Reproductive Health最新文献

Background: Sexual and reproductive health (SRH) is essential for public health. COVID-19 led to major disruptions in the provision of essential services including SRH services. Within the context of a multi-country project, this study aimed to explore individual and service-level impacts on contraceptive and sexual health services during the COVID-19 pandemic and recovery phase in England.

Methods: A longitudinal, mixed-methods design was implemented, collecting data in two phases, approximately 9 months apart (November 2021 and July 2022). The study comprised in-depth interviews with staff (n = 4) and clients (n = 20) of a sexual health and contraceptive clinical service in the Southeast of England. Over the same timeframe, a quantitative service availability and readiness assessment (SARA) was completed, based on World Health Organization validated tools.

Results: Sexual health and contraceptive services continued to operate throughout the pandemic, however measures taken to prevent COVID-19 transmission and staff capacity issues (due to staff redeployment, staff sickness) impacted on patient choice (e.g. how the service could be accessed, methods of contraception available) and patient experience (e.g. delays in accessing healthcare). Despite disruptions, staff described how in-person provision remained available almost continuously for urgent/vulnerable cases. SARA data confirmed service availability, and qualitative data indicate how this was managed. For example, postal home self-sampling for STIs/HIV was expanded and contraceptive counselling by telephone was introduced to reduce clinic visits, and was retained due to popularity. At Time 2, services were running close to normal.

Conclusions: COVID-19 disrupted sexual health and contraceptive services in England. Compared to pre-pandemic, more elements of these services were delivered remotely. Readiness to adapt was aided by the pre-pandemic direction-of-travel towards greater use of digital and telemedicine services. Innovations require robust evaluation to ensure optimisation for public health benefit both in the pandemic and post-pandemic context.

Background: Adolescence is a formative period in which self-concept and sexual identity are developed. Unintended teenage pregnancies represent a sensitive and stigmatized issue, often associated with major psychosocial challenges. The aim of this study is to explore the lived experiences of women with unintended teenage pregnancies in Germany, with a particular focus on adverse childhood experiences (ACE) and Teen Dating Violence (TDV).

Methods: The analysis is based on five biographical narrative interviews conducted within the ELSA project (November 2020-April 2024), which aimed to investigate how unintended pregnancies are managed and to identify needs for counseling and care. Using the documentary method, we reconstructed the meaning of communicative and conjunctive knowledge in adolescents' narratives and compared these orientations across four comparative dimensions: childhood biography, handling of the unintended pregnancy, construction of intimate relationships, and construction of minority.

Results: Two contrasting orientation types were reconstructed across the dimensions, shaped by how adolescents processed external framings. Type 1 (subordinated, resigned orientation) was characterized by communicative deficit narratives and conjunctive patterns of resignation, dependency, and restricted agency. Type 2 (reflexive, pro-active orientation) demonstrated communicative acknowledgment of burdens but conjunctive practices of resilience, negotiation, and self-assertion. Unintended pregnancies were frequently constructed as existential crises, in which personal needs and emotions were suppressed. Minority status intensifies these challenges, while ACE -related patterns of behavior were reproduced in the context of pregnancy and intimate relationships.

Conclusions: The study provides valuable insights into the complex realities and decision-making processes of female adolescents with unintended pregnancies. The findings highlight the need for specific support services that strengthen girls' empowerment and agency in order to promote sexual and reproductive health and rights. Outdated role models that ascribe contraceptive responsibility solely to women should be replaced by gender-equitable sexual education. In addition, legal regulations and counseling services should be better aligned with the often precarious family and partnership situations of young pregnant women.