BMJ Sexual & Reproductive Health最新文献

{"title":"The case for integrating sexual and reproductive health services in Pacific Island countries.","authors":"Kirsten I Black, Titilola Duro-Aina, Deborah Bateson","doi":"10.1136/bmjsrh-2024-202317","DOIUrl":"10.1136/bmjsrh-2024-202317","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"233-235"},"PeriodicalIF":3.4,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987423","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":"Demanding doctorability for abortion on request: a conversation analysis of pre-abortion counselling in public hospitals in the Eastern Cape, South Africa.","authors":"Ryan du Toit, Catriona Ida Macleod","doi":"10.1136/bmjsrh-2023-202020","DOIUrl":"10.1136/bmjsrh-2023-202020","url":null,"abstract":"<p><strong>Background: </strong>Research on abortion counselling generally uses retrospective interviewing regarding providers' and users' experiences. In this article we explore how requests for abortion are made and received in real time in (officially non-mandatory) pre-abortion counselling conducted by nurses and counsellors in South African public abortion clinics.</p><p><strong>Methods: </strong>To capture turn-by-turn interactions, we recorded, using consecutive sampling, 28 sessions at three abortion clinics in 2017/2018. No researcher was present. Conversation analysis, based on an ethnomethodological paradigm, was used to understand the conversational projects of the sessions and to outline how the provider and user oriented to the request for an abortion as a conversational task.</p><p><strong>Results: </strong>Establishing reasons for the abortion featured in most individual counselling sessions. Through posing directive questions, providers required users to justify their request to access abortion. Users complied by providing multiple reasons. These reasons were often followed by a provider question demanding accountability in relation to contraceptive (non)use, thus establishing poor usage as the <i>real</i> reason.</p><p><strong>Conclusions: </strong>As abortion is legal <i>on request</i> in the first trimester in South Africa, no reason for presenting for an abortion is needed. The demand for users to perform 'doctorability' - that is, to present their situation as worthy of a health professional's (in this case abortion provider's) time - served as a precursor to discipline the abortion seeker for assumed poor contraceptive usage. Providers should be trained in user-centred care that supports pregnant people's autonomy in accessing legally induced abortion. A limitation of this study is its restriction to three abortion clinics in one region of South Africa.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"278-284"},"PeriodicalIF":3.4,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141300008","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":"Utilising fruits to enhance first-trimester abortion simulation: can we do better than a papaya?","authors":"Sarah Nicole Owens, Simranvir Kaur, Andrea Henkel","doi":"10.1136/bmjsrh-2024-202354","DOIUrl":"10.1136/bmjsrh-2024-202354","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"303"},"PeriodicalIF":3.4,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141247358","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":"Pain experiences during intrauterine device procedures: a thematic analysis of tweets.","authors":"Neda Taghinejadi, Helene-Mari van der Westhuizen, Francis Ifeanyi Ayomoh, Wasim Ahmed, Trisha Greenhalgh, Anne-Marie Boylan","doi":"10.1136/bmjsrh-2023-202011","DOIUrl":"10.1136/bmjsrh-2023-202011","url":null,"abstract":"<p><strong>Introduction: </strong>In June 2021, high-profile testimonials in the media about pain during intrauterine device (IUD) procedures in the UK prompted significant discussion across platforms including Twitter (subsequently renamed X). We examined a sample of Twitter postings (tweets) to gain insight into public perspectives and experiences.</p><p><strong>Methods: </strong>We harvested tweets posted or retweeted on 21-22 June 2021 which contained the search terms coil, intrauterine system, IUD or intrauterine. We analysed the dataset thematically and selected illustrative tweets with the authors' consent for publication.</p><p><strong>Results: </strong>Following deduplication and screening, we included 1431 tweets in our analysis. We identified testimonials with descriptions of varied pain experiences. Twitter users reported that clinicians had not warned them that pain could be severe or explained the options for pain relief. Some raised concerns about pain being minimised or dismissed and linked this to the management of women's pain in medicine more broadly. Twitter users described connecting to an online community with shared experiences as validating and used this as a springboard for collective action.</p><p><strong>Conclusions: </strong>While we acknowledge the limitations of our sample, this study highlights important perspectives and accounts relating to pain during IUD procedures. Our findings attest to the need for strategies to improve the patient experience for those opting for IUD as a clinical priority. Further research should explore IUD users' experiences, expectations and wishes around pain management.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"271-277"},"PeriodicalIF":3.4,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11503099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141305484","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":"Sexual and reproductive health clinical consultations: preconception care.","authors":"Amy Hough, Jayne Kavanagh, Neha Pathak","doi":"10.1136/bmjsrh-2024-202361","DOIUrl":"10.1136/bmjsrh-2024-202361","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"297-299"},"PeriodicalIF":3.4,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141911771","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":"Double dosing ulipristal acetate emergency contraception for individuals with obesity: a randomised crossover trial.","authors":"Alison Edelman, Jon D Hennebold, Kise Bond, Jeong Y Lim, Ganesh Cherala, Steven W Blue, Shawn P Kraft, David W Erikson, David Archer, Jeffery Jensen","doi":"10.1136/bmjsrh-2024-202401","DOIUrl":"10.1136/bmjsrh-2024-202401","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether increasing the dose of ulipristal acetate (UPA)-containing emergency contraception (EC) improves pharmacodynamic outcomes in individuals with obesity.</p><p><strong>Study design: </strong>We enrolled healthy, regularly-cycling, confirmed ovulatory, reproductive-age individuals with body mass index (BMI) >30 kg/m² and weight >80 kg in a randomised crossover study. We monitored participants with transvaginal ultrasound and blood sampling for progesterone, luteinising hormone (LH), and estradiol every other day until a dominant follicle measuring >15 mm was visualised. At that point, participants received either oral UPA EC 30 mg or 60 mg and returned for daily monitoring up to 7 days. After a no treatment washout cycle, participants returned for a second monitored cycle and received the other UPA dose. Our primary outcome was the proportion of subjects with no follicle rupture 5 days post-dosing (yes/no). For reference, we also enrolled a control group with BMI <25 kg/m² and weight <80 kg who received UPA EC 30 mg during a single cycle. We also obtained blood samples for pharmacokinetic parameters for UPA and its active metabolite, <i>N</i>-monodemethyl-UPA (NDM-UPA) as an optional substudy.</p><p><strong>Results: </strong>We enrolled a total of 52 participants with BMI >30 kg/m² and 12 controls, with the following cycles completed: 12 controls, 49 UPA 30 mg, and 46 UPA 60 mg. The entire cohort demographics were a mean (SD) age of 29.8 (3.4) years and BMI by group: controls 22.5 (1.4) kg/m², group 1 37.9 (6.7) kg/m², and group 2 39.3 (5.4) kg/m². All 12 (100%) of controls had a delay of at least 5 days for follicle rupture. Among the high BMI group, dosing groups (UPA EC 30 mg vs 60 mg) were similar in the proportion of cycles without follicle rupture over 5 days post-UPA dosing (UPA 30 mg: 47/49 (96%), UPA 60 mg: 42/46 (91%), Fisher's exact test p=0.43). However, after excluding cycles where dosing occurred too late (after LH surge), a delay of at least 5 days occurred in all participants at both doses. The 60 mg UPA dose resulted in a twofold increase in maximum observed concentration and the area under the curve of both UPA and NDM-UPA levels compared with 30 mg.</p><p><strong>Conclusion: </strong>A standard 30 mg dose of UPA is sufficient to delay ovulation regardless of BMI or weight. Results of our study do not support dose adjustment for body size.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141615921","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":"Seeking support for abortion online: a qualitative study of women's experiences.","authors":"Rachel Victoria Wilson-Lowe, Carrie Purcell, Ruth Lewis, Lisa McDaid","doi":"10.1136/bmjsrh-2023-202083","DOIUrl":"10.1136/bmjsrh-2023-202083","url":null,"abstract":"<p><strong>Introduction: </strong>Social support can mitigate the impact of stress and stigma before or after an abortion. However, stigma anticipation can limit access to in-person support. Informal online spaces can offer opportunities to address unmet support needs including supplementing in-person support lacking within stigmatised contexts. While earlier studies have explored content of posts comprising personal accounts of abortion, little is known about the nuances of how and to what end online spaces are navigated.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted remotely (online or by telephone) with 23 women living in Scotland (aged 20-54 years) recruited through social media and online advertisements. Reflexive thematic analysis was supported by NVivo12 software.</p><p><strong>Results: </strong>Key themes: obtaining support that was unavailable from in-person networks; preparation for abortion; reducing feelings of isolation. The majority of participants independently searched online for accounts of abortion, with only three receiving any signposting to specific resources. Without guidance, finding relevant, supportive content was not straightforward. The search process was additionally complicated by the prevalence of abortion stigma online, which generated an additional burden at a potentially challenging time. Those who received direction towards particular resources reported primarily positive online experiences.</p><p><strong>Conclusions: </strong>While online content could address perceived in-person support gaps, the process of finding supportive content without guidance can be complex. Online searching may also expose women to stigmatising material and interactions. Signposting by abortion services towards well-moderated and trustworthy online resources could be constructive in limiting exposure to stigma and misinformation, while allowing those seeking it to access better support.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"172-177"},"PeriodicalIF":3.4,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11287619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139711521","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":"Changes in fertility intention among married Chinese couples with two children during COVID-19: a cross-sectional study.","authors":"Ni Ning, Xiangmin Tan, Ying Li, Jingfei Tang, Lisa Lommel, Mei Sun","doi":"10.1136/bmjsrh-2022-201759","DOIUrl":"10.1136/bmjsrh-2022-201759","url":null,"abstract":"<p><strong>Background: </strong>A three-child policy was implemented in China to stimulate a rise in fertility levels and coincided with the COVID-19 pandemic. Data suggested that COVID-19 has a negative impact on fertility intention.</p><p><strong>Aim: </strong>To describe married couples' changes in intention to have a third child during the COVID-19 pandemic and determine factors associated with altered intentions.</p><p><strong>Methods: </strong>An online survey was conducted in October 2021, including sociodemographic characteristics, change of intention to have a third child after the COVID-19 pandemic outbreak, reasons for increased or decreased intention, and the Fertility Intention Scale (FIS). Bivariate and multivariable logistic regression were used to test the potential factors associated with changes in intention.</p><p><strong>Results: </strong>A total of 1308 participants provided responses. Following the COVID-19 outbreak, 35.8% of participants decreased their third-child intention, while 2.8% of participants increased their third-child intention. Males (aOR 1.90, 95% CI 1.42 to 2.54), youngsters (aOR 1.77, 95% CI 1.08 to 2.93) and those living in Estern China (aOR 2.12, 95% CI 1.13 to 3.98) were more likely to decrease their third-child intention. Perceived risk (aOR 1.07, 95% CI 1.03 to 1.10) and policy support (aOR 1.06, 95% CI 1.03 to 1.09) as measured on the FIS decreased couples' intention to have a third child. Social support (aOR 0.94, 95% CI 0.91 to 0.98) as measured on the scale protected participants from decreased intention.</p><p><strong>Conclusions: </strong>During severe public health emergencies, strong prevention and control policies, together with enhancing support from partners and healthcare professionals for women, are necessary to improve intentions to give birth.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"185-193"},"PeriodicalIF":3.4,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140173800","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":"French Parliament ratifies the inclusion in the French Constitution of \"guaranteed freedom\" for abortion: but does this really prevent future restrictions?","authors":"Philippe Faucher","doi":"10.1136/bmjsrh-2024-202316","DOIUrl":"10.1136/bmjsrh-2024-202316","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"153-154"},"PeriodicalIF":3.4,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140288202","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":"Self-managed medication abortion trajectories: results from a prospective observational study in Argentina, Nigeria and Southeast Asia.","authors":"Elizabeth A Pleasants, Ruvani T Jayaweera, Ijeoma Egwuatu, Sybil Nmezi, Ika Ayu Kristianingrum, Ruth Zurbriggen, Belén Grosso, Chiara Bercu, Relebohile Motana, Caitlin Gerdts, Heidi Moseson","doi":"10.1136/bmjsrh-2023-201979","DOIUrl":"10.1136/bmjsrh-2023-201979","url":null,"abstract":"<p><strong>Objectives: </strong>Time is a crucial factor in abortion-seeking because options for care change with pregnancy duration, and most people prefer to access abortion care early in pregnancy. We aimed to collect data on the timing of steps in accompanied self-managed abortion-seeking experiences in legally restrictive settings.</p><p><strong>Methods: </strong>In this prospective, observational, cohort study we recruited callers from three abortion accompaniment groups in Argentina, Nigeria and a country in Southeast Asia. Participants completed a baseline survey before starting a self-managed medication abortion (SMA) and two follow-up surveys (approximately 1 and 3 weeks after taking medication). Primary outcomes of interest included: (1) time from abortion decision to contacting the hotline, (2) time from contacting the hotline to obtaining pills and (3) time from obtaining pills to taking the first dose. We explored relationships between participant characteristics and each of these outcomes and evaluated differences in overall abortion time using survival analyses.</p><p><strong>Results: </strong>Between July 31, 2019 and October 01, 2020 we enrolled 1352 eligible callers; 1148 provided data for this analysis. After deciding to have an abortion, participants took 12.2 days on average (95% CI: 11.6, 12.9) to start medications for abortion. On average, participants at later pregnancy durations progressed through the SMA process more quickly (<4 weeks: 20.9 days, 4 weeks: 11 days, 5-6 weeks: 10.1 days, 7-9 weeks, 10.4 days, 10+ weeks: 9.1 days; p<0.001).</p><p><strong>Conclusions: </strong>Overall, participants accessed accompaniment group support and started abortion regimens quickly and at relatively early pregnancy durations. SMA with accompaniment provided a time-efficient route for obtaining abortions.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"155-164"},"PeriodicalIF":3.4,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71420843","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}