Sexual and Reproductive Health Matters最新文献

Landmark legislative events can shift public opinion. We conducted a longitudinal survey examining abortion attitudes before and after Dobbs v. Jackson which overturned Roe v. Wade in 2022. Wave 1 (N = 1,014) was conducted in June 2022, and Wave 2 (N = 792) in October-November 2022. Using bivariate analyses, we assessed people's attitudes towards the Dobbs decision and potential changes in abortion attitudes over time, across different abortion identity sub-groups (e.g. pro-life, pro-choice). Results indicate that people were informed about (90%) and disagreed (56%) with the decision, and did not report or experience a change in attitudes after the decision (68-73%). However, among those who did change, respondents were more inclined to endorse legal abortion after the decision (19-22%) than indicate abortion should not be legal (6-13%). Through analysing open-ended data, we found that participants more inclined to endorse legal abortion described the ruling as eroding personal rights, government intrusion, and threatening access to healthcare. Participants less inclined to endorse legal abortion indicated the ruling reinforced their belief in defending fetal rights. While not necessarily advocating outright illegality, such participants favoured stricter regulations. Notably, people who identified as "both/neither/prefer not to answer" tended to disagree with the Dobbs decision and lean towards greater endorsement of legal abortion. Uncertainty regarding (dis)agreement with the Dobbs decision was also higher among people who identified as pro-life and "both/neither/prefer not to answer" than among those who identified as pro-choice. These findings highlight important nuances that exist in abortion attitudes beyond the perceived dichotomy of the pro-life/pro-choice spectrum.

Access to abortion is recognised as a key component of the right to healthcare. Yet, to this day, abortion in Germany without medical or criminal indication is illegal and treated under the penal code, although not punished if taking place in the first 12 gestational weeks and following a formalised process including mandatory counselling. Our study aimed to critically examine the pathway to abortion necessitated by the current criminalising legal framework in Germany. We conducted a qualitative study between November 2023 and July 2024, using 17 interviews to capture views of abortion-related service providers on barriers and enablers to abortion in Berlin and Brandenburg, applying a thematic analysis approach using MaxQDA. Our findings point to multiple individual barriers to abortion along the pathway, whose complexity itself presents a structural barrier. Even providers were sometimes insecure about how parts of the process worked and what they were or were not allowed to do. We identified a nine-step series of actions which most individuals seeking abortion must undergo to end an unwanted pregnancy, involving multiple health service visits and the repeated need to communicate their personal situation to different authorities. Our study illustrates that the pathway to abortion in Germany produces a state-induced barrier to a fundamental reproductive health service, and in this respect can be viewed as a form of structural violence against pregnant individuals in a critically decisive situation. Our findings support existing recommendations to decriminalise abortion, which would align Germany´s abortion policy with its international commitments and with international best practices as outlined by WHO.

This qualitative study explored provider perspectives on self-managed abortion (SMA) in India, their roles, and how they share information about pathways to both clinician- and self-managed abortion care. We conducted 33 semi-structured interviews with a range of providers (medical, community health, and pharmacy) in three states in India: Jharkhand, Bihar, and Tamil Nadu. Using thematic analysis, we examined provider perspectives on SMA, their involvement in abortion care, and how they contribute to information sharing around access pathways. We categorised findings by provider type, direction of care pathways, abortion modality (clinician-managed vs. SMA), and the kind of care delivered. Our findings showed most providers described abortion as conditionally acceptable and primarily encouraged clinician-managed care. Concerns about SMA safety and potential liability often led them to discourage SMA. Nonetheless, participants acknowledged three areas where providers played a role in SMA: providing information, dispensing medication, and providing support (i.e. managing pain). Pharmacy workers and local providers shared information with abortion seekers on pathways to access SMA care. Some community health workers directed clients to pharmacies, but more often only provided SMA information and support. Despite provider concerns, support for and pathways to SMA exist in India. Understanding the dynamics of provider perspectives and roles can inform improvements to comprehensive reproductive health policies and programmes in order to promote person-centred abortion care - including SMA - and address provider concerns. Synergies are needed between the formal health sector and SMA support networks to advance person experiences and reinforce quality abortion care as a human right.

The World Health Organization (WHO) recently released revised guidelines on self-care interventions for health and well-being, which, in 2022, included recommendations supporting equitable access to information about and availability of pre-exposure prophylaxis (PrEP) as a self-care strategy. Successful implementation of PrEP as an HIV prevention strategy extends beyond providing access to medication. It hinges on individuals adopting self-care strategies to ensure adherence to PrEP in their daily lives. This paper aims to explore self-care strategies that bolster adherence to oral PrEP among female sex workers in two rural Ugandan settings. Through in-depth interviews with 20 female sex workers residing in fishing communities or Trans-Africa highway towns, we used deductive thematic analysis to explore people-centred and health system-centred perspectives on women's PrEP-related self-care strategies. A people-centred perspective on self-care illustrated a range of self-care strategies to support PrEP adherence conducted by women individually (medication reminders; pairing PrEP with daily habits), and with support from others in familial and social networks (verbal reminders to take tablets; information sharing; shared clinic visits; shared pill-taking routines). A health system-centred perspective illustrated the importance of support from health services and professionals. Examples included information provision; NGO clinics as friendly, safe, non-judgemental spaces; PrEP distribution through home-based care outreach strategies; in-bulk PrEP provision for work-related travel periods; formal integration of female sex workers into the system as peer health workers. By considering both person-centred and health system-centred perspectives on self-care, we can pinpoint strategies for health systems to assist female sex workers and their communities in preventing the acquisition and transmission of HIV.

Access to sexual and reproductive health (SRH) care is key for people to realise their reproductive goals, but sexual and gender minority (SGM) patients may experience different barriers or facilitators to access than their non-SGM counterparts. We analysed a panel dataset of 900 patients using publicly funded SRH services in Wisconsin in 2020-2023 and constructed conditional logistic regression models to explore barriers to contraceptive services and subsequent patient-centred contraceptive method use, stratified by SGM status. Experience of barriers to wanted contraception was strongly related to preferred contraceptive use (aOR = 0.36, CI: 0.20-0.64, p = 0.002) and method satisfaction (aOR = 0.39, CI: 0.20-0.77, p = 0.010). Barriers were also linked to lower use of LARC methods by patients preferring LARC methods, including affordability barriers (aOR = 0.09, CI: 0.01-0.85, p = 0.037). SGM patients were less likely to report preferred method use (aOR = 0.18, CI: 0.08-0.42, p = 0.001) and method satisfaction (aOR = 0.30, CI: 0.11-0.81, p = 0.022) after experiencing barriers. Those who experienced affordability barriers were also less likely to report preferred method use (aOR = 0.18, CI: 0.05-0.68, p = 0.015). For non-SGM patients, only experiencing a missed healthcare visit was related to lower method satisfaction (aOR = 0.48, CI: 0.25-0.92, p = 0.029). Our study highlights that barriers to contraceptive care can hamper people's ability to realise their contraceptive preferences. Furthermore, our differential findings by SGM status point to potential gaps in healthcare systems that are not adequately set up to serve all patients.

As 2024 marked the 30th anniversary of the International Conference on Population and Development, which recognised unsafe abortion as a human rights and public health imperative, it is an apt time to assess global progress on abortion law reform. By mapping changes to abortion laws for 199 nations and semi-autonomous territories from 1994 to 2023 and coupling this with population data, this article demonstrates that the past three decades have been marked by an overwhelming trend towards the liberalisation of abortion laws across all regions, resulting in over 825 million women of reproductive age living under expanded grounds for legal abortion. Notably, a potential sea change has occurred in abortion law reform in the past five years, with countries increasingly liberalising their laws to permit abortion on request instead of adopting more incremental approaches. More countries have reformed their laws to permit abortion on request in the past five years than in the 25 preceding years. Yet, significant disparities continue to exist across regions. Countries banning abortion altogether or narrowly permitting abortion when the pregnant person's life is at risk are concentrated in Africa, Asia, and Latin America, including in resource-scarce contexts where abortion seekers are doubly disadvantaged by restrictive laws and limited access to healthcare, including post-abortion care. It is critical that law and policymakers and public health authorities recognise that restrictive abortion laws are out of step with global norms and support progress towards the liberalisation of abortion laws, particularly towards permitting abortion on request.

Sexual health is a major dimension of global health and well-being. Yet, evidence regarding its assessment at a worldwide level is scarce. Most population-based studies are conducted in a limited number of countries from the Global North using specific measures that do not allow for country comparison. The World Health Organization (WHO) led a process to create a global survey called the Sexual Health Assessment of Practices and Experiences (SHAPE) to assess sexual practices and behaviours that impact on health. This article aims to describe the application and feasibility of this questionnaire in an extended real-world context. It presents the results of the implementation process in Portugal, the first country to use it with a nationally representative sample. This descriptive study was conducted between 14th June and 15th October 2023, involving a sample of 2,010 individuals (52% women) living in Portugal, aged 18-95 (mean = 49.6 years). 1,426 participants responded online and 584 by telephone. Overall response rate was 30.9% (79.5% online, 12.4% by telephone) and 94% of responses were valid. The original SHAPE questionnaire took 17.7 min to answer on average (16.6 min online and 20.3 min by telephone). Including module G (assessing sexual problems), average time was 29.2 minutes. The relatively short response time and choice of formats suggest this tool provides a comprehensive picture of sexual health. It is hoped that it will be widely used in different health and research contexts, to enhance the global evidence base for the development of policies that promote sexual health.This article aims to describe the application and feasibility of this questionnaire in an extended real-world context.

Use of preferred contraceptive methods is a measure of reproductive autonomy, yet barriers persist across the United States in accessing preferred methods of contraception, with disparities in access among communities of colour. Using data from a 2021-2022 cross-sectional survey of 727 people aged 13-50 living in the United States who identified as Asian American, Native Hawaiian, or Pacific Islander (29%); Black or African American (34%), Indigenous (13%), and Latina/Latinx (31%), we examined those who were not using their preferred contraceptive method(s), including the preferred method type and the reasons for not using this method(s). We ran an adjusted logistic regression to test the association between the quality of the last health care interaction related to contraception and the use of a non-preferred method. Thirty-seven percent of respondents preferred a contraceptive method they were not currently using. Among current contraceptive users, long-acting methods were preferred most often, while non-current contraceptive users desired long-acting and short-acting hormonal methods equally. Respondents most often cited concerns about side effects/health risks (65%) and financial/logistical reasons (42%) as the top reasons for not using their preferred method(s). Those who reported receiving higher quality care in a recent contraceptive visit were more likely to be using the method they wanted to be using. Use of a preferred contraceptive method may increase when receiving high-quality counselling and care. Strategies to improve access to preferred methods should address side effects and health concerns, as well as financial and logistical barriers among Black, Indigenous, and people of colour.

Since abortion was legalised in 1973, the United States anti-abortion movement has sought to eliminate abortion services. One strategy has been to foment hatred of abortion providers, which legitimises anti-abortion activists' attacks on providers and facilities, thereby dissuading pregnant people from seeking abortions and hindering providers' willingness to offer services. After the 2022 Dobbs decision overturning Roe v. Wade, these attacks escalated. The goal of our study was to examine a social media platform, YouTube, to identify the categories of videos promulgated by the anti-abortion movement and to investigate how these videos might be propagating hatred of providers. We also sought to discern differences post-Dobbs. Using three search terms - "pro-life," "abortionist" and "abortion providers" - we developed a sample of 291 YouTube videos with high viewership, of which 217 had content about providers or patients. Videos took numerous forms, including debates, testimonials and undercover investigations. We identified four major dimensions of abortion provider depictions, in order of frequency: manipulative (deceptive, greedy and biased), villainous (brutal murderers), uncaring (callously harming women) and immoral. Abortion facilities were characterised as "death camps" and abortions as "baby funerals." Patients were reviled if they "celebrated" their abortions, but not if they were remorseful. Videos post-Dobbs seemed more geared to reducing demand by emphasising patient regret and provider harms. We concluded that despite YouTube content moderation, abortion providers were being maligned in videos, which potentially contributes to clinic attacks. To increase support for abortion providers, content creators may want to specifically extol providers' contributions to public well-being.

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 the 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.