Sexual Reproductive Health Rights Research Articles

Level of Knowledge on Sexual and Reproductive Health Rights Among the Teenage Mothers and Their Parents in Rwanda: A Comparative Cross-Sectional Study.

Parents are the primary caregivers and influential figures in adolescents' lives. They play a crucial role in shaping their children's attitudes, beliefs, and behaviors regarding sexual reproductive health. A vast difference in knowledge between adolescents and their parents indicates failure in knowledge translation and is associated with sexual and reproductive consequences, such as teenage pregnancies. In this cross-sectional study between December 2020 and December 2021, 834 teenage mothers and their parents/guardians (n = 861) were enrolled from all five provinces of Rwanda. Knowledge of sexual reproductive health (SRH) rights was assessed, and the differences between the understanding of parents and their children were analyzed using Chi-square tests. There were statistically significant differences forall the assessed aspects of SRH knowledge rights between parents and their teenagers (ie, on the age of consent,safe abortion,right to education for teenage mothers, understanding of financial responsibilities, and perceptions of legal consequences). There is a significant knowledge difference between the two generations regarding their understanding of SRH rights. It is recommended that future programming should devise innovative ways that bring together parents and their children to discuss sexual reproductive health rights, which will result in empowered children and teenagers in Rwanda. Also, awareness programs are needed to improve the knowledge gaps regarding SRH in the public by policymakers, NGOs, and educators.

‘What are you doing here?’: (mis)trust, COVID-19 pandemic, and sexual reproductive health rights

We explore how the government’s messaging on COVID-19 pandemic response perpetuated mistrust and impeded people’s ability to access and utilise sexual and reproductive health (SRH) services. While the need for SRH information increased, public health messages fostered mistrust in sexual and reproductive health services. We draw on in-depth interviews and focus group discussions conducted among women, girls, and healthcare providers in five African countries (Burkina Faso, Ethiopia, Kenya, Malawi, and Uganda) between May and October 2021. We show how trust was largely eroded through preventive measures, such as stay-at-home directives, social distancing, curfews, and lockdowns. We argue that, on one hand, while state-led epidemic preparedness and response were geared towards the common good, i.e., controlling the virus, on the other hand, de-prioritisation of much-needed services for sexual and reproductive health and rights (SRHR), as well as a lack of transparency among some of the service providers, bred mistrust in healthcare. We conclude that ambiguity in communication and implementation of COVID-19 prevention measures further compromised access to and utilisation of sexual and reproductive health services.

Social Cultural Norms Associated with Early Marriages among Adolescents: Case Study of Chadiza District, Eastern Province of Zambia

Zambia is ranked 16th among countries with the highest rate of child marriage in the world. According to some studies conducted, child marriage rates in the country stand at 42 per cent of women aged between 20 and 24 years married by the attainment of the age of 18 years old. The main objective of this study was to investigate social cultural norms associated with sexuality and child marriages among adolescents in Chadiza district, Eastern province of Zambia. The mixed method design both quantitative and qualitative was used because it provides the researcher with a more comprehensive view of the phenomena being studied in this case, social cultural norms associated with sexuality and child marriages. A Systematic sampling technique was used where every third household was selected for inclusion in the study sample and 150 respondents from which 100 girls and 50 boys were selected by applying a fixed interval. The study findings indicated that most cultural practices in the study area especially initiation ceremonies provoked a girl child to opt for an early sexual debut and early marriage. On the age at first sexual debut, results showed that the minimum age to engage in sexual intercourse by the respondents was 12 years while the maximum age was 22 years for both genders. The study further unearthed the reality that girls’ initiation ceremonies exposed most girls to risk behaviours. After graduating from initiation ceremonies girls wanted to experiment whether they were really sexually able to handle any man since that is what they were taught in their initiation ceremonies a situation which led to early sexual debut among young girls and subsequently to early or teenage pregnancies and early marriages. The study recommends that the Zambian government through the responsible Ministry should regulate initiation ceremonies that pass on bad cultural practices to the adolescents and girls in particular. While appreciating the role initiation ceremonies play in preparing the adolescents for adult responsibilities, there is need to restructure the curriculum for initiation ceremonies to include sexual reproductive health rights and responsibilities.

How and who can address sexual reproductive health rights in Tanzania

How and who can address sexual reproductive health rights in Tanzania

Factors that determine women's autonomy to make decisions about sexual and reproductive health and rights in Nepal: A cross-sectional study.

Women's autonomy on sexual and reproductive health issues is critical to women's health and well-being. Women have the right to decide on their fertility and sexuality, be free from coercion and violence, and achieve well-being. This study has identified women's autonomy regarding decision and exercise of their sexual reproductive health and rights and its association with determining factors in Nepal. Descriptive and analytical statistics such as bivariate and multivariate regression analysis were performed using data from Nepal Demographic and Health Survey 2016. The survey collected data from 12,862 women of reproductive age groups i.e. 15-49 years. However, for this study, we analyzed the data of only ever-married women and they were 9,875 in total. The analysis showed that women's autonomy in exercising their sexual reproductive health rights is highly associated with media exposure after controlling demographic variables. The frequency of exposure to media (i. less than a week: adjusted odds ratio (AOR):1.383; confidence interval (CI):1.145-1.670, p<0.001, ii. at least once a week: AOR:1.657; CI:1.359-2.021, p<0.001) is positively associated with women's autonomy. Furthermore, factors like women from Janajati (AOR:1.298; CI:1.071-1.576, p<0.01) and other Terai ethnic groups (AOR:1.471; CI:1.160-1.866, p<0.01), higher education attainment (AOR:1.482; CI:1.164-1.888, p<0.01), richest wealth quintile (AOR:1.527; CI:1.151-2.026, p<0.01), paid work (AOR:1.277; CI:1.045-1.561, p<0.05) and living in Lumbini Province (AOR:0.622; CI:0.486-0.797, p<0.001) and Sudur Paschim Province (AOR:0.723; CI:0.554-0.944, p<0.05) were found to be significantly associated with women's autonomy in sexual and reproductive health decision making. Similarly, women's autonomy is also increased with their increased age. In conclusion, women's exposure to media, improved socio-economic status and increased age influence their autonomy to make decisions about sexual and reproductive health rights in Nepal. Therefore, this study underscores the need to address socio-economic barriers and improve women's exposure to the media to enhance their autonomy further.

Individual and Community-level factors associated with early marriage in Zambia: a mixed effect analysis

BackgroundChild marriage has long been a public health concern around the world, because it has the potential to deprive adolescent girls of their sexual reproductive health rights and limits their ability to reach their full potential in life. The prevalence of child marriage has been consistently higher in sub-Saharan Africa than elsewhere. However, fewer studies have explored the influence of both individual and community-level influences on early marriage in sub-Saharan Africa. This study, therefore, examined individual and community-level factors associated with child marriages in Zambia.MethodsData came from the Zambia Demographic and Health Surveys (ZDHS) conducted in 2007, 2013–14 and 2018. A pooled weighted sample of 9990 women aged 20–29 years was used in the analysis. Stata software version 17 was used to perform statistical analysis, taking into account complex survey design. The association between individual- and community- level factors and early marital behavior was assessed using multilevel logistic regression models.ResultsThe prevalence of child marriage among women aged 20–29 was 44.4 percent (95% CI: 42.1, 46.7) in 2018, declining from 51.5 percent (95% CI: 48.9, 54.0) in 2007. Women with secondary or higher level of education [aOR = 0.36, 95% CI = 0.26–0.49] and [aOR = 0.07, 95% CI = 0.03–0.18] and those whose age at first birth was (15–19 year) or (20–29 years) were associated with less likelihood of experiencing child marriage. Communities with a high percentage of women who gave birth at a young age [aOR = 1.36, 95% CI = 1.15–1.62] were more likely to experience child marriage. Individual and community-level characteristics accounted for 35% of the overall variations in communities' likelihood of experiencing early marriage. Even after controlling for both individual and community-level influences, the intra-class correlation revealed that around 4.5 percent of the overall variations remained unexplained.ConclusionPrevalence of child marriage has reduced over the years but is still high in Zambia. Both individual and community- level factors influenced child marriage in Zambia. There is a need to strengthen strategies that keep girls in school to delay their exposure to early sexual debut and child marriage. Designing of reproductive health interventions in the country should consider integration of community factors such as economic insecurity and access to reproductive health information.

Girls’ education in Malawi status report

The report has outlined barriers that affect girls’ education in Malawi and gives the statistical outline of the status of girls’ education in different categories and levels of education for primary and secondary schools. It also touches on the necessity of education, starting with the acquisition of literacy and numeracy skills that are essential for survival in the fast changing world. The status report portrays the importance of education as if gives an opportunity to develop social skills among learners and especially the girl child. CARE Malawi (2010), emphasizes that Malawi is one of the countries that have keen interest to ensure every girl goes to school. This report explores possible solutions to barriers to girls’ education that affect the girls in a negative way. These are harmful cultural practices, poverty, illiteracy of parents, cost of schooling, distance to school, lack of role models, pregnancy, marriage, gender based violence, lack of interest and lack of proper teaching and learning methods. This report used data from Education Management Information System (EMIS) and other statistics booklets produced with an aim of capturing data on girls’ education. Even though data on girls’ education might be scanty in Malawi, however, this report provides a general picture which is showcasing on how important it is to educate the girl child for a nation as they contribute to the country’s development agenda. It is in this respect that the status report highlights on what is working and what is not working with reference to the policies and strategies on girls’ education in order for stakeholders to discover areas that need further improvement to achieve the intended purpose on the promotion of girls’ education. Although government, development and implementing partners and other stakeholders in the promotion of girls; education are working tirelessly to overcome the known barriers to girls’ education, still girls lag behind in many areas such as in completion and survival rates. There is also limited participation of women and girls in decision making positions for working women. Girls spend very little time in school due to family responsibilities while boys are given ample time to learn. It is therefore recommended that deliberate efforts should be made to give girls a platform to perform better in school, such as provision of bursaries, change rooms, WASH facilities, Sexual Reproductive Health Rights (SRHR) to address issues of Gender Based Violence (GBV) in schools, communities and the workplace. And to make sure that the campaign on the implementation of the re-admission policy is taken seriously so that drop-outs are given a second chance to access education.

Empowering Communities against Harmful Social Practices through Integrated Water Hygiene and Sanitation and Alternative Rites of Passage Model in Kajiado County, Kenya

Background: In Kajiado County, water, sanitation, and hygiene interventions have been independently implemented in communities that have been targeted with sexual health rights interventions. This approach only achieves a set of disjointed achievements and thus the need for integration. This project implemented and tested the effectiveness of the Integrated Water Hygiene and Sanitation and Sexual Reproductive Health Rights (SRHR)Model to address harmful practices against young girls in the county. This model was implemented on the assumption that addressing a pressing need of the community through providing access to Water hygiene and sanitation services provides a platform to discuss SRHR matters leading to positive change towards WASH and SRHR behaviours such as reduction of FGM, teenage pregnancies and early forced marriages. Methods: A before and after design that compared baseline and endline evaluation data was used to establish the effectiveness of the model. The study was conducted in 4 sub-counties. Data was collected through household surveys. Adolescent Girls and Young Women (AGYW) aged 10-24 years were included. Data were analysed using proportions, frequencies, odds ratios, and adjusted odds ratios. Results: Prevalence of FGM/C dropped to 55.2% from 91% at baseline. More circumcised women (79.5% end line; 28% at baseline) reported that they wished they had not been circumcised. An increase in participants who had ever heard messages of ARP (91.6% end line; 47% baseline) was reported. Approximately 98.1% believed that ARP is acceptable to the community as a means of progressing girls to womanhood. Young girls and Women were more likely to undergo FGM/C if they did not have access to a toilet (AOR, 2.32; 95% CI, 1.50 to 3.59), had never heard of ARP (AOR, 2.50; 95% CI, 1.54 to 4.04) and were not sure if ARP would be acceptable in the community (AOR, 0.51; 95% CI, 0.27 to 0.97). Odds of ever being circumcised were less likely among those that stated that FGC should not continue (AOR, 0.11; 95% CI, 0.01 to 0.81) and had been part of the intervention (AOR, 0.25; 95% CI, 0.17 to 0.38). Conclusions: There is a link between addressing WASH gaps (community-felt needs) in Kajiado and the reduction of FGM/C. Addressing community pressing needs provides a platform to address sensitive social-cultural practices. Recommendations of further studies to explore contextual factors that affect the implementation of this model.

Safe abortion policy provisions in the SADC region: Country responses, key barriers, main recommendations

Background. Abortion is the termination of an already established pregnancy. The abortion may be induced, voluntarily performed or spontaneous, but when it is done by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, it is considered unsafe. The Southern African Development Community (SADC) has a robust policy framework for combating unsafe abortion.Objectives. To examine the relationship between abortion laws and access to safe abortion services in the SADC region as an important and necessary yardstick for measuring the progress of a nation in securing reproductive and sexual health. To analyse the relationship between laws governing abortion, abortion and post-abortion national guidance, and access to safe abortion services by adolescent girls and young women.Methods. A desk review of all legal, policy and national guidelines for all 16 SADC member states was done. Secondary data were collected, and the knowledge, attitudes and practices reflected on abortion surveys were examined in 15 out of 16 of the member states in both rural and urban settings. Sixty-three focus group discussions were held across 15 out of 16 countries, and 127 key informant interviews were held with non-governmental organisations, government ministries and relevant departments in the 15 countries.Results. Countries with restrictive abortion laws are more likely to have a relatively high proportion of unsafe abortions. The results indicated a proportion of unsafe abortions ranging from 43% to 79% for those countries where the legal framework does not lend itself to ease of access. Liberal abortion laws and guidelines do not necessarily mean a reduced incidence of unsafe abortions, especially for adolescents, girls and young women. Multiple barriers still exist in practice. Conclusion. Limits and bounds of the law as a tool to enhance safe abortion exist. The importance of alignment of laws, policies and practices is noted, recognising that all may influence and affect access to safe abortion, and in turn, sexual reproductive health rights for women and girls.

Safe abortion policy provisions in the SADC region: Country responses, key barriers, main recommendations

Background. Abortion is the termination of an already established pregnancy. The abortion may be induced, voluntarily performed or spontaneous, but when it is done by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, it is considered unsafe. The Southern African Development Community (SADC) has a robust policy framework for combating unsafe abortion.Objectives. To examine the relationship between abortion laws and access to safe abortion services in the SADC region as an important and necessary yardstick for measuring the progress of a nation in securing reproductive and sexual health. To analyse the relationship between laws governing abortion, abortion and post-abortion national guidance, and access to safe abortion services by adolescent girls and young women.Methods. A desk review of all legal, policy and national guidelines for all 16 SADC member states was done. Secondary data were collected, and the knowledge, attitudes and practices reflected on abortion surveys were examined in 15 out of 16 of the member states in both rural and urban settings. Sixty-three focus group discussions were held across 15 out of 16 countries, and 127 key informant interviews were held with non-governmental organisations, government ministries and relevant departments in the 15 countries.Results. Countries with restrictive abortion laws are more likely to have a relatively high proportion of unsafe abortions. The results indicated a proportion of unsafe abortions ranging from 43% to 79% for those countries where the legal framework does not lend itself to ease of access. Liberal abortion laws and guidelines do not necessarily mean a reduced incidence of unsafe abortions, especially for adolescents, girls and young women. Multiple barriers still exist in practice. Conclusion. Limits and bounds of the law as a tool to enhance safe abortion exist. The importance of alignment of laws, policies and practices is noted, recognising that all may influence and affect access to safe abortion, and in turn, sexual reproductive health rights for women and girls.

Adolescent Sexual Reproductive Health Rights Issues in Rural Zimbabwe

This study was aimed at examining the knowledge and perceptions of adolescents on Adolescent Sexual and Reproductive Health (ASRH) rural Zimbabwe. Adolescents in Zimbabwe faces limited access to health information and services. Different factors like poverty, gender inequality, socio-cultural and economic status play a crucial role in determining adolescent’s access to ASRH knowledge. Qualitative research methodology was used in the study. Data was gathered through key informant interviews and Focus Group Discussions (FGDs). The culture of communicating ASRH problems with parents was non-existent in most cases save for girls who indicated that they got information from their mothers during menstruation periods. Adolescents indicated that they had limited access to ASRH services available in their community. They further indicated that they were not utilising these services for various reasons such as social stigma, lack of information, poor quality service and the negative attitude displayed by some nurses and counsellors at the nearest health centre.

Pushing the limits of adaptiveness through double loop learning: organisational dilemmas in delivering Sexual Reproductive Health Rights education in Uganda

ABSTRACT This paper untangles the complex realities of Sexual Reproductive Health and Rights education in Uganda based on a Participatory Action Research with staff and volunteers of an NGO. A detailed portrait is offered of the dilemmas faced by the team around value-contradictions in this culturally sensitive domain, the complex nature of change, programme targets and community expectations. Through double loop learning methodology, the Team reflected on their own mental models and strategies used in dealing with these dilemmas and reframed their action theories towards more effective collaboration with learners and community members. The research process and outcomes illustrate the transformative power of reflection and double loop learning; resulting in practical guidance for education NGOs facing dilemmas in community collaboration.

Exploring media framing of abortion content on Kenyan television: a qualitative study protocol

BackgroundMedia framing of abortion messages is an emerging field of research. However, little is known about how the news media frames abortion messages aimed at influencing adolescents’ reproductive health choices. This study therefore seeks to investigate the framing of abortion in TV news items on three leading Kenyan TV outlets over a period of 3 years, understand Kenyan journalists’ perceptions and experiences with abortion coverage, and to examine adolescents’ perceptions and experiences with abortion coverage on Kenyan televised news media.MethodsThis qualitative study which will be conducted in two sites-Nairobi and Uasin Gishu counties-in Kenya will purposively sample abortion news items from three leading media outlets aired between January 2016 to December 2019, for content analysis. Additionally, 12 journalists (9 reporters, 3 news editors) will be purposively sampled for Key Informant Interviews (KIIs) on journalist framing of abortion messages. Finally, convenience sampling will be used to select approximately 48 university-going adolescents for four Focus Group Discussions (FGDs)-2 female, 2 male- aimed at examining adolescents’ perceptions and experiences with abortion coverage in the broadcast news media. The KIIs and FGDs will be audio-recorded, transcribed and translated. These data will be analyzed thematically.DiscussionThis study moves beyond interrogating only media items to further exploring framing from the perspectives of media consumers and investigations in the process behind production of abortion messages. The study interrogates abortion messages aimed at younger demographics such as adolescents as well as the gendered differences of the effects of these abortion messages, an area barely explored. The study findings will be informative to those who wish to develop media that could be used to promote safe abortion as well as advocate for sexual reproductive health rights, especially among adolescents.

Challenges of Poverty on Sexual Reproductive Health

This paper reflects on the challenges of poverty on sexual reproductive health in Botswana. It intends to stimulate discussions on issues surrounding poverty and sexual reproductive and how to alleviate such challenges. The challenges explored include: lack of information on Sexual Reproductive Health Rights (SRHR); poor access to SRHR; lack of negotiation skills for sexuality, and adolescents in poverty and SRHR. The paper starts with an overview of poverty in Botswana, then discusses the challenges of poverty on sexual and reproductive health rights and lastly, the recommendations that intend to address the challenges of poverty related to SRHR.

Talking about gender and sexual reproductive health rights of adolescents and youth in Jharkhand

ABSTRACTJharkhand is one of the most vulnerable and poverty-stricken states of India. There are limited programs and campaigns for communities that include gender and sexuality as prioritized public health concerns of adolescents and youth. This article uses experiences from work done specifically on gender and sexual reproductive health and rights (SRHR) in grassroots of Jharkhand with adolescents and youth over a period of three years. The first part of the article discusses a technology-based health initiative on gender, sex and sexuality in some villages of Jharkhand. The second part of the article is about accounts and an advocacy initiative, Periods pe Charcha (Let’s talk Periods), an independent campaign run digitally and on ground to ensure mandatory menstrual hygiene services for young girls. This paper seeks to provide a few insights regarding gaps in existing policies and programs and argues for the need to have more structured initiatives and campaigns on SRHR for young people at grassroots levels in the state.

‘My vagina is invincible’: The myth of risk-free sensual sex between two women

abstractWith the passing of time and increasing knowledge, the sexual reproductive health rights (SRHR) narrative continues to grow, reshape and reform. This realm has seen internal shifts with the rise of sex positivity, the depathologisation of sexualities and the identification of key populations who need to join the conversation. Despite these movements one group is continuously left out of the dialogue – namely women who have sex with women (WSW). Other than bisexual women (who often feature briefly when discussing issues facing heterosexual women), WSW are often left out of key notions regarding sexual reproductive health due to their perceived ‘low-risk’ status when it comes to sexually transmitted infections or diseases and pregnancy.From ideas of consent and bodily autonomy, and notions of access to safe-sex information and tools, to ideas of pleasure, there is a whole host of notions that tie into a woman’s ability to engage fully with her range of SRHR. It is not simply about how susceptible she is to HIV infection, but what other risks are posed when she engages in sexual activity. For a lot of WSW these other possible risks are often ignored. This perspective piece seeks to debunk the invincibility of WSW when it comes to safe sex and to argue for their need to pull up a chair at the SRHR table. By tackling this notion it further seeks to outline why WSW have much to gain from active engagement in notions surrounding SRHR.

Refusing Reproductive Health Services on Grounds of Conscience in Latin America

The years have seen a rise in the use of conscientious objection (CO) as means to deny women their sexual reproductive health rights. While states have an obligation under international human rights law to protect the freedom of thought, conscience and religion of people, they also have obligations to protect the right to the highest attainable standard of health and other fundamental rights. Over the years, International and regional human rights bodies have indicated the need for CO to be limited so as to protect women’s rights. As a means to balance both rights of medical service providers to exercise their moral beliefs and to protect the right to health of women, countries around the world have also sought different ways to regulate the use of CO. Whereas in some countries, some developments have been made to regulate CO so as to protect fundamental rights of women, in others, few guidelines exist in order to ensure availability of services for women in case refusals are made. This article provides an overview of policies regulating CO in Latin America. It considers the regulation of CO under both international law and under various state laws within the region. It suggests that if women’s reproductive rights are to become a reality, then there is a real need that states as well as international and regional human rights bodies continue to find ways to clarify frameworks around CO, so that grounds of conscience do not become an excuse to deny women realisation of their fundamental rights.

RELIGIO-CULTURAL IDEALS OF WOMEN’S BODY SHAPES: A REVIEW OF BLACK WOMEN’S ENGAGEMENT WITH BODYBUILDING

This article provides an overview of existing literature around the conceptions of women’s engagement in the sport of bodybuilding. It aims to explore specifically how religious and cultural conceptions of black women’s bodies influence their engagement in bodybuilding, with a particular focus on Zulu Christian women. The review foregrounds debates on how, although a previously male-dominated sport, women all around the world are becoming prevalent participators in the sport. It provides a general perspective of the conceptions of women’s engagement in bodybuilding from a western world-view and links it to how black women’s bodies are conceptualised from an African perspective. This review is part of a larger study in Gender, Religion and Sexual Reproductive Health Rights and the themes and concepts covered by the literature review, emanate from the intersections of the above three focus areas, respectively. Although most of the literature in the field of women’s engagement in bodybuilding pertains to white female bodybuilders, certain concepts can be generalised and related to the context of black female bodybuilders, Zulu, Christian female bodybuilders in particular.

PHP71 - Access To Sexual Reproductive Health Rights Information Among The Youth: A Case Of Gucha South District, Kisii County-Kenya

PHP71 - Access To Sexual Reproductive Health Rights Information Among The Youth: A Case Of Gucha South District, Kisii County-Kenya