BMJ Sexual & Reproductive Health最新文献

Background: In general practice, primary care providers can potentially use electronic medical records (EMRs) to identify and invite reproductive-aged women with preconception health risk factors to increase their engagement in preconception care (PCC). However, the acceptability of receiving PCC invitations and women's preferences about the invitation process are poorly understood. This study aims to investigate women's acceptability and preferences for receiving PCC invitations from general practice settings.

Methods: Participants were recruited via convenience, purposive and snowball sampling. Semi-structured interviews were conducted via Zoom from August until November 2023. Interviews were transcribed verbatim and inductive reflexive thematic analysis was undertaken.

Results: PCC invitations sent from general practice are acceptable if the language is sensitive and non-stigmatising. Text or email invitations detailing the importance and scope of the PCC consultation were preferred, after discussing reproductive intentions with a general practitioner or practice nurse. Women with preconception health risk factors or those actively trying to conceive were more likely to engage in PCC. Key strategies to enhance PCC engagement include advertising in waiting rooms, introducing PCC in new patient registration forms, and integrating PCC into holistic care.

Conclusion: Using EMRs to identify and invite women with preconception health risk factors to increase their engagement in PCC is generally acceptable. Invitations sent via text messages or emails are preferred. It is crucial to use respectful and appropriate language to avoid stigmatising or offending women, particularly those with infertility issues, those who have completed their families, or those who do not wish to have children.

Background: The postpartum period is a high-risk time for unintended pregnancy. We developed a 2-minute audiovisual animation on postpartum contraception (PPC) including the return of fertility after birth for patients. The aim of our study was to determine the views of healthcare professionals (HCPs) involved in pregnancy care on the animation and to identify facilitators and barriers to its implementation into routine pregnancy care pathways.

Methods: An anonymous online questionnaire was circulated to 100 HCPs (midwives, doctors, health visitors) in Glasgow, Scotland, UK who provide antenatal and/or postnatal care. The aim was to collect 50 responses. The questionnaire contained 12 questions including fixed responses, categorical Likert rating scale questions and open-ended questions. Content analysis was used for the free-text responses.

Results: Forty-four responses were obtained. HCPs rated the animation positively for information and inclusivity (95%), accessibility for those with a disability (81.8%) and non-English speaking (59%), and usefulness for HCPs (88.6%) and pregnant individuals (97%). Some felt the animation should contain more information or could be displayed on digital screens in clinical waiting areas. Suggestions were made as to the optimal time to view the animation in pregnancy and the importance of choice of whether/how to view and considerations on trauma-informed care. Accessibly for HCPs was mentioned, with considerations on how the resource could alleviate perceived service and financial pressures.

Conclusions: The animation was felt to be an engaging, inclusive and informative knowledge tool for patients. Consideration needs to be given to allow choice to view, timing and the appropriate digital media for delivering it.

Background: Pregnancy offers an opportunity to provide equitable access to contraception information and provision, and professional bodies advocate provision of contraception in the immediate postpartum period. This study examines the contribution of pre-registration midwifery education in preparing student midwives for this aspect of their role.

Method: A qualitative study using semi-structured interviews. Interviews were recorded, transcribed and analysed using thematic analysis. Nine lecturers from pre-registration midwifery programmes representing nine universities in England were interviewed.

Results: There is minimal contraception and sexual health content on pre-registration midwifery programmes; however, specialist lecturers enhance the learning experience. Talking about sex may be difficult, particularly for younger students. Student midwives observe little discussion/provision of contraception in practice and are unlikely to consider it part of a midwife's role.

Conclusions: A formally assessed national standard of knowledge on pre-registration programmes would be helpful, and this needs to be reflected in practice to become embedded. Institutional investment and commitment to continuous practice development is needed for all midwives. Practice placements in sexual and reproductive health clinics or abortion services may be beneficial to student midwives.

Background: The etonogestrel (ENG) subdermal implant is considered a well-tolerated and effective contraception option to avoid unintended pregnancies. However, it is unclear whether being affected by overweight or obesity diminishes the effectiveness of the implant.

Objectives: To systematically assess the published evidence on implant contraceptive effectiveness in women with overweight or obesity, and in women who underwent bariatric surgery.

Search strategy: A systematic search of MEDLINE and Embase for publications reporting implant effectiveness since 2011.

Selection criteria: Primary publications of randomised and non-randomised trials, observational studies and case reports were included.

Data collection and analysis: Two independent reviewers identified the Pearl Index, qualitative descriptions of contraceptive failure, implant exposure and potential bias, and assessed overall quality of evidence.

Main results: We found 12 publications meeting our criteria, consisting of nine observational studies and three case reports. Excluding case reports, the publications reported Pearl Indices from 0.0/100 women-years (WY) to 0.23/100WY for women with overweight and obesity, respectively. No studies met the eligibility criteria for the post-bariatric surgery population.

Conclusions: Observed implant effectiveness in women with overweight and obesity falls within the range of published data across all weight groups (0.0-1.4/100 WY) and does not suggest a reduced effectiveness associated with higher body mass index. Large, well-controlled studies designed to specifically assess the effectiveness of the ENG implant with respect to user weight, particularly in women following bariatric surgery, are warranted.

Objectives: To gather views of healthcare professionals on the regulation and provision of abortion in Britain.

Methods: Cross-sectional, stratified cluster sample survey of healthcare professionals working in a range of healthcare services including abortion services. Measures included knowledge of and attitudes towards the regulation and provision of abortion.

Results: A total of 771 healthcare professionals responded. More than nine in ten supported abortion being a woman's choice and a clear majority favoured abortion being treated as a health rather than a legal issue. Some 6.2% saw abortion at any gestational age as contrary to personal beliefs and a similarly small minority (6.7%) opposed abortion after 12 weeks' gestation. One in five of all healthcare professionals and a third of those aged under 30 years were unaware that the law in Britain requires two doctors to authorise an abortion. Free-text comments revealed opposition to the need for this legal requirement. Support for an extended role for nurses in abortion care was high; 65.3% agreed that nurses should be able to prescribe abortion medication. Little more than a third of all healthcare professionals (37.0%) agreed that abortion should be standard practice in their service; the proportion was highest among those in sexual and reproductive health services (58.4%) and lowest among those in general practice (18.7%).

Conclusions: Healthcare professionals in Britain were generally supportive of abortion being treated in the same way as other health issues and would be likely to support any moves to decriminalise abortion.