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BACKGROUND: Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities experience significant health disparities related to sexual health, including sexually transmitted infections (STIs). Improved access to culturally congruent primary care and sexual health services, including HIV/STI prevention and care, are needed. We describe how we developed a new community-based LGBTQ+ primary care clinic and implemented safety-net sexual health and STI screening and care services in Providence, Rhode Island. METHODS: Open Door Health in Providence, Rhode Island, was started in 2020 to improve access to HIV/STI care and prevention services, primary care, and genderaffirming care for the LGBTQ+ community. We reviewed demographics and behaviors of patients presenting for STI screening services from February 2021 to October 2023 at the clinic. Bivariate and multivariate analyses were used to evaluate demographics and behaviors among patients testing positive for HIV and other STIs. RESULTS: A total of N=1,633 people presented for STI screening. Of these, 56% were 30 years or younger, 65% identified as male, 24% as female, and 9% as non-binary or gender diverse. Forty-three percent were MSM, 19% were Black/African American (B/AA), and 22% were Hispanic/ Latino (H/L). Seventy-one percent reported two or more partners in the last three months. The prevalence of STIs was 22.3% (4.4% syphilis, 7.5% gonorrhea, and 9.7% chlamydia). Those who tested positive for an STI were more likely to be B/AA (23.3% of B/AA individuals versus 15.9% of White, p<0.05), H/L (23.1% versus 17.4%, p<0.05), and MSM (25% versus 16.9%, p<0.05). CONCLUSION: Open Door Health provides important safety-net STI services for the LGBTQ+ community. Individuals presenting for services had a high prevalence of HIV/STIs. Improved approaches are needed for HIV/ STI care and prevention in this group, including among B/AA and H/L communities. [ABSTRACT FROM AUTHOR]

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. Synopsis: FIGO calls for the delivery, advocacy and provision of comprehensive sexual and reproductive health care among member societies, to improve access to care within health systems. [ABSTRACT FROM AUTHOR]

Transgender and gender nonbinary (TGNB) adolescents and young adults (AYA) may present to clinicians with reproductive health expertise for the spectrum of gynecologic, sexual, and reproductive care. As such, clinicians should be knowledgeable in the many facets of gender-affirming care. This clinical opinion reviews language associated with gender diversity and gender-affirming care; current clinical, social, and political barriers faced by TGNB AYA; and the creation of welcoming and inclusive clinical spaces for TGNB AYA. It discusses social, medical, and surgical affirmation processes, and focuses on gynecologic care topics which may arise in the care of TGNB AYA, including those who undergo medical or surgical therapies. This includes menstrual suppression, breakthrough bleeding on testosterone, sexual health, fertility, and the pelvic care of individuals following gender affirming vulvovaginoplasty. [ABSTRACT FROM AUTHOR]

The National Hospital Insurance Fund (NHIF) of Kenya was upgraded to improve access to healthcare for impoverished households, expand universal health coverage, and boost the uptake of essential reproductive, maternal, newborn and child health (RMNCH) services. However, premiums may be unaffordable for the poorest households. The Innovative Partnership for Universal Sustainable Healthcare (i -PUSH) programme targets low-income women and their households to improve their access to and utilization of quality healthcare, including RMNCH services, by providing subsidized, mobile phone-based NHIF coverage in combination with enhanced, digital training of community health volunteers and upgrading of health facilities. This study evaluated whether expanded NHIF coverage increased the accessibility and utilization of quality basic RMNCH services in areas where i -PUSH was implemented using a longitudinal cluster randomized controlled trial in Kakamega, Kenya. A total of 24 pair-matched villages were randomly assigned either to the treatment or the control group. Within each village, 10 eligible households (i.e. with a woman aged 15–49 years who was either pregnant or with a child <4 years old) were randomly selected. The study applied a difference-in-difference methodology based on a pooled cross-sectional analysis of baseline, midline and endline data, with robustness checks based on balanced panels and Analysis of Covariance methods. The analysis sample included 346 women, of whom 248 had had a live birth in the 3 years prior to any of the surveys, and 424 children aged 0–59 months. Improved NHIF coverage did not have a statistically significant impact on any of the RMNCH outcome indicators at midline nor endline. Uptake of RMNCH services, however, improved substantially in both control and treatment areas at endline compared to baseline. For instance, significant increases were observed in the number of antenatal care visits from baseline to midline (mean = 2.62–2.92, P  < 0.01) and delivery with a skilled birth attendant from baseline to midline (mean = 0.91–0.97, P  < 0.01). Expanded NHIF coverage, providing enhanced access to RMNCH services of unlimited duration at both public and private facilities, did not result in an increased uptake of care, in a context where access to basic public RMNCH services was already widespread. However, the positive overall trend in RMNCH utilization indicators, in a period of constrained access due to the COVID-19 pandemic, suggests that the other components of the i -PUSH programme may have been beneficial. Further research is needed to better understand how the provision of insurance, enhanced community health volunteer training and improved healthcare quality interact to ensure pregnant women and young children can make full use of the continuum of care. [ABSTRACT FROM AUTHOR]

Background: Sub-Sahara Africa (SSA) has the greatest unmet need for family planning use, but young people are reported to under-utilise family planning services compared to other groups of women of the reproductive age in the region. Thus, promoting contraceptive services use among adolescents is vital in achieving universal access to sexual and reproductive health services. Objective: The main objective of this study was to assess the prevalence and motivators for family planning services utilization among youth students in higher learning institutions in Dodoma, Tanzania. Methods: An analytical cross-sectional study was conducted among 421 randomly selected youths in higher learning institutions in Dodoma. A self-administered structured questionnaire adopted from previous studies was used to collect data. Bivariate and multivariate logistic regression analysis using SPSS version 25 established association between variables. Statistical significance was declared at 95% confidence interval with α<0.05 and strength of association was reported by Odds Ratio (OR) and Adjusted Odds Ratio (AOR). Results: Majority of the participants 221 (52.5%) were females, and most of them 320 (76.0%) were aged between 21 to 24 years. Of all participants, bachelor's degree scholar were 257 (61.0%). About 305, (72.4%) participants reported to have had sexual intercourse in the past 12 month. Of these 50.5% had their first intercourse at the age between 15 to 19 years. Most participants 239 (56.8%) reported to have used contraceptive method in the past 12 months. After adjusting for confounders (participants' socio-demographic characteristics), the motivators for family planning use among youth students were: living with relatives (AOR = 2.904, p 0.006), adequate FP knowledge (AOR = 2.230 p 0.003), positive perception (AOR = 1.772, p 0.025) and discussing FP matters with sexual partners (AOR = 6.045, p <0. 001). Conclusion: This study highlights a significant unmet need for family planning services among youth students in higher learning institutions in Dodoma, Tanzania, reflecting broader trends in Sub-Saharan Africa. Despite high sexual activity, family planning utilization remains suboptimal. Key motivators for using family planning services include living with relatives, having adequate knowledge, positive perceptions, and discussing family planning with sexual partners. These findings emphasize the need for targeted interventions focusing on education, fostering positive perceptions, and encouraging open partner discussions to enhance family planning utilization among adolescents, contributing to universal access to sexual and reproductive health services. [ABSTRACT FROM AUTHOR]

AbstractDisparities in contraceptive access by ethnicity are widely documented. We drew on 2019–2022 panel data from patients seeking family planning in Arizona and estimated ordinal conditional logistic regression models to examine whether disruptions in access to care led to poor contraceptive outcomes and whether this differed by ethnicity. We found associations between experiencing increased barriers to accessing preferred contraception and reduced odds of using it. We also found associations between location of care and use of preferred contraception that differ by ethnicity. Our study highlights that access barriers can restrict people’s reproductive autonomy and healthcare systems are inadequately set up to ensure sexual and reproductive equity for all. [ABSTRACT FROM AUTHOR]

Background: People who use drugs are at elevated sexual and reproductive health risk but experience barriers to services. Syringe services programs (SSP) are an important venue to provide integrated health services. Few studies have examined SSP use within intersecting gender, racial, and ethnic groups, including by injection drug use (IDU), and differences in sexual and reproductive health among these groups. Methods: Within a cohort study among people who use unprescribed opioids in New York City, we conducted a nested cross-sectional study from November 2021-August 2022 assessing sexual health with a survey (n = 120). The parent study measured baseline characteristics, and the cross-sectional study survey measured self-reported past-year SSP use and sexual and reproductive health. We estimated SSP use within gender, racial, and ethnic groups by IDU, and the prevalence of sexual and reproductive health outcomes by gender, race, ethnicity, and SSP use. Results: Among men (n = 61) and women (n = 54), SSP use was disproportionately low among Black participants irrespective of IDU. Women reporting SSP use had a higher prevalence of multiple, new, sex trade, and/or casual sex partners, history of STI symptoms, and lack of effective STI prevention, although women who did not use SSP had non-negligible levels of risk with variation between racial and ethnic groups. Among men, sexual and reproductive health varied across racial and ethnic groups but not as clearly by SSP use. Conclusions: SSP offer opportunity to address elevated STI risk among people who use drugs but may miss certain intersecting gender, race, and ethnic groups. [ABSTRACT FROM AUTHOR]

Background: The lack of adequate access to and use of sexual and reproductive health care by youth and adolescent, n low- and middle-income countries persists despite international accords on their rights, which exposes them to violence against children; early and unintended pregnancies; and sexually transmitted infections. This study examined functional sexual and reproductive health and right-based friendly services as perceived by exit male and female adolescents, caregivers, and health workers at the Tanzanian health services delivery points as they were the ones who would share their opinions to establish a diversified and representative reality about the matter based on sex. Methods: This was a multicentric study among 205 randomly selected participants in eleven selected health facilities within the three regions of Tanzania including Dar es Salaam, Dodoma, and Kigoma regions using a one-time descriptive cross-sectional design with a quantitative research approach from 01 to 30 November 2022. Triangulation technique of data collection activities using structured questionnaires and observation checklist adopted from the Tanzanian Ministry of Health was used to collect data. IBM Statistical Package for Social Sciences version 26 data entry templates (Sa PSS – 26) were used to analyze data descriptively to establish frequencies and percentages. Results: Results indicated that 205 participants were assessed in this study with a response rate of 100%. Exit adolescents (46%); health workers in dispensaries (60%), and community members (42%) were more likely to confirm the availability of functional SRH right-based adolescent and youth-friendly services at the health services delivery points. The SRH displays (50%); adolescent rights (6%) and confidentiality (5%) were the least reported functional SRH aspects by the study participants. It was noted that the 11 health services delivery points in their totality did not fully implement the National standards in providing the services to adolescents and youth of which standards III (54.0%) and VIII (46.1%) scored the lowest. Conclusion: The results of this study have uncovered that there is disperities in the availability and accessibility of functional SRH right-based adolescent and youth-friendly services across the levels of health facilities; among adolescents and community members. Hospitals were more likely to confirm the availability of Functional Right Based Youth Friendly Services than at health centers and dispensaries with female adolescents, youth, and community members being disadvantaged. There is a need to address issues of differentials in equity to the accessibility of services among adolescents, youth, and community members by improving functional sexual and reproductive health and right-based friendly services provision infrastructures, health care workers capacity building, and mechanisms or approaches to increase adolescents' access and uptake to SRHR services. [ABSTRACT FROM AUTHOR]

Background: Refugee and asylum-seeking women are known to experience a myriad of intersecting sociocultural, institutional, and systemic barriers when accessing healthcare services after resettlement in high-income countries. Barriers can negatively affect service uptake and engagement, contributing to health inequities and forgone care. Access to sexual and reproductive healthcare (e.g., family planning, cervical cancer prevention) has largely been understudied. This scoping review sought to: i) examine the use of sexual and reproductive health services among refugee and asylum-seeking women in high-income countries; and ii) identify barriers and facilitators influencing access to sexual and reproductive healthcare for refugee and asylum-seeking women in high-income countries. Methods: This review was conducted in accordance with Joanna Briggs Institute Methodology for Scoping Reviews. Ten databases (e.g., CINAHL, MEDLINE, Embase) were searched for qualitative, quantitative, mixed method studies, and gray literature published anytime before February 2024 across high-income countries (defined by the World Bank). The Health Behaviour Model was used to examine and understand factors influencing service use and access. Results: 3,997 titles and abstracts were screened, with 66 empirical studies included. Most were conducted in the United States (44%), Australia (25%), Europe (18%) and elsewhere and were qualitative (68%). Papers largely addressed contraception, abortion, cervical cancer screening, gender-based violence, and sexual health education. Included studies indicated that refugee and asylum-seeking women in high-income countries face a greater unmet need for contraception, higher use of abortion care, and lower engagement with cervical cancer screening, all when compared to women born in the resettlement country. Frequently reported barriers included differences in health literacy, shame and stigma around sexual health, language and communication challenges, racial or xenophobic interactions with healthcare providers, and healthcare/medication costs. Conclusions: Studies across the globe identified consistent empirical evidence demonstrating health inequities facing refugee and asylum-seeking and myriad intersecting barriers contributing to underuse of essential sexual and reproductive health services. Facilitators included multilingual healthcare provider, use of interpreters and interpretation services, community health promotion work shops, and financial aid/Medicare. [ABSTRACT FROM AUTHOR]

Background: Macrosomia is a forgotten health problem that directly or indirectly affects maternal and neonatal health outcomes. There is a lack of evidence on the factors that affect macrosomia in eastern Ethiopia. This study aimed to assess the determinants of macrosomia among newborns delivered in Jigjiga City, Eastern Ethiopia. Methods: An institutional-based case-control study was conducted among 82 cases and 164 controls in Jigjiga City from June 25 to August 24, 2023. Bivariable and multivariable logistic regression were used to identify the determinants of macrosomia. An adjusted odds ratio (AOR) with a 95% confidence interval was used to report the strength of the association, and the statistical significance was declared at a p-value < 0.05. Results: This study found that lack of preconception care (AOR = 2.48, 95% CI: 1.29, 4.76); post-term pregnancy (AOR = 2.90, 95% CI: 1.16, 7.28); inadequate physical activity (AOR = 3.52, 95% CI: 1.55, 7.98), having previous macrosomia (AOR = 4.52, 95% CI: 2.18, 9.36), and gestational diabetic mellitus (AOR = 2.58, 95% CI: 1.10, 6.28) were the main risk factors of macrosomia. Conclusion: This study indicated that failed utilization of preconception care, inadequate physical activity during pregnancy, post-term pregnancy, gestational diabetic mellitus, and having previous macrosomia were the risk factors for fetal macrosomia. Encouraging women to utilize reproductive health services and providing special care for high-risk mothers are essential to reducing and preventing the level of fetal macrosomia and its consequences. [ABSTRACT FROM AUTHOR]

The main objective of this study was to investigate the depth and breadth of knowledge and ideas about adolescent health among secondary-level students. A concurrent mixed method approach, both quantitative and qualitative methods, was followed to carry out the study. Students enrolled in tenth grade under the Directorate of Secondary and Higher Education (DSHE) in Khulna City, Bangladesh, were chosen as the respondents of the study. Kotwali and Khanjahan Ali Thana of Khulna City were rationally chosen as the areas of the study. A total of 40 schools were randomly chosen, and 400 surveys, 10 surveys from each school, ideally 05 boys and 05 girls, were carried out, including 10 in-depth case studies. Findings indicated that, on average, more than half of the adolescents have knowledge gaps about adolescents and reproductive health, for example, misconceptions about the adolescent period and age range of puberty, vague understanding of the first sign(s) of physical appearances, and face critical emotional and social challenges. Both qualitative and quantitative data further showed that they hardly get sufficient cooperation and support from family and social environments in dealing with their challenges, display risky health behaviour, and make major decisions based on their self-discretionary assumptions to deal with crises. The findings of this study would provide important guidelines to parents and guardians, local and district and regional and national level GOs and NGOs health professionals who work with adolescent and reproductive health services, policymakers, academics, and researchers to create an adolescent-friendly environment. [ABSTRACT FROM AUTHOR]

Background: Lack of credible sexual partner dialog and support regarding family planning (FP) and other sexual reproductive health issues is a major impediment to contraception service uptake and utilization. This study examined the feasibility and acceptability of attitudes toward using telehealth for remote education of couples through behavioral, motivational, and informational messaging on FP methods and its eventual impact on partner conversations around FP. Methods: The study was conducted in Kampala, Uganda, and involved recruiting 450 men from diverse settings. These men received regular SMS content on FP and sexual and reproductive health for a duration of 6 months. The content aimed to provide information and motivation while serving as a resource for discussions with their spouses. Following the main quantitative study, a qualitative follow-up study was conducted with a subset of 15 randomly selected men. In-depth interviews were conducted with these men to gain deeper insights into their experiences and perspectives. Results: The study revealed positive outcomes where men reported improved knowledge of FP methods such as child spacing, and types of contraception. The messaging prompted discussions with spouses on family size and spousal support. Couples reported a shift toward viewing FP as a joint responsibility, with some couples even taking concrete actions. The findings suggested that telehealth interventions can promote social and behavioral change and can improve couple communication and male involvement in FP decisions in Uganda. Conclusion: The study found that using telehealth messaging to educate men about FP in Uganda successfully improved communication between couples on the topic. [ABSTRACT FROM AUTHOR]

Introduction: Approximately 1.3 billion people worldwide live with a disability, underlining the need for equitable health care for this group is important. Inclusive health systems are consistent with global health priorities, respond to United Nations sustainable development goals and economically viable. Despite advancements in Morocco's health system and legal framework, significant disparities remains inaccessing sexual and reproductive health (SRH) services for women with disabilities. This study explores barriers and facilitators affecting access to SRH services for these women, aiming to provide recommendations for more inclusive services and improved health outcomes. Methods: Using a mixed approach, this study assessSRH access for women with motor disabilities in two cities in Morocco, selected for their socio-demographic, cultural and and healthcare diversity. Quantitative data will be generated through questionnaires administrered to 400 participants, while qualitative information will come from 20 to 30 interviews. Recruitment involves working with health professionals, NGOs and social media campaigns to ensure a diverse sample. Data analysis includes NVivo for qualitative data and descriptive/inferential statistics for quantitative data. Conclusion: The study aims to explore the perspectives of women with disabilities and health professionals regarding SRH services. It will provide recommendations for making SRH services more equitable and inclusive, ultimately improving health out comes and uphold health rights for women with disabilities. [ABSTRACT FROM AUTHOR]

Background: Informal abortions, commonly known as unsafe abortions, refer to all induced abortions that occur outside of formal healthcare settings conducted without the assistance of a licensed, trained healthcare provider. Despite the legalization of safe induced abortion care services, informal abortions continue to be among the major causes of maternal mortality and morbidity among young women in Rwanda living in rural areas with limited or no access to safe abortion care services. The purpose of this qualitative study was to gain an in-depth understanding of the lived experience of seeking informal abortions from the perspective of young women in rural Rwanda and to identify the underlying factors for these women seeking abortion care services outside of the formal healthcare setting. Methods: This qualitative study was guided by a descriptive phenomenology in rural Rwanda, specifically in a selected district located in the Northern Province of Rwanda. Ten young women between 18 and 24 years of age, who had the experience of seeking informal abortion services from informal providers within the last eight years participated in audio-recorded, in-depth, face-to-face interviews. Collected data were analyzed using Colaizzi's (1978) seven steps of the phenomenological method. Results: The study found that young Rwandan women still seek unregulated abortions to end their unintended pregnancies due to limited access to or utilization of sexual reproductive health and rights services. Among the reasons for seeking abortion care services outside of the formal healthcare setting in Rwanda were sociocultural and economic factors and the stigma associated with terminating unintended pregnancies before marriage. Conclusion: In light of the findings of this study, the authors recommend the Ministry of Health and its stakeholders to expand access to comprehensive adolescent and youth-friendly reproductive health and reproductive rights while addressing the sociocultural stigma through public awareness and economic factors that play a big role in unregulated abortions rather than safe abortion care services. [ABSTRACT FROM AUTHOR]

Objective Study Setting and Design Data Sources and Analytic Sample Principal Findings Conclusions To investigate women's perceptions of telemedicine for reproductive health care services, focusing on how perceived benefits and privacy risks influence their intentions to adopt telemedicine and their willingness to disclose personal health information.A cross‐sectional survey was conducted. The study applied the privacy calculus theory to the context of telemedicine for reproductive health, using adapted, validated variables to develop the survey. Outcome variables included intentions to adopt telemedicine and willingness to disclose accurate personal health information.Data were collected in May and June 2023 using Qualtrics online panel services, targeting women across the United States who had not used telemedicine for reproductive health. The sample comprised 847 women aged 18 and older. Structural equation modeling was employed using AMOS v28.0 to test the hypothesized relationships between perceived benefits, perceived risks, and adoption intentions. The analysis controlled for age, household income, political affiliation, religious views, and prior births.Perceived benefits were positively related to intention to adopt telemedicine for reproductive care (β: 0.600, p < 0.001), and willingness to disclose accurate personal health information (β: 0.453, p < 0.001). Unexpectedly, perceived privacy risks were positively related to adoption intentions (β: 0.128, p < 0.001), but negatively related to willingness to disclose (β: −0.282, p < 0.001). Intentions to adopt were positively associated with willingness to disclose (β: 0.089, p < 0.05). Lastly, older women and women located in states with abortion restrictions expressed lower intentions to adopt. The model explained 40.2% of variance in intention to adopt and 38.3% of variance in willingness to disclose.The study demonstrates the importance of perceived benefits and privacy risks in driving telemedicine adoption and disclosure intentions among women in the reproductive health context. These findings suggest the need for targeted strategies to address privacy concerns and support telemedicine adoption, particularly in restrictive regulatory environments. [ABSTRACT FROM AUTHOR]

Background: Despite the progress made in improving maternal and child health in Ethiopia, it still has one of the highest maternal and neonatal mortality rates in the world. This is largely due to inadequate healthcare infrastructure and a lack of comprehensive evidence-based maternal and reproductive health services. To achieve the Sustainable Development Goal targets related to maternal and child health, it is essential to conduct culturally sensitive and policy-relevant research to identify areas for improvement. Methods: To address these issues, through The University of Newcastle's increased global focus and investment into funding international research higher degrees, we developed a program on the Worldwide Wellness of Mothers and Babies (WWOMB) and trained Doctor of Philosophy students who conducted cross-cutting research across the reproductive life course. Importantly, the program aimed to bridge the inequality gaps in maternal and child health whilst cultivating a new generation of research leaders in low- and middle-income countries such as Ethiopia. Results: The WWOMB program has successfully generated a substantial body of epidemiological research in Ethiopia, covering five major themes: family planning and contraception, maternal and child health service utilisation, maternal and child health outcomes, maternal and child nutrition, and health economics. The key findings of the studies conducted in Ethiopia have demonstrated geographical disparities in the use of modern contraception and maternal health service utilisation, high incidence of severe maternal outcomes and neonatal near misses, high prevalence of intimate partner violence during pregnancy and its significant impact on adverse pregnancy outcomes, and the presence of economic disparities in maternal and child health, particularly around service delivery and availability. Conclusions: Investment in healthcare infrastructure and services, coupled with efforts to reduce economic inequalities, can contribute to improved maternal and child health in Ethiopia. The WWOMB project has focused on delivering evidence-based recommendations for policy and practice that could accelerate the country's progress towards achieving Sustainable Development Goal targets related to maternal and child health. [ABSTRACT FROM AUTHOR]

Background: Accessing sexual and reproductive health (SRH) services in rural Australia presents complex challenges that negatively impact women's health and exacerbate health inequities across the life course. This systematic review synthesises evidence on the barriers and facilitators to women's access to SRH services in rural Australia, considering both supply and demand dimensions. Methods: We systematically searched peer-reviewed literature published between 2013 and 2023. Search terms were derived from three major topics: (1) women living in rural Australia; (2) spatial or aspatial access to SRH services; and (3) barriers or facilitators. We adopted the "best fit" approach to framework synthesis using the patient-centred access to healthcare model. Results: Database searches retrieved 1,024 unique records, with 50 studies meeting the inclusion criteria. Most studies analysed access to primary care services (n = 29; 58%), followed by hospital services (n = 14; 28%), health promotion and prevention (n = 5; 10%), and specialist care (n = 2; 4%). The type of care accessed was mostly maternity care (n = 21; 42%), followed by abortion services (n = 11; 22%), screening and testing (n = 8; 16%), other women's health services (n = 6; 12%), and family planning (n = 4; 8%). There were numerous barriers and facilitators in access from supply and demand dimensions. Supply barriers included fragmented healthcare pathways, negative provider attitudes, limited availability of services and providers, and high costs. Demand barriers encompassed limited awareness, travel challenges, and financial burdens. Supply facilitators included health system improvements, inclusive practices, enhanced local services, and patient-centred care. Demand facilitators involved knowledge and awareness, care preferences, and telehealth accessibility. Conclusion: This review highlights the urgent need for targeted interventions to address SRH service access disparities in rural Australia. Understanding the barriers and facilitators women face in accessing SRH services within the rural context is necessary to develop comprehensive healthcare policies and interventions informed by a nuanced understanding of rural women's diverse needs. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Discussion and Conclusions Women who attend alcohol and other drug (AOD) services experience higher rates of unintended pregnancy, and access less contraception, than the general population. This study aims to observe contraceptive initiation and use after contraception services were offered at metropolitan and regional AOD services.Clinical staff were provided contraception education. One hundred women aged 16–49 were recruited from two services between 2017 and 2021. Women completed a questionnaire on their obstetrics and gynaecological history, pregnancy plans and contraception use. Women were provided education on contraception options and offered referral to a contraception pathway. The primary outcome was initiation of highly reliable contraception; secondary outcomes were the types of contraception initiated, and contraception use and pregnancy at 12 months. We compared the initiation of contraception across the two study sites.At baseline, 91% of women were not planning a pregnancy within 12 months, with 21% of these using highly reliable contraception. Of all women not planning a pregnancy, 28% initiated highly reliable contraception via the pathway (2% metropolitan, 51% regional, p < 0.001), with intrauterine devices being the most frequent method initiated (15%). At 12 months, 44% were using highly reliable contraception and 15% had recorded pregnancies.Contraception pathways for women in AOD treatment can improve initiation of highly reliable methods of contraception, although pregnancy rates were still high and there were large differences between the study sites. Care navigation and clinical champions are some potential facilitators to contraception access, and understanding additional barriers to access may be useful. [ABSTRACT FROM AUTHOR]

Background: The United Nations' Sustainable Development Goals identify universal access to sexual and reproductive health services as a global priority. Yet barriers to abortion access remain, including legal restrictions, cost, stigma, and limited services and information. The aim was to identify barriers to and facilitators of abortion care access experienced in Australia. Methods: This qualitative phenomenological study examined abortion access in Australia, where abortion is decriminalised, from March 2020 to December 2022. We used social media and flyers in clinics to recruit adults who had sought abortion care, then interviewed them in-depth. We mapped participant experiences to five dimensions of access identified by Levesque et al.'s patient-centred access to healthcare framework: approachability, acceptability, availability and accommodation, affordability, and appropriateness. Results: The 24 participants lived across Australia and sought abortion during the COVID-19 pandemic. Approachability: Before seeking abortion, most did not know where to access information about the service and where to obtain it. Acceptability: Many were uncomfortable disclosing their abortion to family or friends; they reported that healthcare providers demonstrated varying levels of support. Availability and accommodation: Regional participants travelled far and faced long wait-times, exacerbated by pandemic restrictions. Affordability: Participants described financial stress paying for the service, travel, and related expenses. Appropriateness: Most participants expected judgemental care. Experiences varied widely: many participants experienced unempathetic, rushed, or judgemental interactions with healthcare staff, and many also reported at least one non-judgmental and supportive interaction on the same pathway to care. Discussion: Abortion seekers experienced varying obstacles when seeking care. The findings illustrate the need for population- and system-level initiatives such as: providing accurate information about and normalising abortion; implementing system-level strategies to reduce wait times, travel, and costs, especially for rural populations; and developing regulatory and quality improvement initiatives to increase the workforce and its readiness to provide high-quality, non-judgemental abortion care. Challenges seeking care during pandemic restrictions illustrate the importance of social support during care and choice between abortion modalities and service types. Consumer voices can help understand the diverse pathways to abortion care and inform solutions to overcome the multidimensional barriers to access. [ABSTRACT FROM AUTHOR]

The article discusses the Bar Hostess Empowerment & Support Programme (BHESP) in Nairobi, Kenya, which aims to provide support and services for female sex workers (FSWs) who use drugs. BHESP employs a person-centered approach to develop tailored interventions that address the specific needs and challenges faced by FSWs who use drugs, including stigma, violence, and isolation. Through community engagement, stakeholder consultations, and continuous monitoring and evaluation, BHESP has successfully improved access to essential healthcare services for FSWs who use drugs, leading to positive health outcomes and increased acceptance of harm reduction interventions. The article highlights the importance of collaborative and culturally sensitive approaches in addressing the intersectional challenges faced by marginalized populations. [Extracted from the article]

The article "Leveraging Technology to Transform Sexual and Reproductive Health Services" in the Bangladesh Journal of Medical Science examines how technology, including telemedicine and mobile health apps, is reshaping the delivery of sexual and reproductive health services. It underscores the advantages of these innovations in enhancing access, care quality, and patient empowerment, while also addressing concerns about data privacy, digital literacy, and equity. The document delves into ethical considerations, disparities in digital access, and the significance of health equity in telemedicine and e-health services, emphasizing the need for collaboration among stakeholders for a safe and inclusive integration of technology in SRH services. [Extracted from the article]

Background: Many refugee women and women seeking asylum arrive in high-income countries with unmet preventive sexual and reproductive health (SRH) care needs. Primary healthcare providers (HCPs) are usually refugee and asylum seekers' first point of care. This study aimed to identify HCP characteristics associated with initiating conversations and discussing SRH opportunistically during other health interactions. Methods: An anonymous online survey was distributed nationally to representatives of health professional organisations and Primary Health Networks. Hierarchical logistic regression analysed factors including HCP demographics, knowledge and awareness, perceived need for training and professional experience with refugee women were included in the models. Results: Among 163 HCPs, those initiating conversations ranged from 27.3% (contraceptive care) to 35.2% (cervical screening). Opportunistic discussions ranged from 26.9% (breast screening) to 40.3% (contraceptive care). Positively associated factors included offering care to refugee women or women seeking asylum at least once every 2 months 7.64 (95% CI 2.41;24.22, P < 0.001); 2.82 (95% CI 1.07;740, P < 0.05), working part-time 8.01 (95% CI 2.34;27.86, P < 0.001); 2.43 (95% CI 1.02;5.76, P < 0.05) and having over 10 years of practice in Australia 2.20 (95% CI 0.71;6.87, P < 0.001); 0.40 (95% CI 1.66;0.95, P < 0.05). Barriers identified by HCPs included women's cultural beliefs (76%), lack of SRH knowledge (72.4%), religious beliefs (67.5%) and limited English-language skills (54.6%). Conclusions: Direct professional experience, frequency of service provision, years of practice, and part time work positively influence HCPs' SRH care practices. Enhancing bilingual health worker programs, outreach, education, and support for SRH and cultural competency training are essential to improving the preventive SRH care of refugee women and women seeking asylum. Primary healthcare providers are usually refugee and asylum seekers' first point of care in resettlement countries. Findings indicate direct professional experience characteristics influence healthcare providers' knowledge and beliefs regarding refugee women's sexual and reproductive health. Clinical practice changes and cultural competency training are needed to improve the preventive sexual and reproductive health care of refugee women and women seeking asylum. [ABSTRACT FROM AUTHOR]

Background. Aging women living with HIV are significantly affected by menopause and comorbidities, yet international and Australian HIV guidance on the management of women is scarce. This study aimed to identify gaps in clinical management of menopause, age-related comorbidities, and psychosocial health of women living with HIV attending our metropolitan sexual health service. Methods. A clinical audit of all cisgender women who attended Sydney Local Health District Department of Sexual Health Medicine for ongoing routine HIV care between 1 January 2021 and 1 January 2023 was undertaken. Results. Twenty-seven patient files were examined. Half (13/27, 48.1%) of women were age 45 years and older, of whom 6/13 (46.2%) were postmenopausal and 4/13 (30.8%) did not have menopause status recorded. In the prior 12 months, most women had their blood pressure (19/27, 70.4%), total cholesterol (21/27, 77.8%), glycated haemoglobin (21/27, 77.8%), estimated glomerular filtration rate (27/27, 96.3%), and liver function tests (26/27, 96.3%) measured. Smoking and alcohol intake was documented for less than half of women (13/27, 48.1%; and 12/27, 44.4%; respectively). In women aged 45 years and older, absolute cardiovascular disease risk was calculated in 2/13 (15.4%), and none had a Fracture Risk Assessment Tool score or cognitive screen performed in the prior 12 months. One-fifth (5/27, 18.5%) had a documented history of depression or anxiety. Of those screened, half (4/8, 50.0%) disclosed past intimate partner violence. Conclusions. Our service has now implemented a reference tool to guide routine monitoring of women living with HIV, with sections dedicated to reproductive health and psychological wellbeing. Australian HIV management guidelines would benefit from specific guidance for women. [ABSTRACT FROM AUTHOR]

Objective. To examine maternal mortality in Panama, analyzing its direct obstetric deaths, indirect obstetric deaths, and contributory conditions. Methods. This cohort study used publicly available data from the National Institute of Statistics and Census to present a 25-year retrospective analysis of maternal deaths in the Republic of Panama from 1998 to 2022. Public data were sourced from the National Institute of Statistics and Census website of Panama. Relevant codes from the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD) were used. The maternal mortality ratio (MMR) was defined as the number of maternal deaths per 100 000 live births. Trendline reliability with R2 was performed to analyze the data. Results. A total of 1 026 maternal deaths occurred in Panama from 1998 through 2022, of which 61.2% were attributed to direct obstetric causes; 23.9%, indirect obstetric causes; 13.6%, contributory conditions; and 1.4% were unknown or undetermined. The average MMR was 60.1. The trendline reliability resulted in R2 = 0.1 (y = –0.5147x + 1094.7), which is not statistically significant but meets the 2030 Sustainable Development Goals. The specific primary causes of direct obstetric deaths were: 12.9% due to postpartum hemorrhage (ICD O72); 9.2%, eclampsia (ICD O15); 6.7%, puerperal sepsis (ICD O85); and 6.3%, pre-eclampsia (ICD O14). For indirect obstetric deaths, the primary causes were: 14.9% due to other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth, and the puerperium (ICD O99); and 7.3%, maternal infectious and parasitic diseases classifiable elsewhere but complicating pregnancy, childbirth, and the puerperium (ICD O98). Conclusions. The findings of this study confirmed that there were substantially more direct obstetric causes (61.2%) than indirect obstetric causes (23.9%), contributory causes (13.6%), or unknown/undetermined causes (1.4%) of maternal mortality, despite being highly preventable. Although Panama is right on track to fulfill the target of 70 MMR by 2030, these results highlight the lack of health care access due to the absence of obstetrician-gynecologists per 100 000 population in indigenous comarcas, where 30.8% of the maternal mortalities occur. Furthermore, the health system in Panama is not immune to pandemics and crises. From 1998 to 2022, there were 5 years when the MMR in Panama exceeded 70: 2001, 2002, 2006, 2011, and 2020. These findings also underscore the dichotomy between statistics and health policy. While the trendline reliability was insignificant (R2 = 0.1), the MMR satisfies requirements for the 2030 Sustainable Development Goals. Future studies should consider factors related to indirect obstetrics and contributory causes of deaths, health care access, COVID-19, cesarean section and natural birth, age, economic income, prenatal and postpartum care, as well as the quality of private and public health facilities in the Americas.

OBJECTIVES: Many cisgender women affected by homelessness and substance use desire pregnancy and parenthood. Provider discomfort with patient-centered counseling about reproductive choices and supporting reproductive decisions of these women poses barriers to reproductive healthcare access. METHODS: We used participatory research methods to develop a half-day workshop for San Francisco-based medical and social service providers to improve reproductive counseling of women experiencing homelessness and/or who use substances. Guided by a stakeholder group comprising cisgender women with lived experience and providers, goals of the workshop included increasing provider empathy, advancing patient-centered reproductive health communication, and eliminating extraneous questions in care settings that perpetuate stigma. We used pre/post surveys to evaluate acceptability and effects of the workshop on participants attitudes and confidence in providing reproductive health counseling. We repeated surveys one month post-event to investigate lasting effects. RESULTS: Forty-two San Francisco-based medical and social service providers participated in the workshop. Compared to pre-test, post-test scores indicated reduced biases about: childbearing among unhoused women (p

Access to comprehensive contraceptive services for youth is essential to improving sexual and reproductive health. However, youth in many countries still face substantial obstacles to contraceptive access and use. The purpose of this study is to compare the contraceptive access experiences and perspectives of pregnant and parenting Mexican-origin youth in Guanajuato, Mexico, and Fresno County, California. Focus groups and in-depth interviews were conducted in Spanish and English among female youth in Mexico (n = 49) and California (n = 25). Participants also completed a brief sociodemographic survey. Using a modified grounded theory approach, qualitative data were coded and thematically analysed based on Penchansky and Thomas's Theory of Access, and results were compared by location. Although knowledge of a service provider was high among youth in both locations, access was affected by social, cultural, and institutional dynamics and contraceptive use was mixed. Across locations, participants described obstacles to accessing their preferred method. Participants worried about parental and peer opinions about their use of contraception (acceptability), and about perceived side effects including infertility and pain (adequacy). Contextual differences included lack of contraceptive choice in Guanajuato (availability) and incomplete knowledge about options in Fresno County (awareness). The power to request and receive their method of choice (agency) emerged as an important dimension that was not part of the original theory. Latina youth living in Mexico and the United States face multiple challenges accessing needed contraceptive options and services. Recognising and reducing these barriers can strengthen the contraceptive care landscape and promote the reproductive health and agency of young people. DOI: 10.1080/26410397.2023.2216527Plain language summary: Although sexually active youth need access to comprehensive sexual and reproductive health services, youth in many countries face substantial barriers to care. This study compares the experiences of pregnant and parenting youth in accessing contraceptive services in Mexico and the United States. We conducted interviews and focus groups with 74 Mexican-origin young women and found that contraceptive use and access was affected by their concerns about parental and peer opinions as well as by provider attitudes. In Mexico, several participants reported being denied their preferred method by their provider. Identifying and addressing barriers to services can improve the quality of care and the reproductive health of young people.

ObjectiveCommunity college students engage in more risky sexual behavior compared to their four-year counterparts, yet have access to fewer reproductive health services. The study's purpose was to examine whether California Community College student health centers' participation in Family PACT, a state publicly-funded family planning program, increased reproductive health services to community colleges students.ParticipantsCalifornia community college student health centers.MethodsBivariate analyses of student health centers with and without Family PACT participation and qualitative analysis of five participating campuses.ResultsAmong the 60 colleges in the study, 25 student health centers participated in the Family PACT program. Family PACT campuses reported greater provision of sexual and reproductive health services and higher levels of staffing and revenue.ConclusionsKey benefits of Family PACT participation among community colleges include expansion of sexual and reproductive health services to an underserved population and increased student health centers' financial sustainability.

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: Despite progress in national reproductive health programs, pastoralist regions like Fentale District in Eastern Ethiopia face challenges with low contraceptive coverage, attributed to insufficient positive attitudes and uptake among couples. Methods: This cross-sectional study was conducted from October 1 to December 25, 2021, in Fentale District, Eastern Ethiopia. It involved 1,496 couples selected using multistage sampling. Data were entered into EPI Data and analyzed with SPSS (v23.0) and STATA (v14.0), employing descriptive statistics, bivariate analysis, and binary logistic regression to identify predictors of contraceptive attitudes and use. Results: The study's response rate was 93.8%, with 1,404 pastoralist couples participating, equally split between women and men. A nomadic-pastoralist lifestyle was common (64.6%), and family planning discussions were rare (93.2%). Gender disparities in contraceptive attitudes and use were evident. Contraception use was reported by 27.4%, with women (41.2%) outnumbering men (13.5%). Women showed more positive attitudes towards contraception (87.9% vs. 31.9% for men). Only 33% had favorable attitudes towards different contraceptive methods, with women more likely to be positive. Modern contraception use was low (18.2%), with women (34.8%) predominating over men (1.7%). Among users, women had a more favorable attitude (78.5% vs. 6.6% for men). Health extension workers were key information providers. Predictors of contraceptive attitudes and use included sex, education, occupation, electronic device ownership, migration frequency, treatment preferences, and family planning discussions. Conclusion: The limited positive attitude towards and use of family planning in Fentale District may stem from unfavorable attitudes, low adoption, and couple disparities. Key factors include gender, education, occupation, electronic device ownership, migration, treatment preferences, and family planning discussions. Targeted educational campaigns for men are needed to address these issues and reduce the gender gap in contraceptive attitudes and use. [ABSTRACT FROM AUTHOR]

Background: One of the reasons for the high rates of maternal and child morbidity and mortality in Sub-Saharan Africa is the rising proportion of teenage pregnancy. Preventing teenage pregnancy is critical to meeting sustainable development goal number three which aims to reduce the global maternal mortality ratio to less than 70 per 100,000 live births. To support the achievement of this goal, this study aimed to assess the spatial variation and factors associated with teenage pregnancy in Ethiopia using the recent nationally representative data. Methods: A secondary data analysis of the 2019 Ethiopian mini Demographic and Health Survey was conducted with a total weighted sample of 2211 (unweighted 2100) teenagers. The Bernoulli model was fitted using SaTScan version 9.6 to identify hotspot areas and the geospatial pattern and prediction of teenage pregnancy were mapped using ArcGIS version 10.7. A multilevel logistic regression model was fitted to identify factors associated with teenage pregnancy among teenagers. Adjusted OR with 95% CI was calculated and variables having a p-value less than 0.05 were statistically significant factors of teenage pregnancy. Result: The prevalence of teenage pregnancy among adolescents aged 15–19 years in Ethiopia was 12.89% (95% CI: 11.56%, 14.36%). The SaTScan analysis identified a primary cluster in the Gambella region of Ethiopia (log-likelihood ratio = 14.02, p < 0.001). A high prevalence of teenage pregnancy was observed in Somalia, Afar, Gambella, and the southern part of the Oromia regions of Ethiopia. Age, educational status- primary and secondary, religion- protestant, having television, contraceptive knowledge, household head-female, and region- Small peripheral were significant determinants of teenage pregnancy. Conclusion: The spatial distribution of teenage pregnancy in Ethiopia was nonrandom. Age, educational status, religion, having television, contraceptive knowledge, sex of household head, and region were significant determinants of teenage pregnancy. Therefore, concerned government bodies and other stakeholders should organize periodic educational campaigns and youth-friendly reproductive health services. Collaboration between healthcare professionals, and religious and community leaders could also form a strategic partnership that makes interventions more comprehensive, culturally sensitive, and effective in reducing teenage pregnancy. [ABSTRACT FROM AUTHOR]

Background: Ethiopia has made strides in reducing maternal mortality, but significant discrepancies in maternal health service utilization exist across socioeconomic levels. According to studies, women from higher-income households are far more likely to use essential services such as antenatal care, delivery care, and postnatal care than poorer women. This wealth disparity is a primary contributor to persistently high maternal mortality, particularly among poor populations. The study's goal was to assess wealth disparities in maternal health service uptake and identify contributing factors. Methods and materials: We used the Ethiopian Mini Demographic Health Survey (EMDHS), conducted in 2019 on women aged 15–49 living in selected census areas, with a weighted sample size of 3,909. The Erreygers Concentration Index (ECI) was used to measure wealth inequalities in maternal health care, and the ECI decomposition was used to identify factors contributing to inequality in maternal health services. Results: Maternal health service utilization was pro-rich among women in Ethiopia. The prevalence of antenatal care service (ANC), delivery, and postnatal care (PNC) service utilization showed a pro-rich distribution among Ethiopian women, with ECI = 0.115 (95% CI: 0.091–0.137), ECI = 0.223 (95% CI: 0.191–0.276), and ECI = 0.121 (95% CI: 0.041-0.200), respectively. The ECI indices were decomposed to examine the contributing factors to disparities in maternal service utilization in Ethiopia. Mother's current age, household family size, region, birth order, and parity were contributors to maternal health service utilization. Conclusion: The ANC service, delivery service and PNC service utilization showed a pro-rich distribution among Ethiopian women. Mother's current age, household family size, region, birth order, and parity are important contributors of maternal health service inequality. To improve access and usage among low-income women, policymakers can develop programs including increasing the number of free or subsidized services and providing transportation. [ABSTRACT FROM AUTHOR]

Background: Pregnancy termination or induced abortion is not decriminalized, and access to safe abortion services is largely unavailable in Papua New Guinea (PNG). However, the practice is common throughout the country. This study aimed to estimate the prevalence and determine factors associated with pregnancy termination among married women aged 15–49 years in PNG. Methods: Secondary data from the 2016–2018 PNG Demographic and Health Survey (PNGDHS) was used. A total weighted sample of 6,288 married women were included. The Complex Sample Analysis method was used to account for the cluster design and sample weight of the study. Chi-square tests and multivariable logistic regression were used to assess factors associated with pregnancy termination. Adjusted odds ratios (aORs) with 95% Confidence Intervals (CIs) were reported. Results: The prevalence of pregnancy termination was 5.3%. Nearly half (45.2%) of all pregnancy terminations occurred in the Highlands region. Women aged 35–44 years (aOR = 8.54; 95% CI: 1.61–45.26), not working (aOR = 6.17; 95% CI: 2.26–16.85), owned a mobile phone (aOR = 3.77; 95% CI: 1.60–8.84), and lived in urban areas (aOR = 5.66; 95% CI: 1.91–16.81) were more likely to terminate a pregnancy. Women who experienced intimate partner violence (IPV) were 2.27 times (aOR = 2.27; 95% CI: 1.17–4.41) more likely to terminate a pregnancy compared to those who did not experience IPV. Women with unplanned pregnancies were 6.23 times (aOR = 6.23; 95% CI: 2.61–14.87) more likely to terminate a pregnancy. Women who knew about modern contraceptive methods and made independent decisions for contraceptive use were 3.38 and 2.54 times (aOR = 3.38; 95% CI: 1.39–8.18 and aOR = 2.54; 95% CI: 1.18–5.45, respectively) more likely to terminate a pregnancy. Conclusion: The findings highlight the role of sociodemographic and maternal factors in pregnancy termination among married women in PNG. Efforts aimed at reducing unplanned pregnancies and terminations should focus on comprehensive sexual and reproductive health education and improving easy access to contraceptives for married couples. Post-abortion care should also be integrated into the country's legal framework and added as an important component of existing sexual and reproductive health services. [ABSTRACT FROM AUTHOR]

Introduction: Structural racism plays a major role in reproductive health inequities. Colorism, discrimination based on skin color, may profoundly impact reproductive health access and service delivery. However, quantitative research in this area is limited. Methods: We administered an online survey of women (n = 1,299) aged 18–44 from Harris County, Texas to assess the relationship between skin color discrimination and reproductive health service avoidance. The survey included questions on demographics, self-reported skin tone, and dichotomous measures of previous discrimination experiences and avoidance of care because of perceived discrimination. Binary logistic regression was used to examine whether race/ethnicity, skin tone, and previous discrimination experiences were related to avoidance of contraceptive care because of perceived discrimination. Results: Approximately one-third (31.5%) of the sample classified themselves as non-Hispanic Whites (31.5%), 22.4% as Black, 27.4% as Hispanic and born within the US, and 7.6% as Hispanic born outside of the US. Approximately one-third of women classified themselves in the lightest skin tones, whereas almost one in five women classified themselves in the darkest skin tone palates. Darker skin tones had increasingly greater odds of reporting that they avoided seeking birth control out of a concern for discrimination compared to the lightest skin tone. After adjusting for race/ethnicity and sociodemographic variables (model 3), darker skin tones remained significantly associated with avoiding birth control. Discussion: This study demonstrates the role that skin color discrimination plays in negative reproductive health experiences. While this is not surprising given that those with racist ideologies developed the concept of these racial and ethnic categories, the apparent association with darker skin colors and avoidance of seeking birth control provides evidence that structural and individual racism continues to have far-reaching and insidious consequences. Conclusion: Contraception is recognized for reducing maternal mortality, improving child health, increasing female empowerment, and decreasing poverty. However, not all women equally enjoy the benefits of access to contraception. Addressing colorism within reproductive healthcare has become critically important as the nation becomes increasingly diverse. Focusing on skin tone-based discrimination and its roots in anti-blackness expands our understanding beyond a Black–White binary traditionally applied when addressing racism in healthcare delivery. [ABSTRACT FROM AUTHOR]

Experiences of racism and heterosexism in medical settings are social and systemic barriers to 'on-time' receipt of sexual and reproductive health services among women with both racial and sexual minority identities. Medical mistrust based on experiences related to these dual identities is associated with avoidance and delays in care. However, investigators are just beginning to apply an intersectional lens to quantitatively understanding such barriers. The purpose of this study was to examine the independent and interaction effects of racial and heterosexist medical mistrust on timing of sexual/reproductive health care among Black sexual minority women who have sex with women and men. A total of 320 women participated in an online study of factors affecting sexual health in this population. Ordinal logistic regression was used to assess the independent and interaction effects of racial and heterosexist medical mistrust on self-reported time since last sexual/reproductive health visit. Results indicated an interaction between the two types of medical mistrust. Research on Black women who have sex with women and men's experiences of racism and heterosexism in the US healthcare system can lead to the development of the comprehensive training programmes needed to alleviate medical mistrust among women with racial and sexual minority identities. [ABSTRACT FROM AUTHOR]

This study explores the impact of migration on the access and utilisation of sexual and reproductive health services by women living in an informal settlement in Dhaka, Bangladesh. A total of 16 in-depth interviews were conducted in March and April of 2019 with women (18–49 years old) who had migrated from rural areas to Dhaka. They reported continued economic insecurity while receiving minimal support from the state. All women reported financial and infrastructural barriers to accessing formal sexual and reproductive health services and tended to seek resources and support through social networks within the slum and from informal health services. Compared with more recent migrants, women who had migrated and resided in the slums for longer found it easier to utilise social networks and resources for sexual and reproductive health. Women had more agency in experimenting with contraceptives but had less power in making decisions during pregnancy and when seeking health care. Menstrual health was a neglected aspect of public health. The study indicates that public health policy targeting the urban poor needs to address the unique challenges faced by migrant women in informal settlements to rectify inequities in health services that leave significant portions of the urban poor population behind. [ABSTRACT FROM AUTHOR]

This article discusses the results of ethnographic research conducted in the municipality of Verona (Veneto Region, Northeast Italy), during 2018, aimed at analysing the reproductive health needs of migrant women, and their access to such services in the territory. The research highlighted that, in addition to many critical structural-organizational issues, there was an emotional obstacle to the use of services – that is, the feeling of fear. In this paper, therefore, we will try to reflect on the role exercised by fear in the relationship between migrant women and reproductive health services. We interpret this emotion not as the expression of an individual experience and feeling, but rather as an example of "embedded thinking"; the result of a social construction that reflects dynamics and power relationships, capable of transforming feelings into practices. [ABSTRACT FROM AUTHOR]

Most EU member states fail to provide essential sexual and reproductive health services to undocumented migrants, a vulnerable population facing limited access, utilization, and worse health-related outcomes. This study systematically reviewed the literature on access to and use of these services, as well as related health, economic, and migratory outcomes for undocumented migrants in the EU-EFTA region. The systematic review is reported based on the PRISMA 2020 checklist and includes 37 studies published between 2017 and 2024. Included studies were based upon original quantitative, qualitative, or mixed-methods data; conducted in one or more European countries; and published in one or more of the following languages: English, Spanish, French, Portuguese, or Romanian. A quality assessment was conducted using the CASP checklist for qualitative studies and the NHLBI Study Quality Assessment Tools for quantitative studies. The findings revealed numerous access barriers, including refusal of care, lack of knowledge about national healthcare schemes, bureaucratic hurdles, and affordability issues. Even when care was available, stigma, fear of deportation, socio-economic precarity, and abuse further hindered utilization. These barriers contributed to generally worse reproductive health outcomes for undocumented migrants in Europe, though the findings may not generalize to all EU-EFTA countries. [ABSTRACT FROM AUTHOR]

This document highlights the violations of sexual and reproductive health (SRH)-related human rights in Palestine, particularly in the context of the ongoing conflict in Gaza. It emphasizes the need for immediate action to restore basic services and provide humanitarian aid, as well as ensure the provision of SRH services. The text calls for increased awareness and action to protect SRHR and uphold international human rights law, while acknowledging the challenges of speaking out about these issues. It also emphasizes the relevance of SRHR impacts in other conflict settings worldwide and the importance of continued documentation and advocacy. [Extracted from the article]

Tobacco use during pregnancy is the main avoidable cause of morbidity and mortality both for pregnant women and their offspring. Between 12 and 22% of pregnant women in industrialized countries smoke during pregnancy, and 13% are unable to stop smoking. Pregnancy is considered an ideal opportunity to intervene and control tobacco use among smokers and their families. However, pregnant women experience barriers to quitting smoking, including social stigma and fear of being judged. Thus, it is necessary to develop interventions for smoking cessation adapted for pregnant women. This paper presents a qualitative study protocol to assess the barriers and facilitators of smoking cessation during pregnancy that female smokers encounter or perceive. It consists of a series of focus groups and individual interviews with female smokers who have been pregnant within the last five years. Participants will be recruited from the Sexual and Reproductive Health Care Services of the Camp de Tarragona. A group of 5–10 women who have been pregnant and tried to quit smoking over the last 5 years will be selected. The data will be collected by means of semistructured interviews. All interviews will be transcribed verbatim, coded and synthesized into categories and main themes. Thematic analysis will be conducted employing an iterative and reflexive approach. The results of this study will offer new perspectives on smoking interventions for pregnant women and enhance our comprehension of the main barriers to and facilitators of smoking cessation during pregnancy. This will contribute to the adaptation of the Tobbstop app, originally designed for the general public, to suit the needs of pregnant women. Consequently, the creation of targeted interventions will positively influence the health outcomes of both pregnant women and newborns. Trial registration: Clinicaltrials.gov ID: NCT05222958. The trial was registered 3 February 2022, at https://clinicaltrials.gov/ct2/show/NCT05222958. [ABSTRACT FROM AUTHOR]

Introduction: A state of healthy physical, mental, and social welfare that is linked to reproductive processes and functions is known as reproductive health. Prospective brides require regular updates on initiatives to improve reproductive health and prevent reproductive health issues through the use of the appropriate media. The purpose of this research was to evaluate the effect of booklets on adolescents’ knowledge and attitudes about reproductive health services for prospective brides at the Denpasar City Health Center. Materials and methods: Pre-experimental design with one group pretest-posttest is used in this kind of research. The sample is 65 teenagers using simple random sampling technique. Knowledge and attitude data before and after the intervention were collected by questionnaire. The form of intervention is the use of booklets in reproductive health education and screening of prospective brides. Data were analyzed by Wiloxon test. Results: The analysis’s findings revealed a significant difference in the average knowledge before and after receiving education using booklet media (p=0.000), as well as a significant difference in the average attitude before and after receiving education using booklet media (p=0.000). Conclusion: Booklets are effective to increases adocescents’ knowledge and attitudes about reproductive health services and screening of prospective brides. [ABSTRACT FROM AUTHOR]

INTRODUCTION In India, despite significant progress in reproductive health services, there remain substantial unmet needs for family planning among married women. This situation not only affects maternal health but also impacts economic stability and overall well-being of families. OBJECTIVE To assess the unmet contraceptive needs among married women of reproductive age attending a tertiary care center in Western Odisha. MATERIALS AND METHODS A cross sectional study was conducted among 154 married women of reproductive age group attending the Outpatient department of the Obstetrics and Gynaecology (OBG) OPD of a tertiary care centre of Western Odisha between Jan- Feb 2021. They were all interviewed by using a predesigned and pretested semi-structured questionnaire. RESULTS 51.94% of the women belonged to the age of more than 25 years followed by 46.1% in the 18-25 years category. 8.44% were completely illiterate. 82.4% were home-makers. 41.55% women had one child,29.2% had two children,12.98% had more than 2 children and 16.23% women haven’t had a child yet. 44.80% couples had a baby girl as their last child. 79.22% of the women were of age 18-25years when they got married whereas 18.83% got married even before they crossed 18. Inter-spouse communication about contraception was present in 80.51% of couples. Implants and vasectomy were the least preferred ones followed by injectable contraceptives. The most common reasons for not using contraceptives were, lack of information (40.74%),fear of side effects (27.16%) and need for more children (13.58%). The least common reason was lactational amenorrhea (1.23%). CONCLUSION It was seen that 27.9% of the married had unmet need for contraception. [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]

Background: Short inter-pregnancy or birth interval is associated with an increased risk of adverse perinatal outcomes. However, some emerging evidence questions this association and there are also inconsistencies among the existing findings. This study aimed to systematically review the evidence regarding the effect of short inter-pregnancy or birth intervals on adverse perinatal outcomes in the Asia-Pacific region. Methods: A comprehensive search of five databases was conducted targeting studies published between 2000 to 2023. Studies that reported on short inter-pregnancy or birth interval and examined adverse perinatal outcomes, such as low birthweight (LBW) preterm birth (PTB), small for gestational age (SGA), and neonatal mortality were included and appraised for methodological quality using the Joanna Briggs Institute critical appraisal tools. Three reviewers independently screened the studies and performed data extraction. Narrative synthesis and meta-analyses were conducted to summarise the key findings. Results: A total of 41 studies that fulfilled the inclusion criteria were included. A short-interpregnancy interval was associated with an increased risk of low birthweight (odds ratio [OR] = 1.65; 95%CI:1.39, 1.95), preterm birth (OR = 1.50; 95%CI: 1.35, 1.66), and small for gestational age (OR = 1.24; 95%CI:1.09, 1.41). We also found elevated odds of early neonatal mortality (OR = 1.91; 95%CI: 1.11, 3.29) and neonatal mortality (OR = 1.78; 95%CI: 1.25, 2.55) among women with short birth intervals. Conclusion: This review indicates that both short inter-pregnancy and birth interval increased the risk of adverse perinatal outcomes. This underscores the importance of advocating for and implementing strategies to promote optimal pregnancy and birth spacing to reduce the occurrence of adverse perinatal outcomes. Reproductive health policies and programs need to be further strengthened and promote access to comprehensive family planning services and increase awareness about the importance of optimal pregnancy and birth spacing. [ABSTRACT FROM AUTHOR]

Background Objectives Search Strategy Selection Criteria Data Collection and Analysis Main Results Conclusions Maternal health, in terms of pregnancy and childbirth, is an important aspect of women's reproductive health and remains a public health concern in underdeveloped countries of the world. Reproductive health care seeking behavior (RHSB), in both men and women in society, is influenced by a variety of social and environmental factors that needs to be summarized.This review aims to enhance understanding and perception of services in relation to RHSBs in several domains such as antenatal care (ANC), delivery care, postnatal care (PNC), and family planning (FP) services, for married women of reproductive age in Bangladesh.In major databases, for example, Medline, Ovid, PubMed, Web of Science, ProQuest and Google Scholar following keywords, timeline set as 2010 up to December 30, 2022.Articles that included discussion on married women of reproductive age, and their type of care seeking behavior for reproductive health.A systematic literature search was carried out and expected outcome was health care seeking behavior in the aspects of ANC, delivery care, PNC, and FP services. A data extraction form and quality appraisal form were used for data on RHSB of married women of the reproductive age group in Bangladesh and associated factors.A total of 245 articles were retrieved from databases; stepwise screening was done and finally 23 full‐text articles were included for analysis. Descriptive statistics were used based on the included articles for narrative synthesis. In the selected articles, 17 (73.91%) were cross‐sectional studies and more than half discussed both urban and rural women. Ante‐ and postnatal visits have proven to have positively influenced overall RHSB, as seen in Bangladesh. Grass root level workers play a major role in upgrading RHSB in women. Many factors limit rural access to mother and child health services including distance of the health facility and cost of the health service.In particular, education level, women's autonomy in family decision making and distance from health service can be considered as factors influencing RHSBs in Bangladesh. Exposure to mass media and TV watching are likely to positively impact RHSB patterns for women in Bangladesh. [ABSTRACT FROM AUTHOR]

Motherhood under 15 years is constructed as having crossed the line of societal morals and this construction shapes the provision of sexual and reproductive health services (SRH) for mothers under 15 years in Uganda. Using collaborative ethnography and through the lens of discourses and governmentality, I established that adolescent pregnancy is constructed within normative discourses enshrouded in religious and cultural values. What is constructed as non‐normative is regulated through restrictive SRH policies and penalizing discourses which inhibit access to SRH services and care. A paradigm shift in adolescent SRH policies that are rooted in human rights and equity is one alternative required. [ABSTRACT FROM AUTHOR]

Background: Sexually transmitted infections (STIs) are illnesses mainly spread through unprotected sexual activity. There is a scarcity of aggregate evidence in Ethiopia. The aim of this review was to assess the pooled prevalence of STI, and its associated factors among students in Ethiopia to fill the aforementioned gap. Methods: We extensively searched the bibliographic databases of PubMed, Scopus, and Google Scholar to obtain eligible studies. Further screening for a reference list of articles was also done. The Microsoft Excel Spreadsheet was used to extract data, and Stata 17 was used for analysis. The PRISMA-guidline and Newcastle-Ottawa quality assessment scale were used for quality appraisal. To check heterogeneity, the Higgs I2 and Cochran's Q tests were employed. Sensitivity and subgroup analysis were implemented. To detect publication bias, Egger's test and funnel plots were used. Results: The pooled prevalence of STI among students in Ethiopia was 13.6% with a 95% CI (10.2, 17). Findings from sub group analysis based on student category shows that the pooled prevalence of STI were 14.5% among University students, 14.2% among college students and 10.6% among high school students. Having multiple sexual partners (AOR 3.31; 95% CI: 2.40–4.57), not using condoms during sexual intercourse (AOR 2.56; 95% CI: 1.72–3.81), and having poor knowledge about sexually transmitted infections were 3.08 times (AOR 3.08; 95% CI: 1.84–5.15) significantly associated with STI. Conclusion: The pooled prevalence of STIs among students in Ethiopia was high, and factors like having multiple sexual partners, not using condoms during sexual intercourse, and having poor knowledge about sexually transmitted infections were significantly associated with STIs. Hence, reduce STIs among students, strengthening sexual and reproductive health services, raising awareness about transmission and prevention, and promoting consistent condom use through health information dissemination is crucial. Further qualitative studies are suggested to explore the barriers and facilitators of STI prevention. [ABSTRACT FROM AUTHOR]

Introduction: Adolescent girls and young women (AGYW) remain highly vulnerable to the risk of acquiring HIV (Human immunodeficiency virus). This study was conducted to measure behavioral, biomedical and structural outcomes for the Global Fund funded AGYW programmes in five African countries with high burden of HIV including Botswana, Cameroon. Lesotho, Malawi and Namibia. Methods: The study used a mixed methods approach to collect behavioral, structural and biomedical outcome data. Quantitative data were collected through 418 Polling Booth Survey (PBS) sessions from 4,581 AGYWs. Participants were recruited through a community-based multistage sampling technique using sampling weights for urban and rural communities. 23 Focus Group Discussions (FGD) were conducted to understand barriers to use of HIV prevention programme and community recommendations for improved coverage. Ethical approvals were obtained from the ethics review board in all five countries. Results: More than 50% of the respondents from all five countries reported to be sexually active, and at least 30% or more of those who were sexually active had multiple sex partners. There were wide variations between the countries in condom use with a non-marital sexual partner which ranged between 66% in Namibia to 42% in Cameroon. Cameroon (44%) had high percentage of AGYWs with independent income source while school drop-outs were higher in Malawi (55.5%) and Lesotho (46.6%). Nearly 1/4th of AGYWs in all countries, except Namibia, reported experiencing intimate partner violence. Nineteen percent of the respondents were pregnant in the last 12 months, and 50% of those pregnancies were unplanned. Lesotho had the highest proportion of AGYW (90.5%) ever tested for HIV, followed by Malawi (87.5%), Botswana (75%), Cameroon (69%) and Namibia (62.6%). Discussion: There is diversity across the countries, with country-wise and age-wise variations in results. In all countries, the AGYW programme will benefit from a more targeted approach to reach out to the most vulnerable AGYW, strengthening structural interventions, strengthening linkage to PrEP (Pre-Exposure Prophylaxis) and ART (Antiretroviral Therapy) for those who are living with HIV and a strong linkage with reproductive health services. The assessment helped countries to understand the gaps and opportunities to improve the HIV prevention programme with AGYW. [ABSTRACT FROM AUTHOR]

Background: Comprehensive sexual reproductive health (SRH) programs for female sex workers (FSW) offering clinical, behavioural, and structural interventions have contributed to declining rates of HIV in this population. However, data on costs and cost drivers is needed to support programs and their donors to better allocate resources, make an investment case for continued funding, and to identify areas of improvement in program design and implementation. We aimed to estimate the annual per-FSW costs of comprehensive services for a standalone FSW program in Kenya. Methods: We implemented a top–bottom and activity-based costing study of comprehensive FSW services at two drop-in centres (DICs), Mtwapa and Kilifi town, in Kilifi County, Kenya. Service costs were obtained from routinely collected patient data during FSW scheduled and unscheduled visits using Kenyan Ministry of Health records. Costing data were from the program and organization's expenditure reports, cross checked against bank documents and supported by information from in-depth interviews. Data were collected retrospectively for the fiscal year 2019. We obtained approval from the AMREF Research Ethics Committee (AMREF-ESRC P862/2020). Results: In 2019, the unit cost of comprehensive services was 105.93 USD per FSW per year, roughly equivalent to 10,593 Kenya shillings. Costs were higher at Mtwapa DICs compared to Kilifi town DIC; 121.90 USD and 89.90 USD respectively. HIV counselling and testing cost 63.90 USD per person, PrEP was 34.20 USD and family planning was 9.93 USD. Of the total costs, staff salaries accounted for about 60%. Adjusted for inflation, costs in 2024 would be approximately 146.60. Conclusion: Programs should strive to maximize the number of FSW served to benefit from economies of scale. Given that personnel costs contribute most to the unit costs, programs should consider alternative designs which reduce personnel and other costs. [ABSTRACT FROM AUTHOR]

Background: Mental health conditions affect one in seven young people and research suggests that current mental health services are not meeting the needs of most children and youth. Learning health systems are an approach to enhancing services through rapid, routinized cycles of continuous learning and improvement. Patient-reported outcome measures provide a key data source for learning health systems. They have also been shown to improve outcomes for patients when integrated into routine clinical care. However, implementing these measures into health systems is a challenging process. This paper describes a protocol for a formative evaluation of the implementation of patient-reported measures in a newly operational child and adolescent mental health centre in Calgary, Canada. The purpose is to optimize the collection and use of patient-reported outcome measures. Our specific objectives are to assess the implementation progress, identify barriers and facilitators to implementation, and explore patient, caregivers and clinician experiences of using these measures in routine clinical care. Methods: This study is a mixed-methods, formative evaluation using the Consolidated Framework for Implementation Research. Participants include patients and caregivers who have used the centre's services, as well as leadership, clinical and support staff at the centre. Focus groups and semi-structured interviews will be conducted to assess barriers and facilitators to the implementation and sustainability of the use of patient-reported outcome measures, as well as individuals' experiences with using these measures within clinical care. The data generated by the patient-reported measures over the first five months of the centre's operation will be analyzed to understand implementation progress, as well as validity of the chosen measures for the centres' population. Discussion: The findings of this evaluation will help to identify and address the factors that are affecting the successful implementation of patient-reported measures at the centre. They will inform the co-design of strategies to improve implementation with key stakeholders, which include patients, clinical staff, and leadership at the centre. To our knowledge, this is the first study of the implementation of patient-reported outcome measures in child and adolescent mental health services and our findings can be used to enhance future implementation efforts in similar settings. [ABSTRACT FROM AUTHOR]