Sexual and Reproductive Health Matters最新文献

Early in the COVID-19 pandemic, emerging evidence showed that the provision and use of a range of health services, including sexual and reproductive health (SRH) services, were affected. Otherwise, there was little evidence on whether and how they were adapted to maintain the access of different population groups, including adolescents. The study aims to provide an overview of adaptations to adolescent sexual and reproductive health (ASRH) services carried out during the early phases of the pandemic in low- and middle-income countries (LMICs). The Human Reproduction Program (HRP) at the World Health Organization (WHO) called upon WHO and United Nations Populations Fund (UNFPA) regional offices to reach out to organisations that provided ASRH services to submit analytic case studies using a short-form survey. The study team charted information from 36 case studies and performed a content analysis. Results show that the adaptations covered a wide array of SRH services that were provided to a diverse group of adolescents. Most adaptations focused on SRH education and access to contraception in comparison to other SRH services. Over half of the case studies included mental health services, most of which were not provided before the pandemic. The adaptations varied between being face-to-face, remote, digital, and non-digital. Most adaptations complemented a pre-existing service and were nimble, feasible, and acceptable to the targeted adolescents. Lessons learned from this study could be extrapolated into other humanitarian settings and rapid responses for future public health emergencies, provided that rigorous evaluation takes place.

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.

We investigated the association between values and attitudes toward sexual and reproductive health and rights (SRHR) and gender equality, with reproductive agency in Ethiopia, Kenya, and Zimbabwe. Using 2020-21 World Values Survey (WVS) data (n = 3096), we utilised the SRHR Support Index including five subindices to gauge SRHR attitudes, the WVS Equality Index for gender equality values, and the perceived level of freedom of choice and control over whether, when, and how many children to have as a proxy for reproductive agency. Descriptive statistics, bivariate, and multivariable logistic regressions were used to analyse how values and attitudes differed between respondents of high vs low reproductive agency using the median as cut-off, stratified by country and sex. Country, education, subjective social class, and religion were associated with reproductive agency. Adjusted analyses indicated associations between supportive values and attitudes towards equitable masculinity norms, SRHR interventions and gender equality, with high reproductive agency. Associations varied more between countries than by sex. Findings suggest an association between SRHR and gender equality values and attitudes and the level of reproductive agency, and underscore the importance of addressing values and attitudes in context-specific interventions. Measures of SRHR progress should be critically reviewed and complemented with self-assessed - as opposed to researcher-ascribed - items to support the successful implementation of global SRHR agendas.

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.

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.

Drawing on an interdisciplinary approach, this study adopts and appropriates critical cultural theories such as Julia Kristeva's abjection and Pierre Bourdieu's social theories to examine the entangled and affective complexities of intending mothers, their reproductive trauma, and disenfranchised grief through the lens of Indian films such as Filhaal (2002) and works of fiction such as Baby Makers: A Story of Indian Surrogacy (2014) and Kartikeya: The Destroyer's Son (2017). Ample research has examined surrogate mothers' precarious position in the context of a surrogacy arrangement. However, not much has been discussed to reflect on the vulnerable status of the intending mothers who resort to surrogacy to fulfil their desire for motherhood. Thus, this study aims to highlight the significance of the selected fictional accounts to unfold the vulnerable and marginalised status of the intending mothers in a patriarchal society like India, where they find acceptance for their womanhood and earn respect and autonomy only through the power of their womb. The paper adopts generic fluidity and intersectionality as a methodology to critically analyse how the selected literature and film narratives can aid in instilling in us sensitivity towards the complex sociocultural positionality of the intending mothers who are normatively represented in popular discourses as immoral and monstrous. Emphasising the significance of the human rights-based approach to sexual and reproductive health, this research advocates for developing a non-discriminatory attitude towards intending mothers whose reproductive decision-making, privacy, and confidentiality related to the use of reproductive technology should be treated with respect and dignity.

Rural, indigenous populations in Mexico face barriers to accessing sexual and reproductive health (SRH) resources and services. Given the lack of information to inform educational materials tailored to the needs of these indigenous communities, we aimed to: (a) quantitatively characterise the SRH awareness and practices among adolescents and adults in a rural, mostly indigenous community in northern Mexico and (b) qualitatively assess community perspectives on an educational pamphlet with SRH information (e.g. contraceptive options). Quantitative data collection occurred in November 2018 and April 2019 using convenience sampling in a community clinic and random sampling for community households. Qualitative data collection occurred in November 2019 via individual interviews and focus group discussions to assess community perspectives about an SRH educational pamphlet developed from quantitative data. Participants in the quantitative phase of our study (n = 217) were a median age of 30 years, 71% were female, and those with children reported having a median of three (range = 1-11). SRH knowledge was low, as were self-reported efforts to obtain contraceptives or testing for HIV/STIs. Most believed that children should learn about SRH by age 10-15 years, and 94% felt that parents should deliver such education. Participants had low knowledge about SRH but high motivation to educate children and adolescents on these topics, indicating potential for SRH campaigns in this community. Health education materials were well-received in the qualitative phase of our study (n = 17 from individual interviews; n = 22 from focus group discussions), and raised interest among community members in learning more about these topics.

Black girls in the United States are disproportionately diagnosed with sexually transmitted infections (STIs), which can increase the risk of contracting HIV (human immunodeficiency virus), compared to adolescent girls of other races. Therefore, this study was designed to understand barriers to impactful HIV/STI and substance use prevention programmes for Black girls. Data was collected between October 2021 and June 2022 from twelve focus groups which included (N = 62) participants who identified as Black and female between the ages of 13 and 18 years old. Using intersectionality theory as a guiding framework, the data were analysed thematically. The analysis revealed three themes: (1) need for parent-child discussions on sex; (2) stigma in schools; (3) suggestions for Black girl-centred prevention programming. Participants described minimal discussion about sex in their household as well as STI/HIV and substance abuse stigma as barriers to impactful sex education. They also indicated that current substance use and STI/HIV prevention interventions are not tailored to the experience of Black girls and offered suggestions for improvement. In sum, participants pointed out several barriers to existing sex education and substance abuse prevention programmes. Findings revealed that HIV and drug use prevention information and knowledge may be best received from older peers in small private settings that can allow for intimate discussion and sharing of reliable information on HIV education, aetiology, and safer sexual practices. In addition, the study findings support the need to develop a racial and gender-specific prevention programming that fosters peer relationships, social support, and empowerment-based principles.