Sexual and Reproductive Health Matters最新文献

Comprehensive sexuality education (CSE) seeks to improve young people's knowledge, attitudes and practices in relation to sexual and reproductive health, sexual and social relationships, and dignity and rights. In Ethiopia, young people with disabilities and young women involved in sex work are particularly vulnerable to sexual violence and poor sexual health, yet face stigma and accessibility challenges that continue to exclude them from information, support and services. Because they are often out of school, these groups are also often excluded from programmes that are largely delivered in school settings. This paper explores the challenges faced by these groups of young people in accessing inclusive and age-appropriate sexual and reproductive health knowledge and services in the Ethiopian context and the implications for delivering CSE. The research included literature review, mapping analysis and interviews with young people from those two groups and with service providers and programme implementers. Our findings indicate that young people with disabilities and young women involved in sex work face myriad barriers to accessing information and services that support positive and healthy sexuality, relationships and rights. However, changes over the past decade to national and regional governance structures and a political environment in which CSE has become increasingly contested have generated siloed approaches to the provision of sexual and reproductive health information and services, and poor linkages to complementary services including violence prevention and social protection. It is vital that efforts to implement comprehensive sexuality education are informed by these challenges in the wider policy environment.

This paper examines factors associated with intimate partner violence (IPV) among newly married women in Nepal, and how IPV was affected by food insecurity and COVID-19. Given evidence that food insecurity is associated with IPV and COVID-19, we explored whether increased food insecurity during COVID-19 is associated with changes in IPV. We used data from a cohort study of 200 newly married women aged 18-25 years, interviewed five times over two years at 6-month intervals (02/2018-07/2020), including after COVID-19-associated lockdowns. Bivariate analysis and mixed-effects logistic regression models were used to examine the association between selected risk factors and recent IPV. IPV increased from 24.5% at baseline to 49.2% before COVID-19 and to 80.4% after COVID-19. After adjusting for covariates, we find that both COVID-19 (OR = 2.93, 95% CI 1.07-8.02) and food insecurity (OR = 7.12, 95% CI 4.04-12.56) are associated with increased odds of IPV, and IPV increased more for food-insecure women post COVID-19 (compared to non-food insecure), but this was not statistically significant (confidence interval 0.76-8.69, p-value = 0.131). Young, newly married women experience high rates of IPV that increase with time in marriage, and COVID-19 has exacerbated this, especially for food-insecure women in the present sample. Along with enforcement of laws against IPV, our results suggest that special attention needs to be paid to women during a crisis time like the current COVID-19 pandemic, especially those who experience other household stressors.

The COVID-19 pandemic highlighted the harm reduction potential of virtual sex work (VSW) such as video or audio calls with clients. VSW limits exposure to COVID-19 and STIs. However, sex workers using digital technologies face high risks of technology-facilitated intimate partner violence (IPV), such as non-consensual distribution of intimate images. This study explored perceived risks and benefits of VSW, including the salience of STI harm reduction. Ethnographic interviews and participant observation with self-identified cis women sex workers in Dakar between January 2018 and August 2019 informed a further period of focused data collection in June 2022, in which two key research participants and the author devised a goal of concrete community benefit: a list of contextually relevant digital privacy precautions and resources. Brainstorming this list during workshops with 18 sex workers provided prompts for participant perspectives. While participants generally preferred VSW, citing STI prevention as a key reason, most resumed in-person sex work after COVID-19 curfews lifted; social risks of digital privacy breach and potential outing outweighed physical risks of contracting STIs. Participants proposed privacy features for mobile applications to make VSW viable and benefit from STI prevention. Their reflections call on tech companies to embed values of informed consent and privacy into platform design, shifting the burden of protecting privacy from individuals to companies. This study addresses a gap in technology-facilitated IPV research, which has concentrated on Euro-American contexts. Participant perspectives can inform action in technology policy sectors to advance criminalised communities' rights to sexual health, privacy, and autonomy.

Obstetric violence has been documented throughout the world, yet this human rights issue has mostly been investigated in middle- and low-income countries where the intensity and brutality of abuse and mistreatment is more easily recognised as problematic. This integrative review aimed to analyse sources about obstetric violence in high-income countries with the objective of identifying gaps in the research, challenges to the study of obstetric violence, and solutions to framing research that meets those challenges. A systematic search was conducted using the PubMed and CINAHL databases from February to June 2022. Empirical and non-empirical sources, published in English, with no date restrictions, were retrieved. Citation searching was also done. Forty-six sources were included. Identified gaps in the research were: (a) scarce attention to obstetric violence in most high-income countries; (b) most US sources are non-scientific and from outside the healthcare disciplines; (c) inconsistencies in terminology; (d) most studies were conducted with samples of women who had given birth, with scant research about healthcare providers and obstetric violence, and (e) the association between obstetric violence and traumatic birth was under-recognised. Identified challenges to the study of obstetric violence were: (1) factors that enable and perpetuate obstetric violence are multilevel and nonlinear; (2) the phenomenon is contextually complex; and (3) blind spots from routinised harmful practices and normalised mistreatment can prevent healthcare providers and birthing people from recognising obstetric violence. A systems approach and complexity theory are guiding frameworks recommended as solutions to the challenges of studying and correcting obstetric violence.

Deeply rooted cultural beliefs and norms relating to the position and the responsibilities assigned to men and women play a significant role in propagating intimate partner violence (IPV). It is yet to be understood in what ways experiences of IPV contribute to how people socially construct their health and wellbeing as they navigate the tensions created by the prevailing sociocultural systems. To address this knowledge gap, we employed a social constructionist perspective and the eco-social model to explore how Kenyans aged 25-49 years socially construct their health and wellbeing in relation to their experiences of IPV. We conducted nine in-depth interviews and ten focus group discussions in four counties in Kenya between January and April of 2017. Textual analysis of the narratives reveals that although men are usually framed as perpetrators of violence, they may also be victims of reciprocal aggression by women, as recently witnessed in cases where women retaliate through gang attacks, chopping of male genitalia, and scalding with water. However, women are still disproportionately affected by gender-based violence because of the deeply rooted gender imbalances in patriarchal societies. Women experience social stigma associated with such violence and when separated or divorced in situations of unsafe relationships, they are viewed as social misfits. As such, most women opt to stay in unhealthy relationships to avoid social isolation. These experiences are not only unhealthy for their psychological wellbeing but also for their physical health and socioeconomic status and that of their offspring.

The changing abortion legal and practice landscape in the DRC in recent years calls for a re-examining of induced abortion experiences. The current study provides population-level estimates of induced abortion incidence and safety by women's characteristics in two provinces using direct and indirect approaches to assess indirect method performance. We use representative survey data on women aged 15-49 in Kinshasa and Kongo Central collected from December 2021 to April 2022. The survey had questions on respondents' and their closest friends' experience with induced abortion, including methods and sources used. We estimated one-year abortion incidence and proportion using non-recommended methods and sources overall and by background characteristics for each province separately for respondents and friends. The fully adjusted one-year friend abortion rate was 105.3 per 1000 women of reproductive age in Kinshasa and 44.3 per 1000 in Kongo Central in 2021; these were substantially higher than corresponding respondent estimates. Women earlier in their reproductive lifespan were more likely to have had a recent abortion. Approximately 17.0% of abortions in Kinshasa and one-third of abortions in Kongo Central involved non-recommended methods and sources according to respondent and friend estimates. The more accurate friend abortion incidence estimates indicate that women in the DRC often rely on abortion to regulate their fertility. Many use non-recommended means and sources to terminate, thus, significant work remains to actualise the commitments made in the Maputo Protocol to provide comprehensive reproductive health services that combine primary and secondary prevention services to reduce unsafe abortion and its consequences.