Perspectives on Sexual and Reproductive Health最新文献

Objective: The limited literature on family planning among Asian populations in the United States suggests that this group underutilizes contraception. We examined factors associated with contraceptive use, particularly among South Asians.

Methods: We used cross-sectional data from the 2013, 2014, and 2016 New York City Community Health Surveys and included women and men aged 18-44 years who engaged in sexual activity with a member of a different sex in the last year and did not intend to get pregnant, were not/partner was not pregnant, and could/partner could get pregnant (N = 7101). We conducted bivariate and multivariate logistic regressions with backward elimination to estimate the association between sociodemographic, behavioral, and health care-related factors with the use of any contraceptive at the last sexual encounter. The primary analysis included race as a key independent variable and the secondary analysis was restricted only to South Asians (n = 189).

Results: Two thirds of South Asians (67%) used a contraceptive at last sexual encounter. After full adjustment, compared to South Asians, other Asians showed a higher likelihood of using contraception (aOR 1.54; 95% CI: 1.05, 2.26). In the secondary analysis of South Asians, those who were married/living together (aOR 0.19; 95% CI: 0.08, 0.45) or divorced/separated/widowed (aOR 0.14; 95% CI: 0.03, 0.68) showed a lower likelihood of using any contraception compared to those who were never married.

Conclusion: Researchers need to conduct additional research to better understand contraceptive behavior among South Asians and identify if/what optimal interventions will increase access and help meet and support their reproductive goals and autonomy.

Introduction: Emergency contraception (EC) is essential for full-spectrum contraceptive care, preventing unintended pregnancies and promoting reproductive autonomy. Little is known about EC provision at safety-net clinics serving low-income people. This study examines EC provision at health department and federally qualified health center (FQHC) clinics in two United States (US) southeastern states at multiple points in time.

Methodology: We analyzed data from statewide surveys of publicly funded family planning clinics assessing the years 2016, 2019, and 2022 in Alabama and South Carolina and key informant interviews with staff at surveyed clinics to assess patterns of EC provision by clinic type over time.

Results: Almost all health departments across both states provided EC on-site compared to less than half of FQHCs. Advance provision of EC was less common, with health departments reporting significantly higher rates (2016 = 15.8%; 2019 = 28.7%; 2022 = 15.5%) than FQHCs (2016 = 0%; 2019 = 2.8%; 2022 = 4.3%) (2016, 2019 = p < 0.0001; 2022 p = 0.01). In 2022, 20% of health departments reported providing EC via telehealth compared to 5.1% of FQHCs (p = 0.002). Health department staff noted an increase in advance provision, and FQHC staff noted challenges to provision due to limitations in on-site stocking. EC provision did not change significantly across years.

Discussion: Access to EC varies across safety-net clinics in the US South and has not improved over time. Addressing barriers to EC access and providing accurate information about contraceptive methods is essential to empower informed family planning decisions. As reproductive health legislation continues to evolve, expanding access to EC remains critical for safeguarding reproductive health and autonomy.

Background: Current understanding of reproductive health content in medical school curricula is limited. This study explores abortion education offerings of osteopathic medical students (OMS) in the United States (US). After successfully completing their training, OMS receive a doctorate in osteopathic medicine (DO) rather than a Doctor of Medicine (MD). An increasing number of students are receiving DO medical education.

Methods: We developed and distributed a 19-item survey to OMS through social media and research offices at all US osteopathic medical schools. We used descriptive statistics and logistic regression models to analyze the data.

Results: Our survey resulted in 256 responses from 37 institutions (43% preclinical, n = 108; 57% clinical, n = 143). Approximately 72.1% of respondents (n = 137) were attending medical school in a state with limitations on abortion access. Over half (52.4%, n = 108) of respondents indicated their school was delivering abortion and/or contraception curriculum, with fewer schools having optional training (20%, n = 42) or no educational offerings (27%, n = 56). Of schools offering abortion education, the most frequent content included "both abortion and contraception education" (79.2%, n = 80); fewer reported "contraception education only" (17.8%, n = 18) or "abortion education only" (3%, n = 3) content. Half of respondents with optional abortion education participated, while 40.5% (n = 17) opted out. The most frequently reported time dedicated to abortion education was < 59 min (39.9%, n = 75). Clinical students were significantly more satisfied (p = 0.0458) with the time allotted to abortion content and perceived ability (p = 0.0256) to provide patient education on abortion.

Conclusion: Clinical students reported significantly increased satisfaction with abortion education received during their training as compared to preclinical students. Despite the majority supporting abortion education, most OMS received less than 1 h of dedicated instruction highlighting expansion opportunities.

Introduction: China's one-child policy was implemented in 1980 primarily through mandatory intrauterine devices, tubal surgery, or abortion for "unauthorized pregnancies." While it was replaced in 2015, it affected millions of persons and its effects on reproductive decision making are not well known.

Methods: We designed, validated, and performed a cross-sectional survey of reproductive age Chinese-born or first-generation women of Chinese descent to describe the policy's impact on reproductive decision-making. Descriptive statistics and multivariate logistic regression were used to identify self-reported policy impact on contraceptive utilization and childbearing choices, and demographic associations.

Results: Between June 1 and October 31, 2021, 1098 people accessed the survey, and 838 were eligible. A total of 588 responded to questions pertaining to the primary outcome, yielding a response rate of 70.2%. Approximately 42% of participants lived under the policy and were affected by it in some way. 17.3% of participants stated their contraceptive utilization was affected and 23.3% stated their childbearing choices were affected. Those with low acculturation scores (OR = 2.27, 95% CI 1.35-3.85, p = 0.002) and those living in the United States for < 21 years (OR = 2.25, 95% CI 1.09-4.67, p < 0.01) were more likely to report their contraceptive plans were affected. 72.8% of participants self-reported high reproductive autonomy, whereas acculturation was mixed.

Conclusions: Although the one-child policy has had a large effect on people of the Chinese diaspora, its impact on reproductive decision-making may decrease with the duration of time in the United States and increasing acculturation.

Background: Evidence suggests that symptoms of endometriosis related to sexual dysfunction can disrupt intimate and sexual partnerships. The goal of this study was to understand the association between quality of life and sexual functioning and all its components among women with endometriosis.

Methods: We developed an anonymous online survey, which received responses from 1586 French women with endometriosis. We performed multivariable logistic regression to highlight the association between the Female Sexual Functioning Index (FSFI) and its dimensions with quality of life. Interaction analyses allowed subgroup investigation. Adjusted covariables were age, body mass index (BMI), tobacco, education, children, number of symptoms and menopause. We performed logworth analyses to assess the order of the strength relationships between all the components of FSFI.

Results: We found that FSFI was mainly associated with quality of life (OR = 1.02 [1.01-1.04], p = 0.002). We observed only two interactions between FSFI and BMI (p = 0.015) and education (p < 0.001). When considering educational subgroups, FSFI level was mainly associated with quality of life among those with a moderate educational level (OR = 1.07 [1.04-1.10], p < 0.001) and when considering BMI subgroups, FSFI level was mainly associated with quality of life among those with a moderate BMI (OR = 1.05 [1.02-1.08], p = 0.002). We did not observe an association between sexual functioning and quality of life among obese and low educational level women. Dyspareunia appeared to be the main component of sexual dysfunction among women with endometriosis (FDR logworth = 9.1, p < 0.001).

Conclusion: This study underscores the importance of professionals who treat patients with endometriosis addressing sexual dysfunction to ensure their quality of life.

Background: Sexual health is crucial for well-being, yet research often overlooks middle-aged and older adults, as well as those with disabilities. This study explores the sexual health of disabled middle-aged and older adults in Britain.

Objective: We aim to explain sexual behaviors and outcomes among disabled adults aged 45-74 in Britain.

Methods: We conducted a secondary quantitative analysis using data from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a British population-representative survey. The study did not focus on a specific type of disability but rather included people who consider themselves to have a long-standing illness that limits their activity. The analysis incorporated variables on sexual behaviors and outcomes: bivariate analyses and multiple logistic regressions stratified by sex compared behaviors and outcomes by disability status.

Results: Of 7082 participants included, 1906 were classified as being with limiting disability status. Adjusting for sociodemographic differences, compared to nondisabled individuals, those with limiting disability status adults were less likely to engage in sex in the last 4 weeks (aOR: 0.60, CI: 0.51-0.71) or be in a steady relationship (aOR: 0.69, CI: 0.59-0.80) and were more likely to report poorer sexual health outcomes, including having experienced coerced sex attempts (aOR:1.83, CI:1.48-2.27), had coerced sex (aOR: 1.64, CI:1.33-2.01), had their sex life affected by health in the last year (aOR: 5.08, CI:4.27-6.05), and sought help for their sex lives (aOR:1.73, CI:1.38-2.17).

Conclusions: Middle-aged and older disabled adults in Britain are less likely to be sexually active, yet more likely to experience negative sexual health outcomes. The increased health-seeking behaviors and their vulnerability highlight the necessity for tailored sexual health services, extending into middle age and older adulthood.

Background: Coined the Contraceptive Paradox, unwanted pregnancies and abortions remain stable in most West-European countries despite the wide availability of highly effective contraception. Demographic and contextual reasons for ineffective (or no) contraceptive use in couples with no desire for a child have been described, yet data on women's concerns are scarce.

Objective: This study evaluates a broad range of individual factors potentially determining insufficient/less or ineffective contraceptive use.

Methods: N = 399 women post abortion in Vienna, Austria answered a questionnaire assessing demographics, use of contraception, fertility perception, desire to avoid a pregnancy, influence of family and friends, and attitudes toward hormones, the pharma industry, and naturalness. We used multivariate ordinal logistic regression (OLR), reporting Odds Ratios (OR) to identify factors determining contraceptive use (none vs. moderately effective vs. highly effective contraception). Additionally, decision trees served as a basis for hypothesis generation.

Results: Hormone skepticism (OR when compared with no skepticism ranged from 0.07 for very large to 0.20 for low skepticism), a moderate desire to avoid a pregnancy (1.43), older age (0.98), being unemployed (1.93) and being single (OR = 2.63 for unstable relationship and 1.73 for stable relationship when compared with no relationship, respectively), were all associated with using no contraception. Decision trees suggested perceiving oneself and the partner as fertile and knowing that hormone-free contraception was important for friends and family as additional factors.

Conclusions: Our findings may assist clinicians in better understanding women's attitudes and misconceptions. However, further research is needed to address potential dilemmas in women's contraceptive decision-making processes.

Context: Healthcare providers play a vital role in promoting comprehensive, sex-positive sexual health care. In the United States (US), patient-provider communication frameworks for sexual health predominantly rely on collecting the sexual health history. The most notable framework, the US Centers for Disease Control and Prevention's 5 Ps framework, emphasizes how an individual's current and past behaviors can predict a client's susceptibility to poor sexual health outcomes. However, this behavior centric approach has the capacity to introduce bias, stigma, and shame, potentially hindering effective communication and preventative care. The National Coalition for Sexual Health's 6 Ps framework introduced "Plus" to include sexual satisfaction as an integral part of sexual health communication.

Methods: Building on these existing frameworks, we developed an expanded model designed to reorient providers toward a paradigm that fosters more inclusive and affirming sexual health discussions, improves patient-provider communication and connection, and acknowledges the broader social and structural determinants that shape sexual well-being and vulnerability to human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs).

Results: We propose an expanded 8 Ps sexual health history that introduces "Proximity," which refers to the influence of one's living and sexual environment, and "Perspectives," highlighting how personal beliefs fundamentally shape behaviors.

Conclusion: Fortifying the sexual health discussions between providers and patients with non-behavioral context, such as geographical determinants of health and understanding of sexual health in general, that increase vulnerability to HIV and other STIs can begin to address the limitations in the prior frameworks.

Introduction: Population estimates of the prevalence of intimate partner violence (IPV) victimization and perpetration are limited for sexual minorities in mid-adulthood.

Methods: We examined IPV prevalence estimates, and associations between sexual orientation and self-reported physical and sexual IPV experiences among 10,812 respondents ages 33-43 years who were in a current relationship and participated in Wave V of the National Longitudinal Study of Adolescent to Adult Health, a population-based US study. We conducted sex-stratified logistic regressions to model associations between sexual orientation and IPV, adjusted for age, race/ethnicity, highest educational attainment, and household income as percent of federal poverty level.

Results: Ninety one percent of men and 80% of women self-identified as heterosexual. Prevalence ratios indicated greater victimization and perpetration among male and female sexual minorities compared to heterosexuals. In adjusted regression models, sexual minority men had higher odds of physical perpetration (AOR = 1.8) than heterosexuals. Among women, sexual minorities had higher odds of physical and sexual victimization (AORs = 1.8 and 1.8, respectively) than heterosexual females, and higher odds of physical perpetration (AOR = 1.9).

Conclusions: Even into mid-adulthood, sexually minoritized groups have a disproportionate likelihood of experiencing both IPV perpetration and victimization compared to heterosexual peers. More work is needed to understand and address sources of these disparities.