Background Sexual and Gender-Based Violence (SGBV) affects women and girls in multiple ways. During migration and within humanitarian settings, migrant women and girls are exposed to different forms of SGBV and to higher vulnerabilities compared with those men encounter. Survivors of this kind of violence face challenges in accessing healthcare for reasons that not only include legal status, language barriers, discrimination, misinformation on the availability of healthcare services, but also the growing spread of conservative views regarding sexual and reproductive health which pose a considerable threat to human rights. This study was guided by the question of how humanitarian emergency preparedness and response initiatives within four cities at the Colombo-Venezuelan border are addressing SGBV. The goal of this research was threefold: first, to explain the level of implementation of the second goal of the MISP, which is to prevent and respond to the consequences of sexual violence; second, to assess the availability of services for migrants who have experienced some type of sexual violence; and third, to understand the perceptions of migrants regarding sexual and gender-based violence. Methods and Findings This study assessed the degree of implementation of the Minimal Initial Service Package (MISP) using a set of tools developed by the Inter-Agency Working Group on Reproductive Health in Crises. This study combined the use of different qualitative methods: i) a literature review; ii) 23 interviews with key informants on sexual and reproductive health; iii) an assessment of 21 health institutions which provide services to migrants; and iv) 24 focus groups with migrants between the ages of 14 to 49 years old (241 participants, of which 121 were women and 120 were men). This research was conducted in four cities at the Colombo-Venezuelan border where there was the highest concentration of migrants. Ethical approval was granted by Profamilia´s Advisory Committee on Research Ethics. Although preventing and managing the consequences of sexual violence is the second objective of the MISP, this study found several barriers for the guarantee of comprehensive healthcare for survivors: Venezuelan migrants do not usually consider that healthcare is a need for them after they have survived sexual violence; SGBV during migration is a common occurrence according to key informants; in three out of four cities there were existing organizations working on SGBV, but not all of them could offer comprehensive healthcare services in response to sexual violence. Conclusions In this study, we observed that migrants tend to be more exposed to Sexual and Gender-Based Violence due to the normalization of such forms of violence in the Colombian and Venezuelan cultures. Findings suggest that Venezuelan migrants are facing complex SGBV issues during the humanitarian emergency at the Colombia-Venezuela border. Recommendations include local health systems response ...

Objectives:To describe the mechanisms of implementation of Zika virus diagnosis, prevention, and management guidelines in Colombia, and to characterize their influence on efforts to defend sexual and reproductive rights. Methods:A qualitative study performed between February and April 2018 in three municipalities in Colombia. We conducted 30 semistructured interviews and five focus groups with key informants who played a role during the epidemic. These included decision-makers, program coordinators, healthcare providers, pregnant women diagnosed with Zika virus, and members of affected communities. Results:We identified barriers to and facilitators for the implementation of the national Zika virus response plan. Barriers included a lack of coordination between vector control efforts and in the realms of sexual and reproductive rights. Facilitators included healthcare providers' response to the epidemic, the development of technical skills, and the establishment of coordination and referral networks across different institutions. Conclusion:A multidimensional approach that considers healthcare services, gender issues, and the environment is crucial. We highlight the epidemic's effects on women's sexual and reproductive rights, mainly related to inequalities in sexual and reproductive health such as the increased risk of sexually transmitted infections experienced by the poorest and most vulnerable women.

Background People living a trans-life require access to equitable healthcare services, policies and research that address their needs. However, trans people have experienced different forms of violence, discrimination, stigma, and unfair access barriers when dealing with healthcare providers. Therefore, adapting sexual and reproductive health services with the purpose of providing more equitable, inclusive and discrimination-free healthcare services is an urgent need. The article presents an example of how operative research can be used in order to adjust sexual and reproductive healthcare services to trans people’s needs, identities and circumstances. Methods This is a qualitative study written from a constructivist perspective, and it is based on the voices and experiences of trans people in four major cities in Colombia. The research used a combination of focus groups of discussion (n = 6) and in-depth interviews with trans people (n = 13) in Barranquilla, Bogota, Cali and Medellin. This research had two specific objectives: i) identifying the main sexual and reproductive health needs of people living a trans-life; and ii) generating new evidence in order to guide the adaptation of sexual and reproductive health services centered to trans people’s needs, identities, and circumstances. Qualitative data codification and analysis was using NVivo. Results Once access barriers to sexual and reproductive health services, unmet sexual and reproductive health needs were identified, the research helped define strategies to adapt sexual and reproductive health services to the needs, identities, and circumstances of people living a trans-life in Colombia. Amongst the main barriers found were healthcare costs, lack of insurance, stigmatization, discrimination and abuse by health care providers. Perhaps among the most notable sexual and reproductive health needs presented were trans-specific services such as sensitive assistance for the transition process, endocrinology appointments, and sex reaffirmation surgeries. Conclusions The evidence obtained from this research allowed Profamilia, a Colombian healthcare provider, to adapt the sexual and reproductive health services it provides to people living a trans-life in Colombia. Furthermore, it was possible for Profamilia to design and implement an inclusive sexual and reproductive health program that specifically addresses trans people’s needs, identities, and circumstances.

Background There is substantial evidence of the profound consequences of Zika on women's Sexual and Reproductive Health. Health system resilience begins by measuring critical capacities ahead of a crisis such as Zika outbreak. Even though Zika as vector-borne disease is well documented, there is dearth of studies linking Zika with women's Sexual and Reproductive Health. The main objective of this study was to analyze the national response to the Zika epidemic and its relation to women’s sexual and reproductive health matters through key implementation mechanisms in order to promote resilience of the health system in five cities in Colombia.Methods This study used a qualitative design to enable an in-depth exploration of the national response to the Zika epidemic and sexual and reproductive health matters through key implementation mechanisms (based on facilitators and gaps) within the health system. The overall data set was comprised of 31 semi-structured individual interviews (23 women and 8 men), 25 interviews with key informants responsible for the implementation of the Zika Virus Response Plan; six interviews with pregnant women diagnosed with Zika; and five focus groups discussions with communities (n=122 participants) in five cities in Colombia: Barranquilla, Cucuta, Los Patios, San Andres and Soledad. Results The findings revealed the three major facilitators that promoted the implementation of actions to address the Zika epidemic: i) the role of health care providers; ii) the development of technical equipment capabilities; and iii) inter-institutional coordination. The study also identified implementation gaps: i) absence of a human rights and sexual and reproductive health approach; ii) focus on territorial actions centered on mosquito management; and iii) limited attitudes, behaviors and knowledge at the community level.Conclusion This study provided a comprehensive insight of critical facilitating processes and gaps in the implementation of the government response during the Zika epidemic in Colombia. This study reveals that the lack of understanding of the intersection between gender, the Zika epidemic and Sexual and Reproductive Health limited the adoption, development and implementation of a more comprehensive responses to address the impact on women’s sexual and reproductive health.

Background There is substantial evidence of the profound consequences of Zika on women's Sexual and Reproductive Health. Health system resilience begins by measuring critical capacities ahead of a crisis such as zika outbreak. Even though zika as vector-borne disease is well documented, there is dearth of studies linking Zika with women's Sexual and Reproductive Health. The main objective of this study was to analyze the national response to the Zika epidemic and its relation to women’s sexual and reproductive health matters through key implementation mechanisms in order to promote resilience of the health system in five cities in Colombia.Methods This study used a qualitative design to enable an in-depth exploration of the national response to the Zika epidemic and sexual and reproductive health matters through key implementation mechanisms (based on facilitators and gaps) within the health system. The overall data set was comprised of 31 semi-structured individual interviews (23 women and 8 men), 25 interviews with key informants responsible for the implementation of the Zika Virus Response Plan; six interviews with pregnant women diagnosed with Zika; and five focus groups discussions with communities (n=122 participants) in five cities in Colombia: Barranquilla, Cucuta, Los Patios, San Andres and Soledad.Results The findings revealed the three major facilitators that promoted the implementation of actions to address the Zika epidemic: i) the role of health care providers; ii) the development of technical equipment capabilities; and iii) inter-institutional coordination. The study also identified implementation gaps: i) absence of a human rights and sexual and reproductive health approach; ii) focus on territorial actions centered on mosquito management; and iii) limited attitudes, behaviors and knowledge at the community level.Conclusion This study provided a comprehensive insight of critical facilitating processes and gaps in the implementation of the government response during the Zika epidemic in Colombia. This study reveals that the lack of understanding of the intersection between gender, the Zika epidemic and Sexual and Reproductive Health limited the adoption, development and implementation of a more comprehensive responses to address the impact on women’s sexual and reproductive health.