Walking the talk: localising SRHM in South Asia

Introduction

This editorial marks the first time SRHM has published a journal issue focused on South Asia, alongside a new regional platform. This effort furthers our longstanding commitment to ensuring that voices close to the ground are heard – and that evidence generated engages with action and policy.

For those not acquainted with SRHM's history, the Reproductive Health Matters journal was established in 1992, in the run-up to ICPD, by a group of women committed to advancing reproductive rights. The journal was founded by advocates and practitioners who shared a world view of bridging research, policy and activism. As a result, Reproductive Health Matters (RHM, and from 2019, SRHM) has occupied a unique space for close to three decades. Unlike most global health journals, most of our lead and corresponding authors are from the global South; we actively ensure we publish the voices of those engaged within their context in research and practice. Many of our authors are not academic writers or do not work in English as a first language. In order to make information on sexual and reproductive health and rights (SRHR) accessible, for many years we have published editions in local languages with partners in different regions. Our editorial policies help ensure that authors who do not typically publish in academic journals have a space to share important insights about sexual and reproductive rights. Maintaining this ethos has not been without challenges, particularly in the new era of open access and receding commitment to rights-based research in some settings.

In 2018, SRHM launched a new strategy that included re-orienting the language editions towards a stronger regional organisational presence as a journal. In 2020, we inaugurated a South Asia regional platform, which includes this South Asia issue. This continues SRHM’s tradition of supporting local scholarship and providing a space for practitioners, community and movement organisers and early career researchers to play a role in scholarship and discourse in the region. We experimented with three new initiatives. One, we issued a focused call for papers that gave preference to lead authors based in the region. We hoped this would make space for more new voices. Two, we combined the journal issue with a mentorship programme that paired practitioners or early career researchers with experienced SRHM contributors. We aimed to support a rising generation of contributors and – critically – to ensure that this journal issue reflected insights and lived experiences of structurally excluded groups. And three, we used this opportunity to facilitate region-specific dialogues for readers and authors to compare and learn from each other. In addition to joint training, podcasts and blogs, we hosted a virtual roundtable of youth activists across the region, published in this issue. The South Asia platform is also developing freely available content and training materials on what “rights-based evidence generation” means in practice, building on the years of experience of SRHM contributors and editors.

South Asia issue

This themed issue addresses sexual and reproductive health and rights issues in the South Asia region,* focusing on five countries: Bangladesh, India, Nepal, Pakistan, and Sri Lanka. South Asia is home to a quarter of the global population¹ with a shared cultural and geopolitical history. Progress in access to sexual and reproductive health and rights is steady, albeit uneven, across different components, with variations between and within countries. Abortion is criminalised in most countries of the region except India and Nepal, where barriers to accessing safe abortion services persist. Encouragingly, legal recognition has been acceded to transpersons in some countries of the region, though same-sex relationships continue to be criminalised in Bangladesh, Pakistan, and Sri Lanka.² Young people, one-fifth of the region's population, contend with restrictive gender and sexual norms that influence access to sexual and reproductive health (SRH) information and services. Lastly, the region’s health systems are broadly characterised by low investment in the public health system and increasing policy support for privatisation. This impedes access to sexual and reproductive health and rights, especially for the vulnerable, and results in persistently low performance on access and quality in most South Asian countries.³

South Asia is also home to vibrant and powerful people’s movements for social justice and equity in public health. For example, collectives to improve rights related to disability, sex work, and LGBTI populations have engaged in grassroots mobilisation, institutional reforms, and policy advocacy. Improvements in SRHR owe much to the persistence of people’s organisations that have highlighted gaps in services as well as piloted equitable solutions. Despite emerging challenges to civic spaces and dialogue between civil society and governments, these movements – and community engagement more broadly – are an established feature of SRHR networks and practice in the region.

Against this backdrop, we convened a meeting in March 2020 of SRHR researchers and practitioners in the region to identify priority areas for the journal and mentorship programme. Participants identified under-researched areas to inform our call for papers: the impact of socio-political and economic development on SRHR; marginalisation and discrimination; investigating the SRHR relevance of power and hierarchy; consent, agency, and choice; examining opportunities and challenges around technology; and ageing, infertility, reproductive cancers and sexuality and sexual health through the life course.

Through the regional platform, we identified a wide group of regional experts who share SRHM’s aims and represented diverse experiences and views. We were fortunate to have ten experienced, committed mentors who provided their time with passion and dedication to advance scholarship on SRHR. This programme provided the opportunity for mentees to highlight the SRHR issues of marginalised communities, including their own. Mentees learned to apply a rights-based approach and intersectionality lens while honing their writing and analytical skills through one-on-one interactions with mentors and webinars presented by SRHR experts from across the world. Mentees submitted ensuing manuscripts to the journal issue for peer review.

Overall, the South Asia issue received submissions that covered many under-researched populations and topics specific to SRHR in South Asia, such as: the SRHR of women affected by tuberculosis; environmental determinants of infertility; a gender-based violence programme-based study on health system responses to marital rape; administrative inclusion of LGBTQI needs in hospitals; sexual health needs of women living with spinal cord injuries; perspectives of intersex persons; and community perspectives on emerging reasons for child marriages in Bangladesh. Papers in this issue have expanded our view of underlying determinants of sexual and reproductive health including environmental concerns, as well as amplified the need to keep a rights-based approach central in both how research is conducted and how policies are analysed.

We also received varied perspectives on more commonly published topics: e.g., experiences of women from diverse castes and income groups seeking abortion services; barriers to the SRHR of urban marginalised young women, and of women from nomadic tribes; maternal health of internally displaced persons (IDPs); policy-makers and providers’ perspectives on maternal health policies in Nepal; programme evaluation of an SRH intervention in garment factories; and legal analyses on medical abortion and medico-legal procedures regarding rape cases. We had two cross-regional papers: a round table on young people’s views on fundamentalism and SRHR and a commentary that proposed a research agenda on universal health coverage and SRHR in South Asia.

More than two-thirds of the 35 papers published had authors exclusively from South Asia: only five papers had Northern first or corresponding authors. We made a specific effort to identify at least one of the reviewers, if not both, from the region for each paper, in line with our commitment to strengthening local voices. It was rewarding to see that each of the mentees brought to light under-researched SRHR issues with a rights-based approach. We had rich, sometimes extended, engagement with authors, especially first-time authors.

We note that submissions were unevenly distributed across countries. We were disappointed to see few papers that used qualitative methods or employed a rights-based approach in quantitative analyses, particularly of national surveys. Outside of PhD fellowships and mentored articles, most of the research we published was funded by international private philanthropy and multilateral/bilateral donors. The wide range of SRHR issues, including those affecting marginalised populations, were not covered to the extent we had hoped for, nor were the social determinants of health. The submissions reflected funding patterns and donor priorities in the region, such as a continued focus on maternal and child health and family planning and large surveys.

In this era of much discussion on “decolonising” publishing, we cannot over-emphasise the critical role of funding with the vision to support local, rights-based research on SRHR in South Asia. Mentors and mentees confirmed that sustained investment in such mentorship is essential to strengthening platforms for SRHR in South Asia. Beyond this, rights-based research requires support for the intensive inputs needed to redress the well-known inequalities in who conducts, and who publishes, research. And as we have learned through this issue, engaging with SRHR communities from inception enriches what is published and, importantly, who uses this knowledge.

This SRHM South Asia issue demonstrates what can be achieved when people have the vision – and resources are committed – to giving space to voices from the global South, to new voices, and to SRHR issues that have remained invisible. We are proud to present a unique collection of papers that is locally grounded, and we hope “walks the talk” of SRHM’s commitment to providing a platform for rights-based research. We hope the next edition will have a broader reach across South Asia and, critically, across an even wider set of practitioners, researchers and advocates.

Notes

* Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, Sri Lanka.