Sexual and Reproductive Health and Right Interventions: A Systematic Review

BackgroundOne of the key targets of Ghana’s Adolescent Health Service Policy and Strategy is to ensure that 90% of adolescents and young people have knowledge of sexual and reproductive health services and rights. This phenomenon has led to the establishment of adolescent-friendly health facilities to increase access to health information and services among adolescents. Despite these efforts, access to health information and service utilisation remains low among adolescents. Our study seeks to examine adolescents’ perception of sexual and reproductive health rights (SRHR) and access to reproductive health information and services in the Adaklu district of the Volta region of Ghana.MethodsA baseline cross-sectional household survey of 221 adolescents aged 10–19 years in 30 randomly selected communities was used. A structured questionnaire was developed and administered to the respondents. A binary logistic regression analysis was used to examine the association between adolescents’ perception of adolescent sexual and reproductive health rights (ASRHR) and access to reproductive health information and services.ResultsAdolescents’ perception of SRHR was poor, and this poor perception may have been reflected in a few proportions (10%) of adolescents accessing SRH information and services. Majority (91.9%) of adolescents do not use sexual and reproductive health (SRH) services in the Adaklu district. Adolescents who attained primary education (aOR = 5.99, CI: 1.16–30.95), those who never had sexual communication with their father (aOR = 8.89, CI: 1.99–39.60) and adolescents who never experienced any form of sexual coercion (aOR = 11.73, CI: 1.61–85.68) had a higher likelihood of not utilising SRH services in Adaklu district. Regarding access to SRH information, adolescents who ever discussed sexual matters with their fathers, those who ever used contraceptives and adolescents who ever experienced sexual coercion had lower odds of accessing information on contraception, sexually transmitted infections, and teenage pregnancy.ConclusionsAccess to and use of sexual and reproductive information and health services among adolescents in Adaklu district remain very low, which has implications for adolescents’ knowledge and perception of their SRHR. Considering the factors predicting this phenomenon, it is recommended that interventions can be tailored to address the unique challenges faced by adolescent in accessing comprehensive SRH support.

IntroductionCommunity-based sexual reproductive interventions are key in attaining universal health coverage for all by 2030, yet adolescents in many countries still lack health services that are responsive to their sexual reproductive health and rights’ needs. As the first step of realist evaluation, this study provides a programme theory that explains how, why and under what circumstances community-based sexual reproductive health interventions can transform (or not) ‘ordinary’ community-based health systems (CBHSs) into systems that are responsive to the sexual reproductive health of adolescents.MethodsThis realist approach adopted a case study design. We nested the study in the full intervention arm of the Research Initiative to Support the Empowerment of Girls trial in Zambia. Sixteen in-depth interviews were conducted with stakeholders involved in the development and/or implementation of the trial. All the interviews were recorded and analysed using NVIVO version 12.0. Thematic analysis was used guided by realist evaluation concepts. The findings were later synthesized using the Intervention−Context−Actors−Mechanism−Outcomes conceptualization tool. Using the retroduction approach, we summarized the findings into two programme theories.ResultsWe identified two initial testable programme theories. The first theory presumes that adolescent sexual reproductive health and rights (SRHR) interventions that are supported by contextual factors, such as existing policies and guidelines related to SRHR, socio-cultural norms and CBHS structures are more likely to trigger mechanisms among the different actors that can encourage uptake of the interventions, and thus contribute to making the CBHS responsive to the SRHR needs of adolescents. The second and alternative theory suggests that SRHR interventions, if not supported by contextual factors, are less likely to transform the CBHSs in which they are implemented. At individual level the mechanisms, awareness and knowledge were expected to lead to value clarification’, which was also expected would lead to individuals developing a ‘supportive attitude towards adolescent SRHR. It was anticipated that these individual mechanisms would in turn trigger the collective mechanisms, communication, cohesion, social connection and linkages.ConclusionThe two alternative programme theories describe how, why and under what circumstances SRHR interventions that target adolescents can transform ‘ordinary’ community-based health systems into systems that are responsive to adolescents.

This paper explores how context and actors influence processes and content efforts to co-create gender transformative primary health care systems for adolescents in West Africa and draws out lessons for co-creation of effective adolescent mental, sexual, and reproductive health and rights (AMSRHR) interventions in low and middle income countries. The study design was a multi country case study with the case defined as "processes, context, actors and content of co-creation of gender-transformative adolescent mental, sexual, and reproductive health interventions". Data are from mixed qualitative sources in two research phases: a situational/context analysis and co-creation/data validation workshops. Findings reveal that while national AMSRHR policies promote gender-sensitive approaches, actual programmes remain largely gender-neutral or gender-blind. Important considerations in co-creating AMSRHR interventions include how to effectively engage powerful stakeholders with diverse positions, pay attention to gendered power imbalances in co-creation processes, and raise critical consciousness of complex AMSRHR issues through non-threatening, participatory approaches.

Putting sexual and reproductive health on the agenda

Time to act - reaching the sexual and reproductive health goals of Agenda 2030.

Dorothy Shaw: promoting women's sexual and reproductive rights

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

IntroductionThis study aimed to explore the direct and indirect influences of COVID-19-related restrictions on adolescents and young people’s (AYP’s) sexual and reproductive health and rights (SRHR) in Malawi, Zambia, and Zimbabwe, with a focus on teenage pregnancy and access to and utilization of HIV testing and counselling services.MethodsThirty-four purposively sampled interviews that comprised of selected representatives of organizations involved in activities aimed at addressing adolescent sexual and reproductive health and rights (ASRHR), teenage pregnancies, and HIV testing were conducted in Malawi, Zambia and Zimbabwe. In Zambia, the study conducted an additional four group discussions with adolescents and young people. Adolescents and young people were asked to describe their experience and perceptions of the impact of COVID-19 on their SRHR. Thematic analysis was used to analyze the data.ResultsPriority shifts resulted in the focus of service provision to the COVID-19 response. This led to shortages of already insufficient human resources due to infection and/or isolation, supply chain disruptions leading to shortages of important sexual and reproductive health (SRH)-related commodities and supplies, compromised quality of services such as counselling for HIV and overall limited AYP’s access to SRH information. Suggestions for interventions to improve SRH services include the need for a disaster preparedness strategy, increased funding for ASRHR, the use of community health workers and community-based ASRHR strategies, and the use of technology and social media platforms such as mHealth.ConclusionDisruption of SRH services for adolescents and young people due to pandemic related-restrictions, and diversion of resources/funding has had a ripple effect that may have long-term consequences for adolescents and young people throughout the East and Southern African region. This calls for further investment in adolescents and young people’s access to SRHR services as progress made may have been deterred.

abstractThe adoption of the International Conference on Population and Development (ICPD) Programme of Action (1994), brought sexual and reproductive health rights (SRHR) under the attention of the international community. International law standards recognise the need to create an enabling legal environment that ensures that adolescent sexual and reproductive rights are realised. These standards include, for instance, setting an age at which adolescents can access contraceptives without parental consent, and facilitating the provision of family planning services to adolescents. This article employs a feminist approach to critiquing the protections available to the SRHR of adolescents in Eastern and Southern Africa. It explores the current legal approaches to the protection of the SRHR in international and regional instruments and examines the way they are implemented in the regions. The article establishes that while broad frameworks exist under the international and regional frameworks, reference to the specific rights issues facing adolescents is limited. It also shows that while the international guidance is premised on the principles of gender equality, it fails to provide a holistic approach that the domestic jurisdictions can follow. The article concludes with views on the role of the law in promoting adolescent sexual and reproductive health from a gender-sensitive perspective. Feminist jurisprudence is used as the theoretical framework throughout the article.

Introduction The relationship between conflict and the deterioration of women’s sexual and reproductive rights has been long established in the literature. However, the effect of conflict on women who become refugees is a growing field of research. Recent studies have shown that the experiences of living in conflict zones, prior to becoming refugees, impacts women’s sexual and reproductive health considerably. Reproductive sexual health and rights are particularly more challenging for refugee women as they constitute a new type of population rather than a temporary condition. In fact, international attention to reproductive sexual health needs of refugee women increased over past thirty years with the increasing global conflicts and crisis. Objective General objective: • To close a gap in scholarship on the lived experiences of women refugees from Syria’s attainment of reproductive rights, and to identify the multi-level factors that impact upon this attainment of these rights, with a specific focus on gender-based violence. Specific objectives: • Discover the specific needs and concerns of refugee women seeking to attain their reproductive rights and freedom from gender-based violence; • Engage decision makers in dialogues about how to tackle the vulnerability of refugee women and girls vis-à-vis reproductive rights, and gender-based violence, about how to implement a gendered perspective when designing policies to assist and empower women and girl refugees, and to increase their access to sexual and reproductive health services; Provide information to healthcare providers and humanitarian actors in the problems and recommendations, as told by service recipients themselves; Methods The research is qualitative in nature. It combined several qualitative methods of data collection, including face-to-face interviews, focus groups, and participant observation. Results Results of focus group discussions revealed that women are aware of various forms of violence inflicted upon them by husbands, health services, and community. They experience physical violence, sexual violence, and cope with it in fear and silence to avoid retaliation from husband (marrying another woman), and from her family. Women refugees reported also barriers to access healthcare services like discrimination, mistreatment, and shaming, which seriously affected seeking care for reproductive and sexual health problems. Street harassment was also reported at different levels (taxi drivers, stores, host community). Survivors of violence used few coping mechanism basically being passive, seeking secretly reproductive health care (OCPS, IUDs, meds), and focusing on their children. Conclusions Women refugees are subjected to all form of violence and they need immediate and log term support in terms of empowering them to speak against abuse, freedom to chose to work or not, and education which should be supervised by the international agencies like UNHCR who must be watchful of GBV and sexual violence befalling on the women refugees. Health care providers need to be more culturally sensitive and provide dignified care to those women. Disclosure No

There are global drives towards supporting adolescents' sexual and reproductive health and rights, access to and use of these services among young people in low- and middle-income countries. However, the utilization of Friendly Sexual and Reproductive Health Services remains inadequate, posing a major challenge to progress in this area. This study aimed to examine the utilization of Youth Friendly Sexual and Reproductive Health Services and its association with socio-demographic factors and knowledge in Nakuru County, Kenya. This was a cross-sectional study done in one county in Kenya purposively selected and involved a sample of 400 youths (10-24 years). The response rate was 90 % (n=400). About two-thirds (64%, n=340) of the sampled youths were affirmative to using the Youth-Friendly Sexual and Reproductive Health Services which is considered suboptimal. Whereby it is evident that Kenya is doing better in the utilization of Youth-Friendly Sexual and Reproductive Health Services than its peer countries in the region, it has not achieved the target of 85% utilization as envisaged in the Adolescent Reproductive Health and Development Plan of Action 2005-2015. The utilization of Youth-Friendly Sexual and Reproductive Health Services of significantly associated with the level of education (x2(2) =0.256, p=0.002) and awareness/being knowledgeable (x2(1) =0.019, p=0.001) on Youth Friendly Sexual and Reproductive Health Services. This study thus recommends that policies and programs to upscale the utilization of Youth-Friendly Sexual and Reproductive Health Services should focus on building a knowledge base for the youths on the said subject. Furthermore, the curriculums should introduce aspects of Youth-Friendly Sexual and Reproductive Health Services early enough in the primary school level to formally expose them to sexual health knowledge and eventually improve utilization

Sexual and reproductive health and rights are basic human rights: The FLASOG Panama Declaration and FIGO Cartagena Declaration.

BackgroundVarious countries in the world have achieved promising progress in promoting, protecting and guaranteeing sexual and reproductive health rights (SRHRs) since the 1994 International Conference on Population and Development (ICPD) in Cairo. However, SRHRs have not been recognized to their maximum potential in Ethiopia, despite the domestication of the international instruments related to their successful implementation. This study was intended to determine the magnitude of SRHRs knowledge, reproductive health services utilization and their independent predictors among rural reproductive-age women in the Aleta Wondo District, Ethiopia.MethodsA community-based cross-sectional study was conducted among 833 rural reproductive-age women from April to May 2019. A systematic random sampling technique was employed to select households, and a structured questionnaire was used to gather the data. EPI INFO version 7 was used to enter the data, and SPSS version 23 was used for data analysis. Logistic regression analysis was employed to assess the association between outcomes and explanatory variables. Odds ratios at 95% CI were also computed and reported.ResultsOf 833 respondents, 43.9% had good knowledge of SRHR, and 37% had used at least one sexual and reproductive health (SRH) service. Variables that had a statistically significant association with SRHR knowledge in multivariable analysis were: had formal education, household with the highest income, having information sources for SRH services, and knowing about SRH services and providing institutions. SRH services utilization was associated with: having information sources for SRH services, had formal education, household with the highest income, and knowing about SRH services and providing institutions.ConclusionIn this study demographic and economic factors, such as education and household monthly income were positively identified as independent predictors for knowledge of SRHR and SRH services utilization. Therefore, responsible government sectors and NGOs should design and implement programs to promote women’s educational status and household economic status to enhance women’s SRHR knowledge and SRH services utilization.

What About the Boys? The Importance of Including Boys and Young Men in Sexual and Reproductive Health Research

Sexual rights have been defined as an evolving set of entitlements related to sexuality that contribute to the freedom, equality, and dignity of all people. Sexual rights are human rights related to sexuality that address a wide range of issues and often intersect with several other rights. Examples of sexual rights issues include, but are not limited to, sexuality education, reproductive rights, maternal morbidity and mortality, and sex work. More broadly, sexual rights are one field that falls under sexual and reproductive health and rights (SRHR). Three other related, but separate fields in SRHR are sexual health, reproductive health, and reproductive rights. In the broad concept of SRHR, these four fields are treated as separate, but are inherently intertwined. Beyond this broad definition, what constitutes sexual rights is contested and means different things to different groups.