Sexual and Reproductive Health Matters最新文献

More than 650 million women alive today were married as children. Relative to efforts to prevent child marriage, efforts to support child brides have received much less attention. This review set out to map and describe interventions that support child brides. We performed a scoping review using seven electronic databases coupled with a grey literature search in January 2022. Data were extracted using a piloted extraction tool and findings were reported in narrative synthesis. A total of 34 projects were included in our review. Most projects focused on improving sexual and reproductive health (SRH) knowledge and behaviours among child brides, which was often achieved through a combination of SRH education, counselling and information provision, along with linkages to SRH services. Some interventions were health facility-based and aimed at improving responsiveness of health service providers to the needs of child brides. Very few described economic interventions as one component of a broader health intervention, and only three interventions focused on improving girls' educational outcomes. We also note the paucity of media-based interventions, despite their popularity among adolescents. Over time, interventions addressing the needs of child brides have increased, but the preponderance of evidence has focused on SRH interventions, with interventions that couple education with adolescent-friendly health services demonstrating promise. Interventions addressing other areas of health and social wellbeing of this group, such as mental health, sexual health, and economic independence, have been overlooked in comparison. The review highlights the need for additional empirical evidence on what works to support child brides.

Readers of Sexual and Reproductive Health Matter are no strangers to interrogating evidence in all its forms, assessing which claims it can support, and about challenges and uncertainties in international norms in the fields of sexual and reproductive rights and health. Questions of evidence, positionality and the role of testimony are particularly live in the context of sex work and human rights. As an exploration about good and bad practices in research and evidence, in this Commentary we highlight the errors, mistakes and wrongly shaped conclusions arising in the recent report by the UN Special Rapporteur on violence against women and girls about prostitution law, sex worker health and rights, and the status of international human rights law on sex work and trafficking. We do this not only to reinforce more accurate information about the status of human rights law, public health evidence and the needs of people of all genders in the sex sector, but also as an opportunity to remind us of the principles around evidence, transparency, and self-determination. We are conscious of the current vulnerability of global rights and health systems. Our Commentary seeks to contextualise our criticisms to this current moment of rights and health systems' fragility and multi-pronged attacks on the emancipatory potential of rights for persons in the sex sector as workers especially as they intersect with racist stereotypes. Practices of deploying evidence matter for rights advocacy: its legitimacy as well as its efficacy depend on good practices.

Abortion is an indispensable healthcare service for women of all reproductive ages. Research on abortion is often focused on younger women, neglecting those who are closer to the end of their reproductive lifespan. This study presents findings from qualitative interviews with Belgian women who had an abortion at the age of 40 or older, conducted between May 2022 and April 2023. Using interpretative phenomenological analysis, we explored the experiences and decision-making processes of women who had abortions later in life. We identified three main themes. First, the women's families were at the centre of their abortion decisions, with some women also presenting advanced age as a significant factor in their decision-making. This emphasis on age was connected to perceived social norms about appropriately timed childbearing. Second, the women experienced their unplanned pregnancies as both physically and emotionally demanding, and desired to terminate them as soon as possible. Some participants felt additional emotional burdens because of delays caused by the mandatory waiting period and/or busy schedules at abortion centres. Third, the women expressed feelings of self-blame for their unplanned pregnancies. This self-blame was closely tied to their expectation of social disapproval, which made them cautious to share their abortion experience with people in their social circle. This study enhances our understanding of the experiences and meaning-making of abortion in women of advanced reproductive age. It highlights the need to destigmatise the topic and the importance for professionals and researchers to consider family preservation and advanced reproductive age as potential factors shaping abortion decision-making.

Amidst resurging syphilis infection rates, increasing efforts are being made towards development of a syphilis vaccine. This study aims to identify barriers and facilitators of syphilis vaccine trial participation among priority groups for early phase studies. We conducted interviews with English-speaking individuals ≥18 years old recruited from an infectious disease clinic, a sexually transmitted infection (STI) testing site, an online research bulletin board, and HIV community advisory boards in North Carolina from April 2021-June 2022. Eligibility criteria included STI diagnosis within 12 months, people living with HIV (PLWH), men who have sex with men, or persons engaged in transactional sex. The interview guide examined views on syphilis vaccines, trial participation, and community engagement. Interviews were transcribed verbatim, coded, and analysed for emergent themes using a social ecological model. Thirty individuals were interviewed, including eight (27%) women, 13 (43%) Black/African American individuals, and 19 (63%) PLWH. While 19 (63%) interviewees were interested in syphilis vaccine trial participation, 10 (33%) noted participation would depend on trial parameters; one person expressed no interest. Trial participation barriers included physical risks, time commitments, and concerns related to mistrust and mistreatment. Facilitators included advancing science, syphilis prevention, and trusting the researchers. Interviewees emphasized the importance of community involvement to inform vaccine trials, particularly amidst the lingering shadow of the Tuskegee Syphilis Study. While priority groups thus expressed interest in syphilis vaccine trial participation, tailored community engagement will be essential prior to clinical trials. Additional mixed methods research is urgently needed.

2024 marked the 30th anniversary of the International Conference on Population and Development (ICPD) Programme of Action (PoA) held in Cairo in 1994, which coincided with the year that the United Nations Framework Convention on Climate Change (UNFCCC) went into force. Three decades later, these agendas have become increasingly interconnected and climate change has evolved into a climate crisis, as the world undergoes unprecedented demographic changes. How we deal with these unprecedented changes, and the timings of our shared actions, will define our future. This commentary reflects on the principles of the ICPD PoA and argues for their relevance in today's fight for climate justice. To build a just and sustainable world, climate action must be guided by the aspirations of the ICPD PoA, promoting people-centred solutions, protecting human rights, advancing social justice, ensuring the right to health - including sexual and reproductive health and rights for all - and empowering women and youth in climate action and securing a future in which rights and choices are preserved for every individual.

With drastic changes to abortion policy, the months following the Dobbs leak and subsequent decision in 2022 were a uniquely uncertain and difficult time for abortion access in the United States. To understand experiences of challenges to abortion access during that time, we used a hybrid inductive and deductive thematic coding approach to analyse descriptions of barriers and their impacts shared in an abortion subreddit (r/abortion). A simple random sample of 10% of posts was obtained from those shared from 02 May 2022 through 23 December 2022; comments were purposively sampled during the coding process. In this sample of submissions (n = 523 posts, 88 comments), people described structural barriers identified in past research, including state abortion bans and gestational limits, high costs, limited appointment availability, and long travel required. Posters also commonly described known social barriers, including limited social support and abortion stigma. Several impactful barriers not well-described in past research emerged inductively, including wait time for receiving mail-ordered abortion medication, low credibility of online ordering platforms, and concerns about legal risks of accessing abortion or related medical care. The most common consequences of experiencing barriers were adverse mental health outcomes, delayed access to care, and being compelled to self-manage their abortion because of access barriers. This analysis provides timely insights into the experiences and impacts of abortion access barriers in a group of people with a range of engagement with clinical abortion care, lived experiences, and points in their abortion processes, with public health implications for mental health and abortion access.

Pacific understandings of sexual and reproductive health (SRH) encompass beliefs and practices reflective of Pacific values systems. These are integral to cultural understandings of safety, relationships, and intimacy. Research processes and practices that appropriately address these values and sensitivities are scarcely available in the literature, leading to limited use and understanding of culturally appropriate methods and procedures. Pacific methodologies like Talanoa are useful in ensuring that cultural perspectives unique to Pacific youth are addressed and appropriately represented in the research. This paper describes how cultural factors associated with sexual and reproductive health influenced the Talanoa research processes in a study of Pacific youth and SRH education. Key cultural considerations are discussed focussing on the positionality of the researchers, cultural sensitivities and protocols, communication strategies and the role of flexibility in privileging Pacific youth voices.