The politest form of racism: sexual and reproductive health and rights paradigm in Canada

AbstractThe Canadian national identity is often understood as what it is not; American. Inundation with American history, news, and culture around race and racism imbues Canadians with a false impression of egalitarianism, resulting in a lack of critical national reflection. While this is true in instances, the cruel reality of inequity, injustice and racism is rampant within the Canadian sexual and reproductive health and rights realm. Indeed, the inequitable health outcomes for Black, Indigenous and people of color (BIPOC) are rooted in policy, research, health promotion and patient care. Built by colonial settlers, many of the systems currently in place have yet to embark on the necessary process of addressing the colonial, racist, and ableist structures perpetuating inequities in health outcomes. The mere fact that Canada sees itself as better than America in terms of race relations is an excuse to overlook its decades of racial and cultural discrimination against Indigenous and Black people. While this commentary may not be ground-breaking for BIPOC communities who have remained vocal about these issues at a grassroots level for decades, there exists a gap in the Canadian literature in exploring these difficult and often underlying dynamics of racism. In this commentary series, the authors aim to promote strategies addressing systemic racism and incorporating a reproductive justice framework in an attempt to reduce health inequities among Indigenous, Black and racialized communities in Canada.

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An application of Systematic Anomalous Case Analysis to improve models predicting contraceptive use in the Philippines

Journal of Biosocial Science ◽

10.1017/s0021932021000122 ◽

2021 ◽

pp. 1-14

Author(s):

Subasri Narasimhan ◽

Jessica D. Gipson

Keyword(s):

Reproductive Health ◽

Health Outcomes ◽

Sexual And Reproductive Health ◽

Contraceptive Use ◽

Sexual Debut ◽

Case Analysis ◽

Reproductive Behaviour ◽

The Philippines ◽

Health And Nutrition ◽

Depth Interviews

Abstract Amidst persistently high unintended pregnancy rates and lags in contraceptive use, novel methodological approaches may prove useful in investigating sexual and reproductive health outcomes in the Philippines. Systematic Anomalous Case Analysis (SACA) – a mixed-methods technique – was employed to examine predictors of women’s lifetime contraceptive use. First, multivariable, longitudinal Poisson regression models predicted fertility and sexual debut using the 1998–2009 Cebu Longitudinal Health and Nutrition Surveys (CLHNS), then regression outliers and normative cases were used to identify 48 participants for in-depth interviews (2013–2014) for further examination. Qualitative findings from 24 women highlighted ‘control over life circumstances’ was critical, prompting the addition of two items to the original quantitative models predicting any contraceptive use (n=532). Each of the items, ‘what happens to [them] is their own doing’ and ‘[I] do not [have] enough control over direction life is taking [me]’, significantly and independently predicted any contraceptive use (aOR: 2.37 (CI: 1.24–4.55) and aOR: 0.46 (CI: 0.28–0.77), respectively). The findings demonstrate the utility of SACA to improve the understanding and measurement of sexual and reproductive health outcomes and underscore the importance of integrating psychosocial constructs into existing models of fertility and reproductive behaviour in the Philippines to improve sexual and reproductive health outcomes.

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Sexual and Reproductive Justice for LGBTQI Youth in Policy Responses Across Eastern and Southern Africa

10.1093/acrefore/9780190264093.013.1363 ◽

2021 ◽

Author(s):

Ingrid Lynch ◽

Finn Reygan

Keyword(s):

Young People ◽

Reproductive Health ◽

Sexual And Reproductive Health ◽

Gender Diversity ◽

Minority Youth ◽

Reproductive Justice ◽

Policy Narratives ◽

Sexual And Gender Minority ◽

Eastern And Southern Africa ◽

And Gender

Both significant progress and profound backlash have occurred in the inclusion of sexual and gender diversity across eastern and southern Africa. This includes the decriminalization of homosexuality in Mozambique in 2015 and the introduction of the Anti-Homosexuality Act (later annulled) in Uganda in the preceding year. Simultaneously there is increased pressure on Ministries of Education to engage more robustly with sexual and reproductive health and rights (SRHR) education in education systems across the region. Emerging regional research points to a narrow, heteronormative focus in comprehensive sexuality education; access barriers to sexual and reproductive health services; and pervasive school-related gender-based violence, including homophobic and transphobic violence. Civil society organizations (CSOs) play a key role in developing best practice in advancing the SRHR of sexual and gender minority youth and are therefore a valuable resource for government SRHR policies and programmatic responses. The regional SRHR education policy landscape is underpinned by two policy narratives: that of young people’s SRHR as a public health concern and a focus on young people’s human rights. These policy narratives not only underpin SRHR policy in the region but also in many instances are drawn on in CSO advocacy when positioning the SRHR of lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI) young people as an important policy concern. These two dominant policy narratives, however, have a narrow focus on young people’s risks and vulnerabilities, may inadvertently perpetuate stigma and marginalization of LGBTQI youth, and may limit youth voice and agency. These narratives also do not sufficiently engage local sociocultural and structural conditions that drive negative SRHR outcomes for young people in the region. Research, advocacy, and policy development toward the full realization of the SRHR of sexual and gender minority youth can address some of the limitations of health and rights-based policy narratives by drawing on a sexual and reproductive justice framework. Such a framework expands the policy focus on health risks and individual rights to include engagement with sociocultural and structural constraints on young people’s ability to exercise their rights. A sexual and reproductive justice framework provides a more robust toolkit when working toward full inclusion of sexual and gender diversity in regional school-based SRHR policy and programs.

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Intersectionality and the Struggle for Sexual and Reproductive Health and Rights: An Analysis of UN Discursive Patterns

10.26686/wgtn.16999225 ◽

2021 ◽

Author(s):

◽

Amie Ritchie

Keyword(s):

Reproductive Health ◽

Women's Movement ◽

Sexual And Reproductive Health ◽

Global Scale ◽

Population Movement ◽

Development Discourse ◽

Race And Racism ◽

Policy And Practice ◽

Normative Argument ◽

Men’S Involvement

<p>This thesis makes the normative argument that intersectionality should be taken seriously by the United Nations in their efforts to address Sexual and Reproductive Health and Rights (SRHR). This work suggests that, in spite of widespread recognition of the value of intersectionality for approaching issues of SRHR, the UN has insufficiently adopted the theory into its policy and practice. At the international policy level, intersectionality is nearly absent as a paradigm, yet its central components are dominant within mainstream development discourse. These components include discourses of women's empowerment, human rights, and men's involvement. Drawing on critical feminist and race theory, I argue that a narrow gender vision of SRHR is not sufficient and that intersectionality should be recognized both in discourse and practice by UN agencies. This argument is examined along the parallel tracks of the population movement within the UN system and the evolution of the global women's movement (GWM). This study shows that the UN system has traditionally adopted the approaches and discourses of the global women's movement, as analysed over four decades of UN population movement discourse. However, a shift occurring at the new millennium, as well as significant political barriers barring a discussion of race and racism, have led to a break in this relationship, damaging the take-up of GWM discourse. The conclusion drawn from this argument is that SRHR is an intersectional issue and the new and emerging intersectional paradigm must be adopted by the UN in order to effectively address SRHR on a local and global scale.</p>

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Reproductive justice in the time of COVID-19: a systematic review of the indirect impacts of COVID-19 on sexual and reproductive health

Reproductive Health ◽

10.1186/s12978-021-01286-6 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Trena I. Mukherjee ◽

Angubeen G. Khan ◽

Anindita Dasgupta ◽

Goleen Samari

Keyword(s):

Reproductive Health ◽

Sexual Behaviors ◽

Sexual And Reproductive Health ◽

Underserved Populations ◽

Gynecologic Oncology ◽

Control Measures ◽

Reproductive Justice ◽

Women And Girls ◽

Indirect Impacts ◽

The Impact

Abstract Objective Despite gendered dimensions of COVID-19 becoming increasingly apparent, the impact of COVID-19 and other respiratory epidemics on women and girls’ sexual and reproductive health (SRH) have yet to be synthesized. This review uses a reproductive justice framework to systematically review empirical evidence of the indirect impacts of respiratory epidemics on SRH. Methods We searched MEDLINE and CINAHL for original, peer-reviewed articles related to respiratory epidemics and women and girls’ SRH through May 31, 2021. Studies focusing on various SRH outcomes were included, however those exclusively examining pregnancy, perinatal-related outcomes, and gender-based violence were excluded due to previously published systematic reviews on these topics. The review consisted of title and abstract screening, full-text screening, and data abstraction. Results Twenty-four studies met all eligibility criteria. These studies emphasized that COVID-19 resulted in service disruptions that effected access to abortion, contraceptives, HIV/STI testing, and changes in sexual behaviors, menstruation, and pregnancy intentions. Conclusions These findings highlight the need to enact policies that ensure equitable, timely access to quality SRH services for women and girls, despite quarantine and distancing policies. Research gaps include understanding how COVID-19 disruptions in SRH service provision, access and/or utilization have impacted underserved populations and those with intersectional identities, who faced SRH inequities notwithstanding an epidemic. More robust research is also needed to understand the indirect impact of COVID-19 and epidemic control measures on a wider range of SRH outcomes (e.g., menstrual disorders, fertility services, gynecologic oncology) in the long-term.

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Mental health outcomes of a pilot 2-arm randomized controlled trial of a HIV-prevention program for South African adolescent girls and young women and their female caregivers

BMC Public Health ◽

10.1186/s12889-021-12010-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Geri Donenberg ◽

Katherine G. Merrill ◽

Millicent Atujuna ◽

Erin Emerson ◽

Bethany Bray ◽

...

Keyword(s):

Mental Health ◽

Logistic Regression ◽

Hiv Prevention ◽

Reproductive Health ◽

Health Outcomes ◽

South African ◽

Adolescent Girls ◽

Young Women ◽

Sexual And Reproductive Health

Abstract Background South African adolescent girls and young women (AGYW) report significant mental distress and sexual and reproductive health concerns. Mental health problems and trauma symptoms are consistently associated with sexual and reproductive health behavior. Despite their intersection, few interventions address them simultaneously or engage female caregivers (FC) as collaborators. This study presents findings from a pilot test of an empirically supported culturally adapted family-based HIV-prevention program, Informed Motivated Aware and Responsible Adolescents and Adults- South Africa (IMARA-SA), on AGYW anxiety, depression, and trauma. Methods Sixty 15–19-year-old AGYW (mean age = 17.1 years) and their FC from outside Cape Town were randomized to IMARA-SA or a health promotion control program. AGYW reported their anxiety using the GAD-7, depression using the PHQ-9, and trauma using the PC-PTSD-5 at baseline and follow-up (6–10 months post). Both interventions were delivered by Xhosa-speaking Black South African women in groups over 2 days for approximately 10 h. We examined intervention effects using zero-inflated negative binomial regression for anxiety, multinomial logistic regression for depression, and logistic regression for trauma. Results At baseline, groups did not differ in demographic characteristics but AGYW randomized to IMARA-SA had higher depression scores than controls (p = 0.04) and a greater proportion screened positive for PTSD (p = .07). Controlling for baseline mental health scores, AGYW who received IMARA-SA compared to controls had significantly fewer anxiety symptoms at follow-up (adjusted incidence rate ratio for count model = 0.54, 95% CI = 0.29–0.99, p = 0.05), were less likely to report at least one depressive symptom relative to no symptoms (relative risk ratio = 0.22, 95% CI = 0.05, 0.95, p = 0.04), and were less likely to report symptoms of PTSD relative to no symptoms, but this difference was not statistically significant. Conclusions Mental health is implicated in risky sexual behavior, and reducing emotional distress can mitigate exposure to poor sexual and reproductive health outcomes. This pilot study yielded promising findings for the mental health impact of IMARA-SA, justifying replication in a larger randomized trial. Trial registration ClinicalTrials.gov Number NCT04758390, accepted 17/02/2021.

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