BMJ Sexual & Reproductive Health最新文献

{"title":"Women's needs for lifestyle risk reduction engagement during the interconception period: a scoping review.","authors":"Sharon James,&nbsp;Jessica E Moulton,&nbsp;Anisa Assifi,&nbsp;Jessica Botfield,&nbsp;Kirsten Black,&nbsp;Mark Hanson,&nbsp;Danielle Mazza","doi":"10.1136/bmjsrh-2022-201699","DOIUrl":"10.1136/bmjsrh-2022-201699","url":null,"abstract":"<p><strong>Background: </strong>Unhealthy lifestyle is responsible for many chronic conditions, and antenatal engagement with women about lifestyle behaviours can be too late to prevent some adverse pregnancy outcomes and subsequent childhood risks. To reduce the risk of future adverse outcomes, the interconception period is an opportunity to implement positive health changes. The aim of this scoping review was to explore women's needs for lifestyle risk reduction engagement during the interconception period.</p><p><strong>Methods: </strong>The JBI methodology guided our scoping review. Six databases were searched for peer-reviewed, English-language research papers published between 2010 and 2021 on topics including perceptions, attitudes, lifestyle, postpartum, preconception and interconception. Title-abstract and full text screening was independently undertaken by two authors. Included papers' reference lists were searched to find additional papers. The main concepts were then identified using a descriptive and tabular approach.</p><p><strong>Results: </strong>A total of 1734 papers were screened and 33 met our inclusion criteria. Most included papers (82%, n=27) reported on nutrition and/or physical activity. Papers identified interconception through postpartum and/or preconception. Women's self-management needs for lifestyle risk reduction engagement during interconception included: informational needs, managing competing priorities, physical and mental health, self-perception and motivation, access to services and professional support, and family and peer networks.</p><p><strong>Conclusions: </strong>There is a range of challenges for women to engage in lifestyle risk reduction during interconception. To enable women's preferences for how lifestyle risk reduction activities can be enacted, issues including childcare, ongoing and tailored health professional support, domestic support, cost and health literacy need to be addressed.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10851802","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 access to medicines for early medical abortion: learning from experiences of medicines licensing and service delivery.","authors":"Sam Rowlands,&nbsp;Mira Harrison-Woolrych","doi":"10.1136/bmjsrh-2023-201949","DOIUrl":"10.1136/bmjsrh-2023-201949","url":null,"abstract":"© Author(s) (or their employer(s)) 2023. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Governments worldwide have an obligation to ensure that reproductive health information, supplies and services are available, accessible, acceptable and of good quality. The WHO advises that everyone has the right to access safe and effective abortion care. However, in 2023, there remain many factors working against people’s access to such care. 4 This Editorial discusses two key areas which continue to restrict women’s rights to obtain safe and effective medical abortion.","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10110876","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":null,"pages":null},"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":"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":null,"pages":null},"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":"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":null,"pages":null},"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":"A prospective, comparative study of clinical outcomes following clinic-based versus self-use of medical abortion.","authors":"Nathalie Kapp,&nbsp;Bunsoth Mao,&nbsp;Jamie Menzel,&nbsp;Elisabeth Eckersberger,&nbsp;Vonthanak Saphonn,&nbsp;Tung Rathavy,&nbsp;Erin Pearson","doi":"10.1136/bmjsrh-2022-201722","DOIUrl":"10.1136/bmjsrh-2022-201722","url":null,"abstract":"<p><strong>Background: </strong>To determine whether clinical outcomes differ among women accessing a combined medical abortion regimen from a health clinic when compared with those accessing it from a pharmacy.</p><p><strong>Methods: </strong>We conducted a multicentre, prospective, comparative, non-inferiority study of participants aged ≥15 years seeking medical abortion from five clinics and five adjacent pharmacy clusters in three provinces of Cambodia. Participants were recruited in-person at the point of purchase (clinic or pharmacy). Follow-up for self-reported pill use, acceptability, and clinical outcomes occurred by telephone at days 10 and 30 after mifepristone administration.</p><p><strong>Results: </strong>Over 10 months, we enrolled 2083 women with 1847 providing outcome data: 937 from clinics and 910 from pharmacies. Most were early in their pregnancy (mean gestational age of 6.3 and 6.1 weeks, respectively) and almost all took the pills correctly (98% and 96%,). Additional treatment needed to complete the abortion was non-inferior for the pharmacy group (9.3%) compared with the clinic group (12.7%). More from the clinic group received additional care from a provider, such as antibiotics or diagnostics tests, than those from the pharmacy group (11.5% and 3.2%,), and one ectopic pregnancy (pharmacy group) was successfully treated. Most said they felt prepared for what happened after taking the pills (90.9% and 81.3%, respectively, p=0.273).</p><p><strong>Conclusions: </strong>Self-use of a combined medical abortion product resulted in comparable clinical outcomes as use following a clinical visit, consistent with existing literature on its safety and efficacy. Registration and availability of medical abortion as an over-the-counter product would likely increase women's access to safe abortion.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ff/24/bmjsrh-2022-201722.PMC10579469.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9112269","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":"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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}