Perspectives on Sexual and Reproductive Health最新文献

Background: Among transgender and gender diverse (TGD) individuals there is an increasing desire for parenthood. TGD individuals must overcome unique legal, social and physiological obstacles to realize their desire to become parents. Indeed, since the onset of the COVID-19 pandemic, TGD individuals have experienced a significantly higher prevalence of anxiety and depression, which may be strenuous to all areas of life, including family planning. The aim of this study was to evaluate the impact of the COVID-19 pandemic in Germany on decisions regarding family formation in TGD compared to cisgender individuals, and what role psychological distress might play in this.

Methods: The online survey included general demographic questions, domain-specific questions including gender identity and sexual orientation, questions related to psychological distress, the desire for parenthood as well as motives for and against parenthood.

Results: The desire for parenthood was lower and the level of depressive symptoms was higher in TGD (n = 187) than in cisgender individuals (n = 2135) during the COVID-19 pandemic. Moreover, the desire for parenthood was associated with a lower level of depressive symptoms, younger age, having one or more children and living in an urban area. Further associations are higher scores in the desire for emotional stabilization, as well as lower scores in fear of personal constraints and the desire for social recognition.

Conclusion: Our findings revealed that TGD individuals reported significantly higher levels of depressive symptoms compared to cisgender participants and expressed a lower desire for parenthood. These results highlight the need for targeted support from social services and health care providers, particularly in times of crisis such as the COVID-19 pandemic. Tailored interventions are essential to address the mental health burden and to reduce the additional hurdles TGD individuals face when considering parenthood.

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.

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.

Introduction: Access to sexual and reproductive health care has been a critical issue affecting public health outcomes, particularly for the youth population. This project identified common barriers to accessing sexual and reproductive health care for youth in rural areas and applied multiple educational and clinical interventions that helped enhance access to care.

Methodology: We designed a three-year-long program at Finger Lakes Community Health (FLCH) in rural upstate New York that involved youth, their parents or caregivers, educators, and medical professionals to improve youth access to care. Using results from a survey with 1155 youth participants to determine the barriers to care, we designed the program to overcome the fear of seeking help, basic facts ignorance, transportation issues, parental opposition, and financial issues. We implemented multiple interventions, including providing adequate education and school services, ensuring privacy and confidentiality, changing work hours, establishing phone and online services, facilitating transportation, and reducing cost barriers.

Results: The results were dramatic. Sexual and reproductive health visits to FLCH from youth in the region increased significantly from 280 in 2017 to 1100 in 2019. Even during the COVID-19 pandemic, when the number of visits slightly decreased, visits were still better than before 2018. In 2023, the number of reproductive health visits was 990, which is 3.5 times the visits in 2017.

Discussion: This study emphasizes the substantial role that tailored interventions can play in enhancing reproductive health access for youth in rural areas, significantly promoting healthcare equity and service utilization. These interventions reduce healthcare use inequities and foster potential improved public health outcomes. While our study did not directly measure clinical outcomes, the substantial increase in utilization represents an important step toward achieving them and underscores the need for further research to evaluate resulting health outcomes.

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.

Context: Intrauterine devices (IUDs) are a type of long-acting reversible contraception (LARC) that sit inside the uterus. However, due to the internal nature of the device, pain and lack of control are major concerns for people using IUDs.

Methods: We conducted conventional qualitative content analysis of posts from the global subreddit r/birthcontrol that mentioned IUDs in the month of July 2022 to answer the question "what are people's experiences with IUDs as discussed on Reddit?" Reddit, being an online social media platform, makes the geographic background of most of the participants unknown; however, the posts on this subreddit are written in English.

Results: Of the 456 Reddit posts, four overarching categories were identified: "Interactions with other users," "Concerns," "Reason for getting IUD," and "Dissatisfied with treatment from medical staff." Despite IUD insertion being reported as painful and participants experiencing painful side effects, these concerns were not always taken seriously by medical staff. This was often in the form of feeling dismissed and not being given adequate pain management options before procedures such as IUD insertions and removals.

Conclusion: Findings provide insight into IUD users' perspectives and opinions on the care they receive from medical professionals. Highlighted are areas that need improvement, such as providing more pain management options and more transparency regarding the potential risks and side effects of having an IUD.

Background: The United States (US) federal Title X program provides funding for affordable and accessible family planning and sexual health services through competitive grant funding across US jurisdictions. In 2022, non-profit clinic network Converge: Partners in Access became the sole Title X grantee in the state of Mississippi. Converge developed a strategic evaluation plan to ensure efficient utilization and high-quality provision of care by eligible state residents.

Purpose: The study purpose is to determine the implementation climate of the Title X clinic network, including service utilization, quality improvement opportunities and challenges, and potential patients' awareness of and experience with receiving Title X-funded services.

Methods: The study utilized in-depth, semi-structured phone and in-person interviews conducted between January 2023 and May 2023 with clinic staff, administrators, providers, and potential patients to assess implementation climate, challenges in healthcare provision, and opportunities to improve Title X utilization by eligible state residents.

Main findings: Researchers conducted 22 interviews with clinic staff and health care providers and 16 with potential patients. Clinic-based participants indicated the use of evidence-based practices in their respective settings-a key component of the Title X program. However, challenges to implementation were identified including understaffing, high staff turnover, difficulties with reporting and documentation, competing priorities for patients, and differences in capacity based on clinic characteristics. Potential patients identified the need for person-centered approaches to care and increased awareness and availability of Title X services in their communities.

Conclusions: Results from this study can inform strategies to improve service utilization by potential patients and the quality of care for Title X funded networked clinics in Mississippi. Improving the delivery of care and service utilization can ultimately better meet the reproductive and sexual health needs of patients served through the Title X funded system.

Background: As the number of U.S. Catholic-affiliated hospitals increases, more patients who receive care at Catholic hospitals may face restrictions to reproductive healthcare services, including postpartum contraception and sterilization. Little is known about how Catholic hospital affiliation affects the likelihood of a short-interval pregnancy following a delivery. A short interpregnancy interval is associated with poor obstetric outcomes in subsequent pregnancies.

Methods: In this retrospective study of Medicaid claims data, we examined if an index delivery at a Catholic-affiliated hospital was associated with a short-interval pregnancy among patients in nine states (2010-2014). We used Cox proportional hazards regression to compare the time to subsequent pregnancy for those who delivered at Catholic-affiliated hospitals versus non-Catholic-affiliated hospitals. We also estimated the likelihood of a subsequent pregnancy by 6, 12, and 18 months following an index delivery.

Results: We matched 1,197,898 index births to a provider and the religious affiliation of the delivery hospital. Across all nine states, 20.9% (249,764) of deliveries were at Catholic hospitals. After adjusting for maternal age, maternal race and ethnicity, and rural residence, subjects who delivered in a Catholic hospital had a 5% increased adjusted odds of conception by 18 months (95% confidence interval: 1.04-1.07; adjusted odds ratio: 1.07, 95% confidence interval: 1.05-1.10 by 6 months and adjusted odds ratio: 1.06, 95% confidence interval: 1.05-1.08 by 12 months for Catholic vs. non-Catholic hospitals).

Discussion: Medicaid enrollees who deliver at Catholic hospitals are at increased risk for short-interval pregnancies.

Introduction: Social media platforms have rapidly become key sources of contraceptive health information, shaping the beliefs and behaviors of individuals of reproductive age. Yet, it has become increasingly difficult to distinguish accurate content from misleading information, potentially leading to higher unintended pregnancy rates. Given the limited insights into the quality and reliability of contraceptive information on TikTok, this cross-sectional study aimed to systematically evaluate popular TikTok content on contraception created by various users to identify and analyze misinformation.

Method: Between August and September 2023, we analyzed 100 videos from the top five hashtags related to contraception methods (#birthcontrol, #contraception, #thepill, #naturalbirthcontrol, and #cycletracking) to assess the characteristics of the health information presented and their quality, using the DISCERN tool.

Results: The TikTok videos collectively received 4.85 billion views. Only 10% were created by medical professionals. Overall, the content showed poor reliability and quality, indicating a prominent presence of contraceptive health misinformation. Furthermore, there was a concerning trend favoring natural contraceptive methods over hormonal options, often without appropriate risk disclosures, accompanied by a growing distrust in health professionals.

Discussion: The rise of contraceptive misinformation on social media is re-shaping patient-provider relationships and impacting contraceptive beliefs. TikTok offers an excellent public health opportunity to disseminate accurate contraceptive information accessible to all individuals, regardless of their background or resources. To address the observed distrust in health professionals, it is essential to improve contraceptive care quality and promote shared decision-making, which would likely increase satisfaction with contraceptive choices and mitigate negative narratives online.

Background: Parent-based sexual education interventions have a positive impact on adolescent sexual and reproductive health. However, despite these positive outcomes, there is a lack of comprehensive research to understand the effectiveness of these programs across different communities and demographics.

Methods: We conducted a systematic search of databases from January 2013 to April 2023 and identified 51 published studies conducted globally on the effects of parent-based sexual education. We conducted meta-analyses to understand the pooled effect of interventions on parent-adolescent communication outcomes and adolescent sexual and reproductive behaviors.

Results: This review includes 51 studies. Most of the included studies (n = 36, 68.6%) were conducted in high-income countries; 17 (33.3%) involved only mothers, and 37 (72.5%) stated they were based on theoretical frameworks. The systematic review showed that interventions on sexual communication had mixed effects on parent and adolescent-related outcomes. The meta-analysis, however, showed positive effects on parent-reported sexual health communication frequency, adolescent-reported sexual health communication frequency, parental attitude, and parental self-efficacy, Cohen's d = 0.32, 0.26, 0.38, and 0.41, respectively.

Conclusion: Parent-based sexual health education interventions positively impact various aspects of parent-adolescent sexual health communication and behavior, suggesting the effectiveness of the intervention in different social, cultural, and economic contexts. The lack of research in low- and middle-income nations and limited paternal participation highlights the need for further research.