Trusted networks: a study of communication flow and access to abortion information in Argentina.

In December 2020, Argentina approved a new abortion law following decades of feminist and social advocacy. This paper presents qualitative findings from interviews and focus group discussions with people in local communities focusing on how individuals of reproductive age access and communicate sexual and reproductive health information, particularly regarding abortion. Sixteen in-depth interviews were conducted with key informants working in the field of SRHR and four focus group discussions took place with cisgender women and girls, transmasculine people and non-binary people of reproductive age. We found that information exchange and communication about sexual and reproductive health issues, particularly abortion, took place mainly through informal social networks engaging with activists and feminist grass-root organisations. These informal social networks were built on trust as a collective affect that enabled open communication about abortion. Information sharing through word of mouth, in person and via digital means using different social media platforms, is an important means of information sharing and communication in Argentina. Monitoring the implementation of abortion policies in this country should include investigating the impact of people accessing abortion through informal social networks in terms of abortion pathways and intersections with the formal health system.

Lessons learned from a sexual and reproductive health and rights peer education program to prevent adolescent pregnancies in high schools in Rwanda.

Adolescent pregnancies that occur in schools remain a major public concern in Rwanda. Sexual and Reproductive Health and Rights (SRHR) school based programs are less effective and discussing sexual health with adolescents is considered as taboo in Rwandan societies. Yet, adolescents still seek information about SRHR from their peers and research shows that peers are often incorrectly informed about SRHR topics. One of the effective strategies to reduce adolescent pregnancies in secondary schools is equipping adolescents with accurate and reliable knowledge. In 2019, we conducted our first network event with different stakeholders. The stakeholders included: school directors, head teachers, biology teachers, local political delegates, religious people among others to help gain insights into SRHR. A survey was conducted and administered to in-school adolescents in Kirehe district (S3 - S6 level, n=563) with the aim of examining adolescents' level of knowledge and attitudes regarding SRHR. In addition, six focus group discussions (FGDs) were conducted to obtain a deeper understanding of the SRHR needs and the possible contributions and content of a peer -to- peer education program (PEP). The lessons learned included: a) engaging parents in the network event and development of PEP; b) constant communication utilizing the different social media platforms, c) enhanced collaboration between the project implementers and stakeholders a facet of bottom-up approaches to expedite this project; and d) the project should have better anticipated on possible and unforeseen external barriers. Implementing a PEP in Kirehe secondary schools resulted in substantive changes such as positively transforming peer educators (PEs) and the elimination of teenage pregnancies in the selected schools. Overall, the number of PEs was not adequate to cover the number of students and anti-bullying training should have been provided to all students before the project implementation.

Analysis of adolescents' perception and awareness level for Sexual and Reproductive Health Rights in Pakistan.

Background: Awareness of rights is a precondition to establishing rule of law in society. Sexual and Reproductive Health and Rights (SRHR) are closely knitted in the human rights framework as they overlap with other human rights such as the right to health and life. However, awareness about these rights remains a challenge. Considering the importance of these rights this study has measured the awareness of adolescents about SRHR in Bahawalpur (Division) of Pakistan. Methodology: We conducted a cross-sectional study in the Divison of Bahawalpur, Pakistan from October 2019 to December 2019. The study included a sample size of 500 respondents which included 250 young females of age 15-19 and 250 their parents (mother). The reasoning behind including only females in this study was the increased vulnerability and greater impact of SRHR in their life compared to males. The age range 15-19 was primarily selected as females this age will better understand and respond to the questionnaire compared to females in their early adolescent years. The quantitative research was conducted using two-stage cluster sampling. Detailed structured questionnaires were distributed among the respondents to obtain their points of view on the awareness of SRHR. The population was divided into multi-clusters with 25 households comprising 250 households for the division of Bahawalpur. The information was also gathered from the doctors and the teachers through interviews. The data were analyzed using SPSS version 21. Results: The study explored the knowledge and understanding of adolescent SRHR thereby highlighting the key restrictions in Bahawalpur, Pakistan, which prohibit adolescents from gaining access to SRHR and exercising it. There is a significant portion of adolescents who strongly agreed with the importance and awareness level and think they should be more aware of information regarding SRHR. However, they are of the view that they are less independent in practicing them. Conclusion: The study found a low level of awareness about SRHR among young female and their parents in Bahawalpur, Pakistan. It is a need of time and responsibility of the local government of the Bahawalpur region to devise clear and proper policies which give access to these rights. This can be done by including the information on these rights in the course curriculum and teachers keeping in view the cultural and regional restrictions that guide the young female about SRHR.

Profil des utilisatrices et facteurs associés à la satisfaction des clientes de la qualité des soins après avortement au Burkina Faso: étude transversale menée dans six régions.

RésuméMalgré la dépénalisation de l'avortement et la gratuité des soins après avortement (SAA), les femmes Burkinabè vivent des relations difficiles avec les soignants. Cette étude vise à déterminer le profil des femmes recevant des SAA, leur perception de la qualité des SAA et ses déterminants dans des structures sanitaires publiques et confessionnelles du pays. Une enquête quantitative a été menée auprès de 2174 femmes vues pour des SAA et recrutées de façon exhaustive de 2018 à 2020. Un questionnaire structuré a été administré à la sortie des soins. Une analyse uni-, bi- et multivariée a été faite. La majorité des clientes de SAA vivait en milieu rural (55%), avait 25 ans et plus (60%), vivait en couple (87%) et était sans-emploi (59%). La grossesse était non désirée chez 17% des femmes et 4% d'entre elles souhaitaient avorter. La satisfaction globale de la qualité des SAA était de 84%. Dans l'analyse multivariée, ses déterminants étaient la résidence en milieu rural (OR = 1.80 [1.38; 2.34]), un niveau scolaire primaire (OR = 1.48 [1.06; 2.07]) ou secondaire (OR = 1.95 [1.38; 2.74]), et avoir eu au moins un enfant (OR = 1.43 [1.02; 2.00]). Les facteurs associés à une faible satisfaction des SAA étaient une grossesse non désirée (OR = 0.64 [0.46; 0.89]) ou avoir souhaité avorter (OR = 0.09 [0.05; 0.16]). Le niveau de satisfaction globale est acceptable mais faible chez les clientes ayant souhaité avorter. Il est fondamental d'organiser un programme de formation des professionnels des SAA sur la communication, la relation interpersonnelle et l'empathie pendant les soins de santé.

To Save a Girl-Child, You Must Train a Boy-Child: A Note on Situational Irony.

Despite numerous initiatives and resources to save and protect the health and sexual rights of girls and women, the persistently high rate of unwanted pregnancy, abortion, and sexual violence in sub-Saharan Africa (SSA) has remain a topical public health challenge. This study hypothesised that the continuous conspicuous omission of boys/men in the interventions to combat this menace could be a long-life impediment to the realisation of sustainable health for girls and women in the region. The study adopted a systematic review of extant population-based published studies from Scopus, Google Scholars, PubMed, EMBASE, and AJOL. Literature coverage included the post-United Nations' coordinated International Conference on Population and Development (ICPD), Cairo, 1994, which marked the beginning of a massive campaign for women/girls sexual rights. The obtained qualitative data were appraised and synthesised towards spurring policy recommendations for gender balanced initiatives on the sexual and reproductive health rights in SSA. The study highlighted that unwanted pregnancy occurs only when a boy/man has unprotected sex with a girl/woman without considering her choice or rights. It is considered ironic that the dominant factors are boys and men but many enlightenment initiatives/campaigns are concentrated on girls and women. The study developed a schematic save-a-girl-child framework that illustrated the possible dividends inherent in the training of a boy-child to achieve a safer world for the girls/women. It recommends increase in the exposure of boys and men to sexual education and counselling, which can motivate them to be supporters of family planning, supporters of only wanted pregnancy, wanted fatherhood, marital fidelity, intimate partners' harmonious living rather than violence, and wife or partner empowerment.

Looking for a Silver Lining to the Dark Cloud: A Google Trends Analysis of Contraceptive Interest in the United States Post Roe vs. Wade Verdict.

Background In the wake of the recent Roe vs. Wade judgment, we performed a Google Trends analysis to identify the impact of this decision on the interests regarding contraceptive choices in the United States. Methods A Google Trends search between April 6 and July 5, 2022, with the United States as the area of interest, was performed using the five most popular contraception choices. In addition, a second trend search was performed using oral and injectable hormonal birth control measures. Results Trends showed a spike in interest regarding various contraceptive methods immediately following the verdict. The highest increase in interest was noted for "vasectomy," followed by "tubal ligation." With respect to oral and injectable birth control measures, "morning after pill" showed a marked spike in interest. Conclusion This verdict has triggered increased interest in contraceptive practices, which can be translated into better reproductive health with proper public health initiatives.

The visibility of breastfeeding as a sexual and reproductive health right: a review of the relevant literature.

BACKGROUND: Governments must protect and apply maximum feasible resourcing to the protection, promotion and support of breastfeeding in order to meet their international legal obligations with respect to the human rights of women and children. However, governments across the world have consistently failed in these duties. Breastfeeding has been notably absent from mainstream feminist advocacy on sexual and reproductive health rights ('SRH rights'). Why is there this lack of focus on breastfeeding in feminist advocacy in this area? This review seeks to identify the extent to which the protection, promotion and support of breastfeeding is visible within the SRH rights and the gender responsive budgeting literature. METHOD: A cross-disciplinary single scoping literature review of online and other databases was conducted to yield final samples of eighty-seven publications from the SRH rights literature and forty-four publications from the gender responsive budgeting literature. These publications were searched for references to breastfeeding. RESULTS: Only 21% of the sexual and reproductive health rights literature and just one gender responsive budgeting publication sampled referenced the protection, promotion and support of breastfeeding. Where breastfeeding was mentioned in the publications reviewed it was, in general, brief and on the periphery of discussion. CONCLUSIONS: Reviews of the SRH rights literature and the gender budgeting literature both reveal an overwhelming absence of meaningful analysis on breastfeeding. The lack of attention to breastfeeding in the gender advocacy space represents a lost opportunity to advocate for the alleviation of the economic and social constraints imposed on breastfeeding women and caregivers.

Improving water, sanitation and hygiene (WASH) services in primary health care facilities in Edo State, Nigeria: A call for action.

Addressing water, sanitation, and hygiene (WASH) in health care facilities will foster action towards achieving the inter-related Sustainable Development Goals 3 and 6. WASH plays a significant role in sexual and reproductive health service delivery quality. Despite the relevance of WASH to reproductive health, quality of care, and disease control in Primary Health Care (PHC) facilities, accessibility is considerably low, with minimal attention given to the enormous yet solvable crisis of inadequacy of WASH in PHC facilities in Edo State. This paper provides insight on WASH status in PHC facilities in Edo State, identifies barriers to WASH provision, and practical steps to improving WASH services in the PHC facilities in Edo State. It was concluded that strict adherence to minimum standards for WASH facilities in PHCs should be ensured, and also a regular assessment of the availability and quality of WASH services in PHC facilities in Edo State should be conducted.

Perceptions, knowledge and exercises of sexual and reproductive health rights and associated factors among adolescents in Arsi zone, Ethiopia: A sequential explanatory mixed method study.

Sexual and reproductive health rights (SRHRs) are the rights of all people regardless of their age, sex and other characteristics to make choices about their own reproductive issues. However, evidence showed that adolescents lacked the capacity to exercise due to various factors. This study aimed to investigate the perceptions, knowledge and exercises of SRHR and associated factors among secondary school adolescents in Arsi zone. In this study a sequential mixed-method study design with two phases of data collection was conducted. In Phase I, the quantitative data were collected from adolescents (15-19 years) using self-administered questionnaires. In Phase II, an interview guide was used to collect data from 12 key informant interviews with teachers and health care providers and 4 focus group discussions with adolescents. Quantitative data was analysed using SPSS 25 while thematically used in the qualitative phase. Overall, less than half (26.1%) adolescents had the ability to exercise their SRHRs. Age 17-19 years (AOR=3.30, 95% CI: 2.17-5. 23), grades 11-12 (AOR=1.69, 95% CI: 1. 23-2.35) and knowledge (AOR=1.47, 95%CI: 1.05-2.05) were significantly associated with SRHRs exercises. Adolescents had misperceptions and limited knowledge to exercise their reproductive health rights.

Health Equity in a Post 'Roe Versus Wade' America.

For almost five decades, the US Supreme Court had protected the right to abortion care in the United States. However, the Court's decision in 'Dobbs versus Jackson Women's Health Organization' in 2022 established that the US Constitution does not confer a right to abortion, effectively overturning the Court's own previous judgment in 'Roe versus Wade' from 1973. How could a decision that overturns the precedent for nationwide access to abortion affect women, children, and physicians? How will state laws impact healthcare equity regarding reproductive rights going forward? How will geography affect who can access care financially, and how will this shape the conditions that unwanted children are born into? This work is a systematic analysis of the impact of overturning 'Roe versus Wade' considering the scientific and medical evidence as well as the conflicting political and moral viewpoints regarding abortion. Furthermore, we make constructive recommendations with a view to detoxifying the inflammatory rhetoric surrounding this topic and protecting key stakeholders such as patients seeking abortion and their physicians. The moment 'Roe v. Wade' was overturned, several US states began to enact laws, both protecting and restricting abortion. California and New York, for example, have since enacted laws that extend protection to both patients seeking abortion and the physicians who provide it. Oklahoma and Texas, on the other hand, have enacted laws that make it more difficult for patients to have abortion access, even after fetal death or when the birthing individual's life is in danger. These differences are likely to exacerbate the healthcare access divide across the country and increase the financial burden for those who can become pregnant. As differences in healthcare access and quality of care increase across the nation, an unmatched demand for maternity care, especially in the most restrictive states, could precipitate increased maternal and fetal morbidity and mortality while physician shortages are expected to worsen. It will be up to the US Congress to address these differences while weighing competing stakeholder interests. Currently, the nation is at the center of a seismic shift surrounding health policy with laws changing rapidly. This systematic health policy analysis paper will explore what the long-term consequences of this recent Supreme Court decision might look like while considering some of the most recently reported short-term consequences after the landslide decision.

From criminalised histories to rightful present - nomadic women demand equal rights to sexual and reproductive health: a study in Maharashtra, India.

This paper presents the findings of a research study in Thane District, Maharashtra, India, on access to sexual and reproductive health and rights (SRHR) for women and girls of Nomadic and Denotified Tribes (NT-DNT). NT-DNT communities face stigma and violence due to their historically criminalised status and nomadic lifestyle. Their precarious legal, social, and economic status has a negative impact on women's SRHR. Existing literature on this subject is sparse, and studies by researchers from within the community, which could bring about organic and community-led change, are almost non-existent. This study, carried out by a woman from a Nomadic Tribe, presents an insider's perspective on the experiences of and factors underlying the violation of the SRHR of girls and women of NT-DNT communities. The study used a human rights-based participatory methodology with qualitative methods including three focus group discussions with 21 women and 10 in-depth interviews with women and key informants from NT-DNT communities. The findings describe the gender, community, and health system barriers which hinder women's and girls' access to SRHR. Issues such as language barriers between the women and medical fraternity, criminalisation by the police, and extreme deprivation - more intense than faced by the general poor - are unique to women of these communities. The NT-DNT communities face extreme deprivation of basic resources such as identity documents, shelter, sanitation, education support, workplace safety, and transportation, which further deny women their sexual and reproductive rights. The paper aims to amplify these women's voices to advocate for better SRHR services for women and girls of NT-DNT communities.

Age of consent: A case for harmonizing laws and policies to advance, promote and protect adolescents' sexual and reproductive health rights.

The article assesses the legal and policy frameworks that have an impact on adolescents' sexual and reproductive health rights (ASRHR) in East and Southern Africa (ESA), confirming the interconnectedness of the ages of consent to sexual activity, marriage, and services and its influence on adolescents' human rights. It reviews international, continental and national legal instruments used to identify relevant provisions on ASRHR in the ESA region. The region demonstrates substantial disparities between realities of sexual debut among adolescents, national (statutory and customary) laws and policies on ages of consent to sex, marriage and medical services, and international standards around these SRHR issues. These disparities constitute negative consequences: criminalising adolescents, entrenching child marriage, and excluding adolescents from accessing medical services required to secure and promote ASRHR. While some ESA countries lack clear laws and policies on the three issues, cases of internal contradictions and disharmony with international standards abound. This impacts on the full realization of sexual and reproductive health rights of adolescents and young people in the region.

Health care providers' and mothers' perceptions about the medicalization of female genital mutilation or cutting in Egypt: a cross-sectional qualitative study.

BACKGROUND: Female genital mutilation/cutting (FGM/C) is a traditional harmful practice that has been prevalent in Egypt for many years. The medicalization of FGM/C has been increasing significantly in Egypt making it the country with the highest rate of medicalization. In this qualitative study, we explored the drivers and motives behind why healthcare professionals perform FGM/C and why mothers rely on them to perform the practice on their daughters. METHODS: The study drew on a "mystery client" approach, coupled with in-depth interviews (IDIs) and focus group discussions (FGDs) with health care providers (i.e. physicians and nurses) and mothers. It was conducted in three geographic areas in Egypt: Cairo, Assiut and Al Gharbeya. RESULTS: Study findings suggest that parents who seek medicalized cutting often do so to minimize health risks while conforming to social expectations. Thus, the factors that support FGM/C overlap with the factors that support medicalization. For many mothers and healthcare providers, adherence to community customs and traditions was the most important motive to practice FGM/C. Also, the social construction of girls' well-being and bodily beauty makes FGM/C a perceived necessity which lays the ground for stigmatization against uncut girls. Finally, the language around FGM/C is being reframed by many healthcare providers as a cosmetic surgery. Such reframing may be one way for providers to overcome the law against FGM/C and market the operation to the clients. CONCLUSION: These contradictions and contestations highlighted in this study among mothers and healthcare providers suggest that legal, moral and social norms that underpin FGM/C practice are not harmonized and would thus lead to a further rise in the medicalization of FGM/C. This also highlights the critical role that health providers can play in efforts to drive the abandonment of FGM/C in Egypt.

Knowledge and attitude towards sexual and reproductive health rights and associated factors among Adet Tana Haik College students, Northwest Ethiopia: a cross-sectional study.

OBJECTIVE: Sexual and reproductive health rights are the rights of all people regardless of their age, sex and other characteristics to make choices about their own sexuality and reproductive issues. However, little is known about the knowledge and attitude towards SRH rights in Ethiopia. Therefore, this study aimed to assess knowledge and attitude towards SRH rights and associated factors among Adet Tana Haik college students in northwest Ethiopia. RESULTS: Overall, about 59.6% students were knowledgeable and more than half (53.4%) had favorable attitude towards SRH rights. In this study, students attending third-year class (AOR = 2.20;95% CI 1.29, 3.33), discussion with parents (AOR = 3.35;95% CI 1.61, 6.96), respondent's mothers attended secondary/above school (AOR = 3.01; 95% CI 1.28, 7.13), participation in RH clubs (AOR = 1.72; 95% CI 1.09, 2.70) and favorable attitude towards SRH rights (AOR = 2.41; 95% CI 1.56, 3.74) were significantly associated with knowledge of participants. On the other hand, knowledge of students (AOR = 2.33; 95% CI 1.36, 7.07), participation in RH clubs (AOR = 1.41;95% CI 1.09, 2.20) and discussion with parents (AOR = 2.50; 95% CI 1.15, 5.47) were the predictors for the attitude of students towards SRH rights. Hence, strengthening women's education, encouraging discussions with parents and participation in RH clubs may improve the knowledge and attitude of students towards SRH rights.

Keeping our core values ALIV[H]E. Holistic, community-led, participatory and rights-based approaches to addressing the links between violence against women and girls, and HIV.

There is increasing recognition that violence against women is a barrier to sexual and reproductive health and rights, and a cause and consequence of HIV. In this viewpoint, we describe the recently published Action Linking Initiatives on Violence Against Women and HIV Everywhere (ALIV[H]E) framework [1]. The potential of this framework is explored in terms of it contributing to paradigm change to achieve the sexual and reproductive health rights of women experiencing, or living in contexts of, violence and/or HIV. We go on to suggest that a holistic approach to research and evaluation is vital to strengthen learning and expand the evidence base on violence against women and HIV.

Young women with disabilities and access to HIV/AIDS interventions in Uganda.

Sexual health and autonomy, and the often violent ways in which these are suppressed, are critical women's human rights issues. The process of ensuring that women enjoy their sexual and reproductive rights, including sexual health and freedom from HIV, is particularly challenging for persons with disabilities and most especially women with disabilities. This paper applies a human rights and gender lens to the sexuality and HIV-related vulnerabilities of young women with disabilities in Uganda. Widespread misperceptions about the sexual behaviours of women with disabilities, exposure to violence and exclusion from health promotion activities and health services, render women with disabilities, particularly young women with disabilities, disproportionately vulnerable to HIV and impede the full realisation of their sexual and reproductive health and rights. While limited protections exist for people with disabilities in Uganda, and some efforts have been made to provide appropriate services, the availability, accessibility, acceptability and quality of health services for this population group remains low, with a deleterious impact on their health and rights. This article calls for measures that strengthen the ability of young women with disabilities to prevent HIV infection and that promote responsiveness of the health system (as well as services in other sectors) to the sexual and reproductive health needs of this population.

The sexual and reproductive rights and benefit derived from sexual and reproductive health services of people with physical disabilities in South Africa: beliefs of non-disabled people.

There is a body of theoretical work, and some empirical research, which suggests that non-disabled people assume people with physical disabilities are not suitable romantic partners, do not have sexual drives or desires, or are not sexually active. It has also been proposed that people with physical disabilities face barriers to sexual healthcare access which are structural as well as social. The present paper explores non-disabled South Africans' beliefs concerning the degree to which non-disabled respondents enjoy sexual and reproductive rights, and benefit from sexual and reproductive healthcare, compared to people without disability. Using a survey, we asked 1989 South Africans to estimate the degree to which people with physical disabilities and people without disability have sexual rights, and benefit from sexual and reproductive healthcare services, respectively. Respondents were more likely to support the idea that the population without disability were deserving of sexual rights compared to people with physical disabilities. Respondents were more likely to rate the degree to which people with physical disability benefit from sexual and reproductive healthcare as less than that for people without physical disabilities. These findings provide some of the first empirical support that non-disabled people perceive people with physical disabilities as having fewer sexual and reproductive rights, and deriving less benefit from sexual and reproductive health services, than the population without disability. To have diminished sexual rights, and benefit less from sexual and reproductive healthcare, we suggest, evinces a negation of the sexual and reproductive needs and capacity of people with physical disabilities.

Health Rights and Realization Comment on "Rights Language in the Sustainable Development Agenda: Has Right to Health Discourse and Norms Shaped Health Goals?".

In their hypothesis published in IJHPM, Lisa Forman and colleagues examined the prominence of the right to health and sexual and reproductive health rights (as well as related language) in four of the key reports that fed into the process of negotiating the Sustainable Development Goals (SDGs). Now that the SDGs have been formally adopted, this comment builds on some of the insights of Forman and colleagues to examine the extent to which those rights have been incorporated in SDGs 3 and 5. I argue that sexual and reproductive health rights are relatively well-covered within the SDGs. In terms of the right to health, however, the picture is much less clear. Some of the elements that make up that right are present and correct, but the SDGs have delivered no coherent vision of how a 'right to health' might actually be realized. An important task facing global health and human rights advocates is to continue pushing human rights framings so that progress is made both on meeting the SDGs and on realizing the right to health.