Reproductive Health最新文献

Introduction: Many patients who desire postpartum permanent contraception cannot obtain it, with barriers linked to insurance type - particularly Medicaid's 30-day consent policy - and delivery type (cesarean vs. vaginal). This study uses a mixed-methods approach to examine whether delivery type mediates the relationship between insurance type and permanent contraception fulfillment.

Methods: We conducted a concurrent mixed-methods analysis of data collected from three US hospitals. We analyzed quantitative data from 2,794 patients (2018-2019) using mediation analysis to assess the indirect effect of insurance type on contraception fulfillment via delivery type. We also thematically analyzed qualitative data from semi-structured interviews with 67 patients and 54 obstetrician-gynecologists (2022-2023) to explore how delivery type influences contraceptive decision-making and service provision.

Results: Mediation analysis showed a significant indirect effect of insurance type on contraception fulfillment through delivery type (average causal mediation effect: -0.06; 95% confidence interval [CI]: -0.10, -0.04). Medicaid patients had higher odds of delivering vaginally (odds ratio [OR]:1.78; 95% CI: 1.44, 2.21), and vaginal delivery was strongly associated with reduced fulfillment (OR: 0.05; 95% CI: 0.04, 0.07). Qualitative findings reinforced these results. Patients and providers described how Medicaid's consent policy delayed access, while cesarean delivery made permanent contraception easier. Providers more often discussed permanent contraception with patients already undergoing a cesarean delivery, and patients who delivered vaginally faced logistical challenges with follow-up care.

Discussion: Delivery type is an important mediator in the relationship between insurance type and postpartum permanent contraception fulfillment. Addressing policy restrictions, provider counseling disparities, and institutional constraints is critical to ensuring equitable contraceptive access.

Maternal mortality remains a pressing public health concern globally, with low- and middle-income countries bearing a disproportionate burden. Despite notable progress, India continues to record high maternal mortality rates (MMR), particularly in socio-economically marginalized regions such as Assam. This study investigates maternal mortality among informal worker households in Assam using household-level data and estimates the Maternal Mortality Ratio (MMR) based on WHO's standard methodology. The findings reveal an estimated MMR of 675.68 per 100,000 live births substantially higher than both the national average (97) and the state average (195). This discrepancy reveals the compounded vulnerabilities faced by women in informal employment, who lack access to adequate maternal healthcare, nutrition, and social protection. The study contextualizes India's maternal health performance relative to countries with comparable levels of economic and social development, where India's ranking remains significantly low. The results highlight the need for targeted interventions to strengthen maternal healthcare access and delivery, particularly for women in precarious informal employment. The study also calls for improved data collection and policy attention toward this under-researched population to effectively reduce preventable maternal deaths.

Objective: The aim of this study was to explore the psychosocial experiences and challenges of women who experienced pregnancy loss or termination, and to understand how they coped with the emotional, social, and spiritual effects of this process within the cultural context of Türkiye.

Methods: This study was conducted using a phenomenological qualitative design and employed semi-structured, in depth interviews with 23 women who presented to the Obstetrics and Gynecology outpatient clinic of a state hospital in eastern Türkiye for follow-up within six months after pregnancy loss or termination. Data were collected between September and October 2024. Criterion sampling method, one of the purposive sampling methods, was used to reach the sample group. Interviews continued until data saturation was achieved, which was determined when no new information or perspectives emerged and participants began to repeat similar statements. All interviews were audio recorded and then transcribed. The data of the study were evaluated using thematic analysis. The study was conducted and reported according to the COREQ checklist.

Results: In the analysis of the data, three themes (Psychosocial Experiences Before and After Abortion; Physical, Social, and Psychological/Spiritual Impacts of Abortion; and Coping and Psychosocial Support Needs) and seven sub- themes (Before abortion, After abortion, Physical effects, Social effects, Psychological/spiritual effects, Process management and coping, and Psychosocial support) were identified.

Conclusion: The study revealed that women undergoing pregnancy loss or termination experience multifaceted psychosocial challenges and have a strong need for comprehensive and individualized care. Psychosocial support was identified as an essential component in helping women cope with the emotional and social consequences of abortion. The findings emphasize the need to integrate structured psychosocial support into reproductive health services and policy frameworks to enhance the quality, accessibility, and continuity of care for women.

The recent wave of abortion bans and restrictive legislation across the United States limits access to abortion care. While the societal impacts are wide-reaching, little is known about women's trust in health professionals and their willingness to disclose accurate health information in this context. Leveraging protection motivation theory, we conducted an online national survey (n = 1,016), to examine individuals' risk perceptions, stigma, negative emotion, distrust in health professionals, and intentions to falsify reproductive health data. Our findings show that individuals' reproductive health data threat appraisals (perceived susceptibility, perceived severity, and perceived stigma), and experience of negative emotion when interacting with health professionals are associated with higher distrust, whereas their coping appraisal (perceived control) is associated with lower distrust. Intentions to falsify are positively related to distrust, perceived susceptibility, and perceived stigma. Our findings demonstrate that concerns regarding privacy risk and resulting stigma can engender higher levels of distrust in health professionals and cultivate intentions to falsify reproductive health data. These insights highlight another potential negative impact of the changing reproductive health landscape in the United States on patients' relationships with health professionals and the information they intend to share. Such information can impact access to care, compromise the quality of care, and mislead healthcare providers, resulting in inaccurate diagnoses and adverse health impacts.

Background: Teenage pregnancies remain a pressing issue in Sub-Saharan Africa, including Rwanda. Adolescent girls and young women (AGYW) continue to face a myriad of challenges in accessing sexual reproductive health (SRH) services. This study examines the accessibility and utilization of SRH services provided to AGYW in youth corners in Rwamagana district, Rwanda. It seeks to explore challenges and opportunities for accessing SRH services in youth corners.

Methods: Utilising a descriptive qualitative research design, the study included 8 in-depth focus group discussions and 4 key informant interviews. Stratified sampling methodology was utilised to increase the representativeness of the AGYW and 71 AGYW participated in the study. The feminist standpoint theory aided in focusing on marginalised voices, analysing power structures and contextualising experiences of AGYW in Rwamagana. The socio-ecological model was used to analyse data using thematic analysis.

Results: The findings reveal various SRH services accessed by AGYW in youth corners, including family planning, services regarding sexually transmitted infections (STIs) and menstrual hygiene management. Barriers to service utilisation included limited knowledge about the available services, distance to health facility, unavailability of some services, AGYW being viewed as a prostitute when one is seen with condoms, norms that discourage open discussions about sexual health, and stigma surrounding the use of contraceptives. This was further worsened by the gender norms which create additional hurdles for AGYW, as they navigate societal expectations and restrictions that are not equally imposed on their male counterparts. The inconsistent availability of services coupled with diverse operating schedules also posed a challenge to accessing services. Most AGYW expressed trust in the healthcare providers' ability to maintain confidentiality, given their training and professional obligations. This sense of trust acted as a motivating factor for AGYW to be more open and forthcoming in utilising the available SRH services.

Conclusion: Addressing the identified challenges faced by AGYW in accessing SRH services in youth corners will help to promote their well-being and bodily autonomy.

Background: Unintended pregnancy continues to be a major global public health challenge, with over three-fifths resulting in induced abortion. To reduce unintended pregnancies and associated consequences, providing effective postpartum contraception is crucial. Despite the high rates of unintended pregnancies and low postpartum contraceptive use in Ethiopia, the influence of pregnancy intention on postpartum contraceptive use remains inadequately explored. This study aimed to examine the effect of pregnancy intention on postpartum contraceptive use in Ethiopia at six weeks, six months, and one year postpartum.

Methods: Longitudinal survey data from the Performance Monitoring for Action (PMA) Ethiopia survey were used for this analysis. The analysis included randomly selected pregnant women and those in the early postpartum period who participated in the baseline survey and completed the follow-up surveys. The data were collected from selected regions of Ethiopia between 2019 and 2021. We used inverse probability of treatment weighting based on propensity scores to address the imbalance of baseline confounders between women with intended pregnancies and those with unintended pregnancies. Odds ratios (OR) with 95% confidence intervals (CI) were estimated using a logistic regression model with inverse probability of treatment weights.

Results: Women with intended pregnancies had higher odds of using postpartum contraceptives at six weeks (OR = 1.51, 95%CI: 1.05-2.17), and at six months postpartum (OR = 1.29, 95% CI: 1.06-1.57). Similarly, women with intended pregnancies had a higher likelihood of using postpartum contraceptives at one year postpartum (OR = 1.49, 95% CI: 1.13-1.96) compared with women with unintended pregnancies.

Conclusion: Postpartum modern contraceptive use remained suboptimal across the postpartum period, regardless of pregnancy intention. Women with intended pregnancies demonstrated higher odds of contraceptive uptake at six weeks, six months, and one year postpartum. Sexual and reproductive health services, particularly family planning access for all women, should be strengthened. Targeted strategies such as early identification and linkage to care are needed to address the specific contraceptive needs of those who have experienced unintended pregnancy.

Purpose: Numerous systematic reviews have examined the non-genetic factors associated with the risk of miscarriage. Therefore, this study aimed to conduct an umbrella review on non-genetic factors associated with the risk of miscarriage.

Methods: Scopus, PubMed, Embase, and Web of Science were searched until 2025 and the systematic review and meta-analysis articles that were conducted on observational studies were extracted. Quality assessment of the selected review articles was done by AMSTAR. For each selected meta-analysis, the summary effect size with the 95% confidence interval was estimated using the random-effects model and the predictive interval (PI) at 95% was estimated too. The between-study heterogeneity was assessed by the I² index. In addition, two biases, including small-study effects and excess statistical significance, were investigated.

Results: Finally, 147 meta-analyses and 29 systematic review studies remained. None of the factors met all the necessary criteria and showed a definite association. However, 45 factors were classified as associations supported by suggestive evidence. Among these 45 factors, three factors-hypothyroidism, high serum β-human chorionic gonadotropin, and hairdressers-included the most complete information (they had more than 1,000 cases, significant based on the random-effects model, p < 0.001, respectively; (2/01(1/66-2/44), 2/88(1/76-4/68), 1/28(1/11-1/47)).

Conclusions: Only 45 non-genetic factors had statistically significant associations without bias and heterogeneity, but were classified in the associations supported by suggestive evidence group because the PI (95%) included the null value.