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Murphy N, Rarama T, Atama A, Kauyaca I, Batibasaga K, Azzopardi P, Bowen KJ, Bohren MA. Changing climates, compounding challenges: a participatory study on how disasters affect the sexual and reproductive health and rights of young people in Fiji. BMJ Glob Health 2023; 8:e013299. [PMID: 38103898 PMCID: PMC10729163 DOI: 10.1136/bmjgh-2023-013299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/28/2023] [Indexed: 12/19/2023] Open
Abstract
Pacific youth are at the forefront of the climate crisis, which has important implications for their health and rights. Youth in Fiji currently bear a disproportionate burden of poor experiences and outcomes related to their sexual and reproductive health and rights (SRHR). There is limited information about how the increasing climate impacts may affect their SRHR, and what the implications may be for climate action and disaster risk reduction. We aimed to explore the experiences of 21 Fijian youth in fulfilling their SRHR when living through multiple natural hazards. We conducted 2 workshops and 18 individual semistructured interviews using visual and storytelling methods. Irrespective of the type of hazard or context of disasters, participants identified limited agency as the main challenge that increased SRHR risks. Through reflexive thematic analysis, we identified four themes centred around 'youth SRHR agency'; (1) information and knowledge, (2) community and belonging, (3) needs and resources, and (4) collective risks. These themes encompassed multiple factors that limited youth agency and increased their SRHR risks. Participants highlighted how existing challenges to their SRHR, such as access to SRHR information being controlled by community gatekeepers, and discrimination of sexual and gender diverse youth, were exacerbated in disasters. In disaster contexts, immediate priorities such as water, food and financial insecurity increased risks of transactional early marriage and transactional sex to access these resources. Daily SRHR risks related to normalisation of sexual and gender-based violence and taboos limited youth agency and influenced their perceptions of disasters and SRHR risks. Findings offer important insights into factors that limited youth SRHR agency before, during and after disasters. We underscore the urgency for addressing existing social and health inequities in climate and disaster governance. We highlight four key implications for reducing youth SRHR risks through whole-of-society approaches at multiple (sociocultural, institutional, governance) levels.
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Affiliation(s)
- Nabreesa Murphy
- Gender and Women's Health Unit, Nossal Institute for Global Health, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Tamani Rarama
- Fiji Youth Sexual and Reproductive Health and Rights Alliance (FYSA), Nadi, Fiji
| | - Alanieta Atama
- Fiji Youth Sexual and Reproductive Health and Rights Alliance (FYSA), Nadi, Fiji
| | - Ilaisa Kauyaca
- Fiji Youth Sexual and Reproductive Health and Rights Alliance (FYSA), Nadi, Fiji
| | - Kelera Batibasaga
- Reproductive and Family Health Association of Fiji (RFHAF), Nadi, Fiji
| | - Peter Azzopardi
- Centre for Adolescent Health, Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Adolescent Health and Wellbeing Program, Telethon Kids Institute, Adelaide, South Australia, Australia
| | - Kathryn J Bowen
- Melbourne Climate Futures, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Research Institute for Sustainability-Helmholtz Centre Potsdam, Potsdam, Brandenburg, Germany
| | - Meghan A Bohren
- Gender and Women's Health Unit, Nossal Institute for Global Health, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
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Henderson H, Soares Xavier HA, Mendonca SA, da Silva AM, da Silva M, de Araújo RM, Bohren MA, Vaughan C. 'It depends on who is asking and why they will use it': Access to male condoms in Timor-Leste. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002409. [PMID: 37773929 PMCID: PMC10540955 DOI: 10.1371/journal.pgph.0002409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/25/2023] [Indexed: 10/01/2023]
Abstract
The uptake of male condoms remains markedly low in The Democratic Republic of Timor-Leste (Timor-Leste), an island nation in South-East Asia. To understand why, we conducted participatory and operational research about beliefs, understanding and access to male condoms from both a community and healthcare provider perspective. We held 14 participatory group discussions (PGDs) with 175 community participants (84 men, 91 women; aged 18-72) across seven municipalities (Ainaro, Baucau, Bobonaro, Dili, Lautem, Manufahi, and Oecusse) in 2019. We held individual in-depth interviews (IDIs) with 24 healthcare providers working in the same community catchment areas as the PGDs. Two counsellors, four doctors, fifteen midwives, and three nurses participated (16 women, 8 men; aged 25-56 years). Data were analysed using reflexive thematic analysis. PGD and IDI participant awareness, understanding and beliefs about male condoms were diverse. Male condoms were often discussed as something negative and taboo, and as something that is highly regulated and discouraged within society and the health system. However, many PGD and IDI participants also challenged this narrative by providing a more rights-based perspective about universal access to sexual and reproductive health information and services, including male condoms. Insights from our research have been used to inform programmatic decision-making in Timor-Leste, including health promotion and service delivery initiatives. Our findings can be further used to inform national health policy, healthcare provider training, and advocacy and communication work.
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Affiliation(s)
- Helen Henderson
- Marie Stopes Timor-Leste, Rua Belarmino Lobo, Bidau Lecidere, Dili, Timor-Leste
- Gender and Women’s Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
- MSI Asia Pacific, Melbourne, Victoria, Australia
| | | | | | | | - Mariano da Silva
- Marie Stopes Timor-Leste, Rua Belarmino Lobo, Bidau Lecidere, Dili, Timor-Leste
| | | | - Meghan A. Bohren
- Gender and Women’s Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Cathy Vaughan
- Gender and Women’s Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
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Cammock R, Lovell S, Vaka S. Cultural values influencing iTaukei women's discussion of family planning in the home. CULTURE, HEALTH & SEXUALITY 2023; 25:1198-1213. [PMID: 36409764 DOI: 10.1080/13691058.2022.2146204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
Pacific Sexual and reproductive health is influenced by cultural taboos and sensitivities. Although Pacific values are integral to family planning, open communication in the home is often difficult in the face of changing socio-cultural norms. This study explores the experiences of iTaukei Pacific women living in Fiji and Aotearoa New Zealand, and their discussion of family planning within the family setting. The study utilises talanoa methodology to understand women's realities and their navigation through shifting sexual and reproductive norms in both countries. The study found that although family may be seen as a place of 'truth' in which appropriate, culturally sensitive family planning communication should be available, this was challenged by cultural taboos or tabu which were persistent in family planning discussions. The study calls for greater reliance on holistic approaches to Pacific family planning perspectives and a greater examination of vā or the spaces within which Pacific women's experiences are negotiated and informed.
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Affiliation(s)
- Radilaite Cammock
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Sarah Lovell
- School of Health Sciences, Faculty of Health, University of Canterbury, Christchurch, New Zealand
| | - Sione Vaka
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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Murphy N, Azzopardi P, Bowen K, Quinn P, Rarama T, Dawainavesi A, Bohren MA. Using social capital to address youth sexual and reproductive health and rights in disaster preparedness and response: A qualitative study highlighting the strengths of Pacific community organisations and networks. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001624. [PMID: 37146000 PMCID: PMC10162552 DOI: 10.1371/journal.pgph.0001624] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/12/2023] [Indexed: 05/07/2023]
Abstract
In the Pacific region, youth sexual and reproductive health and rights (SRHR) are strongly influenced by sociocultural and structural factors, which limit access to SRHR information and services for youth. As climate-related disasters intensify in the Pacific, existing challenges to youth SRHR may increase the risk of worse SRHR experiences and outcomes for youth before, during and after disasters. Community-based models of SRHR service provision models increase accessibility for youth in non-disaster times, but there is limited evidence of how community organisations address youth SRHR in disaster contexts. We conducted qualitative interviews with 16 participants from community organisations and networks in Fiji, Vanuatu, and Tonga following the 2020 Tropical Cyclone (TC) Harold. Guided by the Recovery Capitals Framework (natural, built, political, cultural, human, social, and financial capitals), we explored how community organisations addressed challenges to facilitate access to youth SRHR information and services. Social capital in the form of peer networks and virtual safe spaces was used to navigate challenges in political, financial, and natural capitals. Existing relationships and trusted collaborations were crucial to address cultural taboos related to youth SRHR. Previous experiences of disasters and knowledge of contexts enabled participants to provide sustainable solutions to identified SRHR needs. The work conducted by community organisations and networks pre-disaster made it easier to identify and address youth SRHR risks following disasters. Our research offers a unique perspective into how social capitals were used to mitigate challenges to youth SRHR across natural, human, financial, cultural, built, and political capitals. Findings offer important opportunities to invest in existing community strengths, for transformative action to advance the SRHR of Pacific youth.
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Affiliation(s)
- Nabreesa Murphy
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
- Melbourne Climate Futures, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
- Institute for Advanced Sustainability Studies, Potsdam, Germany
| | - Peter Azzopardi
- Department of Paediatrics, Burnet Institute, South Australian Health and Medical Research Institute, Global Adolescent Health Group, Maternal Child and Adolescent Health Program, AND Adolescent Health and Wellbeing Program, Aboriginal Health Equity Theme, University of Melbourne, Melbourne, Australia
| | - Kathryn Bowen
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
- Melbourne Climate Futures, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
- Institute for Advanced Sustainability Studies, Potsdam, Germany
| | - Phoebe Quinn
- Melbourne Climate Futures, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
- Institute for Advanced Sustainability Studies, Potsdam, Germany
- Child & Community Wellbeing Unit, Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Tamani Rarama
- Fiji Youth Sexual and Reproductive Health and Rights Alliance (FYSA), Suva, Fiji
| | - Akanisi Dawainavesi
- Pacific Sub-Regional Office for International Planned Parenthood Federation (IPPF), Suva, Fiji
| | - Meghan A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
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Okeke SR. “Compared to COVID, HIV Is Nothing”: Exploring How Onshore East Asian and Sub-Saharan African International Students in Sydney Navigate COVID-19 versus BBVs/STIs Risk Spectrum. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106264. [PMID: 35627800 PMCID: PMC9141421 DOI: 10.3390/ijerph19106264] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 02/07/2023]
Abstract
Background: While a large body of evidence indicates changes in alcohol and other drug use among young people as a result of the COVID-19 pandemic, there is a lack of evidence around changes in sexual practices and how the pandemic may be impacting the potential spread of blood-borne viruses and sexually transmissible infections (BBVs/STIs). Most of what we know about sex during COVID-19 lockdowns is largely based on solitary sexual practices, which may not answer the critical question around how the pandemic may be shaping sexual practices among young people. Against this backdrop, this study explored how the COVID-19 pandemic may be shaping BBVs/STIs risk and protective practices among a sample of onshore African and Asian international students in Sydney, Australia. Methods: This phenomenological qualitative study involved semi-structured telephone and face-to-face interviews with 16 international university students in Sydney, between September 2020–March 2021. Generated data were coded using NVivo and analysis was guided by reflexive thematic analysis. Results: Participants reported elevated mental health distress because of the COVID-19 pandemic. Some participants reported engaging in casual sexual hook-ups as a strategy to mitigate the mental health distress they were experiencing. Some of these sexual hook-ups were condomless partly because COVID-related disruptions impacted condom accessibility. Additionally, the preventive practices of some participants who were sexually active during the lockdowns were focused on preventing COVID-19, while the risk of BBVs/STIs were downplayed. Conclusions: This study indicates a need for a comprehensive public health response to the evolving and near-endemic COVID-19 situation. Such a comprehensive approach should focus on empowering young people to prevent both SARS-CoV-2 and BBVs/STIs.
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Affiliation(s)
- Sylvester Reuben Okeke
- Centre for Social Research in Health, University of New South Wales Sydney, Sydney 2052, Australia
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Mitchell E, Kelly-Hanku A, Krentel A, Romani L, Robinson LJ, Vaz Nery S, Kaldor J, Steer AC, Bell S. Community perceptions and acceptability of mass drug administration for the control of neglected tropical diseases in Asia-Pacific countries: A systematic scoping review of qualitative research. PLoS Negl Trop Dis 2022; 16:e0010215. [PMID: 35275932 PMCID: PMC8916618 DOI: 10.1371/journal.pntd.0010215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 01/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background Preventative chemotherapy and mass drug administration have been identified as effective strategies for the prevention, treatment, control and elimination of several NTDs in the Asia-Pacific region. Qualitative research can provide in-depth insight into the social dynamics and processes underlying effective implementation of and adherence to mass drug administration programs. This scoping review examines published qualitative literature to examine factors influencing community perceptions and acceptability of mass drug administration approaches to control NTDs in the Asia-Pacific region. Methodology Twenty-four peer reviewed published papers reporting qualitative data from community members and stakeholders engaged in the implementation of mass drug administration programs were identified as eligible for inclusion. Findings This systematic scoping review presents available data from studies focussing on lymphatic filariasis, soil-transmitted helminths and scabies in eight national settings (India, Indonesia, Philippines, Bangladesh, Laos, American Samoa, Papua New Guinea, Fiji). The review highlights the profoundly social nature of individual, interpersonal and institutional influences on community perceptions of willingness to participate in mass drug administration programs for control of neglected tropical diseases (NTD). Future NTD research and control efforts would benefit from a stronger qualitative social science lens to mass drug administration implementation, a commitment to understanding and addressing the social and structural determinants of NTDs and NTD control in complex settings, and efforts to engage local communities as equal partners and experts in the co-design of mass drug administration and other efforts to prevent, treat, control and eliminate NTDs. Conclusion For many countries in the Asia-Pacific region, the “low hanging fruit has been picked” in terms of where mass drug administration has worked and transmission has been stopped. The settings that remain–such as remote areas of Fiji and Papua New Guinea, or large, highly populated, multi-cultural urban settings in India and Indonesia–present huge challenges going forward. Qualitative research can provide in-depth insight into the social dynamics and processes underlying effective implementation of and adherence to mass drug administration programs. This scoping review examines published qualitative literature to examine factors influencing community perceptions and acceptability of mass drug administration approaches to control neglected tropical diseases (NTDs) in the Asia-Pacific region. Our analyses highlight the profoundly social nature of individual, interpersonal and institutional influences on community perceptions of willingness to participate in mass drug administration programs for control of NTDs. For many countries in the Asia-Pacific region, the “low hanging fruit has been picked” in terms of where mass drug administration has worked and transmission has been stopped. The settings that remain–e.g. remote areas of Fiji and Papua New Guinea, or large, highly populated, multi-cultural urban settings in India and Indonesia–present huge challenges going forward. Future NTD research and control efforts would benefit from a stronger qualitative social science lens to mass drug administration implementation, a commitment to understanding the socio-structural determinants of NTDs and NTD control in complex settings, and engaging local communities as equal partners and experts in the co-design of mass drug administration and other efforts to prevent, treat, control and eliminate NTDs.
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Affiliation(s)
- Elke Mitchell
- Kirby Institute, UNSW Sydney, Sydney, Australia
- * E-mail:
| | - Angela Kelly-Hanku
- Kirby Institute, UNSW Sydney, Sydney, Australia
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Alison Krentel
- Bruyère Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Lucia Romani
- Kirby Institute, UNSW Sydney, Sydney, Australia
- Tropical Diseases Group, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Leanne J. Robinson
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
- Burnet Institute, Melbourne, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | | | - John Kaldor
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Andrew C. Steer
- Tropical Diseases Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Melbourne Children’s Global Health, Melbourne Children’s Campus, The Royal Children’s Hospital, Melbourne, Australia
| | - Stephen Bell
- UQ Poche Centre for Indigenous Health, The University of Queensland, St Lucia, Australia
- School of Public Health, The University of Queensland, St Lucia, Australia
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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Okeke SR. "I always prefer to withdraw than use a condom": contextualising condomless sex among East Asian and sub-Saharan African international students in Sydney. Arch Public Health 2022; 80:20. [PMID: 34986875 PMCID: PMC8729151 DOI: 10.1186/s13690-021-00777-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Incidence and prevalence of blood-borne viruses and sexually transmissible infections among young people continue to necessitate population-based studies to understand how contextualised sexual health services can be developed and implemented to promote protective behaviours such as consistent condom use. This study examined condomless sexual practice among a sample of East Asian and sub-Saharan African international university students in Sydney, Australia. METHODS This qualitative study was methodologically guided by interpretative phenomenological analysis. Data was provided by 20 international students sampled from five universities in Sydney, who participated in either face-to-face or telephone semi-structured in-depth interviews. The interview sessions were audio-recorded, transcribed verbatim, coded in NVivo and analysed using reflexive thematic analysis. RESULTS Condomless sexual practices appear to be common among the study group based on participants' self-reports of their own practices and the practices of friends and peers. Three themes contextualising condomless among the study participants were generated from the interview transcripts: (1) unanticipated sex, condom related stigma and alcohol use (2) pleasure-seeking, curiosity and intimacy (3) condomless sex as a gendered practice. CONCLUSIONS The result of this study has implications for public health research, practice and policy around design, implementation and evaluation of multi-layered and population-specific sexual health services that are tailored to addressing the needs of international students, who migrate from traditional sexual cultures to Australia, where sexual norms are more liberal.
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