Reproductive Health最新文献

Background: Overlapping and intersecting structural violence facing im/migrant sex workers has contributed to significant sexual health inequities, such as reduced odds of recent HIV testing, Sexually transmitted and blood borne illness treatment, and client condom refusal. Limited research has been conducted among im/migrant sex workers around access to contraception, particularly using an intersectional lens. The purpose of this paper is to examine the association between im/migration status and difficulty accessing non-barrier contraception among a prospective, community-based cohort of sex workers in Metro Vancouver, Canada, as well as whether this association is modified by racialization.

Methods: Semi-annual questionnaire data were drawn from AESHA (An Evaluation of Sex Workers Health Access), an open, community-based longitudinal cohort of women sex workers in Vancouver, Canada (January 2010 - August 2022). We assessed the association between im/migration status and difficulty accessing non-barrier contraceptives (last 6 months), using racialization (Asian, Black, Latinx, or other racialized identity) as an effect modifier. We developed a multivariable confounder model using modified Poisson regression with generalized estimating equations using sandwich robust standard error.

Results: Eight hundred and three participants were included, contributing a total of 5,133 observations over 12.8 years. The median number of visits per participant was four (range: 1-24). 32.6% of participants were im/migrants to Canada and 34.5% were Asian, Black, Latinx, or another racialized identity. In adjusted multivariable analysis exploring racialized identity as an effect modifier, participants who were both im/migrants and racialized faced the highest risk of experiencing difficulties accessing non-barrier contraceptives, when compared to non-im/migrant and non-racialized sex workers (Risk Ratio: 1.50; 95% CI: 0.99, 2.28).

Conclusions: One-quarter of all participants reported experiencing difficulty accessing non-barrier contraceptives at least once during the study period. Im/migrant women sex workers who are Asian, Black, Latinx, or another racialized identity faced a greater risk of experiencing difficulties accessing non-barrier contraceptives compared to non-racialized, non-im/migrant sex workers. These findings indicate a critical need towards investment in culturally safe, linguistically congruent, and sex work-friendly sexual health services to increase contraceptive access and reduce the potential for sexual health inequities.

Objective: Individuals choosing permanent female contraception (PFC) face barriers including age and parity. Prior literature has focused on regret, but rarely on understanding patient perspectives. Social media is increasingly used to obtain medical information; hence this study seeks to use popular platforms to evaluate motivations, barriers, and facilitators to obtaining PFC.

Methods: This study collected Twitter and Reddit posts from October 2020 to April 2023 and July 2017 to April 2023, respectively. Data was analyzed using Bidirectional Encoder Representations from Transformers (BERT), followed by manual deductive coding of relevant topic clusters to characterize user-generated PFC discussions. We collected 409,641 posts including 321,267 tweets and 88,374 Reddit posts and performed content analysis using a deductive coding schema using the socio-ecological model approach to determine which posts to include in the final analysis. Sentiment analysis was conducted to detect emotions and themes most correlated with post engagement.

Results: We identified 2,356 posts, including 2,076 tweets (88.12%) and 280 subreddit posts (11.88%) from Reddit relevant to PFC discourse. Major themes included clinician (n = 246; 10.44%), patient (n = 1,388; 58.91%), interpersonal (n = 254; 10.78%), institutional (n = 311; 13.20%), and policy-level perspectives (n = 157; 6.66%) and derived 22 subthemes. The top subthemes included patients' seeking/sharing PFC advice (20.80%), discussion of successful completion or commitment/intent to undergo PFC (27.04%), interactions with healthcare providers and beliefs surrounding PFC regret (10.77%), the cost associated with PFC (7.05%), and the Dobbs V. Jackson ruling (6.66%). Additionally, there was a significant increase in posts on PFC following the Dobbs decision. Sentiment analysis shows that posts containing emotional words (both positive and negative) and words related to themes such as home, friends, and family were more likely to receive engagement on Reddit while sentiments related to health, optimism, and communication were correlated with tweet engagement.

Conclusion: As reproductive healthcare continues to face restrictions, online communities provide insight into the motivations and decision-making behaviors of people seeking PFC. Findings can help clinicians better understand patient perspectives, and improve our ability to provide person-centered contraception care for patients desiring PFC.

Background: Women living with HIV (WLHIV) in the United States experience higher rates of death from cervical and breast cancer and lower screening rates for both compared to women without HIV. These disparities highlight the need to better understand access to and uptake of women's preventive health services-particularly cervical cancer screening, breast cancer screening, and HPV vaccination. Most existing data on these services among WLHIV come from urban settings; therefore, the purpose of this study was to investigate factors affecting adherence to these preventive health measures among WLHIV in Vermont, a rural state with unique healthcare challenges.

Methods: This cross-sectional study included a retrospective analysis of electronic medical record (EMR) data and a one-time quantitative survey. The EMR analysis assessed cervical Papanicolaou (Pap) smear, mammography, and human papillomavirus (HPV) vaccination rates among WLHIV and women without HIV enrolled in care at University of Vermont-affiliated sites from January 2017 to December 2020. The survey collected demographic information and details regarding care received from WLHIV.

Results: Among 98 WLHIV and 481 women without HIV, WLHIV were significantly less likely to receive appropriate Pap smears (56.1% vs. 74.2%, p < 0.001), mammographies (57.1% vs. 88.4%, p < 0.001), and at least one dose of the HPV vaccine (7.1% vs. 20.0%, p = 0.002). Survey data from 41 WLHIV revealed that being sexually active, heterosexual, in a relationship, premenopausal, and housing secure were associated with higher Pap smear adherence.

Conclusions: These findings underscore the importance of addressing both individual and systemic factors to improve the provision and receipt of women's preventive health services WLHIV, especially in rural healthcare settings.

Introduction: Despite progress in improving access to and use of maternal and newborn health (MNH) services in Ethiopia, challenges persist in ensuring equitable, high-quality care.

Methods: This study assessed the effective coverage cascade across antepartum and peripartum care (PPC) using formative implementation science research data obtained during July-August 2024. A stratified multistage sampling method recruited 1,922 women with infants (0-11 months), including 1,118 from agrarian and 804 from pastoral regions. The study included facility assessments at 67 primary care facilities and 329 client exit interviews. Service contact was defined as attending at least one antenatal care (ANC) contact and delivering in a health facility. Intervention-adjusted coverage accounted for receipt of key interventions, while readiness- and quality-adjusted coverage incorporated facility input and quality index scores from facility survey readiness assessment and exit interviews. Sampling weights were applied, and household and facility data were linked using ecological methods -that is, by aligning data from the same woreda rather than linking records at the individual level.

Results: Mean facility readiness scores for ANC and PPC were 74% and 80%, respectively. The mean care experience score from exit interviews was 83%, while antepartum and peripartum service provision scores were 60% and 61%. Household survey data showed that fewer than three-quarters of women received recommended ANC interventions, while 82% of women received peripartum and newborn interventions. Most facilities had uterotonics, newborn resuscitation bags, and essential maternal health services. However, gaps in trained staff, diagnostics, emergency transport, and dignified care persisted. Missing services-including ultrasound, deworming, maternal depression screening, and postpartum family planning counseling-highlighted critical service delivery challenges. The effective coverage cascade shows significant drop-offs across the continuum of care. For ANC, 81% of women made initial contact, only 63% received care in facilities with essential inputs, 49% received essential interventions, and only 26% ultimately received quality services. A similar pattern was observed for peripartum services: about 74% of women delivered at a health facility, only 59% received PPC in a facility with essential inputs, 49% received essential interventions, and just 26% received quality services. Regional disparities were evident across the cascade.

Conclusion: While MNH service access has expanded, substantial cascade losses and inequities persist, particularly between agrarian and pastoral regions. Addressing these challenges requires equity-focused strategies to enhance readiness, improve service quality, integrate care, and strengthen accountability.