Sexual and Reproductive Health Matters最新文献

We investigated the association between values and attitudes toward sexual and reproductive health and rights (SRHR) and gender equality, with reproductive agency in Ethiopia, Kenya, and Zimbabwe. Using 2020-21 World Values Survey (WVS) data (n = 3,096), we utilized the SRHR Support Index including five subindices to gauge SRHR attitudes, the WVS Equality Index for gender equality values, and the perceived level of freedom of choice and control over whether, when, and how many children to have as a proxy for reproductive agency. Descriptive statistics, bivariate, and multivariable logistic regressions were used to analyse how values and attitudes differed between respondents of high vs low reproductive agency using the median as cutoff, stratified by country and sex. Country, education, subjective social class, and religion were associated with reproductive agency. Adjusted analyses indicated associations between supportive values and attitudes towards equitable masculinity norms, SRHR interventions and gender equality, with high reproductive agency. Associations varied more between countries than by sex. Findings suggest an association between SRHR and gender equality values and attitudes and the level of reproductive agency, and underscore the importance of addressing values and attitudes in context-specific interventions. Measures of SRHR progress should be critically reviewed and complemented with self-assessed - as opposed to researcher-ascribed - items to support the successful implementation of global SRHR agendas.

Pacific understandings of sexual and reproductive health (SRH) encompass beliefs and practices reflective of Pacific values systems. These are integral to cultural understandings of safety, relationships, and intimacy. Research processes and practices that appropriately address these values and sensitives are scarcely available in the literature, leading to limited use and understanding of culturally appropriate methods and procedures. Pacific methodologies like Talanoa are useful in ensuring that cultural perspectives unique to Pacific youth are addressed and appropriately represented in the research. This paper describes how cultural factors associated with sexual and reproductive health influenced the Talanoa research processes in a study of Pacific youth and SRH education. Key cultural considerations are discussed focussing on the positionality of the researchers, cultural sensitivities and protocols, communication strategies and the role of flexibility in privileging Pacific youth voices.

Sufficient and accurate information is a requirement for menstrual health and supports adolescents in realising their human rights. As mobile connectivity increases globally, many young people may seek or encounter menstrual health information online through web-based platforms, social media, or health apps. Despite the relevance of online information, menstrual health research and programming have focused on formal and school-based learning. Using a participatory and ethnographic approach over seven months from November 2022 to June 2023, this qualitative study explores how adolescent girls between 13-15 years of age in junior high school in two districts of Bali, Indonesia, access and use online information for menstrual health learning. Findings are from 20 group discussions; sessions were held five times with each group across four schools. Fourteen participants also completed solicited diaries, and five participated in interviews. Data is also drawn from participant observation in schools and community spaces. We found that informal online information is a significant source of menstrual health learning and is accessed through active searching and incidental encounters. The motivations to access and use online information were specific to participants' menstrual health needs. We found that online information presented opportunities for personalised and convenient learning. However, it also presented risks associated with excessive and inappropriate information that caused worry and reinforced menstrual myths. Our findings highlight the need to account for informal online information in future research and programming on menstrual health, particularly in contexts with a high level of mobile connectivity among young people.

More than 650 million women alive today were married as children. Relative to efforts to prevent child marriage, efforts to support child brides have received much less attention. This review set out to map and describe interventions that support child brides. We performed a scoping review using seven electronic databases coupled with a grey literature search in January 2022. Data were extracted using a piloted extraction tool and findings were reported in narrative synthesis. A total of 34 projects were included in our review. Most projects focused on improving sexual and reproductive health (SRH) knowledge and behaviours among child brides, which was often achieved through a combination of SRH education, counselling and information provision, along with linkages to SRH services. Some interventions were health facility-based and aimed at improving responsiveness of health service providers to the needs of child brides. Very few described economic interventions as one component of a broader health intervention, and only three interventions focused on improving girls' educational outcomes. We also note the paucity of media-based interventions, despite their popularity among adolescents. Over time, interventions addressing the needs of child brides have increased, but the preponderance of evidence has focused on SRH interventions, with interventions that couple education with adolescent-friendly health services demonstrating promise. Interventions addressing other areas of health and social wellbeing of this group, such as mental health, sexual health, and economic independence, have been overlooked in comparison. The review highlights the need for additional empirical evidence on what works to support child brides.

Abortion is an indispensable healthcare service for women of all reproductive ages. Research on abortion is often focused on younger women, neglecting those who are closer to the end of their reproductive lifespan. This study presents findings from qualitative interviews with Belgian women who had an abortion at the age of 40 or older, conducted between May 2022 and April 2023. Using interpretative phenomenological analysis, we explored the experiences and decision-making processes of women who had abortions later in life. We identified three main themes. First, the women's families were at the centre of their abortion decisions, with some women also presenting advanced age as a significant factor in their decision-making. This emphasis on age was connected to perceived social norms about appropriately timed childbearing. Second, the women experienced their unplanned pregnancies as both physically and emotionally demanding, and desired to terminate them as soon as possible. Some participants felt additional emotional burdens because of delays caused by the mandatory waiting period and/or busy schedules at abortion centres. Third, the women expressed feelings of self-blame for their unplanned pregnancies. This self-blame was closely tied to their expectation of social disapproval, which made them cautious to share their abortion experience with people in their social circle. This study enhances our understanding of the experiences and meaning-making of abortion in women of advanced reproductive age. It highlights the need to destigmatise the topic and the importance for professionals and researchers to consider family preservation and advanced reproductive age as potential factors shaping abortion decision-making.

Across sub-Saharan Africa, there remains disagreement among local expert providers over the best ways to improve access to assisted reproduction in low-income contexts. Semi-structured qualitative interviews were conducted between 2021 and 2023 with 19 fertility specialists and 11 embryologists and one clinic manager from South Africa, Zimbabwe, Namibia, Kenya, Ethiopia and Uganda to explore issues surrounding access and potential low-cost IVF options. Lack of access to ART was variously conceptualised as a problem of high cost of treatment; lack of public funding for medical services and medication; poor policy awareness and prioritisation of fertility problems; a shortage of ART clinics and well-trained expert staff; the need for patients to travel long distances; and over-servicing within the largely privatised sector. All fertility specialists agreed that government funding for public sector assisted reproduction services was necessary to address access in the region. Other suggestions included: reduced medication costs by using mild stimulation protocols and oocyte retrievals under sedation instead of general anaesthetics. Insufficient data on low-cost interventions was cited as a barrier to their implementation. The lack of skilled embryologists on the continent was considered a major limitation to expanding ART services and the success of low-cost IVF systems. Very few specialists suggested that profits of pharmaceutical companies or ART clinics might be reduced to lessen the costs of treatments.

Early in the COVID-19 pandemic, emerging evidence showed that the provision and use of a range of health services, including sexual and reproductive health (SRH) services, were affected. Otherwise, there was little evidence on whether and how they were adapted to maintain the access of different population groups, including adolescents. The study aims to provide an overview of adaptations to adolescent sexual and reproductive health (ASRH) services carried out during the early phases of the pandemic in low- and middle-income countries (LMICs). The Human Reproduction Program (HRP) at the World Health Organization (WHO) called upon WHO and United Nations Populations Fund (UNFPA) regional offices to reach out to organisations that provided ASRH services to submit analytic case studies using a short-form survey. The study team charted information from 36 case studies and performed a content analysis. Results show that the adaptations covered a wide array of SRH services that were provided to a diverse group of adolescents. Most adaptations focused on SRH education and access to contraception in comparison to other SRH services. Over half of the case studies included mental health services, most of which were not provided before the pandemic. The adaptations varied between being face-to-face, remote, digital, and non-digital. Most adaptations complemented a pre-existing service and were nimble, feasible, and acceptable to the targeted adolescents. Lessons learned from this study could be extrapolated into other humanitarian settings and rapid responses for future public health emergencies, provided that rigorous evaluation takes place.

A crisis in early pregnancy can be due to an unplanned pregnancy or a suspected abnormality. Pregnant people have the right to unbiased and comprehensive advice of all options from healthcare providers. Using story completion models (SCM), the aim of this qualitative study was to explore the attitudes of medical students and doctors in training towards crisis pregnancy, specifically two scenarios: early unplanned pregnancy and fatal fetal abnormality (anencephaly). Participants were invited from medical students attending University College Dublin (UCD) and trainees in Obstetrics and Gynaecology at the Royal College of Physicians of Ireland (RCPI) from July to December 2022. SCM involves giving the consenting participant an introduction to a hypothetical situation that acts as the beginning of a story and asking them to complete it. Stories were compiled and analysed using thematic analysis. Research Ethics Committee approval was given by both UCD and the RCPI. The standards for reporting qualitative research guidelines were followed. Eight doctors in training and six medical students consented to participate in the study; all but two medical students completed both stories to the required word count, giving 25 stories for analysis. For both situations, stories described a variety of approaches, all of which were based on the person's, or couple's, wishes, from continuing in pregnancy to deciding to end the pregnancy. SCM allowed detailed analysis of potentially sensitive subjects such as pregnancy options. This study showed that participating medical students and doctors in training recognise that pregnant people have the right to all choices in crisis pregnancy.