Asylum-seeking and refugee women (ASRW) are population groups characterized by diverse social, economic and legal backgrounds as well as diverse needs. Their backgrounds of forced migration have a profound impact on their overall health, including their sexual and reproductive health (SRH). In Europe, the SRH needs of ASRW are usually more pressing than those of the host country population. In the context of refugee health, it is important to distinguish between asylum seekers and statutory refugees, (...) as asylum seekers have distinct needs and often limited rights in their host country. Yet both groups face many barriers in accessing national health services. This article addresses the issue of entitlements to health services for asylum-seeking women in Europe, and highlights the wide range of difficulties of both asylum-seeking and refugee women in accessing (sexual and reproductive) health services. (shrink)

There is increasing interest in the need to address the ethical dilemmas related to the engagement of adolescents in sexual and reproductive health research. Research projects, including those that address issues related to STIs and HIV, adverse pregnancy outcomes, violence, and mental health, must be designed and implemented to address the needs of adolescents. Decisions on when an individual has adequate capacity to give consent for research most commonly use age as a surrogate rather than directly (...) assessing capacity to understand the issues and make an informed decision on whether to participate in research or not. There is a perception that adolescents participating in research are more likely to be coerced and may therefore not fully comprehend the risk they may be taking when engaging in research. This paper examines the various ethical issues that may impact stakeholders' decision making when considering engaging adolescents in SRH research in Nigeria. It makes a case for lowering the age of consent for adolescents. While some experts believe it is possible to extrapolate relevant information from adult research, studies on ethical aspects of adolescents' participation in research are still needed, especially in the field of sexual and reproductive health where there are often differences in knowledge, attitudes and practices compared to adults. The particular challenges of applying the fundamental principles of research ethics to adolescent research, especially research about sex and sexuality, will only become clear if more studies are conducted. (shrink)

Violations of women’s sexual and reproductive health and rights are frequent all over the world. Women’s sexual and reproductive health is related to multiple human rights. The term ‘rights-based’ has become increasingly linked to the concept of a more comprehensive approach to sexual and reproductive rights of women around the globe. The rights-based perspective is derived from the treaties, pacts and other international commitments that recognize and reinforce human rights, including the (...) class='Hi'>sexual and reproductive rights of women. We conducted an extensive review of the guidelines, frameworks, research reports and published articles that have been cited as informing the rights-based approach. The findings of the review highlights what is meant by sexual and reproductive health and rights by the stakeholders, why this matter is important, and what can be done. It demands more partnerships with human rights, women’s and other civil society organizations, increased number of successful national policies, initiatives and/or legislative changes, increased budget and other resources at national and/or local community level, mass communication and engagement of men to promote and advance women’s sexual and reproductive health and rights. Achievement of gender equality is very crucial, because it is a human right that advances women’s empowerment; and is interlinked with sexual and reproductive health and rights. (shrink)

Sexual and reproductive health is a challenge worldwide, and much progress is needed to reach the relevant UN Sustainable Development Goals. This paper presents cross-sectional data collected in Sierra Leone on sexual and gender-based violence, family planning, child, early and forced marriage, and female genital mutilation using an innovative method of measurement: situational judgment tests, as a subset of questions within a larger survey tool. For the SJTs, respondents saw hypothetical scenarios on these themes and had (...) to indicate how they would react. The objective is to give an impression of beliefs and norms on specific behaviors, which provide insights for social and behavior change interventions. Data was collected by enumerators traveling to villages randomly selected in six districts of the country. The sample is composed of 566 respondents. Results show that FGM in particular seem to be a priority topic, in comparison to the other topics for which the norms seem to be stronger against those practices. Age differences emerged and suggest priority groups to be targeted. In terms of validity of the measurement methods, situational judgment test answers correlated positively with other items in the survey, but the magnitude of the association is often small, and sometimes not significant. Thus, more studies are needed to further explore the validity of this measure by comparing against a reference value. Using SJTs could complement other data collection tools to perform community assessment, and orient the direction of the program in its planning phase. (shrink)

There is an increasing recognition internationally of the critical impact of communication within healthcare. The link between ineffective communication, patient dissatisfaction and critical incidents is well established. Family Planning New South Wales has sought to address patient-centred care and communication in its policy platform. This article reports on research conducted within FPNSW, which analysed the discourse features that constituted effective doctor–patient1 communication in sexual and reproductive health consultations. The principal aim of the research was to understand how (...) effectively messages were conveyed and received and to what degree patients were active participants in their own sexual healthcare. Analysed consultations were characterised by extremely high levels of communicative competence on the part of the doctors who integrated medical expertise with the development of interpersonal relationships with patients, thus positioning patients as active contributors to the consultations and to decisions about their ongoing treatment. The detailed linguistic analysis identified characteristic features of patient-centred communication that are essential to patient-centred care. These interactions demonstrate that communicating care is just as important as delivering care and involves a drawing together of the medical and the interpersonal in consultations. The article details strategies for interweaving medical knowledge and establishing rapport that can inform practitioner communication practices across different healthcare contexts. (shrink)

The devastating COVID-19 pandemic and its accompanying containment measures brought exceptional challenges to the health delivery system, and in particular, women’s sexual and reproductive healthcare (hereafter referred to as SRH). The re-routing of health resources and funding to mitigate the effects of the pandemic obstructed the provision of essential SRH services for women and girls. Coupled with the incessant socio-cultural and patriarchal norms and gender inequalities, the COVID-19 pandemic aggravated the pre-existing SRH disproportions already affecting women. (...) By adopting a qualitative approach and drawing on the experiences of women from three high density suburbs in Harare. Firstly, the study sought to explore the implications of the COVID-19 pandemic on SRH for women and girls. Secondly, the research sought to determine key drivers that affect women’s SRH in the context of COVID-19. Participant responses indicated that the COVID-19 lockdown containment measures which confined spouses to the home setting for prolonged periods of time, which is in contrast to the norm, exposed women to SRH related challenges. Participants cited that (i) bruised male ego due to lack of employment as a result of downscaling of companies resulting from COVID-19 containment measures resulted in men asserting their masculinities through heightened sexual intercourse, (ii) restraint of movement resulted in limited time for men to visit their small houses and side-chicks or side dish (euphemisms for illicit sexual relations) therefore resulting in frequent and unprotected sex with their spouses, giving rise to unplanned pregnancies and increased exposure to STIs due to limited access to SRH services and, (iii) increased intimate partner violence (IPV) and sexual abuse. Therefore, the research sought to explore the response of religious leaders and faith-based actors to providing psycho-social support and safe spaces as ways of addressing intersectional injustices giving rise to SRH challenges for women and girls.Contribution: The intersecting crises of the COVID-19 pandemic have extensively hindered progress towards the promotion of women’s SRH. Relating to sustainable development goal 3 (SDG3), the article acknowledges the trust and respect of religious leaders within communities as change agents who can encourage shifts in behaviour, beliefs and practices in ways that promote holistic SRH for women. (shrink)

There are conceptual and ethical challenges to defining adolescents’ autonomy to access health care, and these can lead to health care norms and practices that could be maladjusted to the needs and preferences of adolescents. Particularly sensitive is access to sexual and reproductive health care services (SRHS). Yet, while there has been substantial conceptual work to conceptualize autonomy (e.g., as independence), there is a lack of empirical research that documents the perceptions of adolescents regarding on (...) how they access or wish to access health care services. The main objectives of this research were to (a) understand how adolescents in Colombia interpret the concept of “autonomy,” (b) describe how these adolescents articulate their autonomy (i.e., preferences) in accessing SRHS, and (c) analyze the ethical issues emerging from these data. Forty-five semi-structured interviews were conducted with participants aged 14 to 23 years old in the Departments of Antioquia and Valle del Cauca in Colombia. Our study showed that participants’ understanding of autonomy was context-based and highly dependent on personal experiences, and these influenced their choice in how to access SRHS. Seen through the ethical lens of a reproductive justice framework, our results highlight the unequal opportunities for adolescents in terms of autonomy to access SRHS. (shrink)

IntroductionElements mark the reality of reading the female body in symbolic constructions and social symbols in the exercise of their reproductive health. The study aims to identify elements that characterize the female condition while analyzing the reproductive health of Brazilian and French women.Materials and MethodsA qualitative, multicenter, international study was conducted in Brazil and in France between 2016 and 2019. Data were produced through the use of semi-structured scripts. Focus group discussions and individual interviews were conducted (...) with women who gave birth, hetero-female couples who lived the experience of gestation and birth of a baby, and professionals of maternal and childcare services or members of the associations concerned with the health of mothers and babies. It was guided by the theoretical-methodological framework of institutional analysis in line with the French Institutional Socioclinics.ResultsSexual and reproductive health in the realities researched in Brazil and France are sometimes close and sometimes far apart. In what involves the Brazilian health system, abortion is criminalized and often performed illegally. Furthermore, pregnancy, childbirth, and the postpartum period are highly medicalized. In addition, childbirth is not assured as an experience for a woman and her family. This aspect is confirmed by high numbers of cesarean sections performed or by maternal and infant mortality indicators. The French health system prioritizes vaginal deliveries and seems to assure more autonomy to women, but at the same time, it is worn out by the logic of profit, the efficiency of actions, and the rationalization of practices. In association with these, there are other intrinsic elements in the functioning of the institution that delineates the format of each country: notion of women's rights, violence against women, and discussion regarding the oppression markers of race, gender, sexuality, and social class.ConclusionsBoth countries reveal aspects related to the social role of women's bodies. The established logic reflects in the decision to have children, motherhood, women's autonomy over their own bodies, and in the core values linked to the termination of pregnancy and the professional practices developed in prenatal care, childbirth, and postpartum. (shrink)

This study’s objective was to understand Colombian adolescents’ experiences and preferences regarding access to sexual and reproductive health services (SRHS), either alone or accompanied. A mixed-method approach was used, involving a survey of 812 participants aged eleven to twenty-four years old and forty-five semi-structured interviews with participants aged fourteen to twenty-three. Previous research shows that adolescents prefer privacy when accessing SRHS and often do not want their parents involved. Such findings align with the longstanding tendency to frame (...) the ethical principle of autonomy as based on independence in decision-making. However, the present study shows that such a conceptualization and application of autonomy does not adequately explain Colombian adolescent participants’ preferences regarding access to SRHS. Participants shared a variety of preferences to access SRHS, with the majority of participants attaching great importance to having their parents involved, to varying degrees. What emerges is a more complex and non-homogenous conceptualization of autonomy that is not inherently grounded in independence from parental involvement in access to care. We thus argue that when developing policies involving adolescents, policymakers and health professionals should adopt a nuanced “relational autonomy” approach to better respect the myriad of preferences that Colombian (and other) adolescents may have regarding their access to SRHS. (shrink)

Objective Our study sought to (1) describe the practices and preferences of Colombian adolescents in accessing sexual and reproductive health services: accompanied versus alone; (2) compare actual practices with stated preferences; and (3) determine age and gender differences regarding the practice and these stated preferences. -/- Methods 812 participants aged 11–24 years old answered a survey in two Profamilia clinics in the cities of Medellin and Cali in Colombia. A cross-sectional analysis was performed to compare participants’ answers (...) based on the variables of gender and age. -/- Results A quarter of participants visited the clinic alone (25.4%). Females were more likely to go alone in comparison to males (26.3% vs 14.1%; p = 0.031), and older participants went alone more often than younger participants (p < 0.001). Most participants – 72.7% (95 %CI: 69.3–75.9) – expressed a preference in being accompanied to the clinic, and more than 90% had their preferences met. The preferences of older participants were, however, less likely to be met than those of younger participants (p < 0.001), notably, because they predominantly wanted to be accompanied. -/- Conclusion Contemporary public health and bioethics literature advocates in favor of developing health services that better meet the preferences of adolescents. The present research highlights an apparent blind spot related to the role that others (e.g., parents, friends, partners) can or should play in accompanying adolescent patients when they access sexual and reproductive health services. Respecting adolescents’ preferences, and hence their autonomy, is not simply a matter of ensuring freedom from constraints (e.g., their right and ability to go alone). Rather, it should also consider the liberty to choose whether to be accompanied when accessing SHRS and by whom. (shrink)

The International Covenant on Economic, Social and Cultural Rights was signed by Turkey in 2000 and has been in force since September 23rd, 2003. For this reason, the Covenant is considered as act of parliament in our domestic law, and unlike the general procedure of application of the law, it can not be alleged to contradict the Constitution (According to Article 90 of the Turkish Constitution). The article 12 of the Covenant defines the right to health and its content. (...) In the article 12 of the Covenant, in its General Comment No. 14 published in 2000, the right to the highest attainable standard of health was interpreted and commented upon. This document contains a detailed description of the right to health, its content, and its obligations to State parties. Although this Comment of the Covenant is not binding, it is a document to which the State parties refer when taking measures related to health services. Every publication and comment on the right to health was based on the General Comment 14 of the Covenant. The Article 12 was reinterpreted by the Covenant on May 2nd, 2016 in the context of rights to sexual and reproductive health. İit has been emphasized that legal, procedural, practical and social barriers limit the access of individuals to full range sexual and reproductive health services. It has also been pointed out that accessibility of sexual and reproductive health services is a distant target for women and girls. Moreover, it has been stated that discrimination that increases exclusion in legislation and practice limits lesbian, gay, bisexual, transgender and intersex (LGBTI) individuals and disabled people'senjoyment of sexual and reproductive health rights. For this reason, it is stated that although commenting on the rights of sexual health and reproductive health is included in 14 comments, it is important to make an interpretation about them. This comment is an interpretation of a binding Convention. Therefore; It is a document that will provide guidance on measures to be taken by States Parties in respect of their rights to sexual health and reproductive health. At the same time, obstacles to discrimination in medical practice bring important approaches in terms of respect for autonomy and respect for private life. In our article, information about the content of the ESKHK's interpretation and possible reflections of this content in the field of medical law and ethics will be given. (shrink)

For years, the sexual and reproductive health of women with intellectual and developmental disability or disabilities has been insufficiently addressed by institutions and family members due to a lack of information, training, and, sometimes, religious issues. In this context, contraceptive digital pills can enhance the sexual and reproductive control of this population group. Digital pills could help to improve adherence to treatments aimed to prevent unwanted pregnancies, as well as allowing women and their caregivers to (...) exert better drug intake control. However, there are some ethical risks to consider that may outweigh these benefits. This study sets out to explore the ethical considerations that should be taken into account in the case of a potential roll‐out of contraceptive digital pills as a way of improving the sexual and reproductive health of these women. (shrink)

Introducción: El embarazo, aborto, las infecciones de transmisión sexual incluido el Virus de Inmuno Deficiencia Humana, se han convertido en problemas sanitarios de mayor vulnerabilidad en jóvenes. Objetivo: Describir las conductas de riesgo y prevalencia de problemas sexuales y reproductivos de estudiantes universitarios. Método: Investigación descriptiva, el universo estuvo constituido por alumnos de dos grupos de segundo semestre; el grupo de estudio conformado por la totalidad de estudiantes de la Facultad de Salud Pública ; y el control seleccionado mediante (...) una muestra aleatoria de estudiantes del resto de las facultades, se realizó esta selección con el propósito de valorar la homogeneidad de las variables entre los grupos. Resultados: Existe homogeneidad en la mayoría de conductas de riesgo y problemas sexuales en los grupos, en consecuencia estas variables no están influenciadas por la pertenencia a la Facultad de Salud Pública. Se evidencian conductas de riesgo como: inicio temprano de relaciones sexuales, múltiples parejas, infidelidad, relaciones sexuales ligadas al consumo de sustancias, dificultades con el uso de métodos anticonceptivos o de protección; se encontró prevalencia de problemas como: experiencia de embarazos, la mayoría no planeados, abortos inducidos y presencia de infecciones de transmisión sexual. Conclusiones: Existe vulnerabilidad en la salud sexual y reproductiva de los jóvenes universitarios independientemente de la formación que reciben, por tanto, emerge la necesidad de buscar alternativas integrales de promoción, prevención y educación sexual integral. Introduction: Pregnancy, abortion, sexually transmitted infections including Human Immunodeficiency Virus, have become a health problem of more vulnerable in young people. Objective: To describe risk behaviors and prevalence of sexual and reproductive problems of university. Method: Descriptive study, the universe consisted of students from two groups of second semester; the study group is conformed by students of the Public Health Faculty ; and control selected by a random sample of students from other faculties, in order to assess the homogeneity of the variables between groups. Results: Homogeneity exists in most risk behaviors and sexual problems in groups, therefore these variables are not influenced by membership in the Public Health Faculty. Risk behaviors as evidence: early initiation of sexual activity, multiple partners, infidelity, sexual relationship linked to substance consumption, which prevails alcohol, together with the non-use or inappropriate use of contraception or protection; experience of pregnancy, most unplanned, induced abortions and the presence of sexually transmitted infections: prevalence of problems as found. Conclusions: There is vulnerability in sexual and reproductive health of young students regardless of their training, thus emerges the need to find alternatives comprehensive promotion, prevention and comprehensive sex education. (shrink)

The decision of the House of Lords in Gillick v West Norfolk Area Health Authority carved out a safe space for competent minors to confidentially access sexual and reproductive health care and advice in the UK. Ireland is one of the few common law jurisdictions that has not endorsed Gillick or a similar mature minor doctrine, nor has it securely legislated for the right to consent of those aged 16 and 17 years. The legal lacuna created (...) by this deficiency has left young persons in Ireland seeking sexual and reproductive healthcare, and the clinicians who provide this, in a challenging place. While this void has been partially filled with policy statements by bodies such as the Irish College of General Practitioners and the Health Service Executive, nonetheless the legal shortcomings leave both a sense of insecurity, and real world difficulties for adolescents seeking to access to sexual and reproductive healthcare. (shrink)

Adolescents and youth in South Africa comprise about 30% of the total population. This phenomenon is referred to as a youth bubble. Research shows that 52% of young people have had full penetrative sex by age 17, and yet 35% of teenagers who have sex say they only sometimes wear a condom, while 32% who have sex say they never wear a condom. Furthermore, studies show that more than half (52%) of parents of teenagers and youth are unaware of their (...) children’s sexual experiences. This situation is insignificantly different between the youth who frequently attend church and those who do not go to church. Responses by churches to the situation have ranged from denialism and hence only maintaining an abstinence stance to superficial youth sexuality discussions that only scratch on the surface. Data indicate that many adolescents seldom have an opportunity to discuss issues of sexual and reproductive health with a caring, knowledgeable adult and are often confronted with unresponsive health services. In response to the situation, there is growing awareness of the important role that religious communities play in adolescents and youth sexual health. The National Adolescent Sexual and Reproductive Health and Rights Framework Strategy (2014–2019) encourage parents and faith-based organisations to bridge this gap by empowering adolescents and youth regarding sexuality issues. The fourth priority of the strategy advocates for a strengthening and scaling up of community networks aimed at supporting adolescents. The churches, however, are caught in a dilemma where on the one hand they have to uphold (teaching) the biblical moral values of abstinence and at the same time respond to the realities of youth who are engaging in sex. With the church being a subsystem of society, a question that is posed is: how should a constructive engagement between church and society regarding youth sexual reproductive health be done? A practical theological response of the church to adolescents and youth sexual reproductive health (AYSRH) that is dialectic and juxtaposes the church and its distinctive values and at the same time practically responding to realities of the needs of adolescents and youth is proposed. In such a model, an engagement that upholds the sacredness of the church while observing the public role of the church as a community institution is advanced. (shrink)

ABSTRACT This study is an ethical reflection on the formulation and application of public policies regarding reproductive health in Brazil. The Integral Assistance Program for Women's Health (PAISM) can be considered advanced for a country in development. Universal access for family planning is foreseen in the Brazilian legislation, but the services do not offer contraceptive methods for the population in a regular and consistent manner. Abortion is restricted by law to two cases: risk to the woman's life (...) and rape. This reality favors the practice of unsafe abortion, which is the third largest cause of maternal death in Brazil. Legal abortion is regulated by the State and the procedure is performed in public health centers. However, there is resistance on the part of professionals to attend these women. Prenatal care is a priority strategy for promoting the quality of life of these women and of future generations. Nonetheless, it is still difficult for these women to access the prenatal care services and to have the required number of consultations. Moreover, managers and health professionals need to be made aware of the importance of implementing the actions indicated by the public policies in the area of sexual and reproductive health, favoring respect for autonomy in a context of personal freedom. (shrink)

In any given society, rights are said to co-exist. When rights, however, begin to conflict, a balance must be sought. In few fields has the ability of governments to accommodate two conflicting sets of rights been so controversial as it has in the case of conscientious objection in reproductive health care. Today, states have an obligation under international law to protect the right to the freedom of thought, conscience, and religion of medical providers. They also, however, have an (...) obligation to protect right to the highest attainable standard of health and other fundamental rights of women. Considering the extent to which CO has been invoked in the context of reproductive health care, international law recognizes limits to its use. Over the years, human rights bodies have sought to develop guidelines around CO in order to ensure the protection of women’s basic rights. While some state practices have shown to be consistent with guidelines established at the international level, some countries have struggled to provide an effective balance so as to protect women’s fundamental rights. Taking the example of countries in Latin America and Europe, this article provides an overview of the different ways states have sought to regulate CO in the medical context and the various difficulties ensued. (shrink)

This article examines the regulation of Latina youth sexualities in the context of sexual and reproductive health care provision. In-depth interviews with health care providers working in two Latino-serving community health centers are analyzed for how they interpret and respond to the sexual and reproductive practices of their low-income Latina teen patients. The author finds that providers emphasize teenage pregnancy as a social problem among this population to the exclusion of other dimensions of (...) youth sexualities and encourage Latina girls’ adherence to a life course trajectory that conforms to middle-class, heteronormative ideals as a solution to this problem. By relying on such understandings, providers construct meanings of sexual citizenship that require participation in bourgeois heteronormativity. These findings suggest that Latino-serving community health centers, their providers, and their teen patients could benefit from questioning the assumptions that inform providers’ appraisals of Latina youth and developing a more inclusive approach to Latina youth sexualities beyond a discourse of pregnancy prevention. Such efforts could allow community health centers to actively participate in disrupting the structural inequalities that shape their young patients’ lives. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Abortion to Abolition: Reproductive Health and Justice in Canada by Martha PaynterRebecca Simmons (bio)Abortion to Abolition: Reproductive Health and Justice in Canada by Martha Paynter Winnipeg, MB: Fernwood Publishing, 2022Martha Paynter's Abortion to Abolition: Reproductive Health and Justice in Canada is a bold, ambitious work that seeks to not only catalog Canada's meandering and often backtracking path toward reproductive justice, but (...) to act as a manifesto for Paynter's own ideas and goals for reproductive justice. The book takes the form of an anthology of stories, divided into chapters, that are grouped according to a certain right; for example, the right to bodily autonomy. This format effectively guides the reader from abortion to abolition. Paynter adroitly starts the book with white feminist favorites such as bodily autonomy and not having children. Then she logically progresses to more radical ideas such as parenting in prison and the total abolition of prisons. The stories in this book are accompanied by warm, colorful illustrations by Julia Hunt. These drawings help the reader visualize the person behind the story and the very real life that was affected by reproductive law and/or social norms. Paynter holds a PhD in nursing, and it is from this background that she writes, seeking to educate nurses and other healthcare professionals alongside a broader readership garnered through her clear, approachable writing style.Chapter 1 introduces the reader to many of the book's key themes by considering the right and need to have bodily autonomy, and the multiple ways this manifests itself in ordinary (and less-ordinary) life. Paynter considers the disparate stories of five women, all fighting in some way for bodily autonomy. The stories cover events of gender-based gun violence, sexual assault, transgender rights in prison, the legalization of sex work, police violence, and institutional racism. Each story recounted by Paynter catalogs tragedies and injustices with blunt and brutal honesty—perhaps to an unnecessary extent. Every horrific fact is laid bare for the readers as they uncover the intricacies of gender-based, imperialist, and racist violence. Paynter has chosen these stories to display the multitude of ways in which people—especially Black, Indigenous, people of color (BIPOC) and minoritized genders—can be willfully wronged by the state and [End Page 209] the criminal justice system, such that the reader must begin to confront the fact that these structures don't seem to exist to benefit or protect the most marginalized in society.Chapter 2 approaches the right not to have children through a number of stories related to contraception, abortion, and family planning. Paynter sketches some of the key points in Canada's journey toward the decriminalization of abortion, from paradoxical trailblazers, such as Dr. Emily Stowe in the 1800s, to the viral memefied content of art protestor iamkarats. While the unequivocal legality of abortion in Canada suggests incredible progressiveness and support for women's rights, Paynter paints a more complex picture through her chosen narratives. Crucially, the inequitable geographical access to abortion, in particular, throughout the huge landmass of Canada suggests that the right to not have children in Canada is not universal. Moreover, Paynter suggests that access is also bounded by financial constraints, finite public funding, and the limited availability of inclusive clinics that prioritize healthcare for LGBTQ2S+ people.Chapter 3 considers the topic of having children; in particular, the right to reproductive technologies and freedom from forced sterilization. Paynter quickly makes clear that while many white feminists might see having and not having children as diametrically opposed, they are two equally essential parts of reproductive justice. Paynter draws attention to the Sexual Sterilization Act of 1928 that was only overturned in 1972. She describes it as part of the "genocidal colonial project" (84), a collection of laws and policies aimed at fulfilling eugenicist, neoimperial ideals of increasing production of the white "race" and promoting the genocide of Indigenous peoples. Furthermore, Paynter argues that evidence of forced sterilization of Indigenous peoples, and other physical violence and neglect, persists to the present day and must be stopped and reparations made for previous harms. Paynter then considers the complex, often-debated case of commercialized surrogacy, which she defines... (shrink)

The way health is conceptualized determines the actions taken to protect and promote it and, in turn, the actors responsible for such actions in an increasingly inter-dependent world. This essay presents a brief description of health policies in Peru during the last ten years in order to analyze the implications of paradigms of medical ethics, human rights and quality of care. These paradigms offer distinct ways of formulating, applying and evaluating health policies and understanding the relationship among (...) different actors at various levels. Building upon other detailed analyses of sexual and reproductive health policy in Peru (Coe, 2004; Miranda and Yamin, 2004), as well as critical appraisals of health services models (Gericke, Kurowski, Ranson and Mills, 2005; Krieger, Northridge, Gruskin, Quinn, Kriebel, Davey Smith, Bassett, Rehkopf and Miller, 2003), this article advocates the importance of construing and promoting health as a human right. (shrink)

This article focuses on the initial reactions to the Zika epidemic by national and international public health agencies. It presents and analyzes some responses public officials made about sexual and reproductive health at the inception of the epidemic. It also describes the different challenges and obligations faced by local and international public health agencies, as these have not been clearly outlined. The article argues that these agencies have different obligations and should fulfill them despite existing (...) obstacles. While international agencies should honor their leadership role and make recommendations at a meta-level, local agencies should provide, in the case of Zika, a framework for empowerment and grant women the freedom to achieve sexual and reproductive health so that they can avoid the consequences of this epidemic. (shrink)

A woman’s lack of or limited reproductive autonomy could lead to adverse health effects, feeling of being inferior, and above all being unable to adequately care for her children. Little is known about the reproductive autonomy of married Ikwerre women of Rivers State, Nigeria. This study demonstrates how Ikwerre women understand the terms autonomy and reproductive rights and what affects the exercise of these rights. An exploratory research design was employed for this study. A semi-structured interview (...) schedule was used to conduct thirty-four in-depth interviews and six focus group discussions with purposively sampled educated, semi-educated, and uneducated Ikwerre women in monogamous or polygynous marriages. The collected data was analysed qualitatively with MAXQDA 11 using open and axial coding. The interviews and focus group responses reveal a low level of awareness of autonomy and reproductive rights amongst the Ikwerre women in Nigeria. While some educated women were aware of their reproductive rights, cultural practices were reported to limit the exercise of these rights. Participants reported that Ikwerre culture is a patriarchal one where married women are expected to submit and obey their husbands in all matters; and a good married woman according to Ikwerre standard is one who complies with this culture. Women’s refusal of sexual advances from their husbands is described as not being acceptable in this culture; and hence rape in marriage is not recognized in Ikwerre culture. Education and awareness creation on the importance of women’s reproductive autonomy could improve their reproductive rights and autonomy in marital settings. Overcoming the patriarchal aspects of Ikwerre culture—for example, the greater value placed on male children than female children and treating women as incompetent individuals—is necessary to promote gender equality as well as help improve women’s reproductive autonomy. (shrink)

The relationships between socioeconomic and biogenetic reproduction are always socially constructed but not always acknowledged. These relationships are examined as they apply to an instance of infertility and assisted reproduction presented in a seventeenth-century English play, Thomas Middleton’s 1613 comedy, A Chaste Maid in Cheapside. Middleton’s satirization of the effects of secrecy on the category of reproductive disability is analyzed and its applicability to our own time considered. The discussion is in four parts, focusing on: the attribution of disabled (...) status to one member of the couple, the wife; the use of this attribution to protect the husband’s reputation for sexual and reproductive health; the concealment of the nature of assisted reproduction; and the interests of the child conceived with such assistance. (shrink)

The World Conference on Human Rights that was held in Vienna in 1993, marked an important beginning in the recognition of reproductive and sexual rights as human rights. Among other goals, the Vienna Conference sought to end gender discrimination in all its manifestations; gender-based violence, sexual harassment, and sexual exploitation. However, the turning point for the development of reproductive and sexual rights was the consensus that emanated from the International Conference on Population and Development (...) held in Cairo in 1994, and the Fourth World Conference on Women in held in Beijing 1995 as evidenced by the programs for action that were adopted.The Cairo Conference defined reproductive health as “a state of complete physical, mental and social well-being and not merely the absence of infirmity, in all matters relating to the reproductive system and to its functions and processes.”. (shrink)

What is sex and why is it important? Does marriage have a basic rationale? How should couples manage their fertility, and when and how should pregnancy be achieved? How should we respond to 'embryo adoption', teenage pregnancy, population growth, HIV/AIDS and other STIs, same-sex attraction? This collection of original essays looks at these and other pivotal issues in reproductive and sexual ethics, from the perspectives of philosophy, theology, psychology and economic science.

Feminist scholars have identified how race and gender discourses influence the creation and implementation of school-based sexual health education and the provision of health care, yet there are few studies that examine how race and gender work in sexual health promotion as it occurs through community-based public health efforts. Drawing on three years of ethnographic research in a low-income Puerto Rican community, this article demonstrates how a gendered racial project of essentializing Latinx culture surrounding (...) young women’s sexuality and reproduction works to both obscure and reinforce race and racism in sexual health promotion. Professional stakeholders mobilize culture as an explanation for high birth rates among young Latinas in the city and reproduce a “Latino culture narrative” in which Latina gender and sexuality is understood as deterministic and homogenous. Simultaneously, an ideology of colorblindness enables the uncritical promotion of long-acting reversible contraception and obscures the history of reproductive oppression experienced by women of color. I consider how colorblindness and culture narratives allow stakeholders to abdicate responsibility for gendered racial inequality and conclude by advocating for the incorporation of racial and reproductive justice frameworks in sexual health promotion. (shrink)

In the midst of extreme and dualistic religio-political debates regarding women’s sexual wellness and abortion, one begins to wonder what a new theo-ethical approach might look like which rejects overly-simplistic, harmful understandings of such crucial issues. What might it look like to truly centre women’s full human experiences, loving each other in a way that addresses harm and meets tangible needs? This article examines the complex inequitable structural and institutional realities of sexual wellness and abortion through an intersectional (...) theo-ethical lens. The article then proceeds to suggest a new socio-religio-political ‘Pro-Love’ philosophy, undergirded by foundational theological understandings of justice-oriented love, and situated within the broad fields of Feminist, Liberation, Process, and Queer Theologies, within the Christian tradition. The suggested approach requires systematically addressing root issues affecting the lack of equitable access to sexual wellness and the racist/sexist/classist structures forcing women into under-resourced and unsafe environments, leading to high demand for abortion services. (shrink)

Adolescent sexuality is one of the most important reproductive health issues that confronts healthcare professionals with moral dilemmas and legal issues. In this study, we aim to justify the at-risk adolescents’ regulations on access to key reproductive health services (KRHSs) based on principles of Islamic biomedical ethics and jurisprudence. Despite the illegitimacy and prohibition of sexuality for both girls and boys in Islamic communities, in this study, using 5 principles or universal rules of purpose; certainty, no-harm; (...) necessity; and custom, we argue that first, applying these principles in the context of the no-harm principle can provide the best interests of at-risk adolescents; second, it is permissible to provide KRHSs to these adolescents with their own assent, as long as necessary, only with the intention of preventing or reducing harm. In this framework, while preventing harm, it tries to provide the best interests of at-risk adolescent. Thus, the principle of no-harm requires that the government, by designating the responsibility to healthcare professionals, protects at-risk adolescents from harm, and obliges these professionals to choose and implement the option that best suits adolescents’ interests. (shrink)

The impact of culture and religion on sexual and reproductive health and behavior has been a developing area of study in contemporary time. Therefore, it is crucial for people using reproductive procedures to understand the religious and theological perspectives on issues relating to reproductive health. This paper compares different perspectives of three Abrahamic faiths, i.e., Judaism, Christianity, and Islam on ARTs. Procreation, family formation, and childbirth within the context of marriage have all been advocated (...) by these three major religions of the world. Judaism permits the use of all assisted reproductive technologies when the oocyte and sperm come from the husband and wife, respectively. The different denominations of Christianity have diverse views on reproductive practices. Although the Vatican does not approve of assisted reproduction, Protestant, Anglican, and other religious groups are free to use it. ARTs are acceptable in Sunni Islam, although they can only be carried out if the couples are married. Shia Islam, however, permits third-party donations to married couples under specific restrictions. This comparison reveals that while the three major world religions utilize assisted reproduction in distinct ways, there are also many comparable aspects of each religion. (shrink)

Sexual dimorphism, symmetry, and coloration in human faces putatively signal information relevant to mate selection and reproduction. Although the independent contributions of these characteristics to judgments of attractiveness are well established, relatively few studies have examined whether individuals prioritize certain features over others. Here, participants (N = 542, 315 female) ranked six sets of facial photographs (3 male, 3 female) by their preference for starting long- and short-term romantic relationships with each person depicted. Composite-based digital transformations were applied such (...) that each image set contained 11 different versions of the same identity. Each photograph in each image set had a unique combination of three traits: sexual dimorphism, symmetry, and color cues to health. Using conjoint analysis to evaluate participants’ ranking decisions, we found that participants prioritized cues to sexual dimorphism over symmetry and color cues to health. Sexual dimorphism was also found to be relatively more important for the evaluation of male faces than for female faces, whereas symmetry and color cues to health were relatively more important for the evaluation of female faces than for male faces. Symmetry and color cues to health were more important for long-term versus short-term evaluations for female faces, but not male faces. Analyses of utility estimates reveal that our data are consistent with research showing that preferences for facial masculinity and femininity in male and female faces vary according to relationship context. These findings are interpreted in the context of previous work examining the influence of these facial attributes on romantic partner perception. (shrink)

A reductive reading of Humanae vitae seeks to limit its appeal to a ban on contraception. In truth, however, it offers a vision of human sexuality and conjugal love with broad and enduring relevance. In setting forth the intrinsic complementarity and irreducibility of the unitive and procreative dimensions of the conjugal act, Paul VI has given us a hermeneutical key for assessing many contemporary ethical dilemmas in human reproductive medicine. From this perspective, this article seeks to apply the logic (...) of Humanae vitae to several real-life scenarios confronted by medical practitioners, educators, and ethicists working in the field of fertility and reproductive health. These include a consideration of the ethics of prescribing hormonal contraceptives, the possibilities of investigating male infertility, issues of cooperation in counseling and assisting conception in same-sex relationships, the ethics pertaining to assisted reproductive technology, the contested case of prenatal adoption, and the application of double-effect reasoning. On the occasion of the fiftieth anniversary of the promulgation of Pope Paul VI's encyclical Humanae vitae, this article seeks to defend its enduring relevance to modern-day society, through application of its reasoning to contemporary dilemmas in reproductive medicine. It considers real cases of the ethics of prescribing hormonal contraceptives, of investigating male infertility, of cooperating in counseling and assisting conception in same-sex relationships, of ART, of prenatal adoption, and the application of double-effect reasoning. (shrink)

The introduction of Viagra in Japan is largely associated with the construction of ‘abject masculinities’. The approval of the drug comes amidst worries about hormones polluting the environment and Japanese men's unwillingness to perform their ‘appropriate gender role’ in a country coping with problems in the economy, a growing number of unmarried people, an ageing population and declining birth rates. In this article, I analyse how impotence, gender and reproduction are entangled in the ways in which Japanese physicians report erectile (...) dysfunction (ED) and prescribe Viagra. The accounts of physicians, taken from the media and scientific reports, show that medical doctors tend to uphold ‘the Viagrization of ED’, which will lead to the Viagrization of Japan. Despite discourses on medicalized sexuality, reproductive behaviour and promotion of childbirth, the politics of Viagra largely promote male recreational sex with substantial benefits for the pharmaceutical and sex industries. Also, the politics of Viagra seem to underpin the commodification of a sexualized male body that ignores the reproductive health concerns of Japanese men. (shrink)

India is home to 243 million adolescents. Two million of them belong to Scheduled Tribes living in underserved, rural areas. Few studies have examined the health of tribal adolescents. We conducted a cross-sectional survey to assess the health, nutrition and wellbeing of adolescent girls in rural Jharkhand, eastern India, a state where 26% of the population is from Scheduled Tribes. We aimed to identify priorities for community interventions to serve adolescents and their families. Between June 2016 and January (...) 2017, interviewers visited all households in 50 purposively sampled villages of West Singhbhum district, Jharkhand. They aimed to interview all girls aged 10–19. Interviewers conducted face-to-face interviews with girls to administer a survey about physical and mental health, disability, nutrition, sexual and reproductive health, gender norms, decision-making, education and violence. Interviewers also measured girls’ height, weight, and Mid-Upper Arm Circumference. Interviewers collected data from 3324 of an estimated 4068 girls residing in the study area. Their mean age was 14.3. 82% were from Scheduled Tribes. 89% of younger girls aged 10–14 and 46% of older girls aged 15–19 were in school or college. Girls dropped out of school because they were required for household work or work on the family farm or business. Over a third reported symptoms of anaemia in the past month, but less than a fifth had a blood test. The prevalence of thinness was 14% for younger girls and 6% for older girls. 45% of girls were stunted. 40% reported emotional violence in the past year, 14% physical violence, and 0.7% sexual violence. 12% had problems associated with depression or anxiety. 30% aged 15–19 had heard of contraception. Among married girls and their husbands, only 10% had ever used methods to prevent or delay pregnancy. Our study identified several priorities to improve adolescent girls’ health, nutrition and wellbeing in largely tribal areas of Jharkhand: reducing violence, early marriage and undernutrition, as well as improving mental health, knowledge about contraception and school retention. (shrink)

Antimicrobial Resistance is a threat to individual and to population health and to future generations, requiring “collective sacrifices” in order to preserve antibiotic efficacy. ‘Who should make the sacrifices?’ and ‘Who will most likely make them?’ are ethical concerns posited as potentially manageable through Antimicrobial Stewardship. Antimicrobial stewardship almost inevitably involves a form of clinical cost-benefit analysis that assesses the possible effects of antibiotics to treat a diagnosed infection in a particular patient. However, this process rarely accounts properly for (...) patients – above and beyond assessments of potential (non)compliance or adherence to care regimes. Drawing on a vignette of a pregnant woman of colour and migrant diagnosed with Mycoplasma genitalium, a sexually transmissible bacterium, this article draws out some of the ethical, speculative, and practical tensions and complexities involved in Antimicrobial Stewardship. We argue that patients also engage in a form of cost-benefit analysis influenced by experiences of reproductive and social (in)justice and comprising speculative variables - to anticipate future possibilities. These processes have the potential to have effects above and beyond the specific infection antimicrobial stewardship was activated to address. We contend that efforts to practice and research antimicrobial stewardship should accommodate and incorporate these variables and acknowledge the structures they emerge with(in), even if their components remain unknown. This would involve recognising that antimicrobial stewardship is intricately connected to other social justice issues such as immigration policy, economic justice, access to appropriate medical care, racism, etc. (shrink)

The Justice, Equity, Diversity, Inclusion, and Belonging (JEDIB) committee formed in 2022 in order to support diversity and inclusion in the Health Humanities Consortium and to advance best practices for equity and inclusion in the field of medical and health humanities. This Forum Essay describes our first year of work, including participant-led commitment statement crafting and strategic planning. Health humanities-specific JEDIB work is described in detail in essays about disability justice; gender, sex, sexuality, and reproductive justice; (...) and Indigeneity from a decolonial standpoint. The authors offer transferable techniques for other organizations and institutions with particular attention to heath care and health professions education. Another essay analyzes US institutional and demographic data to show that as an academic program, health humanities gives robust indicators of contributing significantly to student diversity and inclusive success in higher education and medical education. The Forum closes with a reflection on joining the work of equity and inclusion and what new priorities and awareness can emerge to inform health equity scholarship and epistemic justice. (shrink)

Nurses play a key role in the provision of services in relation to sexuality in both primary and sexual and reproductive health‐care. Given the intersection of sexualities with a range of social injustices, this study reviews research on nursing practice concerning sexuality from an emancipatory/social justice perspective. A systematic review of English articles published in nursing journals appearing on the Web of Science database from 2009 to 2014 was conducted. Thirty‐eight articles met the inclusion criteria. Analysis consisted (...) of a descriptive phase (types and location of studies, aspects of sexualities focused on, target health users and aspects of nursing practice focused on) and a critical/emancipatory phase. In terms of practice, our analysis revealed that: barriers exist to the integration of issues relating to sexuality in nursing practice; the social location of nurses and their personal feelings regarding sexuality influence their practice; content that addresses gendered norms and media that assist in communication underpin some emancipatory practices. Few studies locate analyses of nursing practice within gendered, cultural and social norms; consider advocacy as part of the practice of nurses; or analyse the promotion of health user participation in health services and structures. The implications for emancipatory practice are drawn out. (shrink)

In The legal determinants of health: Harnessing the power of law for global health and sustainable development, Gostin et al. provide a sustained account of how law can and should be used as an instrument of health promotion. We pick up on the themes of this report with a specific focus of the importance of abortion for women’s sexual and reproductive health and the impact that particular ways of framing abortion in law can have (...) on the lives of women and girls. In this short comment, we wish to emphasize that abortion regulations need to move beyond frameworks based on narrow understandings of harm towards more progressive agendas that take into account the social determinants of health in order to reduce barriers to care. This contribution is particularly relevant to the Commission’s criticism that those ‘[l]aws that stigmatise or discriminate against marginalized populations are especially harmful and exacerbate health disparities’. (shrink)

The objective of this study is to analyse the tensions between conceptualizations about Islam, women's sexual health and rights in Senegal. Sexual rights are defined here as the right to choose a partner, the right to enjoy sex without fear of violence or disease, and the right to physical integrity. These rights are examined through legal, Islamic and International frameworks in the context of their relevance to Senegal. The general population's, and Ulamas', positions, attitudes and behaviours about (...) these rights were collected through interviews and focus group discussions. These research methods revealed a strong opposition, from both men and women, to women's individual choice and control over her body as far as family planning, sexuality, or abortion are concerned. Most respondents regarded these rights as "Western." In their view, the idea of equality embedded in international human rights conflicts with local cultures and religion. At the level of service delivery, a large number of health care providers still believe that unmarried women should not be given information or family planning methods. Also revealed is how Islam is used to construct and legitimize existing reproductive and sexual roles and deprive women of rights in these areas. Part of the reason why women's rights are not observed relate to the failure by Senegal to enforce international human rights treaties and conventions that it has already signed. Failure by Senegalese women's associations to give priority to sexual rights, has also contributed to lack of real progress in this area. This study is meant to be used by Senegalese women's rights activist and human rights organizations, as, inter alia, a tool for advocacy for the advancement of women's sexual health and rights. (shrink)

This article raises the question of ‘normality’ today and the fracturing of health ideals along new lines of enablement and function. In particular the study asks if ‘functional’ and ‘dysfunctional’ are displacing ‘normal’ and ‘pathological’ as master biopolitical binarisms, and if so, what distinctions can be drawn between them. The discourse of ‘function’ and ‘dysfunction’ is certainly ubiquitous in two areas of research and practice: gerontology and sexology. In the former case ‘functional health’ is linked to successful aging (...) represented by technical tests around activities of daily living (ADLs) and risk-assessment profiles. In the latter case, sexual function and dysfunction have become all-encompassing markers of heterosexual competence, now largely detached from reproductive imperatives, but refashioned as integral to responsible and successful self-management. Presenting examples from both cases, the article concludes that functionality, circulating under the signs of ‘normal’, ‘natural’ and ‘healthy’, furnishes economic, technological, educational, professional, pharmacological and policy fields with a rich intellectual, practical and regulatory resource. (shrink)

The 2024 U.S. election will shape the future of global health policy, with crucial implications for continuing U.S. leadership in global health. The United States has long played a critical role in global health governance, through multilateral institutions under the United Nations (UN) and bilateral assistance to advance U.S. priorities. However, political shifts have challenged U.S. engagement in global health, with the politicization of global health policy threatening global governance under the World Health Organization (...) (WHO) and dividing global health support across political parties. This political polarization in global health proved catastrophic in the COVID-19 pandemic response and influential in the 2020 Presidential Elections. With the United States again seeking to advance global health policy, the 2024 Elections present a clear contrast in global health visions across U.S. political parties – with sweeping impacts on global governance, health funding, sexual and reproductive health, corporate regulations, tax equity, humanitarian challenges, and climate change. The future of U.S. leadership in global health hangs in the balance of this election, raising an imperative for candidates to highlight their global health positions and for voters to consider the global health implications. (shrink)

In Mexico, significant ethical and social issues have been raised by the COVID-19 pandemic. Some of the most pressing issues are the extent of restrictive measures, the reciprocal duties to healthcare workers, the allocation of scarce resources, and the need for research. While policy and ethical frameworks are being developed to face these problems, the gender perspective has been largely overlooked in most of the issues at stake. Domestic violence is the most prevalent form of violence against women, which can (...) be exacerbated during a pandemic: stress and economic uncertainty are triggers for abuse, and confinement limits access to support networks. Confinement also exacerbates the unfair distribution of unpaid labor, which is disproportionately assigned to women and girls, and highlights inequality in the overall labor market. Lack of security measures has resulted in attacks towards health workers, particularly female nurses, due to fear of contamination. Finally, resource results in lack of access to other health necessities, including sexual and reproductive health services. Research across all disciplines to face—and to learn from—this crisis should be done through a gender lens, because understanding the realities of women is essential to understand the pandemic’s true effects in Mexico and the world. (shrink)

Reproductive medical technology has revolutionized the natural order of human procreation. Accordingly, some have celebrated its advent as a new and liberating determinant of kinship at the global level and advocate it as a right to reproductive health while others have frowned upon it as a vehicle for “guiltless exchange of sexual fluid” and commodification of human gametes. Religious voices from both Christianity and Islam range from unthinking adoption to restrictive use. While utilizing this technology to (...) enable the married couple to have children through the use of their own sexual material is welcome, the use of third party, surrogacy, and reproductive cloning are not in keeping with the sacrosanct principles of kinship, procreation through licit sexual intercourse, and social cohesiveness for building a cohesive family as uphold by both Christianity and Islam. To examine such larger issues emanating from these new ways of human procreation, beyond the question of legality, is a point which legal scholars in both Christianity and Islam, when issuing religious decrees, have not anticipated sufficiently. The article proposes to be an attempt to that end through a qualitative critical content analysis of selected literature written on the subject. (shrink)

‘Teachers expect parents to teach you. Parents expect teachers to teach you. So actually you learn nothing and nobody wants to talk about it’. This quote from this research study is an adolescent girls’ cry for liberation from the silence related to sexuality because of the general reluctance of adults to talk to them about it. Given the growing concerns raised about the sexual and reproductive health of adolescents in South Africa, the aim of this study was (...) to conduct research with adolescent girls as subjects in order for girls’ voices to enhance adult researchers’ understanding of children’s need for support and guidance in the context of sexuality education. The purposively selected sample included 75 participants from three diverse high schools in the Western Cape. The research was conducted using a phenomenological approach that values the lived experiences of participants as significant in contributing to the knowledge on adolescent sexuality. A qualitative interpretative research design was applied to collect the data. This article argues that adults cannot help adolescents in their sexual emancipation – to be free – if they themselves are not free. If they were free, they would have been able and willing to engage with adolescents in every aspect, which includes their sexuality. Including adolescent girls as partners in transforming sexuality education is presented as a core principle for the sexual emancipation of both adolescent girls and adults. (shrink)