Reproductive Health最新文献

Introduction: Intimate partner violence (IPV) is a universal problem that exists in most countries of the world. Worldwide, one third of women will experience physical or sexual violence in their lifetime, mainly by intimate partner. IPV can affected on reproductive health and lead to serious injury and death of mother and baby. Current systematic review was conducted with the aim of determining the relationship between intimate partner violence, reproductive health and pregnancy outcome.

Material and methods: Study performed based on "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) by PICO components. The literature review was conducted using the electronic medical databases were searched using the equivalent keywords without starting time limit, up to January 2024. Medical subject headings with Boolean operators, and the proportionate keywords as follows: (fertility OR pregnancy OR child bearing) AND (intimate partner violence OR domestic violence) in title, abstract and keywords of articles were used. Inclusion criteria were published observational studies and clinical trials in English language. Studies participants considered women with a history of IPV and fertility as an outcome. Data extracted according to a predefined checklist. Two investigators independently examined title, abstract, and full-text screening. The study selection, quality assess, and extraction of data were independently by two researchers. Inconsistencies resolved by a third researcher.

Findings: A total of 1834 documents were retrieved that finally; 39 articles were reviewed. About 50% of the articles were related to the last five years. Relationship between IPV and intention to have children through "unwanted and unintended pregnancy", "contraception use", "contraception use and types of IPV and unmet need for contraception use" has a contradictory effect. Additionally, relationship between IPV and pregnancy outcomes through "maternal health", "pregnancy", "number of children and childbirth intervals" and "fetal outcomes" has a contradictory effect in different ways. According to the results, women subjected to violence may face an increased risk of pregnancy complications, abortion, stillbirth and infant death. Also, intimate partner violence may increase the incidence of induced abortion among women experiencing violence.

Conclusion: According to this review study, intimate partner violence can affect the reproductive health, and pregnancy outcome. Therefore, violence against women by the husband should be given more attention and solutions should be considered at the social and individual level for improve the reproductive health and pregnancy outcome.

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.