BMJ Sexual & Reproductive Health最新文献

{"title":"Seeking abortion accompaniment: experiences and self-managed abortion preferences of hotline callers after abortion legalisation in Argentina.","authors":"Brianna Keefe-Oates, Sofia Filippa, Elizabeth Janiak, Ruth Zurbriggen, Belén Grosso, Jarvis T Chen, Caitlin Gerdts, Barbara Gottlieb","doi":"10.1136/bmjsrh-2023-202209","DOIUrl":"10.1136/bmjsrh-2023-202209","url":null,"abstract":"<p><strong>Background: </strong>Until the legalisation of abortion in Argentina in 2021, the Socorristas en Red, a network of feminist collectives, provided support and information ('accompaniment') to people self-managing their abortion with medications. Following legalisation, the Socorristas continued accompanying people self-managing or accessing abortion through the healthcare system. We conducted a cross-sectional study to understand preferences, experiences and choices about abortion when contacting a Socorristas hotline after legalisation of abortion in Argentina.</p><p><strong>Methods: </strong>We surveyed callers to the Socorristas' hotline in Neuquén, Argentina about their demographics, pregnancy history, reasons for calling, and experiences seeking abortion through the hotline and the healthcare system. We assessed overall prevalence of these experiences, and analysed differences between people who contacted the health system before calling the hotline and those who first called the hotline for services.</p><p><strong>Results: </strong>Of the 755 callers in the study, the majority (63.3%) contacted the Socorristas because they trusted them, and 21.7% called because they both trusted the Socorristas and did not want to go to the healthcare system. At the end of the call, most people (95.4%) chose to self-manage their abortion with accompaniment outside the healthcare system. People who called the healthcare system prior to contacting the hotline frequently reported being referred to the Socorristas, as well as challenges scheduling appointments.</p><p><strong>Conclusions: </strong>After legalisation of abortion in Argentina there is continued demand for accompaniment. Globally, ensuring that accompaniment and self-management of abortion is legal and protected will provide individuals with the support and facilitated access to the abortion care they desire.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"152-159"},"PeriodicalIF":3.4,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141417829","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":"What do Australian primary care clinicians need to provide long-acting reversible contraception and early medical abortion? A content analysis of a virtual community of practice.","authors":"Sonia Srinivasan, Sharon Maree James, Joly Kwek, Kirsten Black, Angela J Taft, Deborah Bateson, Wendy V Norman, Danielle Mazza","doi":"10.1136/bmjsrh-2024-202330","DOIUrl":"10.1136/bmjsrh-2024-202330","url":null,"abstract":"<p><strong>Background: </strong>Uptake of long-acting reversible contraception (LARC) is lower in Australia compared with other high-income countries, and access to early medical abortion (EMA) is variable with only 11% of general practitioners (GPs) providing EMA. The AusCAPPS (Australian Contraception and Abortion Primary Care Practitioner Support) Network is a virtual community of practice established to support GPs, nurses and pharmacists to provide LARC and EMA in primary care. Evaluating participant engagement with AusCAPPS presents an opportunity to understand clinician needs in relation to LARC and EMA care.</p><p><strong>Methods: </strong>Data were collected from July 2021 until July 2023. Numbers of online resource views on AusCAPPS were analysed descriptively and text from participant posts underwent qualitative content analysis.</p><p><strong>Results: </strong>In mid-2023 AusCAPPS had 1911 members: 1133 (59%) GPs, 439 (23%) pharmacists and 272 (14%) nurses. Concise point-of-care documents were the most frequently viewed resource type. Of the 655 posts, most were created by GPs (532, 81.2%), followed by nurses (88, 13.4%) then pharmacists (16, 2.4%). GPs most commonly posted about clinical issues (263, 49% of GP posts). Nurses posted most frequently about service implementation (24, 27% of nurse posts). Pharmacists posted most about health system and regulatory issues (7, 44% of pharmacist posts).</p><p><strong>Conclusions: </strong>GPs, nurses and pharmacists each have professional needs for peer support and resources to initiate or continue LARC and EMA care, with GPs in particular seeking further clinical education and upskilling. Development of resources, training and implementation support may improve LARC and EMA provision in Australian primary care.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"94-101"},"PeriodicalIF":3.4,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141497182","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":"General practice preconception care invitations: a qualitative study of women's acceptability and preferences.","authors":"Nishadi Nethmini Withanage, Sharon James, Jessica Botfield, Kirsten Black, Jeana Wong, Danielle Mazza","doi":"10.1136/bmjsrh-2024-202432","DOIUrl":"10.1136/bmjsrh-2024-202432","url":null,"abstract":"<p><strong>Background: </strong>In general practice, primary care providers can potentially use electronic medical records (EMRs) to identify and invite reproductive-aged women with preconception health risk factors to increase their engagement in preconception care (PCC). However, the acceptability of receiving PCC invitations and women's preferences about the invitation process are poorly understood. This study aims to investigate women's acceptability and preferences for receiving PCC invitations from general practice settings.</p><p><strong>Methods: </strong>Participants were recruited via convenience, purposive and snowball sampling. Semi-structured interviews were conducted via Zoom from August until November 2023. Interviews were transcribed verbatim and inductive reflexive thematic analysis was undertaken.</p><p><strong>Results: </strong>PCC invitations sent from general practice are acceptable if the language is sensitive and non-stigmatising. Text or email invitations detailing the importance and scope of the PCC consultation were preferred, after discussing reproductive intentions with a general practitioner or practice nurse. Women with preconception health risk factors or those actively trying to conceive were more likely to engage in PCC. Key strategies to enhance PCC engagement include advertising in waiting rooms, introducing PCC in new patient registration forms, and integrating PCC into holistic care.</p><p><strong>Conclusion: </strong>Using EMRs to identify and invite women with preconception health risk factors to increase their engagement in PCC is generally acceptable. Invitations sent via text messages or emails are preferred. It is crucial to use respectful and appropriate language to avoid stigmatising or offending women, particularly those with infertility issues, those who have completed their families, or those who do not wish to have children.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"86-93"},"PeriodicalIF":3.4,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142341957","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":"Expectations and experiences of pain during medical abortion at home: a secondary, mixed-methods analysis of a patient survey in England and Wales.","authors":"Hannah McCulloch, Danielle Perro, Neda Taghinejadi, Katherine C Whitehouse, Patricia A Lohr","doi":"10.1136/bmjsrh-2024-202533","DOIUrl":"10.1136/bmjsrh-2024-202533","url":null,"abstract":"<p><strong>Objective: </strong>To explore experiences of pain during medical abortion and provide patient-centred recommendations for improving abortion experience and pain counselling.</p><p><strong>Methods: </strong>We invited patients of British Pregnancy Advisory Service who underwent medical abortion up to 10 weeks' gestation to participate in an online, English language questionnaire from November 2021 to March 2022. Participants answered questions about pain, method preference, abortion experience, advice, and how they would describe pain experienced to a friend. In this secondary analysis, we analysed free-text responses using reflexive thematic analysis techniques. We used descriptive statistics and parametric tests to analyse quantitative responses.</p><p><strong>Results: </strong>Of 11 906 patients invited to participate, 1596 (13.4%) completed the questionnaire, including at least one free-text comment. Participants used a range of descriptors for medical abortion pain across three broad themes: pain severity, pain quality and comparisons to other reproductive pain. Some found the commonly used analogy to period pain misleading. Many felt unprepared for the level of pain they experienced, which they attributed to provider comparisons to period pain, as well as a lack of detailed, realistic anticipatory pain counselling. Qualitative and quantitative results suggest pain experiences impact method preference. Participants recommended better counselling for pain and abortion preparation, including first-hand accounts of medical abortion at home and a wide and accessible range of descriptions of pain.</p><p><strong>Conclusions: </strong>Abortion providers should use patient-centred recommendations to better prepare patients for pain during medical abortion. Setting realistic expectations can improve abortion experience and support informed method choice. Further research is needed to develop and test patient-centred counselling materials.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"137-143"},"PeriodicalIF":3.4,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852816","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 qualitative study which aims to explore the factors influencing the delivery of both theory and practice of contraception and sexual health on pre-registration midwifery programmes in England.","authors":"Claire Cousins, Gillian Matthews, Lesley Regan, Edward Mullins","doi":"10.1136/bmjsrh-2024-202293","DOIUrl":"10.1136/bmjsrh-2024-202293","url":null,"abstract":"<p><strong>Background: </strong>Pregnancy offers an opportunity to provide equitable access to contraception information and provision, and professional bodies advocate provision of contraception in the immediate postpartum period. This study examines the contribution of pre-registration midwifery education in preparing student midwives for this aspect of their role.</p><p><strong>Method: </strong>A qualitative study using semi-structured interviews. Interviews were recorded, transcribed and analysed using thematic analysis. Nine lecturers from pre-registration midwifery programmes representing nine universities in England were interviewed.</p><p><strong>Results: </strong>There is minimal contraception and sexual health content on pre-registration midwifery programmes; however, specialist lecturers enhance the learning experience. Talking about sex may be difficult, particularly for younger students. Student midwives observe little discussion/provision of contraception in practice and are unlikely to consider it part of a midwife's role.</p><p><strong>Conclusions: </strong>A formally assessed national standard of knowledge on pre-registration programmes would be helpful, and this needs to be reflected in practice to become embedded. Institutional investment and commitment to continuous practice development is needed for all midwives. Practice placements in sexual and reproductive health clinics or abortion services may be beneficial to student midwives.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"129-136"},"PeriodicalIF":3.4,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142341956","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":"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":"111-121"},"PeriodicalIF":3.4,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013582/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital training for self-injectable contraceptives: a feasibility and acceptability pilot study.","authors":"Rhiana Mills, Rapha Krong, Fiona Kithinji, Paula Baraitser","doi":"10.1136/bmjsrh-2023-202197","DOIUrl":"10.1136/bmjsrh-2023-202197","url":null,"abstract":"<p><strong>Background: </strong>Self-injectable contraceptives, namely subcutaneous depot medroxyprogesterone acetate 104 mg micronised formulation delivered via uniject system, reduce the need to travel to a facility for contraceptive access, but the initial, in-person, training may be a barrier to starting this method. This article reports on a small, exploratory pilot in Kenya to test the feasibility and acceptability of digital self-injection training.</p><p><strong>Methods: </strong>Participants (n=11) who were currently using injectable contraceptives, intramuscular depot medroxyprogesterone acetate 150 mg injected by a healthcare worker, received digital self-injection training from a trained clinician via a WhatsApp video call. Participants administered a simulated self-injection on a model and an actual self-injection (under supervision) on themselves. The participants' self-injection proficiency, a measure of the feasibility of remote training, was documented using a checklist, and participants were administered a questionnaire about their training experience. The training was observed, and content analysis was used to understand the functionality of training.</p><p><strong>Results: </strong>All participants were proficient when performing the self-injection on themselves after receiving the remote training and reported that the training was acceptable. A barrier to training via a video call was lack of access to quality digital devices. Eight training 'lessons learnt' emerged from the training observations.</p><p><strong>Conclusions: </strong>Training participants to administer self-injectable contraceptives via WhatsApp video call was feasible and acceptable. Training lessons learnt offer pragmatic adaptations for communicating about a practical skill via a digital channel. Further research is needed to ascertain the efficacy of digital training for self-injection and feasibility and acceptability for wider groups.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"144-151"},"PeriodicalIF":3.4,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003638","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 emerging role of progesterone receptor modulators in breast physiology, cancer prevention and treatment.","authors":"Abigail Liberty, Alison Edelman, Sarah Margaret Bernhardt","doi":"10.1136/bmjsrh-2024-202662","DOIUrl":"https://doi.org/10.1136/bmjsrh-2024-202662","url":null,"abstract":"<p><strong>Background: </strong>Progesterone is critical for cyclic breast changes and breast cancer carcinogenesis. The commercially available progesterone receptor modulators (PRMs), ulipristal acetate (UPA) and mifepristone, have been utilised for their antiprogestogen effect in gynaecology. Administration of these medicines appears to induce favourable cellular and radiographic changes in the breast.</p><p><strong>Methods: </strong>This is a narrative review of the basic science, translational and clinical trials utilising UPA and mifepristone for breast health. It integrates historical and recent trials from around the world.</p><p><strong>Results: </strong>PRMs have shown promise in decreasing molecular markers of carcinogenesis in BRCA1 carriers. Outside of genetic cancer risk, PRMs decrease background parenchymal enhancement on breast magnetic resonance imaging and could be developed as a personalised protocol for breast cancer screening. Although there was limited efficacy of antiprogestogens in progression-free survival for people with breast cancer, there may be a role as neoadjuvant therapy prior to surgical resection.</p><p><strong>Conclusions: </strong>UPA and mifepristone have the potential to revolutionise breast cancer prevention, screening and treatment. As protocols emerge, gynaecologists will be on the front lines as regards both identifying patients who may benefit from these medications and serving as interdisciplinary support in accessing these medicines.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787711","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 BMJ SRH: a US perspective on achievements in sexual and reproductive health.","authors":"Stephanie Irene Amaya, Paul D Blumenthal","doi":"10.1136/bmjsrh-2024-202560","DOIUrl":"https://doi.org/10.1136/bmjsrh-2024-202560","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728618","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":"Experiences of stigma amongst healthcare professionals working in abortion care: a global survey.","authors":"Louise Bury, Roger Ingham, Suzanna Bright, Lesley Hoggart","doi":"10.1136/bmjsrh-2024-202468","DOIUrl":"10.1136/bmjsrh-2024-202468","url":null,"abstract":"<p><strong>Introduction: </strong>Abortion-related stigma negatively affects healthcare professionals providing abortion care, threatening workforce well-being and service provision. This global study, part of the Royal College of Obstetricians and Gynaecologists' 'Making Abortion Safe' Project, explored healthcare providers' experiences of abortion stigma, its drivers and mitigating factors.</p><p><strong>Methods: </strong>A global online survey was distributed to healthcare professionals trained to provide abortion and post-abortion care (PAC) through 16 partner organisations over a 6-week period in 2021. The Abortion Provider Stigma Scale (APSS) was adapted, and linear regression modelling was used to examine the relationships between demographic variables, attitudes towards abortion, workplace burnout and total APSS scores.</p><p><strong>Results: </strong>In 1674 providers from 77 countries, stigma was universally experienced. Higher stigma levels were associated with countries with restrictive abortion laws; working in non-governmental organisation settings; and providing first- and second-trimester abortions compared with only PAC. A large majority (84%) of providers reported feeling burnout to some degree, with a strong correlation between APSS scores and workplace burnout. Providers exposed to both values clarification and attitude transformation (VCAT) training and other support workshops reported more positive attitudes and lower stigma compared with those with only VCAT or no training.</p><p><strong>Conclusions: </strong>Legal reform is needed to reduce stigma for providers as part of broader initiatives on women's reproductive rights in general. Meanwhile, ongoing support at the organisational level, alongside addressing stigmatising values and attitudes, can help create positive workplaces and resilient providers. Mainstreaming and integrating abortion services into public health systems would also help normalise abortion care.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12322476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633540","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}