Reproductive Rights Of People Research Articles

Massachusetts' innovative policy approach to expanding contraceptive options in primary care.

As health systems pivot toward value-based care and as the reversal of Roe vs Wade has significantly decreased access to abortion care in the United States, contraception is increasingly recognized as a high-value health service. However, the United States has a long and troubling history of using contraceptive policies and practices, including forced sterilization, to limit the reproductive rights of people of color and individuals with disabilities. We hope to highlight an innovative program developed by Massachusetts' Medicaid program, which seeks to expand access to long-acting reversible contraception (LARC) within primary care clinics in a way that promotes both value and reproductive justice. This program provides financial incentives for clinics that serve patients with Medicaid to offer LARC to all patients within the primary care space. Unlike LARC programs that exclusively target patients with Medicaid insurance and provide incentivizes based on number of LARC insertions, this policy has the potential to "lift all boats" and expand access to LARC for all patients regardless of payer. Careful evaluation of this program will be necessary to ensure that the intended outcomes-to increase access to LARC, promote reproductive justice, and deliver value to the health system-are achieved.

To be or not to be a mother: doubtful, fraught, and denied access to motherhood in contemporary Catalan theatre

Like many other regions in Europe, Catalonia has seen significant changes in the demographics of motherhood over recent decades, with decreasing fertility rates and an increase in the average age of women at the birth of the first child. Together with increased social awareness of gender and identity issues such as gestational loss or the sexual and reproductive rights of people with disabilities, this changing landscape seems to have had a noteworthy impact on contemporary Catalan theatre. Indeed, throughout the long 2010s, a significant number of female-authored plays focused on motherhood premiered in Catalan venues, and a significant portion of these addressed doubtful, fraught, and denied access to motherhood. This essay analyses four important works associated with this trend: Júlia & The Empty Lot (2018) and To Be a Mother (2021) by Clàudia Cedó, Conversations With My Uterus and Other Interlocutors (2018) by Núria Planes Llull, and Stigmas (2019) by Concha Milla. These plays respectively address the experience of perinatal loss, the desire of women with disabilities to become mothers, doubts concerning one’s maternal desire, and the consequences of infertility and assisted reproductive technology processes. The analysis is based on dramatic and video criticism, accompanied by a study of performance documentation and paratexts. This essay contends that the analysed plays shed light on the tension between hegemonic narratives around motherhood and the actual experiences of contemporary Catalan women in terms of access to motherhood, which can be fraught with social, political, or physiological obstacles, as well as denied to certain subjects who have historically been excluded from womanhood, such as women with disabilities. In so doing, the plays expand the available narratives for what we understand as motherhood while elaborating feminist responses to the lived experiences they bring to the stage.

Provider-Initiated Family Planning Within HIV Services in Malawi: Did Policy Make It into Practice?

Malawi's guidelines for Clinical Management of HIV in Children and Adults promote the practice of provider-initiated family planning (PIFP) for all clients over the age of 15. The guidelines recommend that providers should offer all clients condoms, offer injectables to female clients, and refer clients to another provider or site if clients prefer another family planning method. This study assessed to what extent family planning services had been integrated into HIV services among 41 facilities in Malawi (hospitals, health posts, health centers; public and nonprofit private) and how the reproductive rights of people living with HIV were being addressed. Data were collected through facility audits (N=41), provider interviews (N=122), client exit interviews (N=425), and mystery client visits (N=58). This study found that contrary to clinical protocols, only 14% of clients at the antiretroviral therapy (ART) clinic had reported being asked about their family planning/fertility intentions during the visit that day. Only 24% of providers at the facility had received training on family planning-HIV integration, and 21% had no family planning training at all. Overwhelmingly, ART clients relied on condoms to meet their family planning needs. Only 24% of ART clinics had injectables available, and only 15% of ART clinics had a full range of family planning methods (short- and long-acting, hormonal and non-hormonal) available to clients. These findings suggest that Malawi's strong national policies on family planning-HIV integration, and specifically PIFP, are not being implemented in practice and thus not adequately addressing the family planning needs of clients with HIV. To improve PIFP, Malawi requires targeted systems changes. Facilities need to broaden their family planning method mix offerings. Furthermore, providers need more training on family planning and the importance of HIV clients having access to family planning services, and referral services need to be strengthened so providers can ensure clients have access to their method of choice in a timely manner.

Equal reproduction rights? The right to found a family in United Nations’ disability policy since the 1970s

ABSTRACT With the adoption of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) in 2006, disability as an issue of human rights and international law can no longer be ignored. The history of this convention can be traced back to the 1970s, when disability was framed in United Nations (UN) declarations as a human-rights issue at the global level. One of the recurrent topics of debate during this trajectory was the right of people with disabilities to found a family. This right was far from self-evident and was evaluated very differently by various stakeholders. This study follows the right to have a family in UN disability policy since the 1970s. The history of the family in relation to disability at the global level has been a neglected field of enquiry compared to other concepts such as gender and race. This study investigates how and why the right to found a family was framed in the Declarations on the Rights of Mentally Disabled Persons (1971) and Disabled Persons (1975), the International Year of Disabled Persons (1981), the International Decade of Disabled Persons (1983 − 1992), the Standard Rules on the Equalization of Opportunities for Persons with Disabilities (1993) and the UNCRPD in 2006. The trajectory of the right of people with disabilities to found a family that emerges from these cases shows a change in the 1990s from a social-policy to a human-rights approach towards disability – which reflects a broader trend in global and local histories of human rights. In the case of reproductive rights of people with disabilities this change meant that the emphasis was laid more on providing a legal protection for the individual against the interference of others (so-called negative freedom) than on enhancing the opportunities for disabled people to practice their (positive) freedom.

Intimacy, intercourse and adjustments: Experiences of sexual life of a group of people with physical disabilities in South Africa.

There is a growing recognition of the sexual and reproductive rights of people with disabilities, and since the World Health Organisation's World Report on Disability, increased international attention has been given to these issues. Past research, however, suggests that this group encounter barriers to sexual and reproductive rights, which are both physical and attitudinal. Against this backdrop, this article employs a sequential mixed qualitative methodology to explore the practical and subjective experiences of 13 people with physical disabilities in South Africa, with regard to their sexual lives and experiences of sexuality. These experiences were marked by concerns about their 'fitness' as sexual beings and indicated that social forces were key in shaping their expectations for their own sexual life.

Should They Also Have Babies? Community Attitudes Toward Sexual and Reproductive Rights of People Living With HIV/AIDS in Nigeria

BackgroundPeople living with HIV have the right to healthy, satisfying sex lives and to appropriate services to ensure their sexual and reproductive health, including having healthy children. The reproductive rights of people living with HIV/AIDS are, however, often met with skepticism and discrimination, despite recent advances in HIV treatment. ObjectiveTo assess the attitudes of community members in Kano, Nigeria, toward the right of persons living with HIV/AIDS to have healthy sexual relationships and bear children. MethodsA cross-section of 399 adults was interviewed using pretested structured questionnaires. Logistic regression analysis was used to obtain adjusted estimates for predictors of agreement with the rights of persons with HIV/AIDS to bear children. FindingsA substantial proportion of respondents (28.6%) strongly agreed and agreed (10.5%) that persons with HIV/AIDS should not be allowed to marry. More than a fifth of the respondents disagreed (16.0%) and strongly disagreed (8.0%) with the rights of HIV-infected persons to bear children. Agreement with the statement “HIV-infected persons should have biological children” was independently associated with higher educational status (adjusted odds ratio: 2.26, 95% confidence interval: 1.82-6.73) and awareness of prevention of mother-to-child HIV transmission effectiveness (adjusted odds ratio: 2.53, 95% confidence interval: 1.92-5.37). Of those who agreed that HIV-infected persons should have children (n = 253), 17.8% and 26.1% strongly agreed and agreed, respectively, that persons living with HIV/AIDS should be restricted to having fewer children. Further, 11.5% and 4.8% of respondents disagreed and strongly disagreed, respectively, that infertile HIV-infected couples should receive fertility treatment. ConclusionsPeople living with HIV/AIDS face discriminatory attitudes to their reproductive rights in northern Nigeria. There is a need for effective, culturally appropriate information, education, and communication approaches to improving community perceptions of sexual and reproductive rights of people living with HIV/AIDS.

Perceptions of Reproductive Rights among Young Adults with Disabilities

Background: The perception that people with disabilities are asexual and lack reproductive rights has existed in the United States since the early 1900s. In the early 1900s in the U.S., approximately 42,000 institutionalized people with disabilities were lawfully sexually sterilized as a result of the Eugenics Movement. The state of California was responsible for one-third of all sterilizations during the Movement. Purpose: This study aimed to assess the perceptions of reproductive rights among young adults with disabilities. Methods: Purposive and snowball sampling was used. Twelve semi-structured interviews with eight young adults with various mental health, physical, intellectual/developmental, and learning disabilities were conducted. Results: Participants reported that their ability to have sex and their reproductive rights were commonly questioned by peers and professionals. Some internalized asexual stereotypes and questioned whether they should reproduce due to the potential that they might pass on a disability or burden their children with their own disability. Others confidently reported their desire to bear their own children. Conclusion: The asexuality stereotype of people with disabilities is pervasive and continues to be present in society today. It is important that professionals reflect on their own biases toward the reproductive rights of people with disabilities.

Sexual and reproductive health services for women with disability: a qualitative study with service providers in the Philippines.

BackgroundThe Philippines has ratified the United Nations Convention on the Rights of Persons with Disabilities and recently passed domestic legislation protecting the sexual and reproductive rights of people with disability. However women in the Philippines continue to report barriers to sexual and reproductive health services, and there is limited empirical evidence available to inform policy makers’ efforts to respond. This study aims to contribute to the available evidence by examining service providers’ perceptions of disability and their experiences providing sexual and reproductive health services to women with disability.MethodsThe study was conducted as part of a larger three-year program of participatory action research that aims to improve the sexual and reproductive health of women with disabilities in the Philippines. Fourteen in-depth interviews and two focus group discussions were conducted with a total of thirty-two sexual and reproductive health service providers in Quezon City and Ligao. Qualitative data were analysed to identify key themes in participants’ discussion of service provision to women with disability.ResultsAnalysis of service providers’ accounts suggests a range of factors undermine provision of high quality sexual and reproductive health services to women with disability. Service providers often have limited awareness of the sexual and reproductive health needs of women with disability and inadequate understanding of their rights. Service providers have had very little training in relation to disability, and limited access to the resources that would enable them to provide a disability inclusive service. Some service providers hold prejudiced attitudes towards women with disability seeking sexual and reproductive health services, resulting in disability-based discrimination. Service providers are also often unaware of specific factors undermining the health of women with disability, such as violence and abuse.ConclusionRecent legislative change in the Philippines opens a window of opportunity to strengthen sexual and reproductive health service provision across the country. However the development of services that are disability-inclusive will require substantial efforts to address supply-side barriers such as prejudiced service provider attitudes and limited capacity. Disability inclusion must be prioritised for the national goal of responsible parenthood and reproductive health to be realised for all.

Sexual and Reproductive Health and Rights, HIV/AIDS, and Public Health

Since the 1994 International Conference on Population and Development, sexual and reproductive health and rights have received increased attention. Improving sexual and reproductive health is essential in meeting health goals of nations, including the United Nations Millennium Development Goals (MDGs). There has also been a strong emphasis on integrating sexual and reproductive health and HIV information and services. Policy makers, program managers, advocates, and people living with HIV now emphasize sexual and reproductive health– and HIV–related programs and planning. In 2007, a Global Consultation on Sexual and Reproductive Health and Rights of People Living with HIV in Amsterdam focused on research, policy analysis, advocacy, and education, with a better understanding of sexual and reproductive rights of people living with HIV and also creating a supportive health system. Men having sex with men, intravenous drug users, sex workers and their clients are among the most at-risk for contracting HIV. Gender norms related to masculinity, for example homophobia, the subsequent stigmatization and discrimination, compound barriers to health care for people living with HIV who have diverse sexual orientations. Globally, there is a rapid feminization of the HIV and AIDS epidemic due to both sex/biology and unequal gender relations.1 Women, relatively, are at greater risk of acquiring HIV after unprotected sex with infected partners than men because of greater efficiency of male-to-female transmission. Women’s primary risk factor for HIV infection is their inability to control when and whether to be sexually active. Often, gender inequalities underlie such forced and unsafe sex, which has been responsible for a large extent of the HIV epidemic. Female sex workers suffer from a high HIV burden and are one of the core populations for HIV transmission. An estimated 15% of HIV prevalence in the general female adult population is attributable to (unsafe) female sex work.2 Sex workers are highly vulnerable to HIV infection as they often experience forced and unprotected sex. In addition, stigma, discrimination, and poverty further exacerbate sex workers’ vulnerability to HIV. Such activities occur mainly because of the lack of education and economic security. Thus, programs emphasizing male responsibility toward safer sex and condom usage and empowering women with negotiation and life skills training are urgently needed. Easy and affordable access to sexual and reproductive health information and services and access to HIV prevention, treatment, and care is warranted. HIV planning and program need to address the underlying gender inequalities3 and further promote gender equality.

Ensuring human and sexual rights for men who have sex with men living with HIV

Ensuring human and sexual rights for men who have sex with men living with HIV

Reproductive Choice for Women and Men Living with HIV: Contraception, Abortion and Fertility

From a policy and programmatic point of view, this paper reviews the literature on the fertility-related needs of women and men living with HIV and how the entry points represented by family planning, sexually transmitted infection and HIV-related services can ensure access to contraception, abortion and fertility services for women and men living with HIV. Most contraceptive methods are safe and effective for HIV positive women and men. The existing range of contraceptive options should be available to people living with HIV, along with more information about and access to emergency contraception. Potential drug interaction must be considered between hormonal contraception and treatment for tuberculosis and certain antiretroviral drugs. Couples living with HIV who wish to use a permanent contraceptive method should have access to female sterilisation and vasectomy in an informed manner, free of coercion. How to promote condoms and dual protection and how to make them acceptable in long term-relationships remains a challenge. Both surgical and medical abortion are safe for women living with HIV. To reduce risk of vertical transmission of HIV and in cases of infertility, people with HIV should have access to sperm washing and other assisted conception methods, if these are available. Simple and cost-effective procedures to reduce risk of vertical transmission should be part of counselling for women and men living with HIV who intend to have children. Support for the reproductive rights of people with HIV is a priority. More operations research on best practices is needed.