Sexual and Reproductive Health Matters最新文献

This systematic review investigates the impact of participatory health-sector led interventions on female adolescent sexual and reproductive health and rights (ASRHR) in Sub-Saharan Africa. Adolescents face many challenges, including high rates of HIV and other risk-factors. Interventions to promote ASRHR are therefore critical for enhancing their overall well-being. Our peer-reviewed search yielded 6225 articles from online databases which we imported to Covidence. 2619 duplicates were removed, leaving 3606 articles that two authors screened by title and abstract. 3545 articles not meeting our inclusion criteria were removed, and 61 full text articles were screened, also by two authors. Only four articles met our eligibility criteria. The interventions in the selected studies included HIV testing preferences in Zambia, layered interventions in Malawi, peer support for HIV testing and adherence in Uganda, and a participatory curriculum in Zimbabwe. Important results included the value adolescents attached to interventions delivered by health providers; the need for interventions to address ASRHR issues in a comprehensive way; and the need for more rigorous indicators of the nature and role of peer support in ASRHR interventions. Several unexpected findings included the paucity of studies on participatory youth-friendly interventions delivered by the health sector; the dominance of adolescent research on HIV issues and the neglect of other priorities; and the limited research attention to adolescent rights. We conclude that investing in the formation and sensitization of African health workers to adolescent needs can have a positive and sustainable impact, although further research is needed to validate these findings.

Legal reform allowing abortion is often considered a proxy for the provision of services. While the law establishes a legal framework, the provision of services is closely tied to the engagement of midwives in service delivery. In 2014, Mozambique decriminalised abortion under spe-cific conditions. Studies of this legal reform focus on the experience of pregnant women, leaving the experi-ence of midwives largely unexplored. This study focuses on midwives providing abortion services to young women (ages 15-24). A qualitative phenomenological study was conducted in Nampula province, northern Mozambique. In-depth in-terviews were conducted with 10 purposively selected midwives across six primary healthcare facilities in three districts. Inductive thematic analysis was employed, and an intersectionality lens guided the dis-cussion. We employed continuous reflection and adhered to COREQ guidelines for the conduct, analysis and reporting of this study. Despite general support among midwives for abortion service availability and provision, some expressed distress and objections to providing the service themselves. A complex interplay between struc-tural and personal factors was significant in shaping their experiences. Traumatic encounters with abortion-related complica-tions emerged as the central factor behind their distress and objections. The intersections of personal factors with structural dilemmas, including few health facilities authorized to provide services, lack of abortion medicines, and legal restrictions for adolescents under age 16, shaped their professional experience, often leading to work-related distress, and challenged their willingness to provide services. Policy efforts should address these barriers, prioritising expansion of service provision, alignment with human rights standards, and midwife training and support.

Sexual health is a vital component of overall well-being, shaped by biological, emotional, and sociocultural influences. In Lebanon, limited provision of sexual healthcare for women remains a neglected concern that perpetuates inequities in access and outcomes. Understanding women's perceptions of sexual healthcare, alongside provider perspectives, is essential to designing effective interventions and strengthening health systems. This study examines Lebanese women's experiences and expectations regarding sexual healthcare seeking. A qualitative study was conducted in Beirut (2022-2023) using in-depth interviews with 19 participants: 6 women who had sought sexual health services, 8 who had not, and 5 healthcare providers. Data were analyzed thematically using an inductive approach, with codes generated and compared within and across interviews to build broader thematic categories. Three overarching themes emerged. (1) Barriers to Care: participants described stigma, cultural restrictions, fear of judgment, poor communication with providers, and limited service options as central obstacles. (2) Facilitators of Care: awareness of available services, sexual activity, supportive relationships, medical needs, and positive physician-patient interactions enabled access. (3) Recommendations: participants highlighted expanding service availability, strengthening awareness campaigns, and training providers to offer sensitive, nonjudgmental care. Despite cultural and systemic barriers, Lebanese women show willingness to seek sexual healthcare when it is accessible, acceptable, and supportive. Improving sexual healthcare requires widening access, enhancing education, and building provider capacity to deliver woman-centered care. Findings underscore the need for policy, practice, and research initiatives that foster open dialogue, equitable access, and integrated services tailored to women's needs.

This commentary introduces the concept of an "architecture of distancing" to describe a mode of reproductive governance that preserves the legal recognition of abortion while constraining the conditions necessary for exercising this right. Using Italy as a paradigmatic case, it illustrates how the law has, from its inception, embedded mechanisms that maintain formal legality yet distance individuals from access - through strict procedural requirements, institutionalised conscientious objection, and the integration of anti-abortion groups into public services. The Italian case demonstrates that obstacles to abortion access are often not mere implementation failures, but features built within even ostensibly liberal legal frameworks, thereby helping illuminate contexts in which abortion is "legal but inaccessible". More broadly, the concept offers a lens for capturing contemporary forms of reproductive governance that restrict without prohibiting. As there is no architecture without architects, the architecture of distancing draws attention to the political, institutional, and social arrangements that sustain these dynamics and underscores the importance of prioritising the material realisation of reproductive rights over their symbolic recognition.

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.

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.

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.