Sexual and Reproductive Health Matters最新文献

Female genital schistosomiasis (FGS) affects approximately 56 million women and girls across sub-Saharan Africa and is associated with up to a threefold increased prevalence of HIV. Integrating FGS with HIV programmes as part of comprehensive sexual and reproductive health (SRH) services may be one of the most significant missed opportunities for preventing HIV incidence among girls and women. A search of studies published until October 2021 via Scopus and ProQuest was conducted using PRISMA guidelines to assess how FGS can be integrated into HIV/SRH and neglected tropical diseases (NTDs) programmes and services. Data extraction included studies that integrated interventions and described the opportunities and challenges. A total of 334 studies were identified, with 22 eligible for analysis and summarised conducting a descriptive numerical analysis and qualitative review. We adapted a framework for integrated implementation of FGS, HIV, and HPV/cervical cancer to thematically organise the results, classifying them into five themes: awareness and community engagement, diagnosis, treatment, burden assessment, and economic evaluation. Most activities pertained to awareness and community engagement (n = 9), diagnosis (n = 9) and were primarily connected to HIV/AIDS (n = 8) and school-based services and programming (n = 8). The studies mainly described the opportunities and challenges for integration, rather than presenting results from implemented integration interventions, highlighting an evidence gap on FGS integration into HIV/SRH and NTD programmes. Investments are needed to realise the potential of FGS integration to address the burden of this neglected disease and improve HIV and SRH outcomes for millions of women and girls at risk.

Abortion bans in the United States often include provisions for abortion in the circumstances of rape or incest experience. Such exceptions have been included in important legislation like the Hyde Amendment, 2003 Partial-Birth Abortion Ban Act, 2010 Affordable Care Act, and state and federal legislation banning abortion in early gestation. Thus, examination of these laws is critical given the 2022 Supreme Court decision to devolve legal access to the state level. This study examines arguments made by proponents and opponents of rape and incest exceptions within early abortion ban legislation using publicly available video archives from legislative sessions in six Southern states. A narrative analysis was conducted on the legislative debate of rape and incest exceptions during the 2018-2019 legislative sessions. We found three core themes when examining legislative debate: belief in people's claims underpinned opposition or support for exceptions; opinions about trauma were related to views on exceptions; and exception supporters called for empathy and non-partisanship in consideration of rape and incest. Additionally, support and opposition for the inclusion of rape and incest exceptions in draft law did not follow party lines. This study seeks to deepen understanding of the strategies used by legislators to promote and rebuff rape and incest exceptions in early abortion legislation while providing greater opportunity for tailored reproductive health, rights, and justice advocacy and policy, especially in the context of the US South where abortion access is now extremely restricted.

Access to safe and comprehensive abortion care has the potential to save thousands of lives and prevent significant injury in a vast and populous country such as the Democratic Republic of the Congo (DRC). While the signing of the Maputo Protocol in 2003 strengthened the case for accessible abortion care across the African continent, the DRC has grappled with de jure ambiguity resulting in de facto confusion about women's ability to access safe, legal abortion care for the past two decades. Conflicting laws and the legacy of the colonial penal code created ambiguity and uncertainty that has just recently been resolved through medical and legal advocacy oriented towards facilitating an enabling policy environment that supports reproductive healthcare. A study of the complex - and frequently contradictory - pathway from criminalised abortion to legalisation that DRC has taken from ratification of the protocol in 2008 to passage of the 2018 Public Health Law and subsequent Ministry of Health guidelines for abortion care, is an instructive case study for the international sexual health and reproductive rights community. Through this analysis, health and legal advocates can better understand the interdependence of law and public health and how a comprehensive approach to advocacy that includes legal, systems, and clinical accessibility can transform a country's system of care and the protection of women's rights. In DRC, new legislation and service delivery guidelines demonstrate a path forward towards concrete improvements for safe abortion care.

Pandemic mitigation measures can have a negative impact on access and provision of essential healthcare services including sexual and reproductive health (SRH) services. This rapid review looked at the literature on the impact of COVID-19 mitigation measures on SRH and gender-based violence (GBV) on women in low- and middle-income countries (LMIC) using WHO rapid review guidance. We looked at relevant literature published in the English language from January 2020 to October 2021 from LMICs using WHO rapid review methods. A total of 114 articles were obtained from PubMed, Google Scholar and grey literature of which 20 met the eligible criteria. Our review found that there was an overall reduction in; (a) uptake of services as shown by lower antenatal, postnatal and family planning clinic attendance, (b) service delivery as shown by reduced health facility deliveries, and post abortion care services and (c) reproductive health outcomes as shown by an increase in incidence of GBV especially intimate partner violence. COVID-19 mitigation measures negatively impact SRH of women in LMICs. Findings from this review could inform policy makers in the health sector to recognise the potential adverse effects of COVID-19 responses on SRH in the country, and therefore implement mitigation measures.

Digital health interventions are gaining ground in conflict-affected countries, but studies on their reproductive health benefits for women are scanty. Focusing on conflict-affected northern Nigeria, this study examined the relationships between Internet use, exposure to digital family planning messages via text messages or social media, and sexual agency - measured as the ability to refuse sex and ask a male partner to use a condom - among partnered women including the rural-urban differentials. Partnered women's data (n= 18,205) from the 2018 Nigeria Demographic and Health Survey were analysed using descriptive and multinomial logistic regression analyses. 44.6% of women are able to refuse sex, and 31.4% to ask a male partner to use a condom. Internet use was positively associated with women's ability to refuse sex in the northern region and urban areas, and across the region to ask a male partner to use a condom. It was also positively associated with women's uncertainty about asking a male partner to use a condom. Exposure to digital family planning messages was positively associated with women's ability to ask a male partner to use a condom across the region, in both urban and rural areas. However, exposure to digital family planning messages was negatively associated with women's uncertainty in urban areas about their ability to refuse sex. Implications of these findings for digital family planning interventions are discussed.

The medicalisation of childbirth has diminished the role of labouring people. We conducted an exploratory phenomenological qualitative study, using purposive sampling, and then conducted 17 semi-structured interviews between December 2016 and October 2017 with people who had recently given birth in a public hospital in the Northern Metropolitan area of Santiago, Chile. The sufficiency of the study group was determined according to saturation criteria. Triangulated content analysis was applied to explore the clinical relationship and processes of autonomy and decision-making. The predominant clinical relationship observed was paternalism. The participation of labouring people in decision-making is scarce, with no evidence of ethically valid processes of informed consent.

Despite the expanding digitisation of individual health data, informed consent for the collection and use of health data is seldom explicitly sought in public sector clinics in South Africa. This study aims to identify perceptions of informed consent practices for health data capture, access, and use in Gauteng and the Western Cape provinces of South Africa. Data collection from September to December 2021 included in-depth interviews with healthcare providers (n = 12) and women (n = 62) attending maternity services. Study findings suggest that most patients were not aware that their data were being used for purposes beyond the individualised provision of medical care. Understanding the concept of anonymised use of electronic health data was at times challenging for patients who understood their data in the limited context of paper-based folders and booklets. When asked about preferences for electronic data, patients overwhelmingly were in favour of digitisation. They viewed electronic access to their health data as facilitating rapid and continuous access to health information. Patients were additionally asked about preferences, including delivery of health information, onward health data use, and recontacting. Understanding of these use cases varied and was often challenging to convey to participants who understood their health data in the context of information inputted into their paper folders. Future systems need to be established to collect informed consent for onward health data use. In light of perceived ties to the care received, these systems need to ensure that patient preferences do not impede the content nor quality of care received.

Sexual violence and HIV/AIDS are major public health concerns in India. By promoting bodily autonomy, wellbeing, and dignity through knowledge and skills, comprehensive sexuality education for young people can help prevent adverse sexual and reproductive health outcomes. While there is increased recognition globally regarding young people's need for sexuality education, translating this recognition into accepted programmes in India has been challenging. This scoping review aims to examine recommendations for promising practices for the design and implementation of sexuality education programmes and resources aimed at youth in India. A systematic search and review of the literature was conducted from June to August 2020. Of the total 5312 citations identified and screened, 622 advanced to full-text screening, and 39 were included in the final analysis. Promising practices include the need to: tailor content to serve the needs of the specific youth population being targeted; use engaging and participatory methods to teach sexual health content; work in partnership and collaboration with local experts and organisations; address potential barriers to participation and work to mitigate those barriers for marginalised youth; be youth friendly, flexible and convenient; and to be developmentally and culturally appropriate for the Indian youth context. Sexuality education programmes should integrate into existing community services and link with local reproductive health services to help provide youth with access to the services they may need. Continued work and efforts are required to address the interrelated and broad structural factors, including political, financial, social, and cultural factors that affect youth sexual health and wellbeing.

Infertility is a reproductive health concern that deserves attention, as reconfirmed by the 2018 report of the Guttmacher-Lancet Commission on Sexual and Reproductive Health and Rights (SRHR). However, governments and SRHR organisations tend to neglect infertility. We conducted a scoping review of existing interventions aiming to decrease the stigmatisation of infertility in low- and middle-income countries (LMICs). The review consisted of a combination of research methods: academic database (Embase, Socological abstracts, google scholar; resulting in 15 articles), Google and social media searches, and primary data collection (18 key informant interviews and 3 focus group discussions). The results distinguish between infertility stigma interventions targeted at intrapersonal, interpersonal and structural levels of stigma. The review shows that published studies on interventions tackling infertility stigmatisation in LMICs are rare. Nevertheless, we found several interventions at intra- and interpersonal levels aiming to support women and men to cope with and mitigate infertility stigmatisation (e.g. counselling, telephone hotlines, and support groups). A limited number of interventions addressed stigmatisation at a structural level (e.g. empowering infertile women to become financially independent). The review suggests that infertility destigmatisation interventions need to be implemented across all levels. Interventions geared to individuals experiencing infertility should include women and men and also be offered beyond the clinical setting; and interventions should also aim to combat stigmatising attitudes of family or community members. At the structural level, interventions could aim to empower women, reshape masculinities and improve access to and quality of comprehensive fertility care. Interventions should be undertaken by policymakers, professionals, activists, and others working on infertility in LMICs, and accompanied with evaluation research to assess their effectiveness.