How Sexual & Reproductive Health & Rights Shaped my Future

David Imbago Jcome

In medicine, sexual and reproductive health (SRH) is usually taught through the perspective of gynaecology, urology, and disease. This makes the intersection of SRH with other medicine-relevant issues harder to find, including, for example, mental health, adolescents health, community health, and so on. Access to comprehensive SRH learning is still very limited.

As a medical student, if you want to increase your knowledge in SRH, and perhaps include a rights-based approach, civil society will be your strongest ally. That was what happened in my case. I got the opportunity to engage Sexual and Reproductive Health and Rights (SRHR) through my involvement in the International Federation of Medical Students Associations (IFMSA) and their collaboration with IPAs on Access to Safe Abortion. Fast forward to the present, a significant portion of my professional life revolves around SRHR.

But why make SRHR such an important part of my life? I believe there are many layers of how and why this happened. In the beginning, it was just curiosity. Growing up in a conservative country, in a catholic school and even a catholic university, most topics related to sexuality were considered taboo, with little to no opportunities for appropriate learning. I cannot say that I had comprehensive sexuality education. Looking back, I feel I had very few prejudices and opinions about many issues, which allowed me to develop my own opinion based on available information and evidence. Is my opinion the right opinion? Certainly not, but I think that opinions that are rooted in human rights and justice are usually on the right side of history.

Regardless of my previous knowledge and background, I think empathy and a sense of belonging were the determining factors that drove my passion for SRHR. I identify as a gay man and a queer person, full of privileges for sure, but with my sexual orientation and identity, which I consider are key elements of my essence, not so aligned with what most people and society consider normal.

Although there has been tremendous progress for people with diverse sexual orientations and gender identities in terms of inclusion in mainstream society, the Latin America region, where I grew up, is still deeply homophobic. In Ecuador, the latest LGBTI national governmental survey stated, in 2013, that 70.9 per cent of LGBTI individuals have experienced discrimination from their families (the lack of updated information is an issue as well). My own personal experiences dealing with my sexual orientation were definitely a fuel to engage in advocacy for SRHR. As I came out, I was no longer advocating for them, I was advocating also for myself.

My first contact with the SRHR ecosystem was with the topic of Access to Safe Abortion. As a gay man, abortion is something that will most likely never affect me directly. Nevertheless, somehow I sensed a significant empathy with the topic considering how its inaccessibility is related to systems of patriarchal oppression, outdated religious beliefs, and lack of education. Those are the same elements connected with the discrimination of people based on their sexual orientation or gender identity. In addition, abortion became an important topic for me because it includes a deep rights-based approach. Unfortunately, the second R in SRHR (rights) is problematic for some people and organisations. I believe among the many components of SRHR, comprehensive abortion care is the one that is harder to advocate for. It is, however, the most rewarding, as it implies several aspects of healthcare law, ethics, privacy, autonomy, etc.

Developing the capacity of medical students around this issue is how it all started. And as I got more and more involved in the field of access to safe abortion, I also started to collaborate with new people. The womens rights/feminist movements definitely gave me a sense of belonging that I had not felt before. Being a cisgender man in the safe abortion advocacy movement made me understand what privilege is, and that even though I can complain about my own struggles, I cannot speak at the forefront of the movement. I strongly feel like an ally but I have also, over time, learned where my place is in the fight.

I have understood that there are many ways to engage in advocacy. I firmly believe that living your true self is an act of advocacy itself, as much as I respect people who dont want labels, I think we need to be explicit about our existence in the first place to demand systemic change. Talking and educating those around you for me is advocacy too. Going to the streets and protesting is the obvious choice, but for many, it is still unsafe. Nowadays, digital platforms are another form to connect with like-minded individuals and develop an online community. Presence on social media is a strong advocacy tool.

I developed interests in Youth Engagement around the same time as SRHR. I usually say that youth are engaged in the harsh topics because addressing them requires boldness. The youth are clearly at the forefront of the mitigating climate change effects and our presence is strong in the SRHR ecosystem. However, there are many challenges. Despite decades of youth involvement in the field, actual meaningful participation is not the norm, with tokenism still present, and youth mostly treated as volunteers without a professional approach.

Providing healthcare services was something I really enjoyed. Not only did I love surgeries, I also enjoyed talking to people, treating them, and feeling that I was helping. But, as time passed I realised that my true passion was advocacy, seeking systemic improvements in the health and well-being of the population. That desire for a larger-scale impact is what drove me to pursue a career in public and global health. Studying public health after finishing medical school allowed me to fill in several gaps. It surprised me how much I knew about diseases and how little I knew about health.

I often ask myself, what would have happened if I had pursued a career in medicine, from a traditional point of view of treating patients or going to a hospital. But I have no regrets. I truly feel that medicine and health go beyond the healthcare facilities and the individuals into research, communities, legislation, funding allocation, etc. I always remember Rudolf Virchows words, Medicine is a social science, and politics nothing but medicine at a larger scale. I deeply respect physicians, medical residents, attendings, nurses, midwives, and other healthcare providers, who are also involved in SRHR through the provision of quality services. But I do not regret my decision, as I feel I am contributing to systematic change that is needed for individual health and well-being.

SRHR shaped my future when I was a medical student. SRHR helped me find my voice to advocate for what I truly believed. It became a motivation for justice in a world full of inequity. SRHR gave me a community where I have felt protection, resilience, and friendship. I have been extremely fortunate to be able to lead different youth-related initiatives and engage in international advocacy for SRHR and Youth Engagement, in addition to building a career and a professional path in the field. I have fallen in love with what I do and I want to support others who are eager to follow a similar path.


David Imbago Jcome writes from Ecuador.

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