Menstrual health: Inequities in a cohort of menstruating people in the Brazilian southeastern region

OBJECTIVE

To assess menstrual hygiene management (MHM) and period poverty in a group of low- and medium-income menstruating people.

METHODS

A cross-sectional study was conducted at the University of Campinas, Brazil, from January to June 2022 with 535 participants aged 18-49. For data collection, we used the abbreviated version of the WHO Quality-of-Life questionnaire (WHOQOL-BREF) and a pre-tested questionnaire with items regarding MHM and period poverty.

RESULTS

We found an inverse relationship between the risk of no access to supplies to perform menstrual hygiene, which increased by 2.5% and each point less in the environmental domain of quality of life (QoL), and this risk increased by up to 3.1 times among participants who reported difficulty making ends meet. The risk of not having adequate conditions to perform menstrual hygiene at home increased by up to 2.6% for every one-point drop in the environmental domain of QoL. The risk of not having adequate conditions to perform menstrual hygiene outside the home increased by up to 1.3% for less points in the psychological domain of QoL, and 44.4% of those who indicated inadequate conditions for menstrual hygiene reported two or more childbirths.

CONCLUSIONS

Menstruating people who have an increased risk of lacking menstrual supplies and have an increased risk of inadequate conditions for MHM at home and outside the home, as well as those who have two or more deliveries and those having difficulties making ends meet, scored low on the QoL, especially in the environmental and psychological dimensions.

Infertility in the Pacific: A crucial component of the sexual and reproductive health and rights agenda

Across Pacific Island countries, women and men are disproportionately affected by several risk factors for infertility, including sexually transmissible infections, complications from unsafe abortions, postpartum sepsis, obesity, diabetes, tobacco smoking and excessive alcohol consumption. Despite this, little is known about community awareness of infertility, behavioural risk factors, the lived experiences of infertile couples or the contexts in which they access fertility care. In this opinion piece we discuss the current evidence and gaps in evidence regarding infertility in Pacific Island countries and the importance of locally tailored approaches to preventing infertility and the provision of fertility care.

Recurrent voluntary termination of pregnancy. Prevalence study and exploration of associated factors. Antioquia, Colombia, 2015 – 2021

Objectives

To describe the prevalence of recurrent voluntary termination of pregnancy (VTP) and to explore associated factors.

Materials and methods

Descriptive, cross-sectional cohort study which included women seen between 2015 and 2021 in five sites of an institution located in the Department of Antioquia which promotes sexual and reproductive health (SRH) care in Colombia. Measured variables included sociodemographics, SRH, recurrent performance of VTP, type of procedure used in the first VTP and contraception method selected afterwards. The prevalence of global and yearly recurrent abortion period is presented. Associated factors were explored using a multivariate analysis. The research committee of the institution approved the study.

Results

In total, 20,423 women were included. The prevalence of recurrent VTP was 4.07% (n = 831) during the entire period, ranging between 2.3 and 6% over the 7 years. The most commonly used method for recurrent VTP was pharmacological induction (48.50%). After the first VTP, 69.81% of women used contraceptive methods classified as “very effective” according to the World Health Organization. The risk factors identified as being associated with recurrent VTP included being part of the state-subsidized health insurance system (adjusted odds ratio [aOR] = 1.35; 95 % CI:1.05-1.72) and having had two or more pregnancies (aOR = 1.23; 95% CI: 1.06 - 1.44). Protective factors were identified and included out-of-pocket payment for VTP service (aOR = 0.71; 95% CI: 0.61-0.82), a history of late VTP (aOR = 0.30; 95% CI: 0.11-0.81), and the selection of a subdermal implant for contraception following the first abortion (sOR = 0.64; 95% CI: 0.49 – 0.83).

Conclusions

It is possible that the prevalence of recurrent VTP is increasing. Prospective studies are required in order to determine whether there is a growing trend and to verify potential association hypotheses derived from this work.

The hyper-regulation of abortion care in Italy

This paper argues that the current abortion regulation by Law 194/1978 is an inadequate basis for the provision of good quality abortion care and must be reformed. First, the paper explains why Law 194/1978 creates a hyper-regulatory regime that is inconsistent with the best clinical evidence and practices in the field as well as relevant international human rights law, as outlined in the World Health Organization's (WHO) 2022 Abortion Care Guideline. Second, it highlights gaps between what the law says and what happens in practice, pointing out how the everyday life of Law 194/1978, especially in the practices of gynecologists, is far removed from international standards of quality abortion care and has yet to comply with international human rights law. Third, it sets out some alternative routes to abortion access "outside" Law 194/1978. Finally, it concludes with some suggestions for a change in the practice of gynecology and a call for the reform of Law 194/1978, in favor of a bodily autonomy model of regulation grounded on decriminalization, demedicalization, dehospitalization, and self-management to ensure compliance with the WHO standards and international human rights law.

Main barriers to services linked to voluntary pregnancy termination on three grounds in Chile

Introduction

After decades of absolute criminalization, on September 14, 2017, Chile decriminalized voluntary termination of pregnancy (VTP) when there is a life risk to the pregnant woman, lethal incompatibility of the embryo or fetus of genetic or chromosomal nature, and pregnancy due to rape. The implementation of the law reveals multiple barriers hindering access to the services provided by the law.

Objectives

To identify and analyze, using the Tanahashi Model, the main barriers to the implementation of law 21,030 in public health institutions. This article contributes to the follow-up of this public policy, making visible the obstacles that violate women's rights of women to have dignified access to abortion and that affect the quality of health care in Chile.

Material and method

Qualitative design, following the postpositivist paradigm. The sample consisted of relevant actors directly related to pregnancy termination. Snowball sampling and semi-structured interviews were used. Grounded theory was used through inductive coding, originating categories regrouped into meta-categories following Tanahashi's model. The rigor criteria of transferability, dependability, credibility, authenticity, and epistemological theoretical adequacy were used. The identity of the participants and the confidentiality of the information were protected.

Results

From January 2021 to October 2022, 62 interviews were conducted with 20 members of the psychosocial support team; 18 managers; 17 members of the biomedical health team; 4 participants from of civil society, and three women users. The main obstacles correspond to availability barriers, accessibility barriers, acceptability barriers, contact barriers, and effectiveness barriers.

Conclusions

Barriers to access abortion under three grounds violate the exercise of women's sexual and reproductive rights. It is urgent to carry out actions of control and follow-up of this public policy to the corresponding entities.

Knowledge, Attitudes and Practices towards Sexual and Reproductive Health and Rights of Girls among Colombian Healthcare Professionals

This research aims to determine knowledge and attitudes towards sexual and reproductive health and rights of adolescent girls among healthcare professionals working at Café Madrid and Colorados health centers, which are highly vulnerable neighborhoods in Bucaramanga, Santander. To this end, in-depth interviews were conducted with a total of eight healthcare professionals from the above health centers using a script based on WHO recommendations on adolescent sexual and reproductive health and rights and recommendations by the DAPRE-Presidential Council for Women's Equity-CedaVida Foundation. Healthcare professionals were found to have proper technical and legal knowledge, especially regarding comprehensive care packages for survivors, as well as a gender perspective in their professional practice aimed at achieving equity. Knowledge and experience with sexual and reproductive health and rights provide insight into women's health from unrestrained choice of contraceptive methods to procedures such as abortion within the current legal framework. Their professional work is also affected by potential barriers that may limit their actions when putting their knowledge into practice.

Administering gender: Trans men's sexual and reproductive challenges in Argentina

BACKGROUND

There is dearth of experiential information about transgender men's sexual and reproductive rights needs and challenges in Argentina, a country that passed the first, and then most comprehensive, Gender Identity Law. Local rules, and administrative, social service, and medical policies fail to meet the transformative scope of the law, thus, creating a tension between trans identity recognition, and medical services.

AIMS

This study aimed to illustrate Argentinean trans men's challenges with the medical and healthcare system, when seeking to become pregnant, in prenatal care, or when needing an abortion.

METHODS

This study sought to counter exploitative research engagement on potentially vulnerable populations. It did so through examining newspaper coverage of trans men's self-representation. Following online media searches, the authors identified three trans men's public narratives about accessing medical services. The authors utilized thematic analysis to develop themes based on the men's accounts of experiences related to administrative violence.

RESULTS

Themes developed focused on (mis)gendering by medical staff, either inadvertently or intentionally, as well as the layers of institutional violence lived by the trans men vis a vis the laws and public policies already in place.

DISCUSSION

The paper closes by discussing implications for clinical services. It seeks to question implementations that center cisgender experiences, in order to take into account other identities, bodies and experiences.

Knowledge and perception of sexual and reproductive rights among married women in Nigeria

Married women of reproductive age can experience violations of their sexual and reproductive rights (SRRs). Adequate knowledge and understanding of SRRs are critical to their ability to protect themselves. This mixed methods study assessed the knowledge and perception of SRRs among ever-married women in Ibadan Metropolis, Nigeria. Quantitative data (N = 423) were obtained using an interviewer-administered questionnaire and summarised by computing scores for knowledge and perception. Qualitative data were obtained from five focus groups. Findings showed that 45.2% of the respondents said that they were aware of SRRs, yet 81.8% had poor knowledge scores. Regarding perceptions about SRRs, 73% of respondents obtained scores over the mean. In focus group discussions, participants generally could not explain the meaning of SRRs. However, they had positive perception of some SRRs, such as rights to family planning and freedom from violence/abuse. Overall, this study revealed that respondents had poor knowledge of SRRs but positive perceptions about them. A concerted effort is needed to raise public awareness and achieve basic education for women of reproductive age.

The overprotection of conscientious objection in Chile's abortion regulation

This paper critically analyses conscientious objection to abortion in the context of the new regulation of pregnancy termination in Chile. It argues that adequate regulation should not be blind: The bioethical requirements that seek to balance the interests involved must consider the legal regulation of the interests at stake, the context in which they are implemented, and, fundamentally, the effectiveness of the solutions adopted. Attention should be paid to the risks involved in the political use of conscientious objection to prevent the implementation of women's reproductive rights. In describing the process of the entrenchment and expansion of conscientious objection to abortion in Chile, we show how this process has overprotected conscience and how the risks of undermining the effectiveness of the new abortion legislation hinder the enjoyment of rights entrenched by the law.

Inclusion, exclusion: Comparative public policy (France/USA) in access to assisted reproductive technology

This article examines what French and American societies mean by the principle of personal autonomy/'right to privacy' and the concept of solidarity/'the best interest of the society at large'. It will attempt to show how these two countries translate these concepts into different public policies, more specifically in the field of access to sexual and reproductive rights of women and men. In order to better highlight these differences, I observe what citizens actually experience on the ground, and in so doing, it becomes clear that each country does not fully meet the principles they purport to defend.

Sexual and reproductive rights under attack: the advance of political and moral conservatism in Brazil

This article discusses political setbacks related to sexual and reproductive health and rights that have occurred in Brazil in the last 5 years (2014-2018) resulting from the significant role played by Christian (Evangelical and Catholic) parliamentarians in the legislative branch. Political initiatives aimed at prohibiting the affirmation of sexual and reproductive rights, while also curtailing debate about sexuality and gender in schools and universities, have raised "moral panic" within some elements of Brazilian society. The discursive strategies used around so-called "gender ideology" stimulated the formation of civil organisations which promote morality based on right-wing political positions. For this study, we looked at official documents and bibliographic material to examine how issues related to abortion rights, health care in cases of sexual violence, the prevention of sexually transmitted infections and homosexual citizenship are currently being suppressed, compromising the defence and advancement of the sexual and reproductive rights of women and the LGBTI+ population. The results point to the steady weakening of public policies that had become law in the 1980s, a time of Brazilian re-democratisation after two decades of military dictatorship. A wide range of civil, political and social rights, which saw significant growth and consolidation over the last 20 years, were rolled back after the resurgence of the extreme right wing in the federal legislature, culminating in the election of the current president in October 2018. However, social movements have increased in strength in the last few decades, especially the black feminist and LGBTI+ rights movements. These movements continue to provide political resistance, striving to affirm and protect all sexual and reproductive rights achieved to date.

A critical review of conscientious objection and decriminalisation of abortion in Chile

From 1989 through September 2017, Chile's highly restrictive abortion laws exposed women to victimisation and needlessly threatened their health, freedom and even lives. However, after decades of unsuccessful attempts to decriminalise abortion, legislation regulating pregnancy termination on three grounds was recently enacted. In the aftermath, an aggressive conservative drive designed to turn conscientious objection into a pivotal new obstacle, mounted during the congressional debate, has led to extensive, complex arguments about the validity and legitimacy of conscientious objection. This article offers a critical review of the emergence of conscientious objection and its likely policy and ethical implications. It posits the need to regulate conscientious objection through checks and balances designed to keep it from being turned into an ideological barrier meant to hinder women's access to critical healthcare.

Legal strategies to protect sexual and reproductive health and rights in the context of the refugee crisis in Europe: a complaint before the European Ombudsperson

In the context of the refugee crisis in Europe, the measures taken by the institutions and bodies of the European Union as they relate to respecting, protecting, and ensuring human rights have proven to be woefully inadequate. The development of a restrictive, defensive, security-based immigration policy has led to failure by European countries and the European Union to fulfil their human rights obligations. Specifically, the Agreement struck between the European Union and Turkey on 18 March 2016, in addition to externalising borders, placed economic and political considerations centre stage, leading to serious violations of the human rights of refugees and migrants, including their sexual and reproductive rights. In an effort to identify the failures and the institutions responsible for promoting the necessary measures to mitigate the negative impacts these policies have had, the international human rights organisation Women's Link Worldwide lodged a complaint with the European Ombudsperson. In its complaint, Women's Link alleges maladministration by the European Commission for its failure to carry out a human rights impact assessment of the 18 March 2016 EU-Turkey Agreement and the reports on its implementation. Such an assessment should include a gender perspective and a children's rights approach, and its omission is not only a failure to comply with international human rights standards, but also directly and negatively affects women's and children's rights.

Public health agencies' obligations and the case of Zika

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.

Should They Also Have Babies? Community Attitudes Toward Sexual and Reproductive Rights of People Living With HIV/AIDS in Nigeria

BACKGROUND

People living with HIV have the right to healthy, satisfying sex lives and to appropriate services to ensure their sexual and reproductive health, including having healthy children. The reproductive rights of people living with HIV/AIDS are, however, often met with skepticism and discrimination, despite recent advances in HIV treatment.

OBJECTIVE

To assess the attitudes of community members in Kano, Nigeria, toward the right of persons living with HIV/AIDS to have healthy sexual relationships and bear children.

METHODS

A cross-section of 399 adults was interviewed using pretested structured questionnaires. Logistic regression analysis was used to obtain adjusted estimates for predictors of agreement with the rights of persons with HIV/AIDS to bear children.

FINDINGS

A substantial proportion of respondents (28.6%) strongly agreed and agreed (10.5%) that persons with HIV/AIDS should not be allowed to marry. More than a fifth of the respondents disagreed (16.0%) and strongly disagreed (8.0%) with the rights of HIV-infected persons to bear children. Agreement with the statement "HIV-infected persons should have biological children" was independently associated with higher educational status (adjusted odds ratio: 2.26, 95% confidence interval: 1.82-6.73) and awareness of prevention of mother-to-child HIV transmission effectiveness (adjusted odds ratio: 2.53, 95% confidence interval: 1.92-5.37). Of those who agreed that HIV-infected persons should have children (n = 253), 17.8% and 26.1% strongly agreed and agreed, respectively, that persons living with HIV/AIDS should be restricted to having fewer children. Further, 11.5% and 4.8% of respondents disagreed and strongly disagreed, respectively, that infertile HIV-infected couples should receive fertility treatment.

CONCLUSIONS

People living with HIV/AIDS face discriminatory attitudes to their reproductive rights in northern Nigeria. There is a need for effective, culturally appropriate information, education, and communication approaches to improving community perceptions of sexual and reproductive rights of people living with HIV/AIDS.

Health care students at an Argentinean school of medicine: are they well prepared to provide quality sexual and reproductive health services?

OBJECTIVES

The aim of our study was to assess what students of the University of Buenos Aires School of Medicine learn about sexual and reproductive health (SRH) and rights, focusing particularly on their knowledge of accessibility to contraception and abortion legislation.

METHODS

In this cross-sectional study, self-administered, anonymous questionnaires were administered to 760 first year students and to 695 final year students from different fields of study (medicine, midwifery, nursing, radiology, nutrition, speech therapy and physiotherapy) between 2011 and 2013. Students' knowledge of SRH was measured according to six variables: contraceptive methods, accessibility to contraception, emergency contraception, legislation on surgical contraception, legislation on voluntary interruption of pregnancy, and HIV transmission and prevention. Their level of knowledge was categorised as low, basic, medium or high, according to their responses.

RESULTS

We observed higher levels of knowledge in final year students compared with first year students. Those with basic level knowledge or higher were doubled in most of the variables. However, when analysed in detail per field of study, the differences were not so marked. It is important that medical, midwifery and nursing students receive formal education in SRH topics.

CONCLUSIONS

Our investigation revealed important deficiencies in knowledge in core topics of SRH care among soon-to-be health care providers that could represent serious barriers to health and rights for the Argentinean population in the near future. Thus, there is an urgent need to improve the teaching of SRH care.

[Adolescents' access to contraception: perceptions of health workers in Huechuraba, Chile]

OBJECTIVE

Identify difficulties in adolescents' access to contraceptive care and information, based on perceptions and experiences of health workers in Huechuraba, in the Metropolitan Region of Chile.

METHODS

This qualitative, descriptive study incorporated principles of participatory action research, involving health care teams in the survey and data analysis, and generating proposals for improvement. Seventeen (17) semi-structured individual interviews and one group interview were conducted with professionals and technical personnel involved in adolescent care in the commune's health centers.

RESULTS

Health workers perceived that adolescents were having difficulties reaching the centers due to cultural factors, lack of information, lack of health activities in the community, while administrative requirements and procedures hindered access to care. Shortcomings were evident in the management and interpretation of fertility regulation standards and of current legislation, and in the absence of explanatory frameworks recognizing adolescents' gender, sexual, and reproductive rights.

CONCLUSIONS

Adolescents and their needs have a low profile and there are conflicts between theory and practice regarding access to contraception and counseling, with a lack of definitions or agreements that take into account social and cultural contexts. It is urgent to provide health workers with training on gender and sexual and reproductive rights, together with opportunities for reflection in order to generate coordinated and effective approaches. Efforts are required to disseminate the program and organize activities in community spaces, together with other community sectors.

Safe, accessible medical abortion in a rural Tamil Nadu clinic, India, but what about sexual and reproductive rights?

Women's control over their own bodies and reproduction is a fundamental prerequisite to the achievement of sexual and reproductive health and rights. A woman's ability to terminate an unwanted pregnancy has been seen as the exercise of her reproductive rights. This study reports on interviews with 15 women in rural South India who had a medical abortion. It examines the circumstances under which they chose to have an abortion and their perspectives on medical abortion. Women in this study decided to have an abortion when multiple factors like lack of spousal support for child care or contraception, hostile in-laws, economic hardship, poor health of the woman herself, spousal violence, lack of access to suitable contraceptive methods, and societal norms regarding reproduction and sexuality converged to oppress them. The availability of an easy and affordable method like medical abortion pills helped the women get out of a difficult situation, albeit temporarily. Medical abortion also fulfilled their special needs by ensuring confidentiality, causing least disruption of their domestic schedule, and dispensing with the need for rest or a caregiver. The study concludes that medical abortion can help women in oppressive situations. However, this will not deliver gender equality or women's empowerment; social conditions need to change for that.

The 'unexpected' Montevideo Consensus

This commentary examines the outcome of the First Latin American Regional Conference on Population and Development, held in Montevideo in August of 2013 to mark the twentieth anniversary of the International Conference on Population and Development (ICPD) and adopt forward-looking recommendations. While highly appraising the outcomes, this article maps the policy paradoxes of ICPD implementation in Latin America, in particular with regard to abortion, and charts challenges ahead to sustain the intersectional vision propelled by the 1994 Cairo Conference.

Beyond Cairo: sexual and reproductive rights of young people in the new development agenda

At the 1994 United Nations International Conference on Population and Development (ICPD), women's rights advocates fundamentally shifted the way the global development community views poverty, gender equality and reproductive rights. While the ICPD's call to action led to a marked improvement in reproductive health, more remains to be done to secure the sexual and reproductive rights and health of all, particularly for young people. As we approach the 20-year anniversary of Cairo, several global processes are happening concurrently that have implications for the future of the sexual and reproductive health and rights agenda, including the 20-year review of progress towards achieving the Cairo Programme of Action, the review of the Millennium Development Goals, and the open group discussions about the sustainable development goals and the new development agenda post-2015. There are five key areas of action where significant investment is needed moving forward to ensure young people's access and safeguard their rights: repeal outdated laws and create new policies that safeguard young people's health and rights; provide youth-friendly sexual and reproductive health services; guarantee young people's access to information and education; end gender discrimination and ensure government accountability.

Sexual, reproductive health needs and rights of young people with perinatally acquired HIV in Uganda

BACKGROUND

Numbers of young people with perinatally acquired HIV is growing significantly. With antiretroviral drugs, children who get infected at birth with HIV have an opportunity to graduate into adolescence and adulthood. This achievement notwithstanding, new challenges have emerged in their care and support needs. The most dynamic being, their sexual and reproductive health needs and rights (SRHR).

OBJECTIVES

This paper aimed at establishing the gaps at policy, program and health systems level as far as addressing sexual and reproductive health needs of young people who have lived with HIV since infancy is concerned.

METHODS

This paper is based on a desk review of existing literature on sexual and reproductive health needs and rights of young positives.

RESULTS

The results indicate young positives are sexually active and are engaging in risky sexual encounters. Yet, existing policies, programs and services are inadequate in responding to their sexual and reproductive health needs and rights.

CONCLUSION

Against these findings, it is important, that policies specifically targeting this subgroup are formulated and to make sure that such policies result in programs and services that are youth friendly. It is also important that integration of Sexual Reproductive Health (SRH) and HIV services is prioritized.