Sexual and Reproductive Health Matters最新文献

Post-abortion care (PAC) counselling and the provision of contraceptive methods are core components of PAC services. Nevertheless, this service is not uniformly provided to PAC patients. This paper explores the factors contributing to young women leaving health facilities without counselling and contraceptive methods. The paper draws from an ethnographic study conducted in Kilifi County, Kenya, in 2021. We conducted participant observation in health facilities and neighbouring communities, and held in-depth interviews with 21 young women aged 15-24 who received PAC. In addition, we interviewed 11 healthcare providers recruited from the public and private health facilities observed. Findings revealed that post-abortion contraceptive counselling and methods were not always offered to patients as part of PAC as prescribed in the PAC guidelines. When PAC contraceptive counselling was offered, certain barriers affected uptake of the methods, including inadequate information, coercion by providers and partners, and fears of side effects. Together, these factors contributed to repeat unintended pregnancies and repeat abortions. The absence of quality contraceptive counselling therefore infringes on the right to health of girls and young women. Findings underscore the need to strengthen the capacities of health providers on PAC contraceptive counselling and address their attitudes towards young female PAC patients.

Increasing rates of mobile phone access present potential new opportunities and risks for adolescents' sexual and reproductive health in resource-poor settings. We investigated associations between mobile phone access/use and sexual risks in a cohort of 10-24-year-olds in South Africa. 1563 adolescents (69% living with HIV) were interviewed in three waves between 2014 and 2018. We assessed mobile phone access and use to search for health content and social media. Self-reported sexual risks included: sex after substance use, unprotected sex, multiple sexual partnerships and inequitable sexual partnerships in the past 12 months. We examined associations between mobile phone access/use and sexual risks using covariate-adjusted mixed-effects logistic regression models. Mobile phone access alone was not associated with any sexual risks. Social media use alone (vs. no mobile phone access) was associated with a significantly increased probability of unprotected sex (adjusted average marginal effects [AMEs] + 4.7 percentage points [ppts], 95% CI 1.6-7.8). However, health content use (vs. no mobile phone access) was associated with significantly decreased probabilities of sex after substance use (AMEs -5.3 ppts, 95% CI -7.4 to -3.2) and unprotected sex (AMEs -7.5 ppts, 95% CI -10.6 to -4.4). Moreover, mobile phone access and health content use were associated with increased risks of multiple sexual partnerships in boys. Health content use was associated with increased risks of inequitable sexual partnerships in adolescents not living with HIV. Results suggest an urgent need for strategies to harness mobile phone use for protection from growing risks due to social media exposure.

As an interface between health and education, comprehensive sexuality education (CSE) offers a potent tool among other interventions to accelerate healthy transition of adolescents into adulthood. With increasing interest in in-school CSE provision/delivery, young people in out-of-school contexts may be left behind. This study forms part of implementation research to understand if the activities used to train and support the facilitators are feasible, appropriate, acceptable, and effective in enabling them to engage a defined group of young people, deliver CSE to them in the out-of-school context, and assist them in obtaining relevant services. This paper presents findings of mapping of out-of-school CSE interventions in Ghana, ongoing or completed between 2015 and 2020, and then discusses a needs assessment of two purposively selected groups of vulnerable out-of-school youth: young people living with HIV and AIDS (YPLHIV) and those living in detention (YPiD). We conducted 10 interviews with YPLHIV and three focus group discussions with YPiD in November 2020. Qualitative data were analysed thematically using both deductive and inductive approaches. The mapping yielded 29 interventions (18/62% were ongoing) focused extensively on the delivery of CSE-related knowledge and information; none were aimed at building facilitators' capacity and most targeted the northern regions. Among YPLHIV, living positively after diagnosis, disclosure skills and use of HIV/AIDS health services were critical. YpID sought clarification on personal hygiene, consent in sexual relationships, medium/channel to deliver CSE, and issues around same-sex sexual intercourse. Both groups sought skills in dealing with stigmatisation and discrimination. Implications of the findings for our own and other interventions are highlighted.

Research from several high-income countries links early menarche with an increased risk for sexual violence. However, the role of early menarche in adolescent girls' and young women's sexual violence risk in sub-Saharan Africa, where sexual violence rates are high, is not well understood. The current study explores the association between early menarche and sexual violence in Ghana with secondary analysis of data collected from 700 adolescent girls and young women followed over three years. Logistic regressions were used to assess the cross-sectional association between early menarche and sexual violence. Generalised estimating equations were used to assess whether the association between early menarche and sexual violence persisted over time. Inverse odds weighting was used to test potential mediators of the association between early menarche and sexual violence. Sexual violence was fairly common in the study sample, with 27% reporting having experienced sexual violence at baseline, and approximately 50% at year three. Early menarche was associated with 72% greater odds of having experienced sexual violence at baseline (95% confidence interval: 1.01-2.93). However, the odds ratio attenuated and lost significance over the three-year study period, with a lower risk of sexual violence among girls with early menarche at year three. Neither child marriage nor early sexual initiation significantly mediated the association between early menarche and sexual violence. The findings suggest that early-maturing girls may be particularly vulnerable to sexual violence in early adolescence, thus necessitating prevention interventions around the time of menarche to reduce the risk for sexual violence.

In Benin maternal mortality remains high at 397 deaths per 100,000 live births, despite 80% of births being attended by skilled birth attendants in health facilities. To identify childbirth practices that potentially contribute to this trend, an ethnographic study was conducted on the use of biomedical and alternative health services along the continuum of maternal care in Allada, Benin. Data collection techniques included in-depth interviews (N = 83), informal interviews (N = 86), observations (N = 32) and group discussions (N = 3). Informants included biomedical, spiritual and alternative care providers and community members with a variety of socioeconomic and religious profiles. In Southern Benin alternative and spiritual care, inspired by the Vodoun, Christian or Muslim religions, is commonly used in addition to biomedical care. As childbirth is perceived as a "risky journey to the unknown", these care modalities aim to protect the mother and child from malevolent spirits, facilitate the birth and limit postpartum complications using herbal decoctions and spiritual rites and rituals. These practices are based on mystical interpretations of childbirth that result in the need for additional care during facility-based childbirth. Because such complementary care is not foreseen in health facilities, facility-based childbirth is initiated only at an advanced stage of labour or at the onset of a perceived immediate life-threatening complication for the mother or baby. Programmes and policies to reduce maternal mortality in Benin must seek synergies with alternative providers and practices and consider the complementary and integrated use of alternative and spiritual care practices that are not harmful.

Plain language statement: Gender norms that centre men and disadvantage women create gender inequality, which can lead to risky sexual behaviour. This study examined how both community and individual attitudes toward gender norms influenced risky sexual behaviour in adolescents, and whether that influence was different between males and females. We found that higher gender-equitable attitudes were linked to increased odds of HIV testing in the last 12 months, and decreased odds of engaging in a sexual relationship with a much older partner. Individual high gender-equitable attitudes among girls were also linked to higher odds of them using condoms and contraceptives. Gender-equitable attitudes did not seem to influence early sexual debut, engagement in transactional sex, having multiple sexual partners at the same time, or the number of sexual partners a participant had in the last 12 months. Based on these findings, programming designed to increase gender-equitable attitudes might be helpful in increasing HIV testing and condom and contraceptive use, but it needs to involve the entire community, not just individual boys and girls.

Recent work in family planning has shifted from an instrumentalist perspective on quality in contraceptive counselling, which views quality as a means to encourage contraceptive uptake, to privilege quality of care as a valued end in itself. In this context of shifting narratives about quality, it is important to understand how health systems and providers navigate potential conflicts between instrumentalist definitions of quality versus a person-centred definition that considers meeting clients' contraceptive needs and preferences as an important end goal in and of itself. However, we know little about how providers and other health system stakeholders interpret the concept of quality in counselling, and how their experiences with different quality monitoring systems influence their ability to provide person-centred care. This qualitative study draws from 51 in-depth interviews with public healthcare providers and health facility administrators in Ethiopia, Mexico and India. Across all three countries, except for some cases in India, administrators were concerned with encouraging uptake of contraceptives in order to meet local and national level goals on contraceptive uptake and maternal health. In contrast, providers were more concerned with responding to client desires and needs. However, participants across all levels shared the opinion that successful counselling should end with contraceptive uptake. We conclude that the instrumentalist view of quality counselling continues to prevail across all three countries. Our findings suggest that encouraging healthcare providers and administrators to meet even relatively broad targets set by government reinforces an instrumentalist approach, as opposed to an approach that privileges person-centred care.

Integrating pleasure may be a successful strategy for reaching young people with sexual and reproductive health and rights (SRHR) interventions. However, sexual pleasure-related programming and research remains sparse. We aimed to assess chatbot acceptability and describe changes in SRHR attitudes and behaviours among Kenyan young adults engaging with a pleasure-oriented SRHR chatbot. We used an exploratory mixed-methods study design. Between November 2021 and January 2022, participants completed a self-administered online questionnaire before and after chatbot engagement. In-depth phone interviews were conducted among a select group of participants after their initial chatbot engagement. Quantitative data were analysed using paired analyses and interviews were analysed using thematic content analysis. Of 301 baseline participants, 38% (115/301) completed the endline survey, with no measured baseline differences between participants who did and did not complete the endline survey. In-depth interviews were conducted among 41 participants. We observed higher satisfaction at endline vs. baseline on reported ability to exercise sexual rights (P ≤ 0.01), confidence discussing contraception (P ≤ 0.02) and sexual feelings/needs (P ≤ 0.001) with their sexual partner(s). Qualitative interviews indicated that most participants valued the chatbot as a confidential and free-of-judgment source of trustworthy "on-demand" SRHR information. Participants reported improvements in sex-positive communication with partners and safer sex practices due to new learnings from the chatbot. We observed increases in SRHR empowerment among young Kenyans after engagement with the chatbot. Integrating sexual pleasure into traditional SRHR content delivered through digital tools is a promising strategy to advance positive SRHR attitudes and practices among youth.