Search

A fundamental component of the basic right to health is the right to sexual health, encompassing an individual's right to decide freely on matters of sexual and reproductive health without discrimination. Provision of these rights is inextricably linked with a wide range of other internationally agreed upon human rights, including the right to information, participation, and equality. Evidence has shown that provision of these rights not only improves maternal and neonatal health, but also healthcare worker safety and the provision of a vast array of critical and necessary medical care. And yet, too often—and with increasing frequency—sexual and reproductive rights are being violated worldwide, with rising taboos, stigma, and discrimination, particularly within abortion, contraception, and fertility care. FIGO strongly supports comprehensive, equitable, and accessible sexual and reproductive health care for all individuals, recognizing that these rights are essential components of global health and fundamental human rights. This includes a particular emphasis on special populations, healthcare workers, and women and girls in crisis zones. FIGO encourages its member societies to deliver comprehensive sexual and reproductive health care, advocate for coverage for sexual and reproductive health care, become involved in analyzing barriers to access within health systems, and provide nonjudgemental, confidential, person‐centered care. [ABSTRACT FROM AUTHOR]

This article explores the difficulties faced in Kenya regarding sexual and reproductive health and rights policy making. It discusses the impact of the global anti-rights movement on women, girls, and the LGBTIQ+ community in Kenya. The article also examines the role of foreign governments, religious groups, and US-based lobby groups in shaping policies and laws in Africa. It emphasizes the importance of defending human rights, social justice, and equality in the face of these challenges. The article further delves into the politicization of comprehensive sexual and reproductive health services in Kenya and the obstacles encountered in implementing abortion provisions. It concludes by addressing the exclusion of SRHR advocates from policy discussions and the suppression of their voices in favor of anti-reproductive rights groups. The text highlights the challenges faced by the SRHR sector in Kenya, particularly in relation to the adoption and implementation of progressive policies. It emphasizes the influence of anti-SRHR actors who rely on moral and religious reasoning, often disregarding scientific evidence and existing data. The SRHR sector has responded by adopting a holistic ecosystem approach and collaborating with diverse partners to address these challenges. The text stresses the need for discreet strategies and continuous advocacy to protect and advance SRHR in the face of opposition. It also calls for stronger African voices and leadership in the global discourse on SRHR to challenge dominant narratives and promote a more nuanced understanding of the regional landscape. [Extracted from the article]

Background: Access to safe abortion care is highly unequal and fundamentally rooted in socioeconomic inequalities which are amplified by restrictive social norms and legal systems. We analyse these inequalities along the reproductive health continuum amongst adolescent girls in Zambia. Methodology: This paper draws from 20 focus group discussions conducted in 2021 with community members (young/adult) in five urban, peri urban, and rural sites in Zambia. Data was analysed using thematic analysis. Results: Adolescent pregnancy in the community was reported to be very common across the communities with girls from poorer families being disproportionately affected. Parents were reported to be complicit in facilitating their daughter's sexual-economic exchanges which emerged as a key driver of pregnancies. Young age and unmarried status meant adolescent girls could face triple stigma: stigma around accessing contraception to prevent a pregnancy, stigma in experiencing an unintended pregnancy and stigma around terminating an unintended pregnancy. There were clear socioeconomic differences in adolescent girl's exposure to community and health provider censure and/or acceptance of their pregnancy, and in their ability to conceal an abortion. Having the means to pay for health care allows some adolescents to seek terminations earlier and to access private health facilities while poorer adolescent girls face greater exposure to community censure through their embeddedness within the community. Abortions in this group attracts greater visibility through complications arising from their constrained choice for safe abortion methods. Stigmatising attitudes of community members also undermined adolescents' reproductive agency and mental health. For adolescents who choose to keep an unintended pregnancy, reintegration into school was highly challenging despite a national policy in place, with marriage being viewed as the only future option for poorer teenage mothers. Conclusion: The embeddedness of adolescent pregnancies within community structures of economic insecurity and gendered and age-related power relations highlight the importance of introducing community level approaches to tackle unintended pregnancies and unsafe abortion. Understanding teenage pregnancy as a community issue creates opportunities for community level support to young girls especially when they return to school. [ABSTRACT FROM AUTHOR]

Objectives: Early abortion increasingly is provided in the primary care setting, allowing improved access, continuity of care, and contraception, if desired. We aimed in this retrospective chart review to describe postabortion contraception provision in a family medicine office. Methods: Participants were those patients who obtained an induced abortion during an 11-year period at a family medicine office. We documented contraception provision within 30 days of abortion and used simple proportions, Fisher exact tests, and χ² tests to describe differences in contraceptive provision by type of abortion and continuity status. Results: Most of the patients who underwent abortions (254/353, 72%) had documentation of a contraceptive method within 30 days of abortion, which was similar for patients who had either a medication (124/166, 75%) or an aspiration abortion (130/187, 70%, P = 0.71). The most common contraceptives were contraceptive pills (104/353, 29%) or intrauterine devices (68/353, 19%). Patients who chose a tier 1 method were more likely to have a procedure abortion (50/87, 57%), whereas patients who chose a tier 2 method were likely to have a medication abortion (83/160, 52%). Fewer than half (45%, 158/353, P = 0.0002) were continuity patients and established patients in the primary care office. Most tier 1 contraceptive users were continuity patients (49/87, 60%), whereas most patients without a contraceptive method were noncontinuity patients (72/99, 73%). Conclusions: The primary care setting is uniquely equipped for providing early abortion and postabortion contraception. Although the providers offered all contraceptive options to eligible patients, continuity patients were more likely to receive more effective contraception in their primary care office. [ABSTRACT FROM AUTHOR]

A questionnaire-based study was jointly organised by European Board and College of Obstetrics and Gynaecology and European Society of Contraception to evaluate the current status as regards access and quality of care regarding contraception, abortion care, and pre-conceptional counselling and care among the 26 European countries. There are considerable variations among these countries as regards the provision of contraceptive services and abortion care. There is ample room for improvement through European training and education programs. However, the most important difference is the absence of a comprehensive network of healthcare providers in various countries to deliver these services at different points of access. There is notable absence of educational programs and instructional materials tailored specifically for nurses and midwives in several countries. This deficiency impedes the professional development and skills enhancement of these healthcare professionals, potentially compromising the quality of healthcare services provided to women in these countries. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusion Describe the characteristics and changes in the profile of women who sought care after experiencing sexual violence (SV) during the first six months of the COVID‐19 pandemic in a Brazilian city.This is a cross‐sectional retrospective study. Data from emergency care and legal abortion requests of women assisted at the Women's Health Care Center Hospital (School of Medical Sciences, University of Campinas, Brazil) due to SV experienced between March 23 and August 23, 2020 (Quarantine Group, QG), were collected and compared with data from the same period of the previous biennium (Comparison Group, CG). χ2 and Fisher's exact tests were used to compare groups; the significance level was 5%.Data for 236 women were analyzed; 70 women were included in the QG and 166 in the CG. In the QG, there was a restriction in the area of origin of women, with a higher proportion of women who lived in Campinas (P = 0.0007) and a higher frequency of chronic SV (P = 0,035). There were no rapes associated with the use of social media or apps in the QG, but 9.8% of women in the CG experienced rape associated with the use of social media or apps. There were higher rates of domestic violence (P = 0.022) and intimidation through physical force (P = 0.011) in the first two months.The COVID‐19 quarantine affected the profile of women who sought care after experiencing SV. The quarantine resulted in changes in the area of origin of patients, hindering access to health services and leading to higher rates of chronic and domestic SV, particularly in the first 2 months of the pandemic. [ABSTRACT FROM AUTHOR]

Background: Although long-acting reversible contraception (LARC) is more effective and longer lasting than short-acting methods, uptake remains low among post-abortion clients. Using a stepped-wedge, cluster-randomized trial, we evaluate the impact of a provider-level peer-comparison intervention to encourage choice of LARC in Nepal among post-abortion clients. Methods: The intervention used prominently displayed monthly posters comparing the health clinic's previous month performance on LARC uptake against peer clinics. To understand how the intervention affected behavior, while ensuring voluntarism and informed choice, we used mystery client visits, in-depth provider interviews, and client exit survey data. The trial examined 17,680 post-abortion clients in 36 clinics in Nepal from July 2016 to January 2017. The primary outcome was the proportion of clients receiving LARCs. Statistical analysis used ordinary least squares (OLS) regression with ANCOVA estimation to assess the intervention's impact on LARC uptake while controlling for client- and clinic-level characteristics. Results: The intervention increased LARC use among post-abortion clients by 6.6% points [95% CI: 0.85 to 12.3, p-value < 0.05], a 29.5% increase in LARC use compared to control clinics. This effect persisted after the formal experiment ended. Analysis of provider and client experiences showed that the behavioral intervention generated significant change in providers' counseling practices, motivated the sharing of best practices. Quality of care indicators either remained stable or improved. Conclusion: We find that a provider-level behavioral intervention increases LARC uptake among post-abortion clients. This type of intervention represents a low-cost option to contribute to reducing unmet need for contraception through provider behavior change. [ABSTRACT FROM AUTHOR]

Background: Despite progress in access to family planning services in many sub-Saharan African countries in recent decades, advances in effective early postpartum contraceptive adoption remain low, and the unmet need for early postpartum contraceptives is high. In Ethiopia, early postpartum modern contraceptive method uptake is still unacceptably low. The barriers/challenges have not yet been sufficiently explored. A deep and detailed understanding of the contextualized barriers and challenges in the adoption of early postpartum contraceptive methods is crucial in developing future locally-appropriate interventions. Objectives: This study aimed to explore barriers/challenges to the uptake of early postpartum modern contraceptive methods after childbirth in Dessie and Kombolcha zones, in northeast Ethiopia. Methods: Aconventional content analysis qualitative study was deployed in Dessie and Kombolcha town zones, northeast Ethiopia using a theoretical purposive sampling technique. A total of 57 study subjects were participated. The sample size was determined using the rule of information saturation through 7 key informant interviews, 6 in-depth interviews, and 5 focused-group discussions with 8–10 participants each. Data were collected using an unstructured interview guide and recorded using a digital audio recorder and field notes. The trustworthiness of the study was assured using different techniques. The collected data were transcribed and translated from native language to English. Atlas-ti version7 software was used to facilitate conventional content qualitative data analysis approach. Open coding, categories, subthemes, and overreaching themes were developed, and a conceptual model of barriers was organized through network analysis. Result: Barriers to uptake of early postpartum modern contraception quoted by study participants and themed were related knowledge, attitude, family-community, health facility, contraceptive method, cultural, religious, fertility desire, gender issues, and misconceptions. The sub-themes of knowledge-related barriers that emerged were lack of awareness of the time to take birth control methods, not knowing the time pregnancy is likely after childbirth, and not being committed to taking contraceptives early enough after childbirth. Moreover, beliefs that modern contraceptives cause breast milk to dry up and perceived low fecundability after childbirth were indicated as attitude barriers. Health facility barriers were lack of reminders and follow-up mechanisms, sporadic service delivery and opening time, long waiting time, and card withdrawal process and providers' approach. Social stigma, child sex preference, and religious restrictions against contraceptive use were community barriers. Conclusion: Generally individual, facility-based, method-related, misconceptions, societal, and cultural barriers were identified as hindrances to the uptake of early postpartum modern contraceptive methods. There is a need for health-seeking behavioral interventions, innovative contraceptive methods, and facility-level interventions to overcome each identified barrier. [ABSTRACT FROM AUTHOR]

Background: Access and use of contraception services by adolescent girls and young women (AGYW) remains suboptimal, exposing AGYW to early and often unexpected pregnancy. Unexpected pregnancies are a public health concern, associated with poor neonatal and maternal health outcomes, as well as school dropout, which may result in economic hardships. This study aimed to explore (a) AGYW perceptions and experiences of receiving contraception services from health care providers and (b) health care providers' perceptions and experiences of providing contraception services to AGYW. Methods: Data were collected through semi-structured individual interviews with AGYW aged 15–24 years old and health care providers working in eight health care facilities around the Cape Town metropolitan area, in South Africa's Western Cape Province. Thematic analysis was used to analyse the data. Results: AGYW and health care providers voiced varying, and often contrasting, perceptions of some of the barriers that hinder AGYW's access to contraception services. AGYW indicated that provider-imposed rules about when to access contraceptive services hindered access, while health care providers felt that these rules were necessary for coordinating their work. In addition, AGYW highlighted health care providers' hostile attitudes towards them as an important factor discouraging access. On the contrary, health care providers did not think that their attitudes hampered AGYW's access to and use of contraception services, instead they emphasised that challenges at the health system level were a major issue, which they feel they have little control over. Such challenges made health care providers' work unpleasant and frustrating, impacting on their work approach and how they receive and offer services to AGYW. Conclusion: The expectation of negative attitudes from health care providers continues to be at the centre of AGYW discouragement towards accessing contraception services. System challenges are among some of the key drivers of health care provider's hostile attitudes, posing challenges to the efficient provision of services. In order to improve AGYW's access to and use of contraception services, and subsequently achieve the country's SDGs, conscious efforts need to be directed towards improving the workload and working conditions of health care providers. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Discussion Financial costs remain one of the greatest barriers to abortion, leading to delays in care and preventing some from getting a desired abortion. Medication abortion is available through in‐person facilities and telehealth services. However, whether telehealth offers a more affordable option has not been well‐documented.We used Advancing New Standards in Reproductive Health (ANSIRH)'s Abortion Facility Database, which includes data on all publicly advertising abortion facilities and is updated annually. We describe facility out‐of‐pocket prices for medication abortion in 2021, 2022, and 2023, comparing in‐person and telehealth provided by brick‐and‐mortar and virtual clinics, and by whether states allowed Medicaid coverage for abortion.The national median price for medication abortion remained consistent at $568 in 2021 and $563 in 2023. However, medications provided by virtual clinics were notably lower in price than in‐person care and this difference widened over time. The median cost of a medication abortion offered in‐person increased from $580 in 2021 to $600 by 2023, while the median price of a medication abortion offered by virtual clinics decreased from $239 in 2021 to $150 in 2023. Among virtual clinics, few (7%) accepted Medicaid. Median prices in states that accept Medicaid were generally higher than in states that did not.Medication abortion is offered at substantially lower prices by virtual clinics. However, not being able to use Medicaid or other insurance may make telehealth cost‐prohibitive for some people, even if prices are lower. Additionally, many states do not allow telehealth for abortion, deepening inequities in healthcare. [ABSTRACT FROM AUTHOR]

Aim Design Methods Results Conclusion Implications for the Profession and/or Patient Care Impact Reporting Method Patient or Public Contribution To describe key features of a co‐designed nurse‐led model of care intended to improve access to early medication abortion and long‐acting reversible contraception in rural Australian general practice.Co‐design methodology informed by the Experience‐Based Co‐Design Framework.Consumers, nurses, physicians and key women's health stakeholders participated in a co‐design workshop focused on the patient journey in seeking contraception or abortion care. Data generated at the workshop were analysed using Braun and Clarkes' six‐step process for thematic analysis.Fifty‐two participants took part in the co‐design workshop. Key recommendations regarding setting up the model included: raising awareness of the early medication abortion and contraceptive implant services, providing flexible booking options, ensuring appointment availability, providing training for reception staff and fostering good relationships with relevant local services. Recommendations for implementing the model were also identified, including the provision of accessible information, patient‐approved communication processes that ensure privacy and safety, establishing roles and responsibilities, supporting consumer autonomy and having clear pathways for referrals and complications.Our approach to experience‐based co‐design ensured that consumer experiences, values and priorities, together with practitioner insights, were central to the development of a nurse‐led model of care.The co‐designed nurse‐led model of care for contraception and medication abortion is one strategy to increase access to these essential reproductive health services, particularly in rural areas, while providing an opportunity for nurses to work to their full scope of practice.Nurse‐led care has gained global recognition as an effective strategy to promote equitable access to sexual and reproductive healthcare. Still, nurse‐led contraception and abortion have yet to be implemented andevaluated in Australian general practice. This study will inform the model of care to be implemented and evaluated as part of the ORIENT trial to be completed in 2025.Reported in line with the Standards for Reporting Qualitative Research (SRQR) checklist.Two consumer representatives contributed to the development of the co‐design methodology as members of the ORIENT Intervention Advisory Group Governance Committee. [ABSTRACT FROM AUTHOR]

This article discusses the ongoing issue of childhood lead poisoning in the United States. Despite efforts to reduce exposure to lead, an estimated 560,000 children under the age of 5 have blood lead levels higher than the recommended threshold for intervention. The symposium aims to address key issues related to lead exposure and develop effective policies to protect future generations. The first paper examines the effectiveness of secondary interventions, finding little evidence that they lower blood lead levels. The second paper focuses on improving lead testing and intervention programs using geospatial techniques. The final article explores the effects of lead exposure on fertility, infant mortality, and birth outcomes. The authors emphasize the need for further research and collaboration among various disciplines to address this public health issue. [Extracted from the article]

Objectives Methods Results Conclusions Philanthropic abortion funds are integral to accessing care in the United States, providing both financial and practical assistance. Yet relatively little is known about those who seek these essential services. In this study, we analyzed data from a Kentucky abortion fund to assess characteristics of abortion fund callers.We analyzed 2014–2021 administrative data from the Kentucky Health Justice Network's (KHJN) Abortion Support Fund and compared them to abortion data from the Kentucky Department for Public Health (KDPH). We analyzed age, race, and pregnancy gestation at calling (KHJN) and abortion (KDPH), and calculated Z‐scores and p‐values to compare proportions in each category between the two data sources.The fund supported 6162 people from 2014 to 2021, when 28,741 people had abortions in Kentucky. Compared with KDPH data, KHJN had a higher percentage of callers who were under age 30, a higher percentage of callers who were Black or another race, and a higher percentage of callers at 14 weeks' gestation or higher.Compared with state data, KHJN supported a higher percentage of young people, people of color, and people at later gestations. These findings support evidence that structurally vulnerable groups are more likely to face barriers to care and that abortion funds provide essential support necessary for reproductive equity. [ABSTRACT FROM AUTHOR]

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: Medical abortion with mifepristone and misoprostol can be provided up to 63 days' gestation in India. This accounts for 67.5 percent of all abortions in the country. We conducted an assessment to determine the availability of medical abortion medicines, specifically the combi-pack, in India. Methods: We applied the World Health Organization landscape assessment protocol at the national level. The assessment protocol included a five-step adaptation of an existing availability framework, including online data collection, desk review, country-level key informant interviews, and an analysis to identify barriers and opportunities to improve medical abortion availability. The assessment was conducted between August and March 2021. Results: Medicines for medical abortion are included in the national essential drug list and available with prescription in India. The assessment identified 42 combi-pack products developed by 35 manufacturers. The quality of medical abortion medicines is regulated by national authorities; but as health is devolved to states, there are significant inter-state variations. This is seen across financing, procurement, manufacturing, and monitoring mechanisms for quality assurance of medical abortion medicines prior to distribution. There is a need to strengthen supply chain systems, ensure consistent availability of trained providers and build community awareness on use of medical abortion medicines for early abortions, at the time of the assessment. Conclusion: Opportunities to improve availability and quality of medical abortion medicines exist. For example, uniform implementation of regulatory standards, greater emphasis on quality-assurance during manufacturing, and standardizing of procurement and supply chain systems across states. Regular in-service training of providers on medical abortion is required. Finally, innovations in evidence dissemination and community engagement about the recently amended abortion law are needed. Plain language summary: Medical abortion is popular in India and benefits from a liberal legal context. It is important to understand the availability of quality abortion medicines in the country. Using the World Health Organization country assessment protocol and availability framework for medical abortion medicines we examined the availability of these medicines from supply to demand. We used this information to identify opportunities for increasing availability of quality-assured medical abortion medicines. We found that the context for medical abortion varies across states. Strengthening procurement and supply chain management, with a greater emphasis on quality-assurance and regulation of manufacturing should be instituted at the state-level. Training is also needed to increase provider knowledge of the latest national guidelines and laws to ensure respectful and person-centered services. Finally, the public should be informed about medical abortion as a safe and effective choice, especially for early abortions. [ABSTRACT FROM AUTHOR]

The article focuses on historical injustices in medicine, particularly the perpetuation of sexist ideas over two centuries. Topics discussed include biases against women in medicine, reproductive biology's portrayal, and medical management of intersex conditions, aiming to critique past practices and inform future improvements in medical discourse and practice.

Key Points: Question: To what extent has the provision of medications for self-managed abortion outside the formal US health care setting increased in the 6 months following the Dobbs v Jackson Women's Health Organization decision? Findings: In this cross-sectional US-wide study, the total number of provisions of medications for self-managed abortion increased by an estimated 27 838 in the 6 months after Dobbs (July-December 2022) vs what would have been expected based on pre-Dobbs levels. Meaning: Provision of medications for self-managed abortion in the US increased in the 6 months after Dobbs. A substantial number of people accessed abortion medications despite implementation of state-level bans and restrictions. Clinicians should be prepared to meet the needs of patients who may be considering self-managed medication abortion or who need or want to connect with the formal health care setting for postabortion care. Importance: The Supreme Court decision in Dobbs v Jackson Women's Health Organization overturned the right to choose abortion in the US, with at least 16 states subsequently implementing abortion bans or 6-week gestational limits. Prior research indicates that in the 6 months following Dobbs, approximately 32 360 fewer abortions were provided within the US formal health care setting. However, trends in the provision of medications for self-managed abortion outside the formal health care setting have not been studied. Objective: To determine whether the provision of medications for self-managed abortion outside the formal health care setting increased in the 6 months after Dobbs. Design, Setting, and Participants: Cross-sectional study using data from sources that provided abortion medications outside the formal health care setting to people in the US between March 1 and December 31, 2022, including online telemedicine organizations, community networks, and online vendors. Using a hierarchical bayesian model, we imputed missing values from sources not providing data. We estimated the change in provision of medications for self-managed abortion after the Dobbs decision. We then estimated actual use of these medications by accounting for the possibility that not all provided medications are used by recipients. Exposure: Abortion restrictions following the Dobbs decision. Main Outcomes and Measures: Provision and use of medications for a self-managed abortion. Results: In the 6-month post-Dobbs period (July 1 to December 31, 2022), the total number of provisions of medications for self-managed abortion increased by 27 838 (95% credible interval [CrI], 26 374-29 175) vs what would have been expected based on pre-Dobbs levels. Excluding imputed data changes the results only slightly (27 145; 95% CrI, 25 747-28 246). Accounting for nonuse of medications, actual self-managed medication abortions increased by an estimated 26 055 (95% CrI, 24 739-27 245) vs what would have been expected had the Dobbs decision not occurred. Conclusions and Relevance: Provision of medications for self-managed abortions increased in the 6 months following the Dobbs decision. Results suggest that a substantial number of abortion seekers accessed services despite the implementation of state-level bans and restrictions. This study assesses whether the provision of medications for self-managed abortion outside the formal US health care setting increased during the 6 months after the Supreme Court decision in Dobbs v Jackson Women's Health Organization overturned the right to choose abortion in the US. [ABSTRACT FROM AUTHOR]

An Institutional Review Board-exempt REDCap survey was distributed through the Society of Academic Urologists to all 508 applicants registered for the 2023 Urology Match following the rank list submission deadline on January 10, 2023. The survey closed on February 1, 2023. Responses were anonymized, aggregated, and characterized using descriptive statistics. Thematic mapping of open text comments was performed by 2 reviewers. The response rate was 42% (215/508). Eighty-eight percent of respondents disapproved of the Dobbs ruling. Twenty percent of respondents (15% male/24% female) eliminated programs in states where abortion is illegal. Fifty-nine percent (51% male/70% female) would be concerned for their or their partner's health if they matched in a state where abortion was illegal, and 66% (55% male/82% female) would want their program to assist them or their partner if they required abortion care during residency. Due to the competitive nature of Urology, 68% of applicants reported feeling at least somewhat obligated to apply in states where abortion legislation conflicts with their beliefs. Of the 65 comments provided by respondents, 4 common themes emerged: (1) avoidance of states with restrictive abortion laws; (2) inability to limit applications because of the competitiveness of urology; (3) impacts on personal health care; and (4) desire for advocacy from professional urology organizations. The Dobbs ruling will impact the urology workforce by affecting urology applicants' decision-making regarding residency selection and ranking. Although the competitiveness of the Urology Match pressures applicants to apply broadly, many are taking reproductive health care access into consideration. [ABSTRACT FROM AUTHOR]

The article discusses the book "Unshrinking" by Kate Manne, which examines fatphobia and its intersection with misogyny and racism. Manne argues that fatphobia is a social system that unjustly ranks fatter bodies as inferior, leading to discrimination and prejudice in various aspects of life. The book also explores the impact of fatphobia on physical and mental health, as well as the historical origins of fatphobia in racism and slavery. The author suggests that psychoanalytic thinking should incorporate Manne's work to challenge the patriarchal gaze on women's bodies and address the prejudice and pathologizing of fatness. [Extracted from the article]

This study aimed to examine pregnancy and fetal outcomes following paternal exposure to glatiramer acetate (GA). Pregnancy reports of paternal GA-exposure at time of conception from 2001 to 2022 were extracted from Teva Global Pharmacovigilance database. Pregnancy reports obtained prior to (prospective) or after (retrospective) knowledge of the pregnancy outcome were included. The primary endpoint was major congenital malformation (MCM) in the offspring according to the US Metropolitan Atlanta Congenital Defects Program (MACDP) and European Surveillance of Congenital Anomalies and Twins (EUROCAT) classification. Other pregnancy and fetal outcomes, including spontaneous abortion, pregnancy termination, fetal death, preterm birth, and low birth weight, were assessed. A total of 466 paternal GA-exposed pregnancies were retrieved, 232 prospective cases and 234 retrospective cases. Of 349 (74.9%) pregnancies with known outcomes, 316 (90.5%) were live births, 28 (8.0%) were spontaneous abortions, 3 (0.9%) were elective pregnancy terminations, and 2 (0.6%) were stillbirths. In prospective live birth cases, there were 7/111 (6.3%) preterm births and 5/115 (4.3%) neonates with a low birth weight. The prevalence of total MCM among prospective cases was 1.7% (2 cases of 116 live births and fetal death/stillbirth), which is slightly lower than the background rates from MACDP (3%) and EUROCAT (2.1%). This study did not indicate an increase in the rate of adverse pregnancy and fetal outcomes after paternal exposure to GA. These results provide additional information regarding pregnancy outcomes following paternal exposure to GA for healthcare professionals, male patients and their female partners who are considering pregnancy while their male partner is using GA. This research aimed to look at how pregnancies and babies were affected when fathers with multiple sclerosis have been prescribed and taken the medication, glatiramer acetate (GA). Researchers looked at reports of pregnancies where the father had taken GA around the time of conception, from 2001 to 2022. They got this information from the Teva Global Pharmacovigilance database. They included reports where the pregnancy was known about either before (prospective) or after (retrospective) the outcome was known. They looked at outcomes like major birth defects, miscarriages, pregnancy terminations, fetal deaths, premature births, and low birth weight. The study found a total of 466 pregnancies where the father had taken GA. Of these pregnancies, the final outcome of pregnancy was found for 349 pregnancies. Most of these pregnancies (90.5%) resulted in live births, 8.0% ended in miscarriage, 0.9% in termination, and 0.6% in stillbirth. Among prospective live births, 6.3% were premature, and 4.3% had low birth weight. The amount of major birth defects was 1.7%, which was slightly lower than usual. The study did not suggest that exposure of the father to GA negatively affects the pregnancy or the baby. These findings can help healthcare providers, male patients taking GA, and their partners who are thinking about pregnancy while the male partner is taking GA. [ABSTRACT FROM AUTHOR]

Contraception is a significant part of comprehensive sexual and reproductive health (SRH) care for adolescents and young adults (AYA). While providers may assume that AYA with chronic illness are not sexually active, studies have shown that there are no differences in their sexual practices compared to their counterparts without an illness. This assumption may result in less SRH screening, preventative services, and counseling by providers resulting in decreased basic sexual knowledge, increased risk of unplanned pregnancy, and other health disparities. Sexually active AYA with medical complexity are particularly in need of contraception for a variety of reasons. A better understanding of the complexities around contraception counseling can help increase utilization rates, improve shared-decision making around family planning, and reduce the stigma around sexual health counseling in this population. We have included three sections. First, a general overview of contraception methods. Next, an overview of contraceptive methods currently available, their efficacy, and medical eligibility criteria for their use in AYA who have certain characteristics or medical conditions. Finally, cases adapted from real clinical scenarios to highlight specific recommendations for contraception in AYA women living HIV, autoimmune conditions, and those who have received a solid organ transplant. This information will help providers to consider the multiple factors that influence contraception decision-making (including clinical status, thrombosis risk, medication interactions, safety), and optimize care for AYA living with chronic illness. [ABSTRACT FROM AUTHOR]

This document is an editorial from the journal Andrology discussing the need for male contraception and the development of guidelines in this area. Despite the availability of contraceptive methods for women, the global unintended pregnancy rate remains high, with a significant number resulting in abortion. The editorial highlights the importance of male-directed contraceptive methods and the potential benefits of introducing new hormonal and non-hormonal options. The document also includes summaries of various papers in the journal's special issue, which cover topics such as the role of the World Health Organization in male contraceptive development, the potential efficacy of a combination gel, and the ethical considerations surrounding male contraception. The editorial emphasizes the importance of gender equity in family planning and the need for further research and development in this field. [Extracted from the article]

Introduction: Person-centeredness is a key principle in the German healthcare system. However, access to high-quality care for women with unintended pregnancy is limited due to social stigma and legal restrictions. There is little research on the adoption of person-centeredness in care for women with unintended pregnancy. The aim of this study was to analyze relevance and actual implementation of dimensions of person-centeredness in psycho-social and medical abortion care from the view of abortion care providers. Methods: Counselors and gynecologist working in psycho-social or medical abortion care participated in one of two digital workshops. Discussions were semi-structured based on the 16 dimensions of an integrative model of person-centeredness, audio-recorded and transcribed verbatim. During qualitative content analysis, deductive categories based on the integrative model of person-centeredness were applied and inductive categories were developed. Additionally, participants rated relevance and actual implementation of the dimensions in an online survey. Results: The 18 workshop participants most intensively discussed the dimensions "access to care", "person-centered characteristics of healthcare providers" and "personally tailored information". Four additional categories on a macro level ("stigmatization of women with unintended pregnancy", "stigmatization of healthcare providers", "political and legal aspects" and "corona pandemic") were identified. Most dimensions were rated as highly relevant but implementation status was described as rather low. Conclusions: In Germany, high quality person-centered care for women with unintended pregnancy is insufficiently implemented through limited access to information, a lack of abortion care providers, and stigmatization. There is a need for changes in health care structures to enable nationwide person-centered care for women with unintended pregnancy. Those changes include a more easy access to evidence-based information and person-centered abortion care, more education on abortion care for healthcare providers, integration of topics of abortion care in medical schools and promotion of de-stigmatizing actions to enable abortions as part of the general healthcare. [ABSTRACT FROM AUTHOR]

The article focuses on the concept of Post-Abortion Syndrome (PAS), likening it to Post-Traumatic Stress Disorder (PTSD), and discusses its contentious diagnostic status. Topics include the psychological and spiritual impacts of moral injury, Reagan administration's efforts to study and potentially validate PAS through a Surgeon General's report, and the implications for abortion policy and women's health rights during that era.

Introduction: Women, and mainly pregnant ones, have been always highly vulnerable to domestic violence/intimate partner violence (DV/IPV) throughout their lives. Covid-19 pandemic brought new unprecedented living conditions that raised the rates of DV during pregnancy. Investigating the association between Covid-19 and DV in pregnant women may help government and community groups seeking to reduce DV/IPV in vulnerable populations in order to better understand the prevalence of this phenomenon and its associated factors and thus find ways to ensure control and stop domestic violence, as the society and health care systems are still disorganized in the way they deal with the DV against pregnant women. Aim: The aim of this study is to investigate the state of DV in pregnant women during the Covid-19 pandemic and to present the incidence rates of domestic violence as well as the possible consequences that can occur for both women and newborns, while also highlighting risk factors connected to Covid-19 that increase DV and attempting to see if there is a way to prevent and address DV through a systematic review of the available literature. Methods: We searched Google Scholar, Medline and PubMed for relevant articles published between 2019--2023. Out of the total number of 772 returned articles, only 25 were included in the present review after excluding all those which failed to meet one of the critical criteria. Results: We identified four themes linked to DV during pregnancy in the pandemic era, including the incidence of negative consequences for mother and fetus, Covid-19-associated factors, interventions and solutions. Also, prevalence of DV was found to be higher than before the pandemic. DV/IPV was linked to Covid-19 factors such as lockdown and quarantine, causing spouses to spend more time together, economic strains from loss of incomes and reduced incomes, unintended pregnancies and limited access to healthcare services for antenatal and prenatal clinics and support. The adverse effects of DV/IPV on pregnant women and the fetus include miscarriages, still births, abortions, early fetal loss, maternal anxiety and depression as well as poor development of the child after birth, among others. Critical interventions to manage DV/IPV during the pandemic include, to name just a few, better screening systems during the pandemic, public awareness, maintenance of support and healthcare systems and connections. Conclusions: Covid-19 created circumstances and measures that increased the risk and incidence of DV/IPV in pregnant women, which led to a higher prevalence of the phenomenon. Sustainable systems can help reduce DV/IPV against women and, in particular women at-risk, such as pregnant ones. Therefore, some interventions, including screening mechanisms and public awareness, healthcare support and interconnections, need to be maintained and strengthened during times of crisis, such as the pandemic, to curb mitigate DV/IPV. [ABSTRACT FROM AUTHOR]

Relative to neighboring countries, Zambia has among the most progressive abortion policies, but numerous sociopolitical constraints inhibit knowledge of pregnancy termination rights and access to safe abortion services. Multistage cluster sampling was used to randomly select 1,486 women aged 15–44 years from households in three provinces. We used latent class analysis (LCA) to partition women into discrete groups based on patterns of endorsed support for legalized abortion on six socioeconomic and health conditions. Predictors of probabilistic membership in latent profiles of support for legal abortion services were identified through mixture modeling. A three‐class solution of support patterns for legal abortion services emerged from LCA: (1) legal abortion opponents (∼58 percent) opposed legal abortion across scenarios; (2) legal abortion advocates (∼23 percent) universally endorsed legal protections for abortion care; and (3) conditional supporters of legal abortion (∼19 percent) only supported legal abortion in circumstances where the pregnancy threatened the fetus or mother. Advocates and Conditional supporters reported higher exposure to family planning messages compared to opponents. Relative to opponents, advocates were more educated, and Conditional supporters were wealthier. Findings reveal that attitudes towards abortion in Zambia are not monolithic, but women with access to financial/social assets exhibited more receptive attitudes towards legal abortion. [ABSTRACT FROM AUTHOR]

A rising percentage of patients are electing medication abortion over procedural abortion for increased safety and privacy. Access to medication abortion is essential healthcare, but many Americans face unsurmountable barriers when pursuing this option. This has been in large part due to unnecessary restrictions imposed by the United States Food and Drug Administration (FDA) Risk Evaluation and Mitigation Strategy (REMS) for mifepristone, used in combination with misoprostol for medication abortion. Moreover, many states have imposed additional restrictions on abortion, further impeding access to care. Since its original approval in 2000, mifepristone can only be prescribed by certified prescribers. Until recently, mifepristone could only be dispensed by certified prescribers, whereby more accessible community and mail‐order pharmacies were prohibited from dispensing mifepristone. During the Coronavirus disease 2019 public health emergency, there was a temporary allowance for certified prescribers to utilize mail or mail‐order pharmacies to deliver medications to patients. In January 2023, the FDA approved modifications to the mifepristone REMS to allow certified pharmacies to dispense the medication. Given the established safety and effectiveness of mifepristone, the evidence supports its distribution via pharmacies and leveraging pharmacists to expand medication abortion access. Pharmacists are one of the most widely accessible healthcare providers and their responsibility centers on patient and medication safety and improving health outcomes. This article, an opinion of the American College of Clinical Pharmacy Women's Health Practice and Research Network, adds the voice of members of the pharmacy profession to the collective efforts to ensure access to medication abortion, including pharmacist dispensing of mifepristone. We encourage pharmacists to embrace this fresh opportunity to provide medication abortion care in their communities. [ABSTRACT FROM AUTHOR]

Background: Unintended pregnancies can pose significant public health concerns for both maternal and child health because of their associated risks and implications. Experience of unintended pregnancies may lead to delay in seeking antenatal care, thus leading to increased risk of complications during pregnancy and childbirth. Globally, the prevalence of unintended pregnancies has declined. However, the problem remains acute in sub-Saharan Africa. This study was conducted to examine the factors associated with an experience of unintended pregnancy among women of reproductive ages in Zambia. Methods: This study used secondary data from the Zambia Demographic and Health Surveys (ZDHSs) which were conducted between 2001 and 2018. A pooled weighted sample of 4,090 pregnant women of reproductive age 15–49 years at the time of the survey was included in the analysis. Multivariable binary logistic regression model was employed to examine the association between independent correlates and experience of unintended pregnancy. All statistical analyses were conducted using Stata software. Results: Findings show that the proportion of women of reproductive age who experienced unintended pregnancy in Zambia declined from 50.4% (95% CI: 47.1, 53.8) in 2001 to 45.2% (95% CI: 40.5, 49.9) in 2018. The decline in the prevalence of unintended pregnancy is more pronounced among women age groups 25–29 years and 30–34 years. Increasing age was associated with an increased risk of experiencing unintended pregnancies. On the other hand, women who were living in rural areas (aOR = 0.76; 95% CI: 0.58, 1.00) and those with tertiary education (aOR = 0.46; 95% CI: 0.26, 0.80) were less likely to experience an unintended pregnancy. Women who desired a large family (aOR = 0.45; 95% CI: 0.24, 0.85) and those who watched television (aOR = 0.75; 95% CI: 0.59, 0.94) had lower odds of experiencing unintended pregnancies. Conclusions: The study has established that the prevalence of unintended pregnancy is still high in Zambia. Women's age, place of residence, level of education, desired family size and exposure to media were associated with the risk of experiencing an unintended pregnancy. Enhancing access to family planning services and commodities targeting women with low education levels will be key to further reduce unintended pregnancies. [ABSTRACT FROM AUTHOR]

Background: Cesarean delivery rates have increased globally resulting in a public health concern. We estimate rates of cesarean deliveries among Thai women using the World Health Organization (WHO) Robson Classification system and compare rates by Robson group to the Robson guideline for acceptable rates to identify groups that might benefit most from interventions for rate reduction. Methods: In 2017 and 2018, we established cohorts of pregnant women aged ≥ 18 years seeking prenatal care at two tertiary Thai hospitals and followed them until 6–8 weeks postpartum. Three in-person interviews (enrollment, end of pregnancy, and postpartum) were conducted using structured questionnaires to obtain demographic characteristics, health history, and delivery information. Cesarean delivery indication was classified based on core obstetric variables (parity, previous cesarean delivery, number of fetuses, fetal presentation, gestational week, and onset of labor) assigned to 10 groups according to the Robson Classification. Logistic regression was used to identify factors associated with cesarean delivery among nulliparous women with singleton, cephalic, term pregnancies. Results: Of 2,137 participants, 970 (45%) had cesarean deliveries. The median maternal age at delivery was 29 years (interquartile range, 25–35); 271 (13%) participants had existing medical conditions; and 446 (21%) had pregnancy complications. The cesarean delivery rate varied by Robson group. Multiparous women with > 1 previous uterine scar, with a single cephalic pregnancy, ≥ 37 weeks gestation (group 5) contributed the most (14%) to the overall cesarean rate, whereas those with a single pregnancy with a transverse or oblique lie, including women with previous uterine scars (group 9) contributed the least (< 1%). Factors independently associated with cesarean delivery included age ≥ 25 years, pre-pregnancy obesity, new/worsen medical condition during pregnancy, fetal distress, abnormal labor, infant size for gestational age ≥ 50th percentiles, and self-pay for delivery fees. Women with existing blood conditions were less likely to have cesarean delivery. Conclusions: Almost one in two pregnancies among women in our cohorts resulted in cesarean deliveries. Compared to WHO guidelines, cesarean delivery rates were elevated in selected Robson groups indicating that tailored interventions to minimize non-clinically indicated cesarean delivery for specific groups of pregnancies may be warranted. [ABSTRACT FROM AUTHOR]

Objectives: To assess changes in the monthly numbers of hospital‐based abortions and outpatient early medical abortions in Victoria during January 2012 – March 2022, with a particular interest in the impact of the coronavirus disease 2019 (COVID‐19) pandemic. Study design: Population‐based retrospective cohort study; time series analysis of Victorian Admitted Episodes Dataset (VAED) and Pharmaceutical Benefits Scheme (PBS) data. Setting, participants: All admitted care episodes in Victoria during 1 January 2012 – 31 March 2022 with medical abortion as the principal diagnosis; all PBS claims for mifepristone–misoprostol (MS‐2 Step) during 1 January 2015 (date of listing) – 31 March 2022. Main outcome measures: Changes in monthly numbers (with 95% confidence intervals [CIs]) of admissions for hospital‐based and outpatient early medical abortions during the pre‐pandemic period (January 2012 – March 2020), the first full month of the COVID‐19 pandemic (April 2020), and the pandemic period (May 2020 – March 2022). Results: The monthly number of hospital‐based abortions declined in Victoria during the pre‐pandemic period (slope, –2.92 [95% CI, –3.45 to –2.38] per month); the rate of decline was greater during the pandemic period (slope, –5.74 [95% CI, –10.5 to –0.96] per month). The monthly number of outpatient early medical abortions increased during the pre‐pandemic period (slope, 5.94 [95% CI, 5.34–6.34] per month); it declined during the first month of the pandemic (slope, –26.4 [95% CI, –70.1 to –17.3] per month), but did not significantly change thereafter. The total monthly number of abortions during the pandemic period did not deviate markedly from the pre‐pandemic median value. The pre‐pandemic declines in monthly numbers of abortions in major city hospitals, in private hospitals, or at earlier than 14 weeks' gestation intensified during the pandemic period. During January 2015 – March 2020, 14 634 of 103 496 abortions were outpatient medical abortions (14%); during the pandemic period, 11 154 of 33 056 abortions were outpatient medical abortions (33%). Conclusions: The use of outpatient early medical abortion has steadily increased in Victoria since the PBS listing of mifepristone–misoprostol, which helped ensure access to abortion during the COVID‐19 pandemic. Outpatient medical abortions may eventually outnumber surgical early abortions in Victoria, but they are not always appropriate: hospitals will continue to be essential for comprehensive abortion care. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence of a history of induced abortion among women who gave birth in Victoria during 2010–2019; to assess the association of socio‐demographic factors with a history of induced abortion. Study design: Retrospective cohort study; analysis of cross‐sectional perinatal data in the Victorian Perinatal Data Collection (VPDC). Setting, participants: All women who gave birth (live or stillborn) in Victoria, 1 January 2010 – 31 December 2019. Main outcome measures: Self‐reported induced abortions prior to the index birth; outcome of the most recent pregnancy preceding the index pregnancy. Results: Of the 766 488 women who gave birth during 2010–2019, 93 251 reported induced abortions (12.2%), including 36 938 of 338 547 nulliparous women (10.9%). Women living in inner regional (adjusted odds ratio [aOR], 0.94; 95% confidence interval [CI], 0.93–0.96) or outer regional/remote/very remote areas (aOR, 0.86; 95% CI, 0.83–0.89) were less likely than women in major cities to report induced abortions. The likelihood increased steadily with age at the index birth and with parity, and was also higher for women without partners at the index birth (aOR, 2.20; 95% CI, 2.16–2.25) and Aboriginal and Torres Strait Islander women (aOR, 1.32; 95% CI, 1.25–1.40). The likelihood was lower for women born in most areas outside Australia than for those born in Australia. The likelihood of a history of induced abortion declined across the study period overall (2019 v 2010: 0.93; 95% CI, 0.90–0.96) and for women in major cities (0.88; 95% CI, 0.84–0.91); rises in inner regional and outer regional/remote/very remote areas were not statistically significant. Conclusions: Access to abortion care in Victoria improved during 2010–2019, but the complex interplay between contraceptive use, unintended pregnancy, and induced abortion requires further exploration by remoteness of residence. Robust information about numbers of unintended pregnancies and access to reproductive health services are needed to guide national sexual and reproductive health policy and practice. [ABSTRACT FROM AUTHOR]

The article focuses on the potential impact of the Alliance for Hippocratic Medicine (AHM) v. FDA lawsuit, where antiabortion physicians challenge the FDA's approval and regulation of mifepristone, aiming to restrict access to medication abortion. It mentions the AHM plaintiffs, invoking their professional privilege, are attempting to influence abortion access by leveraging their medical credentials in ways that the author argues go against the principles of medical practice.

Background: While most countries that allow abortion on women's request also grant physicians a right to conscientious objection (CO), this has proven to constitute a potential barrier to abortion access. Conscientious objection is regarded as an understudied phenomenon the effects of which have not yet been examined in Germany. Based on expert interviews, this study aims to exemplarily reconstruct the processes of abortion in a mid-sized city in Germany, and to identify potential effects of conscientious objection. Methods: Five semi-structured interviews with experts from all instances involved have been conducted in April 2020. The experts gave an insight into the medical care structures with regard to abortion procedures, the application and manifestations of conscientious objection in medical practice, and its impact on the care of pregnant women. A content analysis of the transcribed interviews was performed. Results: Both the procedural processes and the effects of conscientious objection are reported to differ significantly between early abortions performed before the 12th week of pregnancy and late abortions performed at the second and third trimester. Conscientious objection shows structural consequences as it is experienced to further reduce the number of possible providers, especially for early abortions. On the individual level of the doctor-patient relationship, the experts confirmed the neutrality and patient-orientation of the vast majority of doctors. Still, it is especially late abortions that seem to be vulnerable to barriers imposed by conscientious objection in individual medical encounters. Conclusion: Our findings indicate that conscientious objection possibly imposes barriers to both early and late abortion provision and especially in the last procedural steps, which from an ethical point of view is especially problematic. To oblige hospitals to partake in abortion provision in Germany has the potential to prevent negative impacts of conscientious objection on women's rights on an individual as well as on a structural level. [ABSTRACT FROM AUTHOR]

Botswana has a policy of contraception for all that is delivered through a rights‐based family planning program. The program combines a "rights‐based family planning approach" with "supportive policies for contraception," and "a commitment to promote equitable access to modern contraception, and expand availability, method mix and uptake of modern contraceptive methods for all women and girls." However, abortion is legally restricted up to 16 weeks of pregnancy provided that provisions of Section 160–162 of the Botswana Penal Code Amendment Act 1991 are met, and that the termination of pregnancy is carried out by a registered medical practitioner in a health facility approved for the purpose. In 2020, the Ministry of Health and Wellness, Botswana, in collaboration with United Nations Population Fund and World Health Organization, conducted a strategic assessment of unintended pregnancies, contraception, unsafe abortion, and abortion services in Botswana. A consensus operational plan to address these issues was developed during a national stakeholder meeting in Gaborone, Botswana. The consensus reached was to avert unintended pregnancies, improve access to modern contraception, and open nationwide discussions around abortion in the community to enable positive change and decrease maternal morbidity and mortality from unsafe abortion. This article describes the findings of the assessment and outlines the foundation for new or modified services or practices to be developed and pilot tested. Synopsis: A strategic assessment led to consensus on priority interventions to address unintended pregnancies, reduce unmet need for contraception, and accelerate reduction of maternal mortality. [ABSTRACT FROM AUTHOR]

Abortion laws are key in creating an enabling environment that facilitates the advancement of people's sexual and reproductive health and rights. Around 50 countries have liberalized their abortion laws in the last decades by adding new grounds allowing abortion. The road toward the expansion of legal abortion is a long, highly sensitive, and difficult process. The specific role of healthcare providers in influencing abortion law reforms has been scarcely studied. With the objective to better understand their (potential) roles, a qualitative study was conducted in 2021 focusing on three countries that had recently liberalized their abortion regulations: Argentina, South Korea, and Ireland. For each country, key informant interviews were conducted with actors in advocacy for legal change, the majority with healthcare providers. The study results indicate that healthcare providers can contribute to the expansion of legal abortion through their influence on public and legal debates. Healthcare providers were found to be scientifically credible and trustworthy. Their voice and argumentation counteracted anti‐rights arguments and addressed information gaps, by providing specific clinical experiences and medical information. Healthcare providers amplified women's experiences through their testimonies and had entry points within governmental bodies, which facilitated their advocacy. These healthcare providers often functioned as individual operating obstetrician/gynecologists or general practitioners who were engaged in networks of health professionals or had previous advocacy experience. In a global context of social and political contention around abortion, extending the engagement of healthcare providers in law and policy deliberation on abortion appears to be useful. This requires recognizing the diversity of roles that healthcare providers can take up, creating a safe environment in which they can operate, equipping them with skills that go beyond the medical expert role and facilitating strategic partnerships that seek complementarity between multiple stakeholders, building on the uniqueness of each stakeholder's expertise. Synopsis: The study shows how, in various countries across the world, healthcare providers have played contributing roles in the expansion of legal abortion. [ABSTRACT FROM AUTHOR]

In Nepal's constitution, safe abortion care is recognized as an essential component of a comprehensive approach to fulfill individuals' sexual and reproductive health and rights. In the current context of transition to a three‐level governance (federal, provincial, and local), there are opportunities to accelerate decentralization and devolution of decision‐making power, increase access to and coverage of safe abortion services, and improve health outcomes. This article documents the processes and results of the policy change undertaken by the Ministry of Health and Population in collaboration with development partners to decentralize the approval process of safe abortion sites and providers with the objective to increase access to and coverage of safe abortion services. With the decentralization of certification, the approval process for safe abortion service sites and providers has become simpler, less time consuming, and less expensive by reducing cost of traveling to Kathmandu or approaching authorities at the federal level. This has resulted in expanding safe abortion services across the country including remote areas with marginalized populations. Evidence‐based advocacy enabled policy change for decentralization of the approval process. Collaboration among stakeholders has been vital for implementing the policy change, including issuing directives from the federal to provincial levels and capacity strengthening of provincial level officials in understanding the requirements for approval of sites and providers. Synopsis: Concerted efforts by stakeholders resulted in the desired policy change of decentralizing approval of abortion sites and providers and paved the way for expansion of safe abortion services in federal Nepal. [ABSTRACT FROM AUTHOR]

Introduction: Women undergoing an induced abortion are highly fertile and at risk of subsequent unplanned pregnancy. We recently completed a randomized clinical trial showing that routine provision of intrauterine device (IUD) at the time of abortion significantly reduced the risk of subsequent abortion during a 5‐year follow up. As the use of highly effective contraception may affect all subsequent pregnancies, we analyzed the rate and distribution of all subsequent pregnancies (deliveries, miscarriages, and abortions), and the risk factors for these various pregnancy outcomes in the above‐mentioned randomized clinical trial. Material and methods: We enrolled adult women requesting first‐trimester induced abortion and candidates for IUD for post‐abortion contraception. Women (n = 751) were randomized to receive an IUD (either levonorgestrel‐releasing IUD or copper IUD) by the clinic responsible for abortion care vs. routine care of IUD provision in primary health care with oral contraceptives for interval contraception. In the present secondary analysis, we identified all deliveries, miscarriages, and abortions in the intervention (n = 375) and control (n = 373) cohorts during the 5‐year follow up using the Finnish national registries. The trial is registered at Clinical Trials (NTC01223521). Results: The overall delivery, miscarriage, and abortion rates were 42.0, 12.0 and 32.1/1000 years of follow up (yFU). Any new pregnancy occurred in 98 women in the intervention and in 129 women in the control cohort (hazard ratio 0.73, 95% confidence interval 0.56–0.95, p = 0.023). The effect of routine IUD provision in reducing pregnancies was limited to the first 2 yFU. The number of subsequent induced abortions and of women undergoing it were significantly reduced, and time to abortion was prolonged by the intervention. However, the overall number, the number of women with subsequent delivery or miscarriage, and the times to these events were not significantly affected. History of previous pregnancy (delivery or abortion) and smoking were risk factors for subsequent induced abortion, but not for delivery or miscarriage. Conclusions: Routine provision of IUD as part of abortion care did not reduce the rates of delivery or miscarriage during the 5‐year follow up. The rates of all pregnancies and the need of subsequent induced abortion were reduced by IUD provision during the first 2 yFU. [ABSTRACT FROM AUTHOR]

Background: Women living with HIV are a minority population with unique care needs. Rates of unintended pregnancy are higher among women living with HIV versus HIV negative women. However, uptake of contraception among women living with HIV including long-acting-reversible contraceptives (LARCs) remains low. This quality improvement project aimed to identify gaps in reproductive healthcare for women living with HIV attending Melbourne Sexual Health Centre (MSHC). Methods: We performed a retrospective review of women living with HIV attending MSHC for HIV care February 2019–February 2020. Women aged over 45 years were excluded. Primary outcomes included proportion using contraception, methods used and whether a sexual or reproductive health history had been taken in the past year. Results: A total of 100 women were included, predominantly born overseas (Asia, 38%; sub-Saharan Africa, 34%). Of these, 5% were pregnant, 16% were trying to conceive and 1% were undergoing elective oocyte preservation. Of the remaining 74 women, 48.6% were using any form of contraception, including 17.6% women using less-effective methods (withdrawal and condoms), 6.8% using the combined oral contraceptive pill, 18.9% using LARCs and 5.4% using permanent methods. Sexual activity status was documented for 61% women, 1% declined to answer and not documented for 38% women. Conclusions: Rate of contraceptive use in this study was lower than previously reported among women living with HIV in Australia; however, our findings suggest contraceptive methods may be changing in light of undetectable equals untransmittable and increased fertility desires. Discussions regarding sexual activity and reproductive health were limited. Mechanisms to increase clinician–patient discourse regarding these important issues should be explored. Women living with HIV are a minority in Australia. They present unique healthcare challenges, particularly relating to sexual and reproductive health. Evidence shows higher rates of unplanned pregnancy and lower rates of long-acting-reversible contraception use among women living with HIV. We highlight gaps in care at an Australian metropolitan centre and suggest contraceptive options used by women living with HIV may be changing in the era of modern HIV treatment. We suggest changes in care provision to meet demand, including use of 'women-centred' models of care. [ABSTRACT FROM AUTHOR]

Background and Aims: Despite the decriminalization of abortion in Nepal in 2002, unsafe abortion is still a significant contributor to maternal morbidity and mortality. Nepal has witnessed a significant drop in abortion‐related severe complications and maternal deaths owing to the legalization of abortion laws, lowered financial costs, and wider accessibility of safe abortion services (SAS). However, various factors such as sociocultural beliefs, financial constraints, geographical difficulties, and stigma act as barriers to the liberal accessibility of SAS. This review aimed to determine key barriers obstructing women's access to lawful, safe abortion care and identify facilitators that have improved access to and quality of abortion services. Methods: A systematic search strategy utilizing the databases PubMed, CINAHL, Scopus, and Embase was used to include studies on the accessibility and safety of abortion services in Nepal. Data were extracted from included studies through close reading. Barriers and facilitators were then categorized into various themes and analyzed. Results: Of 223 studies, 112 were duplicates, 73 did not meet the inclusion criteria, and 18 did not align with the research question; thus, 20 studies were included in the review. Various barriers to SAS in Nepal were categorized as economic, geographic, societal, legal/policy, socio‐cultural, health systems, and other factors. Facilitators improving access were categorized as economic/geographic/societal, legal/policy, socio‐cultural, and health systems factors. The patterns and trends of barriers and facilitators were analyzed, grouping them under legal/policy, socio‐cultural, geographic/accessibility, and health systems factors. Conclusion: The review identifies financial constraints, unfavorable geography, lack of infrastructure, and social stigmatization as major barriers to SAS. Economics and geography, legalization, improved access, reduced cost and active involvement of auxiliary nurse‐midwives and community health volunteers are key facilitators. Key points: The legalization of abortion in Nepal has not ensured universal access to safe services.Stigma, lack of awareness, and negative attitude of providers hamper access.Rural, low‐income women face additional obstacles such as distance, cost and lack of confidentiality. [ABSTRACT FROM AUTHOR]

Background: Unsafe abortion is a major medical and public health problem in Ethiopia and contributes significantly to abortion-related morbidity and mortality in the country. We explored women's experiences with modern contraceptives and identified barriers to accessing safe abortion care and other sexual and reproductive health services. Methods: We recruited participants from six health clinics and a public hospital in southern Ethiopia. We conducted one-on-one interviews with 34 women aged 18–49 years who sought abortion care within the past twelve months of the study. Interviews were recorded, transcribed verbatim, translated to English, and imported into Dedoose software. We analysed the data using a directed content analysis. Results: Our findings show prevailing belief among participants that contraceptives caused infertility, abnormalities in subsequent pregnancies, and other side effects. Some of the women suggested that medical or unsafe abortions were a better alternative to using modern contraceptives for terminating unplanned pregnancies. Barriers to accessing safe abortion care included costs of services, lack of privacy, and fear of judgment from providers. Women who had negative experiences with providers were more likely to seek unsafe abortion the second time around. Conclusion: Providers need to address women's concerns about using modern contraceptives, educate their clients about the best ways to prevent unwanted pregnancies, and provide non-judgemental services. In addition, comprehensive counselling services that include contraceptive counselling should be made available to women before, during, and after abortion care. Finally, providers should strive to be facilitators of, not barriers to, safe abortion care. [ABSTRACT FROM AUTHOR]

Background: Little is known about postabortion care (PAC) services in Burkina Faso, despite PAC's importance as an essential and life-saving component of emergency obstetric care. This study aims to evaluate PAC service availability, readiness, and accessibility in Burkina Faso. Methods: Data for this study come from the Performance Monitoring for Action (PMA) Burkina Faso project and the Harmonized Health Facility Assessment (HHFA) conducted by the Institut de Recherche en Sciences de la Santé and the Ministry of Health. PMA data from a representative sample of women aged 15–49 (n = 6,385) were linked via GPS coordinates to HHFA facility data (n = 2,757), which included all public and private health facilities in Burkina Faso. We assessed readiness to provide basic and comprehensive PAC using the signal functions framework. We then calculated distance to facilities and examined percent within 5 kms of a facility with any PAC, basic PAC, and comprehensive PAC overall and by women's background characteristics. Results: PAC services were available in 46.4% of health facilities nationwide; only 38.3% and 35.0% of eligible facilities had all basic and comprehensive PAC signal functions, respectively. Removal of retained products of conception was the most common missing signal function for both basic and comprehensive PAC, followed by provision of any contraception (basic) or any LARC (comprehensive). Nearly 85% of women lived within 5 km of a facility providing any PAC services, while 50.5% and 17.4% lived within 5 km of a facility providing all basic PAC and all comprehensive PAC signal functions, respectively. Women with more education, greater wealth, and those living in urban areas had greater odds of living within 5 km of a facility with offering PAC, basic PAC, or comprehensive PAC. Conclusions: Results indicate a need for increased PAC availability and readiness, prioritizing basic PAC services at the primary level—the main source of care for many women—which would reduce structural disparities in access. The current deficiencies in PAC signal a need for broader strengthening of the primary healthcare services in Burkina Faso to reduce the burden of unsafe abortion-related morbidity and mortality while improving maternal health outcomes more broadly. [ABSTRACT FROM AUTHOR]

Background: Pregnancy is the second most common cause of limited duty days among active duty service members in the U.S. Military. Pregnancy accounts for 10% of all days on restricted duty, despite impacting a minority of active duty service members. One out of five service women will experience an unintended pregnancy every year despite the availability of no-cost contraception and reproductive healthcare. Young, single, junior enlisted service women experience the highest rate of unintentional pregnancy. Previous studies have demonstrated service branch-based variability in selection, initiation, and continuation of specific contraceptive methods related to service branch culture and access to contraception during basic training. It is unclear if these differences impact overall contraception use or fertility rates among junior enlisted service women in their first term of enlistment. This study examines rates of contraceptive selection, initiation, continuation, and efficacy among junior enlisted service women in their first 4-year enlistment period, and the service branch specific variability in these outcomes. Methods: This study is a secondary analysis of Military Healthcare Data Repository records from women who began basic training between 2012 and 2020 and remained on active duty for at least 12 months. We used Kaplan–Meier analyses to examine the effect of age and military branch on contraceptive continuation and efficacy. We used binomial regression for interval censored data, to assess the association of service branch with rates of contraceptive initiation, contraception use, births, and childbirth-related duty restrictions. Results: We identified 147,594 women who began basic training between 2012 and 2020. The mean age of these women at the beginning of basic training was 20.4 ± 3.1 years. Women in the marines and navy had higher contraceptive initiation rates than women in the army or air force. Among women initiating a contraceptive pill, patch, or ring (short-acting reversible contraception), 58.3% were still using some form of hormonal contraception 3 months later. Among women initiating depot-medroxyprogesterone (DMPA), 38.8% were still using any form of hormonal contraception 14 weeks later. Long-acting reversible contraceptive methods, such as intrauterine or subdermal contraceptives, had higher continuation rates and less service-based variability in continuation and failure rates than short-acting reversible contraception or depot-medroxyprogesterone. The proportion of days on any form of prescription contraception during the first 4 years on active duty varied from 23.3% in the army to 38.6% in the navy. The birth rate varied from 34.8 births/1,000 woman-years in the air force up to 62.7 births/1,000 woman-years in the army. Compared with women in the air force, women in the army experienced 2,191 additional days of postpartum leave and 13,908 days on deployment restrictions per 1,000 woman-years. Discussion: Service branch specific variability in contraceptive use is associated with differences in days of pregnancy-related duty restrictions during first 4 years on active duty among junior enlisted females. Robust implementation of best practices in contraceptive care across the military health system to improve contraceptive initiation and continuation appears to offer an opportunity to improve military readiness and promote the health and well-being of active duty service women, particularly in the army. [ABSTRACT FROM AUTHOR]

Objective: The COVID-19 pandemic Increased the risk of impairing the mother-infant bonding. The objectives of this study were to evaluate the early bond established between mother and infant and postpartum depression (PPD) in pregnancies that occurred during the pandemic period, to identify the factors that may have influenced these outcomes and to verify if there was an association between bonding and probable PPD. Methods: This is a cross-sectional study of postpartum women from a public maternity hospital in the city of São Paulo conducted from February to June 2021, involving 127 mother-baby dyads. The initial data were collected in the immediate postpartum period and between 21–45 days after birth, using a semi-structured questionnaire on sociodemographic characteristics, gestational and birth conditions, and baby characteristics; the Edinburgh Postnatal Depression Scale (EPDS) and Postpartum Bonding Questionnaire (PBQ) were used to evaluate PPD and bonding, respectively. Results: The presence of probable PPD and unplanned pregnancies were associated with higher PBQ score and risk to impaired bonding (p = 0.001 and p = 0.004, respectively). EPDS showed a high prevalence of PPD (29.1%) and was not associated with any Studied variable. Probably, this high prevalence of probable PPD was due to the context of insecurity secondary to the pandemic. Conclusions: We observed an increase in the prevalence of probable PPD and unplanned pregnancies during the first 18 months of the pandemic, which were associated with worse scores in mother-infant bonding. The impaired bond can affect the future development of children born during this period. [ABSTRACT FROM AUTHOR]

State laws that require minors seeking abortion care to notify or obtain consent from a parent or other legal guardian are broadly referred to as parental involvement laws. Judicial bypass allows a minor to petition the court to bypass parental involvement. Even before the Dobbs v Jackson Women's Health Organization decision overturned Roe v Wade on 24 June 2022, 36 states had at least one parental involvement law, making minor access to abortion care even more complex than adult access. Since the Dobbs decision, at least 15 states have completely banned abortion, adding further complexity, geographic barriers, and inequities to the pursuit of reproductive healthcare. In this narrative review and commentary, we explain parental involvement laws and judicial bypass from both a legal and medical perspective, exploring the evolving challenges created by this system in the year post- Dobbs. [ABSTRACT FROM AUTHOR]

Since 2003, the number of facilities reporting abortions to the Federal Statistical Office has decreased by 46% from 2050 to 1092 in 2021. In the last 5 years, the decrease slowed down. The media report that there is a shortage of physicians willing to perform abortions in some regions of Germany. Reduced availability and accessibility of providers are barriers to access that can negatively impact the health and well-being of abortion seekers. To date, there is no scientific evidence on regional differences in access to abortion in Germany. The article answers the following questions: What data are available in Germany regarding the availability and accessibility of abortion providers? How informative is this data? To what extent do the data show regional differences in availability and accessibility? We conclude that the available data are not sufficient to adequately describe regional variations in the provision of abortion care services. Nevertheless, they give clear indications of differences regarding provider density, provider workload and spatial accessibility, especially between the northern and eastern states on the one hand and the southern and western states on the other. We describe needs and policy recommendations for adequate data collection. [ABSTRACT FROM AUTHOR]

Oral contraceptives are among the most commonly used contraceptive methods. However, Italian women underused reliable hormonal contraceptives as compared with other European women. There is a need to streamline access to oral contraception, with expected benefits on emotional well-being of women and potential savings for health system in Italy. Indeed, women can only access to oral contraceptives through mandatory medical prescription. This is one of the most important barrier experienced by women. We hereby provide an expert opinion on the potential reclassification, extending pharmacy services to include responsible and appropriate use of POP, as an opportunity also in Italy to increase the use of safe and effective contraceptive methods. [ABSTRACT FROM AUTHOR]

Purpose: The authors explore how abortion regulations in Ohio, an abortion-restrictive state in the USA, impact obstetrician-gynecologists' (OB/GYNs) training in reproductive healthcare and describe what OB/GYNs believe to be the broader impact of Ohio's regulations on skillbuilding, skills maintenance, and professional retention of reproductive healthcare providers in the state. Authors discuss how their findings foreshadow abortion training limitations in Ohio and other abortion-restrictive states now that abortion regulations have returned to the states. Methods: The authors conducted four semi-structured focus groups and five in-depth interviews between April 2019 and March 2020. Participants included OB/GYNs practicing obstetrics and gynecology in Ohio between 2010 and 2020. Thematic analysis was conducted using Atlas.ti. Results: Twenty attending physicians and 15 fellows and residents participated in the study. Participants discussed the impact of Ohio's written transfer agreement, gestational-limit, and abortion method and facility bans on training and skill-building opportunities. Participants felt that Ohio's strict abortion regulations 1) limit opportunities to observe and perform abortion procedures during training; 2) require learning the ever-changing legality of abortion provision; 3) limit the number of abortions OB/GYNs can provide, leading to the atrophy of their skills over time; and 4) may prevent prospective medical students and residents from choosing to study in Ohio and may lead to physician attrition from the state. Conclusion: Prior to the reversal of federal protections for abortion in 2022, OB/GYNs in Ohio and other abortion-hostile states experienced barriers to training in abortion care. In returning abortion regulation to the states, access to training is likely to be increasingly restricted. This research demonstrates how abortion-restrictions hamper physicians' skills needed to care for patients, particularly in emergent situations. This puts patients at risk and places physicians in precarious ethical positions. Expanding protections and reducing restrictions on abortion will ensure OB/GYNs and trainees have the skills necessary to care for patients presenting for reproductive healthcare. [ABSTRACT FROM AUTHOR]