Sexual and Reproductive Health Matters最新文献

Globally, sex research has largely centred on Western contexts and has often overlooked women's sexuality. In China, there is a dearth of literature on women's sexual health and behaviours, especially those of sexual and gender minorities. This mixed-methods study addresses this gap by investigating the sexual health, behaviours, and lived experiences of Chinese women with diverse sexual identities. A cross-sectional online survey was conducted in 2021, followed by qualitative interviews in 2022-2023. Overall, 509 women aged 18-56 years participated in the survey, including 250 cisgender heterosexual women, 186 cisgender sexual minority women, and 73 transgender women or individuals assigned female at birth who identify as nonbinary. Additionally, semi-structured interviews were conducted with 33 participants (5 cis-heterosexual women, 18 sexual minority women, 2 transgender women, and 8 nonbinary individuals). Quantitative findings indicated that cis-heterosexual women tended to confirm their sexual identities at an earlier age but initiated sexual practices later than minority participants. Regarding safer sex behaviours, consistent condom use was more prevalent among cis-heterosexual women. In contrast, sexual minority participants, reflecting the diversity of their sexual practices, more often adopted women-controlled safer sex strategies, such as cleaning before sex. Four overarching themes were developed, including 1) women's sexuality has long been invisible but is changing; 2) diverse sexual identities and complex sexual practices; 3) bond between sex and self-worth; and 4) disparities in safer sex awareness and practice. These findings underscore the crucial role of sexual identity and cultural context in the articulation and experiences of women's sexuality and sexual health.

The public plays a central role in producing and sustaining abortion stigma by shaping dominant narratives, reinforcing moral norms, and passing judgment on individuals associated with abortion. These collective attitudes are expressed through social exclusion and symbolic condemnation - practices that shape both personal experiences and structural access to care. This mixed-methods systematic review updates the state of research by synthesizing recent evidence from high-income countries (HICs), with particular focus on how the public enact and experience abortion stigma. We conducted a mixed-methods systematic review of peer-reviewed quantitative and qualitative studies published since 2015, following international standards for systematic reviews. Due to heterogeneity in measurement, quantitative and qualitative data were narratively synthesised. Methodological quality was assessed using standardized appraisal tools for both quantitative and qualitative research. Nineteen studies were included (12 qualitative, 7 quantitative). Quantitative findings reveal that abortion stigma in HICs persists at moderate levels and is associated with religiosity, political conservatism, lower income, and male gender. Qualitative studies demonstrate how stigma is enacted, perceived, and anticipated across diverse social settings, highlighting prevailing stereotypes and uncovering experiences of verbal harassment and social exclusion. Abortion stigma remains deeply embedded within the public. By updating and expanding on previous work, this review underscores the need for targeted, group-specific stigma reduction strategies and more robust instruments for capturing stigma.

Biomedical advancements in HIV prevention and treatment have provided opportunities for women living with HIV to move through pregnancy, give birth, and breastfeed while effectively removing the risk of vertical transmission of HIV to their child. However, existing evidence suggests that the reproductive health and rights of women living with HIV are threatened through coercive practices in healthcare settings because of their HIV status. The objective of this scoping review was to synthesise evidence and identify gaps in literature on reproductive coercion experienced by women living with HIV in clinical settings. This review focused specifically on reproductive coercion in the context of clinical healthcare globally, as opposed to intimate partnerships, and included forced or covertly performed sterilisation, forced abortion, restricted or forced contraceptive methods, forced or denied caesarean sections, and general coercion by healthcare providers regarding fertility-, sexual-, and reproductive-related decision-making. We searched three databases (Embase, PubMed, and LILACS) for quantitative, qualitative, and mixed methods studies. After 2888 unique publications were screened, thirteen publications met inclusion criteria. Sterilisation was the most common coercion type assessed, and Mexico, the United States, and South Africa were common study settings. Variation in reproductive coercion definitions, study methods, and reporting was observed. Evidence from these studies suggests that reproductive coercion among women living with HIV is severe and pervasive. Therefore, there is need to expand research on coercion and stigma that women living with HIV face while navigating reproductive healthcare. Additionally, prevention mechanisms and resource expansion for survivors beyond legal settings should be implemented globally.

In Nepal, pharmacists are legally permitted to dispense medication abortion drugs with a prescription but provision of mifepristone/misoprostol without a prescription is prohibited. However, one in five Nepalese women seeking medication abortion pills do so directly from pharmacies. This mixed-methods study aimed to understand pharmacy workers' knowledge of and practices related to medication abortion care and the reasons behind their provision or non-provision of these pills with and without a prescription. We surveyed 489 pharmacy workers and conducted semi-structured interviews with 25 pharmacy workers in major cities in Nepal's Koshi province. Our survey findings revealed that pharmacy workers are knowledgeable about the legal status of medication abortion (n = 414, 85%), medication abortion in general (n = 404, 83%), and its timing for use (n = 347, 86%). About 16% of pharmacy workers (n = 77) reported stocking and selling medication abortion pills, all in the form of combination packages of mifepristone/misoprostol; the average price was Nepali Rupees 660 (USD5). Pharmacy workers who stocked and sold medication abortion pills reported doing so because of the legal permissibility of the practice and community demand; most required a prescription prior to dispensing the medications. Those who did not stock mifepristone/misoprostol cited lack of training, confusion regarding the legal status of medication abortion, business risks associated with provision, and the inconsistent supply of the combination packages. The role of small, community-based pharmacies as service delivery points for medication abortion as a means to expanding access to safe, effective, and accessible care merits further consideration by researchers and policy makers in Nepal.

National research leadership is critical for generating locally responsive knowledge, especially grounded in gender approaches, given its engagement with local social contexts. We conducted a focused analysis of a scoping review to examine patterns in authorship, geographic and institutional contexts, and funding sources, in studies that apply gender approaches to sexual and reproductive health (SRH) across Africa. The review examined 45 publications in PubMed and Scopus (2012 - 2022) and included consultation with African gender and health experts. Our analysis revealed unequal distribution of papers across sub-regions in Africa (48.9% were based in Southern Africa, 37.8% in Eastern Africa, 11.1% in Western Africa, and 2.1% in Northern Africa). The distribution of articles by first and last authors' country of residence depicted disparity between authors in high-income countries and those in Africa, and between authors based in South Africa and those stationed in the rest of Africa (USA 46.7%, Europe 17.8%, Canada 2.2%, South Africa 22.2%, and rest of Africa 11.1%). Similarly, unequal patterns exist regarding the distribution of last authors (USA 42.9%, Europe 9.5%, Canada 4.8%, South Africa 28.6%, and the rest of Africa 14.3%). One-fifth of the papers feature no local authors. Funding sources shows a stark difference, with just 9.4% of the funding coming from Africa, exclusively South Africa, and the rest originating from high-income countries (USA 36.5%, UK 14.1%, Canada 8.2%, and Sweden 5.9%). The authors call for ensuring local ownership and leadership of research in Africa, and increasing domestic investment and addressing disparities across sub-regions.

The number of IUD and implant (long-acting reversible contraceptive) users in sub-Saharan Africa is increasing. Yet, little is known about LARC users' experiences and their discontinuation, switching, and failure rates. Contraceptive behaviours can support our understanding of user's experiences and whether these methods meet their needs; this understanding can inform user-centred contraceptive programming and decision-making. This study applies event history analysis and life tables to Kenyan Demographic and Health Survey contraceptive calendar data to examine LARC users' behaviours and patterns compared to users of other methods. It also measures pregnancy outcomes following contraceptive failure by method that failed. Results show that contraceptive failure may be under-estimated due to an under-reporting or misreporting of failure. Alongside self-reported failure, this analysis uses a derived failure code which finds that LARC typical-use failure rates may be higher than reported in other studies. LARC users are less likely to switch or discontinue methods compared to other contraceptive method users. However, early LARC discontinuation due to a desire to conceive increases with duration of use. Additionally, LARC users are more likely to experience pregnancy termination following method failure than users of other contraceptive methods. This study has implications for bodily and contraceptive autonomy, contraceptive user's experiences, user-centred contraceptive counselling, and the provision of maternal health and abortion services.

Access to contraception for displaced populations is both lifesaving and a right. This paper argues that displacement demands a separate analytical lens from other mobilities and crisis contexts. I offer a framework, based on established concepts and available evidence, to understand different aspects of contraceptive access in displacement. I then use the case study of Syrians displaced to Türkiye, a population for whom data quality and availability is comparably better than other displacement settings, as a worked example to test the framework using empirical analysis of nationally representative survey data. I analyse contraceptive use and reasons for non-use as a proxy for access among married women, optimising data from the Syrian sample of the 2018 Türkiye Demographic and Health Survey (n = 1,736) and the 2006 Syria Multiple Indicator Cluster Survey (n = 13,619). The results show that the most relevant dimensions of the framework that constrained access to displaced women's preferred methods of contraception were cognitive accessibility and perceived quality of care, specifically fear of side effects and other health concerns. A minority of women who were currently using contraception still faced barriers in accessing their preferred method, suggesting limits to contraceptive autonomy. This case study offers theoretically transferable findings about data and evidence for other displacement settings. Notably, the present data landscape on the sexual and reproductive health of displaced populations does not adequately capture issues around contraceptive access and understandings will remain partial with the currently available metrics.

Restricted abortion access impinges on the human rights and health of a significant number of women globally. The reproductive justice framework, as well as recent calls for the normalisation of abortion, encourage examination of the deleterious effects of abortion restrictions. This study explores the self-generated, online narratives of women who experienced crises in pregnancy while living in a restrictive context, namely pre-2019 Ireland, and who did not travel for abortion care. Mental health and emotional experiences are a specific focus. From an archived version of posts to the In her Shoes - Women of the Eighth Facebook page made in 2018-2019 (N = 728), 96 personal narratives were sampled. Narratives that did not feature travel for abortion care (n = 25) were selected for thematic analysis, which was completed by a single researcher in 2024. Themes that emerged included waiting for intervention as a form of mental torture, fear during self-managed abortion, attempts to self-induce abortion driven by despair, and variation in the extent to which proceeding with the pregnancy was a choice. Most women who stayed in place had been constrained by circumstances in deciding to do so. These results enrich our understanding of the negative effects of restrictive contexts on women's emotional wellbeing. They also draw attention to those who are effectively trapped in restricted contexts and overlooked when the literature narrowly focuses on outward travel from restrictive contexts for abortion care.

In Kenya, access to abortion is legally restricted and allowed under a limited set of conditions. Teleabortion service providers, such as Women on Web (WoW), provide safe and effective abortion care outside the formal health sector. This study explores the characteristics and motivations of individuals in Kenya who completed an online consultation on the WoW website in 2013-2019. We used anonymised data provided by WoW to describe participants' characteristics (n = 857) and their motivations for accessing the WoW online consultation (n = 449, since this information was only available for those who filled out the questionnaire from December 2017). Participants' median age was 23; 65.0% did not have children, and 80.9% had not had a previous abortion. Pregnancies were caused by failure (43.6%) or absence of contraceptive method (49.0%), or rape (6.0%). The most frequently reported reasons for accessing the online consultation were legal restrictions and abortion costs. Those were selected by about half the participants (respectively 235 and 222/449). Next came the wish to keep the abortion private or secret, which was selected by 34.5% and 26.0% of participants. Among more positively framed reasons, home comfort came first (23.6%), followed by wanting to deal with the abortion oneself (20.7%) and finding an abortion through WoW empowering (17.4%). Abortion-seekers turning to teleabortion services usually do so following failing or absent contraception and to get access to safe abortions, avoid stigma, and keep their privacy. Expansion of teleabortion services, within or outside formal healthcare services, could strengthen abortion-seekers' autonomy and agency in Kenya.