Human rights, health and the state in Bangladesh

Background  

This paper broadly discusses the role of the State of Bangladesh in the context of the health system and human rights. The interrelation between human rights, health and development are well documented. The recognition of health as a fundamental right by WHO and subsequent approval of health as an instrument of welfare by the Universal Declaration of Human Rights (UDHR) and the International Covenant on Social, Economic and Cultural Rights (ICSECR) further enhances the idea. Moreover, human rights are also recognized as an expedient of human development. The state is entrusted to realize the rights enunciated in the ICSECR.     

Sexual and reproductive health and human rights of women living with HIV: a global community survey

Objective

To determine the sexual and reproductive health priorities of women living with human immunodeficiency virus (HIV) and to allow the values and preferences of such women to be considered in the development of new guidelines.

Methods

A core team created a global reference group of 14 women living with HIV and together they developed a global community online survey. The survey, which contained mandatory and optional questions, was based on an appreciative enquiry approach in which the life-cycle experiences of women living with HIV were investigated. The same set of questions was also used in focus group discussions led by the global reference group.

Findings

The study covered 945 women (832 in the survey and 113 in the focus groups) aged 15–72 years in 94 countries. Among the respondents to the optional survey questions, 89.0% (427/480) feared or had experienced gender-based violence, 56.7% (177/312) had had an unplanned pregnancy, 72.3% (227/314) had received advice on safe conception and 58.8% (489/832) had suffered poor mental health after they had discovered their HIV-positive status.

Conclusion

The sexual and reproductive health needs and rights of women living with HIV are complex and require a stronger response from the health sector. The online survey placed the voices of women living with HIV at the start of the development of new global guidelines. Although not possible in some contexts and populations, a similar approach would merit replication in the development of guidelines for many other health considerations.     

已婚育龄妇女生殖健康知识知晓现况及影响因素

目的了解已婚育龄妇女生殖健康知识掌握情况及其影响因素,为采取针对性干预措施提供参考依据。方法采用自行编制的调查问卷对2016年7月到潍坊市妇幼保健院就诊的728名已婚育龄妇女进行调查,在对生殖健康知识知晓情况描述性统计的基础上,对影响因素的分析采用秩和检验、单因素方差分析、逐步Logistic回归分析。结果生殖健康知识平均得分(28.02±6.21)分,其中月经期知识、孕产期知识掌握较好,但性病知识掌握不理想;影响因素分析发现,居住在农村(OR=0.617,P0.05,95%CI:0.408~0.932)、受教育程度低(OR=1.547,P0.01,95%CI:1.307~1.831)的妇女生殖健康知识认知情况不理想。结论已婚育龄妇女生殖健康知识有待于进一步提高,应针对性加大宣传力度。     

HIV and childbearing.1. Uncertain risks and bitter realities: the reproductive choices of HIV-infected women

Although most babies born to women with HIV will not develop AIDS, many health professionals and segments of the public object when these women will not forgo pregnancy. Such a view fails to consider fully the cultural, political, and socioeconomic contexts in which seropositive women make reproductive choices. HIV infection is only one of many conditions of chronic disease that can be passed from a woman to her fetus, and should not be singled out as a target for coercive policies. Rather, government and society have an obligation to empower women to protect themselves against HIV infection in the first place, and to offer them options for self-esteem and achievement independent of reproduction.     

已婚育龄女性生殖健康知识、态度及行为量表编制

目的编制已婚育龄女性生殖健康知识、态度及行为量表,为提高已婚育龄女性生殖健康水平提供参考依据。方法采用查阅文献、半结构式访谈、专家咨询等主观方法构建已婚育龄女性生殖健康知识、态度及行为初始问卷,选用离散趋势法、频数分布法、相关系数法、因子分析法等统计方法相结合进一步筛选条目,编制最终量表。结果在含有112个条目的初始问卷基础上,编制出含有3个分量表,即知识(22条目)、态度(24条目)、行为(14条目)共60个条目的已婚育龄女性生殖健康知识、态度及行为量表。结论采用主客观相结合的方法编制出的量表更加准确可靠。     

Human rights and political crisis in Brazil: Public health impacts and challenges

In 31 August 2016, Brazilian president Dilma Rousseff was impeached and replaced by her vice president Michel Temer. Herein, we examine how the conservative agenda of Mr Temer and his supporters is influencing key decisions in the human rights and public health arena in Brazil. The government’s austerity agenda includes severe cuts in critical areas such as health, education and science, jeopardising well-known strategies such as the Brazilian Public Health System (SUS) and nationwide cash transfer program, ‘Bolsa Familia’ – both benefited millions and were the largest of their kind in the world. Mr Temer’s decisions show not only severe cuts in critical areas but also a political agenda that clearly demonstrates a broad shift away from the progressivism and social agenda presented and supported by its predecessors. Most vulnerable groups such as the LGBTQ community, women, people who use drugs and disenfranchised communities have been severely affected. Mr Temer’s administration is putting Brazil far from its once nationwide goal to foster free and universal health care access and social equity for all its citizens. The near future for Brazil is unknown, but both national and international communities anticipate severe problems within the national human rights arena, if nothing changes.

Abbreviations: CCT: Conditional Cash Transfer; LGBTQ: Lesbian, Gay, Bisexual, Transgender and Queer (and/or Questioning); SUS: Brazilian Public Health System     

已婚育龄妇女生殖健康知识、态度及行为量表评价

目的评价已婚育龄妇女知识、态度及行为量表的信效度,为研究已婚育龄妇女生殖健康提供有效的测评工具。方法采用Cronbach'sα、分半信度系数分别评价量表的内部一致性信度、分半信度;采用Pearson相关系数评价量表的内容效度,探索性因子分析和结构方程模型结合评价量表的结构效度。结果态度、行为2个分量表的Cronbach'sα系数分别为0.874、0.638;分半信度系数分别为0.860、0.643;2个分量表与各自所含维度的Pearson相关系数分别为0.497~0.828、0.304~0.866,差异均有统计学意义(P0.05);经探索性因子分析和结构方程模型分析,多数模型适配度指标(χ~2/df=2.16,RMSEA=0.04,GFI=0.96,AGFI=0.96,CFI=0.9680.90,NFI=0.9420.90,IFI=0.9680.90)表明量表结构效度较为理想。结论该量表具有较好的信度、效度,可以作为已婚育龄妇女生殖健康知识、态度及行为评价工具。     

Sexual and reproductive rights: challenges for health policies

This article discusses sexual and reproductive rights in the sense of a stance that assumes a perspective of transformations in social relations, the struggle against prejudices, the guarantee of well-being, and finally the relationship between sexuality, reproduction, and citizenship. The article then proceeds to reflect on health policy challenges in these fields, emphasizing such issues as: guaranteed resources, quality and quantity of health services in response to demands by the population, and cultural changes that produce a new view of the relationship between health professionals and health system clients, based on the principles of citizenship: recognition others as entitled to freedom and equality.     

城市已婚妇女生殖健康状况调查与分析

目的:调查城市已婚妇女生殖健康状况及影响因素。方法:对连云港市5 078例体检妇女进行问卷调查、妇科检查、乳腺检查和有关实验室检查。结果:5 078例妇女妇科病检出率为44.3%,宫颈炎发生率为29.7%,盆腔炎发生率为18.3%,阴道炎发生率为27.4%;≤35岁妇女感染率最高(42.5%),差异有统计学意义(P<0.05),以后依次为36～45岁(24.7%)和>45岁(12.9%),≤35岁妇女宫颈炎、阴道炎、盆腔炎的患病率明显高于36～45岁及>45岁妇女;工人、个体和商业人员中阴道炎、宫颈炎的发病率最高,机关干部中发现乳腺疾病的占16.1%,高于其他职业人员。结论:连云港市城市已婚妇女生殖道感染率较高,应积极开展生殖健康普查和普治工作,针对妇女生殖道感染的影响因素进行有效地预防和干预。     

Son preference and sterilisation use among young married women in two slums in Bengaluru city, India

This paper explores the ways in which women's sterilisation decisions are influenced by the combination of a preference for male children and a desire for smaller family size among young married women in two urban slums in Bengaluru, India. While both son preference and an emphasis on sterilisation are well-known demographic characteristics of most South Asian countries, relatively little research has been conducted that links the two. We take advantage of a longitudinal survey of 416 unsterilised married women aged 16-25 to explore how having sons and the number of children influence a woman's sterilisation decision. Discrete-time event history techniques are used to estimate two models: the first examines the effect of having sons and number of children separately, and the second examines them in combination in the form of an interaction. The results suggest sterilisation is motivated by son preference mainly at lower parities (three or fewer children) and by concerns about family size at higher parities. Understanding how sterilisation and other reproductive behaviours are influenced by the interaction of family size and sex preferences will help policy-makers and programmers to meet the needs of women while continuing to address discriminatory behaviour against females.     

Son preference and sterilisation use among young married women in two slums in Bengaluru city,India

Abstract

This paper explores the ways in which women's sterilisation decisions are influenced by the combination of a preference for male children and a desire for smaller family size among young married women in two urban slums in Bengaluru, India. While both son preference and an emphasis on sterilisation are well-known demographic characteristics of most South Asian countries, relatively little research has been conducted that links the two. We take advantage of a longitudinal survey of 416 unsterilised married women aged 16–25 to explore how having sons and the number of children influence a woman's sterilisation decision. Discrete-time event history techniques are used to estimate two models: the first examines the effect of having sons and number of children separately, and the second examines them in combination in the form of an interaction. The results suggest sterilisation is motivated by son preference mainly at lower parities (three or fewer children) and by concerns about family size at higher parities. Understanding how sterilisation and other reproductive behaviours are influenced by the interaction of family size and sex preferences will help policy-makers and programmers to meet the needs of women while continuing to address discriminatory behaviour against females.     

Sexual and reproductive health and rights of adolescent girls: Evidence from low- and middle-income countries

This paper reviews the evidence on sexual and reproductive health and rights (SRHR) of adolescent girls in low-income and middle-income countries (LMIC) in light of the policy and programme commitments made at the International Conference on Population and Development (ICPD), analyses progress since 1994, and maps challenges in and opportunities for protecting their health and human rights. Findings indicate that many countries have yet to make significant progress in delaying marriage and childbearing, reducing unintended childbearing, narrowing gender disparities that put girls at risk of poor SRH outcomes, expanding health awareness or enabling access to SRH services. While governments have reaffirmed many commitments, policy development and programme implementation fall far short of realising these commitments. Future success requires increased political will and engagement of young people in the formulation and implementation of policies and programmes, along with increased investments to deliver at scale comprehensive sexuality education, health services that are approachable and not judgemental, safe spaces programmes, especially for vulnerable girls, and programmes that engage families and communities. Stronger policy-making and programming also require expanding the evidence on adolescent health and rights in LMICs for both younger and older adolescents, boys and girls, and relating to a range of key health matters affecting adolescents.     

Paying for reproductive health services in Bangladesh: intersections between cost,quality and culture

In 1997 a consortium of non-governmental organizations (NGOs) in Bangladesh began to implement health sector reform measures intended to expand access to and improve the quality of family planning and other basic health services. The new service delivery model entails higher costs for clients and requires that they take greater initiative. Clients have to travel further to get certain services, and they have to pay more for them than they did under the previous door-to-door family planning model. This paper is based on findings from a qualitative study looking at client and community reactions to the programme changes. It examines a number of barriers to access and constraints to cost recovery, including gender, class and ideas about entitlements, the role of government and obligations among people. The NGOs want to maximize cost recovery while making the basic services they offer accessible to most people. The findings suggest that this requires more than the establishment of an appropriate pricing structure. Attitudes related to charging and paying for services must also change, along with the institutional policies and practices that support them.     

Study of unment need for family planning among married women of reproductive age in urban health central field practice area of Govt. Medical College, Aurangabad

A community based cross sectional study was carried out in married reproductive age group women in Urban Health Centre field practice area of Govt. Medical College, Aurangabad. The study aimed to find out extent and socio-demographic correlates of unmet need for family planning. 20.54% of married women in reproductive age had unmet need for contraception, 3.61% for spacing births and 16.93% for limiting births. The main reasons for unmet needwere, littie perceived risk of pregnancy due to perimenopausal age (32.471/o) lactation (31.16%), ignorance (12.32%) etc.     

Addressing the demographic imperative through health, empowerment, and rights: ICPD implementation in Bangladesh

It has been debated since the 1994 International Conference on Population and Development (ICPD) whether the ICPD program of action constitutes population policy. Opponents of the ICPD reproductive health approach argue that vertical family planning programs will be more cost-effective, while proponents counter that the reproductive health approach will be more cost-effective in meeting demographic goals. The program of action calls for social investments to be made by development agencies and budgets, not from family planning budgets. The roles of population professionals and agencies in the program are to conduct relevant research and advocate for broader policy change. The case of Bangladesh is examined. The following issues need to be researched in both Bangladesh and worldwide in order to support the implementation of the ICPD program of action: the situation of young people, the significance of sex and gender in reproductive and health-seeking behavior, the decision-making environment, and applied demographic research into the costs and benefits of reproductive health services. Professionals working in the field of population need to get involved in assessing and promoting changes in broader national development policies.     

Human rights, an opportunity for public policies in health

Human rights outlined a better scenario for public policies in health. For it requires intersectoral and interdisciplinary approach. This article emphasizes the perspective of public health policies based on human rights, clarifies the relationship of public policies with the exercise of human rights, beyond the right to health. It recognizes the need to implement genuinely democratic and participatory mechanisms. It considers the universal declaration of human rights and other institutional expressions about the same as the international covenant on economic, social and cultural rights, discusses the ranking of the same and defend its entirety on the determinants of health through its cohesion and political factor. It defines a framework for public health and human rights that trend by strengthening social rights, as a new area of operation, based on public policies to address the determinants of health, upholding social justice, beyond the health field and the biological and behavioural risk factors to decisions arising from political power, exceeds medical solutions and access to health services. In conclusion, it promoting respect for human rights by greater understanding of them and strengthens the importance of indirect health policies (such as food, environment and health, violence gender) and the role of international policies in the global world.