Advancing Birth Equity in a Post-Dobbs US.

This Viewpoint discusses the US Supreme Court's decision in Dobbs v Jackson Women's Health Organization, describes how that decision threatens birth equity for some racial and social groups, and suggests a reproductive justice approach to address racial and social inequalities and ensure reproductive freedom and autonomy for all people.

Perceptions of and barriers to HIV testing of women in Indonesia.

Indonesia's 2014 health reforms advocated for universal health coverage for all Indonesians. The reforms made provision for integrated human immunodeficiency virus (HIV) programmes, with testing available at community health centres and hospitals for pregnant women and women of childbearing age. The question remains, though, as to whether testing has been effective. This article focuses on barriers women face accessing HIV testing and presents findings from the experiences of 18 HIV-positive women. To triangulate findings, interviews were conducted with 26 health workers, 9 non-governmental organisation workers and 12 HIV stakeholders. The article examines barriers to pregnant women's access to HIV tests, showing that barriers relate to women not having reproductive health rights. It highlights reproductive rights noted in the Respectful Maternity Care Charter, and violations to them relevant to HIV testing in pregnancy. Five reported rights violations include: women being unable to access information; being unable to make informed decisions; having no right to confidentiality and privacy; experiencing ongoing discrimination; and having no right to timely HIV testing. The failure of Indonesia to protect these rights contributes to women being denied HIV testing. Findings show the need for increased HIV testing services for pregnant women and assert that health personnel and programme policy-makers need to be held accountable for the protection and fulfilment of women's rights in respect of HIV testing. The findings show that policy makers must make changes to ensure health services improve, health professionals must be better trained, and women's socio-cultural and political contexts must be considered.

Accountability for sexual and reproductive health and rights in development practice: building synergies.

The 2030 Agenda for Sustainable Development is the culmination of 25 years of global efforts to embed human rights in the development discourse. Epitomising the principle of Leaving No-one Behind, the 2030 Agenda contains concrete references to the realisation of human rights as the ultimate purpose of sustainable development as well as to governments' accountability towards citizens. Despite this compelling narrative, the information produced by States in reviewing progress on Sustainable Development Goals (SDGs) reveals a gap between rhetoric and practice. Voluntary National Review (VNR) reports have emerged as a central tool to inform and guide the national and global reviews of SDGs progress. The UN system recommends that States build upon information from existing platforms, the Universal Periodic Review (UPR) and UN Treaty Bodies, in order to reduce reporting burdens. However, an analysis of information on Sexual and Reproductive Health and Rights (SRHR) in VNR reports from 12 countries shows that States are missing the opportunity to build on the wealth of information they themselves have produced in their engagement with human rights mechanisms. Although many first generation VNRs did not come across as very substantive, their emphasis on participation and multi-stakeholder dialogue has created important, and sometimes unprecedented, national political traction for civil society. This engagement can be built upon to inject a human rights perspective towards the achievement of more equitable development outcomes.

Reproductive injustice, trans rights, and eugenics.

This article explores how the recognition of the gender identity of trans people can have negative consequences on their reproductive health and rights. First, it argues that, while both the right to gender identity and the right to sexual and reproductive health are part of the indivisible core of human rights, in practice trans people are forced to choose between them. Understanding this scenario requires focusing on the eugenic dimensions of trans policies, even in states where the recognition of a gender identity other than that assigned at birth is not tied to surgical or hormonal compromises. The concept of "passive eugenics", coined over twenty years ago by James Bowman, offers a valuable key in this respect. Second, the paper highlights some factors that hinder a successful approach to the reproductive health and rights of trans people. These factors include: the normative imageries about the reproductive capacities and desires of trans people, representations about pregnancy and "womanhood", and the form taken by identity politics in contemporary feminist movements. The attention given as a priority (if not exclusively) to initiatives for the legalisation of voluntary abortion, understood as a right pertaining to (cis) women, offers a significant example of these difficulties. Finally, the paper advocates the adoption of a reproductive justice approach to work on sexual and reproductive health and rights, arguing that it has, among other virtues, that of challenging the binary matrix that characterises Western thought.

Invest in health and uphold rights to "build back better" after COVID-19.

The COVID-19 pandemic is not just a health crisis - it is a full-blown economic and social crisis that is impacting the lives and livelihoods of billions of people. This commentary examines the mutually dependent relationship between health security and universal health coverage (UHC), and how the longstanding underinvestment in both renders us all vulnerable. It also discusses the vulnerability of services for sexual and reproductive health and rights (SRHR) in times of crisis, which is compounded when these services are not included and well integrated into national UHC packages. It concludes with a call for stronger political leadership for UHC and SRHR as the global community strives to "build back better" after COVID-19.

Sexual and reproductive health and rights of refugee and migrant women: gynecologists' and obstetricians' responsibilities.

Ensuring universal access to sexual and reproductive healthcare services is Target 3.7 of the United Nations Sustainable Development Goals (SDG). Refugee and migrant women and children are at particular risk of being forgotten in the global momentum to achieve this target. In this article we discuss the violations of sexual and reproductive health and rights (SRHR) of particular relevance to the refugee and migrant reality. We give context-specific examples of denial of health services to vulnerable groups; lack of dignity as a barrier to care; the vulnerability of adolescents; child marriage; weaponized rape; gender-based violence; and sexual trafficking. We discuss rights frameworks and models that are being used in response to these situations, as well as what remains to be done. Specifically, we call for obstetricians and gynecologists to act as individual providers and through their FIGO member societies to protect women's health and rights in these exposed settings.

Access to public health services and integral care for women during the puerperal gravid period period in Ceará, Brazil.

BACKGROUND: Over time, the Brazilian health system, a growing country, has been developing to ensure good accessibility to health goods and services. This development is focusing on the principle of universality of access and completeness of health care. In this context, we aimed to evaluate the completeness of care and universality of access for women in their pregnancy and puerperal period in Ceará, Brazil. METHODS: A descriptive, cross-sectional study based on a quantitative approach, using information collected from the database of the regulation system of the state of Ceará and data from the Prenatal Monitoring System. The research population comprised of 1701 women who delivered a baby in an obstetric reference unit in the Health Macro-Region of Cariri, Ceará, Brazil from January to December 2015. RESULTS: There was a high rate of cesarean delivery (49.7%) and a high waiting time for access to high-risk delivery (32.6%) and neonatal intensive care unit (72.9%). There was also a low percentage (41.1%) of pregnant women undergoing an adequate number of prenatal consultations, dental care (20%), educational activities (15%), visits to the maternity ward (0.1%), laboratory tests of the third trimester (29.2%) and puerperal consultation (37.9%). CONCLUSIONS: It was concluded that the Maternal and Child Health Policy, especially the Rede Cegonha, which is still under development, does not ensure access and completeness of care for women during the prenatal, delivery, and puerperal periods, thus violating their reproductive rights. The results of this study allow a critical analysis by the academia and health managers in search of strategies to improve the services of Rede Cegonha in Brazil.

Prioritizing the sexual and reproductive health and rights of adolescent girls and young women within HIV treatment and care services in emergency settings: a girl-centered agenda.

BACKGROUND: Extensive documentation exists on a range of negative sexual and reproductive health outcomes and rights violations occurring during humanitarian emergencies. We explore two central questions: Do existing policies, services, and research adequately address the SRH rights, priorities and HIV risks of adolescent girls and young women in emergency settings? What are the missed opportunities for holistically addressing the vulnerabilities experienced by those living with HIV during rapid onset disasters and long term, protracted emergencies? Authors review considerations informing real-time decision making, and highlight missed opportunities to apply a gendered lens in the delivery of AGYW-centered SRHR/HIV services. METHODS: A scoping review identified studies on HIV intervention and outcomes in emergency settings, published in the peer-reviewed literature (2002-2017). This exercise was complemented with a desk review of normative guidance, frameworks, and implementation guidelines on HIV and SRH in emergency responses, and by consultations with subject matter experts. RESULTS: The existing frameworks and guidance pay scant attention to the sexual reproductive health and rights of young women living with HIV (WLHIV), focusing mainly on prevention of mother to child transmission (PMTCT), antiretroviral therapy (ART), HIV testing services, and linkage to treatment services. Applying a gendered sexual and reproductive health lens to the response offers opportunities to identify critical implementation questions, and highlight promising practices, to better tailor current services for AGYW. CONCLUSIONS: A plurality of competing needs crowds out dedicated time and space to effectively integrate HIV and sexual and reproductive health interventions in emergency settings. Political will is required to advance multi-sectoral cooperation, through joint planning, rights-informed learning and integrative responses, and to promote creative solutions for ART continuation, drug supply and HIV testing, treatment and care. Recent advancements in policy and practice would suggest that a more AGYW-centered response is feasible.

Understanding Economic Abuse Through an Intersectional Lens: Financial Abuse, Control, and Exploitation of Women's Productive and Reproductive Labor.

Financial abuse refers to men's control over money, assets, and women's education or paid work. As a corrective to existing undertheorization of men's (and their family's) abuse of and control over women's unpaid (domestic) labor, this article proposes a new conceptualization of economic abuse. Drawing upon life-history interviews with 41 South Asian women from the United Kingdom and India, this article explores control and abuse in relation to financial resources and women's paid work as well as unpaid work. It utilizes an intersectional perspective to explore how gender, migration status, race/ethnicity, and class can improve understanding of women's experiences as a continuum of economic abuse.

Reproductive control by others: means, perpetrators and effects.

BACKGROUND: Reproductive control of women by others comprises a wide range of behaviours, from persuasion to pressure such as emotional blackmail, societal or family expectations, through to threats of or actual physical violence. It is defined as behaviours that interfere with women's reproductive autonomy as well as any actions that pressurise or coerce a woman into initiating or terminating a pregnancy METHOD: Narrative review based on a search of medical and social science literature. RESULTS: Reproductive control by others includes control or coercion over decisions about becoming pregnant and also about continuing or terminating a pregnancy. It can be carried out by intimate partners, the wider family, or as part of criminal behaviour. One form is contraceptive sabotage, which invalidates the consent given to sex. Contraceptive sabotage includes the newly-described behaviour of 'stealthing': the covert removal of a condom during sex. Reproductive control by others is separate from intimate partner violence but there are similarities and the phenomena overlap. Reproductive control by others is reported by as many as one quarter of women attending sexual and reproductive healthcare services. Those treating such women should be familiar with the concept and how to ameliorate its effects. Screening questions for its detection have been developed as well as interventions to reduce its risk. CONCLUSIONS: Reproductive control by others is common and those working in women's health should be familiar with the concept and with screening tools used to detect it.

"In transition: ensuring the sexual and reproductive health and rights of transgender populations." A roundtable discussion.

This roundtable discussion is the result of a research symposium entitled In Transition: Gender [Identity], Law & Global Health where participants took up the challenge to engage with the question: What will it take to ensure the sexual and reproductive health and rights (SRHR) of transgender populations across the globe? The barriers to overcome are fierce, and include not only lack of access to health services and insurance but also stigma and discrimination, harassment, violence, and violations of rights at every turn. Transgender people must of course lead any sort of initiatives to improve their lives, even as partnerships are needed to build capacity, translate lived experience into usable data, and to make strategic decisions. The SRHR of transgender people can only be addressed with attention to the social, cultural, legal, historical, and political contexts in which people are situated, with social, psychological, medical, and legal gender affirmation as a key priority shaping any intervention. Bringing together nine diverse yet complementary perspectives, our intent is to jumpstart a global and multigenerational conversation among transgender activists, lawyers, policy-makers, programmers, epidemiologists, economists, social workers, clinicians and all other stakeholders to help think through priority areas of focus that will support the needs, rights, and health of transgender populations. Making the changes envisioned here is possible but it will require not only the advocacy, policy, programmatic and research directions presented here but also struggle and action locally, nationally, and globally.

Encuesta a posgrados de pediatría sobre conocimiento y aplicación de los derechos de los niños y adolescentes en la práctica clínica / Survey of postgraduate pediatrics students on knowledge and application of children and adolescents rights in clinical practice / Pesquisa entre estudantes de pós-graduação em pediatria sobre conhecimento e aplicação dos direitos de crianças e adolescentes na prática clínica

La concepción de niñez y adolescencia es una construcción socio-histórica que ha evolucionado en el tiempo. En el paradigma actual se reconocen como sujetos de derecho. El cambio en el modelo de atención debe implicar prácticas basadas en este paradigma Objetivos: Describir el conocimiento de los médicos que cursan el posgrado de Pediatría sobre las normativas de derechos de los niños y adolescentes y conocer su percepción sobre la aplicación del enfoque de derechos en la práctica clínica. Metodología: encuesta anónima administrada por los investigadores o vía e-mail a estudiantes de posgrados de pediatría. Se exploran tres dimensiones: conocimiento de la existencia de normativas sobre derechos de niños y adolescentes y su utilización en la resolución de problemas en la práctica, y aplicación del enfoque de derechos en las prácticas clínicas de los encuestados y observada en otros integrantes del equipo de salud. Resultados: Se administraron 180 encuestas, respondieron 77 (43%). 97.4% refirieron conocer la existencia de alguna de las normativas, de estos 25.3% no las aplica en la resolución de problemas. La mayoría de los médicos refieran observar la vulneración de los derechos en su etapa de formación. Conclusiones: a pesar del conocimiento de existencia de normativas, existen dificultades para que las prácticas clínicas tengan un enfoque de derechos respetando a los niños, niñas y adolescentes como sujetos de derechos.

The conception of childhood and adolescence is a social and historical construction that has evolved over the time. In the current paradigm, they are recognized as subjects of rights. The change in the attention care model should imply practices based on this paradigm. Objectives: describe the knowledge of physicians enrolled in postgraduate pediatric courses on the rights of children and adolescents and know their perception on the application of the rights approach in clinical practice Methodology: anonymous survey administered by researchers or by email to postgraduate pediatrics students. Three categories are explored: knowledge of the existence of regulations on the rights of children and adolescents and their use in the resolution of problems in practice, application of the rights approach in the clinical practices of the respondents and observed in other members of the healthcare team. Results: 180 surveys were conducted, 77 responded (43%). Whereas 97.4% reported knowing the existence of some of the regulations, 25.3% do not apply them in the resolution of problems. Most physicians report that they observe the violation of rights in their training stages. Conclusions: despite knowledge of the existence of regulations, there are difficulties to effectively conduct a rights-based approach that respects children and adolescents as subjects of rights.

A concepção de infância e adolescência é uma construção sócio-histórica que evoluiu ao longo do tempo. No paradigma atual, crianças e adolescentes são reconhecidos como sujeitos de direitos. A mudança no modelo de cuidados deve implicar práticas baseadas nesse paradigma Objetivos: Descrever o conhecimento dos médicos matriculados no curso de pós-graduação pediátrica sobre os direitos das crianças e adolescentes e conhecer sua percepção da aplicação da abordagem de direitos humanos na prática clínica. Metodologia: Pesquisa anônima administrada por pesquisadores ou via e-mail aos estudantes do curso pós-graduação pediátrica. São exploradas três dimensões: conhecimento da existência de regulamentos sobre os direitos das crianças e adolescentes, seu uso na resolução de problemas na prática e aplicação da abordagem de direitos nas práticas clínicas dos entrevistados e dos outros membros da equipe de saúde. Resultados: foram realizadas 180 pesquisas, 77 responderam (43%). 97,4% relataram saber a existência de qualquer um dos regulamentos, destes 25,3% não os aplicam na resolução de problemas. A maioria dos médicos relata observar a violação dos direitos na fase de treinamento. Conclusões: Apesar do conhecimento da existência de regulamentos, há dificuldades para que as práticas clínicas tenham uma abordagem baseada em direitos respeitando crianças e adolescentes como sujeitos de direitos.

The no-go zone: a qualitative study of access to sexual and reproductive health services for sexual and gender minority adolescents in Southern Africa.

BACKGROUND: Adolescents have significant sexual and reproductive health needs. However, complex legal frameworks, and social attitudes about adolescent sexuality, including the values of healthcare providers, govern adolescent access to sexual and reproductive health services. These laws and social attitudes are often antipathetic to sexual and gender minorities. Existing literature assumes that adolescents identify as heterosexual, and exclusively engage in (heteronormative) sexual activity with partners of the opposite sex/gender, so little is known about if and how the needs of sexual and gender minority adolescents are met. METHODS: In this article, we have analysed data from fifty in-depth qualitative interviews with representatives of organisations working with adolescents, sexual and gender minorities, and/or sexual and reproductive health and rights in Malawi, Mozambique, Namibia, Zambia and Zimbabwe. RESULTS: Sexual and gender minority adolescents in these countries experience double-marginalisation in pursuit of sexual and reproductive health services: as adolescents, they experience barriers to accessing LGBT organisations, who fear being painted as "homosexuality recruiters," whilst they are simultaneously excluded from heteronormative adolescent sexual and reproductive health services. Such barriers to services are equally attributable to the real and perceived criminalisation of consensual sexual behaviours between partners of the same sex/gender, regardless of their age. DISCUSSION/ CONCLUSION: The combination of laws which criminalise consensual same sex/gender activity and the social stigma towards sexual and gender minorities work to negate legal sexual and reproductive health services that may be provided. This is further compounded by age-related stigma regarding sexual activity amongst adolescents, effectively leaving sexual and gender minority adolescents without access to necessary information about their sexuality and sexual and reproductive health, and sexual and reproductive health services.

Vulnerabilidad impuesta y violación sistemática a los derechos de las mujeres indígenas en México / Imposed vulnerability and systematic violation of the indigenous women rights in Mexico

En México el reconocimiento a los derechos de las mujeres ha transitado un largo camino, acompañado muchas veces de experiencias difíciles para hacerlos valer. Desde 1930 se lucha por el reconocimiento de dichos derechos, se han signado ordenamientos, leyes nacionales e internacionales que norman todo a lo que las mujeres tienen acceso. Sin embargo, los estudios, encuestas y denuncias demuestran lo contrario. Este artículo abordó la problemática que las mujeres indígenas viven en México para que sean respetados y reconocidos sus derechos, específicamente los reproductivos y, particularmente, la esterilización impuesta, que además de violar su derecho a decidir por las instituciones encargadas de cuidar su salud, les genera problemas ginecológicos y rechazo por su pareja (AU).

Women's rights recognition in Mexico has gone through a long way, accompanied many times by difficult experiences to make them true. The fights for the recognition of those rights date back to 1930. Orders, national and international laws have been signed ruling all the rights to which women have access. However, studies, surveys and reports prove the entire contrary. This article approaches the problems affronted by the indigenous women who live in Mexico for the recognition and respect of their rights specially the reproductive ones and, particularly, the imposed sterilization, that besides the violation of their rights to decide from the part of the institutions in charge of taking care for their health, causes them gynecological problems and their couples rejection (AU).

Searching for the Second R in Sexual and Reproductive Health and Rights.

Sexual and reproductive health and rights have gained prominence in the HIV response. The role of sexual and reproductive health in underpinning a successful approach to HIV prevention, treatment, care, and services has increasingly been recognized. However, the "second R," referring to sexual and reproductive rights, is often neglected. This leads to policies and programs which both fail to uphold and fulfill these rights and which fail to meet the needs of those most affected by HIV by neglecting to take account of the human right-based barriers and challenges they face. In this commentary, the authors draw on the approach and practical experiences of the Link Up program, and the findings of a global consultation led for and by young people living with and most affected by HIV, to present a five-point framework to improve programming and health outomces by better protecting, respecting, and fulfilling the sexual health and reproductive rights of young people living with and most vulnerable to HIV.