Sexual and Reproductive Health Matters最新文献

The COVID-19 pandemic has had a detrimental impact on sexual and reproductive health (SRH) and rights globally. However, little is known about the experiences of people with disabilities accessing SRH services during the COVID-19 pandemic. In this community-engaged qualitative study, we examined COVID-related impacts on access to SRH services for people with disabilities. We interviewed 61 women and gender-diverse people in Canada from May 2022 to March 2023. Informed by disability reproductive justice, we identified four major themes through constructivist analysis. First, COVID-related changes to SRH service delivery disrupted access to care and caused disability-related health implications. Second, pandemic response measures changed SRH service accessibility: in-person accessibility barriers were amplified, new in-person accessibility barriers were introduced, and the transition to telehealth exacerbated, as well as mitigated, accessibility barriers. Third, COVID-related social changes (e.g. lockdowns) had disability-related SRH and rights implications. Fourth, disabled people recommended improving SRH services by enhancing funding, provider training, information and communication, disability accommodations, representation, and comprehensive community engagement. Cutting across these themes were disproportionate negative impacts of the COVID-19 pandemic on access to SRH services for racialised women and gender-diverse people with disabilities. Failure to ensure SRH and rights for women and gender-diverse people with disabilities during the COVID-19 pandemic undermined disability reproductive justice. Comprehensive disability community engagement is necessary to inform accessible SRH services and policies, both during and beyond a pandemic.

Since menstrual health and menstrual inequity are determined by social power structures, this study proposes to analyse, from an intersectional perspective, the experiences of menstrual inequity of women and people who menstruate (PWM) (≥18 years) under circumstances of socioeconomic vulnerability in an urban and rural setting in Catalonia (Spain), focusing on menstrual poverty, menstrual management and access to health care for menstrual health. An exploratory and interpretative qualitative study was conducted. Venue-based convenience sampling was carried out, recruiting women from a non-governmental organisation and a primary health care centre. Eighteen individual semi-structured interviews were conducted between October 2022 and February 2023. Data were analysed through reflexive thematic analysis. Analysis revealed that menstrual care was generally a distant preoccupation that revolved around circumstances of socioeconomic vulnerability, housing, and productive/reproductive work. Menstrual poverty, menstrual management and menstrual self-care challenges, barriers to accessing health care for menstrual health, and menstrual taboo, stigma and discrimination were commonplace and deepened by socioeconomic vulnerability. In this way, women's menstrual experiences were rooted in intersecting axes of inequity, based on gender, race and class. Intersectional and critical participatory research, policy and practice are imperative to develop counter mechanisms that confront systems of privilege-oppression to modulate menstrual experience, health and equity.

Indiana consistently ranks among the states with the highest maternal and infant mortality in the United States, particularly affecting Black and Latine communities, endangering their right to safe and respectful maternal care. Providers working with these communities are crucial in identifying challenges faced by their clients, and to inform programs and policies. We interviewed 32 clinical and community-based providers from February to April 2021 to understand their perspectives on the challenges faced by their Black and Latine clients. Participants were identified through online sources and referrals. Interviews, conducted over online video, were recorded, transcribed, and analysed following a six-step thematic approach. Six areas of challenges emerged: non-medical infrastructure and policy problems, effects of systemic racism and bias, insecurity of the Latine community, dissatisfaction with maternal care delivery, issues in navigating maternal healthcare, and limitations to holistic models of care. The results demonstrate the interconnected structural, organisational, and interpersonal nature of the challenges. Though challenges were described at structural and organisational levels, the focus of state maternal care programs is largely at personal and interpersonal levels. Obstetric racism, citizenship restrictions, shortage of Black and Latine providers, and transportation issues are complex problems, requiring multilevel interventions and policies to ensure Black and Latine women can exercise their right to safe and respectful maternal care. A rights-based approach centring the needs of Black, Latine and other minoritised communities should be implemented to make effective changes with an equity focus.

The main objective of this study is to identify the barriers that prevent Roma women and girls from accessing reproductive rights derived from reproductive justice by analysing the discourses of service providers as a facilitating source of information. A qualitative study including nine semi-structured in-person interviews with community service providers was conducted in April-June 2019. The interview script addressed intercultural competences, views on gender discrimination against Roma women, resources available to fight against this discrimination, knowledge and use of these resources in reproductive justice, as well as the networks of actors involved. The qualitative analysis involved a discourse analysis. In the analysis, three focal areas were defined around which barriers to access spaces inspired by reproductive justice for Roma women could be identified. In each of the focal areas (stereotypes, discrimination and intercultural competences), discourses and practices have been observed in contrasting ways that can prevent access, as well as others that can facilitate access based on prejudices about Roma culture and people. The relationship models between professionals and users of the Roma population project stereotypes that are an obstacle in terms of accessing reproductive justice. The right of Roma women to preserve their culture and to actively participate in policies that affect them is not included and guaranteed in public policies. The intention to include the Roma population's situation in an inclusive narrative exists, although without short-term effects. Reproductive justice is an absent framework within professional intervention and the institutional system. DOI: 10.1080/26410397.2024.2439661.

Readers of Sexual and Reproductive Health Matter are no strangers to interrogating evidence in all its forms, assessing which claims it can support, and about challenges and uncertainties in international norms in the fields of sexual and reproductive rights and health. Questions of evidence, positionality and the role of testimony are particularly live in the context of sex work and human rights. As an exploration about good and bad practices in research and evidence, in this Commentary we highlight the errors, mistakes and wrongly shaped conclusions arising in the recent report by the UN Special Rapporteur on violence against women and girls about prostitution law, sex worker health and rights, and the status of international human rights law on sex work and trafficking. We do this not only to reinforce more accurate information about the status of human rights law, public health evidence and the needs of people of all genders in the sex sector, but also as an opportunity to remind us of the principles around evidence, transparency, and self-determination. We are conscious of the current vulnerability of global rights and health systems. Our Commentary seeks to contextualise our criticisms to this current moment of rights and health systems' fragility and multi-pronged attacks on the emancipatory potential of rights for persons in the sex sector as workers especially as they intersect with racist stereotypes. Practices of deploying evidence matter for rights advocacy: its legitimacy as well as its efficacy depend on good practices.

With drastic changes to abortion policy, the months following the Dobbs leak and subsequent decision in 2022 were a uniquely uncertain and difficult time for abortion access in the United States. To understand experiences of challenges to abortion access during that time, we used a hybrid inductive and deductive thematic coding approach to analyse descriptions of barriers and their impacts shared in an abortion subreddit (r/abortion). A simple random sample of 10% of posts was obtained from those shared from 02 May 2022 through 23 December 2022; comments were purposively sampled during the coding process. In this sample of submissions (n = 523 posts, 88 comments), people described structural barriers identified in past research, including state abortion bans and gestational limits, high costs, limited appointment availability, and long travel required. Posters also commonly described known social barriers, including limited social support and abortion stigma. Several impactful barriers not well-described in past research emerged inductively, including wait time for receiving mail-ordered abortion medication, low credibility of online ordering platforms, and concerns about legal risks of accessing abortion or related medical care. The most common consequences of experiencing barriers were adverse mental health outcomes, delayed access to care, and being compelled to self-manage their abortion because of access barriers. This analysis provides timely insights into the experiences and impacts of abortion access barriers in a group of people with a range of engagement with clinical abortion care, lived experiences, and points in their abortion processes, with public health implications for mental health and abortion access.