From Taboo to Transformative: A call to action to recognize proper sexual and reproductive health as a human right

By Camille Rich, Key Correspondent for the Irish Global Health Network

Sex. Condoms. Genitals. Abortion.

Words like these describing aspects of sexual health often make people feel uncomfortable or awkward. Across many cultures, reproductive health is considered an incredibly private matter or thought not to be discussed. This taboo allows reproductive issues and inequalities to be silently perpetuated in health systems arounds the world, disproportionately and negatively impacting women. However, our speakers during the Sexual Reproductive Health and Rights panel at the 2019 Global Health Exchange, advocated that despite this stigma, we can no longer ignore issues surrounding sexual health since it is a critical part to well-being.

Women have always faced difficulties in accessing reproductive health services for a multitude of reasons: restrictive policies, cultural differences, sexist or misogynistic values, gender roles, structural barriers and poor access to medical facilities. Yet today, our five speakers demanded change to reform these negative norms. Our speakers brought sexual health to the forefront of global health through their unique experiences in order for sexual health to be recognized as a human right.

The panel began with Dr. Cliona Loughnane, the Women’s Health Coordinator at the Women’s Council of Ireland. Taking the audience through a brief history of the challenges for women’s health in Ireland, she explained how we must be cognizant of our past in order to learn from it and change the the future for women’s reproductive health. However, all too often, women are left out of the very conversations and decisions that directly impact them. Dr. Loughnane implored us to “radically listen” to women, to develop programs and practices that are specifically designed to give women the care they need.

“We must recognize that women are the experts about their own health experiences” – Dr. Cliona Loughnane

Dr. Tochukwu Igboanugo from University College Cork also urged for women to be included in the conversation about reproductive health. During his time as a doctor in Nigeria, he became frustrated by the lack of reproductive care given to women, discrimination towards female refugees, and the tight restrictions on important procedures, including abortion. To make matters worse he was reprimanded in his workplace for speaking out on behalf of his female patients by the hospital removing his shifts. Therefore, he called for a complete overhaul of the way we think about and treat sexual health, to allow doctors to do their job, preserve fundamental reproductive rights through policy changes, and increase the quality of care for women.

Female genital mutilation (FGM) is a devastating and complex issue in reproductive that Gill Carter from Maastricht University focused her global health research on. Due to its deep cultural and historical roots, health officials have found ending FGM a complicated and difficult task. Ms. Carter spoke about a new approach to ending FGM through “alternative rites of passage” (ARP) in Tanzania. The concept of ARP is to keep the traditions and ceremonies surrounding FGM intact, yet without the actual cutting of the girl’s genitals. Since previous methods of eliminating or outlawing FGM have not been entirely successful, she and her team have found that ARP has worked better since it incorporates the community’s long-held traditions into the solution.

“This works with culture instead of against it” – Gill Carter

Ms. Carter experienced first-hand how local culture plays a critical role in the protection of women’s reproductive health. Two of our other speakers, Adele Fox (National Health Coordinator, Concern Worldwide) and Marie Hallissey (Global Health Advisor, GOAL), both investigated just how much culture and community values affected pregnancy and contraception in Sierra Leone. Adolescent pregnancy is as high as 30% in Sierra Leone and over 20% of those young mothers die during childbirth. These alarming numbers caused these two researchers to investigate where the gaps are in reproductive health for these girls.

During her investigation, Ms. Hallissey found that community ideas around women were often very sexist and held double standards for women engaging in reproductive care. Contraception use was viewed as “promiscuous” for women, leading to high pregnancy rates and gendered expectations of maturity pressured young girls into sex early on. Ms. Hallissey explained that men often use their positions of power to force women into having sex with them through means of extortion.

“Water resources were controlled by men who demanded sex from girls in order to get access to water” – Marie Hallissey

Ms. Fox also noted these damaging societal norms towards women’s reproductive health in Sierra Leone, with a focus on how to combat these issues. She shared her team’s approach to changing these cultural attitudes through a socio-ecological approach at the individual, community and structural levels. Ms. Fox developed a series of classes and programs including a life skills curriculum, community conversation session, parent and husband outreach workshops, campaigns to advocate for gender equality and additional training for adolescent friendly health care services. She found that these interventions at the ground level were successful in changing mindset towards reproductive health and shifting cultural expectations of care and support.

Ms. Fox credits a lot of her success to building trust with the community. This trust stemmed from listening and incorporating the community into the program she was creating, instead of purely implementing it from the outside. This was a common theme amongst all the speakers, that the women and the community need to be the fundamental players in the fight to change female reproductive health. Listening to their experiences, taking note of their needs and allowing them to be part of the decision-making is the first step in bringing equality to women

for reproductive and sexual health. This transforms what was previous believed to be a taboo subject, into an important issue that can be tackled in solidarity with women across the world.

The session’s speakers each had unique backgrounds and experiences, however all agreed on the principle that working hand in hand with the women of local communities is the key to making the world see women’s reproductive health as a human right. In the words of our final speaker Dr. Igboanugo:

“Any inequality encountered by any individual in accessing sexual and reproductive healthcare services is a deprivation of their fundamental right to good health”. – Dr. Tochukwu Igboanugo

22 September 2019