BMJ Sexual & Reproductive Health最新文献

{"title":"Pharmacy dispensing of abortion pills in Ghana: experiences of pharmacy workers and users.","authors":"Mercy Nana Akua Otsin,&nbsp;Kirsten Black,&nbsp;Leesa Hooker,&nbsp;Angela J Taft","doi":"10.1136/bmjsrh-2022-201674","DOIUrl":"10.1136/bmjsrh-2022-201674","url":null,"abstract":"<p><strong>Background: </strong>Self-managed medical abortions are generally safe; however, pharmacy provision of abortion pills is against the Ghanaian abortion law. Nevertheless, evidence shows increasing numbers of women use it. An understanding of the influence of the law on pharmacies dispensing abortifacients and women who needed hospital care after using these pills is lacking. This study aimed to address this gap.</p><p><strong>Methods: </strong>We conducted 26 interviews with eight pharmacy workers and 18 women who sought hospital care after using abortion pills. Study participants were recruited from private pharmacies and hospitals within the Ashanti Region of Ghana between June 2017 and March 2018. We employed phenomenology in analysing the data.</p><p><strong>Results: </strong>Results show that criminalising medical abortion care from pharmacies does not stop abortions but rather drives it to be provided without oversight. It also denied pharmacy workers formal training in medical abortion care, resulting in situations where they failed to provide correct dosage information, used their discretion in determining the price of abortifacients and to whom they would dispense the pills. For women, it contributed to limited interaction with providers and an inability to insist on their rights even in instances where the pills were sold at exorbitant prices.</p><p><strong>Conclusions: </strong>Due to the increasing numbers of Ghanaian women using medical abortion pills from pharmacies, although it is illegal, the ideal would be for medical abortion pills to be made legally available through pharmacies. Given that this may not occur in the short term, an immediate solution would be to upskill pharmacy workers.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"254-259"},"PeriodicalIF":3.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9164101","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":"Improving postpregnancy contraceptive method choice and long-acting reversible contraception provision in Botswana: a quality improvement pilot.","authors":"G Justus Hofmeyr,&nbsp;Rebecca Jane Ryan,&nbsp;Aamirah Mussa,&nbsp;Bame Bame,&nbsp;Sifelani Malima,&nbsp;Thabo Moloi,&nbsp;Rebecca Luckett,&nbsp;Ndiwo B Memo,&nbsp;Badani Moreri-Ntshabele,&nbsp;Mercy Nkuba Nassali,&nbsp;Modimowame Jamieson,&nbsp;Kyungu M Kime,&nbsp;Chelsea Morroni","doi":"10.1136/bmjsrh-2022-201748","DOIUrl":"10.1136/bmjsrh-2022-201748","url":null,"abstract":"© Author(s) (or their employer(s)) 2023. No commercial reuse. See rights and permissions. Published by BMJ. WHY WAS CHANGE NEEDED? The most impactful and costeffective strategy to reduce maternal and perinatal mortality is to enable women to avoid unintended pregnancy. Provision of immediate postpartum contraception, promoted by the WHO, can avert more than 30% of maternal deaths and 10% of child mortality. In Botswana, the maternal mortality ratio is 166.3 deaths per 100 000 live births, unsafe abortion is consistently in the top three contributors to maternal mortality, over 40% of pregnancies are unintended, and the adolescent birth rate is 44.7 per 1000 women; multiple indicators which demonstrate high unmet need for contraception. Preventing unintended pregnancy in women living with HIV confers additional benefits in terms of optimising healthy pregnancies and reducing vertical HIV transmission. Longacting reversible contraception (LARC), that is, the copper intrauterine device (IUD), the hormonal intrauterine system (IUS) and the progestogenonly implant, are recommended by the WHO as the most effective contraceptive methods. Despite this, LARC use was negligible in the most recent Botswana Demographic Survey conducted in 2017, with contraceptive prevalence predominantly comprised of condom use. Initiation of IUDs immediately postpartum is limited in many countries outside of specific implementation programmes. Techniques unique to postdelivery, intracaesarean section (Csection) or postevacuation IUD insertion differ from those used for interval IUD insertion and, therefore, require specific provider training, which is not widely available in Botswana.","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"293-297"},"PeriodicalIF":3.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10806493","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":"Highlights from literature.","authors":"","doi":"10.1136/bmjsrh-2022-201746","DOIUrl":"10.1136/bmjsrh-2022-201746","url":null,"abstract":"Perinatal sexual education is linked with couples’ sexual well-being in pregnancy and the postpartum Sexual wellbeing in pregnancy and the postpartum period is an important but often poorly addressed area of discussion. Over 88% of couples will describe problems with sexual wellbeing yet less than 30% report receiving any information regarding this. In this study 102 couples in pregnancy and another 102 in the postpartum period were questioned regarding their sexual wellbeing. It enquired into the amount of perinatal sexual health information individuals receive/access; gaps between desired and received information; barriers to accessing information; and links between the quantity of information received/accessed and sexual wellbeing outcomes. The study concluded that despite a desire for information little to none was provided. When provided at any gestation it resulted in improved sexual wellbeing. This study highlights a significant gap in antenatal counselling by health professionals and importantly a desire for this education by couples.","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"298-299"},"PeriodicalIF":3.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9602165","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":"Reproductive and sexual health of Australian adolescents exposed to family and domestic violence.","authors":"Carol Orr,&nbsp;Erin Kelty,&nbsp;Melissa O'Donnell,&nbsp;Colleen M Fisher,&nbsp;Rebecca Glauert,&nbsp;David B Preen","doi":"10.1136/bmjsrh-2022-201684","DOIUrl":"10.1136/bmjsrh-2022-201684","url":null,"abstract":"<p><strong>Background: </strong>There is a dearth of research investigating sexually transmitted infections (STIs) in children exposed to family and domestic violence (FDV). Further, there is no research on terminations of pregnancy in children exposed to FDV.</p><p><strong>Methods: </strong>This retrospective cohort study used linked administrative data from Western Australia to investigate whether exposure to FDV is associated with a risk of hospitalisations for STIs and terminations of pregnancy in adolescents. This study involved children born from 1987 to 2010 whose mother was a victim of FDV. Identification of family and domestic violence was from two sources: police and hospital records. This approach provided an exposed cohort of 16 356 and a non-exposed cohort of 41 996. Dependant variables were hospitalisations for pregnancy terminations and STIs in children aged from 13 up to 18 years of age. The primary explanatory variable was exposure to FDV. Multivariable Cox regression was used to investigate the association of FDV exposure and the outcomes.</p><p><strong>Results: </strong>Following adjustment for sociodemographic and clinical factors, children exposed to FDV had an increased risk of hospitalisations for STIs (HR 1.49, 95% CI 1.15 to 1.92) and terminations of pregnancy (HR 1.34, 95% CI 1.09 to 1.63) as an adolescent than non-exposed peers.</p><p><strong>Conclusion: </strong>Children exposed to FDV are at an increased risk of hospitalisation for STI and termination of pregnancy as an adolescent. Effective interventions are needed to support children exposed to FDV.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"245-253"},"PeriodicalIF":3.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9085395","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":"Contraceptive use and pregnancy planning in Britain during the first year of the COVID-19 pandemic: findings from a large, quasi-representative survey (Natsal-COVID).","authors":"Andrew J Baxter, Rebecca S Geary, Emily Dema, Raquel Bosó Pérez, Julie Riddell, Malachi Willis, Anne Conolly, Laura L Oakley, Andrew J Copas, Jo Gibbs, Christopher Bonell, Pam Sonnenberg, Catherine H Mercer, Soazig Clifton, Nigel Field, Kirsten Mitchell","doi":"10.1136/bmjsrh-2022-201763","DOIUrl":"10.1136/bmjsrh-2022-201763","url":null,"abstract":"<p><strong>Background: </strong>Contraceptive services were significantly disrupted during the COVID-19 pandemic in Britain. We investigated contraception-related health inequalities in the first year of the pandemic.</p><p><strong>Methods: </strong>Natsal-COVID Wave 2 surveyed 6658 adults aged 18-59 years between March and April 2021, using quotas and weighting to achieve quasi-representativeness. Our analysis included sexually active participants aged 18-44 years, described as female at birth. We analysed contraception use, contraceptive switching due to the pandemic, contraceptive service access, and pregnancy plannedness.</p><p><strong>Results: </strong>Of 1488 participants, 1619 were at risk of unplanned pregnancy, of whom 54.1% (51.0%-57.1%) reported routinely using effective contraception in the past year. Among all participants, 14.3% (12.5%-16.3%) reported switching or stopping contraception due to the pandemic. 3.2% (2.0%-5.1%) of those using effective methods pre-pandemic switched to less effective methods, while 3.8% (2.5%-5.9%) stopped. 29.3% (26.9%-31.8%) of at-risk participants reported seeking contraceptive services, of whom 16.4% (13.0%-20.4%) reported difficulty accessing services. Clinic closures and cancelled appointments were commonly reported pandemic-related reasons for difficulty accessing services. This unmet need was associated with younger age, diverse sexual identities and anxiety symptoms. Of 199 pregnancies, 6.6% (3.9%-11.1%) scored as 'unplanned'; less planning was associated with younger age, lower social grade and unemployment.</p><p><strong>Conclusions: </strong>Just under a third of participants sought contraceptive services during the pandemic and most were successful, indicating resilience and adaptability of service delivery. However, one in six reported an unmet need due to the pandemic. COVID-induced inequalities in service access potentially exacerbated existing reproductive health inequalities. These should be addressed in the post-pandemic period and beyond.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"260-273"},"PeriodicalIF":3.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10579517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9536085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Priority indicators for sexual and reproductive health self-care: recommendations from an expert working group.","authors":"Claire W Rothschild,&nbsp;GIlda Sedgh,&nbsp;Martha Brady,&nbsp;Holly McClain Burke,&nbsp;Jane Cover,&nbsp;Andrea Cutherell,&nbsp;Austen El-Osta,&nbsp;Kelsey Holt,&nbsp;Dinesh Kumar,&nbsp;Fredrick Makumbi","doi":"10.1136/bmjsrh-2023-201909","DOIUrl":"10.1136/bmjsrh-2023-201909","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"315-316"},"PeriodicalIF":3.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10579514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9602166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Co-produced patient pathway for sexual health follow-up with children and young people using a paediatric sexual assault referral centre (SARC): facilitating elements of self-care and self-testing.","authors":"Jane Meyrick,&nbsp;Rachel Adams,&nbsp;Michelle Cutland","doi":"10.1136/bmjsrh-2023-201866","DOIUrl":"10.1136/bmjsrh-2023-201866","url":null,"abstract":"© Author(s) (or their employer(s)) 2023. No commercial reuse. See rights and permissions. Published by BMJ. BACKGROUND Childhood sexual abuse (CSA) is increasingly recognised and the impact often lifelong. At least 15% of girls/young women and 5% of boys/young men experience some form of sexual abuse before the age of 16 years, after which they may be offered sexual health followup (SHFU) from a paediatric sexual abuse referral centre (SARC). For children and young people (CYP) and their carers, the visit may be anxietyprovoking or risk revisiting trauma. For referring teams, there may be barriers to finding an appropriate provider, especially for CYP aged under 13 years who cannot attend standard sexual health clinics. For primary care providers, these consultations may feel beyond daytoday competencies.","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"311-314"},"PeriodicalIF":3.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9742321","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 telemedical abortion, safeguarding, and under 18s: a qualitative study with care providers in England and Wales.","authors":"Elizabeth Chloe Romanis,&nbsp;Jordan A Parsons","doi":"10.1136/bmjsrh-2022-201762","DOIUrl":"10.1136/bmjsrh-2022-201762","url":null,"abstract":"<p><strong>Background: </strong>Telemedical early medical abortion (TEMA) was introduced in England and Wales as a temporary measure in 2020 and was made permanent in 2022. While there are considerable data showing the safety, efficacy, and acceptability of TEMA for patients, there have been objections raised to TEMA based on safeguarding-particularly for people under 18 years of age. Little is known about abortion care providers' views and experiences of carrying out their safeguarding duties with people aged under 18 in the shift to TEMA.</p><p><strong>Methods: </strong>This is a qualitative study involving online semi-structured interviews and reflexive thematic analysis. Audio-recorded, semi-structured interviews with abortion providers in England and Wales (n=20) generated data about their views and experiences of safeguarding in telemedical abortion care. Recordings were transcribed verbatim and then subject to reflexive thematic analysis to construct themes.</p><p><strong>Results: </strong>While the study was designed with adult safeguarding in mind, the safeguarding of under 18s became a key area of discussion. Three major themes were constructed in relation to under 18s: (1) age as a risk factor in safeguarding; (2) telemedicine as improving access to care; and (3) telemedicine as enhancing communication.</p><p><strong>Conclusion: </strong>Care providers believe TEMA has benefitted the under 18s. There was a strong feeling both that TEMA had improved access (which, in turn, improved safeguarding) and that under 18s were comfortable communicating using remote means. Providers believe safeguarding proformas must account for the different nature of risks where service users are under 18, but that it is disproportionate to assume that TEMA is unsuitable for all under 18s or groups of under 18s.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"238-244"},"PeriodicalIF":3.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10579482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10633336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the experiences and needs of LGBTIQA+ individuals when accessing abortion care and pregnancy options counselling: a scoping review.","authors":"Sally Bowler,&nbsp;Kari Vallury,&nbsp;Ernesta Sofija","doi":"10.1136/bmjsrh-2022-201692","DOIUrl":"https://doi.org/10.1136/bmjsrh-2022-201692","url":null,"abstract":"<p><strong>Background: </strong>Safe, accessible, and inclusive abortion care and pregnancy options counselling are essential components of sexual and reproductive health and rights. Research has documented LGBTIQA+ people are as likely, or more than likely, as the general population to experience an abortion in their lifetime yet face significant barriers to accessing abortion and related care, which undermines well-being.</p><p><strong>Aims: </strong>The present study undertakes a scoping review of research on the needs and experiences of the LGBTIQA+ population (representing lesbian, gay, bisexual, transgender, gender diverse, intersex, queer, asexual, and questioning) when accessing abortion care, pregnancy options, and post-abortion counselling to support improved understanding of pregnant people's preferences, needs, and experiences.</p><p><strong>Methods: </strong>The reporting of this scoping review is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension of Scoping Reviews (PRISMA-ScR). Academic databases were searched using terms relating to gender identity and sexuality, abortion, pregnancy options, and post-abortion counselling to identify peer reviewed papers published in English. Seven publications were included in the review that described experiences of LGBTIQA+ people accessing abortion-related care.</p><p><strong>Results: </strong>The included studies were predominantly conducted in the USA using quantitative and qualitative research designs. Thematic analysis highlighted participants' experiences of discrimination and exclusion in healthcare settings, healthcare avoidance, unsafe abortion, non-disclosure to providers, and poor health outcomes for LGBTIQA+ people.</p><p><strong>Conclusions: </strong>Gender-inclusive services and training for health providers is necessary to provide safe and accessible abortion care and overcome generations of mistrust held by the LGBTIQA+ community. Research into the needs of LGBTIQA+ people when accessing pregnancy options counselling is critically needed.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":"49 3","pages":"192-200"},"PeriodicalIF":3.3,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9829274","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":"Intrauterine devices: a summary of new guidance.","authors":"Ashley Jefferies,&nbsp;Katie Boog","doi":"10.1136/bmjsrh-2023-201841","DOIUrl":"https://doi.org/10.1136/bmjsrh-2023-201841","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":"49 3","pages":"148-150"},"PeriodicalIF":3.3,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9796759","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}