Reproductive Health最新文献

Background: Pregnancy and early childhood cohorts provide a framework for investigating the complex interplay between early-life exposures and health outcomes, thereby informing prevention strategies and interventions to improve maternal and child health. In this paper, we outline the objectives, methodologies and expected contributions of INSIGHT-2, a comprehensive cohort study dedicated to advancing our understanding of pregnancy and pregnancy complications towards improving the health and well-being of mothers and their offspring.

Methods: Over the course of 5 years, the study aims to establish a diverse cohort of 1700 pregnant women and to follow up their children up to 2 years of age. Recruitment targets participants with healthy pregnancies, preexisting conditions, and/or risk factors for pregnancy complications or later child health problems. Clinical and lifestyle data and a range of biological samples will be collected, providing a comprehensive resource for biomarker investigations and cross-sectional analyses. It is anticipated that the cohort will continue beyond this initial 5-year plan.

Discussion: By gathering a wide range of biological samples and using diverse analytical techniques, this study supports broad participation, potential replication and collaboration across various sites. The extensive collection of longitudinal data and samples not only facilitates current investigations but also establishes a biobank for future research. The exploration of pre-pregnancy and pregnancy factors that may contribute to disease processes and impact fetal well-being and future health will provide a comprehensive picture of disease mechanisms in both mothers and children, facilitating the identification of biomarkers for the prediction, diagnosis, and management of pregnancy complications. Additionally, our diverse population allows for the capture of various pregnancy complications and outcomes, enhancing external validity and addressing health disparities. This comprehensive design ultimately aims to improve maternal and child health outcomes by providing a valuable longitudinal study of the relationships among the in utero environment, pregnancy management, and long-term maternal and child health, ensuring that findings are relevant and beneficial to a broader population.

Background: Abortion is partially legal in 48 of 54 countries in Sub-Saharan Africa (SSA); however, abortion laws are generally weakly implemented, and evidence suggests that extending abortion rights does not necessarily improve abortion access.

Objective: Reflecting on the implementation challenges faced by the laws extending rights to abortion in SSA, and enriching this approach by considering complementary avenues to overcome barriers in access to abortion.

Argument: Reproductive justice is a theory that emphasizes the importance of contexts and different levels of societal forces in shaping reproductive freedom. From a reproductive justice perspective, we suggest that the successful implementation of abortion laws is hampered by discrepancies between legal frameworks and socio-cultural contexts in many SSA countries. In many SSA contexts, the legalization of abortion has not been accompanied by a modification of socio-cultural contexts regarding abortion. Until these contexts are more receptive to abortion, implementation issues may persist and access to abortion may remain hindered. Since increasing social acceptability of abortion can be a lengthy process, exploring complementary strategies to improve abortion access can be beneficial. Nego-feminism, an African feminist theory rooted in African values of negotiation and relationships, may be an effective strategy to navigate societal forces to improve abortion access, in the meantime, until greater acceptability and enforcement of abortion laws. An illustration of this promising strategy can be found in abortion accompaniment models such as MAMA network which provide safe access to medication abortion in the informal sector.

Conclusion: Nego-feminism could potentially improve access to abortion in legally and socially restricted settings. However, the continued fight for the legalization of abortion is essential, while using nego-feminism as a complement.

Background: There is a strong evidence showing that women who start menstruation early are at a greater risk of developing breast cancer. Recognizing that women will seek breast cancer screening when they have a high perceived risk, we hypothesized that women who experienced early menarche will be more likely to utilize clinical breast examination (CBE). Hence, we aimed to investigate the association between age at first menstruation and women's utilization of CBE in Côte d'Ivoire.

Methods: We used data from the 2021 Côte d'Ivoire demographic and health survey. A sample of 14,685 women was used for the analysis. A descriptive analysis, as well as bivariate and multivariate logistic regression models were computed in STATA version 18. Adjusted odds ratio (AOR) and a 95% confidence interval was used to present the result.

Results: CBE utilization was 17.4%. Women who had their first menstruation before attaining 15 years were significantly less likely to utilize CBE services [AOR = 0.89; 95% CI 0.81-0.99]. A significantly higher utilization of CBE was found among those with primary [AOR = 1.48, 95% CI 1.29-1.70], secondary [AOR = 2.96, 95% CI 2.59-3.38], and higher education [AOR = 4.35, 95% CI 3.50-5.40] compared to those with no formal education. Increasing likelihood of CBE utilization was observed as age increased. Rural residence was associated with lower odds of CBE utilization (AOR = 0.84, 95% CI 0.74-0.95]. Increasing wealth status was associated with higher odds of CBE utilization with those in the richest households having the highest odds compared to women in the poorest household [AOR = 2.11, 95% CI 1.69-2.64].

Conclusion: Utilization of CBE is low among women of reproductive age in Côte d'Ivoire. We conclude that even though existing literature has established early age at first menstruation as a strong risk factor for breast cancer, CBE utilization is significantly low among those who had early menarche. Going forward, it is necessary for Côte d'Ivoire's health Ministry to intensify breast cancer awareness in the country. Such awareness campaigns must emphasize age at menarche as a risk factor so as to motivate women with a history of early menstruation to utilize CBE.

Background: Family planning (FP) is part of Ethiopia's essential health service package. However, integrating FP into other health care services is a relatively new concept. Integrated service can minimize missed opportunities and allow health workers to provide FP services and Reproductive, Maternal, Newborn, Child, Adolescent, and Nutrition (RMNCAH-N) services simultaneously. Thus, the objective of this study was to assess the levels of FP integration into maternal and child health (MCH) services at primary health care service delivery units in Ethiopia.

Methods: This was a facility-based cross-sectional study conducted from July to October 2022. We conducted a nationally representative survey of primary health care (PHC) facilities selected from seven regions and two-city administrations in Ethiopia to assess the current level of FP integration across four service delivery units (antenatal care unit, postnatal care unit, post-abortion care unit, and immunization unit) of the facilities. We collected data from selected health facilities through interview with health facility managers, healthcare providers in the selected service units, clients seeking health services, and extraction of data from facility records. We employed descriptive analysis, and categorized the degree of FP integration according to the FP information and services provided in the selected service delivery units.

Results: This national FP integration survey included 122 health facilities (39 primary hospitals, 42 health centers, and 41 health posts) from seven regions and two city administrations. The study found a huge discrepancy regarding FP counselling given at ANC, PNC, PAC, and immunization service delivery units as reported by health care providers and clients. The proportion of PNC and immunization clients who received FP counselling was higher at health post compared to hospitals and health centers. Moreover, the proportion of PAC clients who received FP information was higher in primary hospitals compared to health centers.

Conclusion: Data from facility records and provider interviews showed significant FP integration within ANC, PNC, and immunization units of PHC facilities. However, client exit interviews indicated low FP counselling integration. Facility records revealed few PNC and PAC clients received contraceptives in the past year. The study found high FP counselling and provision of at least one short- or long-acting contraceptive at PNC and PAC units. No facility offered contraceptives at immunization units, indicating missed FP integration opportunities.

Background: Anxiety disorders with a specific focus on fear of childbirth (FOC) are the most common mental health challenges in perinatal women. The accurate measurement of FOC is important for correctly identifying women with FOC, as well as for identifying the target population for treatment. We aimed to review FOC scales and evaluate their psychometric properties via the COSMIN methodology to identify the most suitable available instruments.

Methods: We conducted this systematic review via a comprehensive search of databases, including PubMed, Web of Science, Scopus, Science Direct and ProQuest, to identify articles published from inception to May 2024 via combined keywords related to tools that assess FOC in women during pregnancy or postpartum period. The quality of the psychometric properties of the included studies was evaluated via the COSMIN checklist.

Results: Of the 1160 records found initially, 47 articles were included in this review, 24 of which were related to the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). According to the recommended categorization of the COSMIN methodology, among the 18 assessed scales, the Fear of Childbirth Questionnaire (FCQ) was categorized as A, and 11 scales, including the Fear-of-delivery Questionnaire (FDQ), W-DEQ-A & B, Delivery Fear Scale (DFS), Fear of Birth Scale (FOBS), Birth Anticipation Scale (BAS), Childbirth Fear Questionnaire (CFQ), Childbirth Fear Scale (CSF), Slade-Pais Expectations of Childbirth Scale (SPECS), and unnamed tools by Melender et al. (2005) and Eriksson et al. (2005) were categorized as B.

Conclusion: According to the findings, the FCQ can be recommended for evaluating pregnant women with FOC. The measures categorized as B are potentially recommended for use, but further research is needed to evaluate the quality of this group.

Background: Since the Dobbs vs. Jackson Women's Health Organization decision in June 2022, providers throughout the U.S. have been navigating the shifting legal landscape of abortion bans, which diminish the delivery of evidence-based healthcare. The Dobbs decision has had a detrimental impact on medical training, the physician-patient relationship, and provision of medical care. However, few studies have captured the effects on providers in adjacent fields, including contraceptive care. Our objective was to examine the impact of Dobbs on contraceptive care.

Methods: We conducted semi-structured in-depth interviews (August 2022-July 2024), with 41 contraceptive healthcare providers across the US, with the majority (63%) in abortion restrictive states. We utilized deductive thematic analysis to assess providers' practice changes and experiences related to contraceptive services.

Results: In reaction to the Dobbs decision, providers noted increased requests for contraception, especially for highly effective methods. Providers worried that certain methods, such as IUDs or emergency contraception, would become restricted, and mentioned advance provision of pills and other ways that they would try to ensure supplies. Providers also discussed that their patients were worried about threats to contraception, including for adolescents. Some expressed concern, however, that the abortion bans may prompt providers to overemphasize high-efficacy methods with directive counseling. Providers shared that it was stressful to practice in contexts of uncertainty, with shifting abortion policies affecting contraceptive care, including emergent needs such as providing contraceptive services to out-of-state patients before they go home. Several providers shared that they felt an increased importance of their role in their communities, and a deepened commitment to advocate for their patients.

Conclusions: Abortion restrictions profoundly impact providers' contraceptive counseling and care. The effects of Dobbs on providers and their clinical practices underscore providers' legally precarious position in today's reproductive health landscape. Attention to contraceptive access and person-centered care has become a salient public health need across the U.S. The long-term impacts of limited reproductive rights may stretch an already under-resourced healthcare system and further emphasize moral pressures.

Objectives: This study aims to fill the gap in understanding the frequency of changing sanitary pads and the key factors associated with this practice among women in China.

Methods: Using a convenient sampling approach, a cross-sectional study was conducted with a quota sampling method to survey women from 28 cities in China between October 21 and 31, 2020. Basic demographic characteristics, personal hygiene habits, self-efficacy, health-related quality of life, and disease status were collected. Multiple logistic regression model was used to analyze the factors associated with the frequency of changing sanitary pads.

Results: A total of 1682 respondents were included in this study. The condition of frequently changing sanitary pads was divided into three groups: "Not taken" (224 respondents, 13.32%), "Short-term taken" (330 respondents, 19.62%), and "Long-term taken" (1128 respondents, 67.06%). Multiple logistic analysis revealed that women who performed "long-term taken" cleaning up rubbish timely (OR = 22.89, P < 0.05), "long-term taken" regular breast self-examination (OR = 19.46, P < 0.05), "long-term taken" actively obtaining scientific contraception methods (OR = 7.40, P < 0.05), as well as those with higher health-related quality of life (OR = 33.72, P < 0.05), were more likely to perform "long-term taken" frequently changing sanitary pads. Conversely, women with chronic diseases (OR = 0.48, P < 0.05) and those aged 31-40 (OR = 0.44, P < 0.05) were less likely to perform the "long-term taken" frequently changing sanitary pads during menstruation.

Conclusions: Most Chinese women practice good menstrual health management and frequently change their sanitary pads. However, there are still some women whose sanitary pad changing practices fall short of expectations. Multiple factors have been found to be associated with the frequency of changing sanitary pads. Based on the research results, healthcare institutions, schools, and the government can more effectively screen, assess, and support women who face menstrual health issues, thereby improving the overall level of menstrual hygiene management.

Introduction: Maternal and child mortality remains a major public health concern in Ethiopia. Improving the practice of short inter-pregnancy intervals is a key strategy to reduce neonatal and maternal mortality. Several primary studies conducted in Ethiopia have revealed the practice short inter-pregnancy interval. However, inconsistencies among these studies have been observed, and no review has been conducted to report the combined magnitude, determinants, and complications. Therefore, this review aims to estimate the national magnitude, determinants, and complications of short inter-pregnancy intervals among pregnant mothers in Ethiopia.

Methods: Following the PRISMA standards, we systematically reviewed and meta-analyzed articles from PubMed, Cochrane Library, and Google Scholar that investigated the magnitude, determinants, and complications of a short inter-pregnancy interval. The Q and I² tests were used to assess heterogeneity across studies. We utilized a weighted inverse variance random effects model to evaluate the national magnitude and effect size of linked covariates. To examine publication bias, we employed a funnel plot and Egger's regression test. A sensitivity analysis was also performed to determine the impact of the studies.

Results: The analysis included a total of twenty-six studies. The pooled magnitude of a short inter-pregnancy interval in Ethiopia was found to be 44.054% (95% CI 32.735-55.372; I² = 100%; P < 0.001). no formal education (AOR = 1.889; 95% CI 1.261-2.517; I² = 3.42%; P = 0.41), never used contraceptive methods (AOR = 3.38; 95% CI 2.41-4.35; I² = 44.9%; P = 0.027), breastfeeding duration of less than 24 months (AOR = 6.69; 95% CI 4.77-8.52; I² = 95.5%; P = 0.00), having a preceding female child (AOR = 1.45; 95% CI 0.88-2.015; I² = 16.4%; P = 0.301), and experiencing fetal complication (AOR = 3.55; 95% CI 1.986-5.122; I² = 0%; P = 0.482).

Conclusion: A substantial number of women in Ethiopia continue to have a short inter-pregnancy interval. To address this issue, it is crucial to focus on empowering women through education and raising awareness about the importance of spacing pregnancies adequately. Efforts should be made to improve breastfeeding practices, promoting the recommended duration of at least 24 months.

Contraceptive intention is an important woman-centered indicator for family planning. Yet, few studies have examined the determinants of women or couples actualizing their contraceptive intentions. We leverage panel data from the Performance Monitoring for Action (PMA) survey in Ethiopia to examine these dynamics among a pregnancy cohort, over the first year postpartum. Using cluster analysis on intent-to-use trajectories, we find distinct patterns across wealth categories, education levels, and regions. Additionally, we find that receiving family planning counseling in both antenatal and postnatal care visits led to a higher likelihood of intending to use. However, counseling did not increase the odds of actualization. We argue that examining actualization through model-based approaches like cluster analysis generates better insight into woman-centered contraceptive demand and provides stronger evidence for strengthening postpartum family planning interventions, than quantifying contraceptive use alone. Modeling postpartum actualization trajectories can shed light on the barriers to women's and couple's reproductive autonomy and inform future investments in both upstream development of better contraceptive methods and downstream implementation.