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Sex, tensions and pills
Young people’s use of contemporary reproductive and sexual health technologies in Addis
Ababa, Ethiopia
Both, R.E.C.
Publication date
2017
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Citation for published version (APA):
Both, R. E. C. (2017). Sex, tensions and pills: Young people’s use of contemporary
reproductive and sexual health technologies in Addis Ababa, Ethiopia.
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Sex, T
ensions
and Pills
Rosalijn
Both
Sex, Tensions and Pills
Sex, Tensions and Pills
Sex, Tensions and Pills
Sex, Tensions and Pills
Young People’s Use of Contemporary Reproductive and
Sexual Health Technologies in Addis Ababa, Ethiopia
Coverart: Painting by Shewangezal Tamerat, Addis Ababa
Cover design: Emmelie Both
Printed by: Gildeprint - The Netherlands
Sex, Tensions and Pills
Sex, Tensions and Pills
Sex, Tensions and Pills
Sex, Tensions and Pills
Young People’s Use of Contemporary
Young People’s Use of Contemporary
Young People’s Use of Contemporary
Young People’s Use of Contemporary Reproductive and Sexual
Reproductive and Sexual
Reproductive and Sexual
Reproductive and Sexual
Health Technologies in Addis Ababa, Ethiopia.
Health Technologies in Addis Ababa, Ethiopia.
Health Technologies in Addis Ababa, Ethiopia.
Health Technologies in Addis Ababa, Ethiopia.
ACADEMISCH PROEFSCHRIFT
ter verkrijging van de graad van doctor
aan de Universiteit van Amsterdam
op gezag van de Rector Magnificus
prof. dr. ir. K.I.J. Maex
ten overstaan van een door het College voor Promoties
ingestelde commissie,
in het openbaar te verdedigen in de Agnietenkapel
op woensdag 05 april 2017, te 12:00 uur
door
Rosa Elisabeth Christina Both
Rosa Elisabeth Christina Both
Rosa Elisabeth Christina Both
Rosa Elisabeth Christina Both
Promotiecommissie
Promotiecommissie
Promotiecommissie
Promotiecommissie
Promotores:
Prof. dr. R.C. Pool Universiteit van Amsterdam Prof. dr. A.P. Hardon Universiteit van Amsterdam
Overige leden:
Prof. dr. R. Reis Universiteit Leiden
Prof. dr. R. Van Dijk Universiteit van Amsterdam Prof. dr. S.R. Whyte University of Copenhagen Dr. E.M. Moyer Universiteit van Amsterdam Dr. G.J.E. Gerrits Universiteit van Amsterdam
i
Table of contents
Table of contents
Table of contents
Table of contents
Acknowledgements……….iii
Chapter 1
Shifting youth sexualities: Sexual aspirations, frustrations and
the appropriation of pills ... 7
Chapter 2
Young people’s use and perceptions of emergency
contraceptives in sub-Saharan Africa: Existing insights and
knowledge gaps ... 27
Chapter 3
Keeping silent about emergency contraceptives in Addis
Ababa: A qualitative study among young people, service
providers and key stakeholders ... 41
Chapter 4
Emergency contraceptive use in Addis Ababa, Ethiopia:
Challenging common assumptions about young people’s
contraceptive practices ... 61
Chapter 5
Buy & deny: Young men’s sildenafil citrate (Viagra) purchasing
strategies and experiences of bodily effects in Addis Ababa,
Ethiopia ... 75
Chapter 6
A matter of sexual confidence: Young men’s non-prescription
use of Viagra in Addis Ababa, Ethiopia... 91
Chapter 7
Discussion and conclusions ... 109
Chapter 8
Epilogue: A reflection on studying intimate matters in Addis
Ababa ... 123
Overview of literature ... 143
Summary ... 163
Samenvatting ... 169
iii
Acknowledgements
Acknowledgements
Acknowledgements
Acknowledgements
My deepest thanks go to the many young men and women in Addis Ababa who participated in this study. Some of you became close friends. Without you this research would not have been possible. Ijig betam ameseginalehu!!
I would like to express my sincere thanks to my supervisors. Robert Pool has been a constant and important provider of support and guidance to me over the more than five years it has taken me to complete this thesis. Anita Hardon’s sharp reflections on the underlying common threads in my work helped me to move this study to its final stage at a time when I felt overwhelmed by writer’s block and the fatigue accompanying young motherhood. I would also like to thank the other members of the Doctorate Committee for taking the time to read this thesis.
I am very thankful to the AISSR for funding this study and for the unwavering administrative support of José Komen, Janus Oomen, Hermance Mettrop, Muriël Kiesel, Erna de Boer, and Joanne Oakes. Special thanks go to Erin Martineau, David Hymans, and in particular Zoe Goldstein for editing parts of this thesis.
Since my first visit to Ethiopia in 2003, I have developed close friendships with Rahel Endale, Frehiwot Kebede, Mahlet Bisrat, Noah Negussie, and Eyelachew Etsub. I am thankful to each of you for the unique insights you gave me that enriched my fieldwork skills and the write-up of my findings.
Fantawork Samuel and Liya Teklu accompanied me during many months of the fieldwork and their cheerfulness and determination made the otherwise challenging fieldwork move in the right direction. Aklilu Abate’s unique interpersonal skills greatly helped in making young men feel comfortable to share their stories. Mahlet, Maria, Bitania, and Emnet were a great support during data collection. Bruck Messele Habte facilitated my access to pharmacies and drugstores as well as to certain key persons and research assistants. This truly helped to move my research forward and I am glad for our friendship and ongoing academic collaboration. Aster, Yonas, Brook, Edget, Miki, and Murat so graciously let me conduct observations in their drugstores and pharmacies, an opportunity that not only provided me with rich insights but also allowed for moments of stability during the otherwise unpredictable course of the fieldwork. Their hospitality was amazing. Habtamu, Solomon, and Ermias were of utmost importance in connecting me to some of the young men who participated in this study and I feel extremely lucky to have met them. I would like to thank Ezana for realizing an official link with the Sociology Department of Addis Ababa University and for providing me with opportunities to present my preliminary findings there. I also thank Getnet Tadele for our discussions about my research. It was great to have Liza
iv
Debevec around as a co-anthropologist and friend. I am thankful to former country director Andrew Pillar of DKT Ethiopia, the staff members from EnGenderHealth Ethiopia and Marie Stopes Ethiopia, and in particular to Marius de Jong, former first secretary of health at the Dutch Embassy in Addis Ababa, for opening doors to public health and abortion clinics, providing key information, and for our vibrant discussions about my research.
Abeba and Genet made the ‘Kebena’ house where I stayed during the first period of fieldwork into a comfortable place for me to ‘hide’ at times when the frustrations of doing fieldwork on such a sensitive topic prevailed. Ann’s pleasant company and cooking skills and the long, down to earth conversations I had with Regien contributed even more to making the ‘Kebena’ house a real home away from home. During the PhD trajectory, Corien has been a tremendous support. I cannot thank you enough for your hospitality, listening ear, and our afternoons at the pool that served as breakaways from the fieldwork, and your strong belief in my capabilities. You even insisted on travelling with me to the Netherlands to attend my defence. You, Habib, Lidu, and Geremew hold a dear place in my heart. While in the field, Marieke always generously let me use her large network, as well as her house, and she still never misses an opportunity to promote my research. Our countless get-togethers, including on the most beautiful rooftop terrace in Addis Ababa, have been both fun and inspirational. You, Wendemegegn, Grieta, and Ineke always felt like my family in Ethiopia.
In the Netherlands, I could not have wished for better roommates and friends than Eva Vernooij, Erica van der Sijpt, Marije de Groot, Christopher Pell, Josien de Klerk, and Nicole Schulp. In a similar vein, friendships developed with my co-PhDs Carla Rodriquez, Emmy Kageha, Nipa Mrutu, Joseph Simbaya, Fortunate Shabalala, Alfred Adams, Thandeka Dlamini, Jude Rwemisisi, Emmanuel Turinawe, and Laban Musinguzi, all of whom added flavour to what was otherwise an at times lonely journey. I also feel lucky to have had the opportunity to learn from Winny Koster, Trudie Gerrits, and Eileen Moyer through symposia and applied research projects. I am especially thankful to Eileen Moyer for frequently organizing reading groups and delicious meals, events that were useful and gezellig at the same time.
Janneke, your friendship has been invaluable over the past fifteen years. I could always count on you for a nice meal, short holiday, supportive words, and laughter. I am glad our ‘team’ is now strengthened with three little girls. Korrie, ‘Rooie’ Nienke, and ‘Blonde’ Nienke, our friendship started in 2001 during the first months of our studies in History. You know best how my academic life has been full of ups and downs and I am glad that you were and are there to lift me up when needed. With
v Marion, I look forward to gain deeper insights into some of the themes that came out in this study, as we are about to join forces on a new study.
I wonder what my grandmothers Ineke and Corrie and my grandfathers Carel and Gerrit would have thought of the topics I chose to study. In any case, I know you would have been proud of your granddaughter and I love and miss you all dearly. I am thankful to my uncles, aunts, and cousins for always showing an interest in what I have been doing over the years.
I am truly grateful for the unconditional support I received from my parents. Your proofreading, pep-talks, countless visits, and cups of coffee kept me going at times when I felt like giving up. Towards the end of the writing process, I spent several months at your home, leaving my young daughter Hewan largely in your care so that I would be free to write and fight my (many) writer’s blocks. Your hospitality and grandparenting skills during these months undoubtedly moved my thesis forward. So have your babysitting sessions in Amsterdam, which gave me time to go to the library or the office. Both of you visited me in Addis Ababa during fieldwork and it is through you, dad – a frequent visitor to Ethiopia for work since the 1990s – that I embarked in 2003 on what has now turned out to be a lifelong connection with the country. My sisters and brother have always been important pillars of support and this was no different during my PhD trajectory. Marieke, you are a great example to me of how to combine motherhood with work and you were the first in our family to do research in the field of medical anthropology. Jonna, you are both my sister and fellow PhD candidate and we shared many frustrations, laughs, and discussions about our work. I am happy that we are now both completing our PhD journeys and I am looking forward to our post-PhD adventures. Pieter, our many coffees and dinners together in Amsterdam were a welcome distraction from the writing process. I look forward to drinking coffee in Lebanon with you and Kim. Emmelie, you, together with Diederik, formed my creative team. You were always willing to brainstorm with me about chapter titles and you have done the lay-out of this book. You have also supported me tremendously by babysitting Hewan on Fridays so I could get to the library to write. Fatim, Jiyan, Evin, and Neelah, without doubt your bubbling and energetic presence have worked as stress relievers during my PhD trajectory and I love you dearly.
Abe, you deserve my deepest gratitude for your unconditional moral support, for your efforts in teaching me some Amharic, and your brilliant insights and remarks on my work. Through our many conversations about my study topics, I learned that you are by far a better ethnographer than I am and your input has been much more important than you know. Our meeting in Addis Ababa in October 2013 turned out to be a life
vi
changing encounter. Thanks to you, at the moment of writing this, I am a wife and a mother of two amazing girls. Marriage and parenthood have not only been the most exciting and challenging journeys in my life so far, but have also helped me to put the ups and downs of doing a PhD in perspective. Thanks to you, I also have a large and loving family in Ethiopia. Zenebech, Elsa & Samuel (Ebenezer, Nebeyu, Meheretab), Nani & Yayesh (Fasil and Lidiya), Assegu & Abera (Eskinder, Zerkalem, Mentesnot, Robel, Nati, and Eden), Almaz, Tsehay, Ashu & Muna, Kina, and Liya: thank you for your warm company, wonderful cooking skills, and most of all, for making me feel truly welcome.
Hewan, yane konjo, your arrival taught me how to work efficiently and pragmatically, skills that I will benefit from for the rest of my career. You made me a mum. Your smiles and unconditional love teach me every day about what is most important in life. As tiny as you were at one-and-a-half years of age, you could already say ‘mama writing’ when I took time on the weekends to work on this book. Your little sister Adiya, who was born just after I submitted this manuscript, gave me the last little push I needed to finalize this thesis so that I can give my full and undivided attention to you both.
