Comprehensive sex education

From Wikipedia, the free encyclopedia

 

Comprehensive sex education (CSE) is a sex education instruction method based on-curriculum that aims to give students the knowledge, attitudes, skills and values to make appropriate and healthy choices in their sexual lives. The intention is that this understanding will prevent students from contracting sexually transmitted infections in the future, including HIV and HPV. CSE is also designed with the intention of reducing unplanned and unwanted pregnancies, as well as lowering rates of domestic and sexual violence, thus contributing to a healthier society, both physically and mentally.

Comprehensive sex education ultimately promotes sexual abstinence as the safest sexual choice for young people. However, CSE curriculums and teachers are still committed to teaching students about topics connected to future sexual activity, such as age of consent, safe sex, contraception such as: birth control, abortion, and use of condoms. This also includes discussions which promote safe behaviors, such as communicating with partners and seeking testing for sexually transmitted infections. Additionally, comprehensive sex education curricula may include discussions surrounding pregnancy outcomes such as parenting, adoption, and abortion. The most widely agreed benefit of using comprehensive sex education over abstinence-only sex education is that CSE acknowledges the student population will be sexually active in their future. By acknowledging this, CSE can encourage students to plan ahead to make the healthiest possible sexual decisions. This ideology of arming students to most successfully survive their future sexual experiences underlies the majority of topics within CSE, including condoms, contraception, and refusal skills.

History

As of the year 2019, sex education in the United States is mandated on a state level. It is up to the different states, districts, and school boards to determine the implementation of federal policy and funds for sex education. 24 out of the 50 U.S. states and the District of Columbia mandate sex education and 34 states mandate HIV education. Where sex education is mandated, there is no federal policy requiring the instruction of comprehensive sex education.

In prior years under the Bush administration, there was strong support in congress by conservative republicans for the sanction of abstinence-only-until-marriage sex education. Under President Obama's administration, abstinence-only-until-marriage sex education was opposed and suggested to be eliminated. Now under President Trump's administration, federal agenda has reverted back to supporting an abstinence approach. The Centers for Disease Control and Prevention’s 2014 School Health Policies and Practices Study found that on average high school courses require 6.2 hours of taught class time on human sexuality, but only 4 hours or less on HIV, other sexually transmitted infections and pregnancy prevention.

Benefits

Studies have found that comprehensive sex education is more effective than receiving no instruction and/or those who receive abstinence-only instruction. Acknowledging that people may engage in premarital sex rather than ignoring it (which abstinence-only is often criticized for) allows educators to give the students the necessary information to safely navigate their future sexual lives.

CSE advocates argue that promoting abstinence without accompanied information regarding safe sex practices is a disregard of reality, and is ultimately putting the student at risk. For example, programs funded under AEGP are reviewed for compliance with the 8 standards (listed below in "Abstinence Education Grant Program (AGEP) Requirements), but are not screened for medical accuracy. Therefore, critics believe that students under these educational programs are put at a disadvantage because it prevents them from making informed choices about their sexual health. Additionally, under these AEGP programs, health educators have referred to those that engage in sex, especially females, as "dirty" and "used." They have also used phrases such as "stay like a new toothbrush, wrapped up and unused" and "chewed-up gum" to teach abstinence. Under a CSE model, language would be more sensitive. 

There is clear evidence that CSE has a positive impact on sexual and reproductive health (SRH), notably in contributing to reducing STIs, HIV and unintended pregnancy. Sexuality education does not hasten sexual activity but has a positive impact on safer sexual behaviours and can delay sexual debut. A 2014 review of school-based sexuality education programmes has demonstrated increased HIV knowledge, increased self-efficacy related to condom use and refusing sex, increased contraception and condom use, a reduced number of sexual partners and later initiation of first sexual intercourse. A Cochrane review of 41 randomized controlled trials in Europe, the United States, Nigeria and Mexico also confirmed that CSE prevents unintended adolescent pregnancies. CSE is very beneficial in regards to teen pregnancy because studies show that, teen pregnancy and childbearing have a significant negative impact on high school success and completion, as well as future job prospects. A study in Kenya, involving more than 6,000 students who had received sexuality education led to delayed sexual initiation, and increased condom use among those who were sexually active once these students reached secondary school compared to more than 6,000 students who did not receive sexuality education. CSE also reduces the frequency of sex and the number of partners which in turn also reduces the rates of sexually transmitted infections.

UNAIDS and the African Union have recognized CSE’s impact on increasing condom use, voluntary HIV testing and reducing pregnancy among adolescent girls and have included comprehensive, age-appropriate sexuality education as one of the key recommendations to fast track the HIV response and end the AIDS epidemic among young women and girls in Africa.

As the field of sexuality education develops, there is increasing focus on addressing gender, power relations and human rights in order to improve the impact on SRH outcomes. Integrating content on gender and rights makes sexuality education even more effective. A review of 22 curriculum- based sexuality education programmes found that 80 per cent of programmes that addressed gender or power relations were associated with a significant decrease in pregnancy, childbearing or STIs. These programmes were five times as effective as those programmes that did not address gender or power. CSE empowers young people to reflect critically on their environment and behaviours, and promotes gender equality and equitable social norms, which are important contributing factors for improving health outcomes, including HIV infection rates. The impact of CSE also increases when delivered together with efforts to expand access to a full range of high- quality, youth-friendly services and commodities, particularly in relation to contraceptive choice.

A global review of evidence in the education sector also found that teaching sexuality education builds confidence, a necessary skill for delaying the age that young people first engage in sexual intercourse, and for using contraception, including condoms. CSE has a demonstrated impact on improving knowledge, self-esteem, changing attitudes, gender and social norms, and building self-efficacy.

Criticism

Comprehensiveness

While CSE implementation is on the rise in the United States, it remains difficult for state officials to regulate what is and is not taught in the classroom. This is due in large part to the undefinability of CSE; CSE has the potential to comprise such a wide range of sexual information, and over-all focus varies widely between curriculums. Educators have also accused CSE as fundamentally operating as a form of "abstinence-plus," due to the reality that CSE often involves minimal body related information and excessive promotions of abstinence. "So-called Comprehensive Sex Ed" says Sharon Lamb, a professor at the University of Massachusetts Boston, "has been made less comprehensive as curricula are revised to meet current federal, state, and local requirements."

Inclusion of LGBT community

The LGBT population experiences health disparities associated with stigma, discrimination, negative connotations as well as stereotypes. This population is subject to systemic barriers to adequate healthcare services ultimately impacting their wellbeing and welfare negatively. The care that they are provided with often is from clinicians who are not trained well in addressing the concerns of this population. This lack of training from the provider hinders the experience and ultimately influences the quality of care and adequate delivery of healthcare. Due to discrimination and lack of cultural sensitivity that perpetuate prejudice, this population experiences limited health-seeking behaviors. Thus, making preventative services unattainable, furthermore, increasing and prolonging illnesses and ailments. Research shows higher risk of contracting HIV and other STDs; the number is increased when assessing the intersecting population of gay men of color. Lesbian and bisexual females are less likely to obtain routine care like: breast and cervical cancer screenings. Gay men are at an increased risk of prostate, testicular, anal, and colon cancers, while lesbian and bisexual women have an increased risk of ovarian, breast, and endometrial cancers. As a result stigma, discrimination, victimization, and sexual abuse LGBT youth is more likely to be involved in high-risk sexual behaviors at an earlier age.

While comprehensive sex education exists in schooling, many programs do not address the needs of the LGBT community. This population faces different health disparities ultimately driven by discrimination, shortfalls of peers, the lack of parental support, community services, and school based sex education. The implementation of LGBT comprehensive sex education utilized as an intervention seeks to combat these health disparities, by informing the population of the importance of developing sexual health. Sexual health involves not only preventing disease, but also a respectful approach to sexual relationships, sexuality, and accepting an individual's gender iedntity and sexual orientation.

The term "comprehensive" is also often misleading because some comprehensive programs do not show the holistic picture of human sexuality. LGBT advocates have long been critical of the ways in which comprehensive sex education generally promotes marriage as the end goal for students. LGBT advocates want to express other forms of relationships other than marriage. Students should have sex education that encompasses the different forms and should be allowed to exercise those forms in which they are most comfortable with. Even when curriculums claim to be inclusive of LGBT experiences, they often promote heteronormative lifestyles as "normal."  Inclusion of LGBT identities and health topics is necessary for LGBT students to feel safe and seen in their sex ed classrooms. When sex education fails to include LGBT identities and experiences, LGBT youth can be vulnerable to risky sexual behaviors and encourage negative sexual health outcomes. Due to the lack of LGBT sex education provided in schools, LGBT youth will look to peers and the internet which can lead to misinformation. When these students do not have access to or an interest in marriage they are practically erased from the CSE narrative.

In a Canada, a federal report showed that LGBT community has less access to health services and faces more comprehensive health challenges compared to the general population. As a result of lack of support for the LGBT population, the Comprehensive Health Education Workers (CHEW) Project emerged in October 2014. Their goal is to educate the LGBT community about topics such sexual and gender identity, sexually transmitted infections (STIs), healthy social relationships, and depression. They do this though workshops, arts‐based projects, and one‐on‐one meetings. The CHEW project is set exclusively to the LGBT community in order to establish a safe environment in which LGBT youth can gain resources for sex education.

A cross sectional study done in New York City analyzed the sexual behaviors of high school girls. Studies found that, "high school girls who identified as LGBT were more likely to report substance use such as: alcohol, marijuana, cocaine, heroin, meth, ecstasy and prescription drugs. They also had higher rates of contemplating and/or attempting suicide." Another study found that "the LGBT youth accesses health information online five times more than the heterosexual population, and these rates are even higher for LGBT youth that identify as a person of color which stems from the fact that they lack health resources. Rights, Respect, Responsibility includes an inclusive LGBT curriculum for grades K-12. By having a curriculum, such as the Right, Respect, Responsibility suggests, students will be have accurate information to all identities as well as establish a safe classroom for LGBT students.

As of May 2018, only 12 states require discussion of sexual orientation and of these, only 9 states require that discussion of sexual orientation be inclusive (California, Colorado, Delaware, Iowa, New Jersey, New Mexico, Oregon, Rhode Island, and Washington). Additionally, several states have passed legislation that bans teachers from discussing gay and transgender issues, such as sexual health and HIV/AIDS awareness, in a positive light. Furthermore, three states require that teachers only portray LGBT people in a negative light (Alabama, South Carolina, and Texas).

School context

"Before the late 1800s, delivering sex education in the United States and Canada was primarily seen as a parent’s responsibility. Today, programs under the Sexuality Information and Education Council of the United States (SIECUS) begin comprehensive sex education in pre-kindergarten, drawing criticism related to the age at which it is appropriate to address sexual matters with children.

Federal funding for sexual education

Although there is no federal mandate that requires states to teach sexual education, there is federal funding available to assist with sexual education programs.

Abstinence Education Grant Program (AGEP)

Historically, funding for abstinence education has always been favored over CSE. In 1996, during Bill Clinton's presidency, legislation was passed to promote abstinence in education programs. Under Title V Section 510 of the Social Security Act, the Abstinence Education Grant Program (AGEP), was passed. AEGP has always been renewed before its expiration date, and each time funds gradually increase from fifty million dollars per year to seventy-five and as high as $6.75 million per state grant in 2015. The way the funds are disbursed are based on the proportion of low-income children in each state. So far, thirty-six states have been given AEGP funds.

Abstinence Education Grant Program (AGEP) Requirements

Part of Section 510(b) of Title V of the Social Security Act, contains the "A-H guidelines," which are the eight criteria that programs must abide by order to be eligible to receive federal funding. They are as follows:

A. Has as its exclusive purpose teaching the social, psychological, and health gains to be realized by abstaining from sexual activity;

B. Teaches abstinence from sexual activity outside marriage as the expected standard for all school-age children;

C. Teaches that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems;

D. Teaches that a mutually faithful, monogamous relationship in the context of marriage is the expected standard of sexual activity;

E. Teaches that sexual activity outside the context of marriage is likely to have harmful psychological and physical effects;

F. Teaches that bearing children out of wedlock is likely to have harmful consequences for the child, the child's parents, and society;

G. Teaches young people how to reject sexual advances and how alcohol and drug use increase vulnerability to sexual advances; and

H. Teaches the importance of attaining self-sufficiency before engaging in sexual activity;

In addition to abiding by these 8 conditions, AGEP compliant programs cannot discuss contraception, STIs, or methods for protecting against STIs, except when describing failure rates.

Teen Pregnancy Prevention Program (TPP)

More recently legislation has pushed for funding that goes beyond abstinence only education. In 2010, President Obama introduced the Teen Pregnancy Prevention Program (TPP), which provides a total of $114.5 million annually to sex education programs that are "medically accurate and age-appropriate." TPP falls under a subsection of United States Department of Health and Human Services ("HHS") which is overseen by the Office of Adolescent Health. Funding for TPP is dispersed if "they emulate specific evidence-based programs promulgated under TPP."

California Comprehensive Sexual Health and HIV/AIDS Prevention Education Act

In January 2016, the California Healthy Youth Act, amended the California Comprehensive Sexual Health and HIV/AIDS Prevention Education Act to include minority groups and expand health education. Before it authorized schools to provide comprehensive sex education and required that all materials are made accessible to students with a variety of needs. It also focused solely on marital relationships. It now mandates that schools provide comprehensive sex education and states that "materials cannot be biased and must be appropriate for students of all races, genders, sexual orientations, and ethnic and cultural backgrounds, as well as those with disabilities and English language learners." Additionally, education must now include "instruction about forming healthy and respectful committed relationships," regardless if marital status. Furthermore, it is now required to have discussions about all FDA-approved contraceptive methods in preventing pregnancy, including the morning after pill.

In conclusion now requires that all sex education programs promulgated in the state should

• normalize sexuality as part of human development;
• ensure people receive integrated, comprehensive, accurate, and unbiased sexual health and HIV prevention and instruction; and
• provide pupils with the knowledge and skills to have healthy, positive, and safe relationships.

As a human right

Some critics state that young people’s access to CSE is grounded in internationally recognized human rights, which require governments to guarantee the overall protection of health, well-being and dignity, as per the Universal Declaration on Human Rights, and specifically to guarantee the provision of unbiased, scientifically accurate sexuality education.

These rights are protected by internationally ratified treaties, and lack of access to sexual and reproductive health (SRH) education remains a barrier to complying with the obligations to ensure the rights to life, health, non-discrimination and information, a view that has been supported by the Statements of the Committee on the Rights of the Child, the Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW) Committee, and the Committee on Economic, Social and Cultural Rights.

The commitment of individual states to realizing these rights has been reaffirmed by the international community, in particular the Commission on Population and Development (CPD), which – in its resolutions 2009/12 and 2012/13 – called on governments to provide young people with comprehensive education on human sexuality, SRH and gender equality.

Other analysis show that comprehensive sex education is not an international right nor a human right because it not clearly stated in either a treaty nor custom. By international law, states are required to provide access to information and education about reproductive health, but this does not require a sex education curriculum. It may take different forms such as mandating that local school districts create a system for providing information to students, or mandating that health clinics and practitioners dispense information to patients.

In curricula

Teaching methods

As CSE gains momentum and interest at international, regional and national levels, governments are increasingly putting in place measures to scale-up their delivery of some form of life skills-based sexuality education, as well as seeking guidance on best practice, particularly regarding placement within the school curriculum. Sexuality education may be delivered as a stand-alone subject or integrated across relevant subjects within the school curricula. These options have direct implications for implementation, including teacher training, the ease of evaluating and revising curricula, the likelihood of curricula being delivered, and the methods through which it is delivered.

Within countries, choices about implementing integrated or stand-alone sexuality education are typically linked to national policies and overall organization of the curricula. The evidence base on the effectiveness of stand-alone vs. integrated sexuality education programming is still limited. However, there are discernible differences for policy-makers to consider when deciding the position of CSE within the curriculum.

As a stand-alone subject, sexuality education is set apart from the rest of the curriculum, whether on its own or within a broader stand-alone health and life skills curriculum. This makes it more vulnerable to potentially being sacrificed due to time and budget constraints, since school curricula are typically overcrowded.

However, a stand-alone curriculum also presents opportunities for specialized teacher training pathways, and the use of non-formal teaching methodologies that aim to build learners’ critical thinking skills. The pedagogical approaches promoted through sexuality education – such as learner-centred methodologies, development of skills and values, group learning and peer engagement – are increasingly being recognized as transformative approaches that impact on learning and education more widely. As a standalone subject, it is also significantly easier to monitor, which is crucial in terms of evaluating the effectiveness of programming, and revising curricula where it is not delivering the desired learning outcomes.

When sexuality education is integrated or infused, it is mainstreamed across a number of subject areas, such as biology, social studies, home economics or religious studies. While this model may reduce pressure on an overcrowded curriculum, it is difficult to monitor or evaluate, and may limit teaching methodologies to traditional approaches.

Terminology

Apart from the different teaching methods, termiology also differs. Abortion, homosexuality, abstinence have connotations and definitions that vary state. For example, the word "abstinence" may refer to disengaging from all forms of sexual activities until marriage or may refer to only disengaging from sexual intercourse. Furthermore, the degree of sexual activity that "abstinence" connotates is often unclear, because sexual behavior that is not sexual intercourse may or may not be included in its definition. As a result, students are left confused about what activities are risky and teachers do not know what they can and cannot teach.

The term "comprehensive," is also falls on spectrum, therefore can be considered an umbrella term. CSE means something radical for some institutions while it can mean something moderate and even conservative for others.

According to the Sexuality Information and Education Council of the United States (SIECUS), the guidelines for comprehensive sexuality education are as follows:

• appropriate to the age, developmental level, and cultural background of students;
• respects the diversity of values and beliefs represented in the community;
• complements and augments the sexuality education children receive from their families, religious and community groups, and healthcare professionals;
• teaches not only about abstinence, but also contraception, including emergency contraception and reproductive choice;
• teaches about lesbian, gay, bisexual, transgender (LGBT) issues and questions issues;
• teaches anatomy, development, puberty, and relationships;
• teaches all of the other issues one would expect to be covered in a traditional sexuality education class; and
• should be science-based and medically accurate

Sexual education exemption

Just as teaching methods and curricula vary by state, excusal from sex education also varies by state. States may have with an opt out or opt in produce. In some states, students can opt out of receiving sexual education without specifying a particular reason. In other states, students can only opt out for religious or moral reasons. In an opt-in provision, parents must actively agree to allow their children to receive sex education prior to the start of the sexual education.

Sexual content in the media

Since 1997, the amount of sexual content on TV has nearly doubled in the United States. Additionally, a study done in 2008 showed that nearly 40% of popular music lyrics contained sexual references which were often sexually degrading. These lyrics were also often accompanied with mentions of other risk behaviors, such as substance use and violence.

Teens (ages 13–15) in the United States, use entertainment media as their top source for education in regards to sexuality and sexual health. Additionally, a study found that 15-19 year olds in the U.S use media far more than parents or schools to obtain information about birth control. Some studies have found that, "very few teen television shows mention any of the responsibilities or risks (e.g., using contraception, pregnancy, STIs) associated with sex and almost none of the shows with sexual content include precaution, prevention, or negative outcomes as the primary theme."  Television shows 16 and Pregnant and its spin-off, Teen Mom, which first aired on MTV in 2009 received major disapproval from some parents as they thought the shows glamorized teen pregnancy and motherhood. However, 16 and Pregnant actually led to a 4.3 percent reduction in teen pregnancy, mostly as a result of increased contraceptive use. In contrast, other data shows that exposure to high levels of sexual content on the television causes adolescents to have twice the risk of becoming pregnant in the following 3 years, compared to those who were exposed to low levels.

The film Mean Girls, directed by Mark Waters shed light on the state sex education in some parts of the United States. In the film the health instructor states, "At your age, you're going to have a lot of urges. You're going to want to take off your clothes and touch each other. But if you do touch each other, you will get chlamydia and die." This line is meant to be satirical, but it illustrates common flaws within sex education in the U.S. It depicts simplistic descriptions of sexual activity and implementation of fear without any legitimate basis.

Comprehensive sex education is the main topic in the documentary The Education of Shelby Knox released in 2005 about Lubbock, Texas, which has one of the highest teen pregnancy and STD rates in the nation. The "solution" to which is a strict abstinence-only sex education curriculum in the public schools and a conservative preacher who urges kids to pledge abstinence until marriage.

In 2013, How to Lose Your Virginity was released, a documentary that questioned the effectiveness of the abstinence-only sex education movement and observed how sexuality continues to define a young woman's morality and self-worth. The meaning and necessity of virginity as a social construct is also examined through narration and interviews with notable sexuality experts, such as former Surgeon General Dr. Joycelyn Elders, "Scarleteen" creator and editor Heather Corinna, historian Hanne Blank, author Jessica Valenti, and comprehensive sex education advocate Shelby Knox.

Not only have films portrayed sex education, but so has social media. Platforms such as YouTube, Facebook, Vine, and others are used as a tool to uplift the narratives of marginalized communities such as persons of color and LGBT persons in hopes to "strengthen sexual health equity for all."

As a result of the mass amount of sex content in media, media literacy education (MLE) has emerged. It was created to address the influence of unhealthy media messages on risky health decisions, such as intention to use substances, body image issues, and eating disorders. A study analyzed the effectiveness of a teacher-led MLE program, called Media Aware Sexual Health (MASH), which provides students with accurate health information and teaches them how to apply that information to critical analysis of media messages. This comprehensive sex education resulted in increased intentions to talk to a parent, partner and medical professional prior to sexual activity, and intentions for condom use.

Due to knowledge gaps in most sex education curricula for teens, free online resources like Sex, Etc., Scarleteen.com, and teensource.org have been created to promote comprehensive, inclusive, and shame-free sex education for teenagers.

Reproductive health

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Reproductive_health

Public health education with regard to prevention of HIV/AIDS in an educational outreach session in Angola.

Within the framework of the World Health Organization's (WHO) definition of health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health, or sexual health/hygiene, addresses the reproductive processes, functions and system at all stages of life. UN agencies claim sexual and reproductive health includes physical, as well as psychological well-being vis-a-vis sexuality.

Reproductive health implies that people are able to have a responsible, satisfying and safer sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. One interpretation of this implies that men and women ought to be informed of and to have access to safe, effective, affordable and acceptable methods of birth control; also access to appropriate health care services of sexual, reproductive medicine and implementation of health education programs to stress the importance of women to go safely through pregnancy and childbirth could provide couples with the best chance of having a healthy infant.

Individuals do face inequalities in reproductive health services. Inequalities vary based on socioeconomic status, education level, age, ethnicity, religion, and resources available in their environment. It is possible for example, that low income individuals lack the resources for appropriate health services and the knowledge to know what is appropriate for maintaining reproductive health.

Reproductive health

The WHO assessed in 2008 that "Reproductive and sexual ill-health accounts for 20% of the global burden of ill-health for women, and 14% for men." Reproductive health is a part of sexual and reproductive health and rights. According to the United Nations Population Fund (UNFPA), unmet needs for sexual and reproductive health deprive women of the right to make "crucial choices about their own bodies and futures", affecting family welfare. Women bear and usually nurture children, so their reproductive health is inseparable from gender equality. Denial of such rights also worsens poverty.

Adolescent health

Teenage birth rate per 1,000 females aged 15–19, 2000–2009

Adolescent health creates a major global burden and has a great deal of additional and diverse complications compared to adult reproductive health such as early pregnancy and parenting issues, difficulties accessing contraception and safe abortions, lack of healthcare access, and high rates of HIV and sexually transmitted infections, and mental health issues. Each of those can be affected by outside political, economic and socio-cultural influences. For most adolescent females, they have yet to complete their body growth trajectories, therefore adding a pregnancy exposes them to a predisposition to complications. These complications range from anemia, malaria, HIV and other STI's, postpartum bleeding and other postpartum complications, mental health disorders such as depression and suicidal thoughts or attempts. In 2016, adolescent birth rates between the ages of 15-19 was 45 per 1000. In 2014, 1 in 3 experienced sexual violence, and there more than 1.2 million deaths. The top three leading causes of death in females between the ages of 15-19 are maternal conditions 10.1%, self-harm 9.6%, and road conditions 6.1%.

The causes for teenage pregnancy are vast and diverse. In developing countries, young women are pressured to marry for different reasons. One reason is to bear children to help with work, another on a dowry system to increase the families income, another is due to prearranged marriages. These reasons tie back to financial needs of girls' family, cultural norms, religious beliefs and external conflicts.

Adolescent pregnancy, especially in developing countries, carries increased health risks, and contributes to maintaining the cycle of poverty. The availability and type of sex education for teenagers varies in different parts of the world. LGBT teens may suffer additional problems if they live in places where homosexual activity is socially disapproved and/or illegal; in extreme cases there can be depression, social isolation and even suicide among LGBT youth.

Maternal health

Maternal Mortality Rate worldwide, as defined by the number of maternal deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management, excluding accidental or incidental causes.

 

Ninety nine percent of maternal deaths occur in developing countries and in 25 years, maternal mortality globally dropped to 44%. Statistically, a woman's chance of survival during childbirth is closely tied to her social economic status, access to healthcare, where she lives geographically, and cultural norms. To compare, a woman dies of complications from childbirth every minute in developing countries versus a total of 1% of total maternal mortality deaths in developed countries. Women in developing countries have little access to family planning services, different cultural practices, have lack of information, birthing attendants, prenatal care, birth control, postnatal care, lack of access to health care and are typically in poverty. In 2015, those in low-income countries had access to antenatal care visits averaged to 40% and were preventable. All these reasons lead to an increase in the Maternal Mortality Ratio (MMR).

One of the international Sustainable Development Goals developed by United Nations is to improve maternal health by a targeted 70 deaths per 100,000 live births by 2030. Most models of maternal health encompass family planning, preconception, prenatal, and postnatal care. All care after childbirth recovery is typically excluded, which includes pre-menopause and aging into old age.^[16] During childbirth, women typically die from severe bleeding, infections, high blood pressure during pregnancy, delivery complications, or an unsafe abortion. Other reasons can be regional such as complications related to diseases such as malaria and AIDS during pregnancy. The younger the women is when she gives birth, the more at risk her and her baby is for complications and possibly mortality.

Map of countries and territories by fertility rate as of 2018

There is a significant relationship between the quality of maternal services made available and the greater financial standings of a country. Sub-Saharan Africa and South Asia exemplify this as these regions are significantly deprived of medical staff and affordable health opportunities. Most countries provide for their health services through a combination of funding from government tax revenue and local households. Poorer nations or regions with extremely concentrated wealth can leave citizens on the margins uncared for or overlooked. However, the lack of proper leadership can result in a nation's public sectors being mishandled or poorly performing despite said nation's resources and standing. In addition, poorer nations funding their medical services through taxes places a greater financial burden on the public and effectively the mothers themselves. Responsibility and accountability on the part of mental health sectors are strongly emphasized as to what will remedy the poor quality of maternal health globally. The impact of different maternal health interventions across the globe stagger variously and are vastly uneven. This is the result of a lack of political and financial commitment to the issue as most safe motherhood programs internationally have to compete for significant funding. Some resolve that if global survival initiatives were promoted and properly funded it would prove to be mutually beneficial for the international community. Investing in maternal health would ultimately advance several issues such as: gender inequality, poverty and general global health standards. As it currently stands, pregnant women are subjugated to high financial costs throughout the duration of their term internationally that are highly taxing and strenuous.

Contraception

Combined oral contraceptive pill

 

A page from De Morbo Gallico (On the French Disease), Gabriele Falloppio's treatise on syphilis. Published in 1564, it describes an early use of condoms.

 

Margaret Sanger, birth control advocate, and her sister Ethyl Byrne, on the courthouse steps in Brooklyn, New York City, January 8, 1917, during their trial for opening a birth control clinic. Contraception has been and still remains in some cultures a controversial issue.

 

Access to reproductive health services is very poor in many countries. Women are often unable to access maternal health services due to lack of knowledge about the existence of such services or lack of freedom of movement. Some women are subjected to forced pregnancy and banned from leaving the home. In many countries, women are not allowed to leave home without a male relative or husband, and therefore their ability to access medical services is limited. Therefore, increasing women's autonomy is needed in order to improve reproductive health, however doing may require a cultural shift. According to the WHO, "All women need access to antenatal care in pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth". 

The fact that the law allows certain reproductive health services, it does not necessary ensure that such services are de facto available to people. The availability of contraception, sterilization and abortion is dependent on laws, as well as social, cultural and religious norms. Some countries have liberal laws regarding these issues, but in practice it is very difficult to access such services due to doctors, pharmacists and other social and medical workers being conscientious objectors.

In developing regions of the world, there are about 214 million women who want to avoid pregnancy but are unable to use safe and effective family planning methods. When taken correctly, the combined oral contraceptive pill is over 99% effective at preventing pregnancy. However, it does not protect from sexually transmitted infections (STIs). Some methods, such as using condoms, achieve both protection from STIs and unwanted pregnancies. There are also natural family planning methods, which may be preferred by religious people, but some very conservative religious groups, such as the Quiverfull movement, oppose these methods too, because they advocate the maximization of procreation. One of the oldest ways to reduce unwanted pregnancy is coitus interruptus - still widely used in the developing world.

There are many types of contraceptives. One type of contraceptive includes barrier methods. One barrier method includes condoms for males and females. Both types stop sperm from entering the woman's uterus, thereby preventing pregnancy from occurring. Another type of contraception is the birth control pill, which stops ovulation from occurring by combining the chemicals progestin and estrogen. Many women use this method of contraception, however they discontinue using it equally as much as they use it. One reason for this is because of the side effects that may occur from using the pill, and because some health care providers do not take women's concerns about negative side effects seriously. The use of the birth control pill is common in western countries, and two forms of combined oral contraceptives are on the World Health Organization's List of Essential Medicines, the most important medications needed in a basic health system.

There are many objections to the use of birth control, both historically and in the present day. One argument against birth control usage states that there is no need for birth control to begin with. This argument was levied in 1968 when Richard Nixon was elected president, and the argument stated that since birth rates were at their lowest point since World War II ended, birth control was not necessary. Demographic planning arguments were also the basis of the population policy of Nicolae Ceaușescu in communist Romania, who adopted a very aggressive natalist policy which included outlawing abortion and contraception, routine pregnancy tests for women, taxes on childlessness, and legal discrimination against childless people. Such policies consider that coercion is an acceptable means of reaching demographic targets. Religious objections are based on the view that premarital sex should not happen, while married couples should have as many children as possible. As such, the Catholic Church encourages premarital abstinence from sex. This argument was written out in Humanae Vitae, a papal encyclical released in 1968. The Catholic Church bases its argument against birth control pills on the basis that birth control pills undermine the natural law of God. The Catholic Church also argues against birth control on the basis of family size, with Cardinal Mercier of Belgium arguing,  "...the duties of conscience are above worldly considerations, and besides, it is the large families who are the best" (Reiterman, 216). Another argument states that women should use natural methods of contraception in place of artificial ones, such as having sexual intercourse when one is infertile.

Support for contraception is based on views such as reproductive rights, women's rights, and the necessity to prevent child abandonment and child poverty. The World Health Organization states that "By preventing unintended pregnancy, family planning /contraception prevents deaths of mothers and children".

Sexually transmitted infection

Estimated prevalence in % of HIV among young adults (15–49) per country as of 2011.

No data   <0 .10="" small="">   0.10–0.5   0.5–1

1–5   5–15   15–50

Deaths from syphilis in 2012 per million persons

 

Disability-adjusted life year for gonorrhea per 100, 000  inhabitants.

 

Condoms offer effective protection from STIs

 

A Sexually transmitted infection (STI) --previously known as a sexually transmitted disease (STD) or venereal disease (VD)-- is an infection that has a significant likelihood of transmission between humans by means of sexual activity. The CDC analyses the eight most common STI's: chlamydia, gonorrhea, hepatitis B virus (HBV), herpes simplex virus type 2 (HSV-2), human immunodeficiency virus (HIV), human papillomavirus (HPV), syphilis, and trichomoniasis.

There are more than 600 million cases of STI's worldwide and more than 20 million new cases within the United States. Numbers of such high magnitude weigh a heavy burden on the local and global economy. A study conducted at Oxford University in 2015 concluded that despite giving participants early antiviral medications (ART), they still cost an estimated $256 billion over 2 decades. HIV testing done at modest rates could reduce HIV infections by 21%, HIV retention by 54% and HIV mortality rates by 64%, with a cost-effectiveness ration of $45,300 per Quality-adjusted life year. However, the study concluded that the United States has led to an excess in infections, treatment costs, and deaths, even when interventions do not improve over all survival rates.

There is a profound reduction on STI rates once those who are sexually active are educated about transmissions, condom promotion, interventions targeted at key and vulnerable populations through a comprehensive Sex education courses or programs. South Africa's policy addresses the needs of women at risk for HIV and who are HIV positive as well as their partners and children. The policy also promotes screening activities related to sexual health such as HIV counseling and testing as well as testing for other STIs, tuberculosis, cervical cancer, and breast cancer.

Young African American women are at a higher risk for STI's, including HIV. A recent study published outside of Atlanta, Georgia collected data (demographic, psychological, and behavioral measures) with a vaginal swab to confirm the presence of STIs. They found a profound difference that those women who had graduated from college were far less likely to have STIs, potentially be benefiting from a reduction in vulnerability to acquiring STIs/HIV as they gain in education status and potentially move up in demographic areas and/or status.

Abortion

Globally, an estimated 25 million unsafe abortions occur each year. The vast majority of such unsafe abortions occur in developing countries in Africa, Asia and Latin America.

The abortion debate is the ongoing controversy surrounding the moral, legal, and religious status of induced abortion. The sides involved in the debate are the self-described “pro-choice” and “pro-life” movements. “Pro-choice” emphasizes the right of women to decide whether to terminate a pregnancy. “Pro-life” emphasizes the right of the embryo or fetus to gestate to term and be born. Both terms are considered loaded in mainstream media, where terms such as “abortion rights” or “anti-abortion” are generally preferred. Each movement has, with varying results, sought to influence public opinion and to attain legal support for its position, with small numbers of anti-abortion advocates using violence, such as murder and arson.

Articles from the World Health Organization call legal abortion a fundamental right of women regardless of where they live, and argue that unsafe abortion is a silent pandemic. In 2005, it was estimated that 19-20 million abortions had complications, some complications are permanent, while another estimated 68,000 women died from unsafe abortions. Having access to safe abortion can have positive impacts on women's health and life, and vice versa. "Legislation of abortion on request is necessary but an insufficient step towards improving women's health. In some countries where it abortion is legal, and has been for decades, there has been no improvement in access to adequate services making abortion unsafe due to lack of healthcare services. It is hard to get an abortion due to legal and policy barriers, social and cultural barriers (gender discrimination, poverty, religious restrictions, lack of support etc., health system barriers (lack of facilities or trained personnel), however safe abortions with trained personnel, good social support, and access to facilities, can improve maternal health and increase reproductive health later in life.

The Maputo Protocol, which was adopted by the African Union in the form of a protocol to the African Charter on Human and Peoples' Rights, states at Article 14 (Health and Reproductive Rights) that: "(2). States Parties shall take all appropriate measures to: [...] c) protect the reproductive rights of women by authorising medical abortion in cases of sexual assault, rape, incest, and where the continued pregnancy endangers the mental and physical health of the mother or the life of the mother or the foetus."  The Maputo Protocol is the first international treaty to recognize abortion, under certain conditions, as a woman's human right.

The General comment No. 36 (2018) on article 6 of the International Covenant on Civil and Political Rights, on the right to life, adopted by the Human Rights Committee in 2018, defines, for the first time ever, a human right to abortion - in certain circumstances (however these UN general comments are considered soft law, and, as such, not legally binding).

"Although States parties may adopt measures designed to regulate voluntary terminations of pregnancy, such measures must not result in violation of the right to life of a pregnant woman or girl, or her other rights under the Covenant. Thus, restrictions on the ability of women or girls to seek abortion must not, inter alia, jeopardize their lives, subject them to physical or mental pain or suffering which violates article 7, discriminate against them or arbitrarily interfere with their privacy. States parties must provide safe, legal and effective access to abortion where the life and health of the pregnant woman or girl is at risk, and where carrying a pregnancy to term would cause the pregnant woman or girl substantial pain or suffering, most notably where the pregnancy is the result of rape or incest or is not viable. [8] In addition, States parties may not regulate pregnancy or abortion in all other cases in a manner that runs contrary to their duty to ensure that women and girls do not have to undertake unsafe abortions, and they should revise their abortion laws accordingly. [9] For example, they should not take measures such as criminalizing pregnancies by unmarried women or apply criminal sanctions against women and girls undergoing abortion [10] or against medical service providers assisting them in doing so, since taking such measures compel women and girls to resort to unsafe abortion. States parties should not introduce new barriers and should remove existing barriers that deny effective access by women and girls to safe and legal abortion, including barriers caused as a result of the exercise of conscientious objection by individual medical providers."

When negotiating the Cairo Programme of Action at the 1994 International Conference on Population and Development (ICPD), the issue was so contentious that delegates eventually decided to omit any recommendation to legalize abortion, instead advising governments to provide proper post-abortion care and to invest in programs that will decrease the number of unwanted pregnancies.

The Committee on the Elimination of Discrimination against Women considers the criminalization of abortion a "violations of women’s sexual and reproductive health and rights" and a form of "gender based violence"; paragraph 18 of its General recommendation No. 35 on gender based violence against women, updating general recommendation No. 19 states that: "Violations of women’s sexual and reproductive health and rights, such as forced sterilizations, forced abortion, forced pregnancy, criminalisation of abortion, denial or delay of safe abortion and post abortion care, forced continuation of pregnancy, abuse and mistreatment of women and girls seeking sexual and reproductive health information, goods and services, are forms of gender based violence that, depending on the circumstances, may amount to torture or cruel, inhuman or degrading treatment." The same General Recommendation also urges countries at paragraph 31 to [...] In particular, repeal: a) Provisions that allow, tolerate or condone forms of gender based violence against women, including [...] legislation that criminalises abortion".

In 2008, the Parliamentary Assembly of the Council of Europe, a group comprising members from 47 European countries, has adopted a resolution calling for the decriminalization of abortion within reasonable gestational limits and guaranteed access to safe abortion procedures. The nonbinding resolution was passed on April 16 by a vote of 102 to 69.

Accesses to abortion is not only a question of legality, but also an issue of overcoming de facto barriers, such as conscientious objections from medical stuff, high prices, lack of knowledge about the law, lack of access to medical care (especially in rural areas). The de facto inability of women to access abortion even in countries where it is legal is highly controversial because it results in a situation where women have rights only on paper not in practice; the UN in its 2017 resolution on Intensification of efforts to prevent and eliminate all forms of violence against women and girls: domestic violence urged states to guarantee access to "safe abortion where such services are permitted by national law".

There are two primary arguments for maintaining legalized abortion today in the U.S. The first is recognizing the full citizenship of women. The Roe v. Wade court case on abortion compared the citizenship of women and fetuses  Because the Constitution defines born people as citizens, Justice Harry Blackmun ruled that fetuses were not citizens. The citizenship of women is emphasized because fetuses are not individual entities that can exist without the woman. Another reason why the full citizenship of women is defined by advocates for abortion is that it recognizes the right of women to manage their own bodies. Fertility affects women's bodies. The argument for abortion prevents others from making decisions that alter a woman's body. Pro-choice advocates also attempt to confirm that state-mandated education or other outside biases don't attempt to influence these decisions. Feminists argue that women throughout history have had to justify their citizenship politically and socially. The right to manage one's own body is a matter of health, safety, and respect. The citizenship of women and the right to manage their own bodies is a societal confirmation that feminists highlight as a pro-choice justification.

The second primary argument to uphold legalized abortion and creating better access to it is the necessity of abortion and the health and safety of pregnant women. There are two events that largely changed the course of public opinion about abortion in the U.S. The first is Sherry Finkbine, who was denied access to an abortion by the board of obstetrician-gynecologists at her local hospital. Although she was privileged enough to afford the trip, Finkbine was forced to travel to Sweden for an abortion to avoid caring for a damaged fetus in addition to four children. The other event that changed public opinion was the outbreak of rubella in the 1950s and 60s. Because rubella disrupted the growth of fetuses and caused deformities during pregnancy, the California Therapeutic Abortion Act was signed in 1967. This Act allowed doctors to perform abortions when the pregnancy risked the physical or mental health of the pregnant person. These two events are commonly used to show how the health and safety of pregnant women are contingent upon abortions as well as the ability to give birth to and adequately take care of a child. Another argument in favor of legalized abortion to service necessity are the reasons why an abortion might be necessary. Nearly half of all pregnancies in the United States are unintended, and over half of all unintended pregnancies in the United States are met with abortion. Unintended pregnancy can lead to serious harm to women and children for reasons such as not being able to afford to raise a baby, inaccessibility to time off of work, difficulties facing single motherhood, difficult socio-economic conditions for women. Unintended pregnancies also have a greater potential for putting women of color at risk due to systematically produced environmental hazards from proximity to pollution, access to livable income, and affordable healthy food. These factors as threats to the health and safety of pregnant women run parallel to data that shows the number of abortions in the United States did not decline while laws restricting legal access to abortion were implemented.

At a global level, the region with the strictest abortion laws is considered to be Latin America, a region strongly influenced by the Catholic Church in Latin America.

Female genital mutilation

Prevalence of FGM by country, according to a 2013 UNICEF report

 

Anti-FGM road sign, Bakau, Gambia, 2005

 

Female genital mutilation (FGM), also known as female genital circumcision or cutting, is the traditional, non-medical practice of altering or injuring the female reproductive organs, often by removing all or parts of the external genitalia. It is mostly practiced in 30 countries in Africa, the Middle East, and Asia, and affects over 200 million women and girls worldwide. More severe forms of FGM are highly concentrated in Djibouti, Eritrea, Ethiopia, Somalia, and Sudan.

The WHO categorizes FGM into four types:

• Type I (Cliteridectomy) is the removal of all or part of the clitoris. This may or may not include removing the prepuce along with the clitoral glans.
• Type II (Excision) is the removal of the clitoris along with all or part of the labia minora. This may or may not include removing all or part of the labia majora.
• Type III (Infibulation) is the act of removing the inner or outer labia and sealing the wound, leaving only a narrow opening.
• Type IV refers to "all other harmful procedures to the female genitalia for non-medical purposes (piercing, scraping, cauterizing of the genital area)."

FGM often takes the form of a traditional celebration conducted by an elder or community leader. The age that women undergo the procedure varies depending on the culture, although it is most commonly performed on prepubescent girls. Certain cultures value FGM as coming of age ritual for girls, and use it to preserve a woman's virginity and faithfulness to the husband after marriage. It is also closely connected with some traditional ideals of female beauty and hygiene. FGM may or may not have religious connotations depending on the circumstances.

There are no health benefits of FGM, as it interferes with the natural functions of a woman's and girls' bodies, such as causing severe pain, shock, hemorrhage, tetanus or sepsis (bacterial infection), urine retention, open sores in the genital region and injury to nearby genital tissue, recurrent bladder and urinary tract infections, cysts, increased risk of infertility, childbirth complications and newborn deaths. Sexual problems are 1.5 more likely to occur in women who have undergone FGM, they may experience painful intercourse, have less sexual satisfaction, and be two times more likely to report lack of sexual desire. In addition, the maternal and fetal death rate is significantly higher due to childbirth complications.

FGM can have severe negative psychological effects on women, both during and after the procedure. These can include long-term symptoms of depression, anxiety, post-traumatic stress disorder, and low self-esteem. Some women report that the procedure was carried out without their consent and knowledge, and describe feelings of fear and helplessness while it was taking place. A 2018 study found that larger quantities of the hormone cortisol were secreted in women who had undergone FGM, especially those who had experienced more severe forms of the procedure and at an early age. This marks the body's chemical response to trauma and stress, and can indicate a greater risk for developing symptoms of PTSD and other trauma disorders, although there are limited studies showing a direct correlation.

Legislation has been introduced in certain countries to prevent FGM. A 2016 survey of 30 countries showed 24 had policies to manage and prevent FGM, although the process to provide funding, education, and resources were often inconsistent and lacking. Some countries have seen a slight decline in FGM rates, while others show little to no change.

The Istanbul Convention prohibits FGM (Article 38).

Child and forced marriage

Poster against child and forced marriage

The practice of forcing young girls into early marriage, common in many parts of the world, is threatening their reproductive health. According to the World Health Organization:

"The sexual and reproductive health of the female in a child marriage is likely to be jeopardized, as these young girls are often forced into sexual intercourse with an older male spouse with more sexual experience. The female spouse often lacks the status and the knowledge to negotiate for safe sex and contraceptive practices, increasing the risk of acquiring HIV or other sexually transmitted infections, as well as the probability of pregnancy at an early age."

Niger has the highest prevalence of child marriage under 18 in the world, while Bangladesh has the highest rate of marriage of girls under age 15. Practices such as bride price and dowry can contribute to child and forced marriages.

International Conference on Population and Development, 1994

The International Conference on Population and Development (ICPD) was held in Cairo, Egypt, from 5 to 13 September 1994. Delegations from 179 States took part in negotiations to finalize a Programme of Action on population and development for the next 20 years. Some 20,000 delegates from various governments, UN agencies, NGOs, and the media gathered for a discussion of a variety of population issues, including immigration, infant mortality, birth control, family planning, and the education of women.

In the ICPD Program of Action, 'reproductive health' is defined as:

a state of complete physical, mental and social well-being and...not merely the absence of disease or infirmity, in all matters relating to the reproductive system and its functions and processes. Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this last condition are the right of men and women to be informed [about] and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of birth control which are not against the law, and the right of access to appropriate health-care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant.

This definition of the term is also echoed in the United Nations Fourth World Conference on Women, or the so-called Beijing Declaration of 1995. However, the ICPD Program of Action, even though it received the support of a large majority of UN Member States, does not enjoy the status of an international legal instrument; it is therefore not legally binding.

The Program of Action endorses a new strategy which emphasizes the numerous linkages between population and development and focuses on meeting the needs of individual women and men rather than on achieving demographic targets. The ICPD achieved consensus on four qualitative and quantitative goals for the international community, the final two of which have particular relevance for reproductive health:

• Reduction of maternal mortality: A reduction of maternal mortality rates and a narrowing of disparities in maternal mortality within countries and between geographical regions, socio-economic and ethnic groups.
• Access to reproductive and sexual health services including family planning: Family planning counseling, pre-natal care, safe delivery and post-natal care, prevention and appropriate treatment of infertility, prevention of abortion and the management of the consequences of abortion, treatment of reproductive tract infections, sexually transmitted diseases and other reproductive health conditions; and education, counseling, as appropriate, on human sexuality, reproductive health and responsible parenthood. Services regarding HIV/AIDS, breast cancer, infertility, delivery, hormone therapy, sex reassignment therapy, and abortion should be made available. Active discouragement of female genital mutilation (FGM).

The keys to this new approach are empowering women, providing them with more choices through expanded access to education and health services, and promoting skill development and employment. The programme advocates making family planning universally available by 2015 or sooner, as part of a broadened approach to reproductive health and rights, provides estimates of the levels of national resources and international assistance that will be required, and calls on governments to make these resources available.

Sustainable Development Goals

Half of the development goals put on by the United Nations started in 2000 to 2015 with the Millennium Development Goals (MDGs). Reproductive health was Goal 5 out of 8. To monitor the progress, the UN agreed to four indicators:

• Contraceptive prevalence rates
• Adolescent birth rate
• Antenatal care coverage
• Unmet need for family planning

Progress was slow, and according to the WHO in 2005, about 55% of women did not have sufficient antenatal care and 24% had no access to family planning services. The MDGs expired in 2015 and were replaced with a more comprehensive set of goals to cover a span of 2016-2030 with a total of 17 goals, called the Sustainable Development Goals. All 17 goals are comprehensive in nature and build off one another, but goal 3 is "To ensure health lives and promote wellbeing for all at all ages". Specific goals are to reduce global maternal mortality ratio to less than 70 per 100,000 live births, end preventable deaths of newborns and children, reduce the number by 50% of accidental deaths globally, strengthen the treatment and prevention programs of substance abuse and alcohol.

By region

Africa

World AIDS Day 2006 event in Kenya.

 

Prevalence of HIV/AIDS in Africa

 

HIV/AIDS in Africa is a major public health problem. Sub-Saharan Africa is the worst affected world region for prevalence of HIV, especially among young women. 90% of the children in the world living with HIV are in sub-Saharan Africa.

In most African countries, the total fertility rate is very high, often due to lack of access to contraception and family planning, and practices such as forced and child marriage. Niger, Angola, Mali, Burundi and Somalia have very high fertility rates.

The updated contraceptive guidelines in South Africa attempt to improve access by providing special service delivery and access considerations for sex workers, lesbian, gay, bisexual, transgender and intersex individuals, migrants, men, adolescents, women who are perimenopausal, have a disability, or chronic condition. They also aim to increase access to long acting contraceptive methods, particularly the copper IUD, and the introductions of single rod progestogen implant and combined oestrogen and progestogen injectables. The copper IUD has been provided significantly less frequently than other contraceptive methods but signs of an increase in most provinces were reported. The most frequently provided method was injectable progesterone, which the article acknowledged was not ideal and emphasised condom use with this method because it can increase the risk of HIV: The product made up 49% of South Africa's contraceptive use and up to 90% in some provinces.

Tanzanian provider perspectives address the obstacles to consistent contraceptive use in their communities. It was found that the capability of dispensaries to service patients was determined by inconsistent reproductive goals, low educational attainment, misconceptions about the side effects of contraceptives, and social factors such as gender dynamics, spousal dynamics, economic conditions, religious norms, cultural norms, and constraints in supply chains. A provider referenced and example of propaganda spread about the side effects of contraception: "There are influential people, for example elders and religious leaders. They normally convince people that condoms contain some microorganisms and contraceptive pills cause cancer". Another said that women often had pressure from their spouse or family that caused them to use birth control secretly or to discontinue use, and that women frequently preferred undetectable methods for this reason. Access was also hindered as a result of a lack in properly trained medical personnel: "Shortage of the medical attendant...is a challenge, we are not able to attend to a big number of clients, also we do not have enough education which makes us unable to provide women with the methods they want". The majority of medical centers were staffed by people without medical training and few doctors and nurses, despite federal regulations, due to lack of resources. One center had only one person who was able to insert and remove implants, and without her they were unable to service people who wanted an implant inserted or removed. Another dispensary that carried two methods of birth control shared that they sometimes run out of both materials at the same time. Constraints in supply chains sometimes cause dispensaries to run out of contraceptive materials. Providers also claimed that more male involvement and education would be helpful. Public health officials, researchers, and programs can gain a more comprehensive picture of the barriers they face, and the efficacy of current approaches to family planning, by tracking specific, standardized family planning and reproductive health indicators.

Welfare queen

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Welfare_queen 

 

"Welfare queen" is a derogatory term used in the United States to refer to women who allegedly misuse or collect excessive welfare payments through fraud, child endangerment, or manipulation. Reporting on welfare fraud began during the early 1960s, appearing in general-interest magazines such as Readers Digest. The term "welfare queen" originates from media reporting in 1974.

Since then, the phrase "welfare queen" has remained a stigmatizing label and is most often directed toward black, single mothers. Although women in the U.S. could no longer stay on welfare indefinitely after the federal government launched the Temporary Assistance for Needy Families (TANF) program in 1996, the term remains a trope in the American dialogue on poverty.

Origin

The idea of welfare fraud goes back to the early-1960s, when the majority of known offenders were male. Despite this, many journalistic exposés were published at the time on those who would come to be known as welfare queens. Readers Digest and Look magazine published sensational stories about mothers gaming the system.

The term was coined in 1974, either by George Bliss of the Chicago Tribune in his articles about Linda Taylor, or by Jet magazine. Neither publication credits the other in their "Welfare Queen" stories of that year. Taylor was ultimately charged with committing $8,000 in fraud and having four aliases. She was convicted in 1977 of illegally obtaining 23 welfare checks using two aliases and was sentenced to two to six years in prison. During the same decade, Taylor was investigated for alleged kidnapping and baby trafficking, and is suspected of multiple murders, but was never charged.

Accounts of her activities were used by Ronald Reagan, beginning with his 1976 presidential campaign, although he never mentioned her by name. Used to illustrate his criticisms of social programs in the United States. Reagan employed the trope of the "Welfare Queen" in order to rally support for reform of the welfare system. During his initial bid for the Republican nomination in 1976, and again in 1980, Reagan constantly made reference to the "Welfare Queen" at his campaign rallies. Some of these stories, and some that followed into the 1990s, focused on female welfare recipients engaged in behavior counter-productive to eventual financial independence such as having children out of wedlock, using AFDC money to buy drugs, or showing little desire to work. These women were understood to be social parasites, draining society of valuable resources while engaging in self damaging behavior. Despite these early appearances of the "Welfare Queen" icon, stories about able-bodied men collecting welfare continued to dominate discourse until the 1970s, at which point women became the main focus of welfare fraud stories.

In political discourse

The term "welfare queen" became a catchphrase during political dialogue of the 1980s and 1990s. The term came under criticism for its supposed use as a political tool and for its derogatory connotations. Criticism focused on the fact that individuals committing welfare fraud were, in reality, a very small percentage of those legitimately receiving welfare. Use of the term was also seen as an attempt to stereotype recipients in order to undermine public support for AFDC.

The welfare queen idea became an integral part of a larger discourse on welfare reform, especially during the bipartisan effort to reform the welfare system under Bill Clinton. Anti-welfare advocates ended AFDC in 1996 and overhauled the system with the introduction of TANF. Despite the new system's time-limits, the welfare queen legacy has endured and continues to shape public perception.

Gender and racial stereotypes

Political scientist Franklin Gilliam has argued that the welfare queen stereotype has roots in both race and gender:

While poor women of all races get blamed for their impoverished condition, African-American women commit the most egregious violations of American values. This story line taps into stereotypes about both women (uncontrolled sexuality) and African-Americans (laziness).

The media's image of poverty shifted from focusing on the plight of white Appalachian farmers and on the factory closings in the 1960s to a more racially divisive and negative image of poor blacks in urban areas. All of this, according to political scientist Martin Gilens, led to the American public dramatically overestimating the percentage of African-Americans in poverty. By 1973, in magazine pictures depicting welfare recipients, 75% featured African Americans even though African Americans made up only 35% of welfare recipients and only 12.8% of the US population. In 2016, African Americans made up 39.6% of welfare recipients, and, in 2015, African Americans made up 13.3% of the United States population. However, in a study conducted by Van Doorn he suggested the media repeatedly shows a relationship between lazy, black, and poor suggesting why some Americans are opposed to welfare programs.

From the 1970s onward, women became the predominant face of poverty. In a 1999 study by Franklin Gilliam that examined people's attitudes on race, gender, and the media, an eleven-minute news clip featuring one of two stories on welfare was shown to two groups of participants. Each story on welfare had a different recipient—one was a white woman and the other was a black woman. The results showed that people were extremely accurate in their recall of the race and gender of the black female welfare recipient in comparison to those who saw the story with the white female welfare recipient. This outcome confirmed that this unbalanced narrative of gender and race had become a standard cultural bias and that Americans often made implicit associations between race, gender, and poverty.

Furthermore, research conducted by Jennifer L. Monahan, Irene Shtrulis, and Sonja Givens on the transference of media images into interpersonal contexts reveal similar results. The researchers found that "Specific stereotype portrayals of African American women were hypothesized to produce stereotype-consistent judgments made of a different African American woman" (Givens, Monahan, Shtrulis 1).

Impact of the stereotype

In the 1990s, partly due to widespread belief in the "welfare queen" stereotype, twenty-two American states passed laws that banned increasing welfare payments to mothers after they had more children. In order to receive additional funds after the birth of a child, women were required to prove to the state that their pregnancies were the result of contraceptive failure, rape, or incest. Between 2002 and 2016, these laws were repealed in seven states. California State Senator Holly Mitchell said at the time of the repeal of California's law, “I don’t know a woman — and I don’t think she exists — who would have a baby for the sole purpose of having another $130 a month.”