BMC Women's Health最新文献

This study aimed to identify the spatial distribution and its associated factors of unmet need for family planning among women of reproductive age in administrative woredas of Ethiopia, using data from 8,716 married or in-union women in the 2016 Ethiopian Demographic and Health Survey. Spatial analyses, including autocorrelation, hotspot identification, and interpolation, were employed to examine geographical patterns, while a multilevel multinomial logistic regression model identified associated factors. The overall prevalence of unmet need was 21.04% (12.84% for spacing, 8.2% for limiting). Spatial analysis revealed that unmet need for limiting was dispersed, while spacing needs were randomly distributed. Key determinants included knowledge of family planning (spacing: aOR = 1.76, 95% CI:1.21-2.57; limiting: aOR = 2.45, 95% CI:1.41-4.23), having more than four living children (spacing: aOR = 1.40, 95% CI:1.05-1.86; limiting: aOR = 10.04, 95% CI:5.45-18.50), husband's employment (spacing: aOR = 0.44, 95% CI:0.28-0.71; limiting: aOR = 0.35, 95% CI:0.20-0.61), and the interaction of rural residency with husband's employment (spacing: aOR = 1.98, 95% CI:1.17-3.36; limiting: aOR = 2.42, 95% CI:1.28-4.55). The findings indicate that the prevalence of unmet need for family planning in Ethiopia's administrative woredas remains high, greater the acceptable standard defined by global benchmarks. Key factors include women's knowledge of family planning, the number of living children, the husband's occupation, and the contextual influence of rural residency. The spatial heterogeneity, particularly for limiting births, underscores the need for geographically targeted interventions. Therefore, national strategies and woreda-specific programs aimed at reducing unmet need must move beyond uniform approaches. They should prioritize enhancing comprehensive family planning education, addressing high-parity concerns, engaging male partners, and tailoring service delivery to mitigate the specific socio-contextual barriers prevalent in rural settings to ensure equitable access to family planning services across all administrative woredas.

Objective: To evaluate the Swede score for the prediction of high-grade cervical lesions in women undergoing colposcopy without cytology results. This simulates the upcoming scenario in Brazil of HPV-based screening for women testing positive for HPV 16/18.

Methods: This was a partial analysis of an ongoing cross-sectional study that prospectively included 86 women referred for colposcopy due to cytological abnormalities to a public referral center in Rio de Janeiro, Brazil, between September 2023 and June 2025. All women went to colposcopy evaluation. Colposcopy was performed by an examiner blinded to the referral cytology. For this analysis, we included all women with a fully visible squamocolumnar junction (transformation zone types 1 or 2). The gold standard was the histopathological repor. In cases where no biopsy or excisional treatment was performed, classification relied on final colposcopic impression and cytology. Diagnostic performance (sensitivity, specificity, predictive values, and likelihood ratios) was calculated using different Swede score cutoffs. Post-test probabilities were calculated assuming a 20% pre-test probability of CIN2+.

Results: Prevalence of CIN2 + was 33.7%. Swede score ≥ 8 predicted CIN2 + with a positive predictive value (PPV) of 100% and a likelihood ratio of 55.17. Post-test probability in a HPV 16/18-positive scenario without cytology in this threshold was estimated at 93%.

Conclusion: The Swede score cutoff ≥ 8 in women who tested positive for HPV 16/18 and had fully visible transformation zones can be an accurate method to predict that they have CIN2+. These results could support the decision to proceed with immediate treatment without prior cytology or biopsy.

Trial registration: Not applicable. This study does not report the results of a health care intervention.

Little research exists surrounding vulnerable birthing people and their relationships with planning and preventing pregnancy. This study aims to better describe services and barriers that impact family planning choices, including housing, primary care provider accessibility, and insurance access among participants in the Parent Child Assistance Program (PCAP). Participant data was derived from 59 participants enrolled in PCAP, a case management program for birthing people who use substances. Amongst the participants who were recently pregnant, 7/59 (12%) were using birth control around the time of conception of that pregnancy. Of the participants who were not recently pregnant, 53% of clients were using birth control upon intake. This figure rises incrementally by 24 months. Data showed that those with health insurance are almost twice as likely to be using contraceptives at intake. The low prevalence of birth control use even after a recent pregnancy suggests significant barriers still exist in terms of education and access to family planning resources for birthing people. This indicates the need for targeted interventions and supports that empower birthing people to make decisions about their reproductive health.