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Sex, tensions and pillsYoung people’s use of contemporary reproductive and sexual health technologies in AddisAbaba, EthiopiaBoth, R.E.C.

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Citation for published version (APA):Both, R. E. C. (2017). Sex, tensions and pills: Young people’s use of contemporary reproductive and sexualhealth technologies in Addis Ababa, Ethiopia.

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Download date: 23 Feb 2021

Sex, Tensions and Pills

Rosalijn Both

Sex, Tensions and PillsSex, Tensions and PillsSex, Tensions and PillsSex, Tensions and Pills Young People’s Use of Contemporary Reproductive and

Sexual Health Technologies in Addis Ababa, Ethiopia

Coverart: Painting by Shewangezal Tamerat, Addis Ababa

Cover design: Emmelie Both

Printed by: Gildeprint - The Netherlands

Sex, Tensions and PillsSex, Tensions and PillsSex, Tensions and PillsSex, Tensions and Pills

Young People’s Use of Contemporary Young People’s Use of Contemporary Young People’s Use of Contemporary Young People’s Use of Contemporary Reproductive and Sexual Reproductive and Sexual Reproductive and Sexual Reproductive and Sexual

Health Technologies in Addis Ababa, Ethiopia.Health Technologies in Addis Ababa, Ethiopia.Health Technologies in Addis Ababa, Ethiopia.Health Technologies in Addis Ababa, Ethiopia.

ACADEMISCH PROEFSCHRIFT

ter verkrijging van de graad van doctor

aan de Universiteit van Amsterdam

op gezag van de Rector Magnificus

prof. dr. ir. K.I.J. Maex

ten overstaan van een door het College voor Promoties

ingestelde commissie,

in het openbaar te verdedigen in de Agnietenkapel

op woensdag 05 april 2017, te 12:00 uur

door

Rosa Elisabeth Christina Both Rosa Elisabeth Christina Both Rosa Elisabeth Christina Both Rosa Elisabeth Christina Both

geboren te Ede

PromotiecommissiePromotiecommissiePromotiecommissiePromotiecommissie

Promotores:

Prof. dr. R.C. Pool Universiteit van Amsterdam

Prof. dr. A.P. Hardon Universiteit van Amsterdam

Overige leden:

Prof. dr. R. Reis Universiteit Leiden

Prof. dr. R. Van Dijk Universiteit van Amsterdam

Prof. dr. S.R. Whyte University of Copenhagen

Dr. E.M. Moyer Universiteit van Amsterdam

Dr. G.J.E. Gerrits Universiteit van Amsterdam

Faculteit der Maatschappij- en Gedragswetenschappen

i

Table of contentsTable of contentsTable of contentsTable of contents

Acknowledgements……………………………………………………………….iii

Chapter 1 Shifting youth sexualities: Sexual aspirations, frustrations and

the appropriation of pills ....................................................... 7

Chapter 2 Young people’s use and perceptions of emergency

contraceptives in sub-Saharan Africa: Existing insights and

knowledge gaps .................................................................. 27

Chapter 3 Keeping silent about emergency contraceptives in Addis

Ababa: A qualitative study among young people, service

providers and key stakeholders ............................................ 41

Chapter 4 Emergency contraceptive use in Addis Ababa, Ethiopia:

Challenging common assumptions about young people’s

contraceptive practices ....................................................... 61

Chapter 5 Buy & deny: Young men’s sildenafil citrate (Viagra) purchasing

strategies and experiences of bodily effects in Addis Ababa,

Ethiopia .............................................................................. 75

Chapter 6 A matter of sexual confidence: Young men’s non-prescription

use of Viagra in Addis Ababa, Ethiopia................................. 91

Chapter 7 Discussion and conclusions ................................................ 109

Chapter 8 Epilogue: A reflection on studying intimate matters in Addis

Ababa .............................................................................. 123

Overview of literature .............................................................................. 143

Summary ................................................................................................ 163

Samenvatting ........................................................................................... 169

Notes ...................................................................................................... 175

iii

AcknowledgementsAcknowledgementsAcknowledgementsAcknowledgements

My deepest thanks go to the many young men and women in Addis Ababa who

participated in this study. Some of you became close friends. Without you this

research would not have been possible. Ijig betam ameseginalehu!!

I would like to express my sincere thanks to my supervisors. Robert Pool has been a

constant and important provider of support and guidance to me over the more than

five years it has taken me to complete this thesis. Anita Hardon’s sharp reflections on

the underlying common threads in my work helped me to move this study to its final

stage at a time when I felt overwhelmed by writer’s block and the fatigue

accompanying young motherhood. I would also like to thank the other members of

the Doctorate Committee for taking the time to read this thesis.

I am very thankful to the AISSR for funding this study and for the unwavering

administrative support of José Komen, Janus Oomen, Hermance Mettrop, Muriël

Kiesel, Erna de Boer, and Joanne Oakes. Special thanks go to Erin Martineau, David

Hymans, and in particular Zoe Goldstein for editing parts of this thesis.

Since my first visit to Ethiopia in 2003, I have developed close friendships with Rahel

Endale, Frehiwot Kebede, Mahlet Bisrat, Noah Negussie, and Eyelachew Etsub. I am

thankful to each of you for the unique insights you gave me that enriched my

fieldwork skills and the write-up of my findings.

Fantawork Samuel and Liya Teklu accompanied me during many months of the

fieldwork and their cheerfulness and determination made the otherwise challenging

fieldwork move in the right direction. Aklilu Abate’s unique interpersonal skills greatly

helped in making young men feel comfortable to share their stories. Mahlet, Maria,

Bitania, and Emnet were a great support during data collection. Bruck Messele Habte

facilitated my access to pharmacies and drugstores as well as to certain key persons

and research assistants. This truly helped to move my research forward and I am glad

for our friendship and ongoing academic collaboration. Aster, Yonas, Brook, Edget,

Miki, and Murat so graciously let me conduct observations in their drugstores and

pharmacies, an opportunity that not only provided me with rich insights but also

allowed for moments of stability during the otherwise unpredictable course of the

fieldwork. Their hospitality was amazing. Habtamu, Solomon, and Ermias were of

utmost importance in connecting me to some of the young men who participated in

this study and I feel extremely lucky to have met them. I would like to thank Ezana for

realizing an official link with the Sociology Department of Addis Ababa University and

for providing me with opportunities to present my preliminary findings there. I also

thank Getnet Tadele for our discussions about my research. It was great to have Liza

iv

Debevec around as a co-anthropologist and friend. I am thankful to former country

director Andrew Pillar of DKT Ethiopia, the staff members from EnGenderHealth

Ethiopia and Marie Stopes Ethiopia, and in particular to Marius de Jong, former first

secretary of health at the Dutch Embassy in Addis Ababa, for opening doors to public

health and abortion clinics, providing key information, and for our vibrant discussions

about my research.

Abeba and Genet made the ‘Kebena’ house where I stayed during the first period of

fieldwork into a comfortable place for me to ‘hide’ at times when the frustrations of

doing fieldwork on such a sensitive topic prevailed. Ann’s pleasant company and

cooking skills and the long, down to earth conversations I had with Regien

contributed even more to making the ‘Kebena’ house a real home away from home.

During the PhD trajectory, Corien has been a tremendous support. I cannot thank you

enough for your hospitality, listening ear, and our afternoons at the pool that served

as breakaways from the fieldwork, and your strong belief in my capabilities. You even

insisted on travelling with me to the Netherlands to attend my defence. You, Habib,

Lidu, and Geremew hold a dear place in my heart. While in the field, Marieke always

generously let me use her large network, as well as her house, and she still never

misses an opportunity to promote my research. Our countless get-togethers, including

on the most beautiful rooftop terrace in Addis Ababa, have been both fun and

inspirational. You, Wendemegegn, Grieta, and Ineke always felt like my family in

Ethiopia.

In the Netherlands, I could not have wished for better roommates and friends than

Eva Vernooij, Erica van der Sijpt, Marije de Groot, Christopher Pell, Josien de Klerk,

and Nicole Schulp. In a similar vein, friendships developed with my co-PhDs Carla

Rodriquez, Emmy Kageha, Nipa Mrutu, Joseph Simbaya, Fortunate Shabalala, Alfred

Adams, Thandeka Dlamini, Jude Rwemisisi, Emmanuel Turinawe, and Laban

Musinguzi, all of whom added flavour to what was otherwise an at times lonely

journey. I also feel lucky to have had the opportunity to learn from Winny Koster,

Trudie Gerrits, and Eileen Moyer through symposia and applied research projects. I am

especially thankful to Eileen Moyer for frequently organizing reading groups and

delicious meals, events that were useful and gezellig at the same time.

Janneke, your friendship has been invaluable over the past fifteen years. I could

always count on you for a nice meal, short holiday, supportive words, and laughter. I

am glad our ‘team’ is now strengthened with three little girls. Korrie, ‘Rooie’ Nienke,

and ‘Blonde’ Nienke, our friendship started in 2001 during the first months of our

studies in History. You know best how my academic life has been full of ups and

downs and I am glad that you were and are there to lift me up when needed. With

v

Marion, I look forward to gain deeper insights into some of the themes that came out

in this study, as we are about to join forces on a new study.

I wonder what my grandmothers Ineke and Corrie and my grandfathers Carel and

Gerrit would have thought of the topics I chose to study. In any case, I know you

would have been proud of your granddaughter and I love and miss you all dearly. I am

thankful to my uncles, aunts, and cousins for always showing an interest in what I

have been doing over the years.

I am truly grateful for the unconditional support I received from my parents. Your

proofreading, pep-talks, countless visits, and cups of coffee kept me going at times

when I felt like giving up. Towards the end of the writing process, I spent several

months at your home, leaving my young daughter Hewan largely in your care so that I

would be free to write and fight my (many) writer’s blocks. Your hospitality and

grandparenting skills during these months undoubtedly moved my thesis forward. So

have your babysitting sessions in Amsterdam, which gave me time to go to the library

or the office. Both of you visited me in Addis Ababa during fieldwork and it is through

you, dad – a frequent visitor to Ethiopia for work since the 1990s – that I embarked in

2003 on what has now turned out to be a lifelong connection with the country.

My sisters and brother have always been important pillars of support and this was no

different during my PhD trajectory. Marieke, you are a great example to me of how to

combine motherhood with work and you were the first in our family to do research in

the field of medical anthropology. Jonna, you are both my sister and fellow PhD

candidate and we shared many frustrations, laughs, and discussions about our work. I

am happy that we are now both completing our PhD journeys and I am looking

forward to our post-PhD adventures. Pieter, our many coffees and dinners together in

Amsterdam were a welcome distraction from the writing process. I look forward to

drinking coffee in Lebanon with you and Kim. Emmelie, you, together with Diederik,

formed my creative team. You were always willing to brainstorm with me about

chapter titles and you have done the lay-out of this book. You have also supported

me tremendously by babysitting Hewan on Fridays so I could get to the library to

write. Fatim, Jiyan, Evin, and Neelah, without doubt your bubbling and energetic

presence have worked as stress relievers during my PhD trajectory and I love you

dearly.

Abe, you deserve my deepest gratitude for your unconditional moral support, for your

efforts in teaching me some Amharic, and your brilliant insights and remarks on my

work. Through our many conversations about my study topics, I learned that you are

by far a better ethnographer than I am and your input has been much more important

than you know. Our meeting in Addis Ababa in October 2013 turned out to be a life

vi

changing encounter. Thanks to you, at the moment of writing this, I am a wife and a

mother of two amazing girls. Marriage and parenthood have not only been the most

exciting and challenging journeys in my life so far, but have also helped me to put the

ups and downs of doing a PhD in perspective. Thanks to you, I also have a large and

loving family in Ethiopia. Zenebech, Elsa & Samuel (Ebenezer, Nebeyu, Meheretab),

Nani & Yayesh (Fasil and Lidiya), Assegu & Abera (Eskinder, Zerkalem, Mentesnot,

Robel, Nati, and Eden), Almaz, Tsehay, Ashu & Muna, Kina, and Liya: thank you for

your warm company, wonderful cooking skills, and most of all, for making me feel

truly welcome.

Hewan, yane konjo, your arrival taught me how to work efficiently and pragmatically,

skills that I will benefit from for the rest of my career. You made me a mum. Your

smiles and unconditional love teach me every day about what is most important in

life. As tiny as you were at one-and-a-half years of age, you could already say ‘mama

writing’ when I took time on the weekends to work on this book. Your little sister

Adiya, who was born just after I submitted this manuscript, gave me the last little

push I needed to finalize this thesis so that I can give my full and undivided attention

to you both.