Culture, Health & Sexuality最新文献

University students in Myanmar experience a high prevalence of sexual and reproductive health (SRH) problems including unintended pregnancies and sexually transmitted infections. These are compounded by pervasive cultural taboos surrounding sex and sexuality. Sexual and reproductive health literacy is crucial to addressing these problems. Four focus group discussions with 33 university students revealed how cultural taboos act as barriers across five SRH literacy subdomains: accessing, comprehending, criticising and applying SRH information, and communicating with healthcare providers. Students primarily relied on online health information rather than face-to-face discussions. Many students considered SRH information to be 'dirty' and experienced feelings of shame, guilt and fear of being blamed or disrespected while seeking healthcare. They therefore hesitated to visit healthcare providers and sought SRH services only in urgent medical situations. Additionally, all SRH literacy subdomains were influenced by cultural taboos surrounding sex: societal denial towards youth premarital sex, and the perception of sexual matters as embarrassing and inappropriate. Advocacy is needed to promote positive societal attitudes towards sexual matters and youth premarital sex, signalling the value of culturally tailored digital SRH literacy interventions using vernacular language. Healthcare providers should offer non-judgemental youth-centred services to promote SRH literacy among students.

Violence remains a persistent challenge in South African schools, prompting investigations into underlying risk factors and mitigation strategies. However, an under-explored aspect of this violence is the potential link between the consumption of Internet porn via cellphones among girls and boys, and girls' risks to sexual violence inside the classroom. To address this gap, we used focus group discussions with 14-17-year-old South African girls to examine their experiences of porn access via cellphones and their accounts of sexual violence at school. The study illuminates the nuanced ways in which the girls experience risks and express agency. First, the girls illustrate a link between sexual harassment and boys accessing porn on their cellphones during class. Second, the findings show how girls negotiate their sexual agency and safety through contesting sexual violence. Third, there are conflicting views about porn: while some girls admitted liking and viewing porn, others objected to it as harmful and degrading. Finally, this study offers crucial insights into strategies to create safer school environments and gender equality by drawing attention to the intersections between cellphone porn consumption, sexuality, and girls' negotiations of sexual agency amidst sexual risk in the classroom.

This paper explores the definition of, and perceived community attitudes, toward kudanga, a Swahili street term for a type of transactional sex practised in Dar es Salaam, Tanzania. Rooted in economic and gender disparity, transactional sex increases adolescent girls' and young women's vulnerability to HIV and gender-based violence. We sought to understand perceived community attitudes about kudanga, and how the internalisation of norms surrounding gender-based violence relate to the experiences of young women who practise kudanga. Using qualitative data from focus group discussions with 37 young women, we found that community perceptions of kudanga were largely negative, and those who engaged in it were looked down upon and despised. Violence and lack of sexual agency were normalised when doing kudanga. However, young women understood kudanga to often be their best option to obtain economic stability and felt strongly that those who practised kudanga should not be stigmatised. Our research provides further evidence that transactional sex exists on a continuum and highlights the importance of reducing community stigma surrounding transactional sex as a means of decreasing risk of HIV and gender-based violence for young women. To our knowledge, this article is the first to explore kudanga.

Abortion was decriminalised in Northern Ireland in October 2019. Following decriminalisation, the new regulations set out legal provision for abortion up until 12 weeks, with conditions thereafter. This cross-sectional descriptive survey, conducted in late 2019 in Northern Ireland, gathered the views of health professionals on decriminalisation, and their willingness to provide abortion services. This article provides a thematic analysis of answers to narrative questions from the online survey, and identifies priority areas of engagement with healthcare professionals. We assess how healthcare professional roles and responsibilities, abortion procedures, the foetus, and women and pregnant people were discursively constructed by respondents who are willing or unwilling to provide abortion services in Northern Ireland. We identify a narrow understanding of 'harm', and gendered norms of women as irresponsible or duplicitous, as inhibitory factors to the normalisation of abortion services in Northern Ireland.

Utilising automated content analysis with transformer-based topic modelling (BERTopic), this study examines cross-outlet variation in volume and topics over two decades (2000-2022) of abortion coverage in seven major daily newspapers in the Netherlands. Our findings reveal an ongoing coverage of abortion. Volume of coverage was notably highest in religious newspapers, indicating that these newspapers constitute a prominent voice in Dutch abortion debate. We discerned four distinct frames used in abortion news coverage. The first emphasised political developments as well as protest and advocacy related to abortion, framing the issue as a controversial political and moral topic. The second emphasised uncommon and problematic aspects of abortion, neglecting to present it as a commonplace and safe reproductive healthcare procedure. Two other frames seek to undermine women's decision-making agency: the marginalisation of women's personal perspectives; and the highlighting of prerequisites for abortion care. The media's emphasis on a hierarchy of deservedness may consequently reduce public support for particular reasons for choosing abortion. Overall, our findings show that abortion remains a regularly covered and contentious issue, even amidst progressive legislation. This study highlights the need for balanced reporting that engages with women's diverse personal experiences and perspectives.

Young people comprise a significant proportion of migrants and refugees in Australia. Many encounter challenges in accessing contraception information and services. This study explored the views and experiences of young women from migrant and/or refugee backgrounds regarding the contraceptive implant and related decision-making. Interviews were conducted with 33 women, aged 15-24, living in New South Wales, Australia, who spoke a language other than English and had some experience of the implant. Three themes were developed from the data as follows: 'Finding your own path': contraception decision-making (in which participants described sex and contraception as being taboo in their community, yet still made independent contraceptive choices); Accessing 'trustworthy' contraception information and navigating services (in which participants consulted online resources and social media for contraception information, and preferred discussions with healthcare providers from outside their community); and Views and experiences of the contraceptive implant (while the implant was described as a 'Western' method, most participants regarded it as an acceptable, convenient, cost-effective, and confidential means of contraception). Decision-making regarding the implant is influenced by many factors which must be considered in health promotion efforts and when providing clinical care. Consideration of more informative health promotion resources, peer education strategies, and healthcare provider training is warranted to support contraception decision-making and choice.

Miscarriages, stillbirths and neonatal deaths have received limited attention in global health programmes and research, even though pregnancy loss is common, traumatic and stigmatised. This paper seeks to illuminate lived experiences of pregnancy loss in southern Malawi, drawing on findings from semi-structured interviews and focus groups with women who have experienced loss, health professionals and community members, and observations of maternity care. Combining thematic and discourse analysis, we show how societal and medical discourses frame women as responsible for (failed) reproduction, and restrict possibilities to speak about, and respond to, loss. Some accounts and (care) practices invisibilise loss and associated suffering. However, invisibilisation may also be intended as support, and underscores rather than denies the social significance of parenthood. Other accounts (e.g. women emphasising faith and acceptance) constitute moral survival strategies to avoid the acquisition of a 'spoiled identity'. We conclude that societal and medical discourses of loss enact stigmatised, subaltern subject positions for women experiencing pregnancy loss, create social suffering, and amount to a form of structural violence. Programmes and interventions should change these discourses.

This paper analyses the experiences of public healthcare workers in Uganda under the Anti Homosexuality Act (AHA) 2023, who specialise in the provision of HIV prevention and treatment services to criminalised 'key populations' for HIV, including men who have sex with men, transgender women, and female sex workers. Utilising in-depth semi-structured interviews with 17 public healthcare workers and participant observation with LGBTQ+ and HIV activists, public health officials, and development workers, this ethnographic study explored the legal, social and ethical challenges that public healthcare providers faced. Public healthcare workers have experienced various types of stigma from their work, including socio-legal stigma from the criminalisation of 'promoting homosexuality', stigma by association with key populations, concealment stigma, and denial. Legal ambiguities stemming from the AHA 2023 have led to security incidents for some public healthcare workers. The study highlights the ethical dilemmas that have arisen from the 'duty to report' clause, which conflicts with professional healthcare ethics of confidentiality, and the role the Ministry of Health played in passing the AHA 2023, instilling confusion about its enforcement, and minimising and denying the risks the legislation has had on Uganda's HIV epidemic.

Relatively little is known about the unique needs and issues faced by transgender men and their self-care practices during gender transition. This study aimed to analyse self-care practices during gender transition through the life histories of a group of Costa Rican transgender men. A qualitative study with a sociohistorical design employing a thematic life history approach was conducted with fourteen participants between April and September 2022. Data were analysed using Content Analysis. Three categories were developed concerning self-care: (i) the shaping of self-care practices throughout different life stages; (ii) self-care practices related to masculinising the body; and (iii) self-care practices on the margins of a cisheteronormative society. The identified self-care practices took place with the goal of materialising men's gender identity socially, legally and medically. While self-care plays a key role in supporting individuals throughout the transition process, it is limited in its capacity to ensure comprehensive well-being. The social prejudice and violence encountered by transgender men poses a challenge to achieving full well-being. External pressures and adversities limit the effectiveness of self-care practices, highlighting the need for broader systemic change to enhance the overall health and wellness of transgender men in Costa Rica.

Women who suffer from an obstetric fistula endure more than just physical pain. Their ability or desire to bear children may also be affected due to physical damage to their reproductive organs. In addition, they may suffer from emotional trauma which is likely to affect their decision to have children. The aim of this study therefore was to explore in more detail the perspectives of obstetric fistula survivors about childbearing after treatment for their condition. This qualitative study was conducted at a non-governmental organisation in the Central Region of Malawi. Data was collected using in-depth interviews from 18 women who had suffered from an obstetric fistula. The study revealed that many women either had no further desire for children or were unable to bear children. Fear of dying and resulting pain from the fistula surgery deter women from wanting further pregnancies. However, there was still strong emphasis placed on childbearing, especially for the younger women who desired children as a means of maintaining their marriages. The risk of further pregnancies and mitigation strategies for reducing obstetric fistulas, should be fully communicated to women. Those who become infertile as a result of obstetric fistula may also require appropriate counselling.