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Objectives. To present and analyze the Peruvian health system's response to the sexual and reproductive health needs of Venezuelan women living in the city of Lima, Peru, and to identify some of the reasons underlying this response. Methods. Information was collected through semi-structured, in-depth telephone interviews with 30 Venezuelan women, 10 healthcare workers, and two Ministry of Health officials. Results. Based on the experiences of Venezuelan women who sought care through these services during 2019-2020 and the perspectives of healthcare personnel and health authorities, we present an analysis of the public health services' capacity and limitations in meeting the sexual and reproductive health needs of this population. Migrant women's testimonies reported a positive experience with a health system that, despite shortcomings, responds to the most common sexual and reproductive health needs. These perspectives parallel the testimonies of healthcare personnel and authorities who emphasized the existence of priority policies for sexual and reproductive health care. Conclusion. This study shows how a national priority framework (reducing maternal mortality), accompanied by operational mechanisms for social protection (such as the Comprehensive Health Insurance program), represent complementary instruments that have a positive impact on and extend benefits to migrants, even though this population was not considered when designing these policies. [ABSTRACT FROM AUTHOR]

Objective. To understand the sexual and reproductive health (SRH) experiences of migrant women and girls of reproductive age (15-49 years) from the Northern Triangle of Central America (El Salvador, Guatemala and Honduras) during their journey to the United States. Methods. A descriptive, qualitative research design included 39 in-depth interviews with migrant women and unaccompanied migrant girls from El Salvador, Guatemala and Honduras from January to June 2022. Participants were recruited using purposive sampling. Interviews were transcribed, coded and analyzed using thematic analysis. Results. Migrant women and girls lack information and resources to manage their SRH during migration. The SRH of those traveling with smugglers is compromised due to their limited access to menstrual pads, water and sanitation services; the risks of transactional sex and sexual violence; the high risk of sexually transmitted infections; the inability to report sexual violence; the lack of access to SRH and prenatal services; and limited knowledge about their sexual and reproductive rights. Conclusions. There is a significant need for improved interventions during the predeparture phase of migration to inform migrant women and girls about the SRH risks they may encounter and to provide information and resources to support their SRH throughout their journey. Special attention should be directed towards trying to reach girls and women who will travel with smugglers. [ABSTRACT FROM AUTHOR]

Objective. To identify sexual risk behaviors and barriers to sexual and reproductive health care (SRH) among Venezuelan female sex workers living in the Dominican Republic. Methods. This was a mixed-methods study using four focus group discussions (FGDs) and a cross-sectional quantitative survey with Venezuelan migrant female sex workers. The study was conducted from September through October 2021 in two urban areas (Santo Domingo and Puerto Plata) in the Dominican Republic. Information collected from the FGDs was analyzed using thematic content analysis, and quantitative data were analyzed using univariate descriptive statistics. Data analysis was conducted from 30 November 2021 to 20 February 2022. Results. In all, 40 Venezuelan migrant female sex workers with a median (range) age of 33 (19-49) years participated in the FGDs and survey. The FDGs identified barriers to SRH services, including immigration status and its implications for formal employment and health access, mental wellbeing, quality-of-life in the Dominican Republic, navigating sex work, perceptions of sex work, SRH knowledge, and limited social support. Findings of the quantitative analysis indicated that most participants reported feeling depressed (78%), lonely/isolated (75%), and having difficulty sleeping (88%). Participants reported an average of 10 sexual partners in the past 30 days; 55% had engaged in sexual practices while under the influence of alcohol; and only 39% had used a condom when performing oral sex in the past 30 days. Regarding AIDS/HIV, 79% had taken an HIV test in the past 6 months, and 74% knew where to seek HIV services. Conclusions. This mixed-methods study found that nationality and social exclusion have a multilayered influence on migrant female sex workers, sexual risk behaviors, and access to health care. Recommendations for effective evidence-based interventions to address sexual health knowledge need to be implemented to address risky sexual behaviors, improve access to SRH, and reduce affordability barriers. [ABSTRACT FROM AUTHOR]

Objectives. To describe the perspectives of health practitioners on the barriers, gaps, and opportunities that Venezuelan migrant women experienced to accessing sexual and reproductive health (SRH) services during the COVID-19 pandemic and how SRH services were affected in Quito, Ecuador. Methods. Health practitioners involved in SRH services at nine public health care facilities in three zones of Quito were surveyed. The Minimum Initial Service Package readiness assessment tool survey, available from the Inter-Agency Working Group on Reproductive Health in Crisis, was adapted for use and data collection in Ecuador. Results. Of 297 respondents, 227 were included in the analysis. Only 16% of the health practitioners agreed that discrimination against migrant Venezuelans women occurred in the health care system. Of those, only 2.3% described specific conditions associated with discrimination, including requiring identification documents (7.5%) and lack of empathy or responsiveness (6.6%). Most (65.2%) respondents reported that the COVID-19 pandemic affected the use of SRH services by women in the general population and by Venezuelan migrant women more so (56.3%) because of more limited access to SRH services, poverty, and vulnerability. There were no differences between perceptions by levels of health care facility, except with regard to the lack of supplies, awareness of discrimination, and the belief that Venezuelan migrant women were affected more negatively than the local population. Conclusion. The perception among health practitioners in Quito was that discrimination occurred infrequently during the COVID-19 pandemic despite affecting the health care system. However, some level of discrimination toward migrant Venezuelan migrant women seeking SRH services was acknowledged and may be underrepresented. [ABSTRACT FROM AUTHOR]

Objective. To determine the time pattern of adolescent fertility rates (AFRs) in the countries of the Region of the Americas, categorizing them to evaluate their mobility and differences, and to produce a forecast for 2023. Methods. Ecological and descriptive study of a time series of AFRs in 32 countries, from 1960 to 2019, based on information from the World Bank and the Pan American Health Organization (PAHO). Trends in the AFR were estimated using a linear regression model (Prais-Winsten method). Differences were evaluated between two subperiods (1960-1989 and 1990-2019) and among four categories of the AFR for 2019 by testing related samples and analysis of variance, respectively. The AFR for 2023 was predicted with autoregressive integrated moving average (ARIMA) models. Results. The AFR time series for the sample was non-stationary and the annual average trend was downward (coefficient = -1.173; p < 0.001; R2 adjusted = 0.968), dropping from 124 per 1 000 in 1960 to 56.1 per 1 000 in 2019. The countries with the largest and smallest annual trend were Saint Vincent and the Grenadines (-2.783) and Argentina (0.017). Between subperiods (1960-1989 compared to 1990-2019) there were no statistically significant differences between the AFR in Uruguay and Argentina, but there were significant differences among the four categories of AFR for 2019. The average AFR for the sample should continue declining to 2023, but it could increase in eight countries. Conclusions. The time series is largely non-stationary, with a downward trend to 2023. There has been an uneven decline in AFRs, with significant differences among the four groups of countries categorized by their AFR in 2019. The lowest AFRs correspond to two countries in North America, five in the non-Latin Caribbean, and one in South America. The highest AFRs correspond to countries in the Latin Caribbean and in Central and South America. [ABSTRACT FROM AUTHOR]

Objective. To describe, based on the perceptions of adolescents and health service staff, the ways in which adolescent boys interact with sexual and reproductive health services, the changes perceived in this area over time, and the Espacios Amigables strategy ('Friendly Spaces' for adolescent health) to reach out to boys. Methods. An ethnographic, qualitative study was conducted in Friendly Spaces for adolescent and young adult health in five municipalities belonging to Chile's Metropolitan Region. The research methods used were semi-structured interviews (N = 38), discussion groups (N = 5), and participant observation. Results. A masculinities perspective was [TN: "un enfoque de masculinidades". Or simply: "Masculine perspectives were..."] felt to be missing in adolescent sexual and reproductive health care, which is perceived to be an area geared primarily toward females. Most adolescent boys perceive health services as distant and visit them only in case of emergency. Male attendance is low at sexual and reproductive health services in Friendly Spaces within primary health care centers. However, services outside these centers attract boys in larger numbers, for example, one that is exclusively devoted to providing adolescent health care and integrated services in schools. Conclusions. Greater provision of adolescent sexual and reproductive health services does not necessarily translate into increased male access. For such an increase to occur, it is important to engage boys in addressing issues that capture their interest, bring health services closer to them, strengthen intersectoral work, and incorporate a masculinities perspectives in their care. [ABSTRACT FROM AUTHOR]

Objective. To describe the relationship between exposure to physical and/or sexual intimate partner violence (IPV) and indicators of antenatal care (ANC) service utilization among Honduran women of reproductive age. Methods. Data from the 2011-2012 Honduras Demographic and Health Survey were analyzed to describe the relationship between self-reported exposure to IPV and two ANC outcomes: (1) sufficient ANC visits (defined by the Honduran Ministry of Health as five or more visits) and (2) early ANC initiation (within the first trimester). Multiple logistic regression was used to estimate effects of physical and sexual IPV on the outcomes, controlling for women's age, education, literacy, residence, household size, religion, parity, wealth, husband's age, and husband's education. Results. Of women who were married, had at least one living child 5 years or younger, and completed the IPV module (N = 6 629), 13.5% of them reported any physical IPV, and 4.1% reported both physical and sexual IPV. There was no significant association between IPV and early ANC; however, a significant relationship between IPV and sufficient ANC was found. Women who experienced any physical IPV (adjusted odds ratios (aOR) = 1.25; 95% confidence interval (CI): 1.00-1.56) or sexual IPV (aOR = 1.53; 95% CI: 1.08-2.16) were, respectively, 25% and 53% more likely to receive insufficient ANC. Conclusions. Honduras has one of highest rates of interpersonal violence of any nation in the world. In Honduras, IPV is a contributor to this broader category of interpersonal violence as well as a risk factor for insufficient ANC. Our findings suggest that universal IPV screening during ANC as well as future initiatives aimed at reducing IPV might improve ANC utilization in the country. [ABSTRACT FROM AUTHOR]

Objective. To identify perceived barriers to accessing reproductive health care according to the women of Ocotal, Nicaragua; describe their understanding of their reproductive rights; and document their opinions about Nicaragua's total ban on abortion. Methods. From May to June 2014, three focus group discussions were held in Spanish with 17 women from two different neighborhoods (barrios) in the city of Ocotal, Nicaragua. A semi-structured discussion guide with open-ended questions was employed to elucidate local perspectives regarding the focus group discussions themes. Results. Serious obstacles including 1) violence against women, 2) machismo, 3) criticism from others, and 4) lack of communication and education limit women's ability to make their own reproductive health decisions. Women had a pervasive lack of knowledge about reproductive rights and the international human rights documents that define them. In addition, due to religious and cultural ideologies, most women supported the country's total ban on abortion in most circumstances, with the possible exception of rape. Conclusions. Both men and women in Ocotal should be encouraged to participate in community-level programs designed to reduce the impact of the following obstacles to receiving reproductive health care: 1) violence against women and machismo; 2) insufficient, non-standardized sexual education and information about reproductive rights; and 3) poor communication within families and the community at large. Any future public health campaigns to address women's reproductive health needs in Ocotal should implement these types of programs, at the neighborhood level, to reduce stigma surrounding sexual health and activity. [ABSTRACT FROM AUTHOR]

Health care providers play a central role in the promotion and protection of human rights in patient care. Consequently, the World Medical Association, among others, has called on medical and nursing schools to incorporate human rights education into their training programs. This report describes the efforts of one Central American nongovernmental organization to include human rights-related content into reproductive health care provider training programs in Nicaragua and El Salvador. Baseline findings suggest that health care providers are not being adequately prepared to fulfill their duty to protect and promote human rights in patient care. Medical and nursing school administrators, faculty, and students recognize the need to strengthen training in this area and are enthusiastic about incorporating human rights content into their education programs. Evaluation findings suggest that exposure to educational materials and methodologies that emphasize the relationship between human rights and reproductive health may lead to changes in health care provider attitudes and behaviors that help promote and safeguard human rights in patient care. [ABSTRACT FROM AUTHOR]

Objective. Identify the perceptions and opinions of people who provide abortion services in Mexico City, three years after implementation of elective abortion legal reforms. Methods. Nineteen in-depth interviews of health workers assigned to the legal abortion programs at a clinic and a hospital in Mexico's Federal District were carried out between February and June of 2010. Information on sociodemographic data, professional training, and experience in providing services was collected. Results. Some interviewees thought the provision of free services was beneficial because it allowed lower-income women to access this type of care, whereas others interviewed disapproved of the lack of fees, since other gynecological and obstetric health services have to be paid for. Conscientious objection prevailed among newly hired health workers, which can be attributed to their lack of knowledge about the legal abortion program's legal and technical guidelines. Some workers were ambivalent because they did not accept a postabortion contraception method used by some women, perceiving it to be a factor in significant repeated demand for legal abortion services. Conclusions. Health workers evince divided and ambivalent opinions with regard to abortion rights. Analyzing their experiences and opinions will facilitate the creation of a baseline on the subject, and future studies will be able to document changes in and any lessening of approval for this law in Mexico. [ABSTRACT FROM AUTHOR]

At the International Conference on Population and Development (ICPD) that was held in Cairo, Egypt, in 1994, participants acknowledged that population, economic growth, and sustainable development are concepts that are closely linked, and important strides were made in terms of increased recognition of sexual and reproductive rights. The Programme of Action ratified at that Conference was adopted as a platform for designing national and international policies in the areas of population and development for a period of twenty years. However, in Latin America and the Caribbean all types of obstacles--financial, institutional, and human--still stand in the way of attaining the goals of the Programme of Action, and some governments have established measures that undermine their people's exercise of sexual and reproductive rights. The Caribbean Subregional Meeting to Assess the Implementation of the Programme of Action of the International Conference on Population and Development 10 Years after its Adoption was held in Port of Spain, Trinidad and Tobago, in November of 2003. At the meeting, which was attended by representatives from 20 Caribbean countries and territories, a call was made for more rational use of available resources and for mobilization of additional funds for developing and implementing population and development programs and policies in the Caribbean. The meeting also saw the approval of the Caribbean Declaration, which lays out the challenges that should serve as the roadmap for taking actions to consolidate the progress achieved so far and come closer to attaining the goals established by the ICPD. In the Declaration, the countries and territories of the Caribbean asserted their commitment to continue legislative reforms at the national level while seeking to enforce these reforms in an effort to ensure implementation of the ICPD's Programme of Action and of the Caribbean Plan of Action for Population and Development... [ABSTRACT FROM AUTHOR]