Managing Precarity: Understanding Latinas' Sexual and Reproductive Care-Seeking in a Midwest Emergent Latino Community

In this qualitative interview study, we took a two-pronged approach to understand the complexities of sexual and reproductive health (SRH) care access for Latinas in an emerging Latino community (ELC). Phase 1 assessed the SRH resources available for uninsured Latinas through provider interviews. In Phase 2, we interviewed 15 Latina-identified women about their considerations for SRH care-seeking. The scant options for SRH care are focused largely on contraception and pregnancy. Providers viewed themselves as prevention-oriented and perceived Latinas did not prioritize preventive care. Women described compounding challenges and precarious conditions. Annual checkups, accessing contraception, and treating vaginal infections were identified as needs. Barriers to SRH care were enhanced in an ELC. Participants described too much paperwork and limited time as organizational barriers which aggravated others, such as language limitations and feeling embarrassed to ask questions. Further research on SRH care using a reproductive justice approach is needed in ELCs.

Sexual and Reproductive Health Information and Experiences Among Syrian Refugee Adolescent Girls in Lebanon

Providing adolescent girls with sexual and reproductive health (SRH) information protects them from risks and improves their well-being. This qualitative study, conducted in Lebanon, examined Syrian refugee adolescent girls' access to SRH information about and experiences with puberty and menarche, sex, marriage, contraception, and pregnancy. We gathered data through three focus group discussions (FGDs) with unmarried adolescent girls, 11 in-depth interviews with early-married adolescents, and two FGDs with mothers. Our findings highlighted that adolescent participants received inadequate SRH information shortly before or at the time of menarche and sexual initiation, resulting in experiences characterized by anxiety and fear. They also revealed discordance between girls' views of mothers as a preferred source of information and mothers' reluctance to communicate with their daughters about SRH. We advance that mothers are important entry points for future interventions in this refugee population and offer recommendations aimed to improve adolescent girls' SRH and rights.

Pregnant again? Perspectives of adolescent and young mothers who and do not experience a repeat pregnancy in adolescence

Introduction: Teen pregnancy remains a major social and public health issue in developing countries. Each additional child compromises the development of both the mother and children. Scarce studies have been performed in Latin America.

Purpose: This study explores and analyzes individual and family factors associated with repeat pregnancies during adolescence to better elucidate the phenomenon.

Methods: Qualitative-descriptive study. Thirty semi-structured interviews were conducted with mothers 20 years of age or younger from urban areas of Santiago, Chile. Participants were divided into Repeat Pregnancy (RP) and No Repeat Pregnancy (NRP) groups. Qualitative data analysis was based on elements of grounded theory.

Results: The RP group generally related life stories reflecting greater psychosocial vulnerability. Most of the RP group dropped out of school after their first pregnancy to focus on parenting and had a passive attitude towards contraception. In contrast, members of the NRP group actively sought long-term contraceptive methods, motivated largely by the desire to continue their education to improve their living conditions and achieve greater personal fulfilment. They tended to have family support networks that facilitated school retention.

Conclusion: Key differences between groups included use of contraception, focus on life projects, and motivation to finish school. Prevention strategies should promote long-term contraceptive methods, offer strategies to help young mothers continue their education, facilitate achievement of personal projects, and provide support for parenting.

Developing Culturally Tailored mHealth Tools to Address Sexual and Reproductive Health Outcomes Among Black and Latina Women: A Systematic Review

BACKGROUND

In addressing the sexual and reproductive health (SRH) disparities for Black and Latina women, there is a need for the development of innovative programs, framed using theoretical underpinnings that are culturally and contextually tailored so that they align with lived experiences. Mobile health (mHealth) interventions offer considerable potential as a means of providing effective SRH education and services. However, there has been a lack of research assessing culturally and contextually tailored mHealth SRH interventions for Black and Latina women.

METHOD

A comprehensive literature search was undertaken using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Literature was reviewed to evaluate whether a culturally and contextually tailored approach was utilized in the development and implementation of mHealth interventions for Black and Latina women.

RESULTS

A total of 12 articles were included in our synthesis, which encompassed mobile phone-, telephone-, and computer-based mHealth interventions for Black and Latina women. Cultural and/or gender-specific tailoring was included in 10 studies. Reduction of risky sexual behaviors and increased contraception usage were reported in 92% (n = 11) of the studies. Interventions that incorporated tailored content and fostered interaction reported high rates of follow-up.

CONCLUSIONS

Tailored mHealth interventions can be effective in promoting behavior change and improving SRH outcomes for Black and Latina women. However, there is a need for more research assessing user engagement and retention for Black and Latina women, and whether improvements in SRH outcomes are sustainable over the long term.

Obstetric Violence in Spain (Part III): Healthcare Professionals, Times, and Areas

BACKGROUND

Obstetric violence is a worldwide public health problem, which seems greater in Spain. As no studies were found that identify the most representative healthcare professionals, times, and areas involved in obstetric violence, the objective of this work was to study at what time of maternity, with which professionals, and in what areas women identified obstetric violence.

METHODS

This descriptive, retrospective, and cross-sectional study was performed from January 2018 to June 2019. The main variables were the area (hospital, primary care, both), the time (pregnancy, birth, puerperium), and the professionals attending to women.

RESULTS

Our sample comprised 17,541 participants. The area identified with the most obstetric violence for the different studied variables was hospitals. Women identified more obstetric violence at time of birth. Findings such as lack of information and informed consent (74.2%), and criticism of infantile behavior and treatment (87.6%), stood out. The main identified healthcare professionals were midwives and gynecologists, and "other" professionals repeatedly appeared.

CONCLUSIONS

Having identified the professionals, times, and areas of most obstetric violence in Spain, it seems necessary to reflect on not only the Spanish National Health System's structure and management but also on healthcare professionals' training.

Lessons Learned from Replicating a Randomized Control Trial Evaluation of an App-Based Sexual Health Program

This study presents findings from a randomized control trial replication evaluation of Pulse, an app-based pregnancy prevention program implemented with Black and Latinx women aged 18-20, a population with high rates of unplanned pregnancy. We used social media advertisements to enroll 1013 women online across the U.S. and automatically randomized participants to either the Pulse reproductive health app or a general health control app, stratifying by age and race/Latinx ethnicity. Participants received reminder text messages to view the app as well as text messages with app-related content throughout the intervention. Linear probability models were conducted on the analytic sample of 871 participants who completed the six-week survey and 798 who completed the six-month survey and adjusted for permuted block randomization and multiple hypothesis testing. Compared to the control group, intervention group participants had higher contraceptive knowledge (p = 0.000), which replicates findings from an earlier evaluation. However, these impacts were not sustained at six-month follow-up (p = 0.162). We found no other significant program impacts. This contrasts with an earlier evaluation that found intervention participants were less likely to have had sex without a hormonal or long-acting reversible contraceptive (LARC) method and had greater self-confidence to use contraception consistently than the control group. Different demographic characteristics, lower app usage, and more negative attitudes about and usage of hormonal/LARC contraception in the current sample may help to explain fewer impacts than the earlier evaluation.

A systematic review of the evidence on peer education programmes for promoting the sexual and reproductive health of young people in India

In the context of a growing adolescent population globally, it is imperative to understand which interventions will most effectively advance their sexual and reproductive health (SRH). In India and globally, peer education is often utilised as an intervention for promoting the SRH of young people. Globally, the evidence of its effectiveness is mixed. A systematic review of the literature from the Indian context gave insight into the knowledge, attitudinal, and behavioural (KAB) outcomes affected by peer education, as well as the inputs, coverage, content, and context of such interventions. Out of the over 1500 publications initially identified through the database and bibliographic searches, 13 were included in the review; no quality assessment was done, given the dearth of publications matching the inclusion criteria. Analysis of the included publications highlights the multiple ways that peer education is implemented in the Indian context, as part of multi-component programmes and as a stand-alone intervention. The KAB outcomes from these initiatives are mixed, with some multi-component and some stand-alone initiatives affecting statistically significant outcomes and others not-a finding consistent with global literature reviewed for this paper. Despite the mixed results and the limited effects of behaviour relative to knowledge, this paper proposes that peer education has a place in an overall response to improving the SRH of young people. It calls for better research on peer education in India, and for research in relation to the optimal conditions for peer education to succeed in affecting KAB and other outcomes.

Sexual and reproductive health among adolescent girls and young women in Mombasa, Kenya

This secondary data analysis of a cross-sectional survey conducted in Mombasa, Kenya characterises sexual and reproductive health (SRH) indicators among adolescent girls and young women (AGYW) engaged in casual and transactional sexual relationships as well as sex work. It describes the association between awareness of local HIV programmes and SRH services uptake for AGYW engaged in sex work. Thirty-eight percent of the participants reported a history of pregnancy. Among participants not trying to get pregnant, 27% stated that they were not currently using any form of contraception. Of the participants who had an abortion, 59% were completed under unsafe conditions. For AGYW engaged in sex work, awareness of local HIV prevention programmes was associated with increased STI testing within the last year (29%) as well as at least one HIV test (99%) compared to those who were not aware of local programming (18% and 92%, respectively); however, only 26% of participants engaged in sex work had heard of local HIV prevention programmes. There were no associations between awareness of local HIV programming and rates of dual contraception use, safe abortion, most recent birth attended by a skilled health professional or testing for HIV during pregnancy. Our study found high need for SRH services, particularly, access to contraception and safe abortion. Continued efforts are required to improve access to the full spectrum of SRH interventions, including family planning services and access to safe abortion in addition to HIV prevention to promote health equity.

Sex Education in the Spotlight: What Is Working? Systematic Review

Adolescence, a period of physical, social, cognitive and emotional development, represents a target population for sexual health promotion and education when it comes to achieving the 2030 Agenda goals for sustainable and equitable societies. The aim of this study is to provide an overview of what is known about the dissemination and effectiveness of sex education programs and thereby to inform better public policy making in this area. Methodology: We carried out a systematic review based on international scientific literature, in which only peer-reviewed papers were included. To identify reviews, we carried out an electronic search of the Cochrane Database Reviews, ERIC, Web of Science, PubMed, Medline, Scopus and PsycINFO. This paper provides a narrative review of reviews of the literature from 2015 to 2020. Results: 20 reviews met the inclusion criteria (10 in school settings, 9 using digital platforms and 1 blended learning program): they focused mainly on reducing risk behaviors (e.g., VIH/STIs and unwanted pregnancies), whilst obviating themes such as desire and pleasure, which were not included in outcome evaluations. The reviews with the lowest risk of bias are those carried out in school settings and are the ones that most question the effectiveness of sex education programs. Whilst the reviews of digital platforms and blended learning show greater effectiveness in terms of promoting sexual and reproductive health in adolescents (ASRH), they nevertheless also include greater risks of bias. Conclusion: A more rigorous assessment of the effectiveness of sexual education programs is necessary, especially regarding the opportunities offered by new technologies, which may lead to more cost-effective interventions than with in-person programs. Moreover, blended learning programs offer a promising way forward, as they combine the best of face-to-face and digital interventions, and may provide an excellent tool in the new context of the COVID-19 pandemic.

Socioecological Factors Influencing Sexual Health Experiences and Health Outcomes of Migrant Asian Women Living in 'Western' High-Income Countries: A Systematic Review

Migrant health has been identified as one of the most pressing issues of the 21st century. Migration experiences are influenced by gender and gender norms and have important implications for the sexual health of migrant women. This systematic review explored socioecological factors influencing sexual health experiences and health outcomes of migrant Asian women living in "Western" high-income countries. PRISMA guidelines were followed and this study was registered with PROSPERO. Five academic databases were searched for peer-reviewed articles published between 2000 and 2019. Of 2415 studies retrieved, 17 met the selection criteria: 12 qualitative, 4 quantitative, and 1 mixed-methods study. The four levels of Bronfenbrenner's socioecological model were applied to examine the individual, interpersonal, institutional, and societal factors of influence. Most studies (n = 13) reported individual level factors, focusing on knowledge and use of contraceptives. At a societal level, host country sociocultural factors, including gender and cultural norms, influenced knowledge, ability to access and utilise contraceptives, and access to health services. Findings suggest that the public health policy, practice, and research to improve the sexual health of migrant women requires greater consideration of the intersecting factors of gender, culture, and the migration process.

Reproductive Life Goals: A Systematic Review of Pregnancy Planning Intentions, Needs, and Interventions Among Women Involved in U.S. Criminal Justice Systems

Background: Women involved in criminal justice systems (WICJ) are affected by multilevel biological and sociocultural factors that result in adverse health outcomes and health disparities. Criminal justice systems (CJS) must be appropriately resourced to address these issues. Materials and Methods: We developed a systematic review to understand the intentions and needs for pregnancy prevention and planning among WICJ to inform future reproductive health services. We conducted a systematic literature review of epidemiologic and interventional studies that addressed the pregnancy prevention and planning needs of U.S. WICJ (2000-2019). An initial screen identified 7061 articles and 3 independent reviewers determined that 28 articles (16 descriptive studies in adults, 7 descriptive studies in adolescents, and 5 interventional studies) met inclusion criteria. Results: The literature review identified high rates of contraception underutilization and negative attitudes toward pregnancy among WICJ in a wide variety of settings. WICJ described minimal access to reproductive health services, including evidence-based contraception, and experienced high rates of unplanned and undesired pregnancies. Results were interpreted in the context of the reproductive justice (RJ) framework. Conclusions: The CJS, although not designed to provide health care, should dedicate resources to address the multilevel barriers to care experienced by women. WICJ require targeted, gender-responsive, trauma-informed pregnancy prevention and planning interventions that acknowledge the history of reproductive coercion in this population and address key aspects of RJ, including the right to and to not have a child.

Barriers and enablers of contraceptive use among adolescent girls and women under 30 years of age in Cambodia: a qualitative study

OBJECTIVE

Unintended pregnancy and an unmet need for modern contraception remain high among adolescent girls and women in Cambodia. Qualitative descriptive research was conducted to explore the barriers to contraceptive use among young women in urban Cambodia.

METHODS

Semi-structured interviews were conducted among 30 adolescent girls and women aged 16-27 years, using purposive and snowball sampling strategies until data saturation was achieved. The audio-recorded interviews were transcribed verbatim and quality-checked. Inductive thematic data analysis was conducted. The results are presented using Bronfenbrenner's theoretical social ecological model.

RESULTS

The emerging major and minor themes indicate misconceptions about hormonal contraception as well as women's preference for using oral contraceptive pills for family planning after an unintended pregnancy. Women had low autonomy in choosing a contraceptive method, as their partners or husbands tended to prefer the withdrawal method. Young women faced cultural and supply chain barriers in accessing short- and long-acting reversible modern contraceptive methods at health centres.

CONCLUSION

Cambodian women aged 16-27 years are a vulnerable group who have low autonomy and sexual and reproductive health literacy and also face gender inequality.

Information needs of people seeking fertility services in Canada: a mixed methods analysis

Background

Infertility is a challenging experience associated with high levels of psychological distress. Many people seeking fertility services use the internet to obtain information about their conditions and treatments.

Objectives

This mixed-methods study aimed to describe the information-seeking experience of people seeking fertility services with respect to the fulfillment of their individually defined information needs and explore relationships between the fulfillment of information needs and psychological outcomes.

Methods

One hundred and four participants completed a survey with close-ended and open-ended questions about their experience using an informational web-based application (app) called ‘Infotility’ and about their mental well-being before and after using the app. The questionnaires administered were the The Mobile Application Rating Scale (uMARS), the Fertility Quality of Life questionnaire (FertiQol), the Patient Empowerment Questionnaire (PEQ) and the General Anxiety Disorder 7-item Scale (GAD-7). Eleven participants completed in-depth qualitative interviews about their experience using the app. A thematic analysis was used to interpret qualitative results and quantitization was used to dichotomize participants into those with met information needs versus those with unmet information needs. Google Analytics was used to compare participants’ reported experience with their actual use of the app.

Results

The results of this study show that there is variability in the amount of information that people seeking fertility services wish to receive. Participants whose information needs were met reported improved psychological outcomes after using the app, while those with unmet needs showed no change in their psychological outcomes.

Conclusions

Our results suggest that fulfilling information needs was associated with improved psychological outcomes in people seeking fertility services. Our results also suggest that individual differences in information needs should be considered when developing health educational materials.

Adolescent Sexual and Reproductive Health Care Service Availability and Delivery in Public Health Facilities of Plateau State Nigeria

To assess the availability, accessibility, appropriateness and quality of adolescent sexual and reproductive health (ASRH) services in primary health care (PHC) facilities in Plateau State, Nigeria, a cross-sectional study was conducted in 230 PHC facilities across the three senatorial zones of Plateau state. Primary data were obtained through face-to-face interviews with heads of facilities from December 2018 to May 2019. An adapted questionnaire from the World Health Organization (WHO) was used, covering five domains, to ascertain the extent that ASRH services were available and provided. Very few PHC facilities in the state had space (1.3%) and equipment (12.2%) for ASRH services. The proportion of PHC facilities offering counselling on sexuality was 11.3%, counselling on safe sex was 17%, counselling on contraception was 11.3% and management of gender-based violence was 3%. Most facilities were not operating at convenient times for adolescents. Only 2.6% PHC facilities had posters targeted at ASRH and just 7% of the PHCs had staff trained on ASRH. These findings underscore that the majority of PHC facilities surveyed in Plateau State, Nigeria, lacked dedicated space, basic equipment, and essential sexual and reproductive health care services for ASRH, which in turn negatively affect general public health and specifically, maternal health indices in Nigeria. Structural changes, including implementation of policy and adequate additional training of healthcare workers, are necessary to effectively promote ASRH.

The Role of Culture and Religion on Sexual and Reproductive Health Indicators and Help-Seeking Attitudes amongst 1.5 Generation Migrants in Australia: A Quantitative Pilot Study

In Australia, 1.5 generation migrants (those who migrated as children) often enter a new cultural and religious environment, with its own set of constructs of sexual and reproductive health (SRH), at a crucial time in their psychosexual development—puberty/adolescence. Therefore, 1.5 generation migrants may thus have to contend with constructions of SRH from at least two cultures which may be at conflict on the matter. This study was designed to investigate the role of culture and religion on sexual and reproductive health indicators and help-seeking amongst 1.5 generation migrants. An online survey was completed by 111 participants who answered questions about their cultural connectedness, religion, sexual and reproductive health and help-seeking. Kruskall-Wallis tests were used to analyse the data. There was no significant difference between ethnocultural groups or levels of cultural connectedness in relation to sexual and reproductive health help-seeking attitudes. The results do suggest differences between religious groups in regard to seeking help specifically from participants’ parents. Notably, participants who reported having ‘no religion’ were more likely to seek help with sexual and reproductive health matters from their parent(s). Managing cross-cultural experiences is often noted in the extant literature as a barrier to sexual and reproductive health help-seeking. However, while cultural norms of migrants’ country of origin can remain strong, it is religion that seems to have more of an impact on how 1.5 generation migrants seek help for SRH issues. The findings suggest that 1.5 generation migrants may not need to adapt their religious beliefs or practices, despite entering a new ethnocultural environment. Given that religion can play a role in the participants’ sexual and reproductive health, religious organizations are well-placed to encourage young migrants to adopt help-seeking attitudes.

Improving Research, Policy, and Practice to Address Women's Sexual and Reproductive Health Care Needs During Emerging Adulthood

Women in the period of emerging adulthood (18-25 years of age) have the greatest rates of unintended pregnancy and sexually transmitted infections. Despite this disproportionate risk, women's sexual and reproductive health needs during emerging adulthood are poorly understood. As a result, few age-specific policies or person-centered practice guidelines are available to reduce sexual risk. In this commentary we explore the unique characteristics of emerging adulthood that contribute to greater sexual and reproductive health risks for women. Current evidence on sexual and reproductive health outcomes of women during emerging adulthood and limited practice guidelines are discussed. Recommendations for health care providers, especially nurses, for guiding personalized care for women in emerging adulthood are discussed.

Healthcare providers' role in providing sexual and reproductive health information to people with intellectual and developmental disabilities: A qualitative study

BACKGROUND

Individuals with intellectual and developmental disabilities demonstrate disparities in sexual and reproductive health (SRH) compared to individuals without disabilities (e.g., lack of sexual education and knowledge, increased rates of abuse, unplanned pregnancies and sexually transmitted infections). Therefore, the purpose of this study was to identify topics healthcare providers address and perceived barriers and supports to SRH education.

METHODS

We conducted semi-structured interviews with healthcare providers (N = 12).

RESULTS

Providers address relationships, safety, protection and appropriate sexual behaviours with clients with intellectual and developmental disabilities. Parent education and client-centred care were identified as supports, while the patient's level of understanding, the provider's lack of knowledge or access to resources and to appropriate referrals were identified as barriers to SRH education.

CONCLUSION

Future studies are needed to link providers to resources they can use to provide comprehensive, accessible SRH education for clients with intellectual and developmental disabilities.

I-DECIDE: A Social Prescribing and Digital Intervention Protocol to Promote Sexual and Reproductive Health and Quality of Life among Young Cape Verdeans

Cape Verdean governments have intensified the investment on the National Reproductive Health Program, aiming to provide universal and qualified services, especially to the youngest people. Nevertheless, data suggest that some health challenges remain in this group (e.g., high rates of early/unplanned pregnancies, illegal abortions, sexual risk behaviors). In this paper, we present a protocol of a community-based social prescribing and digital intervention to promote wellbeing and quality of life across the life course of young Cape Verdeans, with a specific focus on Sexual and Reproductive Health (SRH) related behaviors. The intervention program, to be developed in three years, will follow an Intervention Mapping approach, namely regarding needs assessment and study’s protocol. The program’s implementation and evaluation will occur simultaneously. The main expected result is the development of a sustainable training program implemented in coproduction with Cape Verdeans from Mindelo (in São Vicente island), with replicable potential in other Cape Verdean regions. The intervention will contribute to SRH-related literacy through the digital health literacy materials and to quality of life across the young’s life course.

Addressing Organizational Barriers to Adolescent Access to High-Quality, Low-Cost, Confidential Sexual and Reproductive Health Services in a Community Health Center

Adolescents face a number of barriers to accessing high-quality, confidential sexual and reproductive health (SRH) services. Although federally qualified health centers (FQHCs), a type of community health center (CHC), are a critical source of health care for medically underserved adolescents, they often lack the capacity and resources to provide specialized SRH services to adolescents. In this article, we describe the development and implementation of an initiative aimed at improving an FQHC's capacity to provide high-quality confidential SRH services to adolescents. For this initiative, a team of clinical and quality improvement staff developed a set of six strategies to improve adolescent SRH services at an FQHC: (1) building community relationships and galvanizing internal organizational support to improve adolescent access to confidential SRH services, (2) developing a long-acting reversible contraception (LARC) program, (3) training clinic staff on SRH and adolescent health topics, (4) adapting the adolescent patient workflow to improve SRH service delivery during appointments, (5) updating and implementing a universal adolescent health assessment tool, and (6) developing billing and registration policies that allow adolescents to receive confidential SRH services. We identified several factors that we believe were key to the successful implementation of our approach in other CHC settings, including encouraging cross-sector collaboration and community focus, providing training as a tool to engage and empower staff as agents of change, involving interdisciplinary staff, piloting on a small scale, and establishing consistent meetings with a clinic champion and improvement team.

Young People's Experiences Using an On-Demand Mobile Health Sexual and Reproductive Health Text Message Intervention in Kenya: Qualitative Study

BACKGROUND

Digital health usability assessments can help explain how well mobile health (mHealth) apps targeting young people with sexual and reproductive health (SRH) information performed and whether the intended purpose was achieved. However, few digital health assessments have been conducted to evaluate young people's perceptions regarding mHealth system interactions and content relevance on a wide range of SRH topics. In addition, the majority of randomized controlled trials (RCTs) have focused on push messaging platforms; therefore, the mHealth field lacks sufficient RCTs investigating on-demand mHealth SRH platforms.

OBJECTIVE

The objective of this study was to explore young people's experiences using an on-demand SRH mHealth platform in Kenya.

METHODS

We used qualitative data related to the usability of an mHealth platform, Adolescent/Youth Reproductive Mobile Access and Delivery Initiatives for Love and Life Outcome (ARMADILLO), collected at the end of the intervention period. A total of 30 in-depth interviews (IDIs) were held with the intervention participants (15 women and 15 men) to elicit their experiences, opinions, and perspectives on the design and content of the ARMADILLO platform. The study participants were randomly selected from a list of intervention arm participants to participate in the IDIs. The interviews were later transcribed verbatim, translated into English, and coded and analyzed thematically using NVivo version 12 software (QSR International).

RESULTS

Respondents reported varied user experiences and levels of satisfaction, ranging from ease of use by the majority of the respondents to systematic frustrations that prevented some participants from progressing to other stages. Interesting features of the mHealth platform included the immediate response participants received when requesting messages, weekly remunerated quizzes, and perceived ability of educative and informative content and messages to change behaviors. Proposed enhancements to the platform included revising some concepts and words for easy understanding and increasing the interactivity of the platform, whereby young people could seek clarity when they came across difficult terms or had additional questions about the information they received.

CONCLUSIONS

The importance of understanding the range of health literacy and technological variations when dealing with young people cannot be overemphasized. Young people, as mHealth end users, must be considered throughout intervention development to achieve optimum functionality. In addition, young people targeted with mHealth SRH interventions must be sensitized to the interactions on mHealth platforms or any other digital health apps if implemented in a nonresearch setting for optimal use by the targeted audience.

Preparing for parenthood: developing a life-skills and socioemotional health program for young married couples in rural Pakistan

Background

Socioemotional life-skills to negotiate important life-transitions such as marriage and parenthood are critical for the wellbeing of young couples and their offspring, but programs addressing this issue are lacking in Low and Middle-Income Countries (LMICs).

Objective

This study describes the development of a ‘life-skills’ program for young married women, their husbands and families, living in rural settings in Pakistan.

Methods

Our methods included: a) a targeted review of relevant literature on life-skills and mental health in young people, b) a qualitative study and, c) intervention development workshops with experts and stakeholders. The review showed that common life-skills employed as part of psychosocial interventions in LMICs were communication skills, problem-solving, assessing relations, stress management, emotional regulation, identifying/eliciting affect, and self-awareness.

Results

The qualitative study indicated that areas of particular need included interpersonal communication skills with significant others, coping with the pressures of parenthood, and mental well-being. Existing helpful practices included social support by family members and elders. Lack of empowerment in young married women and poor engagement of husbands were identified as a barrier to accessing a potential intervention. Our proposed intervention called ‘Preparing for Parenthood’ consisted of 10 core sessions and 10 follow-up sessions designed to be delivered by lay health workers. It synergistically combined evidence-based socioemotional life-skills (awareness, communication skills, assertiveness, decision-making skills, goal-setting, critical thinking, problem-solving, and coping with stress), with cognitive behavioural strategies (gently challenging existing thoughts and attitudes, behaviour activation and problem solving). The intervention focuses on engagement of the entire family, including husbands.

Conclusions

The intervention can supplement existing sexual and reproductive health programs by providing skills to prospective parents to effectively negotiate stressful life-transitions and life-events. We envisage the intervention would improve mental as well as sexual and reproductive health of young couples and plan to test this in future randomised trials.

A collaborative learning approach to improving health worker performance in adolescent sexual and reproductive health service provision: a descriptive feasibility study in six health zones in the Democratic Republic of the Congo

Poor performance among health service providers is a key barrier to high quality, adolescent-responsive health services. Collaborative learning has been shown to strengthen health service provider performance, but few studies have examined its implementation in adolescent health services. In this paper, we describe a collaborative learning approach for adolescent health service providers implemented as part of a project aiming to prevent HIV in adolescent girls and young women in the Democratic Republic of the Congo (DRC) and explore its feasibility, acceptability, benefits and challenges. To do so, we reviewed plans, budgets and progress reports, as well as nested implementation research related to the project. We also carried out a quantitative analysis of the number, location, participants and topics of collaborative learning sessions conducted as part of this initiative, and thematic analysis to synthesise findings on perceived benefits and challenges. Under the project, 32 collaborative learning sessions of approximately two-hour duration were held with up to 15 participants, most of whom were nurses, between June 2018 and May 2019. The project cost was approximately USD 135,000 over three years. Reported benefits included improving health service provider attitudes, knowledge and skills; ensuring delivery of non-judgemental, empathic and confidential health services; and improving communication and collaboration between health services and adolescents together with their parents. While the novelty of the approach in this context presented challenges, our results suggest that collaborative learning in adolescent health services is feasible, acceptable, and inexpensive. It may help strengthen the knowledge and skills of health service providers, build positive attitudes and motivation, and improve their performance and thereby the adolescent-responsiveness of health services. Further research is needed to confirm these results in other settings and to examine the impact of collaborative learning on the acceptability and uptake of health services.

What we know and don't know: a mapping review of available evidence, and evidence gaps, on adolescent sexual and reproductive health in Bangladesh

Across low- and middle-income countries, investment in adolescent sexual and reproductive health (ASRH) is growing. However, the lack of comprehensive ASRH data hinders programmes. This mapping review examines the available evidence on ASRH in Bangladesh and points out the areas where critical information gaps exist. National surveys, research studies, grey literature, and reports on ASRH in Bangladesh published between 2011 and 2021 were reviewed. Data were extracted into categories, and topical summaries were presented. Research gaps were identified using an analytical framework informed by the Guttmacher Institute's global summary of ASRH research gaps. The gaps identified were synthesised according to relevance against three of the framework's categories: coverage, under-reporting and substantive. We also explored the extent to which human rights dimensions of ASRH have been addressed in the literature. While some of the issues covered, such as access to ASRH information, bodily autonomy and self-determination regarding marriage and childbearing choices, clearly address dimensions of human rights, very few studies were found that explored ASRH through a human rights lens. Furthermore, many of the same research gaps identified globally were also evident in the Bangladesh-specific literature. We assert that an expanded ASRH research agenda in Bangladesh that aims to fill the identified evidence gaps would inform more robust, targeted ASRH programming.

Patriarchy at the helm of gender-based violence during COVID-19

Gender-based violence (GBV) or violence against women and girls (VAWG), is a global pandemic that affects 1 in 3 women in their lifetime and VAWG is one of the most prevalent human rights violations in the world. The high level of investment going into the COVID-19 recovery plan is a unique opportunity to reshape our patriarchal society, to coordinate across sectors and institutions and to take measures to reduce gender inequalities. Relief efforts to combat the pandemic should take the needs of the vulnerable population, particularly women and girls afflicted by GBV into consideration, as their needs were mostly ignored in the recovery plan of Ebola. GBV is linked to dominance, power and abuse of authority or because any calamity, be it a pandemic, conflict or a disaster. This will further exacerbate pre-existing gendered structural inequalities and power hierarchies as protective mechanisms fail leaves women and girls more vulnerable, fueling impunity for the perpetrators. There is a need for international and domestic violence prevention policies to not only focus on narrowly defined economic or political 'empowerment' because that is insufficient when it comes to challenging existing gender inequalities. Incorporating an individual's religious beliefs and community of faith (mosque, church, temple or synagogue) can offer a support system for an individual and her/his family amid a public health crisis. There is a need to engage men and boys by tailoring messages to challenge gender stereotypes and unequal gender roles to overcome patriarchy.

Sexual and reproductive health services in universal health coverage: a review of recent evidence from low- and middle-income countries

If universal health coverage (UHC) cannot be achieved without the sexual and reproductive health (SRH) needs of the population being met, what then is the current situation vis-à-vis universal coverage of SRH services, and the extent to which SRH services have been prioritised in national UHC plans and processes? This was the central question that guided this critical review of more than 200 publications between 2010 and 2019. The findings are the following. The Essential Package of Healthcare Services (EPHS) across many countries excludes several critical SRH services (e.g. safe abortion services, reproductive cancers) that are already poorly available. Inadequate international and domestic public funding of SRH services contributes to a sustained burden of out-of-pocket expenditure (OOPE) and inequities in access to SRH services. Policy and legal barriers, restrictive gender norms and gender-based inequalities challenge the delivery and access to quality SRH services. The evidence is mixed as to whether an expanded role and scope of the private sector improves availability and access to services of underserved populations. As momentum gathers towards SRH and UHC, the following actions are necessary and urgent. Advocacy for greater priority for SRH in government EPHS and health budgets aligned with SRH and UHC goals is needed. Implementation of stable and sustained financing mechanisms that would reduce the proportion of SRH-financing from OOPE is a priority. Evidence, moving from descriptive towards explanatory studies which provide insights into the "hows" and "whys" of processes and pathways are essential for guiding policy and programme actions.

From bad to worse: global governance of abortion and the Global Gag Rule

The Trump Administration's Protecting Life in Global Health Assistance (PLGHA) significantly expands the "Global Gag Rule" - and, in so doing, weakens the global governance of abortion. By chilling debate, reducing transparency, ghettoising sexual and reproductive health and rights work, and interfering with research, PLGHA makes an already bad context demonstrably worse. Individual women suffer the most, as PLGHA inhibits ongoing efforts to reduce abortion-related morbidity and mortality.

Assessing sexual and reproductive health dimensions tools in women with type 1 diabetes mellitus with regard to Consensus-based Standards for the selection of health status Measurement Instruments checklist

A valid tool is of paramount importance in determining women's sexual and reproductive health status, meeting their health needs, and recognizing the effectiveness of some interventions. This review study aimed to assess sexual and reproductive health dimensions tools in women with type 1 diabetes mellitus with regard to Consensus-based Standards for the selection of health status Measurement Instruments (COSMIN) checklist. In this review study, in addition to Iranian databases (MagIran, Sid, Irandoc), non-Iranian databases (PubMed, Scopus, Embase, and Web of Science) and Google Scholar search engine were considered. The mentioned databases were searched for articles in English and Persian published within 2000-2019, using the search strategy for each database and Boolean operators along with appropriate keywords according to the MESH term. Articles with nonresearcher-made tools measuring the sexual and reproductive health concepts and dimensions were included in the present study. Afterward, the psychometric properties of the tools were assessed according to the COSMIN checklist. In the selected articles, there were 14 psychometrically valid tools to be assessed from 151 articles containing the sexual and reproductive health dimensions; among which, seven tools were evaluated with regard to COSMIN. None of the tools also had all the features noted in COSMIN. Moreover, all the concerned scales were not interpretable and accountable; however, a majority of them had internal consistency and construct validity. In this study, there was no valid and specific tool for measuring sexual-reproductive health status in this population group. Therefore, it is necessary to develop a valid tool according to the dimensions and needs of specific reproductive health in type 1 diabetes.

Adolescent Pregnancy and Parenting: Perceptions of Healthcare Providers

BACKGROUND

Adverse maternal and child health outcomes due to adolescent pregnancy are central to public health research and practice. In addition, public health has emphasised that the care rendered by healthcare providers plays a pivotal role in the health and well-being of pregnant and parenting adolescents. Healthcare providers may differ in the ways they interpret adolescent pregnancy and parenting and consequently, this may have profound implications for healthcare decision making. The aim of this study was to explore the multiple perspectives of a diverse group of healthcare providers' delivering services and engaging with pregnant adolescents and adolescent mothers at a district hospital in Ugu, KwaZulu Natal, South Africa.

METHODS

This descriptive qualitative study used semi-structured interviews (n=33). Healthcare providers rendering care to pregnant and parenting adolescents were recruited from the maternity, antenatal, paediatrics, psychology, dietetics, physiotherapy and social work departments, as well as from the HIV/AIDS, STIs and TB (HAST) programme. The data were analysed using thematic analysis.

RESULTS

The healthcare providers acknowledged that adolescent pregnancy is a problematic issue in Ugu district. Furthermore, they felt that the postpartum sexual-related and reproductive health of adolescent mothers was not given priority. In the healthcare providers' view, the problems experienced by pregnant and parenting adolescents were school dropout, financial constraints, breakdown of relationships, abandonment, stigmatisation, parenting and child rearing difficulties, and both physical and mental health problems.

CONCLUSION

This study highlights that the issue of sexual- and reproductive-related outcomes of adolescent pregnancy and parenting is not given priority. In addition, the findings also highlighted the need for a multidisciplinary approach to the care of pregnant and parenting adolescents. Multidisciplinary communities of practices as interventions can be used to generate and share knowledge, capacitate healthcare providers and improve clinical practice. The training of healthcare providers, provision of non-judgemental counselling and tailored services for pregnant adolescents and adolescent mothers are essential. When appropriately disseminated, the findings will assist relevant healthcare providers, administrators in healthcare institutions, policymakers, and officials of the Department of Health and the Department of Education in South Africa to address the lack of appropriate care for pregnant and parenting adolescents.

Impacts of the Global Gag Rule on sexual and reproductive health and rights in the Global South: A scoping review

The Global Gag Rule is a United States policy that blocks global health funding to foreign non-governmental organisations if they engage in abortion-related activities. It has been implemented by every Republican administration since 1984 and remains in operation at the time of writing in its most stringent and extensive form. It has been criticised for its implications for women's bodily autonomy, its censorship of non-governmental organisations and health professionals, and for its impact on the health of populations in affected countries. To capture the effects of the policy to date, we conducted a scoping review in April 2020. Forty-eight articles met our eligibility criteria, and were analysed thematically, noting the effects on: the operations of non-governmental organisations; maternal health; sexually transmitted infections; marginalised groups; reproductive rights. We found that the policy increased the abortion rate and had a negative impact on maternal health, STIs, and the health of marginalised groups. We conclude that the policy amounts to the neocolonial co-optation of sexual and reproductive health in the Global South to advance an ideological agenda in the Global North. We urge that the policy be repealed as part of the broader project of protecting and decolonising sexual and reproductive health globally.

How Sexuality Education Programs Have Been Evaluated in Low-and Lower-Middle-Income Countries? A Systematic Review

Background: Complex sexual and reproductive health interventions, such as sexuality education (SE), contain multiple components and activities, which often requires a comprehensive evaluation design and adaptation to a specific context. In this review, we synthetize available scientific literature on types of evaluation designs used for SE programs in low- and lower-middle-income countries. Methods: Two databases yielded 455 publications, from which 20 articles met the inclusion criteria. Narrative synthesis was used to summarize the findings. Evaluation approaches were compared to recommended evaluation frameworks. The quality of articles was assessed by using MMAT 2018. Results: A total of 15 interventions employed in 10 countries were evaluated in the 20 selected articles, with the quality of publications being moderate to high. Randomized controlled trial was the predominant study design, followed by quasi-experimental design. There were seven process evaluation studies, using mixed methods. Main outcomes reported were of public health or behavioral nature—condom use, sexual debut or delay, and number of sexual partners. By comparing evaluation designs to recommended frameworks, few studies fulfilled at least half of the criteria. Conclusions: Evaluations of SE are largely dominated by quantitative (quasi-)experimental designs and use of public health outcomes. To improve understanding of SE program effectiveness, it is important to assess the quality of the program development, its implementation, and its impact, using existing evaluation frameworks and recommendations.

Adolescent-parent communication on sexual and reproductive health issues amongst secondary school students in Western Region 1 of The Gambia

Background

Adolescent–parent communication about sexual issues is a challenging issue worldwide. In The Gambia, many traditional communities limit such communication and this can have an adverse influence on sexual and reproductive health (SRH) outcomes and behaviours in adolescents.

Aim

The study assessed adolescent–parent communication on selected SRH issues amongst secondary school students.

Setting

The study was conducted in selected secondary schools in Western Region 1 of The Gambia.

Methods

This descriptive cross-sectional study utilised mixed methods. For the questionnaire survey, secondary school students were selected using a multistage sampling technique whilst parents for focus group discussions were purposively selected.

Results

A total of 600 adolescents and 48 parents were studied. Only 360 (60.0%) of the students had heard of SRH. One-third (67.3%) knew about sexually transmitted infection (STIs) such as human immunodeficiency virus and acquired immunodeficiency syndrome (56.5%), gonorrhoea (40.5%) and syphilis (2.5%). Social media (31.0%) were the predominant source of information regarding SRH issues, followed by television (22.0%), school (14.0%) and parents (9.0%). Half (50.8%) of the adolescents discussed sexual intercourse with their parents – mostly with their mothers. Parental and cultural factors, fear, shyness and ignorance were the main reasons why adolescents did not discuss specific SRH issues with their parents.

Conclusion

This study showed that adolescent–parent communication on SRH issues was poor. Programmes supporting parents to effectively communicate SRH matters with their children should be designed and implemented.

Staff and Users' Experiences of Pharmacy-Based Sexual and Reproductive Health Services: A Qualitative Interview Study from the UK

Since August 2015, a large range of sexual health and reproductive health services have been provided in more than 120 pharmacies across Birmingham (England). Our study aimed to explore how pharmacy staff and pharmacy users experience delivering or being provided with sexual health and reproductive health services. Between March and September 2019, semi-structured interviews were conducted with 15 pharmacy staff delivering sexual and reproductive health services and 15 people who had used a sexual and reproductive health service at the pharmacy. Interviews were analysed thematically. Pharmacy users found services convenient to use and were largely satisfied with pharmacy staff consultation skills. Staff were motivated to deliver the services, although some felt that they did not receive sufficient recognition for their work. Barriers to pharmacy-based sexual and reproductive health services were identified, including lack of privacy for users, lack of staff and user awareness of the services, lack of trained staff to deliver services and lack of capacity for copper coil insertions in females presenting for emergency contraception. The identification of barriers to effective service provision can be used to improve the delivery of sexual and reproductive health services in pharmacies and lead to a greater uptake.

Predictors of Internet Health Information-Seeking Behaviors Among Young Adults Living With HIV Across the United States: Longitudinal Observational Study

BACKGROUND

Consistent with young adults' penchant for digital communication, young adults living with HIV use digital communication media to seek out health information. Understanding the types of health information sought online and the characteristics of these information-seeking young adults is vital when designing digital health interventions for them.

OBJECTIVE

This study aims to describe characteristics of young adults living with HIV who seek health information through the internet. Results will be relevant to digital health interventions and patient education.

METHODS

Young adults with HIV (aged 18-34 years) self-reported internet use during an evaluation of digital HIV care interventions across 10 demonstration projects in the United States (N=716). Lasso (least absolute shrinkage and selection operator) models were used to select characteristics that predicted whether participants reported seeking general health and sexual and reproductive health (SRH) information on the internet during the past 6 months.

RESULTS

Almost a third (211/716, 29.5%) and a fifth (155/716, 21.6%) of participants reported searching for general health and SRH information, respectively; 26.7% (36/135) of transgender young adults with HIV searched for gender-affirming care topics. Areas under the curve (>0.70) indicated success in building models to predict internet health information seeking. Consistent with prior studies, higher education and income predicted health information seeking. Higher self-reported antiretroviral therapy adherence, substance use, and not reporting transgender gender identity also predicted health information seeking. Reporting a sexual orientation other than gay, lesbian, bisexual, or straight predicted SRH information seeking.

CONCLUSIONS

Young adults living with HIV commonly seek both general health and SRH information online, particularly those exploring their sexual identity. Providers should discuss the most commonly sought SRH topics and the use of digital technology and be open to discussing information found online to better assist young adults with HIV in finding accurate information. Characteristics associated with health information-seeking behavior may also be used to develop and tailor digital health interventions for these young adults.

national priority: impacts of the US Global Gag Rule on Nepal's sexual and reproductive healthcare system

In recent decades, bold steps taken by the government of Nepal to liberalise its abortion law and increase the affordability and accessibility of safe abortion and family planning have contributed to significant improvements in maternal mortality and other sexual and reproductive health (SRH) outcomes. The Trump administration’s Global Gag Rule (GGR) – which prohibits foreign non-governmental organisations (NGOs) from receiving US global health assistance unless they certify that they will not use funding from any source to engage in service delivery, counselling, referral, or advocacy related to abortion – threatens this progress. This paper examines the impact of the GGR on civil society, NGOs, and SRH service delivery in Nepal. We conducted 205 semi-structured in-depth interviews in 2 phases (August–September 2018, and June–September 2019), and across 22 districts. Interview participants included NGO programme managers, government employees, facility managers and service providers in the NGO and private sectors, and service providers in public sector facilities. This large, two-phased study complements existing anecdotal research by capturing impacts of the GGR as they evolved over the course of a year, and by surfacing pathways through which this policy affects SRH outcomes. We found that low policy awareness and a considerable chilling effect cut across levels of the Nepali health system and exacerbated impacts caused by routine implementation of the GGR, undermining the ecology of SRH service delivery in Nepal as well as national sovereignty.

Foreign assistance or attack? Impact of the expanded Global Gag Rule on sexual and reproductive health and rights in Kenya

In 2017, the Trump Administration reinstated and expanded the Global Gag Rule (GGR). This policy requires non-governmental organisations (NGOs) not based in the US to certify that they will not provide, counsel, refer, or advocate for abortion as a method of family planning in order to receive most categories of US global health assistance. Robust empirical evidence demonstrating the policy’s impacts is acutely lacking. This paper describes the effects of the expanded GGR policy in Kenya eighteen months after its reinstatement. We conducted semi-structured interviews with purposively selected representatives of US- and non-US-based NGOs, as well as managers and health providers at public and private health facilities, between September 2018 and March 2019. Organisations reported critical funding loss as they were forced to choose between US government-funded projects and projects supporting safe abortion. This resulted in the fragmentation of sexual and reproductive health and HIV services, and closure of some service delivery programmes. At public and private health facilities, participants reported staffing shortages and increased stock-outs of family planning and safe abortion commodities. The expanded GGR’s effects transcended abortion care by also disrupting collaboration and health promotion activities, strengthening opposition to sexual and reproductive health and rights in some segments of Kenyan civil society and government. Our findings indicate that the GGR exposes and exacerbates the weaknesses and vulnerabilities of the Kenyan health system, and illuminates the need for action to mitigate these harms.

Obstetric Violence in Spain (Part I): Women's Perception and Interterritorial Differences

The decentralization of health systems can have direct repercussions on maternity care. Some inequalities can be noted in outcomes, like neonatal and child mortality in Spain. This study aimed to make the presence of obstetric violence in Spain visible as an interterritorial equity criterion. A descriptive, restrospective and cross-sectional study was conducted between January 2018 and June 2019. The sample comprised 17,541 questionnaires, which represented all Spanish Autonomous Communities. Of our sample, 38.3% perceived having suffered obstetric violence; 44.4% perceived that they had undergone unnecessary and/or painful procedures, of whom 83.4% were not requested to provide informed consent. The mean satisfaction with the attention women received obtained 6.94 points in the general sample and 4.85 points for those women who viewed themselves as victims of obstetric violence. Spain seems to have a serious problem with public health and respecting human rights in obstetric violence. Offering information to women and requesting their informed consent are barely practiced in the healthcare system, so it is necessary to profoundly reflect on obstetric practices with, and request informed consent from, women in Spain.

Knowledge on, Attitude towards, and Practice of Sexual and Reproductive Health among Older Adolescent Girls in Bangladesh: An Institution-Based Cross-Sectional Study

Improving the sexual and reproductive health (SRH) of adolescent girls is one of the primary aims of the Sustainable Development Goals (SDGs). Adequate and accurate knowledge, a favorable attitude, safe behavior, and regular practice contribute to adolescent girls’ SRH, maternal health, and child health. Considering this, this study aims to explore the level of knowledge, attitudes, and practices (KAP) of SRH among college-going older adolescent girls in Chittagong district, Bangladesh. An institution-based cross-sectional study was conducted in four colleges among the older adolescent girl age group of 16–17 years old (N = 792) attending a higher secondary grade in Chittagong district. Data were collected using a structured and self-administered questionnaire. Descriptive statistics and multiple linear regression analyses were used to summarize the SRH-related KAP and identify the associated factors, respectively. The level of knowledge about puberty, family planning, maternal health, and HIV/AIDS was not satisfactory among the older adolescent girls. Different myths are common in the rural area with regards to menstruation, which impose several restrictions on adolescent girls and adult women. Standardized coefficients of beta (β) and p value < 0.05 in linear regression analyses demonstrated that being a student of the science group (β = 0.29, p < 0.001) and reading about or watching SRH issues on media (β = 0.21, p < 0.001) were significantly associated with older adolescent girls’ high level of knowledge in this regard. Furthermore, being a student of the science group (β = 0.17, p < 0.001), urban residence (β = 0.20, p < 0.001), regular SRH communication (at least once a month) with a mother/sister/friend (β = 0.10, p = 0.003), and reading or watching any SRH content on media (β = 0.22, p < 0.001) appeared as predictors of adolescent girls’ positive attitude towards SRH issues. Moreover, being a student of the science group (β = 0.07, p = 0.048), urban residence (β = 0.22, p < 0.001), regular SRH discussions with a mother/sister/friend (β = 0.09, p = 0.005), pre-knowledge on periods before menarche (β = 0.12, p < 0.001), and reading or watching any SRH content on media (β = 0.18, p < 0.001) are the most important factors influencing a regular hygienic practice of SRH. This study suggests strengthening SRH-related comprehensive education programs incorporated into the curriculum, the effective use of mass media, and supplying behavioral change communication materials.

A proposed one-stop-shop approach for the delivery of integrated oral, mental, sexual and reproductive healthcare to adolescents in Nigeria

The interconnectedness of oral, mental, sexual, and reproductive health (OMSRH) in adolescents prompts exploration of novel approaches to facilitate comprehensive access of this population to the relevant health services. This paper proposes an integrated one-stop-shop approach to increasing adolescents' access to OMSRH care by leveraging on dental clinics as a template for integration, using a non-stigmatized platform to deliver stigmatized healthcare. Novel healthcare delivery models are needed to enhance adolescents' access to the comprehensive prevention and treatment services that they critically need. Effective, integrated health care for this population is lacking, especially across various health areas. This is a proposal for leveraging dental clinics for integrated OMSRH care, using facility-based services, to adolescents. Emphasis will be placed on reducing stigma as a barrier to service accessibility, acceptability, equitability and appropriateness. Empirical studies will be required to test the feasibility, validity and effectiveness of this proposed model.

'Somebody that looks like me' matters: a qualitative study of black women's preferences for receiving sexual health services in the USA

Research dedicated to understanding the sexual experiences of Black women has historically been framed around adverse outcomes. There are limited data that can be used to understand the lived experiences of Black women related to sexual health care. Twenty-five Black women aged 18- 35 from across nine US states were interviewed to gain insight into their experiences and preferences for receiving sexual health services. Three themes were developed from their accounts: individual and structural barriers affect access to and perceived quality of care; service provider race and gender impact sexual health care experiences; and personalised care improves engagement. Findings suggest the need for culturally informed training for sexual health practitioners working with Black women.

[Social inequalities related to antimicrobial resistance in N. gonorrhoeae in ColombiaDesigualdades sociais relacionadas à resistência antimicrobiana de N. gonorrhoeae na Colômbia]

Objetivo.

Medir desigualdades sociales en la resistencia antimicrobiana de la Neisseria gonorrhoeae en Colombia.

Métodos.

Estudio ecológico utilizando un multipanel de datos desagregado a nivel subnacional de los aislamientos en la N. gonorrhoeae como proxy de resistencia antimicrobiana (RAM) entre 2009 y 2018. Se llevó a cabo una caracterización sociodemográfica, un análisis de la sensibilidad antimicrobiana de aislamientos de N. gonorrhoeae, y una medición de desigualdades en la RAM para la N. gonorrhoeae mediante el índice de desigualdad de la pendiente, el índice de desigualdad relativo y el índice de concentración.

Resultados.

Los hallazgos indican resistencia antimicrobiana de aislamientos de N. gonorrhoeae a penicilina (50,7%) y tetraciclina (67,3%); y la existencia de desigualdades absolutas y relativas durante el período analizado. Las barreras de acceso a servicios de salud, no haber recibido información de prevención de las infecciones de transmisión sexual, necesidades básicas insatisfechas y analfabetismo explicaron las desigualdades en la RAM de la N. gonorrhoeae.

Conclusiones.

Seis recomendaciones emergen para contener en gran medida la RAM en la N. gonorrhoeae: i) aumentar conciencia sobre la salud sexual y reproductiva segura; ii) repensar cómo entregar mensajes claves con enfoque de equidad; iii) mejorar los sistemas de información, prescripción y cadena de medicamentos; iv) crear coaliciones para mejorar la respuesta y compartir objetivos con el sector privado; v) mejorar la disponibilidad y desagregación de los datos; y vi) apoyar investigaciones en desigualdades en RAM.

A Qualitative Study Exploring Menstruation Experiences and Practices among Adolescent Girls Living in the Nakivale Refugee Settlement, Uganda

(1) Background: Girls in low- and lower-middle income countries face challenges in menstrual health management (MHM), which impact their health and schooling. This might be exacerbated by refugee conditions. This study aimed at describing menstruation practices and experiences of adolescent girls in Nakivale refugee settlement in Southwestern Uganda. (2) Methods: We conducted a qualitative study from March to May 2018 and we intentionally selected participants to broadly represent different age groups and countries of origin. We conducted 28 semistructured interviews and two focus group discussions. Data were transcribed and translated into English. Analysis included data familiarization, manual coding, generation and refining of themes. (3) Results: Main findings included: (a) challenging social context with negative experiences during migration, family separation and scarcity of resources for livelihood within the settlement; (b) unfavorable menstruation experiences, including unpreparedness for menarche and lack of knowledge, limitations in activity and leisure, pain, school absenteeism and psychosocial effects; (c) menstrual practices, including use of unsuitable alternatives for MHM and poor health-seeking behavior. (4) Conclusions: A multipronged approach to MHM management is crucial, including comprehensive sexual education, enhancement of parent–adolescent communication, health sector partnership and support from NGOs to meet the tailored needs of adolescent girls.

Abortion knowledge and experiences among young women and men in Accra, Ghana

Background : Despite the presence of legal abortion services in Ghana, unsafe abortion remains common, particularly among young women. Little is understood about what young people know about safe and legal abortion, and if and how they are utilizing it. Methods : To characterize abortion use and address gaps in safe access, from September-December 2013, we conducted a cross-sectional survey with 100 men and 250 women aged 18-24 in Accra, Ghana. Participants were asked about abortion experiences, including prior services, providers, methods, satisfaction, perceived support, and knowledge of laws. Descriptive statistics, Fisher's exact tests, and chi-square tests were performed. Results : Among surveyed youth, most (87% of women, 64% of men) thought abortion was illegal or did not know the law. In total, 30% of women and 14% of men ever had an abortion and partner who had an abortion, respectively. Among women's most recent abortions, medication abortion (61%), surgical methods (26%), and unsafe methods categorized "least safe" (14%) were the initial or only methods used. Most women who accessed medication abortion initially or as their only method saw a pharmacist (40%) or no one (33%). Nearly one-quarter of women (n=16, 24%) who initially took tablets used more than one method. Conclusions : Despite experiences with abortion, most young people in this study were unaware of its legality and unsafe abortions occurred. More needs to be done to ensure young people understand the law and have access to safe methods, and that pharmacists are trained to provide appropriate doses and formulations of medication abortion.

Abortion and methods of reproductive planning: the views of Malta's medical doctor cohort

Malta is the only EU country where abortion remains illegal in all circumstances. This study aims to assess the previously unexplored views of Malta’s medical doctors on the legality of contraception, abortion, assisted reproductive technology and surrogacy. Following ethics approval, 1578 out of a total of 2468 registered medical doctors in Malta were invited for an anonymous survey. The response rate was 28.8% (n = 454), guaranteeing a maximum margin of error of 4.16% assuming a 95% confidence level. Responses consisted of “Yes”, “No”, and “Not sure”. In the abortion section, “Yes” responses were specific to different gestational age limits. A majority supported all contraceptive methods being legal: morning-after pill (59.7%); intra-uterine device (85.9%); surgical sterilisation (>70%). A majority also agreed with in-vitro fertilisation being legal (93.8%). Embryo freezing and surrogacy garnered less support (39.9% and 40.5% respectively). Legalising abortion for “Woman’s life in danger” and “Non-viable fetal anomaly” was supported at least up to 12 weeks gestation by 66.8% and 63.0% respectively, and in all stages of pregnancy by 54.2% and 50.2% respectively. Support, at least up to 12 weeks gestation, was less for other circumstances: “Rape or incest” (35.3%); “Preserve a woman’s physical health” (30.0%); “Preserve a woman’s mental health” (26.8%); “Viable fetal anomaly” (24.6%); “<16 years of age” (23.8%); “Economic/social reasons” (18.9%); “Any circumstance” (14.5%). According to the surveyed respondents, there is at present a clear majority of doctors in Malta who do not agree with the total legal ban on abortion and support its legalisation in limited circumstances.

Quality assessment in primary health care: Adolescent and Youth Friendly Service, a Mozambican case study

Introduction

despite the Mozambican Ministry of Health's efforts to deliver family planning to all girls of childbearing age, the adolescent pregnancy rate remains high. The Adolescent and Youth Friendly Service (AYFS), integrated into overall primary health care programs throughout the country, aims to reverse this situation. Our study objective was to assess this health care service's quality in its location in Marrere Health Centre, Nampula, northern Mozambique, using clients' perspective.

Methods

we implemented a descriptive cross-sectional quantitative study sampling 124 individuals, who had recently accessed the AYFS at Marrere Health Centre. Data were collected through a questionnaire using a 5-point Likert scale in questions regarding satisfaction level (i.e. always, most times, sometimes, few times, never) and additional open answer questions to gain greater specific understanding.

Results

a total of 126 users of the AYFS were evaluated, all from the Emacua ethnic-linguistic group. 85 (67%) were adolescents (<19 years), 78.2% female. The mean age was 17.6 years. We found an average of 0.54 pregnancies per woman and 87 participants (69%) never had a pregnancy; of 39 (31%) who had been pregnant, 17 (44%) were able to report the date of the first prenatal visit, on average performed at week 16 (2nd trimester), though with 9 (53%) having performed it during the first trimester. Spontaneous and induced abortions were reported respectively in 4 and 34 cases, respectively, and none with adolescents. The “overall satisfaction” rate was more frequent in both groups, being answered by 93.8% of youth and adults (>= 19 years) and 72.0% of adolescents, a statistically significant difference between the two groups (p <0.05).

Conclusion

while most users are satisfied with the services there was, however, some sharp criticism. Health professionals' practice with the protocol varied, and there were significant deficiencies in information and communication with users. Open communication within families and information reinforcement about sexual and reproductive health and male participation in family planning were found to be in need of strengthening. Our recommendations include reinforcing health professional's training to protect adolescents and young people' sexual health, an important strategy in primary health care to achieve universal health coverage.