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Background: Barriers exist for the provision of surgery for permanent contraception in the postpartum period. Prenatal counseling has been associated with increased rates of fulfillment of desired postpartum contraception in general, although it is unclear if there is impact on permanent contraception specifically. Thus, we aimed to investigate the association between initial timing for prenatal documentation of a contraceptive plan for permanent contraception and fulfillment of postpartum contraception for those receiving counseling. Methods: This is a planned secondary analysis of a multi-site cohort study of patients with documented desire for permanent contraception at the time of delivery at four hospitals located in Alabama, California, Illinois, and Ohio over a two-year study period. Our primary exposure was initial timing of documented plan for contraception (first, second, or third trimester, or during delivery hospitalization). We used univariate and multivariable logistic regression to analyze fulfillment of permanent contraception before hospital discharge, within 42 days of delivery, and within 365 days of delivery between patients with a documented plan for permanent contraception in the first or second trimester compared to the third trimester. Covariates included insurance status, age, parity, gestational age, mode of delivery, adequacy of prenatal care, race, ethnicity, marital status, and body mass index. Results: Of the 3103 patients with a documented expressed desire for permanent contraception at the time of delivery, 2083 (69.1%) had a documented plan for postpartum permanent contraception prenatally. After adjusting for covariates, patients with initial documented plan for permanent contraception in the first or second trimester had a higher odds of fulfillment by discharge (aOR 1.57, 95% C.I 1.24–2.00), 42 days (aOR 1.51, 95% C.I 1.20–1.91), and 365 days (aOR 1.40, 95% C.I 1.11–1.75), compared to patients who had their first documented plan in the third trimester. Conclusions: Patients who had a documented prenatal plan for permanent contraception in trimester one and two experienced higher likelihood of permanent contraception fulfillment compared to those with documentation in trimester three. Given the barriers to accessing permanent contraception, it is imperative that comprehensive, patient-centered counseling and documentation regarding future reproductive goals begin early prenatally. Plain language summary: Permanent contraception is a highly desired form of postpartum contraception in the United States, however there are several barriers to accessing it. In this paper, we investigate whether the timing of when a patient has a documented plan for postpartum contraception has an impact on if they achieve postpartum contraception. This is a cohort study from four hospitals in Illinois, Ohio, California, and Alabama for patients with a desire for postpartum permanent contraception documented in their medical record. We specifically investigated the trimester (first, second, or third) where a patient had a plan for permanent contraception first documented. We then used univariate and multivariate models to determine the relationship between the timing of a plan for permanent contraception and if a patient achieved the procedure at three time-points: hospital discharge, 42-days, and 365-days. Our findings showed that of the 3103 patients in our cohort, only 69.1% of them had a documented plan for postpartum contraception at any point before going to the hospital for their delivery admission. We additionally found that patients who had a documented plan for permanent contraception in the first or second trimester had a higher odds of receiving their postpartum contraception procedure compared to people who had their first documented plan in the third trimester. This showed us the importance of earlier counseling regarding contraception for pregnant patients. There are many barriers to accessing postpartum contraception, so having patient focused counseling about future goals around reproductive health early on in pregnancy is critical. [ABSTRACT FROM AUTHOR]

Introduction: This study characterized the extent to which (1) financial barriers and (2) abortion care-seeking within a person's country of residence were associated with delays in abortion access among those travelling to England and the Netherlands for abortion care from European countries where abortion is legal on broad grounds in the first trimester but where access past the first trimester is limited to specific circumstances. Methodology: We drew on cross-sectional survey data collected at five abortion clinics in England and the Netherlands from 2017 to 2019 (n = 164). We assessed the relationship between difficulty paying for the abortion/travel, acute financial insecurity, and in-country care seeking on delays to abortion using multivariable discrete-time hazards models. Results: Participants who reported facing both difficulty paying for the abortion procedure and/or travel and difficulty covering basic living costs in the last month reported longer delays in accessing care than those who had no financial difficulty (adjusted hazard odds ratio: 0.39 95% CI 0.21–0.74). This group delayed paying other expenses (39%) or sold something of value (13%) to fund their abortion, resulting in ~ 60% of those with financial difficulty reporting it took them over a week to raise the funds needed for their abortion. Having contacted or visited an abortion provider in the country of residence was associated with delays in presenting abroad for an abortion. Discussion: These findings point to inequities in access to timely abortion care based on socioeconomic status. Legal time limits on abortion may intersect with individuals' interactions with the health care system to delay care. Plain Language Summary: This paper explores delays in accessing abortion care associated with financial and medical system barriers. We focus on residents of countries in Europe where abortion is available on broad grounds in the first trimester seeking abortion care outside of their country of residence. This study demonstrates an association between difficulty covering abortion costs for people facing financial insecurity and in-country care seeking and delays in accessing abortion abroad. Policy barriers, medical system barriers, as well as financial barriers may interact to delay access to care for people in European countries with broad grounds for abortion access in the first trimester but restrictions thereafter, especially for people later in pregnancy. [ABSTRACT FROM AUTHOR]

Background: Adolescent pregnancy remains a major global health issue, increasing the risk of complications during pregnancy and childbirth in mothers and babies. In Tanzania, adolescent pregnancy threatens girls' education and makes it difficult for them to obtain a proper job; hence, the majority fall into poverty. Previous studies have developed and conducted reproductive health education for adolescent students; however, they evaluated only the effect immediately after education. Therefore, this study investigated the effects of reproductive health education on attitudes and behaviors toward reproductive health among adolescent girls and boys one year after the intervention in rural Tanzania. Methods: A longitudinal quasi-experimental study was conducted with 3295 primary and secondary students (2123 in the intervention group, 1172 in the control group) from three purposefully selected wards in Korogwe District. In the intervention group, the students received reproductive health education. We used paper-based questionnaires to evaluate the effect of the adolescent education program on attitudes and behaviors toward reproductive health education. To analyze the association between the intervention and each outcome, mixed-effect multiple regression analyses was conducted. Results: The mean age, primary school proportion, and female proportion of the intervention and the control group was 13.05 (standard deviation (SD) 1.59), 14.14 (SD 1.7), 77.9% and 34.3%, and 54.2% and 52.6%, respectively. There was no statistically significant effect of reproductive health education on adolescent health attitudes and behaviors in the multiple regression analyses (coefficient: − 0.24 (95% confidence interval (CI): − 0.98 to 0.50), coefficient: 0.01 (95%CI: − 0.42 to 0.43)). Conclusion: A statistically significant effect of reproductive health education on adolescent health attitudes and behaviors was not found. An effective reproductive health education intervention to improve the attitude and behaviors of reproductive health among Tanzania adolescents in the long term remain to be determined, particularly in real-world settings. Trial registration The National Institute for Medical Research, Tanzania (NIMR/HQ/R.8a/Vol. IX988). Plain Language Summary: Adolescent pregnancy increases the risk of complications during pregnancy and childbirth, which could cause death among 15–19-year-old girls. In Tanzania, one in four adolescents aged 15–19 began childbearing. However, there is no officially recognized curriculum for reproductive health in schools. Additionally, cultural and traditional norms prevent parents from discussing sexuality with their children. A solution to this issue is for a third party, such as a non-profit organization, to provide adolescents with adequate reproductive health education in schools. Previous studies have developed and evaluated a reproductive health education program and found significant effects on improved knowledge and behavior among adolescent girls and boys immediately after the intervention. This study examined the effects of reproductive health education on adolescents' attitudes and behavior toward reproductive health one year after the intervention in rural Tanzania. We could not find a statistically significant effect of reproductive health education on adolescents' attitudes and behavior during a one-year period in the multiple regression analyses. These results could have been influenced by the location of the intervention, contents, period of evaluation, and other potentially unknown factors. [ABSTRACT FROM AUTHOR]

Background: Studies have shown that motivation to avoid pregnancy is associated with contraceptive use and continuation. These motivations can change, however, even within a short period of time. This paper uses longitudinal data to look at women's motivation to avoid pregnancy at two time points, and how changes in motivation influence contraceptive continuation. Methods: Data for this analysis came from an evaluation of the IntegratE project which seeks to expand access to family planning (FP) in Nigeria through community pharmacies and drug shops. 491 women were interviewed within 10 days after receiving a FP service from these sources and again approximately 9 months later. The dependent variable was contraceptive continuation at the follow-up interview. A categorical independent variable was used to represent changes in motivation to avoid pregnancy from enrollment to the follow-up interview. Univariate and multivariate logistic regression models were used to assess the association between changes in motivation and contraceptive continuation. Results: 89% of women continued using contraception approximately 9 months after the enrollment interview. Women who remained highly motivated to avoid pregnancy were significantly more likely to continue using contraception compared to women who became more motivated (AOR 2.5; 95% CI 1.0–6.0). Women who became less motivated were 64% less likely to continue using contraception compared to who became more motivated (AOR 0.36 95% CI 0.1–0.9). Conclusion: FP providers, including private sector pharmacists and drug shop owners, should continuously check-in with women about their motivations around pregnancy to support continuation among those who wish to avoid pregnancy. Plain language summary: Previous research has found women's motivations to avoid pregnancy- how important it is to avoid pregnancy now- is associated with their contraception use. Yet women's motivations to avoid pregnancy often change, even within a short period of time. This paper looks at whether changes in motivation to avoid pregnancy are associated with continued use of contraception in Nigeria. We used data from a larger evaluation of the IntegratE project which seeks to expand access to family planning (FP) in Nigeria through community pharmacies and drug shops. 491 women were interviewed within 10 days after receiving a FP service (counseling, referral or FP method) from these sources and again 9 months later. We then used logistic regression models to assess whether changes in motivation to avoid pregnancy between receiving a FP service to 9 months later is associated with continued use of FP. We found that many women (89%) continued using contraception approximately 9 months after the enrollment interview. Women who remained highly motivated (reported it was very important to avoid pregnancy at both interviews) were more likely to continue using contraception compared to women who became more motivated between the two interviews. Women who became less motivated were 64% less likely to continue using contraception compared to who became more motivated. Our results suggest that FP providers, including private sector pharmacists and drug shop owners, should continuously check in with women about their motivations around pregnancy to support continuation contraceptive use among those who wish to avoid pregnancy. [ABSTRACT FROM AUTHOR]

Background: It is estimated that 38.8% of mothers develop postpartum depression (PPD) in South Africa. While empirical evidence documents an association between intimate partner violence (IPV) victimization in pregnancy and PPD among adult women, the association has been underexamined among adolescent mothers (< 19 years). The study's purpose is to examine whether IPV victimization during pregnancy is associated with PPD among adolescent mothers. Methods: Adolescent mothers (14–19 years) were recruited at a regional hospital's maternity ward in KwaZulu Natal, South Africa between July 2017-April 2018. Participants completed behavioral assessments at two visits (n = 90): baseline (up to 4 weeks postpartum) and follow-up (6–9 weeks postpartum, when PPD is typically assessed). The WHO modified conflict tactics scale was used to create a binary measure of any physical and/or psychological IPV victimization that occurred during pregnancy. Participants with scores ≥ 13 on the Edinburgh Postpartum Depression Scale (EPDS) were classified as having symptoms of PPD. We used a modified Poisson regression with robust standard errors to assess PPD in association with IPV victimization during pregnancy, controlling for relevant covariates. Results: Nearly one-half (47%) of adolescent mothers reported symptoms of PPD by 6–9 weeks post-delivery. Further, IPV victimization during pregnancy was highly prevalent (40%). Adolescent mothers who reported IPV victimization during pregnancy had marginally higher risk of PPD at follow-up (RR: 1.50, 95 CI: 0.97–2.31; p = 0.07). The association was strengthened and significant in covariate-adjusted analysis (RR: 1.62, 95 CI: 1.06–2.49; p = 0.03). Conclusions: Poor mental health was common among adolescent mothers, and IPV victimization during pregnancy was associated with PPD risk among adolescent mothers. Implementing IPV and PPD routine screenings during the perinatal period may aid in identifying adolescent mothers for IPV and PPD interventions and treatment. With the high prevalence of IPV and PPD in this vulnerable population and the potential negative impact on maternal and infant outcomes, interventions to reduce IPV and PPD are needed to improve adolescent mothers' well-being and their baby's health. Plain language summary: Background: More than one-third of adult mothers experience postpartum depression (PPD) in South Africa and intimate partner violence (IPV) victimization is a strong risk factor of PPD for adult mothers. However, there are no studies on adolescent mothers that look at the link between IPV victimization and PPD. This paper aims to examine whether IPV victimization during pregnancy is associated with PPD among adolescent South African mothers. Methods: We had 90 adolescent mothers (aged 14–19 years old) complete an initial survey between delivery and 4 weeks postpartum to collect information on IPV during their pregnancy. Participants completed an additional survey between 6 and 9 week postpartum to collect information on the symptoms of PPD. Results: Nearly one-half (47%) of adolescent mothers reported symptoms of PPD by 6–9 weeks post-delivery. Report of IPV victimization during pregnancy was also very high (40%). Adolescent mothers who experienced IPV victimization during pregnancy were more likely to report symptoms of PPD between 6 and 9 weeks postpartum. Conclusions: PPD and IPV was very common in our sample, and IPV victimization during pregnancy was linked to PPD among adolescent mothers. Having routine screenings during pregnancy and postpartum period can identify adolescent mothers IPV and PPD interventions and treatment. With the high reports of IPV and PPD in this sample and the potential negative impact on maternal and infant outcomes, interventions to reduce IPV and PPD are needed to improve adolescent mothers' well-being and their baby's health. [ABSTRACT FROM AUTHOR]

Background: Sexual and reproductive health (SRH) is referring to physical and emotional wellbeing and includes the ability to be free from unwanted pregnancy, unsafe abortion, sexually transmitted infections including HIV/AIDS, and all forms of sexual violence and coercion. SRH is the main services packages that prevent and reduce adolescent reproductive health risks and problems. While the government of Ethiopia has undertaken several measures to improve SRH services, there was limited data on utilization among adolescents and associated factors. Objective: To assess utilization of SRH services and associated factors among adolescents attending secondary schools in Haramaya District, Eastern Ethiopia. Methods: A school-based cross-sectional study was conducted among adolescent students aged 15–19 years. A total of 692 adolescents were selected using a multi-stage sampling from two randomly selected secondary schools, each from rural and urban settings, in Haramaya district where 642 provided complete data and included in the analysis. A structured, pretested, and self-administered questionnaire was used to collect data. Data entry was conducted using Epi Data version 3.1 and exported to STATA version 16 for analysis. Bivariable and multivariable binary logistic regression were used to identify factors associated with school adolescents' utilization of SRH. Statistically significant associations are declared at P-value < 0.05. Result: A total of 642 completed the survey questionnaire, constituting a response rate of 92.7% (642/692). Male adolescents accounted 63.7% and the mean age of respondents was 17.71 years. Among those who completed the survey, 23.5% (95% CI: 20–26.8) utilized SRH services. Adolescents who were exposed to SRH information (adjusted odds ratio (AOR) = 2.11, 95% CI: 1.22–3.6), aware of SRH service providing facility (AOR = 1.83, 95% CI: 1.12–3.0) and SRH service components (AOR = 2.76, 95%, CI: 1.53–4.97), and distance from SRH facilities (AOR = 2.28, 95%, CI: 1.13–4.62) were significantly associated with the utilization of SRH services. Conclusion: Nearly one-in-four secondary school adolescents (23.5%) utilized SRH services. Targeted promotion of SRH providing facilities and SRH service components aimed at awareness creation could improve adolescents' utilization of SRH services. Improved SRH services utilization among adolescents who were far from SRH services providing facilities needs further investigation. Plain language summary: Background: Sexual and reproductive health (SRH) refers to physical and emotional wellbeing and includes the ability to be free from unwanted pregnancy, unsafe abortion, sexually transmitted infections including HIV/AIDS, and all forms of sexual violence and coercion. Components of the SRH services are important to reduce adolescent reproductive health risks and problems. This paper reports on the frequency of in-school adolescents who utilized SRH services and the factors that determined it. Methods: we collected data from 642 in-school secondary school adolescents, aged 15–19 years, in Haramaya district, East Ethiopia. The data were collected from two schools, one from rural and the other from urban areas, using lottery method from the available schools in the district. A face-to-face interview was conducted to obtain data from the adolescents in the selected secondary schools. Result: Out of 642 in-school adolescents, 23.5% utilized SRH services in Haramaya District. Adolescents who previously received SRH information, who knew SRH services providing facility, aware of SRH service components, and those who live not close to the SRH facilities were utilized the SRH services more often compared to their friends. Conclusion: Nearly one-in-four secondary school adolescents (23.5%) utilized SRH services. Targeted promotion of SRH providing facilities and SRH service components aimed at awareness creation could improve adolescents' utilization of SRH services. [ABSTRACT FROM AUTHOR]

Background: Violence against women is now widely recognized as a serious human right abuse, and an important public health problem with substantial consequences physical, mental, sexual, and reproductive health. Data on systematic review of domestic violence are needed to support policy and program recommendations. Therefore, the overall purpose of this systematic review was to assess magnitude of domestic violence against women and associated factors in Ethiopia. Methods: Studies systematically reviewed in Federal Democratic Republic of Ethiopia from 2000 to 2014. Systematic review was employed on published research works from databases such as Pubmed, popline, Hinari, and Google using key words. We also consulted public health experts. Community based studies with a study population (15-49 years) were included for review. Thirteen peer reviewed papers and two consecutive Ethiopian demographic and health surveys (2005 and 2011) were included to the systematic review. Twenty seven available in open access journals were retrieved and assessed based on the criteria's such as community based study, cross sectional study design, clearly report prevalence and associated factors were included in the systematic review work. Finally, 15 papers were included in this review. Results: Lifetime prevalence of domestic violence against women by husband or intimate partner among 10 studies ranged from 20 to 78 %. The lifetime domestic physical violence by husband or intimate partner against women ranged from 31 to 76.5 %. The life time domestic sexual violence against women by husband or intimate partner ranged from 19.2 to 59 %. The mean life time prevalence of domestic emotional violence was 51.7 %. Significant number of women experienced violence during their pregnancy period. Domestic violence against women significantly associated with alcohol consumption, chat chewing, family history of violence, occupation, religion, educational status, residence and decision making power. Conclusion: Domestic violence against women was relatively high in different parts of Ethiopia. Domestic violence has direct relationship with sociodemographic characteristics of the victim as well as perpetrator. Therefore, appropriate health promotion information activities needed to tackle associated factors of domestic violence against women or to prevent and control the problem to save women from being victim. [ABSTRACT FROM AUTHOR]

Background: Access to high-quality antenatal care services has been shown to be beneficial for maternal and child health. In 2016, the WHO published evidence-based recommendations for antenatal care that aim to improve utilization, quality of care, and the patient experience. Prior research in Nepal has shown that a lack of social support, birth planning, and resources are barriers to accessing services in rural communities. The success of CenteringPregnancy and participatory action women's groups suggests that group care models may both improve access to care and the quality of care delivered through women's empowerment and the creation of social networks. We present a group antenatal care model in rural Nepal, designed and implemented by the healthcare delivery organization Nyaya Health Nepal, as well as an assessment of implementation outcomes. Methods: The study was conducted at Bayalata Hospital in Achham, Nepal, via a public private partnership between the Nepali non-profit, Nyaya Health Nepal, and the Ministry of Health and Population, with financial and technical assistance from the American non-profit, Possible. We implemented group antenatal care as a prospective non-randomized cluster-controlled, type I hybrid effectiveness-implementation study in six village clusters. The implementation approach allows for iterative improvement in design, making changes to improve the quality of the intervention. Assessments of implementation process and model fidelity were undertaken using a mobile checklist completed by nurse supervisors, and observation forms completed by program leadership. We evaluated data quarterly using descriptive statistics to identify trends. Qualitative interviews and team communications were analyzed through immersion crystallization to identify major themes that evolved during the implementation process. Results: A total of 141 group antenatal sessions were run during the study period. This paper reports on implementation results, whereas we analyze and present patient-level effectiveness outcomes in a complementary paper in this journal. There was high process fidelity to the model, with 85.7% (95% CI 77.1–91.5%) of visits completing all process elements, and high content fidelity, with all village clusters meeting the minimum target frequency for 80% of topics. The annual per capita cost for group antenatal care was 0.50 USD. Qualitative analysis revealed the compromise of stable gestation-matched composition of the group members in order to make the intervention feasible. Major adaptations were made in training, documentation, feedback and logistics. Conclusion: Group antenatal care provided in collaboration with local government clinics has the potential to provide accessible and high quality antenatal care to women in rural Nepal. The intervention is a feasible and affordable alternative to individual antenatal care. Our experience has shown that adaptation from prior models was important for the program to be successful in the local context within the national healthcare system. Trial registration: ClinicalTrials.gov Identifier: NCT02330887, registered 01/05/2015, retroactively registered. [ABSTRACT FROM AUTHOR]

Background: Poor communication on sexual issues between adolescents and their parents results in high rates of negative sexual practices such as teenage pregnancy. Contributing factors to this poor communication on sexual issues between adolescents and their parents in a high teenage pregnancy setting have not been adequately explored. We sought to fill this gap by examining the factors that predict communication on sexual issues between adolescents and their parents in the Adaklu district of the Volta region of Ghana. Methods: A baseline cross-sectional household survey of 221 adolescents aged 10–19 years in 30 randomly selected communities was used. A well-structured questionnaire was developed. A multinomial logistic regression analysis was used to examine factors that significantly influenced communication between adolescents and their parents regarding sex. Results: Only 11.3% of adolescents had discussions on sexual issues with both parents while 27.6% of communicated sexual issues with only one parent in Adaklu district. Adolescent males (AOR = 0.21, CI = 0.06–0.75), those aged 10–14 years (AOR = 0.41, CI = 0.04–0.57), non-members of adolescent health clubs (AOR = 0.46, CI = 0.21–1.00), and those living with only a father (AOR = 0.19, CI = 0.06–0.61) had lower odds of communicating with their parents on sexual issues. Conclusions: Adolescent-parental communication on sexual issues in Adaklu district is very low. This situation requires more empowerment of adolescents to enable them to discuss sexual issues with their parents through increased engagement with adolescent health club activities and capacity building capacity of parents with the right information on sexual and reproductive health by health staff within the district. Additionally, parents need to be equipped with communication skills to enable them to communicate effectively with their children. Plain language summary: Parent-adolescent and older sibling adolescent communication on issues about sex is considered an important aspect of adolescent development and well-being, as it ensures informed decision making and good behavior and a protective factor for adolescent sexual health. However, poor communication on sexual issues between adolescents and their parents results in high rates of negative sexual practices such as teenage pregnancy. Contributing factors to this poor communication on sexual issues between adolescents and their parents in a high teenage pregnancy setting have not been adequately explored. This paper, therefore, examines the factors that predict communication on sexual issues between adolescents and their parents in the Adaklu district of the Volta region of Ghana. It highlights individual, household, societal and sexual-related factors that predict communication on sexual issues between adolescents and their parents in an area with a high rate of teenage pregnancy among adolescent girls. The data on adolescent sexual and reproductive health in Adaklu district show poor communication on sexual issues between adolescents (aged 10–19 years) and their parents. Improving communication on sexual issues between adolescents and their parents in rural settings requires capacity building of parents (especially mothers) with the right information and communication skills for discussing sexual and reproductive health issues with their children. [ABSTRACT FROM AUTHOR]

Background: Postpartum hemorrhage or postpartum bleeding (PPH) is often defined as loss of > 500 ml of blood after vaginal delivery or > 1000 ml after cesarean delivery within 24 h. Postpartum hemorrhage is a leading direct cause of maternal morbidity and mortality in Ethiopia. Therefore, the main objective of this systematic review and meta-analysis was to estimate the pooled magnitude of postpartum hemorrhage and the pooled effect size of the associated factors in Ethiopia. Methods: Primary studies were searched from PubMed/MEDLINE online, Science Direct, Hinari, Cochrane Library, CINAHL, African Journals Online, Google and Google Scholars databases. The searching of the primary studies included for this systematic review and meta-analysis was limited by papers published from 2010 to October 10/2021. The data extraction format was prepared in Microsoft Excel and extracted data was exported to Stata Version 16.0 statistical software for analysis. A random effect meta-analysis model was used. Statistical heterogeneity was evaluated by the I2 test and Egger's weighted regression test was used to assess publication bias. Result: A total of 21 studies were included in this meta-analysis. The pooled magnitude of postpartum hemorrhage in Ethiopia was 8.24% [(95% CI 7.07, 9.40]. Older age [OR = 5.038 (95% CI 2.774, 9.151)], prolonged labor [OR = 4.054 (95% CI 1.484, 11.074)], absence of anti-natal care visits (ANC) [OR = 13.84 (95% CI 5.57, 34.346)], grand-multiparty [OR = 6.584 (95% CI 1.902, 22.795)], and history of postpartum hemorrhage [OR = 4.355 (95% CI 2.347, 8.079)] were factors associated with the occurrence of postpartum hemorrhage. Conclusions: The pooled magnitude of postpartum hemorrhage among post-natal mothers in Ethiopia was moderately high. The finding of this study will strongly help different stakeholder working in maternal and child health to focus on the main contributors' factors to reduce post-partum hemorrhage among postnatal mothers. Health professionals attending labor and delivery should give more attention to advanced aged mothers, grand-multipara mothers and mothers who had a history of post-partum hemorrhage due to higher risk for postpartum hemorrhage. Encouraging to continue ANC visit and prevent prolonged labor should also be recommended to decrease postpartum hemorrhage. Plain Language summary: Even though other complications occur during pregnancy, post-partum hemorrhage (PPH) is the most serious complication and most critically important cause during pregnancy and child birth. It can cause severe anemia, acute respiratory distress syndrome (ARDS), acute renal failure (ARF), coma, and cardiac arrest. Uterine atony, retained tissue, genital tract tear, coagulation problem, and uterine rupture are most common causes of post-partum hemorrhage. In developing countries, PPH is one of the leading causes of maternal mortality, accounting for 25–43% of maternal death. It is also a leading cause of maternal morbidity and mortality in Ethiopia. This systematic review and meta-analysis were performed following the preferred reporting items for systematic reviews and Meta-Analyses (PRISMA). Primary studies were searched from different databases and random effect meta-analysis model was used. This systematic review and meta-analysis included 21 primary studies with a total of 93,898 study participants. The pooled magnitude of postpartum hemorrhage in Ethiopia was 8.24%. Advanced maternal age, prolonged labor, absence of antenatal care (ANC) visits, grand multi-parity, previous history of postpartum hemorrhage were significantly associated with postpartum hemorrhage. The finding of this systematic review and meta-analysis will strongly help different stakeholders working in maternal and child health to focus on the main contributor factors to reduce PPH If postpartum hemorrhage is reduced, it is the fact that maternal death will be decreased. [ABSTRACT FROM AUTHOR]

Background: Ethiopia is striving to reduce unmet need for family planning (FP) and implementation of the health extension program (HEP) is one of the major actions that the country took to address health issues of rural communities including FP. However, there is limited published evidence demonstrating the role of HEP in reducing the unmet need of married rural women for FP. The aim of this study is to estimate the role of HEP in reducing unmet need for FP in rural Ethiopia. Methods: This paper is based on data extracted from a national rural HEP assessment that covered all regions of Ethiopia. We identified 4991 eligible married women both from agrarian and pastoralist settings. The role of HEP was measured by the exposure of eligible women to FP services through the implementation of HEP packages. We used descriptive statistics to summarize different variables and used logistic regression to model the unmet need for FP. Results: The overall prevalence of unmet need for FP among married rural Ethiopian women was 22.41%, contraceptive prevalence rate (CPR) was 44.60%, and the total demand for FP was 60.86%. Women exposed to HEP had a lower level of unmet need (4.82%), a higher demand for FP (37.78%) and a higher CPR (24.93%) compared to women unexposed to HEP. Having exposure to FP services (adjusted odds ratio (AOR) = 0.46, 95% confidence interval (CI) 0.37–0.59), having level IV Health Extension Workers (HEWs) in the catchment health post (AOR = 0.80, 95% CI 0.67–0.95) and older age are significantly associated with lower levels of unmet need for FP. Having more children (AOR = 2.11, 95% CI 1.67–2.65) and better awareness of the husband about the availability of FP services (AOR = 1.22, 95% CI 1.01–1.48) were associated with a higher likelihood of an unmet need for FP. Conclusion: The unmet need for family planning is high in rural Ethiopia in general and among women who do not have exposure to HEP packages in particular. Assigning a better-qualified health worker at the health post, reaching out to pastoralist women, maximizing opportunities to counsel rural women about FP during any contact with HEWs, and increasing positive attitudes of husbands towards FP use are likely to have positive impacts in reducing the unmet need for FP of rural women. Plain language summary: Family planning is a method that couples can use to limit the number of child or space the gap. Unmet need for family planning is defined as the percentage of reproductive age women who wants to space or limit the number of children but not currently using any family planning method. There is a huge proportion of eligible women have an unmet need for family planning in Ethiopia. The health extension program is one of the strategies to reach rural women to improve the health of the community. Although, family planning service is one of the packages in a health extension program and this study aimed to estimate the role of health extension program in reducing unmet need for family planning. About 4991 married women were asked about the family planning use, need and the place where they get the services. During the assessment the role of health extension program was assessed by different question. Some of the major assessment areas were women exposer to service, service availability, awareness and mode of service delivery. One fourth of the women have unmet need for family planning. The family planning utilization is still low. The contribution of the health extension program in family planning service is significant. Women exposed to HEP through level 4 health extension worker and older age are significantly associated with low level of unmet need FP. The unmet need for family planning is high in rural Ethiopia. This will inform the improvement and sustainability of the program. [ABSTRACT FROM AUTHOR]

Background: Despite Ethiopia's enormous effort in youth-friendly service provision, little was investigated about the challenges of accessing sexual and reproductive health services in Western Ethiopia. Thus, this study aimed to assess factors associated with the utilization of adolescent and youth sexual and reproductive health services in this area. Methods: A community-based cross-sectional quantitative method mixed with the qualitative inquiry was conducted among 771 adolescents and youth aged 15 to 24 years from February 1 to 28, 2020. Data were collected through face-to-face interviews using pretested structured questionaries. Data were entered using EPI-INFO version 7.0 and analyzed by SPSS version 25. Descriptive analysis and logistic regressions were performed. The adjusted odds ratio with a 95% confidence interval was used and statistical significance was declared at P-value < 0.05. The qualitative inquiry was collected through in-depth interviews with service providers, focus group discussions, and observation checklists of service units in the study facilities. Data were analyzed thematically. Results: The mean age of participants was 18.99 years (SD ± 2.49). Two hundred seventeen (28.1%) of participants reported that they have ever heard about adolescents' and youth's reproductive health services. Only 66 (8.6%) have ever visited health facilities for sexual and reproductive health (SRH) services. Factors associated with the utilization of sexual and reproductive health service were age from 15 to 19 years (AOR = 0.36; 95%CI: 0.17, 0.76), history of having sexual intercourse(AOR = 5.34;95%CI: 2.53, 11.23), ever heard about sexual reproductive health service (AOR = 11.33; 95%CI: 5.59, 22.96), and visited a health facility for other health services (AOR = 5.12; 95%CI:1.72,15.24). Conclusion: Sexual and reproductive health service utilization among adolescents and youth was found to be low. The factors associated with adolescents and youth sexual and reproductive health services utilization were age, history of ever having sexual intercourse, ever heard about SRH services, and visit the health facility for other services. Therefore, it is better if the concerned bodies work on improving awareness of adolescents and youth towards SRH services and integrating these services into other routine services. Plain Language Summary: Background: Ethiopia is showing its enormous effort to improve the utilization of sexual and reproductive health services by adolescents and youths. But different factors are affecting it. This paper explains how many adolescents and youths are using sexual and reproductive health services and the factors affecting their utilization. Methods: We interviewed 771 adolescents and youths aged 15 to 24 years in western Ethiopia. We asked them about the awareness and utilization of adolescents' and youths' sexual reproductive health services and the factors affecting their utilization. Results: seven hundred seventy-one adolescents and youths were interviewed. Two hundred seventeen (28.1%) and 66 (8.6%) of them heard about and utilized adolescents' and youths' reproductive health services respectively. Those adolescents and youths who heard about sexual and reproductive health service practiced sexual intercourse and visited a health facility for other health services used sexual and reproductive health service more frequently. Conclusion: Adolescents and youths who were using Sexual and reproductive health services were not many. Therefore, it better if the concerned bodies work on improving awareness and utilization of adolescents' and youths' sexual and reproductive health services. [ABSTRACT FROM AUTHOR]

Background: Implementation of evidence-based practice is crucial to enhance quality health care, professional development, and cost-effective health service. However, many factors influence the implementation of evidence-based practice. Therefore, this study aimed to assess the implementation of evidence-based practice and associated factors among nurses and midwives. Methods: Institutional-based cross-sectional study design was conducted to assess the implementation of evidence-based practice and associated factors from February 15 to March 15, 2019, among 790 nurses and midwives. Data were entered into EpiData version 3.1 then exported to SPSS version 20 for statistical analysis. Categorical variables were presented as frequency tables. Continuous variables were presented as descriptive measures, expressed as mean and standard deviation. Cronbach's alpha was used to measure reliability, mean, standard deviation, and inter-items correlation of the factors. Independent variables with a probability value (P-value) of less than 0.2 in the Chi-square analysis were entered in the multivariable logistic regression model. Statistically significant associated factors were identified at probability value (P-value) less than 0.05 and adjusted odds ratio with a 95% confidence interval. Results: The mean age of participants was 28.35 (SD ± 4.5) years. This study revealed that 34.7% (95% CI 31.5–38%) of participants implemented evidence-based practice moderately or desirably. Age of participants (AOR = 5.98, CI 1.34–26.7), barriers of implementation of evidence-based practice (AOR = 4.8, CI 2.2–10.6), the attitude of participants (AOR = 5.02, CI 1.2–21.5), nursing/midwifery work index (AOR = 3.9, CI 1.4–10.87), self-efficacy of implementation of evidence-based practice skills (AOR = 12.5, CI 5.7–27.5) and knowledge of participants (AOR = 3.06, CI 1.6–5.77) were statistically significant associated factors of implementation of evidence-based practice Concussion: Implementation of evidence-based practice of nurses and midwives was poor. Age of participants, barriers of implementation of evidence-based practice, the attitude of participants, self-efficacy of implementation of evidence-based practice skills, nursing/midwifery work index, and knowledge of participants were found to be predictors of implementation of evidence-based practice. Insufficient time and difficulty in judging the quality of research papers and reports were the most common barriers to the implementation of evidence-based practice. [ABSTRACT FROM AUTHOR]

Background: The persistently high and stalled total fertility in Sub-Saharan Africa, including in Nigeria, calls for new efforts towards fertility reduction. Most efforts on fertility desire in sub-Saharan Africa have focused either on individual men or women with little focus on couples as a unit of analysis. Moreover, the influences of different types of marriages in which couples reproduce have not been adequately explored. Therefore, this study examined fertility desires among couples in Nigeria. Methods: This paper used data from the Nigeria Demographic and Health Survey (NDHS) of 2018 to assess fertility desire by marriage type among couples in Nigeria. In addition, the association between fertility desire and disparity in couples' educational attainment, place of residence, region, religion, occupation, wealth status, children ever born and contraceptive use were considered. The participants consisted of 6813 couples aged between 15–49 years. Couples' characteristics were reported using frequency and percentage distribution tables. Descriptive and logistic regression analyses were conducted. Results: Overall, the study revealed that 73.8% of couples were in monogamous relationships while 26.2% were in polygynous relationships. The mean ideal number of children for men and women were 7.2 and 6.1, respectively. Also, 49.3% of the couples reported husbands desired more children, 43.9% claimed wives desired more children, while 6.8% indicated equal number of desired children among wives and husbands. The results of binary logistic regression showed that couples in polygynous relationships were 4.3 times as likely to desire more children, compared to couples in monogamous relationships (OR = 4.3; 95% CI: 3.5, 5.3). Couples in polygynous relationships wanted as many as four times the number of children desired by couples in monogamous relationships. Fertility desire was significantly higher among couples who indicated the following: either was using contraceptives (OR = 2.3; 95% CI: 1.6–3.4), both were not using contraceptives (OR = 2.8; 95% CI: 1.9, 4.1), lived in North East (OR = 2.0; 95% CI: 1.5, 2.6) and North West (OR = 1.7; 95% CI: 1.3, 2.3), both were not working (OR = 1.33, 95% CI; 1.1, 1.6) and were adherents of Islam (OR = 1.8; 95% CI; 1.5, 2.4). Conclusion: These findings reflect the role of region, use of contraceptives, work status and religion in the fertility desire of couples. Implementing programmes and policies on sexual education and reproductive rights of couples and individuals may reduce high fertility desire and its adverse consequences, such as child and maternal morbidity and mortality in Nigeria. [ABSTRACT FROM AUTHOR]

Background: Efforts to expand access to family planning in rural Africa often focus on the deployment of community health agents (CHAs). Methods: This paper reports on results of the impact of a randomized cluster trial of CHA deployment on contraceptive uptake among 3078 baseline and 2551 endline women of reproductive age residing in 50 intervention and 51 comparison villages in Tanzania. Qualitative data were collected to broaden understanding of method preference, reasons for choice, and factors that explain non-use. Results: Regression difference-in-differences results show that doorstep provision of oral contraceptive pills and condoms was associated with a null effect on modern contraceptive uptake [p = 0.822; CI 0.857; 1.229]. Discussions suggest that expanding geographic access without efforts to improve spousal and social support, respect preference for injectable contraceptives, and address perceived risk of side-effects offset the benefits of adopting contraceptives provided by community-based services. Conclusions: The results of this study demonstrate that increasing access to services does not necessarily catalyze contraceptive use as method choice and spousal dynamics are key components of demand for contraception. Findings attest to the importance of strategies that respond to the climate of demand. Trial registration: Controlled-Trial.comISRCTN96819844. Retrospectively registered on 29.03.2012. [ABSTRACT FROM AUTHOR]

Background: Abortion has been legal in Nepal since 2002 and the country has made striking progress in rolling out induced abortion services. It led to well-known changes in reproductive behavior, however knowledge about legislation and abortion experience by female youth has been least investigated. This paper is an attempt to examine knowledge about legislation of abortion and abortion experiences among female youth in Nepal. Methods: This paper uses data from the Nepal Demographic and Health Survey (NDHS 2011). The analysis is confined to female youth aged 15-24 (n = 5050). Both bivariate and multivariate analyses have been performed to describe the knowledge about law and experience of abortion. The bivariate analysis (chi-square test) was applied to examine the association between dependent variables and female youth's demographic, socioeconomic, and cultural characteristics. Besides bivariate analysis, the net effect of each independent variable on the dependent variable after controlling for the effect of other predictors has also been measured through multivariate analysis (logistic regression). Results: Only two-fifth (41 %) female youth was aware of abortion legislation in the country. Knowledge on at least one condition of abortion law is even lower (21 %). Less than two percent (1.5 %) female youth reported that they ever had an abortion. The multivariate analysis found that the knowledge and experience of abortion varied with different settings. Youth aged 20-24 [adjusted odds ratio (aOR) = 1.3; 95 % O 1.7-5.0)], who have higher education (primary aOR = 1.89,; 95 % CI 1.5-2.5 secondary aOR = 4.6; 95 % CI 3.7-5.9), who were from rich households (aOR = 1.5; 95 % CI 1.2-1.7), who had high autonomy (aOR= 1.29; 95 % O 1.02-1.64) were more likely to be aware compared to their counterparts about legislation of abortion. In the other hand, female from Dalit (aOR = 0.55; 95 % G 0.5-0.7 and Janajati aOR = 0.72; 95 % CI 0.6-0.8) caste, who were married (aOR = 0.80; 95 % CI 0.7-0.9), who were from Muslim (aOR = 0.54; 95 % CI 0.3-0.9) and who resided in Hill (aOR = 0.63 ; 95 % CI 0.5-0.8) and Terai/plain area (aOR = 0.74; 95 % O 0.6-0.9) were less likely to be aware about the law. Similarly, female youth who have knowledge on abortion law (aOR = 2.8;; 95 % CI 1.6-4.8), who have primary (aOR = 5.2; 95 % CI 1.6-16.9) and secondary education (aOR = 3.8; 95 % CI 1.2-12.8), married (aOR= 7.7; 95 % CI 3.8-12.9), who had higher number of children ever born [1-2 children aOR= 1.9; 95 % CI 1.1 -3.6 and 3 or more children aOR = 3.4; 95 % CI 1.1 -10.9), who were from rich households (aOR = 2.62 ;95 % O 1.3-5.4), who have high autonomy (aOR = 3.0; 95 % G 1.6-5.8), who had experienced sexual violence (aOR= 1.91; 95 % O 1.1-8.7) were more likely to undergone abortion compared to their counterparts. Conclusion: Knowledge about legislation of abortion and conditions of abortion law is low among female youth. Awareness program should target these youth as they are more likely to be sexually active. There is a need of comprehensive education about abortion to these youth which can help eventually reduce unsafe abortion that take a large toll on women's life. [ABSTRACT FROM AUTHOR]

Background: Improving maternal healthcare services is crucial to achieving the Sustainable Development Goal (SDG-3), which aims to reduce maternal mortality and morbidity. There is a consensus among different researchers that proper utilization of maternal healthcare services can improve the reproductive health of women, and this can be achieved by providing Antenatal Care (ANC) during pregnancy, Health Facility Delivery (HFD), and Postnatal Care (PNC) to all pregnant women. The main aim of this study was to investigate the utilization and factors associated with maternal and child healthcare services among women of reproductive age in the pastoralist communities in Kenya. Methods: A cross-sectional survey was conducted among 180 pastoralist women who gave birth in the past two years across ten mobile villages in Marsabit County between 2nd January and 29th February 2019. Three key outcomes were analyzed, whether they attended ANC 4+ visits, delivered at HF, and received PNC. Pearson χ2 test and multivariate logistic regression analysis were conducted by IBM SPSS27.0 following Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. The significance level was set at p < 0.05. Results: Of the 180 eligible pastoralist women (mean age 27.44 ± 5.13 years), 92.2% were illiterate, 93.9% were married, 33.3% were in polygamy, and 14.4% had mobile phones. The median commuting distance was 15.00 (10–74) km, 41.7% attended ANC 4+, 33.3% HFD, and 42.8% PNC. Those women residing close (≤ 15 km) to a health facility had a threefold higher ANC 4+ (OR 3.10, 95% CI 1.47–6.53), 2.8-fold higher HFD (OR 2.80, 95% CI 1.34–5.84), and 2.5-fold higher PNC (OR 2.49, 95% CI 1.19–5.22) probability. The likelihood was 30-fold higher for ANC 4+ (OR 29.88, 95% CI 6.68–133.62), 2.5-fold higher for HFD (OR 2.56, 95% CI 0.99–6.63), and 60-fold higher for PNC (OR 60.46, 95% CI 10.43–350.55) in women with mobile phones. A monogamous marriage meant a fivefold higher ANC 4+ (OR 5.17, 95% CI 1.88–14.23), 1.6-fold higher HFD (OR 1.67, 95% CI 0.77–3.62), and a sevenfold higher PNC (OR 7.05, 95% CI 2.35–21.19) likelihood. Hosmer Lemeshow test indicated a good-fitting model for ANC 4+, HFD, and PNC (p = 0.790, p = 0.441, p = 0.937, respectively). Conclusion: In conclusion, the utilization of three essential maternal health services is low. Geographic proximity, monogamous marriage, and possession of mobile phones were significant predictors. Therefore, it is recommended that stakeholders take the initiative to bring this service closer to the pastoralist community by providing mobile health outreach and health education. Plain Language Summary: Attending maternal healthcare clinics is essential to reduce maternal deaths and infections. This can be achieved by receiving antenatal care, delivering at health facilities, and checkups after delivery. We investigated the utilization and factors associated with maternal and child healthcare services among pastoralist women of reproductive age who have given birth in the past two years. Of one hundred and eighty women who participated, most of them were illiterate; the majority were married, of which almost a quarter were in polygamous marriages. This population's uptake of antenatal care, delivery in health facilities, and checkups after delivery is low. This means, that walking distance to the health facility was more than 15 km, almost half of women attended antenatal care and received checkups after delivery but only thirty-three percent delivered at a health facility. Geographic proximity, monogamy, and possession of mobile phones for communication were significant in determining the usage of maternal health care. Living close to a health facility means almost three times more antenatal care, two times more health facility delivery, and checkups after delivery. Women with mobile phones showed twenty-seven more times chances to attend antenatal care, more than four times chances to deliver in a health facility and sixty times more chances of having checkups after delivery. Monogamous marriage showed five times higher odds to attend ANC 4+ visits, and seven times having checkups after delivery. Therefore, it is recommended that stakeholders take the initiative to bring this service closer to the pastoralist community. [ABSTRACT FROM AUTHOR]

Background: Birth preparedness and complication readiness is a holistic approach that empowers mothers and families with the knowledge, attitude, and resources to alleviate potential challenges during childbirth. Despite its benefits, husbands' participation in maternal care differs significantly between countries and regions. There is a lack of previous studies that look at husbands' responses to birth preparedness and complication readiness in the research area. Thus, the primary goal of this study is to find out how husbands who have wives with infants under 12 months old feel about birth preparation, readiness for problems, and its associated factors. Methods: A community-based cross-sectional study design was conducted from May 30 to July 29, 2022. Simple random sampling was employed to select 499 husbands. An interviewer-administered, structured, and pretested questionnaire was used to collect the data. Data entry and analysis were performed using Epi Data version 4.6 and SPSS version 25, respectively. We used multivariable logistic regression to find statistically significant factors. P-values less than 0.05, 95% confidence intervals, and adjusted odds ratios are used to declare statistical significance. The findings were shown in figures, tables, and text. Results: The study found that 55.9% (95% CI: 51.4 to 61.4%) of husbands responded to birth preparedness and complication readiness. This response was significantly associated with being employed (AOR = 3.7, 95% CI: 2.27–5.95), engaging in self-business (AOR = 5.3, 95% CI: 2.34–12.01), having wives who delivered in health facilities (AOR = 7.1, 95% CI: 3.92–12.86), accompanying wives for antenatal care (AOR = 2.2, 95% CI: 1.39–3.56), possessing good knowledge of danger signs during labor (AOR = 2.0, 95% CI: 1.08–3.74) and the postnatal period (AOR = 7.1, 95% CI: 3.14–16.01). Interestingly, residents living near a health facility (AOR = 0.6, 95% CI: 0.39–0.97) were less likely to respond. Conclusion: The present study found that nearly 6 out of 10 husbands actively responded in terms of birth preparedness and complication readiness. While husbands in this study showed some involvement in birth preparedness and complications, it is good when compared to studies carried out nationally. To improve this, educating husbands by focusing on the danger signs and their role in childbirth is recommended. [ABSTRACT FROM AUTHOR]

Background: Female sex workers (FSW) are particularly vulnerable to unintended pregnancy. Research examining the experience of unintended pregnancy due to commercial sex among Chinese FSW, however, is limited. This study aimed to examine the prevalence and correlates of unintended pregnancy due to commercial sex among FSW in China. Methods: In 2021, a cross-sectional study was conducted among 1257 FSW in five cities from Guangdong provinces in South China. Data were collected on social-demographic characteristics, sexual behaviors, experience of unintended pregnancy due to commercial sex and its pregnancy outcome, as well as experience of abortion in lifetime. Multivariable logistic regression analysis was employed to identify factors associated with unintended pregnancy. Results: Among the 1257 FSW, 19.3% reported having at least one unintended pregnancy due to commercial sex. Of those, 96.7% chose to terminate the pregnancy through induced abortion, and 40.5% reported undergoing multiple induced abortions in their lifetime. Multivariable logistic regression indicated that FSW working in current location over one year (adjusted Odds Ratio (aOR): 2.82, 95% CI 1.71–4.64) and having more than seven clients in the past week (aOR: 4.53, 95% CI 2.74–7.51) were more likely to have had unintended pregnancy due to commercial sex. Working in high tier (aOR: 0.21, 95% CI 0.14–0.30) and consistent condom use with clients in the past month (aOR: 0.16, 95% CI 0.10–0.23) were associated with a lower proportion of FSW having ever had unintended pregnancy. Conclusions: Unintended pregnancy are prevalent among FSW in South China. Interventions aimed at reducing the prevalence of unintended pregnancy and enhancing post-abortion care could be necessary among Chinese FSW. Plain English summary: Female sex workers (FSW) are particularly vulnerable to unintended pregnancies. Research on the experience of unintended pregnancy resulting from commercial sex among Chinese FSW is, however, limited. To address this knowledge gap, we investigated the prevalence and correlates of unintended pregnancies due to commercial sex among FSW in China. We conducted a cross-sectional study among 1257 FSW in five cities across Guangdong Province in South China in 2021. Multivariable logistic regression analysis was used to identify factors associated with unintended pregnancy. Among 1257 FSW, 19.3% reported having experienced at least one unintended pregnancy due to commercial sex. The factors significantly associated with unintended pregnancy in the multivariate analysis included participants working in high tier, working in current location over one year, using condom with clients inconsistently in the past month, and having more clients in the past week. The findings from this study could provide valuable insights for the development of policies aimed at reducing unintended pregnancies, improving abortion care, and enhancing family planning programs targeted at FSW. [ABSTRACT FROM AUTHOR]

Background: High completed fertility among married and cohabiting women has profound consequences, including straining resources, increasing healthcare challenges, and contributing to educational and gender inequalities. This study examined the factors associated with high completed fertility among married and cohabiting women aged 40–49 years in Ghana. Methods: Data for the study was sourced from the 2022 Ghana Demographic and Health Survey (GDHS). A spatial map was used to present the women's geographic variations in high completed fertility. A mixed-effect multilevel binary logistic regression analysis was performed to identify the factors associated with high completed fertility. The findings were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI). Results: The national proportion of high completed fertility among married and cohabiting women aged 40–49 years in Ghana was 52.0% [48.8, 55.2]. Women who were Ga/Dangme/Ewe by tribe [aOR = 2.32, 95% CI = 1.06, 5.08] had higher odds of high completed fertility than Akans. Women who indicated 6 + as their ideal number of children had a higher [aOR = 5.60, 95% CI = 2.90, 10.82] likelihood of high completed fertility compared to those whose ideal number of children was 0–3. Those who were using contraceptives at the time of the survey had a higher [aOR = 2.31, 95% CI = 1.17, 4.55] likelihood of high completed fertility compared to those who were not using contraceptives. Women with secondary/higher education [aOR = 0.32, 95% CI = 0.17, 0.58] had lower odds of high completed fertility than those without no formal education. Women with females as household heads [aOR = 0.56, 95% CI = 0.33, 0.95] had lower odds of high completed fertility than males. Women in Volta, Western North, Ahafo, and Bono regions had lower odds of high completed fertility compared to those living in the Northeast region, with the lowest odds among those living in the Volta region [aOR = 0.08, 95% CI = 0.02, 0.40]. Conclusion: High completed fertility is prevalent in Ghana, with more than half of married and cohabiting women having at least five or more children. The government and policymakers in Ghana should promote education for women, increase culturally sensitive family planning programs, increase access to family planning resources, address ideal family size preferences, and improve understanding of contraceptive use. [ABSTRACT FROM AUTHOR]

Background: Limited gender-based research has compared sexual health among pornography users (PUs) and non-users, including non-problematic pornography users (non-PPUs) and problematic pornography users (PPUs), particularly in non-Western cultures. Methods: A 2022 cross-sectional study involving 450 Iranian university students categorized participants as PUs or non-users based on 12 months of use. PUs were further classified as non-PPUs or PPUs using the 'Problematic Pornography Use Scale' cutoff point, with comparisons of demographic and sexual variables made between these groups. Results: Pornography use was reported among 39.6% of students, including 51.7% of men and 33.6% of women. In general, 9.5% of participants were PPUs, including 17.4% of men and 5.6% of women. PUs were mainly men, had fewer children, shorter marriages, lower religiosity, and lower levels of education. Compared with non-users, PUs reported earlier sexual relationships, lower satisfaction with sex frequency and communication, and greater rates of extramarital relationships, masturbation, sexual desire, and sexual distress. PPUs reported more sexual desire, pornography use, masturbation, and extramarital affairs than non-PPUs. Similar patterns in demographics, sexual history, and health were observed in pornography use across genders. The regression indicated being male (OR: 2.42, 95% CI: 1.44–4.06), having lower education (OR: 0.89, 95% CI: 0.81–0.97), fewer children (OR: 0.64, 95% CI: 0.48–0.86), higher masturbation (OR: 1.31, 95% CI: 1.14–1.49), more extramarital relationship (OR: 1.69, 95% CI: 1.07–2.67), less religiosity (OR: 0.87, 95% CI: 0.82–0.93), more sexual excitement (OR: 0.79, 95% CI:0.62–1), and more sexual distress (OR: 1.20, 95% CI: 1.02–1.32) were associated with pornography use. Two-way ANOVA found no significant effects of gender or pornography use on sexual satisfaction. Women had worse sexual function regardless of usage. Pornography users, regardless of gender, experienced higher sexual distress. [ABSTRACT FROM AUTHOR]

Background: Although Pakistan was one of the first countries in Asia to launch national family planning programs, current modern contraceptive use stands at only 26% with a method mix skewed toward short-acting and permanent methods. As part of a multiyear operational research study, a baseline survey was conducted to understand the predictors of contraceptive use and demand for family planning services in underserved areas of Punjab province in Pakistan. This paper presents the baseline survey results; the outcomes of the intervention will be presented in a separate paper after the study has been completed. Method: A cross-sectional baseline household survey was conducted with randomly selected 3,998 married women of reproductive age (MWRA) in the Chakwal, Mianwali, and Bhakkar districts of Punjab. The data were analyzed on SPSS 17.0 using simple descriptive and logistic regression. Results: Most of the women had low socio-economic status and were younger than 30 years of age. Four-fifths of the women consulted private sector health facilities for reproductive health services; proximity, availability of services, and good reputation of the provider were the main predicators for choosing the facilities. Husbands were reported as the key decision maker regarding health-seeking and family planning uptake. Overall, the current contraceptive use ranged from 17% to 21% across the districts: condoms and female sterilization were widely used methods. Woman's age, husband's education, wealth quintiles, spousal communication, location of last delivery, and favorable attitude toward contraception have an association with current contraceptive use. Unmet need for contraception was 40.6%, 36.6%, and 31.9% in Chakwal, Mianwali, and Bhakkar, respectively. Notably, more than one fifth of the women across the districts expressed willingness to use quality, affordable long-term family planning services in the future. Conclusion: The baseline results highlight the need for quality, affordable long-term family planning services close to women's homes. Furthermore, targeted community mobilization and behavior change efforts can lead to increased awareness, acceptability, and use of family planning and birth spacing services. [ABSTRACT FROM AUTHOR]

Background: This paper presents results of baseline data on the determinants of contraceptive use in 7 districts in northern Ghana where there is an ongoing integrated primary health care systems strengthening project known as the Ghana Essential Health Intervention Project (GEHIP). Methods: We used a household survey data conducted within 66 randomly sampled census enumeration areas in seven rural districts of the Upper East Region of northern Ghana where health systems strengthening interventions are currently ongoing in three of the districts with four of the districts serving as comparison districts. This survey was conducted prior to the introduction of interventions. Data was collected on various indices included geographic information systems (GIS) and contraceptive use. The data was analyzed using survey design techniques that accounts for correct variance estimation. Categorical variables were summarized as proportions and associations between these variables and contraceptive use tested using Chi-square test. Uni-variable and multivariable logistic regression techniques were used to assess the effects of the selected covariates on contraceptive use. All tests were deemed to be statistically significant at 5% level statistical significance. Results: Results show that contraceptive use is generally low (about 13 per cent) and use is nearly evenly for spacing and stopping purposes. Factors associated with the use of contraceptives include exposure to integrated primary healthcare services, the level of education, and socioeconomic status, couple fertility preference, marital status, and parity. For instance, the odds of contraceptive use among 15-45 year old women who live 2 km or more from a CHPS compound is 0.74 compared to women who live less than 2 km from a CHPS compound (p-value = 0.035). Conclusion: The findings suggest that rapid scale up of the Community based Health Planning and Services (CHPS) program accompanied with improved door-to-door health services would kindle uptake of modern contraceptive use, reduce unwanted pregnancies and hasten the attainment of MDG 4 & 5 in Ghana. [ABSTRACT FROM AUTHOR]

Background: A negative attitude towards abortion among health care providers providing abortion services could be an obstacle even under a law, which permits abortion on request. Healthcare providers are expected to perform and be change agents of abortion services. However, little information is known about the attitude toward safe abortion among healthcare providers in Ethiopia. Objective: This study aimed to assess health care provider's attitudes towards safe abortion care and its associated factors at the public health facilities of Bahir Dar City, Northwest Ethiopia. Methods: A health facility-based cross-sectional study was employed from March 1 to 30/2021 among 416 health-care providers. The data were collected by computer-based generated simple random sampling technique, entered, coded, and cleaned using Epi data version 4.2 and analyzed using Statistical Package of Social Sciences version 25.0. Bivariate and multivariable logistic regression analyses were employed to estimate the crude and adjusted odds ratio with a confidence interval of 95% and a P-value of less than 0.05 considered statistically significant. Results: The response rate of the study was 99.3%, and 70.2% [95% CI: 65.6–74.6] of health-care providers had a favorable attitude towards safe abortion care. Multivariable analysis indicated that health care providers who are found in the age group of 25–29, 30–34, and ≥ 35 years [AOR = 3.34, 95% CI = 1.03–10.85], [AOR = 4.58, 95% CI = 1.33- 15.83] and [AOR = 5.30, 95% CI = 1.43–19.66] respectively, male health care providers [AOR = 3.20, 95% CI = 1.55–6.60], midwives [AOR = 6.50, 95% CI = 2.40–17.44], working at hospital [AOR = 4.77, 95% CI = 1.53–14.91], ever trained on safe abortion [AOR = 5.09, 95% CI = 2.29–11.32], practicing of an abortion procedure [AOR = 2.52, 95%, CI = 1.13–5.60], knowledge of abortion [AOR = 7.35, 95% CI = 3.23–16.71], awareness on revised abortion law [AOR = 6.44, 95% CI = 3.15–13.17] and need further legalization of abortion law [AOR = 11.78, 95% CI = 5.52–24.26] were associated with a favorable attitude towards safe abortion care. Conclusions: Healthcare providers who had a favorable attitude toward safe abortion care were relatively high compared to the previous studies. Age, sex, profession, workplace, training, knowledge, and practice-related factors were associated with a favorable attitude toward safe abortion. This study indicated that, a need for intervention to help improve the attitude of healthcare providers toward safe abortion care, especially for those working in the maternity care units. [ABSTRACT FROM AUTHOR]

Background: There is a lack of quantitative studies that specifically measure the association between the experience of pregnancy and unintended pregnancy. The present study aims to address the prevalence of unintended pregnancy and identify its predictors. Additionally, the study explores whether unintended pregnancy is associated with pregnancy uplifts and hassles. Methods: This cross-sectional study was conducted on 488 pregnant women between 20 to 40 weeks' gestation at the comprehensive health center in Tabriz City from February 2022 to January 2023. A cluster sampling method was used for sampling, and data were collected using socio-demographic questionnaires and the Pregnancy Experience Scale (PES). Descriptive statistics were used to describe the socio-demographic characteristics and the prevalence of unintended pregnancy. Binary logistic regression was employed to identify the predictors of pregnancy desirability. To examine the relationship between unintended pregnancy and pregnancy experience, an independent t-test was used for bivariate analysis, and a general linear model (GLM) was utilized for multivariate analysis, with control for potential confounding variables. Results: The prevalence of unintended pregnancies was 30.7% (24.3% unwanted pregnancies, and 6.4% mistimed pregnancies). The results of the binary logistic regression indicated that the lower age of both the woman and her spouse were significant predictors for unintended pregnancy (P < 0.05). Based on an independent t-test, the mean score for uplifts in women with unintended pregnancy was significantly lower than in women with intended pregnancy (mean difference (MD): -4.99; 95% confidence interval (CI): -5.96 to -4.02; p < 0.001), While the mean score of hassles in women with unintended pregnancy was significantly higher than women with intended pregnancy (MD: 2.92; 95% CI: 2.03 to 3.80; p < 0.001). The results of GLM showed that women who had unintended pregnancies had significantly lower scores for uplifts (B = -4.99; 95% CI: -5.96 to -4.03; P < 0.001) and higher scores for hassles (B = 2.92; 95% CI: 2.06 to 3.78; P < 0.001). Conclusions: The high prevalence of unintended pregnancies in Tabriz highlights the importance of targeted interventions to address this issue, considering the policy framework and unique challenges faced by women. Future studies should focus on developing context-specific interventions that effectively meet the needs of women with unintended pregnancies. Plain Language Summary: An unintended pregnancy is a pregnancy that occurs either when the woman did not intend to get pregnant at all or when she intended to get pregnant but became pregnant at an inappropriate time. This type of pregnancy can have negative effects on the physical and mental health of women during pregnancy and after delivery. So far, no study has investigated the relationship between the experience of pregnancy and unintended pregnancy, and the existing studies, which are qualitative and based on interviews, have examined women's experiences of unintended pregnancy. For the first time, our study examined the relationship between pregnancy experience and unintended pregnancy in 488 women using a valid questionnaire, the Pregnancy Experience Scale, which includes two parts: uplifts and hassles specific to pregnancy. Our findings showed that women who have an unintended pregnancy have a worse pregnancy experience in both uplifts and hassles specific to pregnancy. Also, limited studies have investigated the prevalence of unintended pregnancy in Iran, especially in the city of Tabriz in recent years. Our study, found this prevalence to be 30.7% in Tabriz, with 24.3% of women having no intention of getting pregnant and 6.4% of women experiencing pregnancy at an inappropriate time. The recommendation is to implement strategies to reduce unintended pregnancy rates and improve women's knowledge of fertility, sexuality, and contraception. [ABSTRACT FROM AUTHOR]

Background: Early antenatal care visit is important for optimal care and health outcomes for women and children. In the study area, there is a lack of information about the time to initiation of antenatal care. So, this study aimed to determine the time to initiation of antenatal care visits and its predictors among pregnant women who delivered in Arba Minch town public health facilities. Methods: An institution-based retrospective follow-up study was performed among 432 women. A systematic random sampling technique was employed to select the study participants. The Kaplan-Meier survival curve was used to estimate the survival time. A Multivariable Cox proportional hazard regression model was fitted to identify predictors of the time to initiation of antenatal care. An adjusted hazard ratio with a 95% confidence interval was used to assess statistical significance. Results: The median survival time to antenatal care initiation was 18 weeks (95% CI = (17, 19)). Urban residence (AHR = 2.67; 95% CI = 1.52, 4.71), Tertiary and above level of education of the women (AHR = 1.90; 95% CI = 1.28, 2.81), having pregnancy-related complications in a previous pregnancy (AHR = 1.53; 95% CI = 1.08, 2.16), not having antenatal care for previous pregnancy (AHR = 0.39; 95% CI = 0.21, 0.71) and unplanned pregnancy (AHR = 0.66; 95% CI = 0.48, 0.91) were statistically significant predictors. Conclusion: Half of the women initiate their antenatal care visit after 18 weeks of their pregnancy which is not in line with the recommendation of the World Health Organization. Urban residence, tertiary and above level of education of the women, having pregnancy-related complications in a previous pregnancy, not having previous antenatal care visits and unplanned pregnancy were predictors of the time to initiation of antenatal care. Therefore, targeted community outreach programs including educational campaigns regarding antenatal care for women who live in rural areas, who are less educated, and who have no previous antenatal care experience should be provided, and comprehensive family planning services to prevent unplanned pregnancy are needed. [ABSTRACT FROM AUTHOR]

Introduction: Contraception is the deliberate prevention of unwanted pregnancy through various contraceptive methods. Its uptake is low in Sub-Saharan African countries, particularly in east Africa. This might be linked to the high prevalence of unwanted pregnancies and the high fertility rate in the area. Although studies reporting the prevalence and associated factors of modern contraceptive uptake are available in other African countries, no study has been conducted in Somaliland. Therefore, the current study aimed to assess its prevalence and associated factors in Somaliland using Somaliland Health and Demographic Survey (SLHDS) data. Methods and materials: The study used Somaliland Demographic Health Survey (SLDHS) 2020 data. The survey was a national-level survey using a cross-sectional study design. A total of 3656 reproductive-age women were included in the current study. To determine independent predictors of modern contraceptive uptake, a multi-level multivariable logistic regression analysis was done. Random effect analysis, standard error (SE) and intra-cluster correlation (ICC) were computed. Results: The proportion of modern contraceptive uptake among reproductive age groups in Somaliland is 1%. Modern contraceptive uptake is significantly associated with the residence, educational level and wealth index of participants. Women from nomadic communities had lower odds (AOR: 0.25; 95% CI: 0.10, 0.66) of modern contraceptive uptake compared to those from urban areas. Being in the highest wealth quintiles (AOR: 17.22; 95% CI: 1.99, 155.92) and having a tertiary educational level (AOR: 2.11; 95% CI: 1.29, 9.11) had higher odds of using the modern contractive method compared to those with the lowest wealth quintiles and non-formal education, respectively. Conclusion: The prevalence of modern contraceptive uptake in Somaliland was very low. It is associated with the level of education, wealth index and residence of the women. [ABSTRACT FROM AUTHOR]

Background: Intimate partner violence (IPV) is high among women of reproductive age in sub-Saharan Africa (SSA). However, empowering women enables them to confront and mitigate IPV. In this study, we examined the association between the survey-based women's empowerment index (SWPER) and IPV in SSA. Methods: We used data from the Demographic and Health Surveys of 19 countries conducted from 2015 to 2021. Our study was restricted to a weighted sample of 82,203 women of reproductive age who were married or cohabiting. We used spatial maps to show the proportions of women who experienced past-year IPV. A five-modelled multilevel binary logistic regression analysis was adopted to examine the association between SWPER and IPV. The results were presented using the adjusted odds ratio (AOR) with their respective 95% confidence interval (CI). Statistical significance was set at p < 0.05. Results: With physical and emotional violence, the country with the highest prevalence was Sierra Leone, with a prevalence of 39.00% and 38.97% respectively. Rwanda (10.34%), Zambia (11.09%), Malawi (15.00%), Uganda (16.88%), and Burundi (20.32%) were the hotspot countries for sexual violence. Angola (34.54%), Uganda (41.55%), Liberia (47.94%), and Sierra Leone (59.98%) were the hotspot countries for IPV. A high SWPER score in attitudes to violence significantly decreased the odds of IPV [AOR = 0.70; 95% CI = 0.66, 0.75]. Also, women with medium score in decision-making were less likely to experience IPV compared to those with lower scores [AOR = 0.89; 95% CI = 0.83, 0.95]. However, higher odds of experiencing IPV was found among women with medium score in autonomy compared to those with low scores [AOR = 1.07; 95% CI = 1.01, 1.14]. Conclusions: Our study has shown that the three dimensions of SWPER significantly predict IPV among women. Consequently, it is crucial that sub-Saharan African countries implement various initiatives, such as IPV advocacy programs and economic livelihood empowerment initiatives. These initiatives should not only aim to improve women's attitudes to domestic violence but also to enhance their social independence, autonomy, and decision-making capacity. [ABSTRACT FROM AUTHOR]

Background: Female genital mutilation (FGM) has negative health implications and has long been recognised as violating sexual rights. Despite the huge efforts expended on eradicating FGM, generational continuation of the practice, i.e. the act of mutilated women also mutilating their daughters, persists in Nigeria. This study investigated the individual, household, and community factors associated with generational continuation of FGM among women in Nigeria. Methods: The study analysed data from the 2018 Nigeria Demographic and Health Survey (NDHS). A weighted sample of 3835 women with FGM history and who had given birth to female children was analysed. Models were estimated using mixed-effects multilevel logistic regression with Stata 16.0. Results: The results showed that 40.0% of women continued FGM for their daughters. Regional prevalence of FGM continuation ranged from 14.9% in the South-South (the lowest) to 64.3% in the North-West (the highest). Women aged 15–24 years (uaOR = 0.40; 95% CI:0.28–0.57) and rich (uaOR = 0.44; 95% CI:0.35–0.56) had the least likelihood of generational continuation of FGM. In communities with low proportions of women unexposed to the media, the likelihood of FGM continuation was significantly higher (uaOR = 1.85; 95% CI:1.35–2.53). Generational continuation of FGM was significantly lower in communities with moderate proportions of uneducated mothers (aOR = 0.6; 95% CI:0.42–0.86). Conclusion: FGM continuation was high in Nigeria, and it was most common among older and poor mothers and in communities with large proportions of uneducated women and those unexposed to the media. Existing National Policy and Plan on FGM elimination should be strengthened to target these characteristics. [ABSTRACT FROM AUTHOR]

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Background: Despite recent achievements in health targets, Ethiopia still faces challenges in health service delivery. Between 2012 and 2015, a non-governmental organisation (NGO), Doctors with Africa CUAMM, implemented a multifaceted project aimed at improving access to maternal and child health services in three districts in Ethiopia. This paper evaluates the performance of this project, based on four maternal health indicators. Methods: A before-and-after study utilising data collected through cross-sectional surveys involving 999 women was conducted. The date of delivery was used to stratify the intervention period as follows: pre-intervention, early intervention, and late intervention. Changes during the intervention in the coverage of four antenatal care (ANC) visits, receipt of three basic components of ANC, skilled birth attendant (SBA) at delivery, and postnatal care (PNC) in seven days were assessed using logistic regression, adjusting for socio-demographic factors. Results: There was an increase in the coverage of receipt of all three ANC components and SBA at delivery between the pre-intervention period and the late intervention period. The percent of health centre deliveries increased from 7.3 % in the pre-intervention period to 35.6 % in the late intervention period. The odds of receiving all three components of ANC were twice higher in the late intervention period than in the pre-intervention period (OR 2.09; 95 % CI 1.12-3.89). The odds of SBA at delivery were five times higher in the late intervention period than in the pre-intervention period (OR 5.04; 95 % CI 2.53-10.06). There was no significant change in the coverage of four ANC visits and PNC after accounting for sociodemographic factors. Conclusions: This NGO implemented maternal health project in three districts in Ethiopia was associated with increased likelihood that a pregnant woman would receive three basic components of ANC and be assisted by a SBA at delivery. Increase in skilled birth attendance was driven by increased utilisation of health centres. More efforts are needed to bolster the coverage of ANC and PNC. [ABSTRACT FROM AUTHOR]

Background: There is limited research on how the empowerment of women and intimate partner violence (IPV) are associated with skilled birth attendance (SBA) among rural women in Uganda. Therefore, the aim of this paper was to investigate the association between women's empowerment, their experience of IPV and SBA in rural Uganda. Methods: Using data from the Uganda Demographic and Health Survey (UDHS), we selected 857 rural women who were in union, had given birth in the last 5 years preceding the survey and were selected for the domestic violence (DV) module. Frequency distributions were used to describe the background characteristics of the women and their partners. Pearson's chi-squared (χ²) tests were used to investigate the associations between SBA and women's empowerment; and partners' and women's socio-demographic factors including sexual violence. Multivariable logistic regression analyses were used to examine the association between SBA and explanatory variables. Results: More than half (55 %) of the women delivered under the supervision of skilled birth attendant. Women's empowerment with respect to participation in household decision-making, property (land and house) (co)ownership, IPV, and sexual empowerment did not positively predict SBA among rural women in Uganda. Key predictors of SBA were household wealth status, partners' education, ANC attendance and parity. Conclusions: For enhancement of SBA in rural areas, there is a need to encourage a more comprehensive ANC attendance irrespective of number of children a woman has; and design interventions to enhance household wealth and promote men's education. [ABSTRACT FROM AUTHOR]

Background: In Uganda, neonatal mortality rate (NMR) remains high at 27 deaths per 1000 live births. There is paucity of data on factors associated with NMR in rural communities in Uganda. The objective of this study was to determine NMR as well as factors associated with neonatal mortality in the rural communities of three districts from eastern Uganda. Methods: Data from a baseline survey of a maternal and newborn intervention in the districts of Pallisa, Kibuku and Kamuli, Eastern Uganda was analyzed. A total of 2237 women who had delivered in the last 12 months irrespective of birth outcome were interviewed in the survey. The primary outcome for this paper was neonatal mortality. The risk ratio (RR) was used to determine the factors associated with neonatal mortality using log - binomial model. Results: The neonatal mortality was found to be 34 per 1000 live births (95 % CI = 27.1-42.8); Kamuli 31.9, Pallisa 36.5 and Kibuku 30.8. Factors associated with increased neonatal deaths were parity of 5+ (adj. RR =2.53, 95 % CI = 1.14-5.65) relative to parity of 4 and below, newborn low birth weight (adj. RR = 3.10, 95 % CI = 1.47-6.56) and presence of newborn danger signs (adj. RR = 2.42, 95 % CI = 1.04-5.62). Factors associated with lower risk of neonatal death were, home visits by community health workers' (CHW) (adj. RR =0.13, 95 % CI = 0.02-0.91), and attendance of at least 4 antenatal visits (adj. RR = 0.65, 95 % CI = 0.43-0.98). Conclusions: Neonatal mortality in rural communities is higher than the national average. The use of CHW's to mobilize and sensitize households on appropriate maternal and newborn care practices could play a key role in reducing neonatal mortality. [ABSTRACT FROM AUTHOR]

Background: Many women throughout the world have history of subfertility (resolved or unresolved), but much remains unknown about services and treatments chosen. Methods: We developed a mixed-mode fertility experiences questionnaire (FEQ) in 2009 through literature review and iterative pilot work to optimize question format and mode of administration. The focus of the FEQ is to collect data retrospectively on time at risk for pregnancy, fertility treatments received and declined, pregnancy, time to pregnancy and pregnancy outcomes. We conducted a validation of key elements of the FEQ with comparison to medical records in 2009 and 2010. The validation sample was selected from women initially seen at a specialized fertility treatment center in Utah in 2004. Results: The FEQ was optimized with two components: 1) written (paper or web-based), self-administered, followed by 2) telephone- administered questions. In 63 patients analyzed, high levels of correlation were identified between patient self-report and medical records for the use of intrauterine insemination and assisted reproductive technology, pregnancy and live birth histories, time at risk for pregnancy and time to pregnancy. There was low correlation between medical records and self-report for the use of oral ovulation drugs and injectable ovulation drugs. Compared to the medical record, the FEQ was over 90 % sensitive for all elements, except injectable ovulation drugs (70 % sensitivity). Conclusions: The FEQ accurately captured elements of fertility treatment history at 5-6 years after the first visit to a specialty clinic. [ABSTRACT FROM AUTHOR]

Background: It is important when conducting epidemiologic studies to closely monitor lost to follow up (LTFU) rates. A high LTFU rate may lead to incomplete study results which in turn can introduce bias to the trial or study, threatening the validity of the findings. There is scarce information on LTFU in prospective community-based perinatal epidemiological studies. This paper reports the rates of LTFU, describes socio-demographic characteristics, and pregnancy/delivery outcomes of mothers LTFU in a large community-based pregnancy registry study. Methods: Data were from a prospective, population-based observational study of the Global Network for Women's and Children's Health Research Maternal Newborn Health Registry (MNHR). This is a multi-centre, international study in which pregnant women were enrolled in mid-pregnancy, followed through parturition and 42 days postdelivery. Risk for LTFU was calculated within a 95%CI. Results: A total of 282,626 subjects were enrolled in this study, of which 4,893 were lost to follow-up. Overall, there was a 1.7% LTFU to follow up rate. Factors associated with a higher LTFU included mothers who did not know their last menstrual period (RR 2.2, 95% CI 1.1, 4.4), maternal age of < 20 years (RR 1.2, 95% CI 1.1, 1.3), women with no formal education (RR 1.2, 95% CI 1.1, 1.4), and attending a government clinic for antenatal care (RR 2.0, 95% CI 1.4, 2.8). Post-natal factors associated with a higher LTFU rate included a newborn with feeding problems (RR 1.6, 94% CI 1.2, 2.2). Conclusions: The LTFU rate in this community-based registry was low (1.7%). Maternal age, maternal level of education, pregnancy status at enrollment and using a government facility for ANC are factors associated with being LTFU. Strategies to ensure representation and high retention in community studies are important to informing progress toward public health goals. [ABSTRACT FROM AUTHOR]

Background: The use of a single national figure fails to capture the complex patterns and inequalities in early childbearing that occur within countries, as well as the differing contexts in which these pregnancies occur. Further disaggregated data that examine patterns and trends for different groups are needed to enable programmes to be focused on those most at risk. This paper describes a comprehensive analysis of adolescent first births using disaggregated data from Demographic and Household surveys (DHS) for three East African countries: Uganda, Kenya and Tanzania. Methods: The study initially produces cross-sectional descriptive data on adolescent motherhood by age (under 16, 16 - 17 and 18 - 19 years), marital status, wealth, education, state or region, urban/rural residence and religion. Trends for two or more surveys over a period of 18 - 23 years are then analysed, and again disaggregated by age, wealth, urban/rural residence and marital status to ascertain which groups within the population have benefited most from reductions in adolescent first birth. In order to adjust for confounding factors we also use multinomial logistic regression to analyse the social and economic determinants of adolescent first birth, with outcomes again divided by age. Findings: In all three countries, a significant proportion of women gave birth before age 16 (7%-12%). Both the bivariate analysis and logistic regression show that adolescent motherhood is strongly associated with poverty and lack of education/literacy, and this relationship is strongest among births within the youngest age group (<16 years). There are also marked differences by region, religion and urban/rural residence. Trends over time show there has been limited progress in reducing adolescent first births overall, with no reductions among the poorest. Conclusions: Adolescent first births, particularly at the youngest ages, are most common among the poorest and least educated, and progress in reducing rates within this group has not been made over the last few decades. Disaggregating data allows such patterns to be understood, and enables efforts to be better directed where needed. [ABSTRACT FROM AUTHOR]

Background: Young people particularly women are at increased risk of undesirable sexual and reproductive health (SRH) outcomes. Structural factors have been reported as driving some of these risks. Although several interventions have targeted some of the structural drivers for adolescent's SRH risk, little has been done to consolidate such work. This would provide a platform for coordinated efforts towards adolescent's SRH. We provide a narrative summary of interventions in sub-Saharan Africa (sSA) addressing the structural drivers of adolescents' SRH risk, explore pathways of influence, and highlight areas for further work. Methods: 33 abstracts and summary reports were retrieved and perused for suitability. Fifteen documents met the inclusion criteria and were read in full. Papers and reports were manually reviewed and 15 interventions that met the criteria for inclusion were summarised in a table format. Results: Most of the interventions addressed multiple structural factors, such as social norms, gender inequality, and poverty. Some interventions focused on reducing economic drivers that increased sexual risk behaviours. Others focused on changing social norms and thus sexual risk behaviours through communication. Social norms addressed included gender inequality, gender violence, and child socialisation. The interventions included components on comprehensive sexuality and behaviour change and communication and parenting, using different designs and evaluation methods. Important lessons from the narrative summary included the need for a flexible intervention design when addressing adolescents, the need for coordinated effort among different stakeholders. Conclusion: There are encouraging efforts towards addressing structural drivers among adolescents in (sSA). There is, however, a need for interventions to have a clear focus, indicate the pathways of influence, and have a rigorous evaluation strategy assessing how they work to reduce vulnerability to HIV. There is also a need for coordinated effort among stakeholders working on adolescent vulnerability in sSA. [ABSTRACT FROM AUTHOR]

Introduction: Utilization of Skilled Birth Attendants (SBAs) at birth is low (20%) in Bangladesh. Birth attendance by SBAs is considered as the "single most important factor in preventing maternal deaths". This paper examined the practices and determinants of delivery by SBAs in rural Bangladesh. Methods: The data come from the post-intervention survey of a cluster-randomized community controlled trial conducted to evaluate the impact of limited post-natal care (PNC) services on healthcare seeking behavior of women with a recent live birth in rural Bangladesh (n = 702). Multivariable logistic regression model was used to identify the potential determinants of delivery by SBAs. Results: The respondents were aged between 16 and 45, with the mean age of 24.41 (± 5.03) years. Approximately one-third (30.06%) of the women had their last delivery by SBAs. Maternal occupation, parity, complications during pregnancy and antenatal checkup (ANC) by SBAs were the significant determinants of delivery by SBAs. Women who took antenatal care by SBAs were 2.62 times as likely (95% CI: 1.66, 4.14; p < 0.001) to have their delivery conducted by SBAs compared to those who did not, after adjusting for other covariates. Conclusion: Our findings suggest that ANC by SBAs and complications during pregnancies are significant determinants of delivery by SBAs. Measure should be in place to promote antenatal checkup by SBAs to increase utilization of SBAs at birth in line with achieving the Millennium Development Goal-5. Future research should focus in exploring the unmet need for, and potential barriers in, the utilization of delivery by SBAs. [ABSTRACT FROM AUTHOR]

Background: Tanzania Health policy insists on the need to provide all women access to contraception despite HIV status. We used data from two HIV epidemiologic serological surveys carried out at different periods of ART provision in rural Tanzania to assess the level of unmet need for modern contraception by HIV status and associated factors. Methods: We performed secondary data analysis of two surveys conducted at the Magu Health and Demographic Surveillance System site, in Mwanza, Tanzania. Information on unmet need for modern contraception was derived from fertility desire and contraception use. Unmet need, HIV status, and socioeconomic and demographic variables were analysed. The percentage of women with unmet needs for modern contraception by HIV status is presented for the 2012 and 2017 surveys. Bivariate and multivariate analyses using logistic regression were used to investigate associated factors showing adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs). Results: Data from 3352 and 3196 women aged 15–49 years collected in the 2012 and 2017 surveys, respectively, were analysed. The percentages of women with unmet needs for modern contraception in the 2012 and 2017 surveys were 30.9% (95% CI 29.4–32.6) and 31.6% (95% CI 30.0–33.3), respectively. The unmet need for modern contraception was 26% lower in HIV-uninfected women in 2012 (aOR = 0.74; 95% CI 0.569–0.973); p = 0.031). Risk factors for unmet need for modern contraception in 2012 were HIV uninfected (adjusted OR = 0.74; 95% CI 0.569–0.973); p = 0.031), married marital status (adjusted OR = 0.768; 95% CI 0.743–0.794); p < 0.0001), higher education (adjusted OR = 0.768; 95% CI 0.743–0.794); p < 0.0001), and taking alcohol (adjusted OR = 0.768; 95% CI 0.743–0.794); p < 0.0001). Only two factors were associated with unmet need for modern contraception in 2017: married marital status (adjusted OR = 0.46; 95% CI 0.305–0.722); p = 0.001) and women who earned for their families (aOR = 0.66; 95% CI 0.494–0.887); p = 0.006). Discussion: Nearly one-third of women had an unmet need for modern contraception, which was lower in HIV-uninfected women than in WLHIV-infected women. The study has identified women whose demand for contraception has not been met: WLHIV, post marital women, women with low education and women who were reported to earn money for their families. Family planning interventions should be tailored to these groups of women. [ABSTRACT FROM AUTHOR]

Background: Preterm birth is a significant contributor to newborns morbidity and mortality. Despite the availability of highly effective and powerful interventions, the burden of preterm birth has not decreased. Given the relevance of the topic to clinical decision-making, strong conclusive and supporting evidence emanating from the umbrella review is required. To this end, this umbrella review study sought to determine the association between intimate partner violence and obstetrics characteristics of women with preterm birth in Ethiopia. Methods: Six systematic review and meta-analysis studies searched across multiple databases were included in this umbrella review. The quality of the included systematic review and meta-analysis studies was evaluated using the Assessment of Multiple Systematic Reviews (AMSTAR-2) checklist. STATA version 18 was used for the statistical analysis. A random-effects model was used to calculate the overall effect measurement. Results: A total of 114 observational studies in the six systematic review and meta-analysis studies involving 75,624 pregnant women were included in this comprehensive analysis. The preterm birth rate among mothers in Ethiopia was 11% (95% CI 10–13%; I2 = 98.08). Preterm birth was significantly associated with intimate partner violence (POR: 2.32; 95% CI 1.74–2.90), multiple pregnancies (POR: 3.36; 95% CI 2.41–4.32), pregnancy-induced hypertension (POR: 4.13; 95% CI 3.17–5.10), anemia (POR: 2.76; 95% CI 1.97–3.56), and premature rupture of pregnancy (POR: 5.1; 95% CI 3.45–6.75). Conclusions: More than one out of ten pregnant women experienced preterm birth in Ethiopia. Intimate partner violence is significantly associated with preterm birth. Furthermore, multiple pregnancies, pregnancy-induced hypertension, anemia, and premature rupture of the membrane were significant predictors of preterm birth. Therefore, policymakers should consider further instigations and implementations of policies and strategies closely related to reductions of intimate partner violence. It is also crucial to the early identification and treatment of high-risk pregnancies. [ABSTRACT FROM AUTHOR]

Background: Several studies have provided evidence about adverse pregnancy outcomes of nurses involved in occupational exposure. However, the pregnancy outcomes among nurses in middle-income countries are not well demonstrated. The main aim of this study is to present the prevalence and influencing factors of pregnancy outcomes among female nurses in China. Methods: We included 2243 non-nurse health care workers, and 4230 nurses in this national cross-sectional study in China. Information on occupational exposures and pregnancy outcomes was collected using a face-to-face investigation. Odds ratios (ORs) were estimated through logistic regression. Results: The proportion of threatened abortion, spontaneous abortion, and stillbirth of female nurses was 2.6%, 7%, and 2.1%, respectively. We found an increased risk of threatened abortion among nurses with overtime work (OR = 1.719, 95% CI 1.158–2.550). The risk of threatened abortion and spontaneous abortion was elevated among nurses handling disinfectant (OR = 2.293 and 1.63, respectively). We found a nearly twofold increased risk of premature birth (OR = 2.169, 95% CI 1.36–3.459) among nurses handling anti-cancer drugs. Conclusions: Our findings suggested that maternal occupational exposures might be associated with the risk of adverse pregnancy outcomes among female nurses in China. We recommend that policy-markers and hospital managers work together to reduce exposure to occupational hazards and improve pregnancy outcomes among female nurses. [ABSTRACT FROM AUTHOR]

Introduction: Despite the threat of violence to the health and rights of women yet, for many years, there has been a dearth of nationally comparable data on domestic violence in sub-Saharan Africa. This paper examines whether women from poor households are more likely to experience violence from husband/partner than other women who are from middle or rich households. Method: Data for the study are derived from most recent DHS surveys of ever-married women age 15- 49 in Cameroun(3,691), Kenya(4,336), Mozambique(5610), Nigeria (16,763), Zambia(3,010) and Zimbabwe(5,016) who participated in the questions on Domestic Violence Module. Bivariate analysis and Binary Logistic Regression Analysis are used to explore the linkage between household poverty-wealth and spousal violence while simultaneously controlling for confounding variables. Results: The overall prevalence of any form of violence (physical, sexual or emotional) ranges from 30.5% in Nigeria to 43.4% in Zimbabwe; 45.3% in Kenya; 45.5% in Mozambique; 53.9% in Zambia and 57.6% in Cameroun. Both bivariate and multivariate analyses show that in two of the six countries -Zambia and Mozambique, experience of violence is significantly higher among women from non-poor (rich) households than those from other households (poor and middle). For Zimbabwe and Kenya, women from poor households are more likely to have ever experienced spousal violence than those from non-poor households. In the remaining two countries- Nigeria and Cameroun, women from the middle class are more likely to have ever suffered abuse from husband/partner than those from the poor and rich households. Conclusion: Our results thus show that similar measurements of household poverty-wealth have produced varying relationships with respect to experience of spousal violence in six sub-Saharan African countries. In other words, experience of violence cuts across all household povertywealth statuses and therefore may not provide enough explanations on whether householdpoverty necessarily serves to facilitate the ending of violence. These results suggest that eliminating violence against women in sub-Sahara Africa requires a comprehensive approach rather than addressing household poverty-wealth alone. [ABSTRACT FROM AUTHOR]

Background: Public health and human right issues are challenging in low and middle income countries. The main objectives of this paper were to determine the prevalence and factors associated with domestic violence, extramarital sex, and spousal communication among male. Methods: A cross-sectional study among 2466 married males in Kathmandu, Nepal was conducted using random sampling method. Adjusted odds ratios (AORs) and 95% confidence intervals (CI) of associated factors were estimated by stepwise backward likelihood ratio method. Results: Prevalence of domestic violence was 63.14% (95% CI 61·20-65·05), extramarital sex was 32.12% (95% CI 30·27-34·00), and spousal communication was 48·87% (95% CI 46·85- 50·90). Nearly one in five male (18·20%) had not used condom during extramarital sex. Interestingly, male who had more than three or equal children were less likely to have perpetrated domestic violence compared with those who had less children. Older male aged 25 and above were more likely (AORs = 1·55, 95% CI 1.19-2.03) to have extramarital sex compared with male aged 24 or below. Those male who had studied secondary or higher level of education were less likely to have extramarital sex compared to those who had primary level or no education. Male who had higher income were more likely to have spousal communication compared to those who had less income. Surprisingly, those male who had extramarital sex were less likely to have spousal communication compared with those was not involved in extramarital sex. Conclusion: Practice of domestic violence and extramarital sex is quite common among married male in Nepal, where spousal communication is sparse. These findings can be used to advocate for immediate attention and activities needs to be endorsed by policymakers and programmers. [ABSTRACT FROM AUTHOR]

Background: India launched a national conditional cash transfer program, Janani Suraksha Yojana (JSY), aimed at reducing maternal mortality by promoting institutional delivery in 2005. It provides a cash incentive to women who give birth in public health facilities. This paper studies the extent of program uptake, reasons for participation/ non participation, factors associated with non uptake of the program, and the role played by a program volunteer, accredited social health activist (ASHA), among mothers in Ujjain district in Madhya Pradesh, India. Methods: A cross-sectional study was conducted from January to May 2011 among women giving birth in 30 villages in Ujjain district. A semi-structured questionnaire was administered to 418 women who delivered in 2009. Socio-demographic and pregnancy related characteristics, role of the ASHA during delivery, receipt of the incentive, and reasons for place of delivery were collected. Multinomial regression analysis was used to identify predictors for the outcome variables; program delivery, private facility delivery, or a home delivery. Results: The majority of deliveries (318/418; 76%) took place within the JSY program; 81% of all mothers below poverty line delivered in the program. Ninety percent of the women had prior knowledge of the program. Most program mothers reported receiving the cash incentive within two weeks of delivery. The ASHA's influence on the mother's decision on where to deliver appeared limited. Women who were uneducated, multiparious or lacked prior knowledge of the JSY program were significantly more likely to deliver at home. Conclusion: In this study, a large proportion of women delivered under the program. Most mothers reporting timely receipt of the cash transfer. Nevertheless, there is still a subset of mothers delivering at home, who do not or cannot access emergency obstetric care under the program and remain at risk of maternal death. [ABSTRACT FROM AUTHOR]

Background: A longstanding gap in the reproductive health field has been the availability of a screening instrument that can reliably predict a person's likelihood of becoming pregnant. The Desire to Avoid Pregnancy Scale is a new measure; understanding its sensitivity and specificity as a screening tool for pregnancy as well as its predictive ability and how this varies by socio-demographic factors is important to inform its implementation. Methods: This analysis was conducted on a cohort of 994 non-pregnant participants recruited in October 2018 and followed up for one year. The cohort was recruited using social media as well as advertisements in a university, school, abortion clinic and outreach sexual health service. Almost 90% of eligible participants completed follow-up at 12 months; those lost to follow-up were not significantly different on key socio-demographic factors. We used baseline DAP score and a binary variable of whether participants experienced pregnancy during the study to assess the sensitivity, specificity, area under the ROC curve (AUROC) and positive and negative predictive values (PPV and NPV) of the DAP at a range of cut-points. We also examined how the predictive ability of the DAP varied according to socio-demographic factors and by the time frame considered (e.g., pregnancy within 3, 6, 9 and 12 months). Results: At a cut-point of 2 on the 0–4 range of the DAP scale, the DAP had a sensitivity of 0.78, a specificity of 0.81 and an excellent AUROC of 0.87. In this sample the cumulative incidence of pregnancy was 16% (95%CI 13%, 18%) making the PPV 43% and the NPV 95% at this cut-point. The DAP score was the factor most strongly associated with pregnancy, even after age and number of children were taken into account. The association between baseline DAP score and pregnancy did not differ across time frames. Conclusions: This is the first study to assess the DAP scale as a screening tool and shows that its predictive ability is superior to the limited pre-existing pregnancy prediction tools. Based on our findings, the DAP could be used with a cut-point selected according to the purpose. [ABSTRACT FROM AUTHOR]

Reproductive autonomy, or the extent to which people control matters related to their own sexual and reproductive decisions, may help explain why some people who do not intend to become pregnant nevertheless do not use contraception. Using cross-sectional survey data from 695 women aged 16 to 47 enrolled in the Umoyo Wa Thanzi (UTHA) study in Malawi in 2019, we conducted confirmatory factor analysis, descriptive analyses, and multivariable logistic regression to assess the freedom from coercion and communication subscales of the Reproductive Autonomy Scale and to examine relationships between these components of reproductive autonomy and current contraceptive use. The freedom from coercion and communication subscales were valid within this population of partnered women; results from a correlated two-factor confirmatory factor analysis model resulted in good model fit. Women with higher scores on the freedom from coercion subscale had greater odds of current contraceptive use (aOR 1.13, 95% CI: 1.03–1.23) after adjustment for pregnancy intentions, relationship type, parity, education, employment for wages, and household wealth. Scores on the communication subscale were predictive of contraceptive use in some, but not all, models. These findings demonstrate the utility of the Reproductive Autonomy Scale in more holistically understanding contractive use and non-use in a lower-income setting, yet also highlight the need to further explore the multidimensionality of women's reproductive autonomy and its effects on achieving desired fertility. [ABSTRACT FROM AUTHOR]

Background: Previous studies examined the effects of obesity on sperm parameters and reported inconsistent results. Thus, the present study aimed to evaluate the association between obesity and the quality of sperm parameters in infertile men. Material and methods: The present cross-sectional study evaluated 218 infertile men aged 20–50. To this end, the 168-item food frequency questionnaire (FFQ) was utilized to evaluate dietary intake. The anthropometric and biochemical variables were examined using standard methods. Further, the association between obesity and the quality of sperm parameters was evaluated using the controlled linear regression for potential confounders. Results: The normal sperm morphology had a significant inverse association with BMI [adjusted β − 0.074, CI (− 0.141 to − 0.008), P = 0.029] and WC [adjusted β − 0.026, CI (− 0.051 to − 0.001), P = 0.038]. Additionally, visceral fat had a marginal inverse association with normal sperm morphology [adjusted β − 0.065, CI (− 0.138 to 0.008), P = 0.079] and non-progressive sperm motility [adjusted β − 0.241, CI (− 0.495 to 0.014), P = 0.063]. Conclusion: Even though the present results indicated that obesity, abdominal obesity, and visceral fat had inverse associations with normal sperm morphology, more mechanism-based studies should be conducted to confirm these findings. [ABSTRACT FROM AUTHOR]

Differing global sociocultural contexts of sexual relationships influence age at first sexual intercourse with potentially long-lasting region-specific effects such as increased risk of contracting HIV and other sexually transmitted infections (STIs). In these cross-sectional analyses of data from the screening and enrollment visits for an HIV incidence study in Kisumu County, Kenya, we evaluated factors associated with having experienced an early sexual debut (ESD) among males and females aged 18–35 years. Clinical evaluation was performed and sexual behaviors were assessed via questionnaire. ESD was defined as self-reported age 15 years or younger at first sexual intercourse. Robust Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (95% CIs) for factors associated with ESD. Of 1057 participants, 542 (51.3%) were female. Participants' median age at study screening was 25 years (interquartile range [IQR]: 22–29), and at sexual debut was 16 years (IQR: 14–17). Five hundred and four participants (47.7%) reported ESD. ESD was less common among females (PR 0.78, CI 0.67–0.90) and participants with more than primary education (PR 0.56, CI 0.47–0.66). ESD was more common in participants with a history of drug use (PR 1.28, CI 1.10–1.49). Drug use removed the protective effect of education (some secondary education or less, no drug use: PR 0.72, CI 0.61–0.85; some secondary education or less, drug use: PR 0.94, CI 0.74–1.18). ESD was common in our study and associated with lower educational attainment and increased likelihood of drug use. Interventions are needed early in life, well before 15 years of age, to encourage engagement in schooling and prevent drug use. Comprehensive sexual education and interventions to prevent drug use may be beneficial before the age of 15 years. Plain language summary: Early sexual debut can be defined as first sexual intercourse at or before 15 years of age. There are many social and cultural factors that influence the age of sexual debut. People who start having sex early in life may exhibit behaviors that increase risk for HIV and other sexually transmitted infections. We conducted a study of men and women aged 18–35 years in Kisumu County, Kenya, which included documentation of medical history, physical examination, laboratory tests, and a questionnaire to assess sexual behaviors. Among the 1057 people studied, the average age of sexual debut was 16.0 years for females and 15.4 years for males. A total of 504 (47.7%) participants reported early sexual debut. The data showed that early sexual debut was less common in females and in participants with more years of education. Early sexual debut was more common in participants with a history of drug use. The findings suggest that interventions to prevent early sexual debut might be improved if they focus on educational attainment and prevention of drug use. [ABSTRACT FROM AUTHOR]

Background: In India, community based studies and media reports indicate a surge in the number of young women undergoing hysterectomy in the past few years. This has led to suspicion on the misuse of procedure, and intense debates on its potential ill health-effects on young women. However, there are no population-based studies that provide insights into hysterectomy prevalence and its determinants at the national level. Data and methods: This study used data from India's District Level Household Survey that involved a sample of 3, 16,361 married women in the age group of 15--49 years spread across 21 States and Union Territories of India. Bivariate and multivariate regression analysis was performed to estimate hysterectomy prevalence and identify its predictors. Results: The study estimated hysterectomy prevalence of 17 per 1000 ever married women. The number of women undergoing hysterectomy ranged from 2 to 63/1000 across different states. A little more than one-third of women who had undergone hysterectomy were under the age of 40 years. The proportion of women below 40 years of age who had had hysterectomy was much higher in southern states of Andhra Pradesh (42%) and Telangana (47%). The likelihood of hysterectomy was higher among women belonging to households with health insurance (OR: 1.88, CI: 1. 77--2.00) and women who were sterilized (OR 1.55; CI 1.45--1.67) than uninsured and unsterilized women, and lower among women with education level of matriculation and above (OR 0.47; CI 0.42--0.50) than those with no and/or low education. Conclusions: A sizable proportion of young women undergoing hysterectomy in India may have severe ill-health effects on their physical, reproductive and socio-psycho health. As women with low or no education are also more prone to hysterectomy, providing more information and education to them on the possible after-effects of hysterectomy and alternative options will enable them to make more informed choices. [ABSTRACT FROM AUTHOR]

Background: Little is known about the acceptance of specific populations of decision makers in Lebanon regarding surrogacy. This study aimed to explore the acceptance and attitude of Lebanese Lawyers and Medical Students regarding surrogacy. Methods: In total 248 medical students and 204 lawyers completed a questionnaire to assess socio-demographic data, attitude toward surrogacy, and three different clinical scenarios to assess patterns of thinking. Finally, we validated a scale to assess the acceptance of surrogacy in these two populations. Results: Concerning medical students, 54.8% reported they were supportive of surrogacy, 35.1% were neutral and 10.1% were against. For lawyers, 52.9% were supportive, 25% were neutral and 22.1% were against. Lawyers were more likely to be against surrogacy (p = 0.001). After conducting a multivariate analysis on the whole studied population to find predictors of acceptance of surrogacy, the best predictors were being single (OR 0.415; 95% CI 0.228, 0.753; p < 0.01), a supportive reported attitude regarding surrogacy (OR 5.464; 95% CI 3.65, 8.13; p < 0.001) and believing that surrogacy is a solution worth discussing in Lebanon (OR 4.186; 95% CI 1.709, 10.256; p < 0.01). Concerning the clinical scenarios, they showed that lawyers were more likely to oppose abortion regardless of the reason (p < 0.01). Also, in a case of gestational surrogacy, lawyers were more likely to give the right to the gestational carrier to keep the baby compared to medical students (p < 0.001). Conclusion: In conclusion, this study shows that only a minority of medical students and lawyers in Lebanon oppose surrogate pregnancy which warrants exploration of the perspective of other populations of decision makers in Lebanon to better guide legislations. [ABSTRACT FROM AUTHOR]