Reproductive Health最新文献

Background: The use of medical abortion using either a combination of mifepristone and misoprostol, or misoprostol alone has contributed to increased safety and decreased mortality and morbidity. The availability of quality medical abortion medicines is an essential component in the provision of quality abortion care. Understanding the factors that influence the availability of medical abortion medicines is important to help in-country policymakers, program planners, and providers improve availability and use of medical abortion.

Methods: Using a national assessment protocol and an availability framework, we assessed the availability of medical abortion medicines across five elements (Registration & Quality Assurance, Policy & Financing, Procurement & Distribution, Provider Knowledge, and End-user Knowledge) in eight countries: Botswana, Burkina Faso, Central African Republic, Democratic Republic of the Congo, Eswatini, Lesotho, Namibia and Uganda between November 2020 and November 2021. The assessment included an online desk review and virtual or telephone-based key informant interviews.

Results: Registration of medical abortion medicines-misoprostol or co-packaged mifepristone and misoprostol products (combi-pack)-was established in all countries, except the Central African Republic. In Lesotho and Eswatini, the national regulatory agency is still in development and importation of Cytotec™ misoprostol is permitted for off-label use in obstetrics/gynecology. Misoprostol was included in all countries' essential medicines lists, except Botswana. Burkina Faso and Democratic Republic of the Congo also include mifepristone on their essential medicines list and medical abortion regimens in national abortion care service and delivery guidelines. Additionally, guidelines clarified health worker roles in the provision of abortion care specific to the legal context of each country and permitted task-shifting of abortion service provision. Where guidelines did not exist, medical abortion medicines and their use were not well integrated into the public health care system. Community awareness activities on abortion rights and services have been limited in scope across the countries assessed, however, end-users' awareness of misoprostol as a medical abortion medicine was reported.

Conclusion: The national landscape assessments identified several cross-cutting opportunities to improve availability of medical abortion medicines, including importing quality-assured medical abortion medicines; developing nationally approved abortion service and delivery guidelines that optimize healthcare worker roles; and expanding communication strategies to reach end-users and pharmacists.

Background: HIV prevention trials usually require that women of childbearing potential use an effective method of contraception. This is because the effect of most investigational products on unborn babies is unknown. We assessed contraceptive use, prevalence and incidence of pregnancy and associated factors among women in a HIV vaccine preparedness study in Masaka, Uganda.

Methods: HIV sero-negative women (18-45 years) at high risk of HIV infection identified through HIV counselling and testing (HCT) were recruited between July 2018 and October 2022. Study procedures included collection of baseline socio-demographics and contraceptive use data, quarterly HCT, counselling on and provision of contraceptive methods onsite/through referral, and 6-monthly urine pregnancy tests. Multivariable Logistic and Poisson regression analyses were conducted to determine factors associated with contraceptive use, prevalence, and incidence of pregnancy.

Results: 652 (73%) of 891 women reported contraceptive use at baseline. Contraceptive use was higher in women who were in a relationship/married/cohabiting [adjusted odds ratio (aOR) = 1.60; 95% confidence interval (CI) 1.07-2.40] or divorced/separated/widowed [aOR = 1.86; 95% CI 1.24-2.79] versus those that were single, and among women reporting transactional sex [aOR = 2.10; 95% CI 1.16-3.80] versus those who did not. Baseline pregnancy prevalence was 4% (95% CI 3-6%) and lower in women who reported using long-acting contraceptive methods (aOR = 0.17; 95% CI 0.07-0.39) versus women who did not use these methods. A total of 65 pregnancies over 301.3 person-years of observation (PYO), an incidence rate of 21.6/100 (95% CI 16.9-27.5) PYO, higher among younger women (≤ 24 versus 25 + years, adjusted incidence rate ratio = 1.97; 95% CI 1.15-3.40).

Conclusion: We observed a high pregnancy incidence in this cohort. Innovative strategies that promote sustained and consistent use of highly effective contraceptive methods especially for young women will be critical to the success of HIV prevention trials in this and similar populations.

Conflict-affected regions face severe reproductive health challenges that disproportionately impact adolescent girls and young women (AGYW) and children, who are especially vulnerable due to the breakdown of healthcare systems and limited access to essential services. AGYW are at heightened risk due to restricted access to family planning, prenatal care, and emergency obstetric services, while children face malnutrition, disease outbreaks, and developmental delays. These challenges have profound long-term consequences for both their physical and psychological well-being. This commentary explores the underlying causes of reproductive health challenges in conflict zones, including the collapse of healthcare infrastructure, increased sexual violence, forced displacement, and the specific vulnerabilities AGYW and children face. The commentary underscores the urgent need for interventions that address both immediate and systemic gaps in reproductive healthcare, particularly for AGYW and children. A unique policy framework is proposed, integrating emergency reproductive health interventions-such as mobile clinics and emergency health kits-with long-term strategies for rebuilding healthcare systems. The framework emphasizes gender-sensitive, context-specific approaches and sustained investments in healthcare infrastructure to effectively address these challenges and mitigate the long-term effects on vulnerable populations. By aligning with global and regional policy frameworks, including the Inter-Agency Working Group on Reproductive Health in Crises (IAWG) and the Minimum Initial Service Package (MISP), the commentary advocates for embedding reproductive health into all phases of humanitarian action-from emergency response to recovery. This integrated approach provides actionable recommendations to improve the well-being of AGYW, children, and other vulnerable populations, fostering sustainable advancements in reproductive health outcomes.

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.