TOPIC
Sexual and Reproductive Health Rights (SRHR)
LEAD ACADEMICS
Carolina Borges Rau Steuernagel
OTHER PARTICIPANTS
DESCRIPTION
Sexual and Reproductive Health Rights (SRHR) are fundamental to healthcare and are explicitly identified as part of the Sustainable Development Goal 5, in recognition of the impact of gender equality on human wellbeing. Most initiatives intended to promote SRHR emphasize contraception, maternal and newborn health, and sexually transmitted diseases. Yet, in more holistic versions SRHR also address adolescent sexuality, gender-based violence, abortion, and the diversity of sexual orientations and identities.
Access to sexual and reproductive health services across the world has been uneven, and in some places access has become more restricted. Progress toward better access is dependent on more than evidence of health benefits and often generates expert, political and public debates. Providing equitable services requires challenging moral and social norms about sexuality, established power relations and hierarchies, political practices and discrimination. This section of the Oslo Medical Corpus is intended to support the critical exploration of a broad range of contested concepts that are debated in relation to the interlocking issues of health, gender, sexuality and politics.
JUSTIFICATION
The focus on SRHR enables researchers in a variety of disciplines, including healthcare, to explore how medical discourses impact and are impacted by broader debates about rights, equity, and power. The sub-topics listed below are particularly suited to examining the extent to which medical knowledge informs political practices and public debates, and in turn how the medical field responds to the competing concerns of various sectors of society. Importantly, because medical knowledge is considered objective and impartial, it lends itself to being deployed in opposing discourses in the debate about different aspects of SRHR, and exercises considerable influence on the way concepts such as rights, autonomy, privacy and freedom are understood and operationalised. Below is a brief rationale and outline of the initial subtopics being prioritised for coverage:
* Education on sex, sexuality and reproduction. The right to scientifically based education is a principal human right and is key to achieving good sexual health and wellbeing. And yet it is currently under threat in many parts of the world and has become a highly polarizing topic. The issues that give rise to controversy range from access to educational material on puberty and sexual identity to the fertility and contraception.
* Menstruation and Menopause. More than 800 million people across the globe menstruate daily. Menstrual health is defined in The Lancet as “complete physical, mental, and social wellbeing in relation to the menstrual cycle”. This definition reflects the multifaceted nature of menstruation and the many ways in which the lives of those who menstruate can be affected by their ability to manage their menstrual health effectively. However, in many regions people who menstruate are considered dirty or impure during menstruation, resulting in prohibition from partaking in social meals and restrictions on access to specific food, contact with animals, going to school, or socializing with members of a different gender. While the nature of concrete challenges might vary in different regions and social spaces, attempts to address the practical aspects of menstruation are generally still hampered by silence, lack of knowledge and shame, even in many high-income countries. Access to effective menstrual health is not only about health and wellbeing but also about access to educational and lived citizenship.
Menstruation is followed by menopause. Notably, medical texts and teaching on menstruation and menopause reveal underlying imaginaries about women’s bodies. Whereas the menstruating body is under close scrutiny because of its role in population control, the menopausal body is regarded as ill or useless. Analysis of relevant discourses in the OMC can provide insight into some of the ways in which menstruation and menopause are depicted in medical sources and how these depictions might seep into political and public debates.
* Abortion. At the heart of the controversy over abortion rights are disagreements about key democratic concepts such as rights, autonomy, privacy and freedom, making the right to abortion one of the most contested in the world. This section of the Oslo Medical Corpus is intended to assist researchers in exploring the relationship between the use of medical knowledge, the exercise of state and legal power, and discursive interventions by civil society groups in contemporary democracies in the context of ongoing debates about the right to and restrictions on abortion. In particular, it is intended to assist in examining how medical knowledge is deployed as a technique of control over the population, determining the limits of freedom of legal subjects, and how it is appealed to by grassroots organisations in pursuit of very different objectives.
* Pregnancy. The medicalisation of pregnancy and childbirth has long been a contentious issue. While medical knowledge and access to healthcare play a vital role in promoting healthy and safe pregnancies, the dominance of scientific knowledge can sometimes overshadow alternative forms of knowledge. Concepts such as authoritative knowledge suggest that women’s own understanding of their bodies, traditional knowledge, and alternative care practices are undervalued in medical discourse, while others such as obstetric violence have been coined to raise awareness about medical practices that constitute abuses under the guise of scientific legitimacy. On the other hand, the rhetoric of naturalness that idealises non-interventionist births might also be construed as equally damaging in that it hinders access to birthing technologies, which are often unevenly distributed across the public and private sectors of healthcare.
* Cervical cancer. Debates surrounding cervical cancer often revolve around access to early screenings, vaccination and treatment options. Cervical cancer disproportionately affects marginalised communities with limited access to healthcare, including racial, ethnic and gender minorities, low-income families, and those without health insurance. While medical knowledge on the effectiveness of screening methods provides valuable information on the accuracy, sensitivity, and specificity of screening tests such as Pap smears, HPV testing and newer technologies, the impact of these measures remains dependent on infrastructure that is unequally distributed. At the same time, the uncertainties and medical debates on potential side effects and overtreatment relating to current screening practices are often muted or under-communicated, especially in governmental programmes designed to maximise the uptake of relevant tests among women.
* LGBT health. While the SDGs recognise the importance of gender equality, they do not explicitly address the specific challenges faced by LGBT individuals. The SDGs primarily adopt a binary understanding of gender, focusing on women and girls and ignoring the unique challenges related to the diversity of sexual orientation, gender identity, or gender expression. Medical knowledge too is historically rooted in binary understandings of sex and gender, but recent interventions from civil society have led to a change in approaches to LGBT health, although restrictive policies and gatekeeping practices continue to hinder timely access to essential care.
* Puberty blockers. The controversies surrounding the use of puberty blockers underscore the importance of evidence-based practice, as well as critical evaluation and ethical considerations within the medical community. Puberty blockers are effective in delaying puberty, allowing individuals to explore their identity for a longer time and to make informed decisions. On the other hand, critics have raised concerns about their long-term effects on bone density and fertility and called attention to potential biases in research supporting their use. Overall, the discussions surrounding puberty blockers in transgender youth emphasise the importance of balancing individual present health and well-being with long-term individual and societal considerations.
INDICATIVE SOURCES
(1) Academic
British Medical Journal: Self reported outcomes and adverse events after medical abortion through online telemedicine: Population based study in the Republic of Ireland and Northern Ireland
Journal of Health Psychology: Restricted reproductive rights and risky sexual behaviour: How political disenfranchisement relates to women’s sense of control, well-being and sexual health
(2) Policy documents
WHO: Abortion care guideline (uio.no)
(3) Grassroots and Civil Society Organizations
FP2020: Doctors of the Word Joins Global Push to Help Women Access Contraception
Amnesty International: Sexual and reproductive rights for women and girls in Nicaragua will be one of the priorities for AIUK
(4) Online Magazines
The Nation: The War Against Abortion Rights Is Also a War Against Democracy
Counterpunch: Sex Is Not Gender
POTENTIAL MA/MD PROJECTS
* The human in human rights. Human rights is one of the many frameworks that shape the debate and interpretation of arguments about abortion. Proponents of abortion rights emphasise reproductive rights in terms of bodily autonomy and gender, race and economic equity. On the other hand, opponents of abortion rights prioritise the right to life extended to all stages of development, including the prenatal stage. Biomedical definitions of life, such as the presence of biological markers for pregnancy or embryological stages, may inform contrasting enactments of moral significance. A corpus analysis of opposing discourses in the OMC can be used to understand how biological attributes are imbued with rights to humanity in the abortion debate.
* Discourses of choice and care. Discourses of bodily autonomy have been central to social movements in their quest for abortion rights. The ability to choose, by controlling and making decisions about one’s body, has traditionally informed understandings of citizenship and freedom. But healthcare is often needed precisely when individuals and patients have lost their ability to control their body due to disease or other bodily phenomena. Care is a practice that is often less about reinstating control and more about making it possible to live with bodies that hinder autonomy. While the discourse of choice implies carrying the burden of the responsibility for one’s choice alone, discourses of care often promote sharing responsibility for one’s wellbeing. A corpus analysis of the OMC can be used to understand how discourses of care may shape appropriate healthcare services in politicised, choice-based debates, including debates about abortion.
* Gender and global policies. The concept of gender is central to global health, global development policies, and the field of SRHR. At the same time, it is a source of significant contestations in global policy making. These contestations play out in various ways, from questioning whether certain issues and priorities belong in a gender equality programme to fundamental disagreements about the legitimacy of deploying the concept of gender within globally negotiated texts such as the SDGs. These contestations reflect fundamental cultural and religious positions as well as ideological and political struggles. Access to the OMC makes it possible to explore how the concept of gender is articulated in global health documents, and how different articulations might impact the type of policies and priorities that are enacted at global and regional levels.
RELEVANT RESEARCH ACTIVITIES
The Medicalisation of Democratic Rights in the Debate about Abortion (MEDRA): The US, Ireland and Argentina – funded by UiO:Democracy, this project explores how medical knowledge is mobilized in debates about abortion through corpus-based analysis.