Historical Primer on Obstetrics and Gynecology Health Inequities in America: A Narrative Review of Four Events.

Four historical events provide context for racial injustices and inequities in medicine in the United States today: the invention of race as a social construct, enslavement in the Americas, the legal doctrine of Partus sequitur ventrem, and the American eugenics movement. This narrative review demonstrates how these race-based systems resulted in stereotypes, myths, and biases against Black individuals that contribute to health inequities today. Education on the effect of slavery in current health care outcomes may prevent false explanations for inequities based on stereotypes and biases. These historical events validate the need for medicine to move away from practicing race-based medicine and instead aim to understand the intersectionality of sex, race, and other social constructs in affecting the health of patients today.

White Privilege: What's a Family Therapist To Do?

Privilege is the freedom to ignore things that other people are forced to confront; dramatic things like being gunned down by a vigilante on the way home from a convenience store or less urban and visible things like having to live on secluded parcels of land that no one else wants. Most family therapists enjoy the freedom not to experience such events. Many of the people who come to us for help don't have that freedom. My intent here is to increase felt awareness of the injustice of institutional racism and to suggest some actions that White family therapists can take to bring forth a more just society in terms of education, housing, access to wealth, and basic safety.

Gender Differences in Violence and Other Human Rights Abuses Among Migrant Workers on the Thailand-Myanmar Border.

We describe human rights violations against migrant workers at the Thailand-Myanmar border, and evaluate differences by gender and industry. This mixed methods study pairs key informant interviews ( n = 40) with a cross-sectional quantitative survey of migrant workers from Myanmar ( n = 589) recruited via respondent-driven sampling. Key informants described significant hazards during migration, including deception, theft, and physical and sexual abuse, the latter primarily for women. Quantitative results confirmed prevalent mistreatment and abuse, with significant gender differences, most notably women's disproportionate burden of sexual abuse. Current evidence on the nature of experiences, and significant differences by gender, can position prevention and response programming.

Study of human rights violations faced by women who use drugs in Estonia.

BACKGROUND: Estonia continues to have the highest prevalence of HIV among people who inject drugs, and the highest overdose mortality, in the European Union. In August 2017, the Eurasian Harm Reduction Association (EHRA), the Canadian HIV/AIDS Legal Network (CHALN), and the Estonian Association of People Who Use Psychotropic Substances (LUNEST) conducted a study in Estonia to assess the situation regarding the human rights of women who use drugs and/or living with HIV. METHODS: The research methodology, developed by EHRA and CHALN, comprised in-depth interviews with 38 drug-dependent women conducted between August 8 and 14, 2017, in Tallinn and Ida-Viru county. The interviews were transcribed, and 37 were analyzed using thematic content analysis. RESULTS: The study has documented widespread violations of parental rights (removal of children because of their mother's inability to cease drug use and barriers to regaining custody), violations of the right to health (the failure to provide quality drug and HIV treatment, and the disclosure of medical data, including HIV status and opioid substitution treatment (OST) records), the violation of labor rights due to drug use, arbitrary arrest, street drug testing, and violations of the right to a fair trial. A number of women have experienced repeated cases of gender-based violence but have had no access to psychosocial support, shelters, or other protection or rehabilitation measures. CONCLUSIONS: Our findings suggest that punitive drug laws and their enforcement practices, the lack of gender-specific drug treatment facilities, combined with stigma related to drugs and HIV, are the main drivers of systematic and serious violations of the human rights of women who use drugs or who are drug dependent. Stigma and human rights violations undermine Estonia's efforts in HIV prevention, care, and treatment, and its overall efforts to respect, protect, and fulfill the right to health of women who use drugs or who are drug dependent. For these reasons, the Government of Estonia should address a variety of issues related to the protection of human rights of this vulnerable population group.

Violations of workers' rights and exposure to work-related abuse of live-in migrant and live-out local home care workers - a preliminary study: implications for health policy and practice.

BACKGROUND: Home care workers work in an isolated environment, with limited supervision and guidance which makes them more prone to abuse and exploitation. While past research focused mostly on the well-being of care recipients, this study aimed to shed light on the care workers' daily reality and explore if and how boundaries of professional care work are blurred. Our primary aim was to assess the working conditions and the prevalence of abuse and exploitation among live-in migrant home care workers and live-out local home care workers. METHODS: A random stratified sample of Israeli older adults aged over 70, who are entitled by law to home care services was used to recruit 338 migrant live-in home care workers and 185 local live-out home care workers to a face-to-face survey. The participants were asked about their relationship with the care recipient and their exposure to violations of workers' rights and work-related abuse. RESULTS: Almost all the participants reported exposure to certain workers' rights violations. Among the migrant live-in care workers, it was found that 58% of them did not receive any vacation days besides the weekly day-off, about 30% reported not get even a weekly day-off on a regular basis, and 79% did not get paid sick days. Local live-out care workers also suffered from a high prevalence of exploitation - 58% did not get any vacation days besides the weekly day-off, and 66% did not get paid sick leave. 20% of the local live-out care workers, and 15% of the migrant live-in care workers did not receive a signed contract. A smaller portion (7.4% among migrant care workers, 2.5% among local care workers) reported work-related abuse. When compared to local workers, migrant home care workers were more vulnerable to some worker's rights violations, as well as emotional abuse. CONCLUSION: These findings are disturbing, as work-related abuse and exploitation affect not only the well-being of the care worker but also the health of the care recipients, as the quality of care provided deteriorates. At the public policy level, more significant attention and regulation of the home care industry is needed. The frequency and the nature of home visits made by home care agencies must be changed. Also, home care workers should be offered emotional support.

Too afraid to go: fears of dignity violations as reasons for non-use of maternal health services in South Sudan.

BACKGROUND: South Sudan has one of the worst health and maternal health situations in the world. Across South Sudan, while maternal health services at the primary care level are not well developed, even where they exist, many women do not use them. Developing location specific understanding of what hinders women from using services is key to developing and implementing locally appropriate public health interventions. METHODS: A qualitative study was conducted to gain insight into what hinders women from using maternal health services. Focus group discussions (5) and interviews (44) were conducted with purposefully selected community members and health personnel. A thematic analysis was done to identify key themes. RESULTS: While accessibility, affordability, and perceptions (need and quality of care) related barriers to the use of maternal health services exist and are important, women's decisions to use services are also shaped by a variety of social fears. Societal interactions entailed in the process of going to a health facility, interactions with other people, particularly other women on the facility premises, and the care encounters with health workers, are moments where women are afraid of experiencing dignity violations. Women's decisions to step out of their homes to seek maternal health care are the results of a complex trade-off they make or are willing to make between potential threats to their dignity in the various social spaces they need to traverse in the process of seeking care, their views on ownership of and responsibility for the unborn, and the benefits they ascribe to the care available to them. CONCLUSIONS: Geographical accessibility, affordability, and perceptions related barriers to the use of maternal health services in South Sudan remain; they need to be addressed. Explicit attention also needs to be paid to address social accessibility related barriers; among others, to identify, address and allay the various social fears and fears of dignity violations that may hold women back from using services. Health services should work towards transforming health facilities into social spaces where all women's and citizen's dignity is protected and upheld.

A Life Course Theory Approach to Understanding Eritrean Refugees' Perceptions of Preventive Health Care in the United States.

Thousands of Eritreans flee their homes each month, embarking on dangerous journeys. With these extreme life experiences in mind, this qualitative study aimed to better understand Eritrean resettled refugees' perceptions of United States (US) preventive health care through the lens of the Life Course Theory. Through secondary thematic analysis of narrative data, two over-arching themes emerged: 1) a thirst for information, understanding and affordable health care and 2) attitudes of gratitude and hope despite lack of information and funding. Health promotion programs should focus on enhancing community engagement while nurturing protective factors of resiliency and hope to improve information dissemination and access to affordable health-care services.

Punishment of Minor Female Genital Ritual Procedures: Is the Perfect the Enemy of the Good?

Female genital alteration (FGA) is any cutting, removal or destruction of any part of the external female genitalia. Various FGA practices are common throughout the world. While most frequent in Africa and Asia, transglobal migration has brought ritual FGA to Western nations. All forms of FGA are generally considered undesirable for medical and ethical reasons when performed on minors. One ritual FGA procedure is the vulvar nick (VN). This is a small laceration to the vulva that does not cause morphological changes. Besides being performed as a primary ritual procedure it has been proposed as a substitute for more extensive forms of FGA. Measures advocated or taken to reduce the burden of FGA can be punitive or non-punitive. Even if it is unethical to perform VN, we argue that it also is unethical to attempt to suppress it through punishment. First, punishment of VN is likely to cause more harm than good overall, even to those ostensibly being protected. Second, punishment is likely to exceed legitimate retributive ends. We do not argue in favor of performing VN. Rather, we argue that non-punitive strategies such as education and harm reduction should be employed.

Desnutrición en niños y niñas de la etnia Wayuu: entre lo ético, lo propio y pertinente / Malnutrition in children of the Wayuu ethnicity: among the ethical, the unique and the relevant

La desnutrición ha cobrado la vida de un importante número de niños y niñas de la etnia wayuu que habitan en el departamento de La Guajira en Colombia. Esa situación existe y persiste sin que los decisores o la sociedad civil tomen acciones que reviertan el problema, mostrando total indiferencia y falta de solidaridad. En el país en general y en La Guajira en particular, es evidente la vulneración de los derechos de los niños y las niñas, como sujetos que se construyen en el presente y cuyo futuro no puede ser preparado sin su participación, el apoyo de sus familias, sus comunidades y las organizaciones civiles e instituciones del Estado. Es importante la solidaridad de la sociedad, puesto que los indígenas requieren respuestas, teniendo en cuenta las consideraciones éticas para su atención. Quienes solicitan se hagan efectivos los derechos que tanto se proclaman por distintos medios y que se han convertido sólo en sueños, puesto que la realidad es otra (AU).

Malnutrition has claimed the lives of a great quantity of children of the Wayuu ethnicity, who live in La Guajira department, in Colombia. This situation has existed for a long time without the action of the decision makers or the social society to solve the problem, showing total indifference and lack of solidarity. In the country in general and particularly in La Guajira, it is evident the violation of the rights of the children as subjects that are in the formation process at that moment of their lives, and whose future could not be granted without their participation and the support of their families, their communities, the civilian organizations and the State institutions. It is important the society's solidarity, because native people require answers and attention, taking into account ethical consideration. There are many people asking for making effective the rights that are so widely proclaimed by different means and have become just dreams, because they are another thing in real life (AU).

Desnutrición en niños y niñas de la etnia Wayuu: entre lo ético, lo propio y pertinente / Malnutrition in children of the Wayuu ethnicity: among the ethical, the unique and the relevant

La desnutrición ha cobrado la vida de un importante número de niños y niñas de la etnia wayuu que habitan en el departamento de La Guajira en Colombia. Esa situación existe y persiste sin que los decisores o la sociedad civil tomen acciones que reviertan el problema, mostrando total indiferencia y falta de solidaridad. En el país en general y en La Guajira en particular, es evidente la vulneración de los derechos de los niños y las niñas, como sujetos que se construyen en el presente y cuyo futuro no puede ser preparado sin su participación, el apoyo de sus familias, sus comunidades y las organizaciones civiles e instituciones del Estado. Es importante la solidaridad de la sociedad, puesto que los indígenas requieren respuestas, teniendo en cuenta las consideraciones éticas para su atención. Quienes solicitan se hagan efectivos los derechos que tanto se proclaman por distintos medios y que se han convertido sólo en sueños, puesto que la realidad es otra (AU).

Malnutrition has claimed the lives of a great quantity of children of the Wayuu ethnicity, who live in La Guajira department, in Colombia. This situation has existed for a long time without the action of the decision makers or the social society to solve the problem, showing total indifference and lack of solidarity. In the country in general and particularly in La Guajira, it is evident the violation of the rights of the children as subjects that are in the formation process at that moment of their lives, and whose future could not be granted without their participation and the support of their families, their communities, the civilian organizations and the State institutions. It is important the society's solidarity, because native people require answers and attention, taking into account ethical consideration. There are many people asking for making effective the rights that are so widely proclaimed by different means and have become just dreams, because they are another thing in real life (AU).

Violência sexual, infância e povos indígenas: ressignificação intercultural das políticas de proteção no contexto das indígenas crianças / Sexual violence, childhood and indigenous people: intercultural redefinition of protection policies in the context of indigenous children / Violencia sexual, niñez y pueblos indígenas: resignificación intercultural de las políticas de protección en el contexto de los niños indígenas

O artigo analisa a construção de política diferenciada de intervenção sobre violência sexual contra indígenas crianças com base nas experiências institucionais da rede de proteção do município de Altamira, estado do Pará, no Brasil. Mediante uso de pesquisa documental e bibliográfica, além da vivência direta como membro desta rede de proteção, problematiza-se a forma como os direitos indígenas e a compreensão intercultural da infância e da violência sexual repercutiram numa mudança de concepção das políticas de enfrentamento no município, possibilitando a condução de processos de pesquisa sobre a realidade sociocultural dos povos indígenas com relação à temática, também à formação continuada dos profissionais que atuam no atendimento direto das vítimas e na elaboração de fluxo de atendimento intercultural que contemple a autodeterminação dos povos indígenas na dinâmica de atuação da rede de proteção.

The article analyzes the construction of differentiated policy for intervention in the area of sexual violence against indigenous children, based in the institutional experiences of a protection network in the municipality of Altamira, Pará State, Brazil. Through the use of documentary and bibliographical research, as well as direct experience as a member of this protection network, we discuss how indigenous rights and intercultural understanding of children and sexual violence have resulted in a change in design of protection policies in the city. This has led to research processes on the socio-cultural reality of indigenous peoples and sexual violence, and the continuing education of professionals working for the direct care of victims, developing an intercultural services that includes the self-determination of indigenous peoples through the protection network

El artículo analiza la construcción de la política diferenciada de intervención sobre la violencia sexual contra los niños y niñas indígenas, con base en las experiencias institucionales de la red de protección de la ciudad de Altamira, estado de Pará, Brasil. A través del uso de la investigación documental y bibliográfica, así como la experiencia directa como miembro de esta red de protección, se discute cómo los derechos indígenas y el entendimiento intercultural de la niñez y de la violencia sexual han promovido un cambio en el diseño de las políticas de protección en la ciudad, permitiendo la realización de procesos de investigación sobre la realidad socio-cultural de los pueblos indígenas en relación al tema; también la formación continuada de los profesionales que trabajan en la atención directa de las víctimas y el desarrollo de flujo de atendimiento intercultural que incluya la autodeterminación de los pueblos indígenas en la dinámica de actuación de la red de protección.

Female genital alteration: a compromise solution.

Despite 30 years of advocacy, the prevalence of non-therapeutic female genital alteration (FGA) in minors is stable in many countries. Educational efforts have minimally changed the prevalence of this procedure in regions where it has been widely practiced. In order to better protect female children from the serious and long-term harms of some types of non-therapeutic FGA, we must adopt a more nuanced position that acknowledges a wide spectrum of procedures that alter female genitalia. We offer a revised categorisation for non-therapeutic FGA that groups procedures by effect and not by process. Acceptance of de minimis procedures that generally do not carry long-term medical risks is culturally sensitive, does not discriminate on the basis of gender, and does not violate human rights. More morbid procedures should not be performed. However, accepting de minimis non-therapeutic f FGA procedures enhances the effort of compassionate practitioners searching for a compromise position that respects cultural differences but protects the health of their patients.

Community Coping Strategies in Response to Hardship and Human Rights Abuses Among Burmese Refugees and Migrants at the Thai-Burmese Border: A Qualitative Approach.

We conducted 10 focus groups (n = 49) with community members and key informant interviews (n = 28) to explore hardships and community coping strategies for sequelae of abuse among Burmese refugees/migrants in Thailand. Transcripts were coded and analyzed for major themes. In Burma, they universally experienced human rights violations and economic hardship. Hardships continued in Thailand through exploitation and threat of deportation. Coping was achieved through both personal and community-based mechanisms including self-reflection, sharing experiences, spirituality, and serving their community. Western psychosocial counseling, although available, was used infrequently. Effective psychosocial support often originates from the community and should be supported by international organizations.

Migrant workers in Sabah, East Malaysia: The importance of legislation and policy to uphold equity on sexual and reproductive health and rights.

Sabah, located in Southeast Asia, hosts the highest number of non-Malaysian citizens (27.7%), predominantly the Indonesian and Filipino migrants in comparison to other states in Malaysia. Sabah has inadequate data on migrants' sexual and reproductive health and rights (SRHRs). Various migrant-related policies and laws are present, but they do not offer full protection and rights to legal migrants in terms of their SRHRs. The aim of the laws and policies appears to be controlling the migrants from having any negative impact on the locals, rather than protecting migrants' health and rights. This affected their rights to marriage, having children, increase their vulnerabilities to labour trafficking and sexual abuse and access to health-care services. Female migrant workers and undocumented migrants form the most vulnerable subgroups of migrants. This narrative review highlights the status of SRHRs of migrants in Sabah and the migrant-related Malaysian laws and policies affecting their SRHRs.

La explotación sexual comercial infantil en la ciudad de Bucaramanga: análisis y propuestas de intervención socio-sanitaria / The sexual exploitation of children in the city of Bucaramanga: analysis and proposals for social and health care intervention

Objetivo: Fortalecer la oferta institucional para la prevención y atención de la problemática de la explotación sexual comercial infantil en la ciudad de Bucaramanga (Colombia). Método: Se realizó una investigación bajo una perspectiva cualitativa con un enfoque de investigación acción y muestreo intencional: 6 grupos focales y 10 entrevistas en profundidad con diferentes actores implicados en la explotación sexual comercial infantil. Resultados: La percepción de la explotación sexual comercial infantil como una forma de trabajo por parte de las víctimas dificulta el reconocimiento de la situación como una violación de derechos humanos. La educación, la salud sexual y reproductiva y la protección desde sectores institucionales, son las mayores debilidades en las que hay que incidir para la prevención y atención de la problemática. Conclusiones: El entorno de pobreza junto con la cultura patriarcal androcéntrica, favorecen la explotación sexual comercial infantil en la ciudad de Bucaramanga. Es necesario priorizar en su agenda pública recursos para la atención y prevención de la explotación sexual comercial infantil poniendo énfasis en la dimensión social y de salud de la misma (AU)

Objective: To strengthen the institutional offer for the prevention and treatment of the problem of sexual exploitation of children in the city of Bucaramanga (Colombia). Method: We performed a qualitative research under an action research approach and a purposive sampling: 6 focus groups and 10 in-depth interviews with different actors involved in children commercial sexual exploitation. Results: The perception of sexual exploitation of children as a form of work on the part of the victims makes difficult to recognize the situation as a human rights violation. Education, sexual and reproductive health, and protection from institutional sectors are the major weaknesses that would need to face it for the prevention and care of the problem. Conclusion: The poverty environment together with androcentric patriarchal culture, promote the sexual exploitation of children in the city of Bucaramanga. It need prioritize in public agenda to resources for care and prevention of sexual exploitation of children by emphasizing the social and health dimensions (AU)