Sexual and Reproductive Health Matters最新文献

The ability to have sex without having an unintended pregnancy is a key motivator for contraceptive use, yet factors related to patients' sexual lives are critically understudied in contraceptive decision-making. We report the first systematic review and meta-analysis examining the extent to which a contraceptive method's effect on a satisfying sexual life results in contraception discontinuation or switching. We searched for relevant qualitative and quantitative literature published during 2004-2023 in 9 databases and included 64 studies, comprising a total of 125,586 participants and corresponding to at least 52,705 discontinuers in need, aged 12-54 and surveyed in clinical or public health settings in diverse global contexts. Our main outcome measures were discontinuation or switching of modern contraceptive methods (excluding condoms) while in need. A meta-analysis of 25 studies indicated that sex life concerns as a reason for contraceptive discontinuation have an overall prevalence of 5% (95% CI: 0.03, 0.08; I² = 94%, τ² = 1.31; Q = 381, p < 0.001). Sub-group meta-analyses and follow-up meta-regressions do not support any differences based on the hormonal content of the contraceptive method, the specific contraceptive method type, or the specific type of sex life reasons. Sex life reasons are important, common reasons for contraceptive discontinuation. Their prevalence is comparable to other reasons for discontinuation, such as cost or access. Future research should investigate impacts of contraceptive methods on sex life more directly and clinicians should include counselling on a method's sexual acceptability as part of the wider conversation on common contraceptive side effects.

In this commentary, we challenge the narrative that presents self-managed medication abortion (SMA) as a recent "discovery" of Western biomedicine. Drawing on our lived experience and a literature review, we compare how different key concepts - autonomy, empowerment, person-centred care, privacy, confidentiality, and demedicalisation - are understood by the feminist SMA movement in Latin America, versus hegemonic medicine. We argue that when the radical ideas of the feminist SMA movement are appropriated by mainstream health systems without proper recognition of their political foundations, they lose their original meaning and may fail to achieve the positive outcomes envisioned by activists. For instance, autonomy, privacy, and demedicalisation may result in individuals feeling unsupported, while person-centred care often means merely being treated without stigma or violence. Maintaining medical control over SMA restricts access, while neoliberal policies that promote "self-care" and the commodification of abortion pills enable states to evade responsibility with regard to abortion care. We advocate for integrating key concepts taken from SMA activism into formal health systems, while honouring their origins and political significance. This requires meaningful, horizontal collaborations between SMA activists and biomedical professionals, acknowledging that SMA activists are abortion experts and should be treated as such.

Adequate access to maternal and infant healthcare in the first 1000 days of life is concurrent with lifelong well-being and should be guaranteed regardless of nationality, legal status, and social conditions. By exploring how migration status affects the social determinants of health, this review provides a nuanced understanding of the barriers and facilitators encountered accessing healthcare by undocumented women and their infants in the first 1000 days of life. Following the PRISMA guidelines and the registered protocol (CRD42022328220), a literature search was conducted in PubMed, Embase, CINAHL, PsycInfo, and Scopus. The search focused on manuscripts including undocumented migrants as study participants and reported direct or indirect data on the utilisation or outcomes of maternal and infant healthcare within the defined first 1000 days of life. Fifty-two studies met the inclusion criteria. A narrative synthesis was performed to summarise the information obtained from the data extraction process. Identified barriers include legal barriers (e.g. criminalisation of migrants or complexity of administrative procedures) and socio-cultural barriers (e.g. inadequate health literacy and financial challenges). Facilitators encompassed legal facilitators, like dedicated healthcare clinics, and socio-cultural facilitators, such as language support and healthier lifestyle habits. Ethical issues in connection to healthcare access of undocumented migrants in the first 1000 days were also mapped from the included papers. Considering the health consequences on future generations, the economic implications, and the vulnerability of migrant women, the findings offer positive examples that could be put into place to move towards universal health coverage through a holistic approach that shifts from exclusion and criminalisation to support and compassion. DOI: 10.1080/26410397.2025.2560189.

Contraceptive decision-making is an ongoing process that affects reproductive life and involves method uptake, use, and discontinuation. Contraceptive pills have been widely studied for their side effects, lived experiences, and links to biomedicalisation. However, there is a lack of research that integrates the entire subjective contraceptive pill experience from implementation to the period after discontinuation. This study explores the lived experience of pill use in Germany through 19 oral contraceptive pill biographies using thematic analysis, a deductive-inductive, iterative coding approach, and team-based discussions. This work is grounded in the theoretical framework of the contraceptive journey and feminist inquiry. Our analysis illustrated the complexity of pill use, with frequent switching, stopping, and restarting influenced by biopsychological issues, normalisation of use, and adverse effects. Attitudes towards hormones and pregnancy risk evolve over time and age. Former users consider their contraceptive journey to be successful in preventing pregnancy, but desire more male contraceptive options and improved information and counselling services. These findings emphasise the importance of prioritising former users' informal knowledge and lived experiences in future research, policy, and practice. This approach can support healthcare providers in incorporating individual and diverse health needs, aligning with the principles of reproductive justice.

Through the examination of scientific evidence related to human embryo development, the aim of this commentary is to support the right to science in sexual and reproductive health, to outline why science supports a legal approach to embryos as the biological material of human life but not as human persons, and to recognise that international human rights law adopts this approach in the protection of sexual and reproductive health and rights.

Midwives possess the skills and competencies required to provide abortion care in Canada, yet their role is constrained in health systems. They are well suited to address barriers to abortion access related to geographical and social inequities, which deprive many Canadians of essential healthcare and impede reproductive justice. To address current gaps, this study explores midwives' experiences providing abortion care in Canada. Qualitative data were collected from 25 in-depth interviews and three focus group discussions with midwives between August and December 2023. Using reflexive thematic analysis, we explored how midwives work in communities to provide or work toward providing abortion care, including health system facilitators, barriers, and their values, needs, and preferences for implementation. Findings highlight the barriers midwives face, including regulatory restrictions and a lack of flexible funding arrangements. Despite these challenges, midwives are leveraging their skills to advance reproductive justice, offering culturally safe, client-centred abortion care to underserved populations, including uninsured individuals. The study also identifies facilitators, such as applying midwifery values and philosophies to provide the midwifery model of abortion care. This research contributes to the growing body of knowledge on midwifery and abortion care, advocating for the removal of regulatory and funding barriers that limit midwives' potential to provide comprehensive sexual and reproductive healthcare. The findings have significant implications for policymakers and health system leaders in Canada and beyond, calling for the optimisation of midwives' roles to improve access to abortion care and advance reproductive rights globally.

Since the release of the Dobbs v. Jackson Women's Health Organization Supreme Court decision in June 2022, researchers have been working to better understand the impact that the growing number of abortion restrictions is having on the provision of and access to abortion services in the United States (US). Less is known about the impact of abortion restrictions on the provision of sexual and reproductive health (SRH) services more broadly, including at clinics that do not directly offer abortion. Between November 2023 and February 2024, we conducted interviews with SRH managers, clinic managers, and other administrators at publicly funded SRH clinics around the US to generate evidence on the effects of state-level abortion restrictions on the provision of abortion and related services, such as pregnancy options counselling and abortion referrals, at facilities providing contraceptive services. Through content analysis, we found that, while clinics in states with abortion restrictions have stopped providing abortions or are struggling to provide abortions amidst the variety of restrictive policies, clinics in states without these restrictions are also facing difficulties, specifically having to adjust their care provision due to the increase in patients seeking abortion. Simultaneously, the complicated web of abortion regulations has led providers in all states to experience challenges related to combating misinformation and protecting reproductive autonomy. These findings demonstrate the ways in which the ripple effects of Dobbs extend well beyond abortion and affect the wider network of publicly funded SRH care.

While almost half of all pregnancies in Uganda are unintended, the use of post-abortion intrauterine devices (IUDs) remains low. In this study, we explored how women in Uganda with current or recent post-abortion IUD use navigated socio-cultural factors, norms and power relations, and overcame challenges that often hinder contraceptive use in this context. Between January and August 2023, we conducted a qualitative study at four health facilities in central Uganda. The study included 24 in-depth interviews with women aged 19 years and above who had used an IUD following treatment for incomplete abortion (spontaneous or induced). The data were transcribed and coded in NVivo and analysed using reflexive thematic analysis. Respondents justified their IUD use through a combination of pragmatic reasoning, personal autonomy and economic considerations. The right to bodily integrity, alongside practical reflections on financial constraints, gender roles and societal expectations, emerged as important considerations. Compassionate post-abortion contraceptive counselling enhanced confidence in their decision and dispelled myths and misconceptions. Concealed IUD use enabled participants to pursue their reproductive goals, while evading influence from partners, peers, or social norms that discourage use. Our findings highlight the potential of post-abortion contraceptive counselling in supporting women's choices, and the role of concealed IUD use in realising reproductive goals. Integrating arguments around bodily autonomy in post-abortion contraceptive counselling and advocacy and supporting overt and covert use may be important strategies to strengthen sexual and reproductive health and rights in this setting.

Lebanon's healthcare system has demonstrated remarkable resilience amidst ongoing political and economic turbulence. Yet, the critical domain of Sexual and Reproductive Health and Rights (SRHR) remains underserved. This commentary analyses the systemic barriers, policy deficiencies, and urgent needs that shape SRHR within Lebanon's healthcare landscape. Despite the country's commitments to international frameworks like the ICPD and CEDAW, SRHR policies are hindered by political fragmentation, societal conservatism, and insufficient prioritisation. These challenges translate into inadequate and inconsistent family planning services, a lack of comprehensive sexuality education, inadequate maternal healthcare, and significant obstacles in accessing essential services, especially for marginalised communities such as refugees, women, and youth. Lebanon's "Vision 2030" health strategy, while ambitious in scope, offers only limited engagement with SRHR, which leaves systemic inequities unaddressed. Renewed episodes of violence and displacement further strain the healthcare system and deepen the disparities faced by vulnerable groups. The reliance on temporary, NGO-led initiatives to fill gaps in service provision underscores a broader policy paralysis and inconsistent resource allocation, which together prevent the sustainable integration of SRHR into national health frameworks. This commentary calls for a gender-sensitive, inclusive healthcare policy that positions SRHR as a foundational pillar of public health, gender justice, and social equity. Achieving this requires concerted efforts among government agencies, NGOs, and international partners to overhaul existing frameworks and address structural barriers.