Knowledge, Attitudes and Practices towards Sexual and Reproductive Health and Rights of Girls among Colombian Healthcare Professionals
Abstract
:1. Introduction
“The Call to Action aims to mobilize institutional actors, both national and international, of the health sector and other relevant sectors and civil society, to collectively strengthen the human resources in health through both policies and interventions, in order to achieve the Millennium Development Goals and according to the national health priorities to provide access to quality health services for all the peoples of the Americas by the year 2015” [5].
“… Developing competencies in human talent from a broad health concept based on managing social determinants of health, a rights approach, interculturality, participation of patients and communities, protection of indigenous peoples, Afro-descendants, minorities and subjects of special protection, among others, is an imperative challenge to progressively guarantee the right to health provided for in the Statutory Law” [6,7].
2. Materials and Methods
Ethical Considerations
3. Results
3.1. Informants
3.2. Technical and Legal Knowledge of Gender Mainstreaming/Gender Equity in the View of Health as a Fundamental Right
(CO2, 27 years old): "The truth is, well, more or less, because the truth is that I have never been touched by a case of sexual violence…".
(CM3, 35 years old): “Yes, I am very aware of it because I am in outpatient clinics and the cases come that way”.
(CO1, 56 years old): "Yes, I worked 17 years in the emergency department (…) and there we were attending patients who were victims of sexual abuse, of course, we knew how to approach the patient from the emergency, we knew the discretion, we knew the protocols to have, to put into practice, to say medication, preventive issues, psychological, psychiatric, gynecological-obstetric management if it was the case".
(CO1, 56 years old): “Yes, of course. We have to take a course on sexual abuse before joining the organization”.
(CM4, 23 years old): “A training I received at the university regarding violence and it lasted 1 h, another particular one that lasted about 8 h”.
(CO3, 35 years old): "There was one of 40 h and the other one was a week long together with the one on gender violence".
(CO2, 27 years old): "Well, in the little course, in the course that I tell you about, the one on sexual violence—That one was sexual violence, physical violence and all types of violence".
(CM4, 23 years old): "Yes, the same day they explained about sexual violence and identification of vaginal injury, how to collect samples and other things...It was a congress that there was that dealt with all types of violence, including gender violence".
(CM1, 36 years old): "I think that is what we do when a case of domestic violence or sexual violence is reported to the entities to which it should be reported and the notification to SIVIGILA".
(CO1, 56 years old): "Sexual rights are a person's right to express it freely, in their decision to be one gender or the other and the other is if they are already...or, better said, if they are homosexual, whether they are a woman or a man, they have the right to exercise their sexuality, that is the sexual right and the right to reproduction is the right to have the children they want".
(CM4, 23 years old): "…are the rights that a woman has to say about herself and her body".
(CO1, 56 years old): "…those are human rights, but many people do not know how to manage them, so if they are rights, absolutely, but there are people who do not know how to manage their rights, they do not know them, they do not value them and do not understand the meaning of why".
3.3. Knowledge of Health Issues, Sexual and Reproductive Rights and Their Relationship with Gender Equity
(CO1, 56 years old): "It was a prerequisite training course. It is a course that must be taken before, because it is required by the entity where you are going to work, now all entities require this preparation".
(CM3, 35 years old):"I took a course for the care of victims of sexual violence, which is required by most of the institutions”.
(CM4, 23 years old): "I give them the freedom to choose which method they want to use. Then I evaluate the metabolic part before suggesting planning methods. I cannot recommend a contraceptive with a high hormonal load to patients with polycystic ovary disease, because I will end up harming them. I can suggest them, but since it is the patient's right, she can choose the method she wants".
(CO1, 56 years old): "She is the first person to be seen when she arrives at an emergency department. If it were an outpatient department, she should be referred urgently to the emergency department”.
(CM2, 40 years old): "In the consultation, the patient should be received with the best possible treatment so that he/she feels more comfortable in the situation”.
(CM1, 36 years old):" When a user who refers to having suffered sexual violence enters, we pass her/him to the general practitioner by scheduling an immediate consultation, who makes a consultation and we follow a route”.
(CO3, 35 years old): "when a girl arrives who does not want to have a baby, they are explained as such, the three grounds, they are given orientation anyway if they do not fall within the grounds they are sent to psychology and they end up doing as such the.... as they say, the training, no, the orientation, to know whether or not they are apt for abortion, the sentence is explained to them, the three grounds, what is the requirement in each ground, then they are oriented as such with psychology so that they can follow the process... one is obliged to give orientation, but that they agree, not in all cases”.
(CM4, 23 years old): "Most of the time dads do not allow girls to express their questions about e.g., contraceptives calmly and freely”.
(CO3, 35 years old): "the girls who come to us looking for guidance, they are mostly the ones who ask questions, they say that my friend's boyfriend does such and such, I don't know what...so we try to guide her directly so that things are clear, education is really very important”.
(CM1, 36 years old): "Yes. I have heard of some entities”.
(CM3, 35 years old): "My understanding is that to the police and emergency room”.
(CO3, 35 years old): "We have a directory that shows the patient what kind of support she has, the prosecutor's office, the family commissioner's office, the psychologist there, yes, the shelters, there are EPSs that provide them with shelters, so they are like alternatives for the client to avoid returning to the place where the aggressor is and not to return to be abused again and to show them alternatives, foundations that we have”.
3.4. Barriers to Healthcare and Exercise of Sexual and Reproductive Rights in Girls and Adolescents
(CM2, 40 years old): "This comes to us as poster-type information, but we do not receive information or training on how to address the issue in the consultation”.
(CO3, 35 years old): "-skills as such, no, the normal course”.
(CO2, 27 years old): "In itself in adult women it is difficult to address cases, in children it is worse, because as children let's say they do not have, how to tell you, that training in sexuality because they are children, then they sometimes, certain things that are obviously considered as sexual assault or abuse, they as such, as they have an immature mind, sometimes they do not interpret it that way and for them, as you know that children sometimes tend a lot to repeat what they say, they sometimes keep quiet because to them it seems normal”.
(CM3, 35 years old): "There are signs that are not so specific, but it can indicate that something is wrong. When children wet the bed, are afraid to go to the bathroom or are afraid of genital exploration. When genital exploration is performed, there is a lesion, a sexual behavior that, due to lack of knowledge or developmental stage, they do not have the capacity to refer to a sexual behavior. In addition, when a child says that he was touched here or that the uncle did such and such a thing to him, it is considered suspicious”.
(CO3, 35 years old): "…also to what the EPS offers, because not all EPS, at least these days, let's put it this way, …we have had this happen … they only have IUDs and quarterly injections, so the girl who arrives from that EPS cannot be offered anything else, because they have nothing else to give her, so it is up to you to manage that information, the effects and tell the patient, she wants these methods, or it is recorded in the history, that the EPS is only managing those methods and that the patient will start with another one for particular or things like that or that the patient is simply left without planning”.
4. Discussion
This study identified that health professionals at some point in their professional practice received training on issues related to violence against girls, adolescents and women; however, it was found that some confusion persists, mainly related to the use of terminology to differentiate the type of violence that girls, adolescents and women may be suffering, hence the importance of integrating gender issues in the education of medical and health professions, as mentioned by Yang [14], as clarity on these issues in students and teachers promotes equal rights for people, and education on these issues should be considered as a professional discipline based on theory and practice as a tool for decision making.
Regarding knowledge on health issues, sexual and reproductive rights and their relationship with gender equity, this study found that professionals recognize the importance of the topic and that it provides them with elements for the approach to victims; this component of sensitization is related to what was mentioned by Ngoma [15], who noted that there is a statistically significant relationship between the level of knowledge of health professionals, receiving training on the topic of gender-based violence and reporting denunciation practices.
5. Conclusions
6. Recommendations
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Part 1—Sociodemographic characteristics: Sociodemographic characteristics: age, sex, marital status, number of children, socioeconomic stratum, religion Self-recognition as a survivor of domestic violence or any type of violence (gender-based violence, intimate partner violence, inflicted by any person or friend) |
Part 2—Semi-structured themes Technical and legal knowledge of gender mainstreaming/gender equity in the view of health as a fundamental right. Training in gender perspective (duration, mode of instruction) Training in sexual violence (duration, mode of instruction) Knowledge of the Protocol for Comprehensive Care for Victims of Sexual Violence Training in intimate partner violence, especially in adolescents Knowledge of health matters, sexual and reproductive rights and their relationship with gender equity Form of healthcare for survivor of sexual and gender-based violence Knowledge of social conditions of the health center where survivors attended Dissemination model used by entities supporting survivors of sexual and gender-based violence Barriers to healthcare and exercise of sexual and reproductive rights in girls and adolescents Selection of contraceptive methods by adolescents Positions regarding abortion and its requirements Knowledge of skills to care for survivors of sexual and gender-based violence in girls and adolescents |
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Rodríguez-Burbano, A.Y.; Galván-Canchila, D.M.; de Diego-Cordero, R. Knowledge, Attitudes and Practices towards Sexual and Reproductive Health and Rights of Girls among Colombian Healthcare Professionals. Int. J. Environ. Res. Public Health 2022, 19, 12295. https://doi.org/10.3390/ijerph191912295
Rodríguez-Burbano AY, Galván-Canchila DM, de Diego-Cordero R. Knowledge, Attitudes and Practices towards Sexual and Reproductive Health and Rights of Girls among Colombian Healthcare Professionals. International Journal of Environmental Research and Public Health. 2022; 19(19):12295. https://doi.org/10.3390/ijerph191912295
Chicago/Turabian StyleRodríguez-Burbano, Aura Y., Diana M. Galván-Canchila, and Rocío de Diego-Cordero. 2022. "Knowledge, Attitudes and Practices towards Sexual and Reproductive Health and Rights of Girls among Colombian Healthcare Professionals" International Journal of Environmental Research and Public Health 19, no. 19: 12295. https://doi.org/10.3390/ijerph191912295