Frontiers in reproductive health最新文献

Introduction: Sexual coercion is a major public health and human rights concern, yet its burden among African adolescents and young adults remains poorly synthesized. This review aimed to estimate the prevalence of sexual coercion in this population and examine variations by gender, setting, and region.

Methods: We systematically searched Web of Science, Scopus, MEDLINE/PubMed, and CINAHL for studies published between January 2000 and June 2025. Two reviewers independently screened, extracted, and appraised eligible studies. A narrative synthesis was integrated with a random-effects meta-analysis due to anticipated high heterogeneity to derive pooled prevalence estimates and conduct subgroup analyses.

Results: Thirty-three studies involving 63,934 participants from 14 African countries were included. The pooled prevalence of sexual coercion was 20% (95% CI: 17%-23%). Females reported higher prevalence (23%) than males (19%). School-based studies showed greater prevalence (26%) compared with community-based studies (16%).

Discussion: Sexual coercion remains a major public health and human rights concern among African adolescents, particularly school-going females. Strengthening school- and community-based programs that integrate comprehensive sexuality education on consent, negotiation, and gender equality is essential. Developing a standardized, context-sensitive tool for measuring sexual coercion will also enhance evidence quality and policy response.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251067378, PROSPERO CRD420251067378.

Introduction: Infertility is a global public health issue which affects significant portion of adult population. In developing nations, infertility has long been disregarded as a reproductive health problem. Despite being available for almost for five decades, most people in resource-poor nations still face challenges to access assisted reproductive technology. We conducted this systematic review to explore the reasons behind such gaps and solutions outlined to address them.

Methods: After a study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO), we conducted a comprehensive search using predefined keywords and medical subject headings across major electronic databases: - Ovid MEDLINE, PubMed, Web of Science, and Google Scholar.

Results and discussion: The database search resulted in total of 3097 citations; after removal of 2256 duplicates, 765 citations were selected for title and abstract review. A full text review was conducted on the 137 articles 43 studies were included in the final analysis. The majorly cited challenge was the high costs associated with treatment, followed by accessibility and infrastructural obstacles, psychosocial and cultural barriers including the unacceptance of a baby born from assisted reproduction. Absence of supportive policies coupled with religious factors worsen the problem. Governmental, non-governmental, and international organizations should collaborate to address affordability and accessibility issues and to resolve socio-cultural and religious challenges through the inclusion of infertility treatment in the existing health system, revisiting the financial mechanisms, and creating supportive policies in partnership with community and religious leaders.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025632094, PROSPERO CRD42025632094.

Introduction: In Kenya, young women face dual epidemics of HIV and unintended pregnancy, yet provision of HIV pre-exposure prophylaxis (PrEP) in reproductive health settings is uncommon. We aimed to estimate PrEP uptake and persistence when PrEP was integrated into services for people seeking postabortion care (PAC) and to determine whether enhancing the PrEP program with an adherence intervention-simple phone calls-impacted PrEP persistence and use.

Methods: PAC clinics in Kenya launched PrEP delivery and were randomized to conduct enhanced support (weekly calls during Month 1, biweekly in Month 2, and monthly thereafter) or standard of care (SOC) for PrEP adherence and retention. The primary outcome for the cluster randomized trial was PrEP refills at one month. PrEP refills and adherence [collected on a subset through point-of-care urine tenofovir (TFV) testing] were compared among participants accessing PrEP at facilities assigned to offer enhanced vs. SOC support via Poisson regression models.

Results: From April 2021 to March 2023, 8,362 women sought PAC from participating facilities. Fifty-five percent of women received PrEP information, 73% of those had HIV testing, and 36% of those received counseling and initiated PrEP. After the trial launch, 4,112 women sought PAC, and 655 (15.9%) initiated PrEP. At Month 1, 63/408 (15.4%) women in facilities who were randomized to the enhanced arm and 14/247 (5.7%) in the SOC arm received a PrEP refill [relative risk (RR) = 2.7, 95% CI: 0.90-8.2]. TFV was detected at Month 1 in 19.0% of the enhanced arm and 9.4% of the SOC arm (RR = 2.03, 95% CI: 0.89-4.65).

Conclusions: We observed large gaps in the provision of PrEP information and PrEP counseling that contributed to low PrEP uptake in PAC clinics. Among women who initiated PrEP, persistence and adherence were low. Phone calls yielded a statistically significantly higher retention at Month 1, a finding that may warrant further investigation.

Menopause brings hormonal changes that can significantly affect quality of life. Herbal remedies like Shatavari (Asparagus racemosus Willd.) and Ashwagandha (Withania somnifera L. Dunal) are Ayurvedic herbs traditionally used for hormonal balance and associated stress adaptation. The study evaluated the efficacy and safety of Shatavari root extract (SHT) alone and, in combination with Ashwagandha root extract (ARE-SHT), in women with menopausal symptoms. This was an 8-week, randomized, double-blind, placebo-controlled, multicentric study that enrolled 135 women aged 45-65 years. Participants were randomized into three groups: SHT (n = 45) or an ARE-SHT (n = 45), or a placebo (PL; n = 45). The primary outcome was evaluated by the change in the Menopause Rating Scale (MRS) score at weeks 4 and 8. Secondary outcomes were evaluated by changes in Perceived Stress Scale (PSS) score, Menopause-Specific Quality of Life Questionnaire (MENQOL) score, Profile of Mood States (POMS) score, hot flashes, and mood improvement. The serum hormonal assessments and safety evaluations (liver, renal, and thyroid function) were conducted at week 8. Baseline values were comparable among the groups. Significant improvements in MRS scores were observed in the ARE-SHT group compared to SHT [Week 4 and 8 (p < 0.0001)] and PL [weeks 4 (p = 0.01) and 8 (p < 0.0001)], respectively. MENQOL scores improved numerically by week 8. Esteem-related affect (p = 0.025) and mood improvement (p = 0.008) showed significant changes between the groups. Normal hormonal levels were maintained. Mild adverse events were reported by four participants (loose stools and dizziness in the ARE-SHT group, nausea in the SHT monotherapy group, and headache in the PL group). Shatavari root extract was safe and effective; however, combined with Ashwagandha root extract demonstrated a promising option in managing menopausal symptoms and in enhancing overall health. Future studies with longer duration and larger sample sizes across defined menopausal stages are required to confirm and extend these findings.

Clinical trial registration: Clinicaltrials.gov, identifier [NCT06716554].

Introduction: Tubal factor infertility is one of the most prevalent and diagnostically complex causes of female infertility. Standard imaging modalities, including hysterosalpingography and laparoscopy, frequently fail to detect subtle mucosal or molecular abnormalities. This study investigated whether combining salpingoscopy with immunohistochemical (IHC) profiling improves diagnostic precision and prognostic assessment in women with tubal-factor infertility.

Methods: This retrospective observational cohort study included 197 women who underwent laparoscopy between April 2020 and February 2025. Salpingoscopy was used to grade mucosal pathology severity, and ampullary biopsies were analyzed by IHC for CD138, Ki-67, and estrogen/progesterone receptors. A composite prognosis score incorporated clinical history, duration of conservative therapy, salpingoscopic findings, and IHC results. Spearman's rank correlation assessed associations between diagnostic parameters and pregnancy outcomes (natural or assisted).

Results: Higher salpingoscopic severity scores were significantly associated with reduced pregnancy likelihood (r = -0.457; p < 0.0001). Elevated IHC scores similarly correlated with decreased conception rates (r = -0.263; p = 0.0002). Tubal dilations and adhesions showed negative associations with reproductive outcomes (r = -0.232; p = 0.001). In contrast, the composite prognosis score demonstrated a strong positive correlation with treatment success (r = 0.578; p < 0.0001).

Discussion: Integrating salpingoscopic visualization with IHC profiling enhances detection of subtle mucosal and molecular abnormalities that are frequently missed by conventional diagnostic approaches. This combined modality offers superior prognostic accuracy and may guide personalized surgical and assisted reproductive treatment strategies. Ethical approval was obtained from the Ethics Committee of the Kazakhstan Medical University «KSPH» (IRB-64-2023).

Background: High rates of HIV among adolescent girls and young women (AGYW) persist as a critical public health issue in South Africa. Pre-exposure prophylaxis (PrEP) is a promising HIV prevention method for reducing new infections. To enable AGYW to access, make decisions about, and effectively use PrEP, they require support from partners, parents, and peers, which is dependent on effective PrEP communication. This study examined barriers to, facilitators of, and outcomes of effective PrEP communication between AGYW and their partners, parents/caregivers and peers.

Methods: This paper presents data from a qualitative study conducted in seven South African provinces. A total of 68 in-depth interviews were conducted with AGYW aged 15-24 years. Audio recordings of interviews were transcribed and translated into English, and preliminary thematic analysis of transcripts was conducted by a team of analysts. A second phase of analysis focusing on PrEP communication was conducted to further extract meaning from the coded data.

Findings: The barriers to effective communication between AGYW and their partners included a lack of accurate information about PrEP, fear that partners would think that they did not trust them, and stigma related to PrEP's association with promiscuity and PrEP being mistaken for HIV treatment. The barriers hindering PrEP communication between AGYW and their parents were similar, including fear of judgement, and PrEP stigma related to assumptions of promiscuity. Open communication was a facilitator of effective PrEP communication between AGYW and partners, parents and peers. The benefits and outcomes of effective PrEP communication included increased knowledge about PrEP, motivation to use PrEP, PrEP use and continuation on PrEP.

Conclusions: To address barriers to effective PrEP communication, community PrEP awareness campaigns and education programmes are needed and should include men, parents and peers. Increased knowledge and awareness of PrEP is likely to result in reduced PrEP stigma, improved PrEP communication and subsequent uptake.

Introduction: This study examined the determinants of the demand for and use of modern contraception among young women aged 15-24 years in Malawi, focusing on the met demand for family planning with modern methods (mDFPS). Previous studies in Malawi have primarily assessed contraceptive prevalence or intentions to use, while limited attention has been given to mDFPS, a key indicator of reproductive autonomy.

Data and methods: The analysis used data from the 2015-16 Malawi Demographic and Health Survey (MDHS). After excluding cases with missing values, the final analytical sample comprised 7,643 young women aged 15-24 who had a demand for family planning. Weighted descriptive, bivariate, and probit regression analyses were conducted to identify factors associated with modern contraceptive use, demand for contraception, and mDFPS.

Results: Bivariate analysis showed significant associations between mDFPS and age, education, marital status, parity, employment, and exposure to health workers (p < 0.001). Multivariate probit regression indicated that higher education, employment, and later sexual debut increased the probability of mDFPS by 11%, 3%, and 7%, respectively, while being married reduced it by 14% (p < 0.01). Parity remained the strongest predictor, with women having one or more children being 44%-55% more likely to have mDFPS. Factors such as wealth, residence, and information exposure were not significant after adjustment.

Conclusion: By focusing on mDFPS rather than overall contraceptive prevalence, this study advances understanding of reproductive autonomy among young Malawian women. The findings suggest that educational attainment, empowerment, and gender-sensitive service delivery are more decisive than economic access alone. Efforts to improve mDFPS should therefore address social norms, marital dynamics, and health system barriers to youth-friendly contraceptive services.

Introduction: Knowledge and use of sexual reproductive health and human immunodeficiency virus (SRH and HIV) services are crucial for the prevention of pregnancy and sexually transmitted infections (STIs) among adolescent girls and young women (AGYW). This study aims to evaluate the knowledge and perceptions of AGYW about the SRH and HIV services offered in health facilities in Maputo, Mozambique.

Methods: An analytical cross-sectional study was conducted based on exit surveys with AGYW held at the health facilities named Zimpeto and June 1st, in Maputo City, between May 1, and June 9, 2023. Data were analyzed through descriptive statistics, t-test and ANOVA, using SPSS version 20. 590 AGYW, aged 15-24 years of age, were included in the study.

Results: In general, knowledge of SRH and HIV services was fairly high, with knowledge of each specific service offered ranging between 38% and 97%. Knowledge about SRH and HIV services differed depending on the health facility where the AGYW sought SRH and HIV services; the participant's age; their occupation; their religion, and who they lived with. Counseling services were the most commonly reported services attended, with >90% of participants reporting having received counseling for each of the following: STI and HIV and pregnancy prevention and safer sex practices. The quality of SRH and HIV services, as well as the attitudes of the providers were considered to be good by >90% of AGYW. Roughly 95% of AGYW at Zimpeto health facility, were either "satisfied" or "very satisfied". Whereas at the June 1st health facility, only roughly 75% of AGYW were either "satisfied" or "very satisfied", and roughly 20% of AGYW were "little satisfied" that their needs had been met that day.

Discussion: Among AGYW interviewed there is a high level of knowledge about SRH and HIV counseling services as compared to STI testing, treatment, and clinical care. Specific attention should be given to ensuring appropriate physical infrastructure, such as dedicated adolescent friendly spaces and comfortable seating. Targeted interventions that are focused on improving the quality of the services delivered, should be designed and implemented for those health facilities perceived by AGYW to have lower quality.

Background: Consanguineous marriages remain prevalent in many regions of the world, particularly within the Middle East, where reported prevalence exceeds 50% in countries such as Saudi Arabia, Oman, and the United Arab Emirates. Despite evidence that consanguineous marriages increase genetic risks through increased levels of homozygosity, which might lead to gene dysfunction, their impact on female fertility remains unclear. Although the data is limited and inconsistent, female offspring of consanguineous marriages appear to have a higher risk of reduced ovarian reserve compared to their peers from non-consanguineous marriages, with a more pronounced effect in young women.

Aim: This mini review synthesizes current evidence on the relationship between parental consanguinity and ovarian reserve in female offspring to clarify existing findings and highlight research gaps.

Methods: A systematic search of MEDLINE, Embase, and Web of Science was conducted up to March 2024 in accordance with the PRISMA guidelines. Studies evaluating ovarian reserve markers, including Anti-Müllerian Hormone (AMH) and Antral Follicle Count (AFC), in women with and without parental consanguinity were included. This review was registered with PROSPERO (Registration ID: CRD42022300162).

Results: Three studies (n = 2,903) from Kuwait, the UAE, and Oman met the inclusion criteria. Two reported significantly lower AMH and AFC levels among women aged ≤35 years with parental consanguinity, whereas one found no significant association between parental consanguinity and ovarian reserve markers.

Discussion: The current findings suggest that parental consanguinity may contribute to reduced ovarian reserve in female offspring; however, the data are not consistent. Differences in study design and degree of consanguinity may explain these inconsistencies. This review could be used to raise awareness about the potential influence of parental consanguinity on the reproductive health of their family's offspring, to encourage early counselling and proactive fertility assessment. The results present a call to action, highlighting the need for further research on this issue within the Middle East region, where consanguinity is highly prevalent.

Systemic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42022300162, PROSPERO CRD42022300162.

Introduction: Menopause represents an important transition in women's lives, often accompanied by physiological, psychological, and lifestyle changes that can affect overall quality of life (QoL). Understanding how individual characteristics, body composition, and daily habits influence QoL during this stage is essential. This study aimed to assess the prevalence of menopausal symptoms and to examine how anthropometric measurements, sociodemographic factors, and lifestyle variables-particularly physical activity levels-independently influence the QoL of Tunisian women during mid-life.

Methods: A cross-sectional study was conducted among 375 women recruited from different regions of Tunisia and classified according to the World Health Organization's definitions of menopausal stages. Data were collected using the Menopause-Specific Quality of Life Questionnaire (MENQOL) and the Physical Activity Self-Assessment Questionnaire (J. Ricci ' L. Gagnon). Anthropometric measurements were performed by the research team. The Mann-Whitney and Kruskal-Wallis tests were applied to compare MENQOL scores across menopausal stages.

Results: Among premenopausal women, the most reported symptom was feeling tired or worn out (76%), with the psychosocial domain showing the greatest QoL impact (score: 2.05), followed by physical (2.03), sexual (1.64), and vasomotor (1.36) domains. In perimenopausal women, fatigue was reported by 81%, with the physical domain most affected (2.03), followed by psychosocial (1.87), vasomotor (1.77), and sexual (1.28) domains. In postmenopausal women, flatulence or gas-related colic was the most frequent symptom (86%), and the psychosocial domain had the highest impact (2.36), followed by physical, vasomotor, and sexual domains. Overall, 68% of participants had a moderate level of physical activity. Higher physical activity was associated with better QoL in the total sample but remained significant only among premenopausal women. Overweight (42%) and obesity (28%) were common, and higher BMI was consistently linked to poorer QoL, particularly during premenopause.

Discussion/conclusion: Physical and psychosocial symptoms were the most prevalent across menopausal stages. While higher physical activity and lower BMI were associated with better QoL in premenopausal women, these associations weakened during menopause, suggesting that other factors, such as income and BMI, may play a stronger role in postmenopausal QoL. Promoting physical activity and healthy weight management could therefore improve QoL outcomes for women throughout the menopausal transition.