Sexual Health Rights Research Articles

Early and unintended pregnancies threaten triple dividend

In the 21st century, the rights of women and girls over their bodies, sexual choices, and access to sexual health services, and the realisation of sexual and reproductive health rights are still determined by patriarchal systems and oppressive power. Attaining sexual and reproductive health rights remains political and in constant disequilibrium, vulnerable to politicised health issues and to financing decisions based on populism or subjective beliefs instead of a rights, health, and gender-equity approach.

Women’s experiences of marital rape and sexual violence within marriage in India: evidence from service records

Sexual violence within marriage is common and manifests in various forms, including marital rape. It has serious physical and mental health consequences and is a violation of women’s sexual and reproductive health rights. Marital rape, reproductive coercion, inserting objects in the vagina or anus, and withholding sexual pleasure are forms of violence routinely experienced by women. Based on service records of survivors coming to public hospitals in an Indian city, this paper presents their pathways to disclosure and institutional responses such as hospitals and police. The findings highlight that a large proportion of survivors of domestic violence confide having experienced forced sexual intercourse by the husband while sharing their experience of physical, economic, and emotional violence with crisis intervention counsellors. However, a small number of women do report marital rape to formal systems like hospitals and police. These systems respond inadequately to women reporting marital rape, as the rape law exempts rape by husband. Sexual violence within marriage can have serious health consequences, and a sensitive healthcare provider can create an enabling environment for disclosing abuse and providing relevant care and support. The paper argues that a necessary precondition to enable women to access health care and justice is to nullify “Exception 2 to Section 375 of the Indian Penal Code” This exception exempts rape by the husband from the purview of the rape law.

Married Men’s Perceptions of Their Wives’ Sexual and Reproductive Health Rights: A Study Conducted in the Rural Area of Waterberg District, Limpopo Province, South Africa

Married women often become victims of STIs and HIV due to inability to exercise their sexual and reproductive health rights. The present study was conducted to explore married men’s perceptions and experiences regarding their partners’ sexual and reproductive rights. Semi-structured interviews were conducted with 12 rural, married men in Lephalale villages of Waterberg District in Limpopo Province. The main findings highlight women’s lack of autonomy within their marriage. The findings further suggest that rural married women are at risk due to their socioeconomic status, religion, and sociocultural influences that silence and deny them the opportunity to exercise their sexual and reproductive rights.

Appreciating complexities, changing contexts and accountability challenges in sexual and reproductive health rights.

Social accountability is fast being recognised as an important strategy for realisation of sexual and reproductive health rights. However, the predominant approach tends to focus on use of top-down monitoring and accountability tools that do not capture the complexity of politics surrounding this deeply contested terrain. This paper draws on discussions that took place at the COPASAH Global Symposium in October 2019 where grassroots practitioners shared their experiences of seeking accountability and reflected on the myriad challenges in this process. The paper calls for greater nuance and awareness of context in the design and implementation of social accountability interventions, which engage with power and politics between the forces that determine people's access to SRH rights.

The World Association for Sexual Health’s Declaration on Sexual Pleasure: A Technical Guide

This article provides technical guidance on the content, meaning, and application of the World Association of Sexual Health (WAS) Declaration on Sexual Pleasure to various stakeholders and practitioners working in the area of sexuality, sexual health, and sexual rights. A growing body of work shows that sexual pleasure is integral to broader health, mental health, sexual health, well-being and rights and indeed can lead to improvements in health. Yet, more research is needed to identify the best ways to incorporate sexual pleasure to achieve sexual health for different outcomes and populations. In the first part of this article, we deconstruct each statement from the WAS Declaration on Sexual Pleasure and provide key evidence from the literature supporting these statements. In the latter part of the article, we provide guidance on how to include sexual pleasure as a fundamental part of sexual health and sexual rights work. We include a series of case studies and highlight key actions and principles for advocacy, implementation, and quality assurance in terms of law and policy, comprehensive sexuality education, health care services and dissemination of knowledge. This technical document seeks to inspire our partners and collaborators to embark on a journey toward a pleasure-based approach to sexual health and sexual rights. Our hope is that the literature, guidance and case studies provided here can ignite ongoing advocacy and collaboration to embrace sexual pleasure in all settings.

Advancing Sexual Pleasure as a Fundamental Human Right and Essential for Sexual Health, Overall Health and Well-Being: An Introduction to the Special Issue on Sexual Pleasure

On September 11, 2021, the World Association for Sexual Health ratified a Declaration on Sexual Pleasure in its General Assembly. This declaration was a bold attempt by WAS to urge all spheres of influence in society to recognize the critical importance of sexual pleasure as a key component of sexual health and sexual rights. This special issue of the International Journal of Sexual Health (the official journal of the WAS) contains a technical document which supports the Declaration. In addition, it contains background papers that were commissioned to inform the evidence supporting the technical document and to outline the strategies for implementing the WAS Declaration on Sexual Pleasure in promoting sexual health and rights.

Nepal’s Gender Policies: Achievements and Challenges

Nepal has experienced extraordinary political and social changes in the last 25 years. Since the Constituent Assembly (CA) election in 2008, progress has been noted in increasing women’s access to literacy, education, and healthcare services. Despite significant gender reforms in policies and strategies, Nepali women continue to experience discrimination and violence mainly because of their gender. Drawing upon six different cases – constitutional and international framework, participation of women, women peace and security, sexual and reproductive health rights, gender-responsive budget and citizenship law – this paper highlights some of the achievements and gaps in the area of gender reform policies and practices. Methodologically, the study adopts document review and personal reflections of authors as the main source of information. The paper concludes with some key recommendations to address existing challenges and gaps of these selected policies/strategies.

PKM KELOMPOK KRR DALAM PENCEGAHAN PERILAKU SEKS PRANIKAH DI MTS TARATE KABUPATEN SUMENEP

Reproductive health has the concept that everyone can have a satisfaction and a safe and responsible Sexual life. Therefore it is the right of every youth to be informed and gain access to Seksual and reproductive health true, complete and honest that enables them to make choices and decisions responsible for their reproductive and Sexual health rights. The main objective of reproductive health is to provide reproductive health services comprehensively to each individual and partner, especially to adolescents so that Each individual is able to undergo the reproductive process in a healthy and responsible manner as well as free from discrimination and violence, including recognition and respect for reproductive and Sexual health rights as an integral part of Human Rights. Providing access to education and adolescent reproductive health services is expected to increase the independence of adolescents in regulating functions and processes reproduction, including their Sexual life, so that their reproductive health rights can be fulfilled in improving the quality of life and the quality of their offspring both physically, mentally and social and free from fear, violence and discrimination. The result achieved from this activity is an increase in participants' knowledge about puberty and reproductive health. Specific objectives of the development of the education system and health services Reproduction for adolescents is to protect adolescents from the risk of early marriage, unwanted pregnancies, abortions, Sexually Transmitted Infections (STIs), HIV/AIDS and Sexual violence.

Differential access to facilities for medical termination of pregnancy and delivery in India: A secondary analysis

IntroductionEmerging evidence suggests a difference in access to facilities for medical termination of pregnancy (MTP) and delivery among women in different regions of the country. However, we lack assessments at a large scale across all geographies. Our study aims to describe the percent contribution of private and public sectors in institutional deliveries and MTP in India. MethodsA secondary data analysis using the Health Management Information System statistics was performed. We obtained selective data regarding the total number of MTP and deliveries conducted at public and private institutions. The standard reports of the period between April 2018 and March 2019 were analyzed. The states (n = 29) and union territories (n = 7) were dichotomized into regions, namely north, south, east, west, north-east, and central. ResultsA large part of women underwent deliveries and abortions in the private sector in the southern and western states of India like Kerala, Tamil Nadu, Andhra Pradesh, Goa, and Maharashtra. Women in most of the northern states opted for public facilities for deliveries as well as abortions, except Punjab and Haryana. On the contrary, states like Bihar, Nagaland, and Union territories like Delhi and Dadra and Nager Haveli had a high percentage of abortions in the private sector and deliveries in public health facilities. ConclusionThis differential access highlights the need to assess the underlying factors for immediate actions by the policy-makers. Ensuring safe and good quality delivery and abortion services is the means to assure the sexual and reproductive health rights of women by the government.

Priority clinic access or outreach to provide Sexual and Reproductive healthcare for people with mental illness?

AimsTo compare two sexual and reproductive health (SRH) clinical pathways (a priority appointment at a mainstream SRH clinic versus assertive community outreach), and to explore how each improves access to care for people with psychotic mental illness, severe addictions and/or learning disability.MethodObservational, descriptive study of two clinical access pathways within SHRINE (Sexual and Reproductive Health Rights, Inclusion and Empowerment), a specialist SRH programme to improve SRH care for severely marginalised people.The SHRINE programme delivers effective, ethical, accessible and user-centred SRH care for people with severe addiction, serious mental illness and/or learning disability in the deprived inner London boroughs of Lambeth and Southwark. These individuals often find accessing conventional SRH clinics very difficult. SHRINE clients can self-refer but most of them are referred by their health or social worker.Clients or referrers indicate their preferred pathway: priority appointment at the mainstream clinic or assertive community outreach. The priority appointment pathway at Camberwell Sexual Health Centre (CSHC) is as flexible as possible, with minimal waiting times, reminders, invitation to bring a friend or care worker and active follow-up of non-attenders via key workers. Assertive community outreach can be in an addiction clinic, postnatal ward, mental health centre, psychiatric ward, outpatient clinic, homeless hostel or the client's home.Time allocation for outreach and priority appointment-based care was 8 and 4 hours per week respectively. Care in both pathways was provided by senior doctors. Content of care was similar but facility for provision of gynaecological care including cervical smears and investigations for abnormal uterine bleeding e.g. pelvic ultrasound scans and endometrial biopsies were only available in the mainstream clinic setting at CSHC.ResultFrom May 2016 to December 2020 SHRINE received 1367 referrals from 125+ teams. We offered 1591 first or follow-up appointments of which 1369 (86%) were attended. A total of 1153 (84%) of our patient contacts occurred in the outreach setting where 93% the appointments were attended. Of the 358 appointments at CSHC 316 (60%) were attended.ConclusionMaking clinic access as simple and convenient as possible is not a sufficient strategy to meet the SRH needs of marginalised people. To enable them to realise their human right to sexual and reproductive health we need to leave our clinics and meet our clients where they are. A combined model of outreach and priority access clinic pathways is essential for provision of SRH care for people with mental illness.

Customary Marriages and Gender Equality : Zimbabwean and South African Perspectives

Patriarchy continues to place limitations on women’s rights in many societies. This is manifested by the unequal gender power relations between sexes, which also adversely impact women’s sexual and reproductive health rights. Using the key human rights principles of non-discrimination and gender equality, the study aimed to analyse gender equality within the sexual and reproductive health domain in customary marriages from the Zimbabwean and South African perspectives. The study was qualitative, conducted in Makwarela (South Africa) and Concession (Zimbabwe) with 16 participants using semi-structured interviews to collect data which were analysed using narrative analysis. The study established that there are restrictive gender norms that negatively affect the interaction of women with the health system, thereby producing negative health outcomes. The study recommends that women be empowered educationally, politically and financially so that they can make their own decisions regarding their health and well-being.

Policy Implementation Challenges and Barriers to Access Sexual and Reproductive Health Services Faced By People With Disabilities: An Intersectional Analysis of Policy Actors' Perspectives in Post-Conflict Northern Uganda.

Emerging from a 20-year armed conflict, Uganda adopted several laws and policies to protect the rights of people with disabilities, including their sexual and reproductive health (SRH) rights. However, the SRH rights of people with disabilities continue to be infringed in Uganda. We explored policy actors' perceptions of existing pro-disability legislation and policy implementation, their perceptions of potential barriers experienced by people with disabilities in accessing and using SRH services in post-conflict Northern Uganda, and their recommendations on how to redress these inequities. Through an intersectionality-informed approach, we conducted and thematically analysed 13 in-depth semi-structured interviews with macro level policy actors (national policy-makers and international and national organisations); seven focus groups (FGs) at meso level with 68 health service providers and representatives of disabled people's organisations (DPOs); and a two-day participatory workshop on disability-sensitive health service provision for 34 healthcare providers. We identified four main themes: (1) legislation and policy implementation was fraught with numerous technical and financial challenges, coupled with lack of prioritisation of disability issues; (2) people with disabilities experienced multiple physical, attitudinal, communication, and structural barriers to access and use SRH services; (3) the conflict was perceived to have persisting impacts on the access to services; and (4) policy actors recommended concrete solutions to reduce health inequities faced by people with disabilities. This study provides substantial evidence of the multilayered disadvantages people with disabilities face when using SRH services and the difficulty of implementing disability-focused policy in Uganda. Informed by an intersectionality approach, policy actors were able to identify concrete solutions and recommendations beyond the identification of problems. These recommendations can be acted upon in a practical road map to remove different types of barriers in the access to SRH services by people with disabilities, irrespective of their geographic location in Uganda.

Age of consent: A case for harmonizing laws and policies to advance, promote and protect adolescents' sexual and reproductive health rights.

The article assesses the legal and policy frameworks that have an impact on adolescents' sexual and reproductive health rights (ASRHR) in East and Southern Africa (ESA), confirming the interconnectedness of the ages of consent to sexual activity, marriage, and services and its influence on adolescents' human rights. It reviews international, continental and national legal instruments used to identify relevant provisions on ASRHR in the ESA region. The region demonstrates substantial disparities between realities of sexual debut among adolescents, national (statutory and customary) laws and policies on ages of consent to sex, marriage and medical services, and international standards around these SRHR issues. These disparities constitute negative consequences: criminalising adolescents, entrenching child marriage, and excluding adolescents from accessing medical services required to secure and promote ASRHR. While some ESA countries lack clear laws and policies on the three issues, cases of internal contradictions and disharmony with international standards abound. This impacts on the full realization of sexual and reproductive health rights of adolescents and young people in the region.

A review on the prevailing gaps in women’s sexual and reproductive health rights in Tanzania’s National Health Policy 2017

Women’s sexual and reproductive health rights (SRHR) are linked to numerous human rights; health, education, freedom from torture, protection from all forms of discrimination, and right of privacy. SRHR refers to a set of rights that every human being is entitled to, regardless of culture, race, religion, ethnicity, or disability. Women’s sexual and reproductive health rights have been taken for granted, especially in Tanzania’s health policies. However, Tanzania has several National Policies and Laws that affect women and men differently and in certain areas, they even contradict other existing laws. The prolonged poor SRHR shows the urgency of the reformation of the policies and laws. The analysis was carried out qualitatively through a reflection focused on the policy and other legal materials concerned. The study revealed that the policy does not cater enough for women’s SRHR. This study concludes that the policies are outdated and have a lot of loopholes. This has led the sexual and reproductive health system in Tanzania astray. The study concludes that the TNHP 2017 has to be reviewed and revised in order to meet the women’s SRHR and also to align it with some of the international policies and targets concerning sexual and reproductive health.

Qualitative study of roles of religious leaders in promoting adolescent sexual reproductive health and rights in Iganga municipality Uganda

Introduction: Young people in adolescent stage are very vulnerable. Sexual and reproductive health choices they make as they transition from childhood to adulthood determine a lot about their well-being.Objective: To assess the role of religious leaders in promoting adolescent sexual and reproductive health rights in Iganga Municipality.Methodology: Qualitative phenomenological design was used. Sample of 30 participants (25religious leaders and 5adolescents) were interviewed. Data was collected using in-depth interviews, transcribed, coded and analyzed using thematic content analysis.Results: Information shared by religious leaders to adolescents helped them to live responsible lives. Results also indicated that; religious leaders perceived promotion of ASRHR to imply elevation of sexual immorality. Religious leaders had both protective and preventive influences on promotion of ASRHR.Conclusion: Religious leaders greatly contribute to promotion of ASRHR by enhancing information sharing. Dialogues, therefore, enhances their awareness about ASRHR and gives them confidence to address the matter with adolescents.  Â

Intersections of Immigration and Sexual/Reproductive Health: An Umbrella Literature Review with a Focus on Health Equity

Identifying the opportunities and barriers of promoting and fulfilling the sexual health rights of migrants remains a challenge that requires systematic assessment. Such an assessment would include estimating the influence of acculturation processes on sexual and reproductive health, and mapping intersectional inequities that influence migrants’ sexual and reproductive health in comparison with the native population. The aim of this research was to locate, select, and critically assess/summarize scientific evidence regarding the social, cultural, and structural factors influencing migrants’ sexual and reproductive health outcomes in comparison with native population. An umbrella review of systematic reviews and/or meta-analyses, following preferred reporting items for systematic reviews and meta-analysis (PRISMA) standards was undertaken. Medline, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews were searched from their start date until June 2019. The quality of the included articles was determined using the assessment of multiple systematic reviews tool (AMSTAR 2). From the 36 selected studies, only 12 compared migrant with native populations. Overall, the findings indicated that migrants tend to underuse maternal health services and have an increased risk of poor sexual and reproductive health outcomes. Specific intersectional inequities were identified and discussed.

A sexual and reproductive health rights approach to menstruation

ABSTRACT While increased attention to menstruation as a significant health issue for women and girls is positive, some menstrual interventions promoted by Water, Sanitation, and Hygiene (WASH) programmes primarily focus on hygiene, infrastructure, and product provision. This focus fails to challenge the social and cultural stigma surrounding menstruation, as well as interconnected issues of gender discrimination, marginalisation, and inequality. We advocate approaching menstruation as a matter of sexual and reproductive health rights (SRHR), which recognises that sexual and reproductive health depends in part upon the realisation of the rights that support it. This requires a holistic approach to menstrual health that includes addressing shame, social stigmas and restrictions, and gender inequality, in addition to providing access to menstrual-friendly toilets. This holistic approach should also include comprehensive and community-driven sustained training and education about sexual and reproductive health and rights. Drawing upon research on four grassroots NGOs in India, Goonj, Barefoot College, Jatan Sansthan, and EcoFemme, we demonstrate that locally based NGOs are well-placed to create community-based educational trainings, provide access to context-specific and culturally appropriate menstrual products, and, perhaps most significantly, to challenge stigma around menstruation.

Spatial distribution, prevalence, and determinants of unintended pregnancy among youth (15-24) in Ethiopia: Further analysis of Ethiopia Demographic and Health Survey.

Objectives:This study aimed to determine the spatial distribution, prevalence, and determinant factors of unintended pregnancy among youth in Ethiopia.Methods:Using the Ethiopian Demographic and Health Survey 2016, a total of 2446 pregnant women aged 15–24 in the last 5 years, including current pregnancy, were included in the study. The unintended pregnancy data were spatially visualized using coordinates for each respondent in the survey using ArcGIS 10.3. The Bernoulli model was used to identify the presence of purely spatial unintended pregnancy cluster using SaTScan software. Logistic regression analysis was fitted to determine factors associated with unintended pregnancy among youth.Results:Unintended pregnancy among youth had spatial variation across the country. Among youth, 20.5% (confidence interval: (19.0, 22.2)) of pregnancies were estimated to be unintended. Spatial scan statistics identified 72 primary clusters (log-likelihood ratio of 37.6, at p < 0.001) which were located in Addis Ababa, southern part of Amhara, northwest of Oromia and northeast of Southern Nations, Nationalities and Peoples Region. Age, region, marital status, occupation, sex of household head, and number of household members were the determinant factors of unintended pregnancy among youth in Ethiopia.Conclusion:The distribution of unintended pregnancy among youth in Ethiopia was nonrandom. Unintended pregnancy prevention strategies among youth need to be targeted on the identified factors. Hence, we recommend creating awareness on sexual and reproductive health rights with special priority to the identified hotspot areas (Amhara, Addis Ababa, Gambella, Northern part of Southern Nations, Nationalities and Peoples Region, and northwest of Oromia region) to reduce unintended pregnancy.

Involvement of husband in maternal and child health care in rural field practice area of a tertiary medical college in South India-A mixed method study.

Background:To commemorate the 25th anniversary of International Conference on Population and Development (ICPD) in the pursuit of Sexual and Reproductive Health Rights views of duty bearers (men) who are mostly not involved in antenatal care in a patriarchal society like India needs to be explored.Design:It is a mixed method study (Triangulation).Setting and Population:It was conducted in a rural field practice area of a private medical college in South India covering a population of 19,200.Objectives:1) To determine the involvement of husband in maternal and child care. 2) To find out the perceptions of the husbands of antenatal pregnant women in maternal and child health (MCH) care.Methods:(Quan) A semi-structured questionnaire to find out the areas where husband is involved maximum during antenatal care (Qual). In-depth interviews was conducted to find out the factors associated with their involvement.Results:About 72.5% came for antenatal visits while it decreased to 27.5% during labor and further decreased to 20.3% during immunization. The reasons for decreased participation were (1) Professional Commitments, (2) Views of a Patriarchal society like India, (3) Financial Difficulties, and (4) Health Facility Related Challenges.Conclusion:There is a need to educate the husband regarding the importance of husband's involvement during delivery and immunization. Programs should also include men as the stakeholders for accountability and better MCH care for women.

Accessibility to Gender-based Violence Health Services for Adolescent Girls and Young Women in Tanzania

Background and Objective: Gender-based violence (GBV) health services can offer lifesaving prevention and treatment, particularly for GBV survivors among adolescent girls and young women (AGYW), which includes post-exposure prophylaxis (PEP) provisions, counseling, and referrals to other GBV programs. Although there are many benefits to GBV services, such as HIV prevention, sexual and reproductive health rights, and mental well-being, the number remains small for GBV survivors who access these services following the violence. This study was focused on identifying and describing the perceived barriers and facilitators of accessing GBV health services among AGYW in Tanzania. Methods: This was a qualitative study in which a structured and in-depth interview process was used for AGYW (N = 20) aged between 15 - 24 years old in two districts of Dar es Salaam: Temeke and Kinondoni. The interviewer explored the participants’ perspectives on barriers and facilitators relating to GBV healthservice access. Audiotapes from the participants’ responses were transcribed and later translated. Thematic areas were identified using the Social-Ecological Model. Transcripts were analyzed using inductive content analysis. Results: The study findings were divided into barriers and facilitators. Key barriers included lack of knowledge on available GBV health services, stigma, low self-esteem, negative attitude, fear of HIV testing, fear of disclosing perpetrator(s), and lack of parental support. Key facilitators included community and parental support, positive-prior experiences, and peer support. Conclusion and Implication for Translation: It is paramount to strengthen existing interventions to address community and GBV health facility stigma and to empower survivors in the overcoming of fear- and esteem-related issues. Additionally, it is necessary to increase GBV survivors’ access to related GBV health services through strengthening facilitators’ abilities and influences.