BMJ Sexual & Reproductive Health最新文献

Background: Women and gender-diverse people are a fast-growing population in prisons in Australia. Incarceration can create barriers to accessing sexual and reproductive healthcare. The objective of this scoping review was to identify what is known about the sexual and reproductive health experiences, needs and outcomes of women and gender-diverse people incarcerated in Australia.

Methods: We used the Joanna Briggs Institute methodology for systematic scoping reviews. Databases searched included PsycINFO, Gender Studies Database, MEDLINE and CINAHL. The search yielded 658 titles and abstracts of which 17 met the criteria for inclusion.

Results: We identified 17 studies published between 2000 and 2023 across three states. The studies included qualitative, quantitative and mixed-methods designs. The main outcomes of interest included: pregnancy and maternal health, contraception, sexually transmitted infections, experiences of sexual violence, and cervical health screening and outcomes.

Conclusions: Evidence indicates that women and gender-diverse populations in prison in Australia experience high rates of sexually transmitted infections, poor perinatal health outcomes, and unmet needs related to contraception access and perinatal health services and programmes. The negative health impacts of incarceration are especially pronounced for Aboriginal and/or Torres Strait Islander women, who face additional discriminatory institutional barriers to participating in health programmes and experience a lack of culturally safe and appropriate care.

Background: Reproductive coercion (RC) is a form of gender-based violence that interferes with reproductive autonomy. General practice is a key primary care setting where individuals, particularly women, access support for sexual and reproductive health (SRH). However, limited research explores how general practice clinicians recognise and respond to RC. We aimed to explore how general practitioners (GPs) and practice nurses (PNs) recognise and respond to RC in Australian general practice.

Methods: A qualitative descriptive study was conducted using semi-structured interviews with 10 GPs and 6 PNs. Interviews were conducted via Zoom, transcribed verbatim and analysed using inductive content analysis.

Results: Participants identified consultation-based 'red flags', including partner dominating the consult, patient discomfort, and disruptions in appointment or contraception use, that prompted RC inquiry. Participants proactively asked about RC in SRH consultations, tailoring questions to the context of contraception, pregnancy, or abortion care. Balancing safety, autonomy, and support was described as challenging, especially in cases involving adolescents or women with disabilities where carers or parents influenced patient consent. Participants described practical and patient-centred strategies, such as using telehealth consultations, discreet signals, covert care planning, and whole-of-practice team-based vigilance, to support women experiencing RC in general practice.

Conclusions: Findings highlight how general practice clinicians in Australia recognise and respond to RC and can inform the development of clinical guidelines and practice approaches to strengthen recognition and response to RC in general practice.

Background: Interconception care (ICC), provided between pregnancies, can improve women's health, pregnancy outcomes and infant health. Women face challenges in accessing and prioritising ICC due to issues including caring roles, transport and clinician availability. We aimed to elicit women's preferences for ICC engagement.

Methods: A discrete choice experiment (DCE) was conducted to assess women's preferences about ICC. Australian women who had experienced pregnancy completed an online survey in March 2024 comprised of questions about sociodemographic characteristics, ICC attitudes regarding informational needs, healthcare professional involvement and service location. We used a mixed logit model to analyse DCE responses, willingness to pay estimates for different attribute levels and applied latent class modelling to explore preference heterogeneity. Free text responses were grouped by key ideas.

Results: From 191 responses, numbers were similar across age categories, 46% had experienced pregnancy loss, and 87% had a child/children. Respondents preferred ICC provided by a nurse/midwife, offered during home visits or in-person consultations with a child-friendly waiting area, with appointments lasting 30 or 60 min, and at lower costs. There were no strong preferences regarding appointment wait times. Respondents favoured consultations scheduled up to 1 year after delivery. Follow-up questions indicated that most identified informational needs about emotional and mental health support (74.3%) as important, midwives were a preferred healthcare professional (71.7%) and general practice was the most favoured ICC location (64.9%).

Conclusions: Ensuring clinician and setting familiarity, longer appointment times and lower appointment costs will support women's access to ICC. Policy and funding support are needed for ICC provision.

Objective: To critically review post-abortion contraception literature from the UK based on Bacchi's 'What's the Problem Represented to Be?' (WPR) approach.

Methods: A systematic search of six electronic databases - complemented by a grey literature search encompassing reports, policy documents and government publications - identified a total of 31 publications: 19 peer-reviewed articles and 12 items of grey literature.

Results: Multiple - and sometimes conflicting - 'problem representations' coexisted across the texts, operating at different levels of abstraction. Applying the WPR approach, six 'problems' were identified: existing abortion rates and repeat abortion; risky groups; meeting service users' needs; organisational capacity; knowledge of contraceptive methods; and abortion stigma.

Conclusions: While some problem representations focused on service user needs, care satisfaction and organisational capacity, the dominant framing positioned abortion rates - particularly subsequent abortions - as the central 'problem'. It is implied that too many abortions are being had and that a key purpose of post-abortion contraception is to address this issue. Abortion was often framed as an individual's failure to use (effective) contraception (correctly). This places the burden on individuals, further exacerbates abortion stigma and obscures structural constraints. Several conceptual slippages were identified, including using 'unplanned', 'unintended' and 'unwanted' pregnancy synonymously. Such practices risk collapsing and misrepresenting different kinds of lived experiences, creating barriers to the provision of person-centred abortion and contraceptive care. We recommend greater critical reflection on the language and assumptions within post-abortion contraception discourse to ensure research, policy and practice remain person-centred, evidence-informed and committed to principles of reproductive justice.