Frontiers in global women's health最新文献

Background: Stress urinary incontinence (SUI) is a prevalent condition among adult women, significantly impairing quality of life. Patients with SUI often exhibit abnormal pelvic floor muscle function, which can be comprehensively assessed using surface electromyography (sEMG) and transperineal ultrasound (TPUS). Electroacupuncture (EA) is an effective treatment for SUI, and multiple studies have confirmed its clinical efficacy; however, objective evidence regarding its impact on pelvic floor muscle function remains limited. This study aims to evaluate the clinical efficacy of EA applied to lower abdominal acupoints for SUI and to explore its impact on pelvic floor function, thereby providing mechanistic insights into EA's therapeutic effect on mild to moderate SUI.

Methods: This is a randomized, single-blind trial with a 1:1 allocation ratio. A total of 64 participants will be enrolled. Following screening, eligible female patients with SUI will be randomly allocated to either the EA group (n = 32) or the sham EA group (n = 32), receiving EA or sham EA treatment, respectively. The intervention period will last 6 weeks. The primary outcome is the change in urine leakage, measured by the 1-hour pad test, from baseline to week 6. Secondary outcomes include: the incontinence episode frequency (IEF); the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score; SUI severity; weekly urine pad usage; participants' self-assessment of therapeutic effect; pelvic floor muscle sEMG parameters; TPUS measurements; discomfort during treatment assessed by a Visual Analog Scale (VAS); participants' acceptability; and intervention-related adverse events.

Conclusion: By comprehensively evaluating symptom improvement, temporal effects, and pelvic floor functional changes following EA treatment for SUI, this study aims to systematically elucidate the therapeutic effects of EA and its mechanism of action on the pelvic floor. The findings are expected to provide robust evidence to support the clinical application of EA for SUI.

Clinical trial registration: https://itmctr.ccebtcm.org.cn/mgt/project/view/-6004709097458762939, identifier ITMCTR2024000151.

Background: Ghana's maternal mortality rate is substantially higher, well above the global target of 70 per 100,000 births. Despite high antenatal care attendance, less than seventy per cent of births are attended by skilled personnel, with some women opting for home births with unskilled attendants due to obstetric violence. Obstetric violence and the abuse inflicted by healthcare workers on pregnant women during childbirth deter women from facility-based births and exacerbate maternal mortality.

Objective: To explore how implementing midwife-led care can mitigate obstetric violence and enhance maternal health outcomes in Ghana through a literature-informed perspective.

Approach: Existing evidence was drawn from primary and secondary sources, including the World Health Organisation and the International Confederation of Midwives. Literature was synthesised to identify common patterns across studies.

Results: Implementing midwife-led care, which emphasises a bio-psycho-social approach and supports women's autonomy and comfort, can mitigate obstetric violence and enhance maternal health outcomes. Scaling up midwife-led primary care and providing training in humanised care at health facility levels are essential steps toward this goal.

Conclusion: Midwife-led care is a valid and evidence-based approach, proven effective in multiple countries. Implementation is feasible in Ghana but requires system readiness and stakeholder engagement.

Background: Ectopic pregnancy (EP) is an abnormal condition in which blastocyst implantation occurs outside the lining of the uterus and is the leading cause of pregnancy-related death. Women who have had one ectopic pregnancy are at increased risk. Early diagnosis may reduce the risk of fallopian tube rupture.

Aim: This study assessed the level of knowledge related to ectopic pregnancy among married Saudi women in Riyadh, Saudi Arabia.

Method: A descriptive cross-sectional design was used. This study was conducted at outpatient obstetrics clinics at the Women's Health Specialist Hospital at King Fahad National Guard Hospital in Riyadh. The convenience sample consisted of 255 pregnant women. The data were collected through a structured interviewing questionnaire, which consisted of demographic data and an ectopic pregnancy knowledge assessment tool.

Results: The study's findings revealed that the mean age of the women was 35.50 ± 6.45 years. More than half of the study sample (66.7%) had a university education, and 63.9% delivered via normal vaginal delivery, whereas 27.8% delivered via cesarean section. More than half of the sample had a poor level of knowledge regarding signs and symptoms, diagnosis, complications, and management of EP, with the total mean knowledge score for ectopic pregnancy being 56.96 ± 17.09. Overall, the study sample (60.40%) demonstrated a poor level of knowledge, 31% had a fair level of knowledge, and only 8.6% had a good level of knowledge.

Recommendations: Designing an educational program for women to increase awareness of ectopic pregnancy, including its signs, symptoms, and risk factors, to improve the understanding and prevention of complications of EP.

Background: Diastasis recti abdominis (DRA) is a prevalent postpartum condition characterized by separation of the rectus abdominis muscles. It has been linked to lumbopelvic pain, pelvic floor dysfunction, and urinary incontinence. However, large-scale epidemiological data from Chinese populations and study investigating its relationship with pelvic organ prolapse (POP) are limited.

Methods: This is a retrospective case-control study which analyzed 4,426 women at 6th week postpartum at Chengdu Women's and Children's Central Hospital between January 2019 and January 2025. DRA was diagnosed by ultrasonography, and POP was staged using the POP-Q system. Maternal, obstetric, and pelvic floor variables were collected. Independent risk factors of DRA were identified through ordinal logistic regression analyses. Spearman correlation was used to examine the relationship between DRA severity and POP stage. A two-tailed p value less than 0.05 is regarded as statistically significant.

Results: DRA was detected in 65.6% of participants, with 52.6% classified as mild to moderate. High neonatal birth weight (≥3.5 kg) is independent risk factor for DRA (OR 2.43, 95% CI 1.75-3.35). Multiparas were more than twice as likely to develop DRA compared to their nulliparous counterparts (OR 2.67, 95% CI 1.30-5.45). Vaginal delivery (OR 0.45, 95% CI 0.40-0.51) and type I pelvic floor muscle strength grade II to IV were associated with lower risks for DRA. More than half of women in each age group (20-29, 30-39, and ≥40-year-old) presented with both DRA and POP. Spearman analysis showed a significant negative correlation between DRA severity and POP stage (ρ = -0.220, p < 0.001).

Conclusion: Diastasis recti abdominis is highly prevalent among Chinese postpartum women and is influenced by parity, birth weight, gestational weight gain, and maternal BMI. Vaginal delivery and moderate (Grade II-IV) strength of Type I pelvic floor muscles were found to be protective against Diastasis Recti Abdominis.

Introduction: Young sexual minority women (YSMW)'s sexual health is often overlooked in research, with most studies focusing on men who have sex with men or transgender women.

Methods: This study compares the sexual and mental health of young lesbians and bisexual women with exclusively heterosexual women using data from a 2017 Swiss study on young adults' sexual health and behaviors. The sample includes 2,316 sexually active cisgender women. Bivariate analyses were conducted, followed by a multinomial regression using exclusively heterosexual women as the reference group.

Results: Sexual orientation is associated with STI diagnosis, HIV testing, age at first gynecological visit, protection at last intercourse, intercourse involving multiple partners and sexual violence. At the multivariate level, lesbians are more likely to use no protection, to be older at their first gynecological visit, to have experienced three-way intercourse and to smoke. Bisexual women are more likely to use no protection, to report STI diagnosis, to be victims of sexual abuse, and to have experienced intercourse involving multiple partners.

Conclusion: Further research and inclusive sexual health education and prevention campaigns are urgently needed to provide inclusive, comprehensive information on topics such as same-gender relationships, bisexual behaviors to reduce disparities in sexual and mental health outcomes.

Introduction: This study applies the Benner interpretation of the Dreyfus Model of Skill Acquisition to birth doulas.

Methods: Sixty-five doulas participated in open-ended interviews in five waves between 2002 and 2022. Constructivist grounded theory methods were used to collect and analyze the data. Participants attended over 25 births, spoke English fluently, and did not utilize any medical skills. The doulas ranged in age from 22 to 65 and practiced in a variety of areas and settings in the United States, Canada, and the Netherlands.

Results: The Benner model was relevant. Birth doulas grow similarly to nurses from novice to expert, including the development of intuition. However, the skill set is different. As they improved in skill acquisition, birth doulas showed advancement in information processing; confidence; decision-making; communication; self-awareness; client and staff relationships; professional detachment; definition of an ideal birth; management of witnessing medical maltreatment and feelings of overwhelm; the ability to read client cues; anticipation of labor events and staff responses; managing the challenges of a professional doula lifestyle; sense of identity, the maturation of expert intuition; and awareness of when they had power to influence a situation. Swiftness in development depended on the variety of birth experiences and locations; the doula's ability to reflect and find meaning; and life and career background.

Conclusion: Birth doula work is more complex and multifaceted than previously thought and requires growth in specific skill sets to be successful. Effective birth doula work requires sophisticated emotion management, analytical and communication skills, in addition to labor support skills. Public perception that anyone can be a doula is erroneous. It is a separate profession from obstetrical nursing, although some skills may overlap. Rather than continually training new people, programs could concentrate on removing the challenges to continuing birth doula work. Doula programs should address the challenges of each stage, thus encouraging greater expertise and retention and growth of an experienced workforce.

Background: Sexual health is a vital component of overall well-being and life happiness. The ability of women to make independent decisions regarding consensual sexual relationships is essential for their empowerment and the achievement of reproductive rights. Globally, only 55% of women can make their own decisions about sexual and reproductive health (SRH). Socioeconomic factors such as age, income, education, and early marriage significantly influence sexual autonomy. Therefore, this study aims to assess socioeconomic inequalities in sexual autonomy among women of reproductive age in four sub-Saharan African countries, using recent Performance Monitoring for Action (PMA) data.

Methods: This study analyzed data from four sub-Saharan African countries-Burkina Faso, Ethiopia, Kenya, and Uganda-using the PMA project dataset. A weighted sample of 17,855 women of reproductive age was included. The dependent variable was sexual autonomy, defined as the presence of choice in sexual decision-making. Socioeconomic inequality was measured using the concentration curve and concentration index. Additionally, decomposition analysis was conducted to determine the contribution of explanatory variables to the overall inequality.

Results: The weighted Erreygers normalized concentration index for low sexual autonomy was calculated as -0.184, with a standard error of 0.021 (P < 0.0001). Similarly, the corresponding concentration curve lies above the line of equality, showing that sexual autonomy is disproportionately distributed among the poor. Decomposition analysis revealed that rural residence (38.62%), followed by media access (16.52%), lower wealth quintile (13.71%), women's education (8.87%), and husband's education (7.24%) contribute to the overall inequality.

Conclusion: Socioeconomic inequality was evident in low sexual autonomy across the four countries. According to the decomposition analysis of this inequality, the primary contributor was rural residence, followed by media access, wealth quintile, women's education, and husband's education.

Background: Physical activity offers numerous health benefits and helps prevent various diseases, making it an essential component of a healthy lifestyle.

Objective: This study aims to examine the barriers and enablers that affect female participation in physical activity.

Methods: This was a cross-sectional quantitative study. The study questionnaire was adopted from a previous study. The survey was conducted online and completed by 668 Saudi women from across the country.

Results: The study findings regarding low physical activity levels among Saudi women are concerning, as 72.2% of participants were classified as sedentary or physically inactive. The study revealed that age, employment status, and income were significant factors affecting engagement of women in physical activity. Moreover, barriers such as expensive gym memberships, a lack of women-only clubs, a lack of enjoyment in sports, and prolonged use of the same exercise devices prevented Saudi women from participating in physical activities. However, women reported exercising to boost their self-satisfaction and self-confidence, thereby promoting overall health.

Conclusion: Saudi women exhibit a low level of physical activity. Barriers such as expensive gym memberships, a lack of women-only clubs, a lack of enjoyment in sports, prolonged use of the same exercise devices, and motivations related to self-satisfaction and self-confidence prevent Saudi women from practicing physical activities. Health system policymakers need to take action to increase physical activity levels and address these barriers.

Indigenous women experience distinctive mental health risks that accumulate across the life course under the continuing impacts of colonization, gendered violence, and systemic racism. Drawing on recent mandates from the United Nations Permanent Forum on Indigenous Issues and the World Health Assembly's Resolution 76.16 (2023), as well as community-based exemplars such as Partners In Health's women-led peer models, this policy brief applies the analytical dimensions of the National Collaborating Centre for Healthy Public Policy to synthesize evidence, contextual factors, and feasible policy options. It identifies disproportionate burdens in suicide rates, perinatal depression, caregiver stress, and menopausal symptom severity, alongside a persistent lack of validated Indigenous-specific screening tools and gender-disaggregated data. The brief recommends an integrated, rights-based strategy that funds Indigenous governance of culturally safe mental health services across the life course, builds an Indigenous Women's Mental Health Data Strategy grounded in data sovereignty, embeds traditional knowledge and place-anchored healing in coverage policies, and extends targeted support for caregiving and menopausal transitions. Implementing these measures would operationalize reconciliation commitments, reduce documented inequities, and generate long-term social and economic benefits for communities and health systems alike.

This paper explores the use of Housing First services for women experiencing homelessness, focusing on those aged 35 and over, who have multiple and complex needs. The paper draws on an evidence review and the results of a five-year evaluation of a Housing First for Women pilot project (2015-20) and three-year longitudinal study of two further Housing First services for Women in the UK (2021-24), which centred on the lived experience of women using these services. Four main arguments are advanced. The first is that the original Housing First model from the US and the initial deployments of the Housing First approach in Europe and the UK used a model designed in a context in which the nature and extent of middle aged and older women's homelessness was poorly understood. High fidelity Housing First services were less likely to be fully effective because the original model did not properly account for the level of trauma associated with domestic abuse and violence against women in middle age and later life. The second argument is that there is, on current and emergent evidence, a clear case for developing Housing First that is designed, managed and run by women for women which includes safeguarding as one of its key operating principles. The third argument is that Housing First for Women, with its comprehensive co-productive support and intensive case management, may offer important advantages over Sanctuary Schemes and other services that are designed to counteract middle aged and older women's homelessness that is associated with abuse, violence and multiple and complex needs. The paper concludes by arguing that in order to fully meet the needs of middle aged and older women experiencing long term and repeated homelessness with multiple and complex needs, an integrated and preventative strategy, including preventative approaches like Domestic Abuse Housing Alliance (DAHA) Accreditation and Housing First for Women must be developed. If Housing First for Women is to be effective, it must be situated within a wider integrated strategy to counteract women's homelessness to reach its full potential.