Sexual & Reproductive Healthcare最新文献

This study aimed to investigate factors associated with exposure to violence over the past 12 months among women seeking abortion. Materials and methods: We conducted a cross-sectional study, nested within a multi-center questionnaire survey, involving 623 abortion-seeking women in Sweden from January to June 2021. Descriptive statistics, bivariate analyses, and multivariate regression analysis (using odds ratios [OR] and 95% confidence intervals [CI]) were employed. Results: Out of the 623 women, 9.9% (n = 59) reported exposure to physical, psychological, and/or sexual violence in the past 12 months. Several factors were correlated with being a victim of violence. However, after adjustment in the regression model, the significant factors included: age 16–26 (OR 2.37, 95% CI; 1.24–4.52, p <.009), poor physical and mental well-being prior to pregnancy (OR 3.29; CI 1.69–6.40, p <.001), having had ≥ 2 previous abortions (OR 2.27, 95% CI; 1.16–4.44, p =.017), and being single (OR 4.70, 95% CI; 2.51–8.77, p <.001). Conclusion: Nearly one in ten women seeking abortion reported exposure to violence in the preceding year. Being young, having poor physical and mental health, undergoing multiple abortions, and singlehood emerge as risk factors for violence exposure. Abortion providers have a crucial role and should consistently identify women exposed to violence, offering them the necessary guidance and referrals for further support.

Background

In Sri Lanka, the Emergency Contraceptive Pill (ECP) is categorized as a Schedule 2A medication, allowing it to be purchased over-the-counter without a prescription, but exclusively from licensed pharmacists. It is estimated that around 3 million ECPs are consumed by Sri Lankan women each year. This study aims to assess the knowledge and practices of Female Factory Workers (FFWs) on ECP and to unearth the association with unintended pregnancy and unsafe abortion.

Methods

After receiving written informed consent, a structured interview schedule was administered among 585 FFWs attached to eight factories in a selected Export Processing Zone (EPZ). Data analysis was performed using SPSS software.

Results

Only 26 % of FFWs were aware of the effective time period to take an ECP to prevent a pregnancy. Most (67 %) had the impression that a valid prescription is required to purchase ECP from the pharmacies. Around one-tenth of the FFWs (11.3 %, n = 66) had used ECP during their lifetime. Among the 65 respondents who reported having experienced unintended pregnancies, only 26.2 % (n = 17) had utilized ECPs. In contrast, among the 22 respondents who disclosed a history of abortion, only two women had ever employed ECPs.

Conclusion

The study highlights the low knowledge and use of ECP among FFWs in Sri Lanka, contributing to unintended pregnancy and unsafe abortion. Results call for targeted interventions to improve knowledge and access to ECP, helping to reduce unintended pregnancy and improve reproductive health outcomes.

Objective

To determine whether trust in the provider and sociodemographics are associated with individual-level abortion stigma.

Methods

We performed a cross sectional and exploratory study design using secondary analysis of a randomized trial that enrolled participants undergoing second trimester abortion. We collected baseline survey data from 70 trial participants to assess stigma (Individual Level of Abortion Stigma scale, ILAS; range 0–4), trust in provider (Trust in Physician scale; range 1–5), anxiety, depression, and sociodemographics. We performed multiple linear regression, for which ILAS score was the outcome of interest. Univariate associations were used to inform the regression model.

Results

The mean abortion stigma score was at the low end of the ILAS at 1.21 (range 0.2–2.8, SD 0.66). Age, race, income, BMI, parity, gestational age at time of abortion, and reasons for ending the pregnancy were not significantly associated with the ILAS score. Higher trust in provider scores were (m 4.0, SD 0.49) and inversely related to the ILAS score, even after adjustment for confounders (β −0.02, CI −0.03 to −0.004, p = 0.013). Screening positive for anxiety or depression was associated with a higher ILAS score ((β 0.48, CI 0.10, 0.90, p = 0.015); (β = 0.27 CI −0.097, 0.643)), while cohabitation was associated with lower ILAS score (β −0.44, CI −0.82 to −0.57, p = 0.025).

Conclusions

Trust in an abortion provider, anxiety, depression, and cohabitation are associated with abortion stigma among people seeking second trimester abortion care. Interventions that improve trust in a provider may be an area of focus for addressing abortion stigma. Future research should confirm these findings in larger populations and across diverse locations and demographics and to conduct qualitative research to understand what patients perceive as trust-promoting behaviors and words during abortion encounters.

Objective

Induction of labour (IOL) does not require formal written consent, and little is known about how consent operates in this context. This prospective study explores pregnant women’s experiences of the IOL consent process.

Methods

Qualitative study using semi-structured, interviews with thirteen women admitted to hospital for IOL. Data were analysed using thematic analysis.

Results

Three themes emerged: 1) Voluntary nature of consent: Some women experienced genuine choice; others perceived pressure to prioritise their baby. 2) Understanding the why and how, risks and benefits: Information provision and explanation was often minimal, particularly regarding risks and alternatives to induction. The possibility of IOL failing was not discussed 3) Non-personalised information process: Few women received information specific and relevant to their circumstance.

Practice implications

There is an urgent need for healthcare professionals to be supported in actively facilitating consent consultations which enable women undergoing IOL to make a fully autonomous, informed choice.

Conclusions

Women did not always experience choice about whether to be induced. This sense of disempowerment was sometimes exacerbated by inadequate information provision. The study reveals a practice imperative to address consent in IOL and we suggest there is an urgent need for HCPs to be offered high quality training specific to IOL.

Background

Male engagement in antenatal care (ANC) has been recommended by the World Health Organization to improve maternal and newborn health outcomes, but implementation challenges remain. This study explored barriers, facilitators, and opportunities to improve male attendance and engagement in ANC.

Methods

In-depth interviews were conducted individually with pregnant women and male partners attending a first ANC visit at two public health facilities in Moshi, Tanzania. Interviews examined factors influencing male ANC attendance and male experiences during the clinic visit. Interviews were recorded, transcribed verbatim, and translated from Swahili into English. Transcripts were coded thematically in NVivo.

Main findings

Constructions of masculinity both positively and negatively influenced male involvement in ANC. Individual-level barriers included a fear of HIV testing, perceptions of pregnancy as the woman’s responsibility, and discomfort with ANC as a predominantly female space. Structural barriers included inability to take time off from work and long clinic wait times. The primary facilitator to male involvement was the preferential care given in the ANC clinic to women who present with a male partner. Additionally, some men desired to learn about their family’s health status and felt that attending ANC was a sign of respect and love for their partner.

Conclusions

Opportunities exist to improve male involvement in ANC, namely training providers to engage men beyond HIV testing and counseling. Peer programs that promote men’s engagement in pregnancy could prove useful to reduce apprehension around HIV testing and dispel conceptions of ANC as only a women’s healthcare space.

Background

‘Collegial Midwifery Assistance’ (CMA) is a clinical practice aiming to reduce severe perineal trauma (SPT) during childbirth. This practice involves two midwives being present during the active second stage of labour rather than one, which is the case in standard care. The effectiveness of CMA was evaluated in the Oneplus trial and a 30% reduction in SPT was shown.

Aim

The aim was to investigate the experience of women who received the CMA intervention in the trial and to explore factors influencing their experiences.

Methods

A cohort study using data from the Oneplus trial and a one-month postpartum follow-up questionnaire. Descriptive statistics, univariable and multivariable logistic regression analyses were performed.

Results

A total of 1050 women who received the CMA intervention responded to the questionnaire. Of these, 35.8% reported that they strongly agreed with feeling safe during the second stage of labour and 42.6% were inclined to have an additional midwife present at a subsequent birth. The intervention was favourably received by women who experienced fear of birth, who were non-native Swedish speakers, and had lower educational attainment. Furthermore, women were more positive towards CMA the longer the intervention lasted.

Conclusions

The results of this study suggest that the CMA intervention is accepted well by women and can be safely implemented into standard care. The duration of the CMA intervention was an important factor that influenced women’s experiences and should be used to guide future practice.

Objective

Expecting mothers with high sense of coherence (SOC) exhibit improved physical, emotional, and childbearing health. However, the dimensions of SOC and the factor structure of the SOC-13 scale during prenatal period is slightly known. Especially the differences in experiencing SOC and its components (comprehensibility, manageability, meaningfulness) among both expecting parents (mothers and fathers) is poorly understood. The association between SOC and mood disorder symptoms (depression and anxiety) during pregnancy is scarcely studied.

Methods

The structure of the SOC-13 scale, differences in SOC experiences, and the associations between SOC and depressive and anxiety symptoms were studied in a sample of 2784 pregnant women (mothers) and 1661 men/partners (fathers) belonging to the FinnBrain Birth Cohort Study. Self-reports (SOC-13, EPDS, SCL-90: ANX) from gestational week 24 were used. Confirmatory factor analysis (CFA) and invariance testing was carried out to investigate the factorial structure of SOC-13 among both groups (mothers and fathers). Group comparisons were used to study differences in the level of SOC among mothers vs. fathers, low vs. high depression and anxiety subgroups, and multiparous vs. nulliparous mothers.

Results

A two-factor model for SOC-13 consisting of comprehensibility-manageability and meaningfulness fitted the data best. Mothers reported higher levels of meaningfulness, whereas fathers reported higher levels of comprehensibility-manageability. SOC was significantly higher among fathers vs. mothers, but mothers with depressive symptoms reported higher SOC than fathers with depressive symptoms.

Conclusions

During pregnancy, SOC can be viewed as a two-dimensional (vs. one- or three-dimensional) concept, and mothers and fathers have differences in the components of SOC. Importantly, mothers vs. fathers with depressive symptoms express higher overall SOC indicating that pregnancy may relate to higher than usual SOC especially among women with psychological distress. Understanding how expecting mothers and fathers experience SOC during pregnancy, particularly in relation to depressive symptoms, helps midwives and maternity care providers to focus health promoting support more precisely.

Objective

To evaluate the influence of a new birthing room at a tertiary hospital in eastern Democratic Republic of Congo (DRC), on the caesarean section (CS) rate in women classified as Robson group 1, i.e., nulliparous women at term with spontaneous onset of labour of one foetus in cephalic presentation.

Method

As part of quality improvement interventions, a new birthing room designed to promote person-centredness was constructed at the labour ward at Panzi General Referral Hospital in DRC. In a quasi-experimental study on women classified as Robson 1, a comparison was performed between the group being cared for in the new birthing room and the group being cared for in the general birthing room. The main outcome measure was CS rate.

Results

In the new person-centred birthing room, the CS rate was 17.1 % versus 28.4 % in women cared for in the general birthing room (p-value 0.001). There was also a higher presence of accompanying persons (p-value < 0.0001) and less use of synthetic oxytocin for the augmentation of labour (p-value 0.024). No difference in fear and childbirth experience was identified between women in the two rooms.

Conclusion

The results demonstrate that it is possible, in a low-income country as the Democratic Republic of Congo, to reduce the CS rate in women classified as Robson 1 by adapting the birthing environment to be more person-centred, without compromising other obstetric and neonatal outcomes.

Background

Cesarean section rates are increasing and surpassing WHO guidelines. While sometimes necessary, excessive use poses risks and additional costs to pregnant women and healthcare systems.

Aim

To evaluate the prevalence of cesarean section according to healthcare professionals, facility location, and the wealth index of pregnant women in each Peruvian healthcare system.

Methods

A cross-sectional study analyzed 20,870 records of women aged 12 to 49 from the Demographic and Family Health Survey (ENDES). The evaluated healthcare systems were the Ministry of Health, Social Health Insurance, Armed Forces and National Police, and private institutions.

Findings

The highest cesarean section prevalence was observed in women receiving prenatal care in private hospitals or clinics (69.13%) and Social Health Insurance hospitals (51.54%). Urban settings, “richest” wealth index, and medical professional involvement increased the probability of cesarean sections. Conversely, the probability of cesarean section was reduced in Ministry of Health facilities when pregnant women belonged to the “poorest” or “poorer” wealth index category and when prenatal care was provided by a midwife in a private facility.

Conclusion

The prevalence of cesarean sections in Peru during 2021 is 33.75%, warranting evaluation of strategies to regulate their indiscriminate use in each system.