Reproductive Health最新文献

Background: Endometriosis is a chronic, progressive, and recurrent condition affecting women of reproductive age. Its negative impact on intimate relationships and sexual function has been reported in a substantial proportion of affected women. This study aimed to explore experiences related to sexual function among women with endometriosis.

Methods: This qualitative study employed a content analysis approach. Participants included 12 women with endometriosis and 12 Healthcare providers (midwives, gynecologists, reproductive health specialists, psychiatrists, and psychologists) who were recruited through purposive sampling with maximum variation in Isfahan, Iran. Data were collected using in-depth individual interviews and field notes, and analyzed using the conventional qualitative content analysis method.

Results: Analysis of interview revealed six main categories including "neglect in addressing sexual dysfunction", "effects of the disease and its treatment on marital life", "sexual foresight", "unmet needs and expectations", "husband's experiences of sexual dysfunction" and "the spectrum of women's sexual dysfunction".

Conclusions: The findings highlight the negative effects of endometriosis on multiple dimensions of sexual function and marital relationships in affected women and their spouses. Managing this condition requires a comprehensive and multi-dimensional approach that includes medical treatment, sexual counseling and education as well as psychological support for couples.

Background: Stillbirth is a substantially under-recognized adverse pregnancy outcome that predominantly occurs in low-middle-income countries. In 2019, Eswatini's stillbirth rate was 13.2 per 1,000 births, higher than global targets. However, there is limited research on stillbirths in Eswatini. This study analyzed factors associated with stillbirths among women giving birth in four selected hospitals.

Methods: A multi-center unmatched case-control study was conducted using secondary data sources from July 1 to December 31, 2021. Birth records of 268 stillbirths (cases) and 1,151 live births (controls) were selected using consecutive and systematic random sampling, respectively. A piloted data extraction tool was used to extract data. Logistic regression (p < .05, 95% CI) was used to estimate crude and adjusted odds ratios for factors associated with stillbirths, with the final model developed through backward selection.

Results: Factors highly significant and strongly associated with stillbirths (p ˂0.001) included lack of iron and folic acid supplementation (aOR = 2.32; CI = 1.50-3.5), positive rapid plasma regain test (aOR = 7.30; CI = 2.39-22.29), hypertensive disorders of pregnancy (aOR = 3.49; CI = 1.99-6.09), antepartum hemorrhage (aOR = 17.04; CI = 4.53-64.09) birth before arrival (aOR = 1.87; CI = 1.75-2.51), meconium-stained liquor grade II (aOR = 11.42; CI = 4.30-30.35), and fetal complications (aOR = 3.17; CI = 1.99-5.11). Other significant factors include alcohol consumption, having eight or more antenatal care visits, abnormal amniotic fluid volume, use of traditional remedies, gestational diabetes, and anemia.

Conclusion: Stillbirth remains a significant public health burden in Eswatini, with key associated factors that are preventable, highlighting critical gaps in antenatal care. Therefore, strengthening routine screening, and integrated maternal health services offers a cost-effective strategy to reduce stillbirth rates and improve outcomes.

Background: Nigeria bears one of the highest global burdens of maternal and perinatal mortality, despite decades of global and national efforts to address preventable deaths. Maternal and Perinatal Death Surveillance and Response (MPDSR) is a key strategy to reduce preventable deaths. This study synthesises the historical trajectory and policy evolution of MPDSR in Nigeria, examining factors shaping its uptake, scope, and institutionalisation.

Methods: We conducted a historical timeline and policy analysis using systematic review principles. Peer-reviewed and grey literature were retrieved through comprehensive database and web searches, complemented by stakeholder engagement. Data were extracted from 24 eligible documents and analysed using Walt and Gilson's policy triangle framework to explore policy content, context, actors, and processes over time.

Results: Four phases of MPDSR implementation were identified, showing a shift from facility-based maternal death reviews to broader inclusion of perinatal and community components. Federal policymakers and professional associations have driven national-level adoption, while state-level uptake varies depending on political will and capacity. Community and facility-based MPDSR have evolved as fragmented practices rather than an integrated system. Facility-level implementation is comparatively more established, while community-based MPDSR remain limited, donor-driven, and inconsistently integrated. Progress towards institutionalisation is hampered by weak legal frameworks and insufficient subnational capacity. Persistent challenges faced by frontline workers and variable community engagement further undermine MPDSR sustainability.

Conclusion: To maximise the potential of MPDSR as a tool for accountability and system strengthening, Nigeria must integrate community and facility-based surveillance within a unified system, backed by legislation, sustained financing, and capacity building.

Background: It is important to understand time-to-pregnancy expectations and when women begin to worry or seek help for fertility-related concerns, particularly in sub-Saharan Africa, where infertility is highly stigmatized and there is considerable pressure to conceive quickly. Yet our understanding of this topic is informed by a small body of literature often involving selective clinic-based samples of those receiving infertility care. This study aims to better understand Ugandan women's expected time-to-pregnancy and their anticipated emotional and behavioral responses to time spent trying as well as its alignment with the 12-month clinical threshold for infertility.

Methods: We use population-based cross-sectional data of women aged 15-49 in Uganda (n = 4227), limiting our analytic sample to women who had ever had sex (n = 3741). Our outcomes of interest were time-to-pregnancy expectations and related worry and help-seeking. We operationalized time-to-pregnancy expectations as a continuous measure, in months, and worry and help-seeking as binary measures, with a 12-month and a 12- and 24-month cut-off, respectively. We fit multivariable Tobit and logistic regression models to identify sociodemographic factors associated with time-to-pregnancy expectations and related worry and help-seeking.

Results: Half of women think it typically takes less than one month to conceive. The majority anticipated that they would begin to worry (82.4%) and seek help (77.3%) before reaching the 12-month clinical threshold for infertility. Women with children, with perceived difficulties conceiving, and with longer time-to-pregnancy expectations had decreased odds of worrying or seeking help before 12 months. Over 10% of women anticipated that they would seek help after 24 months of trying, with those who had longer time-to-pregnancy expectations having increased odds of seeking help after 24 months of trying. Time-to-pregnancy expectations, worry, and help-seeking were highly normative, with 27-36% of the variability in these outcomes explained by the woman's geographic community.

Conclusion: Our study suggests that the clinical threshold for infertility may not align with individuals' expectations and concerns related to delayed childbearing in Uganda. More education about conception and suggested care-seeking timelines, along with early psychosocial support, could help women navigate fertility concerns, especially in cultures where delayed pregnancy leads to stigma and social consequences.

Background: For young adults seeking new experiences, international travel provides opportunities for casual sexual encounters. The aim of this study was to identify the predictive factors associated with travel-associated sex and consistent condom use in a non-random sample of single and partnered young travelers.

Methods: Sexually-active Canadians, aged 18-25 years, who traveled abroad in 2016, were purposively recruited to participate in an online survey. Two binomial logistic regressions were performed to examine the demographic, sexual health and lifestyle factors associated with (1) having sex abroad (N = 646), or (2) consistent external condom use abroad (n = 271 sexually-active travelers).

Results: Packing condoms for international travel was associated with more than twice the odds of both having sex abroad (AOR: 2.58, 95% CI: 1.47-4.51 p < 0.001) and using condoms consistently during intercourse (AOR: 2.62, 95% CI: 1.62-5.32, p = 0.008). Sex under the influence of alcohol at-home, history of sexually transmitted infections, travel-related plans to have sex and drug consumption were also associated with sex abroad. Consistent external condom use abroad was associated with prior condom use at-home and penetrative sexual practices abroad. Unlike previous studies, gender, sexual orientation and relationship status were not significantly associated with either travel-associated sex nor condom use.

Conclusion: Travelers' characteristics and domestic sexual behaviors will inform travel health interventions, but our findings support universal promotion of barrier protection during travel regardless of relationship status, sexual orientation or gender identity. Given the increasingly open and fluid nature of sexual expressions and relationships, pre-travel sexual health interventions should be sex-positive, broadly inclusive and promote strategies for safe sexual behaviors while travelling.

Background: Access to Sexual and Reproductive Health (SRH) services remains a significant public health challenge, particularly in rural and underserved areas. The Health Bazaar initiative was introduced as a community-based intervention to improve SRH service utilization and family planning uptake among reproductive-age women in Ethiopia. This study evaluates the effectiveness of the Health Bazaar model in improving access to SRH services in intervention (Health Bazaar) compared to non-intervention areas (running SRH services in the routine health system).

Methods: A comparative cross-sectional study was conducted in five Ethiopian regions where the Health Bazaar model was implemented. Data were collected from 1,284 reproductive-age women (15-49 years), equally distributed between intervention (n = 642) and non-intervention (n = 642) areas. Additionally, secondary data from the District Health Information System (DHIS2) (2018-2024) were analysed to assess trends in SRH service utilization. A multistage cluster sampling approach was used, and data were analysed using descriptive statistics, trend analysis, and multilevel mixed-effects logistic regression to identify factors associated with SRH service uptake.

Results: The study found that SRH service utilization was significantly higher in intervention areas (65.1%, 95% CI:59.02, 68.21) compared to non-intervention areas (47.6%;95% CI: 42.01, 51.41) (p < 0.001). Contraceptive prevalence was also higher in intervention areas (53.3% vs. 41.8%, p = 0.001), with injectables (45.8%) and implants (44.5%) being the most commonly used methods. ANC service utilization was higher in intervention areas (87.3%) compared to non-intervention areas (77.1%), and institutional birth rates were 89.4% in intervention areas compared to 80.6% in non-intervention areas. Trend analysis showed a greater increase in ANC (10.2 per quarter), institutional births (5.8 per quarter), and PNC utilization (9.5 per quarter) in intervention areas compared to non-intervention areas. These differences remained statistically significant after adjusting for potential confounding factors, including age, marital status, education, household income, region, and participation in SRH-related discussions.

Conclusion: The study highlights that individual factors, particularly participation in SRH discussions, are major drivers of service use, while community-based interventions such as the Health Bazaar program further enhance uptake. Age and marital status also shape service-seeking behaviour, underscoring the need for tailored approaches for different subgroups. The Health Bazaar intervention notably improved SRH service utilization, family planning uptake, and maternal health access in Ethiopia, demonstrating the potential of this community-driven model for scaling up in similar low-resource settings.

Introduction: Many patients who desire postpartum permanent contraception cannot obtain it, with barriers linked to insurance type - particularly Medicaid's 30-day consent policy - and delivery type (cesarean vs. vaginal). This study uses a mixed-methods approach to examine whether delivery type mediates the relationship between insurance type and permanent contraception fulfillment.

Methods: We conducted a concurrent mixed-methods analysis of data collected from three US hospitals. We analyzed quantitative data from 2,794 patients (2018-2019) using mediation analysis to assess the indirect effect of insurance type on contraception fulfillment via delivery type. We also thematically analyzed qualitative data from semi-structured interviews with 67 patients and 54 obstetrician-gynecologists (2022-2023) to explore how delivery type influences contraceptive decision-making and service provision.

Results: Mediation analysis showed a significant indirect effect of insurance type on contraception fulfillment through delivery type (average causal mediation effect: -0.06; 95% confidence interval [CI]: -0.10, -0.04). Medicaid patients had higher odds of delivering vaginally (odds ratio [OR]:1.78; 95% CI: 1.44, 2.21), and vaginal delivery was strongly associated with reduced fulfillment (OR: 0.05; 95% CI: 0.04, 0.07). Qualitative findings reinforced these results. Patients and providers described how Medicaid's consent policy delayed access, while cesarean delivery made permanent contraception easier. Providers more often discussed permanent contraception with patients already undergoing a cesarean delivery, and patients who delivered vaginally faced logistical challenges with follow-up care.

Discussion: Delivery type is an important mediator in the relationship between insurance type and postpartum permanent contraception fulfillment. Addressing policy restrictions, provider counseling disparities, and institutional constraints is critical to ensuring equitable contraceptive access.

Maternal mortality remains a pressing public health concern globally, with low- and middle-income countries bearing a disproportionate burden. Despite notable progress, India continues to record high maternal mortality rates (MMR), particularly in socio-economically marginalized regions such as Assam. This study investigates maternal mortality among informal worker households in Assam using household-level data and estimates the Maternal Mortality Ratio (MMR) based on WHO's standard methodology. The findings reveal an estimated MMR of 675.68 per 100,000 live births substantially higher than both the national average (97) and the state average (195). This discrepancy reveals the compounded vulnerabilities faced by women in informal employment, who lack access to adequate maternal healthcare, nutrition, and social protection. The study contextualizes India's maternal health performance relative to countries with comparable levels of economic and social development, where India's ranking remains significantly low. The results highlight the need for targeted interventions to strengthen maternal healthcare access and delivery, particularly for women in precarious informal employment. The study also calls for improved data collection and policy attention toward this under-researched population to effectively reduce preventable maternal deaths.

Objective: The aim of this study was to explore the psychosocial experiences and challenges of women who experienced pregnancy loss or termination, and to understand how they coped with the emotional, social, and spiritual effects of this process within the cultural context of Türkiye.

Methods: This study was conducted using a phenomenological qualitative design and employed semi-structured, in depth interviews with 23 women who presented to the Obstetrics and Gynecology outpatient clinic of a state hospital in eastern Türkiye for follow-up within six months after pregnancy loss or termination. Data were collected between September and October 2024. Criterion sampling method, one of the purposive sampling methods, was used to reach the sample group. Interviews continued until data saturation was achieved, which was determined when no new information or perspectives emerged and participants began to repeat similar statements. All interviews were audio recorded and then transcribed. The data of the study were evaluated using thematic analysis. The study was conducted and reported according to the COREQ checklist.

Results: In the analysis of the data, three themes (Psychosocial Experiences Before and After Abortion; Physical, Social, and Psychological/Spiritual Impacts of Abortion; and Coping and Psychosocial Support Needs) and seven sub- themes (Before abortion, After abortion, Physical effects, Social effects, Psychological/spiritual effects, Process management and coping, and Psychosocial support) were identified.

Conclusion: The study revealed that women undergoing pregnancy loss or termination experience multifaceted psychosocial challenges and have a strong need for comprehensive and individualized care. Psychosocial support was identified as an essential component in helping women cope with the emotional and social consequences of abortion. The findings emphasize the need to integrate structured psychosocial support into reproductive health services and policy frameworks to enhance the quality, accessibility, and continuity of care for women.