Malvern Tatenda Chiweshe’s research while affiliated with Rhodes University and other places

Since the International Conference on Population and Development in 1994, global policies, and agenda‐setting milestones have emphasized that universal sexual and reproductive health and rights (SRHR) are unattainable without the meaningful engagement and inclusion of men. Despite this, the field of SRHR continues to struggle with how and in what ways men can and should be included in research, programs, and policies. In this commentary, we argue that the programmatic focus of SRHR limits the capacity to produce the data and evidence needed to inform gender transformational change. For men to be meaningfully engaged with by SRHR, researchers need an analytic lens that can capture the manifestations and outcomes of gender and power. We consider the conceptual complementarities between two theoretical frameworks: hegemonic masculinities and Reproductive Justice. We contend that bringing together these conceptual approaches to men and SRHR offers an analytic framework to iterate and innovate approaches to research. Such changes will allow for a greater interrogation of gender and power and the production of data and evidence necessary to grapple with the ongoing injustices that curtail people's sexual and reproductive freedoms.

Lack of access to safe abortions continues to be a major sexual and reproductive health concern. Adolescents can face barriers to safe abortions due to the unique implications of their age. Understanding adolescent abortion experiences and care trajectories is critical. Qualitative and quantitative evidence is analysed from interviews with 313 adolescents aged 10–19 years who sought abortion-related care in public health facilities in Addis Ababa (Ethiopia), Lilongwe (Malawi), and Lusaka (Zambia) between April 2018 and September 2019. The trajectories framework is used to understand how adolescent abortion-related care-seeking differs across a range of socio-legal national contexts. A comparative study design incorporates varying levels of restriction on access to abortion: Ethiopia (legal on broad social or economic grounds, services implemented); Zambia (legal on broad social or economic grounds, complex services with barriers to implementation and information provision); and Malawi (legally highly restricted). Most adolescents (n = 97, 98%) in Ethiopia obtained a medically safe abortion, and most adolescents (n = 70, 64%) in Zambia and almost all adolescents (n = 94, 94%) in Malawi obtained a less medically safe abortion. There is a significant association between country and whether an adolescent tried to end a pregnancy before coming to the facility, X²(2, N = 313) = 135.93, p < 0.001. In Malawi 97% (n = 101) of adolescents had sought to end the pregnancy before coming to the facility, compared to 18% (n = 18) in Ethiopia. Cross-country variations in the relative safety of the abortion and type of care sought by adolescents reflect national laws, policies and service availability. The most facility-based abortions were recorded where care is most accessible (Ethiopia), and most non-facility-based and least safe abortions were recorded where care is the most restricted (Malawi). Across all countries, adolescents experienced delays to their care-seeking; 39% (n = 39), 71% (n = 74), and 66% (n = 73) in Ethiopia, Malawi, and Zambia respectively. Adolescents reported high levels of respectful treatment across countries, with a minority reporting negative experiences. A minority of adolescents in each country reported that unofficial money was paid to facility staff. There were different experiences of post-abortion contraception in the three countries, including an absence of choice. Adolescents’ trajectories – particularly those involving multiple attempts and barriers to achieving abortion care – require tenacity and determination. Our analyses show that less restrictive abortion policies and accessible abortion services improve adolescent chances to access abortion care.

Introduction Policy decisions about young people’s sexual and reproductive health and rights (SRHR) have far-reaching implications for their well-being. Few SRHR policies, however, focus specifically on youth. Rather, youth SRHR tends to be subsumed within national policies of Health, Youth, Education and Development Ministries, particularly in the Eastern and Southern Africa (ESA) region, complicating an assessment of the overall state of youth SRHR policies. Given the fact that youth SRHR policies focus on a particular segment of the population—youth, teenagers or adolescents—how policies depict these subjects has implications for how policy objectives, programmes and interventions are conceptualised and the kind of sexual and reproductive health concerns that are prioritised. Methods Using a subject positioning lens, our critical review of youth SRHR policy in force between 2010 and 2020 spans policy domains to examine depictions of young people across 88 ESA policy documents. Our analysis aimed to identify the qualities and responsibilities associated with different youth subject positions and the broader implications thereof for young people’s SRHR. Results We identify two dominant youth subject positions—risky youth and youth-at-risk—both of which construct risk as inherent to young people, overwhelmingly emphasise negative repercussions of youth sexual practices, foreground individualised interventions and hold young people responsible for preventing negative sexual and reproductive health (SRH) outcomes in the absence of policy objectives that meaningfully address structural constraints on their agency. Conclusions Considering the dominance of public health research underpinning youth SRHR, our findings contribute a much-needed critical social theory complement that supports holistic, justice-oriented and contextually embedded policy responses to young people’s SRHR. Policy Implications Based on our findings, we provide policy recommendations that support a conceptual shift away from vulnerable youth to vulnerabilising contexts, such that young people’s vulnerability to adverse SRH outcomes is situated in the enabling and constraining conditions in which they live their lives.

Despite abortion in Zimbabwe is legally restricted and socially undesirable, it is still a common occurrence and is mostly unsafe. There is dearth of research that explores the role that men play in abortion. Previous research has shown how Zimbabwean men have seen abortion as a challenge to the control that they have over women. Women who have abortions in Zimbabwe speak in socially sanctioned ways of seeing men as masculine providers and inherently good for children. This reasoning positions men as being providers who are needed for women to keep pregnancies to full term. This chapter problematizes this framework as perpetuating the idea of men as saviours and women as victims. Using African feminisms as a theoretical lens, the chapter then reframes the role of men in abortion. African feminisms provide the tools to reframe the role of men and how patriarchy can be understood. In such theorizing abortion is seen as a form of agency and a rejection of patriarchal understandings of the positioning of women.

Objectives: For a person seeking an abortion, the ability to recognise a pregnancy is a critical first step. Pregnancy recognition is complex and shaped by numerous factors. This paper explores the experiences of pregnancy recognition among adolescents in Ethiopia, Malawi, and Zambia. Study design: The final sample included three hundred and thirteen adolescents aged 10-19 who had sought abortion-related care at urban public facilities in Ethiopia (N=99), Malawi (N=104), and Zambia (N=110). Researchers collected mixed-method data on how adolescents came to recognise that they were pregnant and thematically analysed qualitative data alongside descriptive statistics from quantitative data. Results: Most adolescents reported that their main mode of recognising a pregnancy was medical pregnancy tests or late menstruation. Reasons for not recognising a pregnancy included irregular menses or recent menarche and attribution of signs and symptoms to other medical conditions. Psychological barriers to pregnancy recognition were important, including the refusal to accept a pregnancy and denial of a pregnancy. Timing of recognition shaped the abortion care available for adolescents and the affordability of care. For some adolescents, their capacity to recognise their pregnancy led to involuntary or voluntary disclosure, which decreased their reproductive autonomy. Conclusion: Adolescent experiences of pregnancy recognition complement existing evidence, illustrating critical barriers across age and context. Interrogating pregnancy recognition among adolescents exposed the critical implications for the availability, accessibility, affordability, and autonomy of their abortion trajectory.

We use a violence lens to visibilise how adolescents who sought abortion-related care in three African countries are coerced, controlled and punished with regard to their sexual and reproductive health. We suggest the use of the concept of reproductive violence to characterise these diverse experiences. Our data come from a comparative study on adolescent contraceptive and abortion-seeking behaviours in Ethiopia, Malawi and Zambia. We conducted 313 interviews that generated both quantitative and qualitative evidence in each country (2018–2019). Our analysis shows how adolescent bodies are subject to reproductive violence by parents, partners and healthcare workers, situated within a broader framework of structural violence. Reproductive violence manifests in multiple ways, often within a single abortion trajectory, including coercion to accept post-abortion contraception after receiving facility-based abortion services; having few to no choices of contraceptive methods prior to or after pregnancy; parents and relatives coercing adolescents to not/use abortion or contraception; lack of decision-making regarding sexuality or sexual identity; sex and contraceptive use in relationships rooted in gendered and power dynamics with partners; and – ultimately – adolescents’ lack of control over their own bodies. We show how these experiences make adolescents vulnerable to the experience and perpetuation of reproductive violence.

As part of a multisectoral response to gender-based violence (GBV), Nepal is testing the feasibility of having female community health volunteers (FCHVs) play a formal role in identifying GBV survivors and referring them to specialised services at health facilities. This study followed 116 FHCVs in Mangalsen municipality who attended a one-day orientation on GBV. Over the following year, data were collected from knowledge and attitude assessments of FCHVs, focus group discussions with FCHVs, and members of Mothers’ Groups for Health. Most Significant Change stories were collected from FCHVs, in-depth interviews with stakeholders, and service statistics. Results show that the FCHVs’ knowledge increased, attitudes changed, and confidence in addressing GBV grew. During the study period, FCHVs identified 1,253 GBV survivors and referred 221 of them to health facilities. In addition to assisting GBV survivors, FCHVs worked to prevent GBV by mediating conflicts and curbing harmful practices such as menstrual isolation. Stakeholders viewed FCHVs as a sustainable resource for identifying and referring GBV survivors to services, while women trusted them and looked to them for help. Results show that, with proper training and safety mechanisms, FCHVs can raise community awareness about GBV, facilitate support for survivors, and potentially help prevent harmful practices.