Sexual and Reproductive Health Matters最新文献

{"title":"An assessment of facility readiness for comprehensive abortion care in 12 districts of Pakistan using the WHO Service Availability and Readiness Assessment tool.","authors":"Palitha Gunarathna Mahipala, Sabeen Afzal, Qudsia Uzma, Atiya Aabroo, Nilmini Hemachandra, Katy Footman, Heidi Bart Johnston, Bela Ganatra, Tahira Ezra Reza, Ahsan Maqbool Ahmad, Hasan Bin Hamza, Maida Umar, Kauser Hanif, Sayema Awais, Mariyam Sarfraz, Ellen Thom","doi":"10.1080/26410397.2023.2178265","DOIUrl":"10.1080/26410397.2023.2178265","url":null,"abstract":"<p><p>Although Pakistan's Essential Package of Health Services was recently updated to include therapeutic and post-abortion care, little is known about current health facility readiness for these services. This study assessed the availability of comprehensive abortion care, and readiness of health facilities to deliver these services, within the public sector in 12 districts of Pakistan. A facility inventory was completed in 2020-2021 using the WHO Service Availability and Readiness Assessment, with a newly developed abortion module. A composite readiness indicator was developed based on national clinical guidelines and previous studies. Just 8.4% of facilities reported offering therapeutic abortion, while 14.3% offered post-abortion care. Misoprostol (75.2%) was the most common method provided by facilities that offer therapeutic abortion, followed by vacuum aspiration (60.7%) and dilatation and curettage (D&C) (59%). Few facilities had all the readiness components required to deliver pharmacological or surgical therapeutic abortion, or post-abortion care (<1%), but readiness was higher in tertiary (22.2%) facilities. Readiness scores were lowest for \"guidelines and personnel\" (4.1%), and slightly higher for medicines and products (14.3-17.1%), equipment (16.3%) and laboratory services (7.4%). This assessment highlights the potential to increase the availability of comprehensive abortion care in Pakistan, particularly in primary care and in rural areas, to improve the readiness of health facilities to deliver these services, and to phase out non-recommended methods of abortion (D&C). The study also demonstrates the feasibility and utility of adding an abortion module to routine health facility assessments, which can inform efforts to strengthen sexual and reproductive health and rights.</p>","PeriodicalId":37074,"journal":{"name":"Sexual and Reproductive Health Matters","volume":"31 1","pages":"2178265"},"PeriodicalIF":3.3,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e1/da/ZRHM_31_2178265.PMC10013260.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9761325","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":"Reaching young people living with HIV & AIDS and young people in detention with comprehensive sexuality education (CSE): a preparatory formative study in Ghana.","authors":"Joshua Amo-Adjei, Adwoa Yenyi, Brian Ahanotu, Joshua Okyere","doi":"10.1080/26410397.2023.2235801","DOIUrl":"10.1080/26410397.2023.2235801","url":null,"abstract":"<p><p>As an interface between health and education, comprehensive sexuality education (CSE) offers a potent tool among other interventions to accelerate healthy transition of adolescents into adulthood. With increasing interest in in-school CSE provision/delivery, young people in out-of-school contexts may be left behind. This study forms part of implementation research to understand if the activities used to train and support the facilitators are feasible, appropriate, acceptable, and effective in enabling them to engage a defined group of young people, deliver CSE to them in the out-of-school context, and assist them in obtaining relevant services. This paper presents findings of mapping of out-of-school CSE interventions in Ghana, ongoing or completed between 2015 and 2020, and then discusses a needs assessment of two purposively selected groups of vulnerable out-of-school youth: young people living with HIV and AIDS (YPLHIV) and those living in detention (YPiD). We conducted 10 interviews with YPLHIV and three focus group discussions with YPiD in November 2020. Qualitative data were analysed thematically using both deductive and inductive approaches. The mapping yielded 29 interventions (18/62% were ongoing) focused extensively on the delivery of CSE-related knowledge and information; none were aimed at building facilitators' capacity and most targeted the northern regions. Among YPLHIV, living positively after diagnosis, disclosure skills and use of HIV/AIDS health services were critical. YpID sought clarification on personal hygiene, consent in sexual relationships, medium/channel to deliver CSE, and issues around same-sex sexual intercourse. Both groups sought skills in dealing with stigmatisation and discrimination. Implications of the findings for our own and other interventions are highlighted.</p>","PeriodicalId":37074,"journal":{"name":"Sexual and Reproductive Health Matters","volume":"31 2","pages":"2235801"},"PeriodicalIF":6.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/91/ae/ZRHM_31_2235801.PMC10373617.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9876890","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":"Exploring the effect of early menarche on sexual violence among adolescent girls and young women in southeastern Ghana: a longitudinal mediation analysis.","authors":"Mobolaji Ibitoye, Marni Sommer, Leslie L Davidson, Theo G M Sandfort","doi":"10.1080/26410397.2023.2244271","DOIUrl":"10.1080/26410397.2023.2244271","url":null,"abstract":"<p><p>Research from several high-income countries links early menarche with an increased risk for sexual violence. However, the role of early menarche in adolescent girls' and young women's sexual violence risk in sub-Saharan Africa, where sexual violence rates are high, is not well understood. The current study explores the association between early menarche and sexual violence in Ghana with secondary analysis of data collected from 700 adolescent girls and young women followed over three years. Logistic regressions were used to assess the cross-sectional association between early menarche and sexual violence. Generalised estimating equations were used to assess whether the association between early menarche and sexual violence persisted over time. Inverse odds weighting was used to test potential mediators of the association between early menarche and sexual violence. Sexual violence was fairly common in the study sample, with 27% reporting having experienced sexual violence at baseline, and approximately 50% at year three. Early menarche was associated with 72% greater odds of having experienced sexual violence at baseline (95% confidence interval: 1.01-2.93). However, the odds ratio attenuated and lost significance over the three-year study period, with a lower risk of sexual violence among girls with early menarche at year three. Neither child marriage nor early sexual initiation significantly mediated the association between early menarche and sexual violence. The findings suggest that early-maturing girls may be particularly vulnerable to sexual violence in early adolescence, thus necessitating prevention interventions around the time of menarche to reduce the risk for sexual violence.</p>","PeriodicalId":37074,"journal":{"name":"Sexual and Reproductive Health Matters","volume":"31 1","pages":"2244271"},"PeriodicalIF":3.3,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/be/07/ZRHM_31_2244271.PMC10478596.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10167828","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":"\"To give life is a journey through the unknown\": an ethnographic account of childbirth experiences and practices in Southern Benin.","authors":"Armelle Akouavi Vigan,&nbsp;Jean-Paul Dossou,&nbsp;Christelle Boyi,&nbsp;Lydie Kanhonou,&nbsp;Lenka Benova,&nbsp;Thérèse Delvaux,&nbsp;Charlotte Gryseels","doi":"10.1080/26410397.2023.2258478","DOIUrl":"10.1080/26410397.2023.2258478","url":null,"abstract":"<p><p>In Benin maternal mortality remains high at 397 deaths per 100,000 live births, despite 80% of births being attended by skilled birth attendants in health facilities. To identify childbirth practices that potentially contribute to this trend, an ethnographic study was conducted on the use of biomedical and alternative health services along the continuum of maternal care in Allada, Benin. Data collection techniques included in-depth interviews (<i>N</i> = 83), informal interviews (<i>N</i> = 86), observations (<i>N</i> = 32) and group discussions (<i>N</i> = 3). Informants included biomedical, spiritual and alternative care providers and community members with a variety of socioeconomic and religious profiles. In Southern Benin alternative and spiritual care, inspired by the Vodoun, Christian or Muslim religions, is commonly used in addition to biomedical care. As childbirth is perceived as a \"risky journey to the unknown\", these care modalities aim to protect the mother and child from malevolent spirits, facilitate the birth and limit postpartum complications using herbal decoctions and spiritual rites and rituals. These practices are based on mystical interpretations of childbirth that result in the need for additional care during facility-based childbirth. Because such complementary care is not foreseen in health facilities, facility-based childbirth is initiated only at an advanced stage of labour or at the onset of a perceived immediate life-threatening complication for the mother or baby. Programmes and policies to reduce maternal mortality in Benin must seek synergies with alternative providers and practices and consider the complementary and integrated use of alternative and spiritual care practices that are not harmful.</p>","PeriodicalId":37074,"journal":{"name":"Sexual and Reproductive Health Matters","volume":"31 1","pages":"2258478"},"PeriodicalIF":6.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fa/dc/ZRHM_31_2258478.PMC10563624.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41161296","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":"The influence of gender-equitable attitudes on sexual behaviour among unmarried adolescents in rural Tanzania: a longitudinal study.","authors":"Kate Rogers,&nbsp;Meghna Ranganathan,&nbsp;Lusajo Kajula,&nbsp;R Lorraine Collins,&nbsp;Jennifer A Livingston,&nbsp;Tia Palermo","doi":"10.1080/26410397.2023.2260169","DOIUrl":"10.1080/26410397.2023.2260169","url":null,"abstract":"<p><strong>Plain language statement: </strong>Gender norms that centre men and disadvantage women create gender inequality, which can lead to risky sexual behaviour. This study examined how both community and individual attitudes toward gender norms influenced risky sexual behaviour in adolescents, and whether that influence was different between males and females. We found that higher gender-equitable attitudes were linked to increased odds of HIV testing in the last 12 months, and decreased odds of engaging in a sexual relationship with a much older partner. Individual high gender-equitable attitudes among girls were also linked to higher odds of them using condoms and contraceptives. Gender-equitable attitudes did not seem to influence early sexual debut, engagement in transactional sex, having multiple sexual partners at the same time, or the number of sexual partners a participant had in the last 12 months. Based on these findings, programming designed to increase gender-equitable attitudes might be helpful in increasing HIV testing and condom and contraceptive use, but it needs to involve the entire community, not just individual boys and girls.</p>","PeriodicalId":37074,"journal":{"name":"Sexual and Reproductive Health Matters","volume":"31 1","pages":"2260169"},"PeriodicalIF":6.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a9/de/ZRHM_31_2260169.PMC10586071.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41239542","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":"Balancing client preferences and population-level goals: a qualitative study of the ways in which public health providers and facility administrators interpret and incentivise quality of care in contraceptive counselling in Ethiopia, Mexico and India.","authors":"Lauren Suchman, Janelli Vallin, Ximena Quintero Veloz, Lakhwani Kanchan, Ewenat Gebrehanna, Bella Uttekar, Reiley Reed, Lorena Santos, Kelsey Holt","doi":"10.1080/26410397.2023.2229220","DOIUrl":"10.1080/26410397.2023.2229220","url":null,"abstract":"<p><p>Recent work in family planning has shifted from an instrumentalist perspective on quality in contraceptive counselling, which views quality as a means to encourage contraceptive uptake, to privilege quality of care as a valued end in itself. In this context of shifting narratives about quality, it is important to understand how health systems and providers navigate potential conflicts between instrumentalist definitions of quality versus a person-centred definition that considers meeting clients' contraceptive needs and preferences as an important end goal in and of itself. However, we know little about how providers and other health system stakeholders interpret the concept of quality in counselling, and how their experiences with different quality monitoring systems influence their ability to provide person-centred care. This qualitative study draws from 51 in-depth interviews with public healthcare providers and health facility administrators in Ethiopia, Mexico and India. Across all three countries, except for some cases in India, administrators were concerned with encouraging uptake of contraceptives in order to meet local and national level goals on contraceptive uptake and maternal health. In contrast, providers were more concerned with responding to client desires and needs. However, participants across all levels shared the opinion that successful counselling should end with contraceptive uptake. We conclude that the instrumentalist view of quality counselling continues to prevail across all three countries. Our findings suggest that encouraging healthcare providers and administrators to meet even relatively broad targets set by government reinforces an instrumentalist approach, as opposed to an approach that privileges person-centred care.</p>","PeriodicalId":37074,"journal":{"name":"Sexual and Reproductive Health Matters","volume":"31 1","pages":"2229220"},"PeriodicalIF":3.3,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1d/c3/ZRHM_31_2229220.PMC10364555.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9867090","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":"Forgotten by donors: a call to action by persons with disabilities to resource disability justice within sexual and reproductive health rights funding.","authors":"Lisa Adams","doi":"10.1080/26410397.2023.2261688","DOIUrl":"10.1080/26410397.2023.2261688","url":null,"abstract":"","PeriodicalId":37074,"journal":{"name":"Sexual and Reproductive Health Matters","volume":"31 3","pages":"2261688"},"PeriodicalIF":6.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10653688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71486977","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":"Does girls' empowerment predict contraceptive intentions? Evidence from a survey of secondary school girls in Northwest Nigeria.","authors":"Angubeen G Khan, Paula Tavrow, Fatima Adamu","doi":"10.1080/26410397.2022.2146034","DOIUrl":"10.1080/26410397.2022.2146034","url":null,"abstract":"<p><p>In sub-Saharan Africa, women's empowerment has been linked to contraceptive use, but little is known about whether girls' empowerment affects contraceptive intentions, particularly in more traditional societies where early marriage and childbearing are common. Drawing on a survey of 240 secondary school students in Kebbi State, Northwest Nigeria, in September-November 2018, we examined whether dimensions of girls' empowerment (academic self-mastery, perceived career feasibility, progressive gender norms, and marriage autonomy) and family planning indicators (knowledge, desired family size) were associated with future intentions to use family planning. We found that half of the girls had no intention to use contraception, and only one-fourth intended to use contraception for both delaying/spacing and stopping pregnancies. Multivariate analysis revealed that one dimension of empowerment (perceived career feasibility) and family planning knowledge were significantly associated with intentions. These results suggest that girls perceive contraceptive use as risky, and require contraceptive knowledge and an anticipated career to overcome their trepidation. To increase girls' intentions to use contraceptives, it is vital that they receive comprehensive sexuality education and career counselling.</p>","PeriodicalId":37074,"journal":{"name":"Sexual and Reproductive Health Matters","volume":"31 1","pages":"2146034"},"PeriodicalIF":3.3,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10013444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9120472","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":"Assessing acceptability and effectiveness of a pleasure-oriented sexual and reproductive health chatbot in Kenya: an exploratory mixed-methods study.","authors":"Julius Njogu, Grace Jaworski, Christine Oduor, Aarons Chea, Alison Malmqvist, Claire W Rothschild","doi":"10.1080/26410397.2023.2269008","DOIUrl":"10.1080/26410397.2023.2269008","url":null,"abstract":"<p><p>Integrating pleasure may be a successful strategy for reaching young people with sexual and reproductive health and rights (SRHR) interventions. However, sexual pleasure-related programming and research remains sparse. We aimed to assess chatbot acceptability and describe changes in SRHR attitudes and behaviours among Kenyan young adults engaging with a pleasure-oriented SRHR chatbot. We used an exploratory mixed-methods study design. Between November 2021 and January 2022, participants completed a self-administered online questionnaire before and after chatbot engagement. In-depth phone interviews were conducted among a select group of participants after their initial chatbot engagement. Quantitative data were analysed using paired analyses and interviews were analysed using thematic content analysis. Of 301 baseline participants, 38% (115/301) completed the endline survey, with no measured baseline differences between participants who did and did not complete the endline survey. In-depth interviews were conducted among 41 participants. We observed higher satisfaction at endline vs. baseline on reported ability to exercise sexual rights (<i>P ≤ 0.01</i>), confidence discussing contraception (<i>P ≤ 0.02</i>) and sexual feelings/needs (<i>P ≤ 0.001</i>) with their sexual partner(s). Qualitative interviews indicated that most participants valued the chatbot as a confidential and free-of-judgment source of trustworthy \"on-demand\" SRHR information. Participants reported improvements in sex-positive communication with partners and safer sex practices due to new learnings from the chatbot. We observed increases in SRHR empowerment among young Kenyans after engagement with the chatbot. Integrating sexual pleasure into traditional SRHR content delivered through digital tools is a promising strategy to advance positive SRHR attitudes and practices among youth.</p>","PeriodicalId":37074,"journal":{"name":"Sexual and Reproductive Health Matters","volume":"31 4","pages":"2269008"},"PeriodicalIF":6.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11003647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138048101","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":"<i>Tírala Plena</i>: findings from the formative research to inform the initiative \"Reaching those most left behind through comprehensive sexuality education for out-of-school young people\" in Colombia.","authors":"Jair Vega Casanova, Johanna Blanco, Natalia Buitrago Rovira, Diana Matilde Pulido Jaramillo, Karen Adrians Pacheco, Alma Virginia Camacho-Hubner","doi":"10.1080/26410397.2023.2267202","DOIUrl":"10.1080/26410397.2023.2267202","url":null,"abstract":"<p><p>This paper presents the results of formative research conducted from January to June 2020 in the Department of Atlántico, Caribbean region of Colombia, whose findings were used as inputs to design the national strategy for comprehensive sexuality education (CSE) outside school - <i>Tírala Plena</i> - including its curriculum. This is within the framework of the multi-country project coordinated by UNFPA and WHO aimed at generating evidence on the role of facilitators in the delivery of CSE in non-school contexts. The research was carried out in four municipalities in northern Colombia, in rural and marginal urban contexts with conditions of vulnerability for the adolescent population, including a strong presence of migrant populations from Venezuela. A total of 150 male and female adolescents ages 10-17 participated in the formative research. Workshops such as patchwork quilt, body mapping and talking maps were used as methods to gather information. The groups were divided by sex and age (10-13 years old and 14-17 years old). Knowledge, attitudes and social norms regarding adolescent pregnancy, sexually transmitted infections, including human immunodeficiency virus, and gender-based violence, were identified in adolescents (schooled and not schooled, but with minimal or no access to CSE). All of the above enabled us to establish a set of recommendations for the strengthening of the CSE strategy <i>Tírala plena</i>.</p>","PeriodicalId":37074,"journal":{"name":"Sexual and Reproductive Health Matters","volume":"31 2","pages":"2267202"},"PeriodicalIF":6.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10776069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138048104","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}