Reproductive and Sexual Health and Rights SAFE Project Staff Orientation Workshop Dhaka, 29 November 2011 Laila Rahman, Population Council

Reproductive health and Rights Sexual health Sexuality Sexual and reproductive health rights Consent and choice Discussion Points

Reproductive Health Reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease related to the reproductive processes, functions and system at all stages of life. World Health Organization

Have responsible, satisfying and safe sex life Reproduce, and the freedom to decide if, when and how often to reproduce Information and access to safe, effective, affordable and acceptable methods of fertility regulation of their choice Information and access to 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 Reproductive Health Components

Childbirth should be cherished, and exceed beyond mere survival

Right to have a satisfying sex life Right to have a responsible sex life Right to have a safe sex life Right to have the capability to reproduce Freedom to decide if, when and how often to reproduce Right to be informed of and have access to safe, effective, affordable and acceptable methods of fertility regulation of their choice Right of access to health care services to go safely through pregnancy and childbirth Right to the best chance of having a healthy infant Reproductive Health Rights

Sexuality

Source: It’s All One Curriculum Sexuality is a natural dimension of life People are sexual beings throughout the life All can enjoy sex lives that are safe and satisfying with dignity, equality, responsibility and mutual respect Having a safe and satisfying sex life depends on family, community, and society- Society can promote or undermine sexuality

Sexuality Sexuality experienced in… Thoughts Feelings Practices Source: It’s All One Curriculum Sexuality can be expressed … Alone With a partner (in mutually consensual and respectful situation; with same sex, other sex or both)

Sexual Desire Source: It’s All One Curriculum Sexual desire is a longing for sexual expression or a feeling of sexual attraction Various ways to express sexual desire--varies across people Hormone levels, alcohol, drugs, fatigue, illness may affect sexual desire Emotions, personal relationship, experiences, social environment shape peoples’ desire Fantasizing may create or increase desire It is not the same as love, but often confused with love

StatementsT/F? 1Masturbation is harmful 2It’s the man’s role to initiate sex 3The first time a woman has sex, it will hurt 4Size of penis matters to enjoy sex 5The longer the man keep vaginal intercourse, the woman will have an orgasm 6The right age to have sex is 18 7Once a man becomes sexually excited, he cannot control himself and must ejaculate 8A woman who enjoys sex cannot be trusted Sexuality: Myths and facts

Sexual Health Rights

Sexual rights--highly contested term Sexual Rights seen as terminology which has not been ‘agreed upon.’ Many governments limit and equate sexual rights with legalization of homosexuality and same sex marriage however the majority of women who live in patriarchal societies continue to struggle with sexual rights.

Sexual Health and Rights – Embedded in Human Rights of Women "The human rights of women include their right to have control over and decide freely and responsibly on matters related to their sexuality, including sexual and reproductive health, free of coercion, discrimination and violence". Paragraph 96 of the Beijing Declaration

Sexual Health and Rights Rights to achieve the highest attainable standard of sexual health, including access to sexual and reproductive health care services. It includes rights to sexuality education and bodily integrity, and the right to "pursue a satisfying, safe and pleasurable sexual life". The World Health Organization (WHO) Department of Reproductive Health and Research

Definition of Sexual and Reproductive Health Rights in SAFE

Rights to make choices freely (i.e., free of coercion, discrimination and violence) and responsibly (i.e., respecting the rights of others to bodily integrity) on matters related to sexuality, including sexual and reproductive health. SRHR includes rights to access sexual and reproductive health information, education and services. International Conference on Population and Development (UN, 1994) Beijing Declaration and Platform for Action (UN, 1995) Functional Definition of Sexual and Reproductive Health & Rights in SAFE

Bodily Integrity is defined as the ownership of one's own body and ability to determine what happens to it, how it happens, and even why it happens. The classic examples of the right to bodily integrity are sexual assault/abuse and reproductive freedom. Integral to both these issues is women's right to participate or not participate in any kind of sexual activity that they choose (that does not violate someone else's bodily integrity.) Go Go Jo Jo, Journalist

Reproductive Rights in SAFE Access to RH information and education Access to RH services Have choices on receiving RH information and RH services (reproduction, contraception) Making own decision about reproductive health Have choices to get or not to get pregnant Have safe reproductive life

Sexual Rights in SAFE Access to sexual health information and education Access to sexual health services Have choices on receiving sexual health information and services Making own decision about sexual health- to have or not to have sex Have right to choose sexual partner Have satisfying sexual life Have safe sexual life- right not to get infected from sexual relationships

Choice and Informed Consent

Choice One must have right to choose to take part in a particular activity (life events, receiving information, education and services- health/legal aid; participation in a study/survey) after considering different options and fully understanding the risks and benefits of each option. The ability to make a choice is an integral part of realization of SRHR

Informed Consent One must have information about a particular activity (life events, receiving information, education and services- health/legal aid; participation in a study/survey) in order for her/him to decide whether or not s/he wishes to take part in such activity after fully understanding the risks and benefits and the process of the activity. The person must be capable to give consent, and give consent voluntarily, after comprehending the risks and benefits.

Autonomy: The right of people to make decisions about her/his life without any influence, inducement, and coercion Client autonomy allows for the providers to educate the clients but does not allow the provider to make the decision for the client. ©2011 WebMD, Inc. Informed Consent stems from respect towards person’s autonomy

Failing to obtain informed consent before performing a test or procedure on a patient is called battery (a form of assault). Failing to obtain informed consent… An emergency in which medical care is needed immediately to prevent serious or irreversible harm Incompetence in which someone is unable to give permission (or to refuse permission) for testing or treatment Exceptions to Informed Consent

SRHR Violations

SRHR violations Maternal mortality and morbidity Abortion [it is legally restricted except only to save a woman’s life, but menstrual regulation is legal and available in Bangladesh] Violence during or after pregnancy Child marriage Physical, mental and sexual violence Rape, marital rape Trafficking, sex work Discrimination against homosexuality Sub-optimal delivery of SRHR and VAW services Limited SRHR information

Let’s discuss… How to ensure SAFE participants’ SRHR through SAFE Project Activities? How to ensure SAFE staff member’s SRHR through SAFE Project Activities?