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Adolescent reproductive health. An approach to planning health service research. Introduction.
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Adolescent reproductive health. An approach to planning health service research. Overview.
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Adolescent reproductive health. An approach to planning health service research. Introduction.
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Developments in judicial approaches to sexual and reproductive health.
This article reviews the jurisprudence on reproductive and sexual health of national and international tribunals. This review reveals a shift from controlling reproduction and sexuality through the use of criminal law to impose a moral order, to the use of administrative law to ensure availability of safe and effective services, and, finally, to the use of human rights to promote respect for human dignity. The conventional use of criminal law to prohibit provision of reproductive and sexual health services, underage sex, and relations between same-sex partners is waning. Due in part to research showing how criminal law harms reproductive health, an emerging judicial trend is toward the more pragmatic use of law to reduce the harm to health associated with sexuality and reproduction. Most recently, courts are recognizing that respect for individuals' needs to protect their reproductive and sexual health is a matter of social justice.
[Reproductive behavior and health: reflections on the supply of services].
The aim of this article is to put forward a series of reflections on the role that service providers have played in defining the interactions between reproductive behavior and health. In the first section some approximations are presented of what could constitute a framework for analyzing the topic under study, including demographic aspects and the ones involving the provision of services as well as the aspects related to the epistemology of health and a commentary on the importance of norms in the provision of services. In the second section a couple of recent experiences related to the provision of services in a context of "having an impact on reproduction for the purpose of improving health" discussed. The source of information used were two national surveys (Encuesta Nacional sobre Factores de Riesgo en la Anticoncepción Hormonal, or National Survey on Risk Factors in Hormonal Contraception, and Encuesta Nacional sobre Fecundidad y Salud, or National Fertility and Health Survey) made in 1984 and 1987 with women of childbearing age and health service providers (the first of the two surveys mentioned). Based on the experience stated by the female users of the contraceptive methods most frequently used by Mexicans, and on the responses of service providers, an evaluation is made of the medical norms of the institutions belonging to the Mexican health sector, and some hypotheses are suggested on the possible reasons why there are deficiencies in the observance of these norms. Lastly, some lines to prompt a discussion along this subject are proposed.
Special needs call for specialized services: a response to no need to specialize: reproductive health is for all adolescents.
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Women's access to health care: the legal framework.
The Millennium Development Goals set ambitious targets for women's health, including reductions in maternal and child mortality and combating the spread of HIV/AIDS. The law, which historically has often obstructed women's access to the health care they require, has a dynamic potential to ensure women's access that is being progressively realized. This paper identifies three legal principles that are key to advancing women's reproductive and sexual health. First, law should require that care be evidence-based, reflecting medical and social science rather than, for instance, religious ideology or morality. Second, legal guidance should be clear and transparent, so that service providers and patients know their responsibilities and entitlements without litigation to resolve uncertainties. Third, law should provide applicable measures to ensure fairness in women's access to services, both general services and those only women require. Legal developments are addressed that illustrate how law can advance women's equality, and social justice.
The implementation of reproductive health programs: experiences, achievements and challenges.
As a fundamental element of population strategies for international development, reproductive health has received much recognition since the International Conference on Population and Development held in Cairo in 1994. Nevertheless, much remains to be done to improve the understanding of the concept of reproductive health, support reproductive rights, operationalize reproductive healthcare within basic health services and promote a more conducive social, cultural and economic environment, especially for women and girls, to enable the attainment of reproductive health. Collaboration between governments and non-governmental organizations will be crucial and obstetrician-gynecologists have a unique role, through service provision, review of regulatory frameworks, education and advocacy, for the promotion of reproductive health.
The sexuality connection in reproductive health.
Sexuality and power relations based on gender are relevant to researchers, policymakers, and service providers in the reproductive health field, because they underlie virtually all of the behaviors and conditions that their programs address. Yet, a review of conventional treatments in the demographic and family planning literature reveals that, when they consider these topics at all, researchers typically adopt narrow definitions of sexual behavior and focus almost exclusively on risks of pregnancy and disease. This article proposes an analytic framework as a guide to researchers and family planning providers. It relates four dimensions of sexuality to reproductive health outcomes and concludes that family planning policies and programs should address a broader spectrum of sexual behaviors and meanings, consider questions of sexual enjoyment as well as risk, and confront ideologies of male entitlement that threaten women's sexual and reproductive rights and health.
[Sexual behaviors and incidence of sexual and reproductive health programs among poor secondary students and public university students in Cali, Colombia].
In order to qualitatively evaluate sexual behaviors or practices and the incidence of sexual and reproductive health programs in adolescent and postadolescent users educated in Cali, Colombia, two quota samples were carried out, one in schools in poor neighborhoods of the city and one at Valle University (UNIVALLE). In addition, a limited number of twelve open interviews was made among two different student population groups, the schools and the university. The study addresses the sexual behaviors of adolescents and postadolescents, contraceptive methods and prevention of STDs and HIV/AIDS, and the uses of sexual and reproductive health programs by both populations, controlling for social class (socioeconomic stratum), gender, and race. Two sexual and reproductive health programs were taken as reference: that of PROFAMILIA (Pro-Wellbeing of the Colombian Family Association), and the sexual and reproductive health program of the University Medical Service of the UNIVALLE. Results show how the behaviors and responses to sexual and reproductive health programs are mediated by multiple sociological categories that orient the analysis.
Reproductive health knowledge, beliefs and determinants of contraceptives use among women attending family planning clinics in Ibadan, Nigeria.
BACKGROUND: In developing countries especially in Africa, reproductive ill health have been a great concern to many stakeholders as maternal mortality and morbidity are very high compared to developed world. Also reproductive health knowledge and access to quality of care maternal health services in Africa are poor with significant health consequences. Appropriate reproductive health knowledge, belief and will power of women to access quality family planning services (preventive and curative) are essential for improvement in reproductive health of women. OBJECTIVE: The study aimed to assess reproductive health knowledge, beliefs and influential factors of contraceptives use among women attending family planning clinics in Ibadan, Nigeria. METHOD: The study was cross-sectional in nature involving 550 randomly selected respondents among women attending family planning clinics in Ibadan, Nigeria. The study instrument was a self-administered questionnaire. Data was analyzed using SPSS package. RESULTS: Only 56.0% of the respondents knew when pregnancy can occur, 31.5% believed that having sex once with a man will not result in pregnancy. Almost in all items, over 90.0% of respondents had knowledge of benefits of family planning. Consideration about personal health (86.0%) and husband's approval (74.9%) were major determinants of respondents use of contraceptives. CONCLUSION: Though respondents were knowledgeable about benefits of family planning, there is the need for continuous education of women about reproductive health issues and integration of men's participation in family planning programme to increase utilization of family planning services in Ibadan, Nigeria.
The birth of reproductive health: a difficult delivery.
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Exploring women's needs in an Amazon region of Ecuador.
This study broadly explored women's perceptions of their most pressing problems and needs in the mostly rural Amazonian province of Orellana in Ecuador in mid-2000. In-depth interviews with community women and health and social service providers used two rapid structured, qualitative methods--free-listing and pile-sorting--to explore the 'insider's' perspective, with the participation of local organisations, and generated discussion on the emerging issues, giving an opportunity for action aimed at improving women's situation. Unequal gender relations, subordination of women, economic problems, men drinking too much and domestic violence were identified as the most pressing concerns. Several reproductive and sexual health problems were also identified and information about others elicited. This paper describes the methodology used in the research, reports on the 20 most cited problems and looks more closely at the findings in relation to violence against women, lack of access to contraception and ambiguities arising from the need to resort to clandestine abortion. Despite the existence of innovative national policies related to domestic violence and reproductive health, there is a scarcity of resources and poor infrastructure in Orellana. Patronising attitudes on the part of health service staff also greatly limit women's access to reproductive and sexual health services.
Risk factors for the increasing caesarean section rate in Southeast Brazil: a comparison of two birth cohorts, 1978-1979 and 1994.
BACKGROUND: Brazil has the highest caesarean section (CS) rate in the world (36.4% in 1996). METHODS: Risk factors for increasing CS rate were studied in two population-based cohorts of singleton live births in families residing in the municipality of Ribeirao Preto, State of Saõ Paulo, Southeast Brazil. The first comprised births from June 1978 to May 1979 (6750 births-one-year survey) and the second births from May to August 1994 (2846 births-4-month survey). Multiple unconditional logistic regression modelling was used to control for confounding. RESULTS: The CS rate rose from 30.3% in 1978-1979 to 50.8% in 1994. In 1978-1979, socioeconomic, reproductive and demographic variables, and health service factors were associated with CS rate. In 1994, only reproductive, demographic and health service factors remained associated, e.g. hour of delivery (from 7 a.m. to 12 p.m.), attendance by the same physician for prenatal care and delivery, > or =4 prenatal visits, maternal age > or =30 years, 1-3 previous live births and birthweight 3500-3999 g. CONCLUSION: Caesarean section in Brazil is widely performed for non-medical reasons in which physician convenience plays an important role. There is an urgent need for public health interventions to reduce the CS rate in Brazil, mainly directed towards cultural beliefs and physician behaviour.
Transforming family planning services in the Latin American and Caribbean region.
The 1994 International Conference on Population and Development held in Cairo has generated widespread commitment to changing family planning programs from categorical and medically focused service organizations to reproductive health initiatives that embrace a wide range of social and human services. This article uses qualitative data analysis to review the experience of nine family planning association projects in the Latin American and Caribbean region that have made a successful organizational transition from services focused on family planning to a gender-based and sexual health approach. A conceptual framework is proposed, including factors external to the organization. Factors that can promote a pilot intervention's becoming fully institutionalized include: the need for commitment from high-level staff and members of the board of directors, the creation of partnerships with other agencies, and an emphasis on monitoring and evaluation. Lessons from this experience and their potential relevance to other settings are reviewed and discussed.
Interest holder-driven research priorities in sexual and reproductive health for migrant and refugee adolescents and young adults in Australia.
OBJECTIVE: To identify and prioritise sexual and reproductive health research priorities for migrant and refugee adolescents and young adults in Australia using a priority setting partnership approach. METHODS: A James Lind Alliance priority setting partnership was conducted with 92 interest holders: 31 youth from migrant and refugee backgrounds and 61 professionals (healthcare providers, researchers, policymakers and community leaders), recruited online and in-person. The priority setting partnership process included a rapid evidence scan, an online uncertainty survey, evidence verification, interim prioritisation and a final consensus workshop. RESULTS: Eighty-three research uncertainties yielded 11 final priorities across four sexual and reproductive health domains: sexual and reproductive health literacy, sexual violence prevention, accessible services and maternal health. A striking divergence emerged between youth and professional priorities only 3 achieved combined high-priority consensus. Youth prioritised a broader range of topics, including abortion access (rated high by youth but low by professionals), while professionals prioritised fewer areas. Two priorities achieved consensus: community-based maternal health support and barriers to reporting gender-based violence. CONCLUSION: This is the first priority setting partnership to identify sexual and reproductive health research priorities for migrant and refugee youth in Australia and to uniquely highlight substantial misalignment between youth and professional priorities. IMPLICATIONS FOR PUBLIC HEALTH: These identified priorities provide a foundation for targeted research, culturally responsive policy and more equitable sexual and reproductive health service provision for migrant and refugee adolescents and young adults.
Reproductive health care for adolescents.
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