Sexual and Reproductive Health Matters最新文献

The COVID-19 pandemic negatively affected sexual and reproductive health and rights (SRHR) and increased unwanted pregnancies among young people, yet scant evidence documents SRH service-access trajectories and experiences of young people living with HIV during this time. We conducted a remote study, comprised of qualitative Facebook and telephonic data collection with adolescents living with HIV and young parents in South Africa (n = 41, ages 16-29) in 2020/2021. Following this, we conducted in-depth research through calls, WhatsApp and Facebook to explore narratives of two young people living with perinatally-acquired HIV who accessed SRH services and became parents during COVID-19 lockdowns. We engage a narrative approach to illustrate the trajectories of these two young people - documenting their biopsychosocial lives and experiences accessing SRH services - with attention to personal, structural and relational factors. Findings illustrate their agency while detailing gaps in provisions that significantly affected their health and well-being. This study applies practice theory, exploring how gendered, relational, social and geographic factors shaped young people's experiences and SRH. Despite being well-acquainted with the biomedical technologies and relationships governing their care, they struggled to navigate an altered health landscape. Findings document how they were subject to narratives of individual responsibility for their SRH amidst system-level shortcomings. Results highlight significant gaps in service provision and an imperative to enhance the material conditions for young parents living with HIV in South Africa. They underscore the need for resilient, shock-responsive health and social protection systems to maintain continuous SRH services for adolescents living with HIV during crises.

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 From an archived version of posts to the In her Shoes - Women of the Eighth Facebook page made in 2018-2019 (N = 728), 96 personal narratives were sampled.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.

Testimonies of abortion experiences are largely silenced in many contexts around the world, including Poland, and stigma affects how abortion is represented. Pro-choice initiatives, which support abortion rights, aim to challenge stigma through the sharing of personal abortion experiences (i.e. abortion storytelling). However, these initiatives may simultaneously construct normative hierarchies of abortion and stigmatise abortion stories which do not fit context-specific, politicised norms. This study draws on data purposefully sampled from a pro-choice abortion storytelling initiative in Poland, conducted between 2020 and 2021, and organised by the Abortion Dream Team (ADT; Aborcyjny Dream Team), an influential Polish organisation campaigning for abortion access and rights. By conducting a qualitative document analysis of 73 first-person abortion stories shared in this initiative, I explored how abortion was represented, and whether, and how, these representations challenged abortion stigma and its manifestation in normative hierarchies of abortion. Using reflexive thematic analysis, I identified four main themes. My findings show that abortion is represented as a valid decision, both a positive and challenging experience, and an embodied process. The stories shared in the ADT storytelling initiative challenge stigma and deconstruct normative hierarchies of abortion by representing abortion as a complex experience imbued with multiple, and often contradictory, meanings. This study highlights the existence of positive and non-stigmatising representations of abortion in Poland and shows that abortion storytelling can challenge dominant narratives around abortion. These findings therefore have broader significance, as they suggest that abortion storytelling may serve as an effective tool to destigmatise abortion and advance abortion rights. DOI:10.1080/26410397.2025.2535835.

In Chile, despite important advances in access to contraception and a steady reduction in unplanned pregnancy, longstanding barriers for young people to access sexual and reproductive health (SRH) and rights - rooted in a conservative and religious background - have been highlighted by recent socio-political movements, including the feminist student wave of 2018 and the social uprising of 2019. The COVID-19 pandemic further strained access, leading to the suspension of many in-person services. In this context, we conducted a qualitative study between 2020 and 2023 to explore young women's perceptions of sexuality and SRH, their interactions with the formal healthcare system, and the diverse resources they engage with to access support and care. 23 in-depth interviews were carried out with heterosexual and non-heterosexual women aged 18-25 in Chile's Metropolitan Region. The findings reveal a mismatch between young women's holistic understanding of sexuality - which includes emotional, biological, and political dimensions - and the healthcare system's reductionist, heteronormative, and risk-based approach, which became more visible after these societal upheavals. As a result, young women may use biomedical SRH services strategically for prescriptions and testing, while seeking more comprehensive support outside the formal system through virtual platforms, health professionals giving online support, and civil society organisations. The study concludes that systemic changes in the health system are needed to bridge these divides and uphold the sexual and reproductive rights of young women in Chile, especially those who identify as non-heterosexual. DOI: 10.1080/26410397.2025.2558272.

Reproductive coercion (RC) and intimate partner violence (IPV) threaten women's health and reproductive agency globally. The Addressing Reproductive Coercion in Health Settings (ARCHES) intervention integrates screening for RC and IPV, covert contraceptive options, IPV referrals, and an educational booklet into family planning (FP) services. This study examines client and provider perspectives on ARCHES in Nairobi, Kenya. A qualitative study was conducted in the three private clinics implementing ARCHES. Data were collected through 35 in-depth client interviews and 12 provider interviews three months post-intervention. Participants were purposively sampled based on age and RC/IPV experience. Thematic content analysis was used. Clients reported greater reproductive autonomy through increased knowledge of covert contraception, IPV services, and reproductive rights. Providers reported gaining confidence to address RC and IPV and building stronger relationships with clients. Barriers included stigma around IPV referrals and limited counselling time. Screening for RC/IPV was widely accepted, with some clients recognising abuse for the first time. The compact educational booklet improved knowledge retention and community outreach. Perspectives on male partner engagement were mixed due to concerns about safety and confidentiality. ARCHES was well-received by clients and providers, enhancing FP care and addressing critical gaps in RC and IPV support. Future adaptations should address barriers to IPV referral uptake and provider first-line IPV support, and carefully track implementation to ensure continued client-centred counselling. These findings support ARCHES as a scalable model for integrating FP and violence prevention interventions in Kenya and similar contexts.

Elite athletes routinely undertake strenuous training routines, which often involve high-intensity sessions. However, there are knowledge gaps in how they experience training during pregnancy and subsequent return to sport. Combined with inadequate financial and contractual safety, female athletes may jeopardise their careers when starting families. This study aimed to describe female athletes' experiences and perspectives related to pregnancy and motherhood within the context of elite sports in Norway. We interviewed five world-class athletes between October 2022 and April 2023, using a descriptive qualitative approach. Full interview transcripts were analysed based on a reflexive thematic analysis model. Five overarching themes were identified: (1) uncertainty, (2) lack of supportive networks, (3) physical capacity, (4) the impact of postpartum return to sports on maternal health, and (5) combining motherhood and elite sports. Our findings emphasise the challenges that Norwegian pregnant and postpartum athletes face in balancing motherhood with successful careers, highlighting the importance of providing adequate support systems to ensure their health and the well-being of their child.

The advent of planned oocyte cryopreservation (planned OC) represents a pivotal transition from reactive infertility treatments to proactive fertility preservation, providing a contemporary solution for women aiming to synchronise their career aspirations with future fertility plans. While numerous developed Western nations have liberalised access to planned OC for diverse individuals, including opposite-sex married couples, same-sex married couples, and unmarried individuals, mainland China maintains stringent prohibitions, permitting it solely for medical reasons, due to medical, cultural, and ethical considerations. In contrast, Hong Kong, a major urban city in China, has adopted a more permissive approach, allowing access to planned OC for non-medical reasons among unmarried individuals. This article will delve into the evolving landscape of public attitudes, fertility-seeking behaviour, and regulatory governance in Hong Kong. It will reflect on the practices and challenges associated with implementing a more permissive policy on planned OC, aiming to extract valuable lessons for the broader Chinese context.

A roundtable on gynaecological health in South Asia engaged speakers from four countries to share insights on the current context, challenges and priorities for action in the region. Women's gynaecological needs beyond maternal health are overlooked in most settings, with common ailments underdiagnosed or untreated. While over-medicalisation and a lack of data and evidence are two common challenges, midwife-led programmes, investment in primary health care and nationwide data collection on gynaecological health are promising initiatives. The key priorities for evidence generation are to: understand gynaecological health and its interlinked determinants; examine impacts on quality of life; and design approaches that address women's health through the life course.

The WHO recommends two medication abortion regimens, either misoprostol used with mifepristone or misoprostol-only. Both regimens are recognised as safe and effective, but in the United States (US) most abortions are completed using mifepristone and misoprostol. Given current political hostility to abortion, restrictions on mifepristone, and the long-term legal strategy to restrict nationwide access to the combined mifepristone and misoprostol regimen, more people in the US may use misoprostol-only regimens. Globally research has documented experiences with misoprostol-only abortions, but what are the experiences among people living in the US? We conducted a thematic analysis of 31 in-depth interviews with people who self-managed their abortion using misoprostol acquired from a mail-order or retail pharmacy between May and June 2020. We examine the acceptability of using misoprostol for medication abortion across three domains: the medication regimen, the mode of delivery of medications, and the overall model of care. We find that individual perceptions of misoprostol were shaped by both prior and informed knowledge. Picking up misoprostol from a retail pharmacy fostered familiarity, and having a prescription legitimised the service as an authentic medication provider. Receiving medications from the mail-order delivery model met preferences for privacy and anonymity. In reflections on the overall model, satisfaction was high across participants, but those who were adolescents at the time of their abortion had a distinct unmet need for emotional support compared to older participants. These results contribute to a growing evidence base on the acceptability of misoprostol-only regimens and mail-order and retail pharmacy service delivery models.