BMJ Sexual & Reproductive Health最新文献

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.

Introduction: We aim to describe and compare the prevalence of subjective side effects associated with hormonal contraceptive use among reproductive healthcare users seeking either abortion care or contraceptive services.

Methods: This substudy derives from a previously reported cross-sectional survey involving 1006 users of public reproductive healthcare services in the Helsinki metropolitan area in Finland. We included all 813 respondents with a history of hormonal contraceptive use (mean age 27 years, IQR 24-33 for abortion care; 24 years, IQR 19-30 for contraceptive services). The study followed STROBE guidelines.

Results: Altogether 400 respondents sought abortion care, while 413 sought contraceptive services (counselling, prescription renewal, symptoms and/or dissatisfaction with their contraceptive method). Combined oral contraceptives and progestin-only pills were the most used methods in both groups. Respondents seeking abortion care reported contraception-associated weight changes, sex-related problems, mood changes, and acne more frequently than those seeking contraceptive services (p-value<0.05 for all). Some 52% of respondents seeking abortion care reported mood changes compared with 29% of those seeking contraceptive services, with a crude OR of 2.7 (95% CI 2.00 to 3.57). After adjustment, the OR for reporting mood changes among respondents seeking abortion care was 1.5 (95% CI 1.05 to 2.23).

Conclusions: Mood changes associated with hormonal contraceptive use were the most frequently reported side effect among all respondents. These findings suggest a need for individualised counselling on mood-related side effects as mood changes may contribute to higher discontinuation rates.

Background: Misinformation about abortion is widespread and was exacerbated by the overturn of Roe v Wade. Young adults are among those facing the most direct impacts of new abortion restrictions and are more likely to access health information from online sources, where misinformation is prevalent. We explored how young adults perceive and evaluate abortion-related information in a time of heightened abortion restrictions.

Methods: We conducted in-depth, semi-structured interviews with 25 young adults (aged 18-24 years, 56% assigned female at birth), recruited across 17 US states (44% living in states with restrictive abortion policies), between June and September 2022. We derived themes from the interviews using reflexive thematic analysis.

Results: While many participants were aware of and had personally encountered abortion misinformation, their susceptibility to false claims varied substantially based on their previous knowledge of abortion and exposure to anti-abortion rhetoric. Participants tended to reject some common myths regarding the medical risks of abortion (eg, association with breast cancer), while expressing a wider range of views regarding its impacts on fertility and mental health. When presented with contradictory sources of abortion information, most participants were unable to confidently reject the misleading source. Knowledge gaps left participants vulnerable to misinformation, while prior scepticism of anti-abortion rhetoric protected participants against misinformation.

Conclusions: In this diverse national sample, young adults demonstrated a range of perceptions of abortion misinformation and approaches to identify it. These results lay the groundwork for future observational and experimental research in public health communication.

Background: Social stigma and the marginalisation of abortion care within medical settings can negatively affect abortion providers. While some research has evaluated stigma interventions in legally restrictive settings, little work has explored the experiences of healthcare professionals (HCPs) providing abortion and post-abortion care (PAC) outside the USA. This study, part of the Royal College of Obstetricians and Gynaecologists' 'Making Abortion Safe' programme, aimed to understand providers' experiences of abortion stigma in four African countries with restrictive legislation.

Methods: In-depth interviews with 44 abortion and PAC providers were conducted in Nigeria, Rwanda, Sierra Leone and Zimbabwe.

Results: Four themes emerged: personal and professional effects of stigma, multiple manifestations of stigma, driving forces of stigma, and positivity and resilience. Stigma affects providers' professional identity, community belonging and relationships. Restrictive legal frameworks are the main driver of abortion stigma, operating at multiple levels that reinforce each other. The legal status of abortion labels it as 'dirty work', conflicting with healthcare principles. Judgmental attitudes from other HCPs negatively impact providers' well-being and care quality. However, providers showed resilience through professional and personal commitment, and the belief in 'doing the right thing' helped them resist stigma.

Conclusions: Legal changes are crucial for increasing access and reducing stigma among the workforce. In these countries, providers face challenges in offering legal healthcare. Organisational interventions are needed to address stigmatising values and create positive workplaces. Ongoing support is essential for HCPs to remain resilient against abortion stigma, helping to normalise abortion care and those who provide it.

Background: Self-injectable contraceptives, namely subcutaneous depot medroxyprogesterone acetate 104 mg micronised formulation delivered via uniject system, reduce the need to travel to a facility for contraceptive access, but the initial, in-person, training may be a barrier to starting this method. This article reports on a small, exploratory pilot in Kenya to test the feasibility and acceptability of digital self-injection training.

Methods: Participants (n=11) who were currently using injectable contraceptives, intramuscular depot medroxyprogesterone acetate 150 mg injected by a healthcare worker, received digital self-injection training from a trained clinician via a WhatsApp video call. Participants administered a simulated self-injection on a model and an actual self-injection (under supervision) on themselves. The participants' self-injection proficiency, a measure of the feasibility of remote training, was documented using a checklist, and participants were administered a questionnaire about their training experience. The training was observed, and content analysis was used to understand the functionality of training.

Results: All participants were proficient when performing the self-injection on themselves after receiving the remote training and reported that the training was acceptable. A barrier to training via a video call was lack of access to quality digital devices. Eight training 'lessons learnt' emerged from the training observations.

Conclusions: Training participants to administer self-injectable contraceptives via WhatsApp video call was feasible and acceptable. Training lessons learnt offer pragmatic adaptations for communicating about a practical skill via a digital channel. Further research is needed to ascertain the efficacy of digital training for self-injection and feasibility and acceptability for wider groups.