A Response to #MeToo Meets Global Health: A Call to Action

The age of #MeToo calls for not only increased recognition of the pervasiveness of gender-based violence (GBV), but also concerted and sustained efforts to address the causes of and potential solutions to GBV. #MeToo Meets Global Health: A Call to Action exemplifies the type of public and collaborative work that is necessary to move this agenda forward. Centering specifically on experiences of those who engage in global health fieldwork, this statement outlines gendered vulnerabilities that are characteristic of ‘the field.’ Here, I comment on two aspects of this piece: (1) cultural relativity and vulnerabilities in fieldwork, and (2) the framing of GBV.

The authors note that GBV is not exclusive to any culture, community, or setting. Scholars and practitioners of global health often work to outline the negative impacts of violence, and especially gendered violence, on health and well-being.[1] The focus of these studies are most often the local communities targeted by global health interventions. Global health fieldworkers can be seen as ‘frontline responders/researchers.’ As such, they can act as “barometers of violence”[2] in that they have a firsthand and nuanced understanding of violence in the settings in which they work. But what of the individuals researching and implementing the interventions themselves? Who is on the frontline for them? What is their barometer? The Call to Action addresses this blind spot by encouraging us to engage in a form of ‘studying up’[3] that could be called ‘studying in;’ that is, understanding and addressing the impact of GBV on ourselves, our workplaces, and our community of global health workers.

Existing in ‘The Field’

The context of fieldwork in global health creates unique vulnerabilities. The concept of ‘fieldwork’ implies someone who is working outside of their own community. A recent publication[4] outlining experiences of sexual violence in fieldwork represents the type of ‘studying in’ that can illuminate cultural and institutional structures surrounding GBV in fieldwork settings. Fieldworkers often work internationally in a culture and community to which they do not belong. An added layer of complication is that ‘the field’ is not only where someone works, but also where they live. So the classification of ‘the field’ as a workplace and the development of standards of conduct based on workplace settings is not sufficient.

As ‘outsiders,’ fieldworkers must create new social networks of safety and support. In addition, they have to navigate language barriers and cross-cultural misunderstandings. The authors highlight difficulties that arise from differences in cultural norms surrounding gender, sexuality, and appropriate behavior. Anthropologists have long navigated theoretical and methodological tensions stemming from one of our discipline’s cornerstones: cultural relativism. We are trained to abandon ethnocentrism and approach ‘The Other’ with an open mindedness that ranges from non-judgement to endorsement of diverse beliefs and practices.

Feminist and postmodernist theories challenged the canon of cultural relativity by critiquing the notion of cultures as monolithic and static. Instead, culture, as a concept, is a project always in the making, contested, and shaped by both exogamous and endogenous influences. This shift in the conceptualization of culture complicates our ability to distinguish what is ‘culturally acceptable’ and what is not. In reality, the everyday interactions among fieldworkers, coworkers, and local people involve a messy process of negotiating the boundaries of acceptability. As the authors aptly argue, “Relationships are at the center of global health projects, and the deep power dynamics embedded within those relationships impact our successes.” The process of building relationships and negotiating acceptability can be dangerous when bodily integrity is threatened. The authors note that, “There is no clear line between an acceptable ordinary and an abusive extraordinary when it comes to sexual harassment and assault in a cross-cultural context”. Even the concept of an ‘acceptable ordinary’ is problematic because much of what we often think of as normal and acceptable can be classified as GBV. As Veena Das reminds us, “[GBV is] closely linked to the social and cultural imaginaries of order and disorder; and violence, far from being an interruption of the ordinary, is folded into the ordinary.”[5] The challenges of discerning acceptable behavior and maintaining cultural relativity coupled with a detachment from typical forms of social support leads to widespread experiences of GBV in global health fieldwork.

The Call to Action highlights a few important ways to address GBV in fieldwork. One is training. The majority of existing training for fieldwork focuses on methods and ethics, excluding discussions of safety, researcher/practitioner vulnerabilities, and what to do when things inevitably ‘go awry.’[6] I agree with the authors that we need to develop better mentoring and strategies for training fieldworkers at all stages. Another (though not explicitly stated) is to alter the way we conceptualize and value different types of fieldwork. Fieldwork, especially in anthropology, is frequently positioned as an essential ‘rite of passage’ in which one must demonstrate their stoicism and ability to ‘cut it’. Fieldwork is built on a history of hypermasculinity and white privilege. ‘The Field,’ we are told, is something we must conquer in order to be seen as competent and legitimate. As long as we frame fieldwork in such a patriarchal and white-supremacist way, it will not be a safe place for all.

How is Violence Gendered?

Early in the commentary, the authors explain that they use the term ‘gender-based violence’ because of its inclusivity but focus specifically on the experiences of women. It is important that the authors made this caveat. Far too often GBV is equated simply with Violence Against Women (VAW). However, scholars, activists, and frontline workers have long argued against a simplistic view of GBV as ‘man perpetrator, woman victim,’ pointing out that men can also be victims of gendered violence and that women participate in enacting gendered violence against men and other women. Queer theories challenge us to go beyond the binary and incorporate violence against trans and genderqueer people as a form of GBV. Beyond gender, people with non-heteronormative sexualities are also targets of GBV. How does global health fieldwork unfold for queer folks in contexts where our very existence is erased and/or illegal? A shift in terminology from VAW to GBV signals a deeper understanding of the gender and sexual underpinnings of this type of violence and allows for a more comprehensive theorizing of gendering violence.

In embracing a broad definition of GBV, I do not mean to divert attention from the experiences of women. As the authors state, gendered violence against women is a pandemic. Women, girls, and femmes do indeed face vulnerabilities that cismen do not, and this unique position leads to disproportionate rates of victimhood. In recognizing that VAW is a form of GBV and not synonymous, we must not lose sight of the impact of historical legacies of male privilege. Instead, I emphasize the word ‘gender’ to illustrate that in order to tackle GBV, we must move beyond a man vs. woman narrative and toward a deeper understanding of GBV as an abuse of power that is rooted in heteropatriarchy.

I feel this is an important point to make because how we view GBV shapes our approaches to mitigating it. For example, many have argued that GBV might be reduced by increasing the number of women in leadership roles. The authors note that global health is a largely women-dominated field, except at top levels of influence and management. While it is likely that a shift in gender demographics will alter the organizational culture in which global health workers operate, it is problematic to assume that the problem will be solved by some critical mass of women workers and/or women in leadership.

No single example makes this clearer than the case of Nimrod Reitman and Avital Ronell.[7] In this case, Ronell, a woman, was in a position of power over a man, Reitman, as his graduate advisor. Reitman accused Ronell of a Title IX violation including sexual harassment and sexual assault. New York University later found Ronell guilty of sexual harassment. After a short suspension, Ronell is back to her full duties of teaching and advising. What is more, both Reitman and Ronell identify as queer; Reitman as gay and Ronell as lesbian. The sexualities of the two people involved highlight another essential aspect about sexual harassment/abuse/violence: it is rarely about sexual gratification and most often about control, humiliation, and degradation. The Reitman-Ronell case illustrates a fundamental aspect of GBV; it is rooted in unequal power dynamics and the abuse of power. Any approach to GBV that does not identify power and the multiplicity of ways it can be applied and abused as the underpinning of GBV in global health fieldwork will fall short of its goals.

The Path Forward

#MeToo Meets Global Health: A Call to Action is a powerful message to the global health community that inspires us to take the steps necessary to remedy the deleterious impacts of GBV on and in ‘the field.’ The authors offer great suggestions to move this conversation forward. In addition to the recommendations it outlines, I encourage us to expand our approaches to dealing with GBV. Institutional and cultural changes are needed to prevent occurrences of GBV. In the meantime, we also need mechanisms to support victims. Much of the conversation thus far has centered on ‘accountability’ and creating better systems for reporting and managing cases. Let us be clear, accountability is a demand, not a request. However, we also need to look beyond punitive measures against perpetrators of GBV.

Global health institutions and communities need to place the wellbeing of survivors at the forefront. We need to establish better mental and physical health care for victims. We also need to improve professional support in order to ensure that their careers can grow to their fullest potential. Often, professional support is sought from mentors who share vulnerabilities: other victims of GBV, women, persons of color, queer scholars/practitioners. These mentors also exist within marginalized positions and they need to be compensated for the crucial but invisible ‘work of care’ in which they engage. We would also do well to draw from our wealth of knowledge on other, less masculinized, forms of conflict management like restorative justice. This Call to Action inspires us to utilize our skills in research, activism, and implementation to not only ‘study in’ but also to ‘work in.’ I stand with the authors and signatories of this Call in readiness to tackle GBV in global health. Will you stand with us?

[1] See for example: Rylko-Baur B., L. Whiteford, and P. Farmer (eds.), Global Health in Times of Violence (Santa  Fe, NM: School for Advanced Research Press, 2009) and Richter R. “Disparity in Disasters: A Frontline View of Gender-Based Inequities in Emergency Aid and Health Care,” in Anthropology at the Front Lines of Gender Based Violence Jennifer Wies and Hillary Haldane, eds. (Nashville, TN: Vanderbilt University Press, 2011) pp. 19-28.

[2] Wies, J. and H. Haldane. “Ethnographic Notes from the Front Lines of Gender-Based Violence,” in Anthropology at the Front Lines of Gender Based Violence Jennifer Wies and Hillary Haldane, eds. (Nashville, TN: Vanderbilt University Press, 2011) (pp. 2).

[3] Nader, L., “Up the Anthropologist – Perspectives Gained from Studying  Up,” in Reinventing Anthropology  Dell Hymes, ed. (New York, NY: Vintage Books, 1974[1969]) pp. 284-311.

[4] Nelson, R., J. Rutherford, K. Hinde, K. Clancy, “Signaling Safety: Characterizing Fieldwork Experiences and their Implications for Career Trajectories,” American Anthropologist 119/4 (2017), pp. 710-722.

[5] Das, V., “Violence, Gender, and Subjectivity,” Annual Review of Anthropology 37 (2008), pp. 283-299. (pp. 283).

[6] Raybeck, D., Mad Dogs, Englishmen, and the Errant Anthropologist: Fieldwork in Malaysia (Long Grove, IL: Waveland Press, 1996).

[7] https://www.nytimes.com/2018/08/13/nyregion/sexual-harassment-nyu-female-professor.html