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The article discusses the use of menstrual suppression to reduce intrauterine device expulsion in adolescents with inherited bleeding disorders. The study found that hormonal menstrual suppression was effective in preventing early device expulsion due to excessive bleeding. The research suggests that concurrent menstrual suppression for at least 30 days after insertion may enhance safety and minimize complications in this vulnerable population. The authors emphasize the importance of managing heavy menstrual bleeding in adolescents with inherited bleeding disorders to improve outcomes and reduce expulsion rates. [Extracted from the article]

This article discusses the need to increase cervical cancer screening among underscreened women. Despite the availability of screening programs and HPV vaccination, participation rates remain low in many high-income countries, leading to poorer health outcomes for women. The ACCESS Consensus Group has provided evidence-based recommendations to improve screening participation, including developing national action plans, raising awareness, improving accessibility, supporting healthcare professionals, and advocating for health insurance coverage. The article also acknowledges the burden of cervical cancer in low- and middle-income countries and the need for tailored solutions. The text emphasizes the importance of collaboration and knowledge sharing to address the impact of cervical cancer and reduce health inequalities. [Extracted from the article]

A high, sustained HPV vaccination strategy exceeding 70% of eligible girls will not only achieve a significant reduction in high-risk HPV prevalence and associated cervical lesions but will also protect men and unvaccinated women in the general population through herd immunity.[11] The recent WHO recommendation to administer a single dose of the vaccine at the age intervals specified in their documents[[1], [3]] will significantly reduce procurement and delivery costs and make the HPV vaccination highly affordable, even in low-income countries.[[12]] The move to single dose vaccination and targeting multiple age cohorts (e.g. girls aged 10-15 years) will greatly benefit LMICs and improve the economic benefit even further. It is essential to integrate girls' and women's vaccinations into existing vaccination programs and calendars, with a special emphasis on HPV vaccination and vaccination during pregnancy. International schemes of vaccination and policy statements of relevance for women's and girls... The underpinning of vaccination schemes and policies internationally try to marry the knowledge of the best immunological windows for vaccination with opportune times for population vaccinations, such as school-based vaccinations, to provide a template for lifelong vaccination for girls and women. International schemes of vaccination and policy statements of relevance for women and girls' vaccination12FIGO Committee on Women's Cancer: Statement on HPV vaccination to eliminate cervical cancer (2020)712Selected international recommendations on vaccination during and after pregnancy124. [Extracted from the article]

Objective: To investigate how sociodemographic and medical care access variables are associated with influenza vaccine uptake among pregnant women in the USA. Methods: This is an observational study using 2015–2019 data from the US Behavioral Risk Factor Surveillance System. Pregnant women aged 18–49 years were included. Weighted χ2 tests and weighted logistic regression models were performed using the software SAS. Results: A total of 9149 pregnant women were included, of whom 39.9% received the influenza vaccine. Age, income, education and race/ethnicity were significantly associated with influenza vaccination. The following medical access factors were associated with a higher likelihood of receiving the influenza vaccine: having insurance (odds ratio [OR] 1.43, 95% confidence interval [CI] 1.04–1.97), having had a checkup in the past year (OR 1.69, 95% CI 1.40–2.03), and having a primary care provider (OR 1.45, 95% CI 1.18–1.78). In subgroup analysis by race/ethnicity, non‐Hispanic black women had the least difference in influenza vaccine uptake between those with medical care access and those without. Conclusion: Our findings suggest that the influenza vaccine uptake level was far from optimal among pregnant women. Influenza vaccine uptake was associated with social demographics and medical care access among pregnant women. Synopsis: Social demographic and medical care access variables affect the uptake of influenza vaccine among pregnant women. [ABSTRACT FROM AUTHOR]

Int J Gynecol Obstet. 2023; 162: 1. doi: 10.1002/ijgo.14698 23 Binger K, Cui Y, Kelly JA, Palatnik A. Strategies to reduce COVID-19 vaccine hesitancy among pregnant individuals: data from a prospective survey of unvaccinated pregnant women. The 3rd Sustainable Development Goal targets include (i) the reduction of global maternal mortality, (ii) ending preventable newborn and child deaths and (iii) universal access to sexual and reproductive healthcare and safe and effective vaccines.[1] The importance of access to safe and effective vaccines to reduce morbidity and mortality has been highlighted by the COVID-19 pandemic. HUMAN PAPILLOMA VIRUS Cervical cancer is caused by Human Papilloma Virus (HPV), which is a vaccine-preventable disease. [Extracted from the article]

Objective: To analyze the extent to which task-sharing to midlevel providers has been implemented as a strategy to increase access to abortion provision in Colombia, and examine the factors that have affected decentralization of services.Methods: We conducted a case study based on the World Health Organization's 2015 guideline: Health Worker Roles in Providing Safe Abortion Care and Post-abortion Contraception. Documentation was collected on the standard and epidemiological landscape of abortion in Colombia, followed by semistructured discussions with groups and individual stakeholders.Results: Task-sharing as a distinct policy to increase access to abortion services has not been implemented in Colombia. However, role distribution toward nonspecialist physicians has been used as a strategy to ensure access. Other professionals, such as nurses, have limited tasks in abortion care despite evidence to support a more expanded role.Conclusion: The implementation of task-sharing as a strategy to increase access to safe abortion services in Colombia is influenced by a wide range of factors and, although it is not policy, nonspecialist and diverse healthcare professionals supervise abortion care. Knowing the evidence-based guidelines to safely and successfully include other healthcare professionals in abortion provision is a fundamental step in implementing this strategy. [ABSTRACT FROM AUTHOR]

Objective: To estimate the potential impact of the nonavalent HPV vaccine for high-grade cervical lesions and invasive cervical cancer (ICC) in Portugal.Methods: The present secondary analysis used data collected in the CLEOPATRE II study on the prevalence of HPV 6/11/16/18/31/33/45/52/58 among female patients aged 20-88 years. The prevalence of HPV types in patients with cervical intraepithelial neoplasia (CIN) grades 2/3 and ICC was examined.Results: Data were included from 582 patients. There were 177, 341, and 64 patients with CIN2, CIN3, and ICC, respectively, and 169 (95.5%), 339 (99.4%), and 62 (96.9) of them had HPV infections. Of patients with HPV infections, HPV 16, 18, 31, 33, 45, 52, and 58 infections were identified in 150 (88.8%), 329 (97.1%), and 60 (96.8%) patients with CIN2, CIN3, and ICC, respectively. HPV genotypes 6, 11, 16, 18, 31, 33, 45, 52, and 58 were identified in 540 (94.7%) of the patients with HPV infections.Conclusion: The addition of the five HPV genotypes included in the nonavalent HPV vaccine (HPV 31/33/45/52/58) could result in the new HPV vaccine preventing 94.7% of CIN2/3 and ICC occurrences. [ABSTRACT FROM AUTHOR]

Objective: To determine whether prophylactic antibiotics reduce the frequency of postpartum endometritis after manual removal of the placenta.Methods: A retrospective cohort study was conducted using data for all women who underwent manual removal of the placenta after vaginal delivery at a tertiary medical center in Jerusalem, Israel, between January 1, 2010, and December 31, 2015. The study group comprised women who had not received prophylactic antibiotic treatment, whereas the control group comprised women who had received prophylactic antibiotic treatment. The primary outcome measure was the frequency of postpartum endometritis.Results: Of the 407 women included in the analysis, 7 (1.7%) developed postpartum endometritis. Six of the women with postpartum endometritis had received prophylactic treatment with antibiotics, whereas one woman had not (odds ratio 0.555, 95% confidence interval 0.065-4.630).Conclusion: Prophylactic antibiotics before manual removal of the placenta did not decrease the odds of postpartum endometritis. [ABSTRACT FROM AUTHOR]

Objective: To estimate the incidence of hysterectomy following endometrial resection or endometrial ablation (ERA).Methods: The present retrospective study enrolled women who underwent ERA for benign heavy menstrual bleeding (HMB) at Aberdeen Royal Infirmary, UK, between February 1, 1990, and December 31, 1997; follow-up data to the end of 2015 were included from the pathology laboratory report system from the single pathology laboratory in the region. Data were compared between patients who did or did not require a hysterectomy after ERA.Results: There were 901 patients who underwent ERA for HMB during the study period. The mean age of patients was 42.3 ± 5.7 years; of the patients included, 206 (22.9%) women underwent hysterectomy and these patients had a mean age of 40.1 years. Of the patients who had hysterectomies, 155 (75.2%) did so in the first 5 years following ERA, 31 (15.0%) did within 6-10 years, 11 (5.3%) did within 11-15 years, and 9 (4.4%) did within 16-20 years. In total, 51 (24.8%) of these patients had hysterectomies within 6-25 years of ERA.Conclusions: A significant majority of women who underwent ERA for HMB did not require hysterectomy up to 25 years after the procedure. [ABSTRACT FROM AUTHOR]

Objective: To assess quality of postabortion care (PAC) offered by Kenyan healthcare facilities.Methods: A cross-sectional survey was conducted using data from the Incidence and Magnitude of Unsafe Abortions study, conducted among 326 PAC-providing healthcare facilities throughout Kenya from March 13 to June 30, 2012. Descriptive results with weighted proportions and an ordered probit model were used.Results: Overall, 408 (41.8%) first-trimester PAC cases were treated using appropriate technology versus 826 (82.6%) second-trimester cases. Private healthcare facilities lagged behind public healthcare facilities on the use of appropriate technology: 264 (47.5%) public and 144 (33.1%) private facilities used such technology for first-trimester abortion, and 664 (89.6%) public versus 162 (68.8%) private for second-trimester abortions). Most healthcare facilities (251, 70.7%) had at least one provider trained in PAC. A total of 273 (80.7%) healthcare facilities reported offering contraception to all PAC patients, mainly short-acting methods. Delivery of PAC services depended on the availability of separate evacuation room (public level 2-3: odds ratio [OR] 22.93; public level 4-6: OR 77.14), and the number of family planning methods offered within the facility (public level 2-3: OR 1.38; public level 4-6 OR 1.57; private level 2-3: OR 2.27; private level 4-5: 4.89).Conclusion: Effective monitoring of PAC services, particularly among private healthcare facilities, might improve overall quality of services. [ABSTRACT FROM AUTHOR]

Cervical cancer is a leading cause of mortality in Sub-Saharan Africa-in large part because of inadequate coverage of screening and preventive treatment services. A number of programs have begun integrating cervical cancer prevention services into existing family planning or HIV/AIDS service delivery platforms, to rapidly expand "screen and treat" programs and mitigate cervical cancer burden. Drawing upon a review of literature and our experiences, we consider benefits and challenges associated with such programs in Sub-Saharan Africa. We then outline steps that can optimize uptake and sustainability of integrated sexual and reproductive health services. These include increasing coordination among implementing organizations for efficient use of resources; task shifting for services that can be provided by nonphysicians; mobilizing communities via trusted frontline health workers; strengthening management information systems to allow for monitoring of multiple services; and prioritizing an operational research agenda to provide further evidence on the cost-effectiveness and benefits of integrated service delivery. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between living in a county with gynecologic oncologist provision, the performance of fertility sparing surgery, and survival among young women with early epithelial ovarian cancer.Methods: The present retrospective cohort study was based on the SEER 18 dataset of the US National Cancer Institute. Women younger than 45 years with early stage epithelial ovarian cancer diagnosed between 2000 and 2012 were included. Logistic regression and Cox proportional hazards methods were used to analyze all-cause survival. Adjustment was made for relevant clinical and demographic variables.Results: In total, 1499 women were included. Women living in a county with gynecologic oncologist provision were less likely to undergo hysterectomy (adjusted odds ratio, 0.69; 95% confidence interval, 0.52-0.93) at the time of primary surgery. Women who underwent hysterectomy had a similar risk of mortality as women with uterine preservation (adjusted hazard ratio [HR], 0.73; 95% CI, 0.41-1.30). Living in a county with gynecologic oncologist provision was associated with reduced risk of mortality (adjusted HR, 0.53; 95% CI, 0.31-0.92).Conclusion: Living in a county with gynecologic oncologist provision was independently associated with the use of fertility sparing surgery among young women with early epithelial ovarian cancer. [ABSTRACT FROM AUTHOR]

Female genital mutilation (FGM) constitutes a harmful traditional practice that can have a profound impact on the health and well-being of girls and women who undergo the procedure. In recent years, due to international migration, healthcare providers worldwide are increasingly confronted with the need to provide adequate health care to this population. Recognizing this situation the WHO recently developed the first evidence-based guidelines on the management of health complications from FGM. To inform the guideline recommendations, an expert-driven, two-step process was conducted. The first step consisted of developing and ranking a list of priority research questions for the evidence retrieval. The second step involved conducting a series of systematic reviews and qualitative data syntheses. In the present paper, we first provide the methodology used in the development and ranking of the research questions (step 1) and then detail the common methodology for each of the systematic reviews and qualitative evidence syntheses (step 2). [ABSTRACT FROM AUTHOR]

Deinfibulation can prevent or treat gynecological and obstetric complications in women living with type III female genital mutilation (FGM), and subsequently improve childbirth outcomes. Recently published WHO guidelines recommend use of deinfibulation in both circumstances. However, to really impact practice, evidence-based guidance needs to be matched with evidence-based implementation strategies. This qualitative evidence synthesis provides information on the factors that facilitate or act as barriers to use of deinfibulation, and the context and conditions that are necessary for implementing the procedure, including healthcare providers' knowledge and experience, the service delivery environment, as well as broader health system contexts. This information is of great value for policy makers and others considering this as an option for better clinical care of women living with FGM. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of at-home medical abortion in Kazakhstan.Methods: A comparative, non-randomized study was undertaken at three clinics in Kazakhstan between October 10, 2013, and November 27, 2014. Women who sought medical abortion and had an intrauterine pregnancy of up to 70days were enrolled. All participants took 200mg mifepristone followed by 600μg sublingual misoprostol 24-48hours later. Women were offered the choice to take mifepristone at the clinic or at home; all took misoprostol at home. Abortion completion was assessed at an in-clinic follow-up appointment scheduled for all participants 2weeks after mifepristone administration.Results: Of 290 enrolled women, 185 (63.8%) chose to self-administer mifepristone at home. Three (1.0%) of 289 women included in outcome analyses required surgical intervention for incomplete abortion. Therefore, the overall success rate was 99.0% (95% confidence interval 97.0%-99.7%). No serious adverse events occurred.Conclusion: Outpatient medical abortion with mifepristone and misoprostol is safe and effective up to 70days of pregnancy. This service should be offered to women in Kazakhstan. ClinicalTrials.gov: NCT02018796. [ABSTRACT FROM AUTHOR]

Background: Screening reduces cervical cancer incidence and mortality.Objective: To describe cervical cancer epidemiology and screening guidelines in six low- and middle-income countries (LMICs) participating in the Study on global AGEing and adult health (SAGE).Search Strategy: Incidence, mortality, and screening-rate data were obtained for six LMICs and three higher-income comparator countries (Australia, USA, and UK). SCOPUS and PubMed were used to identify literature published after 2000 in English, using several screening-linked terms.Selection Criteria: Literature describing the use of cervical cancer screening guidelines in China, Ghana, India, Mexico, Russia, and South Africa were included.Data Collection and Analysis: Incidence, mortality trends, and screening rates were graphed and screening recommendations were summarized.Main Results: Higher rates of cervical cancer incidence, mortality, and 5-year prevalence were found in LMICs compared with the comparator countries. LMICs with absent or newly implemented screening guidelines had the lowest rates of crude and effective cervical cancer screening, with high cancer incidence and mortality. Countries with established guidelines had higher screening rates and lower disease burden. Cost, inadequate knowledge, geographical location, and cultural views were common barriers to effective screening coverage.Conclusion: Work must continue to improve the implementation of affordable, relevant, and achievable methods to improve screening coverage in LMICs. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To examine the association between the receipt of benefits from a conditional cash transfer (CCT) scheme—Janani Suraksha Yojana (JSY)—and postpartum contraceptive use in Rajasthan, India. Methods: Data from 2920 women who had delivered in the year preceding the interview were used. Univariate and multivariate analyses were used. Results: Adoption of postpartum contraception was limited among study participants. Even so, women who had experienced the benefits of JSY were more likely than those who had not to have received postpartum contraceptive counseling (odds ratio [OR] 1.66; 95% confidence interval [CI], 1.38–2.00) and to have adopted contraception within 3 months of delivery (OR, 1.31; 95% CI, 1.02–1.68). Conclusion: The present findings make a case for special efforts to use the increased opportunity women experience to interact with the health system as a result of CCTs for promoting maternal and newborn health practices, including postpartum contraception. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To determine the predictors of emergency cesarean delivery among international migrant women. Methods: Between February 2006 and May 2009, 1025 postpartum migrant women were recruited from 12 hospitals in Toronto, Montreal, and Vancouver. Logistic regression was used to model migration, social, health service, and biomedical factors predictive of emergency cesarean. Results: Overall, 14% percent of participants underwent emergency cesarean. The greatest risk was for women having their first delivery (odds ratio [OR], 5.9; 95% confidence interval [CI], 3.1–11.3); newborns weighing 4000g or more (OR, 3.5; 95% CI, 1.9–6.5); no health insurance (OR, 2.8; 95% CI, 1.2–6.4); delivery on a Friday (OR, 2.2; 95% CI, 1.2–3.9); incomes of less than 30 000 Canadian dollars (OR, 1.9; 1.2–3.0); and induced labor (OR, 1.8; 95% CI, 1.1–3.0). Compared with immigrants, asylum seekers (OR, 0.3; 95% CI, 0.2–0.6) and refugees (OR, 0.5; 95% CI, 0.2–1.0) were protected against emergency cesarean. Conclusion: Indicators specific to, or more common among, migrants were informative in assessing the likelihood of emergency cesarean. The risk associated with being uninsured, day of delivery, income, and immigration class suggests the importance of considering non-biomedical factors in reducing the need for emergency cesarean among migrants. [Copyright &y& Elsevier]

Objective: To assess the availability and coverage of emergency obstetric care (EmOC) services in Zambia.Methods: Reported provision of EmOC signal functions in the Zambian Health Facility Census and additional criteria on staffing, opening hours, and referral capacity were used to classify all Zambian health facilities as providing comprehensive EmOC, basic EmOC, or more limited care. Geographic accessibility of EmOC services was estimated by linking health facility data with data from the Zambian population census.Results: Few Zambian health facilities provided all basic EmOC signal functions and had qualified health professionals available on a 24-hour basis. Of the 1131 Zambian delivery facilities, 135 (12%) were classified as providing EmOC. Zambia nearly met the UN EmOC density benchmarks nationally, but EmOC facilities and health professionals were unevenly distributed between provinces. Geographic access to EmOC services in rural areas was low; in most provinces, less than 25% of the population lived within 15 km of an EmOC facility.Conclusion: A national Health Facility Census with geographic information is a valuable tool for assessing service availability and coverage at national and subnational levels. Simultaneously assessing health worker density and geographic access adds crucial information. [ABSTRACT FROM AUTHOR]

Objective: To assess the knowledge of, attitudes toward, and practices regarding postpartum contraception among healthcare providers and postpartum women in northern Haiti.Methods: Six focus groups were conducted with postpartum patients and 3 were conducted with maternity service providers; a structured questionnaire was then administered to postpartum patients.Results: In total, 282 postpartum women were included in the present study: 249 in the survey and 33 in focus groups. Although 97.9% of women expressed a desire for family-planning counseling before discharge from the postpartum ward, only 6.0% of women received such counseling. Most women wanted to space or limit their pregnancies; 79.8% of women, including those with only 1 child, wanted to choose a contraceptive method before discharge. Providers expressed concern for the volume of induced abortions and maternal deaths within the hospital, which many felt could be averted by improving postpartum family planning. However, there was no postpartum contraceptive counseling or method provision in the present setting, and no providers had experience in initiating methods immediately postpartum.Conclusion: Efforts to integrate family planning into postpartum care services could help to reduce the unmet need for family planning, and help patients and providers reach their goals. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of the non-pneumatic anti-shock garment (NASG) on maternal outcome following severe obstetric hemorrhage.Methods: A non-randomized pre-intervention/intervention study was conducted in 2 tertiary hospitals in Egypt from June 2006 to May 2008. Women with obstetric hemorrhage (estimated blood loss >or=1000 mL and/or >or=1 sign of shock [systolic blood pressure <100 mm Hg or pulse >100 beats per minute]) were treated with either a standardized protocol (pre-intervention) or a standardized protocol plus the NASG (intervention). The primary outcome was extreme adverse outcome (EAO), combining maternal mortality and severe morbidity (cardiac, respiratory, renal, or cerebral dysfunction). Secondary outcomes were measured blood loss, urine output, emergency hysterectomy, and (individually) mortality or morbidity. Analyses were performed to examine independent association of the NASG with EAO.Results: Mean measured blood loss decreased from 379 mL pre-intervention to 253 mL in the intervention group (P<0.01). In a multiple logistic regression model, the NASG was associated with reduced odds of EAO (odds ratio 0.38; 95% confidence interval, 0.17-0.85).Conclusion: The NASG, in addition to standardized protocols at tertiary facilities for obstetric hemorrhage and shock, resulted in lower measured blood loss and reduced EAO. [ABSTRACT FROM AUTHOR]

Abstract: A hymen may be ruptured by sexual intercourse and several other means. In cultures prizing unmarried women''s virginity, premarital rupture may shame a woman, and her family. Women, including brides whose virginity is not proven at marriage, face humiliation, ostracism, divorce, and violence—at the extreme, “honor” killing. Nevertheless, gynecologists may oppose hymen reconstruction on grounds that it is deceptive, not medically required, or that the requirement of evidence of virginity discriminates against women and the procedure supports holding them to higher standards of virtue than are required of men. Gynecologists may justify the procedure, however, as serving health, which includes patients'' mental and social well-being and women''s human rights to control their own bodies. Further, many adolescents lose their virginity innocently, by rape or coercion, and, without hymen reconstruction, women may face violence and even death. The procedure is usually lawful, and distinguishable from female genital cutting or mutilation. [Copyright &y& Elsevier]

Objective: To introduce an alternative approach to vaginoplasty using transretropubic traction (TRT).Methods: In this case series with 4 patients with complete vaginal aplasia, a plastic "olive" placed on the vaginal dimple was lifted by a mesh tape inserted through the space of Retzius and anchored to the anterior abdominal wall.Results: On day 8 postoperatively all patients had a reasonable vaginal size, 2.5 to 3 cm in width and 6 to 7.5 cm in length. The mean satisfaction scores were 86 points for the patients and 89 points for their husbands, who also reported a mean penetration score of 90 points.Conclusion: As a minimal-access and relatively simple operation, TRT vaginoplasty could be performed by trained gynecologists. Studies with larger populations are required to support this preliminary report. [ABSTRACT FROM AUTHOR]

Objective: To perform vaginal hysterectomy and adnexectomy without laparoscopic assistance in women with ovarian endometriosis by accessing the posterior cul-de-sac via the posterior uterocervical-broad ligament space.Method: The author identified the posterior uterocervical-broad ligament space as a surgical window while reviewing his experience at accessing the pouch of Douglas in 40 women in whom vaginal hysterectomy without laparoscopic assistance was performed for ovarian endometriosis. He then used this window in 102 women to remove the adnexa vaginally during vaginal hysterectomy, also without laparoscopy.Results: This new technique was successful in 98 women, with no major complications, but 4 of the first 50 required laparotomy to complete the surgery.Conclusion: This new approach allows experienced surgeons to treat women with endometrial ovarian cysts by removing the adnexa vaginally during vaginal hysterectomy without laparoscopy, and complete the surgery abdominally or laparoscopically when necessary. [ABSTRACT FROM AUTHOR]

Objective: To evaluate factors associated with progression to cervical cancer or moderate to severe precursor lesions (cervical intraepithelial neoplasia grade 2 [CIN 2] or higher) in women with negative cervical screening results.Method: A cohort of 1236 women from the state of Rio de Janeiro, Brazil, was followed up for 36 months. Hazards ratios (HR) and related 95% confidence intervals (CIs) were calculated, and the Cox proportional hazards model was used to evaluate factors associated with the development of lesions grade CIN 2 or higher.Results: After adjusting for age, education level, number of sexual partners, and parity, the presence of CIN 2 or more advanced lesions was associated with HPV infection (HR, 39.0; 95% CI, 9.8-156.0), smoking (HR, 7.7; 95% CI, 2.0-29.6), and early age at first sexual intercourse (HR, 4.1; 95% CI, 1.1-15.1).Conclusion: These findings suggest that women at increased risk for cervical cancer be screened for HPV at the time of cervical screening, particularly in areas where access to health services is difficult. Antismoking strategies especially targeting young women should be a priority in a comprehensive women's health care program. [ABSTRACT FROM AUTHOR]

Abstract: Women living with HIV/AIDS not only bear the burden of this pandemic in under-resourced countries, but are faced with the human rights issues concerning the management of their condition, not only for their own health, but also for prevention of mother-to-child transmission of the virus and infertility investigation. This article tackles the issues of reproductive health rights pertaining to prevention of HIV, and rights regarding HIV testing including the ethical dilemmas associated with “opt in,” “opt out,” and mandatory testing. Accountability, rights to treatment and travel, and employment issues are also discussed. [Copyright &y& Elsevier]

Objective: Since the Department of Health and Human Services chose Rabia Balkhi Hospital (RBH) in Kabul, Afghanistan, as a site for intervention in 2002, the status of women's health there has been of interest. This study created a tool to assess accessibility and quality of care of women admitted from May to July, 2005.Methods: A 39-item questionnaire was created in English and translated into Dari. Hospital staff administered the survey to 292 women admitted to RBH for obstetric and gynecological complaints.Results: Approximately 40% of the women traveled between 1 and 5 hours to reach RBH. Only 54% (158/292) of women reported having their blood pressure monitored during their pregnancy. About one-third of women reported that they had never received an immunization.Conclusions: This survey tool ascertained that women who received care at RBH traveled great lengths to reach the facility. Preventative measures such as blood pressure checks and immunizations are areas that need improvement. [ABSTRACT FROM AUTHOR]

Objective: : Research has shown differences in health status and health care utilization related to culture, economic status, and health care development. This paper reports on a study comparing attitudes of women in three countries, at various stages of development, about their own health and self-worth and asks if these differences account for differences in health care utilization and inequities in health status.Method: : A questionnaire, administered to 100 women in each of Yemen, Uganda and Canada, explored women's perception of their own health and health care seeking behavior.Result: : Women's perception of themselves as worthy of care was positively related to utilization. The ability to make one's own health care decisions varied with her country's development level. Implementation strategies must consider women's decision-making capacity.Conclusion: : To achieve improved health status, policies and programs must commit to encouraging appropriate social and cultural changes, using a 'cross-sectoral approach', involving both gender and development issues. [ABSTRACT FROM AUTHOR]

Cancer of the uterine cervix is the commonest gynaecologic cancer in India, with most women presenting with disease extending beyond the cervix. The majority of women belong to the lower socioeconomic status, are rural, aged between 35 and 64 years and highly noncompliant for complete treatment and follow-up. Opportunistic screening with cytology, colposcopy and test for Human Papilloma Virus and appropriate treatment are available on payment at urban private medical centres but are not available at urban and rural government health centres that are accessed by women of the lower socioeconomic status. The Government's investment in health is 0.9% of the GDP. Thus cytology screening as a government health measure is not feasible. The 'social vaccine' of health empowerment along with visual inspection and appropriate referral by the rural and urban health personnel (Department of Health and Family Welfare); with an additional input of health awareness and motivation by Anganwadi Workers (Department of Women and Child Development), elected women representatives in the Panchayats (Department of Rural Development and Panchayati Raj) and non-governmental development agencies could be a collaborative effort towards "downstaging" cervical cancer. This could lay the foundation for the introduction of cytology screening when resources are available. [ABSTRACT FROM AUTHOR]

Summary: Maternal mortality reduction has been a focus of major international initiatives for the past two decades. Widespread provision of emergency obstetric care (EmOC) has been shown to be an important strategy for addressing many of the complications that might otherwise lead to maternal death. However, unsafe abortion is one of the major causes of pregnancy-related deaths, and will be only partially addressed by EmOC. This manuscript presents a comprehensive approach to measuring whether abortion-related needs are met.Proposed Methods: We propose a set of indicators for monitoring the implementation of safe abortion care (SAC) interventions. We build on the model developed for monitoring the availability and use of Emergency Obstetric (EmOC) services. We describe the critical elements ("signal functions") of SAC - including treatment of abortion complications, legal, induced abortion and postabortion contraception - and define the indicators necessary to assess the availability, utilization and quality of abortion-related services.Sample Evidence: Data from 5 countries suggest there are sufficient service delivery points to provide decentralized abortion care, but that the full range of necessary abortion care services may not be provided at all these sites. Studies from several countries also show that many women receiving services for the treatment of abortion complications accept contraceptive methods when offered prior to discharge. This is an important strategy for reducing unwanted pregnancy, repeat unsafe abortion and risk for abortion-related mortality. Both findings suggest there are considerable opportunities within the present facilities to improve the delivery of abortion care services.Conclusion: This article recommends that the proposed model undergo field-testing on its own or in conjunction with the EmOC indicators, and encourages increased support for this important but often neglected aspect of pregnancy-related health. [ABSTRACT FROM AUTHOR]

Abstract: The rates of HIV infection among women are rising at a higher rate than among men. After citing the reasons for women''s vulnerability, this report argues the potential role of gynecologists and obstetricians through integration of HIV/AIDS into sexual and reproductive health services to strengthen the response to the epidemic. [Copyright &y& Elsevier]

Abstract: Cervical cancer can be successfully prevented if timely identification of precancerous lesions is followed by effective treatment. In many developing countries, treatment of precancer is neglected because therapeutic services are unavailable, inaccessible, inappropriate, or inadequately linked to screening services. One of the main focuses of the Alliance for Cervical Cancer Prevention (ACCP) has been to ensure that safe and effective methods of treatment for precancer are both available and accessible to women who need them. Cryotherapy, in use for the past 40 years, is a relatively simple, safe, effective, acceptable, and appropriate outpatient procedure for the treatment of precancer. ACCP studies conducted in more than a dozen developing countries show that cryotherapy for precancer can be performed safely and effectively as an outpatient procedure at all levels of health facilities by trained and competent midlevel providers, thus increasing availability and accessibility to precancer treatment services. [Copyright &y& Elsevier]

Abstract: The Alliance for Cervical Cancer Prevention (ACCP) came together in 1999 to answer key research questions and to advocate for greater global and national interest in reducing the heavy burden of morbidity and mortality caused by this preventable disease. Visual inspection with acetic acid (VIA), visual inspection with Lugol''s iodine (VILI), and human papillomavirus (HPV) tests have been shown to be viable alternatives to traditional cytology. ACCP experience confirmed that cryotherapy is a safe and effective method that is acceptable to women and can be delivered by a range of health providers, including nonphysicians. Programs can maximize coverage by accommodating local needs and involving community leaders and women in planning and implementation. Advocacy efforts have led to significant policy changes and galvanized support for cervical cancer prevention. Despite the prospect of new HPV vaccines, screening will be needed for at least the next 30–40 years. Our experience has shown that with creativity, flexibility, and well-focused use of resources, the inequitable burden of cervical cancer borne by women in poor countries can be sharply reduced. [Copyright &y& Elsevier]

Abstract: The goals of any cervical cancer prevention program should be threefold: to achieve high coverage of the population at risk, to screen women with an accurate test as part of high-quality services, and to ensure that women with positive test results are properly managed. This article focuses on the experiences of the Alliance for Cervical Cancer Prevention (ACCP) in delivery of screening and treatment services as part of cervical cancer prevention projects in Africa, Latin America, and Asia. Research and experience show that cervical cancer can be prevented when strategies and services are well planned and well managed and when attention is paid to program monitoring and evaluation. Coordination of program components, reduction of the number of visits, improvement of service quality, and flexibility in how services are delivered are all essential features of an effective service. [Copyright &y& Elsevier]

Abstract: Underutilization of cervical cancer prevention services by women in the high-risk age group of 30–60 years can be attributed to health service factors (such as poor availability, poor accessibility, and poor quality of care provided), to women''s lack of information, and to cultural and behavioral barriers. The Alliance for Cervical Cancer Prevention (ACCP) partners have been working to identify effective ways to increase women''s voluntary participation in prevention programs by testing strategies of community involvement in developing countries. The ACCP experiences include developing community partnerships to listen to and learn from the community, thereby enhancing appropriateness of services; developing culturally appropriate messages and educational materials; making access to high-quality screening services easier; and identifying effective ways to encourage women and their partners to complete diagnosis and treatment regimens. Cervical cancer prevention programs that use these strategies are more likely to increase demand, ensure follow-through for treatment, and ultimately reduce disease burden. [Copyright &y& Elsevier]

The medical world is facing increasing demands for improvement of the quality of life of women of all ages. This is not possible without overall improvement of the healthcare of females, and, in particular, of the quality of surgical treatment for gynecologic pathology. Positive changes are ensured by the active introduction of minimally invasive technologies into all spheres of gynecologic practices. There are almost no medical, demographic or technical limits for the application of endoscopy in gynecology, while the benefits it provides are extraordinary. The process of positive change towards minimally invasive surgery in operative gynecology should be supported and promoted by the medical community in every possible way. [Copyright &y& Elsevier]

Gender-based violence (GBV) is a worldwide problem that can have serious physical and psychological consequences. Women need to be assessed for GBV and a logical place to do so would be where women go for health care, reproductive health facilities. The United Nations Population Fund (UNFPA) has developed 'A Practical Approach to Gender-Based Violence: A Program Guide for Health Care Providers and Managers' to assist reproductive health facilities in integrating GBV into their programs. This article briefly describes the project options and the steps that need to be taken in order to implement such projects. [ABSTRACT FROM AUTHOR]

This paper discusses the experiences of the Khonkaen provincial hospital, which has been selected as an intervention case site for a one-stop crisis service for women who have been physically or sexually assaulted. It will be compared with another provincial hospital where no intervention has taken place. [ABSTRACT FROM AUTHOR]

Describes a counseling and support intervention in primary health care which is being piloted in a health center in São Paulo, Brazil. This proposal integrates sexual and domestic violence assistance and hospital and primary care, providing comprehensive care and intersectorial response for women. [ABSTRACT FROM AUTHOR]

Vezimfilho, a model program for the training of health care workers was developed, implemented and evaluated in close collaboration with government and non-government partners in South Africa. It was implemented and evaluated in two districts in the Eastern Cape and Western Cape provinces, respectively. This initiative represents one of the first attempts to build capacity in the health sector to address gender-based violence and has been a leading example of how to address within the South African context. Outputs have been the development of a model for the health sector response to gender violence, a training package Vezimfilho! and a partnership with the Department of Health to address the sustained integration of capacity building in this area. [ABSTRACT FROM AUTHOR]

Three Latin American affiliates of the International Planned Parenthood Federation, Western Hemisphere Region, Inc. (IPPF/WHR) have begun to integrate gender-based violence screening and services into sexual and reproductive health programs. This paper presents results of a baseline study conducted in the affiliates. Although most staff support integration and many had already begun to address violence in their work, additional sensitization and training, as well as institution-wide changes are needed to provide services effectively and to address needs of women experiencing violence. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the experiences, preferences, and needs of women undergoing colposcopy in southeastern Nigeria. Methods: Women undergoing colposcopy at 2 centers in southeastern Nigeria between August 1, 2009, and October 31, 2011, were interviewed using structured interviewer-administered questionnaires. Results: In total, 409 women were interviewed. The majority (60.8%) of these women were satisfied with the overall process of colposcopy. Invasion of privacy and re-assuring attitude of attending clinic personnel were reported as the most dissatisfying and most satisfying aspects of colposcopy, respectively. Privacy during the procedure and written take-home information were the most frequently reported needs. Most participants preferred a female colposcopist and the presence of their spouse during colposcopic examination. Conclusion: Southeastern Nigerian women are less satisfied with the overall process of colposcopy than their counterparts from high-income settings. The majority of the women interviewed would have an improved colposcopic experience if their privacy concerns and information needs were addressed and their spouses allowed into the examination room. The findings from the present study should encourage existing and emerging colposcopy service providers in low-resource settings to improve both service delivery and their patients'' overall colposcopic experience. [Copyright &y& Elsevier]