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Introduction: Unwanted pregnancy constitutes a huge health issue. Long‐acting reversible contraception (LARC) are the most effective methods for preventing unwanted pregnancy, especially among young women. This study evaluates the intervention effect of structured contraceptive counseling on the choice, initiation, and use of LARC in young women. Material and Methods: This is a secondary analysis of women aged 18–25, enrolled in a multicenter cluster randomized controlled trial performed in abortion, youth, and maternal health clinics across the Stockholm County in Sweden. Clinics were randomized (1:1) to provide structured contraceptive counseling (intervention) or standard counseling (control). Surveys were administered at the clinic visit and follow‐ups at 3, 6, and 12 months. Primary outcome focused on the choice of LARC among women 18–25 years of age. Secondary outcomes included initiation, and use of LARC at 3 and 12 months, satisfaction with the counseling received and information on extended use of combined hormonal contraceptives. The study was registered at Clinicaltrials.gov (NCT03269357). Results: From September 2017 to May 2019, 770 women aged 18–25 years from 28 clinics/clusters were recruited. There was a significant intervention effect on LARC choice (aOR 5.96, 95% CI 3.25–10.94), initiation (aOR 4.43, 95% CI 2.32–8.46), and use at 12 months (aOR 2.21, 95% CI 1.31–3.73). The odds of LARC choice at pre‐booked visits were higher and more women received information about extended‐use regimen for short‐acting reversible contraception in the intervention group compared to the control group. The intervention package was well received, but with higher satisfaction at pre‐booked compared to drop‐in visits. Conclusions: Our study demonstrates that comprehensive structured contraceptive counseling significantly increases LARC choice, initiation and use, with high satisfaction among young participants, especially at pre‐booked visits. The results highlight an approach that merits implementation to increase quality of care in contraceptive services, to enhance reproductive health for adolescents and young adults. [ABSTRACT FROM AUTHOR]

Background: Proper use of emergency contraception can reduce unintended pregnancy and the risk of abortion. Despite this fact, there is a high rate of unwanted pregnancies among adolescents in Ethiopia. Therefore, determining the level of knowledge and use of Emergency contraceptives (EC) among female youth is important. Objective: To assess Knowledge and use of EC methods and their associated factors among female college students in Gondar City, Northwest Ethiopia, 2023. Methods: Institution-based cross-sectional study was employed among 814 female college students in Gondar City from April 15 to 28, 2023. A multi-stage sampling technique was applied to select the study participants. A self-administered questionnaire was used to collect the data. Epi-data version 4.6 and STATA Version 16, respectively, were used for data entry and analysis. A logistic regression model was fitted to identify factors associated with the outcome variables. Statistical significance was defined at a p-value < 0.05 and a corresponding 95% confidence interval. Result: In this study, 46.2% [95% CI (42.78, 49.63%)] of the participants had adequate knowledge about EC and 26.1% [95% CI (22.82–29.74%)] of sexually active participants used EC. Muslim religion [AOR = 1.82: 95% CI (1.07, 3.09)], being single [AOR = 0.34: 95% CI (0.19, 0.63)], no discussion about reproductive health issues with their husband/partner [AOR = 0.43: 95% CI (0.27, 0.69)], year of study; second year [AOR = 1.63: 95% CI (1.03, 2.58)], third year [AOR = 1.80: 95% CI (1.11, 2.94)], and fourth-year students [AOR = 2.91: 95% CI (1.43, 5.96)] were significantly associated with knowledge about EC. While no discussion about reproductive health with their husband/partner [AOR = 0.09: 95% CI (0.04, 0.20)], monthly allowance [AOR = 3.03: 95% CI (1.54, 5.95)], perceive use emergency contraceptives as not a sin [AOR = 2.59: 95% CI (1.20, 5.60], knowledge about EC [AOR = 2.32: 95% CI (1.253, 4.29)] were associated with the use of EC. Conclusions: Participants' knowledge and of use EC in the study area was low. Religion, years of study, marital status, monthly allowance, perception and knowledge, and having discussion were associated with the use of EC. School-based health education, and behavioral change communication interventions should be established and/or strengthened to address students in need of EC services. [ABSTRACT FROM AUTHOR]

The prevalence of postpartum depression in teenage mothers is higher than that in adult mothers. The present study aimed to investigate the prevalence of depression, distress, and post-traumatic stress disorders (PTSD) following childbirth and its resultant risk factors among teenage mothers. Material and Methods. This cross-sectional study was carried out on 167 teenage women aged 11–19 years, 8-week after giving birth, in Tabriz, Iran. The data were collected using by socio-demographic characteristics questionnaire, Edinburgh Postnatal Depression Scale, Posttraumatic Stress Disorder Checklist and Postpartum Distress Measure scale. Results. The study results revealed that 12.6% and 7.2% of the participants had postpartum depression and PTSD, respectively. The results showed that the variables of the number of children, dissatisfaction with marriage, and history of preconception depression were among the risk factors associated with postpartum depression. The results indicated that unwanted pregnancy, lack of spousal support, insufficient income, and infant restlessness variables were predictors of PTSD. Conclusion. Based on our findings, it is crucial to identify teenage mothers with predisposing factors for postpartum depression and PTSD. Providing family planning counseling to reduce unwanted pregnancies, training fathers to support their spouses, and ensuring timely referral of high-risk individuals are essential interventions to address the mental health challenges faced by teenage mothers. [ABSTRACT FROM AUTHOR]

Background: Antenatal care (ANC) is an important component of maternal and child health care. To reduce perinatal mortality and improve women's experience of care, the World Health Organization (WHO) recommends pregnant women should attend at least eight ANC visits. However, in Sub-Saharan Africa (SSA), the mean number of ANC visits among reproductive-age women using Demographic and Health Surveys (DHS) data following the new WHO recommendation is so far limited. Therefore, the study aimed to determine the mean number of ANC visits and its predictors among reproductive-age women in SSA. Method: Community-based cross-sectional study was conducted among 188,880 weighted reproductive-age women in SSA using a recent round of DHS data from 2017–2023. Zero-inflated negative binomial regression (ZINB) was conducted and statistical significance was declared at p-value <0.05 and adjusted incidence rate ratio(AIRR) for count model part and adjusted odds ratio for logit model inflated part of ZINBR with 95% confidence interval (CI) were reported. Result: The mean number of ANC visits among reproductive-age women in SSA was 4.08 with 95%CI [4.07, 4.09]. Among reproductive-age women who gave birth in the last five years before the survey, 7.3% had eight or more ANC visits during pregnancy. Age of women, maternal and husband educational status, types of pregnancy, birth order, household size, number of under-five children, and wealth index were associated with the numbers of ANC visits among reproductive-age women in Sub-Saharan. Conclusion: The mean number of ANC visits among reproductive-age women in SSA is too lower than the new WHO recommendation of ANC visits for a positive pregnancy experience. This study also highlights that the proportion of at least eight ANC visits is low and there are still disparities in the mean of ANC visits across different regions of SSA. The increasing maternal age, higher maternal and husband educational status, wanted pregnancy, the number of household members, the number of under-five children, and higher wealth index increase the number of ANC visits. Unwanted pregnancy, no more fertility desire, and rural residences were contributed for zero ANC visits in SSA. Therefore, efforts should be geared towards improving maternal and husband's educational status. We strongly recommend that the governments of SSA countries should empower women economically and educationally to achieve the goals of ANC as recommended by the WHO. [ABSTRACT FROM AUTHOR]

Background: Abortion could impact the mental well-being of parents. Resilience also has a significant effect on the mental health of the family as a factor in coping with abortion. This study aimed to compare depression, anxiety, perceived stress, and resilience in parents after abortion. Methods: The present longitudinal study was performed on 200 hospitalized women and their spouses in the post-partum department of Shiraz hospitals in 2023. The instruments used in this study included questionnaires of fertility and demographic characteristics, hospital depression and anxiety (HADS), Connor's resilience, and Cohen's perceived stress. Data analysis was performed using SPSS 25. Results: The mean age of the fathers was 35.37 ± 4.99 and that of mothers was 31.35 ± 6.23. The scores of parents' anxiety, depression, and perceived stress in the first 24 h after facing abortion were in the highest possible state and decreased in 12 weeks, and their resilience also increased. In all three time periods, the mean scores of the fathers' anxiety, depression, and perceived stress were lower than those of the mothers, but the mean score of resilience was always higher in fathers. Fathers´ age and mothers' age, mothers' age at the time of marriage, fathers' job, number of children, gender of the last child (boy or girl), and unwanted pregnancy were among the predicting variables of anxiety, depression, perceived stress, and resilience of both parents faced with abortion. Conclusion: Although mental disorders in fathers were fewer than mothers compared to post-abortion resilience, identifying and managing these issues promptly is crucial for enhancing post-abortion mental well-being in both parents. How parents navigate the challenges of pregnancy, childbirth, and abortion can significantly impact the couple's health. [ABSTRACT FROM AUTHOR]

Background: Understanding the geographic variation of unintended pregnancy is crucial for informing tailored policies and programs to improve maternal and child health outcomes. Although spatial analyses of unintended pregnancy have been conducted in several developing countries, such research is lacking in India. This study addresses this gap by investigating the geographic distribution and determinants of unintended pregnancy in India. Methods: We analysed data from the National Family Health Survey-5 encompassing 232,920 pregnancies occurring between 2014 and 2021 in India. We conducted a spatial analysis to investigate the distribution of unintended pregnancies at both state and district levels using choropleth maps. To assess spatial autocorrelation, Global Moran's I statistic was employed. Cluster and outlier analysis techniques were then utilized to identify significant clusters of unintended pregnancies across India. Furthermore, we employed Spatial Lag Model (SLM) and Spatial Error Model (SEM) to investigate the factors influencing the occurrence of unintended pregnancies within districts. Results: The national rate of unintended pregnancy in India is approximately 9.1%, but this rate varies significantly between different states and districts of India. The rate exceeded 10% in the states situated in the northern plain such as Haryana, Delhi, Uttar Pradesh, Bihar, and West Bengal, as well as in the Himalayan states of Himachal Pradesh, Uttarakhand, Sikkim, and Arunachal Pradesh. Moreover, within these states, numerous districts reported rates exceeding 15%. The results of Global Moran's I indicated a statistically significant geographical clustering of unintended pregnancy rates at the district level, with a coefficient of 0.47 (p < 0.01). Cluster and outlier analysis further identified three major high-high clusters, predominantly located in the districts of Arunachal Pradesh, northern West Bengal, Bihar, western Uttar Pradesh, Haryana, Delhi, alongside a few smaller clusters in Odisha, Madhya Pradesh, Uttarakhand, and Himachal Pradesh. This geographic clustering of unintended pregnancy may be attributed to factors such as unmet needs for family planning, preferences for smaller family sizes, or the desire for male children. Results from the SEM underscored that parity and use of modern contraceptive were statistically significant predictors of unintended pregnancy at the district level. Conclusion: Our analysis of comprehensive, nationally representative data from NFHS-5 in India reveals significant geographical disparities in unintended pregnancies, evident at both state and district levels. These findings underscore the critical importance of targeted policy interventions, particularly in geographical hotspots, to effectively reduce unintended pregnancy rates and can contribute significantly to improving reproductive health outcomes across the country. [ABSTRACT FROM AUTHOR]

Oral hormonal contraception (OHC) is a widely employed method in females for the prevention of unintended pregnancies, as well as for the treatment of menstrual disorders, endometriosis, and polycystic ovarian syndrome. However, it is believed that with OHCs use, some females may have higher risk of cardiovascular diseases, such as hypertension, diabetes, myocardial infarction, thrombosis, and heart failure. Although such risks are infrequently detected in healthy young females with the use of oral contraceptives, slightly elevated risks of cardiovascular diseases have been observed among reproductive-aged healthy females. However, prolonged use of OHC has also been claimed to have protective cardiac effects and may contribute to reduced risk of cardiovascular disease. In fact, the debate on whether OHC administration increases the risk of cardiovascular diseases has been ongoing with inconsistent and controversial viewpoints. Nevertheless, a great deal of work has been carried out to understand the relationship between OHC use and the occurrence of cardiovascular risk in females who use OHC for preventing the unwanted pregnancy or treatment of other disorders. Therefore, in this review we summarize the most recent available evidence regarding the association between the use of oral hormonal contraceptives and the risk for cardiovascular disease in females who are using OHC to prevent unintended pregnancy. [ABSTRACT FROM AUTHOR]

Background: Medical Termination of Pregnancy (MTP) Act legalizes abortion to moderate extent and describes various grounds under which termination of pregnancy can be done. The present study aims to know the proportion of women and to analyse their determinants which lead to seek for MTP services in the family planning unit of a tertiary care hospital Methodology: A retrospective cohort study done between December 2023 to January 2024 for which data of 2 years ie., from January 2022 to December 2023 was retrieved from the MTP registers in the family panning unit. Data was entered in Microsoft Excel and analysed using SPSS Version 21. Results: There were a total of 119 MTPs done in the family planning unit over a period of 2 years, which were all of first trimester abortions. 60.3% fall under socioeconomic causes, 17.2% were due to failure of contraceptive methods. The mean age was 28 years ranging from 17 to 40 years. Conclusion: Most common indication for MTP was found to be socioeconomic causes. Women who did not practice contraception after having desired family size contributes for this unwanted pregnancy. [ABSTRACT FROM AUTHOR]

The alarming prevalence of HIV/AIDS and unwanted pregnancy among learners is of considerable concern. This study aimed to explore the barriers encountered by youth workers in implementing sexual and reproductive health education (SRHE) in secondary schools South Africa in the Western Cape province of South Africa and also to explore the benefits these youth workers bring. Qualitative methods and individual interviews were used to gather data. The findings show that cultural socialisation remains a major barrier to the effective implementation of SRHE by youth workers. Positive outcomes from the presence of the youth workers in schools include an increase in learners' self-esteem and greater acceptance of moral values such as good citizenship and respect for others regardless of differences. Accordingly, this study recommends integrating youth workers into the schools by adding SRHE to the curriculum and having it implemented by them. When such programmes are set up, the role of youth workers in schools should be clearly articulated to avoid conflict between teachers and youth workers. [ABSTRACT FROM AUTHOR]

Sex health is an essential part of adolescent development. Sex education is important to provide information on body development. Sexually transmitted diseases and its prevention. This study aimed at determining the knowledge, attitude and significance of sex education among secondary school students in University of Nigeria secondary school Enugu campus, Nigeria: This study was a cross sectional study which involved a total of 368 students of University of Nigeria secondary school Enugu campus that were issued a questionnaire between the age bracket 20-22 the largest percentage of respondents, 58.2% (214) are those within the age of 13-15 years. Majority were males and these constituted about 240 (67.9%). The classes had equal sizes of 184(50%) each. Majority, 363 (98.6%) were Igbo's and about 365 (99.2%) were Christians. Majority of respondents, 261(70.9%) had knowledge of sex education. Most of the respondents 163 (30.7%) agreed their source was from school. The rest 69.3% heard from other sources. On sex education, majority 24(145%) said it was all about teaching various topics on sex education. Many participants, 220 (59.8%) did not know the types of sex education. Only 148 (40.2%) agreed to knowing the types. On the types, majority 76(20.7%) agreed to comprehensive sex education types. Majority of participants, 235 had not attended sex education program in the past. Out of those who had attended, 64.7% had done so only once. Majority 267 (72.6%) agreed that sex education was not given much attention in secondary school. 329 (89.4%) agreed that sex education helps sexual behavior and decision making among adolescents. Majority, 295 (80.2%) agreed that it should be added to school curriculum. On parental role, 193(52.4%) agreed parents should be involved in sex education. Only 70 (19%) agreed sex education is not a waste of time. Majority, 300(81.5%) agreed that sex education can prevent unwanted pregnancy. 254 (69%) agreed that they feel comfortable discussing sex education with their parents and siblings. 304(82.6%) agreed it is an important aspect of one's life. Majority, 273 (74.2%) however agreed that it can lead to promiscuity in secondary school. 192 (53.2%) said sex education should not only be taught by parents. 222 (60.3%) agreed it can lead to sexual debut in early life. Majority, 223 (60.9%) says Nigerian educational system is not ready for sex education. 302(82.1%) said sex education is an important subject matter. Majority, 264(71.7) said they are comfortable being taught sex education in class. Generally, the level of knowledge among respondents was poor as only 140(38%) had good knowledge. On attitude and significance, 341 (92.7%) showed good attitude and significance. There is good attitude, but poor knowledge of sex education among secondary school students in University of Nigeria secondary school Enugu campus. Sex education is important especially to developing adolescents, so we recommend that families should teach their children sex education. Schools and other institutions of higher learning should focus on sex education and create more programs to further increase the level of sex education knowledge and government should create sex education friendly programs to educate adolescents. [ABSTRACT FROM AUTHOR]

CHOICES-TEEN is a bundled intervention aimed at reducing the risks of unintended pregnancy, sexually transmitted infections, and alcohol- and tobacco-exposed pregnancies for adolescent girls involved in the juvenile justice system. We examined youths' (N = 22) elicited pros and cons concerning alcohol, tobacco, condom, and contraception use to inform future iterations of CHOICES-TEEN and other prevention programming during a one-arm pilot study. Content analysis was used to identify recurring themes elicited and recorded during a decisional balance exercise with a counselor. The most recurrent pros and cons were factors that directly affected these adolescents, with more immediate consequences. The results provide insight into motivations for engaging in substance use and risky sexual behaviors for these youth, as well as barriers to change. [ABSTRACT FROM AUTHOR]

Background: Uganda is burdened by high unintended and teen pregnancies, high sexually transmitted infections, and harm caused by unsafe abortion. Objectives: Explore factors influencing sexual and reproductive health and rights (SRHR) in Uganda by synthesizing evidence from qualitative studies using a scoping review. Eligibility Criteria: Original qualitative peer-reviewed research studies published between 2002 and 2023 in any language exploring factors influencing SRHR in Uganda. Sources of Evidence: Eight databases searched using qualitative/mixed methods search filters and no language limits. Charting Methods: Information extracted included author, article title, publication year, study aims, participant description, data collection type, sample size, main findings, factors at the individual, interpersonal, community, and policy levels, implications for SRHR in Uganda, and study limitations. Quality of the selected articles was assessed using the Critical Appraisal Skills Programme tool. Results: One hundred seventy-three studies met inclusion criteria. At the individual level, knowledge and attitudes toward SRHR, risky sexual behavior, and access to maternal SRHR services were identified as critical factors influencing health outcomes. Interpersonal factors included communication with sexual partners and relationships with family, school, and community members. Healthcare organization factors included adolescent access to education, SRHR services, and HIV prevention. Cultural and social factors included gendered norms and male involvement in SRHR. Policy-level factors included the importance of aligning policy and practice. Conclusions: Multiple factors at individual, interpersonal, community, healthcare, cultural, and policy levels were found to influence SRHR in Uganda. The findings suggest that interventions targeting multiple levels of the socio-ecological system may be necessary to improve SRHR outcomes. This review highlights the need for a holistic approach that considers the broader socio-ecological context. Reducing identified gaps in the literature, particularly between policy and practice related to SRHR, is urgently needed in Uganda. We hope this review will inform the development of policies and interventions to improve SRHR outcomes. Plain language summary: A scoping review of qualitative studies on sexual and reproductive health and rights in Uganda In Uganda, there are significant challenges regarding sexual and reproductive health and rights (SRHR), including high rates of unintended and teen pregnancies, sexually transmitted infections, and unsafe abortions. To better understand these issues, we conducted a comprehensive review of qualitative studies published between 2002 and 2023. Our analysis identified 173 studies that revealed various factors influencing SRHR in Uganda across different levels. At the individual level, factors such as knowledge and attitudes toward SRHR, risky sexual behavior, and access to maternal SRHR services were found to significantly impact health outcomes. Interpersonal relationships also played a crucial role, with communication with sexual partners and relationships with family, school, and community members being identified as important influences. Furthermore, the organization of healthcare services was found to be vital, particularly regarding adolescent access to education, SRHR services, and HIV prevention. Cultural and social factors, including gender norms and the involvement of males in SRHR, were noted as significant contributors to SRHR outcomes. Additionally, the alignment of policy and practice was emphasized as essential for improving SRHR outcomes in Uganda. Overall, the review concluded that addressing SRHR challenges in Uganda requires interventions that target multiple levels of the socio-ecological system. A holistic approach considering individual, interpersonal, community, healthcare, cultural, and policy factors is necessary. There is an urgent need to bridge gaps between policy and practice related to SRHR. Findings could inform the development of policies and interventions aimed at improving SRHR outcomes in Uganda. [ABSTRACT FROM AUTHOR]

To investigate the opinions of women residing in Turkey regarding abortion and its correlation with spirituality. A descriptive and cross-sectional study. The study included 487 women and data was collected between October and December 2023. The Descriptive Information Form, Stigmatizing Attitudes, Beliefs and Actions Scale (SABAS), and Spirituality Scale (SS) were used to evaluate the data and determine the correlation between them. Of the women surveyed, 78.6% reported no prior experience with curettage. The participants had low SABAS scores (26.95 ± 7.43) and high SS scores (22.50 ± 5.80). Age, education, employment status, religious affiliation, history of curettage, age at first childbirth, number of children, and number of siblings were all significantly correlated with SABAS and SS (p < 0.05). Additionally, a significant positive correlation was found between the participants' SABAS total score and all sub-factor scores, as well as their SS total scores. It was also determined that as women's stigmatization and negative attitudes towards curettage increased, their spiritual feelings increased as well (p < 0.05). A significant positive correlation was found between SS score and age and SABAS, and a negative correlation was found with the number of births (p < 0.05). It was found that women's stigmatizing attitudes towards abortion were influenced by their spiritual beliefs. To prevent women from being caught between the consequences of unwanted pregnancies and their spiritual beliefs, it is important to meet their needs for family planning and health counseling. [ABSTRACT FROM AUTHOR]

Background: Proponents of abortion restriction cite advancements in contraceptive technology as a reason against the need for abortion care today, most recently through oral arguments in the Supreme Court of the United States case, Dobbs v. Jackson Women's Health. However, consistent and correct use of contraception requires reproductive health literacy. Our objectives were to quantify contraceptive risk events and assess contraceptive history and preferences among a population well-equipped to evade contraceptive risks, family planning specialists following initiation of their medical training. "Risk events" are defined as reported episodes of contraceptive failure, emergency contraception use and/or unprotected or underprotected intercourse. Methods: This was a cross-sectional study among current members of a professional organization of family planning specialists. Inclusion criteria included: status as a current or retired clinician, consensual penile-vaginal intercourse and personal or partner capacity to become pregnant since the start of medical training. Descriptive statistics were performed. This study was IRB exempt. Results: Among 229 respondents, 157 (69%) reported experiencing a contraceptive risk event since training. Twenty-nine (13%) respondents reported an occurrence within the last year. By category, 47% (108/229; 3 reported unknown) reported under- or unprotected intercourse, 35% (81/229) reported emergency contraception use, and 52% of participants (117/227; 2 unknown) reported known or suspected contraceptive failure. The mean number of contraceptive methods used was 3.7 (SD 1.7) out of the 13 methods listed. Almost all (97%) participants reported at least one method was not an acceptable option, with a mean of 5.6 (SD 2.7) of the 13 listed methods. Conclusions: The majority of family planning specialists have experienced contraceptive risk events during times of active pregnancy prevention since their medical training. Contraceptive method change is common and most respondents were limited in the number of methods that were personally acceptable to them. Dialogue idealizing the role of contraception in minimizing or eliminating abortion need is simplistic and inaccurately represents the lived realities of pregnancy-capable individuals and their partners, including among those with exceptional contraceptive literacy and access. Plain English Summary: Since Dobbs v. Jackson, the landmark Supreme Court of the United States case overturning the right to abortion, it is very important to better understand current birth control use and the risk of unintended pregnancy. While birth control helps people to avoid unintended pregnancy, current methods are not perfect. This study examined the limitations of current birth control, even when used by expert clinicians with special knowledge and access. We provided an online survey to doctors and advanced practice clinicians who specialize in birth control. We measured risk of unintended pregnancy by asking about experiences with birth control failure, emergency contraceptive use (such as plan B), and unprotected sex since the start of medical training. We also asked about reasons for changing or avoiding certain birth control methods. Among 229 expert clinicians, we found that nearly 70% had experienced a risk of unintended pregnancy since beginning their medical training. Birth control method change was common, and many reported that several options were unacceptable. Participants shared that they found methods difficult, unreliable, unpleasant, or had health conditions that limited the number of safe options available. Our findings suggest that, even among experts, everyone remains at risk of unintended pregnancy. The study highlights the need for improved birth control options as well as access to safe and legal abortion. [ABSTRACT FROM AUTHOR]

Simple Summary: In Equids, twin pregnancy is an unwanted event, and the traditional management of twin pregnancies involves the early, pre-fixation, manual crushing of one embryo before the 16th day after ovulation when the two embryos are still mobile. However, due to the high percentage of natural reduction of one embryo in unilaterally fixed twins, early post-fixation manual crushing management can also be proposed, allowing the time for natural reduction occurrence. The present study aimed to report data about managing twin pregnancies through natural reduction and post-fixation manual crushing in the Martina Franca donkey breed. The natural reduction of one embryo occurred at 20–21 days after ovulation in 87.5% of unilateral twin pregnancies, with 12.5% of cases requiring post-fixation manual crushing, and none of the bilateral twin pregnancies requiring manual crushing. The single embryo pregnancy rate at 28 days after ovulation was 93.8% for unilateral twin pregnancies and 88.9% for bilateral twin pregnancies, with an overall pregnancy rate of 92%. The live foal rate was 87%. Taken together, the results showed that waiting for the natural reduction of one embryo and using post-fixation manual crushing can be a practical option for the management of twin pregnancy in donkeys. In Equids, undetected twin pregnancy represents the most important cause of abortion and is also associated with high neonatal mortality rates. Therefore, the detection and management of twin pregnancies is pivotal to allow the continuation of single pregnancies. Although pre-fixation manual crushing of one embryo is the most common management of twin pregnancies, and the impact of natural reduction has been reported in mares, very little is known about donkeys. The present study aimed to report results on the natural reduction occurrence and post-fixation manual crushing management of twin pregnancies in the Martina Franca donkey breed. Methods: Twenty-five twin pregnancies were detected at 11–13 days after ovulation. At 16 days after ovulation, twin pregnancies were classified as unilateral or bilateral and left untreated. The occurrence of natural reduction of one embryo was assessed at 20–21 days after ovulation, and post-fixation manual crushing of one embryo was performed in those cases in which natural reduction did not occur. The pregnancy rate at 28 days after ovulation and live foal rate were recorded. Result: Sixteen out of 25 twin pregnancies were unilateral and nine bilateral. At 20–21 days after ovulation, the natural reduction of one embryo occurred in 87.5% of the unilateral and in none of the bilateral twin pregnancies. The remaining twin pregnancies were treated by post-fixation manual crushing of one embryo. The 28-days-after-ovulation single embryo pregnancy rate was 93.8% for unilateral twin pregnancies and 88.9% for bilateral twin pregnancies, with an overall pregnancy rate of 92%. The live foal rate was 87%. Conclusions: The success rate of natural reduction within 20–21 days after ovulation, the 28-days-after-ovulation pregnancy rate, and the live foal rate suggest that waiting for the natural reduction of one embryo and choosing the post-fixation manual crushing of one embryo could be considered as an alternative to traditional early pre-fixation manual crushing in the Martina Franca donkey breed. [ABSTRACT FROM AUTHOR]

Using a feminist narrative approach, this article explores how unintended pregnancy can rupture young lives, and how young people respond to and navigate these ruptures. We analyse qualitative data from a longitudinal cohort study in Luwero, Uganda, focusing on narratives of a girl and a boy about their recent experiences of unintended and unwanted pregnancy during COVID-19 school closures. We argue that laws, policies and norms relating to education, sexual and reproductive health, and the family in Uganda position young people in complex and contradictory ways, that create the conditions for unintended pregnancies, and restrict the choices open to them. The analysis traces how pregnancy ruptures their everyday lives, their identities, and relationships. Their narratives reveal gendered ways in which they enact identities to manage the ruptures. Families are sites of contestation, where gender and sexuality are regulated, but are also mobilised by young people to support their efforts to repair the ruptures. Our analysis underscores the importance of working with young people to understand their positionalities, resource environments and social networks as they make and navigate decisions about pregnancy, and of addressing the structural forces that underpin the rupturing effects of pregnancy on teenage lives. [ABSTRACT FROM AUTHOR]

Unplanned or unwanted pregnancies and births are linked to adverse maternal outcomes, but the extent to which such relationships hold for all racial/ethnic groups remains unknown. In this paper, I use large-scale data to estimate unadjusted and inverse propensity weighted associations between a five-level measure of pregnancy intention and six indicators of maternal well-being among separate samples of white, Black, and Hispanic mothers. I find substantial racial/ethnic variation. White and Hispanic mothers who reported that their pregnancies were mistimed, unwanted, or that they were unsure how they felt were significantly more likely to experience adverse outcomes than same-race/ethnicity mothers who reported that their pregnancy was intended, but the pattern was much more tenuous for Black mothers. After adjusting for potential confounding variables, relationships between pregnancy intentions and adverse outcomes remain substantial only for white and Hispanic mothers. Significance: What is already known on this subject?: Recent research has found links between unplanned or unwanted pregnancies and adverse maternal outcomes, but the extent to which the relationship varies by race/ethnicity is unknown. What this study adds?: This study estimates unadjusted and inverse propensity weighted associations between a 5-level measure of pregnancy intention and six indicators of maternal well-being among separate samples of white, Black, and Hispanic mothers. Both unadjusted and inverse propensity weighted relationships are considerably stronger among Hispanic and white mothers than among Black mothers. Possible causes of these differences are discussed. [ABSTRACT FROM AUTHOR]

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BACKGROUND: Postpartum depression (PPD) is an important and prevalent disorder that can have short-term and long-term adverse effects on the mother, child, and family. This meta-analysis was conducted with the aim of investigating factors related to PPD in Iran. METHODS: This systematic review and meta-analysis reviewed observational studies in Iran. Four Persian language databases (Magiran, IranDoc, ISC, and SID) and four English language databases (ScienceDirect, Scopus, PubMed, and Web of Science) were searched from their inception to September 20, 2023. Google Scholar search engine was used to find relevant sources and complete the search coverage. The process of searching and selecting studies was drawn using the Preferred Reporting Items for Systematic reviews and Meta-Analysis diagram. The strength of the association was summarized using the odds ratio (OR) with 95% confidence intervals (CIs). We used RevMan 5.4 software to analyze the data after extraction. RESULTS: A total of 28 studies involving 11,784 participants were included. The meta-analysis showed that cesarean section (OR = 0.77, 95% CI [0.60, 0.98]), history of abortion (OR = 1.48, 95% CI [1.14, 1.92]), unwanted pregnancy (OR = 0.58, 95% CI [0.45, 0.76]), formula feeding (OR = 0.50, 95% CI [0.39, 0.65]), diploma and less education (OR = 1.27, 95% CI [1.08, 1.48]), neonatal hospitalization (OR = 1.77, 95% CI [1.13, 2.76]), more than two deliveries (OR = 0.76, 95% CI [0.67, 0.86]), and low and moderate socioeconomic status (OR = 1.77, 95% CI [1.34, 2.34]) have a significant effect on PPD. Satisfaction of the newborn gender (OR = 0.88, 95% CI [0.58, 1.33]), employment (OR = 1.16, 95% CI [0.97, 1.40]), age (OR = 0.89, 95% CI [0.58, 1.39]), previous depression (OR = 1.76, 95% CI [0.88, 3.50]), and gender of the newborn (OR = 0.82, 95% CI [0.42, 1.60]) did not have a significant effect on PPD. CONCLUSION: The results of this study showed that many factors influence PPD. Most of these factors can be identified during pregnancy, which shows the importance of screening during pregnancy. Therefore, it is necessary to design and use screening tools to identify predisposing variables for PPD according to the social–cultural characteristics of different populations. [ABSTRACT FROM AUTHOR]

Abstract Background Understanding the geographic variation of unintended pregnancy is crucial for informing tailored policies and programs to improve maternal and child health outcomes. Although spatial analyses of unintended pregnancy have been conducted in several developing countries, such research is lacking in India. This study addresses this gap by investigating the geographic distribution and determinants of unintended pregnancy in India. Methods We analysed data from the National Family Health Survey-5 encompassing 232,920 pregnancies occurring between 2014 and 2021 in India. We conducted a spatial analysis to investigate the distribution of unintended pregnancies at both state and district levels using choropleth maps. To assess spatial autocorrelation, Global Moran’s I statistic was employed. Cluster and outlier analysis techniques were then utilized to identify significant clusters of unintended pregnancies across India. Furthermore, we employed Spatial Lag Model (SLM) and Spatial Error Model (SEM) to investigate the factors influencing the occurrence of unintended pregnancies within districts. Results The national rate of unintended pregnancy in India is approximately 9.1%, but this rate varies significantly between different states and districts of India. The rate exceeded 10% in the states situated in the northern plain such as Haryana, Delhi, Uttar Pradesh, Bihar, and West Bengal, as well as in the Himalayan states of Himachal Pradesh, Uttarakhand, Sikkim, and Arunachal Pradesh. Moreover, within these states, numerous districts reported rates exceeding 15%. The results of Global Moran’s I indicated a statistically significant geographical clustering of unintended pregnancy rates at the district level, with a coefficient of 0.47 (p

Background: There are 1.2 billion adolescents in the world today, more than ever before, making up 16% of the world's population and nearly one-fourth of the total population in Sub-Saharan Africa. Adolescents are facing life-threatening health challenges attributed to sexual and reproductive health issues such as unwanted pregnancies, unsafe abortions, and sexually transmitted infections, including the human immunodeficiency virus, and acquired immunodeficiency syndrome. The aim of this research is to explore the individual and relational levels of factors that drive adolescents to engage in risky sexual behaviour. Methods: A qualitative phenomenological study design was used from February to June 2020. Adolescents and health professionals were selected purposefully. A total of 12 individual in-depth interviews, five focus group discussions with adolescents, and eight key informant interviews with health professionals were conducted using a semi-structured guide. Data analysis was performed using thematic analysis with ATLAS Ti version 7 software. Credibility, dependability, transferability, and confirmability were used to ensure the trustworthiness of the data. Results: In this study, two themes were identified; individual level factors such as sexual desire and emotion driven sex, limited knowledge of sexual and reproductive health, and a permissive attitude towards sexual activities drive adolescents to engage in risky sexual behaviour; and relational level factors such as, limited family support and involvement, negative peer pressure and influence, male partner dominance during the partnership, and pressuring females to engage in sexual intercourse were perceived factors influencing adolescents to engage in risky sexual behaviour. Conclusion: Various individual-level and relational-level factors are influencing adolescents to engage in risky sexual behaviour. Socially and culturally acceptable, comprehensive sexual education should be provided for in-school and out-school adolescents to enhance their knowledge, attitude, and skill about sexual and reproductive health. Interventions at the peer and partner level should be considered to enhance the life skills that enable them to resist pressure from peers and their partners. Child-parent communication on sexual and reproductive health matters should be promoted. [ABSTRACT FROM AUTHOR]

Objectives: Food insecurity (FI) remains a major public health problem globally. However, there is limited information about adolescents' experiences. The current study explored FI experiences of pregnant adolescents and adolescent mothers in Cape Coast, Ghana using a Photovoice method. Methods: This study recruited 34 pregnant adolescents and adolescent mothers from communities in Cape Coast, Ghana. Each participated in a training session then was provided prompts to take photos that portrayed food access barriers, facilitators and coping strategies. In a debrief session, each participant selected two pictures they took and explained the image, followed by a group discussion of the selected photos. Debrief sessions were audio recorded and transcribed verbatim to develop themes using a theory-driven approach. Results: Most participants reported several or many experiences with FI (64.7%) in the previous month. Participants discussed money, unwanted pregnancy, and unstable work as barriers to obtaining food and working, selling goods, and family support as facilitators to obtaining food. Coping strategies mentioned include providing services to others, borrowing food and goods, meal stretching, pawning personal items and trading. Conclusion: The FI experience of this population is complex; interventions, including trade training or school retention, should be multifaceted. [ABSTRACT FROM AUTHOR]

Maternal health is a global public health concern. The paucity of antenatal care (ANC) during pregnancy is directly associated with maternal mortality. This study assessed the individual and community-level determinants of quality ANC in six South-Asian countries. Data were obtained from a Demographic health survey of six South-Asian countries. This study included a sample of 180,567 (weighted) women aged 15–49 who had given birth in the preceding three years prior to the survey. The quality of ANC was determined by assessing whether a woman had received blood pressure monitoring, urine and blood sample screening, and iron supplements at any ANC visits. Frequency, percentage distribution, and inferential analysis (multilevel mixed-effects model) were conducted. The proportion of quality antenatal care utilization in South Asia was 66.9%. The multilevel analysis showed that women aged 35–49 years (AOR = 1.16; 95% CI = 1.09–1.24), higher education (AOR = 2.84; 95% CI = 2.69–2.99), middle wealth status (AOR = 1.55; 95% CI = 1.49–1.62), richest wealth status (AOR = 3.21; 95% CI = 3.04–3.39), unwanted pregnancy (AOR = 0.92; 95% CI = 0.89–0.95) and 2–4 birth order (AOR = 0.86; 95% CI = 0.83–0.89) were among the individual-level factors that were significantly associated with quality ANC utilization. In addition, rural residence (AOR = 0.77; 95% CI = 0.74–0.8), and big problem – distance to health facility (AOR = 0.63; 95% CI: 0.53–0.76) were the among community level factors there were also significantly associated with use of quality ANC. Meanwhile, women who lived in India (AOR: 22.57; 95% CI: 20.32–25.08) and Maldives (AOR: 33.33; 95% CI: 31.06–35.76) had higher odds of quality ANC than those lived in Afghanistan. Educational status, wealth status, pregnancy wantedness, sex of household head, birth order, place of residence, and distance to health facility were associated with quality ANC. Improving educational status, improving wealth status, reducing the distance to health facilities, and providing rural area-friendly interventions are important to increase the quality of ANC in South Asia. [ABSTRACT FROM AUTHOR]

Background: Filicide, the act of a parent or parental figure killing their child, has been reported in various African countries. However, there is a lack of comprehensive reviews on the prevalence and associated factors of filicide across the African continent, which is characterized by diverse cultural beliefs and practices. This review aims to examine the prevalence and risk factors of filicide in Africa. Methods: This review included studies on filicide in Africa, identified through searches in various databases (PubMed, Scopus, Africa Journal Online, and Google Scholar) using relevant keywords. The Mendeley reference manager was used to organize all identified articles and remove duplicate entries. A two-round screening process was conducted by two independent reviewers, with the final set of articles selected through mutual agreement. The quality of the studies was then assessed. Results: Out of the 107 retrieved articles, only 15 were included in the review. These studies revealed diverse prevalence rates: 3.7% of total homicides, 1.38% of deaths from family violence, and 13.02% for autopsied children. Various potential risk factors for filicide were identified, including unwanted pregnancies, marital conflicts, family disputes and violence, low socio-economic status, mental health issues in perpetrators, and mental, physical, or neurological vulnerabilities in victims. Cultural beliefs were also recognized as contributing factors to filicide. Conclusion: Filicide is a complex and multi-dimensional issue influenced by various individual, familial, and societal factors. The review highlighted a high prevalence of filicide in Africa, shaped by these diverse factors. [ABSTRACT FROM AUTHOR]

Background and purpose: Parents play an important role in the sexual health of adolescents. There are multiple ways to educate adolescents about sexual issues, but the most effective method of imparting sexual knowledge to them is through sexual conversations between parents and adolescents. The aim of improving the sexual health of adolescents has been achieved through the design and implementation of many studies in the field of sexual education of parents, Sexual education for adolescents has been examined through different aspects by each of these. The present study aimed to review the articles that have been conducted in the field of sexual education of parents and the effect of parental educational intervention on the parents' communication skills and adolescent's sexual health. Materials and methods: This study is a systematic review in that relevant articles between 2000 and 2023 were extracted by searching internal and external databases including Magiran, Irandoc, SID, Science Direct, Scopus, Web of Sciences, PubMed, and DOAJ. Relevant studies were searched using sex education, sexual behavior, parents, adolescents, dialogue, intervention, and clinical trials in external databases and their Persian equivalents in internal databases. Inclusion criteria included types of clinical or semi-experimental trials, the target group of parents, and articles with full text, in Farsi or English. Related articles were reviewed using PICO criteria. So studies conducted on parents (mother, father, or both) and teenagers were considered. In terms of intervention, studies that included educational interventions including lectures, film watching, role- playing, and other educational methods were included in the study. Desirable outcomes for the present study include parents' sexual literacy, parents' skills in communicating with their adolescents, condom use skills, avoiding premature sexual relations, and promotion of adolescents' sexual health. Results: The number of primary studies found in the relevant databases equaled 66 articles. After removing duplicates (12 articles), articles were screened based on the title and abstract, and as a result, 21 articles were removed due to lack of relevance to the study title. Out of the remaining 33 articles, 13 articles that had full text and matched the inclusion criteria of the present study were included in the study. Based on the results of the included studies in this systematic review regarding the types of effects of parental educational intervention, the results obtained in two categories: the effect of parental educational interventions on parents' communication skills on sexual issues (8 studies) and the effect of parental educational interventions on adolescent’s sexual health (6 studies) were categorized. The findings of the study showed that teaching parents about sexual dialogue can, on the one hand, strengthen the parent's communicational skills regarding parent-adolescent sexual dialogue and increase the self-reliance of parents to solve the sexual problems of adolescents. on the other hand, promoting the sexual health of adolescents, causes them to postpone sex, use condoms, and prevent sexually transmitted diseases and unwanted pregnancy. Conclusion: From the findings of the study, it can be concluded that educating parents and increasing their awareness of adolescent sexual issues, in addition to improving parents' communicational skills in dealing with adolescent sexual crises, can improve parents' sexual dialogue with adolescents and their avoidance of unhealthy sexual relations, and improve the adolescent’s sexual health. [ABSTRACT FROM AUTHOR]

Indoor temperature trends and the unintended interaction effects In recent years, it has been noticeable that indoor temperatures in residential buildings have followed three trends: decreasing spatial variation, decreasing temporal variation and simultaneously increasing mean levels of indoor temperature. At the same time, architectural design and the construction technologies applied in new buildings and building renovation have undergone a change. In addition, what is considered an appropriate indoor temperature level has changed over time. This is reflected both in quotes from the technical literature and in the requirements set in standards. Research suggests that such changing indoor temperature patterns are associated with unintended interactions in the following main areas: human health and resilience, human indoor climate perception, environmental impacts of buildings, and resilience of buildings in a changing climate. Possible explanations lie in considering the interplay of techno‐cultural factors, techno‐physical building factors, occupant behavioural factors, physiological adaptation factors and psychological factors, rather than considering any one of these factors individually. This leads to the question of whether the established ways of thinking in building planning and operation should remain unchanged in the future. The article concludes with suggestions for adapting these approaches to support such a discussion. [ABSTRACT FROM AUTHOR]

Introduction: Adolescent pregnancy remains a contentious issue despite improvements in quality of life and increased access to sexual education. The average age of first pregnancy has shifted due to financial instability among young people, leading to delayed pregnancies until financial stability is achieved. Teenage mothers face social stigma, and early sexual initiation not only increases the risk of pregnancy but also sexually transmitted infections (STIs). Often, adolescent pregnancies are unwanted, resulting in delayed medical consultation due to fear or ignorance. Aim of the Study: This study aims to investigate the medical and social implications of adolescent pregnancy, emphasizing the importance of early sexual education and comprehensive healthcare support. Description of the State of Knowledge: Adolescent pregnancy, defined as pregnancy between ages 10 and 19, is a global concern with millions of cases annually. It poses significant health risks, including premature birth, low birth weight, and intrauterine growth restriction. Socially, it affects educational attainment and financial stability, with adolescents from lower socioeconomic backgrounds facing greater challenges. Early sexual initiation and risky sexual behaviors further compound the issue, increasing the risk of STIs. Lack of comprehensive sexual education exacerbates these risks, highlighting the need for multidisciplinary support from healthcare professionals. Conclusions: Adolescent pregnancy requires a holistic approach encompassing medical, social, and legal dimensions. Effective sexual education programs, involving gynecologists, pediatricians, and educators, are essential for prevention. Legal frameworks must protect adolescents and address issues of consent and sexual health. Additionally, access to comprehensive healthcare services, including prenatal care and contraception, is crucial for mitigating the adverse effects of adolescent pregnancy on both individuals and society. [ABSTRACT FROM AUTHOR]

Individuals with a germline CDKN2A pathogenic variant (PV) have a highly increased life time risk of melanoma and pancreatic cancer. This cross-sectional study assessed the attitudes among toward genetic testing, family planning, and preimplantation genetic testing (PGT) in confirmed CDKN2A PV carriers and individuals with a 50% risk of the PV (at-risk carriers) using of a one-time questionnaire. A total of 537 individuals were screened for eligibility, of whom 208 of 366 (57%) confirmed carriers (56% female, median age 54 years [IQR 46–63]) and 39 of 171 (23%) at-risk carriers (59% female, median age of 26 years [IQR 22–32]) participated in the study. Primary motivations for genetic testing were to gain control over their personal and children's cancer risk, as well as increasing cancer surveillance practices. In contrast, concerns about obtaining a mortgage and life insurance were frequently cited as reasons for postponing genetic testing. Family planning decisions remained largely unaffected in both confirmed and at-risk carriers; however, the majority of confirmed carriers were still unaware of their familial or personal cancer risk when starting a family. More than 60% of the participants were unfamiliar with PGT and only a minority (19% of confirmed carriers and 10% of at-risk carriers) would be open to considering PGT as a reproductive option. This study found different attitudes toward genetic testing, family planning, and PGT among individuals affected by the CDKN2A PV. Understanding these different attitudes can help clinicians to address the complexities surrounding these issues, especially for younger individuals facing difficult decisions about the timing of genetic testing, family planning, and the potential use of assisted reproductive options. [ABSTRACT FROM AUTHOR]

Most studies on the impact of birth intentions on children's well‐being do not separate risks of infant mortality associated with pregnancy intention status from the risks that are associated with sociodemographic characteristics. There is a lack of studies taking a multicountry comparative perspective. We analyzed 60 Demographic and Health Surveys in Asia, the Americas, and Africa to examine the association between birth intentions and infant mortality using sibling fixed‐effects linear probability models accounting for confounding due to time‐invariant maternal characteristics. Compared to wanted births, the probability of infant mortality was higher after an unwanted or mistimed birth, or both, in 41 countries. Particularly in West Africa, mostly mistimed pregnancies were associated with infant mortality, whereas in the Americas unwanted pregnancies mattered more. These differences could be partly due to contextual variation in the concept of birth intentions and in the importance of birth spacing and limiting. We show that the risk of infant mortality after an unwanted/mistimed pregnancy was higher in countries with low human development index and high overall infant mortality rate, highlighting the importance of taking context into account rather than pooling data. To the best of our knowledge, this is the first large‐scale, cross‐regional, and cross‐country comparative study to analyze the association between birth intentions and infant mortality using a fixed‐effects approach. [ABSTRACT FROM AUTHOR]

Introduction: The escalating number of teenage pregnancies, especially in the Eastern province of Rwanda, continues to raise concerns regarding the sexual and reproductive health of adolescents in the country. Recent statistics indicate that 5% of adolescent girls between the ages of 15 and 19 have given birth and 4% are currently pregnant with their first child. This highlights the critical need for comprehensive sexual and reproductive health education tailored for adolescents. However, there is limited evidence on factors affecting adolescents' efforts to prevent unwanted pregnancies and sexually transmitted infections in the Eastern Province of Rwanda, and the support systems available to adolescents in secondary schools, including the role of parents in promoting their sexual and reproductive health to minimize the risky sexual practices. Methods: An explorative qualitative study utilizing focus group discussions was conducted to garner the perspectives of 118 adolescents enrolled in six twelve-year-basic-education schools from three districts of the Eastern Province of Rwanda. Thematic analysis was employed to identify themes related to the impact of various factors on adolescents' sexual and reproductive health as they navigate through the physical and emotional changes from puberty to adolescence. Results: Adolescents are aware of the potential consequences of engaging in unprotected sexual intercourse which include the risk of unplanned pregnancy, sexually transmitted infections, HIV/AIDS, and emotional distress. Female participants emphasized that young girls who do not receive adequate support upon becoming pregnant prematurely may encounter depression, discontinue their education, face the harsh reality of extreme poverty, and struggle significantly in assuming the responsibilities of parenthood as young single mothers. Adolescents highlighted the lack of parental guidance concerning sexual and reproductive matters as a significant obstacle in their pursuit of a healthy and safe sexual and reproductive health during adolescence. Conclusion: Inadequate parental engagement still hinders adolescents in navigating the physical bodily, mental, and emotional changes during adolescence. This affects their capacity to make well-informed decisions to prevent adverse consequences such as unintended pregnancies, substance misuse, sexually transmitted infections, and HIV/AIDS resulting from unsafe sexual practices. Since this study was qualitative, quantitative data necessary for a precise evaluation of the extent of the problem related to the absence of parental involvement in educating adolescents on sexual and reproductive health needs further research. [ABSTRACT FROM AUTHOR]

Background: Multipurpose prevention technologies (MPTs) are products capable of simultaneously addressing multiple sexual and reproductive health needs such as unwanted pregnancy, STIs including HIV-1, and other reproductive tract infections. MPTs are urgently needed to address the double burden of unplanned pregnancy and HIV. While condoms are currently the only accessible MPTs, they are not solely under a woman's control, and female condoms face limitations due to poor acceptability and high cost. Methods: We conducted a sub-analysis of qualitative data from 39 couples participating in the MTN 045 study to examine the perception of couples on choice and acceptability of a "2 in 1" MPT that combines HIV and pregnancy prevention. Results: Couples recognized the benefits of MPTs for HIV and pregnancy prevention but perceptions tied to each indication and a novel prevention technology tool raised important concerns relevant to use of future MPTs. In the study, participants' perceptions of MPT use were influenced by pregnancy planning. When the timing was less critical, they prioritized HIV prevention. Misinformation about family planning methods, including MPTs, affected decision-making with potential to hinder uptake of future MPTs. Concerns about side effects, such as weight gain and hormonal imbalances, influenced willingness to use MPTs. Conclusion: Addressing the myths and misconceptions surrounding the use of contraceptives is crucial in promoting their acceptance and ultimate use. Strategies for addressing the drawbacks women might experience while using a particular product should be in place as new MPTs progress through the development pipeline and approach roll-out. [ABSTRACT FROM AUTHOR]

Background: Recent studies revealed an elevated likelihood of unintended pregnancies among women with psychiatric disorders compared to their counterparts without such vulnerability. Despite the importance of understanding family planning decision-making in this group, qualitative inquiries are lacking. This study explored family planning decisions among women with psychiatric disorders. Methods: Utilizing a qualitative approach, three focus group discussions were conducted with purposive sampling: women with a history of unintended pregnancies (N = 3), women without children (N = 5), and women with a history of intended pregnancies (N = 9), all of whom had self-reported psychiatric disorders. Using thematic framework analysis, we investigated the themes "Shadow of the past," reflecting past experiences, and "Shadow of the future," reflecting future imaginaries, building upon the existing "Narrative Framework." Results: The Narrative Framework formed the foundation for understanding family planning among women with psychiatric disorders. The retrospective dimension of focus group discussions provided opportunities for reflective narratives on sensitive topics, revealing emotions of regret, grief and relief. Childhood trauma, adverse events, and inadequate parenting enriched the "Shadow of the past". The "Shadow of the present" was identified as a novel theme, addressing awareness of psychiatric disorders and emotions toward psychiatric stability. Social influences, stigma, and concerns about transmitting psychiatric disorders shaped future imaginaries in the shadow of the future. Conclusions: This study enlightens how family planning decision-making in women with psychiatric disorders might be complex, as marked by the enduring impact of past experiences and societal influences in this sample. These nuanced insights underscore the necessity for tailored support for women with psychiatric disorders. Plain English Summary: Recent studies show that women with psychiatric disorders are more likely to experience unintended pregnancies. However, the underlying reasons are not fully understood. Understanding those reasons is important to provide better healthcare. Our study explored how women with psychiatric disorders make decisions about family planning. We had conversations with different groups of women—women with unintended pregnancies, women without children, and women with intended pregnancies—through focus group discussions. We partnered with the Dutch mental health organization MIND to capture diverse opinions. Key themes and categories in the discussions were identified and organized. We found four main themes: "Shadow of the past" showed how past events, trauma, and lack of knowledge about parenting affect family planning. "Shadow of the present" revealed different feelings about family planning, the importance of the awareness of psychiatric disorders, and uncertainty about decisions. "Shadow of the future" included thoughts about becoming a mother, the impact of social influences, and concerns about passing on psychiatric disorders. "Reflections on the decision" showed how psychiatric disorders, experiences with motherhood, and feelings of regret, grief and relief had an influence on family planning decisions. In conclusion, our study highlighted the complexity of family planning decisions for women with psychiatric disorders. Past experiences and societal influences, like stigma, play a big role. These insights show the need for personalized family planning support for women with psychiatric disorders. [ABSTRACT FROM AUTHOR]

Unintended pregnancies, which occur in almost half (45%) of all pregnancies in the United States, are associated with adverse health and social outcomes for the infant and the mother. The risk of unintended pregnancies is significantly reduced when women use long-acting reversible contraceptives (LARCs), namely intrauterine devices and implants. Although LARCs are highly acceptable to women at risk of unintended pregnancies, barriers to accessing LARCs hinder its uptake. These barriers are greater among racial and socioeconomic lines and persist within and across the intrapersonal, interpersonal, institutional, and policy levels. A synthesis of these barriers is unavailable in the current literature but would be beneficial to health care providers of reproductive-aged women, clinical managers, and policymakers seeking to provide equitable reproductive health care services. The aim of this narrative review was to aggregate these complex and overlapping barriers into a concise document that examines: (a) patient, provider, clinic, and policy factors associated with LARC access among populations at risk of unintended pregnancy and (b) the clinical implications of mitigating these barriers to provide equitable reproductive health care services. This review outlines numerous barriers to LARC uptake across multiple levels and demonstrates that LARC uptake is possible when the woman is informed of her contraceptive choices and when financial and clinical barriers are minimized. Equitable reproductive health care services entail unbiased counseling, a full range of contraceptive options, and patient autonomy in contraceptive choice. [ABSTRACT FROM AUTHOR]

Mediation analysis with contemporaneously observed multiple mediators is a significant area of causal inference. Recent approaches for multiple mediators are often based on parametric models and thus may suffer from model misspecification. Also, much of the existing literature either only allow estimation of the joint mediation effect or estimate the joint mediation effect just as the sum of individual mediator effects, ignoring the interaction among the mediators. In this article, we propose a novel Bayesian nonparametric method that overcomes the two aforementioned drawbacks. We model the joint distribution of the observed data (outcome, mediators, treatment, and confounders) flexibly using an enriched Dirichlet process mixture with three levels. We use standardization (g-computation) to compute all possible mediation effects, including pairwise and all other possible interaction among the mediators. We thoroughly explore our method via simulations and apply our method to a mental health data from Wisconsin Longitudinal Study, where we estimate how the effect of births from unintended pregnancies on later life mental depression (CES-D) among the mothers is mediated through lack of self-acceptance and autonomy, employment instability, lack of social participation, and increased family stress. Our method identified significant individual mediators, along with some significant pairwise effects. [ABSTRACT FROM AUTHOR]

Introduction: Postnatal period is a vulnerable time for women, with 85% experiencing mood disturbances due to physical and emotional changes. Depression, being one such common occurrence is known to have large impact on morbidities of mother and child. Hence it is crucial to know the factors effecting post-partum depression (PPD). Aims: To assess the burden of postpartum depression and factors associated with it. Materials and methods: The cross-sectional study was conducted in a private tertiary care hospital on women in their postnatal period (6 – 8 weeks). Data was collected using pretested semi-structured questionnaire, and depression was assessed using Edinburgh Postnatal Depression Scale; data was analyzed using SPSS. Results: Around 34% had probable depression. Risk factors were found be: those having lower educational status, semi/unskilled occupation, non-nuclear family, lower SES, complications in present / past pregnancy, multiple gestation, unwanted pregnancy, pressure for female child, poor relationship with family members including husband’s absence during delivery. Conclusion: Prevalence of depression in postnatal women is high. Modifiable psychosocial factors have a close association with PPD, which constitute the potential factors of intervention. [ABSTRACT FROM AUTHOR]

Background: PGF2α is commonly given at the end of embryo flushing (EF) to shorten the interval to the next oestrus and ovulation. Objectives: To determine the effect of repeated EF on plasma progesterone concentration, percentage of mares with endometritis, unwanted pregnancy and subsequent fertility in mares flushed without the use of PGF2α. Study design: Controlled experiments. Methods: Nine mares were inseminated in seven consecutive cycles (n = 63), to either perform an EF (n = 54) 7–9 days after ovulation or left pregnant (n = 9). PGF2α was not used to induce oestrus. Ultrasound examination and blood sampling were performed just before the EF and 72 h later to determine changes in progesterone concentration and signs of endometritis. Results: The overall percentage of positive EF/pregnancy was 55.5% (30/54) and 66.7% (6/9), respectively. The likelihood of pregnancy/positive EF in the first three cycles was 55.5% (15/29). This was not different (p > 0.1) from the fertility of the last four cycles (69.4%, 25/36). In five EF cycles (9.3%), mares had signs of endometritis and early luteolysis (progesterone <2 ng/mL) 72 h after EF. The reduction in progesterone concentration by 72 h after EF was greater (p < 0.05) for Day 9 (−2.3 ± 0.7 ng/mL) than Day 7 (−1.0 ± 0.8 ng/mL) or Day 8 (−1.3 ± 1.1 ng/mL) cycles. The progesterone concentration in non‐flushed mares did not vary significantly during the sampled period (Day 7–12). There were 5 cycles in which the donor mare remained pregnant after the EF, although four were from a single mare. Main limitations: The mare population was limited to barren and maiden mares. The cycle order and operator allocation to each EF were not randomised. Conclusions: EF induces a subtle, but significant reduction in progesterone concentrations compared with non‐EF cycles. However, the percentage of mares with EF‐induced full luteolysis is low (9.3%). The fertility of mares after repeated EF without administration of PGF2α was unaffected; however, there is a considerable risk of unwanted pregnancy (5/27 = 18.5%) in donors from which an embryo was not recovered. [ABSTRACT FROM AUTHOR]

Copyright of Special Treatment / Különleges Bánásmód is the property of University of Debrecen and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

AbstractUnsafe abortions contribute significantly to maternal mortality and morbidity in Ghana. To reduce this, in 1982 abortion laws in Ghana underwent reform to broaden the conditions under which abortion is accessed. Although, evidence in other contexts highlights the contribution of violence to women’s experience of unwanted pregnancy and abortion, such evidence is limited within the Ghanaian abortion literature. This study aims to fill that gap. Informed by phenomenology, interviews were conducted with 10 women who had experienced various forms of violence leading to unwanted pregnancy and unsafe abortions. Participants were recruited between June 2017 and March 2018 in the Ashanti region of Ghana where they sought hospital care for unsafe abortion related complications. Participants mentioned intimate partners as the main perpetrators of violence. Financial challenges were also identified as important in increasing women’s vulnerability to violence. Verbal abuse from health workers contributed to denying women access to safe abortion. This paper advances dialogue about the ways in which women’s experience of violence from intimate/non-intimate partners and healthcare workers impacts their overall abortion experience. It advocates the empowerment of women to enable them to leave violent relationships, and the retraining of health workers to enable them to adopt respectful and empathetic care practices. [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: Most Norwegian adolescents experience their first sexual intercourse during late adolescence. Use of contraception is important to avoid unwanted pregnancy, while condoms can also protect against sexually transmitted diseases. There are few studies on the use of contraception at first sexual intercourse, most with varying results, and some studies have only examined the use of contraception among girls. In our study, we aimed to determine the use of contraception at first sexual intercourse, and to investigate associations between use of contraceptives at first sexual intercourse, sociodemographic factors, and alcohol and other substance use. Methods: The study was based on data from the national electronic youth survey Ungdata, conducted in 2020–2022 among 113 049 upper secondary pupils (15–19 years) in Norway, which was around 65% of pupils attending upper secondary school during the study period. Descriptive analysis was used to estimate the prevalence of contraceptive use at first sexual intercourse, and multivariate logistic regression analyses to investigate the association between contraceptive use, sociodemographic factors, and alcohol intoxication and substance use. Result: 32% of Norwegian adolescents did not use contraception at first sexual intercourse. More girls (57.4%) than boys (42.6%) reported use of contraception. Factors associated with non-use of contraception during first sexual intercourse among boys were having parents with no college /university education (OR = 1.22: CI 1.13–1.32), perceived poor family finances (OR = 1.22: CI 1.06–1.40), alcohol intoxication, and use of cannabis or other narcotic substances during the past 12 months. The same factors were associated with non-use of contraception among girls. Additionally, being older than 16 years (OR = 1.13: CI 1.06–1.19) was also associated with non-use of contraception at first sexual intercourse. Conclusion: Many adolescents did not use contraception at first sexual intercourse. Alcohol intoxication and use of cannabis or other narcotic substances were associated with a lower likelihood of using contraceptives. This highlights the importance of preventive efforts including earlier prevention education that focuses more on the consequences of not using contraception in order to prevent unwanted pregnancies and sexually transmitted infections. [ABSTRACT FROM AUTHOR]

Background: Transgender and gender diverse youth experience multiple disproportionate adverse sexual health outcomes. Sexual health education teaches knowledge, attitudes, and skills for promoting sexual health, including reducing risk for sexually transmitted infection, HIV acquisition, and unintended pregnancy. Provision of sexual health education may be protective, but research remains scarce. Methods: We conducted a multi‐stage thematic analysis of 33 in‐depth interviews among transgender and gender diverse youth (ages 15–24) living in the southeastern United States on their sexual health education experiences. Results: Our study participants described school‐based sexual health education as unhelpful due to a lack of relevant information, inadequately prepared teachers, and a perceived negative tone toward sexuality. They reported relying on online sources of sexual health information, finding relevant content and community despite some limitations. Participants desired content and pedagogy that expands beyond binary and white‐centric presentations of sexuality and gender and sought resources that provide relevant, accurate, and judgment‐free information while holding positive framing around sexuality and gender. Conclusion: There is much work needed to improve the breadth, quality, and relevance of school‐based sexual health education. Sexual health education can improve by strengthening critical media literacy skills of youth; raising staff cultural competency on gender, race, and sexual identity through training and supports; using culturally relevant and inclusive curricula; and partnering with community‐based organizations. Transgender and gender diverse youth would benefit from sexual health education from multiple sources which is queer‐friendly, affirms their existence, and provides information on gender, race, and sexuality in positive and expansive ways. [ABSTRACT FROM AUTHOR]

Background: There are few reliable Iranian‑induced abortion data. The aim of this paper was to investigate the prevalence and socioeconomic characteristics of women and men who report having had or been a partner in an abortion. Materials and Methods: A cross‑sectional survey of women and men aged 15–49 years referred to the health center that randomly selected from 110 health center that was used. Results: Data from 1520 women and men surveys were analyzed. One in 10 women and one in 12 men had experienced or been a partner in an abortion. In adjusted analyses, women and men in the 34–49 age group [adjusted odds ratio (AOR) 0.62, 95% (CI) 0.41, 0.96], the importance of religion in fertility (AOR = 0.42; 95% CI 0.26, 0.67), dissatisfied general health (AOR = 0.52; 95% CI 0.32, 0.87), and history of unwanted pregnancy for twice (AOR = 2.32; 95% CI 1.43, 3.77) and history of unwanted pregnancy for three‑time or more (AOR = 2.69; 95% CI 1.59, 5.49) were associated with significantly increased odds of abortion. Haven’t heard of medication abortion, that is, abortion with tablets (AOR = 0.43; 95% CI 0.29, 0.67) was associated with significantly reduced odds of abortion. Conclusions: The findings contribute to scarce information about abortion in Iranian. Due to the high prevalence of abortion and the country’s population growth policy, Iranian women need a full range of sexual and reproductive health services, including contraceptive counseling and accessible abortion care. [ABSTRACT FROM AUTHOR]

Copyright of Revista Electrónica de Psicología Iztacala is the property of Facultad de Estudios Superiores Iztacala and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This empirical research on children's poverty and the accompanying risk behavior was conducted in the Baktalórántháza micro-region, in one of the most disadvantaged micro-regions of Hungary. The study, completed in 2023, was conducted utilizing three methods, a questionnaire for families, interviews, and focus group interviews with social professionals working in the settlements. The region is one of the ten micro-regions with the highest poverty rate in the country. The majority of the population only has an elementary education, and the proportion of graduates is much lower than the national average. The proportion of households with three or more children is higher than the national average and the proportion of unemployed people in households with children is twice as high as the national average. Based on the experience of social workers working in the area, in addition to smoking and drinking alcohol, the consumption of psychoactive and psychotropic substances has increased among adolescents and young adults. Based on various indicators, children regularly consume illegal drugs. The origin and composition of these drugs are typically unknown. According to the reports by drug users, everyday life is easier, and they can escape from problems when under the influence of drugs. Based on the observations of experts, the consumption of various psychoactive substances has harmful effects on behavior, health, learning, and family life. School performance and the ability to think and learn decrease. Drug users are dissatisfied with their lives, have problems with social relationships, engage in partner violence, and may develop antisocial behavior in their lives. [ABSTRACT FROM AUTHOR]

This study quantifies the cost of unwanted pregnancy in relation to early childhood health in 62 developing countries. The endogeneity problem is dealt with through the household fixed‐effects model that utilizes the variation in the degree of birth wantedness among children within a household. The study uncovers the serious health consequences of children born unwanted. Specifically, children from unwanted births tend to have lower height‐for‐age, weight‐for‐age, and weight‐for‐height by 0.054, 0.065, and 0.04 standard deviations, respectively. We further present suggestive evidence that these health consequences might be ascribed to inadequate prenatal care and unfavorable postpartum behaviors among unintentionally pregnant women. Because poor health in early childhood can lead to long‐term negative ramifications, it is urgent to make contraceptives accessible to reduce unwanted births as well as to implement effective measures to assist women facing unwanted pregnancies. [ABSTRACT FROM AUTHOR]

Unwanted pregnancies resulting in detrimental consequences for both the mother and the child, including low birth weight, pose a remarkable challenge in developing countries. Although the association between low birth weight (LBW) and unwanted pregnancy is widely demonstrated, the results have been inconsistent, and the underlying mechanisms remain unclear. We examined maternal antenatal care (ANC) completeness as a potential mediating factor of the association between unwanted pregnancy and LBW among women in Indonesia, as well as the moderating effect of family support during pregnancy. We used women's records from the Indonesian Demographic and Health Survey (IDHS), a population-based survey conducted in 2017. This study involved 13,179 women aged 15–49 whose most recent child was aged 1–5 years. The multiple logistic regression results demonstrated that unwanted pregnancy was not associated with LBW. The generalized structural equation modeling (GSEM) results depicted that the effect of unwanted pregnancy on LBW was overwhelmingly explained by incomplete ANC, suggesting the mediation and suppression effect in the model (b = 0.32; 95 % Bias-corrected CI = 0.19–0.50; p =