The concept of reproductive health promises to play a crucial role in improving health care provision and legal protection for women around the world. This is an authoritative and much-needed introduction to and defence of the concept of reproductive health, which though internationally endorsed, is still contested. The authors are leading authorities on reproductive medicine, women's health, human rights, medical law, and bioethics. They integrate their disciplines to provide an accessible but comprehensive picture. (...) They analyse 15 cases from different countries and cultures, and explore options for resolution. The aim is to equip readers to fashion solutions in their own health care circumstances, compatibly with ethical, legal and human rights principles. (shrink)

Violations of women’s sexual and reproductive health and rights are frequent all over the world. Women’s sexual and reproductive health is related to multiple human rights. The term ‘rights-based’ has become increasingly linked to the concept of a more comprehensive approach to sexual and reproductive rights of women around the globe. The rights-based perspective is derived from the treaties, pacts and other international commitments that recognize and reinforce human rights, including the sexual and reproductive (...) rights of women. We conducted an extensive review of the guidelines, frameworks, research reports and published articles that have been cited as informing the rights-based approach. The findings of the review highlights what is meant by sexual and reproductive health and rights by the stakeholders, why this matter is important, and what can be done. It demands more partnerships with human rights, women’s and other civil society organizations, increased number of successful national policies, initiatives and/or legislative changes, increased budget and other resources at national and/or local community level, mass communication and engagement of men to promote and advance women’s sexual and reproductive health and rights. Achievement of gender equality is very crucial, because it is a human right that advances women’s empowerment; and is interlinked with sexual and reproductive health and rights. (shrink)

Conscience in Reproductive Health Care responds to the growing worldwide trend of health care professionals conscientiously refusing to provide abortions and similar reproductive health services in countries where these services are legal and professionally accepted. Carolyn McLeod argues that conscientious objectors in health care should prioritize the interests of patients in receiving care over their own interest in acting on their conscience. She defends this "prioritizing approach" to conscientious objection over the more popular "compromise (...) approach" without downplaying the importance of health care professionals having a conscience or the moral complexity of their conscientious refusals. McLeod's central argument is that health care professionals who are gatekeepers of services such as abortions are fiduciaries for their patients and for the public they are licensed to serve. As such, they owe a duty of loyalty to these beneficiaries and should give primacy to their beneficiaries' interests in accessing care. This conclusion is informed by what McLeod believes is morally at stake for the main parties to the conflicts generated by conscientious refusals: the objector and the patient. What is at stake, according to McLeod, depends on the relevant socio-political context, but typically includes the objector's integrity and the patient's interest in avoiding harm. (shrink)

In this article I focus on two issues concerning bioethics in Argentina: reproductive health and ethics in research. Although these topics are quite dissimilar, they share a particular feature: their special relationship with context.

This article examines the barriers to quality health care for transgender, nonbinary, and gender-expansive people (TGE) who become pregnant and give birth, identifying three central themes that emerge from the literature. These insights suggest that significant reform will be necessary to ensure access to safe, appropriate, gender-affirming care for childbearing TGE people. After illustrating the need for systemic changes that untether rigid gender norms from the provision of perinatal care, the article proposes that the Midwives Model of Care offers (...) a set of values and clinical practices that are well-suited to meet the needs of many TGE patients during pregnancy and childbirth and which should be incorporated into the healthcare system more broadly. (shrink)

As the largest labour flow in human history, the recent rise in migration in China has opened up unprecedented opportunities for millions of Chinese to rearrange their lives. At the same time, this process has also posed great challenges to Chinese migrants, especially female migrants, who not only face a bias against ‘outsiders’ but also have a greater need for reproductive health-related services in their migratory destinations. Based on data collected via multiple sources in Shanghai, China’s largest metropolis, (...) this study profiles the changing characteristics of female migrants, presents data on self-reported symptoms of reproductive health-related problems and knowledge on reproductive health issues, compares maternal and child health measures between migrants and local residents, and examines factors related to reproductive health knowledge and migrants’ access to health care in urban china. Results of this study show a relatively low level of self-reported reproductive health problems among female migrants, coupled with a relatively high level of ignorance in knowledge related to STD. both self-reported health status and knowledge of reproductive health are related to migrants’ educational attainment and length of stay in the urban destination. This study also finds ample evidence that female migrants’ access to urban health care is limited by a number of institutional barriers. (shrink)

This study aims at assessing the level of knowledge, attitudes, and practices (KAP) concerning reproductive health (RH) among adolescent college-going girls in the urban and rural areas of Chittagong District, Bangladesh. A college-based cross-sectional study was conducted among college-going girls (N = 792) of four colleges attending Higher Secondary Certificate (HSC) classes (eleven/twelve classes) in Chittagong District. Data were collected using a structured and self-administered questionnaire. Chi-square (χ2) and independent-samples t-test were conducted to make the comparison between urban (...) and rural participants. Data were analyzed using IBM SPSS version 24.0. The authors’ interpretation of the findings was also informed by anthropological as well as qualitative considerations. Mothers were reported to be the key informants of reproductive health for the adolescent girls of both urban and rural areas. Besides, urban respondents were more likely than rural respondents (p <.001) to feel comfortable during the discussion on RH with mother/sister/relative; to communicate frequently with their mothers; to discuss RH issues regularly; to have prior knowledge on menstruation. Moreover, this study also found significant differences (p <.05) regarding most of the items addressing RH knowledge, attitude, and practice between adolescent girls in urban and rural areas of Bangladesh due to the existing socio-cultural disparities between the areas of residence. (shrink)

On March 31, 2000, the Massachusetts Supreme Judicial court ruled that a contract awarding custody of frozen pre-embryos to the wife upon divorce was unenforceable because it violates public policy. This is the first reported case to address a contract between the clinic and the parties where the contract would have awarded the pre-embryos to one of the gamete providers. The decision in A.Z. v. B.Z. 431 Mass. 150 differs from decisions in the two other courts of last resort deciding (...) related cases where enforcement of contracts was supported. This case represents an important development in the legal doctrines associated with frozen pre-embryos as it explicitly differs from the other courts’ decisions in addressing pre-embryos at the same developmental stage. (shrink)

On March 31, 2000, the Massachusetts Supreme Judicial court ruled that a contract awarding custody of frozen pre-embryos to the wife upon divorce was unenforceable because it violates public policy. This is the first reported case to address a contract between the clinic and the parties where the contract would have awarded the pre-embryos to one of the gamete providers. The decision in A.Z. v. B.Z. 431 Mass. 150 differs from decisions in the two other courts of last resort deciding (...) related cases where enforcement of contracts was supported. This case represents an important development in the legal doctrines associated with frozen pre-embryos as it explicitly differs from the other courts’ decisions in addressing pre-embryos at the same developmental stage. (shrink)

ABSTRACT This study is an ethical reflection on the formulation and application of public policies regarding reproductive health in Brazil. The Integral Assistance Program for Women's Health (PAISM) can be considered advanced for a country in development. Universal access for family planning is foreseen in the Brazilian legislation, but the services do not offer contraceptive methods for the population in a regular and consistent manner. Abortion is restricted by law to two cases: risk to the woman's life (...) and rape. This reality favors the practice of unsafe abortion, which is the third largest cause of maternal death in Brazil. Legal abortion is regulated by the State and the procedure is performed in public health centers. However, there is resistance on the part of professionals to attend these women. Prenatal care is a priority strategy for promoting the quality of life of these women and of future generations. Nonetheless, it is still difficult for these women to access the prenatal care services and to have the required number of consultations. Moreover, managers and health professionals need to be made aware of the importance of implementing the actions indicated by the public policies in the area of sexual and reproductive health, favoring respect for autonomy in a context of personal freedom. (shrink)

This study is an ethical reflection on the formulation and application of public policies regarding reproductive health in Brazil. The Integral Assistance Program for Women's Health (PAISM) can be considered advanced for a country in development. Universal access for family planning is foreseen in the Brazilian legislation, but the services do not offer contraceptive methods for the population in a regular and consistent manner. Abortion is restricted by law to two cases: risk to the woman's life and (...) rape. This reality favors the practice of unsafe abortion, which is the third largest cause of maternal death in Brazil. Legal abortion is regulated by the State and the procedure is performed in public health centers. However, there is resistance on the part of professionals to attend these women. Prenatal care is a priority strategy for promoting the quality of life of these women and of future generations. Nonetheless, it is still difficult for these women to access the prenatal care services and to have the required number of consultations. Moreover, managers and health professionals need to be made aware of the importance of implementing the actions indicated by the public policies in the area of sexual and reproductive health, favoring respect for autonomy in a context of personal freedom. (shrink)

This study’s objective was to understand Colombian adolescents’ experiences and preferences regarding access to sexual and reproductive health services (SRHS), either alone or accompanied. A mixed-method approach was used, involving a survey of 812 participants aged eleven to twenty-four years old and forty-five semi-structured interviews with participants aged fourteen to twenty-three. Previous research shows that adolescents prefer privacy when accessing SRHS and often do not want their parents involved. Such findings align with the longstanding tendency to frame the (...) ethical principle of autonomy as based on independence in decision-making. However, the present study shows that such a conceptualization and application of autonomy does not adequately explain Colombian adolescent participants’ preferences regarding access to SRHS. Participants shared a variety of preferences to access SRHS, with the majority of participants attaching great importance to having their parents involved, to varying degrees. What emerges is a more complex and non-homogenous conceptualization of autonomy that is not inherently grounded in independence from parental involvement in access to care. We thus argue that when developing policies involving adolescents, policymakers and health professionals should adopt a nuanced “relational autonomy” approach to better respect the myriad of preferences that Colombian (and other) adolescents may have regarding their access to SRHS. (shrink)

McLeod's Conscience in Reproductive Health Care offers a number of valuable contributions to the literature, both within and beyond reproductive care. In this commentary, I begin by discussing two potential applications of her argument that healthcare professionals—specifically, those "who are charged with gatekeeping access to healthcare services" —have a fiduciary duty of loyalty to prioritize the interests of their patients over their own. Then, I turn to a couple of concerns one might raise about extending this fiduciary (...) duty to pharmacists who function as gatekeepers of reproductive services. Finally, I pose some questions about the ways in which McLeod conceives of the harms and wrongs of... (shrink)

The US Food and Drug Administration (FDA) is fraught with controversies over the role of values and politics in regulatory science, especially with drugs in the realm of reproductive health. Philosophers and science studies scholars have investigated the ways in which social context shapes medical knowledge through value judgments, and feminist scholars and activists have criticized sexism and injustice in reproductive medicine. Nonetheless, there has been no systematic study of values and gender norms in FDA drug regulation. (...) I focus on three questions about values in regulatory science. First, how have societal values and gender norms shaped the way that the FDA regulates drugs in the realm of reproductive health, specifically with drug labels? Second, what are the ethical, epistemic, and social consequences of these influences on regulation for women and other marginalized groups? Third, which societal values and gender norms ought to influence drug regulation about reproductive health, and how ought this happen? Integrating philosophical analysis with historical archival research and in-depth interviews, I conduct three case studies of drug labeling about reproductive health: (1) the “drug fact” about the mechanism of the morning-after pill; (2) the package inserts for patients about the health risks of oral contraceptives; and (3) the special physician labels made for prescribing drugs to pregnant women. I identify three challenges for the FDA and suggest ways to reduce the influence of sexist values and facilitate feminist alternatives. First, across these cases, I have found that there are many ways in which other concerns in reproductive medicine (such as zygotic life, fetal health, and population control) have devalued women’s health. Second, both knowledge and ignorance xvi about their reproductive health have contributed to women’s oppression, especially poor women and women of color. Finally, by avoiding the epistemic dimensions of ethics, powerful, mostly male parties in medicine (such as doctors, pharmaceutical companies, and religious institutions) have misused “informed consent,” “religious freedom,” and “paternalism” for unethical purposes. For improvement, I suggest extracting sexist values and gender norms from regulatory science that cause epistemic injustices, and I point to success stories for reforming sexism with feminism at the FDA. (shrink)

Sexual and reproductive health is a challenge worldwide, and much progress is needed to reach the relevant UN Sustainable Development Goals. This paper presents cross-sectional data collected in Sierra Leone on sexual and gender-based violence, family planning, child, early and forced marriage, and female genital mutilation using an innovative method of measurement: situational judgment tests, as a subset of questions within a larger survey tool. For the SJTs, respondents saw hypothetical scenarios on these themes and had to indicate (...) how they would react. The objective is to give an impression of beliefs and norms on specific behaviors, which provide insights for social and behavior change interventions. Data was collected by enumerators traveling to villages randomly selected in six districts of the country. The sample is composed of 566 respondents. Results show that FGM in particular seem to be a priority topic, in comparison to the other topics for which the norms seem to be stronger against those practices. Age differences emerged and suggest priority groups to be targeted. In terms of validity of the measurement methods, situational judgment test answers correlated positively with other items in the survey, but the magnitude of the association is often small, and sometimes not significant. Thus, more studies are needed to further explore the validity of this measure by comparing against a reference value. Using SJTs could complement other data collection tools to perform community assessment, and orient the direction of the program in its planning phase. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Abortion to Abolition: Reproductive Health and Justice in Canada by Martha PaynterRebecca Simmons (bio)Abortion to Abolition: Reproductive Health and Justice in Canada by Martha Paynter Winnipeg, MB: Fernwood Publishing, 2022Martha Paynter's Abortion to Abolition: Reproductive Health and Justice in Canada is a bold, ambitious work that seeks to not only catalog Canada's meandering and often backtracking path toward reproductive justice, but (...) to act as a manifesto for Paynter's own ideas and goals for reproductive justice. The book takes the form of an anthology of stories, divided into chapters, that are grouped according to a certain right; for example, the right to bodily autonomy. This format effectively guides the reader from abortion to abolition. Paynter adroitly starts the book with white feminist favorites such as bodily autonomy and not having children. Then she logically progresses to more radical ideas such as parenting in prison and the total abolition of prisons. The stories in this book are accompanied by warm, colorful illustrations by Julia Hunt. These drawings help the reader visualize the person behind the story and the very real life that was affected by reproductive law and/or social norms. Paynter holds a PhD in nursing, and it is from this background that she writes, seeking to educate nurses and other healthcare professionals alongside a broader readership garnered through her clear, approachable writing style.Chapter 1 introduces the reader to many of the book's key themes by considering the right and need to have bodily autonomy, and the multiple ways this manifests itself in ordinary (and less-ordinary) life. Paynter considers the disparate stories of five women, all fighting in some way for bodily autonomy. The stories cover events of gender-based gun violence, sexual assault, transgender rights in prison, the legalization of sex work, police violence, and institutional racism. Each story recounted by Paynter catalogs tragedies and injustices with blunt and brutal honesty—perhaps to an unnecessary extent. Every horrific fact is laid bare for the readers as they uncover the intricacies of gender-based, imperialist, and racist violence. Paynter has chosen these stories to display the multitude of ways in which people—especially Black, Indigenous, people of color (BIPOC) and minoritized genders—can be willfully wronged by the state and [End Page 209] the criminal justice system, such that the reader must begin to confront the fact that these structures don't seem to exist to benefit or protect the most marginalized in society.Chapter 2 approaches the right not to have children through a number of stories related to contraception, abortion, and family planning. Paynter sketches some of the key points in Canada's journey toward the decriminalization of abortion, from paradoxical trailblazers, such as Dr. Emily Stowe in the 1800s, to the viral memefied content of art protestor iamkarats. While the unequivocal legality of abortion in Canada suggests incredible progressiveness and support for women's rights, Paynter paints a more complex picture through her chosen narratives. Crucially, the inequitable geographical access to abortion, in particular, throughout the huge landmass of Canada suggests that the right to not have children in Canada is not universal. Moreover, Paynter suggests that access is also bounded by financial constraints, finite public funding, and the limited availability of inclusive clinics that prioritize healthcare for LGBTQ2S+ people.Chapter 3 considers the topic of having children; in particular, the right to reproductive technologies and freedom from forced sterilization. Paynter quickly makes clear that while many white feminists might see having and not having children as diametrically opposed, they are two equally essential parts of reproductive justice. Paynter draws attention to the Sexual Sterilization Act of 1928 that was only overturned in 1972. She describes it as part of the "genocidal colonial project" (84), a collection of laws and policies aimed at fulfilling eugenicist, neoimperial ideals of increasing production of the white "race" and promoting the genocide of Indigenous peoples. Furthermore, Paynter argues that evidence of forced sterilization of Indigenous peoples, and other physical violence and neglect, persists to the present day and must be stopped and reparations made for previous harms. Paynter then considers the complex, often-debated case of commercialized surrogacy, which she defines... (shrink)

Asylum-seeking and refugee women (ASRW) are population groups characterized by diverse social, economic and legal backgrounds as well as diverse needs. Their backgrounds of forced migration have a profound impact on their overall health, including their sexual and reproductive health (SRH). In Europe, the SRH needs of ASRW are usually more pressing than those of the host country population. In the context of refugee health, it is important to distinguish between asylum seekers and statutory refugees, as (...) asylum seekers have distinct needs and often limited rights in their host country. Yet both groups face many barriers in accessing national health services. This article addresses the issue of entitlements to health services for asylum-seeking women in Europe, and highlights the wide range of difficulties of both asylum-seeking and refugee women in accessing (sexual and reproductive) health services. (shrink)

Going through reproductive experiences (especially pregnancy and childbirth) in contemporary Western societies almost inevitably involves interaction with medical practitioners and various medical technologies in institutional context. This has important consequences for women as embodied subjects. A critical appraisal of these consequences—coming dominantly from feminist scholarship—relied on a problematic theory of both technology and the subject, which are in contemporary approaches no longer considered as given, coherent and well individualized wholes, but as complex constellations that are locally situated and that (...) can only be described empirically. In this study, we will be relying on the developments in phenomenological theory to reconceptualize women as technologically mediated embodied subjects and on the new paradigms in philosophy of technology and STS to reconstruct medical technology as situated—with the aim of reconceptualizing their relationship and exploring different possibilities for the mediating role of medical technology. It will be argued that technologization of female reproductive processes and alienating consequences for women are not necessary or directly interrelated. The role of technology varies from case to case and depends mainly on the nontechnological and relational aspects of institutional context, in which medical practitioners play a decisive role. (shrink)

At the 2022 Central American Philosophical Association meeting, there was an Author-Meets-Critics session on Carolyn McLeod’s book, Conscience in Reproductive Health Care: Prioritizing Patient Interests. The event was organized and chaired by Heather Stewart and sponsored by the APA Committee on the Status of Women and Kate Norlock, chair of that committee. There were four speakers, including McLeod and three “critics”: Javiera Perez Gomez, Alison Reinheld, and Jennifer Parks, who were all generous enough to provide McLeod with their (...) comments beforehand. The sessions occurred over Zoom even though some speakers were present in person at the conference. McLeod kicked things off by providing a summary of her book, which was then followed by critical comments by the critics in the order in which they’re named above. McLeod responded to their remarks and then Stewart led a Q&A session with our small but lively and intelligent audience. The content of what was said has been reproduced here. (shrink)

Carolyn McLeod's book is timely and important, especially when one considers the state of conscientious objection in a country like the United States. During his presidency, Donald Trump announced an expanded "conscience rule" for healthcare workers according to which they would have the protected right to morally and religiously oppose a variety of procedures, including abortion, sterilization, assisted suicide, and other medical procedures. In 2019, a number of states, local governments, and healthcare organizations brought lawsuits against the proposed rule, leading (...) a federal judge to reject it. New York Attorney General Letitia James said the state of New York sued in part because the... (shrink)

There is increasing interest in the need to address the ethical dilemmas related to the engagement of adolescents in sexual and reproductive health research. Research projects, including those that address issues related to STIs and HIV, adverse pregnancy outcomes, violence, and mental health, must be designed and implemented to address the needs of adolescents. Decisions on when an individual has adequate capacity to give consent for research most commonly use age as a surrogate rather than directly assessing (...) capacity to understand the issues and make an informed decision on whether to participate in research or not. There is a perception that adolescents participating in research are more likely to be coerced and may therefore not fully comprehend the risk they may be taking when engaging in research. This paper examines the various ethical issues that may impact stakeholders' decision making when considering engaging adolescents in SRH research in Nigeria. It makes a case for lowering the age of consent for adolescents. While some experts believe it is possible to extrapolate relevant information from adult research, studies on ethical aspects of adolescents' participation in research are still needed, especially in the field of sexual and reproductive health where there are often differences in knowledge, attitudes and practices compared to adults. The particular challenges of applying the fundamental principles of research ethics to adolescent research, especially research about sex and sexuality, will only become clear if more studies are conducted. (shrink)

Hastings Center Report, Volume 52, Issue S1, Page S18-S21, March‐April 2022.

A peer commentary on an AJOB article by Kyle Fritz called "Unjustified Asymmetry: Positive Claims of Conscience and Heartbeat Bills.".

Liminal Bodies, Reproductive Health, and Feminist Rhetoric presents composition professor Lydia McDermott's "sonogram" methodology of rhetorical listening, an exercise that discloses feminine voices muted or unjustly disciplined within texts ostensibly written on women's behalf. The texts examined by McDermott range from eighteenth-century pregnancy manuals to speeches by Favorinus, the ancient sophist, who is described from antiquity as a hermaphrodite. Part of McDermott's purpose in sonogramming is to critique modern and contemporary feminists. She objects to the feminist trend of (...) perpetuating and answering a "disability" rhetoric about women, or of demonstrating that women can overcome a... (shrink)

There are conceptual and ethical challenges to defining adolescents’ autonomy to access health care, and these can lead to health care norms and practices that could be maladjusted to the needs and preferences of adolescents. Particularly sensitive is access to sexual and reproductive health care services (SRHS). Yet, while there has been substantial conceptual work to conceptualize autonomy (e.g., as independence), there is a lack of empirical research that documents the perceptions of adolescents regarding on how (...) they access or wish to access health care services. The main objectives of this research were to (a) understand how adolescents in Colombia interpret the concept of “autonomy,” (b) describe how these adolescents articulate their autonomy (i.e., preferences) in accessing SRHS, and (c) analyze the ethical issues emerging from these data. Forty-five semi-structured interviews were conducted with participants aged 14 to 23 years old in the Departments of Antioquia and Valle del Cauca in Colombia. Our study showed that participants’ understanding of autonomy was context-based and highly dependent on personal experiences, and these influenced their choice in how to access SRHS. Seen through the ethical lens of a reproductive justice framework, our results highlight the unequal opportunities for adolescents in terms of autonomy to access SRHS. (shrink)

Adolescent sexuality is one of the most important reproductive health issues that confronts healthcare professionals with moral dilemmas and legal issues. In this study, we aim to justify the at-risk adolescents’ regulations on access to key reproductive health services (KRHSs) based on principles of Islamic biomedical ethics and jurisprudence. Despite the illegitimacy and prohibition of sexuality for both girls and boys in Islamic communities, in this study, using 5 principles or universal rules of purpose; certainty, no-harm; (...) necessity; and custom, we argue that first, applying these principles in the context of the no-harm principle can provide the best interests of at-risk adolescents; second, it is permissible to provide KRHSs to these adolescents with their own assent, as long as necessary, only with the intention of preventing or reducing harm. In this framework, while preventing harm, it tries to provide the best interests of at-risk adolescent. Thus, the principle of no-harm requires that the government, by designating the responsibility to healthcare professionals, protects at-risk adolescents from harm, and obliges these professionals to choose and implement the option that best suits adolescents’ interests. (shrink)

Objective Our study sought to (1) describe the practices and preferences of Colombian adolescents in accessing sexual and reproductive health services: accompanied versus alone; (2) compare actual practices with stated preferences; and (3) determine age and gender differences regarding the practice and these stated preferences. -/- Methods 812 participants aged 11–24 years old answered a survey in two Profamilia clinics in the cities of Medellin and Cali in Colombia. A cross-sectional analysis was performed to compare participants’ answers based (...) on the variables of gender and age. -/- Results A quarter of participants visited the clinic alone (25.4%). Females were more likely to go alone in comparison to males (26.3% vs 14.1%; p = 0.031), and older participants went alone more often than younger participants (p < 0.001). Most participants – 72.7% (95 %CI: 69.3–75.9) – expressed a preference in being accompanied to the clinic, and more than 90% had their preferences met. The preferences of older participants were, however, less likely to be met than those of younger participants (p < 0.001), notably, because they predominantly wanted to be accompanied. -/- Conclusion Contemporary public health and bioethics literature advocates in favor of developing health services that better meet the preferences of adolescents. The present research highlights an apparent blind spot related to the role that others (e.g., parents, friends, partners) can or should play in accompanying adolescent patients when they access sexual and reproductive health services. Respecting adolescents’ preferences, and hence their autonomy, is not simply a matter of ensuring freedom from constraints (e.g., their right and ability to go alone). Rather, it should also consider the liberty to choose whether to be accompanied when accessing SHRS and by whom. (shrink)

Biobanks are designed with particular purposes in mind. These purposes are reflected in the governance frameworks that define the conditions for participation and access by researchers. In this paper, I analyse two different models: the commercially aligned deCODE biobank and the ‘public good’ framework of UK Biobank. These diametric models have both featured ‘the public interest’ as pivotal to their achievements. However, if properly understood, the public interest rhetoric of deCODE actually conflicts with any professed community interest. The reasons why (...) are explained, and the effects this has on conditions for participation are critiqued, before reflecting on how each model might have an impact on reproductive health research. (shrink)

Religion holds unique importance in peoplereligious factor effectiveness in rural areas. They thought that religious leaders could contribute positively to community education, and suggested ways in which they could educate the community in reproductive health issues. They also suggested various channels through which religious leaders could be approached to convince them to cooperate in reproductive health programmes. The study concludes that involving religious leaders in rural settings could enable reproductive health programmes and services to (...) reach more conservative groups in society, and thus contribute effectively to bringing about positive change in the attitudes of Pakistani society towards reproductive health. (shrink)

We argue the dearth of research on elite ciswomen athletes’ reproductive health is because athletics remains associated with masculinity, and female athletes therefore do not adhere to normative femininity and motherhood. In choosing a masculine career, it is assumed that elite athletes will reject other feminine activities, such as motherhood. We further argue that female athletes are considered especially ineligible for motherhood because their career choice violates normative motherhood by engaging in “risky” behavior (i.e., physical activity). By continuing (...) with their career, athletes are accused of being “bad” mothers by not adhering to the gender norm of mothers as self-sacrificing. (shrink)

In any given society, rights are said to co-exist. When rights, however, begin to conflict, a balance must be sought. In few fields has the ability of governments to accommodate two conflicting sets of rights been so controversial as it has in the case of conscientious objection in reproductive health care. Today, states have an obligation under international law to protect the right to the freedom of thought, conscience, and religion of medical providers. They also, however, have an (...) obligation to protect right to the highest attainable standard of health and other fundamental rights of women. Considering the extent to which CO has been invoked in the context of reproductive health care, international law recognizes limits to its use. Over the years, human rights bodies have sought to develop guidelines around CO in order to ensure the protection of women’s basic rights. While some state practices have shown to be consistent with guidelines established at the international level, some countries have struggled to provide an effective balance so as to protect women’s fundamental rights. Taking the example of countries in Latin America and Europe, this article provides an overview of the different ways states have sought to regulate CO in the medical context and the various difficulties ensued. (shrink)

The devastating COVID-19 pandemic and its accompanying containment measures brought exceptional challenges to the health delivery system, and in particular, women’s sexual and reproductive healthcare (hereafter referred to as SRH). The re-routing of health resources and funding to mitigate the effects of the pandemic obstructed the provision of essential SRH services for women and girls. Coupled with the incessant socio-cultural and patriarchal norms and gender inequalities, the COVID-19 pandemic aggravated the pre-existing SRH disproportions already affecting women. By (...) adopting a qualitative approach and drawing on the experiences of women from three high density suburbs in Harare. Firstly, the study sought to explore the implications of the COVID-19 pandemic on SRH for women and girls. Secondly, the research sought to determine key drivers that affect women’s SRH in the context of COVID-19. Participant responses indicated that the COVID-19 lockdown containment measures which confined spouses to the home setting for prolonged periods of time, which is in contrast to the norm, exposed women to SRH related challenges. Participants cited that (i) bruised male ego due to lack of employment as a result of downscaling of companies resulting from COVID-19 containment measures resulted in men asserting their masculinities through heightened sexual intercourse, (ii) restraint of movement resulted in limited time for men to visit their small houses and side-chicks or side dish (euphemisms for illicit sexual relations) therefore resulting in frequent and unprotected sex with their spouses, giving rise to unplanned pregnancies and increased exposure to STIs due to limited access to SRH services and, (iii) increased intimate partner violence (IPV) and sexual abuse. Therefore, the research sought to explore the response of religious leaders and faith-based actors to providing psycho-social support and safe spaces as ways of addressing intersectional injustices giving rise to SRH challenges for women and girls.Contribution: The intersecting crises of the COVID-19 pandemic have extensively hindered progress towards the promotion of women’s SRH. Relating to sustainable development goal 3 (SDG3), the article acknowledges the trust and respect of religious leaders within communities as change agents who can encourage shifts in behaviour, beliefs and practices in ways that promote holistic SRH for women. (shrink)

There is an increasing recognition internationally of the critical impact of communication within healthcare. The link between ineffective communication, patient dissatisfaction and critical incidents is well established. Family Planning New South Wales has sought to address patient-centred care and communication in its policy platform. This article reports on research conducted within FPNSW, which analysed the discourse features that constituted effective doctor–patient1 communication in sexual and reproductive health consultations. The principal aim of the research was to understand how effectively (...) messages were conveyed and received and to what degree patients were active participants in their own sexual healthcare. Analysed consultations were characterised by extremely high levels of communicative competence on the part of the doctors who integrated medical expertise with the development of interpersonal relationships with patients, thus positioning patients as active contributors to the consultations and to decisions about their ongoing treatment. The detailed linguistic analysis identified characteristic features of patient-centred communication that are essential to patient-centred care. These interactions demonstrate that communicating care is just as important as delivering care and involves a drawing together of the medical and the interpersonal in consultations. The article details strategies for interweaving medical knowledge and establishing rapport that can inform practitioner communication practices across different healthcare contexts. (shrink)