Frontiers in reproductive health最新文献

Background: High-quality family planning (FP) counselling is essential for informed contraceptive choice, reducing discontinuation, and improving reproductive health. However, many women in sub-Saharan Africa continue to face barriers. This study examined client-, provider-, and facility-level determinants of FP counselling quality in Ethiopia using nationally representative, multi-source data.

Methods: We analysed data from the 2021/22 Ethiopia Service Provision Assessment, including 2,224 women who received or were prescribed injectables, pills, or implants. Counselling quality was assessed using a 15-item checklist derived from direct observations and client exit interviews. Multilevel ordinal logistic regression was applied to identify predictors at the client-, provider-, and facility-levels.

Results: Only 32% of clients received high-quality FP counselling, with key information on side effects, STI protection, and a follow-up frequently omitted. High-quality counselling was more likely among women who had never used FP (aOR 1.40; 95% CI: 1.01-1.95) or were past users (aOR 2.05; 95% CI: 1.44-2.92), those counselled by providers with more than five years of experience (aOR 1.91; 95% CI: 1.26-2.89), and those served by providers with high adherence to medical-eligibility screening (aOR 1.67; 95% CI: 1.22-2.29). The presence of a FP-trained provider and national FP guidelines was also positively associated. Marked regional disparities were observed, with facilities in Sidama performing better and those in emerging regions lagging behind. Facility-level factors accounted for approximately 52% of the variation in counselling quality.

Conclusion: The quality of FP counselling in Ethiopia remains suboptimal and is largely driven by provider and facility-level factors. Strengthening provider training, ensuring guideline availability, addressing regional disparities, and improving counselling for current users are essential for enhancing service quality, reducing discontinuation, and improving reproductive health outcomes.

Primary dysmenorrhea is a common gynecological condition among women. Complementary and alternative medicine (CAM) has been used for the treatment of primary dysmenorrhea for centuries. These therapies lack the drawbacks associated with traditional symptomatic medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) and oral contraceptives, which can increase the risk of adverse effects like mild neurological symptoms (headaches, drowsiness, dizziness) and gastrointestinal symptoms (nausea, indigestion). This article reviews current CAM strategies for treating primary dysmenorrhea, including vitamins, herbal supplements, acupuncture, exercise, transcutaneous electrical nerve stimulation (TENS), acupressure, and aromatherapy. The article analyzes the benefits and potential mechanisms of these therapies, aiming to provide practitioners with the most commonly used and widely recommended CAM methods. Finally, the review highlights future directions for dysmenorrhea treatment, including ongoing research and potential new therapies. The goal of this review is to provide a brief summary of the current literature on the most commonly used CAM approaches for patients with primary dysmenorrhea, as a comprehensive approach to managing primary dysmenorrhea and improving quality of life.

Background: The critical importance of women's autonomy in sexual and reproductive health (SRH) decision-making overall well-being is widely recognized. Existing research often provides only a generic understanding without specifically identifying the nuanced socio-economic, cultural, and demographic factors that truly enable or hinder women's autonomous SRH in Tanzania. High adolescent fertility and ongoing disparities in healthcare decision-making autonomy highlight a significant gap between policy intentions and lived realities. Therefore, this study aimed to close this gap by assessing the determinants of women's autonomy in sexual and reproductive health decision-making.

Methods: This study employed an analytical cross-sectional design, utilizing secondary data from the 2022 Tanzania Demographics and Health Survey. Women's autonomy in SRH decision-making was an outcome variable derived from three questions assessing autonomy over: (1) sexual relations, (2) contraceptive use, and (3) reproductive health care. This study's analysis included 9,252 women in sexual unions. The data were analyzed using multilevel mixed-effects logistic regression, employing four models to identify determinants of women's autonomy in SRH.

Results: The prevalence of women's autonomy in SRH was 49.6% (95%CI: 47.5-51.8). The individual factors influencing SRH decision making autonomy were, women aged 35-49 years (AOR = 1.33, 95%CI: 1.09-1.61), women with primary education (AOR = 1.49, 95%CI: 1.31-1.70) and secondary or higher education (AOR = 2.16, 95%CI: 1.83-2.55) were more likely to have autonomy in SRH decision making. Women in rich households (AOR = 1.19, 95%CI: 1.02-1.40) and those with media exposure (AOR = 1.49, 95%CI: 1.33-1.67) had higher odds of autonomy in SRH than their counterparts. At the community level, women in rural settings (AOR = 0.73, 95%CI: 0.61-0.87) were less likely to have autonomy in SRH compared to women in urban settings.

Conclusion: This study found that nearly half of Tanzanian women lacked autonomy in SRH decision-making, significantly influenced by factors such as age, education, media exposure, current employment status, parity, wealth index, and geographic region. To address these disparities, comprehensive and context-specific interventions are necessary to overcome the cultural and socio-economic challenges faced by underserved populations.

This review examines the critical role of IQ motif family genes in male infertility. Characterized by conserved calmodulin-binding IQ domains, these genes, including IQUB, IQCN, and IQCH, exhibit reproductive tissue-specific expression and regulate fundamental processes in spermatogenesis and sperm function, such as Ca²⁺ signaling, cytoskeletal dynamics, and RNA splicing. Specific loss-of-function mutations are strongly linked to distinct clinical phenotypes: IQUB variants to asthenozoospermia, IQCN mutations to total fertilization failure, and IQCH deficiency to azoospermia. The article discusses emerging diagnostic applications, including genetic screening via whole-exome sequencing and the evaluation of sperm protein biomarkers like IQCD. Furthermore, it outlines mechanism-informed therapeutic strategies, from clinically applied artificial oocyte activation for IQCN defects to preclinical explorations of gene correction. The synthesis underscores how research on this gene family is advancing the field toward precision medicine in male infertility.

South Africa's Choice on Termination of Pregnancy Act (CTOP) protects legal abortion access, yet systemic service delivery barriers persist, limiting care and contributing to preventable maternal morbidity. This policy brief draws on a 2023-2024 mixed-methods study, including a literature review, online survey, focus groups, and in-depth interviews with 33 abortion providers across seven provinces. Findings highlight chronic underinvestment, staffing shortages, unclear conscientious objection guidelines, facility-based stigma, and inadequate managerial support, alongside discrimination against women seeking services. These barriers drive some women toward unsafe alternatives. Despite challenges, providers remain committed, viewing their work as central to reproductive justice and constitutional rights. Addressing gaps requires integrating CTOP into core services, expanding values clarification training, supporting providers, enforcing rights-based guidelines, and engaging communities to ensure safe abortion care.

Spinal ependymomas are intradural intramedullary tumors that present frequently in adults with a bimodal peak at 25-29 years and again at 45-59 years. The risk of progressive neurological deficit in these patients creates the need for surgical resection and radiation therapy. Myxopapillary ependymomas specifically occur at the conus medullaris within the lumbar spine, and these treatments can have a significant impact on patient fertility. However, recent reports illustrate that a vast majority of adults with cancer receive inadequate fertility preservation education, counseling, or resources, and providers tend to cite barriers such as lack of knowledge about fertility preservation options or referrals as well as discomfort with broaching the topic. This review aims to explore the extent to which fertility preservation counseling was offered by a neurosurgery department at a single institution to patients with ependymomas and the subsequent utilization of fertility preservation services. A retrospective review of our local spine tumor database from 2015 to 2025 identified 15 patients who underwent surgery for spinal ependymomas at Rhode Island Hospital. Patients who were outside of child-bearing years (<18 years to >44 years) were excluded (N = 4). Medical records were searched for references to fertility counseling within the notes as well as subsequent receipt of patient services. This cohort consisted of 3 female and 8 male patients with a median age of 42 years. Two patients underwent postoperative radiation treatment. Only one patient in the cohort received any type of fertility preservation counseling or discussion of fertility-related risks of treatment and was referred for sperm banking services. These results shed light on a gap in care regarding fertility in neurosurgical oncology. Previous research suggests that there are significant benefits of fertility preservation counseling and REI referral in every specialty that provides oncology care. This implies that, as a part of the oncological care team, neurosurgeons may be missing a critical opportunity to help their patients achieve goals that extend past their cancer journeys, and further development of protocols for fertility preservation counseling are needed in order for neurosurgeons to provide quality care beyond the doors of the operating room.

Objective: Endometriosis is a gynecological disorder for which awareness and detection rates are rising globally. The purpose of this study is to highlight atypical presentations of the disease; to present four adolescent patients with laparoscopically confirmed endometriosis at our hospital in Katowice, Poland, in 2024; and to discuss these cases in the context of the relevant literature.

Methods: We present the clinicopathological data of four adolescent patients with atypical presentations of endometriosis who were treated at our institution with a comprehensive report of laparoscopic examination. We performed a narrative PubMed review for the period 2017-2025 to identify and discuss atypical clinical symptoms and laparoscopic findings of adolescent endometriosis. We used the following keywords were used: endometriosis, adolescents, laparoscopy, atypical presentation, bowel lesions, hydrosalpinx, coexisting ovarian tumor, pelvic organs shift. Inclusion criteria were adolescent age of patients (age 10-19) and laparoscopic confirmation of endometriosis diagnosis. We excluded articles published in languages other than English.

Results: Young patients present atypical, non-specific clinical symptoms and diverse laparoscopic appearances. Shared features included lesions on the serous membrane of the large bowel and pelvic structural distortion as a consequence of uterosacral ligaments shortening or uterine adherence to the anterior abdominal wall. Additional findings included hydrosalpinx and the coexistence of an ovarian tumor. The follow-up confirmed the therapeutic success as a consequence of compliance with the oral contraceptive regimen and the following laparoscopic approach, despite the moderate-stage endometriosis in the majority of the reported cases.

Conclusions: In adolescents, the diagnosis of endometriosis remains challenging because of non-classical clinical manifestations and atypical laparoscopic findings compared with those observed in adults. The presented atypical cases underscore the importance of careful interview and consideration of rare anatomical anomalies that may co-occur with endometriosis. Increasing awareness of the disease's diverse clinical variants is important among adolescent patients, their parents, and especially pediatricians, who are often the first medical contact for these patients.

The molecular basis of spermatogenesis, which is a tightly regulated spatiotemporal process in testicular seminiferous tubules where germ cell differentiation and somatic-germ cell interactions drive sperm production, remains incompletely understood. Histological staining techniques lack molecular resolution, while scRNA-seq loses spatial context. Conventional spatial transcriptomics (approx. 100 μm resolution) is too coarse-grained for testicular cells (10-20 μm in diameter), leading to mixed-cell signals. In this study, we used Salus-STS high-resolution spatial transcriptomics (∼1 μm resolution) and Salus Cellbins Algorithm to characterize the spatial transcriptomic profile of mouse testes at single-cell level. Integrating the spatial data with scRNA-seq via RCTD annotated major cell subtypes, whose distributions aligned with histology. Pseudotime and spatial gradient analyses revealed a basement membrane-to-lumen developmental axis, with luminal genes (e.g., Prm2) enriched in sperm maturation and basal genes (e.g., mt-Nd4) linked to mitochondrial metabolism-validated by PPI and GO analyses. The biological relevance of these marker genes is underscored by the fact that mutations in Prm2 and mt-Nd4 are known to be associated with human male infertility, highlighting their potential diagnostic value. This work enables high-resolution dissection of spermatogenesis' spatiotemporal dynamics, providing insights into male reproductive biology.

Background: The pandemic created global disruption acting as a health system shock not seen before in living memory. As a consequence, there were significant implications for healthcare delivery in low- and middle-income countries. Challenges such as lockdown restrictions created substantial modifications to the delivery of maternity care. This review aims to explore the experiences of maternity care by women, specifically in low- and middle-income countries, during the pandemic global health system shock.

Methods: A systematic search was conducted for qualitative literature published about maternity healthcare experiences during the pandemic. Studies which provided qualitative data on women's experiences of digital healthcare, and other maternity care reconfigurations in low- and middle-income countries were included. The studies underwent quality assessment using twelve criteria adapted from the quality appraisal tool developed by the Evidence for Policy & Practice Information (EPPI) Centre. Thematic synthesis was employed.

Results: Of the 21,860 records identified, 30 met the inclusion criteria for this review. Across the 4 key predetermined areas of study: (1) Care seeking and experience; (2) Digital health; (3) Vaccination; and (4) Ethical future of maternity services; 10 concepts were reported upon, namely: (1.1) Emotional challenges and uncertainty, (1.2) Disruption of services, (1.3) Stigma and discrimination, and (1.4) Changing support systems; (2.1) Safety and reassurance, (2.2) Locus of responsibility; (3.1) Vaccine understanding and acceptance; and (4.1) Improvements for maternity care delivery, (4.2) Implementation of virtual care, (4.3) Education and empowerment.

Conclusion: Our findings suggest emotional challenges, isolation, and limited access to maternity services were prominent among pregnant individuals in low- and middle-income countries. This synthesis provides insights into how pandemic associated adaptations, which have been retained beyond, such as digital health solutions were experienced by women within constrained health systems, revealing both opportunities and persistent gaps in digital health access and equity. Although a review of low- and middle-income countries-there is learning to be taken from these settings which could easily be applied not only across low- and middle-income countries, but also in high-income settings, in the form of reverse (or "trickle-up") innovation to improve maternity care as we recover and re-build from the pandemic and offer more resilient ways of providing maternity care through future health system shocks. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42022355948, identifier CRD42022355948.

Introduction: Since 2017, 32 US states have enacted policies to increase menstrual material access in schools. Yet, the implementation and equity of these efforts remain poorly understood. This mixed methods study evaluated the implementation-as-usual (IAU) processes of Georgia's statewide MHH policy, the first in the US to establish recurring appropriations for menstrual materials in public schools without mandating their provision.

Methods: We conducted document reviews and key informant interviews (KIIs) with state, district, and school-level stakeholders to evaluate IAU. Using framework analysis, we identified and described the core implementation components guided by Quality Implementation Framework and Interactive Systems Framework for Dissemination and Implementation.

Results: Georgia's funding-based approach facilitated administrator buy-in, signaled state support, and enabled local adaptation across contexts. Advocacy groups filled key capacity gaps by providing technical assistance, training, and feedback to policymakers, which helped sustain and expand appropriations. However, limited programmatic guidance led to variability in implementation, communication gaps, and menstrual material access across schools.

Discussion: Findings illustrate the trade-offs between flexibility and accountability in statewide MHH policy design. Appropriations without mandates can enhance local ownership but require complementary structures for guidance and monitoring to ensure equitable and effective implementation.