BMJ Sexual & Reproductive Health最新文献

{"title":"Experiences of abortion in the UK Armed Forces: a cross-sectional survey.","authors":"Victoria Elizabeth Kinkaid, Ruth Guest, Antony Willman, Kate King","doi":"10.1136/bmjsrh-2024-202513","DOIUrl":"https://doi.org/10.1136/bmjsrh-2024-202513","url":null,"abstract":"<p><strong>Background: </strong>Abortion is a common pregnancy outcome; in the UK one in three women will have an abortion by age 45 years. Despite women making up 11.7% of the UK Armed Forces (UKAF), anecdotal voices from patient groups and clinicians highlight their gender-specific health needs not being addressed by the UKAF. There is a worldwide absence of literature and policy on abortion care in the AF, including rates and experiences. This survey addresses the paucity of data on abortion experiences in UK servicewomen to ensure the UKAF is providing the best possible care for them.</p><p><strong>Methods: </strong>A REDCap survey was circulated among UK servicewomen via email and social media networks, and snowball distribution was utilised to widen participation. Quantitative data were used for descriptive statistics and qualitative data were analysed iteratively by the authors, with regular meetings to agree on themes.</p><p><strong>Results: </strong>A total of 427 servicewomen responded: 124 (29%) declared they previously had an abortion, with 102 (23.9%) being in service. Twelve (11.8%) of these abortions were required when on deployment. Four key themes emerged: 'Trust in information holders', 'Influencers, barriers and access', 'Systemic lack of awareness' and 'Life in the military'.</p><p><strong>Conclusions: </strong>This is the first study to collect data on UK servicewomen's experience around abortion care, and highlights a complex interplay of factors which may influence abortion care decisions. Stigma and judgement were pervasive threads running through all themes, negatively impacting UKAF women. Evidence-based policies and information on abortion are recommended for both servicepeople and healthcare professionals to facilitate access to abortion and begin to destigmatise it in the AF.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499301","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 before missed menses: a prospective observational study of outcomes of abortion at less than 30 days from last menstrual period.","authors":"Elizabeth April Wheate, John Joseph Reynolds-Wright, Sharon T Cameron","doi":"10.1136/bmjsrh-2024-202534","DOIUrl":"https://doi.org/10.1136/bmjsrh-2024-202534","url":null,"abstract":"<p><strong>Introduction: </strong>High-sensitivity urine pregnancy tests can detect pregnancy before missed menses. The widespread availability of these tests, alongside improvements in abortion access in many settings, may mean more women present for abortion at a very early stage of pregnancy. We aimed to examine the outcome of early medical abortion (EMA) in pregnancies less than 30 days from last menstrual period (LMP).</p><p><strong>Methods: </strong>This study analysed prospectively collected data on patients at less than 30 days from LMP seeking abortion at a single service in Edinburgh, UK between March 2020 and December 2023. We determined the effectiveness, outcomes of the pregnancy (complete abortion, ongoing pregnancy, incomplete abortion) and serious complications among those seeking EMA at this gestation.</p><p><strong>Results: </strong>Of 13 565 patients seeking abortion, 78 (0.6%) presented with a self-reported positive home pregnancy test and less than 30 days from LMP. Some 63/78 patients (81%) proceeded to EMA with mifepristone followed by misoprostol. Of this group, 31/63 (49%) had a pre-abortion ultrasound. Complete abortion occurred in 58/63 (92%, 95% CI 82% to 97%), 4/63 (6%) had an ongoing pregnancy and 1 (1%) had a surgical evacuation for incomplete abortion. There were no serious complications.</p><p><strong>Conclusions: </strong>Only a very small percentage of patients present for abortion before a missed period. Nevertheless, EMA at this stage is safe and effective. There may be a higher rate of ongoing pregnancy, and so those patients wishing to proceed to EMA should be advised of the importance of confirming success in line with local protocols.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482228","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":"Understanding patient experiences during gynaecological procedures: a qualitative exploratory study.","authors":"Deepti Divya Gopisetty, India Rogers-Shepp, Elisa Padron, Megha Shankar, Kate A Shaw","doi":"10.1136/bmjsrh-2024-202588","DOIUrl":"https://doi.org/10.1136/bmjsrh-2024-202588","url":null,"abstract":"<p><strong>Background: </strong>Pain with gynaecological clinic-based procedures is common and undertreated. Prior research has focused on interventions for reducing pain and anxiety with analgesics, yet there remain gaps in understanding the myriad of facilitators and barriers to a person's positive experience. We aimed to start to address these gaps by exploring factors that influence a person's experience during gynaecological procedures beyond quantitative measures of pain.</p><p><strong>Methods: </strong>A qualitative thematic analysis approach was used for this exploratory study. Through convenience sampling, we recruited 15 participants with gynaecological procedural experience with intrauterine device (IUD) insertions, surgical abortions, colposcopies and/or endometrial biopsies. We conducted in-depth, semi-structured 1:1 interviews that explored participants' experience of the procedure. We then used a mixed inductive and deductive approach for development of a codebook and thematic analysis based on the Person-Centered Care Framework for Reproductive Health Equity (PCFRHE).</p><p><strong>Results: </strong>Four themes fundamental to understanding how patients process procedural experiences were identified: (1) Balancing preparation and anxiety, (2) Variable rapport with clinicians, (3) Self-advocacy and autonomy and (4) Clinician responsiveness to pain.</p><p><strong>Conclusions: </strong>Person-centred care in an inclusive, trauma-responsive environment is essential for improving gynaecological procedural experience. Ensuring patient access to pre- and post-visit information and offering multiple options to increase comfort are tangible actions clinicians can take to improve patient experience. This study underscores the importance of person-centred care in gynaecological procedures, emphasising better preprocedural education and support.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405676","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":"Understanding women from ethnic minorities' perspectives about contraception in the UK: a qualitative study using a participatory action research approach with community research link workers.","authors":"Emma Linton, Rebecca L Mawson, Ryan James Cory, Richard Ma, Kate Fryer, Habiba Aminu, Aaishah Aslam, Fatima Nasiru Nabage, Sheila Daley, Caroline Anne Mitchell","doi":"10.1136/bmjsrh-2024-202522","DOIUrl":"https://doi.org/10.1136/bmjsrh-2024-202522","url":null,"abstract":"<p><strong>Background: </strong>Contraception has revolutionised women's health, enabling planned pregnancies and improved outcomes for mothers and babies. However, disparities exist in rates of unintended pregnancies and contraceptive uptake among ethnic groups. The reasons for this are poorly understood.</p><p><strong>Objective: </strong>To understand women from ethnic minorities' perspectives about contraception.</p><p><strong>Methods: </strong>Our qualitative study used a participatory action research approach, utilising community research link workers. Public engagement was embedded in the study's conception. We used focus groups and interviews to elicit perspectives, then analysed the data using thematic analysis. The study participants were women who self-identified as being from an ethnic minority group in Sheffield, UK.</p><p><strong>Results: </strong>Thirty-six women participated in four focus groups and five interviews. Thematic analysis revealed four themes: (1) The role of contraception in a woman's life, (2) External influencers, (3) Cultural and religious considerations and (4) Everyone is different (individuality). Contraceptive needs should be considered holistically, rather than with a siloed, targeted approach. 'External influencers', such as partners, family and communities, determine how contraception is accessed and experienced. 'Cultural considerations', such as personal, sociocultural and religious factors specific to women from ethnic minorities, influence contraceptive choice.</p><p><strong>Conclusions: </strong>This study provides a transcultural perspective of the issues at play when a woman from an ethnic minority makes a decision about contraception. Practitioners and health providers must be culturally competent and tailor consultations and services to the individual.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398128","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":"Reusable menstrual hygiene products may lead to underdiagnosis of heavy menstrual bleeding: a randomised trial.","authors":"Bethany Samuelson Bannow, Katrina Ramsey, Katherine Courchaine, Alison Edelman, Alyssa C Colwill","doi":"10.1136/bmjsrh-2024-202541","DOIUrl":"10.1136/bmjsrh-2024-202541","url":null,"abstract":"<p><strong>Background: </strong>Clinical diagnosis of heavy menstrual bleeding (HMB) is dependent on patient report of menstrual product usage of pads and tampons, but it is unknown if newer reusable menstrual products (cup and underwear) are similarly diagnostic.</p><p><strong>Methods: </strong>We enrolled 20 regularly menstruating individuals with HMB for two menstrual cycles. Participants completed a retrospective baseline Pictorial Blood loss Assessment Chart (PBAC) at the time of enrolment (eligibility PBAC score ≥100) as well as several different measures with each study cycle. In cycle 1, participants used study-provided disposable pads and tampons. For cycle 2, participants were randomised to menstrual cup or underwear and collected their menstrual fluid on their heaviest 2 days. We compared the two cycles with respect to the weight of menstrual fluid collected and the frequency of product changes and leaks during the heaviest days in cycles 1 and 2, as well as questionnaire responses.</p><p><strong>Results: </strong>Overall, the mean rate of product changes per heaviest day were 5.5 disposable product changes (range 1.5-11), 3.6 cup changes (range 1.3-6.2), and 3.5 underwear changes (range 2.7-6.9). Both groups (cup users and underwear users) reported a median 3.5 leaks (range 1-5) per heaviest day in cycle 2, while using the menstrual cup or underwear.</p><p><strong>Discussion: </strong>Participants reported fewer daily changes of reusable products compared with disposable ones, but more leaks, suggesting that 'rate of product change' with reusable products may result in missed diagnoses of HMB.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944886","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":"Lifestyle risk reduction engagement during interconception: a qualitative descriptive study of women's preferences.","authors":"Sharon James, Sarah E Ratcliffe, Anisa Rojanapenkul Assifi, Jessica Botfield, Kirsten Black, Mark Hanson, Danielle Mazza","doi":"10.1136/bmjsrh-2024-202518","DOIUrl":"https://doi.org/10.1136/bmjsrh-2024-202518","url":null,"abstract":"<p><strong>Background: </strong>Prevention and self-management of lifestyle risks can reduce non-communicable disease risks and improve the health of mothers and their children. We explored Australian women's preferences for lifestyle risk reduction engagement during the interconception period.</p><p><strong>Methods: </strong>We conducted a qualitative descriptive interview study between February and May 2022. Women and people who have been pregnant and intended to have more children were recruited. We asked participants about their preferences for lifestyle risk reduction between pregnancies. Following reflexive thematic analysis, we conceptualised findings using the COM-B system.</p><p><strong>Results: </strong>Among 17 participants, most had given birth to one child and intended to have another child in 1 to 2 years. Our analysis found that most described lifestyle risk reduction engagement through nutrition and exercise, informed by personal experiences and their health goals for a future pregnancy/child. Key attributes affecting engagement in lifestyle risk reduction activities included their feasibility and practicality, habits and routines, motivation, pregnancy planning, and the source and quality of information. Participants' capacity and capability to engage in lifestyles supportive of interconception health were varied and influenced by juggling the routines of work, finances, health and evolving caring responsibilities. Community-based influences, including the availability of recreational infrastructure, the level of support provided by partners/family/peers and culture, also influenced participants' engagement in lifestyle risk reduction activities.</p><p><strong>Conclusions: </strong>For lifestyles that encourage interconception health, maximising participants' capability and opportunities required motivation and access to infrastructure supportive of healthy meal options and exercise, health services and community networks.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073894","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":"Response to the letter: 'Sexual and reproductive health clinical consultations: preconception care' by Chingara <i>et al</i>.","authors":"Amy Hough, Jayne Kavanagh, Neha Pathak","doi":"10.1136/bmjsrh-2025-202733","DOIUrl":"https://doi.org/10.1136/bmjsrh-2025-202733","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063907","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":"Abortion skills and workforce 50 years on: an ageing workforce in need of rejuvenation.","authors":"Edgar Kennedy Dorman","doi":"10.1136/bmjsrh-2024-202559","DOIUrl":"10.1136/bmjsrh-2024-202559","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909301","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":"Comment on 'Sexual and reproductive health clinical consultations: preconception care'.","authors":"Olivia Chingara, Andrea Woolner, Susan Logan","doi":"10.1136/bmjsrh-2024-202685","DOIUrl":"https://doi.org/10.1136/bmjsrh-2024-202685","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027970","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":"Fifty years of epidemiological research on the cardiovascular and cancer risks of hormonal contraception.","authors":"Lisa Iversen, Philip Hannaford","doi":"10.1136/bmjsrh-2024-202414","DOIUrl":"https://doi.org/10.1136/bmjsrh-2024-202414","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027971","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}