This chapter examines the evolution of international human rights standards for health equity, fo... more This chapter examines the evolution of international human rights standards for health equity, focusing on sexual and reproductive health and rights (SRHR). A rich history of women’s rights advocacy informs the international commitments that define SRHR. Over time, sexual and reproductive health rights have been incorporated into development agendas, clarified by treaty bodies, expanded to include sexual minorities, and implemented (or not) at the national level. With the progressive trajectory of SRHR increasingly uncertain, there are continuing challenges to the realization of SRHR, including the continuing criminalization of those who seek out sexual and reproductive health services, the rise of right-wing populism in direct opposition to feminist advancements, and the pushback against lesbian, gay, bisexual, and transgender (LGBT) rights. Given rising opposition to sexual rights, safe abortion, and sexuality education, creative stealth advocacy will be required to advance SRHR.
Any erosion of Roe v Wade will have devastating health outcomes that are likely to widen existing... more Any erosion of Roe v Wade will have devastating health outcomes that are likely to widen existing healthcare inequalities, says Terry McGovern
Gender equity in HIV clinical research raises several distinct issues for a clinician or lawyer w... more Gender equity in HIV clinical research raises several distinct issues for a clinician or lawyer working with HIV-infected women. First most HIV-infected women come from impoverished communities that are underserved "hard to reach" and historically underrepresented in clinical trials. Second sex-specific data and studies have been neglected for all women especially low-income women and even more so low-income HIV-infected women. Third reproductive risk (ie endangerment of fetuses or children) represents a commonly cited obstacle to the participation of women in clinical trials. Since the 1980s HIV/AIDS clinical trials have depended heavily on enrollment of gay white male subjects: those individuals who had knowledgeable personal physicians or who attended HIV clinics at academic centers and were often eager to explore new therapies for their life-threatening illness. By comparison women persons of color and drag users who increasingly bear the burden of the epidemic from a ...
Journal of the American Medical Women's Association (1972)
Thirteen years into a devastating epidemic that is having a serious impact on women of color, we ... more Thirteen years into a devastating epidemic that is having a serious impact on women of color, we are only a few steps closer to genuine participation by women in AIDS clinical trials. Those who depend most heavily on research settings not only for the promise of an accessible cure, but also for life-prolonging therapies and state-of-the-art medical care are hurt most by exclusionary policies. Restrictive and contradictory federal policies, pharmaceutical company reluctance to complete animal toxicology and reproductive studies, inadequate informed consent, and unfounded industry fear of liability all play a part in keeping women with AIDS from participating in clinical research.
Abstract The Trump Administration’s Protecting Life in Global Health Assistance (PLGHA) significa... more Abstract The Trump Administration’s Protecting Life in Global Health Assistance (PLGHA) significantly expands the “Global Gag Rule” – and, in so doing, weakens the global governance of abortion. By chilling debate, reducing transparency, ghettoising sexual and reproductive health and rights work, and interfering with research, PLGHA makes an already bad context demonstrably worse. Individual women suffer the most, as PLGHA inhibits ongoing efforts to reduce abortion-related morbidity and mortality.
BackgroundEpidemics and other complex emergencies historically have had a disproportionate impact... more BackgroundEpidemics and other complex emergencies historically have had a disproportionate impact on women and girls, increasing their vulnerability to gender-based violence (GBV). The COVID-19 pandemic has been no different, with reports of rising cases of GBV emerging worldwide. Already a significant problem in Kenya, Uganda, Nigeria, and South Africa, GBV in these countries has been exacerbated by government restrictions intended to contain the spread of COVID-19. The purpose of this study was to understand how the COVID-19 pandemic affected the availability of GBV prevention and response services from the perspective of the organizations that provide them.MethodsA cross-sectional online survey of people who work in GBV prevention and response in Kenya, Uganda, Nigeria, and South Africa was administered from July to October 2020. A convenience sample was identified through web search, contacts of in-country consultants, and relevant listservs and technical working groups. Descrip...
In recent decades, bold steps taken by the government of Nepal to liberalise its abortion law and... more In recent decades, bold steps taken by the government of Nepal to liberalise its abortion law and increase the affordability and accessibility of safe abortion and family planning have contributed to significant improvements in maternal mortality and other sexual and reproductive health (SRH) outcomes. The Trump administration’s Global Gag Rule (GGR) – which prohibits foreign non-governmental organisations (NGOs) from receiving US global health assistance unless they certify that they will not use funding from any source to engage in service delivery, counselling, referral, or advocacy related to abortion – threatens this progress. This paper examines the impact of the GGR on civil society, NGOs, and SRH service delivery in Nepal. We conducted 205 semi-structured in-depth interviews in 2 phases (August–September 2018, and June–September 2019), and across 22 districts. Interview participants included NGO programme managers, government employees, facility managers and service provider...
ObjectiveA weak and politicised COVID-19 pandemic response in the United States (US) that failed ... more ObjectiveA weak and politicised COVID-19 pandemic response in the United States (US) that failed to prioritise sexual and reproductive health and rights (SRHR) overlaid longstanding SRHR inequities. In this study we investigated how COVID-19 affected SRHR service provision in the US during the first 6 months of the pandemic.MethodsWe used a multiphase, three-part, mixed method approach incorporating: (1) a comprehensive review of state-by-state emergency response policies that mapped state-level actions to protect or suspend SRHR services including abortion, (2) a survey of SRHR service providers (n=40) in a sample of 10 states that either protected or suspended services and (3) in-depth interviews (n=15) with SRHR service providers and advocacy organisations.ResultsTwenty-one states designated some or all SRHR services as essential and therefore exempt from emergency restrictions. Protections, however, varied by state and were not always comprehensive. Fourteen states acted to susp...
ABSTRACT Pandemics and government-imposed restrictions to control them, such as quarantines and s... more ABSTRACT Pandemics and government-imposed restrictions to control them, such as quarantines and school closures, exacerbate gender-based inequalities and increases exposure of women and girls to gender-based violence (GBV). The impacts of these adverse outcomes are further heightened due to diminished access to comprehensive GBV services, as governments redirect resources towards the emergency and deprioritise services such as GBV. Early reports suggest that the COVID-19 pandemic is no different, with GBV surging as governments imposed restrictive policies. In response, we conducted a rapid study in Kenya and interviewed 37 GBV and sexual and reproductive health (SRH) stakeholders from different sectors and types of organisations to understand how COVID-19 containment polices were impacting harder-to-reach women and girls, as well as availability and access to services and programmes. As the Government of Kenya imposed restrictive policies to contain the spread of COVID-19, comprehensive GBV services were not deemed essential in the beginning. The government turned its attention to GBV only after reports of rising GBV in the early months of the pandemic led to advocacy by GBV stakeholders. Even then, the government’s response was ad hoc, and lacking sector-specific guidelines to ensure availability of comprehensive GBV services and programmes. Ultimately, this led to confusion and large-scale disruption in the availability of GBV services and programmes on the ground. Kenyan women and girls will pay the price of this negligence, and some may never fully recover from experienced adverse outcomes.
This chapter examines the evolution of international human rights standards for health equity, fo... more This chapter examines the evolution of international human rights standards for health equity, focusing on sexual and reproductive health and rights (SRHR). A rich history of women’s rights advocacy informs the international commitments that define SRHR. Over time, sexual and reproductive health rights have been incorporated into development agendas, clarified by treaty bodies, expanded to include sexual minorities, and implemented (or not) at the national level. With the progressive trajectory of SRHR increasingly uncertain, there are continuing challenges to the realization of SRHR, including the continuing criminalization of those who seek out sexual and reproductive health services, the rise of right-wing populism in direct opposition to feminist advancements, and the pushback against lesbian, gay, bisexual, and transgender (LGBT) rights. Given rising opposition to sexual rights, safe abortion, and sexuality education, creative stealth advocacy will be required to advance SRHR.
Any erosion of Roe v Wade will have devastating health outcomes that are likely to widen existing... more Any erosion of Roe v Wade will have devastating health outcomes that are likely to widen existing healthcare inequalities, says Terry McGovern
Gender equity in HIV clinical research raises several distinct issues for a clinician or lawyer w... more Gender equity in HIV clinical research raises several distinct issues for a clinician or lawyer working with HIV-infected women. First most HIV-infected women come from impoverished communities that are underserved "hard to reach" and historically underrepresented in clinical trials. Second sex-specific data and studies have been neglected for all women especially low-income women and even more so low-income HIV-infected women. Third reproductive risk (ie endangerment of fetuses or children) represents a commonly cited obstacle to the participation of women in clinical trials. Since the 1980s HIV/AIDS clinical trials have depended heavily on enrollment of gay white male subjects: those individuals who had knowledgeable personal physicians or who attended HIV clinics at academic centers and were often eager to explore new therapies for their life-threatening illness. By comparison women persons of color and drag users who increasingly bear the burden of the epidemic from a ...
Journal of the American Medical Women's Association (1972)
Thirteen years into a devastating epidemic that is having a serious impact on women of color, we ... more Thirteen years into a devastating epidemic that is having a serious impact on women of color, we are only a few steps closer to genuine participation by women in AIDS clinical trials. Those who depend most heavily on research settings not only for the promise of an accessible cure, but also for life-prolonging therapies and state-of-the-art medical care are hurt most by exclusionary policies. Restrictive and contradictory federal policies, pharmaceutical company reluctance to complete animal toxicology and reproductive studies, inadequate informed consent, and unfounded industry fear of liability all play a part in keeping women with AIDS from participating in clinical research.
Abstract The Trump Administration’s Protecting Life in Global Health Assistance (PLGHA) significa... more Abstract The Trump Administration’s Protecting Life in Global Health Assistance (PLGHA) significantly expands the “Global Gag Rule” – and, in so doing, weakens the global governance of abortion. By chilling debate, reducing transparency, ghettoising sexual and reproductive health and rights work, and interfering with research, PLGHA makes an already bad context demonstrably worse. Individual women suffer the most, as PLGHA inhibits ongoing efforts to reduce abortion-related morbidity and mortality.
BackgroundEpidemics and other complex emergencies historically have had a disproportionate impact... more BackgroundEpidemics and other complex emergencies historically have had a disproportionate impact on women and girls, increasing their vulnerability to gender-based violence (GBV). The COVID-19 pandemic has been no different, with reports of rising cases of GBV emerging worldwide. Already a significant problem in Kenya, Uganda, Nigeria, and South Africa, GBV in these countries has been exacerbated by government restrictions intended to contain the spread of COVID-19. The purpose of this study was to understand how the COVID-19 pandemic affected the availability of GBV prevention and response services from the perspective of the organizations that provide them.MethodsA cross-sectional online survey of people who work in GBV prevention and response in Kenya, Uganda, Nigeria, and South Africa was administered from July to October 2020. A convenience sample was identified through web search, contacts of in-country consultants, and relevant listservs and technical working groups. Descrip...
In recent decades, bold steps taken by the government of Nepal to liberalise its abortion law and... more In recent decades, bold steps taken by the government of Nepal to liberalise its abortion law and increase the affordability and accessibility of safe abortion and family planning have contributed to significant improvements in maternal mortality and other sexual and reproductive health (SRH) outcomes. The Trump administration’s Global Gag Rule (GGR) – which prohibits foreign non-governmental organisations (NGOs) from receiving US global health assistance unless they certify that they will not use funding from any source to engage in service delivery, counselling, referral, or advocacy related to abortion – threatens this progress. This paper examines the impact of the GGR on civil society, NGOs, and SRH service delivery in Nepal. We conducted 205 semi-structured in-depth interviews in 2 phases (August–September 2018, and June–September 2019), and across 22 districts. Interview participants included NGO programme managers, government employees, facility managers and service provider...
ObjectiveA weak and politicised COVID-19 pandemic response in the United States (US) that failed ... more ObjectiveA weak and politicised COVID-19 pandemic response in the United States (US) that failed to prioritise sexual and reproductive health and rights (SRHR) overlaid longstanding SRHR inequities. In this study we investigated how COVID-19 affected SRHR service provision in the US during the first 6 months of the pandemic.MethodsWe used a multiphase, three-part, mixed method approach incorporating: (1) a comprehensive review of state-by-state emergency response policies that mapped state-level actions to protect or suspend SRHR services including abortion, (2) a survey of SRHR service providers (n=40) in a sample of 10 states that either protected or suspended services and (3) in-depth interviews (n=15) with SRHR service providers and advocacy organisations.ResultsTwenty-one states designated some or all SRHR services as essential and therefore exempt from emergency restrictions. Protections, however, varied by state and were not always comprehensive. Fourteen states acted to susp...
ABSTRACT Pandemics and government-imposed restrictions to control them, such as quarantines and s... more ABSTRACT Pandemics and government-imposed restrictions to control them, such as quarantines and school closures, exacerbate gender-based inequalities and increases exposure of women and girls to gender-based violence (GBV). The impacts of these adverse outcomes are further heightened due to diminished access to comprehensive GBV services, as governments redirect resources towards the emergency and deprioritise services such as GBV. Early reports suggest that the COVID-19 pandemic is no different, with GBV surging as governments imposed restrictive policies. In response, we conducted a rapid study in Kenya and interviewed 37 GBV and sexual and reproductive health (SRH) stakeholders from different sectors and types of organisations to understand how COVID-19 containment polices were impacting harder-to-reach women and girls, as well as availability and access to services and programmes. As the Government of Kenya imposed restrictive policies to contain the spread of COVID-19, comprehensive GBV services were not deemed essential in the beginning. The government turned its attention to GBV only after reports of rising GBV in the early months of the pandemic led to advocacy by GBV stakeholders. Even then, the government’s response was ad hoc, and lacking sector-specific guidelines to ensure availability of comprehensive GBV services and programmes. Ultimately, this led to confusion and large-scale disruption in the availability of GBV services and programmes on the ground. Kenyan women and girls will pay the price of this negligence, and some may never fully recover from experienced adverse outcomes.
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Papers by Terry McGovern