Title of the project:

Decides Espana

Please describe your action/project

Under the framework of Programa de Ciudadanía Activa – Financial Mechanism of the European Economic Area (EEA Grants) 2009-2014 for Spain, DECIDES ESPAÑA is based on the assumption that cultural factors are very important in the realization of sexual and reproductive rights (SRR) and it is inspired by the learning of cultural cooperation for development.

Given the growing cultural diversity and with the understanding that cultural factors are essential to improve access to and quality of health services as well as to counteract gender violence, this project develops research, training and awareness-raising activities designed to encourage an articulated approach to SRR, with a focus on both young and women of migrant origin, particularly those at risk of social exclusion and those in reproductive age DECIDES ESPAÑA promotes dialogue between sectors usually independent one from another (health, gender, education, culture, etc.) to promote a multidisciplinary and broad approach to SRR as a right to receive a sexual education or to live in a violence free context. 75% of the activities have been implemented in Catalonia, one of the regions with the highest levels of immigration, but the project’s remit is national and its methodology has been designed to be replicated throughout the country.

The project is part of the DECIDES Program (Cultural Rights to Promote Health and Development) which, since 2007, has been implemented in Bolivia, Ecuador, Peru and Mali, in collaboration with international NGOs such as FCI or PROMSEX, among others, and with the support of organizations such as AECID, ACCD and Barcelona Solidaria of the City Council.

The activities implemented include a) an assessment on equality of access to SRR services; b) the development of educational materials on the role of culture in promoting SRR; these materials will strengthen the cultural competencies of the health sector as well as of key actors intervening in the field of SRR; c) 10 training workshops on the use of the educational materials by health professionals; 1 workshop on audiovisual creation and reflection on SRR for young migrants; awareness-raising activities geared towards civil society on sexual and reproductive rights and equality in a context of cultural diversity; and talks on SRR in a context of cultural diversity and equality.

This project is co-funded by the Financial Mechanism of the European Economic Area (EEA Grants) which aims at contributing to the reduction of economic and social inequalities, and to strengthening the relationships between donor states (Iceland, Liechtenstein and Norway) and beneficiary states (17 EU Member States). The Plataforma de ONG de Acción Social is the Operating Agency of the Programa de Ciudadanía Activa (Active Citizenship Programme) which is endowed with EUR 4.6 million for the strengthening of NGOs and their contribution to social justice and sustainable development. Follow on Twitter: @Ciudadania_Act #CiudadaníaActiva and Facebook: Programa de Ciudadanía Activa.

Tell us something more about your project/activity:

• Content: assessments, awareness-raising, workshops, training sessions and other cultural activities, mainly addressed to migrant people and health professionals to promote a more equitable access to and exercise of Sexual and Reproductive Rights in Spain.
• Duration: from 01/05/2014/ to 30/09/2015/
• Location: Spain
• Field/discipline: Culture and Sexual and Reproductive Rights (SRR)

 

Tell us something about who did it

INTERARTS

Founded in 1995, INTERARTS is a private agency with international projection to: • support the design of cultural policies, • contribute to the processes of development through the cultural sector, • facilitate the transfer of knowledge and information in the field of culture. Our principal areas of activity are in the field of cultural policies and cultural co-operation. Today we are active in innovative fields such as those concerned with cultural rights and with the creative and cultural economy. We strive to include a cultural approach in projects concerning human development. society, the private operators and public administrations. INTERARTS is organized in accord with the following: Design As a laboratory of ideas and centre of applied investigation, INTERARTS focuses on emergent cultural issues of political relevance and contributes to the elaboration of proposals for the implementation of cultural policies. Consultancy Culture is a key element in the process of development. It is with this end in mind that INTERARTS coordinates the management of international projects concerned with cooperation for development and acts as consultant in the organization of creative industries. Formation and information Training is one of the core activities of INTERARTS with the organisation of short cycles of thematic seminars and of initiatives such as the international Campus for cultural cooperation, implemented in different geographic areas. Through its bulletin, Cyberkaris, and its website, INTERARTS continuously diffuses studies and information relevant to cultural cooperation. Since 2007, Interarts is working on projects that contribute both to social change, that improves the health and welfare of people, and the design and implementation of public policies related to this issue. In this area, the foundation has expanded its projects, developed in collaboration with international NGOs such as FCI or PROMSEX, among others; and with the support of organizations like the AECID, the ACCD and Barcelona Solidaria from Barcelona City Council.

VHIR

Interarts’s partner for DECIDES ESPAÑA is the Vall d’Hebron Institut de Recerca (VHIR), a public sector institution that promotes and develops research and innovation at Vall d’Hebron University Hospital (HUVH), the hospital of Barcelona and the largest of Catalan Institute of Health (ICS). Its public health/community health team of the Unidad de Salud Internacional Drassanes-Vall d’Hebron (PROSICS Barcelona) has extensive experience in the field of intercultural medicine, both at local / national and international levels. Since its creation in 1994, VHIR works to find solutions to the health problems of people, and is willing to contribute to the scientific, educational, social and economic development of our environment. VHIR has an extensive experience in: applied research, educational materials grounded in scientific research, training of trainers and specific knowledge on the subject of the SRR (sexually transmitted infections, maternal health …) of groups at risk (migrants).

Tell us something about the people who in your view received the most significant impact

80% of direct beneficiaries are in Catalonia, while 20% of beneficiaries are from the rest of Spain and other countries in Europe, Africa and Latin America: – Professionals involved in sexual and reproductive health and the prevention and treatment of violence against women from the public, private and third sectors who integrate equity and cultural diversity in their daily activities. These professionals shared a space for reflection and work and were trained to provide quality services. – Representatives of civil society (NGOs representing and working with migrant groups, education sector, etc.) who took part in the talks on SRHR. – Young people, particularly those at risk of social exclusion who attended the outreach activities, launch and project closure. – Representatives of migrant groups and NGOs/other organisations working with them (particularly migrant women and young people). – Migrant women, particularly those at risk of social exclusion and those in reproductive age, as they are considered one of the main users of the health system. – General public who has visited the project’s website or attended any awareness-raising sessions. – Users of the socio-health services in Spain.

Was the impact planned from the start?

The impact on a national level was planned from the beginning of the project and has been correctly accomplished. The impact on an international level was initially planned mainly through the project’s website and other online networks, but it has been increased due to; the attendance to some activities of professionals within the cultural sector who came from other European, African and Latin American countries; and the presentation of the project on the 9th European Congress on Tropical Medicine and International Health (ECTMIH) held in Basel (Switzerland) on 6-10 September, 2015.

Tell us something about the context

The access of all citizens to sexual and reproductive rights is still a non-visible problem in today’s society. All societies have vulnerable groups, due to multiple factors, that have a greater difficulty in accessing health services and education than the rest of the population. In recent years, Spain has seen a sharp increase in extra-community migration. Migrants are among the groups most vulnerable to the precarious economic situation in which people live due to the lack of social networks and family support, their local language skills and the knowledge of how the health system of the host country works, not to mention the fact of having different visions and own understandings of health, gender roles, etc. In this context, migrant women are particularly affected by teenage pregnancy, abortions, abuse or other forms of gender-based violence such as female genital mutilation. Besides, violence against women is a major public health problem that threatens all women, especially migrants (based on data from the Spanish Ministry of Labour and Social Affairs and the Ministry of Health)

According to the Institute of Statistics of Catalonia (statistics from 2013 and 2014 available at www.idescat.cat), there is currently has a very strong concentration of foreign population: 14.5% of the total catalan population (1.089.214 people in January 2014) came mostly from other European Countries but also (in this order) from America (mostly from Latin America), Africa (5.7% from Sud- Saharan Africa) and Asia. The countries with a greater representation of population are: 20.38% from Morocco, 8.96% from Romania, 4.4% from Ecuador and around 4-4.3% from China, Bolivia and Pakistan. Within them, 52.66% are men and 47.34% women.

Among migrant population, youngsters are a group at risk not actively involved in promoting SRHR. It is also a group that often subject to myths and prejudices about certain issues such as HIV or unwanted pregnancy. Despite education campaigns, according to Amnesty International (“Derechos sexuales y reproductivos: datos y cifras. 2013.” Available at http://imagenes.publico-estaticos.es/resources/archivos/ 2013/3/6/1362600330588ai.pdf), gender violence and AIDS are among the leading causes of death for young people. In addition, young people between 15 and 24 are 41 % of all new HIV cases in the population 15 to 49 years.

The context of crisis in which Spain is immersed, has changed the pattern of immigrants living in Spain, as well as the administrative legal framework regarding immigration policies. This scenario, in all its complexity, not only affects the welfare state of the immigrant population, but also changes social structuring factors that hinder or facilitate access to health. Since the amendment of the immigration law in 2013, access to health by the immigrant population has undergone a change that questions the universal access to health care. The legal nature of the law, which links the permit to reside in the country with a contract of employment, has increased the number of people without a residence permit. This regulatory change means those without a contract and therefore a residence permit they can only receive health care in the following three cases: if they are minors; if they are in a situation of pregnancy and/or the postpartum period; and in an emergency or serious illness (until medical discharge).

Despite the growing recognition of the key contribution of culture to development processes (UN Resolution no.65 / 1, n.65 / 166 and N.66 / 208), there is still little consideration of culture in programs and policies addressing sexual and reproductive rights (SRHR). The integration of cultural components leads to better results in the field of social welfare and SRHR. Based on the experience of the DECIDES program (“Cultural Rights to Promote Development and Health”: www.decides.pro) implemented by Interarts with vulnerable groups, this project aims to strengthen cultural competencies of public and private actors and their ability to influence inequalities observed on SRHR, including care and prevention of violence against women. Gender-based violence affects all women regardless of their social, economic or cultural status, but foreign women are those most exposed to this type of problem. Through education and awareness actions, Interarts aims to create bridges between experiences in developing countries (Mali, Bolivia, Ecuador, etc.) and in the local reality of Barcelona, where the increasing arrival of migrants presents new problems for those professionals working in the care and health education sectors.

Tell us what were your expected results and the actual ones

The project’s main objectives were: · To achieve a more equitable society in which the population as a whole has the opportunity to access and exercise sexual and reproductive rights (SRR).

• To raise the awareness of health institutions on the issue of equality in health.
• To encourage collaborative work processes between the organizations closer to the most vulnerable segment of the population, particularly young and migrant women, and the public health system.
• To make visible the situation of the most vulnerable segment of the population, particularly young and migrant women, as regards SRR.

The project aimed, and has accomplished, to generate a critical reflection on how to provide care in the field of sexual and reproductive health (SRH) in an increasingly culturally diverse population. The training, information and awareness raising activities about the reality of vulnerable groups, particularly young and female migrants, have mainly impacted in Catalonia (approximately 75-80%). However, through the efforts on the project socialization and complicity with public and private institutions such as the Institut Català de la Salut (ICS); diverse NGOs in Spain; Cultural institutions (both in Spain and the rest of Europe; Professionals from around the world in the health and Culture sectors; etc., the scope of the project have achieved both a national and international relevance.

In order to achieve a wider impact, alliances have been established with institutions specialized in education on sexual and reproductive health and providers of services to women victims of violence and gender equality, which are also involved in the process of adapting the health system to the consequences of immigration processes.

The goal has been to ensure the participation of major groups of beneficiaries (mainly young women and women of migrant origins, particularly those in reproductive age) as well as to encourage their ownership of the project. Most of these migrant beneficiaries have been women (around 60%), but it is expected that the men participating in the project will also act as multipliers.

In addition, the project has been based on the previous experience with ethnic minorities and marginalized youth in developing countries in order to promote SRR and to prevent gender-based violence, which has allowed an in-depth investigation on the impact that culture has on the behavior of people and on the potential that culture and creativity have to strengthen both specialized staff and institutions. With a will to create bridges between these diverse contexts and the Spanish reality, the lessons learnt have been transferred to institutions operating locally, nationally and internationally.

Tell us something about the most relevant resource inputs of your project/action

Human resources and organization:

The IA and VHIR teams (over 15 people in total) have frequently held meetings to ensure the technical coordination and administrative monitoring of the project in order to assess the timely and correct carrying out of the foreseen activities, and to encourage a multidisciplinary approach to SRR in their broad meaning (right to sexual education or to live without violence).

Interarts has carried out the activities oriented towards raising the awareness of civil society on sexual and reproductive rights and equality in a context of cultural diversity; have organized a workshop of audiovisual creation and reflection on SRR in a context of cultural diversity and equality; and presentations / talks on SRR in a context of cultural diversity and equality. In parallel, Interarts have ensures the monitoring of the activities and a proper communication and dissemination plan of the project. The previous experience of Interarts in cultural development projects has been fundamental for DECIDES ESPAÑA’s success.

VHIR has undertaken an analysis on the current situation regarding the access to SRR and have organizes the training activities addressed to health care professionals on the use of educational material that promotes cultural diversity and equality programs and activities to promote SRR. Moreover, VHIR has been critical in fostering the ownership of the project by the health sector. In this sense, the partnership with the VHIR has allowed a good reception by the professional sector and increased the project’s impact on the national territory.

Financial resources:

The global BUDGET of the project has been 128.980,54€. DECIDES ESPAÑA has been co-funded by the Financial Mechanism of the European Economic Area (EEA Grants) which aims at contributing to the reduction of economic and social inequalities, and to strengthening the relationships between donor states (Iceland, Liechtenstein and Norway) and beneficiary states (17 EU Member States). The Plataforma de ONG de Acción Social is the Operating Agency of the Programa de Ciudadanía Activa (Active Citizenship Programme) which is endowed with EUR 4.6 million for the strengthening of NGOs and their contribution to social justice and sustainable development.

Time:

The total duration of the project has been 17 months.

Start date: 01/05/2014 End date: 01/10/2015

Tell us how you have attained the main change

One of the main obstacles has been the difficulty of making a transversal work between apparently unrelated sectors, such as health and culture and cooperation. Combining methodologies and unify the efforts of professionals from various fields to give coherence and cohesion to the project and not fall into the conduct of activities and unconnected materials, but transverse and useful for both sectors and society as ultimate beneficiary of the project, has been a major challenge due to the different nature of the two organizations working on the project. But precisely, fostering a dialogue between these various actors in order to promote a multidisciplinary approach to SRHR was one of the objectives of the project and it has certainly achieved the desired result.

Tell  us  the  main  area  of  impact  of  your  project

The main impact has been produced on the long lasting change of attitude of health professionals regarding their attention to migrant population. In the “Assessment of the health care approach to access to Sexual and Reproductive Health Rights (SRHR) for women in reproductive age of migrant origins in Spain”, a series of weaknesses and strengths which affect, on the one hand, the quality of the services rendered by health care professionals to immigrant women in reproductive age and, on the other, the latter’s access to SRHR and Affective Sexual and Reproductive Health (ASRH), were identified. Among them, it was highlighted that prejudices, limited knowledge of migrants’ cultural dimension, and lack of time, were relevant issues for the health care professionals when approaching their migrant patients. In order to improve their skills, the need of being provided with tools to create an empathic and trusted relationship with their immigrant women patients in order to achieve better results regarding their health and the exercise of their sexual and reproductive rights, was a common demand.

DECIDES ESPAÑA has collaborated to help generate a more comprehensive treatment to the users and a change in attitudes towards cultural diversity, and ultimately to create a more equitable society with: the production of new material on SSH, the launch of the online resource platform DIVERXUAL (www.decides-diverxual.pro) and the training of health professionals has helped to provide health professionals with knowledge and practical tools associated with Emotional, Sexual and Reproductive Health (SRH) in order to achieve a more equal society.

Which is the Big Idea behind your project/action?

To mobilize professionals and civil society to achieve equitable access to and exercise of sexual and reproductive rights (SRR) through a cultural, cross-sectorial and participatory approach to human rights and gender, with special attention to vulnerable groups (young women and women of migrant origin, particularly those in reproductive age) in Spain.

Audiovisuals and more information

• DECIDES PROGRAM http://www.decides.pro

• DECIDES BROCHURE

✓ Spanish: http://www.interarts.net/descargas/interarts2067.pdf

✓ French: http://www.interarts.net/descargas/interarts2068.pdf

✓ English description as in the Flyer: http://www.decides.pro/about-decides/

• DECIDES ESPAÑA website: www.decides.pro/decides-espana

• DIVERXUAL resources platform (only in Spanish): www.decides-diverxual.pro

• DECIDES ESPAÑA – COUNTRY PROFILE http://www.interarts.net/descargas/ interarts2058.pdf • ASSESSMENT & OPERATIONAL GUIDE (both documents in Spanish, but a good summary in English can be found at http://www.decides.pro/decides-espana-cpost/ decides-espana-assessing-the-health-care-approach-to-access-to-sexual-and-reproductive-health-rights-srhr-for-women-in-reproductive-age-of-migrant-origins-in-spain/)

✓ ASSESSMENT DOCUMENT http://www.decides.pro/wp-content/uploads/ 2015/01/DIFUSION.-Diagnostico-acceso-DSSR-DECIDES-ESPA–A1.pdf

✓ OPERATIONAL GUIDE http://www.decides.pro/wp-content/uploads/2015/01/ DIFUSION.-Guia-de-actuacion-DECIDES-ESPA–A1.pdf

• SUMMARY VIDEO (in Spanish) https://www.youtube.com/watch?v=6T1OSXd2rzg •

VIDEO “LA FOTO” (“THE PHOTOGRAPH”) (English subtitles): https:// www.youtube.com/watch?v=DT_Rd6MMHyo

• VIDEO “CONDÓN ROTO” (“BROKEN CONDOM”) (English subtitles): https:// www.youtube.com/watch?v=rD48peraz_c