A Sinner or a Saint?
- A study of Reproductive Health in a Catholic context
A Minor Field Study in Honduras
Sara Holsbrink and Maria Bergerlind 2004-09-12
Public health 41-60 p. C-level essay 10p.
Malmö University, School of Health and Society Supervisor: Per-Anders Tengland
A Sinner or a Saint?
-A Study of Reproductive Health in a Catholic context A Minor Field Study in Honduras
Maria Bergerlind och Sara Holsbrink Handledare: Per-Anders Tengland
Folkhälsovetenskap 41-60p, C-uppsats 10p. Hälsa och Samhälle, Malmö Högskola
Det övergripande syftet med denna C-uppsats är att få en generell förståelse för hur religion kan influera på folkhälsofrågor. Vi spenderade två och en halv månad i Honduras med syftet att få en förståelse för hur religion kan påverka folkhälsofrågor och folkhälsoarbete. I det specifika fallet Honduras är syftet att diskutera hur katolska kyrkan influerar på den
reproduktiva hälsan i Honduras. Studien är kvalitativ till sin karaktär och resultatet baseras på information från personliga intervjuer. För att ta reda på hur katolska kyrkan influerar den reproduktiva hälsan i landet intervjuade vi personal som arbetar på de största aktörerna involverade i arbetet med reproduktiv hälsa. Vi intervjuade även två katolska organisationer. Det finns en konflikt mellan katolska kyrkan och de icke-katolska organisationerna som arbetar med reproduktiv hälsa. En majoritet av de icke-katolska organisationerna ser katolska kyrkan, i synnerhet de två katolska organisationerna Pro Vida och Opus Dei, som ett hinder i arbetet med att förbättra den reproduktiva hälsan hos befolkningen.
Sett från ett maktperspektiv blir slutsatsen att det existerar en synlig konflikt mellan katolska kyrkans intressen och den honduranska befolkningens intressen och att katolska kyrkan utövar makt över den honduranska befolkningen i den bemärkelsen att de inkräktar på deras reproduktiva rättigheter. Hur katolska kyrkan influerar på den reproduktiva hälsan behöver dock mer omfattande undersökas.
Nyckelord: Folkhälsa, Religion, Reproduktiv hälsa, Katolska kyrkan, Honduras, Makt, Intressen, Reproduktiva Rättigheter
-A study of Reproductive Health in a Catholic context A Minor Field Study in Honduras
Maria Bergerlind y Sara Holsbrink Supervisor: Per-Anders Tengland
Salud Pública: 41-60p, Composición de nivel C 10p Instituto de Salud y Sociedad, Universidad de Malmö
El objetivo de esta composición es principalmente comprender cómo la religion influye en la salud pública. Estuvimos en Honduras dos meses y medio para comprender cómo la religion influye en cuestiones de salud pública y en el trabajo de la salud pública. En el caso
específico de Honduras el objetivo es discutir cómo la Iglesia Católica influye en la salud reproductiva en Honduras. Es un estudio cualitativo y los resultados están basados en información obtenida de entrevistas personales. Para averiguar cómo la Iglesia Católica influye en la salud reproductiva del país nos entrevistamos personalmente con los actores principales que participan en el trabajo de salud reproductiva. También nos entrevistamos con dos organizaciones católicas.
Existe un conflicto entre la Iglesia Católica y las organizaciones no católicas que trabajan en salud reproductiva. Casi todas las organizaciones no católicas miran a la Iglesia Católica, entre ellas especialmente a las organizaciones Pro Vida y Opus Dei, como un obstáculo en el trabajo de mejorar la salud reproductiva de la población.
Nuestras conclusiónes son, desde una perspectiva de poder, que hay un conflicto visible entre las intereses de la Iglesia Católica y las intereses de la población en Honduras y que la Iglesia Católica ejerce poder sobre la población al entrometerse en sus derechos
reproductivos. El cómo la Iglesia Católica influye en la salud pública se requeriría una investigación más exhaustiva.
Palabras más utilizadas: Salud Pública, Religion, Salud Reproductiva, la Iglesia Católica, Honduras, Poder, Intereses, Derechos reproductivos
A Sinner or a Saint?
-A Study of Reproductive Health in a Catholic context A Minor Field Study in Honduras
Maria Bergerlind and Sara Holsbrink Supervisor: Per-Anders Tengland
Public Health: 41-60p, C-level Essay 10p. School of Health and Society, Malmö University
The overall objective of this essay is to provide a general understanding of how religion can influence on public health issues. We spent two and a half month in Honduras with the goal to achieve an understanding of the influence of religion on public health issues and public health work. In the particular case of Honduras the purpose is to discuss how the Catholic Church influences reproductive health in Honduras. It is a qualitative study and the result is based on information gathered in one-on-one interviews. As a way to find out how the Catholic Church influences reproductive health in the country we interviewed the staff of the main actors involved in the work with reproductive health, as well as two Catholic organizations. There is a conflict between the Catholic Church and the Non-Catholic organizations working with reproductive health. Almost all of the Non-Catholic organizations view the Catholic Church, with focus on the two Catholic organizations, Pro Vida and Opus Dei, as an obstacle in the work with improving the reproductive health in the population.
From a power theory perspective we reach the conclusion that there is a visible conflict between the interests of the Catholic Church and the interests of the Honduran population and that the Catholic Church exercises power over the population by intruding on their
reproductive rights. However, how the Catholic Church influences reproductive health matters needs to be further investigated.
Keywords: Public Health, Religion, Reproductive Health, Catholic Church, Honduras, Power, Interests, Reproductive Rights
2. List of abbreviations……….. 2 3. Introduction……… 3 4. Objectives……… 4
4.1 Research questions 4
4.2 Limitations 4
5. Disposition of the essay……….. 5 6. Definitions………... 5 7. Background………. 6
7.1 The Honduran society 6
7.2 Reproductive health in Honduras 8
7.3 The Roman Catholic Church 10
7.3.1 The emergency pill 11
7.4 International commitments and the Catholic Church 12
7.5 The organizations 13
8. Methods………... 16
8.1 Documents 17
8.2 Selecting organizations 18
8.3 The interviews 18
8.4 Analyzing the interviews 19
8.5 Ethics 20
8.6 Discussion about our methods 20
9. Theory………..……... 22
9.1 Understanding power 22
9.2 Theorizing power 23
10. Results………... 26
10.1 The Catholic Church as a political actor 26
10.2 Who represents the Catholic Church? 27
10.3 The course of action of Pro Vida and Caritas 28
10.4 HIV/AIDS 29
10.5 Cooperation 31
10.9 Disagreements and conflicts 34 10.9.1 International conflicts 36 10.9.2 Sexual education 37 10.10 Political influence 37 11. Discussion………. 39 11.1 A political actor 39
11.2 The representatives of the Catholic Church 39
11.3 Visible and non-visible conflict 40
11.4 Quality of life and reproductive health 41
11.5 Power and responsibility 43
11.6 Conclusions for the future 43
12. References………. 45 Appendix
1. Acknowledgements
This study could not have been done without the help of others. We would like to thank Janet Vähämäki at Sida in Honduras for sending us an invitation to Honduras and for all the help we got from her when we arrived. She was an important link to get in touch with persons that could be of use in our study. We would also like to thank our supervisor in the field, dr.Carlos Samayoa at Pan American Health Organization, he made us feel most welcome to Honduras and helped us a lot with practical issues and contacts.
Even though our study changed course we would like to thank the staff at Sida, Education Division, in Sweden for all the help with getting the documents we needed when writing our project description. There have been many other people involved in the whole process of this Minor Field Study and we thank all of you for your kindness and hospitality. A special thank you to our wonderful family in Honduras who offered us a room in their house for two months, and also to Jens Malmström that helped us with some theoretical guiding in our essay1.
2. List of abbreviations
PAHO - Pan American Health Organization
UNAIDS - United Nations Programme in HIV/AIDS UNFPA - United Nations Population Fund
UNICEF - United Nations Children Fund
UNIFEM - United Nations Development Fund for Women
USAID - The United States Agency for International Development ASHONPLAFA - Asociación Hondureña de planificación de Familia SoH - Secretary of Health
MoH - Ministry of Health
IPPF- International Planned Parenthood Federation CDC – Centre for Disease Control
MSH – Management Sciences for Health
Sida – Swedish International Development Agency
ICPD – International Conference on Population and Development FWCW – The United Nations Fourth World Conference on Women NGO – Non Governmental Organization
3. Introduction
This paper is more than a C-level essay, it is a journey, not only crossing the Atlantic but also crossing culture and values.
Millions of people all over the world are religious believers, this has united people but also been the cause of major conflicts. In many countries religious values are an important component in the political culture and religion therefore cannot be neglected.
A scholarship from Sida gave us the opportunity to go to Honduras. It is a small catholic country situated in the middle of Central America. The country has about 6.7 million inhabitants and the capital is Tegucigalpa. The majority of the population lives in poverty, which strongly influences the health of the population. Honduras struggles with high rates of maternal mortality, infant mortality, teenage pregnancies and HIV/Aids.
We spent two and a half month in Honduras and during that time we tried to put our own values and perspectives aside, as much as possible, in order to gain an understanding of how public health issues and measures work in a religious society. Being a part of the Honduran society helped us with this. It was not only in the obvious situations of an interview or a visit to someone’s office that we received information, but also in taxis, supermarkets or on busses on the major roads. The Catholic beliefs among the population were obvious; cars and houses were often labelled with words like; God is my protector, I
love Jesus and God is my guide. How these Catholic beliefs influence public health issues is
a more subtle matter.
In this essay we try to gain an understanding of the involvement of religion in a public health context. We believe it is necessary to highlight that religion and certain public health issues do not always match.
4. Objectives
The overall objective of this essay is to provide a general understanding of how religion can influence public health issues. In the particular case of Honduras the purpose is to discuss how the Catholic Church influences reproductive health in Honduras. The essay aims (1) to investigate how organizations working with reproductive health in Honduras view the influence of the Catholic Church regarding reproductive health and (2) to investigate how the Catholic organizations view their own influence on, and work with reproductive health.
4.1 Research questions
The main research question is:
1. How does the Catholic Church influence reproductive health in Honduras?
The following research questions will enable us to answer the main research question:
2. How does the staff at organizations working with reproductive health in Honduras view the influence of the Catholic Church regarding reproductive health?
3. How do Catholic organizations view their own influence on and work with reproductive health?
4.2 Limitations
We are aware of the fact that gender inequities regarding reproductive health issues exist and that reproductive health in many ways is a gender issue. In this essay we will however focus on power relations in general. This does not mean that we consider gender an
unimportant task. Furthermore we discuss reproductive health and reproductive rights in the paper. This involves many aspects but since space is limited we choose to focus on issues related to the use of contraceptives and sexual education and information.
5. Disposition of the essay
In the Background-chapter we begin with providing the reader with information regarding the Honduran society and describe the reproductive health in Honduras. Further the Catholic Church is described and a section about the International Conference on
Population and Development and United Nations Fourth World Conference on Women and the involvement of the Catholic Church in these conferences is included. The Background-chapter ends with a short presentation of the organizations we studied. The Method-Background-chapter describes our method and how we operated in the field, it also includes a discussion about the problems and ethical issues we faced. The chapter is followed by a Theory-chapter, which begins with a section about understanding power and ends with a presentation of the power theory we choose to apply. Next a short presentation of the Definitions most
commonly used in the paper are presented. The Result-chapter aims to answer our two research questions that are based on the empirical data collected in Honduras and in the Discussion-chapter we discuss our results after applying the power theory presented, and try to answer our main question. Finally, this will lead us to our conclusions.
6. Definitions
This section provides the most important definitions of the main concepts used in this essay. We use the definitions of reproductive health and reproductive rights established during the ICPD in Cairo 1994. Since the definition of sexual health is embraced in the wider definition of reproductive health we use the term reproductive health as to refer to both of the terms. The definitions of reproductive health and rights are chosen not because they are perfect but because they are the most commonly used definitions in an
international context.
Reproductive health
“Reproductive health is a state of complete physical, mental and social well- being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this last condition are the right of men and women to be informed and to have access to safe, effective,
affordable and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility which are not against the law, and the right of access to appropriate health-care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant. In line with the above definition of reproductive health, reproductive health care is defined as the constellation of methods, techniques and services that contribute to reproductive health and well-being through preventing and solving reproductive health problems. It also includes sexual health, the purpose of which is the enhancement of life and personal relations, and not merely counselling and care related to reproduction and sexually transmitted diseases” (web document 1).
Reproductive rights
“Reproductive rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. They also include the right of all to make decisions concerning reproduction free of discrimination, coercion and violence” (web document 2).
Power
A exercises power over B when A affects B in a manner contrary to B’s interest (Lukes 1974:34).
7. Background
This chapter gives a picture of the Honduran society and the reproductive health situation in the country. A description of how the Catholic Church functions and operates in the
country is followed by a section about the international involvement of the Catholic Church. The chapter ends with a presentation of the organizations.
7.1 The Honduran society
The Republic of Honduras is situated in Central America between Guatemala, El Salvador and Nicaragua. Honduras has approximately 6 732 000 inhabitants and the majority of the population is under the age of 40. Life expectancy at birth is 65.8 years in the total
population. Almost two-thirds of the households live in poverty and 24.3 percent of the population live on less than 1.08 US Dollar per day2 (web document 3).
Honduras became independent from Spain in 1821 but it was not until 1982, after two and a half decades of military rule, that the first elected civilian government came to power. Before that the country alternated between military and civilian rule. Today Honduras is a democratic constitutional republic with a unicameral congress elected by separate ballots. In November 2001 Ricardo Maduro, representing the National Party of Honduras, was elected president for a four years term with 52.2 percent of the votes. Maduro took office in January 2002 and is still president and The National Party of Honduras now has 61 seats in parliament and the liberals 55 (web document 4).
In 1998 Honduras was badly affected by Hurricane Mitch and approximately 5 600 people died and 1.5 million were displaced. This made the already poor country even poorer, the total economical cost was estimated to 3.8 billion US Dollars. The infrastructure was severly affected; almost one third of the highway network was destroyed, leaving people isolated in their homes in the rural areas without food and water. Honduras received aid from many countries and organizations after the hurricane but has not yet fully
recovered (web document 5).
An independent judiciary is provided by the constitution but it is under-staffed and ineffective, often due to corruption and political influence. Corruption is a systematic national problem, the elites in the Honduran society are bound together by bussiness interests, political loyalties and family-ties and are rarely arrested or jailed. The political, military and social elite enjoy impunity under the legal system eventhough the Constitution bans discrimination on the basis of race, sex or class. Two out of four national newspapers are under the rule of politicians; one is a former Liberal Party President and the other a congressman. The newsmedia faces obstacles such as internal corruption, politicization and outside influence (web document 6).
The Roman Catholic Church has been a powerful institution in Honduras since colonial times but the number of Protestants has grown in the past years. The state is separated from
2
The international poverty line is prepared by the World Bank, based on its most recent consumption purchasing power parity (PPP) estimates in 1993 prices. The poverty line is set to 1.08 US dollar a day.
the church but the government subsidizes Catholic schools, and religious education is part of the public school curriculum (web document 7).
7.2 Reproductive health in Honduras
The general reproductive health status in Honduras is low, as in many other Latin American countries. Honduras struggles with major reproductive health problems such as high rates of maternal mortality (108 of 100 000 live births). This could be due to several reasons such as lack of access to healthcare, that the women bear too many children too close together, that they are malnourished and that they are too young or too old (web document 8). Also the number of teenage pregnancies and the rate of HIV/AIDS have increased (ENESF/ENSM-2001:2ff, 6).
Domestic violence and sexual violence has become important public health issues in recent years. In 1997 a law for violence against women was established with the intent to protect and strengthen the rights of women. Yet the law does not impose any fines and the offender does not end up in jail, instead the penalties are community service or 24 hour preventive detention (web document 9). Several projects concerning men are starting up as a way to reduce machismo and violence and to get the men more involved in family planning (web document 10).
The average number of children per woman in Honduras is 4, 4. Of all the children born between 1998 and 2001 the number of not planned and not wished pregnancies was 25, 5 percent. So, one out of four children born in Honduras is not wanted. The unwanted children are born from separated or divorced women, women without education, women aged 40-49 and women who give birth to many children (ENESF/ENSM-2001:2). Since abortion is illegal in Honduras women do not have this option. Yet, the estimated number is that abortion accounts for 8.7 percent of all maternal deaths. This indicates that women in desperation try to terminate unwanted pregnancies (web document 11).
There are not any laws that prohibit the use of contraceptives and both NGOs and the Secretary of Health distribute contraceptives. However, the distribution does not cover all rural areas; more contraceptives are distributed in urban areas than in rural and the
areas. Almost every woman in Honduras is aware of some sort of contraceptive method that can help her regulate her number of children. The most known contraceptives are orals, condoms, and female sterilization, and the least known are Billings3 and vaginal methods. Less than one fifth of all women are familiar with the method Billings, one of the methods promoted by the Catholic Church. About 60 percent of the women between the ages of 15-44 were using some kind of contraceptive when the survey was done and the use of contraceptives has amounted since 1996. Of these 60 percent using contraceptives the majority, 90 percent, are using artificial methods. The most commonly used contraceptive is female sterilization. The majority of women using contraceptives are married or engaged in some sort of relationship. The reasons why some women do not use contraceptives are that they are already pregnant, are not able to have children, have certain socio-cultural believes or are not sexually active (ENESF/ENSM-2001:3f, 12, 77).
The majority of the population in Honduras knows about HIV/AIDS but there are still individuals who do not know how this disease transmits, who do not know the symptoms and the fact that it is lethal. There is a lack of knowledge concerning the relation between HIV and AIDS and 9, 6 percent of the women and 7, 9 percent of the men were not aware of any ways of protecting themselves from HIV/AIDS. The people living in urban areas know more about HIV/AIDS and a higher level of education goes hand in hand with a greater knowledge about HIV/AIDS (ENESF/ENSM-2001:6ff).
A majority of the population (95, 2 percent of the women and 97, 0 percent of the men) would like the Secretary of Health to provide the general population with sexual
information. In schools in Honduras today there is not much sexual education provided. According to this survey 85.4 percent of the women and 81.8 percent of the male
population do though, wish that their children had sexual education in school. There are no differences in attitude between Catholics and Non-Catholics in these matters
(ENESF/ENSM-2001:374).
The result in ENESF/ENSM-2001 emphasizes that the status and knowledge of one’s reproductive health is strongly connected to ones socioeconomic situation. Poverty leads to a worse reproductive health.
7.3 The Roman Catholic Church4
The Catholic Church is still the largest individual Christian organization in the world and Catholics make up 17 percent of world population, nearly one billion people and has representatives in almost all countries in the world (web document 12).
The Catholic Church follows the word of the Catechism. There are several articles concerning marriage, fidelity, fertility and human love in it. The marriage bond is
something established by God and this bond can never be dissolved since it is seen as a free human act from the spouses and is guaranteed by God’s fidelity. The marriage is an
institution confirmed by the divine law. Children are seen as the supreme gift of marriage. According to Catholic beliefs God said: "It is not good that man should be alone," and "from the beginning [he] made them male and female"; wishing to associate them in a special way in his own creative work, God blessed man and woman with the words: "Be fruitful and multiply” (www.vatican.va/archive/ccc_css/archive/catechism/p2s2c3a7.htm#1638). Children are a gift that only can be given to a married couple and divorces within the Catholic Church are very unusual. Fidelity is one of the most important Catholic value (web document 13). The only method of birth regulation approved by the Catholic Church is periodic continence which is based on self-observation and the use of infertile periods and suits the objective criteria of morality. These methods respect the bodies of the spouses and encourage tenderness between them. Every action which makes procreation impossible is evil. Donation of sperm or ovum, suggerate uterus is gravely immoral because it is taking the child’s rights to be born of a father and mother known to him and bounded to each other by marriage. So, the sexual act is something that only can take part within a marriage that consists of conjugal love. The Catholic Church strongly rejects to any kind of abortion rights (web document 14).
Even though the Vatican and the word of the Catechism have a great influence on
Catholics, there are diverse opinions regarding reproductive health issues among Catholics. According to the Vatican, periodic abstinence is the only recommended method of birth control but studies show that a majority of Catholics support international family planning
4
The Roman Catholic Church is in general referred to as only the Catholic Church, and therefore, the term Catholic Church is used in this essay.
assistance (web document 15). Catholics for Free Choice is a catholic non-profit organization engaged in issues regarding gender equality and reproductive health. They work for the free choice of all women to decide over their own bodies and they approve of abortion and the use of artificial contraception. It is therefore important to know that the Catholic Church is not a homogeneous group but a group of diversity in attitudes and practices (web document 16).
The Pope is the head of state in the Vatican (the Holy See) and also the bishop of Rome. The Vatican is the leading centre of the Catholic Church. The Holy See has a special status at The United Nations as the only “Non-Member State Maintaining Permanent Observer Missions at UN Headquarters”. Since the United Nations makes most of its decisions by consensus the Vatican can derail negotiations on issues concerning reproductive health. No other church has the same status as the Catholic Church in the United Nations, instead they are represented by NGO:s. The Holy See was given this status in 1964 (web document 17).
7.3.1 The emergency-pill
An example of the influence of the Catholic Church in Honduras is the debate concerning contraceptives, especially the emergency pill where the Catholic Church has had an opinion. Several articles concerning the emergency pill, or the morning after pill as it is often referred to, have occurred in the media. The emergency pill has been distributed in Honduras since the year 2000. This has caused major debate in the media since the Catholic Churches together with other churches in the country are strong opponents of the use of this pill. The Churches all claim that the pill is intruding on human life because it is an
abortifacient, an abortion pill. Abortion is illegal in Honduras and has therefore caused further debates about the definition of life. The churches believe that life begins in the moment of conception and to use the emergency pill is according to them to commit murder. The position of the Catholic Church is very definitive and they reject to both Ashonplafa´s and the Health secretary’s distribution of the pill. In an article from 2004-02-11 in El Heraldo5, father Josè de Jesús Mora, press spokesman of the Catholic Church,
threatens the promoters of the emergency pill;
“You can not be a member of the body of Christ, which is the church, if you are an accomplice in the promotion of the abortive methods” (Estrada, Glenda:”Todas las iglesias contra ”la píldora del día siguente”,
El Heraldo 2004-02-11)
These articles are an indicator of how the Catholic Church is raising its voice in issues regarding reproductive health. Feminist groups, on the other hand, are defending the pill claiming that the health authorities should inform the population about it. They believe that the population needs to be further informed about the advantages of the pill so they can be a part of the debate (Cruz, Denia 2004). The conflict between the Catholic Church and the feminists is obvious.
7.4 International commitments and the Catholic Church
The International Conference on Population and Development in Cairo 1994 and later on the United Nations Fourth World Conference on Women in Beijing 1995 have been two international milestones in the agenda of reproductive health. In Cairo a wider definition of reproductive health was undertaken6 which opened doors to a broader perspective including both human rights and gender relations. In Beijing further attention to the women’s
situation in a global context was drawn. A platform for action was agreed upon that contained important commitment concerning reproductive health and rights. Unsafe abortion as a major public health concern was recognized and a call to all governments to deal with the health impact of this issue was made (web document 18).
Nevertheless, during the conference in Beijing conflicts around reproductive health concerns arose. A coalition of Catholic and Muslim countries, including Honduras, led by the Vatican (the Holy See), made reservations on several of the paragraphs in the Platform for action. The reservations concerned the area of reproductive health and rights and especially actions that, according to their beliefs, would lead to or support abortion. This led to total opposition, from the coalition, to the notion of sexual rights and to the broader perspective adopted during the conference. Honduras also objected to actions that could lead to a more democratic relation within families, these actions seemed to be a threat
towards the traditional gender roles and Honduras showed a resistance to radical changes in these roles (Bayes & Tohidi, 2001:140f).
Given the position of the Holy See, the Catholic countries and the Islamic states, reaching a consensus was extremely difficult (Bayes & Tohidi, 2001). According to an article
written in USA Today 1999-05-01 by Frances Kissling the Catholic Church was, maybe for the first time in the 20:th century, seen clearly as a political player in issues of both
international and national political significance7. Kissling states that because of this, it has become obvious that not only Catholics but also Non-Catholics are affected by the views from the Catholics on reproductive health. The public policy position put forward by the Catholic Church for example limits all women to make decisions about their own lives (Bayes & Tohidi, 2001:140f).
In the conference Cairo and Beyond 2004, one of the most highlighted issues was to break the silence and taboos on culture and religion and their relation to reproductive health (web document 19).
7.5 The organizations
In this chapter we introduce the interviewed organizations and their work in Honduras.
Pan American Health Organization (PAHO) is an international public health agency
working to improve health and living standards of the people of the Americas. It is the regional office for the Americas of the World Health Organization and its mission is to strengthen national and local health systems. PAHO has 27 country offices and nine scientific centres. In Honduras the office of PAHO is situated in Tegucigalpa. PAHO Honduras works together with the 38 government members and with the community to provide and protect the health of the countrie’s inhabitants (web document 20).
United Nations Programme on HIV/AIDS (UNAIDS) was launched in 1996 and brings
together nine UN organizations in the work of preventing AIDS globally (web document 21). In Honduras UNAIDS works together with, among others, UNFPA, UNESCO, PAHO, World Bank and World food program to organize a response to the spread of HIV/AIDS. It
attempts to gather the efforts from a wide range of sectors and associations, from the government to the civil society and the communities.
United Nations Population Fund (UNFPA) began operating in 1969 and is the world’s
largest international source of funding for population and reproductive health programmes. (web document 22) The main objective for UNFPA in Honduras is to support the
government in order to improve the quality of life and to decrease the social vulnerability of the population. UNFPA sign a contract with the government for five years at a time and they work with different subprograms, of which one is reproductive health.
United Nations Children Fund (UNICEF) was created by the United Nation in 1946 and
is currently working in 157 countries to protect the rights of children (web document 23). In Honduras UNICEF cooperates mainly with the government, the Ministry of Health, the local government, municipalities and also many NGO’s like Save the children, and
Catholic Religious Service. In Honduras UNICEF has three main programs. In the area of
sexual and reproductive health the work is mostly performed on the community level, with volunteers working with healthcare. The main programs are divided into subprograms where the action takes place. The subprograms focus on a wide spectrum of issues regarding children such as sanitation, self-awareness and sports.
United Nations Development Fund for Women (UNIFEM) was created in 1976 and is
the women’s fund at the United Nations. It promotes women’s human rights, political participation and economic security by financial and technical support to innovative strategies and programmes (web document 24). In Central America the main office is situated in Mexico. In Honduras UNIFEM is a small organization with a few employees. Among other things they are now working on a project that started in June 2003 that is called Seguridad humana en el contexto VIH/SIDA8.
Foro Nacional de SIDA (The national AIDS-forum) was put together by the UNDP
(United Nations Development Programme) in 2001 and is still running as a UNDP-project.
El Foro Nacional de SIDA is defined as a multisectorial participation instance that was created to support and facilitate the resources, programs, projects and activities that the government and the civil society in Honduras has put together to face the HIV/AIDS situation in the country. The purpose of the Forum is to promote coordination, direct or indirect, between all actors involved in the prevention work of HIV/AIDS and especially in the civil society (web document 25).
Asociacíon Hondureña de Planificacíon de Familia (ASHONPLAFA) is the biggest
non-governmental organization in Honduras and it cooperates with all sectors, from the government to the civil society, and the community in general. The services of Ashonplafa are different services in family planning. They have 27 clinics all over the country. The clinic in Tegucigalpa is the main clinic and it is a full-equipped clinic with advisory, laboratory, gynaecologists, pharmacy selling contraceptives etc. The main donor for the work of Ashonplafa is USAID and IPPF (web document 26).
The United States Agency for International Development (USAID) is the official U.S.
Government agency responsible for international cooperation through development programs. USAID/Honduras is part of the US Embassy in Honduras and it is supported by the US government foreign policy of economic assistance to the government and people in Honduras. The supported programs focus on improving the socioeconomic development of Honduras by supporting economic stability, economic growth and an equal distribution of the benefits of this growth (web document 27).
Secretary of health is one of the departments under the Ministry of Health. They are put in
charge of the supervision of the health state and the process of improving the people’s health (web document 28).
Pro Vida is a civil organization founded by a small number of people in Honduras in 1983.
Today the organization is political active with the purpose to watch over the interests of the unborn baby and to, promote and defend the dignity of men and women and the rights of
the family as the fundamental cell of society. They strongly reject abortions in all forms and the use of contraceptives. The organization is promoted as a non-political and non-religious organization even though the president is catholic and a member of Opus Dei (web
document 29).
Opus Dei, founded in Madrid in 1928, is a personal prelature of the Catholic Church with
over 80 000 people from all over the world. The headquarters are in Rome.
“The aim of Opus Dei is to contribute to that evangelizing mission of the Church. Opus Dei encourages Christians of all social classes to live consistently with their faith, in the middle of the ordinary circumstances of their lives, especially through the sanctification of their work”(web document 30). The members are mostly middle- and upper-class (Bayes and Tohidi 2001:149).
Caritas is an international organization founded in the Vatican in Rome. The organization
exists in many countries worldwide and is a confederation of 162 catholic organizations. The purpose is to have an effect on policy makers at the international level and to build a better world for the poor (web document 31). In Honduras there are seven offices and the central office is situated in Tegucigalpa. The organization follows the word of the Vatican, they are against artificial contraceptives, and instead they promote natural family planning methods.
8. Methods
In the same way that travellers need a map for their journey, readers need a design to guide them through the thoughts of the author. In this chapter we describe our methods of how the study was done.
This Minor Field Study is a qualitative study similar to a descriptive instrumental case study. A descriptive instrumental case study focuses on a certain issue or issues and illustrates the issue with a case as an example. A case study involves a wide range of data collection. With detailed in-depth data collection the case, bounded in time and place, is to be studied. The final result will be a detailed description of the case. There is however no
standard format of how this should be performed. In this type of study it is important to situate the case within its settings, in history as well as in society as a whole. We use the particular case of Honduras to provide a general understanding of public health issues in a religious context. The case is reproductive health and Catholicism. It is bounded in place, to Honduras but it cannot be bounded in time. Being present in Honduras provided us with the opportunity to study the phenomenon in its natural setting. We collected data from a wide time spectra and multiple data collection was used. Interviews and study of documents and reports provide the foundation of the result. In order to answer the research questions we used both quantitative and qualitative data (Creswell:1998:61ff).
8.1 Documents
When studying documents one must keep in mind that documents most often are produced for other reasons than research. It is possible that the data contains normative judgements not based upon scientific grounds, and therefore it is important to question the value of the material (Creswell:1989:132, Malterud and Aschehoug:1996:67). To get a broader
knowledge and understanding of our subject we read the daily press, in the two largest newspapers El Heraldo and La Prensa. We also used information handed out by the informants such as reports with statistics and data concerning for example the rate of HIV/AIDS and violence against women. Information about their projects and work and practical information brochures about the organizations, were also given to us during the interviews. At PAHO (Pan American Health Organization) there was a documentation library that we had access to where we found information on most subjects concerning public health. The youth centre library at Ashonplafa (Asociación Hondureña de planificación de Familia) had books and brochures about reproductive health for both Catholics and Non-Catholics. We were informed about a survey performed every fourth year in the country, concerning family planning and reproductive health issues called
ENESF/ENSM-20019, which we studied. Since we did not do any interviews with the
“everyday people” in Honduras this survey served as a representation of the people since it is based on interviews with 12 000 households.
8.2 Selecting organizations
In qualitative studies a purposeful sampling strategy is always important, the data collected should provide the researcher with adequate data in relation to the purpose of the study. A case study can be based on almost all known sampling methods including the snowball selection that will be used here. Snowball selection involves that the researcher identifies people who know people who know information-rich sources. Gatekeepers are valuable in a case study, it is a person or persons that could help the researcher to be introduced to important persons and gain entrance to for example organizations (Creswell:1998:118f). People who work with reproductive health are informants in our study. These people take part in the daily work with reproductive health, meeting and talking to people on all levels of society. As a way to find out how the Catholic Church influences reproductive health in Honduras we therefore decided to interview the staff of the main actors involved in the work with reproductive health.
We used the snowball selection and in most of the interviews new names and numbers came to our knowledge and the snowball selection lead us to the conclusion that it was of great importance to also interview the Catholic organizations mentioned by the informants. Three organizations came up several times during the interviews; Pro Vida, Opus Dei and Caritas.
8.3 The interviews
Practical arrangements of the interview situation are to be taken into consideration. This includes preparations as, choosing the type of interview, recording procedures, deciding where the interview shall take place and designing a protocol that is suitable. The protocol should consist of approximately five questions and be open-ended. In the interview situation the role of the interviewer as a listener rather than a speaker becomes important (Creswell 1998:124f).
Thirteen interviews were conducted, PAHO (three different persons), UNAIDS; UNFPA,
UNICEF, UNIFEM, National Aids Forum, Ashonplafa, USAID; SoH, Pro Vida and Caritas. The interviews all took place in Tegucigalpa where the main actors working with
Some of the interviews were held in Spanish, others in English and sometimes we communicated in both languages. The recording device consisted of a mini-disc with a microphone.
One-on-one semi-structured interviews were held. The question-form contained three main questions that were the same for all organizations and also smaller more detailed questions that were directly turned to the specific organization we interviewed10. We wanted an open dialogue and to accomplish this, the main questions were open and only suggested some themes they could discuss around. The interviews lasted for approximately 30 minutes to one hour. All the interviews have been transcribed and the Spanish
interviews translated into English.
8.4 Analyzing the interviews
Analyzing a case study means making a detailed description of the case and its settings. The analysis consists of four steps: first a categorical aggregation where the researcher seeks issue-relevant meanings from a collection of examples and then a direct
interpretation of the single examples. Establishing patterns is the third step in the analysis
and aims to find connections between the different examples. Finally the researcher develops naturalistic generalizations from the material (Creswell 1998:153f).
Since our material mainly consists of interviews and the results are based on information collected during them, we have used these four steps when analyzing the interviews. The categorical aggregation consisted of selecting parts regarding the Catholic Church. From the direct interpretation of the chosen parts, patterns were constructed. These patterns shaped categories, and in the Result-chapter the categories are presented. In the Discussion- chapter generalizations of the results of the study are discussed.
8.5 Ethics
Protecting the anonymity of the informants is an ethical aspect of a qualitative study. The ethical aspects do however affect the quality of the study. When protecting the informants the result of the study might be perceived as diffuse or incoherent because the information
cannot be derived to a specific source. The more you protect your informants, the harder it becomes to produce a satisfying study. A case of perfect validity would not tolerate any anonymity for the informants, which would imply a violation of ethical principals. Therefore one must weight the integrity of the informants against the quality of the scientific study (Starrin 1994:171).
The researcher should inform the study participants of their involvement and also explain the purpose of the study. She should present the general information about the study but may leave out specific details (Creswell 1998:132f). In this study the persons interviewed are anonymous. Before every interview we informed our informants about the purpose of the interview, however, at that time the objective of the study was not in detail specified.
8.6 Discussion about our methods
This is a Minor Field Study and the field chosen in this essay is reproductive health in Honduras, a Catholic country. The study is similar to a case study but it cannot be defined as one since what we studied was not a true case. It can be bounded in place, to Honduras, but it cannot be bounded in time. We were in Honduras from the 18th of February to the 30th of April but what we studied does not have a beginning nor an end. It seems like there is no adequate definition of this study except for the concept Minor Field Study. We have applied the research design of a case study and used multiple data collection to gather information as well as different methods to analyze this information.
The snowball selection was an effective method in Honduras considering the lack of organized registers of organizations working with reproductive health within the country. On the other hand it is possible that snowball selection may have resulted in that some organizations of potential interest were not included, since we only contacted people others had recommended.
We have not found any reliable government statistics on Church membership and attendance. A register of the official churches of Honduras is not either to be found. The statistic concerning the number of Catholics in the country has been varied but we have relied on the ENESF/ENSM-2001 where the number is 53 percent (ENESF/ENSM-2001:33).
There are no official opinions or statements about the Catholic Church expressed by the organizations interviewed, but the staff working in these organizations do have the experience of working in a Catholic context. The interviews are therefore based on the personal opinions of individuals working with reproductive health in Honduras. These people do however represent an organization, which may involve that their personal opinion has an impact on the organization in different ways but also that the organization might have an impact on the individual in question.
The mini-disc was a very useful tool as it enabled us to focus more on the conversation and less on the documentation during the interview and also because it later helped us to clarify things we may have missed because of language barriers. We are aware though, of the fact that the mini-disc may have prevented the persons interviewed from revealing all information. Even though our informants approved of the mini-disc it is not possible to know what would have been said if we had not used the mini-disc. Since we translated the Spanish interviews to English this could have caused some minor language errors and the quoting cannot be exactly literal.
The people interviewed always welcomed us and made time for us in their schedules, sometimes at very short notice. Some of the organizations we interviewed receive financial aid from Sida and that, we believe, did in some cases have an effect on the interviews. It seemed as it was important for those organizations to give a good impression. Our gatekeepers also played an important role in this.
We interviewed two Catholic organizations, Pro Vida and Caritas, although the aim was three, Pro Vida, Caritas and Opus Dei. These Catholic organizations, mainly Pro Vida and Opus Dei, were mentioned during many of the interviews with the Non-Catholic
organizations and we came to the conclusion that these organizations were the most influent organizations within the Catholic Church. We managed to arrange interviews with Pro Vida and Caritas but not with Opus Dei. When we contacted Opus Dei they
consistently referred us to Pro Vida claiming that Pro Vida and Opus Dei share the same opinions regarding the subject of reproductive health.
In this study the persons interviewed are anonymous and so are the Non-Catholic organizations. They have instead of the name been given a number. The intention was to
use the names of the organizations, but then we weighted the quality of the study against the anonymity of our informants and came to the conclusion not to write the names of the Non-Catholic organizations under the quotes, as this would ensure protection of the informants. This hopefully can guarantee total anonymity. Notice that the numbers of the organizations in the result chapter are randomized and do not follow the presentation- order ranked in the Background- chapter. The Catholic organization’s names have on the other hand been used as names. These interviews took place at the end of the study when the objective was more clarified and therefore we could give a more detailed description of the study. The Catholic organizations gave their consensus being quoted as organizations. Before the interviews we asked for permission to use the mini-disc and we also explained about their anonymity, which they agreed upon. Since the objective of the study was not in detail specified we offered some of the organizations the possibility of later approving of their quotes, used in our paper, via e-mail. UNFPA (United Nations Population Fund) chose to withdraw the quotes that we wanted to use from the interview with them.
9. Theory
This chapter sets out the framework of our theoretical thoughts. A short introduction to why we choose to have a Power theory approach is followed up by a presentation of a theory of Steven Lukes.
9.1 Understanding power
Power can be seen as the centre of decision-making, it is the engine that keeps the political arena going. Since public health is often about politics and the Catholic Church is an actor on the political arena its inevitable not to speak of power in this paper (Hague and Harrop 2001:10f). The Catholic religion exerts power and influence on society; it organizes
people’s lifes and provides a framework with certain values and concepts to a large number of people (Bayes and Tohidi 2001:44).
The word power is often used in everyday language but when it comes to defining it difficulties arise. Various ways of understanding the concept of power have been presented throughout the last century. Power to, a concept often associated with the sociologist
Talcott Parson, could be described as the capacity to achieve collective goals within a community. In contrast, power over refers to the exercise of control over countries and people, the ability of an individual or group to get its way against opposition (Lukes 1974:31). The concept power over is most commonly used and is probably how people in general understand power.
On the arena of politics power is a tool in the competition of what goals that are to be achieved. To put it frankly, power often involves conflict rather than consensus. Max Weber defined power as individuals realising their wills despite the resistance of others. Weber’s definition of power is one of the most acknowledged power theories, however he has been challenged by other more radical theorists who have broadened the definition (Lukes1974:11f). Weber is a predecessor of the concept of power but his definition is yet incomplete. We argue for a more radical view of power, using the theory and definition of Steven Lukes.
9.2 Theorizing power
Steven Lukes defines the concept of power by saying that A exercises power over B when A
affects B in a manner contrary to B’s interests. In this way Lukes broadens the notion of
power by saying that whenever people’s interests are ignored, power is exercised over them11. Lukes thereby establishes that power can be exercised even though people are unaware of the fact that their interests are being ignored and conflict is therefore not necessary in exercising power (Hague & Harrop 2001:11). As Lukes writes:
A may exercise power over B by getting him to do what he does not want to do, but he also exercises power over him by influencing, shaping or determining his very wants. Indeed, is it not the supreme exercise of power to get another or others to have the desires you want them to have-that is to secure their compliance by controlling their thoughts and desires? (Lukes 1974:23)
A, an individual, an institution or a collective can control the public in different ways, through the mass media, through the control of information and through the process of
socialisation. In this way A can prevent a conflict from arising in the first place (Lukes 1974:23).
Lukes emphasises that the word interests is a normative word. Different conceptions of the notion of interests are strongly connected to one’s moral and political positions. According to Lukes people’s wants are a product of a system and the people accept the existing system since they see it as natural and therefore unchangeable, as something divinely ordained and beneficial. The system shapes their wants and beliefs to the extent where there is no choice. To use the radical view of power presented by Lukes is to assume that people think and act not only upon subjective grounds but upon the impact of their surroundings (ibid:34).
When talking about exercising power there is in general always the fact of discussing what B would otherwise do if not affected by A. If there is no observable conflict between actors, other ways of justifying our expectations that B would have acted or thought differently if not affected by A are needed. In short: one must prove that B would have acted differently without the impact of A and one must also show how A affected B. This is complicated to achieve but not impossible (Lukes 1974:41f). To prove this Lukes uses an example from Matthew Crenson’s book The Un-Politics of Air Pollution: A study of
Non-Decisionmaking in the Cities. This book presents how leaders of U.S Steel exercise power
over citizens by not informing them about their company polluting the air. By this the writer means that if the citizens were aware of the air pollution they would not find it in their interests to be poisoned. They would then have acted according to their interests and made a political issue of the air pollution (ibid:45).
The standard objection to Lukes theory is the question of how to study and explain what can not be observed. Lukes answers this criticism by saying that just because it is
troublesome or even impossible to show when power has been exercised we can never conclude that it has not. He believes that it is possible to identify this invisible exercise of power, but that it is difficult (ibid:41f).
Lukes distinguishes three difficulties with his theory; first Lukes discusses the problems to empirically identify a non-event from taking place which could cause some
action had not taken place, the consequence would be absent. In this sense inaction has consequences as well as an action in the form of an absent event. Issues may for example be kept out of politics and A can in this way shape the political agenda. In the example with U.S Steel the author clearly showed how one can empirically identify that a non-.event has taken place. U.S. Steel’s inaction caused the public silence over air pollution. U.S. Steel prevented the question of air pollution from being raised, if the company had not done that, the public would have acted (Lukes 1974:50f).
Second, according to Lukes the exerciser can exercise power unconsciously. There are several scenarios when one could be unaware of what one is doing. First there is the
Freudian case; one could simply be unaware of one’s real motives of an action. Second; one may be unaware of how others interpret one’s action and third, one may be unaware of the consequences of one’s action. It is mainly the third scenario that causes trouble, if A is unaware of the consequences of A’s action we cannot always speak about power, only if we assume that A, considering the circumstances, could have ascertained those consequences (ibid: 51f).
The third difficulty highlighted by Lukes arises when talking about attributing an exercise of power to collectives. The question raised is where to draw the line between structural determinism and the exercise of power. If a certain process is to be identified as an act of exercised power it is however not sufficient that B’s interests have been ignored by A. Lukes theory also implies that it must have been possible for A to act differently. If we say that a collective has exercised power over a group of people we assume that the collective could have acted or organized in a different way. If not, that collective more takes on the role of a structural determinism than an exerciser of power and cannot in that case be held responsible for its actions (ibid: 52, 54f).
The core of Lukes theory is that potential issues are kept out of politics with or without an observable conflict as a result of social forces, institutional practices or individuals
decisions. There does though exist a latent conflict between those who exercise power and the real interests of those they exercise power over. The conflict is latent because people are a part of a system; they are not always aware of their real interests and therefore cannot oppose objections. It is thought that these interests are possible to identify.
10. Results
In the following chapter we will answer our two research questions with the help of the empirical data collected in Honduras. This chapter consists of two parts, in part one the first research question will be answered and in part two the result of research question number two will be presented.
Part one
10.1 The Catholic Church as a political actor
Overall, in all the interviews we found a consensus regarding the fact that religion does matter in the work with reproductive health. All the Non-Catholic organizations mentioned this in some aspect and most of them saw the Catholic Church as an obstacle in their work;
[…] The biggest problem in the population is the influence of the church and their resistance to the use of contraceptives. (org. 5)
Some more specifically name the Catholic Church as the church with the greatest influence and others only speak of churches in general but there is clearly an agreement that the Catholic Church does play a vital role on the political arena of reproductive health.
yes the churches have muuuuch influence, the churches have much influence, especially the Catholic Church. (org. 7)
[…] The main obstacle is the Catholic Church that has a strong influence on the policymakers. (org. 9)
[…] And there is politics about sexual and reproductive health, but there has been a resistance from some actors in the society, the churches and other more conservative actors [s]o regarding possibilities and obstacles in the work, this is one. (org.5)
When major decisions and guidelines in the work of reproductive health are to be made, the main actors meet over the “round table”. There are several “round tables” in different areas, for example one for reproductive health and another specialized in HIV/AIDS etc. Both governmental and non-governmental organizations are members of the round tables. These round tables are a part of what we call the political arena but we also refer to the political arena when we speak of policymaking in general and decisions regarding reproductive health that will affect the population in some way. The Churches are a part of this political
arena, involved in decisions made in the round tables but also involved in the general work with reproductive health. The informants above saw the Churches as an obstacle because of this involvement but during the interview with organization 1 a different aspect of the Churches came up;
From a reproductive health point of view, I think that the church is an easy barrier because, especially the Catholic Church has a very radical opinion against modern contraceptives such as condoms, but at the same time they allow everyone to do as they like. […] They have a very clear manifest against abortion but on the other hand they promote positive global values and perspectives regarding reproductive health. (org. 1)
The Churches are according to organization 1 still seen as an actor in politics regarding reproductive health but it is not seen as such a great barrier The informant also points out that the Catholic Church is sending out positive values. The person believes that the Catholic Church has the influence to promote these positive values.
10.2 Who represents the Catholic Church?
The Catholic Church is a broad conception, but our informants very often defined the Catholic Church by naming one organization in particular;
[…] Pro Vida are strong and have strong influence on the politics to. The people in the high classes are involved in this organization […]. (org. 9)
and;
Pro Vida and Opus Dei are groups with impact on family planning, HIV/AIDS, use of condom, sexual education, they are a strong group because they have much power and influence. (org. 7)
So, Pro Vida and Opus Dei are considered influential and powerful organizations. Over and over again Pro Vida was referred to as a Catholic organization that counteract against the purposes of the non-catholic organizations.
The obstacles we have are of the religious type; there is a group in the Catholic Church, the group Pro Vida, that turn down all kinds of family planning […]. (org. 3)
a norm exist and some of the aspects of these norms parts in the religious sector don’t like, especially the group Pro Vida […]. (org. 7).
10.3 The course of action of Pro Vida and Caritas
Pro Vida is known in society and uses media to promote it self;
they are known in society, it is Pro Vida, these types of religious groups, like the catholic group Pro Vida. (org 3)
[…] Pro Vida pays a lot for commercials […] (org. 7)
The conflict regarding the morning after pill in Honduras often occurred as a subject during the interviews.
[…] I don’t know if you have been here the latest month and heard all of the questioning about the emergency-pill (day-after pill), that is a part of the sexual and reproductive health program, it is part of these politics. (org. 7)
the churches have for example been against the emergency-pill, and they have a quite radical position regarding contraceptives in general. (org. 5)
This conflict is one example of how the Catholic Church uses media to spread its opinions, it also shows how the Catholic Church over and over again questions reproductive health work in the country and they are so persistent that doubts arise among the leaders whether or not to proceed an intervention.
[…] Sometimes the ministry of health doesn’t continue working with an issue because of the influence of the church. […] The government and the Ministry of Health don’t want to get in conflict with the church. (org. 1)
At the same time it seems like the same informant means that the Churches also try to avoid too much conflict with the Ministry of Health;
[…] They don’t want the people to use condoms but they also say; alright if you have to use a condom its your problem. They are not going to promote condom but they are not going to condemn condom. They don’t want to get in conflict with the ministry of health. (org. 1)
During the interview with organization 7 we were told that the use of all
contraceptives is very controversial in Honduras. It is therefore hard to implement the politics already defined;
There are various aspects regarding the use of condom, it is very controversial, the contraceptives are also very controversial. The politics exist, the politics are very clear, the politics are clear and implemented in the health services but to some religious groups these aspects of the politics are very questioned […]. (org. 7)
This leads to confusion according to the same informant;
[T]hey really don’t contribute a lot. They only contribute to confuse the population. (org.7 )
Others mean that there is no confusion and that the Catholic Church only raise their voice when they find it necessary;
[…] There does not exist a permanent activity against the modern methods. When they have to express their opinion, they express it clearly, they don’t support the modern methods, and they especially don’t support the ones who promote abortion. (org. 1)
10.4 HIV/AIDS
Some of the organizations expressed that the Catholic Church as well as the other churches in Honduras have considered the spread of HIV/AIDS as something especially important. We believe that the informant indicates that the churches do not view HIV/AIDS as something included in sexual and reproductive health issues;
[…] I think, and this is a very personal opinion, not on the professional level or the opinion of [org. 2] [our alteration], but it seems that some of them have looked at the HIV/AIDS crisis as a sort of humanitarian thing. It is like, OK, this is something we need to act upon, people are suffering, people are dying, and we have got to take some action here. (org. 2)
HIV/AIDS is increasing in the country and all actors involved in the work with
reproductive health have taken some action to prevent this increase. Old values about HIV-transmission still exist in the country which leads to stigmatization and discrimination.
There is still a huge stigma attached to HIV which means people don’t talk about it, it means people don’t go and get tested […] So there is still a lot of lack of knowledge. [B]efore it was considered such a taboo that anyone with it must be a huge immoral person and the attitude still exist that these people deserve it. (org. 2)
In preventing the spread of HIV/AIDS the Catholic Churches take action in different ways. Organization 2 explained that it is difficult to talk about the Catholic Church as a
homogenous unit, instead different approaches within the churches can be found.
[…] It is hard to say, this is the position of the Catholic Church and this is the position of the evangelical. That really depends. (org. 2)
Some are very active, supporting people living with HIV/AIDS and educating about condoms as a way of prevention,
[…] And they have a lot of activities in, for example, supporting people living with HIV/AIDS, in educating people that come to church in prevention and so on, it is quite unusual. (org. 2)
Others are stricter and do only promote abstinence and fidelity;
[A]nd then there are other religious organizations that say abstinence, fidelity, that’s it. If you want to talk about condoms go to somebody else. (org. 2)
The church says that the people have the right to know everything about HIV, but as a way to prevent HIV they promote values like fidelity, abstinence, self-care and human values […] (org. 1)
So, on one hand one could say that the Catholic Church tries to cooperate in the work with HIV/AIDS but on the other hand this causes confusion among the people, as usage of condoms is a protection against HIV/AIDS, but the Catholic Church will not promote it. The Catholic Church promotes that the only way to protect one self from HIV/AIDS is abstinence or fidelity.
