Influences on reproductive decision-making among forcibly displaced women resettling in high-income countries: a scoping review and thematic analysis.

BACKGROUND: Forced displacement impacts the health, rights and safety of women, which is further compounded by gender inequality. In particular, this has consequences for forcibly displaced women's reproductive health once resettled in a new country. To ensure the reproductive health and rights of forcibly displaced women during and after resettlement, there must be careful consideration of their reproductive decision-making taking into account the context and environment of the host country. AIM: This scoping review aimed to explore the influences on reproductive decision-making among forcibly displaced women resettling in high-income countries. METHOD: A scoping review was conducted following the PRISMA-ScR for reporting. EBSCO was used to search databases covering global health, health policy, psychology, sociology, and philosophy for articles published from 1 January 2012 to 27 April 2022. Data extracted from each article included author(s), year of publication, publication type, aims/objectives, study design, sampling method, data collection or eligibility criteria, study population (i.e., sample size and characteristics), migration status, country(ies) of origin, host country(ies), key findings and limitations. Two independent reviewers screened all articles against eligibility criteria using Covidence. Data charting and thematic analysis were performed independently by one reviewer. FINDINGS: Nineteen articles published between 2013 and 2022 mostly conducted in the United States (36.8%) and Australia (21.1%), with the majority reporting on qualitative findings (68.4%), and women from a wide array of countries and cultures (most commonly African countries) were included. Influences on women's reproductive decision-making related to the contexts before displacement, during displacement, and after arrival, with influences on women's reproductive decision-making identified specific to the context. The influences before displacement included conflict; religious beliefs; socio-cultural gendered expectations; and external control over reproductive autonomy. During displacement influences included paternalism and access to education. Influences after arrival included pressure, restriction, coercion; knowledge and misconceptions; patriarchal power dynamics; and seeking empowerment. An adapted socio-ecological model was developed to interpret the findings. CONCLUSION: This review highlights the complexity and nuances within forcibly displaced women's experiences which influence their reproductive decision-making. Further research may review the evidence base to provide guidance for healthcare professionals and health policies aimed at empowering women to make autonomous reproductive decisions; develop training for healthcare professionals to prevent pressure, restriction and coercion of women's reproductive autonomy; and inform development of policy that takes an intersectional approach to women's health rights and gender equality.

Meeting the reproductive health needs of female sex workers in Côte d'Ivoire: protecting the human right to dignified health.

The sexual and reproductive health needs of female sex workers (FSW) are often understudied and underserved in the context of HIV-related research in countries across Sub-Saharan Africa and West Africa. We assessed the lived experiences of FSW across Côte d'Ivoire to characterize unmet reproductive health needs and opportunities to address them. From February-August, 2020, ENDA Santé, Côte d'Ivoire conducted 75 in-depth interviews and 15 focus group discussions with FSW and community informants in five cities in Côte d'Ivoire. Themes that emerged included the inconsistent use of contraception services, a history of unintended pregnancies, and experiences of stigma at public healthcare facilities. Opportunities to increase the impact of both SRH and HIV services included strengthening existing HIV and family planning service integration for FSW. Taken together, the results highlight the importance of addressing the unmet reproductive health needs of FSW to both optimize the HIV response and increase the delivery of human-rights affirming sexual and reproductive health services for sex workers.

In Côte d'Ivoire, female sex workers (FSW) continue to have an unmet need for sexual and reproductive health (SRH) and HIV prevention services. The disproportionate burden of HIV/STIs is driven by several shared factors including behavioral, social, and structural determinants of HIV, STIs, and pregnancy; as well as biological efficiency of transmission of HIV in the context of STIs. This qualitative study examined the unmet SRH needs of FSW in 5 cities in Côte d'Ivoire to better understand how to offer integrated and high quality SRH and HIV programs and services. Working together with ENDA Santé Côte d'Ivoire, an organization that works closely with FSW, 75 in-depth interviews were held among FSW and community informants, and 15 focus group discussions with FSW. After analyzing the transcripts, several key themes emerged including use of contraceptive methods and unintended pregnancy, the experience of pregnancy and childbirth, HIV care access and quality, FSW-differentiated healthcare services and providers, and opportunities for service integration. The findings from this study underline gaps in the health system for FSW and the benefits of including SRH programming into routine HIV services to strengthen existing efforts.

Hydrometeorological field instrumentation in Lesser Himalaya to advance research for future water and food security.

Hydrometeorological monitoring and continuous data collection in ungauged mountainous regions are exciting and challenging for water resource planners compared to the measurement in plain areas. Lesser Himalayas in the mountainous areas face the insufficiency of continuous hydrometeorological data, hindering our understanding of hydrological processes and hampering integrated water resources management. This present study focuses on the setup of the field instruments for collecting hydrometeorological data and analyzing continuously collected data at Aglar watershed to assess hydrometeorological parameters' spatial and temporal distribution. The instrumentation includes monitoring one sub-surface flow, five stream flows, four rain gauges, and one automatic weather station. The relationship between the stage and the discharge was established based on the collected data for three streams. The analyzed seasonal rainfall revealed 726.7 mm of rain occurred during the monsoon with an intensity of less than 16 mm/day. The Paligaad sub-watershed displayed a flashy response towards the rainfall events, whereas the Upper Aglar exhibited a wide range of dampening runoff responses for different rainfall events. The monitored sub-surface flow varies annually, and during the monsoon season, interflow and baseflow hydrograph decayed more rapidly at the rate of 0.04 day-1 and 0.78 day-1, respectively. The installed AWS has been used to measure crop water requirements and plan for better strategies to cope with future food and water security. The high-frequency generated data will help answer the queries related to hydrological responses of different watershed characteristics.

Barriers to Overcoming Child Hunger and Malnutrition: Applying a Human Rights Approach to Improve Policy and Action.

Objective: Analyze key barriers to achieving children's right to food under Colombia's food and nutrition security policies and programs. Methods: A literature review was conducted along with 17 semi-structured expert interviews. The law framework on the right to food was applied to analyze findings. Results: Four key barriers were found. First, a reductionist approach prevails in the political narrative. This focuses on ensuring personal food access overlooking societal and environmental impacts. Second, the implementation of policies and programs is passed on to third parties, preventing civic participation and accountability. Third, there are insufficient national data sources and indicators to monitor the impact of interventions and funding. Fourth, program implementation is unequal and inadequate, which inadvertently supports illicit economies that thrive on conditions of hunger and poverty. Conclusion: Children's food and nutrition are reliant on organizations that focus on personal food supply without strengthening civic participation. Strengthening participation requires a human rights approach. International organizations can help the government to engage communities in policy and program improvement and oversight.

Does the Human Right to Healthcare Apply Universally? A Contribution from a Trauma Therapeutic Perspective.

Access to the best possible healthcare is a fundamental human right. However, the provision of medical treatment is not only dependent on the actual treatment options available and the type of illness to be treated but is significantly influenced and restricted by structural and legal conditions. This is particularly evident in the case of refugees and other groups such as the so-called "paperless", whose access to medical treatment is de facto seriously impeded or denied altogether. At the same time, these individuals are particularly vulnerable to the development of mental illness for a variety of reasons. Refugees in particular often suffer from trauma sequelae, resulting in a broad range of impairments. Based on a case study of a refugee woman living in her host country, the interactions between mental illness and limited psychiatric/psychotherapeutic treatment options due to legal restrictions are analyzed from a medical perspective. Her initially only medically oriented treatment was insufficient to mitigate the consequences of these restrictions. As it was a protracted treatment process, the legal aspects of her case therefore also had to be decisively considered. This case study shows that the human right to the best possible healthcare can be considerably restricted by structural requirements, which, in the case of sequential traumatization and severe illnesses with suicidal tendencies, can be labelled as structural violence.

Death by Detox: Substance Withdrawal, a Possible Death Row for Individuals in Custody.

Suffering through substance withdrawal is a major problem for the majority of individuals in custody, yet there are no guidelines or standards to ensure their safety. Instead, individuals in custody are having their Constitutional rights violated and many die at the hands of the justice system. When their families seek accountability for the lack of adequate care provided by correctional facilities and employees, families are faced with a lack of consistency from one circuit to the next for knowing as to the correct standard to have a successful claim. Strain v. Regalado was a chance for the Supreme Court to address this issue, but by denying cert in that case, the Court has signed off on the injustice these individuals face. This note proposed having the subjective prong for the deliberate indifference claim for inadequate medical care for withdrawal for individuals in custody presumed. Allowing the subjective prong to be presumed better aligns with the reality of this issue because correctional officers see many inmates suffering withdrawal and the symptoms which indicate the need for medical intervention are similar to those that would indicate a medical need in any other situation. Additionally, correctional officers are purportedly held to a higher standard. This note then proposed a federal standard for claims and medical care. These are both basic rights in the United States, unless and until a person is in custody.

The Endless Vulnerability of Migrant Children In-Transit across the Darién Gap.

Many people from poverty-stricken countries are migrating across South and Central America to reach the México-United States border, a movement exacerbated by the COVID-19 pandemic. Migrant people who begin their northbound journey in South America must transit across a significant geographic bottleneck, the Darién Gap, a mountainous rainforest region between Colombia and Panama. Most migrant people crossing this region originate from Cuba, Haiti, and Venezuela. Other people reach the shores of South American countries from west and central Africa or central and southeastern Asia and continue to the Darién Gap. Poverty and violence drive families with children to flee their homes and endure incalculable risks in their path. Children traveling with their families or as unaccompanied minors across the Darién Gap are exposed to life-threatening situations and human rights violations, including abuse, exploitation, malnourishment, and limited access to medical care. In addition to experiencing untreated medical illnesses, children experience mental health disorders during migration and after they reach their destination as a result of victimization and adverse traumatic experiences. Therefore, providing migrants, especially children, with rapid medical screenings and mental health support when they arrive at their destination is critical to reduce health inequities. Furthermore, making these interventions available during their transit and ensuring their safety may prevent further human rights abuses in children and families. Latin American governments must address the ongoing humanitarian crisis endured by migrants throughout their migratory path by offering access to essential healthcare services and safeguarding the rights and security of children and vulnerable groups.

Challenging the US Supreme Court's Majority Ruling on Roe v. Wade at the International Human Rights Level.

This paper proposes that US human rights experts and abortion rights advocates challenge the striking down of Roe v. Wade in June 2022 by the majority of US Supreme Court justices because of the multiple human rights violations it has engendered. The paper has three parts. The first part summarizes the compelling response of the three dissenting Supreme Court justices to the majority ruling, which spells out those violations in detail. The second part offers a history of cases of violations of human rights related to abortion in other countries that have been heard and adjudicated by a range of human rights bodies in the last 20 years, and their outcomes. It shows that working on these cases has created working relationships between national and international human rights experts and advocates. Based on this information, the third part proposes that US human rights and abortion rights advocates take a case to the Inter-American Commission on Human Rights against the US Supreme Court ruling, asking the commission to direct the US government to void the majority ruling on Roe v. Wade-on the grounds that it violates the human rights of anyone who seeks an abortion and potentially also of those whose wanted pregnancies become a risk to their health and life and need to be terminated. And if the United States does not agree, the commission should refer the case to the Inter-American Court of Human Rights.

Does New Mental Health Legislation in Victoria, Australia, Advance Human Rights?

In introducing the Mental Health and Wellbeing Bill of 2022 into Parliament in Victoria, Australia, the state government claimed that the new legislation "delivers on the vision for rights-based mental health and wellbeing laws." This paper examines the new legislation in light of both local human rights legislation and international human rights law. Drawing primarily on the United Nations Convention on the Rights of Persons with Disabilities and the Victorian Charter of Human Rights and Responsibilities Act of 2006, this paper argues that while the new legislation is not, in fact, rights based, it does represent some rights-related improvements over existing legislation. The paper concludes with a discussion of how rights-based legislation could be applied to the Victorian context, using the latest guidance from the World Health Organization and the United Nations.

No Dignity on the Floor: A Human Rights Argument for Adult-Sized Changing Tables in Public Restrooms in the United States.

Many individuals with disabilities utilize adult-sized changing tables to take care of their toileting needs with the help of a caregiver.1 These tables are not explicitly required by the Americans with Disabilities Act (ADA), and no legal case in the United States has yet addressed whether the ADA requires public restrooms to have adult changing tables.2 This paper draws on an analysis of op-eds and news articles published in the United States to explore how individuals with disabilities and their caregivers access public restrooms that do not provide adult-sized changing tables. These experiences demonstrate violations of the human rights to accessibility, integrity, and health as outlined in the Convention on the Rights of Persons with Disabilities. Utilizing a human rights analysis, I argue that adult-sized changing tables are inherently the same as toilets and that providing one but not the other in public facilities may constitute discrimination under the ADA. Finally, I briefly explore promising initiatives that would increase access to adult-sized changing tables in the United States.

Awareness of the Need for Change: A Constructivist Grounded Theory of Medical Students' Understanding of Human Rights in Mental Health.

Traditionally, teaching in psychiatry has had a passing focus on human rights. Against this backdrop, the aim of this study was to construct a theory of the learning value of a service user-led human rights-focused teaching program for final-year medical students. We used descriptive qualitative analysis based on constructivist grounded theory to examine final-year medical students' understandings of human rights following a formal teaching program. The overarching theory that emerged focuses on an awareness of the need for change within student learning. This involves both a need for understanding the mental health care system and a need for self-reflection. These two processes appear to interact, promoting learning about the value of a human rights focus. While acknowledging the difficulties in securing such a change, students felt that doing so would be valuable to the practice of mental health. This service user-led human rights teaching program produced new awareness in medical students, both in terms of their understanding of their own biases and in terms of understanding the influence of systemic and structural elements of the psychiatric system on the protection of service users' human rights. Teaching human rights in psychiatry is likely to enrich their future self-reflective practice.

Self-Managed Abortion in Africa: The Decriminalization Imperative in Regional Human Rights Standards.

Self-managed abortion holds particular promise for revolutionizing people's access to quality reproductive care in Africa, where the burden of abortion-related mortality is the highest globally and where abortion remains criminalized, in violation of various internationally and regionally recognized human rights. Increasingly safe and effective, self-managed medication abortion is still subject to many restrictions, including criminal laws, across the continent. Drawing on recent evidence and human rights developments around self-managed abortion, this paper explores whether and to what extent Africa's regional legal framework builds a normative basis for the decriminalization of self-managed abortion. We conclude that the region's articulation of the rights to dignity, to freedom from cruel, inhuman, and degrading treatment, and to nondiscrimination, among others, provides strong grounds for decriminalization, both concerning individuals who need abortions and concerning the constellation of actors who enable self-management.