Call for papers
"Reproductive Health, Unmet Needs, and Poverty:
Issues of Access and Quality of Services"
Bangkok, Thailand - 25-30 November 2002
The CICRED is planning an interregional seminar on Reproductive Health, Unmet Needs, and Poverty: Issues of Access and Quality of Services to be held in Bangkok, 25-30 November 2002. Any center in the world working on population is invited to communicate to the CICRED staff a proposition of communication on this theme. Approximately 40 Centers will be selected to attend this meeting. The seminar will provide an opportunity for centers to discuss and exchange research findings and experiences in this area. Following the seminar, participants are expected to conduct various activities in the promotion of access to quality reproductive health services by poor and vulnerable groups.
The United Nations Fund for Population will be funding the seminar and covering transportation and accommodation costs for approximately 25 representatives of the Southern Centers. Representatives of Northern Centers are expected to seek support from their own center. The co-organizers are Pr Susana Lerner, from el Colegio de Mexico (Mexico) and Pr Napaporn Chayovan, from the College of Population Studies (CPS), Chulalongkorn University (Thailand).
A description of the seminar, its objectives and planned activities and the topics to be addressed are exposed above. If you are interested in applying for participation in this seminar, please complete the form in Annex A. Please also complete Annex B about each of the research projects your center is conducting on the theme of the seminar. The deadline for returning the forms to CICRED is 25 February 2002. You can send Annex A and B either by fax (00 33 1 56062165) or by Email (email@example.com) in order to avoid post delays, and send the orginal by courrier mail. The proposed abstracts and information provided will enable us to draw up a list of centers CICRED will invite to participate in the seminar.
Download annexes A and B
During the last decades of the 20th century, the perspective of social and demographic research on human reproduction, sexuality and health changed, as it gradually incorporated issues of human rights, social and gender inequality and a broader range of crucial health dimensions related to reproduction. Concern about women's reproductive health during their different life stages -birth, infancy, childhood, adolescence, adulthood and the menopause- and incorporating men's reproductive health at various stages, was another key innovation. Research and intervention practices were also modified by the involvement of new actors in these issues and by the re-formulation, re-orientation and focussing of social and population policies on the vulnerable and excluded population groups in most countries. Redistributing responsibilities and the provision of certain services among governments, the private sector, civil society organizations and the family, were novel proposals for implementing public policies and programs. The emergence of the reproductive health (RH) concept, as a theoretical conceptual paradigm, and as an instrumental and operative approach, has contributed decisively to the transformation of this scenario.
As part of this scenario, eradicating or reducing global poverty and promoting fundamental rights to development have emerged at the forefront of almost all current international agendas. At the national level, this problem has also become a priority issue that has led to the positing of major new challenges in both public policies and social movements, as well as in the academic context. Not only does it warn of the complexity, contradictions, tensions and conflicts in the way this issue is dealt with, but it also criticizes the simplicity and fallacy underlying the conceptualization, measurement and significance of poverty.
Although economic factors are at the root of poverty, alleviation of the latter is not only confined to economic processes and measures. Poverty is a multidimensional phenomenon, comprising cultural, social, political and ideological dimensions. The backwardness and deficiencies in the population's RH are also an expression of poverty. Unsatisfactory ill-health parameters, low life expectancy, high maternal and child morbi-mortality rates, barriers in access to health services and the inadequate quality of the latter, unequal power relations between genders and between the providers and users of these services, backwardness and a lack of response to the needs and demands of the population in the field of health are, among others, issues that must be considered when analyzing the links between RH and poverty. In addition, eradicating global poverty requires actions to encourage fairer relations between men and women, to promote the exercise of sexual and reproductive rights, to create more and better opportunities in the various spheres of individuals' lives as well as to develop and increase options, freedom, and individuals' fundamental capacity.
As most of the world's poor are women, special attention must be paid to their reproductive and sexual situation and in their economic, social and cultural conditions. But men should not be omitted. Their participation and responsibility in this sphere and risk practices linked to their reproductive lives and therefore to those of their partners should be regarded as issues that are closely linked to the seminar theme. It is also essential to describe the limitations of adolescents and young women in the sphere of their reproductive lives, and not only to emphasize those linked to RH information, communication and counseling. Cultural gender and sexuality constructions and the opportunities and life expectations that they perceive have a powerful impact on their reproductive behavior.
Furthermore, the analysis and discussion of the relationship between RH and poverty must be placed within the context of the current national, regional and international debates on the effectiveness and consequences of hegemonic social policies, including those concerning population and health. Neo-liberal and structural adjustment policies, the reduction of government resources and changes in their social responsibilities have had unfavorable effects. Not only have they led to growing social inequality and to the impoverishment of the great majority of the population, they have also restricted and hampered the implementation of public policies designed to create better opportunities for adequately paid jobs as well as policies aimed at providing suitable, affordable, quality infrastructure services in health, education and housing.
Objectives and planned activities
This seminar does not seek to deal exhaustively with the considerations described earlier that serve as its framework. Its aim is to advance understanding on the interrelationships between poverty and RH, by focussing on and identifying the barriers that constrain and prevent vulnerable groups from fully meeting their reproductive and sexual health needs. Given the wide diversity of contexts throughout the developing and developed world , social, cultural, institutional and gender-specific sources of inequality should be identified by considering existing national and local realities as central analytical axes.
The understanding of the links between poverty, development and RH is still limited and often unable to describe their complexity. Therefore, for development processes to assist individuals in their reproductive choices and practices, the concept and meaning of unmet needs in the field of RH must be tackled. Moreover, the parameters and issues regarding access and quality of RH services have yet to be fully identified and explored. This is especially true of particularly vulnerable groups such as the rural population. Likewise, proper attention to the needs of the urban poor and other marginalized groups, such as indigenous persons, refugees, and internally displaced persons, is also required.
The seminar will facilitate the exchange of research experiences and cooperation in the above-mentioned key areas and in various areas of reproductive health. This in turn will serve as an evidence-base for consciousness raising and advocacy efforts, for policy planning purposes, and for providing guidelines in implementing appropriate initiatives to promote access to quality reproductive health services, taking into account individual needs and demands. The following successive activities have been planned:
Seminar topics to be addressed
1.Conceptual perspectives and methodological issues
Alternative ways for defining and measuring poverty, unmet needs, accessibility and quality of health services, particularly reproductive health services and reproductive and sexual health. Concepts, meanings, analytical categories, variables and measures that have been developed or have to be constructed for a multidimensional poverty approach and for the other concepts, concepts related to RH are welcome. The following questions are examples of aspects to be considered: What are the theoretical and methodological challenges and problems that prevent these problems from being dealt with within the sphere of RH for both research and action? What are the potentials, advantages and limitations of a multidimensional concept of poverty linked to this sphere? How are needs and quality health services parameters defined ? Who defines (or should define) aspects concerning unmet needs and quality service (Individuals, men and or women, policy makers, civil society organizations, other actors, among several actors; individual or private needs vis a vis political and/or social needs)? Who are they defined for (for what groups of sectors of the population, and how homogenous or heterogeneous are the latter)? These topics can be addressed from various theoretical and methodological perspectives, as well as by including empirical evidence.
2. Current overview of reproductive and sexual health status
Assessment of RH conditions in specific countries, within local and differentiated contexts in a country, identifying social groups and gender inequalities between different groups, generations and life course stages, and focusing on particularly vulnerable groups (for example, families headed by women, adolescents and young people, indigenous groups and so on) are part of the diagnosis issues to be considered by participants. Among the questions to be dealt with are: What are the main changes in the parameters and aspects included in the RH approach (family planning, STDs or RTIs, and HIV/AIDS, infant, child and maternal morbi-mortality, breast and cervico-uterine cancer, and coverage of the principal reproductive events, such as pregnancy, childbirth, the postnatal period and abortions? What are the conditions of access to and quality of health services like? What are the conditions or status of individuals, particularly women and teenagers as regards the exercise of their sexual and reproductive rights in their reproductive decisions, and so forth?. This topic will provide an initial approach to the interrelationships between RH status, poverty, unmet needs and access to and quality of services as well as the lags in RH and these last issues.
3. Identification of unmet needs
This topic will explore and provide an overview of the factors affecting major unmet needs related to reproductive and sexual behavior and the provision of services. The impact of gender inequity (as regards people's power, roles, resources and skills, particularly those of women) inequalities between social groups, generations and at different stages of individuals' life cycle in the identification of their reproductive and sexual needs, including their health needs, are crucial issues for dealing with this subject. Describing the diversity or similarity of needs and demands linked to reproductive events and the care of the latter among women and men in similar or different social or national contexts, as well as between various cultural and social groups, particularly among the poorest and most vulnerable will help to identify the aspects to be taken into account by decision-makers. The comparison between unmet needs as defined by the women themselves and those identify by the programs and interventions will also provide an important overview of the tensions and conflicts that occur between individual and social priorities.
4. Assessment of health services-related factors
Given the specificity of the subject of this seminar, it is important to have papers that will provide an overview of the factors affecting access to and the quality of RH services and the variations of the latter in various social, cultural and economic contexts. The following questions are some examples of issues to be addressed: What are the barriers and impact of both gender roles, gender power relations and negotiations and gender inequality, as well as social and cultural differentials in access to RH and general health services? How do economic factors intervene (i.e varying costs of access to health services), together with cultural factors (such as constraints on women's physical mobility)? What are the difficulties involved in incorporating the notions of gender and reproductive and social rights and sexuality issues into health services? What are the advantages and disadvantages of the new proposals and health care models (i.e. popular and other public health care systems
or models, private, etc.) in the reduction of unequal access and the quality of RH services, and in general, in the reduction of social inequalities?
One issue that has become increasingly important and warrants consideration is the distinction and comparison between government RH services and traditional or alternative health services: effectiveness of these services and their impact on the access to and quality of the latter, particularly in developing countries and even more so among marginalized groups and the differences between these services in relation to individuals' needs and demands.
5. Policy and ideological implications related to the provision of RH services and the population's needs and demands
Papers in this topic will provide case studies of the way in which structural changes, economic, social, health and population policies, and different and conflicting ideologies are determinants influencing both access to and the quality of health services (whether they are included or neglected, i.e, abortion, provision and treatment of STDs, etc. ), and the various responses to the population's unmet needs and demands. Case studies from effective or limited RH and other related interventions focussing mainly on the poor, vulnerable or specific groups are also welcome. Some of the following questions could also be addressed: What is the relative importance of reproductive health services in relation to family planning services in government health programs, actions and local services? What are the main social, cultural, political and ideological problems that arise in the implementation of RH programs, particularly in relation to unmet needs and access to and the quality of health services, particularly in contexts of extreme poverty? What role have civil organizations and other social organizations (i.e. religious, educational or other groups and institutions) played in the identification of the population's needs and demands, access to and the provision of quality services, and in the follow-up and monitoring of specific intervention programs? What are the various ideological paradigms or visions of the various actors and social institutions in relation to these issues?
6. Identifying research priorities and summary of main issues addressed in seminar topics
If possible, a closing session will be held on these issues, which will then be followed by a general discussion.
Abstracts are requested for research papers on any of the above topics. The aim of the seminar is for participants to present papers based on existing programs and research projects, to stimulate and facilitate information exchange and to encourage the dissemination of new approaches pertaining to the area of population covered. Studies that compare and contrast more than one country are also encouraged. Participants will be selected from a range of countries and are expected to have varying prior experience of research on the seminar theme. Invited papers by leading researchers in certain specific topics of the seminar will be sought. Commentators will also be selected from among the attendees for each of the themes in the program.