Sexual and Reproductive Health Matters最新文献

Global health programmes aimed at reducing maternal and childhood mortality and morbidity are increasingly employing the concept of "preconception care" - an approach that the World Health Organization defines as interventions that occur before women (or couples) conceive and that address factors that could lead to poor birth outcomes. While the goal of improving maternal and child health outcomes is a vital one that is most assuredly shared by all in the global health community, the concept of preconception care is not without its limits and has significant drawbacks. From a gender rights and equity perspective, the preconception care framework has the potential to introduce harms and risks to women and people capable of getting pregnant. In this article, we summarise the key concerns about preconception care for global health in the twenty-first century. We recommend alternative frameworks that do not revolve around conception and have the potential to benefit all, including women, men, people who can get pregnant, people who do not want to get pregnant, pregnant individuals, and children.

The experiences and timings of pregnancy recognition trajectories have significant impacts on pregnancy-related care. Understanding individuals' contextually informed trajectories is crucial to their reproductive rights and service delivery needs. While many studies take pregnancy recognition as a starting point, capturing the complexities and nuances of these trajectories has received much less attention. This paper critically reflects on new approaches to capturing pregnancy recognition trajectories in two studies conducted between 2018 and 19, one in Nigeria with women aged 18 and over (n = 394), and a three-country study with adolescents aged 10-19 in Ethiopia, Malawi, and Zambia (n = 313). Pregnancy recognition trajectories were complex and involved multiple physical, material, and psychological recognition factors. Adolescents in the three-country study cited predominantly between two and four factors that led to their pregnancy recognition, with a range of one to seven factors. In the Nigerian study, 43.4% of respondents named two factors that led them to recognise they were pregnant, with a range of one to five factors. As pregnancy recognition is the starting point for many public health actions and interventions, it is imperative that future survey tools better capture this complex and poorly understood process. Our analyses suggest that questions should include response categories that capture physical, material, and psychological contributors to pregnancy recognition, including open-ended responses to capture heretofore unidentified aspects of this process. Questions on the duration of time between recognition factors would be beneficial, as well as an understanding of what factors were most important to an individual when recognising a pregnancy.

The climate crisis poses major challenges to reproductive justice. Climate-related events and natural disasters are severely impacting sexual and reproductive rights as well as the ability of individuals to become parents and care for their children. Through a systematic review conducted using the PRISMA method, this article addresses the impact of the climate crisis on the three core principles of reproductive justice: (1) the right not to have a child; (2) the right to have a child; and (3) the right to parent children in safe and healthy environments. While the review found no empirical studies addressing how the climate crisis impacts the right not to have children, the findings suggest that hurricanes, floods, heatwaves, droughts, and coastal erosion are associated with greater intentions of remaining childless and having fewer children, increasing fetal mortality and preterm births, decreasing new-born sex ratios and birth weight, rising birth risks, declining birth rates, and increasing challenges to parenting and childcare. We argue that the climate crisis fundamentally undermines reproductive justice by preventing individuals from fully and equitably exercising their reproductive rights to have children and to parent in safe and sustainable environments. In doing so, we stress that the climate crisis should be considered when addressing the challenges of reproductive justice and that addressing these challenges requires implementing policies that not only seek to mitigate the effects of climate disruptions but also strengthen the capacity of individuals and communities to adapt to changing environmental conditions, ensuring more sustainable reproductive futures.

Breast cancer treatment is a contested space in which therapeutic decisions often collide with women's values and preferences. In northern Sri Lanka, mastectomy remains the mainstay of surgical treatment of early breast cancer (EBC) despite evidence of equivalent survival following breast conserving surgery (BCS) and radiotherapy. This study explores autonomy in decision-making among women with EBC who were eligible for BCS and underwent mastectomy in northern Sri Lanka. A descriptive qualitative study was carried out among 15 women referred for adjuvant therapy to Tellippalai Trail Cancer Hospital in Jaffna district after having a mastectomy for EBC. Participants were recruited between January and May 2022 until data saturation was reached. Data were gathered through semi-structured interviews, which were transcribed in Tamil, translated into English, coded using QDA Miner Lite software, and analysed thematically. Women's autonomy in EBC treatment decisions is limited by various factors in northern Sri Lanka. The hospital setting is not conducive to informed decision-making, and women do not receive sufficient information. Neither survival rates nor risks/benefits of the surgical options are discussed in a systematic way. Although many women appear to be satisfied with their involvement in decision-making, their decisions are guided by incomplete information and fears of spread/recurrence communicated by treating teams. In the absence of policies and protocols to support patient autonomy, women "choose" the more invasive option: mastectomy. While it behoves medical professionals to provide evidence-based information, governments and the global health community must support strengthening healthcare systems to advance women's health and rights in lower-resource settings.

Access to safe, affordable, and supported abortion care is a crucial component of reproductive justice and human rights. Abortion seekers consider nurses and midwives to be more supportive than other health professionals. Nurses and midwives have long been recommended providers of comprehensive abortion care, including second trimester care. This iterative scoping review aimed to explore the evidence on abortion learning mechanisms available to nurses and midwives and what can be improved about abortion training. Using the Arksey and O'Malley (Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1): 19-32) and Levac et al. (Scoping studies: advancing the methodology. Implement Sci. 2010;5(1): 69) scoping review frameworks, four databases were searched, resulting in 879 articles published in English from 01.01.2010 to 01.08.2024. The authors included 43 studies and identified five learning mechanisms. The evidence is presented under three themes: (1) the adequacy of abortion learning mechanisms for nurses and midwives, (2) listening to nurses and midwives' experiences, and (3) barriers to abortion training. This review found that in almost all legal and practice contexts, abortion training may be de-prioritised and hard to access because of institutional barriers, especially in centres of education. In conclusion, there is a low investment in abortion training for nurses and midwives. Policy-makers, health care systems, and educators should consider ways to continuously instil nurses and midwives with skills, confidence, and social authority to provide person-centred abortion care to combat harmful bias and mitigate the risk of reproductive coercion.

Informed choice is a cornerstone of bodily autonomy and dignity, yet remains underdeveloped in menstrual health programmes and markets, particularly in low- and middle-income countries. Currently, menstruation-related stigma and gaps in access, availability, and education constrain individuals' ability to choose menstrual supplies that best suit their needs. This article proposes a gender-transformative definition of informed choice for menstrual supplies, adapted from the "full, free, and informed" framework widely used in family planning. Informed choice for menstrual supplies means having access to the broadest possible range of supplies, the freedom to choose without stigma or coercion, and access to accurate, unbiased information. The range of menstrual supplies should include single-use and reusable products, contraception, pain relief, and supportive items. Pathways for operationalising this framework in both commercial and free distribution settings are explored, with recommendations for expanding choice, addressing systemic barriers, and improving menstrual literacy. Ultimately, enabling full, free, and informed choice in menstrual health can improve individual health outcomes, reduce stigma, enhance equity, and foster well-functioning markets responsive to the needs of all who menstruate.

Since October 2023, Gaza, Palestine, has been the site of a humanitarian crisis due to violence from Israel, with numerous violations currently undermining sexual and reproductive health and rights. In this commentary, we detail these violations through the activist and theoretical framework of reproductive justice which centres on three tenets: the right to have children, the right not to have children, and the right to parent in safe environments and with dignity. Through examples such as the destruction of healthcare facilities, the lack of access to contraception or abortion and the total inability to parent safely, we document that all three tenets have been decimated through the systematic sexual, reproductive and gender-based violence inflicted on Palestinians by the Israeli security forces. We end the commentary with a discussion of "reproductive genocide" which we believe to be a term that accurately captures the wholesale decimation of life in Gaza.

Bias in sexual and reproductive health care (SRH) undermines the quality and delivery of essential services. For transgender and gender diverse (TGD) patients, barriers to care may be acute when seeking gendered services, such as contraception. Few studies have assessed providers' perceptions of TGD patients in SRH. Our objective was to examine bias in contraceptive providers' attitudes towards and experiences with TGD patients. We conducted in-depth interviews, from August 2022 to August 2024, with 41 healthcare providers located throughout the US and attending CME-accredited trainings on contraceptive counselling. We utilised deductive thematic analysis to identify the domains of implicit and explicit bias specific to TGD patients. Many providers struggled to understand gender diversity and had difficulty using gender-inclusive frameworks in care delivery. Explicit biases were exemplified in the pervasiveness of gender binarism within the healthcare system and providers' lack of experience with TGD patients. Providers demonstrated implicit biases through their deficits in knowledge regarding TGD patients' medical needs and culturally insensitive approaches. They offered suggestions to mitigate bias, including institutional changes to make clinics more trans-inclusive and affirming. Biases and disparities specific to TGD patients are perpetuated through a lack of awareness and stigmatisation in healthcare settings. Our findings highlight areas to improve awareness of bias, dispel confusion with evidence on gender-inclusive care, and integrate structural changes within clinics to reduce the burdensome impacts of bias on TGD patients. Advocacy at both the provider and institutional levels is needed to offer quality contraceptive care for TGD patients.

Adolescents and young adults (AYAs) constitute approximately 30% of the African population and face significant challenges in accessing sexual and reproductive health (SRH) services. Low service uptake, despite availability, may indicate service provision misalignment with AYAs' preferences. This reflects the health sector gap and will partly compromise AYAs' rights. This study synthesised stated preference studies on SRH services among AYAs in Africa, following the PRISMA 2020 guidelines. Searches were conducted across six databases (MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus and Global Health) and Google Scholar for grey literature on 24 April 2024. The attributes used to measure SRH preferences were classified based on the Donabedian quality of healthcare framework. A risk of bias assessment was conducted to evaluate the quality of included studies. The review was registered in PROSPERO (CRD42023386944). From 8,329 identified records, 16 studies with 8,005 participants from six countries were included in the final analysis. The attributes used were related to the structural (44.3%), process (41.7%) and outcome-related (13.9%) dimensions. The most important attributes were the cost of services, effectiveness of treatment and treatment frequency. Conversely, the least important attributes were treatment side effects, treatment and medical test sample collection characteristics, provider characteristics (age, gender and profession), and incentive type and recipient. In conclusion, AYAs' preferences were mainly influenced by cost, treatment effectiveness and incentive distribution methods. Policymakers need to develop affordable and effective SRH programmes with tailored incentives to align with AYAs' preferences to improve service uptake. However, these insights reflect data from a limited range of African countries.