Sexual and Reproductive Health Matters最新文献

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.

In the medically assisted reproduction (MAR) pathway, one of the most complex phases is the end of the treatment. Unlike other medical contexts, there is no biological endpoint in the MAR setting. This absence makes the decision to end MAR treatment extremely challenging for both patients and healthcare professionals. Accordingly, our research aimed to examine the process related to the end of MAR treatment, as devised by healthcare professionals. Our sample included physicians, biologists, and psychologists aged ≥18 years with specialised training in assisted reproduction. Data were collected through four focus groups (in February-May 2023), focusing on the topic of the end of treatment (EoT) and its definition. Data were collected and analysed according to the principles of Grounded Theory. The findings shed light on the attributes and components related to the end of the treatment process. The central category "the end of treatment" consists of a definition of what is considered the end of treatment and the associated decision-making process. In the phase leading up to the EoT, the process is influenced by contextual and proximal factors, which interact and influence each other. To cope with and manage the EoT, healthcare providers adopt spontaneous strategies that lead to positive or negative outcomes. End-of-treatment management is a key facet of clinical practice. This contribution increased knowledge about EoT and highlighted healthcare professionals' perspectives, which should be considered for the implementation of best practice points and respect for patients' rights to the highest attainable standard of mental and physical health.

This commentary analyses the state of legal abortion in Brazil over the past decade, contextualising the increasing restrictions and political disputes surrounding the issue within broader anti-gender offensives. While Brazilian law permits abortion only in limited cases - rape, risk to the pregnant person's life, and anencephaly - access to these rights has been consistently undermined, particularly amid the strengthening of far-right political forces. We explore how moral arguments and conservative discourses - often framed through the notion of "gender ideology" - have been mobilised to roll back sexual and reproductive rights, resulting in significant institutional and legislative setbacks, including attempts to criminalise legal abortion practices. In contrast, the commentary highlights forms of resistance led by feminist movements, progressive lawmakers, and the judiciary, such as mass protests, strategic litigation, and efforts to socially decriminalise abortion. Furthermore, it addresses the role of strategic ignorance in perpetuating state inaction and the importance of academic research in illuminating these dynamics and resisting the erosion of rights. The struggle for reproductive justice in Brazil is ongoing, marked by both persistent threats and collective resistance.

This paper analyses emerging trends in judicial approaches to sexual and reproductive health and rights (SRHR) in Africa, arguing for a paradigm shift from the conventional rights-based framework that emphasises "choice" to an Africentric Reproductive Justice framework (ARJ). It employs a qualitative research design, combining a literature review with an in-depth analysis of eight purposively selected SRHR court cases from African countries and the United States to examine how recent judicial decisions reflect a growing integration of reproductive rights with broader social justice issues. The proposed ARJ framework is grounded in the reproductive justice theory, incorporating conceptual principles of decoloniality and Africentrism, which emphasises amplifying positive African narratives, leveraging African-based judicial institutions, involving civil society organisations, and empowering African individuals to engage with judicial systems for reproductive justice. This approach addresses intersectionality, race, class, gender, and socioeconomic status in SRHR issues in Africa. The findings demonstrate that African courts are increasingly balancing competing rights and interests in culturally sensitive ways, reflecting an evolving understanding of reproductive justice in African contexts. This paper concludes by arguing that achieving genuine reproductive justice necessitates moving beyond the "right to choice". It requires deconstructing enduring structural barriers and addressing historical injustices perpetuated by colonial legacies, and the ARJ framework, rooted in decolonial principles, presents a holistic, context-specific approach towards achieving equitable SRHR for all individuals on the continent.

Short interpregnancy intervals (IPIs) of <6-18 months are associated with adverse maternal and child outcomes. This study aimed to identify the individual, relationship, community, and societal factors that influence short IPIs in high-income countries. A comprehensive search was undertaken in CINAHL Plus, Ovid/EMBASE, Ovid/MEDLINE, Ovid/PsycINFO, ProQuest, PubMed, Scopus, Web of Science, and Google Scholar for articles published in English from 1st January 1990 to 26th October 2023. Studies were included if they reported an effect estimate of at least one determinant of pregnancy spacing in a high-income country. The quality of the included studies was assessed using the Johanna Briggs Institute Critical Appraisal Tool and Cochrane Risk Assessment Tool. Multi-level factors at the individual, relationship, community, and societal level were systematically identified through the socio-ecological model. This study is registered with PROSPERO (CRD42020176311). Of 2005 unique articles, 220 were identified for full-text review, and 55 met the inclusion criteria representing a total of 27,103,055 women from 13 high-income countries. All the included studies were deemed to be of moderate to high quality. Most of the studies reported determinants of short IPI at the individual level, with non-use of contraception the most common reported factor. Peer influence was a factor at the relationship level, and access to health care and reproductive services were impactful at the community and societal levels, respectively. Future research and efforts should support the development and implementation of policies and practices that support optimum pregnancy spacing from a comprehensive socio-ecological position.

Endometriosis is a chronic condition characterised by cyclic pain symptoms that often significantly affect health-related quality of life. Predominantly framed as a "woman's condition", current research overlooks the experiences of transgender and gender-diverse (TGD) individuals with endometriosis. This jeopardises the right to health for a community that faces historically rooted social and health disparities. This study aims to explore the embodied relationship between gender and endometriosis symptoms among TGD people living with endometriosis. A secondary objective is to examine the accessibility and competence of healthcare systems in addressing the needs of this community. The methodology included two focus group discussions conducted across four focus groups (4 × 2). Fourteen participants representing diverse gender identities, various stages of endometriosis and ages, were recruited online from nine countries across three continents, forming a heterogeneous group. Reflexive thematic analysis identified 15 codes and 7 clusters. The results were organised into themes, following the four embodiment epidemiological notions. Participants reported their gender self-perception and endometriosis symptoms to be interrelated and mutually influential. Feelings of disconnection and alienation were prevalent, particularly during life events such as menarche. Due to mistrust and experiences of discrimination, many TGD individuals withhold critical information during medical consultations. TGD people with endometriosis have unique health needs, e.g. how to combine gender-affirming and endometriosis care, and they are often concerned about future employability. Overall, the study underscores the urgent need to improve healthcare for TGD individuals with endometriosis as a matter of health justice.

Across sub-Saharan Africa, there remains disagreement among local expert providers over the best ways to improve access to assisted reproduction in low-income contexts. Semi-structured qualitative interviews were conducted between 2021 and 2023 with 19 fertility specialists and 11 embryologists and one clinic manager from South Africa, Zimbabwe, Namibia, Kenya, Ethiopia and Uganda to explore issues surrounding access and potential low-cost IVF options. Lack of access to ART was variously conceptualised as a problem of high cost of treatment; lack of public funding for medical services and medication; poor policy awareness and prioritisation of fertility problems; a shortage of ART clinics and well-trained expert staff; the need for patients to travel long distances; and over-servicing within the largely privatised sector. All fertility specialists agreed that government funding for public sector assisted reproduction services was necessary to address access in the region. Other suggestions included: reduced medication costs by using mild stimulation protocols and oocyte retrievals under sedation instead of general anaesthetics. Insufficient data on low-cost interventions was cited as a barrier to their implementation. The lack of skilled embryologists on the continent was considered a major limitation to expanding ART services and the success of low-cost IVF systems. Very few specialists suggested that profits of pharmaceutical companies or ART clinics might be reduced to lessen the costs of treatments.

A crisis in early pregnancy can be due to an unplanned pregnancy or a suspected abnormality. Pregnant people have the right to unbiased and comprehensive advice of all options from healthcare providers. Using story completion models (SCM), the aim of this qualitative study was to explore the attitudes of medical students and doctors in training towards crisis pregnancy, specifically two scenarios: early unplanned pregnancy and fatal fetal abnormality (anencephaly). Participants were invited from medical students attending University College Dublin (UCD) and trainees in Obstetrics and Gynaecology at the Royal College of Physicians of Ireland (RCPI) from July to December 2022. SCM involves giving the consenting participant an introduction to a hypothetical situation that acts as the beginning of a story and asking them to complete it. Stories were compiled and analysed using thematic analysis. Research Ethics Committee approval was given by both UCD and the RCPI. The standards for reporting qualitative research guidelines were followed. Eight doctors in training and six medical students consented to participate in the study; all but two medical students completed both stories to the required word count, giving 25 stories for analysis. For both situations, stories described a variety of approaches, all of which were based on the person's, or couple's, wishes, from continuing in pregnancy to deciding to end the pregnancy. SCM allowed detailed analysis of potentially sensitive subjects such as pregnancy options. This study showed that participating medical students and doctors in training recognise that pregnant people have the right to all choices in crisis pregnancy.