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Tirado V, Engberg S, Holmblad IS, Strömdahl S, Ekström AM, Hurtig AK. "One-time interventions, it doesn't lead to much" - healthcare provider views to improving sexual and reproductive health services for young migrants in Sweden. BMC Health Serv Res 2022; 22:668. [PMID: 35585585 PMCID: PMC9115984 DOI: 10.1186/s12913-022-07945-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 04/11/2022] [Indexed: 11/14/2022] Open
Abstract
Background Sexual and reproductive health and rights (SRHR) is an important aspect for young people. In Sweden, young migrants often encounter barriers to accessing and using sexual and reproductive health (SRH) services, despite that these services are free of charge for young people (ages 15–25). Healthcare providers’ views and best practices are of great importance for improving the utilisation of existing SRH services, particularly for young people. This study aims to understand healthcare providers’ experiences and perspectives on barriers to SRHR among young migrants and their suggestions for strategies to improve the provision of SRH services to this group. Methods Midwives, counsellors and nurses with at least five years of professional experience within SRHR were reached through a purposeful sample at primary care clinics, specialised clinics and youth-friendly clinics, which provide SRH services to migrant youths in Stockholm. Twelve interviews were conducted from May 2018 to February 2020. Qualitative content analysis was performed. Results The analysis identified one theme: Improving the fragmentation in the SRH services, and four sub-themes: 1. Being unaware of SRHR; 2. Creating trust and responsive interactions; 3. Communicating in the same language; and 4. Collaborating to build bridges. The barriers included distrust in the healthcare system, socio-cultural norms surrounding SRHR, incomplete translations, and a need for long-lasting collaboration with SRH services and other range of services for migrants. The strategies for improvement as suggested by participants included involving existing cultural groups and organisations to enable trust, consistent and dependable interpreters, a streamline of SRH services with other healthcare staff and health facilities, and collaborations with homes designated for young migrants and language schools for a direct linkage to service providers. Conclusions Findings indicate that there are fragmentations in SRH services, and these include lack of knowledge about SRHR among migrant youth, language and communication barriers, and a lack of structure needed to build dependable services that go beyond one-time interventions. While initiatives and strategies from healthcare providers for improvement of SRH services exist, the implementation of some strategies may also require involving the regional and national decision-makers and multi-stakeholders like communities, civil society and young migrants themselves.
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Affiliation(s)
- Veronika Tirado
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Siri Engberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Susanne Strömdahl
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Medical Sciences, Infectious Medicine, Uppsala University, Uppsala, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Venhälsan, Södersjukhuset, Stockholm, Sweden
| | - Anna Karin Hurtig
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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202
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Gouvernet B, Sebbe F, Chapillon P, Rezrazi A, Brisson J. Period poverty and mental health in times of covid-19 in France. Health Care Women Int 2022; 44:657-669. [PMID: 35549829 DOI: 10.1080/07399332.2022.2070625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We investigate the relationship between period poverty and anxiety and depression in women aged from 18 to 50 years in the context of the first French covid19 lockdown. 890 participants completed an online survey. Anxiety was assessed with the General Anxiety Disorder scale, depression with the Major Depression Inventory. 9.6% of participants experienced difficulties accessing period protection during the first lockdown. Among the women experiencing period poverty, 49.4% showed depressive symptoms compared to 28.6% of the women who had not experienced menstrual poverty, 40% showed anxious symptoms (vs 24.1%). The relationships between period poverty, depression and are significant even in adjusted models controlled by sociodemographics variables (depression: AOR = 2.191 [1.372 - 3.499]; anxiety: AOR = 1.793, [1.110 - 2.897]). As clinicians, psychologists or social workers, it seems interesting to go beyond the first symptoms of depression and anxiety and question the patients' access to menstrual health products.
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Affiliation(s)
- B Gouvernet
- Department of Psychology, CRFDP Laboratory, UFR SHS, Rouen Normandy University, Mont Saint Aignan, France
| | - F Sebbe
- Department of Psychology, CRFDP Laboratory, UFR SHS, Rouen Normandy University, Mont Saint Aignan, France
| | - P Chapillon
- Department of Psychology, CRFDP Laboratory, UFR SHS, Rouen Normandy University, Mont Saint Aignan, France
| | - A Rezrazi
- Department of Psychology, CRFDP Laboratory, UFR SHS, Rouen Normandy University, Mont Saint Aignan, France
| | - J Brisson
- Department of Psychology, CRFDP Laboratory, UFR SHS, Rouen Normandy University, Mont Saint Aignan, France
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203
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Macleod CI, Reynolds JH, Delate R. Women Who Sell Sex in Eastern and Southern Africa: A Scoping Review of Non-Barrier Contraception, Pregnancy and Abortion. Public Health Rev 2022; 43:1604376. [PMID: 35646420 PMCID: PMC9131513 DOI: 10.3389/phrs.2022.1604376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/15/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: There is a need to hone reproductive health (RH) services for women who sell sex (WSS). The aim of this review was to collate findings on non-barrier contraception, pregnancies, and abortion amongst WSS in Eastern and Southern African (ESA). Methods: A scoping review methodology was employed. Inclusion criteria were: 1) empirical papers from 2) ESA, 3) published since 2010, and 4) addressing WSS in relation to 5) the identified RH issues. Results: Reports of rates of non-barrier contraceptive usage varied from 15% to 76%, of unintended pregnancy from 24% to 91%, and of abortion from 11% to 48%. Cross-cutting factors were alcohol use, violence, health systems problems, and socio-economic issues. Pregnancy desire was associated with having a non-paying partner. Barriers to accessing, and delaying, antenatal care were reported as common. Targeted programmes were reported as promoting RH amongst WSS. Conclusion: Programmes should be contextually relevant, based on local patterns, individual, interpersonal and systemic barriers. Targeted approaches should be implemented in conjunction with improvement of public health services. Linked HIV and RH services, and community empowerment approaches are recommended.
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Affiliation(s)
- Catriona Ida Macleod
- Critical Studies in Sexualities and Reproduction, Rhodes University, Makhanda, South Africa
| | | | - Richard Delate
- 2gether 4 SRHR, United Nations Population Fund, Johannesburg, South Africa
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204
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Unmarried Adolescents’ Experiences of Using Reproductive and Maternal Health Services in Nigeria and Uganda: A Qualitative Study. SOCIAL SCIENCES-BASEL 2022. [DOI: 10.3390/socsci11050203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Adolescents’ access and use of reproductive and maternal health (RMH) services is a critical part of the global strategy for achieving the Sustainable Development Goals (SDGs). However, previous studies have shown that a complex range of factors, including restrictive policies and punitive laws, limit adolescents from accessing a full range of RMH services in Sub-Saharan Africa (SSA). Our study explores the experiences of unmarried adolescents’ access and use of RMH services in Nigeria and Uganda to understand the extent to which the diverse policy environment in both countries enables or hinders adolescents’ access to and use of RMH services. Our qualitative research design involved eight focus group discussions (FGDs) in Nigeria and in Uganda, 14 in-depth interviews, and eight FGDs among adolescents. The data were analysed thematically and organised according to the WHO’s five broad dimensions for assessing youth-friendly health services. Our findings show that RMH services were inequitably delivered in both countries. Adolescents were restricted from accessing services based on age and marital status. Being unmarried and having no partner, especially in Uganda, was a cause for discrimination during antenatal appointments. We also observed that the expectations of adolescents were not adequately met. Service providers tended to be impolite, judgemental, and unwilling to provide services, especially contraceptives, to younger and unmarried adolescents. Our findings suggest that the existence of a youth-friendly health policy does not translate into effective youth-friendly service provision. This underscores the need for further studies to understand the complexities surrounding this by using a realist evaluation method to examine how adolescent and youth-friendly health services can be designed to improve uptake of reproductive and maternal health services among adolescents in Sub-Saharan Africa.
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205
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Mulubwa C, Hurtig AK, Zulu JM, Michelo C, Sandøy IF, Goicolea I. Combining photo-elicitation and discourse analysis to examine adolescents' sexuality in rural Zambia. Int J Equity Health 2022; 21:60. [PMID: 35505309 PMCID: PMC9066825 DOI: 10.1186/s12939-022-01662-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/17/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION This article aimed to analyse constructions of adolescents' sexualities and sexual health and the consequences of these discourses for adolescents' exercise of their sexual reproductive health and rights (SRHR) in rural Zambia. METHODS Interpretative repertoires, which is rooted in discursive psychology was used to analyse data from photo-elicitations interviews and focus group discussions. Our participants included 25 adolescents who participated in a SRHR intervention that aimed to reduce adolescents' pregnancies and early marriages. RESULTS We identified three interpretative repertories: 1) sex is for mature people in which adolescents positioned themselves as 'immature, and young to engage in sex; 2) gendered respectful behaviours in which what was considered disrespectful (and respectful) behaviour in relation to sexuality were strongly influenced by gender, and more clearly defined for girls than it was for boys. Sexuality was not only about individual choices but about being respectful to parents; and 3) acquiring and using knowledge about sexuality in which adolescents conflicted between having and applying SRHR knowledge. CONCLUSION These repertories offer an important context that shape how adolescents negotiate, adopt and resist SRHR interventions. Future interventions that target adolescents' SRHR must aim to address the sexual scripts that serve to erect barriers against positive sexual behaviours, including access to SRHR services that promote safer sex.
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Affiliation(s)
- Chama Mulubwa
- School of Public Health, University of Zambia, P.O. Box 50110, Lusaka, Zambia. .,Department of Epidemiology and Global Health, Umeå University, Umeå, SE, Sweden. .,Centre of Infectious Diseases and Research in Zambia, P.O Box 34620, Lusaka, Zambia.
| | - Anna-Karin Hurtig
- Department of Epidemiology and Global Health, Umeå University, Umeå, SE, Sweden
| | - Joseph Mumba Zulu
- School of Public Health, University of Zambia, P.O. Box 50110, Lusaka, Zambia
| | - Charles Michelo
- School of Public Health, University of Zambia, P.O. Box 50110, Lusaka, Zambia
| | - Ingvild Fossgard Sandøy
- Department of Global Public Health and Primary Care, Centre for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health (CIH), University of Bergen, Bergen, Norway
| | - Isabel Goicolea
- Department of Epidemiology and Global Health, Umeå University, Umeå, SE, Sweden
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206
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Kaya Senol D, Polat F. Effects of the pandemic on women's reproductive health protective attitudes: a Turkish sample. Reprod Health 2022; 19:106. [PMID: 35501810 PMCID: PMC9059458 DOI: 10.1186/s12978-022-01412-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/11/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This descriptive, cross-sectional study was performed to examine the effects of the COVID-19 pandemic on women's reproductive health protective attitudes. METHODS The study sample included 306 women and data were collected through a web-based, online questionnaire. The data were collected using the Personal Information Form, Determination of Married Women's Reproductive Health Protective Attitudes Scale. Descriptive statistics, independent samples t-test, ANOVA test were used to assess the data. RESULTS The mean scores for Determination of Married Women's Reproductive Health Protective Attitudes Scale significantly differed in terms of education, employment status, income, health insurance and perceived health status (p < 0.05). A total of 69.3% of women had their first pregnancy at the agerange of 21-34 years, 17.6% of the women had four or more pregnancies, 55.6% of the women gave birth 1-3 times, 13.4% of the women gave birth at home and 57.8% of the women did not use modern family planning methods. A total of 23.2% of women experienced a problem with their reproductive organs during the pandemic, 70.6% of them did not present to a health center for their problems and 74.5% of these women did not present to a health center to avoid the risk of COVID-19 transmission. A total of 40.2% of women used the methods they already know at home to relieve their problems and 16.0% of the women used them edications previously prescribed by their doctors. CONCLUSION The pandemic negatively affects there productive health of women. In the COVID-19 pandemic, health policies should be planned in accordance with the continuation of reproductive health and sexual health services.
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Affiliation(s)
- Derya Kaya Senol
- Department of Midwifery, Faculty of Health Sciences, Osmaniye Korkut Ata University, Osmaniye, Turkey
| | - Filiz Polat
- Department of Midwifery, Faculty of Health Sciences, Osmaniye Korkut Ata University, Osmaniye, Turkey
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207
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Measuring contraceptive use in a displacement-affected population using the Multiple Indicator Cluster Survey: the case of Iraq. J Migr Health 2022; 6:100114. [PMID: 35677661 PMCID: PMC9168485 DOI: 10.1016/j.jmh.2022.100114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/19/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Abstract
Offers substantive and methodological contributions to the literature on IDP health. Uses Multiple Indicator Cluster Survey data with displacement screening questions. Tests associations between modern contraceptive use and displacement in Iraq. Total survey error and feminist approaches highlight the limits of national household surveys.
Access to safe, effective, affordable, and acceptable contraceptive methods of choice is a basic right for displaced people. Yet displaced people are typically invisible in national sample surveys on population health, and quantitative evidence on their reproductive health outcomes is limited. This study focuses on the case of Iraq, a country with widespread displacement and where contraceptive use is a government policy priority. Using displacement screening questions in the Iraq 2018 Multiple Indicator Cluster Survey questionnaires, I construct two displacement-related indicators based on reason for last move and previous household residence. Descriptive statistics and binary logistic regression are used to test associations between modern contraceptive use and displacement, demographic, and socioeconomic factors. Controlling for the variables in the models, factors significantly associated with modern contraceptive use among married women aged 15–49 in Iraq are Federal Iraq region (reference Kurdish Region of Iraq, OR 1.78), upper secondary and primary education (reference pre-primary or no education, OR 1.50 and 1.20, respectively), parity, age, and exposure to television. The association between displacement (reason for last move) and modern contraceptive use significantly depends on a woman's level of education and whether they live in an urban or rural area. Women who previously lived in a camp are almost half as likely to use modern contraception compared to other previous residence types. This paper highlights the methodological potential and substantive value of using national household surveys to analyse reproductive health outcomes through a displacement lens. It also critically examines the limitations of these data and measures, drawing on total survey error and feminist theory.
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208
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Choi B, Yoon J, Kim JH, Yoo J, Sorensen G, Kim SS. Working Alone, Limited Restroom Accessibility, and Poor Menstrual Health Among Cosmetics Saleswomen in South Korea. New Solut 2022; 32:40-47. [PMID: 35243928 DOI: 10.1177/10482911221083666] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Menstrual hygiene management (MHM) at work has been neglected in occupational health research despite its importance for female workers' health. This study investigated the association between hours of working alone and poor menstrual health among 740 cosmetics saleswomen in South Korea. Hours of working alone in a day were classified into 4 categories. MHM was measured by asking "Over the past six months, have you ever experienced that you could not change your sanitary pad when you need to change it at work?" We also measured the experience of dermatopathy due to unchanged sanitary pads. Cosmetics saleswomen who worked alone for 3 h or more in a day reported a higher prevalence of ever being unable to change the sanitary pads (prevalence ratio [PR] 1.84, 95% confidence interval [CI]: 1.37-2.46) and dermatopathy due to unchanged sanitary pads (PR 2.06, 95% CI: 1.18-3.59) than those who worked alone less than 1 h in a day.
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Affiliation(s)
- Bokyoung Choi
- Department of Public Health Sciences, Korea University, Seoul, Republic of Korea
| | - Jaehong Yoon
- Department of Public Health Sciences, Korea University, Seoul, Republic of Korea
| | - Ji-Hwan Kim
- Department of Public Health Sciences, Korea University, Seoul, Republic of Korea
| | - Junghun Yoo
- Future Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Glorian Sorensen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston MA, USA
| | - Seung-Sup Kim
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston MA, USA.,Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Republic of Korea, South Korea
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209
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Gillespie B, Balen J, Allen H, Soma-Pillay P, Anumba D. Shifting Social Norms and Adolescent Girls' Access to Sexual and Reproductive Health Services and Information in a South African Township. QUALITATIVE HEALTH RESEARCH 2022; 32:1014-1026. [PMID: 35592927 PMCID: PMC9189597 DOI: 10.1177/10497323221089880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Despite policy on adolescent sexual and reproductive health (SRH) services and education, teen pregnancies remain common in South Africa. Social norms and cultural resistance are a well-documented challenge for SRH program implementation in South Africa, and beyond. To gain insight on the complex picture of adolescents' access to SRH information and services in a peri-urban township, we explored this topic from a diversity of perspectives, carrying out 86 interviews to capture perceptions of adolescents, their parents, community members, and health professionals. Our research shows that despite the taboo nature of the issue of adolescent SRH, individual positions on adolescent access to SRH services and information are shifting and diverse, and are influenced by factors other than cultural norms. This research serves as a reminder to avoid simplistic reference to "culture" as a way of explaining health-related behaviors and people's responses to health challenges.
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Affiliation(s)
- Bronwen Gillespie
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Julie Balen
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Haddijatou Allen
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Priya Soma-Pillay
- Department of Obstetrics and Gynaecology, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Dilly Anumba
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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210
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Razafimahefa RH, Pardosi JF, Sav A. Occupational Factors Affecting Women Workers’ Sexual and Reproductive Health Outcomes in Oil, Gas, and Mining Industry: A Scoping Review. Public Health Rev 2022; 43:1604653. [PMID: 35574566 PMCID: PMC9096608 DOI: 10.3389/phrs.2022.1604653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: Globally, female workers workforce in Oil, Gas, and Mining (OGM) industry have increased significantly. The complexities of the OGM operations and the extensive exposure to workplace hazards potentially affect the health status of workers, including sexual and reproductive health (SRH) outcomes of female workers. Yet, the current state of knowledge on SRH issues in OGM contexts seems to be limited and fragmented. This scoping review aims to identify the occupational factors that influence women’s SRH outcomes in OGM industry.Methods: This scoping review followed the Joanna Briggs Institute’s guidelines (PRISMA) and was conducted in five databases, including the citation chaining via Google Scholar and manual search through relevant organisations and Government websites. Sixteen articles met the inclusion criteria and were analysed.Results: Despite the scarcity of evidence, chemical and physical are found to be the predominant factors greatly influencing women workers’ SRH outcomes in OGM. Most studies showed menstrual and cycle disorders, and risky pregnancy as key SRH issues. However, menstruation disorder was considerably linked with psychological and organisational factors.Conclusion: This review suggests further empirical research on the relationship between OGM occupational hazards and women workers’ SRH. This will contribute to improvements in workplace safety legislations, measures, policies, and management systems taking into account women’s needs.
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Affiliation(s)
- Rina Hariniaina Razafimahefa
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
- Centre for Accident Research and Road Safety, Queensland University of Technology, Kelvin Grove, QLD, Australia
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
- *Correspondence: Rina Hariniaina Razafimahefa,
| | - Jerico Franciscus Pardosi
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Adem Sav
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
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211
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Vincent R, Krishnakumar K. School-Based Interventions for Promoting Sexual and Reproductive Health of Adolescents in India: A Review. JOURNAL OF PSYCHOSEXUAL HEALTH 2022. [DOI: 10.1177/26318318221089621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In India, the prevalent stigma and taboos regarding sexuality prevent adolescents from acquiring information about sexual and reproductive health. This review assessed the school-based interventions for adolescents designed to enhance their sexual health knowledge, attitudes, and behaviors. Studies were gathered from 4 online databases: PubMed, DOAJ, Google Scholar, and ScienceDirect. Relevant studies conducted in India among adolescents, published in peer-reviewed journals between 2000 and 2020, available in the public domain and written in English, were considered for the review. 14 studies were selected through database searches that fulfilled the eligibility criteria. Findings highlighted that school-based sexuality education positively influences adolescents to develop their knowledge, attitude, and behavior related to sexual and reproductive health outcomes. Sexual and reproductive health (SRH) programs and interventions are limited to small-scale experiments conducted in a few schools. The researchers recommend educating adolescents about pregnancy prevention, sexually transmitted infections (STIs), sexual hygiene, and reproductive health. Comprehensive reproductive health education programs should be implemented in every school setting to ensure that all school-going adolescents are convinced of the importance of sexual and reproductive health.
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Affiliation(s)
- Rosna Vincent
- Department of Social Work, Pondicherry University, Puducherry, Puducherry, India
| | - K. Krishnakumar
- Department of Social Work, Pondicherry University, Puducherry, Puducherry, India
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212
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Khalil M, Carasso KB, Kabakian-Khasholian T. Exposing Obstetric Violence in the Eastern Mediterranean Region: A Review of Women's Narratives of Disrespect and Abuse in Childbirth. Front Glob Womens Health 2022; 3:850796. [PMID: 35547827 PMCID: PMC9082810 DOI: 10.3389/fgwh.2022.850796] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/07/2022] [Indexed: 11/27/2022] Open
Abstract
Background Obstetric violence (OV) threatens the provision of dignified, rights-based, high-quality, and respectful maternal care (RMC). The dearth of evidence on OV in the Eastern Mediterranean Region poses a knowledge gap requiring research to improve rights-based and respectful health practice and policy. While efforts to improve the quality of maternal health have long-existed, women's experiences of childbirth and perceptions of dignity and respect are not adequately or systematically recorded, especially in the said region. Aim This study centered on the experiences of women's mistreatment in childbirth to provide an overview of OV and offer recommendations to improve RMC. Methods A scoping review was conducted, and a total of 38 articles met the inclusion criteria and were analyzed using Bowser and Hill's framework of the seven typologies of Disrespect and Abuse (D&A) in childbirth. D&A in childbirth (or violations to RMC) is a manifestation of OV and served as a proxy to analyze its prevalence in the EMR. Findings and Discussion This study indicated that across the EMR, women experienced every type of D&A in childbirth. This happens regardless of health systems' strength or country's income, with 6 out of 7 types of D&A found in almost two-thirds of included countries. In the EMR, the most common types of D&A in childbirth are physical abuse (especially overused routine interventions) and non-dignified care (embedded in patriarchal socio-cultural norms). The intersections of these abuses enable the objectification of women's bodies and overuse of unconsented routine interventions in a hierarchical and patriarchal system that regards the power and autonomy of doctors above birthing women. If unchecked, the implications include acceptance, continuation, and underreporting of D&A in childbirth, as well as passivity toward human-rights violations, which all further cause the continuing the cycle of OV. Conclusion In order to eliminate OV, a paradigm shift is required involving infrastructure changes, education, empowerment, advocacy, a women-centered and gender-sensitive approach to health system strengthening, and policy development. Recommendations are given at individual, community, health systems, and policy levels to ensure that every woman achieves her right to health and birth in a dignified, respectful, and empowered manner.
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Affiliation(s)
- Merette Khalil
- Your Egyptian Doula, Cairo, Egypt
- International Course for Health and Development, Health Unit, KIT Royal Tropical Institute, Amsterdam, Netherlands
- *Correspondence: Merette Khalil
| | - Kashi Barbara Carasso
- International Course for Health and Development, Health Unit, KIT Royal Tropical Institute, Amsterdam, Netherlands
| | - Tamar Kabakian-Khasholian
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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213
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Schaaf M, Boydell V, Topp SM, Iyer A, Sen G, Askew I. A summative content analysis of how programmes to improve the right to sexual and reproductive health address power. BMJ Glob Health 2022; 7:bmjgh-2022-008438. [PMID: 35443940 PMCID: PMC9021801 DOI: 10.1136/bmjgh-2022-008438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/27/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Power shapes all aspects of global health. The concept of power is not only useful in understanding the current situation, but it is also regularly mobilised in programmatic efforts that seek to change power relations. This paper uses summative content analysis to describe how sexual and reproductive health (SRH) programmes in low-income and middle-income countries explicitly and implicitly aim to alter relations of power. METHODS Content analysis is a qualitative approach to analysing textual data; in our analysis, peer-reviewed articles that describe programmes aiming to alter power relations to improve SRH constituted the data. We searched three databases, ultimately including 108 articles. We extracted the articles into a spreadsheet that included basic details about the paper and the programme, including what level of the social ecological model programme activities addressed. RESULTS The programmes reviewed reflect a diversity of priorities and approaches to addressing power, though most papers were largely based in a biomedical framework. Most programmes intervened at multiple levels simultaneously; some of these were 'structural' programmes that explicitly aimed to shift power relations, others addressed multiple levels using a more typical programme theory that sought to change individual behaviours and proximate drivers. This prevailing focus on proximate behaviours is somewhat mismatched with the broader literature on the power-related drivers of SRH health inequities, which explores the role of embedded norms and structures. CONCLUSION This paper adds value by summarising what the academic public health community has chosen to test and research in terms of power relations and SRH, and by raising questions about how this corresponds to the significant task of effecting change in power relations to improve the right to SRH.
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Affiliation(s)
- Marta Schaaf
- Independent Consultant, Brooklyn, New York, USA
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Victoria Boydell
- School of Health and Social Care, University of Essex Faculty of Science and Health, Colchester, UK
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Aditi Iyer
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Gita Sen
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
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Macharia P, Pérez-Navarro A, Sambai B, Inwani I, Kinuthia J, Nduati R, Carrion C. An Unstructured Supplementary Service Data–Based mHealth App Providing On-Demand Sexual Reproductive Health Information for Adolescents in Kibra, Kenya: Randomized Controlled Trial. JMIR Mhealth Uhealth 2022; 10:e31233. [PMID: 35436230 PMCID: PMC9055479 DOI: 10.2196/31233] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/07/2021] [Accepted: 02/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Adolescents transitioning from childhood to adulthood need to be equipped with sexual reproductive health (SRH) knowledge, skills, attitudes, and values that empower them. Accessible, reliable, appropriate, and friendly information can be provided through mobile phone–based health interventions.
Objective
This study aims to investigate the effectiveness and impact of an Unstructured Supplementary Service Data (USSD)–based app in increasing adolescents’ knowledge about contraceptives, gender-based stereotypes, sexually transmitted infections (STIs), abstinence, and perceived vulnerability, and helping adolescents make informed decisions about their SRH.
Methods
A randomized controlled trial (RCT) methodology was applied to investigate the potential of a USSD-based app for providing on-demand SRH information. To be eligible, adolescents aged 15 to 19 years residing in Kibra, Kenya, had to have access to a phone and be available for the 3-month follow-up visit. Participants were randomly assigned to the intervention (n=146) and control (n=154) groups using sequentially numbered, opaque, sealed envelopes. The primary outcome was improved SRH knowledge. The secondary outcome was improved decision-making on SRH. The outcomes were measured using validated tools on adolescent SRH and user perceptions during the follow-up visit. A paired sample t test was used to compare the changes in knowledge scores in both groups. The control group did not receive any SRH information.
Results
During the RCT, 54.9% (62/109) of adolescents used the USSD-based app at least once. The mean age by randomization group was 17.3 (SD 1.23) years for the control group and 17.3 (SD 1.12) years for the intervention group. There was a statistically significant difference in the total knowledge scores in the intervention group (mean 10.770, SD 2.012) compared with the control group (mean 10.170, SD 2.412) conditions (t179=2.197; P=.03). There was a significant difference in abstinence (P=.01) and contraceptive use (P=.06). Of the individuals who used the app, all participants felt the information received could improve decision-making regarding SRH. Information on STIs was of particular interest, with 27% (20/62) of the adolescents seeking information in this area, of whom 55% (11/20) were female. In relation to improved decision-making, 21.6% (29/134) of responses showed the adolescents were able to identify STIs and were likely to seek treatment; 51.7% (15/29) of these were female. Ease of use was the most important feature of the app for 28.3% (54/191) of the responses.
Conclusions
Adolescents require accurate and up-to-date SRH information to guide their decision-making and improve health outcomes. As adolescents already use mobile phones in their day-to-day lives, apps provide an ideal platform for this information. A USSD-based app could be an appropriate tool for increasing SRH knowledge among adolescents in low-resource settings. Adolescents in the study valued the information provided because it helped them identify SRH topics on which they needed more information.
Trial Registration
Pan African Clinical Trial Registry PACTR202204774993198; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=22623
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Peterson JM, Bendabenda J, Mboma A, Chen M, Stanback J, Gunnlaugsson G. Turned Away and at Risk: Denial of Family Planning Services to Women in Malawi. Stud Fam Plann 2022; 53:281-299. [PMID: 35383384 PMCID: PMC9320944 DOI: 10.1111/sifp.12192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Family planning (FP) has been a development priority since the mid‐1990s, yet barriers to access persist globally, including women being turned away from facilities without a method. This study aimed to assess the extent of, and reasons for, FP turnaway in three districts of Malawi. In 2019, data collectors screened women exiting 30 health facilities and surveyed those who had been denied a method. Follow‐up surveys were conducted via telephone with turned away clients at six and 12 weeks postvisit. Of the 2,246 women who were screened, 562 were new or restarting users. Of these, 15% (83/562) reported having been turned away from the health facility without an FP method. Women cited 14 different reasons for turnaway; the top three were unavailability of method (34%), unavailability of a provider (17%), or a requirement to return on the scheduled FP day (15%). The multiple reasons cited for leaving the health facility without an FP method indicate that reducing turnaway will not be achieved easily. The top reasons for turnaway are related to health systems or management issues within health facilities. Facilities need additional support for staffing, training on long‐acting and permanent methods, and a consistent supply of methods.
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Emtell Iwarsson K, Larsson EC, Bizjak I, Envall N, Kopp Kallner H, Gemzell-Danielsson K. Long-acting reversible contraception and satisfaction with structured contraceptive counselling among non-migrant, foreign-born migrant and second-generation migrant women: evidence from a cluster randomised controlled trial (the LOWE trial) in Sweden. BMJ SEXUAL & REPRODUCTIVE HEALTH 2022; 48:128-136. [PMID: 35102001 DOI: 10.1136/bmjsrh-2021-201265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This trial aimed to evaluate effects of structured contraceptive counselling among non-migrants, foreign-born migrants and second-generation migrants. METHODS A cluster randomised controlled trial was conducted in 2017-2019 at abortion, youth and maternal health clinics in Stockholm, Sweden (the LOWE trial). Patients were eligible if they were 18 years or older, could understand Swedish or English (or if assisted by an interpreter), were sexually active or planning to be, and were seeking contraception for pregnancy prevention. We randomised clinics at a 1:1 allocation ratio to give either structured contraceptive counselling (intervention) or to maintain standard contraceptive counselling (control). Blinding was not deemed feasibile. A study-specific package for structured contraceptive counselling was used and comprised an educational video, an effectiveness chart, four key questions and a box with contraceptive models. Outcomes were effects of the intervention on long-acting reversible contraception (LARC) choice, initiation and use, and satisfaction with the intervention material among the participants. RESULTS We involved 14 clinics in each of the intervention and control groups, respectively. A total of 1295 participants were included: 1010 non-migrants, 169 foreign-born migrants and 116 second-generation migrants. Participants in the intervention group chose LARC to a higher extent than the control group (adjusted OR (aOR) 2.85, 95% CI 2.04-3.99), had higher LARC initiation rates (aOR 2.90, 95% CI 1.97 to 4.27) and higher LARC use within the 12-month follow-up period (aOR 2.09, 95% CI 1.47 to 2.96). The majority of the participants who received the intervention package found all the different parts to be supportive in contraceptive choice. The effectiveness chart was the only part of the package that a higher proportion of foreign-born migrants (58/84, 69%) and second-generation migrants (40/54, 74.1%) found supportive in contraceptive choice compared to non-migrants (259/434, 59.7%) (p = 0.048). CONCLUSIONS Structured contraceptive counselling increased LARC choice, initiation and use, controlled for participants' migration background. The effectiveness chart was found to be significantly more supportive among foreign-born migrants and second-generation migrants compared to non-migrants when choosing contraceptive methods. TRIAL REGISTRATION NUMBER NCT03269357.
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Affiliation(s)
- Karin Emtell Iwarsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Division of Gynaecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Elin C Larsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Isabella Bizjak
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Division of Gynaecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Niklas Envall
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Helena Kopp Kallner
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynaecology, Danderyd Hospital, Stockholm, Sweden
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Division of Gynaecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
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217
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“Dear Brother Farmer”: Gender-Responsive Digital Extension in Tunisia during the COVID-19 Pandemic. SUSTAINABILITY 2022. [DOI: 10.3390/su14074162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Providing farmers with essential agricultural information and training in the era of COVID-19 has been a challenge that has prompted a renewed interest in digital extension services. There is a distinct gender gap, however, between men’s and women’s access to, use of, and ability to benefit from information and communication technologies (ICTs). The overall purpose of this research is to examine how digital extension can address gender inequality in rural areas in the context of the COVID-19 crisis by designing and evaluating the gendered impacts of a digital extension intervention delivered to 624 farmers (363 men and 261 women) (which included phone distribution, radio and SMS messages, and sharing of information prompts) in northern Tunisia. In order to assess the effectiveness of gender-responsive digital extension that targets husband and wife pairs, as opposed to only men, we employed logistic regression and descriptive statistics to analyze a sample of 242 farmers (141 women and 141 men). We find that phone ownership facilitated women’s access to their social network, as well as agricultural information and services, ultimately improving their participation in household decision making and agricultural production. We find that gender-responsive digital extension is effective for men and especially women in terms of usefulness, learning, and adoption. We identified education level and cooperative membership as important factors that determine the impact of digital extension services on farmers and demonstrate the positive impact of radio programming. We recommend strengthening phone access for women, targeting information (including through non-written ways) to both husbands and wives, using sharing prompts, and more rigorous extension for knowledge-intensive topics such as conservation agriculture and rural collectives.
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218
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Groenewald C, Isaacs N, Isaacs D. Adolescent Sexual and Reproductive Health During the COVID-19 Pandemic: A Mini Review. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:794477. [PMID: 36303613 PMCID: PMC9580774 DOI: 10.3389/frph.2022.794477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
This mini review explores the impact of the COVID-19 pandemic on adolescent sexual and reproductive health. We conducted a rapid review of the literature across three databases, with a particular focus on the African continent. Few studies have specifically focused on adolescents in Africa and this paper contributes to this paucity of research. Findings revealed the unintended consequences of the pandemic. Studies across several countries showed that the respective lockdown measures restricted adolescents' access to sexual and reproductive health services. The literature also showed increases in adolescent pregnancies during the lockdown, along with increases in reports of sexual violence against adolescents. We conclude this paper by offering recommendations to address these unintended consequences and potentially improve adolescent sexual and reproductive health in African communities.
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Affiliation(s)
- Candice Groenewald
- Centre for Community-Based Research, Human Sciences Research Council, Durban, South Africa
- Psychology Department, Rhodes University, Grahamstown, South Africa
| | - Nazeema Isaacs
- Human and Social Capabilities, Human Sciences Research Council, Cape Town, South Africa
- *Correspondence: Nazeema Isaacs
| | - Dane Isaacs
- Human and Social Capabilities, Human Sciences Research Council, Cape Town, South Africa
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219
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Strong J. Men's involvement in women's abortion-related care: a scoping review of evidence from low- and middle-income countries. Sex Reprod Health Matters 2022; 30:2040774. [PMID: 35323104 PMCID: PMC8956302 DOI: 10.1080/26410397.2022.2040774] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Men’s involvement in abortion is significant, intersecting across the individual, community and macro factors that shape abortion-related care pathways. This scoping review maps the evidence from low- and middle-income countries relating to male involvement in abortion trajectories. Five databases were searched, using search terms, to yield 7493 items published in English between 01.01.2010 and 20.12.2019. 37 items met the inclusion criteria for items relating to male involvement in women’s abortion trajectories and were synthesised using an abortion-related care-seeking framework. The majority of studies were conducted in sub-Saharan Africa and were qualitative. Evidence indicated that male involvement was significant, shaping the ability for a woman or girl to disclose her pregnancy or abortion decision. Men as partners were particularly influential, controlling resources necessary for abortion access and providing or withdrawing support for abortions. Denial or rejection of paternity was a critical juncture in many women’s abortion trajectories. Men’s involvement in abortion trajectories can be both direct and indirect. Contextual realities can make involving men in abortions a necessity, rather than a choice. The impact of male (lack of) involvement undermines the autonomy of a woman or girl to seek an abortion and shapes the conditions under which abortion-seekers are able to access care. This scoping review demonstrates the need for better understanding of the mechanisms, causes and intensions behind male involvement, centring the abortion seeker within this.
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Affiliation(s)
- Joe Strong
- PhD Researcher, Department of Social Policy, London School of Economics and Political Science, London, UK. Correspondence:
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220
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Sharma A, Ronan A, Namiba A, Oktariani A, Davies L. Beyond toolkits: sexual and reproductive health and rights literacy requires women-centred structures, services and policies. J Int AIDS Soc 2022; 25:e25888. [PMID: 35257488 PMCID: PMC8902286 DOI: 10.1002/jia2.25888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/04/2022] [Indexed: 11/30/2022] Open
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221
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Cappiello JD, Boardman MB. Sexual and Reproductive Health Content in the 3 Ps in Nurse Practitioner Education. J Nurs Educ 2022; 61:131-136. [PMID: 35254163 DOI: 10.3928/01484834-20220109-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Nurse practitioners (NPs) in primary care provide sexual and reproductive health care, an integral component of health and well-being. This study explored the degree of inclusion of sexual and reproductive health content in the foundational courses in NP preparation including advanced health assessment, advanced physiology and pathophysiology, and advanced pharmacology, known as the 3 Ps. METHOD Qualitative interviews were conducted with 30 NPs in their first 2 years of practice. RESULTS Sexual and reproductive health content was well integrated into advanced assessment courses, although participants wanted more comfort and skill with discussing sensitive sexual health issues. Advanced pharmacology and advanced pathophysiology courses were not likely to include the content. CONCLUSION Interactive learning opportunities, such as simulation with feedback, promote communication skills with sensitive health issues. Foundational courses would benefit from a deeper understanding of the menstrual cycle, sexual functioning, and medications specific to sexual and reproductive health. [J Nurs Educ. 2022;61(3):131-136.].
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Peterson JM, Bendabenda J, Mboma A, Chen M, Stanback J, Gunnlaugsson G. The Provider Role and Perspective in the Denial of Family Planning Services to Women in Malawi: A Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053076. [PMID: 35270771 PMCID: PMC8910402 DOI: 10.3390/ijerph19053076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/24/2022] [Accepted: 03/02/2022] [Indexed: 12/04/2022]
Abstract
Family planning (FP) has been a global health priority for decades, yet barriers persist, including women being turned away from facilities without receiving services. This study assessed the provider role and perspective in client turnaway in three districts of Malawi. In 2019, data collectors surveyed 57 FP providers from 30 health facilities. All reported being comfortable providing FP to married women with children and married adolescents under 18 years old with children, whereas 12% of the providers expressed discomfort providing such services to married adolescents under 18 without children. Sixty percent of the providers required clients desiring FP and wishing to initiate oral contraceptives or injectables to be currently menstruating. Data collectors later conducted in-depth interviews (IDIs) with 8 of the 57 providers about client turnaway. During IDIs, providers’ most frequently mentioned reasons for turnaway was client pregnancy or suspicion of pregnancy. Providers expressed fears that initiating FP with a pregnant woman could cause community mistrust in the efficacy of modern contraception. Provider support for FP waned for nulliparous clients, regardless of age or marital status. To improve FP services in Malawi, providers need continuous education on all available methods of FP, a reduction in stockouts and programs to further sensitize the community to how contraception works. Understanding how Malawi has helped providers overcome social and cultural norms regarding provision of FP to adolescents might help other countries to make improvements.
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Affiliation(s)
- Jill M. Peterson
- Department of Global Health and Population Research, FHI 360, Durham, NC 27701, USA; (M.C.); (J.S.)
- Faculty of Sociology, Anthropology and Folkloristics, University of Iceland, IS-102 Reykjavik, Iceland;
- Correspondence:
| | - Jaden Bendabenda
- Department of Nutrition and Food Safety, World Health Organization, 1211 Geneva, Switzerland;
| | - Alexander Mboma
- Midwifery Department, Kamuzu University of Health Sciences, Lilongwe, Malawi;
| | - Mario Chen
- Department of Global Health and Population Research, FHI 360, Durham, NC 27701, USA; (M.C.); (J.S.)
| | - John Stanback
- Department of Global Health and Population Research, FHI 360, Durham, NC 27701, USA; (M.C.); (J.S.)
| | - Geir Gunnlaugsson
- Faculty of Sociology, Anthropology and Folkloristics, University of Iceland, IS-102 Reykjavik, Iceland;
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223
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Zaneva M, Philpott A, Singh A, Larsson G, Gonsalves L. What is the added value of incorporating pleasure in sexual health interventions? A systematic review and meta-analysis. PLoS One 2022; 17:e0261034. [PMID: 35148319 PMCID: PMC8836333 DOI: 10.1371/journal.pone.0261034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/21/2021] [Indexed: 01/14/2023] Open
Abstract
Despite billions of dollars invested into Sexual and Reproductive Health and Rights (SRHR) efforts, the effect of incorporating sexual pleasure, a key driver of why people have sex, in sexual health interventions is currently unclear. We carried out a systematic review and meta-analysis following PRISMA guidelines across 7 databases for relevant articles published between 1 January 2005–1 June, 2020. We included 33 unique interventions in our systematic review. Eight interventions reporting condom use outcomes were meta-analyzed together with a method random effects model. Quality appraisal was carried out through the Cochrane Collaborations’ RoB2 tool. This study was pre-registered on Prospero (ID: CRD42020201822). We identified 33 unique interventions (18886 participants at baseline) that incorporate pleasure. All included interventions targeted HIV/STI risk reduction, none occurred in the context of pregnancy prevention or family planning. We find that the majority of interventions targeted populations that authors classified as high-risk. We were able to meta-analyze 8 studies (6634 participants at baseline) reporting condom use as an outcome and found an overall moderate, positive, and significant effect of Cohen’s d = 0·37 (95% CI 0·20–0·54, p < 0·001; I2 = 48%; τ2 = 0·043, p = 0·06). Incorporating sexual pleasure within SRHR interventions can improve sexual health outcomes. Our meta-analysis provides evidence about the positive impact of pleasure-incorporating interventions on condom use which has direct implications for reductions in HIV and STIs. Qualitatively, we find evidence that pleasure can have positive effects across different informational and knowledge-based attitudes as well. Future work is needed to further elucidate the impacts of pleasure within SRHR and across different outcomes and populations. Taking all the available evidence into account, we recommend that agencies responsible for sexual and reproductive health consider incorporating sexual pleasure considerations within their programming.
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Affiliation(s)
| | - Anne Philpott
- The Pleasure Project, United Kingdom and India
- * E-mail:
| | | | | | - Lianne Gonsalves
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Hensel DJ, Von Hippel CD, Sandidge R, Lapage CC, Zelin NS, Perkins RH. "OMG, Yes!": Feasibility, Acceptability, and Preliminary Efficacy of an Online Intervention for Female Sexual Pleasure. JOURNAL OF SEX RESEARCH 2022; 59:269-282. [PMID: 34176390 DOI: 10.1080/00224499.2021.1912277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The purpose of this study was to evaluate the acceptability, feasibility, and preliminary efficacy of using an online educational resource that presents research-informed strategies for women's pleasure, OMGyes.com, as a resource to empower women to broaden the ways in which they understand, advocate for, and enjoy sexual pleasure. A cohort of 870 adult women was given access to OMGyes.com and asked to explore the resource over a four-week period and complete online pre/post questionnaires. Participants reported a high level of satisfaction with the relatability, usefulness, and functionality of OMGyes.com. We observed statistically significant, large effect size increases in participants' knowledge about their own pleasure preferences, their confidence and positivity about that knowledge, as well as how pleasurable their sexual experiences were during both masturbation and partner sex. Many participants reported that after using OMGyes.com they felt more motivated to explore their preferences and more confident to explain their preferences to their partners. Our data suggest that OMGyes.com may be useful for positively impacting how women think about sexual pleasure, how they understand their own specific preferences, how they advocate for what they enjoy with partners, and how they actually experience pleasure.
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Affiliation(s)
- Devon J Hensel
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine
- Department of Sociology, Indiana University Purdue University-Indianapolis
- OMGyes, For Goodness Sake, LLC
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Choonara S, Govender K, Mpofu D, Kapira A, Humphries H. Early and unintended pregnancies threaten triple dividend. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:79-80. [PMID: 35085487 DOI: 10.1016/s2352-4642(21)00376-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/12/2021] [Accepted: 11/23/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Shakira Choonara
- Regional Inter-Agency Task Team on Children Affected by AIDS in Eastern and Southern Africa, Johannesburg 2194, South Africa.
| | - Kaymarlin Govender
- Regional Inter-Agency Task Team on Children Affected by AIDS in Eastern and Southern Africa, Johannesburg 2194, South Africa; HEARD, University of KwaZulu-Natal, Durban, South Africa
| | - Dephin Mpofu
- Regional Inter-Agency Task Team on Children Affected by AIDS in Eastern and Southern Africa, Johannesburg 2194, South Africa
| | - Anock Kapira
- Regional Inter-Agency Task Team on Children Affected by AIDS in Eastern and Southern Africa, Johannesburg 2194, South Africa
| | - Hilton Humphries
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
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Mutahi J, Larsen A, Cuijpers P, Peterson SS, Unutzer J, McKay M, John-Stewart G, Jewell T, Kinuthia J, Gohar F, Lai J, Wamalwa D, Gachuno O, Kumar M. Mental health problems and service gaps experienced by pregnant adolescents and young women in Sub-Saharan Africa: A systematic review. EClinicalMedicine 2022; 44:101289. [PMID: 35198916 PMCID: PMC8851289 DOI: 10.1016/j.eclinm.2022.101289] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/11/2022] [Accepted: 01/18/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Pregnant adolescent girls and young women (AGYW, aged 12-24 years) are at high risk for mental health problems, particularly in the Sub-Saharan African (SSA) region. METHODS We performed a systematic review of mental health studies among pregnant AGYW in SSA published between January 1, 2007 and December 31, 2020 in PubMed, Embase, CINAHL, PsycInfo, and Global Index Medicus following PRISMA guidelines (PROSPERO: CRD42021230980). We used Bronfenbrenner's bioecological model to frame and synthesize results from included studies. FINDINGS Our search yielded 945 articles from which 18 studies were included (N = 8 quantitative, N = 9 qualitative, N = 1 case report). The most frequently studied mental health problem was depression (N = 9 studies); the most frequently utilized measurement tool was the Edinburgh Postnatal Depression Scale (N = 3). Studies reported life course factors, individual, microsystem, exosystem, macrosystem, and chronosystem-level factors associated with mental health problems. Gaps in mental health service delivery for pregnant AGYW included lack of confidentiality, judgmental healthcare worker attitudes, and lack of services tailored to their unique needs. INTERPRETATION Gaps remain in research and services for mental health among pregnant AGYW in SSA. Integration of mental health services within school, community, and healthcare settings that are tailored to pregnant AGYW could strengthen health systems within SSA. FUNDING Author contributions were supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (F31HD101149 to AL) and the Fogarty International Center (K43TW010716 to MK). The funding agencies had no role in the writing of the manuscript or the decision to submit it for publication. The project itself was not funded.
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Affiliation(s)
- Joan Mutahi
- Department of Psychiatry, College of Health Sciences, University of Nairobi, 00100 (19676), Nairobi, Kenya
| | - Anna Larsen
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherland
| | | | - Jurgen Unutzer
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Mary McKay
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, United States
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Teresa Jewell
- University of Washington Libraries, Seattle, WA, United States
| | - John Kinuthia
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Fatima Gohar
- United Nations Children's Fund (UNICEF), New York, NY, United States
| | - Joanna Lai
- United Nations Children's Fund (UNICEF), New York, NY, United States
| | - Dalton Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Onesmus Gachuno
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - Manasi Kumar
- Department of Psychiatry, College of Health Sciences, University of Nairobi, 00100 (19676), Nairobi, Kenya
- Brain and Mind Institute, Aga Khan University, Kenya
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Ford JV, Corona-Vargas E, Cruz M, Fortenberry JD, Kismodi E, Philpott A, Rubio-Aurioles E, Coleman E. The World Association for Sexual Health's Declaration on Sexual Pleasure: A Technical Guide. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2022; 33:612-642. [PMID: 38595778 PMCID: PMC10903694 DOI: 10.1080/19317611.2021.2023718] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/12/2021] [Indexed: 04/11/2024]
Abstract
This article provides technical guidance on the content, meaning, and application of the World Association of Sexual Health (WAS) Declaration on Sexual Pleasure to various stakeholders and practitioners working in the area of sexuality, sexual health, and sexual rights. A growing body of work shows that sexual pleasure is integral to broader health, mental health, sexual health, well-being and rights and indeed can lead to improvements in health. Yet, more research is needed to identify the best ways to incorporate sexual pleasure to achieve sexual health for different outcomes and populations. In the first part of this article, we deconstruct each statement from the WAS Declaration on Sexual Pleasure and provide key evidence from the literature supporting these statements. In the latter part of the article, we provide guidance on how to include sexual pleasure as a fundamental part of sexual health and sexual rights work. We include a series of case studies and highlight key actions and principles for advocacy, implementation, and quality assurance in terms of law and policy, comprehensive sexuality education, health care services and dissemination of knowledge. This technical document seeks to inspire our partners and collaborators to embark on a journey toward a pleasure-based approach to sexual health and sexual rights. Our hope is that the literature, guidance and case studies provided here can ignite ongoing advocacy and collaboration to embrace sexual pleasure in all settings.
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Affiliation(s)
- Jessie V. Ford
- Sociomedical Sciences, Columbia University, New York, NY, USA
| | | | | | | | - Eszter Kismodi
- International Human Rights Lawyer on Sexual and Reproductive Health and Rights Research, Policy and Programming, Geneva, Switzerland
| | | | | | - Eli Coleman
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MNUSA
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Mare KU, Aychiluhm SB, Tadesse AW, Abdu M. Married women’s decision-making autonomy on contraceptive use and its associated factors in Ethiopia: A multilevel analysis of 2016 demographic and health survey. SAGE Open Med 2022; 10:20503121211068719. [PMID: 35083044 PMCID: PMC8785292 DOI: 10.1177/20503121211068719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/05/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Women’s decision-making autonomy has a positive effect on the scale-up of contraceptive use. In Ethiopia, evidence regarding women’s decision-making autonomy on contraceptive use and associated factors is limited and inconclusive. Therefore, this study was intended to assess married women’s decision-making autonomy on contraceptive use and associated factors in Ethiopia using a multilevel logistic regression model. Methods: The study used data from the 2016 Ethiopia Demographic and Health Survey that comprised of a weighted sample of 3668 married reproductive age women (15–49 years) currently using contraceptives. A multilevel logistic regression model was fitted to identify factors affecting married women’s decision-making autonomy on contraceptive use. Akaike’s information criterion was used to select the best-fitted model. Results: Overall, 21.6% (95% confidence interval = 20.3%–22.9%) of women had decision-making autonomy on contraceptive use. Community exposure to family planning messages (adjusted odds ratio = 2.22, 95% confidence interval = 1.67–3.05), media exposure (adjusted odds ratio = 2.13, 95% confidence interval = 1.52–3.23), age from 35 to 49 years (adjusted odds ratio = 2.09, 95% confidence interval = 1.36–4.69), living in the richer households (adjusted odds ratio = 1.67, 95% confidence interval = 1.32–3.11), and visiting health facility (adjusted odds ratio = 2.01, 95% confidence interval = 1.34–3.87) were positively associated with women’s decision-making autonomy on contraceptive use. On the contrary, being Muslim (adjusted odds ratio = 0.53, 95% confidence interval = 0.29–0.95), being married before the age of 18 years (adjusted odds ratio = 0.33, 95% confidence interval = 0.12–0.92), and residing in rural residence (adjusted odds ratio = 0.48, 95% confidence interval = 0.23–0.87) were negatively associated with women’s independent decision on contraceptive use. Conclusion: Less than one-fourth of married reproductive age women in Ethiopia had the decision-making autonomy on contraceptive use. Media exposure, women’s age, household wealth, religion, age at marriage, visiting health facilities, community exposure to family planning messages, and residence were the factors associated with women’s decision-making autonomy on contraceptive use. The government should promote women’s autonomy on contraceptive use as an essential component of sexual and reproductive health rights through mass media, with particular attention for adolescent women, women living in households with poor wealth, and those residing in rural settings.
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Affiliation(s)
- Kusse Urmale Mare
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Setognal Birara Aychiluhm
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Abay Woday Tadesse
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
- Dream Science and Technology College, Dessie, Ethiopia
| | - Mohammed Abdu
- Department of Midwifery, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
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Martínez P, Nazif-Munoz JI, Rojas G, Magaña I. Structural gender inequalities and symptoms of postpartum depression in 40 countries. J Affect Disord 2022; 297:381-385. [PMID: 34656672 DOI: 10.1016/j.jad.2021.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/02/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The role of structural gender inequality in macro-level differences in women's perinatal mental health remains largely unexplored. This short communication explores structural gender inequalities and their potential as a macro-level, upstream social determinant of postpartum depression (PPD). METHODS We compiled meta-analytically derived national-level prevalence estimates of PPD symptoms - based on the Edinburgh Postnatal Depression Scale - with economic (e.g., income inequality), health (e.g., infant mortality rate), sociodemographic (e.g., urban population), and structural gender inequality variables (e.g., abortion policies) for 40 countries. Meta-regression techniques and traditional p-value based stepwise procedures, complemented with a Bayesian model averaging approach, were used for a robust selection of variables associated with national-level PPD symptom prevalence. RESULTS Income inequality (β = 0.04, 95% CI = 0.02 to 0.07) and abortion policies (β = 0.02, 95% CI = 0.00 to 0.03) were the only variables selected in the final, adjusted model, accounting for 60.7% of cross-national variations in PPD symptoms. LIMITATIONS Study quality of primary studies was not assessed and some national-level meta-analytical estimates were based on few primary studies. A fifth of world countries and territories could be included, with high-income regions overrepresented. High rate of missing national-level data for potential predictors of PPD. Cross-sectional analyses precludes causal inferences. CONCLUSIONS Abortion policies are a significant macro-level social determinant of PPD, and its liberalization might be associated with women's mental health at a population level. Our findings should be a relevant argument for clinicians to advocate for changing discriminatory social norms against women.
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Affiliation(s)
- Pablo Martínez
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 150, place Charles-Le Moyne, Longueuil, Québec J4K A08, Canada; Centre de recherche Charles-Le Moyne, 150, place Charles-Le Moyne, Longueuil, Québec J4K A08, Canada.
| | - José Ignacio Nazif-Munoz
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 150, place Charles-Le Moyne, Longueuil, Québec J4K A08, Canada; Centre de recherche Charles-Le Moyne, 150, place Charles-Le Moyne, Longueuil, Québec J4K A08, Canada
| | - Graciela Rojas
- Hospital Clínico Universidad de Chile, Carlos Lorca 999, Santiago 8380456, Chile; Millennium Nucleus in Social Development (DESOC), Diagonal Paraguay 257, Santiago 8330015, Chile
| | - Irene Magaña
- Escuela de Psicología, Facultad de Humanidades, Universidad de Santiago de Chile, Av. Ecuador 3650, Santiago 9170197, Chile
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230
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Asklöv K, Ekenger R, Berterö C. Transmasculine Persons' Experiences of Encounters with Health Care Professionals Within Reproductive, Perinatal, and Sexual Health in Sweden: A Qualitative Interview Study. Transgend Health 2022; 6:325-331. [PMID: 34988289 PMCID: PMC8664105 DOI: 10.1089/trgh.2020.0081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Transmasculine persons may experience stigma, which increases the risk of psychological distress. They may need reproductive, perinatal, and sexual health care; however, qualitative studies addressing transgender individuals' experiences are scarce. This study aimed at interpreting and describing the experiences of transmasculine persons in encounters with health care professionals (HCPs) within reproductive, perinatal, and sexual health care. Methods: Nine qualitative semi-structured online interviews were conducted via email with transmasculine persons, and data were analyzed by using Braun and Clarke's thematic analysis. Results: Two themes were identified. The first theme is normalization and confirmation of the gender identity. This theme comprises the knowledge and experience that these transmasculine persons are facing. The verbal approach from the HCPs was important as well as could be addressed with a non-binary approach. The second theme is Respect in an especially exposed situation. This theme shows the great importance of being involved in the care and at the same time being met with openness and empathy. There must be good prospects of being able to preserve dignity. Conclusion: Transmasculine persons are in an exposed position in reproductive, perinatal, and sexual health care. The encounters in health care could be negatively affected if HCPs show inadequate knowledge or express gender stereotypical attitudes. A good encounter is characterized by respect, preserved integrity, involvement in the care, and an open attitude toward gender variations.
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Affiliation(s)
- Kristin Asklöv
- Department of Obstetrics and Gynecology and Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Regina Ekenger
- Department of Obstetrics and Gynecology and Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Carina Berterö
- Division of Nursing Science and Reproductive Health, Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
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Carter A, Gormley B, Muchenje M, Zhu D, Patterson S, Kestler M, Hankins C, Logie CH, Brotto LA, Tharao W, Lee M, Li J, Ding E, de Pokomandy A, Loutfy M, Kaida A. Prevalence and correlates of sexual concerns and associated distress among women living with HIV in Canada. WOMEN'S HEALTH 2022; 18:17455065221074877. [PMID: 35088623 PMCID: PMC8801632 DOI: 10.1177/17455065221074877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: We assessed the prevalence and correlates of sexual concerns and associated distress among women living with HIV in Canada. Methods: We analyzed cross-sectional survey data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (2017–2018). Self-identified women living with HIV were asked about sexual concerns post-HIV diagnosis and associated distress (none, mild, moderate, severe). Five areas of concern were assessed, including difficulties related to sexual self-esteem, sexual function, relationships, and emotional and behavioral aspects of sex. Logistic regression analyses identified correlates of reporting any sexual concerns and severe distress about these concerns. Results: Of 906 participants (median age 48, Q1–Q3 = 41–55), 596 (65.8%) reported sexual concerns post-HIV diagnosis. We found a high prevalence of concerns related to relationships (43.3%), sexual self-esteem (49.4%), and emotional aspects of sex (45.4%), relative to sexual functioning (38.4%) and behavioral aspects (33.7%). Of those with sexual concerns, 36.7% reported severe distress. Reports of severe distress were the highest for relationship difficulties (32.5%), relative to other areas of concern (21.4%–22.8%). In adjusted analyses, women reporting sexual dissatisfaction and high HIV-related stigma had significantly higher odds of reporting sexual concerns. Conversely, those reporting higher resilience, better mental health, African, Caribbean, and Black identity, and sex as somewhat unimportant, not at all important, or neutral to their lives had lower adjusted odds. Factors associated with severe distress about sexual concerns included older age, body dissatisfaction, sexual dissatisfaction, and high HIV-related stigma, while better mental health and getting support from someone living with HIV were protective. While 84.4% of women had discussed with a provider how viral load impacts transmission risk, only 40.6% had conversations about sexual wellbeing. Conclusion: More attention to women’s sexual wellbeing within social and relational contexts is critical to ensure the sexual rights of women living with HIV are upheld.
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Affiliation(s)
- Allison Carter
- Kirby Institute, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
- Australian Human Rights Institute, UNSW Sydney, Sydney, NSW, Australia
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Becky Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Marvelous Muchenje
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Denise Zhu
- Faculty of Science, The University of British Columbia, Vancouver, BC, Canada
| | - Sophie Patterson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Mary Kestler
- Division of Infectious Diseases, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital and Healthcare Centre, Vancouver, BC, Canada
| | - Catherine Hankins
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Women’s Health Research Institute, Vancouver, BC, Canada
| | | | - Melanie Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Jenny Li
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Erin Ding
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | | | - Mona Loutfy
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Women’s Health Research Institute, Vancouver, BC, Canada
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232
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Moseson H, Jayaweera R, Egwuatu I, Grosso B, Kristianingrum IA, Nmezi S, Zurbriggen R, Motana R, Bercu C, Carbone S, Gerdts C. Effectiveness of self-managed medication abortion with accompaniment support in Argentina and Nigeria (SAFE): a prospective, observational cohort study and non-inferiority analysis with historical controls. THE LANCET GLOBAL HEALTH 2022; 10:e105-e113. [PMID: 34801131 PMCID: PMC9359894 DOI: 10.1016/s2214-109x(21)00461-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background Clinical trials have established the high effectiveness and safety of medication abortion in clinical settings. However, barriers to clinical abortion care have shifted most medication abortion use to out-of-clinic settings, especially in the context of the COVID-19 pandemic. Given this shift, we aimed to estimate the effectiveness of self-managed medication abortion (medication abortion without clinical support), and to compare it to effectiveness of clinician-managed medication abortion. Methods For this prospective, observational cohort study, we recruited callers from two safe abortion accompaniment groups in Argentina and Nigeria who requested information on self-managed medication abortion. Before using one of two medication regimens (misoprostol alone or in combination with mifepristone), participants completed a baseline survey, and then two follow-up phone surveys at 1 week and 3 weeks after taking pills. The primary outcome was the proportion of participants reporting a complete abortion without surgical intervention. Legal restrictions precluded enrolment of a concurrent clinical control group; thus, a non-inferiority analysis compared abortion completion among those in our self-managed medication abortion cohort with abortion completion reported in historical clinical trials using the same medication regimens, restricted to participants with pregnancies of less than 9 weeks' gestation. This study was registered with ISCRTN, ISRCTN95769543. Findings Between July 31, 2019, and April 27, 2020, we enrolled 1051 participants. We analysed abortion outcomes for 961 participants, with an additional 47 participants reached after the study period. Most pregnancies were less than 12 weeks' duration. Participants in follow-up self-managed their abortions using misoprostol alone (593 participants) or the combined regimen of misoprostol plus mifepristone (356 participants). At last follow-up, 586 (99%) misoprostol alone users and 334 (94%) combined regimen users had a complete abortion without surgical intervention. For those with pregnancies of less than 9 weeks' gestation, both regimens were non-inferior to medication abortion effectiveness in clinical settings. Interpretation Findings from this prospective cohort study show that self-managed medication abortion with accompaniment group support is highly effective and, for those with pregnancies of less than 9 weeks' gestation, non-inferior to the effectiveness of clinician-managed medication abortion administered in a clinical setting. These findings support the use of remote self-managed models of early abortion care, as well as telemedicine, as is being considered in several countries because of the COVID-19 pandemic. Funding David and Lucile Packard Foundation. Translations For the Arabic, French, Bahasa Indonesian, Spanish and Yoruba translations of the Article see Supplementary Materials section.
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233
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Ruschel AE, Machado FV, Giugliani C, Knauth DR. Women victims of sexual violence: critical paths in the search for the right to legal abortion. CAD SAUDE PUBLICA 2022. [DOI: 10.1590/0102-311xen105022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Legal abortion in cases of pregnancy resulting from rape has been provided for in Brazil since 1940. However, access to this right is still very restricted, and there are numerous barriers that hinder women’s access to referral services that perform the procedure. This article discusses the trajectory of women who had an abortion due to rape from 2000 to 2018 at a public referral hospital in the city of Porto Alegre (Rio Grande do Sul State, Brazil). This is a qualitative, documentary, and retrospective study that used the concept of Critical Paths to understand the difficulties encountered by the women, the decisions made in the face of sexual violence and the discovery of pregnancy, as well as, the consequences resulting from this situation. Data were collected from women’s medical records, totaling 127 cases. Based on the content analysis, three interrelated categories were identified and subsequently ordered to explain the sequence of facts, actions, and complications in women’s lives, according to the dynamics of the critical paths produced: Between the secrecy of violence and the silencing of rights; Psychological illness and social disorganization; Institutional flows: validation of the word and conscientious objection. We noticed that there is a silencing in the face of sexual violence, and the performance of legal abortion proved to be an invisible problem surrounded by stigmas. The psychosocial disorganization resulting from violence was aggravated by misinformation, the precariousness of the service networks, and the professionals’ conscientious objection.
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Affiliation(s)
- Angela Ester Ruschel
- Universidade Federal do Rio Grande do Sul, Brazil; Hospital Materno Infantil Presidente Vargas, Brasil
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Zhu Y, Wang B, Zhu Q, Ye J, Kuang Y. OUP accepted manuscript. Hum Reprod 2022; 37:1287-1296. [PMID: 35258084 DOI: 10.1093/humrep/deac044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/07/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yanwen Zhu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bian Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qianqian Zhu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Ye
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanping Kuang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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235
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Ruschel AE, Machado FV, Giugliani C, Knauth DR. Mulheres vítimas de violência sexual: rotas críticas na busca do direito ao aborto legal. CAD SAUDE PUBLICA 2022; 38:e00105022. [DOI: 10.1590/0102-311xpt105022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/16/2022] [Indexed: 11/27/2022] Open
Abstract
O aborto legal nos casos de gravidez resultante de estupro é previsto no Brasil desde 1940. No entanto, o acesso a esse direito ainda é muito restrito, havendo inúmeras barreiras que dificultam o acesso das mulheres aos serviços de referência que realizam o procedimento. Este artigo discute a trajetória das mulheres que realizaram aborto por estupro entre 2000 e 2018 em um hospital público de referência na cidade de Porto Alegre (Rio Grande do Sul, Brasil). Trata-se de um estudo qualitativo, documental e retrospectivo, que utilizou o conceito das Rotas Críticas para compreender as dificuldades enfrentadas, as decisões tomadas diante da violência sexual e da descoberta da gravidez e as consequências oriundas dessa situação. Os dados foram coletados dos prontuários clínicos das mulheres, totalizando 127 casos. A partir da análise de conteúdo, foram traçadas três categorias que se inter-relacionam, sendo ordenadas de modo a explicitar a sequência de fatos, ações e intercorrências na vida das mulheres, de acordo com a dinâmica das rotas críticas produzidas: entre o segredo da violência e o silenciamento do direito; o adoecimento psíquico e a desorganização social; fluxos institucionais: validação da palavra e objeção de consciência. Percebeu-se que existe um silenciamento diante da violência sexual, sendo que a realização do aborto legal se mostrou um problema invisibilizado e cercado de estigmas. A desorganização psicossocial decorrente da violência foi agravada pela desinformação, pela precariedade das redes de atendimento e pela objeção de consciência dos profissionais.
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Affiliation(s)
- Angela Ester Ruschel
- Universidade Federal do Rio Grande do Sul, Brazil; Hospital Materno Infantil Presidente Vargas, Brasil
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Bohren MA, Vazquez Corona M, Odiase OJ, Wilson AN, Sudhinaraset M, Diamond-Smith N, Berryman J, Tunçalp Ö, Afulani PA. Strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings: A mixed-methods systematic review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000582. [PMID: 36962453 PMCID: PMC10021469 DOI: 10.1371/journal.pgph.0000582] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 05/13/2022] [Indexed: 11/19/2022]
Abstract
Stigma and discrimination are fundamental causes of health inequities, and reflect privilege, power, and disadvantage within society. Experiences and impacts of stigma and discrimination are well-documented, but a critical gap remains on effective strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings. We aimed to address this gap by conducting a mixed-methods systematic review and narrative synthesis to describe strategy types and characteristics, assess effectiveness, and synthesize key stakeholder experiences. We searched MEDLINE, CINAHL, Global Health, and grey literature. We included quantitative and qualitative studies evaluating strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings. We used an implementation-focused narrative synthesis approach, with four steps: 1) preliminary descriptive synthesis, 2) exploration of relationships between and across studies, 3) thematic analysis of qualitative evidence, and 4) model creation to map strategy aims and outcomes. Of 8,262 articles screened, we included 12 articles from 10 studies. Nine articles contributed quantitative data, and all measured health worker-reported outcomes, typically about awareness of stigma or if they acted in a stigmatizing way. Six articles contributed qualitative data, five were health worker perspectives post-implementation and showed favorable experiences of strategies and beliefs that strategies encouraged introspection and cultural humility. We mapped studies to levels where stigma can exist and be confronted and identified critical differences between levels of stigma strategies aimed to intervene on and evaluation approaches used. Important foundational work has described stigma and discrimination in sexual and reproductive healthcare settings, but limited interventional work has been conducted. Healthcare and policy interventions aiming to improve equity should consider intervening on and measuring stigma and discrimination-related outcomes. Efforts to address mistreatment will not be effective when stigma and discrimination persist. Our analysis and recommendations can inform future intervention design and implementation research to promote respectful, person-centered care for all.
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Affiliation(s)
- Meghan A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Martha Vazquez Corona
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Osamuedeme J Odiase
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Alyce N Wilson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- Nossal Institute, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - May Sudhinaraset
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Nadia Diamond-Smith
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Jim Berryman
- Brownless Biomedical Library, University of Melbourne, Melbourne, Victoria, Australia
| | - Özge Tunçalp
- Department of Sexual and Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneve, Switzerland
| | - Patience A Afulani
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
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Community pharmacists’ provision of sexual and reproductive health services: a cross sectional study in Alberta, Canada. J Am Pharm Assoc (2003) 2022; 62:1214-1223. [DOI: 10.1016/j.japh.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 11/18/2022]
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Gibson B, Hoff E, Haas A, Adams ZM, Price CR, Goddard-Eckrich D, Sheth SS, Dasgupta A, Meyer JP. Overlapping needs for sexual and reproductive health and HIV prevention in women with substance use disorders. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455065211070543. [PMID: 35023410 PMCID: PMC8771433 DOI: 10.1177/17455065211070543] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/23/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Women with substance use disorders have high unmet needs for HIV prevention and drug treatment and face challenges accessing care for other unique health issues, including their sexual and reproductive health. METHODS We did a cross-sectional evaluation of sexual and reproductive health behaviors and outcomes among women with substance use disorders, who were enrolled in one of two concurrent clinical trials of pre-exposure prophylaxis for HIV prevention. Descriptive analyses and bivariate logistic regression were used to assess factors driving contraceptive use, and other essential sexual and reproductive health services utilization and outcomes. RESULTS Among 226 women, 173 (76.5%) were of reproductive age. Most women had histories of unintended pregnancy (79.2%) or miscarriage (45.1%) and high HIV risk behaviors (53.5%). Most (61%) participants did not use any form of contraception at the time of assessment, although few (15%) reported pregnancy intentions. In bivariate models, ongoing criminal justice involvement was associated with 2.22 higher odds of not using contraception (95% confidence interval = 1.09-4.53; p = 0.03) and hazardous drinking was protective against not using contraception (odds ratio = 0.33, 95% confidence interval = 0.13-0.81; p = 0.02). Contraception use was not significantly associated with any other individual characteristics or need factors. CONCLUSIONS This is the first study that identifies the unmet sexual and reproductive health needs of women with substance use disorders who are engaging with pre-exposure prophylaxis. We found that women accessed some health services but not in a way that holistically addresses the full scope of their needs. Integrated sexual and reproductive care should align women's expressed sexual and reproductive health intentions with their behaviors and outcomes, by addressing social determinants of health.
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Affiliation(s)
- Britton Gibson
- Department of Obstetrics and Gynecology, University of Connecticut, Farmington, CT, USA
| | - Emily Hoff
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Alissa Haas
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - Dawn Goddard-Eckrich
- Social Intervention Group, Columbia University School of Social Work, New York, NY, USA
| | - Sangini S Sheth
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Anindita Dasgupta
- Social Intervention Group, Columbia University School of Social Work, New York, NY, USA
| | - Jaimie P Meyer
- AIDS Program, Yale School of Medicine, New Haven, CT, USA
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239
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Hammarström S, Alehagen S, Kilander H. Violence and sexual risk taking reported by young people at Swedish youth clinics. Ups J Med Sci 2022; 127:7823. [PMID: 35140876 PMCID: PMC8788656 DOI: 10.48101/ujms.v127.7823] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 11/26/2021] [Accepted: 12/01/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Early identification of sexual risk taking and exposure to violence is fundamental when seeking to strengthen young people's health. The purpose of this study was to study factors associated with sexual risk taking and ill health, as well as to study gender differences, and the associations amongst exposure to multiple forms of violence, sexual risk taking and ill health. METHODS This was a cross-sectional study based on data from 3,205 young people answering a questionnaire belonging to the Sexual health Identification Tool (SEXIT 2.0), during consultations at 12 youth clinics in Sweden. The analyses are based on descriptive statistics and nominal multiple regression analysis. RESULTS Male, transgender and non-binary youths reported significantly more events of sexual risk taking and ill health compared to women. Those who reported sexual initiation before the age of 15 (OR 2.87, CI 1.81-4.56), three or more sexual partners in the past 12 months (OR 2.68, CI 1.70-4.22) and to have ever experienced an unintended pregnancy (OR 2.29, CI 1.32-3.97) were more than twice as likely to report exposure to physical, emotional and sexual violence. Transgender, non-binary youths and women were more exposed to multiple violence (OR 3.68, 13.50) compared to men. CONCLUSIONS Transgender and non-binary youths are exposed to significantly more violence compared to women and men. Experiences of sexual risk taking and ill health demonstrated strong associations with exposure to multiple violence.
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Affiliation(s)
- Sofia Hammarström
- Region Västra Götaland, Knowledge Center for Sexual Health, Gothenburg, Sweden
- Division of Society and Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Siw Alehagen
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Helena Kilander
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Obstetrics and Gynaecology, Eksjö Hospital, Jönköping, Sweden
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Women’s and Children’s Health, Karolinska Institutet, Sweden
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240
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Ssebunya RN, Boopa M, Nguyen D, Ligon L. Disparities in Accessing Sexual and Reproductive Health Services and Rights Among Adolescents and Young People During COVID-19 Pandemic: Culture, Economic, and Gender Perspectives. CURRENT TROPICAL MEDICINE REPORTS 2022; 9:234-242. [PMID: 36311053 PMCID: PMC9589761 DOI: 10.1007/s40475-022-00274-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 01/11/2023]
Abstract
Purpose of Review As the world grapples with the health systems' challenges during the COVID-19 pandemic, addressing the needs of the already vulnerable adolescents and young people is vital. This narrative synthesis is aimed to highlight the current gender, cultural, and socioeconomic dynamics fueling inequalities to accessing sexual, reproductive health and rights (SRHR) services among adolescents and young people in low- and middle-income countries (LMIC). Recent Findings The COVID-19 pandemic has in most countries exacerbated already existing inequalities due to economic, gender, cultural, and legal aspects. Strategies implemented by most governments to mitigate the spread of the virus have also had a negative impact on the access to SRHR services, some of which are long term. Few published studies have assessed the extent to which the pandemic has fueled each of these paradigms regarding access to SRHR, especially among adolescents and young people (AYP). Additionally, there is paucity in data on the same in most countries, as the systems to track such effects were not available at the inception of the pandemic. Summary Despite efforts to mitigate the effects of the pandemic on this population, deficits remain and a multi-stakeholder approach is needed to achieve the intended goals, especially where cultural and gender values are deeply rooted. Further research is needed to quantify how the pandemic has fueled economic, gender, and cultural aspects to influence access to SRHR services among AYP especially in LMIC.
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Affiliation(s)
- Rogers N. Ssebunya
- Baylor College of Medicine Children Foundation, Mulago Hospital Complex, P.O. Box 72052, Kampala, Uganda
| | - Mafusi Boopa
- Baylor College of Medicine Children Foundation, Maseru, Lesotho
| | | | - Lee Ligon
- Baylor College of Medicine, Houston, Texas USA
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Nho JH. The evolvement of sexual and reproductive health policies in Korea. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2021; 27:272-274. [PMID: 36311457 PMCID: PMC9328641 DOI: 10.4069/kjwhn.2021.11.30.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 08/03/2023] Open
Affiliation(s)
- Ju-Hee Nho
- College of Nursing, Jeonbuk Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Korea
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242
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Kågesten A, van Reeuwijk M. Healthy sexuality development in adolescence: proposing a competency-based framework to inform programmes and research. Sex Reprod Health Matters 2021; 29:1996116. [PMID: 34937528 PMCID: PMC8725766 DOI: 10.1080/26410397.2021.1996116] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Positive aspects of sexuality remain understudied among young people globally, and consensus is lacking on how to conceptualise different aspects of healthy adolescent sexuality development in order to guide programmes, research, and policy. We propose a conceptual framework that draws on theories and literature related to positive youth development, empowerment, human rights, gender, social-ecological and life-course perspectives. The framework highlights six key competencies for healthy adolescent sexuality development: (1) sexual literacy, (2) gender-equal attitudes, (3) respect for human rights and understanding consent, (4) critical reflection skills, (5) coping skills, and (6) interpersonal skills. These competencies have the potential to strengthen or impede adolescents’ sense of sexual wellbeing in relation to both themselves (e.g. body image, self-efficacy) and others (e.g. mutually respectful relationships). Whether adolescents are able to translate competencies into desired actions and achieve a sense of sexual wellbeing depends on the resources available to them, their agency, and on the influence of social-ecological opportunity structures. The framework can provide concrete direction for sexual and reproductive health practitioners and researchers by providing a platform for recognising and operationalising indicators of healthy sexuality development, and serve as a Theory of Change for programmes aiming to improve adolescent sexual and reproductive health and wellbeing. Our assets-based, life-course approach can also be used to make the case to donors and policymakers for why early investments and positive approaches to adolescent sexuality are needed to achieve sexual wellbeing over time.
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Affiliation(s)
- Anna Kågesten
- Assistant Professor, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden. Correspondence:
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243
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Sheehy G, Omoluabi E, OlaOlorun FM, Mosso R, Bazié F, Moreau C, Bell SO. A mixed-methods study exploring women's perceptions of terminology surrounding fertility and menstrual regulation in Côte d'Ivoire and Nigeria. Reprod Health 2021; 18:251. [PMID: 34930322 PMCID: PMC8686364 DOI: 10.1186/s12978-021-01306-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022] Open
Abstract
Background Women use various terms when discussing the management of their fertility and menstrual irregularities and may interpret the experience of ending a possible pregnancy in nuanced ways, especially when their pregnancy status is ambiguous. Our study aims to understand the terminology used to refer to abortion-like experiences (specifically menstrual regulation and pregnancy removal), and the specific scenarios that these practices encompass among women who reported doing something to bring back a late period or ending a pregnancy in Nigeria and Côte d’Ivoire. Methods Our analysis draws upon surveys with women in Nigeria (n = 1114) and Cote d’Ivoire (n = 352). We also draw upon qualitative in-depth interviews with a subset of survey respondents in Anambra and Kaduna States in Nigeria, and Abidjan, Cote d’Ivoire (n = 30 in both countries). We examine survey and interview questions that explored women’s knowledge of terminology pertaining to ending a pregnancy or bringing back a late period. Survey data were analyzed descriptively and weighted, and interview data were analyzed using inductive thematic analysis. Results We find that the majority (71% in Nigeria and 70% in Côte d’Ivoire) of women perceive menstrual regulation to be a distinct concept from pregnancy removal, yet there is considerable variability in whether specific scenarios are interpreted as referring to menstrual regulation or pregnancy removal. Menstrual regulation is generally considered to be more ambiguous and not dependent on pregnancy confirmation in comparison to pregnancy removal, which is consistently interpreted as voluntary termination of pregnancy. Conclusions Overall, menstrual regulation and pregnancy removal are seen as distinct experiences in both settings. These findings have relevance for researchers aiming to document abortion incidence and experiences, and practitioners seeking to address women’s reproductive health needs. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01306-5. Women use various words and phrases to describe their experiences managing their fertility and menstrual irregularities, and may interpret the experience of ending a possible pregnancy in nuanced ways, especially when their pregnancy status is ambiguous. Our study aims to understand the terminology women use to refer to abortion-like experiences (specifically menstrual regulation, which refers to actions taken to regulate a menstrual cycle, and pregnancy removal), and the specific scenarios that these practices encompass among women who reported having had an abortion in Côte d’Ivoire and Nigeria. Our analysis draws upon data from surveys and qualitative interviews conducted in both countries. We find that the majority (71% in Nigeria and 70% in Côte d’Ivoire) of women perceive menstrual regulation to be a distinct concept from pregnancy removal, yet there is considerable variability in whether specific scenarios are interpreted as referring to menstrual regulation or pregnancy removal. Menstrual regulation is generally considered to be more ambiguous and not dependent on pregnancy confirmation in comparison to pregnancy removal, which is consistently interpreted as voluntary termination of pregnancy. These findings have relevance for researchers aiming to document abortion incidence and experiences, and practitioners seeking to address women’s reproductive health needs.
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Affiliation(s)
- Grace Sheehy
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA.
| | - Elizabeth Omoluabi
- Centre for Research, Evaluation Resources and Development, Ile-Ife, Nigeria.,Statistics and Population Studies Department, University of the Western Cape, Cape Town, South Africa
| | | | - Rosine Mosso
- École Nationale Supérieure de Statistique et d'Économie Appliquée d'Abidjan (ENSEA), Abidjan, Côte d'Ivoire
| | - Fiacre Bazié
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Suzanne O Bell
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
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Gonsalves L, Hunter EC, Brizuela V, Tucker JD, Srinivas ML, Gitau E, Mercer CH, Bajos N, Collins D. Cognitive testing of a survey instrument to assess sexual practices, behaviours, and health outcomes: a multi-country study protocol. Reprod Health 2021; 18:249. [PMID: 34923998 PMCID: PMC8684588 DOI: 10.1186/s12978-021-01301-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Population level data on sexual practices, behaviours and health-related outcomes can ensure that responsive, relevant health services are available for all people of all ages. However, while billions of dollars have been invested in attempting to improve sexual and reproductive health (including HIV) outcomes, far less is understood about associated sexual practices and behaviours. Therefore, the World Health Organization embarked on a global consultative process to develop a short survey instrument to assess sexual health practices, behaviours and health outcomes. In order for the resulting draft survey instrument to be published as a 'global' standard instrument, it is important to first determine that the proposed measures are globally comprehensible and applicable. This paper describes a multi-country study protocol to assess the interpretability and comparability of the survey instrument in a number of diverse countries. METHODS This study will use cognitive interviewing, a qualitative data collection method that uses semi-structured interviews to explore how participants process and respond to survey instruments. We aim to include study sites in up to 20 countries. The study procedures consist of: (1) localizing the instrument using forward and back-translation; (2) using a series of cognitive interviews to understand how participants engage with each survey question; (3) revising the core instrument based on interview findings; and (4) conducting an optional second round of cognitive interviews. Data generated from interviews will be summarised into a predeveloped analysis matrix. The entire process (a 'wave' of data collection) will be completed simultaneously by 5+ countries, with a total of three waves. This stepwise approach facilitates iterative improvements and sharing across countries. DISCUSSION An important output from this research will be a revised survey instrument, which when subsequently published, can contribute to improving the comparability across contexts of measures of sexual practices, behaviours and health-related outcomes. Site-specific results of the feasibility of conducting this research may help shift perceptions of who and what can be included in sexual health-related research.
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Affiliation(s)
- Lianne Gonsalves
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland.
| | - Erin C Hunter
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Vanessa Brizuela
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland
| | - Joseph D Tucker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, USA
| | - Megan L Srinivas
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, USA
| | - Evelyn Gitau
- African Population and Health Research Center, Nairobi, Kenya
| | - Catherine H Mercer
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London, London, UK
| | - Nathalie Bajos
- Institut National de la Santé et de la Recherche Medicale (INSERM), IRIS-EHESS, Paris, France
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245
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Mailloux NA, Henegan CP, Lsoto D, Patterson KP, West PC, Foley JA, Patz JA. Climate Solutions Double as Health Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13339. [PMID: 34948948 PMCID: PMC8705042 DOI: 10.3390/ijerph182413339] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/06/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022]
Abstract
The climate crisis threatens to exacerbate numerous climate-sensitive health risks, including heatwave mortality, malnutrition from reduced crop yields, water- and vector-borne infectious diseases, and respiratory illness from smog, ozone, allergenic pollen, and wildfires. Recent reports from the Intergovernmental Panel on Climate Change stress the urgent need for action to mitigate climate change, underscoring the need for more scientific assessment of the benefits of climate action for health and wellbeing. Project Drawdown has analyzed more than 80 solutions to address climate change, building on existing technologies and practices, that could be scaled to collectively limit warming to between 1.5° and 2 °C above preindustrial levels. The solutions span nine major sectors and are aggregated into three groups: reducing the sources of emissions, maintaining and enhancing carbon sinks, and addressing social inequities. Here we present an overview of how climate solutions in these three areas can benefit human health through improved air quality, increased physical activity, healthier diets, reduced risk of infectious disease, and improved sexual and reproductive health, and universal education. We find that the health benefits of a low-carbon society are more substantial and more numerous than previously realized and should be central to policies addressing climate change. Much of the existing literature focuses on health effects in high-income countries, however, and more research is needed on health and equity implications of climate solutions, especially in the Global South. We conclude that adding the myriad health benefits across multiple climate change solutions can likely add impetus to move climate policies faster and further.
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Affiliation(s)
- Nicholas A. Mailloux
- Center for Sustainability and the Global Environment, Nelson Institute for Environmental Studies, University of Wisconsin-Madison, Madison, WI 53726, USA; (N.A.M.); (C.P.H.); (D.L.)
| | - Colleen P. Henegan
- Center for Sustainability and the Global Environment, Nelson Institute for Environmental Studies, University of Wisconsin-Madison, Madison, WI 53726, USA; (N.A.M.); (C.P.H.); (D.L.)
| | - Dorothy Lsoto
- Center for Sustainability and the Global Environment, Nelson Institute for Environmental Studies, University of Wisconsin-Madison, Madison, WI 53726, USA; (N.A.M.); (C.P.H.); (D.L.)
| | | | - Paul C. West
- Project Drawdown, San Francisco, CA 94118, USA; (K.P.P.); (P.C.W.); (J.A.F.)
- Department of Applied Economics, University of Minnesota, St. Paul, MN 55108, USA
| | - Jonathan A. Foley
- Project Drawdown, San Francisco, CA 94118, USA; (K.P.P.); (P.C.W.); (J.A.F.)
| | - Jonathan A. Patz
- Center for Sustainability and the Global Environment, Nelson Institute for Environmental Studies, University of Wisconsin-Madison, Madison, WI 53726, USA; (N.A.M.); (C.P.H.); (D.L.)
- Global Health Institute, University of Wisconsin-Madison, Madison, WI 53706, USA
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI 53726, USA
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Baral S, Rao A, Twahirwa Rwema JO, Lyons C, Cevik M, Kågesten AE, Diouf D, Sohn AH, Phaswana-Mafuya N, Kamarulzaman A, Millett G, Marcus JL, Mishra S. Competing Health Risks Associated with the COVID-19 Pandemic and Early Response: A Scoping Review. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.01.07.21249419. [PMID: 33442703 PMCID: PMC7805463 DOI: 10.1101/2021.01.07.21249419] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND COVID-19 has rapidly emerged as a global public health threat with infections recorded in nearly every country. Responses to COVID-19 have varied in intensity and breadth, but generally have included domestic and international travel limitations, closure of non-essential businesses, and repurposing of health services. While these interventions have focused on testing, treatment, and mitigation of COVID-19, there have been reports of interruptions to diagnostic, prevention, and treatment services for other public health threats. OBJECTIVES We conducted a scoping review to characterize the early impact of COVID-19 on HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition. METHODS A scoping literature review was completed using searches of PubMed and preprint servers (medRxiv/bioRxiv) from January 1st to October 31st, 2020, using Medical Subject Headings (MeSH) terms related to SARS-CoV-2 or COVID-19 and HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition. Empiric studies reporting original data collection or mathematical models were included, and available data synthesized by region. Studies were excluded if they were not written in English. RESULTS A total of 1604 published papers and 205 preprints met inclusion criteria, including 8.2% (132/1604) of published studies and 10.2% (21/205) of preprints: 7.3% (68/931) on HIV, 7.1% (24/339) on tuberculosis, 11.6% (26/224) on malaria, 7.8% (13/166) on sexual and reproductive health, and 9.8% (13/132) on malnutrition. Thematic results were similar across competing health risks, with substantial indirect effects of the COVID-19 pandemic and response on diagnostic, prevention, and treatment services for HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition. DISCUSSION COVID-19 emerged in the context of existing public health threats that result in millions of deaths every year. Thus, effectively responding to COVID-19 while minimizing the negative impacts of COVID-19 necessitates innovation and integration of existing programs that are often siloed across health systems. Inequities have been a consistent driver of existing health threats; COVID-19 has worsened disparities, reinforcing the need for programs that address structural risks. The data reviewed here suggest that effective strengthening of health systems should include investment and planning focused on ensuring the continuity of care for both rapidly emergent and existing public health threats.
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Affiliation(s)
- Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Amrita Rao
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | | | - Carrie Lyons
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Muge Cevik
- Division of Infection and Global Health Research, School of Medicine, University of St. Andrews, Scotland
| | - Anna E Kågesten
- Department of Global Public Health, Karolinska Institutet, Sweden
| | | | - Annette H Sohn
- TREAT Asia, amfAR, the Foundation for AIDS Research, Bangkok, Thailand
| | - Nancy Phaswana-Mafuya
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg
| | | | | | - Julia L Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Sharmistha Mishra
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada
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247
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Somefun O, Constant D, Endler M. Immediate IUD insertion after second trimester abortion: implications for service delivery. BMC Health Serv Res 2021; 21:1304. [PMID: 34863166 PMCID: PMC8645068 DOI: 10.1186/s12913-021-07306-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022] Open
Abstract
Background The availability of modern contraception including long-acting reversible contraceptives (LARC), is a fundamental component of postabortion care. Findings from a recent randomized controlled trial (RCT) in South Africa comparing immediate to delayed insertion of the copper intrauterine device (IUD) after medical abortion (MA) at 17-20 gestational weeks showed that immediate insertion resulted in higher IUD use at 6 weeks postabortion, but that expulsion rates were significantly higher than for delayed insertion. This study aims to explore barriers, facilitators, and context-specific factors relevant to the implementation of immediate IUD provision after second trimester medical abortion. Methods We performed a qualitative study alongside the RCT in which we conducted in-depth interviews with 14 staff providing healthcare to study participants and 24 study participants. Research questions explored barriers and facilitators to implementation of immediate IUD insertion, contraceptive decision-making, and the impact of context and supplementary trial activities on service provision. Interviews were recorded and transcribed, with translation into English if needed. We performed a triangulated thematic analysis at the level of the transcribed interview text. Results Contraceptive counselling at the abortion facility by a study nurse improved knowledge, corrected misconceptions, and increased demand for the IUD postabortion. Women expressed a clear preference for immediate insertion. Convenience, protection from pregnancy and privacy issues were paramount and women expressed preference for engagement with staff who knew their abortion history, and with whom they had an established connection. Doctors and nurses were generally in favour of immediate insertion and said it could be incorporated into standard care if women wanted this. This contrasted with the need for interventions by the research team to reinforce adherence by staff to provide contraception as allocated during the trial. Conclusions Women and staff favour immediate IUD insertion after second trimester medical abortion, but service delivery may require structures that ensure timely insertion postabortion, continuity of care, communication that mitigates loss to follow-up and training of staff to ensure competence.
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Affiliation(s)
- O Somefun
- Women's Health Research Unit, University of Cape Town, Anzio Road, 7925 Observatory, Cape Town, South Africa
| | - D Constant
- Women's Health Research Unit, University of Cape Town, Anzio Road, 7925 Observatory, Cape Town, South Africa.
| | - M Endler
- Women's Health Research Unit, University of Cape Town, Anzio Road, 7925 Observatory, Cape Town, South Africa.,Department of Women and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Gruskin S, Jardell W, Ferguson L, Zacharias K, Khosla R. Integrating human rights into sexual and reproductive health research: moving beyond the rhetoric, what will it take to get us there? Sex Reprod Health Matters 2021; 29:1881206. [PMID: 33595424 PMCID: PMC8011684 DOI: 10.1080/26410397.2021.1881206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The integration of human rights principles in sexual and reproductive health (SRH) research is often recognised to be of value. Good examples abound but lack of clarity persists as to what defines rights-inclusive SRH research. To help move the field forward, this article seeks to explore how key stakeholders responsible for funding and supporting rights in SRH research understand the strengths and weaknesses of what is being done and where, and begins to catalogue potential tools and actions for the future. Interviews with a range of key stakeholders including international civil servants, donors and researchers committed to and supportive of integrating rights into SRH research were conducted and analysed. Interviews confirmed important differences in what is understood to be SRH rights-oriented research and what it can accomplish. General barriers include lack of understanding about the importance of rights; lack of clarity as to the best approach to integration; fear of adding more work with little added benefit; as well as the lack of methodological guidance or published research methodologies that integrate rights. Suggestions include the development of a comprehensive checklist for each phase of research from developing a research statement through ultimately to publication; development of training modules and workshops; inclusion of rights in curricula; changes in journal requirements; and agreement among key funding sources to mandate the integration of rights principles in research proposals they receive. As a next step, cataloguing issues and concerns at local levels can help move the integration of human rights in SRH research from rhetoric to reality.
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Affiliation(s)
- Sofia Gruskin
- Director, USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA. Correspondence:
| | - William Jardell
- Program Specialist, USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - Laura Ferguson
- Director, Program on Global Health and Human Rights, USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - Kristin Zacharias
- Research Associate, USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - Rajat Khosla
- Human Rights Advisor, World Health Organization, Geneva, Switzerland
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Hepburn JS, Mohamed IS, Ekman B, Sundewall J. Review of the inclusion of SRHR interventions in essential packages of health services in low- and lower-middle income countries. Sex Reprod Health Matters 2021; 29:1985826. [PMID: 34779749 PMCID: PMC8604543 DOI: 10.1080/26410397.2021.1985826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Sexual and reproductive health and rights (SRHR) and universal health coverage (UHC) are fundamental to health as a human right. One way that countries operationalise UHC is through the development of an essential package of health services (EPHS), which describes a list of clinical and public health services that a government aspires to provide for their population. This study reviews the contents of 46 countries' EPHS against the standard of the Guttmacher-Lancet Report's (GLR) nine essential SRHR interventions. The analysis is conducted in two steps; EPHS are first categorised according to the level of specificity of their contents using a case classification scheme, then the most detailed EPHS are mapped onto the GLR's nine essential SRHR interventions. The results highlight the variations of EPHS and provide information on the inclusion of the GLR nine essential SRHR interventions in low- and lower-middle income countries' EPHS. This study also proposes a case classification scheme as an analytical tool to conceptualise how EPHS fall along a spectrum of specificity and defines a set of keywords for evaluating the contents of policies against the standard of the GLR. These analytical tools and findings can be relevant for policymakers, researchers, and organisations involved in SRHR advocacy to better understand the variations in detail among countries' EPHS and compare governments' commitment to SRHR as a human right.
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Affiliation(s)
| | - Idil Shekh Mohamed
- Master of Public Health, Department of Clinical Sciences, Lund University, Malmö, Sweden and Research Coordinator, Swedish Institute for Global Health Transformation, Stockholm, Sweden
| | - Björn Ekman
- Associate Professor, Division of Social Medicine and Global Health, Lund University, Malmö, Sweden
| | - Jesper Sundewall
- Assistant Researcher, Division of Social Medicine and Global Health, Lund University, Malmö, Sweden; Associate Professor, HEARD, University of KwaZulu-Natal, Durban, South Africa
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Otu A, Danhoundo G, Toskin I, Govender V, Yaya S. Refocusing on sexually transmitted infections (STIs) to improve reproductive health: a call to further action. Reprod Health 2021; 18:242. [PMID: 34852842 PMCID: PMC8634744 DOI: 10.1186/s12978-021-01296-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Akaninyene Otu
- Department of Infection and Travel Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Department of Internal Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Georges Danhoundo
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Igor Toskin
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Veloshnee Govender
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, 120 University Private, Ottawa, ON, K1N 6N5, Canada. .,The George Institute for Global Health, Imperial College London, London, UK.
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