Madagascar has been a hotspot for sex tourism in recent decades, with European men often flying in to its coastal areas. Reports of increasing prostitution and the sexual exploitation of children has placed the country on a Tier 2 Watch List under the Trafficking Victims Protection Act (TVPA) of the United States’ (US) Department of State, resulting in a 2007 decree against it by the government of Madagascar.⁽²⁾ Though Madagascar does not criminalise sex work per se, efforts at moral policing continue. Despite growing recognition of sex workers’ rights across Latin America, Asia and Europe, those in Madagascar have been denied basic human rights—even within the framework of sexual and reproductive health (SRH) and rights.

This CAI paper analyses SRH interventions aimed at female sex workers in Madagascar in order to understand the extent to which they meet the workers’ sexual and reproductive rights. The paper argues that a dissociation of rights from the SRH paradigm and the limited consideration of issues of sexuality are inadequate in ensuring equal rights related to non-discrimination and well-being of all groups of women.

Sex work in Madagascar

More than half of Madagascar’s total population of almost 23 million is below the age of 25. With a per capita GDP of US$ 471 and 92.8% of the population living below US 2 a day, Madagascar is one of the poorest and least developed countries in the world.⁽³⁾ The situation has deteriorated since a coup d’état in 2009, after which the country lost its preferential trade status with the US, resulting in a loss of around 200,000 jobs.⁽⁴⁾ Although the US reinstated its status under the African Growth and Opportunities Act (AGOA) after a new president was elected in January 2014, the suspension is believed to have had a bigger impact on the economy than the political crisis did. Many women employed in the textile industries who lost their jobs because of the trade suspension moved on to other forms of employment, including domestic work in the Middle East ⁽⁵⁾ and sex work within and outside of Madagascar. Within this context, there is an increasing number of young women and children resorting to sex work within the capital Antananarivo and the coastal cities of Toamasina, Nosy Be, Toliary and Mahajunga.⁽⁶⁾ A 2007 study by the United Nations Children’s Fund (UNICEF) in Toamasina and Nosy Be found that between 30-50% of girls involved in commercial sex were below 18 years of age.⁽⁷⁾

Though Madagascar does not explicitly criminalise prostitution, the 2007 decree prohibits trafficking in women and children for the purpose of sexual exploitation. However, specific rights related to sex workers have been completely excluded from the country’s National Action Plan (2007-2012)⁽⁸⁾ and the National Action Plan in Gender and Development (2004-2008),⁽⁹⁾ which aims to eliminate gender-based violence. Without any provisions to ensure their rights, sex workers are often subject to police harassment and exploitation. In April 2014, the police in Antananarivo issued a notice to sex workers to keep off the streets or face arrest and heavy fines, allegedly in a bid to “preserve the dignity of the Malagasy capital.”⁽¹⁰⁾ Critics have opposed this move as an infringement on the right to work and to free movement, for not only female but also gay and transgender sex workers.⁽¹¹⁾ Meanwhile, women sex workers’ collectives like Fikambanaina Vehivavy Miavotena Toamasina (FIVEMITO)—translated as “Women’s Future”—have been working with local governments to establish an identity card system to provide sex workers above the age of 18 with healthcare and legal protection. While this has had sporadic success, it has been unsuccessful in areas like Toamasina, where the police continue to harass workers often.⁽¹²⁾ The lack of effectiveness of associations like FIVEMITO and Femmes Interessee au Development de Antalaha—an association partially funded by the World Bank (WB) that also works in reproductive health and rights of sex workers and those vulnerable to the profession—is also linked to a lack of adequate funding for such programmes.⁽¹³⁾

The SRH paradigm

Global organising around sex workers’ rights has been most successful around international platforms provided by conferences on AIDS since the 1980s, though formal and informal organising of sex workers’ collectives existed long before.⁽¹⁴⁾ As a result, sex workers have received increasing attention within global SRH interventions, even though those interventions were largely aimed at population control when they began in the 1970s. By the mid 1990s women’s rights activists were able to shift the debate from population control to reproductive rights. In 1996 women were recognised as sexual beings for the first time in UN history at the Conference on Population and Development (ICPD). Though this recognition of women beyond their childbearing role was revolutionary, the conference avoided explicit mention of sexual rights as distinct from reproductive rights. This tentativeness over sexual rights is still prevalent in SRH interventions around the world.

A cursory look at the websites of some of the most influential organisations in SRH in Madagascar shows that current interventions can be broadly divided into two categories: the first aimed at population control and the second aimed at preventing the spread of HIV/AIDS and Sexually Transmitted Infections (STIs). Under the population control strategy, SRH interventions by the United Nations Population Fund ⁽¹⁵⁾ and USAID funded Population Services International (PSI)⁽¹⁶⁾ have essentially targeted issues like early pregnancy, maternal mortality, contraception and family planning for women and girls (within heterosexual relationships).⁽¹⁷⁾ The population control strategy is also conspicuous in the Madagascar Action Plan (2007-2012), in which family planning is one among eight national commitments. Women engaged in sex work, on the other hand, form a different category and are addressed under interventions around HIV/AIDS and STI prevention and control under PSI programmes. Fikambanana Miaro Ny Zon’ny Rehetra (FIMIZORE), a network of 18 national associations working with sex workers and Madagascar’s National Committee for the Fight against HIV/AIDS,⁽¹⁸⁾ reports the difficulty in getting funding for anything other than HIV/AIDS.⁽¹⁹⁾ This should be seen within the context of the AIDS pandemic beginning in the 1980s, when sex workers were seen as vectors and transmitters of diseases. This seemingly natural association of sex work with negative aspects of sexuality is closely linked to a disdain of overt expression of female sexuality ⁽²⁰⁾ that has been present in global attempts to control prostitution since the early 1900s.⁽²¹⁾

Limitations of SRH interventions

The ICPD Programme of Action addressed sexuality within SRH by stating that “the purpose of [sexual health]…is the enhancement of life and personal relations, and not merely counselling and care related to reproduction and sexually transmitted diseases.”⁽²²⁾ However, the sensitivity towards issues of non-conforming sexual identities and practices has relegated sexuality to a violations framework, whereby it is often limited to issues of sexual violence/exploitation and human rights violations based on one’s sexuality. This, along with the SRH focus on sexual and reproductive “ill health,”⁽²³⁾ further reinforces the notion that sex and sexuality mostly pose danger and risk to human lives. In the case of sex work, this anxiety is reflected in the state’s failure to ensure distinct rights to workers who might engage in adult, heterosexual and consensual but commercial and non-procreative sex. Such failure is based on a distinction made between “sex workers” and “the rest of the women” that overlooks the crucial fact that sex workers have the same needs as other women, such as information and counselling; safe abortion; antenatal, delivery and post-partum care; and social and legal assistance. In addition, they might also require “information about their rights as workers, mothers and citizens,” including professional training in financial management as the bread-winners of their household.⁽²⁴⁾ It is especially pertinent in the case of Madagascar, which has a high fertility rate of 4.28 children per woman and a low mean age at first pregnancy of 19.5 years.⁽²⁵⁾ Malagasy women also face additional constraints of a low literacy rate (64% for girls between 15-24 years of age)⁽²⁶⁾ and a lack of state benefits for single, unmarried mothers and minimal benefits for those married and widowed.⁽²⁷⁾

The current lack of clearly defined scope and content of sexual rights—not only in Madagascar, but also at the international level—has limited the ability to make claims to those rights and weakened the basis on which to demand government accountability. A health approach without a strong sexual rights component denies the agency of women who choose sex work, often sidelining them as victims instead of legitimate workers with equal rights which, in turn, makes it all the more difficult to prove the agency of such bodies. It contradicts the fact that women engage in sex work with diverse motivations ⁽²⁸⁾ and fails to acknowledge the social and economic power and independence of sex workers.⁽²⁹⁾

Finally, the maintenance of a sexual hierarchy of individuals according to choices around sexuality also extends to those outside the binary of men/women. The penal code of Madagascar criminalises acts that are “indecent or against nature with an individual of the same sex under the age of 21”⁽³⁰⁾ but remains silent about minimum age of consent within heterosexual relations.⁽³¹⁾ Such social and political privileging of heterosexual sex has ramifications for the realisation of rights, not only for lesbians, gays, bisexuals and transexuals (LGBT)—who have received scant attention from SRH and HIV/AIDS interventions within Madagascar ⁽³²⁾—but also for male and transsexual sex workers, who are often invisible within such programmes.

Concluding remarks

While this paper does not mean to devalue the importance of safe sex, it argues that an exclusive focus on disease and risk within SRH interventions is likely to send a message of what activist and theorist Gayle Rubin calls “sex negativity,”⁽³³⁾ which ignores the agency of those engaged in sex, especially through commercial exchange. In addition, health and population policies have often been blamed for ignoring sexuality and the significance of gender power relations in achieving SRH goals, despite their being a recurrent theme in recent preventive strategies employed by SRH programmes.⁽³⁴⁾ The exclusion of non-reproductive and non-heterosexual practices and identities from human rights protection also subjects these practices to moral, religious or criminal regulations, as in the case of sex workers. A parallel adoption of health- and human rights-focused approaches would be more effective in countering conservative resistance on one hand and excessive medicalisation of sexuality on the other. A human rights framework would also act as a tool to ensure state action and accountability for marginalised groups like sex workers and sexual minorities. This ensures principles of integrity, autonomy, equality, non-discrimination and empowerment within health rights. This should also be accompanied by state obligations to promote education on various forms of sexual diversity, discussions on conditions that support this diversity, and efforts at transforming gender power relations as necessary elements of sexual rights.

Written by Kumud Rana ⁽¹⁾

NOTES:

(1) Kumud Rana is a Research Associate with CAI and social science researcher interested in feminist, post-colonial and critical development studies. Contact Kumud through Consultancy Africa Intelligence’s Rights in Focus unit ( rights.focus@consultancyafrica.com). Edited by Liezl Stretton. Research Manager: Mandy Noonan.
(2) ‘Law No. 2007-038’, Antananarivo: Ministry of Justice, 2007, http://www.hsph.harvard.edu.
(3) ‘Madagascar overview’, The World Bank, 12 May 2014, http://www.worldbank.org.
(4) ‘When will the donor floodgates open for Madagascar?’, IRIN, 13 February 2014, http://www.irinnews.org.
(5) Ross, A., ‘Why are thousands of Malagasy women being trafficked to abusive jobs in the Middle East?’, The Nation, 5 May 2014, http://www.thenation.com.
(6) ‘Madagascar trafficking in persons report’, 2014, United States Department of State, 20 June 2014, http://www.antananarivo.usembassy.gov.
(7) These young women provide services to Malagasy men as well as foreigners visiting these places, some of whom are there for the express purpose of sex tourism.(7) An influx of mainly Japanese male migrant workers employed in large fishing companies and prawn farms in Nosy Be and Mahajunga (8) and miners from the multibillion dollar Ambotavy nickel mine in Toamasina have also increased demand for sex workers in these regions. See, Fortin, J., ‘Poverty driving Madagascar’s women into prostitution, while foreign workers flourish’, International Business Times, 29 August 2012, http://www.ibtimes.com; ‘Interview with Mr. Seigi Hinata – Ambassador of Japan to Madagascar’, Far Eastern Economic Review, 28 March 2002, http://www.winne.com; ‘Madagascar: Sex for survival’, IRIN, 28 August 2012, http://www.irinnews.org.
(8) ‘Madagascar action plan (2007-2012)’, Antananarivo: Government of Madagascar, 2007, http://www.un.org.
(9) ‘National action plan in gender and development (2004-2008)’, Antananarivo: Government of Madagascar, 2004, http://www.genreenaction.net.
(10) Razafison, R., ‘Madagascar puts sex workers on notice’, Africa Review, 4 April 2014, http://www.africareview.com.
(11) Ibid.
(12) ‘Madagascar: Sex for school fees’, IRIN, 1 August 2011, http://www.irinnews.org.
(13) ‘Madagascar: Sex for survival’, IRIN, 28 August 2012, http://www.irinnews.org.
(14) Petchesky, R.P., 1997. “Spiraling discourses of reproductive and sexual rights: A post-Beijing assessment of international feminist politics”, in Kohen, K., Jones, K. and Toronto, J. (eds). Women question politics. Routledge: New York.
(15) United Nations Population Fund (UNFPA) Madagascar website, http://countryoffice.unfpa.org.
(16) Population Services International (PSI) website, www.psi.org.
(17) In cases of interventions aimed at young people, the organisations have largely limited themselves to providing information and services related to prevention and control of sexually transmitted diseases.
(18) Comité National de Lutte contre le SIDA (CNLS) website, www.aidsmada.mg.
(19) ‘Sex workers tackling violence’, Epidremiology: Adventures in public health and human rights, 17 December 2010, http://epidreamiology.wordpress.com.
(20) For more on sexual morality in Madagascar, see Predelli, L.N., 2000. Sexual control and the remaking of gender: The attempt of nineteenth-century Protestant Norwegian women to import Western domesticity to Madagascar. Journal of Women’s History, 12(2), pp. 81-103; Stoebenau, K., 2010. “Côtier” sexual identity as constructed by the urban Merina of Antananarivo, Madagascar. Études Océan indien, 45(4), pp. 2-14.
(21) Reanda, L., 1991. Prostitution as a human rights question: Problems and prospects of United Nations Action. Human Rights Quarterly, 13(2), pp. 202-228.
(22) Miller, A.M., 2000. Sexual but not reproductive: Exploring the junction and disjunction of sexual and reproductive rights. Health and Human Rights, 4(2), pp. 68-109.
(23) Hawkins, K., Cornwall, A. and Lewin, T., ‘Sexuality and empowerment: An intimate connection’, Institute of Development Studies, October 2011, https://www.ids.ac.uk.
(24) Chacham, A.S., et al., 2007. Sexual and reproductive health needs of sex workers: Two feminist projects in Brazil. Reproductive Health Matters, 15(29), pp. 108-118.
(25) ‘People and society: Madagascar’, CIA World Factbook, 20 June 2014, https://www.cia.gov.
(26) ‘Madagascar: Statistics’, UNICEF, 27 December 2013, http://www.unicef.org.
(27) ‘Social security progress throughout the world: Africa, 2011’, US Social Security Administration: Office of Retirement and Disabilty Policy, http://www.ssa.gov.
(28) Stoebenau, K., 2010. Côtier’ sexual identity as constructed by the urban Merina of Antananarivo, Madagascar. Études Océan indien, 45(4), pp. 1-14.
(29) Cole, J., 2005. The joambilo of Tamatave (Madagascar), 1992-2004: Reflections on youth and globalisation. Journal of Social History, 38(4), pp. 891-914.
(30) ‘2013 country reports on human rights practices – Madagascar’, United States Department of State, 27 February 2014, http://www.refworld.org.
(31) However, it criminalises commercial exploitation below the age of 18 as well as recruitment and incitement to prostitution, sexual exploitation, sex tourism and incest involving a child under the age of 15.
(32) The SRH focus is mostly on men who have sex with men (MSM), sex workers and young adolescents within heterosexual exchanges.
(33) Rubin, G., 1999. “Thinking sex: Notes for a radical theory of the politics of sexuality”, in Parker, R. and Aggleton, P. (eds.). Culture, society and sexuality: A Reader. Routledge: London.
(34) Pettifor, A., et al., 2010. Perceived control over condom use among sex workers in Madagascar: A cohort study. BMC Women’s Health, 10(4), pp. 1-7; Stoebenau, K., et al., 2009. “…But then he became my Sipa”: The implications of relationship fluidity for condom use among sex workers in Antananarivo, Madagascar. American Journal of Public Health, 99(5), pp. 811-819.