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Reproductive rights and reproductive behavior. Clash or convergence of private values and public policies?

Using a rational scientific approach upholding public health values, this article notes experience gained from 25 years of cooperative transnational research on reproductive behavior. An overview of world population trends is followed by discussions of reproductive rights as a human right, the utility of acceptability studies of modern methods of fertility regulation, and findings from research on psychological responses to abortion, long-term developmental effects of compulsory pregnancy, and the use of incentives and disincentives to influence family size. There is also consideration of the clash between private values and public policy on reproductive behavior in the United States and the convergence achieved in Denmark and the Netherlands, where rates of unintended pregnancy are among the world's lowest.

Abortion, Legal↗

Reproductive rights and the state in Serbia and Croatia.

The global reproductive rights movement arose in the late 1980s and early 1990s as a challenge to the population control paradigm that has dominated family planning policy for almost half a century. The essence of the challenge is to place women into the center of population discussions as subjects, not objects of policy, and to reorient family planning and health programs toward meeting the broad reproductive health needs of individuals, rather than the narrow population control objectives of states. Reproductive rights advocates argue that the use of family planning programs for developmentalist-oriented population control objectives is illegimate, and inevitably relegates women to the status of depersonalized policy "targets". The cases of Croatia and Serbia, the two dominant partners in the former Federal Republic of Yugoslavia, offer interesting twists on these reproductive rights issues. In Croatia and Serbia, unlike in many nations, the governments are deliberately seeking to increase rather than decrease fertility levels. Moreover, the objective concerns identity politics, more so than development: the governments have encouraged increased fertility to safeguard the survival of their nations and to strengthen national power amidst threatening internal and external environments of ethnic conflict. In this paper, we examine the dynamics of pro-natalist fertility policy in Croatia and Serbia. We do so with a view to explaining why, despite similarities, the two have followed divergent paths. While reproductive rights violations have occurred in both nations, they have been markedly higher in Serbia than Croatia. To explain this divergence we look at a series of sociopolitical factors, including the space available for groups to mobilize in each political system; the degree of nationalistic extremism present in the discourse of central political leaders; and perceptions of threats and opportunities in external geopolitical environments. In conducting this analysis we seek to drive home the point that a nation's reproductive rights situation and prospects cannot be understood divorced from its sociopolitical context. We also raise an additional impetus for promoting the reproductive rights agenda--one largely unexplored in the family planning literature-that emerges from low fertility nations facing identity issues. Women's bodies must be protected not only against those states seeking to use their reproductive capacities for developmentalist-oriented fertility control, but also against those wanting their bodies for nationalistic-oriented fertility promotion.

Authoritarianism↗

Reproductive rights of Egyptian women: issues for debate.

Because the definitions of reproductive health and reproductive rights are so broad, it has been possible in Egypt and elsewhere for one or other issue on the reproductive health agenda to be prioritised to the detriment or exclusion of others, and a comprehensive approach avoided. Reproductive health and rights language was introduced in Egypt around the time of the International Conference on Population and Development in Cairo in 1994. From the moment these concepts were translated into Arabic, activists, scholars and women themselves discussed and debated their meanings and questioned whether Egyptian culture permitted a rights approach of this kind and whether reproductive rights were actually perceived as such by Egyptian women. This paper discusses the language of reproductive rights in relation to cultural specificity in the Egyptian context, Egyptian women's perceptions of reproductive rights, the role of tradition and religion, and the ways in which reproductive rights are taken up under Egyptian law. It analyses some of the arguments used against reproductive rights on these grounds.

Arabs↗

Reproductive rights and HIV/AIDS.

Reproductive and sexual rights are at the centre of the acquired immunodeficiency syndrome (AIDS) epidemic through culturally defined gender roles, gender-based violence and limited access to quality health care. AIDS control is one of the Millennium Goals, and the '3-by-5' initiative [antiretroviral (ARV) therapy for all in need by 2005] is far from reaching its target. Apart from the reduction in morbidity and mortality due to antiretroviral (ARV) therapy, proven effective interventions for reproductive health include consistent condom use, voluntary counselling and testing, promoting earlier treatment and adhesion to preventative measures, and the use of ARV therapy, Caesarean section and bottle-feeding to reduce vertical transmission. The effectiveness of control of sexually transmitted infection is dependent on the maturity of the AIDS epidemic, but is an essential intervention due to other serious consequences for sexual and reproductive health. Male circumcision is a polemic preventive measure under debate, and microbicide products, a promising women-controlled method, are still undergoing efficacy trials. A reasonably organized and accessible health sector, the involvement of males in reproductive health debate and a gender-sensitive, rights-based political agenda, with ample participation of communities, are necessary for reproductive health interventions to move from proved efficacy to necessary effectiveness, putting evidence into practice.

Acquired Immunodeficiency Syndrome↗

IPPF Charter on Sexual and Reproductive Rights. International Planned Parenthood Federation.

For most of human existence and in most societies, women have been considered to be property and subject to men. Throughout history, with such notable exceptions as Queen Boadicea, Eleanor of Aquitaine, Elizabeth I of England, and Catherine the Great of Russia, women had little or no power until early in the 20th century when the women's suffrage movement was successful in the United States and in some European countries. As women have gained political rights, groups of women have sought sexual and reproductive rights, as exemplified by the feminist movement of the past few decades in the United States. Although marked strides toward achievement of reproductive choice have been taken in high-income countries, there remain major strictures to reproductive freedom for women in low-income countries. This area, which is replete with ethical and moral issues, has been addressed by the International Planned Parenthood Foundation (IPPF), which has worked to improve the sexual and reproductive health of women throughout the world. The IPPF Charter on Sexual and Reproductive Rights is a paradigm for both women's rights and human rights. Karen Newman is policy adviser with the IPPF and has codrafted the IPPF Charter on Sexual and Reproductive Rights together with two lawyers. She has held several positions within the IPPF, including medical researcher, press officer, and programme adviser in Europe, where she had responsibility for working with new family planning associations (FPAs) in the Czech Republic and Slovakia. At present, she is working to increase the capacity of IPPF member FPAs to undertake human rights-based advocacy for sexual and reproductive health and rights. Judith F. Helzner is director of Sexual and Reproductive Health at International Planned Parenthood Federation/Western Hemisphere Region, Inc., where she has worked since 1987. She holds M.A. degrees from the University of Pennsylvania in International Relations and Demography. Her previous employment includes the Pathfinder Fund and the International Women's Health Coalition.

Family Planning Services↗

Integrating sexual and reproductive rights into the medical curriculum.

All individuals and couples are entitled to enjoy reproductive rights, which are guaranteed through human rights that are already recognized in national laws, international human rights documents and other consensus documents. Indeed, they are essential for the attainment of the goal of the International Conference on Population and Development Goal of universal access to reproductive health through the primary healthcare system by 2015. However, reproductive rights are usually absent from the undergraduate curriculum in medical schools. This chapter examines the components that should be included in the curriculum, and ways in which reproductive rights can be integrated into medical education.

Curriculum↗

Reproductive rights in Hungarian law: a new right to assisted procreation?

Hungary has a mixed record in terms of fulfilling reproductive rights as a whole, but in the context of artificially assisted procreation, it provides reproductive health services far beyond those offered by its neighbors, beyond what is stipulated by the ICPD Programme of Action, and, arguably, beyond the internationally accepted parameters of reproductive rights. Recent legislation on assisted procreation has established important new regulations and formulated a new "right to continuation of infertility treatment" applicable to women who have been widowed or divorced. The new legislation is examined in the context of the international reproductive rights movement, with comparisons to other European countries and with reference to Hungarian attitudes and laws on abortion and surrogacy.

Abortion, Legal↗

What is the relevance of women's sexual and reproductive rights to the practising obstetrician/gynaecologist?

Women's sexual and reproductive rights are an integral part of daily practice for obstetricians/gynaecologists and the key to the survival and health of women around the world. Women's sexual and reproductive health is often compromised because of infringements of their basic human rights, not the lack of medical knowledge. Understanding the relevance of respecting and promoting sexual and reproductive rights is critical for providing current standards of care, and includes access to information and care, confidentiality, informed consent and evidence-based practice. The violation of women's rights in their daily lives through common problems such as gender-based violence and discrimination results in serious consequences for their health. Obstetricians/gynaecologists are natural advocates for women's health, yet may be lacking in their understanding of relevant laws or the limits of conscientious objection. This chapter outlines the framework for sexual and reproductive rights, and explores its relevance to the practising clinician.

Attitude of Health Personnel↗

The FIGO study group on women's sexual and reproductive rights. International Federation of Gynecology and Obstetrics.

In October 1998, the FIGO Executive Board established a Study Group on Women's Sexual and Reproductive Rights to develop specific details regarding observance, enforcement and advancement. At its inaugural meeting in April 1999 the Study Group reviewed international and national progress in respect of such rights. International initiatives had achieved considerable progress towards specification and monitoring of rights, particularly through the committee receiving reports of national compliance under the Convention on the Elimination of All Forms of Discrimination Against Women. National progress was more mixed. While some countries had improved women's sexual and reproductive rights, many had not, and rights in some had regressed. The Study Group considered actions available to FIGO member societies to advance rights in their countries, how advancement of rights might be pursued in countries in general, and initiatives that FIGO itself might undertake and facilitate to protect and promote women's sexual and reproductive rights.

Female↗

[Breast feeding: instinctive? Natural? The biological paragon X the reproductive rights in debate].

The objective of this essay was to reflect about the naturalization of the breastfeeding, inserting the field of the breastfeeding in the range of the women rights, seeking to destroy the paragon that biologizes the female body to the maternal functions, in special to the breastfeeding in the range of the reproductive rights. In discussion we protrude the importance of the actions which estimulate the breastfeeding are embrased in the notion of the reproductives rights, which will allow the health professionals to comprehend the meaning of the breastfeeding in the women's mark of life and their everyday. By the end, we propose that the reproductive rights drive the actions of breastfeeding incentive developed by the health professionals, in the perspective of to redeem the view of the women while the main subject of this practice.

Breast Feeding↗

Assisted reproduction and reproductive rights: the case of in vitro fertilization.

In vitro fertilization (IVF) and other assisted reproduction technologies (ARTs) have become widely accepted as therapy for a wide array of fertility problems and accompanied by the rapid expansion of clinics that provide full range of ARTs. Although these technologies undoubtedly offer benefits for some individuals, they raise important questions over reproductive rights to safe and effective treatment as well as access. This article analyzes current data concerning the safety, effectiveness, and cost of IVF. It concludes that IVF and related techniques have been transformed too rapidly and easily from experimental to therapy status, despite evidence that suggests considerable caution is warranted. Unfortunately, the widespread diffusion of IVF has preceded rather than followed firm evidence of its value in extending the reproductive rights of women and couples. Resources might better be directed toward prevention of fertility problems and discovering the causes of infertility.

Cost-Benefit Analysis↗

An assessment of the awareness of sexual and reproductive rights among adolescents in south western Nigeria.

This study, conducted in Ikeja and Ikorodu Local Government Areas of Lagos State, examined the awareness of sexual and reproductive rights among adolescents in south-western Nigeria. A total of 600 in-school and out-of-school adolescents were interviewed using quantitative and qualitative methods. The study revealed that majority of the adolescents were aware of sexual and reproductive health rights (60.3% in Ikeja LGA and 62.3% in Ikorodu LGA) but lacked knowledge of contents of the rights. Majority of them in various categories (by school condition and type of settlement) were not aware of sexual and reproductive health programmes being implemented for adolescents. In addition, those who were aware of such intervention programmes could not access or use the services due to certain sociocultural barriers. The study recommends formulation of appropriate intervention strategies and programmes for adolescents so that they may be aware and knowledgeable of their sexual and reproductive rights.

Adolescent↗

Sexual but not reproductive: exploring the junction and disjunction of sexual and reproductive rights.

Although the term "sexual rights" has gained widespread currency, its concrete scope and content have not yet been fully defined. The need for definition is critical not only for promoting governmental accountability but also for ensuring that sexual rights can be claimed by diverse persons around the world. Ironically, the concept of "sexual and reproductive rights" poses a challenge to this effort; practices and people not traditionally addressed by reproductive rights work must be explicitly named and protected. This article considers how international norms have contributed to a gendered regulation of sexuality and of contemporary theories of "socially constructed sexuality," and it proposes a focus on the conditions that contribute to the ability to choose and on the links between sexuality, conduct, identity, social structures, and reproduction. Given the probable politically charged responses, global coalition-building is needed.

Human Rights↗

[Reproductive rights of women and men in light of new legislation on voluntary sterilization in Brazil].

This paper aims to analyze the impacts and possible changes that the implementation of a new Brazilian family planning law has on reproductive practices, especially voluntary sterilization, and to determine whether men's and women's reproductive rights are being respected. The methodological approach is based on a six-month follow-up survey taken monthly, applied to a sample of 159 individuals in six contextually different State capitals. Besides verifying whether the health sector is complying with the criteria set by the law, we analyze the waiting time between the request for sterilization and the surgery itself, utilizing survival analysis. We also conduct interviews with health professionals, shedding light on the procedures adopted in the practice of sterilization. For various reasons, the law has produced little change in the usual practice of sterilization, besides failing to satisfy individual reproductive rights.

Brazil↗