Sexual and Reproductive Health Matters最新文献

Costa Rica prohibits abortion except under narrow circumstances to save the pregnant person's life. The country boasts historically strong support for social policy and human rights, while also presenting a complex and restrictive abortion access landscape. From September 2021 to March 2022, we conducted 23 interviews with obstetrician-gynecologist (OB/GYN) physicians, OB/GYN medical residents, and policy stakeholders to explore the socio-ecological influences on abortion access in Costa Rica. We sampled clinicians and policy stakeholders from the Universidad de Ciencias Médicas listserv through snowball sampling and conducted semi-structured in-depth interviews in Spanish. We identified limited access to comprehensive sexual health education, lack of support from interpersonal networks, inadequate provider knowledge and training, financial and migratory status, and both provider and community stigma as substantial barriers to abortion access. This study addresses a gap in published research around the social determinants of abortion in Costa Rica and sheds light on the attitudes and opinions of the medical and policy stakeholder communities about abortion access. The results highlight the need for expanded access to comprehensive sexual health education, abortion-related training for healthcare providers, and increased programming efforts, such as funding, outreach, and implementation, to ensure comprehensive reproductive health services are available and accessible, especially for vulnerable populations in Costa Rica.

This study aims to contribute to the development of a comprehensive framework for sexual well-being of young people. By making space for diverse young people's perspectives through co-creating the framework, we seek to enhance the understanding of sexual well-being in sexual and reproductive health and rights (SRHR) research in a culturally sensitive and inclusive way. A modified Delphi study invited SRHR young professionals (aged 18-30) with different backgrounds to participate as experts in three rounds of online discussions. A framework of sexual well-being was co-created by 15 young professionals from countries across Europe, Asia, Africa, and South America. This framework recognised sexual well-being as a subjective concept with different meanings: for example, by applying an open understanding of sexual activity, and intimacy. It also acknowledged the challenges individuals face in fully understanding and achieving their sexual well-being, due to societal injustices. The framework outlined key capabilities inherent to sexual well-being, including informed decision-making, bodily autonomy, consent, exploration, self-awareness, pleasure, communication, comfort, safety, and self-esteem. Considering that these capabilities can only be realised within an enabling environment, access to sexual health information and services, as well as acceptance, respect, safety, and freedom from coercion and violence, were included as a key part of the framework. This study captured young people's views on sexual well-being to co-create a culturally sensitive framework. This framework recognises different interpretations of sexual well-being, and focuses on supportive environments that empower individuals to define and pursue sexual well-being in a way that honours their experiences and needs.

Decision-making on childbearing and safer conception use in HIV sero-different couples involves an intricate balance of individual desires and perceived HIV acquisition risk. This paper addresses an important knowledge gap regarding HIV sero-different couples' considerations and the relationship and power dynamics involved when deciding to use a safer conception method. Between February and June 2019, we conducted semi-structured in-depth interviews among 14 men and 17 women, representing 17 couples, who exited the SAFER study - a pilot study assessing the feasibility, acceptability and cost-effectiveness of a safer conception programme for HIV sero-different couples in Zimbabwe. All couples in SAFER were provided with a choice of safer conception methods and were followed for up to 12 months of pregnancy attempts and 3 months following pregnancy. While couples generally perceived their safer conception discussions to be easy and consensus-driven, the decision-making process also involved complex gender dynamics and trade-offs in relationship power, which resulted in differing interpretations of what constituted a joint or shared couple decision. Participants regarded effective couple communication as an essential component of and precursor to good safer conception conversations and requested additional training in couple communication. Couples relied on information from healthcare providers to kickstart their safer conception discussions. Safer conception programmes should address relationship power imbalances, promote effective couple communication and offer healthcare provider support to enable HIV sero-different couples to make informed choices about conception in a manner that upholds their safety and reproductive autonomy.

Studies show that gender socialisation shapes differently the gendered identity, self-esteem, and sexual behaviours of girls and boys. While pre-adolescence is viewed as a pivotal period for gendered socialisation, few studies in francophone Africa investigate the role of gender identity effects on aspirations and sexual and reproductive behaviours at this life stage. This article explores how the internalisation of gender stereotypes during socialisation is linked to the aspirations of girls and boys for certain life events, such as having their first child or getting married. A survey was conducted in 10 primary schools in Ouagadougou, among pupils aged between 9 and 16 years, as well as seven focus group discussions with their parents. The findings indicate a gender-based variation in the effects of adherence to unequal gender norms among young adolescents. As a result, girls tend to have earlier aspirations towards marriage and later aspirations for childbearing, while boys show earlier aspirations for childbearing and later ones for marriage. These effects may expose both girls and boys to risks of poor sexual and reproductive health. Interventions promoting egalitarian gender norms could boost girls' self-esteem as well as mutual respect among young adolescents of both genders, aiming to improve their sexual and reproductive health during adolescence and into adulthood.

Iran has witnessed three major reversals of population policies since their inception in the 1960s. In response to a rapid decline in fertility to very low levels, the latest policy shift has led to the development of legislation that aims to encourage marriage and fertility, particularly the "Youthful Population and Protection of the Family" law approved in 2021. This study reviews the changes in population policy and their interrelations with fertility trends, focusing mainly on the shift towards pronatalist policies since 2005, and accompanying restriction of reproductive health and family planning services. Combining international and national sources, we position the new pronatalist drive in the country within the broader trend of government attempts to reverse fertility decline and promote conservative family values. Our study has three main aims. (1) We provide an overview of fertility trends, policy discourses and policy shifts in the context of the changes in the societal and political structures of Iran during the last half a century. (2) We highlight and discuss the most problematic features of the new Family Law, especially the legislation pertaining to maternal and reproductive health, access to abortion and contraception, and incentives supporting earlier marriage and higher fertility. (3) We discuss the likely consequences of the new legislation for maternal and child health and sexual and reproductive rights, for women in general, and the country's socio-economic disparities. As well as violating reproductive rights, the new policy is unlikely to achieve its aim of initiating a sustained rise in fertility in Iran.

A new public policy was instituted in Argentina for free distribution of subdermal contraceptive implants to women aged 15-24 years old in the public healthcare system. The objective of this study is to determine the extent to which this population adhered to the implant, as well as predictors of continuation. The retrospective cohort study was based on a telephone survey of a random sample of 1101 Ministry of Health-registered implant users concerning the continuation of use, satisfaction with the method and side-effects, and reasons for removal. Descriptive statistics and multivariate regression analysis were used to explore the association between adherence and having received contraceptive counselling, satisfaction, and side effects. We found high levels of adherence (87%) and satisfaction (94%). Common reported side effects were amenorrhoea or infrequent bleeding, perceived weight gain, increased menstrual bleeding and headaches. Multivariate regression analysis indicates that, among adolescents, having received contraceptive counselling increased comfort, while frequent bleeding at six months hindered trust. Participants who had a history of a prior delivery or who had themselves primarily chosen the method were less likely to request the removal of the implant. Our results support the public policy of free implant distribution in the public health sector. This is a sustainable public policy that contributes to equity and access to effective contraception. It is appropriate for adolescents and young women and will also reduce unintended pregnancies. Our results suggest that counselling patients is key prior to insertion of the implant, as it improves acceptability and continuation.

The increasing digitisation of personal health data has led to an increase in the demand for onward health data. This study sought to develop local language scripts for use in public sector maternity clinics to capture informed consent for onward health data use. The script considered five possible health data uses: 1. Sending of general health information content via mobile phones; 2. Delivery of personalised health information via mobile phones; 3. Use of women's anonymised health data; 4. Use of child's anonymised health data; and 5. Use of data for recontact. Qualitative interviews (n = 54) were conducted among women attending maternity services in three public health facilities in Gauteng and Western Cape, South Africa. Using cognitive interviewing techniques, interviews sought to:(1) explore understanding of the consent script in five South African languages, (2) assess women's understanding of what they were consenting to, and (3) improve the consent script. Multiple rounds of interviews were conducted, each followed by revisions to the consent script, until saturation was reached, and no additional cognitive failures identified. Cognitive failures were a result of: (1) words and phrases that did not translate easily in some languages, (2) cognitive mismatches that arose as a result of different world views and contexts, (3) linguistic gaps, and (4) asymmetrical power relations that influence how consent is understood and interpreted. Study activities resulted in the development of an informed consent script for onward health data use in five South African languages for use in maternity clinics.