Welcome Planned Parenthood readers! If you appreciate what you read here, please consider making a donation or becoming a subscriber. Articles like this rely entirely on support from readers like you.


At a Mexfam Clinic in Mexico City I met Maria, a 20-year-old in rectangular glasses, during a reproductive health and gender-based violence workshop. She lives in one of Mexico City’s poorest neighborhoods, where violence is a part of life. “Throughout my life, I’ve witnessed many situations of violence that I didn’t even know were violence,” she told me. “I’ve been in violent relationships that I thought were normal. Now I wonder, why is it that men can hit us?”

The workshop, which trained young volunteers to teach their peers, featured engaging games and activities designed by Mexfam and other NGOs. In an activity called “Is it love?”, Maria danced with nine other youth volunteers among sheets of paper on the floor. The young people, with their tattooed arms and ear tunnels, moved with self-conscious irony to the insistent beat of Mexican pop. When the music stopped they picked up the closest paper and answered the question: "Is it love?"

They see different examples of actions done by romantic partners:

Forgiving someone; Not letting you see your friends; Accepting differences; Showing weakness; Compromising; Being jealous; Showing interest; Being possessive; ‘I will be your everything…..’; ‘You don’t need a condom because if you get pregnant I’ll marry you’; Apologizing; Demanding access to your social media; Asking for naked pictures; Reading your texts.

The volunteers, already well-schooled in sexual rights, got most of them right. But not all.

“Forgiving someone for hitting you,” one teenager read aloud. “If the person is really sorry, it could be love.”

Karla Ramírez, head of Mexfam’s youth programming, disagreed.

She wore a black shirt with sunflowers and a gold necklace featuring little black pompoms. She looked not much older than her students. A two hour bus ride each way to work through Mexico City’s fog gave her a nagging cough.

“Violence can escalate,” she said. She described the cultural context around a man’s request for forgiveness, how the power dynamic between partners in sexual decision making is rarely equal. Religion, social class and race all play a role, but women’s opinions or bodies usually aren’t valued the same way as men are. Frequently, such violence escalates.

“Women need to understand the power of inequality and protect themselves,” Ramírez concluded.

A rough part of town

Statistics reveal the simple fact that violence to women is culturally acceptable in nearly every part of the world, including ours.

In the places most dangerous to women – those with high rates of femicide, child brides, rape - certain educational techniques have proven most effective in changing this acceptance. But could those techniques be used elsewhere to address the violence behind the ongoing revelations of sexual harassment, abuse and misconduct by men and behind the millions of women who posted in social media that they had been sexually harassed or abused?

When I traveled with Mexfam educators to Iztapalapa, one of the poor neighborhoods in the hills that ring Mexico City, the social workers suggested that I wear no jewelry – not my silver wedding band, not my $30 watch. Earlier that week, I’d read a New York Times article about Iztapalapa – how some women wait in line for three hours to get drinking water. How sometimes fights break out.

Outside a school yard, Maria and Mexfam’s other youth volunteers engaged their peers with explicit sex facts and free condoms. Suddenly, bump – a girl pushed another girl hard with her shoulder, hard. Boys whistled encouragement and circled around the girls. One girl spoiled for a fight. The other tried to escape. Maria signaled to the promoteras to rejoin her and we walked quickly away.

“Things get out of hand quickly,” one of my colleagues said. She kept close beside me on the twenty minute walk back to a clinic while I worried about the girl trapped within that circle.

Growing up in Iztapalapa

Maria grew up there, in Iztapalapa. Her sister got pregnant at fifteen, so Maria avoided sex until, at age 17, she was raped by someone she knew.

No one had ever talked to her about sex and she wasn’t even sure what had happened. It seemed expected, normal. But she knew she might be in trouble one time when the condom broke. She panicked and told a friend, one of Mexfam’s youth volunteers. The friend took her to a Mexfam clinic. Fortunately, Maria tested negative for pregnancy.

“The counselor said to me, ‘If you don’t feel safe, don’t have sex.’” Maria told me.

Maria realized for the first time that she has exclusive rights over her body. “Everything that I needed to know, the counselor told me,” Maria said. After that, she became a youth volunteer to so that she could speak comfortably about sex with others – and tell them the things she wish she’d known. “Now I’m somebody who has information, who can help in certain situations” she told me. “Even if it isn’t always good news.”

No “isms” allowed

According to Mexfam and other NGOs, understanding power and gender is a big part of understanding one’s reproductive health. In societies like Mexico, traditional gender roles and the view that domestic violence is a private matter make it hard to negotiate for one’s reproductive health. Women who experience violence are more likely to become pregnant as teenagers, have unsafe abortions and give birth to underweight babies. Unfortunately, the cycle of violence doesn’t end there—children born from these relationships have a higher risk of dying before reaching age five.

The most effective way to reduce violence toward women is to confront the power imbalance between women and men in a straight forward manner as part of a reproductive health curriculum. Not incidentally, shining a light on the attitudes that bring violence to women also improves reproductive health outcomes. A 2015 review of programs showed that programs that address gender or power as part of reproductive health were five times as likely to be effective as those that did not. Eighty percent of them significantly lowered the rate of STDs or unintended pregnancy. In contrast, only 17 per cent of the programs that did not address gender or power showed reductions in these areas.

Back in the Mexfam classroom, Angélica García, head of Mexfam’s social programs, expanded on the theme of gender inequality. García would fit in on the streets of Vancouver, in her skinny jeans, can-do boots and a slim black tunic with a modern take on Mayan art. She’s married, has four cats and enjoys a cigar. She mourns that opportunities for Mexican youth are increasingly scarce, yet calls her job “the beautiful work.”

“Before you can talk about sexual decision-making,” she told the volunteers, “you have to look at relations of power.” She got the volunteers into groups of four by way of a riotous game and asked them to list examples of power imbalance in the home, the street, the media and work or school. Sharpies in hand, the volunteers knelt on the floor and got to work.

A Mexfam researcher takes notes on the how the workshop participants respond to activities so they can continue to test and improve the new curriculum. Participants are encouraged to draw, write, act and even dance.

In the home, spouses withhold money. Some men consider economically dependent women to be part of them, and consider violence as their right. When women work, some men assert their authority through violence. García noted that, prior to 2010, spousal rape was not considered rape under the law.

In the street, the machista culture assumes that men are sexual all the time. It’s expected of a man. Groping in the busses and subways is so bad that the front cars are for women and children only. Posters tell men to not leer. The city has instituted pranks to bring attention to the epidemic.

“The public space is male space,” García stated.

In the media, themes of romantic love make girls and women more likely to accept violence. Women get treated as pure or impure. Angélica pointed out that most Mexican women have very few possible roles: mother, spouse, girlfriend, whore, or care-giver.

“Gender roles are mechanisms of control,” García said. “They are so embedded that they can be hard to see.”

“Wow,” I thought to myself. “They’re teaching feminism!”

Later, I made this observation to Victoria Fuentes, Mexfam’s Executive Director.

“No ‘isms’ at Mexfam,” she said with Mary Poppins crispness. “The curriculum is based on evidence of what works. Not ideology.”

Victoria Fuentes, ED of Mexfam shows a new violence scale poster which begins with mean jokes (1) and ends with murder (30). Aggressive caresses – like those that have brought down many famous men in recent months, is in the middle (15). The scale is displayed in schools and universities. Photo by Carrie Saxifrage

More evidence

Mexfam’s new gender-based violence curriculum is the subject of collaborative research between Mexfam and Shelly Makleff, a doctoral candidate at the School of Hygiene and Tropical Medicine at the University of London. “The curriculum requires a full 24 hours over the course of a term,” Makleff explained when I met with her at Mexfam’s headquarters. “Currently, some students receive a one-time chat about contraception which varies according to a teacher’s comfort level. Kids can learn some things in one hour, but we want this information to be transformational.”

An afternoon I spent tallying data collected from Makleff’s study confirmed the existence of some of the cultural norms that lead to violence against women: that men by nature can’t control their sexual desire and this can make them violent; that rape doesn’t exist within relationships; and that stress, drunkenness and the end of a relationship can make violent behavior more acceptable.

Makleff will survey these attitudes again, after the students have received the new curriculum. She will also compare pregnancy rates among those who received the information with those of control groups. “If gender based violence and teen pregnancy rates drop,” Makleff said, “that will be hard to argue with.” Ideally, this research will convince funders and inspire donors to pay for volunteer training so that this curriculum can be presented in all of Mexico’s schools. For the Mexican government, it’s an opportunity to meet obligations under the international treaties to which it is a party and honor the right to reproductive health which is enshrined in the constitution.

Mexfam is not alone in heeding research that establishes the effectiveness of teaching about gender and power as an effective means of reducing violence to women. In Uganda, this approach reduced community acceptance of men’s violence against a partner and increased acceptance of a woman’s right to refuse sex. In India, the message lowered rates of violence to women and increased use of contraceptives. The successful premise seems to be that knowledge changes the cultural norms which determine the rate of violence to women.

Women in Canada and the US have much less to fear than women in Mexico or Kenya. Yet our culture still has the same disease and it wreaks havoc in countless lives. One in three Canadians say they had experienced abuse before the age of 15. Men and boys suffer from the devaluation of human characteristics that have been “feminized.”

Reproductive health ed in Canada and the U.S.

The Canadian Guidelines for Sexual Health Education embrace comprehensive sexual education which, in all studies, has been shown to be better than abstinence based programs in delaying the initiation of sexual intercourse, reducing the number of sexual partners, and increasing condom or contraceptive use.

But in Canada, like Mexico, consistent delivery of a thorough curriculum doesn’t exist as a practical matter. Local school boards approve curriculum so principals may be forced to provide euphemisms for anatomy or avoid topics such as menarche at the behest of religious parents. Like Mexico, much depends on the comfort level and priorities of individual teachers.

One B.C. teacher showed me the reproductive health materials sent by the province: a two page pamphlet, one for boys and one for girls, which featured ads for personal care products. The box the pamphlets arrived in also contained samples of Old Spice deodorant. In an Ontario study, adolescents at the end of secondary school had poor understanding of concepts related to reproductive physiology, contraception, HIV/AIDS and sexual assault. Only one province, Quebec, mentions love.

Regarding the imbalance of power between women and men, the Canadian Guidelines bury gender inequality in its “Philosophy” section, number eight out of nine. (These guidelines are up for public input.)

The U.S. is worse. With no federal mandate, responsibility for sexuality education is left to the state and local authorities. In the resulting mess of policies, close to 50 per cent of teenagers between 15 and 19 do not receive information about birth control. In a Republican administration, this number is likely to increase as funding shifts back to abstinence programs, which are proven to be ineffective.

Model Mexfam

As I sat in that plain classroom in Mexico City, I listened to Angélica García explain that society’s more restrictive expectations for women result in less power and this makes situations of physical and emotional violence more likely.

And I couldn’t imagine that level of honesty in the classrooms of Canada.

Yet physical and emotional violence to women exists in Canada and the US for the same reasons, and there’s clear evidence on what can change it. The reproductive health curricula that most effectively reduce violence, STDs and unwanted pregnancy have the following elements: 1) addressing gender and power explicitly; 2) using participatory and learner-centered teaching approaches (remember the game, Is it love?); 3) facilitating critical thinking about gender and power in participants’ society (such as Mexfam’s activity of listing examples of power imbalance in several arenas); 4) fostering personal reflection about how these concepts affect one’s own life and relationships; and 5) helping participants value their own potential as individuals and as change agents. Mexfam encouraged youth like Maria to draw on their difficult life experiences to pave an easier way for others.

The epidemic of violence to women in places like Mexico creates an urgent incentive for programs like Mexfam’s, and we should support them through organizations like the International Planned Parenthood Federation.

But in Canada and the U.S., I find we, too, are trapped in a world where many men think they have the right to treat women poorly and many women fear the repercussions of calling them on it. We, too, need reproductive health education that names gender power dynamics and their unfair consequences to create the healthier norms in which both women - and men - have the safety and latitude to thrive.

Keep reading