Bargaining Power within Households: Can it Prevent HIV?

Over the last few months, we’ve been looking at how gender imparity has affected equity and efficiency in some very high-power spaces: politics, the corporate board, academia, and the STEM fields. But what about those more banal, day-to-day issues of gender imparity---those that most people don’t even see? Namely, how couples relate to one another. As commonplace as it might seem, relationship dynamics can have wide and profound consequences for society.

In the WAPPP seminar this week on “Intra-household bargaining power and HIV prevention,” WAPPP Fellow and PhD Candidate at the University of St. Gallen in Switzerland, Berit Gerritzen, looked at how married couples in rural Malawi approach issues of sexual health. Approximately 14.3 percent of the adult population of Malawi were living with HIV/AIDS in 2005, demonstrating the need for better information on its transmission.

And because many HIV infections throughout Sub-Saharan Africa take place during heterosexual intercourse between persons in stable couple relationships, the way that each of those partners approaches the other---and the issue itself---can be most telling for the diffusion of the virus.

Through data from the Malawi Diffusion and Ideational Change Project, Gerritzen looked at questions of (a) whether partners spoke about HIV risk, (b) accepted condom usage within marriage, (c) self-reported infidelity, among other issues including, of course, (d) HIV infection itself. Gerritzen cross-referenced those answers with indicators of household bargaining power, namely a spouse’s personal economic status, the number of wives in the family, local political participation, and other demographic data.

While conceding that there are a number of additional variables at play, Gerritzen concludes that factors associated with gains in female bargaining power---such as a wife’s own earnings and education, fewer co-wives, and political participation---are in fact generally related to increases in spousal discussions of sexual health, greater acceptance of condom use within marriage, and other HIV risk-reduction efforts.

When women demand the processes and outcomes that they know to be best for themselves, the household’s own welfare improves. And behaviors within the house are often what influence societal health outcomes, further strengthening the case that empowering women and increasing agency has benefits far beyond equality.



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Negotiating a Better Future - WAPPP Seminar Series

The Women:
Kathleen McGinn, Cahners-Rabb Professor of Business Administration, Harvard Business School
Nava Ashraf, Associate Professor, Harvard Business School

The Talk: Negotiating a Better Future: Measuring the Impact of Negotiation Skills on Health and Social Outcomes in Zambia

The Question: Can teaching young girls negotiating skills impact their health and education?

Teaching girls negotiating skills may not just boost morale, it may also change lives. At least that’s what research from Harvard Business School is finding when it comes to young girls in Zambia making choices around pursuing education and making decisions around sexual behavior. While the study is ongoing, the research suggests that when girls are taught negotiation skills and techniques -- in addition to information about sexual behavior and education -- they are better equipped to influence their future.

The Numbers.

Currently 57 percent of adults living with HIV in Zambia are women; young girls have a higher prevalence of HIV compared to boys of the same age; and girls are less likely to be enrolled in school. This puts girls at an increased risk of early pregnancy, marriage, HIV infection, and lowered economic and social capital.

Plenty of research exists on the role of public health campaigns and educational programs to reduce HIV and prevent early pregnancy; yet, simply teaching safe sex practices may not be enough.

Why Not?

Teaching women and girls about condom use, reproductive health and the importance of education assumes one critical component -- women and girls have the agency to influence and make these decisions.

“Information is power, but not if you’re powerless,” says Kathleen McGinn. For example, negotiating sex or requesting money for education may not be areas where young girls can control the outcome. Patriarchal systems, social stigmas, male-favoritism -- a myriad of reasons -- means that having the information does not necessarily translate to gaining the desired results.

This is where the power of negotiation enters. When women and girls couple negotiation skills with knowledge, they may be more likely to effectively influence and persuade those in power, thus leading to better results. In terms of education and health, this could have an exponential impact for girls, families and communities. Furthermore, the World Health Organization recently cited both “negotiation skills for women” and “expanded efforts to keep girls in school” as two significant tools for women and girls to protect themselves from HIV. McGinn, Ashraf and Low appear to be reinforcing this recommendation.

While the trials are still ongoing, McGinn et al found that girls in their program reported positive impacts in both school and social environments. These included advocating for themselves, setting ambitious goals, and effectively communicating.

“There is great variation in how well individuals can take advantage of the information in front of them. That ability is a skill that we believe can be taught,” says McGinn.

*Photo courtesy of Nava Ashraf, taken by Kelsey Jack.

Melissa Sandgren is an MPP1 candidate at the Harvard Kennedy School and a participant in WAPPP's From Harvard Square to the Oval Office program.