Position statement: Political interference in sexual and reproductive health research and health professional education

Corrigendum to position statement: Political interference in sexual and reproductive health research and health professional education [Nursing Outlook 65/2 (2017) 242–245

Clinician Perspectives on Ethics and COVID-19: Minding the Gap in Sexual and Reproductive Health.

Individuals with psychosis are at elevated risk of adverse sexual and reproductive health (SRH) outcomes, and not receiving adequate SRH care. SRH is important for youth, yet little is known about SRH care access and experiences among those with early psychosis. This study explored SRH care experiences among women and nonbinary individuals with early psychosis. We conducted semistructured qualitative interviews with 19 service users (cisgender and transgender women, nonbinary individuals) receiving care in 2 early psychosis programs in Ontario, Canada. We also conducted semistructured interviews and focus groups with 36 clinicians providing SRH or mental health care to this population. Participants were asked about SRH care access/provision experiences and the interplay with psychosis. Using a social interactionist orientation, a thematic analysis described and explained service user and clinician perspectives regarding SRH care. Amongst both service users and clinician groups, common themes developed: (a) diversity of settings: SRH services are accessed in a large range of spaces across the health care system, (b) barriers in nonpsychiatric SRH care settings: psychosis impacts the ability to engage with existing SRH services, (c) invisibility of SRH in psychiatric settings: SRH is rarely addressed in psychiatric care, (d) variability of informal SRH-related conversations and supports, and cutting across all of the above themes, (e) intersecting social and cultural factors impacted SRH services access. SRH is important for health and wellbeing; improvements are urgently needed across the healthcare system and within early psychosis programs to meet this population's multifaceted SRH needs.

Society of Family Planning Research Practice Support: Researcher and institutional review board considerations for sexual and reproductive health research with minor adolescents.

Research Priorities to Support Women Veterans' Reproductive Health and Health Care Within a Learning Health Care System.

Professor Finkin unpacks critique of tenure written by economist David Breneman for American Association of Higher education's New Pathways project. Finkin argues that Breneman's argument is historically inaccurate, that his assessment is indeterminate of result he claims for it, and that his proposal for change is intrinsically inimical to academic freedom. Finkin sees Breneman's proposal as an effort to socialize young academics to accept a market-driven model of professoriate that pits young against old and more applied disciplines against humanities and many of social sciences. He questions whether Breneman's proposal will better conduce toward the common good than does academic tenure. David Breneman, a distinguished economist of higher education, university Dean and former college president, questions continued viability of academic tenure and proposes a scheme for its elimination, at least for those relatively underendowed and relatively unselective colleges and universities that constitute majority of higher (1997). He takes an and economic perspective to advance his argument; but, tack he takes is freighted with sociological significance as well. In what follows, I propose to examine his arguments and his proposal; and to raise a question concerning academic world he would move us toward. CHANGE AND DYSFUNCTION [C]hanging circumstances, Breneman argues, create a need to rethink employment relationship in higher education (1997:3). The circumstances he adverts to are and social; and a benchmark against which that change is to be measured is 1940, AAUP's statement on tenure and academic freedom was written and widely (1997:1) Just what these changes are is advanced with verve: *Direct all correspondence to: Matthew W. Finkin, College of Law, 306 Law Building, The University of Illinois, 504 East Pennsylvania Avenue, Champaign, IL 61820. This content downloaded from 157.55.39.35 on Sat, 03 Sep 2016 04:02:22 UTC All use subject to http://about.jstor.org/terms 730 SOCIOLOGICAL PERSPECTIVES Volume 41, Number 4, 1998 [W]e are well into a period of entrepreneurial institution, an era when each college and university is rather mercilessly cast into competition for for growth, for quality enhancement. Market forces are operating on institutions in powerful ways, and without buffers that earlier periods provided. This change is not only in fact; it has ideological roots as well, as talk of privatization, limited government, productivity, assessment, outcomes, and efficiency dominates much public discourse about higher education....As a result, colleges and universities have lost much of autonomy and independence from market that they enjoyed in earlier periods. Higher is now a mature industry... .(1997:2). Consequently, for many institutions tenure is largely (1997:4) in ways that Breneman catalogues: (1) as a drag on institutional flexibility in this new, market-driven world, a flexibility needed for institutional survival; (2) as imposing a cost on junior faculty who, failing to achieve tenure, face a labor market of excess supply; (3) as depressing academic salaries; and, (4) as depressing total level of academic employment. As will be shown below, Breneman's historical arguments are mistaken and his arguments are indeterminate of result he would reach. But a word before addressing them. Ordinarily, one would think dysfunctionality of tenure would require an assessment first of extent to which it performs its intended function i.e., primarily protection of academic freedom, and, second, of whether drawbacks inherent in system, and drawbacks there are, outweigh its advantages in that regard. But Breneman dismisses relationship of tenure to academic freedom in passing observation that academic freedom can be protected in other ways. In other words, tenure never had a chance: If academic freedom can be protected adequately without tenure, then tenure could not possibly be necessary for its intended purpose, and any drawback renders tenure dysfunctional by definition. Historical Change in Institutional Circumstances Breneman argues that institutions today face a stark threat to their very survival, in contradistinction to circumstances obtaining when 1940 Statement of Principles on Academic Freedom and Tenure was negotiated, when institutions were far more buffered and far more autonomous from market forces. Let us see. Negotiations between American Association of University Professors (AAUP) and Association of American Colleges (AAC), then leading organization of liberal arts colleges (mostly private and many denominational), began in 1937.1 A draft was agreed to two years later, and a final document was accepted by both organizations following year. These negotiations were informed by a comprehensive study conducted by AAUP and financed by Carnegie Foundation for Advancement of Teaching, Depression, Recovery and Higher Education. According to that study, in 1931-1932, there were 931 colleges and universities in United States: 262 (28%) were publicly controlled; 669 (72%) were private, 464 of these under denominational control. The vast majority This content downloaded from 157.55.39.35 on Sat, 03 Sep 2016 04:02:22 UTC All use subject to http://about.jstor.org/terms Tenure and Entrepreneurial Academy 731

Professor Finkin unpacks critique of tenure written by economist David Breneman for American Association of Higher education's New Pathways project. Finkin argues that Breneman's argument is historically inaccurate, that his assessment is indeterminate of result he claims for it, and that his proposal for change is intrinsically inimical to academic freedom. Finkin sees Breneman's proposal as an effort to socialize young academics to accept a market-driven model of professoriate that pits young against old and more applied disciplines against humanities and many of social sciences. He questions whether Breneman's proposal will better conduce toward the common good than does academic tenure. David Breneman, a distinguished economist of higher education, university Dean and former college president, questions continued viability of academic tenure and proposes a scheme for its elimination, at least for those relatively underendowed and relatively unselective colleges and universities that constitute majority of higher (1997). He takes an and economic perspective to advance his argument; but, tack he takes is freighted with sociological significance as well. In what follows, I propose to examine his arguments and his proposal; and to raise a question concerning academic world he would move us toward. CHANGE AND DYSFUNCTION [C]hanging circumstances, Breneman argues, create a need to rethink employment relationship in higher education (1997:3). The circumstances he adverts to are and social; and a benchmark against which that change is to be measured is 1940, AAUP's statement on tenure and academic freedom was written and widely (1997:1) Just what these changes are is advanced with verve: *Direct all correspondence to: Matthew W. Finkin, College of Law, 306 Law Building, The University of Illinois, 504 East Pennsylvania Avenue, Champaign, IL 61820. This content downloaded from 157.55.39.35 on Sat, 03 Sep 2016 04:02:22 UTC All use subject to http://about.jstor.org/terms 730 SOCIOLOGICAL PERSPECTIVES Volume 41, Number 4, 1998 [W]e are well into a period of entrepreneurial institution, an era when each college and university is rather mercilessly cast into competition for for growth, for quality enhancement. Market forces are operating on institutions in powerful ways, and without buffers that earlier periods provided. This change is not only in fact; it has ideological roots as well, as talk of privatization, limited government, productivity, assessment, outcomes, and efficiency dominates much public discourse about higher education....As a result, colleges and universities have lost much of autonomy and independence from market that they enjoyed in earlier periods. Higher is now a mature industry... .(1997:2). Consequently, for many institutions tenure is largely (1997:4) in ways that Breneman catalogues: (1) as a drag on institutional flexibility in this new, market-driven world, a flexibility needed for institutional survival; (2) as imposing a cost on junior faculty who, failing to achieve tenure, face a labor market of excess supply; (3) as depressing academic salaries; and, (4) as depressing total level of academic employment. As will be shown below, Breneman's historical arguments are mistaken and his arguments are indeterminate of result he would reach. But a word before addressing them. Ordinarily, one would think dysfunctionality of tenure would require an assessment first of extent to which it performs its intended function i.e., primarily protection of academic freedom, and, second, of whether drawbacks inherent in system, and drawbacks there are, outweigh its advantages in that regard. But Breneman dismisses relationship of tenure to academic freedom in passing observation that academic freedom can be protected in other ways. In other words, tenure never had a chance: If academic freedom can be protected adequately without tenure, then tenure could not possibly be necessary for its intended purpose, and any drawback renders tenure dysfunctional by definition. Historical Change in Institutional Circumstances Breneman argues that institutions today face a stark threat to their very survival, in contradistinction to circumstances obtaining when 1940 Statement of Principles on Academic Freedom and Tenure was negotiated, when institutions were far more buffered and far more autonomous from market forces. Let us see. Negotiations between American Association of University Professors (AAUP) and Association of American Colleges (AAC), then leading organization of liberal arts colleges (mostly private and many denominational), began in 1937.1 A draft was agreed to two years later, and a final document was accepted by both organizations following year. These negotiations were informed by a comprehensive study conducted by AAUP and financed by Carnegie Foundation for Advancement of Teaching, Depression, Recovery and Higher Education. According to that study, in 1931-1932, there were 931 colleges and universities in United States: 262 (28%) were publicly controlled; 669 (72%) were private, 464 of these under denominational control. The vast majority This content downloaded from 157.55.39.35 on Sat, 03 Sep 2016 04:02:22 UTC All use subject to http://about.jstor.org/terms Tenure and Entrepreneurial Academy 731

Refugee women have poor outcomes and low utilization of sexual and reproductive health (SRH) services, which may be driven by access to and quality of SRH services at their resettled destinations. While healthcare providers offer valuable insights into these topics, little research has explored United States (U.S.) providers' experiences. To fill this literature gap, we investigate U.S. providers' perspectives of healthcare system-related factors influencing refugee women's access and utilization of SRH services. Between July and December 2019, we conducted in-depth, semi-structured interviews with 17 providers serving refugee women in metropolitan Atlanta in the state of Georgia (United States). We used convenience and snowball sampling for recruitment. We inquired about system-related resources, facilitators, and barriers influencing SRH services access and utilization. Two coders analyzed the data using a qualitative thematic approach. We found that transportation availability was crucial to refugee women's SRH services access. Providers noted a tension between refugee women's preferred usage of informal interpretation assistance (e.g., family and friends) and healthcare providers’ desire for more formal interpretation services. Providers reported a lack of funding and human resources to offer comprehensive SRH services as well as several challenges with using a referral system for women to get SRH care in other systems. Culturally and linguistically-concordant patient navigators were successful at helping refugee women navigate the healthcare system and addressing language barriers. We discussed implications for future research and practice to improve refugee women's SRH care access and utilization. In particular, our findings underscore multilevel constraints of clinics providing SRH care to refugee women and highlight the importance of transportation services and acceptable interpretation services. While understudied, the use of patient navigators holds potential for increasing refugee women's SRH care access and utilization. Patient navigation can both effectively address language-related challenges for refugee women and help them navigate the healthcare system for SRH. Future research should explore organizational and external factors that can facilitate or hinder the implementation of patient navigators for refugee women's SRH care.

The integration of human rights principles in sexual and reproductive health (SRH) research is often recognised to be of value. Good examples abound but lack of clarity persists as to what defines rights-inclusive SRH research. To help move the field forward, this article seeks to explore how key stakeholders responsible for funding and supporting rights in SRH research understand the strengths and weaknesses of what is being done and where, and begins to catalogue potential tools and actions for the future. Interviews with a range of key stakeholders including international civil servants, donors and researchers committed to and supportive of integrating rights into SRH research were conducted and analysed. Interviews confirmed important differences in what is understood to be SRH rights-oriented research and what it can accomplish. General barriers include lack of understanding about the importance of rights; lack of clarity as to the best approach to integration; fear of adding more work with little added benefit; as well as the lack of methodological guidance or published research methodologies that integrate rights. Suggestions include the development of a comprehensive checklist for each phase of research from developing a research statement through ultimately to publication; development of training modules and workshops; inclusion of rights in curricula; changes in journal requirements; and agreement among key funding sources to mandate the integration of rights principles in research proposals they receive. As a next step, cataloguing issues and concerns at local levels can help move the integration of human rights in SRH research from rhetoric to reality.

(264) Prioritizing Sexual and Reproductive Health Research and Care for People with Cystic Fibrosis: A 2023 Workshop Report From the Cystic Fibrosis Foundation Sexual Health, Reproduction, and Gender Research (SHARING) Working Group

Most professors and administrators are aware that academic freedom is in danger of being brushed aside by a public that has little understanding of what is at stake. They may be only marginally aware that the defense of academic freedom is endangered by certain confusions concerning the nature of academic freedom, the criteria for its violation, and the structure of an adequate justification for claims to it. These confusions were enshrined in some of the central documents on the subject, including the 1940 Statement on Academic Freedom and Tenure, agreed upon by the American Association of University Professors and the Association of American Colleges and endorsed by many professional organizations. Careful analysis of them will not do away with debate; it will bring the debate into focus, so that attacks on academic freedom can be appraised as near or far away from the center of the target and can then be appropriately answered. Nearly all the contemporary writing on academic freedom consists of attack or defense. The Concept of Academic Freedom is the first book to deal exclusively with fundamental conceptual issues underlying the battle. In the discussion of these issues, certain philosophical positions crystallize: radical versus liberal conceptions of the status and function of university teachers, specific versus general theories of academic freedom, consequential versus nonconsequential theories of justification. Partisans (and enemies) of academic freedom would do well to decide on which side of these divisions they stand, or how they would mediate between sides. Otherwise many questions will remain unclear: What is under discussion-a special right peculiar to academics or a general right that is especially important to academics? Is justification of that right possible? Can the right be derived from other rights, or from the theory of justice or of democratic society? Or is the argument for academic freedom one that more properly turns on the consequences for society as a whole if that freedom is not protected? The essays in this book explore these and other problems concerning the defense of academic freedom by radicals, the justification for disruption on campus, and the control of research. Contributors to the volume include Hugo Adam Bedau, Bertram H. Davis, Milton Fisk, Graham Hughes, Alan Pasch, Hardy E. Jones, Alexander Ritchie, Amelie Oksenberg Rorty, Rolf Sartorius, T. M. Scanlon, Richard Schmitt, John R. Searle, Judith Jarvis Thomson, and William Van Alstyne. All are outstanding in their fields. Many have had practical experience in the legal profession or with the American Association of University Professors on the issue of academic freedom.

Academic Freedom:The Continuing Challenge Sara Dreyfuss and Marianne Ryan I want to congratulate librarians, not famous for their physical strength or their powerful political connections or their great wealth, who, all over this country, have staunchly resisted anti-democratic bullies who have tried to remove certain books from their shelves, and have refused to reveal to thought police the names of persons who have checked out those titles. —Kurt Vonnegut1 Think, for a moment, about academic freedom. It is essential to the mission of the academy. It permits teachers, students, and educational institutions to pursue knowledge wherever it may lead, without fear of sanctions or interference from government. Academic freedom includes the right to engage freely in the full range of activities involved in generating knowledge. For teachers, it includes the license to inquire into any subject; to present their findings to students, colleagues, and others; to publish their data and conclusions without censorship; and to decide what to teach in the classroom. For students, it includes the freedom to study subjects that interest them; to form conclusions for themselves; and to express their opinions. For librarians, it includes open and unfiltered access to the Internet; the right to collect materials representing a variety of perspectives, including resources on subjects that may be controversial; and the right to maintain the confidentiality of library users. The fundamental statement on academic freedom in higher education in the United States is the 1940 Statement of Principles on Academic Freedom and Tenure, developed by the American Association of University Professors (AAUP) and the Association of American Colleges & Universities (AAC&U). Endorsed by the American Library Association (ALA) and more than 240 other scholarly and professional organizations, it asserts: Teachers are entitled to full freedom in research and in the publication of the results, subject to the adequate performance of their other academic duties … Teachers are entitled to freedom in the classroom in discussing their subject, but they should be careful not to introduce into their teaching controversial matter that has no relation to their subject.2 [End Page 1] The constitutions of many countries grant a separate right to free learning, teaching, and research. In the United States, the Supreme Court has consistently ruled that academic freedom is a constitutional right under the First Amendment, which states that “Congress shall make no law … abridging the freedom of speech, or of the press.” In 1957, the court summarized the “four essential freedoms” that constitute academic freedom for a university. Academic freedom, the court said, means that an institution can “determine for itself on academic grounds who may teach, what may be taught, how it should be taught, and who may be admitted to study.”3 What Academic Freedom Is Not Academic freedom is not without limits. Gary Olson, a college president and scholar of cultural theory, explains: Academic freedom gives both students and faculty the right to study and do research on the topics they choose and to draw what conclusions they find consistent with their research, though it does not prevent others from judging whether their work is valuable and their conclusions sound. Neither academic freedom nor tenure protects an incompetent teacher from losing his or her job.4 Olson adds: Because academic freedom is specifically intended to foster the free exchange of ideas within a community of scholars, it does not protect … other types of utterances and behavior, such as slander or libel, bullying co-workers, lying on a curriculum vitae, or conducting one’s classes in irresponsible ways.5 William Van Alstyne, a professor of constitutional law, points out: The false shouting of fire in a crowded theater may not immunize a professor of psychology from having to answer for the consequences of the ensuing panic, even assuming that he did it in order to observe crowd reaction first-hand and solely to advance the general enlightenment we may otherwise possess of how people act under great and sudden stress.6 Academic freedom also has limits for students. For example, it does not protect them from uncomfortable, unwelcome, or inconvenient teaching. Undergraduates who believe in the literal truth of the Bible’s Creation story are entitled to respect for those...

The need to improve the sexual and reproductive health (SRH) and rights of women with disabilities is increasingly acknowledged. Unfortunately, women with disabilities in low- and middle-income settings, including Ghana, face several barriers (including structural, financial, physical, social and attitudinal) to accessing SRH services and care. This paper explores the enablers and barriers to accessing SRH services and care among visually impaired women in the Ashanti and Brong Ahafo Regions of Ghana. Qualitative data from in-depth interviews and focus group discussions were collected from 21 visually impaired women, selected through purposive and snowballing sampling techniques. Thematic analysis was used to develop codes, and data were further grouped into emerging themes. The barriers to accessing SRH services and care were financial difficulties and lack of preferential treatment. The enablers which facilitated access to SRH services and care were the support provided by caregivers and friendly relationships with health providers. To address these challenges and promote access, SRH related policies, services and programmes should be inclusive of the needs of visually impaired women, and measures to remove financial challenges to service utilisation and foster positive relationships with health workers, church and community members should be adopted.

A blueprint for a new model of sexual and reproductive health care in subspecialty medicine.

To explore the attitudes, preferences, and experiences of patients with cystic fibrosis (CF) and CF providers toward sexual and reproductive health (SRH) care for young women with CF. Young women with CF aged 18 to 30 years from a US CF care center and pediatric and adult CF program directors from a national sample participated in qualitative interviews investigating their experiences regarding SRH care and their attitudes and preferences toward SRH care provision in the CF setting. Interviews were audio-recorded, transcribed, and coded by using a thematic analysis approach. Twenty-two patient participants and 16 CF program directors were interviewed. Themes shared by both groups included the importance of SRH discussion in the CF care setting, patient and provider discomfort as a barrier to SRH care, and the need for SRH educational resources and provider training to improve SRH care. Providers highlighted the lack of standardization around SRH care in the current CF care model. Patients desired SRH educational resources coupled with early SRH discussions initiated by their CF provider. Both CF providers and patients agree that the CF provider has a fundamental role in providing CF-specific SRH care. Educational resources coupled with individualized SRH discussions may facilitate improved SRH care for young women with CF. Investigation into the implementation of SRH education and services into pediatric-onset chronic disease care models is needed.