Between a woman and her fetus: Bedouin women mediators advance the health of pregnant women and babies in their society.

INTRODUCTION: Bedouin women in Israel confront a challenging circumstance between their traditional patriarchal society and transition to modernity. In terms of reproductive health, they face grave disparities as women, pregnant women and mothers. In this article we aim to understand the challenges of Bedouin women who work as mediators in the promotion of Bedouin women's perinatal health. We explore their challenges with the dual and often conflictual role as health peer-instructors-mediators in mother-and-child clinics, and also as members of a Bedouin community, embodying a status as women, mothers, and family caretakers. Drawn upon a feminist interpretative framework, the article describes their challenges in matters of perinatal health. Our research question is: how do women who traditionally suffer from blatant gender inequality utilize health-promotion work to navigate and empower themselves and other Bedouin women. METHODS: Based on an interpretive feminist framework, we performed narrative analysis on eleven in-depth interviews with health mediators who worked in a project in the Negev area of Israel. The article qualitatively analyses the ways in which Bedouin women mediators narrate their challenging situations. RESULTS: This article shows how difficult health mediators' task may be for women with restricted education who struggle for autonomy and better social and maternal status. Through their praxis, women mediators develop a critical perspective without risking their commitments as women who are committed to their work as well as their society, communities, and families. These health mediators navigate their ways between the demands of their employer (the Israeli national mother and child health services) and their patriarchal Bedouin society. While avoiding open conflictual confrontations with both hegemonic powers, they also develop self-confidence and a critical and active approach. CONCLUSIONS: The article shows the ways by which the mediator's activity involved in perinatal health-promotion may utilize modern perinatal medical knowledge to increase women's awareness and autonomy over their pregnant bodies and their role as caregivers. We hope our results will be applicable for other women as well, especially for women who belong to other traditional and patriarchal societies.

Ethical challenges for women's healthcare highlighted by the COVID-19 pandemic.

Healthcare policies developed during the COVID-19 pandemic to safeguard community health have the potential to disadvantage women in three areas. First, protocols for deferral of elective surgery may assign a lower priority to important reproductive outcomes. Second, policies regarding the prevention and treatment of COVID-19 may not capture the complexity of the considerations related to pregnancy. Third, policies formulated to reduce infectious exposure inadvertently may increase disparities in maternal health outcomes and rates of violence towards women. In this commentary, we outline these challenges unique to women's healthcare in a pandemic, provide preliminary recommendations and identify areas for further exploration and refinement of policy.

Emergency contraception: unresolved clinical, ethical and legal quandaries still linger.

Emergency contraception (EC) has been prescribed for decades, in order to lessen the risk of unplanned and unwanted pregnancy following unprotected intercourse, ordinary contraceptive failure, or rape. EC and the linked aspect of unintended pregnancy undoubtedly constitute highly relevant public health issues, in that they involve women's self-determination, reproductive freedom and family planning. Most European countries regulate EC access quite effectively, with solid information campaigns and supply mechanisms, based on various recommendations from international institutions herein examined. However, there is still disagreement on whether EC drugs should be available without a physician's prescription and on the reimbursement policies that should be implemented. In addition, the rights of health care professionals who object to EC on conscience grounds have been subject to considerable legal and ethical scrutiny, in light of their potential to damage patients who need EC drugs in a timely fashion. Ultimately, reproductive health, freedom and conscience-based refusal on the part of operators are elements that have proven extremely hard to reconcile; hence, it is essential to strike a reasonable balance for the sake of everyone's rights and well-being.

Conflicting abortion laws in India: Unintended barriers to safe abortion for adolescent girls.

This article examines the laws related to abortion in India, demonstrating how conflicting laws create unintended barriers to safe abortion for adolescent girls. It focuses specifically on the situation of adolescent girls seeking abortion, showcasing the unintended consequences that arise from the existing lack of clarity in the legal regime. The article also discusses the recommendations of the Committee on the Rights of the Child and the United Nations' Convention on the Rights of the Child.

Conscientious objection to abortion, the law and its implementation in Victoria, Australia: perspectives of abortion service providers.

BACKGROUND: In Victoria, Australia, the law regulating abortion was reformed in 2008, and a clause ('Section 8') was introduced requiring doctors with a conscientious objection to abortion to refer women to another provider. This study reports the views of abortion experts on the operation of Section 8 of the Abortion Law Reform Act in Victoria. METHODS: Nineteen semi-structured qualitative interviews were conducted with purposively selected Victorian abortion experts in 2015. Interviews explored the impact of abortion law reform on service provision, including the understanding and implementation of Section 8. Interviews were transcribed verbatim and analysed thematically. RESULTS: The majority of participants described Section 8 as a mechanism to protect women's right to abortion, rather than a mechanism to protect doctors' rights. All agreed that most doctors would not let moral or religious beliefs impact on their patients, and yet all could detail negative experiences related to Section 8. The negative experiences arose because doctors had: directly contravened the law by not referring; attempted to make women feel guilty; attempted to delay women's access; or claimed an objection for reasons other than conscience. Use or misuse of conscientious objection by Government telephone staff, pharmacists, institutions, and political groups was also reported. CONCLUSION: Some doctors are not complying with Section 8, with adverse effects on access to care for some women. Further research is needed to inform strategies for improving compliance with the law in order to facilitate timely access to abortion services.

The limits of compromise: the range of perspectives on women's reproductive rights in Poland.

OBJECTIVES: A discourse analysis was carried out to identify how women's reproductive rights and needs are reflected in pro-life and pro-choice public debate in Poland. METHODS: The research procedure was based on the need to answer the question: how do pro-life and pro-choice discourses define women's reproductive rights in Poland (including the right to abortion)? Discourse analysis was applied to answer this question. The analysis covered materials published in rightist-conservative and leftist-feminist social-political portals and in popular media during the period 2009-2014, when the so-called 'abortion compromise' was in force, and the period 2016-2017, when a proposal for an absolute ban on abortion caused women to protest throughout Poland. RESULTS: Our research showed that construction of the analysed discourses is of a processual nature. Owing to social changes, both discourses have become strongly radicalised. The rightist-conservative discourse is emotional and criticising, restricting women's rights to the benefit of the rights of the fetus. The leftist-feminist view is oriented towards emphasising freedom of choice and observing women's rights. CONCLUSION: The pro-life movement's discourse may be defined as promoting the restriction of women's reproductive rights, while leftist-feminist discourse may be seen as promoting women's reproductive rights.

The politics of female pain: women's citizenship, twilight sleep and the early birth control movement.

The medical intervention of 'twilight sleep', or the use of a scopolamine-morphine mixture to anaesthetise labouring women, caused a furore among doctors and early 20th-century feminists. Suffragists and women's rights advocates led the Twilight Sleep Association in a quest to encourage doctors and their female patients to widely embrace the practice. Activists felt the method revolutionised the notoriously dangerous and painful childbirth process for women, touting its benefits as the key to allowing women to control their birth experience at a time when the maternal mortality rate remained high despite medical advances in obstetrics. Yet many physicians attacked the practice as dangerous for patients and their babies and antithetical to the expectations for proper womanhood and motherly duty. Historians of women's health have rightly cited Twilight Sleep as the beginning of the medicalisation and depersonalisation of the childbirth process in the 20th century. This article instead repositions the feminist political arguments for the method as an important precursor for the rhetoric of the early birth control movement, led by Mary Ware Dennett (a former leader in the Twilight Sleep Association) and Margaret Sanger. Both Twilight Sleep and the birth control movement represent a distinct moment in the early 20th century wherein pain was deeply connected to politics and the rhetoric of equal rights. The two reformers emphasised in their publications and appeals to the public the vast social significance of reproductive pain-both physical and psychological. They contended that women's lack of control over both pregnancy and birth represented the greatest hindrance to women's fulfilment of their political rights and a danger to the healthy development of larger society. In their arguments for legal contraception, Dennett and Sanger placed women's pain front and centre as the primary reason for changing a law that hindered women's full participation in the public order.

Percepção dos profissionais para implantação do teste rápido para HIV e Sífilis na Rede Cegonha / The professional's perception for the implantation of the rapid test for HIV and Syphilis in Rede Cegonha / La percepción de los profesionales para la implantación de la prueba rápida para VIH y Sífilis en la Rede Cegonha

O artigo investiga a avaliação dos profissionais da Atenção Primária (AP) sobre a implantação do aconselhamento e do teste rápido de HIV e Sífilis na Rede Cegonha (RC). Trata-se de um estudo qualitativo, descritivo e exploratório, no qual foram realizadas 13 entrevistas semiestruturadas com profissionais da AP, analisadas a partir da análise temática. Os resultados apontam a falta de conhecimento dos profissionais em relação às inovações da RC na AP. Os profissionais receberam capacitações referentes à testagem rápida, porém o matriciamento foi considerado inexistente. A solicitação do teste rápido das gestantes é realizada de forma compulsória. O aconselhamento, quando presente, é restrito ao pré-teste de HIV e outras Infecções Sexualmente Transmissíveis (IST), tendo caráter informativo, desconsiderando as especificidades da gestação. Indica-se a necessidade de se refletir sobre a autonomia das mulheres durante o pré-natal e o aconselhamento, espaço este que pode ser repensado como um momento de fortalecimento e acolhimento.

The article investigates the evaluation of the Primary Health Care (PHC) professionals about the implementation of the HIV and Syphilis rapid test in the care policy for pregnant women (CPPW). This is a qualitative, descriptive and exploratory study, which were conducted 13 semi-structured interviews with professionals, and analyzed from the thematic analysis. The results show a lack of knowledge of professionals about the innovations of CPPW in PHC. The professional received trainings for the rapid test, but the matricial support, with longitudinal supervision with specialized professionals, was considered inexistent. The test request of the pregnant women is released of compulsory form. Counseling is restricted to the pre-test of HIV and other Sexually Transmitted Infections (STIs), and just informative, disregarding the specifics of pregnancy. It is necessary to rethink the women's autonomy during the prenatal care and counseling and to construction these spaces as a moment of empowerment and welcoming.

El artículo investiga la evaluación de los profesionales de la Atención Primaria (AP) en relación a la implantación del asesoramiento y prueba rápida del VIH y Sífilis en la red de atención a las gestantes. El presente estudio es cualitativo, descriptivo y exploratorio, en el cual se realizaron 13 entrevitas semiestructuradas con los profesionales de la AP, analizadas a partir del análisis temático. Los resultados señalan la falta de conocimiento de los profesionales en relación a las innovaciones del RC en la AP. Los profesionales recibieron capacitaciones referentas a la prueba rápida del VIH, pero la supervisión longitudinal de los casos fue considerado inexistente. La solicitud de la prueba rápida de VIH y otras Infecciones Sexualmente Transmissibles (ISTs) a las gestantes se realiza de forma obligatoria. El asesoramiento, cuando presente, se limita al pre-test del VIH y otras ISTs, teniendo carácter informativo, desconsiderando las especificidades de la gestación. Se indica que es necesario repensar la autonomía de las mujeres durante el prenatal y el asesoramiento, para que este sea un espacio de empoderamiento y acogida para las mujeres.

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.

"Las 17". Estrategias legales y políticas para legalizar el aborto en El Salvador / "Las 17". Legal and political strategies to legalize abortion in El Salvador / "Les 17": estratègies legals i polítiques per legalitzar l'avortament a El Salvador1

En El Salvador desde 1997 rige una prohibición absoluta del aborto. Desde esa fecha, múltiples han sido las acciones de los movimientos feministas para intentar revertir este sistema penal. El presente trabajo se centra en el análisis de la campaña "Las 17" en tanto una de las principales estrategias impulsada por las organizaciones de mujeres en El Salvador, en miras de incidir política, jurídica y socialmente en el debate del aborto

Since 1997, abortion has an absolute ban in El Salvador. There have been multiple actions lead by feminist movements in order to reverse this penal system. This paper focus on the analysis of "Las 17" Campaign, as one of the main collective strategies developed by women's organizations in El Salvador, in order to influence politically, legally and socially in the abortion debate

A El Salvador des de 1997 regeix una prohibició absoluta de l'avortament. Des d'aquesta data, moltes han estat les accions dels moviments feministes per intentar revertir aquest sistema penal. El present treball se centra en l'anàlisi de la campanya "Les 17" en tant que una de les principals estratègies impulsades per les organitzacions de dones a El Salvador, de cara a incidir política, jurídica i socialment en el debat sobre l'avortament

Caso Esperancita: hacia un estándar legal mínimo de aborto terapéutico en el Sistema Interamericano de Derechos Humanos / Esperancita Case: towards a minimum legal standard on therapeutic abortion in the Interamerican System of Human Rights / Cas Esperancita: cap a un estàndard legal mínim d'avortament terapèutic en el Sistema Interamericà de Drets Humans

El presente artículo describe la estrategia jurídica utilizada en el caso de Rosaura Almonte (Esperancita) vs. República Dominicana ante la Comisión Interamericana de Derechos Humanos. Se argumenta que el artículo 4 de la Convención Americana de Derechos Humanos (CADH), que consagra el derecho a la vida, establece que los Estados, en cumplimiento de sus obligaciones, deben permitir como mínimo el aborto terapéutico. A partir de un análisis de los métodos de interpretación establecidos en la Convención de Viena sobre Derecho de los Tratados y su aplicación en el Sistema Interamericano de Derechos Humanos, resulta admisible establecer que el artículo 4 de la CADH protege la vida y salud de la mujer embarazada cuando se encuentren en riesgo

This paper describes the legal strategy used in the case of Rosaura Almonte (Esperancita) vs. the Dominican Republic before the Inter-American Commission on Human Rights. This argues that Article 4 of the American Convention on Human Rights (ACHR), which enshrines the right to life, establishes that States, in compliance with their obligations, should allow at least therapeutic abortion. Indeed, based on an analysis of the methods of interpretation established in the Vienna Convention on the Law of Treaties and their application in the Inter-American System of Human Rights, it is admissible to establish that Article 4 of the ACHR protects the life and health of the pregnant woman when they are at risk

El present article descriu l'estratègia jurídica utilitzada en el cas de Rosaura Almonte (Esperancita) vs. la República Dominicana davant la Comissió Interamericana de Drets Humans. S'argumenta que l'article 4 de la Convenció Americana de Drets Humans (CADH), que consagra el dret a la vida, estableix que els Estats, en compliment de les seves obligacions, han de permetre com a mínim l'avortament terapèutic. A partir d'una anàlisi dels mètodes d'interpretació establerts en la Convenció de Viena sobre Dret dels Tractats i la seva aplicació al Sistema Interamericà de Drets Humans, resulta admissible establir que l'article 4 de la CADH protegeix la vida i salut de la dona embarassada quan es trobin en risc