Sexual Harassment

Jan 31, 2022 | Fact Sheet, Sexual Health Fact Sheet

What is it?

Also known as unwelcome sexual advances, it occurs when someone has an undesirable behavior through inappropriate sexual remarks or physical advances in different situations. The harasser can be male or female, although a male harasser is more common. The harasser can be a stranger, friend, family member, coworker, supervisor, co-worker, client, or customer. Sexual harassment can happen outside the workplace and occur anywhere work-related, such as hotels, conference centers, nightclubs, and taxis.

Other types of harassment/discrimination include: 

  • Sex Discrimination: is a behavior that arises when employers make decisions or treat an employee differently based on gender.
  • Quid Pro Quo Harassment: arises when employers make decisions or treat an employee differently based on the employees’ acceptance or rejection of sexual behavior.
  • Hostile Work Environment: is when a work environment is uncomfortable when there is an unwanted sexual behavior or an offensive comment that is hostile, intimidating, or both due to an employee’s sex, and that negatively impacts the employee’s capability to do their tasks.

Catcalling

Also known as street harassment, it can happen no matter where you are and at any time. It is an experience anyone can go through when a stranger harasses them using sexually explicit comments towards them. Catcalling is a type of abuse that is physical (grabbing the wrists, chasing, and stopping) and psychological because people, especially women, actually feel like they are weak. Some people experience body shame and change their appearance by dressing down and not trying to look attractive or purposefully looking disgruntled. 

Catcalling can also be online, and harassers can be anonymous. Online catcalling is dangerous because anonymous harassers can target children. Therefore, the victim might run into the harasser in real life and not know. Catcalling has usually targeted women, but on rare occasions, men experience it too. There are different types of catcalling, but the two most common forms are whistling and yelling words that make the other person uncomfortable or unsafe. The comments made include cruel words, belittling jokes, mocking or criticizing a persons’ traits, and more.

Catcalling can damage the psyche of an individual because offensive/unwarranted comments can decrease self-esteem & worth and increase self-criticism. People may feel intimidated, inferior, and embarrassed. Some might not even want to walk on their own, making them lose their independence. This can evolve into not taking a genuine compliment because of negative thoughts that the complimenter is lying and is saying the opposite.

Causes for Catcalling

Some people have a behavior of catcalling due to several reasons that can include: 

      • Lack of awareness: growing up in areas where catcalling is regular and is socially acceptable or isn’t seen as illegal.
      • Toxic masculinity: some men grew up in a culture that has them believing they’re above women, forces them not to be emotional, and always be powerful. Therefore, these men use catcalling knowingly to make them feel superior.
      • Peer pressure: people sometimes change their attitudes, values​​, or behaviors to fit a particular group’s standards. When the group is a negative influence, it can lead an individual into a dangerous path.
      • Misunderstanding freedom of speech: some people assume that they are “expressing themselves” by saying whatever they want, offensive or not.
        A person may choose to ignore & walk away/into a store or engage with the catcaller in these situations. However, engaging may not be safe as the catcaller may get aggressive and cause more problems. It is essential to know how to respond or not respond and stay safe.
Online Catcalling

Online catcalling has been increasingly occurring as technology advances. Anyone can be harassed through email, text messages,  and direct messaging on social media pages. It is more appealing for harassers because they can hide behind their screens and be anonymous. Online catcallers may not be tracked down in real life. Still, their account can be exposed when a victim takes a screenshot of the message and exposes the harasser to inform their followers of the wrongdoing and reports the account to the social media site. People can prevent these harassers by either only accepting friend requests from people they know or blocking them after realizing the situation they’re in.

Sexual Assault

Jan 26, 2022 | Fact Sheet, Sexual Health Fact Sheet

What is it?

Also known as sexual abuse or violence, it occurs when you don’t consent to any sexual activity, but the other person isn’t willing to stop. It is any sexual activity or attention from one person that is unwelcome by the other person. This includes rape, revealing (naked) themselves to you, or making you see images that are sexual. Sexual assault is committed by anyone including someone familiar, like a friend, coworker, partner, relative, etc. Legal definitions of sexual assault differ from country to country so make sure you know your country of residence details.

Types of Sexual Assault

Sexual assault can be verbal, visual, or physical. Some types of sexual assault are:

  • Rare or attempted rape
  • Sexual coercion
  • Pedophilia (sexual contact with a minor, below 18 years old)
  • Unwanted touching
  • Peeping (spying on someone during have private sexual acts)
  • Sexual harassment or threatening
  • Taking sexual pictures of someone without consent or by force
  • Texting or sending photos of a sexual nature
Mental Health Effects

After the assault, you may feel a range of emotions such as feeling vulnerable, scared, ashamed, in shock, angry, and many more. People who experience sexual assault tend to have long-term health effects such as severe anxiety, stress, fear, depression, alcohol or drug abuse, eating disorders, self-injury, suicide, and so on. It is vital to remember that it is not your fault. If you’re having difficulty coping, reach out to close friends or family for help (they might suggest a therapist). If you don’t want to talk to people you know, look up therapists to talk to and get help.

If you know someone who has been assaulted, offer them help by listening and comforting them. Remind them that it is not their fault. Research or ask about the side effects of rape and use the tools provided to help more. Remember, this is a challenging time for them, and they could be unstable for a while. Try to be understanding and patient until they heal from this trauma.

What is a Rape Kit?

Sexual assault can be verbal, visual, or physical. Some types of sexual assault are:

  • Rare or attempted rape
  • Sexual coercion
  • Pedophilia (sexual contact with a minor, below 18 years old)
  • Unwanted touching
  • Peeping (spying on someone during have private sexual acts)
  • Sexual harassment or threatening
  • Taking sexual pictures of someone without consent or by force
  • Texting or sending photos of a sexual nature
What To Do If You Have Been Raped?

A rape kit exam is a forensic examination (using technology or science to prove something legally) to collect evidence left after an assault. Evidence must be collected in 96 hours to be most effective, given that the victim hasn’t washed and removed the evidence. 

Every country has its own rape kit content. Still, most contain detailed instructions for the examiner, forms for documentation, containers to collect evidence, swabs, floss, items for scrapping, comb, envelopes, and boxes with labels.

The procedure is a long process and usually takes about 4 hours. The examiner collects any object that could be evidence, such as hair strands, foreign objects (like the attacker’s peace of clothing), and more. Any physical injury is documented (photographs and notes of bite marks and bruises) and treated. Biological evidence such as saliva, blood, semen, urine, skin cells, and hair is collected by swabbing (taking a specimen of tissue or secretions) the victim’s mouth, skin, genital areas, and anus.

The doctor will also take samples from the hair (head & pubic) by combing and under the fingernails if the attacker’s DNA is there. Additional samples include, when the examination is complete, the evidence is packaged and labeled to prevent contamination.

    Infertility

    Jan 26, 2022 | Fact Sheet, Reproductive Health Fact Sheet

    What is it?

    • It is the inability to get pregnant after a year of regular unprotected sex. Both men and women can contribute to infertility. Women who can get pregnant but cannot stay pregnant may also be infertile (miscarriage). 

    • There are many different causes of infertility caused by one or both partners.

    Female Infertility
      This is usually a result of abnormal ovaries, uterus, fallopian tubes, and endocrine system. The most common is an ovulation disorder. Other causes include blocked fallopian tubes caused by pelvic inflammatory disease or endometriosis, birth defects affecting the uterus’ structure, and uterine fibroids (associated with repeated miscarriages).
      A woman’s infertility can be increased due to age (35 and older because there are fewer less healthy eggs), hormonal dysfunctions (severe emotional stress causing amenorrhea (absent periods), and polycystic ovary syndrome (PCOS) (a condition that makes it more difficult for ovaries to produce a mature egg)), thyroid problems, infections, cervical issues, uterus & fallopian tube issues, smoking, excessive alcohol use, and extreme weight gain or loss.
    Combined Infertility
        This occurs when both man and woman have problems that cause infertility. It is not determined based on causes of infertility but the existence of infertility-linked issues with both partners. Combined infertility usually causes unexplained infertility.
    Male Infertility
          This is usually a result of problems in semen ejection, sperm count, or abnormal shape & movement of the sperm. The most common cause of male infertility is varicoceles, a varicose vein found in the scrotum. Other causes include the complete absence of sperm (azoospermia), low sperm count (oligospermia), abnormal sperm shape (teratozoospermia), problems with sperm movement (asthenozoospermia), completely immobile sperm (necrozoospermia), the sperm that’s dead, a block, previous vasectomy, or retrograde ejaculation (occurs when semen that’s supposed to be ejaculated through the urethra is redirected to the urinary bladder), problems with erections, or other sexual problems.
          A man’s infertility can be increased due to age (40 & over), obesity, smoking, excessive alcohol use & marijuana use, drugs, infections, testosterone or radiation (or both) exposure, regular exposure to high temperatures to the testes (such as when on a wheelchair, or frequent sauna or hot tub), certain medications (such as flutamide, cyproterone, bicalutamide, spironolactone, ketoconazole, or cimetidine), environmental toxins (including pesticides, lead, cadmium, or mercury), damage to the testicles, and endocrine problems.
    Unexplained Infertility
          This happens when infertility problems in both partners cause certain issues that cannot be interpreted clearly. Approximately 10% of infertile women have unexplained infertility. This simply means that the commonly performed tests to diagnose the cause of infertility are all normal and do not define the reason for infertility.

    Diagnosis

    The diagnosis is not too complicated but can occasionally be difficult (depending on partners’ health indicators). To get a complete grasp, both partners should undergo several tests. Medical history is essential to provide indications that cause infertility, such as lifestyle and other factors.

    For the woman, tests are conducted to check for ovulation and any abnormalities in the uterus or fallopian tubes. Other tests are conducted to check hormone levels such as FSH (which helps control the menstrual cycle and stimulates the growth of eggs in the ovaries.), LH (a hormone stimulating ovulation, egg cell release from the ovary), prolactin (hormone to produce milk), and progesterone (a hormone regulating ovulation and menstruation.). This checkup is usually performed within one or two menstrual cycles.

    For the man, tests include semen analysis to assess the quality & quantity of sperm and varicocele (which can increase the testes temperature that affects sperm factors (such as sperm count). Semen analysis is typically done at three and 6-month intervals after the operation to correct varicocele.

    Treatment

    A reproductive endocrinologist (a doctor specializing in managing infertility, recurrent pregnancy loss, and spontaneous miscarriages) will suggest specific treatments based on infertility factors and the partners’ treatment choice after advising on different options.

    Male infertility may be treated with medical, surgical, or assisted reproductive therapies. Intrauterine inseminations (IUIs) or in vitro fertilization (IVF) may be suggested to help with infertility. Varicocelectomy is a surgical procedure to treat varicocele. 50% of men who undergo varicocelectomy are fertile within the first year. It usually takes about six months to produce a sufficient quantity of new sperm for fertilization.

    Female infertility may be treated with medications or surgery. Medications are taken either orally or injected to aid in stimulating ovulation. A woman who takes fertility drugs may increase her chances of having multiple pregnancies. Although, multiple pregnancies will lead to a higher risk of premature births. If fallopian tubes have a disease that causes infertility, surgery is performed to repair the tubes or remove blockages. However, These surgeries increase the risk of ectopic pregnancy (a pregnancy occurring outside the uterus). Other surgeries include surgery to remove patches of endometriosis that can double the chances for pregnancy and surgery be remove uterine fibroids, polyps, or scarring, but can affect fertility.

    There are different types of treatment:

    Intrauterine insemination (IUI) or artificial insemination

    It is when specially prepared sperm are inserted into the woman’s uterus. In some cases, the woman is given medications to prompt ovulation before IUI. IUI is usually used to treat mild male factor infertility, unexplained infertility, cervical factor infertility, female infertility affected by mild endometriosis (layer of tissue covering the inside of the uterus, grows outside the uterus), and female infertility with ovulation problems.

     

    Assisted Reproductive Technology (ART)

    It is all fertility treatments where the eggs or embryos are handled outside the body. These procedures can involve using donor eggs, sperm, or embryos. If a woman can’t produce eggs, she’ll receive donor eggs. Donor eggs or sperm can also be used to prevent a genetic disease from being passed on to the baby. An infertile couple may use donor embryos created by couples in infertility treatment or created from donor sperm and donor eggs. The donated embryo is transferred to the uterus. This means that the child is not genetically related to either parent.

    Gestational carrier: is when a woman uses her egg, fertilizes with her partner’s sperm, and then the embryo is placed inside another healthy woman’s uterus. Women with ovaries but no uterus may be able to use this procedure. It can also be an option for women who have serious health problems and shouldn’t get pregnant. 

    Preimplantation genetic diagnosis (PGD): is a genetic procedure used before implantation to identify genetic defects within an embryo created through in vitro fertilization and prevent certain diseases or disorders from being passed on to the child. Typically, the female or male (or both) have been genetically screened and selected as carriers.

    There are different types of ART:

    1. In vitro fertilization (IVF): is the most common effective type of ART and is a procedure where fertilization occurs outside of the body. It consists of using a needle to remove a woman’s mature eggs from ovaries, combining them with sperm in the laboratory to create embryos. After a few days, they are transferred into the woman’s uterus or given to another woman. Embryos can also be frozen for a future transfer called frozen embryo transfer (FET). Preimplantation genetic testing identifies genetic disorders or chromosomal abnormalities in embryos created during an IVF cycle. One or more cells are biopsied from each embryo and sent for testing. The procedure is referred to as preimplantation genetic screening (PGS) and preimplantation genetic diagnosis (PGD).
    2. Intracytoplasmic sperm injection (ICSI): is a type of IVF usually used for male factor infertility. Sometimes it is also used for older couples or those with failed IVF attempts. A single sperm is injected into a mature egg and transferred into the uterus or fallopian tube in this procedure. An alternative referred to as “conventional” fertilization is when the egg and several sperm are placed in a petri dish (a shallow, circular, transparent dish with a flat cover) together. The sperm fertilizes an egg on its own.
    3. Gamete intrafallopian transfer (GIFT): involves harvesting eggs & sperm, combining 3-4 eggs with 200,000 sperm, and transferring them into the woman’s fallopian tube, so fertilization occurs naturally in the woman’s body. GIFT is considered a more invasive process than IVF. GIFT is also an option when intrauterine insemination (IUI) is unsuccessful and in cases where ovulatory disorders and cervical problems are causing infertility. In addition, GIFT can be a good option in cases where the male partner has fertility problems, such as a low sperm count.
    4. Zygote intrafallopian transfer (ZIFT): is a combination of IVF and GIFT. ZIFT fertilization occurs in the laboratory, similar to IVF. Then the young embryo is transferred to the fallopian tube instead of the uterus. Since the fertilized egg is transferred directly into the tubes, the procedure is also called tubal embryo transfer (TET). This is more successful than GIFT because there’s a higher chance of fertilization. This treatment can be performed for issues like tubal blockage or damage, anatomic problems with the uterus (severe intrauterine adhesions), and sperm not penetrating an egg.
    5. Tubal embryo transfer (TET): involves transferring more advanced embryos that are more advanced in development than those in ZIFT (cleaved embryos). The aim is to achieve fertilization in-vitro (in the laboratory) and replace the cleaved embryos in the Fallopian tube, the usual spot for fertilization. It is suitable only for women with at least one healthy Fallopian tube. This procedure is also used for women keen to have gamete intra-Fallopian transfer (GIFT). Still, it isn’t 100% effective for women who encounter problems in embryo transfers through the cervix.

    Problems With Receiving Treatment

    Availability and quality of infertility treatments are still a challenge in many parts of the world, especially developing countries. In addition, major barriers include lack of trained professionals, the availability of equipment and infrastructure, and the high costs of treatment medicines. These are factors even for countries actively managing infertility needs.

    Governments need to recognize that infertility can usually be prevented and implement policies and programs such as fertility awareness in sexual education programs, promote healthy lifestyles (including prevention, diagnosis, and early treatment of STIs), prevent unsafe abortion complications, postpartum depression, abdominal/pelvic surgery, address environmental toxins causing infertility, and more.

    Abortion

    Jan 25, 2022 | Fact Sheet, Reproductive Health Fact Sheet

    What is it?

    • Abortion or induced abortion is the termination of pregnancy intentionally by using drugs or surgery before the embryo or fetus has fully developed. This procedure is safer and more manageable during the early stages of pregnancy. During the late first or early second trimester, pregnancy is terminated by surgical means such as dilation & evacuation (D&E) or vacuum aspiration. Late-term abortions are rare and performed (D&E procedure) if the mother is in danger.

    • The abortion procedure is usually not complicated if done correctly. There are safe and unsafe abortions. Safe abortion is performed by a trained healthcare professional with proper equipment & technique and hygienic environment standards. Unsafe abortion is performed by someone who doesn’t have the required skills in an environment without the standard medical requirement. It can cause maternal death.

    •  Suppose abortions aren’t performed by a professional. In that case, the complications that arise include incomplete abortion, hemorrhage (heavy bleeding), infection, holes in the uterine (caused when a sharp object pierces the uterus), and genital tract & internal organs damage, as a result of the insertion of dangerous objects into the vagina or anus. 

    Types of Abortion 

    There are two types of abortion: spontaneous or missed abortion (called miscarriage) and induced abortion (medical or surgical means).

    Medical Abortion

    Abortion can be induced during the first trimester through menstrual regulation, injecting prostaglandins (hormones that contract the uterus to remove the fetus), or a combination of abortion medications. The abortion pill needs to be taken within nine weeks of the first day of your last period.  The first pill, called Mifepristone, stops the pregnancy from developing and is taken at a medical office. The second called Misoprostol, causes the uterus to empty and is taken at home. These pills thin the uterus to stop the embryo from staying attached or growing and remove it. You will have a follow-up visit to ensure you’re healing, evaluate the uterine size, or check for any signs of infection. 

    Risks:

    • Incomplete abortion that may require you to get a surgical abortion
    • The procedure might work, and you will still be pregnant
    • Heavy bleeding for an extended period
    • Infection
    • Fever
    • Discomfort in the digestive system

     

    Surgical Abortion

    Surgical abortion is a quick and minor operation (with sedation) that enlarges the opening to the uterus and inserts a small suction tube to remove the fetus. A urine test and an ultrasound test will be performed to determine how many weeks pregnant you are.

    Risks:

    • Heavy bleeding for 2 hours (going through 2 or more pads every hour)
    • Vaginal discharge that smells awful
    • Fever
    • Cramping that worsens after two days
    • Dispelling blood clots (gel-like clumps of blood) that are bigger than a lemon for over 2 hours
    • Damage to the uterus

    There are two types called vacuum aspiration and Dilate and Evacuate (D&E).

    • Vacuum aspiration: is usually performed during the first trimester and involves removing the fetus by inserting a suction device after dilating your cervix. The suction device could be manual or mechanical. There are three main steps. First, the cervix is numbed by injection. Second, a soft, flexible tube is inserted through the cervix into the uterus. Lastly, suction is used to remove the pregnancy from the uterus. It usually takes less than 5 minutes for the procedure to be complete.
    • Dilate and Evaluate (D&E): usually performed during the second trimester. It requires 2-3 consecutive days. For the first day, an ultrasound is needed to check the size and position of the fetus. Then, the cervix is numbed by injection, and dilators inserted into it expand overnight. The cervix is numbed again for the second day, and the doctor will remove the dilator. Then, the doctor will use special instruments to terminate the pregnancy. The last step is using the suction, the same as the Vacuum aspiration. More dilators are placed on the second day for more advanced pregnancies, and the removal procedure will be on the third day. The actual procedure usually lasts from 10-15 minutes.

    Most abortion procedures do not influence future fertility. Menstrual cycles resume about 2 or 3 weeks after a first-trimester abortion and about three months after a second or third-trimester abortion.

    Complications

    After surgery, it will take a few hours to recover since you’ll still be sleepy from the medicines. You need to arrange for someone to pick you up. Depending on the stage of pregnancy, it will take a few days for physical recovery. You will have a follow-up appointment to make sure you’re recovering properly. A woman with several surgical abortions will have difficulty getting pregnant because the inner lining of her uterus might be scarred. You must refrain from sex and use tampons for two weeks to prevent infection.

    Late-term Abortion

    This method is rare, but it is for women in their third trimester and is only performed if the mother’s life is in danger. This can be done with the D&E procedure.

    Risks:

    • Cramping after three days
    • Nausea for two days
    • Sore breasts
    • 2-4 weeks of light to heavy bleeding for two or more hours (going through 2 or more pads every hour)
    • Dispelling blood clots (gel-like clumps of blood) that are bigger than a lemon
    • Fever
    • Vaginal discharge that smells awful

    Postabortion Care (PAC)

    It is a care service that treats women with complications of abortion following spontaneous abortion and unsafe abortion. PAC reduces maternal mortality & morbidity and includes both medical and preventive care. Essential elements of PAC include emergency treatment of incomplete abortion & potentially life-threatening complications and post-abortion family planning counseling & services. 

    After your abortion, your doctor will provide you with specific after-care instructions, but sometimes it isn’t enough to reduce undesirable side effects. Some methods to increase comfort after an abortion include: 

    • Use heating pads to relieve cramps
    • Stay hydrated, particularly if you’re vomiting or diarrhea
    • Have a support system to help with emotional changes due to the hormone shift
    • Rest for a day or two to recover at home
    • Take medication to decrease cramps and pain
    • Massage the area where you have cramps
    • Wear a tight-fitting bra to reduce breast soreness

     Women who receive PAC without the necessary tools or information needed to prevent subsequent unwanted pregnancies and abortions may find themselves returning to health centers for similar services in the future. Lack of family planning information and tools leaves women trapped in a negative cycle of unwanted pregnancy and unsafe abortion. Research shows that reaching women at this critical stage helps increase contraceptive use significantly, leading to fewer repeat and possibly unsafe abortions.

     Every woman seeking PAC care should receive physical and emotional support. The woman must be aware of precisely what will happen before, during, and after the procedure, including pain relief, immediate & future side effects, and possible complications. If the patient is an adolescent, additional care and attention are required to prepare her for the whole process.

     A diagnosis for complications must be performed in any woman who missed her period and has bleeding, cramping, partial expulsion of POC, dilated cervix, smaller uterus than expected, or a combination of these. The diagnosis should assess injury or permanent damage to internal and external organs, permanent damage to the bladder or bowel that cause chronic problems, permanent infertility, possible death due to complications like infection and hemorrhage.

    Ethiopian Law for Abortion

    In Ethiopia, abortion is a sensitive topic where religious outlooks spread the controversy regarding criminalizing and decriminalizing abortion. Most religions believe that abortion is ending a life. Therefore, it is not accepted under any circumstance. However, advocates of women’s rights claim that the woman’s decision is the one that should count in the end. 

    Unsafe abortions cause over 10,000 yearly maternal deaths in Ethiopia. Safe abortion services in Ethiopia weren’t available until recent times. Many women still do not have access to medical care and abortion that can be performed in health facilities that can perform the procedure effectively. However, a woman can’t legally abort her baby unless it is due to the reasons listed by Ethiopian Law. 

    The Ministry of Health issued “Technical and Procedural Guidelines for Safe Abortion in Ethiopia” in June 2006. The guidelines state that abortion is the termination of pregnancy before fetal viability of fewer than 28 weeks from the last menstrual period or a birth weight of less than 1000 gm. After counseling, the woman can have it within three working days. In addition, minors and mentally disabled women should not be required to sign a consent form to obtain the procedure.

    The grounds on which abortion is permitted in Ethiopia are: 

    • The pregnancy is the result of rape or incest
    • Pregnancy endangers the mother’s or fetus’ life 
    • Fetal Deformity
    • Women with physical and mental disability 
    • Unable to raise a child due to being a minor and aren’t physically or psychologically prepared

    Abortion services are available in Marie Stopes Ethiopia (MSIE),  private maternal and child care hospitals, public health facilities, IPAS Ethiopia, Engender Health, and Family Guidance Association. The cost of an abortion at clinics ranges from ETB 500 for medical and 2000 for surgical.

    wpChatIcon
    en English
    am Amharicen English