Reproductive Health最新文献

Introduction: Although the Government of Nepal has developed strategies to integrate contraceptive services with abortion care to better meet the contraceptive needs of women, data indicate that significant gaps in services remain. This paper assessed post-abortion contraceptive use, trends over 36 -months, and factors influencing usage.

Methods: Data from this paper came from an ongoing cohort study of 1831 women who sought an abortion from one of the sampled 22 government-approved health facilities across Nepal. Women were interviewed eight times over 36 months between April 2019 to Dec 2023. Bivariate and multivariate analysis were used to analyze the data.

Results: Results show that after abortion, 59% of women used modern contraception, with injection being the most prevalent method, followed by condoms, pills, implants, and IUD. The hazard model showed that discontinuation of modern contraception was significantly higher among women desiring additional children (aHR 0.62) and lower among literate (aHR - 0.15) and those with existing children (aHR - 0.30). Women's age, ethnicity, cohabitation with husband, household's income and autonomy were not associated with continuation.

Conclusion: After having an abortion, we found that just slightly more than half of women used modern methods of contraception; this percentage did not increase significantly over the course of three years.

Target 3.7 of the Sustainable Development Goals (SDGs) aims for universal access to sexual and reproductive health (SRH) services by 2030, including family planning services, information, education, and integration into national strategies. In contemporary times, reproductive medicine is progressively incorporating artificial intelligence (AI) to enhance sperm cell prediction and selection, in vitro fertilisation models, infertility and pregnancy screening. AI is being integrated into five core components of Sexual Reproductive Health, including improving care, providing high-quality contraception and infertility services, eliminating unsafe abortions, as well as facilitating the prevention and treatment of sexually transmitted infections. Though AI can improve sexual reproductive health and rights by addressing disparities and enhancing service delivery, AI-facilitated components have ethical implications, based on existing human rights and international conventions. Heated debates persist in implementing AI, particularly in maternal health, as well as sexual, reproductive health as the discussion centers on a torn between human touch and machine-driven care. In spite of this and other challenges, AI's application in sexual, and reproductive health and rights is crucial, particularly for developing countries, especially those that are yet to explore the application of AI in healthcare. Action plans are needed to roll out AI use in these areas effectively, and capacity building for health workers is essential to achieve the Sustainable Development Goals' Target 3.7. This commentary discusses innovations in sexual, and reproductive health and rights in meeting target 3.7 of the SDGs with a focus on artificial intelligence and highlights the need for a more circumspective approach in response to the ethical and human rights implications of using AI in providing sexual and reproductive health services.

Background: The reduction of maternal mortality has stagnated globally. Estimates project a rise to 140.9 deaths per 100,000 live births by 2030, which is double the Sustainable Development Goal target. Male involvement in pregnancy care has been proposed as an intervention to improve maternal and child health outcomes. However, there is limited understanding of how communities view the role of men beyond the instrumentalist approach that only targets men as accompanying partners without altering the underlying gender and socio-cultural determinants that shape their involvement in pregnancy care. This study broadens existing research by exploring and and contextualising the role of male partners during pregnancy in Bamenda, Cameroon.

Methods: This study employed a qualitative design underpinned by symbolic interactionism. We conducted 68 semi-structured interviews (SSIs) and three focus group discussions (FGDs) with purposively selected pregnant women (n = 38 SSIs; n = 2, FGD) and male partners (n = 30 SSIs; n = 1, FGD) in an urban hospital in the North West Regional capital-Bamenda. Nvivo was used for data management and subsequently, we performed thematic analysis using a critical discourse lens to generate manifest and latent interpretations of study findings.

Results: The role of male partners reflected hegemonic masculinity and was broadly conceptualised in three categories: breadwinner, protector/comforter, and 'sender' for antenatal care. Perceptions of men's role differed between male and female participants. While women sought male involvement for pragmatic reasons like joint attendance of antenatal care, psychosocial support (affirmation) and assistance with domestic chores, men limited their involvement to roles that matched gendered preconceptions of masculinity like financial support for antenatal fees, maternal nutrition and birth supplies. Nonetheless, the perceived benefits for antenatal attendance was expressed by some men in terms of the direct access it gives them to pregnancy-related education from experts, paternal bonding and the appeal of fast-track services for couples.

Conclusion: Male involvement in maternal and child health in Bamenda Health District is an extension and reflection of how patriarchal norms on masculinity are constructed and adapted in this setting. To address gaps in male involvement, intervention designers and implementers will need to take into account prevailing culture-specific norms while deconstructing and leveraging masculine ideals to situate male involvement in the prenatal context.

Background: Tanzania, like most low- and middle-income countries, is facing an increasing prevalence of obesity in the general population, including among women of reproductive age. Excess weight pre-pregnancy is a risk factor for the onset of gestational diabetes mellitus (GDM), which is associated with several poor pregnancy outcomes. Screening for GDM, as a primary preventive measure, is not systematically done in Tanzania. This study aims to explore current practices of screening for GDM during routine antenatal care (ANC), estimate the prevalence of GDM among ANC users and compare the performance of two commonly used GDM screening algorithms. We will then explore the best ways for implementing a functional screening practice for GDM at primary level hospitals using perspectives of health care workers, health managers, and pregnant women.

Methods: This will be an observational cross-sectional study design with sequential mixed-methods approach conducted in ANC clinics of two primary level hospitals: Kisarawe District Hospital in Coast region and Mbagala Rangi Tatu Hospital in Dar es Salaam region, Tanzania. Quantitative data will be collected to determine the current structural capacity and screening practices for GDM, the prevalence of GDM among ANC users, and the sensitivity and specificity of the two recommended screening algorithms. Qualitative data will be collected through key informant interviews with health managers and pregnant women and focus group discussions with healthcare workers to understand the rationale, challenges, possible solutions and benefits of the used screening algorithm. We will also explore the meaning of screening/diagnosis to pregnant women, and propose a functional GDM screening algorithm informed by users (i.e. pregnant women, health managers and care workers).

Discussion: ANC is an entry point for pregnant women to access preventive services including screening for GDM. When done appropriately, GDM screening would reduce undesired outcomes attributed to GDM also beyond the pregnancy period. Through this study we will understand the bottlenecks and propose evidence to inform feasible ways to overcome them and establish a functional and standardized GDM screening service.

Background: Cultural and religious structures encompass a set pattern of values, beliefs, systems and practices that define a community's behaviour and identity. These structures influence women's health-seeking behaviour and access to maternal health services, predisposing women to preventable maternal health complications. However, most maternal health policies have focused on biomedical strategies, with limited attention to women's cultural challenges around childbirth. The overall aim of this paper is to provide a thick description and understanding of cultural and religious structures in Nigeria, their meaning and how they influence women's use of maternal health services.

Methods: Roper and Shapira's (2000) focused ethnography comprising 189 h of observation of nine women from the third trimester to deliveries. Using purposive and snowballing techniques, 21 in-depth interviews and two focus group discussions comprising 13 women, were conducted in two Nigerian primary healthcare facilities in rural and urban area of Kogi State. Data was analyzed using the steps described by Roper and Shapira.

Results: Using the PEN-3 cultural model, nine themes were generated. Positive factor, such as the language of communication, existential factor, such as religion, and negative factors, such as the use of prayer houses and lack of women's autonomy, were either positive or negative enablers influencing women's use of maternal health services. Additionally, women's perceptions, such as their dependency on God and reliance on cultural norms were significant factors that influence the use of maternal health services. We also found that the use of herbal medicine was a negative enabler of women's access to facility care. At the same time, family support was also a positive and a negative nurturer that could influence how women use facility care. Finally, factors such as religion, Ibegwu, and male child syndrome were negative nurturers influencing women's contraceptive use.

Conclusion: Cultural and religious structures are significant factors that could promote or limit women's use of maternal health services. Further studies are needed to understand culturally focused approaches to enhance women's use of maternal health services in Nigeria.

Background: Comprehensive sexuality education (CSE) has been introduced in many sub-Saharan African countries, but limited political interest and insufficient funding have resulted in many CSE initiatives being dependent on donor funding or non-governmental organisations (NGOs) supporting its implementation. This has created concerns about the sustainability of the programmes. The objective of this study was to explore factors affecting the sustainability of CSE delivered through a youth club organized after school hours in Zambia.

Methods: We interviewed teachers and community health workers (CHWs) who had implemented CSE as part of an after-school youth club set up as part of a cluster randomized controlled trial. The trial evaluated the effectiveness of economic support for adolescent girls, CSE and community dialogue meetings on adolescent childbearing. Teachers and CHWs in 63 schools were trained to facilitate the CSE youth clubs, and they were given economic incentives during the trial´s two-year intervention period to organize meetings every fortnight. Two years after the external support for the youth clubs ended, we conducted qualitative interviews with the facilitators in 15 of the 63 schools, interviews with some head teachers, and focus group discussions with guardians of adolescent girls.

Results: Whereas CHWs were generally supportive of teaching adolescents about contraception, some of the teachers stressed that abstinence was the most effective method to avoid pregnancy and diseases. The respondents' diverging points of view did not affect their willingness to continue teaching CSE, including contraception. However, the youth club meetings were only continued in a few schools after the external support period ended. This was attributed to transfers of trained teachers and a lack of training among the remaining staff; lapse of moral support, resources and incentives; limited involvement of the school management in the CSE initiative; and attention shifting to other projects.

Conclusion: To ensure the sustainability of CSE initiatives for adolescents, emphasis should be placed on training several teachers in each school, and continued moral support and encouragement also appeared essential.

Trial registration: ISRCTN (ISRCTN12727868).

Background: Childbirth experience is a unique event that involves psychological and physiological aspects influenced by social, environmental, organizational, and political factors. In 2018, the World Health Organization (WHO) introduced 56 recommendations for ensuring a positive childbirth experience at different stages of labor and delivery. Owing to the importance of implementing these guidelines, we have chosen to assess adherence to the WHO recommendations and their association with the fear and experience of childbirth.

Methods: This cross-sectional study was conducted on women hospitalized in the labor departments of the Al-Zahra and Taleghani Educational centers in Tabriz, Iran from 2023 to 2024. Sampling was performed via a convenience method, and data were collected via sociodemographic characteristics questionnaire, childbirth experience questionnaire.2 (CEQ.2), delivery fear scale (DFS), and the WHO recommendation checklist. The data were analyzed via Pearson correlation, independent t tests, one-way analysis of variance, and a general linear model (GLM).

Results: The average adherence score to the WHO recommendations among the women studied was 36.4 (SD 9.3), out of a range of 0-56. There was a significant negative correlation between adherence to the recommendations and delivery fear (r = - 0.249; p < 0.001) and a significant positive correlation with childbirth experience (r = 0.414; p < 0.001). The GLM results, after adjusting for sociodemographic variables, revealed a significant increase in positive childbirth experience with increasing adherence score (B = 0.01; 95% CI 0.005 to 0.02, p = 0.001) and a nonsignificant association between delivery fear and adherence score (B = - 0.1; 95% CI - 0.4 to 0.04, p = 0.114).

Conclusion: This study highlights the need to improve the implementation of WHO recommendations in educational and therapeutic centers and to consider various factors that affect the experience and fear of childbirth. Policymakers and medical center managers should place greater emphasis on training, monitor the complete implementation of the recommendations, and provide psychological and social support to pregnant women. This approach can help improve the childbirth experience, reduce delivery fear, and increase the preference for natural childbirth.

Background: Despite high coverage of antenatal care (ANC) and family welfare assistant (FWA) visits, emergency contraceptive pill (ECP) awareness is critically low in Bangladesh. We aim to investigate the missed opportunities in generating ECP awareness through ANC and FWA visit programs; and assess the missed opportunities and sociodemographic discrimination in receiving family planning (FP) counseling during ANC.

Methods: We used data from the nationwide Bangladesh Demographic and Health Survey 2017-18. Sample includes 5012 reproductive-aged women who gave live birth in the last 3 years preceding the survey. We used mixed-effect multiple logistic regression considering women nested within clusters to conclude.

Results: Nationally, 79% of women who gave live birth in the last 3 years preceding the survey were unaware of ECP. The estimated missed opportunities in generating ECP awareness was 59.5% in ANC, 0.9% in FWA visits, and 12.3% in both ANC and FWA visits. While FWA visit was not associated with ECP awareness, receiving FP counseling during ANC was significantly associated. About 88.4% of women remained unexposed to FP counseling through ANC during their last pregnancy. Missed opportunities in FP counseling during ANC was 80.4% of which 72% points were from qualified providers. The odds of missed opportunities was not associated with provider type, rather significantly increased among women with low education, lower parity, and poor socioeconomic status.

Conclusions: This study highlights the fragile status of FP counseling during ANC and FWA visits in generating ECP awareness. A prominent provider bias is excluding women of the disadvantageous sociodemographic group from receiving FP counseling.