Decolonizing North-South Relationships in Global Health

By Yarrow Global

“The master’s tools will never dismantle the master’s house.” – Audre Lorde

Decolonizing Global and maternal health can’t be done without having those people who are most affected by negative maternal health outcomes at the table, such as women from Low-Middle Income Countries (LMICs). This is one of the key takeaways from the “Rethinking North-South Relations – A gendered challenge”  panel that Yarrow Global Consulting held on November 30th.

We were extremely grateful to be able to hear from three experts who thoughtfully expanded on the legacy of colonialism within the development context today.  They discussed the ways discrimination in the Global Health and development community plays out and intersects with different identities, such and gender, race, and neocolonialism. We ended the conversation looking at what a more inclusive and intersectional approach to health might look like, and steps people can take on their own journey to decolonize development. 

Our speakers included Judy Khanyola from University of Global Health Equity, Sumegha Asthana a global health governance researcher, and Njeri Kimotho a gender and social inclusion expert. 

The Conversation was full of excellent discussions and insight from our panelists. We have summarized some of the key points and included timecodes (TS) so that you can refer back to the video (highly recommended!) for your reference.

One of the most obvious power imbalances that continues to perpetuate power imbalances in international development and Global Health is knowledge, often created in countries in the Global North, predominantly by people who have no lived experience of the problems they are purportedly attempting to solve. Our first panelist Sumegha Asthana opens with a reflection on the politics of knowledge and the power hierarchies that exist within them. For example, the lack of female leaders is extremely apparent in Global Health institutions, creating a disbalance of power. But gender inequity is just one of several ways discrimination plays out in these knowledge systems  (TC 00:16:07).

“There is an inherent bias towards what we understand as Global Health knowledge, ” said Asthana,  “there’s an assumption that all institutions in the North are superior to all institutions in the South.”

Part of how that plays out, she explained, is in politics. For example the Global Health 50:50 report in 2020 showed that of the more than 200 Global Health institutions studied, 92 percent of the CEOs and boards had completed their highest education in high income countries. When we look at this in terms of the Global Health leadership landscape, then only five percent of the global leaders who were women come from Low-Middle Income Countries (TC 00:19:54).

“People who claim to be formally educated in certain colleges, universities and so on disregard the knowledge that exists at the grassroots with community health workers or even the community,” said Asthana.

Njeri Kimotho opened her introduction with several personal anecdotes about the ways that different race, gender, and geographic identities intersect (TC 00:23:00 – 00:32:00). The goal of creating more inclusivity, and encouraging more diversity shouldn’t be about checking boxes Global Health, she said. International aid programs need to see diversity as more than just checking boxes.“I think it goes beyond the binary counting of women to really asking these global programs, these international development programs, how it is going to benefit or change the status quo?” (TC 00:35:00 – 00:42:00)

We got deeper into the topic of colonization when Judy Khanyola responded to a question about the root causes of high maternal mortality rates in Africa. She showed us how racism and discrimination, perpetuated during colonization, continue to play out today in contributing to poor Maternal Health outcomes. “I’m going to answer this with two words for the Global North and two words for the Global South,” said Khanyola. “To the Global North two words, racism and discrimination… Two words to the Global South: greed and corruption.”

Another focus of the panel was in response to a question about how we can collectively bring about positive change in gender roles, as well as how we can stop women from also playing a role in negatively sustaining gender roles (TC 01:13:30)

Generally the consensus was that, while gender inequality is a problem, it can’t be separated from the larger issue of racism and discrimination. The panelists agreed that it’s not only on the international level – it trickles down to the country level and the local level, all the way to our family relations (TC 01:14:56). “What we’re also missing is to impart good value to our daughters that homemaking, getting the family together and keeping them together in itself is a skill that not just the women, but also the men need to learn,” said Asthana. “In this haste of adopting the “The Western Ideas of Families,” and “Individual Progress and Freedom”, and so on, somewhere we are ignoring the fact that the value of a family is also equally important for your group.”

Every woman and every person who is fighting the fight on the international level also deals with these issues on a deeply personal level. Those realities can’t be completely separated. And those realities are also not static – generational change in how inequity, racism, and discrimination are experienced influence the ways that emancipation and positive change are experienced as well (TC 01:22:15). “What we see is a lot of the discussions that have evolved as realization of the people. A realization and then acknowledgment that solutions can also come from within,” said Kimotho. “Especially from a gender perspective, I think what I’ve been asking is: do women want empowerment and what does that look like to them? Are we pushing them to empowerment or are we taking on board what empowerment looks to them? 

We wrapped up the panel with a look towards the future, asking what individuals can do on a practical level to decolonize health and knowledge systems, and work towards creating gender and racial equity in Global Health (TC 01:30:05). “Just speaking about it but not really doing anything is what now the status quo wants to happen. After we talk, what happens next?” Khanyola asked. Especially Maternal Health can start by taking seriously the expertise and knowledge of those whose lived experience makes them absolute experts in the field. “You know, a woman who’s given birth to seven children like my mother in law has, and my grandmother gave birth to 10 children, surely has some understanding of her body in the process. It is important that you should take cognizance of. And these ways are not Western .”

Ultimately, while gender is an important way discrimination plays out, it is one of many and more is gained by looking at the bigger picture and structures of inequity (TC 01:36:53). “Gender itself has to be broader than gender. It has to be,” Asthana said. “We have to think about gender with the idea that those who are marginalized, those who are more vulnerable are not necessarily always women in all classes of society.”

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