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Reproductive Health Matters

Alba Ruibal
The implementation of the 2012 Argentinean Supreme Court landmark ruling, which declared abortion legal in all cases of rape and established standards of implementation of lawful abortions at all levels of government, shows an uneven pattern of compliance by subnational governments throughout the country. Based on a case-study of the implementation of the Court's decision in the province of Salta, this article advances an explanation of mechanisms that can affect the definition and enforcement of abortion rights at the local level, in a federation...
November 14, 2018: Reproductive Health Matters
Alison Swartz, Christopher Colvin, Abigail Harrison
In South Africa, early fertility and teenage pregnancy have become a central focus of both political and public health concern. In this article, we explore the ways that young men and women have used their fertility and performance of parenthood to navigate the transition from childhood to adulthood. For these young people, the persistent inequities related to income poverty, inadequate education, lack of employment opportunities and a high burden of disease remain significant barriers to achieving this transition...
November 9, 2018: Reproductive Health Matters
Parisa Patel, Mahua Das, Utpal Das
The caste system is a complex social stratification system which has been abolished, but remains deeply ingrained in India. Scheduled Caste (SC) women are one of the historically deprived groups, as reflected in poor maternal health outcomes and low utilisation of maternal healthcare services. Key government schemes introduced in 2005 mean healthcare-associated costs should now be far less of a deterrent. This paper examines the factors contributing to this low use of maternal health services by investigating the perceptions, health-seeking behaviours and access of SC women to maternal healthcare services in Bihar, India...
November 7, 2018: Reproductive Health Matters
Resham Bahadur Khatri, Rajendra Karkee
Nepal has one of the highest maternal and neonatal mortality rates among low- and middle-income countries. Nepal's health system focuses on life-saving interventions provided during the antenatal to postpartum period. However, the inequality in the uptake of maternity services is of major concern. This study aimed to synthesise evidence from the literature regarding the social determinants of health on the use of maternity services in Nepal. We conducted a structured narrative review of studies published from 1994 to 2016...
November 7, 2018: Reproductive Health Matters
Hanneke Pot, Bregje C de Kok, Gertrude Finyiza
Despite the strong global focus on improving maternal health during past decades, there is still a long way to go to ensure equitable access to services and quality of care for women and girls around the world. To understand widely acknowledged inequities and policy-to-practice gaps in maternal health, we must critically analyse the workings of power in policy and health systems. This paper analyses power dynamics at play in the implementation of maternal health policies in rural Malawi, a country with one of the world's highest burdens of maternal mortality...
November 2, 2018: Reproductive Health Matters
Alimata Thelma Flora Abdul Karimu
The sexual and reproductive health (SRH) needs of persons with disabilities have received minimal attention from the Government of Ghana in the past. This was partly reinforced through reproductive health (RH) policies that did not well recognise disability inclusion and the inaccessibility of services for persons with disabilities. In acknowledgement of national and international RH policies, frameworks and legal instruments highlighting disability inclusion, the 2016 adolescent health policy document recognised the need to give attention to the SRH of adolescents and persons with disabilities...
October 26, 2018: Reproductive Health Matters
Stephen Bell, Elissa Kennedy, Kirsten Black, Andrew Vallely, Lisa Vallely, Glen Mola, John Kaldor, Mary Bagita, Caroline Ninnes, William Pomat, Angela Kelly-Hanku
Despite persistent international attention, adolescent pregnancy remains a major public health concern in low- and middle-income countries, like Papua New Guinea (PNG), where health inequities related to social and cultural norms, gender power imbalance, education and socio-economic deprivation affect young and unmarried women in particular. In PNG - where there is high adolescent fertility, high early childbearing and high maternal mortality ratio, and evidence of high rates of unintended pregnancy and abortion among young women - adolescent pregnancy is a policy priority...
September 27, 2018: Reproductive Health Matters
Joanna N Erdman, Kinga Jelinska, Susan Yanow
This commentary explores how self-managed abortion (SMA) has transformed understandings of and discourses on safe abortion and associated health inequities through an intersection of harm reduction, human rights and collective activism. The article examines three primary understandings of the relationship between SMA and safe abortion: first SMA as health inequity, second SMA as harm reduction, and third SMA as social change, including health system innovation and reform. A more dynamic understanding of the relationship between SMA, safe abortion and health inequities can both improve the design of interventions in the field, and more radically reset reform goals for health systems and other state institutions towards the full realisation of sexual and reproductive health and human rights...
September 19, 2018: Reproductive Health Matters
Timothy Abuya, Pooja Sripad, Julie Ritter, Charity Ndwiga, Charlotte E Warren
Measuring mistreatment and quality of care during childbirth is important in promoting respectful maternity care. We describe these dimensions throughout the birthing process from admission, delivery and immediate postpartum care. We observed 677 client-provider interactions and conducted 13 facility assessments in Kenya. We used descriptive statistics and logistic regression model to illustrate how mistreatment and clinical process of care vary through the birthing process. During admission, the prevalence of verbal abuse was 18%, lack of informed consent 59%, and lack of privacy 67%...
September 13, 2018: Reproductive Health Matters
Lynn P Freedman, Stephanie A Kujawski, Selemani Mbuyita, August Kuwawenaruwa, Margaret E Kruk, Kate Ramsey, Godfrey Mbaruku
Human rights has been a vital tool in the global movement to reduce maternal mortality and to expose the disrespect and abuse that women experience during childbirth in facilities around the world. Yet to truly transform the relationship between women and providers, human rights-based approaches (HRBAs) will need to go beyond articulation, dissemination and even legal enforcement of formal norms of respectful maternity care. HRBAs must also develop a deeper, more nuanced understanding of how power operates in health systems under particular social, cultural and political conditions, if they are to effectively challenge settled patterns of behaviour and health systems structures that marginalise and abuse...
September 10, 2018: Reproductive Health Matters
Gita Sen, Bhavya Reddy, Aditi Iyer
Concerns about disrespect and abuse (D&A) experienced by women during institutional birth have become critical to the discourse on maternal health. The rapid growth of the field from diverse points of origin has given rise to multiple and, at times, confusing interpretations of D&A, pointing to the need for greater clarity in the concepts themselves. Furthermore, attention to measurement of the problem has been excessive when viewed in relation to the small amount of work on critical drivers of disrespect and abuse...
September 7, 2018: Reproductive Health Matters
Ernest T Maya, Kwame Adu-Bonsaffoh, Phyllis Dako-Gyeke, Caroline Badzi, Joshua P Vogel, Meghan A Bohren, Richard Adanu
Mistreatment of women during childbirth at health facilities violates their human rights and autonomy and may be associated with preventable maternal and newborn mortality and morbidity. In this paper, we explore women's perspectives on mistreatment during facility-based childbirth as part of a bigger World Health Organization (WHO) multi-country study for developing consensus definitions, and validating indicators and tools for measuring the burden of the phenomenon. Focus group discussions (FGDs) and in-depth interviews (IDIs) were used to explore experiences of mistreatment from women who have ever given birth in a health facility in Koforidua and Nsawam, Ghana...
August 28, 2018: Reproductive Health Matters
Beatrice Odallo, Evelyne Opondo, Martin Onyango
Access to comprehensive reproductive health care for women and girls, including access to quality maternal health services remains a challenge in Kenya. A recent government enquiry assessing close to 500 maternal deaths that occurred in 2014 revealed gaps in the quality of maternal care, concluding that more than 90% of the women who had died had received "suboptimal" maternal care. In Kenya, the Center for Reproductive Rights (the Center) has undertaken public interest litigation among other strategies to challenge human rights violations and systematic failures within the health sector...
August 28, 2018: Reproductive Health Matters
Ann M Moore, Mardieh Dennis, Ragnar Anderson, Akinrinola Bankole, Anna Abelson, Giulia Greco, Bellington Vwalika
Although abortion is legal in Zambia under a variety of broad conditions, unsafe abortion remains common. The purpose of this project was to compare the financial costs for women when they have an induced abortion at a facility, with costs for an induced abortion outside a facility, followed by care for abortion-related complications. We gathered household wealth data at one point in time (T1) and longitudinal qualitative data at two points in time (T1 and T2, three-four months later), in Lusaka and Kafue districts, between 2014 and 2015...
December 2018: Reproductive Health Matters
Jenny O'Donnell, Alisa Goldberg, Ellice Lieberman, Theresa Betancourt
How rurality relates to women's abortion decision-making in the United States remains largely unexplored in existing literature. The present study relies on qualitative methods to analyze rural women's experiences related to pregnancy decision-making and pathways to abortion services in Central Appalachia. This analysis examines narratives from 31 participants who disclosed experiencing an unwanted pregnancy, including those who continued and terminated a pregnancy. Results suggest that women living in rural communities deal with unwanted pregnancy in three phases: (1) the simultaneous assessment of the acceptability of continuing the pregnancy and the acceptability of terminating the pregnancy, (2) deciding whether to seek services, and (3) navigating a pathway to service...
December 2018: Reproductive Health Matters
Ben Kasstan
This commentary discusses Ireland's 25 May 2018 Referendum result to repeal the Eighth Amendment and has two key aims. Firstly, it encourages policy-makers to grasp the full potential of legislative reform by enabling and protecting women's access to abortion care within a continuum of sexual and reproductive healthcare options. Secondly, it calls for urgent clarity about access to abortion care in the interim period of legislative transition.
December 2018: Reproductive Health Matters
Omar Galárraga, Jane Harries, Brendan Maughan-Brown, Diane Cooper, Susan E Short, Mark N Lurie, Abigail Harrison
The objective of this study is to measure the preliminary efficacy of a pilot intervention, grounded in behavioural economics, increasing adherence of dual protection (simultaneous use of effective modern contraception and a barrier method, such as a condom) to protect against HIV, other sexually transmitted infections, and unintended pregnancy. Between 2015 and 2016, 100 women aged 18-40 years, seeking post-abortion care in Cape Town, South Africa were recruited to Empower Nudge, a randomised controlled trial to test a lottery incentive intervention designed to increase dual protection...
December 2018: Reproductive Health Matters
Sofia Gruskin, Avery Everhart, Diana Feliz Olivia, Stefan Baral, Sari L Reisner, Eszter Kismödi, David Cruz, Cary Klemmer, Michael R Reich, Laura Ferguson
This roundtable discussion is the result of a research symposium entitled In Transition: Gender [Identity], Law & Global Health where participants took up the challenge to engage with the question: What will it take to ensure the sexual and reproductive health and rights (SRHR) of transgender populations across the globe? The barriers to overcome are fierce, and include not only lack of access to health services and insurance but also stigma and discrimination, harassment, violence, and violations of rights at every turn...
December 2018: Reproductive Health Matters
Deeqa Mohamed, Nadia Diamond-Smith, Jesse Njunguru
Although abortion is now legal in Kenya under expanded circumstances, access is limited and many providers and individuals still believe it is illegal. This study aimed to characterise Kenyan women's perceptions and experiences with abortion and post-abortion care (PAC) services in Nairobi regarding barriers to care, beliefs about abortion, and perceived stigma. We conducted 15 semi-structured in-depth interviews with Kenyan women aged 18-24 years who recently received abortion and PAC services at four Marie Stopes Kenya clinic sites in Nairobi...
December 2018: Reproductive Health Matters
Sarah Raifman, Selma Hajri, Caitlin Gerdts, Diana Foster
Despite Tunisia's historically progressive reproductive health policies, Tunisian women now face significant challenges accessing legal abortion. Through in-depth interviews with providers at six facilities, we explored factors influencing provider attitudes about abortion and provider perspectives about abortion morality, safety, and legality. We found that gatekeepers (counsellors and front office staff) generally believed abortion was immoral, while obstetricians and gynecologists were more likely to support an individual's right to access abortion...
December 2018: Reproductive Health Matters
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