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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
Sreeparna Chattopadhyay
Institutional births in India, including the north eastern state of Assam, have increased steeply in the last decade such that 71% of all births now occur in facilities. Most analyses of disrespect and abuse during childbirth have largely framed the problem within a binary that juxtaposes all users of services in one category, subordinate to institutions and institutional actors. This commentary explores whether a different analysis is possible within a relational context where citizenship itself is graded, and not all marginal groups experience either the same form or the same intensity of mistreatment...
August 22, 2018: Reproductive Health Matters
Andrea Solnes Miltenburg, Sandra van Pelt, Tarek Meguid, Johanne Sundby
Disrespect and abuse of patients, especially birthing women, does occur in the health sector. This is a violation of women's fundamental human rights and can be viewed as a consequence of women's lives not being valued by larger social, economic and political structures. Here we demonstrate how such disrespect and abuse is enacted at an interpersonal level across the continuum of care in Tanzania. We describe how and why women's exposure to disrespect and abuse should be seen as a symptom of structural violence...
August 22, 2018: Reproductive Health Matters
Carmen Simone Grilo Diniz, Daphne Rattner, Ana Flávia Pires Lucas d'Oliveira, Janaína Marques de Aguiar, Denise Yoshie Niy
Brazil is a middle-income country with universal maternity care, mostly by doctors. The experience of normal birth often includes rigid routines, aggressive interventions, and abusive, disrespectful treatment. In Brazil, this has been referred to as dehumanised care and, more recently, as obstetric violence. Since the early 1990s, social movements (SM) have struggled to change practices, public policies and provider training. The aim of this paper is to describe and analyse the role of SM in promoting change in maternity care, and in provider training...
August 14, 2018: Reproductive Health Matters
Neha Madhiwalla, Rakhi Ghoshal, Padmaja Mavani, Nobhojit Roy
This paper draws on findings from a qualitative study of two government hospitals in Mumbai, India, which aimed to provide a better understanding of the institutional drivers of disrespect and abuse (D&A) in childbirth. The paper describes the structural context, in which government hospital providers can exercise considerable power over patients, yet may be themselves vulnerable to violence and external influence. Decisions that affect care are made by a bureaucracy, which does not perceive problems with the same intensity as providers who are directly attending to patients...
August 13, 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, Julia Hussein
No abstract text is available yet for this article.
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
Julia Hussein
No abstract text is available yet for this article.
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
Julie Hennegan, Alexandra K Shannon, Kellogg J Schwab
Inadequate menstrual hygiene presents a barrier to women's dignity and health. Recent attention to this marginalised challenge has resulted in the first national assessments of menstrual practices. Intuitively, surveys require women to have had a recent menses to be eligible. This study seeks to determine if there are demographic differences between women who are eligible and ineligible to answer questions about their menstrual hygiene during these assessments. Secondary analyses were undertaken on nationally or state representative data collected by the Performance Monitoring and Accountability 2020 survey programme across eight countries (Burkina Faso, Ethiopia, Ghana, India, Kenya, Niger, Nigeria, and Uganda)...
December 2018: Reproductive Health Matters
Shireen J Jejeebhoy, K G Santhya
While there are a growing number of interventions and evaluations of programmes aimed at changing gender norms and violence against women and girls, there remains a dearth of documentation outlining the challenges faced in conducting these interventions and evaluations, particularly in traditional and low literacy settings. The Do Kadam Barabari Ki Ore (Two Steps Towards Equality) programme sought to understand what works to prevent violence against women and girls in Bihar, India. This paper draws insights from process evaluation data...
December 2018: Reproductive Health Matters
Laura Ferguson, Sapna Desai
No abstract text is available yet for this article.
December 2018: Reproductive Health Matters
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