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Background Antenatal Care (ANC) is one of the key care-packages required to reduce global maternal and perinatal mortality and morbidity Objectives To identify the essential components of ANC and develop signal functions Search strategy MESH headings for databases including Cinahl, Cochrane, Global Health, Medline, PubMed, and Web of Science Selection Criteria Papers and reports on content of ANC published from 2000-2020 Data collection and Analysis Narrative synthesis of data and development of signal function through 7 consensus-building workshops with 184 stakeholders Main Results A total of 221 papers and reports are included from which 28 essential components of ANC were extracted and used to develop 15 signal functions with the equipment, medication and consumables required for implementation of each. Signal functions for the prevention and management of infectious diseases (malaria, HIV, tuberculosis, syphilis and tetanus) can be applied depending on population disease burden. Screening and management of pre-eclampsia, gestational diabetes, anaemia, mental and social health (including intimate partner violence) are recommended universally. Three signal functions adress monitoring of foetal growth and wellbeing and identification and management of obstetric complications. Promotion of health and wellbeing via education and support for nutrition, cessation of substance abuse, uptake of family planning, recognition of danger signs and birth preparedness are included as essential components of ANC. Conclusions New signal functions have been developed which can be used for monitoring and evaluation of content and quality of ANC. Country adaptation and validation is recommended.

Background: From December 2019, the coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) broke out in Wuhan, China, and spread rapidly around the world. The pandemic also becomes a great challenge to radiation oncology departments since interruptions of radiation therapy increase the risks of cancer recurrence or the whole therapy failure. The present study aims to elucidate the influences of COVID-19 on the radiotherapy (RT) staff in China. Methods: The working staff members from different radiation oncology departments in China were retrospectively enrolled between December 1st, 2020 and March 9th, 2020 as many as possible. All the enrolled ones were invited to fill out a specific questionnaire to collect essential data. The basic information, anxiety levels, and workload of the staff were analyzed. Results: 1. A total of 1,755 questionnaires were sent back; 2. From December 1st , 2019 to March 9th, 2020, 7 out of 1,755 radiation oncology staff members contracted COVID-19 (P 0.05);3. The anxiety level of the RT staff about the COVID-19 outbreak (average score: 6.57) was higher than that of Wuhan medical staff (5.18) and higher than the national level (4.79); 71.43% of infected RT staff members expressed the need for psychological interventions; 4. During the epidemic, the departments of the 428 RT staff members shut down (24.39%). The 76.71% of the RT staff members felt workload relief during COVID-19 as compared to before. Conclusion: Among the 1,755 RT staff, the gender, age, and comorbidities were not related to COVID-19 infection. The geographic position and whether the person worked in a designated COVID-19 hospital were relevant factors with COVID-19 infection. The staff contracting COVID-19 experienced greater psychological pressure than that of the uninfected ones and therefore needed more psychological interventions. Funding Statement: This research was supported by grant No.2014CFB394, 2019CFB721 from the Natural Science Foundation of Hubei Province (CN) and No.WJ2017M027, No.WJ2019M200 from Health and Family Planning Commission of Hubei Province (CN). Declaration of Interests: None. Ethics Approval Statement: This study was approved by the Ethics Committee of Renmin Hospital of Wuhan University.

With 69,000 newly diagnosed cases every year, breast cancer (BC) is the most frequent cancer disease among women in Germany. Familial clustering is seen in about 30% of newly diagnosed cases. Besides the high-risk genes BRCA1/2, there are also moderate-risk BC genes (MBCG) that are associated with a 20%-50% risk of BC, such as CHEK2, ATM, and PALB2. In Germany, carriers of pathogenic variants in MBCG receive specific information on their test results, individual risks, and preventive options during genetic counseling for the disclosure of the results in a specialized center. Little is known about the medical knowledge that women have after attending counseling. This study aims to identify the medical knowledge, further information needs, and the possible impact of a lack of information on dealing with everyday life for women with pathogenic variants in MBCG who have attended genetic counseling at an academic hospital in Germany. Problem-centered, guided, individual interviews were conducted with twelve women carrying pathogenic variants in MBCG. The interview guide was developed based on the methods of the problem-centered interview according to Witzel. The interview analysis was based on Mayring's qualitative content analysis. The women were between 29 and 59 years old and carried pathogenic variants in the risk genes CHEK2 (n = 8), ATM (n = 1), or PALB2 (n = 3). Several medical uncertainties and information needs emerged from the data, concerning (a) medical terms, (b) risk perception, (c) BC therapy for hereditary BC, (d) lifestyle advice and risk factors, and (e) family planning and risk-reducing mastectomy. Women with pathogenic variants in MBCG might develop their own conceptions regarding the onset of disease and inheritance. In order to meet the need for information and address the uncertainties that may still exist after genetic counseling, structured, evidence-based and comprehensible written information in German should be developed for this group.

Background: Papua-New Guinea (PNG) has one of the highest maternal mortality rates in the world; complications due to unsafe abortion are an important cause. Abortion laws are restrictive, and safe, induced abortions are unavailable to the majority of women, while unsafe abortions are known to be practised throughout the country. The topic of abortion is stigmatised, for women and health professionals. Aim: To conduct a study of PNG health professionals’ experience of induced abortion and their views on the provision of safe, accessible abortion services for PNG women. Materials and Methods: A questionnaire developed from similar surveys conducted in Australia and New Zealand was distributed in 2017 to doctors working in provincial hospitals of the public health system; in 2020, the questionnaire was distributed to doctors and nursing staff in Port Moresby General Hospital, and to medical, nursing and health sciences students in the University of Papua-New Guinea. Results: Significant numbers of senior medical officers and nurses reported experience of women presenting following unsafe induced abortion. There was wide variation across all respondents with regard to accurate knowledge of PNG’s abortion laws, and to views on the provision of safe accessible abortion services in the country’s public health system. Conclusions: Abortion training for service providers and provision of primary care services are necessary to ensure that PNG women have equitable access to abortion care instead of seeking out untrained providers or attempting self-abortion. Innovative approaches also need to be adopted to complement family planning efforts in PNG.

OBJECTIVE African American and Hispanic women with systemic lupus erythematosus (SLE) have the highest rates of potentially avoidable pregnancy complications, yet racial disparities in family planning among reproductive-age women with SLE have not been well-studied. Our objective was to examine whether there are racial differences in contraception encounters and dispensing among US Medicaid-insured women with SLE. METHODS Using Medicaid claims data from 2000-2010, we identified women ages 18-50 years with SLE. We examined contraception encounters and uptake over 24 months. We used multivariable logistic regression to estimate the odds ratio and 95% confidence interval by race/ethnicity of contraception encounters, any contraception dispensing, and highly effective contraception (HEC) use, adjusted for age, region, year, SLE severity, and contraindication to estrogen. We also compared contraception encounters and dispensing among women with SLE to the general population and women with diabetes mellitus. RESULTS We identified 24,693 reproductive-age women with SLE; 43% were African American, 35% White, 15% Hispanic, 4% Asian, 2% other race, and 1% American Indian/Alaska Native. Nine percent had a contraceptive visit, 10% received any contraception, and 2% received HEC. Compared to White women, African American and Asian women had lower odds of contraception dispensing, and African American women had lower odds of HEC use. Women with SLE were more likely to receive HEC than the general population and women with diabetes mellitus. CONCLUSION In this study of reproductive-age women with SLE, African American and Asian women had lower odds of contraception dispensing and African American women had lower odds of HEC use. Further study is needed to understand the factors driving these racial disparities among this population.

The unmet need for modern contraception remains high around the world, particularly for youth. While some of this unmet need is driven by limited health infrastructure and method mix availability, many adolescents who visit family planning providers still do not receive methods that fit their needs. This suggests that providers may be biased against youth and that interventions to change provider behavior could help close this gap. However, it is unclear if this bias is a result of age or other characteristics common among young women such as not being married and not having children. We use a discrete choice experiment in Burkina Faso, Pakistan, and Tanzania to disentangle the effects of age on providers' decisions to provide contraception from the effects of other potential confounding factors. We find that, although young women may experience the most bias, age is not the main driver. Rather, marital status and parity seem to influence provider decisions to offer services or counsel on modern methods. These findings suggest that interventions to reduce provider bias should focus on changing behavior towards unmarried and nulliparous women, regardless of their age.

Background Vasectomy remains a safe, simple, and effective contraceptive option. Conflicting data on the trend of vasectomy use among men have been described previously at various snapshots in time over the last two decades. Objectives This paper seeks to describe the trend of vasectomy utilization in the last 15 years using a nationally representative US survey. Materials and methods We analyzed data from male respondents aged 18 to 45 years of the Cycle 6 (2002), 2006-2010, 2011-2013, 2013-2015, and 2015-2017 National Survey of Family Growth (NSFG) surveys. Population estimates are calculated based on the official NSFG instructions, accounting for the complex survey design. Multivariate logistic regression models are used to study demographic and socioeconomic factors associated with vasectomy use in men. Results Baseline characteristics for men undergoing vasectomy do not differ significantly across survey years. Increased age, White race, marital status, higher education level, birthplace within the United States, higher household income, non-Catholic affiliation, and higher number of biological kids have significant positive associations with vasectomy use. After accounting for factors associated with vasectomy utilization, there was a significant temporal decline in vasectomy utilization rates in all age groups across survey years which remained in subgroup analyses of all men greater than 25, 30, and 35 years of age. Discussion This is the first population-based analysis of US data to observe a decline in vasectomy utilization over the past two decades. The decline was statistically significant after accounting for all demographic and socioeconomic factors. Conclusion There is a steady decline in the prevalence of vasectomy use in men from 2002 to 2017. Given the limited contraceptive options for men and the importance of contraception and family planning in the United States, further research is needed to understand the temporal decline.

This paper investigates the extent to which in-utero exposure to temperature shocks affects birth weight outcomes in Vietnam. Exploiting the variations across districts and conception timing within districts, we show that a one standard deviation increase in temperature relative to the local norm (approximately 0.52 degree Celsius) during the first trimester of pregnancy reduces the child’s weight at birth by 67 grams or 2.2%. Our heterogeneity analysis suggests that infants living in rural areas, born to poor and low-educated mothers are especially vulnerable to temperature shocks.

The global family planning community has made significant progress towards enabling 120 million more women and girls to use contraceptives by 2020, though we enter the decade ahead with a long road yet to travel. While investment in strong health systems and supply chains is still needed, the supply‐driven approach dominant in family planning fails to address the individual, relational, and social barriers faced by women and couples in achieving their reproductive intentions and desired family size. Overcoming these barriers will require a better understanding of behavioral drivers and the social environment in which family planning decisions are made, and an increased investment in the proven, yet underutilized, approach of social and behavior change (SBC). We make the case that a more intentional focus on the science of human behavior in family planning can help advance the achievement of global, regional, and national goals while also calling for strategic and sustained investment that reflects the critical importance and proven impact of SBC approaches.

BACKGROUND Cesarean birth, especially repeat cesarean, is associated with significantly higher morbidity than vaginal birth. Appropriately counseling women who are candidates for labor after cesarean (LAC) has the potential to confer significant health benefits for women. Little guidance exists about optimal counseling techniques, especially for Latina women. The aim of this study was to evaluate satisfaction among Latinas about how LAC counseling is performed, specifically as it relates to shared decision making. METHODS We conducted a qualitative study of pregnant women at several clinics in a Federally Qualified Health Center system in Utah. We interviewed eleven Latina women about satisfaction with recent LAC counseling with a specific aim of obtaining rich, personal narratives rather than reaching data saturation. A codebook representing the most common themes was developed. RESULTS Three major themes emerged related to LAC counseling including influences on satisfaction, influences on the birth decision process, and preferences surrounding method and timing of counseling. Women experienced greater satisfaction from providers who used jargon-free communication, were perceived as trustworthy, cared about her experiences, and empowered her to make an informed decision. Women's decisions were influenced by prior birth experiences, desire for a safe delivery and easy recovery, and future family planning. CONCLUSIONS Understanding the aspects of LAC counseling that are most meaningful for Latina women can promote effective communication between patient and provider and improve patient satisfaction. Globally, our findings highlight the importance of evaluating the experiences and preferences of minority groups; majority populations cannot be assumed to speak for minority populations.

OBJECTIVE To explore the sexual and reproductive health (SRH) care and counseling needs of young women with rheumatic diseases in the context of their rheumatology care. METHODS Semistructured qualitative telephone interviews were conducted with female patients with rheumatic diseases ages 18-45 years (n = 30). Women were recruited from outpatient rheumatology clinics in western Pennsylvania. Interviews were audiorecorded and transcribed verbatim. A codebook was inductively developed based on the interview transcripts, and the finalized coding was used to conduct a thematic analysis. RESULTS Four themes emerged from interviews: 1) women want rheumatologists to initiate conversations about SRH and to revisit the conversation over time; 2) women desire clear and complete information regarding fetal, pregnancy, and infertility risks associated with their diseases and disease-modifying antirheumatic drugs (DMARDs); 3) women want to be treated holistically, with SRH addressed in the context of their life circumstances and personal values in addition to their rheumatic diseases; 4) women generally feel that they are intermediaries between their rheumatologists and obstetrician-gynecologists (OB/GYNs), but preferred for providers to communicate directly with one another about their SRH. CONCLUSION Patients strongly desired rheumatologists to play an active role in their SRH, by initiating family planning conversations, providing SRH education in the context of their diseases and DMARDs, and directly coordinating SRH care with OB/GYNs. To meet patients' SRH needs, further work is needed to clarify the specific role of rheumatologists in providing SRH care and to identify ways to better facilitate communication between rheumatologists and reproductive health care providers.

Objective Assess the impact of the Be Your Own Baby (BYOB) public awareness campaign including population-level exposure, the effectiveness of ad platforms, and the effect of the campaign on family planning clinic attendance, the campaign's primary goal. Data sources The study relied on administrative data on traffic and engagement from the campaign's website, population survey data measuring campaign exposure, and clinic attendance volumes from state-by-year restricted-use versions of the Office of Population Affairs' Family Planning Annual Reports (2006-2018). Study design Bivariate analyses were used to assess website traffic and engagement and population-level exposure across key subgroups. We then used the synthetic control method to examine the impact of the BYOB campaign on per capita Title X clinic attendance among the target demographic, women 18-29 years of age. Data collection/extraction methods Not applicable. We relied on secondary sources. Principal findings Primary media platforms used by the campaign included social media, digital display, streaming audio, YouTube, and search. Website traffic was driven primarily by digital display ads, but engagement was highest for search. Our results suggest nearly 12% of Delaware women 18-29 years of age were exposed to the campaign. However, exposure was measured at the end of the campaign and was likely much larger during its peak. Our results indicated that the campaign was associated with between 13 and 23 additional Title X clinic visits per 1000 women compared with 110 users per 1000 at baseline in 2014. Conclusions Our findings suggest the BYOB campaign was successful at increasing clinic attendance among the target demographic. These results have important implications for other programs seeking to use public awareness messaging to increase participation in the health care system and are especially important for Title X administrators who have faced declining patient volumes for over 10 years.

BACKGROUND Natural disasters and epidemics can strain already-fragile health systems, diverting resources away from essential sexual and reproductive health (SRH) services, threatening supply chains, and adversely impacting access to health facilities. OBJECTIVE To describe how natural disasters and epidemics affect multiple dimensions of SRH service delivery and outcomes, and identify potential approaches to facilitate resumption of services. SEARCH STRATEGY Key words searched in Google Scholar, PubMed, and Scopus. SELECTION CRITERIA Studies published in English between 2005 and 2020 covering events in low- and middle-income countries. DATA COLLECTION AND ANALYSIS This review was developed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2009 checklist. The initial electronic database searching yielded 64 345 studies, but after screening 13 studies were included in the final review. MAIN RESULTS Across contexts, disruptive events worsened the availability of and women's access to SRH services, contributed to decreased utilization of SRH services, and often resulted in lower use of family planning, particularly methods requiring facility-based interaction. CONCLUSION SRH in disaster response plans must be prioritized, as women often lose access to these essential services at a time when they are at their most vulnerable. Evidence regarding effective interventions and policies is lacking.

BACKGROUND Short and long interpregnancy intervals (IPI) are associated with increased risk of hypertensive disorders of pregnancy, yet whether this association is modified by maternal age remains unclear. OBJECTIVES To examine if the association between IPI and hypertensive disorders of pregnancy varies by maternal age at birth prior to IPI. METHODS We conducted a population-based cohort study of all mothers who had their first two (n = 169 896) consecutive births in Western Australia (WA) between 1980 and 2015. We estimated the risk of preeclampsia and gestational hypertension for 6 to 60 months of IPI according to maternal age at birth prior to IPI (

Recent data suggest increasing rates of emergency contraception (EC) use in Ghana, particularly in urban areas. In 2018, we collected survey data from 3,703 sexually experienced women aged 16-44 years living in low-income settlements of Accra. We estimated the prevalence of lifetime and current EC use. Multivariate logistic regression was used to assess factors associated with current use of EC. Retrospective monthly calendar data on contraceptive use were analyzed to identify patterns of EC use, including repeat and continuous use, and uptake of other contraceptive methods in the months following EC use. Nearly 15 percent of women had ever used EC. About half of recent EC users (52 percent) used EC for at least four months cumulatively within a 12-month window. There was no evidence of adoption of other modern methods in the months after using EC. Our results suggest that EC is a common method for pregnancy prevention in Accra, particularly among young, unmarried, highly educated women. Counseling on effective EC use and strategies that promote equitable access should be prioritized.

Norms and beliefs toward contraception, both positive and negative, motivate contraceptive use; however, they have seldom been explored longitudinally in low- and middle-income countries, limiting our understanding of their influence on contraceptive dynamics. We used PMA2020 Uganda national longitudinal data of reproductive aged women in 2018 (baseline) and 2019 (follow-up) to explore discontinuation and switching among modern contraceptive users at baseline (n = 688) and contraceptive use at follow-up among nonusers at baseline (n = 1,377). Multivariable simple and multinomial logistic regressions assessed the association of individual and community-level contraceptive beliefs with contraceptive uptake, discontinuation and switching. One-quarter of nonusers at baseline were using contraception at follow-up, while 37 percent of users at baseline had discontinued and 28 percent had switched methods at follow-up. The odds of contraceptive uptake were lower among women who strongly agreed that contraception impacted future fertility or caused conflict within a couple, relative to those who strongly disagreed (adjusted odds ratio (aOR): 0.7 and aOR: 0.6, respectively), but higher among women who strongly agreed that contraception preserved beauty (aOR: 1.6). Women who strongly agreed that it was acceptable to use contraception before having children were less likely to discontinue their method than those who strongly disagreed (adjusted relative risk ratio (aRRR): 0.5), though living in a community where more women agreed with this statement was associated with higher discontinuation (aRRR: 6.0). Family planning programs that promote positive beliefs toward family planning could improve contraceptive uptake and continuation. More research is needed to understand how contraceptive beliefs shape contraceptive decisions across the life course.

OBJECTIVE To compare the sociodemographic characteristics of users of the copper intrauterine device (Cu-IUD) and the levonorgestrel intrauterine system (LNG-IUS) at a family planning clinic in Campinas, SP, Brazil. METHODS A retrospective audit study was conducted to analyze the characteristics of new users of IUDs at the clinic of the Department of Obstetrics and Gynecology, University of Campinas. Data covered insertions performed between 1979 and 2006 when only the Cu-IUD was offered at the clinic, and between 2007 and 2019 when the LNG-IUS was also offered, both free of charge to women. Logistic regression analysis was performed. RESULTS There were 31 385 insertions. Cu-IUD: n = 17 156 (1979-2006) and n = 2013 (2007-2019); LNG-IUS n = 12 216 (2007-2019). Up to 2006, Cu-IUD users were less likely to be nulligravidas, more likely to be younger than 40 years of age, and with fewer years of schooling. Following introduction of LNG-IUS, the sociodemographic characteristics of users presented major changes over time. Comparing the period 1979-2006 with 2007-2019, new users of the LNG-IUS were more likely to be older than 40 years of age, with fewer years of completed schooling, and to be nulligravidas. CONCLUSION Major changes in sociodemographic characteristics of users were noted according to preference over time. Introduction of the LNG-IUS presents a major opportunity to increase IUD use.

BRCA1 and BRCA2 pathogenic variant carriers have a high lifetime risk of developing breast and ovarian malignancies. Given the risks and significant ramifications of undergoing risk-reducing surgeries, many pathogenic variant carriers unaffected by cancer (previvors) struggle with family planning and reproductive decision making. The objective of this study was to determine the attitudes and practices of BRCA1 and BRCA2 pathogenic variant carriers with respect to family planning decision making. A cross-sectional survey was conducted of BRCA1 and BRCA2 previvors at four Northeastern medical centers. The survey was administered electronically via email using REDCap. The survey included demographic information as well as questions about genetic testing, prophylactic surgeries, family planning, and partnering. Data were analyzed with Fisher's exact tests and t tests. The survey was completed by 139 of 422 BRCA1 and BRCA2 pathogenic variant carriers (response rate 33%). Thirteen were excluded from analysis due to self-reported cancer history. Of the remaining 126, 21 (16.7%) were male and 105 (83.3%) were female. Female participants

OBJECTIVE: To assess the feasibility, functionality and acceptability of a mobile application (app), the World Health Organization (WHO) Postpartum Family Planning (PPFP) Compendium, in clinical care. METHOD: This prospective qualitative study was conducted among family planning providers routinely delivering PPFP care in Accra, Ghana. We conducted in-depth interviews at baseline and 3 months after app introduction. We elicited expected technological, psychological and environmental barriers to use, actual use in clinical settings, and feedback for app improvement. With inter-coder reliability, we analyzed the content of interview transcripts. RESULTS: Twenty providers participated in baseline interviews, and 19 participated in follow-up interviews. At baseline, providers did not have significant technological barriers to its use and felt the app was acceptable, but were concerned about the appropriateness of using an app during clinical care. At 3-month follow-up, 18 out of 19 participants reported using the app weekly, and found the app acceptable for use in clinical care. Providers recommended expanding clinical content and including similar guidance relevant to times outside the postpartum period. CONCLUSIONS: Use of a PPFP counseling app to aid family planning providers in clinical care delivery is feasible and acceptable. Providers recommended inclusion of similar guidance relevant to times outside the postpartum period.

Population-based indicators of the coverage of key elements of high-quality family planning services are tracked via household surveys with female respondents, yet little work has been done to establish their validity. We take advantage of existing data sets from Cambodia and Kenya to compare women's responses at exit interviews following a health facility visit against the observations of a trained third-party observer during the visit. The results, which treat the observations as the reference standard, show that indicators that measure contraceptive methods received are accurately reported while indicators of whether the woman received her preferred method and whether information was "discussed" or "explained" during counseling are less reliably reported. Studies designed explicitly to assess the validity of family planning questions in household surveys, especially questions in large survey programs critical for monitoring demographic trends and programmatic coverage, are needed.

Objective To report the proportion and determinants of repeat induced abortions in China. Methods Cross‐sectional data were collected of 79 954 women who received an induced abortion from 297 hospitals across 30 Chinese provinces in 2013, using a stratified cluster sampling design. Logistic and Poisson regression models were fitted to identify characteristics associated with repeat abortion. Putative factors included age, household registration (hukou) status, marital status, education, occupation, reproductive history, and current contraceptive practices. Results Of all abortions, 65.2% were repeat induced abortions. The proportion of repeat abortions varied substantially across provinces, from 36.9% in Qinghai to 85% in Hubei. The strongest factors associated with repeat induced abortion were being older than 40 years (adjusted odds ratio [ORadj] 7.0, 95% confidence interval [CI] 6.2–7.9), divorced or widowed (ORadj 2.1, 95% CI 1.6–2.7), and using oral contraceptives (ORadj 2.1, 95% CI 1.9–2.3). Conclusion A high proportion of repeat induced abortion was observed across many Chinese provinces, highlighting the need to reduce the incidence of unwanted pregnancy. Several sociodemographic and clinical factors were found to be significantly associated with repeat abortions and should be considered in post‐abortion family planning services.

Key content Lynch syndrome is an autosomal dominant condition closely associated with colorectal, endometrial and ovarian cancer.Women with Lynch syndrome are at increased risk of both endometrial and ovarian cancer and should be offered personalised counselling regarding family planning, red flag symptoms and risk-reducing strategies.Surveillance for gynaecological cancer in women with Lynch syndrome remains controversial; more robust data are needed to determine its effectiveness.Universal testing for Lynch syndrome in endometrial cancer is being adopted by centres across Europe and is now recommended by the National Institute for Health and Care Excellence; thus, gynaecologists must become familiar with testing strategies and their results.Testing strategies involve risk stratification of cancers based on phenotypical features and definitive germline testing. Learning objectives To define the pathogenesis of Lynch syndrome and its associated gynaecological cancers.To understand the testing strategies for Lynch syndrome in women with gynaecological cancer.To learn how best to counsel women with Lynch syndrome regarding gynaecological cancer and risk-reducing strategies to enable informed decision-making. Ethical issues Offering gynaecological surveillance despite a lack of robust evidence for its clinical effectiveness may falsely reassure women and delay risk-reducing hysterectomy.Genetic testing may yield variants of unknown significance with ill-defined clinical implications, which can lead to confusion and anxiety.Genetic testing has implications not only for the individual, but also for the whole family, so expert counselling is crucial.

Objective: To create and assess a clinic model to address the unmet need for effective contraception among women living with HIV in Botswana, where half of all pregnancies are unintended and 30% of women of reproductive age are living with HIV. Methods: We introduced family planning services into an HIV clinic in Gaborone, Botswana. Our intervention gave HIV providers brief training on contraceptive counseling plus the option of immediate referral of interested patients to an on-site contraception provider. We administered a survey to patients and providers before and after intervention. Patients were female, aged 18–45 years and using antiretrovirals. Results: At baseline, 6% of 141 patients discussed contraception with their HIV-care provider, compared with 61% of 107 post intervention (P < 0.001). At baseline, 6% of patients reported wanting to use long-acting reversible contraception (LARC). Post intervention, 45% of patients chose to meet with the contraception provider, and 29% wanted to use LARC (P < 0.001 versus baseline). All providers strongly agreed that they were better informed about contraception post intervention and were satisfied with their ability to counsel and refer women for contraception. Conclusions: Provision of on-site contraceptive services in this HIV clinic encouraged family planning discussions and increased interest in LARC. K E YWORDS Botswana, contraception, family planning, HIV, service integration

Objective This study aimed to examine whether pregnancy following bariatric surgery affects long-term maternal weight change and offspring birth weight. Methods Using data from the Longitudinal Assessment of Bariatric Surgery (LABS)-2 study, linear regression was used to evaluate percent change in total body weight over a 5-year follow-up period among reproductive-aged women who underwent Roux-en-Y gastric bypass or laparoscopic adjustable gastric banding as well as evaluate the association of bariatric procedure type and offspring birth weight. Results Of 727 women with preoperative age of 36.1 (6.3) years (mean [SD]) and BMI of 46.9 (7.0) kg/m2 , 80 (11%) reported at least one pregnancy. After adjusting for covariates, percent change in total body weight was not significantly different between women who became pregnant and those who did not during a 5-year follow-up period (β = 2.02; 95% CI: -1.03 to 5.07; P = 0.19). Additionally, mean birth weight was not significantly different between mothers who underwent Roux-en-Y gastric bypass versus laparoscopic adjustable gastric banding (P = 0.99). Conclusions Postoperative pregnancy did not diminish long-term weight loss in women in the LABS-2 study. The finding of comparable weight loss is relevant for providers counseling women of reproductive age on weight-loss expectations and family planning following bariatric surgery.

Background In the field of veterinary surgery, women neither marry nor have children at the same rate as men, and those who do may experience more career disruption as a result. The American College of Veterinary Internal Medicine (ACVIM) is 1 of the few areas of specialized medicine that is predominantly female; it is unknown if such a demographic shift would produce a different environment for individuals cultivating their personal life. Hypothesis/objectives To report data regarding subjective and objective aspects of the intersection of the personal and professional lives of Diplomates of the ACVIM. Sample Eight hundred ninety-six surveys (781 completed) of ACVIM Diplomates, including cardiology, large and small animal internal medicine, neurology, and oncology. Methods An 82-item online survey was distributed to ACVIM Diplomates via Diplomate college listservs. Participation was voluntary. Results Men were more likely to be married and have children than were women. Women had or adopted their first child at a later career stage compared with men, and agreed more strongly that career stage was an influential factor in family planning. Those with children worked fewer hours compared with those without, and this effect was greater among women. Women were more likely to require external childcare, but most men and women shared childcare responsibilities equally outside of working hours. Conclusions and clinical importance The intersection of personal and professional life differs between men and women in the ACVIM, which may create different needs, preferences, or barriers to work-life balance in the workforce.

Issue addressed Healthy behaviours prior to conception can improve pregnancy outcomes and intergenerational health. Adolescence is an important period to promote preconception health, but education resources need to be age and culturally appropriate. Few studies have addressed preconception awareness and knowledge among Aboriginal and Torres Strait Islander youth, and few culturally appropriate resources exist. Methods A mixed methods, co-design process engaging Aboriginal and Torres Strait Islander youth and an Indigenous Reference Group (IRG). Additionally, a survey was carried out to identify preconception health awareness and interest among a broader youth audience. Results Several main themes emerged from consultation meetings with youth reflecting an awareness of preconception health, but limited understanding. Youth revealed an interest in fertility, and a need for more information on lifestyle factors associated with infertility. Preconception information related to the opposite sex was seen as important as well as information incorporating current local knowledge and world views. Among the survey respondents, 46% (11/24) had a pre-existing understanding of preconception health. Optimising lifestyle behaviours prior to pregnancy was perceived as important for women (21/24; 88%), but less so for men (16/24; 67%), highlighting a gap in knowledge regarding the importance of preconception health for men. Conclusion The co-designed resource "Getting healthy before pregnancy" is available in print and electronically, with illustrations and synchronised audio overlay in Aboriginal English or East-side Kriol. The resource includes information on preconception health and behavioural risk factors. So what We present a co-designed preconception health resource for evaluation with Aboriginal and Torres Strait Islander youth.

Restrictive social norms and strategic constraints imposed by family members can limit women’s access to and benefits from social networks, especially in patrilocal societies. We characterize young married women’s social networks in rural India and analyze how inter-generational power dynamics within the household affect their network formation. Using primary data from Uttar Pradesh, we show that co-residence with the mother-in-law is negatively correlated with her daughter-in-law’s mobility and ability to form social connections outside the household, especially those related to health, fertility, and family planning. Our findings suggest that the mother-in-law’s restrictive behavior is potentially driven by the misalignment of fertility preferences between the mother-in-law and the daughter-in-law. The lack of peers outside the household lowers the daughter-in-law’s likelihood of visiting a family planning clinic and of using modern contraception. We find suggestive evidence that this is because outside peers (1) positively influence daughter-in-law’s beliefs about the social acceptability of family planning and (2) enable the daughter-in-law to overcome mobility constraints by accompanying her to health clinics.