricky!

Strategy

Q: How groups are encountering the subject Q: How they are responding when it presents itself  What our clients tell us about their experiences attempting to access… +  our own observations about what happens when we try to help clients access (or access ourselves)…

Consultation Structure

Participants were asked to discuss… • • • • • • • • Their

familiarity with the term and concept

of Reproductive Coercion The frequency and range of

Reproductive Coercion experiences reported to them

by women

What they hear from, & any barriers they perceived for, clients

attempting to access services for linked SRH/VAW needs in their own sectors, or across sectors Any

experiences for distinct populations

they might serve Any barriers they perceived for themselves in providing cross-sector services Any

training/education needs

they perceived for themselves, their sector, or across sectors

Existing training/education vehicles

within their own organizations/sectors

Preferred forms of training and education

delivery

Consultation Participants

• • Diverse Representation of providers and populations served Majority had over 10 years in the field

Who Did We Talk To?

Sexual & Reproductive Health [21.2%] Other Service Provider [31.7%] Violence Against Women [54.8%] *Totals exceed 100% due to some agencies Identifying in multiple sectors

What Do We Know About Reproductive Coercion?

Unfamiliar Term & Concept

Many providers struggled to:  see a relationship between their work & the other sector  think of RC as part of the range of things we need to deal with “It just doesn’t naturally flow in my mind how I associate them together (VAW & SRH).”

VAW • STIs • Pregnancy • Forced pregnancy • Birth control sabotage or interference • Contraception or safe sex

But…..

SRH • Sexual Assault • Coercive Sex • Contraceptive Coercion • Pregnancy as a result of sexual assault • Violence in pregnancy , sex work, etc.

OSP • Physical & Sexual Assault* • STIs, Pregnancy & Birth Control • Reproductive Coercion • Violence Related to Mental Health, Sex Work, Sexual Exploitation, HIV Systemic Abuses & Barriers and Deficiencies in Service

Control By….

    coercing/forcing her to have sex refusing to use/forcing her not to use birth control coercing/forcing her to have an abortion coercing/forcing her to maintain a pregnancy

PREGNANCY

 threatening using the pregnancy, increasing fear by attacking while pregnant  harming her through ending the pregnancy by violence or coerced/forced abortion  OR… children are then used to threaten her again

Learnings Needs

Practices were familiar, but thinking about them as a category along a continuum of violence was not When given examples & a common language providers start identifying it very quickly • • Reconceptualize how & what we think of as part of violence Common language & examples that relate to our work to understand it

Finding

Clients are talking to all consultation groups about all the elements of RC Most providers said they were talking about it “frequently” or “occasionally” Only about 15% said “infrequently” Only four people said “never”

Providers told us….

“Some workers don't engage in certain conversations with clients because it goes against their morals. Some workers tell women what to do with their lives and monitor what women are doing. I don't feel all of our clients really trust us to be engaging in open and honest conversations because of these barriers.” “Unfortunately in a shelter environment there are very different reactions to client’s choices by the different staff. It is challenging to have all staff coming from a supportive non-judgemental framework when talking with clients about sexual health.”

Learning



Stigma & Judgements are affecting both clients’ ability to talk about these issues, and service providers ability to recognize them

• • • Lack of support for options Culture of Disbelief – discriminatory beliefs Problematic approaches • • Negative experiences accessing care Non-inclusive spaces

“Unless you’re the local town lawyer or dentist and there’s a little slip up and you need something it’ll be no problem. But if you are young, single, have issues with addictions, have issues with violence in your relationships, some of them even have issues in terms of intersecting with the law, it’s like ‘Can you not even look after this part?’ and I think that there’s not maybe a good understanding that somebody’s not letting them. It’s always, ‘You’re just careless’, or like you’re not smart enough to figure out how this happened.”

Learnings

Assumptions Stigmatizing beliefs

Needs

Directive approaches Providers own moral stances Many workers feel challenged on how to tackle the problem • • • Training on R.C.

Non-judgemental, survivor-directed support – Assumptions Anti-oppression training

Some other examples…

Provider-Based

Confidentiality Concerns • systemic consequences for disclosure • translators Cultural Barriers Language Barriers Accessibility issues

Client-based

Reluctance to Disclose • Stigma & Judgements • Cultural mores about talking about sex Lack of info or unsure where to go Safety reasons Women don’t recognize these things as part of violence themselves

Distinct Communities

Some groups may be experiencing more RC and more stigmatization at the same time Some groups are experiencing forms of reproductive coercion not typically captured in the standard definitions

Distinct Communities

Young Women Newcomer, Immigrant & Refugee Women Sex Workers Queer/Trans* folks Mothers (Young Mothers) DisAbled Women & those labelled “Mentally Ill” Persons Living with HIV/AIDS

Reluctance to Engage the Issue

Knowledge Deficits Discomfort talking about “sex” Priorities/Time • Needed to know more about R.C. & how to support • How to support around VAW (discomfort) • Came out repeatedly • Sex positivity & open environments • Sex positivity trainings can isolate some people • Dealing with immediate crisis • (SRH) “Don’t Want To Open The Can Of Worms” • Don’t feel we can trust that the supports will be there

Good News!

Providers themselves shared this information

• Great providers out there • Willingness & desire to engage the problems they pointed out • A lot of the things they pointed to can be acted on by training

Learnings

Knowledge Deficits Discomfort talking about “sex” Priorities &Time Lack of faith

Needs

Need training – VAW & SRH Need sex positivity work, done sensitively Need supportive inter-sector options or partnerships

More Good News! Providers Have & Use Strategies

Invisible Forms of Birth Control

Abortion options that resemble miscarriages SRH Providers – fake X-rays; “fake” medical appointments VAW providers accompany women; “cover appointments” so clients can meet SRH needs Innovative partnering

Training

In Person – participatory workshop style Accessible to most = (1) On-site (2) Off-site Low-to-no cost Adaptable timeframe (1 hour  afternoon) Written Materials for themselves & Clients

Learned from Consultation…

Concepts – continuums of violence Scenarios that relate to people’s work Assumptions & Judgements Non-directive, survivor based, harm reduction approaches

Training Con’t

Supplemental information about distinct groups; easily incorporated into/out of trainings Where possible, we should consult with community service providers in doing that Available to VAW, SRH, but also others Incorporate information about successful partnerships and how to build them

Training - Materials

Use Futures Without Violence models to develop some provider-targeted materials Create downloadable 1-page fact sheets that can be used by providers and given to clients Provide the training template for on-going internal work

“Wishlist Items”

Awareness of training available to us in our communities Specific materials about “how-to’s” & challenges of partnering “Who Are Your Ottawa SRH Service Providers” mini-guide Reproductive Coercion

Sample Provider Education Tools

Sample Public Education Posters

Acknowledgements and Appreciations AIDS Committee of Ottawa Amelia Rising Sexual Assault Centre of Nipissing Amethyst Women's Addiction Centre CALACS francophone d’Ottawa Canadian Mental Health Association Canadian Federation for Sexual Health Canadians for Choice Carlington Community Health Centre Catholic Family Services Ottawa Chrysalis House Comité Réseau d'Ottawa Eastern Ottawa Resource Centre Ernestine's Women's Shelter Family Services Ottawa Immigrant Women Services Interval House of Ottawa Lanark County Interval House Maison d’Amitié Mary Pat Bingley/Perth & Smiths Falls District Hospital Mothercraft Ottawa - Birth and Parent Companion Program Nelson House OASIS – Sandy Hill Community Health Centre Ontario Aboriginal HIV/AIDS Strategy Ottawa Coalition to End Violence Against Women (OCTEVAW) Ottawa Inner City Health Ottawa Rape Crisis Centre Ottawa Victim Services Pink Triangle Services Planned Parenthood Ottawa Salvation Army Pre-Charge Diversion Program Sexual Assault Network Sexual Assault Support Centre of Ottawa Shepherds of Good Hope Somerset West Community Health Centre St. Mary's Home & Young Parent Outreach Centre The Women's Resource Centre (Student Federation of the University of Ottawa) Western Ottawa Community Resource Centre Women’s Support Network of York Region Youth Services Bureau of Ottawa

This research was funded by the Community Foundation of Ottawa