BMJ Sexual & Reproductive Health最新文献

{"title":"Predictors and prediction models for complications of early medical abortion: a scoping review.","authors":"Angela Dawson, Fantu Mamo Aragaw, Deborah Bateson","doi":"10.1136/bmjsrh-2026-203390","DOIUrl":"https://doi.org/10.1136/bmjsrh-2026-203390","url":null,"abstract":"<p><strong>Background: </strong>Despite its overall safety and efficacy, early medical abortion (EMA) may result in complications. Understanding factors predicting these complications is essential for improving clinical risk assessment by healthcare providers and guiding effective management of complications associated with EMA. The purpose of this scoping review is to systematically map the existing evidence of predictors and prediction models of complications associated with EMA.</p><p><strong>Methods: </strong>We conducted a comprehensive literature search using databases with Embase (OVID), Medline (OVID), Scopus and Web of Science. Studies were included if they presented evidence on the predictors and prediction models of complications associated with EMA. Retrieved articles were screened using Covidence. A descriptive and narrative synthesis of the included studies was conducted to summarise findings across studies.</p><p><strong>Results: </strong>Thirteen studies were included in the final synthesis. Pain, incomplete abortion and retained products of conception, continuing pregnancy, heavy bleeding requiring transfusion and infection were the most frequently addressed complications associated with EMA. Gestational age was identified as a key determinant across major complications of EMA. Two studies included the development of a model to predict surgical intervention following EMA demonstrating moderate discriminatory performance (AUC 63%).</p><p><strong>Conclusions: </strong>This review highlights an evidence gap in the identification of predictors and the development of clinical prediction models for complications associated with EMA. Future research using larger prospective studies is needed to identify the predictors and develop individualised prediction models for assessing the risk of complications in patients undergoing EMA to support evidence-based clinical decision-making in post-abortion care.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early medical abortion in Irish general practice: the Activity Data on Abortion in General Practice (ADAPT) data collection project and telemedicine as routine care.","authors":"Katelin Bratt, Danielle Young, Mary Favier, Patricia Horgan, Catherine Conlon, Mark Murphy","doi":"10.1136/bmjsrh-2026-203296","DOIUrl":"10.1136/bmjsrh-2026-203296","url":null,"abstract":"<p><strong>Background: </strong>Early medical abortion (EMA) in Ireland is delivered through general practitioners (GPs) operating within a nationally standardised, three-visit care protocol. Since 2020, a blended model has emerged in which the initial consultation and follow-up may be conducted by telemedicine, with in-person attendance required for medication administration. We describe the development and implementation of the Activity Data on Abortion in General Practice (ADAPT) data collection tool and present the first GP-level evidence on the integration of telemedicine into Irish GP-delivered EMA.</p><p><strong>Methods: </strong>ADAPT was developed in 2025 by a subcommittee of the Southern Taskforce on Abortion and Reproductive Topics (START) and researchers at Trinity College Dublin to fill a critical void in abortion data collection in Ireland. The tool collects 49 prospective anonymous patient- and practice-level measures. Descriptive, provider-level statistics were reviewed.</p><p><strong>Results: </strong>Between August 2025 and April 2026, 124 GPs expressed interest in ADAPT, 112 signed consent and data-sharing agreements and 64 submitted at least one complete patient record. Of these 64 GPs, 48.4% provided mixed (both remote and in-person) consultation modalities, 32.8% delivered fully in-person care and 18.8% provided fully remote care at Visit 1, with no significant differences by provider characteristics.</p><p><strong>Conclusions: </strong>ADAPT provides the first structured GP-level evidence base for EMA in Ireland. Our early data show that telemedicine is not a marginal or exceptional feature of Irish GP-delivered EMA: the majority of participating GPs offer it in some form.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Privacy, temporal flexibility and connection: how online spaces shape abortion support.","authors":"Rachel Victoria Wilson-Lowe, Carrie Purcell, Ruth Lewis, Lisa McDaid","doi":"10.1136/bmjsrh-2026-203253","DOIUrl":"https://doi.org/10.1136/bmjsrh-2026-203253","url":null,"abstract":"<p><strong>Background: </strong>Online spaces are increasingly used by people seeking support around sexual and reproductive healthcare and can offer anonymity and flexibility. Relatively little is known about how these spaces are used in relation to abortion. This article explores what informal online spaces (eg, social media and discussion forums) offer to those seeking support around abortion, in the face of increasingly digitalised healthcare, persistent abortion stigma and resource constraints on sexual and reproductive health services.</p><p><strong>Methods: </strong>We conducted semi-structured interviews with individuals who had sought abortion-related support online. Twenty-three women, aged 20-54 years, who had undergone abortion and were living in Scotland at the time of the interview were recruited through social media and online advertisements. Data were analysed using reflexive thematic analysis.</p><p><strong>Results: </strong>We identified three principal affordances of online spaces that shaped participants' experiences of accessing support online: (1) privacy-participants chose online spaces based on perceptions of the potential (in)visibility of their interactions with abortion-related content and anonymity; (2) temporal flexibility-support could be sought as and when needed, derived from posts long after they were created; and (3) connection to others with experiential knowledge of abortion-engagement ranged from active interactions to anonymous browsing, with one-way participation providing meaningful support at low social cost.</p><p><strong>Conclusions: </strong>Our findings suggest that online spaces can provide flexible, stigma-sensitive, abortion-affirming support. Those who provide abortion services should consider ways in which trustworthy online spaces can be integrated into existing care pathways to reduce isolation and address unmet social support needs.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescents' motivations for obtaining online medication abortion in the United States: a mixed-methods analysis.","authors":"Dana M Johnson, Doris Huijsmans, Dirk Essink, Rebecca Gomperts","doi":"10.1136/bmjsrh-2026-203347","DOIUrl":"https://doi.org/10.1136/bmjsrh-2026-203347","url":null,"abstract":"<p><strong>Background: </strong>State-level abortion bans, parental involvement laws and structural barriers to abortion care create a complicated landscape for adolescents under 18 years old seeking clinic-based abortion. Because of such obstacles, adolescents may seek medication abortion from online sources. We aimed to understand their individual motivations for obtaining medication abortion from one online telemedicine service instead of in-person clinic-based care.</p><p><strong>Methods: </strong>We conducted a mixed-methods study among adolescents who requested medication abortion between 1 July and 30 November 2022 from a service providing asynchronous clinician consultation and medication dispensed by mail to people in all 50 United States (US) states. We examined demographic characteristics, reasons for request, and conducted a content analysis of a subsample of anonymised email communications.</p><p><strong>Results: </strong>Over a 5-month period, 558 adolescents requested medication. The most frequently selected motivations were: I would rather keep my abortion private (66%); I would be more comfortable at home (64%); I need to keep my treatment a secret from my partner/family (64%); Pills at home are more affordable (47%); I prefer to take care of my own treatment (47%); and I want to have my partner/friend with me (45%). In email communications, adolescents expressed an urgent need for abortion and articulated additional barriers including the high cost of the service and lack of access to credit cards or digital payment methods.</p><p><strong>Conclusions: </strong>Our results provide insights into why adolescents in the US pursue online medication abortion services and raise the need to address cost and payment barriers to telehealth abortion.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of contraception after birth, experience of contraception counselling and structural barriers to access: a mixed-methods survey.","authors":"Eleanor M F Richards, Annette Thwaites, Jennifer Hall","doi":"10.1136/bmjsrh-2026-203315","DOIUrl":"https://doi.org/10.1136/bmjsrh-2026-203315","url":null,"abstract":"<p><strong>Background: </strong>To avoid unplanned, rapid repeat pregnancies, women are recommended to use effective contraception by day 21 postpartum. This study describes postpartum contraception use, impact of contraception counselling, and structural barriers to access from the perspective of doctor-mothers who have knowledge of health systems and high health-literacy.</p><p><strong>Methods: </strong>This is a secondary analysis of a survey which compared postpartum contraception use in women who had conceived spontaneously versus with in vitro fertilisation, using data from doctor-mothers who conceived spontaneously. Contraception use over time is presented as a Sankey plot. Chi-squared or Fisher's exact tests compared contraception effectiveness by sociodemographics and pregnancy planning. Qualitative data on contraception counselling experience were analysed using thematic analysis.</p><p><strong>Results: </strong>Of 634 records, 177 participants were eligible for analysis, with 72 providing qualitative data. Most (146/177, 82.5%) reported vaginal sex post-birth, and 19.8% had had sex within 6 weeks. Only 11.6% (17/146) of sexually active participants used very effective methods as first contraception. Greater contraception effectiveness was associated with earlier initiation (p<0.001). Of sexually active participants who initiated contraception within 3 weeks postpartum, 92.3% (12/13) used effective or very effective methods. Counselling only at place of birth was associated with initiation of effective contraception (p=0.041). Qualitative analysis of counselling experience generated three themes: (1) counselling style, (2) multidisciplinary working and (3) need for self-advocacy.</p><p><strong>Conclusions: </strong>Use of effective postpartum contraception was low overall, despite a highly health-literate population. Counselling at place of birth has a potentially significant impact on the individual. Of those who initiated contraception before 3 weeks, almost all chose effective methods indicating acceptability where available.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal trends and characteristics of medication abortion provision in Australian general practice: a national open-cohort study using MedicineInsight, 2014 to 2021.","authors":"Gizat M Kassie, Danielle Mazza, Kristina Edvardsson, Kirsten Black, Laura Schummers, Wendy V Norman, Luke E Grzeskowiak","doi":"10.1136/bmjsrh-2026-203337","DOIUrl":"https://doi.org/10.1136/bmjsrh-2026-203337","url":null,"abstract":"<p><strong>Objectives: </strong>To examine longitudinal trends in the provision of medication abortion (MA) in Australian general practice.</p><p><strong>Study design: </strong>Retrospective study of Australian females aged 14-49 years attending Australian general practices between 2014 and 2021. Data were sourced from the national general practice dataset, MedicineInsight. We calculated rates of MA provision and reported characteristics of those receiving and providing MA services.</p><p><strong>Results: </strong>We identified 4306 instances of MA provision to 3980 unique individuals. The rate of MA provision increased from 0.11 per 1000 females in 2014/15 to 2.10 per 1000 females in 2020/21. A greater absolute increase in the rate of MA was evident among those aged 25-29 years, those residing in regional areas or those in areas of lower socioeconomic status. The proportion of general practices providing MA increased from 4.4% in 2014 to 22.7% in 2021. The proportion of general practices providing MA was higher among those located outside of major cities and in higher socioeconomic status areas.</p><p><strong>Conclusions: </strong>Despite modest increases in the rates of MA provision in general practice over time, less than one third of general practices provide MA. Significant geographical variation in MA provision is also evident according to remoteness, socioeconomic status and state/territory. The findings emphasise the need for additional initiatives to ensure equitable access to abortion care within the general practice setting, and future research should examine the underlying reasons for differences in MA uptake by patient characteristics and geographical location, informing targeted interventions and service planning.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postpartum contraception priorities for a collaborative network to support informed decision-making and optimise pregnancy planning and spacing.","authors":"Jessica R Botfield, Jenna Perkins, Clare J Boerma, Danielle Mazza, Kirsten I Black","doi":"10.1136/bmjsrh-2026-203379","DOIUrl":"https://doi.org/10.1136/bmjsrh-2026-203379","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical screening care for women living with the impact of sexual violence and abuse: a systematic review.","authors":"Ceryl T Davies, Kalpa Pisavadia, Sion Williams, Deb Fitzsimmons, Helen Weatherly, Rhiannon T Edwards","doi":"10.1136/bmjsrh-2026-203225","DOIUrl":"https://doi.org/10.1136/bmjsrh-2026-203225","url":null,"abstract":"<p><strong>Background: </strong>Cervical cancer is one of the most preventable cancers. Screening uptake may be lower among women affected by sexual violence and abuse (SV&A), although evidence remains mixed. These women face unique barriers to accessing intimate healthcare, reflecting deep-rooted inequities. This systematic review examined how experiences of SV&A influence engagement with cervical screening and identified approaches that improve access to and experiences of screening care for this population.</p><p><strong>Methods: </strong>Medline, Embase, ASSIA, CINAHL, PsycINFO and the Cochrane Library were searched. English-language studies and grey literature published from 2000 onwards exploring barriers and prevalence of cervical screening among women living with the impact of SV&A across OECD (Organisation for Economic Co-operation and Development) countries were included. PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines were used by two independent reviewers to search, screen, data extract, critically appraise and narratively synthesise included studies.</p><p><strong>Results: </strong>30 studies met the inclusion criteria. Three overarching themes were identified: (1) engagement with cervical screening care, (2) influential factors and (3) compassionate care. Practical, emotional and structural barriers influenced attendance, with experiences of SV&A often leading to avoidance of intimate examinations. Compassionate and trauma-informed approaches emphasising trust, communication, choice and control were linked to improved engagement and more positive screening experiences.</p><p><strong>Conclusions: </strong>Understanding barriers to accessing cervical screening care for women who have experienced SV&A can enhance access to intimate screening care. Enhancing care at each stage of the screening process may better respond to women's individual experiences. Further research is needed to explore models of compassionate care and their longer-term impact on quality of life and health outcomes.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148435040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing appointment times for intrauterine device insertion procedures: a post-intervention service review.","authors":"Shingisai Ndoro, Sana Zaman, Esther Okon","doi":"10.1136/bmjsrh-2025-202941","DOIUrl":"10.1136/bmjsrh-2025-202941","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"236-237"},"PeriodicalIF":3.2,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Embedding a culture of research in independent sector abortion services: opportunities and challenges.","authors":"Danielle Perro, Patricia A Lohr","doi":"10.1136/bmjsrh-2025-202860","DOIUrl":"10.1136/bmjsrh-2025-202860","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"238-239"},"PeriodicalIF":3.2,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}