Frontiers in global women's health最新文献

{"title":"Abdominopelvic hydatid disease during pregnancy: a systematic review of the literature.","authors":"Evangelos Chinis, Kyriakos Tzanakis, George Lockett, Laura Burney Ellis, Stergios Bobotis, Georgios Geropoulos, Maria Kyrgiou, Konstantinos S Kechagias","doi":"10.3389/fgwh.2026.1928979","DOIUrl":"10.3389/fgwh.2026.1928979","url":null,"abstract":"<p><strong>Objective: </strong>To review the available literature on abdominopelvic cystic echinococcosis (CE) during pregnancy, focusing on clinical presentation, diagnostic approaches, management strategies, and maternal and foetal outcomes.</p><p><strong>Methods: </strong>A systematic review was conducted in accordance with PRISMA guidelines. Studies reporting abdominopelvic hydatid disease in pregnant women were included without restrictions on study design or geography.</p><p><strong>Results: </strong>Fifty-one studies (45 case reports and 6 case series) including 79 patients were analysed. The mean maternal age was 28 years (range 15-42). Most patients with reported clinical-presentation data were symptomatic (56/67, 83.6%), commonly presenting with right upper quadrant or nonspecific abdominal pain. Ultrasound was the primary diagnostic modality (50/52, 96.1%), while MRI was used in selected cases. The liver was the most frequently involved site (50/72, 69.4%), followed by pelvic and adnexal locations. Surgical intervention was performed in 38.5% of cases, conservative management in 30.8%, and cyst aspiration in 14.1%. Surgery was often timed during caesarean section or the second trimester. Benzimidazole therapy was administered to 31 patients, most commonly during pregnancy. Caesarean delivery occurred in 43.3% and vaginal delivery in 34.3% of cases. Adverse pregnancy outcomes included miscarriage (4.5%), termination of pregnancy (3.0%), one maternal death (1.5%), and one neonatal death (1.5%). Among the 36 pregnancies with reported gestational age at delivery, 13 (36.1%) resulted in preterm birth.</p><p><strong>Conclusion: </strong>Abdominopelvic CE during pregnancy is rare and clinically challenging, with substantial heterogeneity in presentation and management across the published literature. Given the limited available evidence, management should be individualised within a multidisciplinary team, while prospective international registries are needed to strengthen the evidence base.</p>","PeriodicalId":73087,"journal":{"name":"Frontiers in global women's health","volume":"7 ","pages":"1928979"},"PeriodicalIF":2.4,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding treatment options for syphilis during pregnancy: a review of alternatives to penicillin.","authors":"Claire L Townsend, Lynne Mofenson, Sami Gottlieb, Remco P H Peters, Oriol Mitjà, Clara Pérez-Mañá, Elaine J Abrams, Sinead Delany-Moretlwe, Shahin Lockman, Catriona Waitt, Kathryn Miele, Melanie M Taylor, Françoise Renaud","doi":"10.3389/fgwh.2026.1879243","DOIUrl":"10.3389/fgwh.2026.1879243","url":null,"abstract":"<p><p>Syphilis infection during pregnancy leads to around 390,000 adverse birth outcomes each year and is an important cause of preventable stillbirth. Although benzathine penicillin G is safe and effective during pregnancy for treating maternal and fetal infection, there are frequent global shortages and limited options for people with penicillin allergy. We conducted a review of potential alternatives to penicillin for treating syphilis during pregnancy when penicillin is not available or cannot be used, including ceftriaxone, amoxicillin, doxycycline, cefixime, and linezolid. Despite some efficacy data on their use in non-pregnant adults with syphilis, limited data were available on placental transfer, pharmacokinetics and dosing, efficacy or effectiveness, and safety in pregnancy. Given its favourable preclinical reproductive toxicity data, efficacy data in non-pregnant adults with syphilis, and safety during pregnancy when used for other indications, ceftriaxone could potentially be considered as an alternative treatment for pregnant women with syphilis in cases where penicillin cannot be used, as currently recommended by the World Health Organization. However, evidence about optimal dosing, feasibility, and efficacy/effectiveness for treating syphilis during pregnancy is needed. Several planned and ongoing clinical trials will provide additional data to inform the use of cefixime, amoxicillin, and linezolid in pregnant women with syphilis. Going forward, evaluation of new and existing medications for treating syphilis and preventing congenital syphilis should include a pregnancy investigation plan. Where possible, efforts should be made to ensure that high-quality pregnancy safety and efficacy or effectiveness data on drug candidates are generated in carefully designed studies to ensure that pregnant women and their infants are able to benefit from the full range of treatment options.</p>","PeriodicalId":73087,"journal":{"name":"Frontiers in global women's health","volume":"7 ","pages":"1879243"},"PeriodicalIF":2.4,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recorded gestational violence and neonatal outcomes in a cohort of deliveries requiring neonatal hospitalization: a 15-year hospital-based perinatal registry study.","authors":"Santiago Vasco-Morales, Mercy Rosero-Quintana, Alexandra Amaguaya-Guala, Emily Tamayo-Saenz, Paola Toapanta-Pinta","doi":"10.3389/fgwh.2026.1920014","DOIUrl":"10.3389/fgwh.2026.1920014","url":null,"abstract":"<p><strong>Background: </strong>Gestational violence is incompletely captured in routine perinatal registries, limiting prevalence estimation and etiologic interpretation. We evaluated associations between registry-recorded gestational violence, maternal characteristics, and neonatal outcomes in a selected hospital-based population.</p><p><strong>Methods: </strong>This cross-sectional study included 26,519 delivery records from the Perinatal Information System at a tertiary referral hospital in Quito, Ecuador, from January 2009 to June 2024. Eligibility was restricted to deliveries whose newborns required neonatal hospitalization. Associations were estimated using maximum-likelihood, Firth-penalized, and Bayesian logistic regression. Neonatal analyses examined 12 prespecified outcome-trimester combinations, analyzed as exploratory. Sensitivity analyses addressed behavioral co-exposures, exposure misclassification, informative missingness, calendar time, prior specification, unmeasured confounding, and third-trimester ascertainment opportunity.</p><p><strong>Results: </strong>Gestational violence was recorded in 1.19% of deliveries. The strongest maternal associations were observed for illicit drug use [Bayesian odds ratio [OR], 6.44; 95% credible interval [CrI], 3.78-10.74], passive smoking (OR, 3.56; 95% CrI, 2.62-4.79), and alcohol use (OR, 3.18; 95% CrI, 2.19-4.54). Third-trimester recorded violence showed the most consistent association with preterm birth (OR, 1.325; 95% CrI, 0.956-1.822; E-value, 1.57), corresponding to a risk difference of 6.5 percentage points (95% confidence interval, -0.8-14.2). The estimate weakened when restricted to births ≥34 weeks and when adjusted for calendar-related registry completeness, but increased modestly with adjustment for behavioral markers. These findings should not be interpreted as establishing causal associations.</p><p><strong>Conclusions: </strong>Routine perinatal registry data may be useful for hypothesis generation and for guiding clinical and epidemiologic research until stronger evidence from prospective studies using validated violence-assessment instruments becomes available.</p>","PeriodicalId":73087,"journal":{"name":"Frontiers in global women's health","volume":"7 ","pages":"1920014"},"PeriodicalIF":2.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When choice is not performative: the struggle for agency among women accessing family planning services in Senegal.","authors":"Thais Gonzalez-Capella, Marieme Fall, Mbenoye Ndiaye, Cheikh Issa Diop, Manuela Reveiz, Nour Horanieh, Elizabeth Larson, Beniamino Cislaghi","doi":"10.3389/fgwh.2026.1826792","DOIUrl":"10.3389/fgwh.2026.1826792","url":null,"abstract":"<p><strong>Introduction: </strong>Despite ongoing efforts to improve family planning (FP) counselling as a means of increasing uptake and safeguarding women's sexual and reproductive rights, interactions between FP providers and users continue to play a decisive role in shaping contraceptive decisions. In practice, these encounters may influence method choice in ways that raise questions about the extent of women's reproductive autonomy. Drawing on theoretical perspectives on agency and informed choice, this study examines how women in Senegal navigate counselling and enact agency in FP decision-making.</p><p><strong>Methods: </strong>This qualitative study included 256 participants (130 men and 126 women) from four Senegalese regions: Dakar, Tambacounda, Ziguinchor, and Matam. Data were collected through 116 semi-structured interviews and 16 focus group discussions (8-10 participants per group), using purposive sampling. Discussions explored experiences related to FP service delivery and data were analyzed thematically.</p><p><strong>Results: </strong>Findings suggest that participants perceived some counselling practices as encouraging the adoption of LARCs in ways that limited their ability to make autonomous contraceptive decisions and influenced method choice during client-provider counselling interactions in Senegal. Women described a range of counselling practices from providers, such as presenting the implant as the primary or only available method, selectively emphasizing or omitting side-effects, limiting opportunities for dialogue, or expressing resistance to implant removal. In response to these dynamics, some women reported choosing to withdraw from contraception altogether. Such decisions may reflect constrained circumstances in which exercising agency may come at the expense of women's reproductive intentions and the right to effectively manage the timing and spacing of their own pregnancies.</p><p><strong>Discussion: </strong>Safeguarding freedom of choice, and the ability to act upon that choice is a central but complex objective of FP programming in Francophone West Africa (FWA). Our findings underscore the pressing need for improved policy dialogue and ethical reflection on FP service delivery practices, more focused on women's lived experiences, including their expressions of hesitation, fear, resistance, or withdrawal, which are essential to understanding how agency is enacted in practice and to strengthening rights-based approaches to family planning across contexts.</p><p><strong>Conclusion: </strong>Based on the experience from 256 adult women and men of reproductive age in Senegal, this study demonstrates that method choice unfolds within complex normative and institutional landscapes, where counselling practices can either enable or constrain women's reproductive agency, underscoring the urgent need to strengthen rights-based, autonomy-centered family planning approaches.</p>","PeriodicalId":73087,"journal":{"name":"Frontiers in global women's health","volume":"7 ","pages":"1826792"},"PeriodicalIF":2.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Screening tools for maternal mental health in Africa: a systematic review.","authors":"Joyce Jebet, Irene Mageto, Benard Mutwiri, Abednego Ongeso, Ruth Wagathu, Rose Maina, Denis Munene, Rosemary Kithuci, Peter Gatiti","doi":"10.3389/fgwh.2026.1920751","DOIUrl":"https://doi.org/10.3389/fgwh.2026.1920751","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.3389/fgwh.2026.1763729.].</p>","PeriodicalId":73087,"journal":{"name":"Frontiers in global women's health","volume":"7 ","pages":"1920751"},"PeriodicalIF":2.4,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical wisdom in family planning programming.","authors":"Beniamino Cislaghi, Elizabeth Larson, Eloisa Montt-Maray, Marieme Fall, Lamiah Adamjee, Thais Gonzalez-Capella, Nour Horanieh","doi":"10.3389/fgwh.2026.1779064","DOIUrl":"10.3389/fgwh.2026.1779064","url":null,"abstract":"<p><p>Despite the contemporary intellectual consensus within the family planning (FP) community on the need to implement rights-based interventions, little attention has gone into understanding when, why, and which rights-based interventions are ethically sound. Although we are in a time of increased attention to decolonisation processes on global health, current political climate is shifting the discourse on the need for decolonisation, reproductive justice and rights-based approaches in sexual and reproductive health. Hence, we offer this paper to begin the conversation on what questions can help the design of ethical right-based family planning grants and interventions. We suggest six interconnected principles governing these conversations, which we present separately to look at their specific validity: (1) compassion; (2) vulnerability; (3) voice; (4) authenticity; (5) agency; and (6) equity. Using these principles as a guide, we encourage actors across the family planning community to come together to hold courageous critical conversations on whether the resources invested in family planning interventions go beyond effectiveness to have ethics as the ultimate goal. We hope that the family planning community will build on and expand upon this framework, incorporating it into standards of practice as part of a broader transition toward self-reflection and transparency around intentions and actions.</p>","PeriodicalId":73087,"journal":{"name":"Frontiers in global women's health","volume":"7 ","pages":"1779064"},"PeriodicalIF":2.4,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and preliminary psychometric evaluation of the vaginal douching practice scale.","authors":"İmren Arpacı Kızıldağ, Saliha Yurtçiçek Eren, Feride Yiğit","doi":"10.3389/fgwh.2026.1776421","DOIUrl":"10.3389/fgwh.2026.1776421","url":null,"abstract":"<p><strong>Background: </strong>Vaginal douching remains common in several settings despite its association with adverse reproductive health outcomes. A standardized instrument for assessing how frequently women perform vaginal douching in specific circumstances is lacking.</p><p><strong>Objective: </strong>To develop the Vaginal Douching Practice Scale (VDPS) and examine preliminary evidence for its content validity, factor structure, and reliability among married women.</p><p><strong>Method: </strong>This methodological study included 423 married women aged 18 years and older. An initial 17-item pool was generated from the literature, reviewed for content, and pilot-tested with 50 women. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted sequentially in the same sample; therefore, the CFA was treated as an internal model check rather than an independent confirmation.</p><p><strong>Results: </strong>The mean age of participants was 33.34 ± 8.55 years. The Kaiser-Meyer-Olkin value was 0.959, and Bartlett's test of sphericity was significant (<i>χ</i>2 = 8,750.245, <i>p</i> < 0.001). EFA yielded a one-factor solution explaining 71.89% of the variance, with loadings ranging from 0.694 to 0.920. Internal consistency was very high (Cronbach's alpha = 0.97), split-half reliability was 0.93, and the two-week test-retest correlation in 31 participants was 0.92. CFA loadings ranged from 0.642 to 0.937; however, global model fit was inadequate (<i>χ</i> ²/df = 4.428, GFI = 0.786, RMSEA = 0.123, 90% CI = 0.116-0.131) despite several incremental indices exceeding 0.90. Composite reliability was 0.975 and average variance extracted was 0.694, but these values do not compensate for the poor global fit.</p><p><strong>Conclusion: </strong>The VDPS showed strong internal consistency and promising exploratory evidence; however, the proposed one-factor structure was not adequately supported by CFA. The instrument should be regarded as preliminary and requires item refinement and independent validation before routine clinical or research use.</p>","PeriodicalId":73087,"journal":{"name":"Frontiers in global women's health","volume":"7 ","pages":"1776421"},"PeriodicalIF":2.4,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13538847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endometriosis-associated bone loss: re-evaluating the potential role of systemic inflammation and hypoestrogenic therapies.","authors":"Farzaneh Motafeghi, Marzieh Saei Ghare Naz, Fahimeh Ramezani Tehrani, Samira Behboudi-Gandevani","doi":"10.3389/fgwh.2026.1895443","DOIUrl":"10.3389/fgwh.2026.1895443","url":null,"abstract":"<p><p>Endometriosis is frequently managed with hormonal suppression that can induce hypoestrogenism during a period when many patients are still accruing peak bone mass. This narrative review summarizes current clinical and mechanistic evidence on bone health in endometriosis and its treatments and discusses a preliminary conceptual framework for risk stratification and monitoring. This review discusses two hypothetical converging pathways: (1) an intrinsic pathway in which chronic systemic inflammation may shift bone remodeling toward resorption (via cytokine-mediated effects on osteoclastogenic and Wnt signaling pathways and oxidative stress), and (2) an iatrogenic pathway in which ovarian suppression, most notably with gonadotropin-releasing hormone agonists/antagonists and some progestin-based regimens, reduces estrogen exposure and can lead to measurable short-term bone mineral density loss. Available observational data generally do not show clinically meaningful bone mineral density deficits or excess fracture incidence in untreated endometriosis, but treatment-associated bone mineral density loss is well documented; long-term fracture outcomes and bone-quality measures remain insufficiently studied. We compare the skeletal safety signals across commonly used therapies, discuss the role and limitations of add-back therapy, and highlight when baseline evaluation and follow-up assessment (including consideration of trabecular bone score) may be warranted in higher-risk patients.</p>","PeriodicalId":73087,"journal":{"name":"Frontiers in global women's health","volume":"7 ","pages":"1895443"},"PeriodicalIF":2.4,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of breastfeeding on serological recovery and metabolic homeostasis in postpartum women with celiac disease: a longitudinal study.","authors":"Eva Pilar López García, Mercedes Sánchez-Martínez","doi":"10.3389/fgwh.2026.1888403","DOIUrl":"10.3389/fgwh.2026.1888403","url":null,"abstract":"<p><strong>Objetives: </strong>Pregnancy and the subsequent postpartum period represent a physiological challenge for women with Celiac Disease (CD), often characterized by nutritional depletion and hormonal fluctuations. While the benefits of breastfeeding for the infant are well-established, its impact on maternal CD clinical evolution remains under-researched.</p><p><strong>Objective: </strong>To evaluate the influence of exclusive breastfeeding (EBF) on the normalization of serological markers, iron stores, and bone mineral homeostasis in women with CD.</p><p><strong>Methods: </strong>A prospective longitudinal study was conducted with 255 CD women in Central Spain. Participants were followed from the third trimester of pregnancy (T0) to 12 months postpartum (T2). Parameters included anti-tissue transglutaminase (tTG-IgA) titers, serum ferritin, and bone mineral density (<i>Z</i>-score).</p><p><strong>Results: </strong>At 12 months, the EBF group (<i>n</i> = 160) showed a significantly higher rate of serological remission (92%) compared to the formula-feeding (FF) group (74%, <i>p</i> < 0.001). Mean tTG-IgA levels decreased more rapidly in the EBF group (18.4 ± 4.2 to 2.1 ± 0.8 U/mL). Furthermore, EBF was independently associated with a robust recovery of ferritin stores (42.1 ± 8.2 vs. 31.5 ± 7.1 ng/mL, <i>p</i> = 0.012) and significant improvements in bone <i>Z</i>-scores (+0.8 ± 0.2 deviation).</p><p><strong>Conclusions: </strong>Breastfeeding acts as a beneficial physiological modulator in the celiac mother, accelerating the clearance kinetics of serological markers and promoting a more efficient recovery of metabolic and nutritional homeostasis during the postpartum transition.</p>","PeriodicalId":73087,"journal":{"name":"Frontiers in global women's health","volume":"7 ","pages":"1888403"},"PeriodicalIF":2.4,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13534093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Compounding, not adding: a layered framework for why maternal health programs gain coverage without saving lives.","authors":"Shyamkumar Sriram","doi":"10.3389/fgwh.2026.1908098","DOIUrl":"10.3389/fgwh.2026.1908098","url":null,"abstract":"<p><p>For 30 years, investment in maternal health has delivered rising coverage: more antenatal visits, more skilled attendance, and more births inside facilities. However, survival has not kept pace. Each of the two frameworks that dominate the field explains one half of this issue. The Three Delays Model identifies where along the path to care a woman dies; the social determinants tradition explains why those delays fall where they do. There is no framework that connects the two. This Perspective sets out a framework that does, which I call the Compounding Vulnerability Framework. It is conceptualized as a pyramid: a broad base of structural root causes (poverty, gender inequality, schooling, and geography), a band of social and economic barriers above it, and the three care-seeking delays stacked higher still, narrowing to the apex where a preventable death occurs. The organizing idea is that these disadvantages multiply rather than add. A program that works on one layer alone-particularly the middle and upper layers that throw off visible coverage figures-will raise those figures and leave mortality almost unchanged, because the obstacle simply moves to the next layer left untouched. Read against the documented record of national programs, the evidence is consistent with this expectation. The framework turns the familiar argument about what works into a question about how many layers an investment reaches at once.</p>","PeriodicalId":73087,"journal":{"name":"Frontiers in global women's health","volume":"7 ","pages":"1908098"},"PeriodicalIF":2.4,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}