Preventive work for men’s sexual and reproductive health and rights within primary care

In everybody’s interest but no one’s assigned responsibility: midwives’ thoughts and experiences of preventive work for men’s sexual and reproductive health and rights within primary care

Abstract

Background

Sexual and reproductive health and rights (SRHR) have historically been regarded as a woman’s issue. It is likely that these gender norms also hinder health care providers from perceiving boys and men as health care recipients, especially within the area of SRHR. The aim of this study was to explore midwives’ thoughts and experiences regarding preventive work for men’s sexual and reproductive health and rights in the primary care setting.

Methods

An exploratory qualitative study. Five focus group interviews, including 4–5 participants in each group, were conducted with 22 midwives aged 31–64, who worked with reproductive, perinatal and sexual health within primary care. Data were analysed by latent content analysis.

Results

One overall theme emerged, in everybody’s interest, but no one’s assigned responsibility, and three sub-themes: (i) organisational aspects create obstacles, (ii) mixed views on the midwife’s role and responsibility, and (iii) beliefs about men and women: same, but different.

Conclusions

Midwives believed that preventive work for men’s sexual and reproductive health and rights was in everybody’s interest, but no one’s assigned responsibility. To improve men’s access to sexual and reproductive health care, actions are needed from the state, the health care system and health care providers.

Prostitution and sex work: nature and prevalence in England and Wales (report)

University of Bristol, commissioned by the Home Office and the Office of the South Wales Police and Crime Commissioner, October 2019

The University of Bristol was commissioned by the Home Office and the Office of the South Wales Police and Crime Commissioner to look in to the current ‘nature’ and ‘prevalence’ of prostitution in England and Wales, involving adults aged 18 or over. The research was carried out between May 2018 and June 2019.  We were not asked to report on policy or law.  Drawing on the literature and initial findings, we used the following definition:

Prostitution and/or sex work constitutes the provision of sexual or erotic acts or sexual intimacy in exchange for payment or other benefit or need.

Following a systematic search of the existing national and international evidence base, including a review of previous prevalence studies, we sought views, data and personal experiences through a 6-month public online survey, yielding almost 1200 often detailed responses with over 500 from those currently or formerly involved in selling sexual services.  We also worked through NGOs and support services to identify individuals unlikely to respond to online surveys. We completed follow up in-depth email interviews with 42 individuals.  We invited 155 organisations, collectives and individuals to consult on our draft finding at four regional meetings in early 2019.

Given methodological and ethical constraints, we recognise two groups whose voices are under-represented or absent within this report: (1) Migrant sex workers; (2) British and non-British individuals who are/were forcibly coerced, who are/were trafficked, who are/were sexually exploited and/or who are traumatised in relation to their experience.

In terms of ‘prevalence’, currently in England and Wales there is no source of data which allows for the production of representative population estimates for this group.  Stigma, the private and hidden nature of the sex industry, complex engagement patterns and definitions of activities mean that estimating prevalence is challenging.  Producing an accurate estimate would require studies to follow the guidance and recommendations on data collection jointly produced by the UNAIDS and World Health Organisation (WHO) (2010) and/or to use statistically representative samples.  Focused and small-scale prevalence studies are also more likely to be accurate.  The report provides guidance on such work.

In terms of ‘nature’, overall, we found that the way that sex is sold in England and Wales today is both complex and diverse.  It is common for individuals to move between settings and services, for safety or to maintain income, and to engage full-time, part-time (sometimes alongside other paid work or study), intermittently or casually.  Looking across our data, we identified and structured our commentary around the following:

Cross-cutting themes

Identifying sex work, identifying as a sex worker

·         Social identities, inequalities and routes in

·         Patterns of engagement and moving between settings/services

·         Advertising, payment and third parties

·         Risk, harm and managing safety

·         Buyers and buying

 Settings and services

·         Bar-based sex work and hostess bars

·         BDSM, kink and fetish

·         Brothels, parlours, saunas

·         Erotic and exotic dance

·         Erotic massage

·         Escort: independent

·         Escort: agency

·         Pornography, glamour, erotica

·         Sex parties

·         Street and outdoor sex work

·         Sugar arrangements

·         Telephone, text-based, TV-based, live voyeurism

·         Therapeutic services

·         Webcamming

Individuals selling sex in England and Wales today are varied in terms of demographics and motivation. At the same time, there are recurrent patterns of experience or identity that mark some individuals’ entry into the sex industry and/or the type of setting, service or the conditions in which they work.

We found that a substantial proportion of individuals (mainly women and trans women) are selling sex to get by financially, given different constraints in their lives around caring responsibilities, physical and mental health, lack of access to social security benefits and support services, workplace discrimination, or other reasons.  Their situation is compounded by stigma and managing safety, and many find that the longer they sell sex, the harder it can be to leave completely.  This moves beyond individual ‘choosing or ‘not choosing’ and recognises the structural economic and social context in which choices are narrowed: or in the case of those coerced in to selling sex, choices removed.

Intersex Peer Support Australia launches

Intersex Peer Support Australia (IPSA), 25th October 2019

On the eve of Intersex Awareness Day, an internationally observed awareness day designed to highlight human rights issues faced by intersex people, and observed on 26 October each year, one of the oldest intersex groups in the world is launching a new name, branding and website.

Intersex Peer Support Australia (IPSA) will carry on the important work of the 1985-founded Androgen Insensitivity Syndrome Support Group Australia (AISSGA), which for more than three decades has been dedicated to assisting people born with variations in sex characteristics and their families, providing Australia-wide peer support, information and advocacy.

Elise Nyhuis, President of IPSA said, “The new identity will make us more visible to government agencies and support funders, and is more inclusive of the more than 40 known intersex variations, our diverse community and their families.”

“Our organisation advocates for and provides peer support to its members and the wider intersex community, focusing on the lived experience of having intersex bodies that physically differ from stereotypical, medical notions of male and female.

“The intersex community in Australia is strong and growing as people come out of hiding to stand together in the face of continued challenges from medicalisation, stigma and discrimination, shame, mental health issues, social inclusion, access to affirmative healthcare, parenting and human rights protection from medically unnecessary medical interventions on intersex children.

“Beyond our core work of providing intersex peer support, IPSA advocates for intersex issues through educating service providers, liaising with medical professionals, conducting policy review and consulting with government and NGOs, as well as by building community through coordinating opportunities and events for people with intersex variations to meet and share knowledge and experiences.

“The updated IPSA website will be a great resource for the whole community to learn more about the ‘I’ in the LGBTIQ acronym, while our membership will have access to a range of online extras through password-secured access,” said Elise.

Hidden Forces: Shining a light on Reproductive Coercion (White Paper)

Marie Stopes Australia, 2018

Reproductive Coercion (RC) is behaviour that interferes with the autonomy of a person to make decisions about their reproductive health. Many Australians do not have full control over their reproductive choices. Their choices are constrained by people in their familial and community networks or by structural forces at play in our society.

Reproductive Coercion is gaining greater attention in Australia. Brave people are coming forward to share stories of their lived experience of Reproductive Coercion in order to build greater understanding of this important issue and how it has shaped their lives.

For twenty months, Marie Stopes Australia coordinated a public consultation process that has culminated in this White Paper on Reproductive Coercion. This White Paper has emerged following a roundtable of 50 stakeholders, two phases of public submissions, comment on a draft White Paper and targeted engagement of leading
academics, healthcare professionals and psychosocial specialists.

84 submissions that have informed the development of this White Paper. These submissions have provided a wide spectrum of views on this complex issue.

 

UNESCO paper busts myths about comprehensive sexuality education

UNESCO, 2019

Comprehensive sexuality education is an essential part of a good quality education that improves sexual and reproductive health, argues Facing the Facts, a new policy paper by the Global Education Monitoring (GEM) Report at UNESCO that seeks to dispel social and political resistance to sexuality education in many countries.

Globally, each year, 15 million girls marry before the age of 18, some 16 million 15-19 year olds and one million girls under 15 give birth. Young people moreover account for a third of new HIV infections among adults and across 37 low and middle-income countries, yet only approximately one third of people aged 15-24 years have comprehensive knowledge of HIV prevention and transmission.

Sexual health and its linkages to reproductive health: an operational approach

 World Health Organization, 2017

Sexual health and reproductive health are closely linked, but crucial aspects of sexual health can be overlooked when grouped under or together with the domain of reproductive health.

In order to create broader awareness of comprehensive sexual health interventions and to ensure that sexual health and reproductive health both receive full attention in programming (including provision of health services) and research, the World Health Organization (WHO) has reviewed its working definition of sexual health to create a framework for an operational approach to sexual health.

The framework, which is intended to support policy-makers and programme implementers and to provide a stronger foundation for further research and learning in sexual health, is presented and described in full in this brief.