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Efforts to define a new post-2015 development agenda are advancing, with consultations, meetings and reports proliferating. The aim – to articulate a goal for health that includes comprehensive sexual and reproductive health and rights, and another for gender equality – needs to avoid the limitations of the MDGs and broaden the remit of responsibility and global commitment. The papers here start from the contribution of the ICPD Programme of Action 1994 and critique the Millennium Development Goals, their targets and indicators, their intended and unintended consequences, and limited definitions of accountability for taking the agenda forward. A number of papers contain country case studies that analyse national policy, budgets, expenditure and external funding. Several expose the disconnect between international agreements and country-level realities. Still others look at current and alternative development paradigms for supporting gender equality and the right to health, and sexual and reproductive health and rights within them. Using words like “transformational”, they demand a better world.
The overarching messages of this journal issue are that adolescents and young people want and need information and health care with a sex-positive approach to sex, sexuality, sexual health and relationships; those providing it need specialist training; and adolescent/youth leadership and involvement in policy and programmes are crucial. Papers cover using visual and social media; youth activism; peer support and networks; involving young people in formulating problems and solutions, running youth clubs and acting as providers of contraceptives and condoms. Papers are about sexuality education, adolescent pregnancy, abortion, sexual and gender norms, sexual violence and harassment, body image, sexuality and living with HIV, menstrual hygiene, self-efficacy and the evolving capacity of youth to take decisions about their lives, health and health care. Papers are from Australia, Bangladesh, Colombia, Guatemala, Ecuador, India, Indonesia, Mexico, Nicaragua, Rwanda, South Africa, Tanzania, Zambia, UK, USA. Young peer researchers participated in much of the research and a number of the articles were (co-)authored by young people too.
This journal issue is overflowing with diverse perspectives on a wide range of morbidities in 20 countries, north and south. A number of the papers focus on personal experiences, and command attention. The morbidities covered include lack of safety for childbirth during military assault; violence against disabled, lesbian and sex-working women; gynaecological cancers; infertility; discontinuation of contraception due to side effects; consequences of fistula following corrective surgery; health risks from the material used in breast implants; using female genital mutilation to cure reproductive tract infections; gonorrhoea becoming untreatable; the need for maternity protection for working mothers; a plethora of maternal morbidity; and unwanted fertility. This journal issue offers two important lessons: first, the extent and types or morbidity are overwhelming, especially when collected all in one place, yet data are even more limited than for causes of mortality. Second, sexual and reproductive morbidity of whatever kind and from whatever point of view are not a priority in a world with limited resources and where mortality remains high. This must change.
With the advent of antiretroviral therapy and with continued channelling of resources into HIV services, greater numbers of HIV-positive women are living longer, healthier lives. As a result, they are contending with a range of issues affecting their sexual and reproductive health and rights. This supplement aims to determine ways to work across disciplines and life experiences with the ultimate goal of ensuring that women living with HIV are at the centre of decision-making about their sexual and reproductive health and rights.
The supplement responds to an identified need for a stronger evidence base, drawing from biomedical, economic, political, legal and social science perspectives alike. It recognises the importance of moving beyond disciplinary silos to bring these perspectives together in order to provide more comprehensive information relevant to the lives of women and men living with HIV, as well as to create demand for appropriate services and policies.
The supplement grew out of a conference on HIV and pregnancy at the Harvard School of Public Health in March 2010, where it was noted that despite recent attention to the sexual and reproductive health concerns of HIV-positive women in some specific areas, the challenge remains to ensure the voices of HIV-positive women are heard and to address relevant issues from multidisciplinary perspectives.
We have included papers here that represent a diversity of topics, experiences, geographical areas and disciplines. Taken together these papers are intended to help drive policy, programmatic, research and advocacy efforts to promote and protect the sexual and reproductive health and rights of women living with HIV.
This journal issue contains papers which start from the premise that maternal deaths constitute a violation of the most basic human right of all - the right of women to life. They aren't only about women dying in vain, or that the poorest and the youngest women are still the ones dying the most. They are also about women and communities, women's health and human rights advocates, and health professionals, governments and inter-governmental agencies taking action. Maternal deaths are not just about delivery. They are also about miscarriage, stillbirths, near-misses, lifelong morbidity, and unsafe abortion deaths, and these must not become invisible. The papers in this issue show that on the ground, some countries are making serious efforts to improve health systems and services, and human resources, while in others, appalling, chaotic, uneven and negligent situations persist. Papers also explore new ways to support change, e.g., analysis of pregnancy registration, data collection and use, and assessment of budgets and expenditure. Authors don't just talk about what needs to be done, but describe what is being done to make change happen in Brazil, Haiti, India, Nigeria, Peru, Tanzania, and also regionally in Latin America, sub-Saharan Africa and south Asia.
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