1
|
Ferguson L, Anderson ME, Liang M, Filmer-Wilson E. Why a good law is not always good enough: a global review of restrictions to supportive laws for sexual and reproductive health and rights. BMJ Glob Health 2024; 9:e014100. [PMID: 38365430 PMCID: PMC10875527 DOI: 10.1136/bmjgh-2023-014100] [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: 09/29/2023] [Accepted: 01/01/2024] [Indexed: 02/18/2024] Open
Abstract
Laws and regulations provide the framework for implementing sexual and reproductive health and rights (SRHR)-related policies, programmes and services. They can promote the fulfilment of health and human rights; however, they may also limit the achievement of these goals. This study uses data collected under Sustainable Development Goal Indicator 5.6.2 to analyse SRHR-related laws and restrictions from 153 countries. Looking beyond the existence of supportive laws to assess the constellation of legal restrictions and contradictions such as criminalisation and plural legal systems provides a more nuanced understanding of factors involved in achieving full and equal access to SRHR.The interaction between restrictions and contradictions within the law disproportionately impacts some populations' health access and outcomes. Restrictions based on third-party authorisations and age are the most common restriction types, disproportionately impacting young women. Contraception, emergency contraception and abortion face the greatest number of restrictions, indicating a significant layering of barriers to family planning services. Further, plural legal systems commonly contradict guarantees of contraceptive services and emergency contraception. Our analyses suggest that one of the populations most affected by restrictions to SRH services as they appear in legal and regulatory frameworks is adolescent girls and young women in sub-Saharan Africa seeking abortion or contraceptive services.Study findings provide a critical starting point for advocacy to address legal barriers to SRH services and evidence for future policy and programming. For individual countries, this study can serve as a model for analysis of their own legal and regulatory frameworks to identify priority areas for reform efforts.
Collapse
Affiliation(s)
- Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
| | | | - Mengjia Liang
- United Nations Population Fund, New York, New York, USA
| | | |
Collapse
|
2
|
Trapani VF, Feuerschuette OHM, Júnior AT. Legal Pregnancy Interruption due to Sexual Violence in a Public Hospital in the South of Brazil. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:945-952. [PMID: 36446561 PMCID: PMC9738043 DOI: 10.1055/s-0042-1755457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To analyze the cases of all women who attend to a service of legal termination of pregnancy in cases of sexual violence in a public reference hospital and to identify the factors related to its execution. METHODS Cross-sectional observational study with information from medical records from January 2014 to December 2020. A total of 178 cases were included, with an evaluation of the data referring to the women who attended due to sexual violence, characteristics of sexual violence, hospital care, techniques used, and complications. The analysis was presented in relative and absolute frequencies, medians, means, and standard deviation. Factors related to the completion of the procedure were assessed using binary logistic regression. RESULTS Termination of pregnancy was performed in 83.2% of the cases; in 75.7% of the cases, the technique used was the association of transvaginal misoprostol and intrauterine manual aspiration. There were no deaths, and the rate of complications was 1.4%. Gestational age at the time the patient's sought assistance was the determining factor for the protocol not being completed. Pregnancies up to 12 weeks were associated with a lower chance of the interruption not occurring (odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.12-0.88), while cases with gestational age > 20 weeks were associated with a greater chance of the interruption not happening (OR: 29.93; 95%CI: 3.91-271.50). CONCLUSION The service studied was effective, with gestational age being the significant factor for resolution.
Collapse
Affiliation(s)
| | | | - Alberto Trapani Júnior
- Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil,Address for correspondence Alberto Trapani Júnior, PhD, MD Rua Esteves Júnior,458/802, CEP 88015-130. Florianópolis, SCBrazil
| |
Collapse
|
3
|
Ferguson L, Jardell W, Lambert-Peck M, Guo L, Lopez S, Canaves V, Filmer-Wilson E. Mind the Gap: Understanding Differences Between Sexual and Reproductive Health-Related Legal Frameworks on Paper and in Practice. Front Glob Womens Health 2022; 3:838976. [PMID: 35602852 PMCID: PMC9120771 DOI: 10.3389/fgwh.2022.838976] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 04/14/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction UNFPA recently developed a composite indicator to assess sexual and reproductive health (SRH)-related laws as part of the Sustainable Development Goals monitoring framework (Indicator 5.6.2). However, there is still little understanding of how best to ensure a supportive SRH-related legal framework can improve SRH outcomes. This research draws on country case studies (Colombia, Malawi, Uruguay, Zambia) to provide more generalizable lessons on the processes by which these laws are translated into practice and their impact on lived realities. Methods Peer-reviewed and gray literature on laws and policies related to maternity care, contraception, sexuality education, HIV and HPV was reviewed. Key informant interviews were carried out with 8–16 people in each country, including representatives of government, civil society and academia to understand factors affecting implementation of relevant laws and policies. Findings were thematically analyzed by country and contextualized within each country's score on Indicator 5.6.2 and relevant SRH outcome data. Findings Across these countries, some common organizational steps help move from laws on paper to impacting people's lives including budget allocation, development of technical guidance, health worker training, population awareness creation and demand generation. It is also important to address sociocultural challenges such as entrenched inequalities, conservative cultural and religious beliefs and the potential existence of customary law. Challenges can be encountered across all these steps and can vary based on the area of SRH: implementation of laws to reduce maternal mortality is generally less controversial than laws around abortion, often making the latter harder to implement. Local specificities in structures, systems and cultures bring opportunities and challenges, highlighting the need for tailored actions. Discussion A legal framework supportive to SRH is critical, particularly in the face of backlash against sexual and reproductive rights, but alone it is insufficient. Understanding that a generic pathway exists for moving laws into practice is a critical starting point for exploring the specificities of each national context as a way of identifying entry points for action. These findings can be used to inform advocacy and monitoring to help ensure that the potential benefits of supportive SRH-related laws can be realized in these four countries and around the world.
Collapse
Affiliation(s)
- Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, United States
- *Correspondence: Laura Ferguson
| | - William Jardell
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, United States
| | - Miles Lambert-Peck
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, United States
| | - Lillie Guo
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, United States
| | - Sophia Lopez
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, United States
| | | | | |
Collapse
|
4
|
Romero M, Gomez Ponce de Leon R, Baccaro LF, Carroli B, Mehrtash H, Randolino J, Menjivar E, Estevez Saint-Hilaire E, Huatuco MDP, Hernandez Muñoz R, Garcia Camacho G, Thwin SS, Campodonico L, Abalos E, Giordano D, Gamerro H, Kim CR, Ganatra B, Gülmezoglu M, Tuncalp Ö, Carroli G. Abortion-related morbidity in six Latin American and Caribbean countries: findings of the WHO/HRP multi-country survey on abortion (MCS-A). BMJ Glob Health 2021; 6:bmjgh-2021-005618. [PMID: 34417270 PMCID: PMC8404437 DOI: 10.1136/bmjgh-2021-005618] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/10/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Abortion-related complications are a significant cause of morbidity and mortality among women in many Latin American and Caribbean (LAC) countries. The objective of this study was to characterise abortion-related complication severity, describe the management of these complications and report women's experiences with abortion care in selected countries of the Americas region. METHODS This is a cross-sectional study of 70 health facilities across six countries in the region. We collected data on women's characteristics including socio-demographics, obstetric history, clinical information, management procedures and using Audio Computer-Assisted Self-Interviewing (ACASI) survey the experience of abortion care. Descriptive bivariate analysis was performed for women's characteristics, management of complications and reported experiences of abortion care by severity of complications, organised in five hierarchical mutually exclusive categories based on indicators present at assessment. Generalised linear estimation models were used to assess the association between women's characteristics and severity of complications. RESULTS We collected data on 7983 women with abortion-related complications. Complications were classified as mild (46.3%), moderate (49.5%), potentially life-threatening (3.1%), near-miss cases (1.1%) and deaths (0.2%). Being single, having a gestational age of ≥13 weeks and having expelled products of conception before arrival at the facility were significantly associated with experiencing severe maternal outcomes compared with mild complications.Management of abortion-related complications included both uterotonics and uterine evacuation for two-thirds of the women while one-third received uterine evacuation only. Surgical uterine evacuation was performed in 93.2% (7437/7983) of women, being vacuum aspiration the most common one (5007/7437, 67.4%).Of the 327 women who completed the ACASI survey, 16.5% reported having an induced abortion, 12.5% of the women stated that they were not given explanations regarding their care nor were able to ask questions during their examination and treatment with percentages increasing with the severity of morbidity. CONCLUSIONS This is one of the first studies using a standardised methodology to measure severity of abortion-related complications and women's experiences with abortion care in LAC. Results aim to inform policies and programmes addressing sexual and reproductive rights and health in the region.
Collapse
Affiliation(s)
- Mariana Romero
- Health, Economy and Society Department, CEDES, Buenos Aires, Argentina .,CONICET, Buenos Aires, Argentina
| | - Rodolfo Gomez Ponce de Leon
- Latin American Center for Perinatology/Women's Health and Reproductive Health, Pan American Health Organization (CLAP/WR-PAHO/WHO), Montevideo, Uruguay
| | | | | | - Hedieh Mehrtash
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | | | - Elisa Menjivar
- Pan American Health Organization El Salvador, San Salvador, El Salvador
| | | | | | | | | | - Soe Soe Thwin
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | | | | | | | | | - Caron Rahn Kim
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Bela Ganatra
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Metin Gülmezoglu
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Özge Tuncalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | | |
Collapse
|