Reproductive Health最新文献

{"title":"Effect of behavioral interventions on contraceptive use among women living with HIV: Systematic review and meta-analysis of randomized controlled trials.","authors":"Michael Deynu, Jerry John Ouner, Sarah A Gutin, Ifeyinwa V Asiodu, Peggy Tahir, Glenn-Milo Santos","doi":"10.1186/s12978-026-02391-0","DOIUrl":"10.1186/s12978-026-02391-0","url":null,"abstract":"<p><strong>Background: </strong>Contraceptive use is a cost-effective public health strategy to prevent unplanned pregnancy, maternal mortality and morbidity, and reduce vertical HIV transmission. However, contraceptive use remains low among women living with HIV. Reviews examining effect of behavioral interventions on contraceptive use among women living with HIV using randomized controlled trials are limited. We evaluated the effect of behavioral interventions on contraceptive use among women living with HIV using randomized controlled trials.</p><p><strong>Methods: </strong>We conducted a systematic literature search across PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov and the Cochrane Central Register of Control Trials from their inception to 09/15/2025. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA-2020) guidelines were followed in conducting this review. Peer reviewed and published randomized controlled trials (RCTs) focusing on behavioral interventions were included. Effect estimates (odds ratios) were pooled using a random-effects model (REM). Quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.</p><p><strong>Results: </strong>The search yielded 853 records. Five trials involving 5903 women living with HIV and published between 2009 and 2021 were included in this review. Across the trials, structured contraceptive counseling was the most common intervention implemented while others included provision of family planning vouchers, client outreaches and education and counseling on safe sex, and social support. Two of the studies were conducted in Uganda, two in Kenya and one in the United States. Two of the studies reported 100% antiretroviral therapy use with mean duration ranging 4.1 years (SD = 3.33) to 7.8 years (SD = 7.1), while one study reported 83.9% viral suppression among their sample. Across the trials, behavioral interventions were significantly associated with greater odds of contraceptive use among women living with HIV with pooled odds ratio, 3.61 (95% CI: 1.15, 11.32), p = 0.04 compared to controls.</p><p><strong>Conclusions: </strong>The findings underscore the efficacy of behavioral interventions in enhancing contraceptive use among women living with HIV. Leveraging behavioral interventions could offer an opportunity to increase contraceptive use and improve the reproductive health outcomes for women living with HIV.</p>","PeriodicalId":20899,"journal":{"name":"Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148318120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burden and determinants of stillbirth in a Nigerian Tertiary health facility: a five-year retrospective cohort analysis.","authors":"Taofik Oluwaseun Ogunkunle, Tajudeen Lanre Ibrahim, Usman Abiola Sanni, Babajide Oyewale Oyebiyi, Adewemimo Charles Olaosebikan, Surajudeen Oyeleke Bello, Khadijah Asabe Jibril, Salihu Ozegya Muhammed, Tina Lavina, Abdulaziz Imam","doi":"10.1186/s12978-026-02397-8","DOIUrl":"10.1186/s12978-026-02397-8","url":null,"abstract":"<p><strong>Background: </strong>Stillbirth rates can reflect the quality of a country's healthcare system for pregnant women. The burden, however, differs across and within countries. Hence, determining the burden and associated factors could provide valuable location-specific insights that could guide interventions.</p><p><strong>Objectives: </strong>To determine the incidence and correlates of stillbirth in a Nigerian Tertiary health facility.</p><p><strong>Methods: </strong>This was a retrospective study of women who delivered in the Dalhatu Araf Specialist Hospital, Lafia, Nasarawa State, Nigeria, between 1st January 2016 and 31st December 2020. Data for the women were extracted from medical records, including sociodemographic data, time of delivery, mode of delivery, and perinatal outcomes. Regression analysis was used to identify predictors of stillbirth.</p><p><strong>Results: </strong>The overall stillbirth rate was 88.30 per 1,000 births (1,033/11,699 per 1,000 births), while the rates from 2016 to 2020 were 93.65, 96.25, 90.98, 82.84, and 80.72, respectively. Multiple gestations are associated with a 2.22-fold higher risk of stillbirth compared to single gestations (AOR: 0.45, 95% CI: 0.30-0.67). Primiparous women were 2.63 times at risk of delivering stillbirths compared to multiparous women (AOR: 0.38, 95% CI: 0.30-0.47) and 1.75 times the risk compared to grand multiparous women (AOR: 0.57, 95% CI: 0.47-0.68). Furthermore, unbooked pregnancy and prematurity were associated with 3.47 (AOR 3.47, 95% CI: 2.99-4.07) and 9.60 (AOR 9.62, 95% CI: 7.99-11.57) times increased odds of stillbirths. Maternal employment status and maternal age showed no significant association with the risk of stillbirth.</p><p><strong>Conclusions: </strong>The stillbirth rate is high and calls for comprehensive intervention. Strengthening antenatal and perinatal care for high-risk groups, including women with multiple gestations, unbooked pregnancies, and premature deliveries, is essential.</p>","PeriodicalId":20899,"journal":{"name":"Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148318827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and associated factors of non-fistulous urinary incontinence among adult women in Bantama, Ghana: a cross-sectional study.","authors":"Andrew Panyin Vormawor, Rex Mawuli Kwadjo Djokoto, Anthony Amanfo Ofori, Samuel Yaw Adu, Kingsley Afreh Nduro, Timothy Adjei, Victor Boachie Owusu, Edward Anabila Agana, Johnny Arthur-Komeh, Opei Adarkwa, Isaac Kofi Adu","doi":"10.1186/s12978-026-02359-0","DOIUrl":"10.1186/s12978-026-02359-0","url":null,"abstract":"<p><strong>Background: </strong>Non-fistulous urinary incontinence (UI) is a common but understudied condition in sub-Saharan Africa, despite its well-documented negative effects on women's quality of life. In Ghana, population-based data on its prevalence, associated factors, and impact remain limited.</p><p><strong>Objective: </strong>To determine the prevalence of non-fistulous UI, identify associated factors, and assess its impact on quality of life among women aged 20-69 years in Bantama, Kumasi, Ghana.</p><p><strong>Methods: </strong>A cross-sectional household survey was conducted among 374 women selected through multistage cluster sampling in the Bantama sub-metropolis. Data were collected using a structured questionnaire incorporating the King's Health Questionnaire (KHQ) to assess UI symptoms and quality-of-life domains. Descriptive statistics and bivariate analyses were performed.</p><p><strong>Results: </strong>Of the 411 women approached, 374 participated (response rate: 91%). The mean age was 45.2 years. The prevalence of UI was 32.9%, indicating that approximately one in three women experienced urine leakage. Most affected women reported leakage occurring once a week or less; however, increasing frequency was significantly associated with greater interference with daily activities (χ² = 13.86, p = 0.0078). UI was significantly associated with older age, obesity (particularly Class I), higher parity, menopausal status, history of hysterectomy, and childbirth weight ≥ 2.6 kg. Educational level was not significantly associated with UI. Urge incontinence was associated with poorer quality of life, particularly in emotional (\"Feeling Bad\") and social (\"Personal Relationships\") domains, with increasing severity linked to greater emotional distress and social strain.</p><p><strong>Conclusion: </strong>Non-fistulous UI is common among adult women in Bantama and is associated with identifiable reproductive and metabolic risk factors, as well as substantial emotional and social quality-of-life impairments. These findings support the need for routine screening and context-specific UI prevention and management strategies within existing women's health services in Ghana, particularly for older, multiparous, and menopausal women.</p>","PeriodicalId":20899,"journal":{"name":"Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148309189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strengthening health systems to reduce adolescent fertility: an analysis of Chile's experience, 2010-2023.","authors":"Matilde Maddaleno, Fernando González, Erika Vivanco, Venkatraman Chandra-Mouli","doi":"10.1186/s12978-026-02383-0","DOIUrl":"10.1186/s12978-026-02383-0","url":null,"abstract":"<p><p>Adolescent pregnancy remains a persistent and inequitable in Latin America. Chile has achieved one of the fastest declines in adolescent fertility in the region, offering insights into how policy and health system responses may accelerate progress.MethodsWe conducted a national descriptive-analytical case study using a mixed-methods approach to examine policies, programs, and health system transformations implemented in Chile between 2010 and 2023. Data sources included administrative data, repeated cross-sectional surveys, policy documents, and scientific literature. The analysis was guided by frameworks on political prioritization and health system building blocks.ResultsAdolescent fertility among girls aged 15-19 declined from 51.6 births per 1,000 in 2010 to 10.6 in 2023 (- 79%). This reduction coincided with sustained political commitment, rights-based health system reforms, and expansion of adolescent-responsive primary care services. Access to contraception-including long-acting methods-increased substantially, alongside improvements in service delivery and health system capacity. Declines occurred alongside persisting and, in some cases, widening socioeconomic inequalities. As a result, marked socioeconomic and territorial inequities in contraceptive uptake persist.ConclusionsChile's experience suggests that rapid declines in adolescent fertility can occur alongside coordinated, rights-based policies and strengthened health systems, particularly with expanded access to contraception. However, causal attribution cannot be established.</p>","PeriodicalId":20899,"journal":{"name":"Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148302739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of patient-reported experience and patient-reported outcome measurement tool for abortion care in Ethiopia: a mixed-method study.","authors":"Negash Wakgari, Stuart J Watson, Gizachew A Tessema, Delayehu Bekele, Zoe Bradfield","doi":"10.1186/s12978-026-02393-y","DOIUrl":"10.1186/s12978-026-02393-y","url":null,"abstract":"<p><strong>Background: </strong>Measuring patient-reported experiences and outcomes of abortion care would enhance access to person-centred and rights-based abortion care. Assessment requires a reliable measurement approach to improve healthcare outcomes and service quality. Worldwide, there are no patient-reported measures to assess abortion care experiences and outcomes from the perspectives of the women accessing this service. This study developed a Patient-Reported Experience Measure (PREM) and Patient-Reported Outcome Measure (PROM) tool for women receiving abortion care services in Ethiopia.</p><p><strong>Methods: </strong>A sequential, exploratory mixed-methods study was conducted to develop the measures through standard tool development approaches. First, item pools were identified via a systematic review exploring experiences and current measures of outcomes of abortion care in sub-Saharan countries, and a qualitative study exploring the lived experience of abortion care pathways in Ethiopia. Second, item pools for experiences and outcomes of abortion care were assessed by a panel of experts in Ethiopia during two modified Delphi rounds. Items were removed if expert consensus or the item-level content validity index (I-CVI) was not achieved (I-CVI < 0.70). Finally, cognitive interviews were conducted with women to assess the relevance of measurement, interpretation, judgment formation, information recall, and response mapping. Qualitative data were analysed using inductive thematic analysis. Quantitative data were analysed descriptively using frequencies and percentages.</p><p><strong>Results: </strong>Overall, 72 items were included in the first round of the modified Delphi study, while 30 items remained in the final tools. Twenty-one items for the PREM and nine items for the PROM were retained. During the second Delphi round, I-CVI ranged between 0.55 and 1. During cognitive interviews, women reported that item instructions, wording, response options, and the recall period were clear and comprehensible. Women also described that the developed tool was relevant, brief, and covered important experiences and outcomes of abortion care.</p><p><strong>Conclusions: </strong>The PREM and PROM tool was developed to assess experiences and outcomes for Ethiopians who access abortion care services. Researchers and healthcare providers can use the new measurements to monitor service quality, and policymakers can use the tool's results to improve women's health. Future research should undertake psychometric validation and assess potential applications worldwide.</p>","PeriodicalId":20899,"journal":{"name":"Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148302773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and risk factors of home delivery among rural women: evidence from 28 African countries.","authors":"Ebenezer Kwesi Armah-Ansah, Deborah Okeke-Obayemi, Sylvester Okeke, Eugene Budu, Charity Oga-Omenka, Edward Kwabena Ameyaw","doi":"10.1186/s12978-026-02386-x","DOIUrl":"10.1186/s12978-026-02386-x","url":null,"abstract":"<p><strong>Background: </strong>Home delivery continues to be a significant factor contributing to maternal mortality in Africa, particularly among rural women with limited access to skilled birth attendants and healthcare facilities. Factors influencing home delivery operate at individual, household, and community levels. Therefore, this study aimed to examine the prevalence and risk factors of home delivery among rural women in 28 African countries.</p><p><strong>Methods: </strong>This retrospective cross-sectional study analyzed the most recent Demographic and Health Surveys (2011-2024) from 28 African countries. The weighted sample included 103,011 rural women of reproductive age. We performed descriptive analysis, chi-square tests, and binary logistic regression. Results are presented as frequencies, percentages, and odds ratios (ORs) with 95% confidence intervals (CIs). Statistical significance was set at p < 0.05.</p><p><strong>Results: </strong>The overall prevalence of home delivery among rural women in Africa was 34.01% [95% CI: 23.33%-35.26%], ranging from 5.91% in Rwanda to 85.19% in Chad. Women with mistimed pregnancy [aOR = 0.79, 95% CI = 0.76-0.82] and those with unwanted pregnancy [aOR = 0.86, 95% CI = 0.81-0.92] had lower odds of home delivery. Risk factors included having four or more births [aOR = 2.04, 95% CI = 1.91-2.17], no/other religion [aOR = 2.41, 95% CI = 2.24-2.56] and those in Central Africa [aOR = 2.09, 95% CI = 1.98-2.19].</p><p><strong>Conclusion: </strong>This research reveals that home delivery remains prevalent among rural women in Africa, with significant between-country disparities. Key risk factors include high parity, no/other religion, and Central African residence. Programs should prioritize multiparous women and expand maternal health services across all religious groups. Additionally, context-specific policies and targeted investments are needed in Central Africa to address regional disparities.</p>","PeriodicalId":20899,"journal":{"name":"Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Couple-based preconception care as a gender-responsive strategy for improving health and well-being: a systematic review.","authors":"Patience Fakornam Doe, Frederick Acheampong Nimo, Edward Odoom, Mildred Awinpiini Asore, Amidu Alhassan, Godswill Sedinam Lanyo, Justice Enock Kagbo, Bernard Nabe, Mustapha Amoadu","doi":"10.1186/s12978-026-02385-y","DOIUrl":"10.1186/s12978-026-02385-y","url":null,"abstract":"<p><strong>Background: </strong>Adverse reproductive outcomes such as infertility, miscarriage, preterm birth, and congenital anomalies remain major public health concerns. Preconception care (PCC) can help address these risks, but most programmes focus mainly on women, leaving men under-involved. Couple-based preconception care (CB-PCC) offers a more inclusive and gender-responsive approach. This review aimed to synthesise global evidence on CB-PCC interventions and their effects on reproductive health outcomes.</p><p><strong>Methods: </strong>A systematic search was conducted in PubMed Central, Scopus, CINAHL, and JSTOR, with additional hand searches. Studies were included if they involved couples or men of reproductive age, delivered PCC interventions before conception, and reported couple-related outcomes. Data were extracted using a structured form and appraised with Joanna Briggs Institute tools. A thematic synthesis was used to summarise findings.</p><p><strong>Results: </strong>Fourteen studies from 10 countries were included, most from high-income settings. CB-PCC interventions covered biomedical, lifestyle, psychosocial, and family planning components. Reported outcomes included improved fertility treatment success, healthier lifestyle habits, reduced psychosocial distress, stronger partner communication, and increased contraceptive uptake. However, studies varied in design, delivery mode, and measurement, limiting direct comparisons.</p><p><strong>Conclusion: </strong>CB-PCC shows promise in promoting shared responsibility and improving preconception health behaviours. However, most evidence comes from high-income countries and heterogeneous study designs. More high-quality research is needed in low- and middle-income settings. Future programmes should adapt CB-PCC to local contexts, promote male engagement, and integrate it into existing health systems to strengthen reproductive health outcomes.</p>","PeriodicalId":20899,"journal":{"name":"Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148278032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of preterm birth and second-trimester loss following intrapartum cesarean sections and uterine extensions: a population-based cohort study.","authors":"Fathima Minisha, Jis Thomas, Feazlin Din, Sadia Mehmood, Dhannya Stanley John, Asma Gul, Salwa Abu Yaqoub, Zeena Bu Shurbak, Nader Aldewik, Megan Hall, Andrew Shennan, Thomas Farrell","doi":"10.1186/s12978-026-02387-w","DOIUrl":"https://doi.org/10.1186/s12978-026-02387-w","url":null,"abstract":"<p><strong>Background: </strong>Preterm birth (PTB) is associated with significant neonatal morbidity and mortality. Antenatal risk assessment is crucial for prevention and management. Recent evidence suggests that cervical injury during cesarean is a potential risk factor. This study aimed to evaluate the impact of intrapartum cesarean, specifically at full cervical dilatation (CSFD), on subsequent second-trimester loss and preterm birth.</p><p><strong>Methods: </strong>Women delivering by their first term cesarean in 2017 were included in this retrospective cohort study, and data on all subsequent pregnancies till 2024 were extracted. They were divided based on the type of cesarean- elective (CS-E) versus cesarean in latent labour (CS-L), cesarean in active labour (CS-A) and CSFD (± uterine extensions). Adjusted risk ratios (aRR) with 95% confidence intervals (CIs) were calculated to evaluate associations with subsequent pregnancy outcomes.</p><p><strong>Results: </strong>Among 984 women, 267 had CS-E, 256 had CS-L, 212 had CS-A and 249 had CSFD. The incidence of spontaneous PTB < 37 weeks was 17.9% in CSFD (3-6% in others; p < 0.001). 26.7% of those who had a cesarean for failed instrumental delivery (FID) had a subsequent sPTB. 10.7% (vs. < 1%) and 12.5% (vs. < 6%) of CSFD with 3-5 cm extension had a second-trimester miscarriage and sPTB < 34 weeks, respectively. CSFD group had a 6.5 times higher risk of sPTB < 37 weeks compared to CS-E (CI 2.47-16.9; p < 0.001); the risk increased to 8.2 times in CSFD with 3-5 cm extensions (CI 2.27-29.5, p = 0.001). For every cm increase in cervical dilatation at the time of the index cesarean, the risk increased by 27% (CI 1.14-1.41;p < 0.001). Cesarean for no descent of head and FID had 5.3 times (CI 2.20-12.8; p < 0.001) and 8.7 times higher risk (CI 2.72-28.0; p < 0.001), respectively.</p><p><strong>Conclusion: </strong>CSFD is associated with a 6.5-fold increase in risk of spontaneous preterm birth. Uterine extension was an important predictor for second-trimester loss and sPTB. Risk assessment for sPTB should potentially include detailed cesarean history, and women with CSFD should potentially be referred to dedicated PTB clinics and offered preventive measures such as serial cervical length assessments, vaginal progesterone and cervical cerclage.</p>","PeriodicalId":20899,"journal":{"name":"Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284261","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":"\"My story is good… It's not like that for all\": Uneven access to contraception among incarcerated women in New South Wales, Australia.","authors":"Helene Smith, Basil Donovan, Jocelyn Jones, Tony Butler, Paul Simpson","doi":"10.1186/s12978-026-02382-1","DOIUrl":"10.1186/s12978-026-02382-1","url":null,"abstract":"<p><strong>Background: </strong>Evidence indicates high levels of unmet contraceptive need among justice-involved women, linked to intersecting vulnerabilities such as housing instability, substance use, violence and poor mental health. In Australia, limited research has explored how women in prison navigate access to family planning services. This study aimed to examine the experiences of incarcerated women in New South Wales (NSW) in accessing contraception and making fertility-related decisions.</p><p><strong>Methods: </strong>The study formed part of the Second Sexual Health and Attitudes of Australian Prisoners (SHAAP-2) study. Seventeen women aged 19-45 were recruited from two NSW correctional centres. Semi-structured qualitative interviews were conducted face-to-face or via video call, recorded, transcribed, and analysed thematically in NVivo14. Coding drew on the Behavioural Model for Vulnerable Populations, supplemented by inductive thematic analysis to capture cross-cutting themes. Content analysis was also applied to describe contraceptive needs.</p><p><strong>Results: </strong>Three overarching findings were identified. First, women's access to contraception was less shaped by mistrust of providers than by system unreliability. While some reported supportive care, many described unanswered requests, long delays, and unsafe practices such as attempting implant removals. Second, incarceration prompted reflection and deliberate fertility planning. Women re-evaluated what it meant to be \"ready\" for motherhood, some seeking to delay pregnancy until achieving stability, others eager to conceive quickly after release, due to a sense of lost time. Third, women's choices were constrained by side-effects and limited method options. Repeated failures with pills, injections, or devices sometimes led women to sterilisation as the \"only certain\" option, though some later regretted this decision.</p><p><strong>Conclusions: </strong>Prisons represent a critical but underutilised setting for meeting reproductive health needs. Despite policy commitments to equivalence of care, contraceptive services in custody remain neglected. Findings highlight the need for stronger structural supports including timely service pathways and effective pre-release planning, to ensure women can access safe, flexible, and non-coercive contraception. Addressing these gaps is essential to upholding reproductive rights and reducing health inequities for incarcerated women.</p>","PeriodicalId":20899,"journal":{"name":"Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148277985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and motivations: analyzing the factors influencing abortion provision by gynecologists in Germany - a cross-sectional study.","authors":"Vanessa Le, Eva Christalle, Mareike Rutenkröger, Jördis Zill, Isabelle Scholl, Anja Lindig","doi":"10.1186/s12978-026-02389-8","DOIUrl":"10.1186/s12978-026-02389-8","url":null,"abstract":"<p><strong>Background: </strong>The influence of factors like attitudes, subjective norms, or perceived behavioral control on physicians' intention to provide abortion care in Germany is not evaluated so far. We applied the Theory of Planned Behavior to analyzes the role of those factors, and compare providers and non-providers to identify possible barriers to abortion provision amongst physicians.</p><p><strong>Methods: </strong>A cross-sectional online survey was conducted between June and November 2024 among office-based gynecologists and abortion providers of all specialties, recruited via cluster sampling. The survey assessed a range of factors influencing the provision of abortion, including attitudes, subjective norms, perceived behavioral control, religiosity, fear of stigmatization, gender and knowledge. Multiple regression analysis tested the TPB model, abortion providers and non-providers were compared via t-tests.</p><p><strong>Results: </strong>N = 213 participants completed the survey. Perceived behavioral control (β = 0.479, p < 0.001) explained the most variance in behavioral intention to provide abortions, followed by subjective norms (β = 0.326, p < 0.001) and attitudes (β = 0.136, p = 0.010). The group comparisons between abortion providers and non-providers revealed that abortion providers showed more positive attitudes towards abortions, stronger perceived subjective norms on providing abortions, higher perceived behavioral control of providing abortions, lower fear of stigmatization, lower religiosity and higher subjective knowledge on abortions and legal regulations than non-providers.</p><p><strong>Conclusions: </strong>Intentions to provide abortion care are influenced by attitudes, subjective norms, and especially perceived behavioral control, indicating a need for targeted interventions addressing those factors to improve intentions to provide abortion care.</p>","PeriodicalId":20899,"journal":{"name":"Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13288800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148278029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}