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

The 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.

An overview of the sexual and reproductive health status and service delivery among Syrian refugees in Jordan, nine years since the crisis: a systematic literature review

BACKGROUND

The Syrian refugee crisis has led to massive displacement into neighboring countries including Jordan. This crisis has caused a significant strain on the sexual and reproductive health (SRH) services to the host communities and Syrian refugees. The Minimum Initial Service Package (MISP) is a standard package of services that should be implemented at the onset of an emergency. Due to their importance in protracted humanitarian crisis, this systematic review aimed to assess the utilization of SRH and MISP after 9 years of the crisis.

METHODS

We searched PubMed, Medline/Ovid and Scopus for both quantitative and qualitative studies from 1 January 2011 to 30 November 2019. Our search included both free text key words and Medical Subject Headings (MeSH) for various forms and acronmym of the following terms: (Sexual and) Reproductive Health, Sexual/Gender-based/Family/Intimate partner violence, Minimum Initial Service Package, MISP, Women, Girls, Adolescents, Syrian, Refugee, Jordan, Humanitarian crisis, War, (armed) conflict, and Disaster. Boolean operators and star truncation (*) were used as needed. We further conducted an in-depth review of the available grey literature published during the same timeframe. Using a narrative synthesis approach, two authors independently extracted and analyzed data from published papers. After removal of duplicates, screening, and assessing for eligibility of 161 initially identified citations, 19 papers were selected for review.

RESULTS

Findings from this review indicated a number of barriers to access, utilization, and implementation of SRH services, including lack of reliable information on sexual and gender-based violence (SGBV), aggravation of early marriages by crisis setting, gaps in the knowledge and use of family planning services, inadequate STIs and HIV coverage, and some issues around the provision of maternal health services.

CONCLUSION

The findings from this review are suggestive of a number of barriers pertaining to access, utilization, and implementation of SRH services. This is especially true for transitioning from MISP to comprehensive SRH services, and particularly for refugees outside camps. Following are needed to address identified barriers: improved inter-agency coordination, better inclusion/engagement of local initiatives and civil societies in SRH services delivery, improved quality of SRH services, adequate and regular training of healthcare providers, and increased awareness of Syrian women and adolescent girls. Also, more implementing research is required to identify ways to transition SRH provision from the MISP to comprehensive care for the Syrian refugee population in Jordan.

Emergency contraception in Jordan: Assessing retail pharmacists' awareness, opinions, and perceptions of need

OBJECTIVES

Jordan has a robust contraceptive method mix in both the public and private sectors and oral contraceptive pills and the copper-T intrauterine device are widely available. However, Jordan remains one of only a few countries in the world without a registered dedicated product for emergency contraception (EC). We aimed to explore retail pharmacists' knowledge of and attitudes toward EC in six Jordanian governorates.

STUDY DESIGN

In 2016, we conducted 100 structured interviews with pharmacists in both urban and rural areas regarding their EC knowledge and provision practices. We interviewed representatives from both chain and independently-owned pharmacies in purposively selected areas of the country. We analyzed interviews for content and themes using deductive and inductive techniques.

RESULTS

Our findings reveal a lack of knowledge of all EC modalities as well as misinformation about effectiveness and protocols for use. However, after describing dedicated progestin-only EC pills, study participants expressed tremendous enthusiasm for a dedicated product and the overwhelming majority indicated that they would stock EC pills if and when they were registered.

CONCLUSION

The private sector plays a major role in contraceptive service delivery in Jordan. Although pharmacists are not well-versed in post-coital contraception they appear interested in incorporating EC pills into the contraceptive method mix. Redoubling efforts to register a dedicated progestin-only EC pill and supporting initiatives to educate pharmacists about how to use available technologies as EC appear warranted.

IMPLICATIONS

Lack of access to emergency contraception has significant implications for women, in general, and refugee and displaced populations in particular. Supporting efforts to incorporate EC pills into the contraceptive mix in Jordan is a first step in supporting adherence to global standards of care and could help address unmet contraceptive needs.

"If I ever did have a daughter, I wouldn't raise her in New Brunswick:" exploring women's experiences obtaining abortion care before and after policy reform

INTRODUCTION

New Brunswick (NB)'s Regulation 84-20 has historically restricted funded abortion care to procedures deemed medically necessary by two physicians and performed in a hospital by an obstetrician-gynecologist. However, on January 1, 2015, the provincial government amended the regulation and abolished the "two physician rule."

OBJECTIVES

We aimed to document women's experiences obtaining abortion care in NB before and after the Regulation 84-20 amendment; identify the economic and personal costs associated with obtaining abortion care; and examine the ways in which geography, age and language-minority status condition access to care.

METHODS

We conducted 33 semistructured telephone interviews with NB residents who had abortions between 2009 and 2014 (n=27) and after January 1, 2015 (n=6), in English and French. We audiorecorded and transcribed all interviews and conducted content and thematic analyses using ATLAS.ti software to manage our data.

RESULTS

The cost of travel is significant for NB residents trying to access abortion services. Women reported significant wait times which impacted the disclosure of their pregnancy and the gestational age at the time of the abortion. Further, many women reported that physicians refused to provide referrals for abortion care. Even after the amendment to 84-20, all participants reported that they were required to have two physicians approve their procedure.

CONCLUSIONS

The funding restrictions for abortion care in NB represent a profound inequity. Amending Regulation 84-20 was an important step but failed to address the fundamental issue that clinic-based abortion care is not funded and significant barriers to access persist.

IMPLICATIONS

NB's policies create unnecessary barriers to accessing timely and affordable abortion care and produce a significant health inequity for women in the province. Further policy reforms are required to ensure that women are able to get the abortion care to which they are entitled.