Reproductive Health最新文献

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.

Background: Knowledge of fertile period among adolescent girls and young women (AGYW; 15-24 years) is crucial for understanding and managing reproductive health, yet it remains under explored. Many AGYW possess limited knowledge about their reproductive systems and the menstrual cycle, which can lead to misconceptions regarding fertile period and contraceptive use. In regions like Tanzania, where early and unintended pregnancies are prevalent, enhancing fertile period awareness through tailored educational initiatives becomes increasingly vital. This study aimed to assess the knowledge of the fertile period and associated factors among AGYW in Tanzania for evidence-based interventions.

Methods: An analytical cross-sectional study was conducted using secondary data from the 2022 Tanzania demographic and health survey. Given the survey's complex design, weighted binary logistic regression model was used to determine factors associated with knowledge of the fertile period. Adjusted odds ratio (AOR) with corresponding 95% confidence intervals (CI) were used to estimate the strength of the association. A p-value of < 0.05 was declared statistically significant.

Results: The overall prevalence of knowledge about the fertile period was 19.4% (95% CI: 17.9-20.9). Several factors were associated with a higher likelihood of having knowledge about the fertile period; being aged 20-24 years (AOR = 1.43, 95% CI: 1.16-1.76), having secondary education (AOR = 3.15, 95% CI: 2.23-4.45), exposure to media (AOR = 1.28, 95% CI: 1.02-1.59), visiting a health facility in the past 12 months (AOR = 1.40, 95% CI: 1.29-1.66), and residing in the central (AOR = 2.55, 95% CI: 1.67-3.89) or southern zones of mainland Tanzania (AOR = 1.67, 95% CI: 1.11-2.48).

Conclusion: This study revealed the factors impacting knowledge of fertile period among AGYW, highlighting the roles of educational attainment, media exposure, healthcare access, and geographical location. Increased education and health service access correlate with better knowledge. To address these challenges, tailored interventions that account for above would be essential. ​Ultimately, enhancing fertile period awareness necessitates engaging educational programs across various platforms, empowering AGYW to make informed reproductive health choices. Further research needs to be conducted to monitor the knowledge on fertile periods.

Background: Caesarean section on maternal request (CSMR) raises ethical and clinical challenges despite Sweden's low overall caesarean section (CS) rate. National written recommendations are restrictive, yet regional differences suggest unequal care. While previous research has focused on women and healthcare professionals, little is known about the views on CSMR of policymakers and other key stakeholders. The aim of this study was to investigate how stakeholders in the Swedish healthcare system view CSMR in relation to medical considerations, individual autonomy and societal values.

Methods: A qualitative study with an inductive approach was conducted using reflexive thematic analysis of semi-structured interviews. Sixteen stakeholders were recruited, including regional politicians, policymakers, national authority representatives, and members from organisations and associations with relevant interest and expertise in the field.

Results: Five themes were generated: (1) Caesarean section is a valid way of giving birth for some; (2) The right to choose and the decision process are complex issues; (3) Individual options for childbirth are desirable; (4) There is a lack of trust in maternity care; (5) Economic and ethical challenges in maternity care exist. The participants viewed CSMR as a legitimate option for some women, despite the increased medical risks, which were considered concerning but not disqualifying. Support and guidance in decision-making were considered essential by the participants. They valued continuity in care and emotional support highly. The participants expressed the views that distrust in Swedish maternity care was linked to media portrayals and inconsistent handling of CSMR. Economic and ethical concerns included questions of resource allocation and the scope of public healthcare responsibilities. The option to pay privately for a planned CS was broadly rejected by the participants.

Conclusions: This study highlights the complexity of CSMR and its varied perspectives. While individual risks may be low, population-level risks could rise with increased prevalence, and the perception of risk varies depending on perspective. Both medical and psychological risks should inform decisions, with counselling seen as crucial by the participants. Continuity of midwife care models may offer an alternative to CSMR for some. Stakeholders are key to ensuring clear guidelines, equal care, and trust in the system.