Reproductive Health Matters最新文献

{"title":"A tough job: recognizing access to abortion as a matter of equality. A commentary on the views of the UN Human Rights Committee in the cases of Mellet v. Ireland and Whelan v. Ireland","authors":"Katarzyna Sękowska-Kozłowska","doi":"10.1080/09688080.2018.1542911","DOIUrl":"https://doi.org/10.1080/09688080.2018.1542911","url":null,"abstract":"Abstract This paper comments on the views of the UN Human Rights Committee (hereafter the Committee) in the cases Mellet v. Ireland [1] and Whelan v. Ireland [2]. It focuses on the Committee’s findings regarding a violation of the prohibition of discrimination. The interpretation presented by the Committee, although much welcomed and undeniably tackling reproductive health and rights in a progressive way, still leaves room for future improvements. It is argued herein that the Committee’s reasoning is marked by some inaccuracies due to its inconsistent approach regarding gender equality. Whereas the Committee seems to have fully integrated a “substantive equality” approach when providing general interpretation of States’ obligations under the International Covenant on Civil and Political Rights (hereafter the ICCPR), its assessment of individual cases remains to some extent influenced by the “formal equality” approach.","PeriodicalId":32527,"journal":{"name":"Reproductive Health Matters","volume":"26 1","pages":"25 - 31"},"PeriodicalIF":0.0,"publicationDate":"2018-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09688080.2018.1542911","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49255561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring inequities, inspiring new knowledge and action","authors":"J. Hussein","doi":"10.1080/09688080.2018.1545438","DOIUrl":"https://doi.org/10.1080/09688080.2018.1545438","url":null,"abstract":"“No one left behind”, the mantra of the Sustainable Development Goals (SDGs), resonates in the global and development agenda and is being taken up by a myriad of organisations and agencies. It is an appealing, memorable and seductive phrase, beguilingly simple, yet immensely ambitious. Firmly embedded in the recognition of every individual’s dignity, the aim is that the SDG targets be met globally, for all people, in all segments of society. The idea of redressing inequities is implicit within the pledge of the SDGs, with concerns of exclusion, deprivation and denial of social and economic opportunities being highlighted, along with the need to confront the fundamental causes of why some are forgotten, disregarded or ostracised. Equity is a term grounded in the concept of fairness, implying that opportunities should exist for every person to attain their full potential. Inequities arise when the unequal distribution of a resource is judged to be avoidable, unacceptable and indefensible. Inequity can result for many reasons, not least because of poor governance, corruption or societal exclusion. Exploring inequities related to sexual and reproductive health and rights (SRHR) requires attention to intersecting political, legal, social and economic factors which influence people’s knowledge, their access to rights and use of health and other public services. Inequities in SRHR may also be usefully considered in the context of specific population groups, especially those who are vulnerable, including, for example, younger and older populations, persons with disabilities, people living with HIV, transgender and intersex people, indigenous people, minorities and those who have been displaced. The papers in this themed issue do exactly these things, reflecting complex and multidimensional concerns from different populations within countries, as was the focus of our call, and from all corners of the globe. Perspectives of different population groups","PeriodicalId":32527,"journal":{"name":"Reproductive Health Matters","volume":"26 1","pages":"1 - 4"},"PeriodicalIF":0.0,"publicationDate":"2018-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09688080.2018.1545438","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48830611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Denying access of Particularly Vulnerable Tribal Groups to contraceptive services: a case study among the Baiga community in Chhattisgarh, India","authors":"Sulakshana Nandi, Deepika Joshi, P. Gurung, Chandrakant Yadav, G. Murugan","doi":"10.1080/09688080.2018.1542912","DOIUrl":"https://doi.org/10.1080/09688080.2018.1542912","url":null,"abstract":"Abstract Baigas are a Particularly Vulnerable Tribal Group (PVTG), categorised as the most vulnerable amongst indigenous communities in India. As a strategy to stall their decreasing population, due mainly to high mortality, in 1979 the government restricted their access to permanent contraceptive methods, and this is enforced as a “ban”. Using a case study design with mixed methods, this study aims to understand the experiences and perceptions of Baigas in Chhattisgarh in accessing contraceptive services. Data was collected through: a household survey (n = 289) in 13 habitations; individual interviews and group discussions with Baiga men and women and health service providers; and anthropometry. The Baiga suffer poor nutritional status and poverty, out of proportion with district and state averages. Of the women interviewed, 61.3% have had four or more pregnancies and 61.3% have experienced the loss of child at least once during pregnancy or later. Baiga women's forehead tattoo, a marker of their identity, is used to deny them contraceptive services. Baiga women either have to travel to the neighbouring state to avail themselves of services, or lie about their identity. They are usually unable to access even the temporary methods. This coercive policy has led to their further impoverishment. Baigas have been demanding the right to contraceptive services. Denying contraceptive services is a violation of reproductive and human rights and the right to self-determination and bodily autonomy.","PeriodicalId":32527,"journal":{"name":"Reproductive Health Matters","volume":"26 1","pages":"84 - 97"},"PeriodicalIF":0.0,"publicationDate":"2018-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09688080.2018.1542912","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44019715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To be young, unmarried, rural, and female: intersections of sexual and reproductive health and rights in the Maldives","authors":"S. Hameed","doi":"10.1080/09688080.2018.1542910","DOIUrl":"https://doi.org/10.1080/09688080.2018.1542910","url":null,"abstract":"Abstract This paper explores sexual and reproductive health and rights (SRHR) among young people, identifying intersecting factors that create inequities in access to services, health-seeking behaviour, and ultimately health outcomes. Based on qualitative interviews with young people in the Maldives, it demonstrates how these intersectional experiences are contrary to what is often assumed in official data, policies, and services. Three factors were found to shape young people’s experiences: marital status, gender, and urban/rural differences. Non-marital sexual activity is illegal in the Maldives, but it is somewhat expected of unmarried men, while unmarried women are stigmatised for being sexually active. Although access to SRH services is restricted for all unmarried people, young women face additional difficulties, as the risk of being exposed is much greater in small island communities. Maldivian island communities are extremely small and characterised by an inward-looking culture that exerts considerable social pressure, particularly on unmarried women. For an unmarried woman, being known to be sexually active, or worse, pregnant outside of marriage, has severe social consequences including stigma and isolation from the community, and their own family. This concern is more prevalent among rural young women, as they live in smaller communities where stigma is inescapable. The need to avoid public scrutiny and humiliation contributes to making unsafe abortion a common solution for many unintended pregnancies. Failure to acknowledge these intersecting factors in SRHR experience and access has led to inequities among an already overlooked population, shaping their experiences, knowledge, health-seeking behaviour, and health outcomes.","PeriodicalId":32527,"journal":{"name":"Reproductive Health Matters","volume":"26 1","pages":"61 - 71"},"PeriodicalIF":0.0,"publicationDate":"2018-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09688080.2018.1542910","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"59629611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Title, Table of Contents and Acknowledgements","authors":"","doi":"10.1080/09688080.2018.1552416","DOIUrl":"https://doi.org/10.1080/09688080.2018.1552416","url":null,"abstract":"","PeriodicalId":32527,"journal":{"name":"Reproductive Health Matters","volume":"26 1","pages":"i - iv"},"PeriodicalIF":0.0,"publicationDate":"2018-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09688080.2018.1552416","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44876809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The history of universal access to emergency contraception in Peru: a case of politics deepening inequalities.","authors":"Cristina Puig Borràs, Brenda I Álvarez Álvarez","doi":"10.1080/09688080.2018.1542913","DOIUrl":"https://doi.org/10.1080/09688080.2018.1542913","url":null,"abstract":"According to UNFPA estimates, four girls under the age of 15 give birth each day in Peru. In 2010, 34% of adolescents who reported having suffered sexual violence became pregnant as a result of the assault, and 14% were aged 10–14 years. Adolescent pregnancy, sexual violence and forced motherhood (i.e. resulting from the lack of true choice young women may have in becoming pregnant and/or carrying the pregnancy to term) remain serious health and human rights concerns in Peru. Girls from marginalised or low-income populations are more likely to become pregnant and consequently to drop out of school, because of their limited access to information and health care services. Despite this serious public health problem, ensuring universal access to emergency contraception (EC) (the only contraceptive method that can prevent pregnancy after intercourse), has remained an object of political dispute, further deepening social inequalities in Peruvian society. Emergency contraceptive pills (ECPs) are a safe and effective contraceptive method that can prevent pregnancy up to five days after unprotected sexual intercourse. ECPs, also known as “the morning after pill” or “post-coital contraception”, work primarily by delaying ovulation and are more likely to be effective the sooner they are taken. Scientific evidence shows that ECPs do not prevent a fertilised egg from implanting in the uterus, and do not induce abortion. Ensuring universal access to a wide range of contraceptives, including EC, is associated with higher use and a decrease in the number of teen pregnancies. A number of international treaties (such as the Convention on the Elimination of All Forms of Discrimination Against Women, or the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment) recommend that, in order to protect and promote the right to health, States make universally available a comprehensive range of good quality, modern and effective contraceptives, including EC. Furthermore, ECPs are included in theWorld Health Organization (WHO) Essential Medicines Model List, an inventory of the medicines considered most necessary and effective tomeet the needs of a country’s population. WHO recommends that ECPs be integrated into healthcare services and routinely offered to girls who have been raped.","PeriodicalId":32527,"journal":{"name":"Reproductive Health Matters","volume":"26 54","pages":"47-50"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09688080.2018.1542913","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36765569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Youth-centred research to help prevent and mitigate the adverse health and social impacts of pregnancy amongst young Papua New Guineans.","authors":"Stephen Bell,&nbsp;Elissa Kennedy,&nbsp;Kirsten Black,&nbsp;Andrew Vallely,&nbsp;Lisa Vallely,&nbsp;Glen Mola,&nbsp;John Kaldor,&nbsp;Mary Bagita,&nbsp;Caroline Ninnes,&nbsp;William Pomat,&nbsp;Angela Kelly-Hanku","doi":"10.1080/09688080.2018.1512297","DOIUrl":"https://doi.org/10.1080/09688080.2018.1512297","url":null,"abstract":"<p><p>Despite persistent international attention, adolescent pregnancy remains a major public health concern in low- and middle-income countries, like Papua New Guinea (PNG), where health inequities related to social and cultural norms, gender power imbalance, education and socio-economic deprivation affect young and unmarried women in particular. In PNG - where there is high adolescent fertility, high early childbearing and high maternal mortality ratio, and evidence of high rates of unintended pregnancy and abortion among young women - adolescent pregnancy is a policy priority. Yet there are no youth-specific sexual, reproductive and maternal health services or community-based outreach programmes. There is limited in-depth qualitative data on young women's and young men's experiences of pregnancy, the social contexts within which these pregnancies occur, young people's contraception practices and experiences with existing sexual, reproductive and maternal health services. These issues inhibit the design and delivery of youth-friendly health services and outreach support programmes that could prevent or mitigate adverse health and social outcomes associated with adolescent pregnancy. In this commentary article, we propose the need for novel youth-centred research to inform the development of policies, health services and outreach programmes that pay honest and respectful attention to young people's lived experiences of pregnancy. Whilst we focus on the situation in PNG, these ideas are relevant to diverse low resource settings where the harmful impacts of health inequities among young people persist and are particularly detrimental.</p>","PeriodicalId":32527,"journal":{"name":"Reproductive Health Matters","volume":"26 54","pages":"5-12"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09688080.2018.1512297","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36523167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The perceptions, health-seeking behaviours and access of Scheduled Caste women to maternal health services in Bihar, India.","authors":"Parisa Patel,&nbsp;Mahua Das,&nbsp;Utpal Das","doi":"10.1080/09688080.2018.1533361","DOIUrl":"https://doi.org/10.1080/09688080.2018.1533361","url":null,"abstract":"<p><p>The caste system is a complex social stratification system which has been abolished, but remains deeply ingrained in India. Scheduled Caste (SC) women are one of the historically deprived groups, as reflected in poor maternal health outcomes and low utilisation of maternal healthcare services. Key government schemes introduced in 2005 mean healthcare-associated costs should now be far less of a deterrent. This paper examines the factors contributing to this low use of maternal health services by investigating the perceptions, health-seeking behaviours and access of SC women to maternal healthcare services in Bihar, India. Eighteen in-depth, semi-structured interviews were conducted with SC women in Bihar. Data were analysed using Framework Analysis and presented using the AAAQ Toolbox. Main facilitating factors included the introduction of accredited social health activists (ASHAs), free maternal health services, the Janani Shishu Suraksha Karyakram (JSSK), and changes in the cultural acceptability of institutional delivery. Main barriers included inadequate ASHA coverage, poor information access, transport costs and unauthorised charges to SC women from healthcare staff. SC women in Bihar may be inequitably served by maternal health services, and in some cases may face specific discrimination. Recommendations to improve SC service utilisation include research into the improvement of postnatal care, reducing unauthorised payments to healthcare staff and improvements to the ASHA programme.</p>","PeriodicalId":32527,"journal":{"name":"Reproductive Health Matters","volume":"26 54","pages":"114-125"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09688080.2018.1533361","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36655484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social determinants of health affecting utilisation of routine maternity services in Nepal: a narrative review of the evidence.","authors":"Resham Bahadur Khatri,&nbsp;Rajendra Karkee","doi":"10.1080/09688080.2018.1535686","DOIUrl":"https://doi.org/10.1080/09688080.2018.1535686","url":null,"abstract":"<p><p>Nepal has one of the highest maternal and neonatal mortality rates among low- and middle-income countries. Nepal's health system focuses on life-saving interventions provided during the antenatal to postpartum period. However, the inequality in the uptake of maternity services is of major concern. This study aimed to synthesise evidence from the literature regarding the social determinants of health on the use of maternity services in Nepal. We conducted a structured narrative review of studies published from 1994 to 2016. We searched five databases: PubMed; CINAHL; EMBASE; ProQuest and Global Index Medicus using search terms covering four domains: access and use; equity determinants; routine maternity services and Nepal. The findings of the studies were summarised using the World Health Organization's Social Determinants of Health framework. A total of 59 studies were reviewed. A range of socio-structural and intermediary-level determinants was identified, either as facilitating factors, or as barriers, to the uptake of maternity services. These determinants were higher socioeconomic status; education; privileged ethnicities such as Brahmins/Chhetris, people following the Hindu religion; accessible geography; access to transportation; family support; women's autonomy and empowerment; and a birth preparedness plan. Findings indicate the need for health and non-health sector interventions, including education linked to job opportunities; mainstreaming of marginalised communities in economic activities and provision of skilled providers, equipment and medicines. Interventions to improve maternal health should be viewed using a broad 'social determinants of health' framework.</p>","PeriodicalId":32527,"journal":{"name":"Reproductive Health Matters","volume":"26 54","pages":"32-46"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09688080.2018.1535686","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36655483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When things fall apart: local responses to the reintroduction of user-fees for maternal health services in rural Malawi.","authors":"Hanneke Pot,&nbsp;Bregje C de Kok,&nbsp;Gertrude Finyiza","doi":"10.1080/09688080.2018.1535688","DOIUrl":"https://doi.org/10.1080/09688080.2018.1535688","url":null,"abstract":"<p><p>Despite the strong global focus on improving maternal health during past decades, there is still a long way to go to ensure equitable access to services and quality of care for women and girls around the world. To understand widely acknowledged inequities and policy-to-practice gaps in maternal health, we must critically analyse the workings of power in policy and health systems. This paper analyses power dynamics at play in the implementation of maternal health policies in rural Malawi, a country with one of the world's highest burdens of maternal mortality. Specifically, we analyse Malawi's recent experience with the temporary reintroduction of user-fees for maternity services as a response to the suspension of donor funding, a shift in political leadership and priorities, and unstable service contracts between the government and its implementing partner, the Christian Health Association of Malawi. Based on ethnographic research conducted in 2015/16, the article describes the perceptions and experiences of policy implementation among various local actors (health workers, village heads and women). The way in which maternity services \"fall apart\" and are \"fixed\" is the result of dynamic interactions between policy and webs of accountability. Policies meet with a cascade of dynamic responses, which ultimately result in the exclusion of the most vulnerable rural women from maternity care services, against the aims of global and national safe motherhood policies.</p>","PeriodicalId":32527,"journal":{"name":"Reproductive Health Matters","volume":"26 54","pages":"126-136"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/09688080.2018.1535688","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36690325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}