Challenges to integrating sexual health issues into reproductive health programs in Uzbekistan

This study examines the direction and result of efforts of nongovernmental organizations (NGOs) in the area of reproductive and sexual health in Uzbekistan. It focuses specifically on the institutional, structural, epidemiological, and cultural forces responsible for the exclusion of sexual health issues from reproductive health campaigns in the most populous Central Asian country. In Uzbekistan, as in other countries of the region, significant international support was given to NGOs providing reproductive health services in the mid-to-late-1990s, well into the early period of the HIV/AIDS pandemic and after the 1994 mandate of the International Conference on Population and Development for the inclusion of sexual health as a key reproductive health component. Examining the exclusion of sexual health issues from reproductive health campaigns in Uzbekistan highlights problems relating to time lags in program and evaluative development and the difficulties NGOs experienced in balancing donor-state agendas with recipient-state priorities. Findings question standard assumptions regarding the advantageous structural aspects of NGOs, in terms of flexibility, responsive agenda generation, and state independence.     

Reproductive health awareness: an integrated approach to obtaining a high quality of health

The Georgetown University Institute for Reproductive Health has evolved a multi-dimensional approach to reproductive health education which has grown from their work in natural family planning and fertility awareness. This cohesive approach offers help to community, educational, and health organizations in providing knowledge and skills development in body/self-care, gender awareness, sexuality, and interpersonal communications.     

Implementing reproductive health awareness: progress to date

This paper describes the experience of various institutions in integrating a reproductive health awareness (RHA) approach into different health, school and community-based programs. RHA, an educational approach that evolved from the Institute's client empowerment approach to natural family planning and fertility awareness, is based on helping women and men to participate actively in their own family planning and reproductive health care by developing skills in self-observation, communication and self-advocacy. In addition to providing the Institute with an avenue for responding to the Cairo and Beijing mandates, RHA has also provided a means to introduce family planning, particularly natural methods of family planning, into programs and institutions. RHA has continued to evolve and strengthen during the process of field testing its contributions to existing reproductive health programs.     

Progress on scaling up integrated services for sexual and reproductive health and HIV

This paper considers new developments to strengthen sexual and reproductive health and HIV linkages and discusses factors that continue to impede progress. It is based on a previous review undertaken for the United Kingdom Department for International Development in 2006 that examined the constraints and opportunities to scaling up these linkages. We argue that, despite growing evidence that linking sexual and reproductive health and HIV is feasible and beneficial, few countries have achieved significant scale-up of integrated service provision. A lack of common understanding of terminology and clear technical operational guidance, and separate policy, institutional and financing processes continue to represent significant constraints. We draw on experience with tuberculosis and HIV integration to highlight some lessons. The paper concludes that there is little evidence to determine whether funding for health systems is strengthening linkages and we make several recommendations to maximize opportunities represented by recent developments.     

性健康与生殖健康的关系

随着经济和社会的不断发展以及人们对健康需求的普遍提高,作为健康重要组成部分的性健康和生殖健康已受到广泛关注.性健康是生殖健康的基石,不仅关系着当代人的健康,也影响着下一代人的健康.而随着性领域出现的如多性伴、未保护性、不洁性、性功能障碍及有关性别和性行为的暴力等相关问题的日益凸显,更导致相关的生殖健康问题愈加严重,为了让人们深入地了解性健康与生殖健康的关系,加强对性健康的重视,更好地满足人们对性及生殖方面的健康需求,该文分析了近年来有关性健康与生殖健康的文献,总结当前性健康及生殖健康问题出现的新趋势,为改善性健康与生殖健康状况提供理论基础.     

流动人口性与生殖健康综合咨询框架及案例剖析

该文阐述了性与生殖健康综合咨询的瑞迪(REDI)框架,介绍了流动人口性与生殖健康咨询的案例及剖析,为今后开展流动人口性与生殖健康服务提供参考。     

Commentary on sexual and reproductive health

Conclusion The ultimate aim of sexual and reproductive research of disabled women is moving from the medical management of fertility prevention to attention to sexual pleasure and response, safe reproductive choices, safe pregnancy, labor, and delivery, and the ability to form healthy and loving relationships, healthy sexual identities, and a rich sexual culture within the disability community. The success of the research will depend on the influences of two factors. First, disabled women must define their own life problems. Here is where initial interviewing studies can be a rich source of research ideas. Understanding the realities of disabled women's lives depends on the investigator's viewing disabled women as the experts, viewing disabled women as a unique group, and not positioning nondisabled women as the standard of measurement. The second influence is to ensure that disabled women have access to knowledge and play a role in designing interventions that will enable them to protect their own health and safety. In the deepest sense, research will be successful when the life of a disabled woman is no longer expendable; when harmful contraceptives are replaced by those that are in harmony with her body; when obstetricians learn safe vaginal delivery techniques; when sexual violence is not an inevitable hazard of being both disabled and female; when disabled lesbians no longer live a furtive life, having fallen in a crack between the lesbian and disability communities; and when disabled girls grow up with the confidence that they have a positive sexual future.     

Sexual and physical abuse: a threat to reproductive and sexual health

According to the cross-cultural data, violence has two fundamental certainties: 1) that the overwhelming majority of perpetrators are men; and 2) that the targets are usually women. Sexual and physical abuse subsume a wide variety of violent behaviors, some of which are legally recognized as criminal acts. Evidence indicates that the most invisible of all is child sexual abuse, in which nonreporting of crime is prevalent. Although there appears to be no simplistic response to the question as to why men are violent towards women, it is noted that it involves several contributing factors. These include inequalities between women and men at the societal level, and cultural norms and expectations about behaviors of women and men at another level. In terms of the identity of the perpetrators, research has found that a large majority of perpetrators are socialized for violence. The effects of violence on the sexual and reproductive health of the victim are multiple and long lasting. For example, physical consequences of rape include sexually transmitted diseases and HIV infection, as well as unwanted pregnancy, miscarriage, unsafe abortion, homicide, and suicide. With respect to the psychological consequences, the most common symptoms are anxiety, depression, sexual dysfunction, and difficulties with interpersonal relationships. In view of this, there is a need for a long-term management of victims of sexual abuse.     

Gender,sexual health and reproductive health promotion

The underlying factors of poverty, migration, marginalization, lack of information and skills, disempowerment, and poor access to services which affect HIV/STD risk are also closely related to those which affect sexual and reproductive health. Reproductive health problems include unplanned and unwanted pregnancies, unsafe abortions, pregnancy-related illness and death, and STDs including HIV/AIDS. This interrelationship between factors is leading increasingly to the integration of HIV/STD education and prevention within the broader framework of sexual and reproductive health promotion. Such intervention allows the possible reinforcement of the impact of interventions upon important underlying factors and behaviors linked to individual, family, and community vulnerability to HIV/STDs as well as other reproductive health problems. Integration will also optimize the use of increasingly scarce resources and increase the likelihood of responses, interventions, and programs being sustainable. Sexual and reproductive health, placing HIV/STD prevention into context, and focus upon men are discussed.     

Body/self awareness and interpersonal communications: fundamental components of reproductive health awareness

To protect and advocate for their own reproductive health, people of all ages can greatly benefit from enhanced body/self awareness and strong interpersonal communication skills. Body/self awareness and interpersonal communications, along with gender awareness and the integration of sexuality, are the fundamental components of a new approach to obtaining high quality health called reproductive health awareness.     

Changing behavior: a challenge for reproductive health awareness

Social marketing applies commercial sector ideas to programs to change behavior. It involves a mindset that is customer-focused; a process that starts with customers and continually returns to them for validation; and concepts to make change happen. Customer behavior models guide strategy. One useful model is based on stages of change and four behavioral influences: perceived benefits, perceived costs, the influence of others, and perceived behavioral control.     

Factors to be considered in integrated programs for young children: A review

The following paper outlines the elements to be considered in the process of integration in preschool, day care, and early school programs. This review of research focuses, in particular, on the attitudes and behaviours of teachers and the opinions and concerns of parents involved in the process. The authors contend that the roles of the teacher and the parents of all children must be considered for a successful integration experience.     

江苏省某卫生职业学校学生性与生殖健康知识认知情况调查

目的了解卫生职业学校在校生对性与生殖健康知识的认知情况、知识来源渠道以及性观念和性态度,为学校加强在校生性与生殖健康教育提供理论和实践依据。方法采用整群抽样的方法,对江苏联合职业技术学院淮阴卫生分院1 400名在校学生进行调查,使用SPSS 15.0统计软件对问卷结果进行统计处理和分析。结果不同年级的学生对性与生殖健康知识得分为（10.74±6.21）-（16.86±6.36）,掌握程度差异有统计学意义（P〈0.01）;但不同专业的学生掌握程度的差异无统计学意义（P〉0.05）;不同性别和生源地的学生在性态度和性观念方面差异都有统计学意义（P〈0.01）。结论高职院校的学生的性与生殖健康知识的现状不容乐观,性态度较开放,对性知识的需求较大。