Social Work Reproductive Health
by
Tamarah Moss
  • LAST REVIEWED: 29 September 2015
  • LAST MODIFIED: 29 September 2015
  • DOI: 10.1093/obo/9780195389678-0231

Introduction

Research indicates that social work is constantly faced with social problems influenced by local and global processes. Reproductive health is no exception to the challenges that are relevant to social work practice, research, and policy. These same challenges present opportunities for learning and successful interventions and social policy development. Reproductive health is inclusive of sexual health as well as sexual and reproductive rights. In reviewing the literature on reproductive health, it is important to highlight the interrelationship of psychological and mental health aspects of reproductive health, diverse communities in North America, and international perspectives. A distinction is made between North America and international to highlight the diverse communities of America. As reproductive health approaches grow to become more integrated and translational, the link to HIV and AIDS while limited initiates the need for understanding related to the co-morbidity of clients and communities that exist. The National Association of Social Workers supports “public policies and legislation, nationally and internationally, that recognize a woman’s authority over her own sexual life and reproductive choices, free from coercion, violence, and discrimination,” as indicated on their website. In keeping with the broad mission of the social work profession to promote social justice, the relationship of reproductive health to rights and policy are highlighted. The implications to social work are broadly mentioned as an introduction to stimulate further discussion and exploration for the reader. The overviews and annotations while not exhaustive set the stage for initial inquiries of reproductive and sexual health. In addition, this article serves primarily as a great resource for multiple readers, including graduate students; faculty engaged in course reading lists; and social work practitioners seeking applied research and frameworks to inform their practice, research, and policy development. It should be noted that the section on Definitions Overview ensures clarity on understanding what is referred to as reproductive health. Peer-reviewed research articles and organizational guides and resources are cited. It should be noted that male reproductive health and involvement are essential for addressing reproductive and sexual health in social work, and are presented throughout the list of annotations. The logic of the headings bridge from a definition of reproductive health that is inclusive of sexual health. The international perspectives provide a broad perspective that moves to a more specific global region of North America. Links between reproductive health and HIV and AIDS, as an example to highlight the co-morbidities that exist among clients and communities alike, are important considerations for social workers. Keeping in alignment with social justice as a tenet of social work, the inclusion of rights and policy are important. The implications to social work illustrate how practice, research, and policy are informed by these issues. It should be noted that the reproductive and sexual health needs and rights of men will also be addressed within this topic of bibliographies, but the needs and rights of women and girls will be emphasized, as women account for 20 percent of the global burden on reproductive and sexual ill-health, compared to men at 14 percent, according to “Conclusions” (in Mental Health Aspects of Women’s Reproductive Health), by M. C. de Mello and S. Saxena (cited under Psychological/Mental Health Aspects and available on the WHO website).

Definitions Overview

To ensure that the definition of reproductive health is clear for the purposes of this article, the details in this section provide a framework for consideration in definition, while reviewing the overviews and annotations. The United Nations defines reproductive health as a state of complete physical, mental, and social well-being, and not merely the absence of reproductive disease or infirmity. The International Conference on Population and Development Program of Action (or ICPD Program of Action) states that “reproductive health . . . implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.” Implicit in this last condition are the right of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility which are not against the law. Access to appropriate 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 includes sexual health and not just counseling, care and treatment related to reproduction and sexually transmitted diseases.” According to the World Health Organization, sexual health is defined as “a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.” When it comes to sexual and reproductive rights, the 1994 ICPD Program of Action provides a clear definition that includes the following comprehensive elements: voluntary, informed, and affordable family planning services; prenatal care, safe motherhood services, assisted childbirth from a trained attendant (e.g., a physician or midwife), and comprehensive infant health care; prevention and treatment of sexually transmitted infections (STIs), including HIV and AIDS and cervical cancer; prevention and treatment of violence against women and girls, including torture; safe and accessible postabortion care and, where legal, access to safe abortion services; and sexual health information, education, and counseling, to enhance personal relationships and quality of life.

Psychological/Mental Health Aspects

When referring to reproductive and sexual health, issues are typically framed in physical health terms. As the articles in this section demonstrate, there is a significant relevance of the psychological/mental health aspects of reproductive health for social workers to consider. There is interconnectedness of mental health and reproductive health. The importance of meaning making and symbolism of reproductive health procedures are also important to the discussion. The overview of key areas discussed include pregnancy, childbirth, and postpartum period; psychosocial aspects of family planning; spontaneous pregnancy loss; gynecological conditions, infertility, and assisted reproduction; and female genital mutilation. Kim 2010 provides the historical perspectives on the executive functions (ECFs) and executive cognitive impairment behaviors, highlighting the importance of social workers as critical to HIV and AIDS care and treatment for screening for ECFs, follow-up with clients, and explanation of medical jargon. The dearth in the literature on women’s thoughts and emotions related to receiving a breast cancer diagnosis and the impact on their perspectives on fertility is addressed in Lee, et al. 2011. Lutala, et al. 2011 provides the sociocultural context in terms of the meaning attached to tubal ligation. In addition, the role of a Christianity, the environment, and ways in which providers manage counseling and the impact of extended family on clients were highlighted. Price, et al. 2012 introduces Motivational Interviewing, which is described as a technique to address perinatal depression. Raguz, et al. 2014 provides practical measurement tools for consideration in the field. Finally, Sarid, et al. 2012 provides an expansion on previous research on the interrelationship of reproductive experience, depression, and chronic medical conditions. This article highlights a comprehensive understanding of reproductive and sexual health related to psychological and mental health aspects of reproductive health, as important to social work practice.

  • de Mello, M. C., and S. Saxena. 2009. Conclusions. In Mental health aspects of women’s reproductive health. By the World Health Organization, 158–166. Geneva, Switzerland: World Health Organization.

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    This chapter is part of a WHO publication highlighting mental health needs as an integral part of reproductive health priorities in developing countries. The annex includes the “WHO Survey Questionnaire on Mental Health Aspects of Reproductive Health” (pp. 167–168). The implication is that of a two-pronged approach, giving more attention to research on reproductive mental health and the incorporation of mental health into reproductive health programs and the training of providers at all levels.

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  • Kim, S. -H. 2010. The global security perspective on the effects of executive cognitive function on complex behavioral screening intervention and HIV/AIDS. Social Work in Public Health 25:591–608.

    DOI: 10.1080/19371910903127083Save Citation »Export Citation » Share Citation »

    This article focuses on how social workers and other HIV and AIDS providers observe a decline in brain function, movement, and shifts in behavior and mood of patients/clients. The implications to multidisciplinary and interdisciplinary settings in terms of practice, research, and policy are discussed.

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  • Lee, R. J., A. Wakefield, S. Foy, S. J. Howell, A. M. Wardley, and A. C. Armstrong. 2011. Facilitating reproductive choices: The impact of health services on the experiences of women with breast cancer. Psycho-Oncology 20:1044–1052.

    DOI: 10.1002/pon.1826Save Citation »Export Citation » Share Citation »

    This qualitative study sample size includes women under forty years old from the United Kingdom. While survival is the key for women living with breast cancer, the study provided insight on the importance of fertility for premenopausal women and the implications related to early fertility referral, as well as information and education to facilitate reproductive choice in a more informed way.

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  • Lutala, P. M., J. F. Hugo, and L. N. Luhiriri. 2011. Psychosocial implications of tubal ligation in a rural health district: A phenomenological study. Reproductive Health 8:38–48.

    DOI: 10.1186/1742-4755-8-38Save Citation »Export Citation » Share Citation »

    This qualitative study focuses on the physical aftermath and mental aftermath of tubal ligation on women living in the Congo. Tubal ligation is the most popular form of family-planning methods, worldwide. Women experience feelings of guilt and regret following the sterilization procedure; reminds social workers to consider clients’ state of mind during follow-up treatment and counseling.

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  • Price, S. K., J. Corder-Mable, and K. Austin. 2012. Perinatal depression screening and intervention: Enhancing health provider involvement. Journal of Women’s Health 21.4: 447–455.

    DOI: 10.1089/jwh.2011.3172Save Citation »Export Citation » Share Citation »

    This study focuses on enhancing depression screening and mental health services for providers and women of reproductive age. Motivational Interviewing is discussed as an important technique for consideration, to respond to perinatal depression. It is important for social workers and other providers to work and build a collaborative infrastructure so that the mental health needs of women are addressed.

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  • Raguz, N., S. W. McDonald, A. Metcalfe, C. O’Quinn, and S. C. Tough. 2014. Mental health outcomes of mothers who conceived using fertility treatment. Reproductive Health 11:19–26.

    DOI: 10.1186/1742-4755-11-19Save Citation »Export Citation » Share Citation »

    This study includes the self-reporting on depression and anxiety symptoms among women living in Canada who are four months postpartum. The scales used for measurement include the Edinburg Postnatal Depression Scale, the Spielberger State Anxiety Inventory, and the Parenting Morale Index. The findings indicate no statistical significance between women who conceived spontaneously versus fertility treatment.

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  • Sarid, O., D. Segal-Englechin, and J. Cwikel. 2012. The contribution of negative reproductive experience and chronic medical conditions to depression and pain among Israeli women. Psychology, Health & Medicine 17.1: 82–94.

    DOI: 10.1080/13548506.2011.579987Save Citation »Export Citation » Share Citation »

    This study examines the association of stressful reproductive experiences and chronic medical conditions, pain, and depression. A random telephone survey of twety-five to forty-two-year-old women with children under eighteen years old was included in the sample. Stress includes emotional and physical experiences. Findings indicate that chronic medical conditions and pain are significant predictors of current depressive symptoms.

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Male Reproductive Health and Involvement

Male reproductive health and involvement is essential for addressing reproductive and sexual health in social work. Adongo, et al. 2013 (cited under International Perspectives) highlights the need for cultural and linguistic ability of providers as critical. Knowledge of contraceptives is generally high for males, which provides an opportunity for men to utilize their male privilege in a positive way toward women’s health, reproductive health, and choices. Ekúndayo and Tataw 2013 (cited under Diverse Communities in North America) highlights the importance of community engagement, given that behavior and service utilization among black men is enhanced if they are involved in the process of outreach and educational interventions. Husaini, et al. 2008 (cited under Diverse Communities in North America) utilizes the integration of public health and need for research to focus on decision making related to prostate cancer screening, utilizing the Health Belief Model approach. Ditekemena, et al. 2012 recommends that a behavior campaign focused on changing men’s attitudes and belief systems is essential in determining male involvement in maternal and child health services. Mishra, et al. 2014 highlights the need for more research related to men’s attitudes about gender equality in relation to contraceptive behavior.

  • Ditekemena, J., O. Koole, C. Engmann, et al. 2012. Determinants of male involvement in maternal and child health services in sub-Saharan Africa: A review. Reproductive Health 9:32–40.

    DOI: 10.1186/1742-4755-9-32Save Citation »Export Citation » Share Citation »

    The purpose of the study is to determine male partners’ involvement in maternal and child health activities, including the prevention of mother-to-child-transmission of HIV. The authors reviewed literature including male involvement and participation. Three categories were identified as important to the process, which included sociodemographic factors, health service–related factors, and sociological factors. It is important to assess and monitor the five A’s of improving accessibility, affordability, availability, accommodation, and acceptability of women’s reproductive health, including maternal and child health services.

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  • Kaye, D. K., F. Mirembe, A. M. Ekstrom, G. B. Kyomuhendo, and A. Johansson. 2005. Implications for bride price on domestic violence and reproductive health in Wakiso District, Uganda. African Health Sciences 5.4: 300–303.

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    Bride price is discussed as a contextual factor for domestic violence, gender inequality, and “reproductive ill-health” in Wakiso District, Uganda.

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  • Kishor, S., and K. Johnson. 2006. Reproductive health and domestic violence: Are the poorest women uniquely disadvantaged? Demography 43.2: 293–307.

    DOI: 10.1353/dem.2006.0014Save Citation »Export Citation » Share Citation »

    The countries of Cambodia, Dominican Republic, and Haiti are compared. The key sample includes women exposed to spousal violence. Findings indicated that the negative impact of domestic violence extended across “poverty-wealth” barriers.

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  • Mishra, A., P. Nanda, L. S. Speizer, L. M. Calhoun, A. Zimmerman, and R. Bhardway. 2014. Men’s attitudes on gender equality and their contraceptive use in Uttar Pradesh India. Reproductive Health 11:41–54.

    DOI: 10.1186/1742-4755-11-41Save Citation »Export Citation » Share Citation »

    Peer outreach (interpersonal communication) and mass media were found to be effective for engaging men. This study addressed the lack of literature on male perspectives. This insight will inform policies and programs to increase contraceptives in urban settings.

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  • National Association of Social Workers. Healthy families, strong communities: Social workers address the rights of women and girls worldwide through MDG 5.

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    Background information on the Millenium Development Goals is provided to give context to the focus on Goal 5 with the emphasis on improving maternal health. Strategies to promote improved mental health through social work practice are emphasized.

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  • Palattiyil, G., E. Blyth, D. Sidhva, and G. Balakrishnan. 2010. Globalization and cross-border reproductive services: Ethical implications of surrogacy in India for social work. International Social Work 53.5: 686–700.

    DOI: 10.1177/0020872810372157Save Citation »Export Citation » Share Citation »

    The adequate protection of young Indian women’s engagement in surrogacy is featured. “Cross-border” reproductive care should be considered as part of health tourism and globalization. The International Federation of Social Workers provides key principles to govern the social work profession.

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International Perspectives

As migrations of people continue, natural and manmade disasters occur, and interdisciplinary collaborations in the field of social work grow, the need for being informed about international perspectives has become more important and vital to effective social work practice, research, and policy. The lessons learned across borders are essential, and the local becomes international with immigrant communities worldwide. The social work response to the needs and strengths of communities of origin to communities of acculturation grow in importance in terms of assessing needs and strengths. The social worker’s ability to practice in diverse settings and environments—where the sociocultural, environmental, political, and overall relational contexts matter—is essential. Asfaw and Gashe 2014 emphasized the need for individualized counseling, as well as care and support. Chandra-Mouli, et al. 2014 addresses the unmet reproductive health needs of adolescents living in low- and middle-income countries and the importance of counseling, as one approach to overcome related barriers. Kumar and Srivastava 2011 highlights the importance of cultural taboos with implications to social work counseling. Lee and Oh 2005 presents research of particular interest to social service providers, as improvement in the quality of the welfare system would promote possible successful child rearing among women living with physical disabilities. Onat 2014 discusses psychosocial analysis of five domains of violence through routine screening. Trinh and Rubin 2006, although dated, provides perspective and addresses the barriers for women accessing antenatal care, including migrant women, which is relevant in the early 21st century.

  • Adongo, P. B., P. Tapsoba, J. F. Phillips, et al. 2013. The role of community-based health planning and services strategy involving males in the provision of family planning services: A qualitative study in southern Ghana. Reproductive Health 10:36–51.

    DOI: 10.1186/1742-4755-10-36Save Citation »Export Citation » Share Citation »

    The Ministry of Health in Ghana adopted the Community-Based Health Planning Services health policy to reduce barriers to accessing health services including family planning. This qualitative study explores male involvement and the relevance of socioculture/context in terms of gender equality, cultural norms, and community ridicule. Research indicates that male involvement is essential for successful family planning programs and the empowerment of women. The perceived benefits and barriers to family planning are discussed.

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  • Akyuz, A., T. Tavan, G. Sachiner, and A. Kilic. 2012. Domestic violence and women’s reproductive health: A review of the literature. Aggression and Violent Behavior 17.6: 514–518.

    DOI: 10.1016/j.avb.2012.07.005Save Citation »Export Citation » Share Citation »

    Domestic violence includes reproductive health control such as forced sterilization, genital mutilation, and killing of female children. The research indicates the importance of including experiences of gender discrimination and violence as part of medical history.

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  • Asfaw, H. M., and F. E. Gashe. 2014. Fertility intentions among HIV positive women aged 18–49 years in Addis Ababa Ethiopia: A cross-sectional study. Reproductive Health 11:36–44.

    DOI: 10.1186/1742-4755-11-36Save Citation »Export Citation » Share Citation »

    HIV burden is heaviest in sub-Saharan Africa where 53 percent of adults are women and approximately 58 percent of adults live with HIV. The factors that impact fertility in the study sample of women living with HIV include presence of antiretroviral treatment (ART), improvement of health conditions, influence of husband, children being a “gift from God,” and health workers advising on ideal family size.

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  • Chandra-Mouli, V., D. R. McCarraher, S. V. Phillips, N. E. Williamson, and G. Hainsworth. 2014. Contraception for adolescents in low and middle income countries: Needs, barriers, and access. Reproductive Health 11:1–8.

    DOI: 10.1186/1742-4755-11-1Save Citation »Export Citation » Share Citation »

    Complications from pregnancy and childbirth continue to be the cause of death for adolescents living in low- and middle-income countries (LMIC)—the unmet need of contraception among adolescents, barriers to access, and successful interventions. Counseling and components of adolescent-friendly health services to improve access is especially important in terms of the role of social workers. Legal barriers and attitudes of health workers contribute to the disparity among adolescents.

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  • Kumar, A., and K. Srivastava. 2011. Cultural and social practice regarding menstruation among adolescent girls. Social Work in Public Health 26:594–604.

    DOI: 10.1080/19371918.2010.525144Save Citation »Export Citation » Share Citation »

    The issue of adolescent girls experiencing their menstrual cycles and the taboos experienced in the sociocultural context of India is highlighted. This community-based cross-sectional study found that the education of the mothers matters in terms of raised consciousness related to menstrual hygiene. The suggestions to overcome stigma include the development of school curriculum, counseling services, education, and awareness as approaches to address concerns related to menstrual cycles and adolescent female reproductive health.

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  • Lee, E. K. O., and H. Oh. 2005. A wise wife and good mother: Reproductive health and maternity among women with disability in South Korea. Sexuality and Disability 23.3: 121–144.

    DOI: 10.1007/s11195-005-6728-ySave Citation »Export Citation » Share Citation »

    This study is a part of the first national survey on disability and reproductive health in South Korea. The emphasis of this article is on the needs of women living with a physical disability (WWPD). Women with a physical disability are thought to face a double jeopardy of being female and disabled. The findings indicate a lack of knowledge on sexuality and reproductive health care, lack of provider understanding, and the inability to afford postnatal care.

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  • Onat, G. 2014. Development of a scale for determining violence against infertile women: A scale development study. Reproductive Health 11:18–24.

    DOI: 10.1186/1742-4755-11-18Save Citation »Export Citation » Share Citation »

    This article contributes to the understudied area of the relationship of infertility and violence. The term infertility is defined as the consequence of psychosocial violence through “social isolation, stigma, humiliating curious questions, and pressures from family. . .” (p. 19). Screening tools are introduced, and the need for routine screening at infertility clinics is emphasized. The “Infertile Women’s Exposure to Violence Determination Scale” is discussed in depth.

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  • Trinh, L. T. T., and G. Rubin. 2006. Late entry to antenatal care in New South Wales, Australia. Reproductive Health 3:8–16.

    DOI: 10.1186/1742-4755-3-8Save Citation »Export Citation » Share Citation »

    The World Health Organization recommends antenatal care in the first four months of pregnancy for women in developing countries. The Andersen Health Seeking Behavior Model is utilized as a framework to discuss late antenatal care. The four main components of predisposing, enabling, needs, and personal health behavior are emphasized in terms of the characteristics of women entering antenatal care late. Barriers to access and the special needs of migrant women are highlighted.

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Diverse Communities in North America

Just as the ethnic, cultural backgrounds and various identities of people in North America are diverse, so are their reproductive health needs. The strategies for social workers to engage with diverse communities in North America involves an understanding of the roles of race and the unmet needs of reproductive health, especially for communities of color and adolescents. The perspectives from the micro, mezzo, and macro are essential when it comes to belief systems and the organizing of macrosystems such as Medicaid and beneficiaries. Bullock and McGraw 2006, although dated, is important to highlight, as the authors suggest guidelines that align with the National Association of Social Workers Code of Ethics to guide the approach to providing effective breast and cervical cancer screening. Dominguez 2010 suggests race as an indicator for reproductive health disparities. Ely and Dulmus 2010 suggests that reproductive health policy and advocacy recommendations lend to an enabling environment to create reproductive health policy that is informed by science and not nonscientific assumptions, or moral and emotional preferences of lawmakers. The best interest of female adolescents is critical. Ford and Forthofer 2010 highlights the role of health professionals in facilitating the access of adolescent reproductive health services. Guilamo-Ramos, et al. 2012 recommends practitioner strategies for social workers to meet the needs of Latino youth, which include a familial process and the clinical issues. Haase and Thomas-Maclean 2011 emphasizes the need for further research on provider understanding and client/patient experience with the integration of the women’s health approach in cervical cancer care and treatment. Hall, et al. 2012 contributes to determining the unmet need of sexual and reproductive health for ethnic minority as well as socially and economically vulnerable women. Laliberté, et al. 2014 highlights the role of preventative reproductive health services impacting Medicaid-related services. Wall 2013 highlights the importance for practitioners at the microlevel to be aware of the diversity of lesbian-headed families and the reproductive and sexual health of lesbians, including the choice to parent.

  • Bullock, K., and S. A. McGraw. 2006. A community capacity-enhancement approach to breast and cervical cancer screening among older women of color. Heath & Social Work 31.1: 16–25.

    DOI: 10.1093/hsw/31.1.16Save Citation »Export Citation » Share Citation »

    This article is important for social workers who are involved in health promotion, especially breast and cervical cancer screening. The emphasis is on addressing the reproductive health needs of older women of color and assessing their capacity for health behavior change. Culturally congruent networks are essential. The principles of the community capacity-enhancing framework are important. Guidelines and implications for social work and links to the National Association of Social Workers Code of Ethics emphasized, are still relevant for the early 21st century.

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  • Dominguez, T. P. 2010. Adverse birth outcomes in African American women: The social context of persistent reproductive disadvantage. Social Work in Public Health 26.1: 3–16.

    DOI: 10.1080/10911350902986880Save Citation »Export Citation » Share Citation »

    African American women continue to have the highest rates of infant mortality and adverse birth outcomes in the United States, compared to other groups. The focus on reproductive disadvantage in the context of American race relations lends to a shift in the epidemiological perspective from a micro- to a macrolevel of determinants. It is important in addressing the reproductive health disparities that persist among African American women.

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  • Ekúndayo, O. T., and D. B. Tataw. 2013. Barriers to prostate cancer prevention and community recommended health education strategies in an urban African American community in Jackson, Mississippi. Social Work in Public Health 28.5: 520–538.

    DOI: 10.1080/10911359.2013.763707Save Citation »Export Citation » Share Citation »

    Despite the disproportionate representation of African American men for prostate cancer, they remain low in terms of preventative health behavior. This study aims to assess prostate cancer awareness and needs among men living in the Georgetown community of Jackson, Mississippi. This cross-sectional survey involved qualitative and quantitative data collection. The needs identified include ability to identify the disease as well as awareness and utilization of resources. An empowerment approach is essential.

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  • Ely, G. E., and C. N. Dulmus. 2010. Disparities in access to reproductive health options for female adolescents. Social Work in Public Health 25.3–4: 341–351.

    DOI: 10.1080/19371910903240779Save Citation »Export Citation » Share Citation »

    While adolescents in the United States may engage in sexual intercourse without parental consent, they are not allowed under law to access reproductive health services. Highlights on disparities in three areas of reproductive health options include abortion, over-the-counter emergency contraception, and the human papillomavirus vaccine. Specific policy and advocacy recommendations that social workers and other providers may initiate to support the reproductive and sexual health rights of adolescents are provided.

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  • Ford, J. L., and M. S. Forthofer. 2010. Social disparities in the receipt of contraceptive services among sexually experienced adolescent females. Social Work in Public Health 24.3–4: 352–367.

    DOI: 10.1080/19371910903240894Save Citation »Export Citation » Share Citation »

    Findings from Wave I of the National Longitudinal Study of Adolescent Health indicate that the educational level of the mother matters, as adolescents with mothers having less than a high school degree were less likely to receive reproductive and sexual health services. Structural and social barriers need to be addressed in order to promote responsible sexual behavior among adolescents.

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  • Guilamo-Ramos, V., V. Goldberg, J. Lee, K. McCarthy, and S. Leavitt. 2012. Latino adolescent reproductive and sexual health behaviors and outcomes: Research informed guidance for agency-based practitioners. Clinical Social Work Journal 40.2: 144–156.

    DOI: 10.1007/s10615-011-0355-0Save Citation »Export Citation » Share Citation »

    Evidence-based intervention strategies are the best approach in addressing how agency-based social work practitioners may serve the sexual and reproductive health needs of Latino youth. In the United States, Latino adolescents face disparities related to unintended pregnancies, sexually transmitted infections, and HIV. Case studies on the role of parent-adolescent communication and the role of parental monitoring and supervision provide effective teaching and learning tools in the classroom.

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  • Haase, K., and R. Thomas-Maclean. 2011. Exploring the presence of a women’s health approach in cervical cancer care. APORIA: The Nursing Journal 3.2: 15–25.

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    Cervical cancer is complex, given the nature of the condition as a chronic disease and the link to sexually transmitted infections. The authors provide the women’s health approach as a way for healthcare workers to address care and delivery of services for women living in Canada. A women’s health approach highlights the needs of women and girls, especially related to female sexuality and reproduction in a holistic framework that addresses the health needs across the lifespan.

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  • Hall, K. S., C. Moreau, and J. Trussell. 2012. Continuing social disparities despite upward trends in sexual and reproductive health service use among young women in the United States. Contraception 86:681–686.

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    The data used in this quantitative study included the National Survey for Family Growth. Trends were observed between 2006 and 2010, using a four-point indicator related to when the survey was administered. In terms of sexual and reproductive health use, the findings indicated that race/ethnicity and residence are strongly associated. Inequalities for young women in the United States still persist despite the decline in negative trends.

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  • Husaini, B. A., M. S. Reece, J. S. Emerson, S. Scales, P. C. Hull, and R. S. Levine. 2008. A church-based program on prostate cancer screening for African American men: Reducing health disparities. Ethnicity & Disease 18.2 (Suppl. 2): 179–184.

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    The main focus of this study is to assess the effect of a prostate cancer educational program. This church-based program emphasizes changes in knowledge, perceived threat, and screening behaviors related to prostate cancer among African American men, between the ages of forty and seventy years old living in Tennessee.

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  • Laliberté, F., P. Lefebvre, A. Law, et al. 2014. Medicaid spending on contraceptive coverage and pregnancy-related care. Reproductive Health 11:20–31.

    DOI: 10.1186/1742-4755-11-20Save Citation »Export Citation » Share Citation »

    This article is especially pertinent for social workers working with Medicaid beneficiaries experiencing pregnancy. The authors highlighted that pregnancy and delivery as well as care of newborn infants are the two most expensive conditions that require hospitalization, and are billed to Medicaid. Claims data was analyzed between 2004 and 2010 for five states, which included Florida, Iowa, Kansas, Missouri, and New Jersey.

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  • Wall, M. L. 2013. Lesbian’s perceived readiness to parent. Affilia 28:391–400.

    DOI: 10.1177/0886109913504723Save Citation »Export Citation » Share Citation »

    Women self-identifying as lesbian are navigating their reproductive choice, including parenthood, in what may be considered a heterocentric and homophobic culture. Perceptions of parenting readiness are based on emotional and financial readiness, relationship stability, and adequate sources of support. This study addresses the gap in the literature for lesbians navigating reproductive health and the choice to parent. Barriers to motherhood include financing reproductive technologies or adoption, which are both expensive.

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Link to HIV and AIDS

Highlighting the interrelationship of HIV to reproductive health is essential to a holistic approach about reproductive health for persons living with HIV and AIDS (PLWHA). Research indicates that fertility regulation is achieved when women are functioning in environments where there is relative autonomy in their decisions related to reproductive health. Fanta and Worku 2012 emphasizes the importance of antenatal care to reproductive health. Gruskin, et al. 2007, although a bit dated, highlights the importance of addressing the reproductive health needs of persons living with HIV—an important part of the social work perspective in reproductive health. Kim 2010 draws attention to the implications of multidisciplinary approaches and discusses interdisciplinary settings in terms of practice research and policy. McIntyre 2005 highlights the integration of HIV information and education essential to maternity care and services as well as family planning. The role of the social worker is highlighted, in terms of counseling on safer sexual behavior, HIV, and perinatal transmission, as well as diagnosis and treatment of sexually transmitted infection.

  • Asfaw, H. M., and F. E. Gashe. 2014. Fertility intentions among HIV positive women aged 18–49 years in Addis Ababa Ethiopia: A cross-sectional study. Reproductive Health 11:36–44.

    DOI: 10.1186/1742-4755-11-36Save Citation »Export Citation » Share Citation »

    HIV burden is heaviest in sub-Saharan Africa where 53 percent of adults are women and approximately 58 percent of adults live with HIV. The factors that impact fertility intention include utilization of ART, improvement of health conditions, influence of husband, children being a “gift from God,” and health workers advising on ideal family size. This indicates the need for individualized counseling, as well as care and support.

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  • Fanta, W., and A. Worku. 2012. Determinants for refusal of HIV testing among women attending an antenatal care in Gambella Region, Ehtiopia. Reproductive Health 9:8–21.

    DOI: 10.1186/1742-4755-9-8Save Citation »Export Citation » Share Citation »

    The sociocultural context and existing barriers in Ethiopia related to women attending antenatal care is discussed. A comprehensive, strategic approach to address prevention of HIV; the prevention of unintended pregnancy among women living with HIV; the prevention of mother-to-child transmission; and the treatment care and support provided to women living with HIV, their infants, and families. The Health Belief Model is the framework of discussion.

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  • Gruskin, S., L. Ferguson, and J. O’Malley. 2007. Ensuring sexual and reproductive health for people living with HIV: An overview of key human rights, policy and health systems issues. Reproductive Health Matters 15.29 (Suppl.): 4–26.

    DOI: 10.1016/S0968-8080(07)29028-7Save Citation »Export Citation » Share Citation »

    There is a need for true integration of addressing the reproductive and sexual health of persons living with HIV, especially the most vulnerable or key populations, which include injection-drug users, men who have sex with men, sex workers, migrants, adolescents, and young people. It is important for social workers and other providers to support persons living with HIV to realize their “reproductive goals while ensuring human rights” (p. 4).

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  • Kim, S. -H. 2010. The global security perspectives on the effects of executive cognitive function on complex behavioral screening intervention and HIV/AIDS. Social Work in Public Health 25:591–608.

    DOI: 10.1080/19371910903127083Save Citation »Export Citation » Share Citation »

    This article highlights how social workers and other HIV and AIDS service providers observe a decline in brain function, movement, and shifts in behavior and mood of patients/clients. Historical perspectives on the executive functions (ECFs) and the executive cognitive impairment behaviors that may emerge, highlighting the importance of social workers as critical to HIV and AIDS care and treatment for screening for ECFs, follow-up with clients, and explanation of medical jargon.

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  • McIntyre, J. 2005. Maternal health and HIV. Reproductive Health Matters 13.25: 129–135.

    DOI: 10.1016/S0968-8080(05)25184-4Save Citation »Export Citation » Share Citation »

    The true impact of HIV/AIDS leading to maternal mortality is hard to measure because the HIV status of pregnant women is not always known, so underestimations occur. Research indicates that AIDS is the leading cause of maternal mortality versus direct obstetric causes. At the same time, a pregnant women living with HIV is more susceptible to obstetric complications. Preventing mother-to-child transmission must take on a broader primary prevention focus, which include overall maternal health and not just the issue of transmission.

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Reproductive Rights and Policy

Understanding issues related to reproductive and sexual health rights is essential for social workers to effectively and comprehensively address reproductive health. Alzate 2009 raises the issue of ongoing movement for the integration of human rights into social work teaching, practice, and research, which are all important. There is also a consensus building from the 1995 Beijing Conference that recognized mental, physical, social, reproductive, and sexual health as important to women’s well-being. It should be noted that men’s physical, social, sexual, and reproductive health are important as well. The annotations in this section also include guiding principles, statements, and approaches for the governing bodies of the social work profession, such as the National Association of Social Workers and the International Federation of Social Workers. Also included are the perspectives of multilateral agencies, such as the World Health Organization, International Planned Parenthood, and the United Nation’s Population Fund. Dean, et al. 2013 introduces the term “preconception care,” which is important in the realm of providing reproductive health services. Girard and Waldman 2000 highlights the need for following up on refugees and internally displaced persons that are not, or are no longer, in the care of UN agencies and NGOS; it is important to ensure that they are a part of the larger population and that they are obtaining access, without prescription, to high-quality, comprehensive sexual and reproductive health services. Gruskin, et al. 2007 (cited under Link to HIV and AIDS) again identifies the need for addressing the reproductive health needs of persons living with HIV. Laliberté, et al. 2014 again addresses the needs of Medicaid beneficiaries and related preventive reproductive health needs that may cut overall costs. Lubben, et al. 2002, although dated, discusses the currently relevant issue of reform in reproductive and health sectors, in the context of developing countries. Pillai and Gupta 2011 highlights the importance of integrating a reproductive rights approach to reproductive health. Sossou 2007 highlights gender inequality in Ghana, with implications for early-21st-century and broader-developing country contexts.

  • Alzate, M. M. 2009. The role of social and reproductive rights in social work practice. Affilia 24:108–119.

    DOI: 10.1177/0886109909331695Save Citation »Export Citation » Share Citation »

    In exploring the role of social work in sexual and reproductive rights, there are four areas that need particular attention: (1) right to health and reproductive health, (2) right to decide the number and interval of children, (3) right to physical integrity and a life free from violence, and (4) right to education. This is in alignment with social work, as a human rights profession.

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  • Dean, S. V., E. M. Mason, C. P. Howson, Z. S. Lassi, A. M. Imam, and Z. A. Bhutta. 2013. Born too soon: Care before and between pregnancy to prevent preterm births; From evidence to action. Reproductive Health 10 (Suppl.): S3–S19.

    DOI: 10.1186/1742-4755-10-S1-S3Save Citation »Export Citation » Share Citation »

    The concept and application of preconception practice is defined, and the implications for increasing reproductive and sexual health outcomes are discussed. A conceptual framework for preconception care is introduced, for before and between pregnancies. The authors conclude that in order to improve the health of women and newborns, outreach and awareness in adolescence is critical.

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  • Girard, F., and W. Waldman. 2000. Ensuring the reproductive rights of refugees and internally displaced persons: Legal and policy issues. International Family Planning Perspectives 26.4: 167–173.

    DOI: 10.2307/2648254Save Citation »Export Citation » Share Citation »

    The authors highlight common guidelines that may be used as frameworks for social work practice and policy; United Nations agencies are identified as resources and as collaborating partners; the importance of nongovernmental agencies is emphasized, including their critical roles and perspectives in meeting the sexual and reproductive health needs of refugees and internally displaced persons.

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  • Laliberté, F., P. Lefebvre, A. Law, et al. 2014. Medicaid spending on contraceptive coverage and pregnancy-related care. Reproductive Health 11:20–31.

    DOI: 10.1186/1742-4755-11-20Save Citation »Export Citation » Share Citation »

    This article is especially pertinent for social workers working with Medicaid beneficiaries experiencing pregnancy. The authors highlight that pregnancy and delivery and also care of newborn infants are the two most-expensive conditions that require hospitalization, which is billed to Medicaid in the United States. Claims data was analyzed between 2004 and 2010 for five states, which included Florida, Iowa, Kansas, Missouri, and New Jersey.

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  • Lubben, M., S. H. Mayhew, C. Collins, and A. Green. 2002. Reproductive health and health sector reform in developing countries: Establishing a framework for dialogue. Bulletin of the World Health Organization 80.8: 667–674.

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    Although dated, it is important to include this perspective for novice and more experienced social workers alike. The authors highlight the importance and need for communication on policy between the areas of reproductive health and the reform of the health sector. The matrix of country comparisons on program integration and health sector reform emphasizes planning and priority setting, service delivery, and service support; it provides implementation examples.

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  • Pillai, V. K., and R. Gupta. 2011. Reproductive rights approach to reproductive health in developing countries. Global Action 4.

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    In the context of women’s reproductive health in developing countries, gender equality and reproductive rights components of empowerment strategy are investigated. The authors express that the finding of economic development having no effect on reproductive health was surprising. It should be noted that at the same time, economic development had an indirect effect on reproductive health through gender equality.

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  • Sossou, M. -A. 2007. Gender inequality and lack of sexual and reproductive rights of women in Ghana: Implications for social work education. Professional Development: The International Journal of Continuing Social Work Education 10.2: 26–35.

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    This phenomenological qualitative study focuses on the sexual and reproductive health concerns of Ghanaian women. Findings reveal insight on concepts of motherhood, the role of culture, and gender dynamics. Collaboration of social workers with women’s groups on curriculum development and structural changes is necessary to improve the status of women.

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  • United Nations Population Fund. 2013. UNFPA strategy on adolescents and youth. New York: United Nations Population Fund.

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    Emphasis is placed on UNFPA’s multisectoral agenda toward the empowerment of youth as the main outcome in achieving reproductive and sexual health goals.

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  • United Nations Population Fund. 2014. Accelerating progress towards MDG 5. New York: United Nations Population Fund.

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    The Millenium Development Goal (MDG) 5 is the goal focused on improving material health. This resource demonstrates UNFPA’s commitment to this goal and presents strategies for ensuring sexual and reproductive health worldwide.

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Implications to Social Work

The implications of understanding reproductive health and integration in social work practice are vast and emerging as local and international challenges faced by social workers are ever evolving, as are the populations, communities, families, and individuals served. Alzate 2009 (cited under Reproductive Rights and Policy) raises the issue of the ongoing movement for the integration of human rights into social work teaching, practice, and research. There is also a consensus building since the 1995 Beijing Conference that recognized mental, physical, social, reproductive, and sexual health as important to women’s well-being, and there are implications for using this framework to inform practice and policy development. This is in alignment with social work as a human rights profession. Berger 2004 makes recommendations related to the restructuring of services, which includes a list of policy and service-related actions at the country- and international-proposal levels. Blyth 2008 emphasizes that effective collaborations are a recommended priority for the international social work community in addressing the inequalities of reproductive health that exist in developing and industrialized countries. Elliott 1993 indicates that the integration of social development theory enhances the ability to operationalize how to address reproductive health in social work, research that is still relevant in the early 21st century. Flaherty, et al. 2012 frames the responsibility of future and current social workers to maintain the National Association of Social Workers policy statement on family planning and reproductive health, regardless of level of religiosity. Girard and Waldman 2000 (cited under Reproductive Rights and Policy) highlights the need for following up with refugees and internally displaced persons that are not or are no longer in the care of UN agencies and nongovernmental organizations. It is important to ensure that refugees and displaced persons are included as part of the larger population in obtaining access, without prescription, to high-quality, comprehensive sexual and reproductive health services. These are practical opportunities for application. Jayasundara 2011 introduces the Amartya Sen’s human development perspective as an approach that addresses the interconnectedness of reproductive health and social work that is in sync with the professional values of international social work, ethics, mission, and goals regarding the rights of men and women, which are all highlighted.

  • Berger, M. 2004. HIV/AIDS, sexual and reproductive health: Intersections and implications for national programmes. Health Policy and Planning 19 (Suppl. 1): i62–i70.

    DOI: 10.1093/heapol/czh046Save Citation »Export Citation » Share Citation »

    This article outlines the ways of integrating HIV/AIDs prevention, care, and treatment programs into all sexual and reproductive services, including sexuality education, family planning and abortion, pregnancy-related care, and sexually transmitted infection services. Although dated, the importance of implications to national programs still remains.

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  • Blyth, E. 2008. Inequalities in reproductive health: What is the challenge for social work and how can it respond? Journal of Social Work 8.3: 213–232.

    DOI: 10.1177/1468017308091037Save Citation »Export Citation » Share Citation »

    The challenges of female genital cutting, HIV/AIDS, infertility, antenatal elimination of girls, children born with congenital health problems, pregnancy termination, unsafe pregnancy and childbirth, sexual health, and sexual violence related to reproductive health are highlighted. The International Federation of Social Workers and the International Association of Schools of Social Work statements act as guidelines for social work practice.

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  • Elliott, D. 1993. Social work and social development: Towards an integrative model for social work practice. International Social Work 36:21–36.

    DOI: 10.1177/002087289303600103Save Citation »Export Citation » Share Citation »

    Service delivery in social work takes place predominantly through a residual model. This article focuses on the importance of integrating social development theory and general systems theory. This micro-macro continuum framework allows for various levels of social work tasks that include therapy, administration, etc. Although dated, the topics of social work and social development are still relevant in the early 21st century, and a classic read for newer social workers and students.

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  • Flaherty, C., G. E. Ely, S. Akers, M. Dignan, and T. B. Noland. 2012. Social work student attitudes toward contraception and the HPV vaccine. Social Work in Health Care 51.4: 361–381.

    DOI: 10.1080/00981389.2011.642945Save Citation »Export Citation » Share Citation »

    The National Association of Social Workers’s position on reproductive health, as outlined in the NASW policy statement on family planning and reproductive health, is used as the framework. Study findings indicate that students are most challenged in finding support for adolescent access to over-the-counter emergency contraception, even with parental consent.

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  • International Federation of Social Workers. Cross-Border Reproductive Services. International Federation of Social Workers.

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    The International Federation of Social Workers (IFSW) provides issue and policy statements related to reproductive health “tourism” in the form of cross-border reproductive services, with implications for social workers.

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  • International Federation of Social Workers. Women. International Federation of Social Workers.

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    The IFSW provides a policy statement on women’s health and wellbeing. Special emphasis is given to the social work’s commitment to the well-being of women and girls as part of ethical practice toward ensuring human rights.

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  • Jayasundara, D. S. 2011. Applicability of Amartya Sen’s human development perspectives to the field of reproductive health and social work. International Social Work 56.2: 134–147.

    DOI: 10.1177/0020872811414598Save Citation »Export Citation » Share Citation »

    The author highlights the criticism of social work to marginalize the study of reproductive health, and suggests the theoretical perspective of Amartya Sen as a framework to guide social workers’ integration of reproductive health. Social work focuses on human well-being, and so issues related to reproductive and sexual health would certainly align with the priorities of the profession.

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  • World Health Organization. 2013. Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines. Geneva, Switzerland: World Health Organization.

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    This resource provides information on clinical care and policy development, centered on women, with implications for men who may be abused by their partners. Human rights underpins the guidelines, which may be used by providers across disciplines.

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