Contraception and reproductive medicine最新文献

Background: Sexual and reproductive rights (SRRs) include the ability to make informed choices about family planning and reproductive health, free from discrimination, coercion, or violence. This study aimed to assess awareness and identify factors influencing perceptions of reproductive rights among women aged 15-35 years in Chandigarh.

Methods: A concurrent mixed-method study was conducted among 116 women in Chandigarh using a pretested, semi-structured tool for quantitative analysis. A grounded theory approach was used to explore perceptions among 37 women through six focus group discussions (FGD), guided by a pretested FGD guide. Quantitative data were analyzed using IBM SPSS Trial Version 26.0, while thematic analysis of qualitative data was conducted manually. Data integration was performed at the interpretation stage.

Results: Urban residents had significantly higher awareness of SRRs and legal abortion rights [Adjusted odds ratio (AOR) = 5.2, 95% CI = 1.5-17.5; AOR = 3.5, 95% CI = 1.28-9.55]. Unmarried women were more aware of abortion rights (AOR = 4.68, 95% CI = 1.83-11.06). Higher education was associated with greater awareness of family planning (AOR = 16.06, 95% CI = 2.8-91.6). Individual factors included differing priorities, hesitancy to discuss, and fear of abortion and contraceptive side effects. Family-related factors involved decision-making roles (in-laws and husbands). Societal factors included low autonomy and religious beliefs. The stigma surrounding reproductive health and sex education hindered women from exercising their rights.

Conclusion: Significant gaps exist in SRR awareness, particularly among married, less educated, and slum-dwelling women. Family control, religious beliefs, and stigma hinder reproductive autonomy.

Background: Infertility is a significant public health concern affecting millions of couples globally, with a particularly high prevalence in Sub-Saharan Africa, where its social and psychological impacts are profound. Despite advances in reproductive health research, comprehensive data on infertility in the region remain limited, and existing studies often yield inconsistent and inconclusive findings. Therefore, this systematic review and meta-analysis conducted to estimate the prevalence of infertility and identify its risk factors in Sub-Saharan Africa.

Methods: We conducted a systematic search of electronic databases and grey literature using predefined search terms. Original articles published in English between January 1, 2000, and May 30, 2024, reporting the prevalence and/or associated factors of infertility in Sub-Saharan Africa were included. The review followed PRISMA guidelines and was registered in PROSPERO (CRD42023428778). Data were extracted using the Joanna Briggs Institute tool. A random-effects meta-analysis using STATA version 14 generated pooled prevalence estimates with 95% confidence intervals (CIs). Heterogeneity was assessed using Cochran's Q and I² statistics; publication bias was evaluated using funnel plots and Egger's test.

Result: Sixteen primary studies from ten Sub-Saharan African countries, comprising a total of 22,303 participants were included in the review. The pooled prevalence of infertility in the region was 16.98% (95% CI: 11.62, 22.33%). Factors such as obstetric complications (OR = 7.94, 95% CI: 4.74, 13.30), STIs / PID (OR = 3.24; 95% CI: 2.33, 4.52), substance use (OR = 3.84, 95% CI: 1.71, 8.63), and women's age (OR = 2.19, CI: 1.48, 3.22) were identified as significant risk factors of infertility.

Conclusions: Nearly one in six couples in Sub-Saharan Africa experience infertility. Key contributing factors include STIs/PID, substance use, and obstetric complications. These findings highlight the need for targeted, context-specific reproductive health interventions and policies to mitigate the burden of infertility in the region.

Objective: To examine the association between attitudes towards contraception and future intention to use a method among women aged 15-45 years in two refugee settlements in Uganda.

Data and methods: We used baseline data from a prospective study conducted among 1794 sexually active women aged 15-45 years, who were not using a contraceptive method at the time of the survey in Kyangwali and Kiryandongo refugee settlements in Uganda. We generated descriptive statistics and chi-square tests to examine the association between intention to use a contraceptive method in future and beliefs and attitudes towards contraception.

Results: About a third (30.7%) of non-users intended to use a contraceptive method in future. The proportion of women who intended to use contraception in future was significantly higher among those who, or whose partners, supported its use compared to those who, or whose partners, opposed or were uncertain. Most women who did not intend to use contraception in future believed that their religion did not support married couples using contraception. More women intended to use a method in future if they believed that they could easily access it, the method is effective at preventing a pregnancy, and the method suitable to use or easy to use.

Conclusions: Intention to use a method in future was low among women living in refugee settings in Uganda, with side effects being a major reason for non-use among those who intend to use a method in future. Interventions aimed at increasing contraceptive use should focus on counselling strategies that diffuse misinformation related to health concerns.

Objective: This study aimed to evaluate the effectiveness of Platelet-Rich Plasma (PRP) in preserving ovarian reserve in patients with endometriosis who underwent laparoscopic cystectomy.

Method: A randomized, parallel, open-label phase II clinical trial was conducted. A total of 38 eligible women aged 20 to 35 years with ovarian endometrioma, candidates for laparoscopic ovarian cystectomy, were randomly assigned to either the PRP group (n = 20) or the control group (n = 18). The PRP group received an intra-ovarian injection of 2-4 cc of PRP immediately after cystectomy, while the control group underwent cystectomy without additional intervention. The primary outcome was the change in serum anti-Müllerian hormone (AMH) levels six months post-intervention. The secondary outcome was the antral follicle count (AFC) six months post-intervention. Short-term adverse effects were monitored within the first 48 h after the procedure.

Results: The PRP group showed a negligible change in AMH levels (mean difference 0.05, 95% CI: -0.17 to 0.26), while the control group exhibited a significant decline (mean difference - 0.24, 95% CI: -0.5 to 0.12). The adjusted mean difference between the groups was - 0.308 (-0.626 to -0.01), tending toward statistical significance (P = 0.057). No significant differences in AFC were observed between the groups, and no short-term adverse events were reported.

Conclusions: This phase II exploratory trial found a near-significant trend toward preservation of AMH levels with intra-ovarian PRP injection after endometrioma surgery. While these findings are not definitive, they support the feasibility and safety of the approach and warrant further evaluation in larger, controlled trials.

Trial registration: The study was prospectively registered in the Iranian Registry of Clinical Trials under the number IRCT20191123045476N3 on December 1, 2021 ( https://irct.behdasht.gov.ir/trial/58688 ).

Introduction: Little research has focused on measuring free contraceptive choice, or whether individuals can make decisions about contraception without barriers or coercion. To advance measurement, we pilot survey questions focused on experiences of provider-imposed contraceptive coercion using population-based data collected among contraceptive users in Kisumu, Kenya.

Methods: We describe the percentage of women who reported provider-imposed coercion-related outcomes. We then examine demographic and facility-level correlates of feeling pressured or unable to say no to contraception and compare the extent that measures of feeling pressured and unable to say no to contraception overlap using 2 × 2 tables and Cohen's Kappa Statistic.

Results: The percentage of participants who reported provider-imposed coercion ranged by question from 1% to 57%. There were no associations between demographic or facility characteristics, including age, marital status, parity, and facility type (public or private), and either reporting feeling pressured or reporting feeling unable to say no to using contraception. There was no agreement between measures of feeling pressured and unable to say no to contraception (Kappa statistic - 0.11).

Conclusions: Our findings suggest that many women in Kisumu report experiencing some form of provider-imposed contraceptive coercion, though the proportion who report such experiences varies based on survey question. Further research is needed to improve reliable measurement of free contraceptive choice.

Background: Few studies have examined the sociodemographic characteristics associated with modern contraceptive use in Japan. This study investigated these associations using data from the National Fertility Survey.

Methods: Data were retrieved from the National Fertility Survey targeting unmarried individuals and married women in Japan. The analysis included unmarried individuals with sexual experience and sexually active married women intending to stop or space childbirths. Modern contraceptive use was examined in relation to sociodemographic characteristics, including age group, number of children, educational attainment, employment status, and income, among unmarried men and women as well as married women. Modified Poisson regression models were employed for the analysis.

Results: Data from 4,874 unmarried individuals and 1,533 married women were used in the analysis. Among both groups, younger age was associated with a higher prevalence of modern contraceptive use. Among unmarried individuals, having one or two children was significantly negatively associated with modern contraceptive use. Conversely, among married women, having multiple children was positively associated with modern contraceptive use. Additionally, a significant negative association was found between being a junior high or high school graduate and modern contraceptive use among unmarried men. Similarly, a significant negative association was observed among married women who were high school graduates. Conversely, modern contraceptive use was significantly positively associated with being an unemployed wife.

Conclusions: Modern contraceptive use in Japan was associated with various sociodemographic characteristics, including the number of children, educational attainment, and employment status.