Reproductive Health最新文献

Afghanistan faces persistently high maternal mortality, high fertility, and low use of modern contraceptives-trends at risk of worsening under current restrictions on women's mobility, education, and access to health services. Although family planning is a cost-effective strategy in high-fertility, low-resource settings, generating demand has long remained a challenge in Afghanistan. While socio-cultural barriers to family planning are well documented, limited evidence captures how women themselves interpret and negotiate fertility and childbearing within these constraints. This study explored married women's attitudes toward fertility and childbearing in Kabul to inform locally appropriate approaches to strengthening reproductive well-being. Methods In 2024, in-depth semi-structured interviews were conducted with 23 married women aged 20-43 years (mean = 32.1) in Kabul, Afghanistan, purposively selected for demographic diversity. Interviews were audio-recorded when possible or otherwise documented in detailed notes, and analyzed concurrently in MAXQDA 2024, with data collection continued until no new codes or insights emerged across three successive interviews. Results Five major categories were identified: (1) socio-cultural norms and expectations, (2) religious and ethical perspectives, (3) economic and functional dimensions of childbearing, (4) health and well-being considerations, and (5) emotional and psychological motivations. Across interviews, pronatalist norms and expectations for early and repeated childbearing remained dominant and were reinforced by misconceptions about contraception. Nevertheless, some women emphasized maternal health, child well-being, and more balanced decision-making within families-reflecting a diversity of reproductive perspectives within the prevailing social context. Conclusions Women's fertility attitudes reflected the coexistence of enduring pronatalist expectations with value-oriented considerations emphasizing maternal and child well-being. These perspectives illustrate nuanced forms of reproductive reasoning that may inform culturally responsive approaches to reproductive health promotion. Future research should examine how such orientations vary across Afghan settings. Within the current social constraints, discreet and context-appropriate counseling integrated into existing maternal and child health services could help support informed fertility decisions and contribute to safer maternal outcomes.

Background: Obstetric fistula, an abnormal opening between a woman's genital tract and her urinary tract or rectum. It's caused by prolonged, obstructed labor without access to timely, high-quality medical treatment. A significant number of women face barriers in accessing care, prompting this study to focus on the complicated obstacles hindering effective healthcare, and preventing timely diagnosis, treatment, and prevention.

Objectives: This study investigates the health-seeking behaviors and experiences of obstetric fistula survivors, spanning from the onset of the condition until surgical treatment is obtained.

Methodology: A qualitative study design, drawing from a phenomenological approach, was employed to explore the lived experience of a purposively selected sample of eight women with obstetric fistula and six key informant interviews which are 5 Experts and 1 Fistula ambassador/ treated. Transcription was used, entered as primary documents into Atlas. ti 9 software. Thematic categories were identified.

Results: The study identified barriers for health-care seeking and experiences of women with obstetric fistula, Women's experiences were marked by prolonged suffering, social isolation, and delayed healthcare-seeking. Many initially believed obstetric fistula was caused by spiritual punishment or witchcraft, leading them to seek help from traditional healers rather than medical facilities. Fear of shame, leaking urine, and social rejection discouraged public disclosure and prevented them from traveling to hospitals. Some women remained untreated for years due to lack of financial means or because male family members discouraged seeking help. However, survivors who accessed care typically did so with the encouragement of community health workers or NGOs, and often described the surgery as life-changing.

Conclusion: Women suffering from obstetric fistula often face complicated routes to seek treatment due to multiple factors. Primary barriers include financial difficulties, lack of awareness about the condition and its treatment, social and cultural challenges, and war. To alleviate the prolonged suffering experienced by women awaiting fistula treatment, it is crucial to increase awareness and improve access to fistula treatment center.

Billions of dollars are spent on family planning in low- and middle-income countries each year. Despite this investment, about half of all pregnancies are still unintended. In recent years, there have been indications of progress against closing this gap, including meaningful commitments from country governments, increased investment in reproductive health supplies, and the development of new contraceptive technologies. There is, however, one issue that emerges in almost all research focused on women's needs and preferences related to reproductive health but has been woefully absent from the global agenda: infertility. Quality and accurate data are scarce, but studies suggest that one in six people is affected by infertility globally, with rates as high as 30-40% in parts of Sub-Saharan Africa. What if one of the most promising ways to meet family planning needs and goals was actually by addressing infertility? In a context of declining resources for reproductive health, adding infertility to the agenda may seem daunting. However, if we shift our health systems from treating infertility to preventing infertility we may be able to support more women in preventing and having pregnancies when they want them. Active investment and attention to infertility may also combat the efforts of anti-rights movements to link international actors with population control which can erode reproductive health gains. Challenging times call for unconventional thinking and addressing infertility may be the counterintuitive answer to making progress in family planning as well as more holistically answering the demands of women and families around the world.

Background: Gender-affirming hormones do not completely suppress fertility in transgender and gender diverse individuals, highlighting the need for counseling on pregnancy risk and contraceptive options. However, research on current contraceptive care is limited. Studies from the US have identified several barriers to care as well as facilitators, but no studies on this topic have yet been conducted in Europe. This study examined transgender and gender diverse contraceptive care in Germany from the perspective of healthcare providers, assessing its importance and their roles in it, as well as exploring barriers and facilitators.

Methods: Thirty semistructured qualitative interviews with German healthcare providers were conducted between December 2023 and February 2024. The interview guide included questions on contraceptive care for transgender and gender diverse individuals. Data were analyzed using structuring qualitative content analysis (Kuckartz) with deductive and inductive category development.

Results: Most interviewees highlighted the need for contraceptive care, depending on various factors such as the type of gender-affirming care applied, sexual practices, and transgender and gender diverse individuals' desire for pregnancy prevention. Half of the interviewees also offered contraceptive care (depending on their specialization). Numerous barriers to contraceptive care, such as a lack of awareness of contraceptive needs, insufficient research and training programs for medical staff, have been reported, highlighting the importance of facilitators for care such as the implementation of contraceptive counseling as a standard protocol.

Conclusion: To improve contraceptive care for transgender and gender diverse individuals, the establishment of clear structures and responsibilities, more research, and qualifications among the involved specialties are needed. To gain a comprehensive understanding of the care situation, future research should include the perspectives of transgender and gender diverse individuals.

Trial registration: We obtained the approval of the Hamburg Medical Council ("Ärztekammer Hamburg") to conduct our study by means of a "scientific case" (2023-300381-WF, September 11th 2023).

Objectives: To explore the longitudinal associations between maternal sleep, anxiety, depression across pregnancy trimesters and adverse pregnancy outcomes.

Methods: A prospective cohort study was conducted in a maternal and child health hospitals in China from September 2018 to March 2021. Totally of 3147 pregnant women completely participated in this study, who were with complete data available. Measures included Pittsburgh Sleep Quality Index, Self-Rating Anxiety Scale, Self-Rating Depression Scale and pregnancy outcomes to estimate the sleep quality, anxiety, and depression, respectively.

Results: Sleep quality of pregnant women in the first trimester pregnancy had not significant association with adverse pregnancy outcomes (p-value > 0.05). However, compared with pregnant women with good sleep quality, women with poor sleep quality in the second trimester pregnancy was associated with 1.421 times risk of adverse pregnancy outcomes (95% CI: 1.037-1.947, p-value < 0.05). In addition, in the second trimester pregnancy, anxiety was associated with a significantly reduced risk of adverse pregnancy outcomes (OR = 0.632, 95% CI: 0.42-0.95, p-value < 0.05), while depression in the second trimester pregnancy was not significantly associated with adverse pregnancy outcomes (p-value > 0.05). Moreover, both anxiety and depression of pregnant women in the third trimester pregnancy were not significantly associated with adverse pregnancy outcomes (p-value > 0.05).

Conclusion: Longitudinal associations between sleep, anxiety, depression and pregnancy outcomes across pregnancy trimesters indicated that maternal health care workers should focus on changes of the sleep quality, anxiety and depression across pregnancy trimesters, and its effects on pregnancy adverse outcomes.

Introduction: Violence against women (VAW) is a manifestation of power relations. One in three women experience physical or sexual violence at least once globally. This concern poses a substantial barrier to accomplishing target 5.2 of the Sustainable Development Goals (SDGs) to eliminate all forms of VAW. This escalates in humanitarian crises settings. Despite the importance there is a dearth of evidence about VAW in refugee settings in Ethiopia.

Methods: A community-based cross-sectional study was conducted between March and August 2023 in Asayta, Ethiopia. The study population consisted of 867 women, including Eritrean refugees residing in Asayta camp and women from the surrounding Afar pastoralist host community. A multistage compact segmentation technique was employed to collect data. Logistic regression and latent class analysis (LCA) were used for advanced analysis.

Results: Overall, 231 (33%), or 1 out of 3 women 'ever' experienced physical or sexual violence. Married women (AOR = 19.80; 95% CI: 2.18, 166), age group 24-49 years (AOR = 4.0; 95% CI: 1.28 ,12.54), better women's education (AOR = 2.89; 95% CI: 1.40, 5.96), contraceptive use (AOR = 2.17; 95% CI: 1.07-4.42), history of childhood abuse (AOR = 43; 95% CI: 19.24, 96.39) and husband's substance use (khat) (AOR = 3.49 (2.09-5.87) were associated with an increased risk for VAW. On the other hand, better income (AOR = 0.35; 95% CI: 0.19, 0.67), being pregnant (AOR = 0.26; 95% CI: 0.14, 0.48) and access to referral services (AOR = 0.26; 95% CI: 0.11, 0.60) showed protective effect from VAW. The likelihood of VAW is found to be almost 15 times higher (AOR: 15.64, 95% CI: 1.52, 161) among women constituted in class seven (multiple violence group) of the LCA model.

Conclusion: VAW was found to be a prevalent problem among Eritrean refugee women in Asayta refugee camp, Ethiopia. Despite wide variations in the magnitude of the problem, risk exposures seem similar across studies. Women's age, marital status, income level, history of childhood abuse, husband`s substance use and access to sexual and reproductive health (SRH) services, including contraceptive use-were strongly associated with VAW. Multi-level violence prevention programs are needed. These should focus on challenging harmful gender norms, preventing childhood abuse, empowering women economically and socially, and tailored community awareness about the link between substance use and VAW.