Pub Date : 2017-04-01Epub Date: 2017-02-24DOI: 10.1136/jfprhc-2017-101753
Lucy Cox
Many thanks to Hermione Lovel for her letter1 commending my personal view article on the vulva.2 I welcome the discussion as a way to further explore and emphasise this important topic. I want to respond to the points raised by Dr Lovel in turn. I agree wholeheartedly with Dr Lovel that using international terminology is helpful in describing female genital mutilation (FGM), which is why I used, and …
{"title":"Response to 'WHO classification of FGM omission and failure to recognise some women's vulnerability to cosmetic vaginal surgery'.","authors":"Lucy Cox","doi":"10.1136/jfprhc-2017-101753","DOIUrl":"https://doi.org/10.1136/jfprhc-2017-101753","url":null,"abstract":"Many thanks to Hermione Lovel for her letter1 commending my personal view article on the vulva.2 I welcome the discussion as a way to further explore and emphasise this important topic. I want to respond to the points raised by Dr Lovel in turn.\u0000\u0000I agree wholeheartedly with Dr Lovel that using international terminology is helpful in describing female genital mutilation (FGM), which is why I used, and …","PeriodicalId":15734,"journal":{"name":"Journal of Family Planning and Reproductive Health Care","volume":"43 2","pages":"166"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/jfprhc-2017-101753","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34762852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-04-01Epub Date: 2017-03-01DOI: 10.1136/jfprhc-2016-101649
Subhendu K Acharya
Hysterectomy is the second most common surgery performed on women in India, after caesarean sections. An estimated national mean age at hysterectomy is 30–40 years, and this is as low as 24 years in Andhra Pradesh.1 However, India does not have a national surveillance mechanism in this regard. Fieldwork conducted among several tribes and rural communities in Odisha, West Bengal and Bihar witnessed high incidences of hysterectomy-related medical anomalies and narratives of women's suffering. Normally, uterine fibroids, endometriosis, uterine prolapse, cancer and hyperplasia result in a hysterectomy.2 However, women suffering from reproductive tract infection or those seeking permanent sterilisation, particularly those from underprivileged, rural and tribal backgrounds, predominantly reported unethical medical practices in connection with hysterectomy; male patriarchy, women's low status in society, ignorance and superstitious …
{"title":"Womb, womanhood and medical ethics: concern about rising hysterectomy cases in India.","authors":"Subhendu K Acharya","doi":"10.1136/jfprhc-2016-101649","DOIUrl":"https://doi.org/10.1136/jfprhc-2016-101649","url":null,"abstract":"Hysterectomy is the second most common surgery performed on women in India, after caesarean sections. An estimated national mean age at hysterectomy is 30–40 years, and this is as low as 24 years in Andhra Pradesh.1 However, India does not have a national surveillance mechanism in this regard. Fieldwork conducted among several tribes and rural communities in Odisha, West Bengal and Bihar witnessed high incidences of hysterectomy-related medical anomalies and narratives of women's suffering.\u0000\u0000Normally, uterine fibroids, endometriosis, uterine prolapse, cancer and hyperplasia result in a hysterectomy.2 However, women suffering from reproductive tract infection or those seeking permanent sterilisation, particularly those from underprivileged, rural and tribal backgrounds, predominantly reported unethical medical practices in connection with hysterectomy; male patriarchy, women's low status in society, ignorance and superstitious …","PeriodicalId":15734,"journal":{"name":"Journal of Family Planning and Reproductive Health Care","volume":"43 2","pages":"165-166"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/jfprhc-2016-101649","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34774662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-04-01Epub Date: 2017-03-02DOI: 10.1136/jfprhc-2016-101699
Daniel Grossman
Even before President Trump's inauguration, it was clear that women's sexual and reproductive health (SRH) was going to be a focus of his policy initiatives. Now that he is in office, the impact of these policy changes is beginning to come into focus – and these initiatives affecting abortion, contraception, maternity care and more – are concerning from a medical and public health perspective. The past decade has seen improvements in the use of more effective contraception and a reduction in unintended pregnancy in the USA,1 and it is worrisome that Trump's policies could roll back progress on women's health. One of President Trump's first executive orders after his inauguration was to re-impose the Mexico City Policy, which regulates US funding to foreign non-governmental organisations. Also known as the Global Gag Rule, this policy prevents organisations that receive United States (US) funding from using any of their financial resources, regardless of source, to provide, inform about or advocate for access to abortion care in their countries. The Trump order appears to have expanded the scope of the Gag Rule, which has been imposed by every Republican president since Ronald Reagan: it now extends beyond funding from the United States Agency for International Development (USAID) to include programmes such as the President’s Emergency Plan for AIDS Relief (PEPFAR) and the National Institutes of Health (NIH). If reducing abortion were the aim of this policy, it is not at all clear that it is effective. Data from over a quarter of a million women across 20 nations …
{"title":"Sexual and reproductive health under the Trump presidency: policy change threatens women in the USA and worldwide.","authors":"Daniel Grossman","doi":"10.1136/jfprhc-2016-101699","DOIUrl":"https://doi.org/10.1136/jfprhc-2016-101699","url":null,"abstract":"Even before President Trump's inauguration, it was clear that women's sexual and reproductive health (SRH) was going to be a focus of his policy initiatives. Now that he is in office, the impact of these policy changes is beginning to come into focus – and these initiatives affecting abortion, contraception, maternity care and more – are concerning from a medical and public health perspective. The past decade has seen improvements in the use of more effective contraception and a reduction in unintended pregnancy in the USA,1 and it is worrisome that Trump's policies could roll back progress on women's health.\u0000\u0000One of President Trump's first executive orders after his inauguration was to re-impose the Mexico City Policy, which regulates US funding to foreign non-governmental organisations. Also known as the Global Gag Rule, this policy prevents organisations that receive United States (US) funding from using any of their financial resources, regardless of source, to provide, inform about or advocate for access to abortion care in their countries. The Trump order appears to have expanded the scope of the Gag Rule, which has been imposed by every Republican president since Ronald Reagan: it now extends beyond funding from the United States Agency for International Development (USAID) to include programmes such as the President’s Emergency Plan for AIDS Relief (PEPFAR) and the National Institutes of Health (NIH). If reducing abortion were the aim of this policy, it is not at all clear that it is effective. Data from over a quarter of a million women across 20 nations …","PeriodicalId":15734,"journal":{"name":"Journal of Family Planning and Reproductive Health Care","volume":"43 2","pages":"89-91"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/jfprhc-2016-101699","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34778298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-04-01DOI: 10.1136/jfprhc-2017-101767
Sandy Goldbeck-Wood, Toni Belfield
With this journal issue, we are introducing a new requirement for authors of original research papers to tell us how they have involved patients, or service users, in the conception, design, conduction and interpretation of their research. We are doing this because we think it will help us publish better papers – meaning papers better able to improve clinical outcomes - and because we think it is the right thing to do. Involving patients in research is a step towards reducing bias and waste in research1 as well as the kind of injustice which arises when the views of relevant stakeholders are discounted or downgraded.2 We are not the first to take such an initiative – the BMJ has led the way with its Patient Partnership Strategy, …
{"title":"Partnering with patients: how did you involve patients in your research?","authors":"Sandy Goldbeck-Wood, Toni Belfield","doi":"10.1136/jfprhc-2017-101767","DOIUrl":"https://doi.org/10.1136/jfprhc-2017-101767","url":null,"abstract":"With this journal issue, we are introducing a new requirement for authors of original research papers to tell us how they have involved patients, or service users, in the conception, design, conduction and interpretation of their research. We are doing this because we think it will help us publish better papers – meaning papers better able to improve clinical outcomes - and because we think it is the right thing to do. Involving patients in research is a step towards reducing bias and waste in research1 as well as the kind of injustice which arises when the views of relevant stakeholders are discounted or downgraded.2 We are not the first to take such an initiative – the BMJ has led the way with its Patient Partnership Strategy, …","PeriodicalId":15734,"journal":{"name":"Journal of Family Planning and Reproductive Health Care","volume":"43 2","pages":"94-95"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/jfprhc-2017-101767","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34907408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-04-01Epub Date: 2016-05-12DOI: 10.1136/jfprhc-2015-101356
Marguerite Kelly, Kumiyo Inoue, Kirsten I Black, Alexandra Barratt, Deborah Bateson, Alison Rutherford, Mary Stewart, Juliet Richters
Background: Contraception is a field in which good doctor-patient communication is crucial and core to shared decision making. Despite the centrality of contraception to primary health care in Australia, little is known about how doctors manage the contraceptive consultation. In particular, little is known about how doctors discuss sexual issues related to contraception.
Methods: Fifteen contraceptive providers participated in qualitative interviews averaging 45 min. Interviews were audio recorded, transcribed verbatim, and analysed using an inductive thematic approach.
Results: We found doctors were aware that they had to modify their illness-based 'scripts' in consultations about contraception, and said it was challenging always to adhere to a shared model of decision making. Prescribing behaviour reflected personal preferences in relation to some forms of contraception, and doctors were enthusiastic about the levonorgestrel-releasing intrauterine system. Doctors identified gaps in training in relation to sexuality and reported feeling tentative in raising sexual issues, even within contraceptive consultations.
Conclusions: A range of factors-including tendencies to use illness scripts, personal preferences, and discomfort with communications about sexuality-appear to influence doctors' approaches to contraceptive management. Medical training that enables doctors to move out of an illness-treating framework and to improve their understanding of and comfort in discussing sexuality issues will improve their management of healthy women seeking contraception.
{"title":"Doctors' experience of the contraceptive consultation: a qualitative study in Australia.","authors":"Marguerite Kelly, Kumiyo Inoue, Kirsten I Black, Alexandra Barratt, Deborah Bateson, Alison Rutherford, Mary Stewart, Juliet Richters","doi":"10.1136/jfprhc-2015-101356","DOIUrl":"https://doi.org/10.1136/jfprhc-2015-101356","url":null,"abstract":"<p><strong>Background: </strong>Contraception is a field in which good doctor-patient communication is crucial and core to shared decision making. Despite the centrality of contraception to primary health care in Australia, little is known about how doctors manage the contraceptive consultation. In particular, little is known about how doctors discuss sexual issues related to contraception.</p><p><strong>Methods: </strong>Fifteen contraceptive providers participated in qualitative interviews averaging 45 min. Interviews were audio recorded, transcribed verbatim, and analysed using an inductive thematic approach.</p><p><strong>Results: </strong>We found doctors were aware that they had to modify their illness-based 'scripts' in consultations about contraception, and said it was challenging always to adhere to a shared model of decision making. Prescribing behaviour reflected personal preferences in relation to some forms of contraception, and doctors were enthusiastic about the levonorgestrel-releasing intrauterine system. Doctors identified gaps in training in relation to sexuality and reported feeling tentative in raising sexual issues, even within contraceptive consultations.</p><p><strong>Conclusions: </strong>A range of factors-including tendencies to use illness scripts, personal preferences, and discomfort with communications about sexuality-appear to influence doctors' approaches to contraceptive management. Medical training that enables doctors to move out of an illness-treating framework and to improve their understanding of and comfort in discussing sexuality issues will improve their management of healthy women seeking contraception.</p>","PeriodicalId":15734,"journal":{"name":"Journal of Family Planning and Reproductive Health Care","volume":"43 2","pages":"119-125"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/jfprhc-2015-101356","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34380441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-04-01DOI: 10.1136/jfprhc-2017-101776
{"title":"In this Issue","authors":"","doi":"10.1136/jfprhc-2017-101776","DOIUrl":"https://doi.org/10.1136/jfprhc-2017-101776","url":null,"abstract":"","PeriodicalId":15734,"journal":{"name":"Journal of Family Planning and Reproductive Health Care","volume":"43 1","pages":"87 - 88"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/jfprhc-2017-101776","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49193180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-16DOI: 10.1136/jfprhc-2016-101469
Claire Rogers, Jaya A. R. Dantas
Aim This systematic literature review documented, analysed and critiqued the accessibility of contraception and sexual and reproductive health (SRH) information for women living in low- and middle-income countries who have undergone medical or surgical abortion. Methodology This review systematically collated relevant and recent empirical evidence regarding women's access to contraception and SRH information post-abortion within low- and middle-income countries. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework Guidelines, Flow Diagram and Checklist were utilised to undertake the review. The Ovid (MEDLINE), ProQuest, Science Direct, Web of Science, PUBMED and CINAHL databases were searched and studies that met edibility criteria were assessed for validity and analysis. A narrative synthesis of characteristics and results of the included studies is presented. Findings After detailed assessment of available and relevant literature, nine studies were selected for inclusion in the review. Studies highlighted barriers to contraception and SRH information including supply limitation, lack of comprehensive education and counselling, lack of skilled post-abortion care (PAC) providers and abortion stigma. Conclusions The review found that with access to a wide range of contraceptive methods combined with comprehensive SRH information and education, contraception uptake in women post-abortion does increase. The review also highlights the inconsistencies in clinic-reported ‘counselling’ and what this term actually involves within a PAC setting.
目的这篇系统的文献综述记录、分析和批评了生活在中低收入国家接受过药物或手术流产的妇女获得避孕药具以及性健康和生殖健康信息的情况。方法本综述系统地整理了有关中低收入国家妇女获得避孕药具和流产后性健康和生殖健康信息的相关和最新经验证据。PRISMA（系统评价和荟萃分析的首选报告项目）框架指南、流程图和检查表用于进行审查。检索Ovid（MEDLINE）、ProQuest、Science Direct、Web of Science、PUBMED和CINAHL数据库，并评估符合可食用性标准的研究的有效性和分析。对所包含研究的特点和结果进行了叙述性综合。研究结果在对现有和相关文献进行详细评估后，选择了9项研究纳入综述。研究强调了避孕和性健康和生殖健康信息的障碍，包括供应限制、缺乏全面的教育和咨询、缺乏熟练的堕胎后护理提供者以及堕胎耻辱。结论审查发现，随着获得广泛的避孕方法，再加上全面的性健康和生殖健康信息和教育，堕胎后妇女的避孕率确实有所提高。该审查还强调了诊所报告的“咨询”中的不一致之处，以及这个术语在PAC环境中实际涉及的内容。
{"title":"Access to contraception and sexual and reproductive health information post-abortion: a systematic review of literature from low- and middle-income countries","authors":"Claire Rogers, Jaya A. R. Dantas","doi":"10.1136/jfprhc-2016-101469","DOIUrl":"https://doi.org/10.1136/jfprhc-2016-101469","url":null,"abstract":"Aim This systematic literature review documented, analysed and critiqued the accessibility of contraception and sexual and reproductive health (SRH) information for women living in low- and middle-income countries who have undergone medical or surgical abortion. Methodology This review systematically collated relevant and recent empirical evidence regarding women's access to contraception and SRH information post-abortion within low- and middle-income countries. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework Guidelines, Flow Diagram and Checklist were utilised to undertake the review. The Ovid (MEDLINE), ProQuest, Science Direct, Web of Science, PUBMED and CINAHL databases were searched and studies that met edibility criteria were assessed for validity and analysis. A narrative synthesis of characteristics and results of the included studies is presented. Findings After detailed assessment of available and relevant literature, nine studies were selected for inclusion in the review. Studies highlighted barriers to contraception and SRH information including supply limitation, lack of comprehensive education and counselling, lack of skilled post-abortion care (PAC) providers and abortion stigma. Conclusions The review found that with access to a wide range of contraceptive methods combined with comprehensive SRH information and education, contraception uptake in women post-abortion does increase. The review also highlights the inconsistencies in clinic-reported ‘counselling’ and what this term actually involves within a PAC setting.","PeriodicalId":15734,"journal":{"name":"Journal of Family Planning and Reproductive Health Care","volume":"43 1","pages":"309 - 318"},"PeriodicalIF":0.0,"publicationDate":"2017-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/jfprhc-2016-101469","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47555024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-13DOI: 10.1136/jfprhc-2017-101744
Pamela Warner
Tim Albert. CRC Press (Taylor & Francis Group): Boca Raton, FL, 2016 ISBN-13: 978-1-785-23011-0. Price: £24.99. Pages: 156 (paperback) From the book title, right through to the concluding “Make sure you celebrate” (publication having been achieved!), this is a book to motivate anyone wishing to publish their research. The book was developed from a course – ‘How to publish a scientific paper’ – that Albert was invited to run over two decades ago. This fourth edition is testament to the success of earlier editions, and to the development of a book from ongoing extensive experience in delivering such a course. The book, updated to reflect the contemporary electronic publishing context, is light-hearted and very easy to read, albeit clearly based on substantial expertise. Albert's guidance is structured into 10 stages, and working through these will ensure that before launching his/her writing project, the researcher is clear about his/her goal, and has a realistic understanding of what publishing a paper entails. The first half of the book is focused on …
{"title":"Winning the Publications Game: The Smart Way to Write Your Paper and Get it Published (4th edition)","authors":"Pamela Warner","doi":"10.1136/jfprhc-2017-101744","DOIUrl":"https://doi.org/10.1136/jfprhc-2017-101744","url":null,"abstract":"Tim Albert. CRC Press (Taylor & Francis Group): Boca Raton, FL, 2016 ISBN-13: 978-1-785-23011-0. Price: £24.99. Pages: 156 (paperback)\u0000\u0000From the book title, right through to the concluding “Make sure you celebrate” (publication having been achieved!), this is a book to motivate anyone wishing to publish their research. The book was developed from a course – ‘How to publish a scientific paper’ – that Albert was invited to run over two decades ago. This fourth edition is testament to the success of earlier editions, and to the development of a book from ongoing extensive experience in delivering such a course.\u0000\u0000The book, updated to reflect the contemporary electronic publishing context, is light-hearted and very easy to read, albeit clearly based on substantial expertise. Albert's guidance is structured into 10 stages, and working through these will ensure that before launching his/her writing project, the researcher is clear about his/her goal, and has a realistic understanding of what publishing a paper entails. The first half of the book is focused on …","PeriodicalId":15734,"journal":{"name":"Journal of Family Planning and Reproductive Health Care","volume":"43 1","pages":"168 - 168"},"PeriodicalIF":0.0,"publicationDate":"2017-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/jfprhc-2017-101744","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47275673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-10DOI: 10.1136/jfprhc-2015-101424
H. Chahal, Z. Mumtaz
Objective To examine how availability of misoprostol has impacted women's abortion-seeking behaviour in Pakistan. Design Focused ethnography. Setting A facility providing reproductive health services, including induced abortions in Chakwal, a small town in Northern Punjab, Pakistan. Population Women who came to the clinic seeking an abortion or who had had one in the last 6 months (n=23) and all healthcare providers working in the facility (n=14). Methods Semi-structured interviews (n=37), a focus group discussion (n=1) and participant observation (n=41). Latent content analysis was conducted drawing on principles of constant comparison to generate key themes in reported experiences. Results All the respondents had sought an abortion to limit their fertility. Although some reported contraceptive use, improper use, undesirable side effects and restrictions on use had led to the unwanted pregnancy. All the women specifically requested misoprostol within days of their pregnancy, suggesting that they not only had knowledge of misoprostol as a backup in case of contraceptive failure, but may have pre-planned its use of in place of using contraception. Women reconciled their decision to undergo an abortion by describing it as a mistake, miscarriage or menstrual cycle issue. Conclusions Misoprostol's availability, ease of use and effectiveness have increased the role of abortion in fertility control.
{"title":"Abortion and fertility control in Pakistan: the role of misoprostol","authors":"H. Chahal, Z. Mumtaz","doi":"10.1136/jfprhc-2015-101424","DOIUrl":"https://doi.org/10.1136/jfprhc-2015-101424","url":null,"abstract":"Objective To examine how availability of misoprostol has impacted women's abortion-seeking behaviour in Pakistan. Design Focused ethnography. Setting A facility providing reproductive health services, including induced abortions in Chakwal, a small town in Northern Punjab, Pakistan. Population Women who came to the clinic seeking an abortion or who had had one in the last 6 months (n=23) and all healthcare providers working in the facility (n=14). Methods Semi-structured interviews (n=37), a focus group discussion (n=1) and participant observation (n=41). Latent content analysis was conducted drawing on principles of constant comparison to generate key themes in reported experiences. Results All the respondents had sought an abortion to limit their fertility. Although some reported contraceptive use, improper use, undesirable side effects and restrictions on use had led to the unwanted pregnancy. All the women specifically requested misoprostol within days of their pregnancy, suggesting that they not only had knowledge of misoprostol as a backup in case of contraceptive failure, but may have pre-planned its use of in place of using contraception. Women reconciled their decision to undergo an abortion by describing it as a mistake, miscarriage or menstrual cycle issue. Conclusions Misoprostol's availability, ease of use and effectiveness have increased the role of abortion in fertility control.","PeriodicalId":15734,"journal":{"name":"Journal of Family Planning and Reproductive Health Care","volume":"43 1","pages":"274 - 280"},"PeriodicalIF":0.0,"publicationDate":"2017-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/jfprhc-2015-101424","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48923944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-02-09DOI: 10.1136/jfprhc-2016-101492
M. Erickson, S. Goldenberg, M. Akello, G. Muzaaya, P. Nguyen, J. Birungi, K. Shannon
Background While female sex workers (FSWs) face a high burden of violence and criminalisation, coupled with low access to safe, non-coercive care, little is known about such experiences among FSWs in conflict-affected settings, particularly as they relate to sexual and reproductive health (SRH) and rights. We explored factors associated with lifetime abortions among FSWs in northern Uganda; and separately modelled the independent effect of lifetime exposures to incarceration and living in internally displaced persons (IDP) camps on coerced and unsafe abortions. Methods Analyses are based on a community-based cross-sectional research project in Gulu District, northern Uganda (2011–2012) with The AIDS Support Organization (TASO) Gulu, FSWs, and other community organisations. We conducted questionnaires, sex worker/community-led outreach to sex work venues, and voluntary HIV testing by TASO. Results Of 400 FSWs, 62 had ever accessed an abortion. In a multivariable model, gendered violence, both childhood mistreatment/or abuse at home [adjusted odds ratio (AOR) 1.96; 95% confidence interval (95% CI) 0.99–3.90] and workplace violence by clients (AOR 3.57; 95% CI 1.31–9.72) were linked to increased experiences of abortion. Lifetime exposure to incarceration retained an independent effect on increased odds of coerced abortion (AOR 5.16; 95% CI 1.39–19.11), and living in IDP camps was positively associated with unsafe abortion (AOR 4.71; 95% CI 1.42–15.61). Discussion and conclusions These results suggest a critical need for removal of legal and social barriers to realising the SRH rights of all women, and ensuring safe, voluntary access to reproductive choice for marginalised and criminalised populations of FSWs.
{"title":"Incarceration and exposure to internally displaced persons camps associated with reproductive rights abuses among sex workers in northern Uganda","authors":"M. Erickson, S. Goldenberg, M. Akello, G. Muzaaya, P. Nguyen, J. Birungi, K. Shannon","doi":"10.1136/jfprhc-2016-101492","DOIUrl":"https://doi.org/10.1136/jfprhc-2016-101492","url":null,"abstract":"Background While female sex workers (FSWs) face a high burden of violence and criminalisation, coupled with low access to safe, non-coercive care, little is known about such experiences among FSWs in conflict-affected settings, particularly as they relate to sexual and reproductive health (SRH) and rights. We explored factors associated with lifetime abortions among FSWs in northern Uganda; and separately modelled the independent effect of lifetime exposures to incarceration and living in internally displaced persons (IDP) camps on coerced and unsafe abortions. Methods Analyses are based on a community-based cross-sectional research project in Gulu District, northern Uganda (2011–2012) with The AIDS Support Organization (TASO) Gulu, FSWs, and other community organisations. We conducted questionnaires, sex worker/community-led outreach to sex work venues, and voluntary HIV testing by TASO. Results Of 400 FSWs, 62 had ever accessed an abortion. In a multivariable model, gendered violence, both childhood mistreatment/or abuse at home [adjusted odds ratio (AOR) 1.96; 95% confidence interval (95% CI) 0.99–3.90] and workplace violence by clients (AOR 3.57; 95% CI 1.31–9.72) were linked to increased experiences of abortion. Lifetime exposure to incarceration retained an independent effect on increased odds of coerced abortion (AOR 5.16; 95% CI 1.39–19.11), and living in IDP camps was positively associated with unsafe abortion (AOR 4.71; 95% CI 1.42–15.61). Discussion and conclusions These results suggest a critical need for removal of legal and social barriers to realising the SRH rights of all women, and ensuring safe, voluntary access to reproductive choice for marginalised and criminalised populations of FSWs.","PeriodicalId":15734,"journal":{"name":"Journal of Family Planning and Reproductive Health Care","volume":"43 1","pages":"201 - 209"},"PeriodicalIF":0.0,"publicationDate":"2017-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/jfprhc-2016-101492","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46709565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：