Reproductive Health最新文献

{"title":"Population-based self-sampling under primary care conditions - a possible approach for cervical cancer screening in Indonesia (IndoCerCa study).","authors":"Supriyatiningsih Wenang, Dianita Sugiyo, Sutantri Sutantri, Lidia Febrianti, Wiwik Kusumawati, Ova Emilia, Muhammad Ary Zucha, Ardhanu Kusumanto, Detty Siti Nurdiati, Mohamad Saifudin Hakim, Faizah Dwi Tirtasari, Boedi Andriani Ontowiryo, Pia Wilkening, Peter Hillemanns, Jörg Haier","doi":"10.1186/s12978-026-02350-9","DOIUrl":"https://doi.org/10.1186/s12978-026-02350-9","url":null,"abstract":"<p><strong>Introduction: </strong>In low- and middle-income countries (LMICs), cervical cancer is a major burden. Screening is mainly based on visual inspection lacking sufficient sensitivity and specificity. For roll-out of colposcopy-based early detection sufficient qualified staff is not available. Several self-sampling device products have been proposed as alternative, but their usability in primary care needs to be proven. Implementation of an HPV-based self-sampling approach in a population-based setting in Indonesia was evaluated.</p><p><strong>Methods: </strong>Four self-sampling devices (2 urine, 2 swab) were applied in a primary care setting covering an entire district in Indonesia with Kulon Progo as pilot region. Cluster randomization was used for comparison of rural and urban areas. HPV-testing was done using standardized and validated PCR-techniques. HPV-positive women and a randomly selected HPV-negative control group underwent colposcopy, PAP smears and biopsies for cervical intraepithelial neoplasia (CIN) validation.</p><p><strong>Results: </strong>In 21 primary care units 2056 women (30-55 y) were recruited. Three devices achieved sufficient technical validation (92.1 - 99.7% DNA detection rate). Participant's test acceptance was 99.1%. HPV-prevalence was 2.6% (urine 2.4%, swab 2.8%). In 29.4% of HPV-positive women high-risk HPV-16/18 were detected. Colposcopy and morphological examination were refused by 3.0% of HPV-positive women and were technically invalid in 5.0%. Pathology revealed Negative for Intraepithelial Lesion or Malignancy (NILM) in 55.8%, CIN I in 25.0% and CIN II + in 3.8%. In the control group CIN I was found in 2.0%. This resulted in a sensitivity of 27.4% for all CIN and 100.0% for CIN II + , with specificities of 98.5% and 97.7%, respectively. The negative predictive values (NPV) were 97.9% and 100.0%, and positive predictive values (PPV) were 34.1% and 4.5%. Regression analysis confirmed high negative predictive impact of HPV-negativity in women > 40 years.</p><p><strong>Conclusions: </strong>Under primary care setting self-sampling-based HPV-testing is accepted. Urine- and swab-based techniques can be applied if the test systems provide technically valid DNA-detection rates. The prevalence was very low and requires further comparison within Indonesia. High NPV of this approach supports its applicability as screening in LMICs. For high-risk lesions PPV is still low suggesting a combination with additional test that are mainly independent from the availability of qualified staff.</p>","PeriodicalId":20899,"journal":{"name":"Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends, regional disparities, and projected burden of anemia among women of reproductive age in Ghana, 2000-2030.","authors":"Abdul-Wahab Inusah, Temple Jagha, Michael G Head, Abdul-Aziz Seidu, Shamsu-Deen Ziblim","doi":"10.1186/s12978-026-02345-6","DOIUrl":"https://doi.org/10.1186/s12978-026-02345-6","url":null,"abstract":"<p><strong>Background: </strong>Anemia remains a significant public health concern among women of reproductive age (WRA) in Ghana, contributing to adverse health and socioeconomic outcomes. Despite national nutrition and malaria control interventions, progress has been modest with persistent regional disparities. This study assessed national and regional trends in anemia prevalence among WRA from 2000 to 2019, quantified regional inequalities, and forecasted national prevalence to 2030 to measure progress toward global reduction targets.</p><p><strong>Methods: </strong>Population-representative estimates of anemia among WRA were obtained from the WHO Health Equity Assessment Toolkit (HEAT) database. National and regional prevalence were analyzed using four inequality measures: difference (D), ratio (R), population attributable risk (PAR), and population attributable fraction (PAF). Time-series forecasting was conducted using an ARIMA (1, 1, 0) model to project prevalence from 2020 to 2030.</p><p><strong>Results: </strong>Anemia prevalence among WRA declined modestly from 47.8% in 2000 to 44.3% in 2019, a 3.5%-point reduction. The Ashanti region recorded the greatest decline (43.3% to 37.3%), while the Upper West region observed the highest increase (41.0% to 45.2%). Regional inequalities widened from 2000 to 2019 across several measures: D (18.1 to 22.2), R (1.5 to 1.6), and PAF (- 16.2 to - 18.4). ARIMA forecasting suggests a plateauing effect, with national prevalence projected to reach 43.6% (95% CI: 40.4-46.9) by 2030.</p><p><strong>Conclusion: </strong>The modest decline in prevalence, coupled with widening regional inequalities and a projected plateau through 2030, indicates that current progress is insufficient to achieve WHO global targets. Addressing these gaps requires geographically targeted, multi-sectoral interventions, such as improving food storage infrastructure and integrating malaria control with nutritional counseling, to accelerate progress and ensure equitable health outcomes for WRA across all regions of Ghana.</p>","PeriodicalId":20899,"journal":{"name":"Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tailored-prom: tailored therapeutic regime in patients with preterm premature rupture of membranes to prolong pregnancy, improve maternal and neonatal outcomes, and reduce antibiotic burden: a randomized controlled trial protocol.","authors":"Karolina Mikova, Anna Jouzova, Zdenek Lastuvka, Klara Jonas, Truong An Nguyen, Jana Termerova, Vaclava Adamkova, Hana Benakova, Jiri Hrdy, Lenka Planickova, Petra Hanulikova, Tereza Lamberska, Richard Plavka, Lukas Hruban, Andrea Stanikova, Jiri Vojtech, Michal Koucky, Martina Borcinova, David Cibula, Katerina Mackova","doi":"10.1186/s12978-026-02353-6","DOIUrl":"https://doi.org/10.1186/s12978-026-02353-6","url":null,"abstract":"<p><strong>Background: </strong>Preterm premature rupture of membranes is a major cause of preterm birth and is associated with substantial maternal and neonatal morbidity. Current management is largely uniform and includes routine administration of antibiotics and antenatal corticosteroids, although a considerable proportion of women do not have infection or inflammation at the time of membrane rupture. This approach may lead to unnecessary exposure to medication and suboptimal timing of treatment. Measurement of interleukin-6 in amniotic fluid is a promising marker of intra-amniotic inflammation and may allow a more individualized management strategy. The aim of this study is to evaluate whether tailored antibiotic and corticosteroid therapy based on interleukin-6 levels in amniotic fluid can prolong pregnancy compared with standard care.</p><p><strong>Methods: </strong>This is a prospective, randomised controlled trial conducted at two tertiary perinatal centres. Pregnant women aged 18 years or older with singleton pregnancies complicated by confirmed preterm premature rupture of membranes between 22 + 0 and 33 + 6 weeks of gestation will be eligible. After providing signed informed consent, participants will be randomised in a 1:1 ratio to tailored management or standard care. In the tailored arm, transabdominal amniocentesis will be performed within 24 h of admission, and subsequent antibiotic and corticosteroid therapy will be guided by the interleukin-6 concentration in amniotic fluid. In the standard care arm, antibiotics and antenatal corticosteroids will be administered at admission according to current guidelines. The primary outcome is pregnancy latency longer than 7 days from membrane rupture to delivery. Secondary outcomes include overall latency to birth, maternal infectious and non-infectious morbidity, and short-term neonatal outcomes. A total of 138 women will be randomised to account for the expected drop-out and non-feasible amniocentesis.</p><p><strong>Discussion: </strong>This trial addresses an important clinical question by testing a personalised approach to the management of preterm premature rupture of membranes. If effective, tailored treatment based on interleukin-6 measurement may prolong pregnancy, reduce unnecessary exposure to antibiotics and corticosteroids, and improve maternal and neonatal outcomes. The results may support a change toward more individualised care in this high-risk obstetric population.</p><p><strong>Trial registration: </strong>EU Clinical Trials Register: 2024-520237-77-00. Registered on 30th March 2025.</p>","PeriodicalId":20899,"journal":{"name":"Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drivers of child marriage in Eastern and Western provinces in Zambia and effective preventive interventions: Findings from a rapid document review and three stakeholder meetings.","authors":"Hannah Kabelka, Joseph M Zulu, Pam Baatsen, Maryse Kok","doi":"10.1186/s12978-026-02327-8","DOIUrl":"https://doi.org/10.1186/s12978-026-02327-8","url":null,"abstract":"<p><strong>Background: </strong>Zambia has one of the highest child marriage rates in the world. Drivers of child marriage are multifaceted, complex and interrelated, firmly embedded in the social and cultural context. This study explored why, despite lower poverty and equal teenage pregnancy levels, child marriage is more prevalent in Eastern than in Western province in Zambia; and mapped effective preventive interventions. This knowledge is vital for informing the development of effective preventive interventions in Eastern Zambia and beyond.</p><p><strong>Methods: </strong>Guided by a conceptual framework on drivers of child marriage by Psaki et al. (2021), this study combined a rapid review of the literature on drivers and preventive interventions concerning child marriage relevant to Zambia with three participatory stakeholder meetings in Zambia to discuss, validate and complement findings.</p><p><strong>Results: </strong>Poverty and lack of opportunity, including low education levels, are among the main drivers of child marriage in Zambia. Influenced by socio-cultural and gender norms and practices, people in the Western and Eastern provinces seem to react differently to teenage pregnancy. In Eastern province, pregnancy is often followed by marriage, while in Western province, a historical high value of education makes more pregnant girls to continue school. Conditional cash transfers to keep girls in school and, to a lesser extent, empowerment interventions emerged as the most effective evidence-informed preventive interventions. Limited acceptability of young people's sexuality and needs for information and services and too little involvement of traditional and religious leaders need further attention to address child marriage in both provinces.</p><p><strong>Conclusion: </strong>Interventions to prevent child marriage in Zambia need to focus on the main drivers of the practice. Norm change around the value of education, conditional cash transfer, working towards increased acceptability of sexual and reproductive health information and services for young people, empowerment interventions and strategic alliances with traditional and religious leaders, can contribute to combat child marriage.</p>","PeriodicalId":20899,"journal":{"name":"Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and type of contraception use among US college students: A needed update.","authors":"Sara B Oswalt, Alyssa M Lederer","doi":"10.1186/s12978-026-02314-z","DOIUrl":"https://doi.org/10.1186/s12978-026-02314-z","url":null,"abstract":"<p><strong>Background: </strong>While rates of unintended pregnancy are declining among adolescents and young adults in the United States (US), rates remain higher than other industrialized nations and are associated with both educational and economic challenges. Studies examining young adult contraceptive practices are dated and limited in scope. Understanding current contraceptive use of young adults is critical to ensure intentional pregnancies.</p><p><strong>Methods: </strong>We used the American College Health Association-National College Health Assessment III 2022-2023 national dataset to examine contraceptive use patterns among 30,568 sexually active 18- to 24-year-old college students at 4-year institutions. Differences based on students' biological sex, race/ethnicity, year in school and number of sexual partners in the last 12 months were examined. Prevalence estimates with confidence intervals were calculated; chi-square tests were used to assess initial bivariate differences and t-tests were used to determine significant pairwise comparisons. Bonferroni correction set the significance level to p<.001219.</p><p><strong>Results: </strong>Most sexually active college students were using contraception (87.6%); however, there were significant differences among students based on demographic characteristics. Black, Latinx, and multiracial students and students with more than one sexual partner in the last 12 months were less likely to use contraception (ps < 0.001). There were also differences in the types of single and dual contraceptive methods used among students based on demographics. Significant differences based on race/ethnicity occurred across all methods and combinations of methods. Results indicated less consistent patterns of differences for sex, year in school, and number of sexual partners for single and dual use.</p><p><strong>Conclusions: </strong>This study provides a critical update on contraceptive use among US college students. The findings indicate which subgroups may be more at risk for an unintended pregnancy due to lower overall contraceptive use and use of methods that are less effective. Differences in race/ethnicity regarding contraceptive use continue to exist, and students with fewer years of education emerged as another essential group deserving attention. Improved awareness of methods and access to birth control are potential strategies to increase uptake. College health professionals and other clinical providers who work with US college students can use these findings to inform discussions with students who may need additional information about all available options.</p>","PeriodicalId":20899,"journal":{"name":"Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The design and use of ACASI to elicit sexual behaviour in the PHASE survey - the Gambian experience.","authors":"Adedapo O Bashorun, Larry Kotei, Ousubie Jawla, Solinda Gomez, Sheikh-Omar Jallow, Nfamara Camara, Mehrab Karim, Mamadou Sk Jallow, Abdoulie F Jallow, Emmanuel U Richard-Ugwuadu, Bai Lamin Dondeh, Ed Clarke","doi":"10.1186/s12978-026-02339-4","DOIUrl":"https://doi.org/10.1186/s12978-026-02339-4","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Collecting reliable sexual behaviour data remains a major challenge in conservative, low-literacy contexts such as The Gambia, where stigma, privacy concerns, and social desirability bias influence responses. The Prevalence of Human Papillomavirus, Antimicrobial resistance, and Sexually transmitted infection Estimation (PHASE) survey sought to address this challenge by introducing Audio Computer-Assisted Self-Interviewing (ACASI) for the first time in The Gambia. This paper documents the design, development, and piloting of the ACASI tool, highlighting key lessons for similar settings in sub-Saharan Africa.A Community Advisory Board (CAB) was central to the tool's development, ensuring cultural sensitivity, acceptability, and linguistic accuracy. CAB members guided the drafting and adaptation of sexual behaviour questions, advised on culturally relevant response categories, and reviewed translations into four local languages (Mandinka, Serahule, Fula, Wolof). They also oversaw the design of non-threatening, familiar images to accompany response options and ensured accurate, context-appropriate audio recordings. Technical implementation was achieved using the SurveyCTO platform, allowing offline use, encryption, and integration of multilingual audio and images. Privacy safeguards were embedded, including screen codes replacing text to prevent disclosure in shared settings and restricted staff access to individual responses.Pilot testing revealed critical operational considerations. Many women lacked prior experience with digital tools and required extra support during the introductory phase. Adjustments included re-recording unclear questions, reordering items to reduce priming effects, and randomising response lists to enhance validity. Additional measures, such as repeating select questions at different points, improved internal consistency checks. Despite these challenges, participants demonstrated increasing confidence with the tool, and CAB feedback confirmed that ACASI was more acceptable for sensitive questions than face-to-face interviewing.Our experience demonstrates that ACASI is a feasible and culturally appropriate method to collect sexual behaviour data in The Gambia, even within low-literacy, conservative populations. The use of familiar images, validated translations, and community engagement enhanced usability, while technical refinements addressed privacy and confidentiality concerns. Key challenges related to computer literacy and dialect variation were addressed through training, piloting, and iterative refinement. This process illustrates that by prioritizing community involvement, technical adaptation, and cultural sensitivity, ACASI offers a promising framework to enhance the acceptability and potentially the accuracy of sexual behaviour reporting in large-scale epidemiological surveys. These lessons can be applied to similar sub-Saharan African contexts seeking to generate high-quality data to inform HPV (human papillo","PeriodicalId":20899,"journal":{"name":"Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abortion care pathways in Addis Ababa healthcare facilities: a qualitative descriptive study.","authors":"Negash Wakgari, Gizachew A Tessema, Stuart J Watson, Delayehu Bekele, Zoe Bradfield","doi":"10.1186/s12978-026-02333-w","DOIUrl":"https://doi.org/10.1186/s12978-026-02333-w","url":null,"abstract":"<p><strong>Background: </strong>Understanding how women navigate induced abortion care pathways is critical to ensuring person-centred, quality reproductive health services. Evidence indicates that persistent abortion stigma, the lack of choices of abortion methods and respectful care during abortion remain a global challenge to reproductive healthcare. Yet there is minimal evidence regarding abortion care pathways. This study explored induced abortion care pathways in Addis Ababa healthcare facilities.</p><p><strong>Methods: </strong>We used a descriptive qualitative approach, adopting purposive sampling techniques to recruit women who sought induced abortion care from seven facilities. The data were collected from May to July 2024. In-depth semi-structured interviews with sixteen women were digitally recorded and transcribed into the local language before being translated into English. Data were coded, organised, and analysed using inductive thematic analysis.</p><p><strong>Results: </strong>Five main themes and their corresponding subthemes were developed through data analysis. Themes were: (i) social and emotional support, (ii) moral and social meanings shaping abortion care, (iii) accessibility and service delivery, (iv) perceived competency of abortion providers, and (v) physical and emotional effects of abortion. Many women attended the clinic alone, without their families, and received no support. Women often sought care at clinics away from their community due to concerns related to fear of stigma and social pressure. This study found long waiting times to receive abortion care, a lack of medicine and ultrasound at some facilities and limited availability of second-trimester abortions. Women reported that many providers were welcoming and competent, while others reported poor communication, the use of medical jargon, and stigmatising behaviours. Participant reported pressure to accept methods they did not want during contraceptive counselling and fear of breaches in privacy and confidentiality. Participants also described physical symptoms such as bleeding and pain, and felt ashamed and upset after the abortion, which could be associated with negative experiences.</p><p><strong>Conclusions: </strong>Inadequate social support, abortion stigma, and barriers to accessing abortion services, such as long waiting times and insufficient resources, were identified as significant gaps. These findings emphasised the need to strengthen person-centred abortion care and address systemic and socio-cultural barriers that undermine the quality of care.</p>","PeriodicalId":20899,"journal":{"name":"Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147820117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intimate partner violence during pregnancy in sub-Saharan Africa: a systematic review and meta-analysis.","authors":"Richard Gyan Aboagye, Husna Razee, Nuworza Kugbey, Blessing Jaka Akombi-Inyang","doi":"10.1186/s12978-026-02293-1","DOIUrl":"https://doi.org/10.1186/s12978-026-02293-1","url":null,"abstract":"<p><strong>Background: </strong>Intimate partner violence (IPV) has health and human rights implications for its victim-survivors. During pregnancy, IPV can be associated with several morbidities, injuries, and mortality among women and their foetuses. Identifying the prevalence and factors associated with IPV during pregnancy is crucial towards developing preventive strategies to curb its occurrence. This review aims to estimate the prevalence of IPV during pregnancy and its associated factors in sub-Saharan Africa.</p><p><strong>Methods: </strong>This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A literature search was conducted in PubMed, Scopus, Web of Science, PsycINFO, Embase, and CINAHL for articles published on IPV experienced during pregnancy in sub-Saharan Africa from January 01, 2011, to May 30, 2025. Grey literature search was also conducted to complement the articles retrieved from the six databases. All the published articles that met the inclusion criteria were included in the final analysis. Stata 18.0 was used for data analysis. Microsoft Excel was utilised for synthesising the factors influencing IPV during pregnancy.</p><p><strong>Results: </strong>A total of 3988 records were retrieved from the six databases and sixteen from grey literature, of which 65 articles were finally included in the study. The pooled prevalence of IPV was 38.1% [95%CI = 33.3-42.9]. The prevalence of physical, sexual, and emotional violence was 15.7% [95%CI = 13.2-18.3], 18.0% [95%CI = 14.6-21.5], and 27.7% [95%CI = 23.6-31.9], respectively. The risk factors for IPV during pregnancy were substance use, unplanned pregnancy, justification of violence against women, exposure to violence during childhood, experience of controlling behaviour, past experience of IPV and marital conflicts, rural residency, and polygyny. Women's empowerment, social support, and education were identified as key factors that reduce women's likelihood of experiencing IPV during pregnancy.</p><p><strong>Conclusion: </strong>Our study highlights the prevalence of IPV during pregnancy in sub-Saharan Africa, emphasising the need for targeted strategies that address key risk factors. It advocates for promoting women's empowerment, improving girls' education, and strengthening legal frameworks to effectively prevent IPV. Ministries of Health across sub-Saharan African countries could integrate routine, confidential IPV screening into antenatal care and ensure immediate access to evidence-based interventions with clear referral pathways to supportive services to prevent further violence.</p>","PeriodicalId":20899,"journal":{"name":"Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147820186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A theory-based educational intervention to change intention of fetal protection among women with unplanned pregnancies: study protocol of a cluster randomized controlled trial.","authors":"Seyedeh Elahe Mousavi, Mojgan Hashemzadeh, Maryam Moridi","doi":"10.1186/s12978-026-02349-2","DOIUrl":"https://doi.org/10.1186/s12978-026-02349-2","url":null,"abstract":"<p><strong>Background: </strong>Unplanned pregnancies are a significant global public health concern, associated with elevated risks of adverse maternal and fetal outcomes, including unsafe abortion, inadequate prenatal care, and psychological distress. Fetal protection, which encompasses proactive health behaviors and safeguards, is a critical but complex goal within this population. Theory-based educational interventions are needed to effectively promote the necessary behavioral intentions.</p><p><strong>Objective: </strong>The main objective of the study is to evaluate the effectiveness of an educational intervention in enhancing fetal protection intentions among women experiencing unplanned pregnancies, utilizing an extended Protection Motivation Theory (PMT) model as its framework.</p><p><strong>Methods: </strong>This study employs a two-arm, parallel-group randomized controlled trial (RCT) design involving 40 women with unplanned pregnancy. The intervention consists of a structured four-session educational program, explicitly mapped onto an extended Protection Motivation Theory (PMT) framework that integrates threat appraisal (perceived susceptibility, severity), coping appraisal (self-efficacy, response efficacy, response costs), and the added constructs of awareness and subjective norms. Data will be collected at three time points: baseline (S0), immediately post-intervention (S1), and 12 weeks' post-intervention (S2), using a demographic questionnaire, the London Measure of Unplanned Pregnancy (LMUP) at S0, and a researcher-developed PMT-based fetal protection intention questionnaire administered at all three time points.</p><p><strong>Conclusion: </strong>This protocol outlines a novel, theory-driven approach to addressing fetal protection in unplanned pregnancies. By targeting the psychological mechanisms of behavior change, the intervention aims to empower women to adopt protective health behaviors. The findings from the subsequent trial will contribute to the evidence based on effective strategies for improving maternal and fetal health outcomes in this vulnerable population.</p>","PeriodicalId":20899,"journal":{"name":"Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protocol of the Temporality, Eating and Metabolic health during PreconceptiOn (TEMPO) study in females with overweight and obesity: a prospective observational cohort nested within a preconception lifestyle intervention program.","authors":"See Ling Loy, Chee Wai Ku, Jun Wei Pek, Yin Bun Cheung, Melvin Khee Shing Leow, Tuck Seng Cheng, Mary Foong-Fong Chong, Keith M Godfrey, Fabian Yap, Jerry Kok Yen Chan","doi":"10.1186/s12978-026-02347-4","DOIUrl":"https://doi.org/10.1186/s12978-026-02347-4","url":null,"abstract":"<p><strong>Introduction: </strong>Human reproduction is tightly regulated by circadian and metabolic signals. However, the extent to which alterations in these systems affect fertility, especially in females with overweight or obesity who are at increased risk of infertility, remains poorly understood. This study, nested within the Healthy Early Life Moments in Singapore (HELMS) integrated lifestyle intervention program, aims to: (i) examine the associations between changes in circadian behavior and metabolic health indicators over a 3-month period and subsequent reproductive outcomes during a year of conception attempts, (ii) identify risk factors associated with these changes, and (iii) elucidate the biological mechanisms underpinning these relationships in females attempting to conceive.</p><p><strong>Methods: </strong>This prospective observational cohort study will enroll 283 females with a BMI of 25-40 kg/m² participating in the HELMS program at KK Women's and Children's Hospital, Singapore. Participants will be followed for one year as they attempt to conceive. At baseline and at the 3-month mark, circadian behavior will be assessed using validated questionnaires, tracking diaries, and digital wearables. Metabolic health will be evaluated through anthropometry, body fat composition, a metabolic syndrome score, and an insulin resistance index. Blood samples will be collected to analyze metabolic biomarkers and gene expression levels. We will use modified Poisson regression models to examine associations with the clinical pregnancy rate (primary outcome) and discrete-time proportional hazards models to estimate associations with fecundability (secondary outcome) within one year of conception attempts.</p><p><strong>Discussion: </strong>This study is pivotal for identifying potential novel modifiable risk factors to address low fertility rates. Insights from this research will generate hypotheses for interventions designed to enhance preconception care. By screening and managing circadian behaviors and metabolic profiles among females with overweight and obesity, these strategies may benefit those experiencing unexplained infertility. Ultimately, this approach could foster a shift towards a more holistic and patient-centered model of reproductive healthcare.</p>","PeriodicalId":20899,"journal":{"name":"Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147820164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}