Integrating gender perspectives in gynecology and obstetrics: Engaging medical colleges in Maharashtra, India.

Failure to acknowledge the impact of sex and gender differences affects the quality of health care provision, and is an impediment to reducing health inequities. Systematic efforts were initiated in Maharashtra, India for reducing these disparities by developing gender-integrated curricula in undergraduate (UG) medical education between 2015 and 2018. A review of UG obstetrics and gynecology curricula indicated a lack of gender lens and focus on the reproductive rights of women. Based on these gaps, a gender-integrated curriculum was developed, implemented, and tested with medical students. Significant positive attitudes were seen among male and female students for themes such as access to safe abortion; understanding reproductive health concerns and their complex relationship with gender roles; violence against women as a health issue; and sexuality and health. These results strengthened the resolve to advocate for such a curriculum to be integrated across all medical colleges in the state.

Contribuições do enfermeiro no pré-natal para a conquista do empoderamento da gestante / The nurse's contributions in prenatal care towards achieving the pregnant women empowerment / Contribuciones de enfermería prenatal para conquista de habilitación de la embarazada

Objetivo: Compreender as contribuições do enfermeiro no pré-natal para o incentivo ao empoderamento feminino no processo de parturição natural, sob a ótica da gestante. Métodos: Estudo descritivo exploratório com abordagem qualitativa, desenvolvido em uma Unidade de Saúde da Família, em São Luís/MA, com gestantes que realizavam o pré-natal. Para análise dos depoimentos utilizou-se o referencial teórico Empowerment. Resultados: As orientações fornecidas pelos enfermeiros fazem alusão a muitos aspectos da gravidez, porém não evidencia que as gestantes se utilizaram das informações para alcançar o empoderamento no parto. Ademais, não se identificou a realização de ações educativas que visem à obtenção do empoderamento. Conclusão: As estratégias utilizadas pelo enfermeiro para o incentivo ao empoderamento caracterizam-se como práticas fragmentadas, refletindo ausência de diálogo entre gestante e profissional e não oferecendo o conhecimento suficiente para o preparo do exercício da autonomia feminina

Objective: The study's purpose has been to further understand the nurse's contributions in prenatal care in order to encourage female empowerment during the process of natural parturition by taking the pregnant woman perspective. Methods: It is a descriptive-exploratory study with a qualitative approach, which was carried out in a Family Health Unit at São Luís city, Maranhão State, Brazil, and having pregnant women who performed prenatal care as participants. For the testimonies' analysis, the Content Analysis Technique was used. Results: The nurses provided guidelines allude to many aspects of pregnancy, but it does not show that pregnant women have used the information in order to achieve empowerment during childbirth. Furthermore, it was not identified the accomplishment of educational actions aiming to obtain this empowerment. Conclusions: The strategies used by the nurses to encourage empowerment are considered as fragmented practices, thus reflecting the absence of dialogue between the pregnant women and the professionals, and also not offering sufficient knowledge to arrange the female autonomy implementation

Objetivo: La comprensión de las contribuciones de las enfermeras en el cuidado prenatal para fomentar la autonomía de la mujer en el proceso del parto natural desde la perspectiva de la mujer embarazada. Métodos: Estudio exploratorio descriptivo con un enfoque cualitativo, desarrollado en una Unidad de Salud de la Familia en São Luis/MA, con las mujeres embarazadas que realizaron allí prenatal. Para el análisis de los informes se utilizó la técnica de análisis de contenido. Resultados: Las directrices proporcionadas por enfermeras aluden a muchos aspectos del embarazo, pero no hay evidencia de que las mujeres embarazadas se utilizaron la información para lograr la potenciación en el parto. Por otra parte, no se identifica la realización de actividades educativas dirigidas a la consecución de este empoderamiento. Conclusión: Las estrategias utilizadas por las enfermeras para fomentar la potenciación se caracterizan por prácticas fragmentadas, lo que refleja la ausencia de diálogo entre la madre y profesional y no proporcionar suficiente conocimiento para preparar el ejercicio de la autonomía de la mujer

Participação do homem no planejamento reprodutivo: revisão integrativa / La participacion masculina en ma planificación reproductiva: una revision integrativa / Male participation in reproductive planning: an integrative review

Reproductive or family planning was a great achievement for the population. However, even though reproductive planning is a space for men and women, it is clear that the largest participating audience is composed by women. Objective: To describe the scientific knowledge of the participation of men in family planning. Method: This was an integrative review carried out in the LILACS, BDENF, and IBECS databases. Thirteen publications were found meeting the inclusion criteria. Results: The women’s control over their own fertility is considered one of the foundations of the women empowerment process with the consequent fall back of the derivations of a possible unwanted pregnancy on females. Conclusion: Based on the thought that conception is the result of natural and sexual performance between men and women, it is imperative that we continue to work on this in all areas of educational activities, especially in reproductive planning, so that we can build gender equality in the process of choosing a contraceptive method.

O planejamento reprodutivo ou familiar foi uma grande conquista para a população. Porém, ainda que o planejamento reprodutivo seja um espaço para homens e mulheres, é visível que o maior público de participação presente são as mulheres. Objetivo: Descrever o conhecimento científico sobre a participação do homem no planejamento familiar. Método: Revisão integrativa realizada na LILACS, BDENF e IBECS. Foram encontradas treze publicações que atenderam aos critérios de inclusão. Resultados: O comando da mulher sobre a própria fecundidade é considerado um dos grandes alicerces do processo de empoderamento, recaindo, consequentemente, sobre o ser feminino as decorrências de uma possível gravidez indesejável. Conclusão: Partindo do pensamento que a concepção é resultado natural e sexual entre homem e mulher, é imprescindível que continuemos a trabalhar isso em todos os espaços de ações educativas, principalmente no planejamento reprodutivo, para que possamos construir a igualdade de gênero na escolha do método contraceptivo.

La planificación reproductiva o de la familia fue un gran logro para la población. Sin embargo, a pesar de que la planificación reproductiva ser un espacio para hombres y mujeres, parece que la mayor audiencia de esta participación es de mujeres. Objetivo: Describir el conocimiento científico de la participación de los hombres en la planificación familiar. Método: Revisión integrativa llevado a cabo en las bases de dados LILACS, BDENF y IBECS. Se encontraron trece publicaciones que cumplieron con los criterios de inclusión. Resultados: El control de las mujeres sobre su propia fertilidad es considerada una de las bases del proceso de empoderamiento, por lo tanto las derivaciones de un posibleembarazo no deseadovolviendo a caer en la hembra. Conclusión: En base a la idea de que el diseño es el rendimiento natural y sexual de hombres y mujeres, es imprescindible que continuemos trabajando esto en todas las áreas de actividades educativas, especialmente en la planificación reproductiva, por lo que así podemos construir la igualdad de género en la elección del método anticonceptivo.

Linking Sexual and Reproductive Health and Rights and HIV Services for Young People: The Link Up Project.

Sexual health and access to services are a pressing need for young people. This article introduces Link Up, a 3-year project in three African and two Asian countries, to enable and scale up access to integrated HIV services and sexual and reproductive health and rights for marginalized young people. The young people we worked with in this project included young men who have sex with men, young sex workers, young people who use drugs, young transgender people, young homeless people, and other vulnerable young people. The research and programmatic activities of Link Up, as illustrated in this Supplement, have highlighted the importance of recognizing and engaging with diversity among young people to improve access to services and outcomes protecting their health and human rights.

Stigma Reduction Training Improves Healthcare Provider Attitudes Toward, and Experiences of, Young Marginalized People in Bangladesh.

PURPOSE: Working with health providers to reduce HIV stigma in the healthcare setting is an important strategy to improve service utilization and quality of care, especially for young people who are sexually active before marriage, are sexual minorities, or who sell sex. A stigma reduction training program for health providers in Bangladesh was evaluated. METHODS: A cohort of 300 healthcare providers were given a self-administered questionnaire, then attended a 2-day HIV and sexual and reproductive health and rights training (including a 90-minute session on stigma issues). Six months later, the cohort repeated the survey and participated in a 1-day supplemental training on stigma, which included reflection on personal values and negative impacts of stigma. A third survey was administered 6 months later. A cross-sectional survey of clients age 15-24 years was implemented before and after the second stigma training to assess client satisfaction with services. RESULTS: Provider agreement that people living with HIV should be ashamed of themselves decreased substantially (35.3%-19.7%-16.3%; p < .001), as did agreement that sexually active young people (50.3%-36.0%-21.7%; p < .001) and men who have sex with men (49.3%-38.0%-24.0%; p < .001) engage in "immoral behavior." Young clients reported improvement in overall satisfaction with services after the stigma trainings (63.5%-97.6%; p < .001). CONCLUSIONS: This study indicates that a targeted stigma reduction intervention can rapidly improve provider attitudes and increase service satisfaction among young people. More funding to scale up these interventions is needed.

Leadership and Innovation-Listening to and Learning From Young People in Burundi.

This commentary describes young people's leadership from the perspective of a youth-led organization in the Link Up project in Burundi, Réseau National des Jeunes vivant avec le VIH. It describes processes that enable young people to guide, influence, deliver, and improve health service provision; the challenges faced by Réseau National des Jeunes vivant avec le VIH and how they are addressing these challenges.

Mediación pedagógica en salud sexual y reproductiva, derechos sexuales y reproductivos dirigida a adolescentes / Pedagogical mediation in sexual and reproductive health, sexual and reproductive rights for adolescents / Mediação pedagógica emsaúde sexual e reprodutiva, direitossexuais e reprodutivos destinado a adolescentes

ResumenIntroducción. Al abordar el tema de la sexualidad desde el ámbito educativo, se han utilizado diversos métodos y procesos que, a lo largo de la historia, contribuyeron y facilitaron el desarrollo y la transmisión de conocimientos desde un sujeto o mediador, hacia una población determinada. Por ello es importante analizar la forma en cómo los temas de sexualidad se han transmitido a la población de adolescentes..El objetivo fue desarrollar estrategias de mediación pedagógica en salud sexual, salud reproductiva, derechos sexuales y reproductivos dirigidas a adolescentes que viven en el Hogar Madre Redentor de Pérez Zeledón, 2013.Método. Participó un grupo de adolescentes (15) entre 10 y 19 años, residentes del Hogar Madre Redentor de Pérez Zeledón. El estudio es diseño no experimental transeccional con un enfoque cuantitativo de tipo descriptivo.Resultado. Los resultados indican que utilizar métodos y técnicas pedagógicas interactivas, aunados al conocimiento, la experiencia y la práctica de un profesional en enfermería obstétrica, resultan muy beneficiosos, puesto que las participantes lograron comprender tanto los componentes de la adolescencia y la sexualidad, así como la importancia de mantener una vida sexual sana.Conclusión. Es importante que el profesional en enfermería en obstetricia conozca y desarrolle técnicas educativas con el fin de facilitar un aprendizaje colaborativo sobre salud sexual, salud reproductiva, derechos sexuales y derechos reproductivos, principalmente porque el efecto que causan es seguro para el aprendizaje y la alfabetización sexual de diferentes poblaciones, especialmente aquellas representadas por adolescentes.

AbstractIntroduction. This article presents the results of the implementation of strategies for pedagogical mediation in Sexual Health, Reproductive Health, Sexual Rights and Reproductive Rights. The aim was to develop strategies for teaching mediation in Sexual Health, Reproductive Health, Sexual Rights and Reproductive Rights for adolescents living at home Madre Redentor de Pérez Zeledón, 2013.Method. It involved a group of adolescents (15) between 10 and 19 years, residents of the Madre Redentor de Pérez Zeledón Home. Within the parameters of non-experimental design with a descriptive quantitative approach. A questionnaire, was previously validated prior to the implementation of mediation, in order to verify the pre- and post-knowledge of the participants on Sexual and Reproductive Health, The implementation of mediation was established in four basic units:1. Adolescents, 2. Sexuality in adolescence, 3. Health and sexual and reproductive rights, 4. Self-assessment and self-knowledge.Result. The results indicate that by using interactive teaching methods and techniques, coupled with the knowledge, experience and professional practice in midwifery, are very beneficial. Since the participants were able to understand both components of adolescence and sexuality, as well as the importance of maintaining a healthy sex life.Conclusion. It is important that the nurse practitioner in obstetrics learns to develop educational techniques in order to facilitate collaborative learning about sexual health, reproductive health, sexual rights and reproductive rights.

ResumoIntrodução. Este artigo apresenta os resultados da implementação de estratégias de mediação pedagógica emSaúde Sexual, SaúdeReprodutiva, DireitosSexuais e DireitosReprodutivos. O objetivo foi desenvolver estratégias para ensinar a mediaçãoemSaúde Sexual, SaúdeReprodutiva, DireitosSexuais e DireitosReprodutivos para adolescentes que vivemem casa Mãe Redentor Pérez Zeledón, 2013.Método.Tratava-se de um grupo de adolescentes (15) entre 10 e 19 anos, residentes do Casa Mãe Redentor Perez Zeledón. Dentro dos parâmetros de designnão experimental, comabordagemquantitativadescritiva. Umquestionário, que é previamente, antes da implementação da mediação e posterior das mesmas aplicadas, a fim de verificar o pré e pós-conhecimento dos participantes sobre Saúde Sexual e Reprodutiva, foi utilizado lei Sexual e Reprodutiva para coleta de dados . A implementação da mediaçãofoiestabelecidaemquatro unidades básicas: 1. Adolescentes, 2. sexualidade na adolescência, 3. saúde e direitossexuais e reprodutivos, 4. Auto-avaliação e auto-conhecimento.Resultado. Os resultados indicam que, usando métodos de ensinointerativos e técnicas, juntamente com o conhecimento, experiência e práticaprofissionalemobstetrícia, sãomuito benéficas, uma vez, os participantes foramcapazes de compreender ambos os componentes da adolescência e sexualidade, bem como a importância de manteruma vida sexual saudável.Conclusão. É importante que a enfermeiraemobstetrícia aprender e desenvolver técnicas de ensino, a fim de facilitar a aprendizagem colaborativa sobre a saúde sexual, saúdereprodutiva, direitossexuais e direitosreprodutivos, principalmente porque o efeito causado por ele é seguro para a aprendizagem e literacia sexual de diferentes populações, especialmente aqueles representados por adolescentes.

Current regulatory arrangements for assisted conception treatment in European countries.

Infertility is a condition affecting an increasing number of individuals all over the world. In recent years, this phenomenon has spread across both western countries and developing countries, thus developing the features of a pandemic. For this reason, the World Health Organization (WHO) acknowledged that infertility should be considered a disease to all intents and purposes, as it diminishes the health and wellbeing of the individuals who suffers from it. At present, the most effective means to contain the spread of infertility are essentially prevention and Assisted Reproductive Technologies (ART). With reference to the latter, although most of these techniques are routinely used in the majority of countries, they are still subject to medical, ethical and political debates. There are huge variations noted when the regulatory legislation adopted by different countries to govern infertility treatment in various countries all over the world are reviewed. In fact, it has to be recognized that ART legislation depends on a variety of factors, such as social structure, political choices, ethical issues and religious beliefs. This makes it apparently impossible to create a standard regulation for different countries, especially in case of controversial issues like gamete and embryo donation, embryo cryopreservation or surrogacy.

Nurse Perspectives on Referrals for Oncology Patients to Reproductive Endocrinologists: Results of a Learning Activity.

BACKGROUND: Although concern about future fertility for adolescents and young adults (AYAs) with cancer is high, referrals to reproductive endocrinologists (REI) are low. Oncology nurses are well positioned to facilitate these referrals but may lack the knowledge and training. This report describes a learning activity in the Educating Nurses about Reproductive Issues in Cancer Healthcare (ENRICH) program whereby oncology nurses interviewed REIs. METHOD: Participants were instructed to conduct an interview with an REI using a semistructured guide and provided a written report of the discussion. We examined responses to each question using qualitative content analysis. RESULTS: Seventy-seven participants across 15 states provided a summary. Learner summaries highlighted four themes related to FP, including Cost, Time, Lack of Information or Referrals, and Learning About Available Options. CONCLUSION: Oncology nurses have an opportunity for a partnership to ensure that concerns about fertility among AYA patients are addressed. J Contin Educ Nurs. 2016;47(8):376-384.

Accessibility to sexual and reproductive health and rights education among marginalized youth in selected districts of Tanzania.

INTRODUCTION: Access to information, education and services is central in the promotion of sexual and reproductive health and rights (SRHR) among young people. It enables young people make informed choices on sexuality matters, hence reduce teenage pregnancies and sexually transmitted infections (STIs). This study assessed accessibility of SRH rights' information among marginalized young people in three municipalities of Iringa, Ilala and Kinondoni in Tanzania. METHODS: A cross-sectional study design using mixed methods was conducted in 2013 in three selected districts of Tanzania. We randomly selected 398 young people including those with disabilities to partake in quantitative survey while 48 community members were purposely selected for qualitative part. Quantitative data analysis was done using descriptive statistics and chi square test with the assistance of the Statistical Package for Social Science(SPSS) version 20, while qualitative data was thematically analyzed. RESULTS: There were 396 (99%) participants (144 Males and 251 females), with a mean age of 20.1years. The majority were out of school female, cohabiting and had completed secondary education. Overall, 317 (79.6%) had SRH rights knowledge. The leading sources of SRH rights information were peer educators (36.7%) and radio (22.8%). Awareness regarding laws and policies related to SRH right was 55.1%. However, young people living with HIV and school truants had more access to SRHR education and services than the other youth groups(χ2 30.69, p< 0.0001). The qualitative study revealed that parents and teachers perceived themselves to be incompetent in providing SRH information to their youngsters despite of being mostly trusted. CONCLUSION: Access to SRH rights information is high but decreases when it is disaggregated across different age groups. There is a need for diversified approach for reaching specific groups of young people depending on their needs and circumstances.

Programa de Planificación Familiar y Riesgo Reproductivo sensible al género / Program for family planning and reproductive risk gender sensitive

Introducción: la escasa asistencia masculina a la consulta de planificación familiar es reconocida en las publicaciones científicas como una problemática que imposibilita, entre otros factores, el acceso equitativo a ese servicio, dificulta la distribución y manejo de recursos en función de necesidades de atención femeninas y masculinas. Los hombres se encuentran en desventaja con respecto a las mujeres en cuanto a: prestación de servicios de planificación familiar enfocados a ellos como población diana, beneficios de las acciones o estrategias de salud sexual y salud reproductiva plasmadas en planes, programas o políticas de salud y esto constituye, en términos de derechos reproductivos, una limitación al momento de garantizarlos a cada persona sin distinción alguna. Objetivo: identificar en el Programa de Planificación Familiar y Riesgo Reproductivo la contemplación de las necesidades de atención relativas a salud sexual y reproductiva de los hombres. Método: se realizó un análisis de contenido cualitativo de tipo temático al Programa de Planificación Familiar y Riesgo Reproductivo por el que se guían los servicios de planificación familiar en Cuba. Resultados: el Programa de Planificación familiar y Riesgo reproductivo carece de propuestas concretas para lograr la identificación y satisfacción de las necesidades de los hombres; situación que repercute en la escasa participación masculina en el servicio de Planificación Familiar. Conclusiones: el Programa de Planificación familiar y Riesgo reproductivo solo responde de manera explícita a una única necesidad de atención masculina: la falta de orientación y educación sexual de los hombres(AU)

Introduction: the low male attendance to family planning consultation is recognized in the scientific literature as a problem which precludes, inter alia, equal access to that service, it makes the distribution and management of resources according to needs of female and maleassistance. Men are at a disadvantage with respect to women regarding: provision of family planning services aimed at them as a target population benefits of actions or strategies of sexual and reproductive health reflected in plans, programs and policies on health and this is, in terms of reproductive rights, a limitation on the time of guaranteeing to every person without distinction. Objective: Identify care needs on sexual and reproductive health of men in the Program for Family Planning and Reproductive Risk. Method: A qualitative analysis was made on thematic content of theProgram for Family Planning and Reproductive Risk by which family planning services are guided in Cuba. Results: Program for Family Planning and Reproductive Risk lacks concrete proposals for identifying and meeting the needs of men, which affects the low male participation in family planning service. Conclusions: Family Planning Program and reproductive risk only responds to a sole need for male assistance: the lack of guidance and sex education for men(AU)

Sexuality education: emerging trends in evidence and practice.

The International Conference on Population and Development and related resolutions have repeatedly called on governments to provide adolescents and young people with comprehensive sexuality education (CSE). Drawing from these documents, reviews and meta-analyses of program evaluations, and situation analyses, this article summarizes the elements, effectiveness, quality, and country-level coverage of CSE. Throughout, it highlights the matter of a gender and rights perspective in CSE. It presents the policy and evidence-based rationales for emphasizing gender, power, and rights within programs--including citing an analysis finding that such an approach has a greater likelihood of reducing rates of sexually transmitted infections and unintended pregnancy--and notes a recent shift toward this approach. It discusses the logic of an "empowerment approach to CSE" that seeks to empower young people--especially girls and other marginalized young people--to see themselves and others as equal members in their relationships, able to protect their own health, and as individuals capable of engaging as active participants in society.

Effective strategies to provide adolescent sexual and reproductive health services and to increase demand and community support.

Access to youth friendly health services is vital for ensuring sexual and reproductive health (SRH) and well-being of adolescents. This study is a descriptive review of the effectiveness of initiatives to improve adolescent access to and utilization of sexual and reproductive health services (SRHS) in low- and middle-income countries. We examined four SRHS intervention types: (1) facility based, (2) out-of-facility based, (3) interventions to reach marginalized or vulnerable populations, (4) interventions to generate demand and/or community acceptance. Outcomes assessed across the four questions included uptake of SRHS or sexual and reproductive health commodities and sexual and reproductive health biologic outcomes. There is limited evidence to support the effectiveness of initiatives that simply provide adolescent friendliness training for health workers. Data are most ample (10 initiatives demonstrating weak but positive effects and one randomized controlled trial demonstrating strong positive results on some outcome measures) for approaches that use a combination of health worker training, adolescent-friendly facility improvements, and broad information dissemination via the community, schools, and mass media. We found a paucity of evidence on out-of-facility-based strategies, except for those delivered through mixed-use youth centers that demonstrated that SRHS in these centers are neither well used nor effective at improving SRH outcomes. There was an absence of studies or evaluations examining outcomes among vulnerable or marginalized adolescents. Findings from 17 of 21 initiatives assessing demand-generation activities demonstrated at least some association with adolescent SRHS use. Of 15 studies on parental and other community gatekeepers' approval of SRHS for adolescents, which assessed SRHS/commodity uptake and/or biologic outcomes, 11 showed positive results. Packages of interventions that train health workers, improve facility adolescent friendliness, and endeavor to generate demand through multiple channels are ready for large-scale implementation. However, further evaluation of these initiatives is needed to clarify mechanisms and impact, especially of specific program components. Quality research is needed to determine effective means to deliver services outside the facilities, to reach marginalized or vulnerable adolescents, and to determine effective approaches to increase community acceptance of adolescent SRHS.

Creating an enabling environment for adolescent sexual and reproductive health: a framework and promising approaches.

This article provides a conceptual framework and points out the key elements for creating enabling environments for adolescent sexual and reproductive health (ASRH). An ecological framework is applied to organize the key elements of enabling environments for ASRH. At the individual level, strategies that are being implemented and seem promising are those that empower girls, build their individual assets, and create safe spaces. At the relationship level, strategies that are being implemented and seem promising include efforts to build parental support and communication as well as peer support networks. At the community level, strategies to engage men and boys and the wider community to transform gender and other social norms are being tested and may hold promise. Finally, at the broadest societal level, efforts to promote laws and policies that protect and promote human rights and address societal awareness about ASRH issues, including through mass media approaches, need to be considered.

"Abortion will deprive you of happiness!": Soviet reproductive politics in the post-Stalin era.

This article examines Soviet reproductive politics after the Communist regime legalized abortion in 1955. The regime's new abortion policy did not result in an end to the condemnation of abortion in official discourse. The government instead launched an extensive campaign against abortion. Why did authorities bother legalizing the procedure if they still disapproved of it so strongly? Using archival sources, public health materials, and medical as well as popular journals to investigate the antiabortion campaign, this article argues that the Soviet government sought to regulate gender and sexuality through medical intervention and health "education" rather than prohibition and force in the post-Stalin era. It also explores how the antiabortion public health campaign produced "knowledge" not only about the procedure and its effects, but also about gender and sexuality, subjecting both women and men to new pressures and regulatory norms.

Abortion law reforms in Colombia and Nicaragua: issue networks and opportunity contexts.

This article analyses two instances of abortion law reform in Latin America. In 2006, after a decades-long impasse, the highly controversial issue of abortion came to dominate the political agenda when Colombia liberalized its abortion law and Nicaragua adopted a total ban on abortion. The article analyses the central actors in the reform processes, their strategies and the opportunity contexts. Drawing on Htun's (2003) framework, it examines why these processes concluded with opposing legislative outcomes. The authors argue for the need to understand the state as a non-unitary site of politics and policy, and for judicial processes to be seen as a key variable in facilitating gender policy reforms in Latin America. In addition, they argue that 'windows of opportunity' such as the timing of elections can be critically important in legislative change processes.

South Africa's abortion values clarification workshops ­ an opportunity to deepen democratic communication missed.

A rich literature exists on local democracy and participation in South Africa. While the importance of participation is routinely built into the rhetoric of government, debate has increasingly focused on the dysfunctionality of participatory mechanisms and institutions in post-apartheid South Africa. Processes aimed ostensibly at empowering citizens, act in practice as instruments of social control, disempowerment and cooptation. The present article contributes to these debates by way of a critique of the approach used by the South African state, in partnership with the non-governmental sector, in what are called abortion "values clarification" (VC) workshops. This article examines the workshop materials, methodology and pedagogical tools employed in South African abortion VC workshops which emanate from the organization Ipas ­ a global body working to enhance women's sexual and reproductive rights and to reduce abortion-related deaths and injuries. VC workshops represent an instance of a more general trend in which participation is seen as a tool for generating legitimacy and "buy-in" for central state directives rather than as a means for genuinely deepening democratic communication. The manipulation of participation by elites may serve as a means to achieve socially desirable goals in the short term but the long-term outlook for a vibrant democracy invigorated by a knowledgeable, active and engaged citizenry that is accustomed to being required to exercise careful reflection and to its views being respected, is undermined. Alternative models of democratic communication, because they are based on the important democratic principles of inclusivity and equality, have the potential both to be more legitimate and more effective in overcoming difficult social challenges in ways that promote justice.