Sexual Rights Research Articles

Fear generation in the multimodal communication of sexual and reproductive health to Malaysian adolescents

There has been much debate about the state of sexuality education in Malaysia which is heavily influenced by conservative cultural and religious attitudes. To better understand the scenario, this study examines how sexual and reproductive health and rights (SRHR) education is communicated multimodally to adolescents via printed and digital promotional materials. These materials were produced by the three main responsible agencies: the National Population and Family Development Board, the Ministry of Health Malaysia and the Federation of Reproductive Health Association Malaysia. Adopting Kress and Van Leeuwen’s visual grammar framework in Reading Images (1996) with a focus on visual composition, social actor analysis and viewer positioning, the materials were found to predominantly address Malay teenagers and carry fear-based messages about abstinence and the consequences of committing zina (a Malay word for illicit sexual relations). Custom and conformity rather than expert legitimation and trust in the social and health authorities dominate local sexual health education. The authors argue that contraception should be advocated through a discourse of health and social risk mitigation and responsible gender roles while respecting cultural and moral obligations. Adolescents also have a right to be informed about options appropriate to their own circumstances in line with Target 3.7 of the United Nations Sustainable Development Goals. Locally, such recommendations would contribute to Malaysia’s Shared Prosperity Vision 2030 and Twelfth Malaysia Plan which seek to improve the well-being of young citizens through targeted education and public services.

“The Loved Home” and Other Exclusionary Care Discourses

Based on a conceptualization of heteroactivism as a transnational phenomenon manifesting in local contexts to spread and express resistance to gender and sexual rights, this article aims to illuminate new dimensions of heteroactivism beyond a sole focus on gender and sexuality by bringing its specificities in the Swedish context to the fore. Drawing on digital ethnography with members of the neo-conservative, far-right thinktank Oikos and the ethnonationalist political party the Sweden Democrats (SD), the article shows how heteroactivist forms of resistance seek to reshape the state and the nation through the gender–sexuality nexus and how these resistances enter into negotiation with spatiohistorically established notions of gender equality and sexual rights. Through a multiscalar transnational approach, the article brings forth how heteroactivism connects several levels horizontally—from the local to the national and the transnational—and vertically and establishes linkages among gender, sexuality, the state and the nation. The analysis reveals how care, love and gratitude for the shared home are core elements used in heteroactivist negotiations, with contextually established notions of gender equality and sexual rights as national values. It also demonstrates how the home, which these actors seek to cherish and protect, takes shape as an exclusive and exclusionary space.

Empowering Women’s Health: Transforming Maternal Health Care in India

An indicator of the reproductive health of women in an area is the maternal mortality rate. A lot of women in the reproductive age range pass away from difficulties during, during, or related to pregnancy, childbirth, or abortion. Maternal mortality, a critical indicator of a country's healthcare system and women's well-being, has been a persistent concern in India. The study examines the progress and strategies employed in reducing maternal mortality in India. The research explores the initiatives undertaken by the Indian government under the National Health Mission to address maternal health. The findings serve as a valuable resource for policymakers, healthcare professionals, and researchers striving to advance women's sexual and reproductive health rights while reducing maternal mortality globally.
 KEYWORDS: Maternal mortality, Reproductive health, women, India

Intimate partner violence against HIV-Positive women on ART follow-up and associated factors in public health facilities of western Ethiopia

IntroductionIntimate partner violence is the most pervasive but less recognized problem which affects millions of women world. It is more common among marginalized individuals including women affected by HIV. However, there is limited information regarding this problem among HIV-Positive Women in Ethiopia. Thus, the study was aimed to assess the magnitude and factors associated with intimate partner violence among HIV positive women in western Ethiopia.MethodsA facility-based cross-sectional study was conducted among HIV-positive women on ART follow-up in Nekemte town. A total of 420 women were selected by the simple random sampling technique and an interviewer-administered questionnaire was used for data collection. The data were entered to EpiData version 3.1 and analyzed by SPSS version 20. Univariable and mult- variable logistic regression analysis with their corresponding odds ratio (95%CI) were computed, and statistical significance was declared at p < 0.05.ResultsThe magnitude of intimate partner violence among HIV-positive Women during Lifetime and since diagnosed with HIV was 49.29%, [(95% CI: 44.3–53.6%)] and 41.67%, [(95% CI: 37.1–45.7%)] respectively. Skipping daily ART medication ≥ 6 times/month [AOR = 3.56; (95% CI 1.18, 10.74)], experiencing controlling behavior by a partner[AOR = 6.37; (95% CI 3.26, 12.44)], women inter-parental witness of violence [AOR = 1.74; (95% CI 1.09, 2.79)], women having favorable attitude that justify wife-beating [AOR = 1.76; (95% CI 1.06, 2.94)]and non-disclosure of test result to partner [AOR 0.38; (95% CI 0.22, 0.66)] were factors associated with intimate partner violence since diagnosed with HIV.ConclusionThe magnitude of intimate partner violence among HIV-positive Women on ART follow-up was found to be high in the study area. Therefore, integrating intimate partner violence victim screening with ART services, empowering HIV-positive women, and increasing their awareness of sexual and reproductive rights is needed.

Seeking support for abortion care from national hotlines in Canada: Caller characteristics and call outcomes, 2019-2021.

Both the National Abortion Federation Canada and Action Canada for Sexual Health and Rights operate national toll-free hotlines that provide information, financial support, and travel assistance to abortion seekers. We aimed to characterize callers to both hotlines before and after the onset of the COVID-19 pandemic. Hotline personnel routinely document information about callers and type(s) of assistance needed and received. We received call logs from both organizations for a two-year period (April 1, 2019 through March 31, 2021). We exported these data to Microsoft Excel® and analyzed them using descriptive statistics. We analyzed case notes for content and themes. Over the study period, the two hotlines worked with 270 unique callers. Nearly two-thirds of callers (n = 174) were seeking support to obtain abortion care for pregnancies after 14 weeks gestation, including 69 callers (26%) who were at or beyond 24 weeks gestation. Most callers were seeking support to obtain abortion care outside of their province of residence because services at their gestational age were not available. Caller needs were similar before and after the onset of the pandemic, but fewer traveled to the United States for abortion care in the COVID-19 era. Assistance hotlines play an important role in helping some abortion seekers navigate the Canadian health system to obtain needed abortion care. The needs of those seeking care after the 14 weeks gestation points to gaps in current service availability. Identifying ways to expand later abortion care in Canada, particularly after 24 weeks, appears warranted.

Understanding Community Engagement in Sexual and Reproductive Health and Rights Promotion in the Eastern Cape, South Africa: A Conceptual Framework to Inform Practice

Understanding Community Engagement in Sexual and Reproductive Health and Rights Promotion in the Eastern Cape, South Africa: A Conceptual Framework to Inform Practice

Assessing the effectiveness of a sexual and reproductive health and rights training programme in changing healthcare practitioners’ attitudes and practices in low-income countries

ABSTRACT Introduction In low-income countries the utilisation of sexual and reproductive health and rights (SRHR) services is influenced by healthcare practitioners’ knowledge, attitudes and practices. Despite awareness of the potential problems due to ingrained biases and prejudices, few approaches have been effective in changing practitioners’ knowledge, attitudes and practices concerning SRHR in low-income countries. Objectives 1) To assess whether participating in an SRHR international training programme (ITP) changed healthcare practitioners’ SRHR knowledge, SRHR attitudes and SRHR practices and 2) examine associations between trainees’ characteristics, their SRHR work environment and transfer of training. Methods A pre- and post-intervention study, involving 107 trainees from ten low-income countries, was conducted between 2017 and 2018. Paired samples t-test and independent samples t-test were used to assess differences between trainees’ pre- and post-training scores in self-rated SRHR knowledge, attitudes, knowledge seeking behaviour and practices. Linear regression models were used to examine association between trainees’ baseline characteristics and post-training attitudes and practices. Results Trainees’ self-rated scores for SRHR knowledge, attitudes and practices showed statistically significant improvement. Baseline high SRHR knowledge was positively associated with improvements in attitudes but not practices. High increases in scores on knowledge seeking behaviour were associated with higher practice scores. No statistically significant associations were found between scores that measured changes in SRHR knowledge, attitudes and practices. Conclusion The findings indicate that the ITP was effective in improving trainees’ self-rated scores for SRHR knowledge, attitudes and behaviours (practices). The strongest association was found between improvement in SRHR knowledge seeking behaviour and the improvement in SRHR practices. This suggests that behaviour intention may have a central role in promoting fair open-minded SRHR practices among healthcare practitioners in low-income countries.

Crip-queer intimacy, alliance and activism: towards holistic sexuality education in Taiwan

ABSTRACT This study investigates the significance of sexuality education for individuals with disabilities in Taiwan. It highlights the importance of understanding sexuality as a fundamental aspect of identity, encompassing intimate relationships and connection to others. Since the implementation of the Gender Equity Education Act in 2004, Taiwan has made efforts to include comprehensive sexuality education in the school curriculum and integrate disabled students into mainstream education. However, disabled individuals still face barriers due to ableism and heteronormativity, which impede their access to sexual and reproductive health services, including sexuality education. To address this issue, we conducted a qualitative investigation using narrative and policy data, drawing on Scott’s phenomenology of nothingness and crip theory to explore the intersection of sexualities and disabilities in educational contexts. Our findings reveal that individuals with disabilities in Taiwan often rely on pornography and other erotic materials as informal sources of sex education. Hand Angels, a volunteer-based group established in 2013, has been actively promoting sexual rights within disability rights organisations, advocating for a comprehensive, sex-positive, pleasure-focused, and rights-based approach to sexuality education. However, there are still gaps in knowledge production and policy implementation, which systematically deny people with disabilities their right to sexual agency.

COVID-19 vaccines, sexual reproductive health and rights: Negotiating sensitive terrain in Zimbabwe

COVID-19 vaccines, sexual reproductive health and rights: Negotiating sensitive terrain in Zimbabwe

Protocol for a multi-country implementation research study to assess the feasibility, acceptability, and effectiveness of context-specific actions to train and support facilitators to deliver sexuality education to young people in out-of-school settings

Comprehensive sexuality education (CSE) is a well-established component of the package of interventions required to improve adolescent sexual and reproductive health and rights. As the international community has increased its emphasis on equity and leaving no-one behind with the Agenda for Sustainable Development, attention has been drawn to the need for complementary CSE programmes to reach young people who are not in school, or whose needs are not met by in-school CSE programmes. CSE in out-of-school contexts presents unique considerations, especially those related to facilitation. In this manuscript, we present the protocol for a multi-country implementation research study in Colombia, Ethiopia, Ghana, and Malawi to assess the feasibility, acceptability, and effectiveness of context-specific actions to prepare and support facilitators to deliver CSE in out-of-school settings to defined groups of young people with varying needs and circumstances. This study will be led by the World Health Organization and the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, in partnership with local research institutions. It will be nested within a multi-country programme led by UNFPA, in partnership with local implementing partners and with financial support from the Government of Norway. This study will shed new insight into what it takes to effectively deliver CSE in out-of-school contexts, to enhance progress towards the achievement of SDG 3 “Ensure healthy lives and promote wellbeing for all at all ages” and SDG 5 “Achieve gender equality and empower all women and girls”.

Muslim Women Against Feminism: The Family Love Alliance (Aliansi Cinta Keluarga) and Its Impact on Women's and Sexual Rights in Contemporary Indonesia

Abstract This article discusses how Islamic conservatism has affected public discourse and policymaking on gender and sexuality and its impact on the struggle for gender equality and sexual rights in contemporary Indonesia. It particularly seeks to examine and analyse how Muslim women in the Family Love Alliance produced a counter-discourse against feminism in their struggle to oppose the ratification of the sexual violence eradication bill. While research on Islam and gender in Indonesia has primarily focused on Islamic feminism, little research has addressed the counter-discourse against Islamic feminism produced by Muslim women and how this might influence ideas of and advocacy for women's rights and gender equality. Some scholars on Indonesian Islam have also argued that rising Islamism has turned the country more religiously conservative. However, scholarly understanding of the relationship between Islamic conservatism and gender remains limited. Drawing on my fieldwork in 2018 and 2019 and informed by social movement theory, this study captures how AILA women activists represent a conservative Islamic backlash against gender equality movements in contemporary Indonesia's public sphere.

Gender, Medicine, and the Creation of a Modern Nation: Calls to End Female Genital Cutting in Egypt, 1940 to 1960

Abstract While considerable research exists on female genital cutting (FGC) in Egypt, debates about its legitimacy prior to the 1970s have barely received any scholarly attention. However, the analysis of Egyptian magazines and newspapers indicates that the 1940s and 1950s witnessed a broad debate over FGC. Drawing on this evidence, the article argues that calls to end female circumcision did not primarily assert the physical and sexual rights of women and girls. Rather, the debate was dominated by a male-centered perspective that conceptualized FGC as a backward practice whose eradication was deemed necessary to create a healthy and progressive nation, while both female sexual satisfaction and the agency of female traditional health practitioners were marginalized. The history of combatting FGC between 1940 and 1960 thus needs to be understood as part of broader debates about public health and social reform that centered on the female and rural population to civilize and modernize the nation.

Depressive symptoms and anxiety among women with a history of abortion living in urban slums of Bangladesh

BackgroundGlobally, major emphasis has been placed on understanding the physiological consequences of losing a pregnancy. However, its mental health impact on socially disadvantaged women remains unexplored. To further inform the field the present study investigated the prevalence and factors associated with the development of depressive symptoms and anxiety among women with a history of spontaneous abortion living in the urban slums of Dhaka, Bangladesh.MethodsInformation was obtained from 240 women who experienced a spontaneous abortion from July 2020 to December 2021. It was obtained through the urban health and demographic surveillance system (UHDSS) survey. Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) were used to measure mental health symptoms. Bivariate and multivariate linear regression analyses were performed to assess the associated factors with the mental health outcomes.ResultsOf the 240 women, majority (77.50%) of the women experienced mild to severe depressive symptoms and more than half (58.75%) of the respondants experienced mild to severe anxiety, within one and half years of experiencing spontaneous abortion. A higher level of education and being employed were protective factors for anxiety and depressive symptoms, respectively. However, women with higher sexual and reproductive health rights (SRHR) knowledge had significantly increased anxiety and depressive symptoms. In contrast, receiving post-abortion care (PAC) was associated with decreased anxiety and depressive symptoms.ConclusionThe findings indicate that ensuring access to affordable PAC services and integrating mental health services into the standard PAC service package is crucial. This study also emphasizes the importance of providing education for women living in urban slums and encouraging them to participate in economic activities.

How Self-Efficacy and Agency Influence Risky Sexual Behavior among Adolescents in Northern Uganda

Background: Risky sexual behaviors remain common among adolescents regardless of those with comprehensive knowledge of safer sex practices. Self-efficacy has been shown to have a positive relationship with safer sex practices. Thus, investigating self-efficacy, and enhancing it to agency is important. The current study explores the predictors of self-efficacy for avoiding risky sexual behaviors and what limits agency among sexually active adolescents (15–19 years) in Northern Uganda. Methods: The study consisted of a sub-sample of 396 sexually active adolescents (145 in school, 251 out of school) interviewed as part of a household survey for the program on Advancing Sexual Reproductive Health and Rights in Northern Uganda. Poisson and Poisson regression models with survey weights were implemented in Stata. Results: A total of 94% of male and 64% of female adolescents reported self-efficacy to avoid unsafe sex, including using condoms and avoiding multiple sexual partnerships or transactional sex. At multivariable analysis, a higher proportion of adolescents who listened to a radio or television program about sexual and reproductive health within the past 12 months had self-efficacy as compared to others (PR = 1.13, p-value = 0.002). Similarly, higher proportions of adolescents who knew all the sexual and reproductive health (SRH) rights (PR = 1.33, p-value = 0.007) and who had comprehensive knowledge about pregnancy, prevention of sexual transmission infections, and sources of SRH services (PR = 1.24, p-value = 0.013) had self-efficacy as compared to others. However, among those who reported self-efficacy, 42% of the girls and 53% of the boys could not uphold their self-efficacy in actual sexual encounters in the past 12 months. Partner’s refusal or girls’ fear to ask their sexual partner to use a condom were commonly cited reasons. Alcohol consumption was associated with failure to act on one’s self-efficacy (RR = 0.74, p-value = 0.048). Conclusions: Programs should target self-efficacy beliefs and attempt to enhance them into agency by increasing positive and decreasing negative expectations associated with risky sexual behavior.

Novel gonorrhea strain in the United States of America leading to increase of sexually transmitted diseases load: is it an outcome of inexorable process of developing antibiotic resistance?

Novel gonorrhea strain in the United States of America leading to increase of sexually transmitted diseases load: is it an outcome of inexorable process of developing antibiotic resistance?

My Body, Your Body, Our Bodies.

This poem was written by a high school student in the 9th grade and read aloud at an abortion speak out after the U.S. Supreme Court decision to overrule Roe v. Wade. The poem showcases the ways one young person has experienced the intersection of mental health, reproductive and sexual rights, and sense of wellbeing. To view the original version of this poem, see the supplemental material section of this article online.

Prevalence and Correlates of HIV Disclosure Without Consent Among Women Living With HIV in Metro Vancouver, Canada.

This study identified the prevalence and perpetrators of HIV disclosure without consent, and social-structural correlates, among women living with HIV (WLWH). Data were drawn from 7 years (September 14 to August 21) of a longitudinal community-based open cohort of cis and trans WLWH living and/or accessing care in Metro Vancouver, Canada. The study sample included 1871 observations among 299 participants. Overall, 160 (53.3%) women reported lifetime HIV disclosure without consent at baseline, and 115 (38.5%) reported HIV disclosure without consent in the previous 6 months during 7 years of follow-up. In a subanalysis (n = 98), the most common perpetrators of HIV disclosure without consent were friends, people in the community, family, health professionals, and neighbors. In multivariable logistic regression analysis with generalized estimating equations, recent (last 6 months) housing insecurity [adjusted odds ratio (AOR): 1.43, 95% confidence interval: (1.10-1.86)], minoritized sexual identities (LGBQ2S) [AOR: 1.84 (1.22-2.78)], recently being treated, monitored, or diagnosed with depression, anxiety, or post-traumatic stress disorder [AOR: 1.37 (0.98-1.92)], and experiencing physical symptoms related to HIV [AOR: 1.75 (1.25-2.44)] was positively associated with recent disclosure without consent. In a context where HIV nondisclosure before sex is criminalized unless viral load is low and a condom is used, it is concerning that a large proportion of women have experienced HIV disclosure without consent. Laws should focus on protecting rights of WLWH, promoting equity, guaranteeing sexual and reproductive rights, and ensuring access to essential services and privacy. Findings highlight the need for trauma-informed approaches among health and housing services that are responsive to intersections of violence and stigma, and include a focus on confidentiality, autonomy, and safe disclosure practices.

Ma Vie en (Etats) Rouges (‘My life in red [states]’)

The cancellation of a student-sponsored drag show by the president of a public university in Texas was one of a number of recent moves by officials in so-called ‘red states’ in the United States targeting sexual and gender diversity and reproductive rights. Those actions are part of broader assaults on diversity, equity and inclusion efforts at state-supported institutions that may be seen as attempts at reinforcing traditional social power structures. Moreover, they seek to push into hiding legitimate and constitutionally protected cultural practices that are imbedded in the heritage of the LGBTQ+ communities. They stand in sharp contrast to the work of this journal, which celebrates difference and inclusiveness, and which has devoted significant space to such subjects as post-human drag, trans* invisibility, and gender fluidity and disruption. That important work continues in the pages of this issue.

Main barriers to services linked to voluntary pregnancy termination on three grounds in Chile.

After decades of absolute criminalization, on September 14, 2017, Chile decriminalized voluntary termination of pregnancy (VTP) when there is a life risk to the pregnant woman, lethal incompatibility of the embryo or fetus of genetic or chromosomal nature, and pregnancy due to rape. The implementation of the law reveals multiple barriers hindering access to the services provided by the law. To identify and analyze, using the Tanahashi Model, the main barriers to the implementation of law 21,030 in public health institutions. This article contributes to the follow-up of this public policy, making visible the obstacles that violate women's rights of women to have dignified access to abortion and that affect the quality of health care in Chile. Qualitative design, following the postpositivist paradigm. The sample consisted of relevant actors directly related to pregnancy termination. Snowball sampling and semi-structured interviews were used. Grounded theory was used through inductive coding, originating categories regrouped into meta-categories following Tanahashi's model. The rigor criteria of transferability, dependability, credibility, authenticity, and epistemological theoretical adequacy were used. The identity of the participants and the confidentiality of the information were protected. From January 2021 to October 2022, 62 interviews were conducted with 20 members of the psychosocial support team; 18 managers; 17 members of the biomedical health team; 4 participants from of civil society, and three women users. The main obstacles correspond to availability barriers, accessibility barriers, acceptability barriers, contact barriers, and effectiveness barriers. Barriers to access abortion under three grounds violate the exercise of women's sexual and reproductive rights. It is urgent to carry out actions of control and follow-up of this public policy to the corresponding entities.

Challenges and opportunities from using abortion harm reduction and value clarification and attitude transformation engagements for safe abortion advocacy in Uganda

BackgroundFrom 2018, the International Federation of Gynecologists and Obstetricians (FIGO) implemented the Advocating Safe Abortion project to support national obstetrics and gynecology (Obs/gyn) societies from ten member countries to become leaders of Sexual and Reproductive Health and Rights (SRHR). We share experiences and lessons learnt about using value clarification and attitude transformation (VCAT) and abortion harm reduction (AHR) as strategies for our advocacy engagements.MethodsThe advocacy goal of ending abortion-related deaths followed predefined pathways from an extensive needs assessment prior to the project. These pathways were strengthening capacity of the Obs/gyn society as safe abortion advocates; establishing a vibrant network of partners; transforming social and gender norms; raising awareness of the legal and policy environment regarding abortion, and promoting the generation and use abortion data for evidence-informed policy and practice. Our advocacy targeted multiple stakeholders including media, policy makers judicio-legal, political and religious leaders, health workers and the public.ResultsDuring each engagement, facilitators required audiences to identify what roles they can play along the continuum of strategies that can reduce maternal death from abortion complications. The audiences acknowledged abortion complications as a major problem in Uganda. Among the root causes for the abortion context, audiences noted absence of an enabling environment for abortion care, which was characterized by low awareness about the abortion laws and policy, restricted abortion laws, cultural and religious beliefs, poor quality of abortion care services and abortion stigma.ConclusionVCAT and AHR were critical in enabling us to develop appropriate messages for different stakeholders. Audiences were able to recognize the abortion context, distinguish between assumptions, myths and realities surrounding unwanted pregnancy and abortion; recognize imperative to address conflict between personal and professional values, and identify different roles and values which inform empathetic attitudes and behaviors that mitigate abortion harms. The five pathways of the theory of change reinforced each other. Using the AHR model, we delineate strategies and activities which stakeholders could use to end abortion deaths. VCAT enables critical reflection of views, beliefs and values versus professional obligations and responsibilities, and promotes active attitude and behavior change and commitment to end abortion-related deaths.