What constitutes evidence in human rights-based approaches to health? Learning from lived experiences of maternal and sexual reproductive health

The impact of human rights interventions on health outcomes is complex, multiple, and difficult to ascertain in the conventional sense of cause and effect. Existing approaches based on probable (experimental and statistical) conclusions from evidence are limited in their ability to capture the impact of rights-based transformations in health. This paper argues that a focus on plausible conclusions from evidence enables policy makers and researchers to take into account the effects of a co-occurrence of multiple factors connected with human rights, including the significant role of “context” and power. Drawing on a subject-near and interpretive (in other words, with regard to meaning) perspective that focuses on the lived experiences of human rights-based interventions, the paper suggests that policy makers and researchers are best served by evidence arrived at through plausible, observational modes of ascertaining impact. Through an examination of what human rights-based interventions mean, based on the experience of their operationalization on the ground in culturally specific maternal and reproductive health care contexts, this paper contributes to an emerging scholarship that seeks to pluralize the concept of evidence and to address the methodological challenges posed by heterogeneous forms of evidence in the context of human rights as applied to health

Challenges in ‘translating’ human rights: perceptions and practices of civil society actors in western India

Rights-based approaches have become prevalent in development rhetoric and programmes in countries such as India, yet little is known about their impact on development practice on the ground. There is limited understanding of how rights work is carried out in India, a country that has a long history of indigenous rights discourse and a strong tradition of civil society activism on rights issues. In this article, we examine the multiple ways in which members of civil society organizations (CSOs) working on rights issues in the state of Rajasthan understand and operationalize rights in their development programmes. As a result of diverse ‘translations’ of rights, local development actors are required to bridge the gaps between the rhetoric of policy and the reality of access to healthcare on the ground. This article illustrates that drawing on community-near traditions of activism and mobilization, such ‘translation work’ is most effective when it responds to local exigencies and needs in ways that the universal language of human rights and state development discourse leave unmet and unacknowledged. In the process, civil society actors use rights-based development frameworks instrumentally as well as normatively to deepen community awareness and participation on the one hand, and to fix the state in its role as duty bearer of health rights, on the other hand. In their engagement with rights, CSO members work to reinforce but also challenge neoliberal modes of health governance

Re-visioning evidence: Reflections on the recent controversy around gender selective abortion in the UK

Reports in the British media over the last 4 years have highlighted the schisms and contestations that have accompanied the reports of gender selective abortions amongst British Asian families. The position that sexselection may be within the terms of the 1967 Abortion Act has particularly sparked controversy amongst abortion campaigners and politicians but equally among medical practitioners (and their professional organisation BPAS) who have hitherto tended to stay clear of such debates. In what ways has the controversy around gender-based abortion led to new framings of the entitlement to service provision and new ways of thinking about evidence in the context of reproductive rights? We reflect on these issues drawing on critiques of what constitutes best evidence, contested notions of reproductive rights and reproductive governance, comparative work in India and China as well as our involvement with different groups of campaigners including British South Asian NGOs. The aim of the paper is to situate the medical and legal provision of abortion services in Britain within current discursive practices around gender equality, ethnicity, reproductive autonomy, probable and plausible evidence, and policies of health reform

[Introduction] Re-situating abortion: bio-politics, global health and rights in neo-liberal times

New modes of neoliberal and rights-based reproductive governance are emerging across the world which either paradoxically foreclose access to universal health services or promote legislative reform without providing a continuum of services on the ground. These shifts present new opportunities for the expansion but also the limitation of abortion provision conceptually and ‘on-the-ground’, both in the Global North and South. The collection of papers in this special issue examine current abortion governance discourse and practice in historical, socio-political contexts to analyse the threat posed to women's sexual and reproductive health and rights globally. Focusing on abortion politics in the context of key intersectional themes of morality, law, religion and technology, the papers conceptually ‘re-situate’ the analysis of abortion with reference to a changing global landscape where new modes of consumption, rapid flows of knowledge and information, increasingly routinised recourse to reproductive technologies and related forms of bio-sociality and solidarity amongst recipients and practitioners coalesce

Conflicted reproductive governance: the co-existence of rights-based approaches and coercion in India’s family planning policies

India’s current population policy is situated between two conflicting discourses of population management, one that is governed by a demographic rationale advocating strict State regulation of fertility, and the other that is delineated by a rights-based framework that promotes individual reproductive choice and bodily autonomy. In this chapter, I show how this conflicted policy discourse becomes supportive of processes that empower the State, rather than facilitate reproductive autonomy among claimants on the ground. The chapter draws on textual analysis of policy and programme documents and discussions with health providers, users and policy makers during long-term fieldwork in the state of Rajasthan. I show that, in their role in promoting regional state directives on reproductive health policies, health workers are at once agents and subjects of State policy processes and of their community’s ideologies, preferences and practices related to childbirth and reproductive care. It is in their work and embodied practice of family planning that we most clearly evidence the implications of ‘conflicted reproductive governance’. When health workers struggle for their own remuneration and recognition, the State’s rights-based health policy objectives will remain unreachable

Anthropology and Bioethics: linking knowledge production and professional regulation

The need for ethical reflection relating to the accountability of anthropological researchers has been an implicit part of the discipline ever since it became established in Britain and the US in the first half of the nineteenth century. This is because the 'field' and relationships stemming therefrom have been central in defining the nature of anthropological knowledge itself. The past two decades have especially been marked by watershed debates to do with the anthropological politics of locating the 'field' in relation to research and researcher (Clifford and Marcus 1986, Marcus and Fisher 1986, Gupta and Ferguson 1997 are good representatives of these shifts for the 1980s and 1990s respectively). Yet, despite this disciplinary reflection, the setting up and practice of actual guidelines for ethical conduct has been relatively slow, given impetus largely when the researched communities themselves have raised concerns or when anthropologists have undertaken fieldwork at 'home'

The potential role of network-oriented interventions for survivors of sexual and gender-based violence among asylum seekers in Belgium

Background Social support and social network members have been identified as an important factor in mitigating the effects of sexual and gender-based violence (SGBV) and improving the coping process for many survivors. Network oriented strategies have been advocated for among domestic violence survivors, as they help build on improving social support and addressing factors that alleviate repeat victimization. There are opportunities to implement such strategies among asylum seekers who are survivors of SGBV in asylum centres, however, this has not been fully explored. This study sought to identify key strategies and opportunities for developing peer-led and network-oriented strategies for mitigating the effects of SGBV among asylum seekers at these centres. Methods Twenty-seven interviews, were conducted with service providers (n = 14) / asylum seekers (n = 13) at three asylum centres in Belgium. A theoretical model developed by the research team from a literature review and discussions with experts and stakeholders, was used as a theoretical framework to analyse the data. An abduction approach with qualitative content analysis was used by the two researchers to analyse the data. Data triangulation was done with findings from observations at these centres over a period of a year. Results Many of the asylum seekers presented with PTSD or psychosomatic symptoms, because of different forms of SGBV, including intimate partner violence, or other trauma experienced during migration. Peer and family support were very influential in mitigating the effects and social costs of violence among the asylum seekers by providing emotional and material support. Social assistants were viewed as an information resource that was essential for most of the asylum seekers. Peer-peer support was identified as a potential tool for mitigating the effects of SGBV. Conclusion Interventions involving asylum seekers and members of their network (especially peers), have the potential for improving physical and mental health outcomes of asylum seekers who are SGBV survivors

Culture and Reproductive Ageing

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Thinking through surrogacy legislation in India: reflections on relational consent and the rights of infertile women

As its main focus the article is concerned with explaining the proposed Indian Assisted Reproductive Technologies (ART) Bill 2010 (2008), and in particular discusses some of its limitations using a relational conception of consent and autonomy. It is argued that two major limitations arise from, firstly,the way the Bill attempts to introduce niversal’ notions of informed consent into a cultural context of socially determined decisionmaking,resulting in the failure to safeguard the welfare of Indian surrogates. A second limitation is that the proposed law entitles only some poor women (surrogates) in India to realise access to quality medical healthcare services compared to others (poor, infertile women). Given the significant class and gender based inequalities which frame reproductive healthcare service delivery in the country, legally guaranteed access to health services for surrogates becomes a privilege where the rights of some individuals and couples to reproduce and exercise procreative agency is valued and not others. The article argues that the Bill must give due consideration to the complex, relational and highly stratified contexts in which women undertake childbearing in India to understand why legally comprehensive consent procedures can co-exist with violations of personhood in practice. Without such consideration the article suggests that injustice toward infertile women can become part of the same legal process wherein overcoming infertility is recognised as a right