Perspectives on Sexual and Reproductive Health最新文献

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.

Introduction: Over the last decade at the University Hospital of Nancy in Lorraine, France, we have observed an increasing number of people under 35 years old who receive consultation for gender incongruence, from an average of 7 new patients per year in 2002-2013 to an average of 27 per year in 2014-2017.

Methods: We conducted a mixed-methods study, including a retrospective quantitative analysis of medical records of youths who sought care for gender incongruence from 2004 to 2020, and a qualitative analysis of in-depth interviews with 11 patients identified through the medical records.

Results: The study included 235 participants (135 assigned female at birth, 100 assigned male at birth). Transgender men were younger than transgender women: mean age 20 (1.6, standard deviation, [SD]) years vs. 22.7 (4.3 SD) years; p = 0.01 at first referral. We observed no difference in age at the initiation of gender-affirming hormonal treatments. More than half of our participants chronologically situated their first questioning about their gender identity in the prepubertal period. Their life experiences revealed a lack of transgender representation in society, discomfort with the treatments offered, difficulties in becoming aware of and disclosing their gender identity, and the importance of peer/community support.

Conclusion: The present study provides insights into the growing population of transgender and gender nonconforming people receiving care in the University Hospital of Nancy which has coincided with the evolution of the national legal framework. Our results identify several priorities for transgender youth who are receiving gender-affirming care. Further research outside hospital networks appears warranted.

Purpose: We investigated the extent to which the COVID-19 pandemic affected hospital abortion rates in a Canadian setting.

Methods: We obtained all abortions between 2012 and 2022 from hospital discharge data in the Maintenance and Use of Data for the Study of Hospital Clientele database for Quebec, Canada. The exposure was the pandemic (March 2020 to March 2022) compared with the preceding period (January 2012 to February 2020). The outcome included hospital-based abortions versus other pregnancy admissions. We examined if the pandemic affected monthly hospital abortion rates using interrupted time series regression. We estimated risk ratios (RRs) and 95% confidence intervals (CIs) for the association between the pandemic and hospital-based abortions, accounting for pandemic wave, abortion method, gestational age, and other patient characteristics.

Results: There were 21,675 hospital abortions in total, including 4177 (19.3%) during the pandemic. Abortion rates decreased by 1.2 per 1000 pregnancies the first month of the pandemic and continued to decrease by 0.15 per 1000 every month thereafter. Compared with the preceding year, patients were less likely to have a hospital abortion anytime during the pandemic (RR 0.88, 95% CI 0.84-0.93), particularly during the third (RR 0.81, 95% CI 0.74-0.88) and fourth (RR 0.82, 95% CI 0.75-0.89) waves. The decrease was most apparent for instrumentation abortions, abortions before 14 weeks of gestation, and abortions among patients aged ≥ 40 years or who were socioeconomically advantaged.

Conclusions: The pandemic was associated with fewer hospital abortions before 14 weeks, as well as among older or socioeconomically advantaged patients.

Objective: To assess unmet menstrual hygiene needs and explore experiences with menstruation management among students at four charter high schools in the City of St. Louis, Missouri, United States in order to inform the development of future educational resources.

Methods: Using a cross-sectional design with mixed-methods data collection, we collected quantitative data from 117 participants through anonymous, electronic surveys. We conducted four focus group discussions (FDGs), one at each high school, with 7-10 participants per group.

Results: Among survey respondents, 41% were in 10th grade and a majority identified as non-Hispanic Black (68%), with an average age of 16 years (15.6 ± 2.82 years). During the previous school year (2021-2022), over half of students (51%) were unable to access period products when needed at least once because they or their family could not afford them. The FDGs centered around four key domains of inquiry: (a) menstruation management-related school resources, (b) menstrual symptoms and coping strategies, (c) menstrual hygiene education, and (d) menstrual cycle tracking strategies.

Conclusions: Our findings highlight how essential it is to address the issue of unmet needs for menstrual products and hygiene management to ensure all students who experience menstruation can access period products, minimize menstruation-related absenteeism, and promote the overall well-being of adolescent students.

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.

Background: Abortion law reform (ALR) in Aotearoa New Zealand occurred in 2020 and included removing legal criteria for an abortion to be performed prior to 20 weeks' gestation, and enabling women to self-refer, abortifacients to be taken at home, and non-specialists to offer abortion care.

Objective: Assess the impact of ALR on access to abortion services and contraception provision, by ethnicity.

Methods: This is a retrospective national cohort study of all women in Aotearoa New Zealand who had an abortion, comparing the year before ALR (1 January to 31 December 2019) to after (1 July 2020 to 30 June 2021). We obtained anonymous datasets from the Ministry of Health. We used Poisson regression to analyze outcomes. We estimated relative risks and 95% confidence limits (CL) for the association between demographic and clinical variables and outcomes. We then performed multivariable analysis to adjust for age, parity, ethnicity, deprivation and domicile of residence. The primary outcome was the proportion of women who had an abortion prior to 10.0 weeks' gestation.

Results: Post-ALR, more women accessed abortion < 10.0 weeks' gestation (78.3% vs. 64.5% pre-ALR, adjusted relative risk 1.21 (95% CL: 1.19-1.23), p < 0.0001). Post-ALR, more Māori women accessed abortion < 10 weeks' (68.4% vs. 53.3% pre-ALR, p < 0.001). Both pre- and post-ALR, fewer Māori women accessed abortion < 10 weeks' compared to non-Māori women (53.3% vs. 67.8%, and 68.4% vs. 81.2%, respectively, both p < 0.0001).

Conclusions: Following ALR in Aotearoa New Zealand, women have a 21% better chance of having an abortion procedure < 10.0 weeks' gestation compared to before ALR, after adjusting for demographic variables. Although access improved for Māori women, inequity by ethnicity remains.

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.

Objective: This study analyzed young adults' understanding of and thoughts about permanent contraception amidst increased demand for sterilization in this population following changes in abortion and contraception access in the United States (US).

Methods: Undergraduate students at a northeastern US university (N = 53) completed an online questionnaire assessing opinions about sterilization and factors they believed physicians should consider before performing sterilization. Quantitative analysis explored whether attitudes toward vasectomy versus tubal ligation differed by capacity to become pregnant. We used inductive thematic analysis to interpret qualitative data.

Results: There were no differences in attitudes toward sterilization methods by capacity to become pregnant. However, participants estimated posttubal ligation regret would be significantly more prevalent than postvasectomy regret. Key qualitative themes included patient-centered care, regret, and sociocultural influences.

Conclusions: This study revealed young adults value bodily autonomy in reproductive choices, regardless of permanence or potential regret, factors some providers weigh heavily. Whether interest in sterilization among this population increases or remains static, it is important for healthcare providers to be aware of these attitudes when handling requests from younger adults.