BMJ Sexual & Reproductive Health最新文献

{"title":"Shifting discourses, changing interests? How the language of sexual and reproductive health has evolved in the past 50 years.","authors":"Aideen O'Shaughnessy, Carrie Purcell","doi":"10.1136/bmjsrh-2024-202456","DOIUrl":"https://doi.org/10.1136/bmjsrh-2024-202456","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614958","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":"Attitudes towards the regulation and provision of abortion among healthcare professionals in Britain: cross-sectional survey data from the SACHA Study.","authors":"Kaye Wellings, Rachel H Scott, Sally Sheldon, Ona McCarthy, Melissa J Palmer, Jill Shawe, Rebecca Meiksin, Maria Lewandowska, Sharon T Cameron, Jennifer Reiter, Rebecca S French","doi":"10.1136/bmjsrh-2024-202353","DOIUrl":"https://doi.org/10.1136/bmjsrh-2024-202353","url":null,"abstract":"<p><strong>Objectives: </strong>To gather views of healthcare professionals on the regulation and provision of abortion in Britain.</p><p><strong>Methods: </strong>Cross-sectional, stratified cluster sample survey of healthcare professionals working in a range of healthcare services including abortion services. Measures included knowledge of and attitudes towards the regulation and provision of abortion.</p><p><strong>Results: </strong>A total of 771 healthcare professionals responded. More than nine in ten supported abortion being a woman's choice and a clear majority favoured abortion being treated as a health rather than a legal issue. Some 6.2% saw abortion at any gestational age as contrary to personal beliefs and a similarly small minority (6.7%) opposed abortion after 12 weeks' gestation. One in five of all healthcare professionals and a third of those aged under 30 years were unaware that the law in Britain requires two doctors to authorise an abortion. Free-text comments revealed opposition to the need for this legal requirement. Support for an extended role for nurses in abortion care was high; 65.3% agreed that nurses should be able to prescribe abortion medication. Little more than a third of all healthcare professionals (37.0%) agreed that abortion should be standard practice in their service; the proportion was highest among those in sexual and reproductive health services (58.4%) and lowest among those in general practice (18.7%).</p><p><strong>Conclusions: </strong>Healthcare professionals in Britain were generally supportive of abortion being treated in the same way as other health issues and would be likely to support any moves to decriminalise abortion.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582081","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":"\"That's not how abortions happen\": a qualitative study exploring how young adults navigate abortion misinformation in the post-Roe era.","authors":"Jennifer N John, Allie Westley, Paul D Blumenthal, Lee M Sanders","doi":"10.1136/bmjsrh-2024-202498","DOIUrl":"https://doi.org/10.1136/bmjsrh-2024-202498","url":null,"abstract":"<p><strong>Background: </strong>Misinformation about abortion is widespread and was exacerbated by the overturn of <i>Roe v Wade</i>. Young adults are among those facing the most direct impacts of new abortion restrictions and are more likely to access health information from online sources, where misinformation is prevalent. We explored how young adults perceive and evaluate abortion-related information in a time of heightened abortion restrictions.</p><p><strong>Methods: </strong>We conducted in-depth, semi-structured interviews with 25 young adults (aged 18-24 years, 56% assigned female at birth), recruited across 17 US states (44% living in states with restrictive abortion policies), between June and September 2022. We derived themes from the interviews using reflexive thematic analysis.</p><p><strong>Results: </strong>While many participants were aware of and had personally encountered abortion misinformation, their susceptibility to false claims varied substantially based on their previous knowledge of abortion and exposure to anti-abortion rhetoric. Participants tended to reject some common myths regarding the medical risks of abortion (eg, association with breast cancer), while expressing a wider range of views regarding its impacts on fertility and mental health. When presented with contradictory sources of abortion information, most participants were unable to confidently reject the misleading source. Knowledge gaps left participants vulnerable to misinformation, while prior scepticism of anti-abortion rhetoric protected participants against misinformation.</p><p><strong>Conclusions: </strong>In this diverse national sample, young adults demonstrated a range of perceptions of abortion misinformation and approaches to identify it. These results lay the groundwork for future observational and experimental research in public health communication.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582080","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":"Reported side effects from hormonal contraceptives among those seeking abortion care versus contraceptive services.","authors":"Karoliina Jaskari, Aydin Tekay, Tuire Helene Saloranta, Riina Korjamo, Oskari Heikinheimo, Frida Gyllenberg","doi":"10.1136/bmjsrh-2024-202442","DOIUrl":"https://doi.org/10.1136/bmjsrh-2024-202442","url":null,"abstract":"<p><strong>Introduction: </strong>We aim to describe and compare the prevalence of subjective side effects associated with hormonal contraceptive use among reproductive healthcare users seeking either abortion care or contraceptive services.</p><p><strong>Methods: </strong>This substudy derives from a previously reported cross-sectional survey involving 1006 users of public reproductive healthcare services in the Helsinki metropolitan area in Finland. We included all 813 respondents with a history of hormonal contraceptive use (mean age 27 years, IQR 24-33 for abortion care; 24 years, IQR 19-30 for contraceptive services). The study followed STROBE guidelines.</p><p><strong>Results: </strong>Altogether 400 respondents sought abortion care, while 413 sought contraceptive services (counselling, prescription renewal, symptoms and/or dissatisfaction with their contraceptive method). Combined oral contraceptives and progestin-only pills were the most used methods in both groups. Respondents seeking abortion care reported contraception-associated weight changes, sex-related problems, mood changes, and acne more frequently than those seeking contraceptive services (p-value<0.05 for all). Some 52% of respondents seeking abortion care reported mood changes compared with 29% of those seeking contraceptive services, with a crude OR of 2.7 (95% CI 2.00 to 3.57). After adjustment, the OR for reporting mood changes among respondents seeking abortion care was 1.5 (95% CI 1.05 to 2.23).</p><p><strong>Conclusions: </strong>Mood changes associated with hormonal contraceptive use were the most frequently reported side effect among all respondents. These findings suggest a need for individualised counselling on mood-related side effects as mood changes may contribute to higher discontinuation rates.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543792","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":"The post-Roe potential of mifepristone and misoprostol in the United States.","authors":"Dana M Johnson","doi":"10.1136/bmjsrh-2024-202603","DOIUrl":"https://doi.org/10.1136/bmjsrh-2024-202603","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543793","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":"Effectiveness of the etonogestrel subdermal implant in users with overweight and obesity: a systematic literature review.","authors":"Daisuke Goto, John W Grunden, Moritz Klinghardt, Vanessa Perez Patel, Sophia von Stockum, Clare Barnett, Johannes Bitzer","doi":"10.1136/bmjsrh-2024-202424","DOIUrl":"https://doi.org/10.1136/bmjsrh-2024-202424","url":null,"abstract":"<p><strong>Background: </strong>The etonogestrel (ENG) subdermal implant is considered a well-tolerated and effective contraception option to avoid unintended pregnancies. However, it is unclear whether being affected by overweight or obesity diminishes the effectiveness of the implant.</p><p><strong>Objectives: </strong>To systematically assess the published evidence on implant contraceptive effectiveness in women with overweight or obesity, and in women who underwent bariatric surgery.</p><p><strong>Search strategy: </strong>A systematic search of MEDLINE and Embase for publications reporting implant effectiveness since 2011.</p><p><strong>Selection criteria: </strong>Primary publications of randomised and non-randomised trials, observational studies and case reports were included.</p><p><strong>Data collection and analysis: </strong>Two independent reviewers identified the Pearl Index, qualitative descriptions of contraceptive failure, implant exposure and potential bias, and assessed overall quality of evidence.</p><p><strong>Main results: </strong>We found 12 publications meeting our criteria, consisting of nine observational studies and three case reports. Excluding case reports, the publications reported Pearl Indices from 0.0/100 women-years (WY) to 0.23/100WY for women with overweight and obesity, respectively. No studies met the eligibility criteria for the post-bariatric surgery population.</p><p><strong>Conclusions: </strong>Observed implant effectiveness in women with overweight and obesity falls within the range of published data across all weight groups (0.0-1.4/100 WY) and does not suggest a reduced effectiveness associated with higher body mass index. Large, well-controlled studies designed to specifically assess the effectiveness of the ENG implant with respect to user weight, particularly in women following bariatric surgery, are warranted.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495371","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":"Undergraduate midwifery contraception training in England and Wales.","authors":"Gillian Matthews, Claire Cousins, Lesley Regan, Edward Mullins","doi":"10.1136/bmjsrh-2024-202461","DOIUrl":"https://doi.org/10.1136/bmjsrh-2024-202461","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142458417","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":"Nurse practitioner medication abortion providers in Canada: results from a national survey.","authors":"Emma Stirling-Cameron, Andrea Carson, Abdul-Fatawu Abdulai, Ruth Martin-Misener, Regina Renner, Madeleine Ennis, Wendy V Norman","doi":"10.1136/bmjsrh-2024-202379","DOIUrl":"https://doi.org/10.1136/bmjsrh-2024-202379","url":null,"abstract":"<p><strong>Background: </strong>In 2017, nurse practitioners (NPs) became the first non-physician healthcare providers authorised to independently provide medication abortion (MA) in Canada. We aimed to report on demographic and clinical characteristics of NPs providing mifepristone/misoprostol MA in Canada and to identify context-specific barriers and enablers to NP provision of mifepristone/misoprostol MA in Canada among MA providers and non-providers.</p><p><strong>Methods: </strong>From August 2020 to February 2021, we invited Canadian NPs to complete a national, web-based, bilingual (English/French) survey. The survey was distributed through national and provincial nursing associations and national abortion health professional organisations. We collected demographic and clinical care characteristics and present descriptive statistics and bivariate analyses to compare the experiences of NP providers and non-providers of MA.</p><p><strong>Results: </strong>The 181 respondents represented all Canadian provinces and territories. Sixty-five NPs (36%) had provided MA at the time of the survey and 116 (64%) had not. Nearly half (47%) of respondents worked in rural or remote communities and 81% in primary care clinics. Significant barriers impacting non-providers' abilities to provide MA included limited proximity to a pharmacy that dispensed mifepristone/misoprostol, few experienced abortion providers in their community of practice, poor access to procedural abortion services, policy restrictions in NPs' places of employment, and no access to clinical mentorship. Some 98% of NPs providing MA services had never encountered anti-choice protest activity.</p><p><strong>Conclusions: </strong>NPs appear prepared and able to provide MA, yet barriers remain, particularly for NPs in smaller, lower-resourced communities. Our findings inform the development of supports for NPs in this new practice to improve abortion access in Canada.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142458416","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":"Home use of mifepristone for medical abortion: a systematic review.","authors":"Kristina Gemzell-Danielsson, Ingela Lindh, Jan Brynhildsen, Anna Christensson, Klas Moberg, Emma Wernersson, Susanne Johansson","doi":"10.1136/bmjsrh-2024-202302","DOIUrl":"10.1136/bmjsrh-2024-202302","url":null,"abstract":"<p><strong>Background: </strong>In many countries, persons seeking medical abortion with mifepristone followed by misoprostol can self-administer the second drug, misoprostol, at home, but self-administration of the first drug, mifepristone, is not allowed to the same extent.</p><p><strong>Objectives: </strong>This systematic review aims to evaluate whether the efficacy, safety and women's satisfaction with abortion treatment are affected when mifepristone is self-administered at home instead of in a clinic.</p><p><strong>Search strategy: </strong>A literature search covered CINAHL, Cochrane Library, Embase, Ovid MEDLINE and APA PsycInfo in October 2022.</p><p><strong>Selection criteria: </strong>Eligible studies focused on persons undergoing medical abortion comparing home and in-clinic mifepristone intake. Outcomes included abortion effectiveness, compliance, acceptability, and practical consequences for women.</p><p><strong>Data collection and analysis: </strong>Two reviewers independently assessed eligibility and risk of bias. Meta-analysis included similar studies while those differing in design were synthesised without meta-analysis.</p><p><strong>Results: </strong>Six studies (54 233 women) of medical abortions up to 10 weeks were included. One randomised controlled trial and one retrospective register study had moderate risk of bias, and four non-randomised clinical trials where women could choose the place for intake of mifepristone had serious risk of bias. There was no difference in abortion effectiveness (high confidence) or compliance (moderate confidence) between mifepristone administered at home or in-clinic. No differences in complications were detected between groups and most women who chose home administration of mifepristone expressed a preference for this approach.</p><p><strong>Conclusions: </strong>Our systematic review demonstrates that the effectiveness of medical abortion is comparable regardless of mifepristone administration and intake, at home or in the clinic.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388139","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":"Interconnections between unintended pregnancy, alcohol and other drug use, and pregnancy, birth, infant, childhood and socioeconomic outcomes: a scoping review.","authors":"Kelly A McNamara, Bridin Murnion, Penelope Fotheringham, Mishka Terplan, Nicholas Lintzeris, Ju Lee Oei, Diana M Bond, Natasha Nassar, Kirsten I Black","doi":"10.1136/bmjsrh-2023-202140","DOIUrl":"10.1136/bmjsrh-2023-202140","url":null,"abstract":"<p><strong>Background: </strong>Unintended pregnancy (UIP) and substance use disorder share underlying root causes with similar impacts for women and their offspring in pregnancy, birth and beyond. Furthermore, intoxication with alcohol and other drugs (AOD) increases the risk of UIP.</p><p><strong>Objectives: </strong>To assess the available evidence on associations between UIP and health, social and economic outcomes, in women who use AOD.</p><p><strong>Search strategy: </strong>The review utilised the Joanna Briggs Institute Methodology for Scoping Reviews and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. The search was conducted across multiple databases, including Scopus and Medline, and limited to studies published between January 2000 to June 2023.</p><p><strong>Selection criteria: </strong>Studies reporting on interactions between AOD use and UIP, and pregnancy, birth, infant, childhood, social or economic outcomes. All patterns and types of AOD use, except isolated use of tobacco, were included. Studies were available in English and conducted in high-income countries.</p><p><strong>Data collection and analysis: </strong>Selected articles were reviewed, and data collected by two independent reviewers using a standardised data extraction sheet. Findings were summarised and reported descriptively.</p><p><strong>Main results: </strong>A total of 2536 titles and abstracts were screened, 97 full texts were reviewed, and three studies were selected for inclusion in the scoping review. There was heterogeneity in types and patterns of AOD use, differences in study design and tools to assess pregnancy intention, and each focused on disparate outcomes. No study assessed or reported on birth outcomes.</p><p><strong>Conclusion: </strong>There is a paucity of data examining the intersection between AOD use and UIP and further research is needed.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"285-293"},"PeriodicalIF":3.4,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140109219","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}