Research Project
MSc. Conflict Resolution and Governance
Supervisor: dr. J. Krause
Second reader: dr. M.B. Parlevliet
Master’s Thesis
Name:
Vikki Oriane de Jong
Student number:
10174672
Number of words: 24.442
Date of submission: 30
thJune 2017
Biding Time
Understanding the impact of the Venezuelan humanitarian crisis on Venezuelan
women and their motherhood through a human security health lens
2 Abstract
The aim of this thesis was to understand the health impact of the humanitarian crisis in Venezuela on Venezuelan women and their motherhood. Theory on constructivist feminism and situated agency have been used to understand the health impact; the latter was explained using human security theory. This thesis included a focus on a group of women referred to as ‘future mothers’, which has so far not been included in existing literature. Semi-structured interviews (N=8) have been conducted to understand the (constructed) role of women in Venezuelan society. Narrative interviews (N=12) with Venezuelan women have been conducted to understand the physical and mental health impact of the current crisis. The semi-structured interview data showed that motherhood is highly valued, expected in Venezuelan society and is a desired identity to achieve for Venezuelan women. The narrative interview data showed deep concerns about crisis-induced deteriorating physical health care. The mental health impact as described by all women was classified into five categories: economic insecurity, physical insecurity, loneliness, emotional responses and coping/resilience. The mental health impact regarding motherhood was divided in two groups: mothers and future mothers. Mothers showed altruistic behaviour towards their children and insecurities about crisis-induced childrearing and care taking choices. Future mothers took the situated decisions to postpone having children, despite a desire to have them, because the current crisis prevents them from providing good care. Consequently, they cannot live up to the (constructed) societal expectations of good motherhood and cannot reach a highly valued identity. This thesis suggests it is important to look at the effect this has on these women’s mental health because (prolonged) postponing reaching a valued identity, like motherhood, can affect mental health. Hence, it is suggested that for both mothers and future mothers in post-crisis Venezuela, policies need to be designed to address these mental health needs. It is also suggested that, more generally speaking, a mental health aspect of postponing motherhood should be included in reproductive healthcare services in humanitarian aid.
3 Dedication
This thesis is dedicated to my mother, the strongest woman I know and to my father, who always has my back.
For your unconditional support, constant encouragement and for giving me the opportunity to follow my dreams.
4 Acknowledgements
After five months of intensive ‘learning by doing’, I would like to thank the people who have supported and helped me through and throughout this Master’s thesis period.
I would first like to thank my thesis supervisor, dr. Jana Krause for pointing out relevant theory and literature. Also, my gratitude goes out to dr. David Laws and dr. Michelle Parlevliet for their support, input and encouragement during this research project.
Furthermore, I would like to thank all who helped in making this thesis possible. Gerardo, muchísimas gracias por todo lo que hiciste por mi tesis, no hubiera sido posible sin tu ayuda. Mónica, mi linda amiga, estoy muy agradecida de habernos podido encontrar en la Haya. Muchas gracias por tu ayuda con las entrevista y por tu amistad. Espero que yo te pueda ayudar más con VenezuelaSonrie. Juan, muchas gracias por ponerme en contacto con Anicar, con tu mamá y por todos los articulos que me enviaste durante estos cinco meses. Anicar, tambien te quiero agradecer por tu tiempo, tus contactos y por invitarme a tu casa y a la Haya. Obviamente también me gustaría agradecer a todas las mujeres que pude entrevistar. Para proteger sus identitades no voy a mencionar sus nombres, pero estoy muy agradecida que ustedes hayan querido compartir sus historias conmigo. Ustedes son mujeres tan lindas, demasiado fuertes y valientes. Tengo muchísimo respeto hacia ustedes. Con todo mi corazón espero que la situación en Venezuela se mejoré muy pronto. Un abrazo para todos.
I would furthermore like to thank the Waperveeners and my CRG friends for their support. Lauren, I will forever treasure our Bushuis moments (including tiny chair) and evenings filled with risotto. Abeer, Barbara and Iris, thanks for lending a shoulder when needed. Also special thanks to Lisa, Virág and Zeineb for sharing food, laughter and smiles in times of stress. My BG friends and ´de watermeloentjes´ likewise: you have been invaluable in your support. Gratitude furthermore goes out to Cuautli for his encouragement and help in Spanish grammar checks.
A last big thanks goes out to my family. My parents, who are always there to help me with wise council and sympathetic ears. My brother, who I love so dearly. And my sister, my best friend who just understands me without words needed.
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Table of Content page number
Abstract………. 4
Dedication……… 5
Acknowledgements ………. 6
1. Introduction ……… 7
2. Background ……….… 10
2.1 Venezuela: recent political and economic history………. 10
2.2 Venezuela’s current situation: humanitarian crisis and violent conflict……… 12
3. Theoretical Framework………... 16 3.1 Introduction ……… 16 3.2 Constructivist feminism……… 16 3.2.1 Constructed womanhood………. 17 3.2.2 Constructed motherhood………. 18 3.3 Situated agency………. 19
3.4 Human security: the health impact ……… 20
3.4.1 Physical health impact………... 21
3.4.1.1 Reproductive health……….. 21
3.4.1.2 Maternal health……….. 22
3.4.2 Mental health impact: women……… 23
3.4.3 Mental health impact: mothers and future mothers………... 24
3.4.3.1 Mothers………. 24
3.4.3.2 Future mothers……….. 24
3.5 Summary………... 25
4. Methodology………. 27
4.1 General research design………. 27
4.2 Fit of research approach……… 27
4.3 Samples………. 28
4.3.1 Semi-structured interviews sample……….. 29
4.3.2 Narrative interviews sample……… 30
4.4 Interview setting……… 31
4.5 Language during interviews……….... 31
4.6 Operationalization………. 32
5. Venezuela’s constructed society………. 33
6. Health impact of Venezuela’s crisis on mothers and future mothers………. 37
6.1 Physical health impact………... 37
6.1.1 Reproductive health……….. 38
6.1.1.1 Traditional contraceptives………. 38
6.1.1.2 Sterilization……… 39
6.1.2 Maternal health……….. 40
6.1.3 Summary………... 41
6.2 Mental health impact: women……… 42
6.2.1 Economic insecurity……….. 42 6.2.2 Physical insecurity……….. 43 6.2.3 Loneliness……….. 44 6.2.4 Emotional responses……….. 45 6.2.5 Coping/resilience……….. 46 6.2.6 Summary………... 47
6 6.3.1 Mothers………. 48 6.3.1.1 Care work………... 48 6.3.1.2 Rearing……….. 49 6.3.2 Future mothers………. 50 6.3.3 Summary………... 51 7. Discussion………. 53 7.1 Findings………. 53 7.1.1 Physical health………... 54
7.1.2 Mental health: women……… 56
7.1.3 Mental health: mothers and future mothers………... 56
7.2 Limitations……… 59
8. Conclusion……… 61
7 1. Introduction
“You’ve thrown the worst fear that can ever be hurled fear to bring children into the world”
Bob Dylan, Masters of War, 1963 Bob Dylan catches the devastating effect war, conflict and crises have on people in just a few words. If people do not want to bring (more) children into the world because of the circumstances they live in, it has the connotation of losing hope. If children are indeed the future, then these decisions show the despair, the way people (women) are giving up on that future. On the other hand, it shows how people (women) try to protect and prevent their unborn and unnamed children from suffering. This is now happening in Venezuela.
In August 2016, Ulmer (2016) published an article about a growing number of (young) women that opt for sterilization in Venezuela. The current situation in the country, including food shortages, inflation in the three-digit numbers and deteriorating health care have become a source of anguish. It is reported that 85% of the households are eating less than they did before the crisis, resulting in an average weight loss of Venezuelans of 19 pounds because of the crisis (Toro, 2017). Food is hardly affordable for Venezuelans, whose money is worth less every day. Around 85% of medicines necessary for basic health care are unavailable (Ulmer, 2016). These women who are seeking sterilization do not want to have (more) children in this situation and do not want to bring them into the world of scarcity that constitutes contemporary Venezuela. With traditional contraceptives very limited available (only on the black market) and (consequently) hardly affordable, participating in the free or heavily subsidized government-and non-profit run sterilization program has become more popular (Barbarani, 2016). This phenomenon shows the severity of the current situation in Venezuela for these women. It furthermore raised other questions: “What does making these decisions do to these women?” and “How is their well-being affected by these decisions?”.
This phenomenon subsequently became the reason for writing this thesis. However, sterilization and reproduction are only some of the aspects women have to deal with in crisis situations. In this thesis, therefore, the focus will be broader, and other aspects of wellbeing will be looked at. This led to the following research question: “What is the health impact of Venezuela’s current humanitarian crisis on Venezuelan women and their (future) motherhood?”.
To understand the impact of the crisis, situated choices made by these women will be looked at from a constructivist feminist perspective. The way societal norms and values about womanhood and motherhood are constructed in society are relevant in understanding the way choices about motherhood are experienced and made by these women. These constructs form the context in which these decisions
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are made, i.e. the situated agency of these women. In Latin American societies, motherhood is highly valued (Sutton, 2010). Such constructed norms shape the nature and the experience of the decisions about motherhood.
On top of the prior to the crisis existing societal construct, a crisis context is foisted. This crisis pushes for new decisions and choices regarding motherhood, hence affects women’s agency.
To understand how the crisis impacts Venezuelan women’s wellbeing, the theory on human security will be used. Human security theory, which is normally used with respect to civil war situations, is helpful as it provides a framework for well-being of people in conflict situations. Venezuela used to be a rich, ‘middle-income’ Latin American country. That image does not rhyme anymore with the “realities that families face on the ground” (Toro, 2017). The agency of middle-class women has changed rapidly from a relatively wealthy position to ‘struggling to get by’ over the course of the crisis. Their wellbeing is consequently affected by this crumbling middle-class position and other (practical) effects of the current crisis.
A short overview of the structure of this thesis will be given here. Chapter 2 will provide some background information regarding recent political and economic history, argue why Venezuela is an interesting case study and will provide the concepts and justify the terminology used throughout this thesis. Chapter 3 will then explain the theoretical framework, building on the theories of constructivist feminism, situated agency and human security. What this chapter will furthermore show and justify is that within the human security approach, a specific health focus is used. This combination of theories and focus has been used before to explain a certain impact of war, conflict or crisis (Tripp et al., 2013). However, what this thesis shows is how this general (physical and mental) health impact that results from the crisis is required in order to specifically look at the situated choices Venezuelan women make regarding motherhood. This study looks both at women who are already mothers and women with a desire for (more) children. This last group of women is hardly included in the current literature on human security with a (mental) health focus. Especially in a society where motherhood is so valued, it seems important to look at what crisis situated choices mean for these women’s wellbeing and mental health. Chapter 4 then moves into the methodology used in this thesis. It will explain that no actual fieldwork was possible in Venezuela. Consequently this thesis consists of two separate parts. First, a part in which 8 semi-structured interviews have been conducted to provide for the context of Venezuelan society and existing societal constructs. The second part follows in which 12 narrative interviews have been conducted to ascertain the health impact of the crisis in Venezuela. In chapter 5 and 6 the results of these interviews will be given respectively. The first chapter will show that women, mothers, form the cornerstone of Venezuelan society and that for Venezuelan women motherhood is a highly valued identity. The second chapter will point out the concerns of the interviewed women about the deteriorating (medical) health care system as a result of the crisis. It will highlight five mental health impact categories (i.e. economic insecurity, physical insecurity, loneliness, emotional responses and coping/resilience) that follow from
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practical consequences of the crisis. The results of the mental health impact regarding motherhood will demonstrate that the interviewed mothers show altruistic behaviour towards their children but simultaneously feel insecure about their childrearing and child care choices. The future mothers show frustration about having to postpone and alter future (family planning) plans because of the crisis.
Chapter 7 will then discuss these results within the theoretical framework of constructed roles and situated agency. Finally, the overall conclusions of this thesis will be given in chapter 8. It will be argued that, because of the crisis in Venezuela, Venezuelan future mothers take situated decisions to postpone pregnancy because the situation prevents them from providing good care for their children. Consequently, they cannot live up to the (constructed) societal expectations of (good) motherhood. This can have an affect on their mental health. As long as the crisis continues, there seems no possibility for these women to have children in Venezuela although they do have a desire to have them. Unless the crisis is resolved and the situation returns sufficiently back to normal, these women cannot reach the highly valued motherhood identity. Suggestions for policy regarding the main findings are subsequently made.
10 2. Background
To understand the current situation in Venezuela, a brief overview of recent Venezuelan history will be given. Secondly, the nature of the current situation in Venezuela as a humanitarian crisis and violent conflict is established.
2.1 Venezuela: recent political and economic history
Venezuela is a country located in South America, with around 30 million inhabitants. In the 1920s it was discovered that Venezuela had one of the biggest oil reserves in the world (Al Jazeera News, 2017). Foreign oil companies invested in Venezuela, booming its economy. Venezuela became the richest country in Latin America (Fisher & Taub, 2017). Of course not everybody benefitted; a divide between the extreme rich and the poor has always existed in Venezuela and continues to exist (Helmer, 2010; González, 2017). However, Venezuela also always has had a large middle class and the reputation of being a ‘middle-income country’ (Toro, 2017).
In the 1980s Venezuela was hit by an economic crisis, like most Latin American countries. Many people lost their jobs, and inequality levels rose. Poverty rose from 17% in 1981 to 78% in 1997 (Wagner, 2005). A coup attempt took place lead by Hugo Chávez in February 1992, then lieutenant in the Venezuelan army. It failed, however, and Chávez ended up in prison. After the presidential shift, replacing former (elected) president Carlos Andrés Pérez with Rafael Caldera, Chávez was given amnesty and released in 1994. Chávez used the following 4 years to increase his popularity. Eventually he won the presidential elections in 1998.
When Hugo Chávez came into power, he made some radical reforms. The biggest was the constitutional reform (by popular referendum) in 1999, replacing the 1961 Venezuelan Constitution with the “Constitución Bolivariana”. The main change in this new Constitution was that the Venezuelan democracy became participatory instead of representative, i.e. aiming to increase (involved forms of) citizen participation and subsequent political representation. According to some, the changes that were part of the new constitution empowered many citizens (Fox, 2013). They could now raise their voice and stand up for their rights. Others however argue that this was more pretence than anything else, because many (organisations) were in practice not able to participate (Rojas, 2009). It is furthermore claimed that this new participatory democracy actually only listened to pro-Chávez groups (Helmer, 2010).
That said, in the fourteen years of his presidency, Chávez did launch many social programs, ‘misiones’ as part of his ‘21 century socialist revolution’. Between 2003 and 2004, Chávez rapidly implemented thirteen of these plans because he feared an electoral defeat during the 2004 referendum about his presidency (Helmer, 2010). Chávez used his close connections with Cuba to launch initiatives to improve the (national) education and health care systems. With positive result; (children of) poor families got
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educational opportunities and graduated high school and university. Furthermore, health clinics with around 20.000 Cuban doctors were created in the barrios, shantytowns (Helmer, 2010).1 Around
seventeen million poor Venezuelans benefited from this (Helmer, 2010, p.34). Chávez started misiones to ensure affordable food for everyone. His government created supermarkets where people could buy basic products for 40-50% off the normal price. Around ten million Venezuelans made use of this possibility (Helmer, 2010). Also, soup kitchens were created that offered women and children in need one free meal a day (Fox, 2013).
As this thesis focusses at Venezuelan women specifically, it is interesting to look at the Venezuelan policies aimed at women. This will help also in understanding the role of women in Venezuelan society and the subsequent level of gender equality. Chávez implemented policies that were specifically designed for women (Helmer, 2010; Valero, 2010). The new Venezuelan Constitution (1999), for example, included art. 88. This article recognized by law the work in the household as contribution to the economy (Cedeño, 2016). As a result, housewives got access to social security benefits, financial support, job training and sexual education (Fox, 2013). Chávez also adopted a comprehensive reproductive healthcare approach for (future) mothers, including family planning services (Freitez, 2010). Two institutes were furthermore established for women. In 2000 Inamujer, the National Institute for Women, was established “to defend and materialize the rights of the female population and the improvement of their participation in the misiones and social programs of the State” (Inamujer, 2015). Banmujer was established as a microcredit bank that gave microfinances to (poor) Venezuelan women. Furthermore, some laws to defend women’s rights were drawn up. Two examples will be given. First, the Law on Women’s Rights to a Life Free from Violence (2007) was introduced to tackle (domestic) violence against women. Second, the Labour Law (2013) guaranteed amongst other things pensions for full time mothers (constituting 80% of the minimum wage) and increased maternity leave to six months (Fox, 2013; Helmer, 2010).
Especially on the grassroots level Venezuela’s misiones made a difference for (poor) women (Fernandes, 2007). They targeted problems that were of importance to specifically women in their traditional roles as wives and mothers: food, health care, housing, income (Espina & Rakowski, 2010, p.197). It is thus not surprising that (poor) women from the barrios shortly made up the majority of those (voluntarily) working in these community-related misiones (Espina & Rakowski, 2010). It is also argued that women, because of Chávez’s inclusive policy, became politically more active (Helmer, 2010, p.42). They got a more prominent role in politics and, by acting on their own behalf politically, raised their voice (Helmer, 2010).
Whether Chávez’s initiatives on women’s behalves were actually indeed that successful is doubted (Helmer, 2010). Most projects were designed with a top-down approach rather than a bottom-up one. They were also, as briefly mentioned before, highly political. Consequently they were often only available for women who supported the government (Helmer, 2010). Rojas (2009) therefore states that the situation for women in fact only worsened because of Chávez’s policy: women from the opposition who spoke up
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were not listened to and women’s rights thus remained secondary to the interest of the government and state.
Despite those critiques, Venezuela was in 2004 praised for their policy work on gender equality at the UN Committee on the Elimination of Discrimination against Women (TeleSur, 2014). Recognition was given to Venezuela because enrolment rates in schools had gone up and became almost equal for boys and girls: 92,3% and 92,1% respectively (TeleSur, 2014). Also, female unemployment rate had fallen between 1999 and 2014 from 16% to 7,5% respectively (TeleSur, 2014).
Chávez policy agenda changed over the course of the fourteen years of his presidency. It started as a progressive, ideological ideal to ‘free Venezuela’ from corruption, the ruling elite and economic malfunctioning. However, it moved into a quite radical, revolutionary socialist approach which leaned more towards communism (Helmer, 2010, p.9). Most of the Venezuelans kept supporting Chávez. However, the opposition did demonstrate and showed its discontent. In 2004, leading up to Chávez’s re-election referendum, big demonstrations filled the streets of Caracas, Venezuela’s capital. Of the 70% of the Venezuelan who voted, however 59% decided they wanted to keep Chávez as president (Helmer, 2010).
A short notion of the economic history is also relevant in this section. Under Chávez’s presidency, the Venezuelan economy was growing. Inflation rates dropped by 20% a year between 1999 and 2006. Also the number of Venezuelans living in poverty decreased (55% in 1995 to 26,4 in 2009) and unemployment rates reduced (15% in 1999, 7,8% in 2009) (Guardiola-Rivera, 2013). Chávez financed his previously mentioned misiones mostly with money that came (directly or indirectly) from the Petróleos de Venezuela, Venezuela’s state-owned oil company. Oil prices were opportune and could by and large support the misiones financially. One barrel could be sold for prices up to $100 (Al Jazeera News, 2017). This was also necessary as the taxes in Venezuela were not able to finance these misiones. Indirect taxes (on products in shops, etc.) had stayed the same over the course of his presidency (Helmer, 2010, p.35). However, in 2014 oil prices that had sustained Venezuela’s economy for a long time dropped to only $30 a barrel (Al Jazeera News, 2017). Consequently, the social programs and subsidies became unsustainable.
After Chávez’s death in 2013, Nicolás Maduro came into power as his appointed successor. He is not nearly as popular as Chávez was. Current figures show that only 24% of the Venezuelan population is still supporting him and the Bolivarian revolution (The Economist, 2017).
2.2 Venezuela’s current situation: humanitarian crisis and violent conflict
The combination of the political (unsustainable) decisions made by Chávez and the inevitable drop in oil prices that financed most of Venezuela’s misiones hit Venezuela (economically) hard. As a result, Venezuela currently has a debt of $7,2 billion, incredibly low foreign exchange reserves, four-digit inflation and
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“currency controls that limits imports, putting a strain on supply” (Al Jazeera News, 2017; Imbert, 2017). A black market emerged, where products unavailable in the supermarkets (including most basic products) can be purchased for high prices.
Rapidly, Venezuela moved from being the richest country in Latin America to one of the poorest. This makes Venezuela an interesting case to study. Most research that uses human security theory focusses on war-torn countries or refugee-and humanitarian crises that follow from (civil) war. Venezuela is different in the fact that the situation as it has unfolded is not a civil war or a crisis following from a (civil) war. In order to use the right concepts and subsequent terminology when referring to the situation in Venezuela, the terms used by some (widely acknowledged and reliable) intergovernmental and non-governmental organisations have been looked at. In August 2016 UN Secretary Ban Ki-moon has referred to the situation in Venezuela as “humanitarian crisis” caused by political instability (BBC, 2016). This term has also been used by Human Rights Watch (HRW, 2016). Thirdly, Amnesty International also refers to the current situation in Venezuela as a humanitarian crisis (AI, 2017).
The Humanitarian Coalition (2017) acknowledges it “is not always easy to categorize a humanitarian crisis”. The term ‘humanitarian crisis’ is used by many (humanitarian) agencies, without specifying criteria. The Inter-Agency Standing Committee (IASC) gives the definitions of (complex) emergencies and disasters used by different organisations like the WHO, UNHCR and UNICEF aligned with their mandates. It shows thereby there is no widely used definition of humanitarian crisis (IASC, 1994). Rather, it is a term that is used to describe complex emergencies (IASC, 1994). Two similar description of a humanitarian crisis were found, using crisis and disaster interchangeably: “a humanitarian disaster occurs when the human, physical, economic or environmental damage from an event or series of events overwhelms a community’s capacity to cope” (Humanitarian Coalition, 2017; World Vision International, 2017). This description does however not provide for various criteria that can be used in determining whether a situation is humanitarian crisis. In a report by Action Contre la Faim (AFC) a definition of humanitarian crisis was used as given by two psychologist involved in humanitarian action, Josse and Dubois (2009):
“A crisis is an acute situation, difficult to manage, with severe and long-term consequences, which are generally harmful. A crisis should not be understood in relation to a stable condition, a stable state, a system or by universal references, but must be seen as a process. In fact, it constitutes a change in state, from one moment or type of organisation to another, for example from a stable or critical situation to a catastrophic situation. A crisis is therefore a disastrous upheaval from a previous situation” (in Coillard et al., 2017).
They mention five criteria: (serious) deterioration in a situation; numerous victims or people’s lives in danger; population in a situation of great distress; substantial material destruction and lastly, institutional
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management in difficulty or incapable of managing the situation (Coillard et al., 2017). In this section it will be argued that the current situation in Venezuela meets those five criteria.
The situation that has unfolded in Venezuela includes “deteriorating human rights conditions” (HRW, 2016). With the inflation rate over 750% and the economy still shrinking (18,6% over the course of 2016) one can easily state that “Venezuela’s economy is in tatters” (López, 2017). At the moment of writing, in Venezuela 85% of the medicines necessary for basic health care are unavailable. Basic food products are similarly hardly available and very costly (Ulmer, 2016). In March 2017, for a basic basket of products necessary for a month (family of five), an income of 1.06 million bolivares is needed; an increase of 424% compared to 2016 (Al Jazeera News, 2017). Also, according to official statistics by the ministry of health in Venezuela, compared to 2015, maternal mortality has risen with 65% and infant mortality with 30% (Caporale, 2017). In 2016, 81,8% of the Venezuelans lived in poverty, of which 51,51% in extreme poverty, compared to 48% of which 23,6% lived in extreme poverty in 2014 (Fundación Bengoa, 2016). Because of this deteriorating situation, people’s lives are in danger. The food insecurity has led to Venezuelans losing weight: on average 19 pounds (around 8,6 kg) (Zabludovsky, 2017). Venezuelans are sarcastically calling it ‘the Maduro diet’ (Toro, 2017). By April 2017, 11,4% of children in vulnerable areas in Venezuela were experiencing (severe) acute malnutrition (Toro, 2017). Humanitarian agencies use a 10% threshold to declare food crises. Venezuela consequently is in food crisis. It has been reported that 63% of the households in Venezuela have turned to eating ‘unusual foods’ (Toro, 2017). Around 70% has reported that they have stopped eating food they consider important – 85% of the households reportedly eat less than before the crisis, of which 44% go a whole day without eating (Toro, 2017). Furthermore, as the maternal health statistics show, pregnant women and young children are in increased danger because of the current situation. In addition, it is relevant to mention the profound physical insecurity that has set foot in Venezuela. Crime rates have increased tremendously. In 2016, 28.479 homicides have been reported in Venezuela, which is comparable to 91,5 murders per 100.000 inhabitants, while in 2014 there were 54 murders per 100.000 inhabitants (OVV, 2015). The current rate is one of the highest murder rates in the world (López, 2017; OVV, 2015). Just being on the streets already constitutes a danger to Venezuelans.
Consequently, the Venezuelan population is in a situation of great distress. As of the 1st of April 2017,
Venezuelans take to the streets daily to protest against the Maduro government and the current situation (López, 2017). These Venezuelans are from the opposition, but also more and more former-Chávez supports join (El Nacional, 2017). This results in violent clashes between the protesters and the government officials. A violent conflict has consequently emerged. The WHO defines violence as “the intentional use of physical force or power, threatened or actual, against oneself, another person or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, mal-development or deprivation” (in Krug et al., 2002). A violent conflict, then, is defined as a “situation in which at least two organized parties resort to the use of force against each other”
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(Miall et al. (1999) in Baumann et al., 2006). Violent conflict thus has a collective dimension as well as a sustained nature (Baumann et al., 2006, p.14). This is the case in Venezuela. There are widespread reports of government intimidation and harsh government responses to peaceful expressions of dissent, arbitrary arrests and torture of political prisoners (Fundación Bengoa, 2016; HRW, 2016). The government officials also increase the use of teargas, water cannons, rubber bullets and pellets. Also non-conventional weapons have been used like nails and marbles loaded in tear gas canisters, also shot and aimed at protesters at close range (López, 2017). As of June 2017, with more than 50 subsequent days of protesting, the death toll is set at 67 people (López, 2017).
As a result of this violent conflict, substantial material destruction has been reported. These violent clashes result in destructed shops and other buildings after lootings (Zabludovsky, 2017). Furthermore, schools and hospitals are less and less equipped with the required materials, varying from simple things like light bulbs and air-conditioning. Hospital operation rooms and mortuaries are without air-conditioning or light (Zabludovsky, 2017). Also unavailability of cleaning materials and materials needed for building maintenance or construction are relevant to mention here. Consequently, destructed areas cannot be rebuilt.
Finally, from the responses by the government (officials) to the daily protests of most Venezuelans, it is clear that institutional management is in difficulty. The political situation in Venezuela is highly unstable (HRW, 2016). Maduro is often referred to as a dictator, more publicly so after his decision to let the Supreme Court take over the functions of the opposition-led National Assembly on April 29, 2017. This de facto annulled its mandate (Oré & Cawthorne, 2017). Quickly after, under international pressure, Maduro reversed the most controversial part of that decision. However, he keeps trying to bar the opposition from having any political influence (Ulmer & Gupta, 2017). Henrique Capriles, leader of the opposition, has been banned from politics for fifteen years (BBC(b), 2017). Another opposition leader, Leopoldo Lopez has been incarcerated in military prison for over three years already for his role in a protest against Maduro’s government (Buncombe, 2015). Not surprising that many reporters refer to Maduro’s presidency rather as a (authoritarian) regime (Alarcón, 2017; Fisher & Taub, 2017; González Vargas, 2017). The increasing violence used by government officials indicates that Maduro is still trying to get a grip on the situation despite signals that the majority of the Venezuelans consider his government illegitimate (López, 2017).
All five criteria for the definition of humanitarian crisis as given by Josse & Dubois (2009) are thus met. Within this humanitarian crisis, also a violent conflict has unfolded that follows from political instability, causing many injured and every day more death. Throughout this thesis, the humanitarian crisis and violent conflict in Venezuela will be referred to simply as ‘crisis’.
16 3. Theoretical framework
3.1 Introduction
Some background information has been provided in order to understand the conflict situation in Venezuela. This chapter presents the foundation and theoretical framework for this research. Three theories form the backbone of this thesis: constructivist feminism, situated agency and human security (with a focus on health). First, the theory of constructivist feminism will be outlined, followed by theory on situated agency. Thirdly human security with the specific focus on health within that body of literature will be discussed.
3.2 Constructivist Feminism
The majority of research on gender in conflict situations and crises focusses on the widespread conception that the primary victims in emergencies are women and children (Byrne & Baden, 1995; Aoláin, 2011; Lake & Berry, 2017). Casting them as victims, they lack independent agency (Lake & Berry, 2017). Lately, however, more literature has been published about women as perpetrators and the role of women in peacebuilding, in the case of the latter highlighting the possibilities and opportunities that can unfold for women in post-conflict politics (Lake & Berry, 2017). This study follows this relatively new trend by looking at agency.
Aoláin (2011) states that often an analysis of the role of social relations and gender relations prior to the crisis are not included in studies on (human security in) crises. These, however are essential in understanding the vulnerabilities and capacities of people in crises and should be taken into account (Aoláin, 2011, p.5). The first structure entails the social, societal and political construct that determines women’s (and also men’s) everyday lives. As such it provides insights in the impact a specific crisis has on their lives (Byrne & Baden, 1995). Or, as Aoláin (2011, p.6) argues: “contextualizing the ordinary experiences that shape women’s lives form the bedrock upon which a specific crisis is then foisted”. Following this line of reasoning, feminist theory will be used in this research as it provides insights in gender equality, constructed womanhood and motherhood and the constitution of gender. Feminist theory comprises an intrinsically interdisciplinary field and has therefore often refrained from conceptualization: there are no real, defined boundaries (Disch & Hawskesworth, 2016). It takes many different forms, ranging from equality feminism to post-modern feminism. However, it also shares several defining features. For example, the “convictions that the widely held presumptions about the naturalness of sexed embodiment, gender identity, and heterosexuality are mistaken, and that sex, gender, and normative sexuality vary cross-culturally and from one historical era to another” (Disch & Hawskesworth, 2016, p.2). Contemporary feminist literature, part of the ‘second wave feminism’, focusses specifically on ‘women’s liberation’, with two dominant perspectives: constructivist feminism and essentialist feminism (Tolan, 2006). It is chosen to use the constructivist perspective in this thesis, for two reasons. First,
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because if follows Aoláin (2011) in the constructed societal norms that form woman’s daily lives. Second, because essentialism groups women together, thereby ignoring the way gender is constructed and the way woman- and motherhood varies across cultures. This will be illustrated in the next sections.
3.2.1 Constructed womanhood
Constructivism is a sociological theory that refers to the idea that behaviour and knowledge is constructed through experiences and interaction with others in the social world. Berger & Luckman (1966) argue that this (social) knowledge consists of constructs, constructed realities and is part of the socialization process that helps humans in determining what is real, important, valuable and necessary. These norms are then internalized, taken in as being one’s own (Berger & Luckman, 1966).
Feminists have often referred to constructivism as the explanation of the position of women in society. These societal norms have shaped the traditional role for women, which have been internalized by women (to some extent). Consequently, they are now deeply embedded in society. Simone de Beauvoir (1949, p.293), who inspired the second wave feminism, summed up in one sentence what forms the constructivist feminists’ argument: “one is not born, but rather becomes, a woman”. According to constructivist feminists, gender is socially constructed through culture, religion, social class, (global) politics and language (Tolan, 2006).2 It is not pre-political: it is not nature, biology and/or psychology that
decides one’s gender and determines the roles men and women have in society. Rather, as de Beauvoir (1949, p.653) states: “the types of behaviour – argumentative, cautious, petty, but also patient, passive and obedient – are not dictated to women by her hormones or predestined in her brain’s compartments: they are suggested in negative form by her situation”. The way a woman is raised is shaped and formed by societal influences; these deeply rooted constructs are ideas about gender and the related position of women in society which are created through (global) politics, society and its discourses (de Beauvoir, 1949, p.654).
Essentialists disagree with the constructivist feminists on the difference in nature of men and women. They argue that the biological differences between men and women inevitably bring about psychological and emotional differences. For example, according to essentialists, women have an unique, female identity that differs from a male one: they are far more empathetic, co-operative and more connected to others, as compared to more rationalist and authoritarian (Tolan, 2006, p.323). According to essentialists, there is something essentially “woman” to all women: an essence of womanhood (Fulfer, 2008). One of the main critiques on this perspective is what would constitute that “essence of womanhood”, who could make such a normative claim and decide what is should look like for all women. After all, women from different races, different classes and with different sexualities do not all have identical ideas about womanhood (Fulfer, 2008). For that reason, constructivist feminism is used in this thesis, as it explains how womanhood is defined by and through societal norms and values instead of coming ‘from women within’.
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Such a theory allows to look at the context in which women fulfil their role, and that is relevant for the current research question.
3.2.2 Constructed motherhood
Undeniably there are biological differences between men and women; after all the female body has the reproductive ability which constitutes the main bodily sexual difference between men and women. Constructivist feminists do not deny that. They neither deny that part of the maternal instinct is biological (Tolan, 2006). They do, however, disagree with the idea that because of it, the natural role as caretaker of children belongs to women (Tolan, 2006, p.323). For constructivist feminists, it is not possible to look at women, mothers, families and family structures out of the context in which they exist, namely society and the political sphere.
For essentialists, however, some level of biological determinism is part of the perspective. Women, because they biologically are the ones that give birth, consequently have a maternal instinct designed for the caretaker role that is not socially constructed but rather connected to the natural, biological difference between men and women (Tolan, 2006). Hence, especially regarding motherhood there are differences between the perspectives of constructivist feminists and essentialist feminists.
Constructivist feminist theories on motherhood counter the argument that women have the natural instinct to altruistic, nurture behaviour as caretakers. Rather, such constructs are seen as coming from the patriarchal society that shape practices, giving women these roles as caretakers. These constructs have become part of the culture, the social framework which women inhabit.
Most cultures, according to Johnson and Ferguson (1990) have specific rules that define the motherhood role, thereby institutionalizing it (in Walls, 2007). These institutional definitions about motherhood then are internalized and personalized by women, who thus take in these rules and make them their own. This ensures a multitude of specific role descriptions (Walls, 2007, p.5). Consequently, each society has norms about “which women are entitled to bear children and how many they may bear”; there is thus a certain level of social control present, making the social organization of human reproduction a political process by its very nature (Browner, 2016).
It is imperative to note that most feminist scholars, regardless of their ideological position, view motherhood as an idealized role (Walls, 2007). Motherhood is referred to mostly with ‘natural love’, ignoring other feelings that are undeniably also attached to it like stress, depression and anger (Walls, 2007, p.5).Constructivist feminists therefore have subdivided women’s ‘nature’ into biological and social motherhood. Associating social motherhood (“the care work done by mothers and the rearing of children”) with the natural motherhood that is biologically determined is an assumption that legitimizes women’s subordination (Neyer & Bernardi, 2011). Only this distinction can “help reveal the social
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perceptions of motherhood that are constructed so as to allow the exploitation of women as bearers and rearers of children” (Neyer & Bernardi, 2011).
Using constructivist feminism, the role of women in Venezuelan society and the expectations concerning motherhood will be analysed, to provide the context that shape Venezuelan women’s lives which then forms the bedrock upon which the crisis is foisted. The second theory, situated agency, states that people (women) make their choices within the context of social constructs.
3.3 Situated Agency
This study aims to highlight the agency of women affected by insecurities resulting from the current crisis in Venezuela. Crises tend to expose gender-based inequalities, “but the causes of the crisis and the ways in which people respond to them are premised on structural inequalities based on capabilities, rights and access to resources that have evolved over decades and even centuries” (Aoláin, 2013, p.21).3 The
structures that are formed by both the societal constructs and the crisis are thus both relevant to take into account when looking at agency.
De Beauvoir (1949) wrote extensively on agency within (constraining) structure. She calls this ‘situated agency’: the situation, or the context in which one grows up and forms oneself determines the freedom possible. Situated agency balances the recognition of autonomy alongside the acknowledgement of how that core expression of our autonomy, our agency, is rooted in real, often restrictive, contexts (de Beauvoir, 1949; Gray, 2016, p.7). With this perspective, de Beauvoir takes a middle path in the agency versus structure debate. A more recent and also important author on this topic is Giddens (1984, p.14; p.18; p.19). His structuration theory similarly argues that agency (“ability to deploy a range of causal powers”) and structure (“rules and resources in society”) are related in such a way that “the rules and resources drawn upon in the production and reproduction of social action are at the same time the means of system reproduction”. Stones (2005) builds further on the structuration theory and designed ‘the quadripartite nature of structuration’. Of these four components, especially his division within the external structures, “independent forces and pressuring conditions that limit the freedom of agents to do otherwise” are interesting for this study (Stones, 2005, p.109). He distinguished ‘independent causal influences’ from ‘irresistible causal forces’. The first influences are external structures which are constituted or changed independently of the agent’s wishes while having the possibility of directly affecting the agent’s life. Examples are structures of politics, health care systems and military escalation (Stones, 2005, p.111). The second refer to external structures where the agent does have the capacity to resist the external influence, but does not feel able to do so (Stones, 2005). Examples of these are societal structures like norms and values that determine someone’s (social) position (Stones, 2005, p.61-66).
3 Needs to be noted that this is not just the case for gender relations, but also “intersectionality of gender, race, class, sexual
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This model of agency as situated within (constraining) external structures can be used to look at the situation in Venezuela. The societal constructs form the context in which these Venezuelan women grow up and form themselves. These influence and shape the decisions they make accordingly. Second, there is another structure build on that first societal structure: the current crisis in Venezuela. This forms an external structure that affects the agent’s life and their subsequent choices, independently of the agent’s wishes.
3.4 Human security: the health impact
The last theoretical concept used in this thesis is human security, which focusses on “the well-being and welfare of people” to “safeguard the vital core of all human lives from critical pervasive threats” (Iqbal, 2006, p.632; Tripp et al., 2013, p.6). These threats range from “economic, food, health or environmental insecurity to personal, community and political insecurity and human rights violations” according to the UNDP (1994) (Tripp et al., 2013, p.6). What is interesting to note here is that most research on human security focusses on (international) war and humanitarian crises following from civil wars (Tripp et al., 2013). The case-study in this thesis differs from that as it concerns a humanitarian crisis that does not follow from civil war or violent conflict. Rather it unfolded because of political malfunctioning which eventually was accompanied by violent conflict.
Many (overlapping) definitions exist of human security (Iqbal, 2006). However, it is safe to say that human security focusses on the impact of insecurities on people rather than on the more traditional ideas of state security (Tripp et al., 2013). According to former Secretary-General of the UN, Kofi Annan, “human security, in its broadest sense, embraces far more than the absence of violent conflict. It encompasses human rights, good governance, access to education and health care and ensuring that each individual has opportunities and choices to fulfil his or her potential” (Iqbal, 2006, p.632). Interesting here is also the notion that human security goes beyond violent conflict and (civil) war. The current case-study of Venezuela can thus be investigated from a human security framework.
There is a wide variety of aspects of human security, such as economic, social, food and environmental- insecurities (Tripp et al., 2013). Health is also one of these aspects (Iqbal, 2006; Tripp et al., 2013). Iqbal (2006) studied the effect of conflict on public health to deepen the understanding of human security. After all, the public health of the population is “integral to the well-being of communities and individuals” (Iqbal, 2006, p.633). Roses Periago (2012) similarly did research on the specific relationship between human security and (public) health. She states that threats to safety and security of people in general, specifically mentioning “vulnerable groups like women, children and ethnic groups” can constitute threats to the welfare and well-being of society as a whole (Roses Periago, 2012, p.335). Looking at the health impact can thus explain the broader implications of a crisis. The scope of this thesis does not allow for the inclusion of all aspects of human security. Iqbal (2006) and Roses Periago (2012) will be followed in their practices to choose for a specific focus on health within human security theory.
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In focussing on the health impact, both physical and mental health will be looked at. As the WHO states, “there is no health without mental health” (WHO, 2016). The types of choices the women in Venezuela make as a result of the current crisis (especially regarding motherhood), keeping in mind the constructed societal norms regarding womanhood and motherhood, are situated in two structures. First, the societal constructs. Second, the crisis context that constitutes contemporary Venezuela. The mental health impact of human security theory is the lens through which the impact of the crisis is investigated using constructivism and situated agency theories.
The next section will briefly review existing literature on physical and mental health in crises with a gender perspective. Most of this literature refers to civil wars and violent conflicts that might not form exactly the same context as the crisis in Venezuela (see chapter 2). It does however provide for an existing framework that can be used.
3.4.1 Physical health impact
Humanitarian emergencies, as well as violent conflicts, weaken health systems (Chi et al., 2015). A normal functioning health system includes a well-performing health workforce, equitable access to medical products, vaccines, technologies as well as a well-functioning health information system (Chi et al., 2015, p.5). A deteriorating health care system inevitably affects health care services that are especially relevant for women: reproductive healthcare and maternal healthcare.
3.4.1.1 Reproductive health
The 1979 Convention on the Elimination of All forms of Discrimination against Women (CEDAW) states that adequate reproductive health services are essential for women in exercising their right to decide for themselves on the number of children and the timing of having these children (Alzate, 2007, p.138). Reproductive health, accordingly, addressed the “reproductive processes, functions and system at all stages of life” and is defined by the WHO as “ability to have a responsible, satisfying sex life and the capability to reproduce with the freedom to decide if, when and how often to do so” (WHO(a), 2017). Proper access to reproductive health care is often associated with women’s agency and empowerment; the combination of decision-making power and autonomy (Patrikar et al., 2014). This empowerment flows from both education about family planning and sexually transmitted diseases, HIV and AIDS as access to contraceptives (Alzate, 2007; Patrikar et al., 2014). Family planning is often neglected in crises, however, although it is a human right protected by various declarations (McGinn et al., 2011). Most women in crises do not have adequate access to reproductive health services. Reports show that one in five women of childbearing age is likely to be pregnant in crises (UNFPA, 2017). However, more and more attention is given to reproductive health in humanitarian aid by among others the UNFPA.
Access to contraceptives as part of the reproductive health means two distinct types of contraceptives: traditional contraceptives and permanent contraception, like (female) sterilization. The female sterilization,
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or tubal ligation, referred to in this section is defined as a (minor) operation that cuts or blocks (ties) a woman’s fallopian tubes. It is a procedure that happens regularly in Latin American countries like Colombia, Peru, the Dominican Republic and Puerto Rico (da Costa Leite et al., 2004). There have been reports on forced sterilization in some of these countries, namely Peru and Puerto Rico, but beyond that it is a regular practice. It can be seen as a form of empowerment. Fertility while living in very poor circumstances brings along vulnerability, and struggles to support the family when a pregnancy does occur (Smith, 2013). Taking away this fertility can improve a woman’s (political) mobility. It can contribute “in ‘freeing’ women from a state of social, economic and sexual stasis in which their fertility so often holds them” (Smith, 2013).
With contraceptives often unavailable, not accessible or just because of lack of education about family planning, crises tend to witness an increase in the number of unwanted pregnancies and unsafe abortions (Al Gasseer et al., 2008, p.10). Furthermore, not all women have the power to refuse sexual relations (Rehn & Sirleaf, 2002, p.31). This increases women’s vulnerability in crises and it can alter women’s initial family planning decisions (Smith, 2013). These women have to make reproductive ‘choices’ “under restricted social conditions that they as mere individuals are impotent to change” (Barolet-Forgarty, 2007, p.64).
3.4.1.2 Maternal health
The WHO’s defines maternal health as: “the health of women during pregnancy, childbirth and the postpartum period” (WHO(b), 2017). This postpartum period consists of 42 days. Often associated with maternal health is maternal mortality, “the death of a woman while pregnant or within 42 days of the termination of the pregnancy” that did not take place because of an accidental or incidental cause, and maternal morbidity, which is “a condition outside of normal pregnancy, labour and child birth that negatively affects a woman’s health during those times” (Orshan, 2008, p.15).
Maternal health care is often affected in conflict by displacement, limited resources, unavailability or inaccessibility of reproductive healthcare (see section 3.4.1.1) and because of destruction of health care facilities (Adam, 2015). Pregnancies can be extremely dangerous and life-threatening in crises because of lack of simple delivery and health services, raising the number of maternal and infant mortality (Rehn & Sirleaf, 2002, p.38; Lopez, 1993). It is therefore not surprising that when looking at maternal health, the definition refers to this high-risk period of the pregnancy and 42 days thereafter, especially in crises under deteriorating health care circumstances.
However, the health of the mother of a child goes beyond that rather short period of time as referred to in the definition. There is a lot of research done on maternal health in conflict situations and crises. If the focus on women’s health in crises is limited to only that limited period of time, the physical health impact of mothers of infants older than 42 days old is not included. However, it is widely acknowledged that women as mothers tend to show altruistic behaviour towards their children (for example, in giving food to
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them rather than themselves in times of scarcity) which in turn can have a somatic health effect on these mothers (Worell & Goodheart, 2005, p.203). In crises this is especially the case, as traditional gender roles are often exacerbated (Byrne & Baden, 1995). It thus seems relevant to look beyond mortality, morbidity and beyond the limited timeframe when looking at maternal health in looking at the physical health of mothers.
3.4.2 Mental health impact: women
When talking about human security and women’s well-being through a health lens, mental health is also an important aspect. As the WHO states, mental health is “more than just the absence of mental disorder”, rather it is “an integral part of health” which is determined by “socioeconomic, biological and environmental factors” (WHO, 2016). According to the WHO, there are thus three big influences on mental health: socioeconomic position, biological status (referring to aspects like gender and physical health) and environmental factors (referring to the context one lives in).
Survey-based research reports from agencies show that exposure to conflict can lead to (high levels of) traumatic symptoms, stress, anxiety, aggressive behaviour and depression in humans (Buvinic et al., 2013, p.118). In (complex) humanitarian crises, “due to a combination of effects like poor nutrition, lack of access to care, decreasing support systems and increasing caregiving burdens, women are likely to experience short-term and/or long-term deleterious mental health effects (Al Gasseer et al., 2008, p.10; UNHCR, 2015) Conflicts and crises have an impact on mental health that can follow from different aspects of the conflict; persistent insecurity, poverty, sexual violence, witnessing of traumatic events (Baingana et al., 2015, p.6). Scholarly research has looked at these specific correlations individually.
When including a gender focus, literature on the mental health impact of crises on women often focusses on the effects of sexual-and gender based violence (WHO et al., 2011; Tol et al., 2013). The UNHCR, for example, gave special attention to the vulnerabilities of (young) women regarding sexual violence, forced marriages and gender-and sexual based violence in their mental health and psychosocial well-being report on Syria (UNHCR, 2015, p.14). This makes sense because it addresses real and obvious vulnerabilities of women in such crises. Furthermore, literature on the mental health impact often tend to “first and foremost link the well-being of women to that of children and the family”, thereby surpassing “women’s needs as women as well as mothers” (DelVecchio Good & Ware, 1995, p.156). There might be a discrepancy between those needs, however, hence leaving certain needs of women unmet (DelVecchio Good & Ware, 1995).
The different mental health impacts categories used in human security research will be used in the analysis of the data (see chapter 7), as will be discussed in the methodology section (see chapter 4).
24 3.4.3 Mental health impact on mothers and future mothers
As stated in the introduction, what initially led to the choice of the current research topic was the fact that Venezuelan women are giving up on having (more) children because of the crisis (Ulmer, 2016; Barbarani, 2016). Therefore, the mental health impact regarding motherhood is specifically addressed. Especially from a constructed motherhood point of view, it is interesting to look at the (situated) choices women are making about their reproduction and motherhood in crises: What does this (prolonged) crisis situation mean to them, how does it affect their choices regarding motherhood and how does that in its turn affect their mental health?
3.4.3.1 Mothers
Women tend to “bear the brunt of the burden of caring for those who are ill, the children, the elderly, their husbands, siblings and parents” (Rehn & Sirleaf, 2002, p.42). Women’s resilience under stress and the way they take care of and sustain their families in crises is widely recognized (Murthy & Lakshminarayana, 2006). Related to this care work of mothers are several consequences. Women, as mothers and caretakers, often themselves prioritise care for their children over their own (Save the Children, 2014). This altruistic behaviour is in some cases also expected from mothers, which refers to the previously mentioned constructed ‘social motherhood’ being seen as naturally following from biological motherhood (Byrne & Baden, 1995; Neyer & Bernardi, 2011). The altruistic behaviour of mothers is not limited to crisis situations only. However, in crises situations traditional gender roles are often exacerbated (Byrne & Baden, 1995; Samman et al., 2016). Traditional caretaking roles of women are thus often amplified. Duffy (1991) refers to this altruistic behaviour of mothers as the ‘conflict of nurturance’: “the conflict in women in caring for others at the cost of attending to their own needs” (in Worell & Goodheart, 2005 p.203). Nurturing others on the one hand gives women often feelings of satisfaction. However, there is a personal cost. The satisfaction derived from, as well as the attributed value of the (altruistic) behaviour depend furthermore on the context in which the behaviour takes place (Worell & Goodheart, 2005, p.203). There are (long-term) effects connected to this behaviour: depleted resources of the giver, and the creation of self-loss (Worell & Goodheart, 2005, p.203). It is widely accepted that physical health and mental health are linked; a decrease in physical health negatively influences mental health and vice versa (Rhode et al., 2014, p.4). Altruistic behaviour of mothers seems thus important to look at when assessing mental health in crises.
3.4.3.2 Future mothers
It is striking how little has been written about women with a desire for children in crisis situations but postpone it because of the crisis and the (mental) health impact this has on them. There is only a limited
body of research that examines the mental health of childless women during their reproductive years (Graham et al., 2015). These studies moreover do not conduct research in the context of crises, they look from a rather Western perspective at women who intentionally and deliberately take the decision not to
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have children. Findings are contradictory. Graham et al. (2015), for example, found that “childless women experience poorer physical and mental health and well-being during the peak reproductive years”. Umberson et al. (2010) on the other hand suggest that “childlessness has few costs for psychological well-being and may even be associated with enhanced well-well-being, at least for certain groups”, acknowledging that the (social) context in which decisions about children are made “shape the meaning, experience and consequences of childlessness in ways that may undermine well-being for some select groups”.
Furthermore, research is done on the inability of women to achieve a valued identity despite their efforts. This includes, according to Turner et al., (1995), the “inability to have the desired number of children” (in Quesnel-Vallée & Maximova, 2009). This can cause psychological distress (McQuillan et al., 2003). Furthermore, it is suggested that a continued inability to achieve motherhood “undermines a valued identity” (Quesnel-Vallée & Maximova, 2009; McQuillan et al., 2003). These scholars research infertility rather than external conditions that ‘force’ or ‘push’ women to make decisions about their reproduction. It can be argued that the resulting situation of the two groups of women sufficiently overlap. The circumstances prevent these women from making their desired choice and prevent them from achieving a valued identity.
There are several reasons why this gap in the literature (i.e. not including the childless group of women in their reproductive years) needs to be filled. First, because there is increasing attention to reproductive health in conflict regions and as part of humanitarian aid programs (United Nations Foundation, 2013). If this will eventually lead to increased availability of (traditional) contraceptives, the group of women referred to in this section might grow substantively. Women in crises situations who are able to access and afford birth control are thus empowered in that they can make (situated) decisions about whether or not to become a mother. Such a situated choice to refrain from getting (another) child can however potentially affect their mental health. Second, women are recognized as having an important role to play in post-conflict situations (Klot, 2007).4 This will apply to post-crisis Venezuela, too. In the light of (inclusive)
governance, it seems important to include and address the needs of this group of women as well. Their mental health can be negatively affected because they were unable to achieve a (constructed) valued identity, i.e. motherhood.
3.5 Summary
This thesis uses three different theories as theoretical framework. The first is constructivist feminism, i.e. the way in which womanhood and motherhood are constructed in society. Second, theory on situated agency provides insights in the choices women make in two contexts; the first one, which is the constructed society context prior to the crisis, and the second one, which is formed by the crisis situation itself. Lastly, theory on human security, specifically the health aspect of crises, will be used as the lens to look at and understand the impact of the crisis in Venezuela on women and their (future) motherhood.
4 It is acknowledged that the term ‘post-conflict’ or ‘post-crisis’ is somewhat problematic. However, for the purpose of this
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Dividing health in physical and mental health, first an overview was given of literature on physical health especially relevant for women: reproductive health and maternal health. It is argued that the latter needs to be looked at beyond the limited definition given by the WHO to include mother’s health beyond the first six weeks of a child’s life. As this thesis specifically addresses health regarding motherhood in crises, a brief overview of literature on mental health has been given for specifically three groups of women: women in general, women as mothers and women as future mothers. So far, the last group, future mothers, has not been included in the literature. Arguments were presented why inclusion of this group is important.
The theoretical framework has now been established. The next chapter will explain the methodology used to show how the data for this thesis was collected and analysed in order to be able to answer the research question.
27 4. Methodology
This chapter presents the design of the research methods conducted in this thesis. Firstly the general research design will be explained, followed by the fit of this research approach. Thirdly the samples used in this thesis will be discussed. Fourthly, the interview setting and the language used in the interviews will be elaborated on briefly. Finally, the operationalization will be explained.
4.1 General research design
As Yin (2009, p.19) states: “in the most elementary sense, the [research] design is the logical sequence that connects the empirical data to the study’s initial research questions and, ultimately, to its conclusions”. To ascertain the health impact of the crisis in Venezuela on women, qualitative research approach is taken. This consists of two parts. First, semi-structured interviews to generate data to grasp the Venezuelan culture and constructed society. Also, in these interviews information was gathered regarding reproductive health in Venezuela during the crisis. Second, narrative interviews have been conducted to generate date regarding the health impact of the crisis in Venezuela.
In addition to these interviews, general sources of information were used, mainly news articles. This varied from articles from the Washington Post, Independent, Thomson Reuters, Aljazeera, the Economist and Caracas Chronicles (the only English newspaper in Venezuela).5 The first news sources listed are reliable
sources that provided information about the current situation in Venezuela. From Reuters also the correspondent in Venezuela has been interviewed, A.U, as she was the first to report on the (female) sterilization increase in Venezuela. She works together with local partners in Venezuela as well as other Reuters and international/free-lance reporters. One of these free-lance reporters, S.B. was also interviewed about the same topic. Lastly, statistics released by the Venezuelan government in May 2017 (after two years without publishing health statistics) have been used.6
4.2 Fit of research approach
In this section it will be argued why the choice for semi-structured and narrative interviews fit the research approach.
The current crisis in Venezuela is so severe that it was not safe to go to Venezuela for actual field work. Unless one has the resources and contacts for proper safety measures, one cannot consider fieldwork there. Such was not possible during this thesis. Consequently, this research was done from the Netherlands using Skype and telephone interviews. However, from a constructivist feminism point of view, it is important to have a good understanding of the culture, the context. To compensate for the fact that no fieldwork was done in Venezuela itself, semi-structured interviews have been conducted with
5 This list is not exhaustive. For an exhaustive list of the news articles used, please see the list of references.
6 It seems relevant to mention that the Venezuelan health minister, Antonieta Caporale, was fired after the publication of the data
