How Do Medical Education And Sexual Reproductive Health Intersect? A Closer Look At Initiatives In Switzerland

The following is an overview of initiatives started and run by Swiss Medical Students relating to sexual health taking place under the umbrella organization of swimsa (Swiss Medical Students Association).

Can you tell us briefly which swimsa initiatives tackle Sexual health?

Sure!  We have several that are all brought together by the Commission on Sexual Health (CoSH). Our initiatives are CLASH, Achtung Liebe and MedSexPlain which I will go into more detail in below.

Let’s start with CoSH – can you tell us a bit more about it? 

The Commission on Sexual Health(CoSH, previously SCORA CH) is a collaboration between five projects of the Swiss Medical Student’s Association (swimsa) working in the field of Sexual and Reproductive Health and Rights (SRHR). It is integrated into the Standing Committee on Sexual and Reproductive Health and Rights including HIV and AIDS (SCORA) of the International Federation of Medical Student Association (IFMSA) and aligns with their vision, namely “a world where every individual is empowered to exercise their sexual and reproductive health and rights equally, free from stigma and discrimination”. The main role of CoSH is coordinating the different initiatives taking place in Switzerland, advocate for Sexual Health by writting Policy Papers and provide national and international opportunities to swiss students regarding Sexual and Reproductive Health and Rights (SRHR).”

Out of the five projects you mentioned are there some that are working especially on women’s health and rights? 

“Yes, that would be: MedSexPlain and CLASH. Both are initiatives centered on women’s Health and Rights as well as gender equality.

Can you tell us a bit more about both? 

CLASH, the French acronym for « Collectif de Lutte contre les Attitudes Sexistes en Milieu Hospitalier”, is a medical students’ association composed of approximately forty individuals among four swiss universities: Lausanne (@associationclash), Fribourg (@clashfribourg), Geneva (@clashgeneve), and Zürich (@clashzurich).  Its main purpose is to fight sexism and sexual harassment in both the medical curriculum and the professional field.

Since 2018, several surveys on sexism and sexual harassment in both the workplace and clinical internships have been conducted among doctors and medical students in Switzerland. These have established that 40% of women were victims of gender discrimination and 18% of sexual harassment in these contexts (1). Following these results, sexism and sexual harassment in the medical field have become a major concern. The consequences of such behaviours include physical and psychological repercussions ranging from chronic illnesses, burnout and restraint from learning opportunities to career change (2).

The medical field is particularly affected by sexism and sexual harassment for multiple reasons. Indeed, the strict hospital hierarchy entails strong dependant relationships of mentees with mentors, which makes questioning and testifying of such events exceptionally complex. Moreover, male-dominated fields are known to be more tolerant of these behaviours, hence these attitudes are even more present in the medical domain. Furthermore, learning environments may be isolating and encourage a high sense of self-sacrifice (3).

This so-called medical culture is particularly problematic as it not only tolerates sexism and sexual harassment, but it also forces victims to remain silent. Unfortunately, it is perpetuated predominantly by senior physicians who possess all the decisional power and is currently the biggest barrier to change. In order to fight against this culture, CLASH has implemented many different actions in the universities mentioned above. These include surveys, support for victims, campaigns and awareness courses, discussion groups as well as podcasts (4) (5).

CLASH is part of FemTech’s initiative to improving women’s health. Indeed, by fighting against sexism and harassment, we protect both the physical and mental health of physicians and create healthy medical environments which patients will also benefit from. We aim to raise awareness of this systemic issue that all women face, whether they are physicians, medical students or patients. CLASH would be more than happy to collaborate with FemTech associates on other occasions to discuss and exchange on these topics.

And what do the other projects focus on? 

Achtung Liebe (@achtungliebe), the founding member of CoSH, is based in Basel, Zürich and Bern and mostly provide Comprehensive Sexuality Education to students in schools (6^th grade up to high school, refugees). EROS and C.A.L.W.H.A are two projects of the medical faculty of Lausanne. EROS (@eros_lausanne) focuses its activities on sensibilizing and educating future doctors and health professionals about sexual orientation, gender, sexual development variations and sexuality in general. CALWHA is helping children and adolescents living with HIV/AIDS in Shirati and Ukerewe (Tanzania). In their actions, they all contribute to improve women’s health, mainly by providing information and tools to empower them in their sexual and reproductive health. The last two projects,MedSexPlain and CLASH, are born on an initiative centered on women’s Health and Rights as well as gender equality…

Okay and lastly MedSexPlain? 

MedSexPlain (@medsexplain) is a project composed of thirty people from the Association of Medical Students of Geneva (AEMG). It was founded after an awareness stand during International Women’s Day in 2019. This stand was repeated every year and acted as a steppingstone to one of its focus areas, women’s Health and Rights. Through various projects such as an Instagram account and in person interventions, we aim at raising public awareness about women’s conditions such as menstrual precariousness and endometriosis that were two main projects of the year. Both are public health problems leading to major psychological and social impact as well as serious professional and societal consequence such as absenteeism and working and studying in inadequate conditions.

Menstrual precariousness is unfortunately very present in Switzerland and affects the quality of life of many women. The students’ community is not spared from this problematic and can be impacted in their studies. Hence, we aimed at diminishing the phenomenon by implementing free menstrual protector dispensers in the universities of Geneva and organizing distributions of menstrual cups.
Even though endometriosis affects one tenth of the menstrual people, it is still and under researched disease and many people affected from it suffer from a great diagnostic delay. To tackle this, we realized an all-public conference and round table on endometriosis.

References

1. Najjar I, Socquet J, Gayet-Ageron A, Ricou B, Le Breton J, Rossel A, et al. Prevalence and forms of gender discrimination and sexual harassment among medical students and physicians in French-speaking Switzerland: a survey. BMJ Open. 2022 Jan;12(1):e049520.
2. Jakab ZL, Apetrei S, Socquet J. Conséquences des discriminations et harcèlement en milieu professionnel. Rev Médicale Suisse. 2021;17(752):1660–4.
3. Dzau VJ, Johnson PA. Ending Sexual Harassment in Academic Medicine. N Engl J Med. 2018 Oct 25;379(17):1589–91.
4. Chavaz L. Sensibilisation au sexisme et harcèlement sexuel dans le milieu medical. Huit affiches pour dénoncer des mots encore trop souvent prononcés. Rev Médicale Suisse. 2022;18(776):683–5.
5. Aubry L, Delacrétaz R, Piccand E, Rufener L, Rrustemi I. « Le problème, c’est qu’elle est mal baisée »: la lutte contre le sexisme en milieu médical menée par les étudiant·e·s en médecine. Rev Médicale Suisse. 2021;17(7442):1250–3.