Factors influencing sexual and reproductive health of Muslim women: a systematic review

Female genital self-image and body appreciation in Turkish women: a mixed methods study

The study investigated negative genital self-image in women and determined the effect of education on natural/normal female genital appearance diversity on the change in women's genital self-image. The type of research is a mixed method descriptive study. The participants were 259 women living in Turkey. In the first stage of the study, female genital self-image levels and body appreciation levels were evaluated. In the second stage of the study, women were interviewed thoroughly about negative female genital self-image, and then, visual education presentation was made on natural/normal female genital diversity. One week after the presentation, the women's genital self-image levels were re-evaluated. In the first phase of the study, the mean Female Genital Self-Image Scale (FGSIS) total score was 22.07 ± 4.07 and the mean Body Appreciation Scale (BAS) total score was 42.40 ± 8.13 of the women. Higher FGSIS and BAS scores showed an increase in women's positive genital self-image and body appreciation. The relationship between the FGSIS and the BAS scale scores of the women was found to be significantly correlated (r = 0.401, p < 0.001). In the second stage of the study, four main themes were examined as "positive thoughts," "size and image," "metaphors related to genital organs," and "negative thoughts." In conclusion, in the first phase, it was determined that women's feeling of discomfort with their sexual organs during sexual intercourse, comparing their genital organs with other women's genital organs, thinking of genital organ aesthetic surgery, and BAS scores were associated with FGSIS scores. In the second phase, women's positive or negative feelings and thoughts about their genital self-image were revealed.

The Knowledge and Practice of Family Planning Among Muslim Women in Rural Karnataka, India

Introduction Women's health is significantly impacted by undesirable pregnancies and unsafe abortions, leading to the deaths of thousands of women and causing many others to suffer from infertility and long-term reproductive health issues. To address this problem, the use of modern contraception methods is increasing, regardless of economic status and dwelling, allowing women to exercise their rights and access reproductive health services. Objective The objective of this study is to examine the knowledge and practice of family planning and the factors associated with it. Setting and design A cross-sectional study was conducted among Muslim women (n=461) using a two-stage stratified random sampling method with a semi-structured questionnaire in the five taluks of Dakshina Kannada district in Karnataka. Methods and materials The required study sample was drawn by adopting the two-stage stratified random sampling technique. The study population was divided into different strata consisting of panchayats and wards. The number of households was selected from these panchayats/wards. Statistical analysis The association between faith in family planning and the knowledge and practice of family planning is studied using a chi-squared test. The factors associated with the practice of family planning are identified using a univariable and multivariable logistic regression analysis. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 27 (IBM SPSS Statistics, Armonk, NY). Results There is a significant association between faith in family planning and its practice, with a p-value of less than 0.0001. Age was also found to be a significant factor associated with the practice of family planning. Specifically, women aged 31-40 were less likely to practice family planning compared to women aged 21-30, with a p-value of 0.012. The majority of individuals indicated the preferred child (23.9%) and going against the custom (16.5%) as their reasons for not using family planning. Conclusions Muslim women are reasonably well-informed about modern methods of contraception, but their usage remains relatively low. Outreach initiatives, health worker mobilization from within the community, and health education and information sharing are examples of program interventions that could help address this issue.

"I don't want my marriage to end": a qualitative investigation of the sociocultural factors influencing contraceptive use among married Rohingya women residing in refugee camps in Bangladesh

BACKGROUND

The timely provision of comprehensive contraceptive services to Rohingya women is impeded due to a lack of clarity and understanding of their traditional beliefs and cultural frameworks. Recognizing this challenge, our paper aims to explore the socio-cultural factors influencing the utilization of contraceptives among married Rohingya women living in the refugee camps of Cox's Bazar, Bangladesh.

METHOD

A qualitative study was conducted in two unregistered Rohingya camps (Camp 7&14) located in Ukhiya Upazila, Cox's Bazar from January 10th to 20th, 2022. A total of 14 In-Depth Interviews (IDIs) were conducted among married Rohingya women of reproductive age (15-49 years), along with 16 Key Informant Interviews (KIIs) involving stakeholders engaged in reproductive healthcare provision. Participants were selected using purposive sampling. All interviews were conducted in the local language, recorded, transcribed verbatim, and subsequently translated into English. The data were analyzed using NVivo (Version 11), and the analysis process followed Neuman's three-phase coding system.

RESULTS

Five broad themes were identified: Sociocultural expectations and values attached to births, power imbalances within marital relationships, the role of religious beliefs, fear of side effects, and misperceptions about contraception. Having a larger number of children is viewed positively as it is believed that children play a crucial role in preserving the lineage and contributing to the growth of the Islamic population. Despite expressing an inclination towards contraception, the disapproval of husbands becomes a significant barrier for women. Defying their husbands' wishes can result in instances of Intimate Partner Violence (IPV) and even marriage dissolution within the camps. Moreover, the fear of side effects, such as a particular method would cause infertility, discourages women from using contraception. Many of these fears stem from myths, misconceptions, and mistrust in the existing medical system.

CONCLUSION

Addressing the socio-cultural barriers that prevent women from using modern contraception will have important public health implications. These findings can support in crafting culturally sensitive programs and educational interventions. These initiatives can assist Rohingya refugee women in planning their pregnancies and reducing high-risk pregnancies, ultimately leading to a decrease in maternal mortality rates within the community.

Caring for Muslim Patients: A Primer for the Obstetrician Gynecologist

Studies show that Muslim American patients experience discrimination and feel uncomfortable seeking appropriate health care for various reasons. Obstetrician-gynecologists should be educated regarding Islamic perspectives on topics such as modesty, sexual health, contraception, abortion, infertility, and fasting during pregnancy. Understanding the barriers Muslim patients face and improving cultural humility will improve the quality of sexual and reproductive care delivered to Muslim patients.

Trends, patterns and predictors of high-risk fertility behaviour among Indian women: evidence from National Family Health Survey

BACKGROUND

Numerous studies have demonstrated that high-risk fertility behaviour (HRFB), which includes maternal age below 18 or above 34 years, short birth intervals (less than 24 months), and high parity (birth order above 4), is associated with adverse maternal and child health outcomes. There is a substantial research gap in the domain of high-risk fertility behaviour in the Indian context. Therefore, this study is designed to investigate the current trends and patterns in the prevalence of high-risk births among Indian women, with a primary focus on identifying contributing factors associated with this prevalence.

METHODS

The study utilized data from the nationally representative National Family Health Survey (NFHS), which has been conducted in five rounds since 1992-93. Data from all rounds were used to assess the overall trend. However, data from the most recent round of NFHS, conducted during 2019-21, were employed to evaluate current levels and patterns of HRFB prevalence and to identify socio-economic and demographic predictors of HRFB using binomial and multinomial logistic regression models.

RESULTS

The prevalence of HRFB has exhibited a consistent decreasing pattern from 1992 to 93 to 2019-21 in India. However, 29.56% of married women continue to experience high-risk births with notably higher rates in several states (e.g., 49.85% in Meghalaya and 46.41% in Bihar). Furthermore, socio-demographic factors like wealth index, educational level, social group, religion, mass media exposure, family size, age at marriage, type and region of residence, and reproductive factors like birth intention, place and type of delivery, ANC visits and current contraceptive use were identified as significant predictors of high-risk births among women in India.

CONCLUSION

Despite a 20.4 percentage point decline in HRFB prevalence over the past three decades, a significant proportion of women in specific regions and demographic subgroups continue to experience high-risk births. Therefore, the present study recommends interventions aimed at preventing high-risk births among women in India, with particular emphasis on states with high HRFB prevalence and women from socioeconomically disadvantaged backgrounds.

Spatial distribution and determinants of unmet need for family planning among all reproductive‑age women in Uganda: a multi‑level logistic regression modeling approach and spatial analysis

INTRODUCTION

Unmet need for family planning is defined as the percentage of sexually active and fecund women who want to delay the next birth (birth spacing) or who want to stop childbirth (birth limiting) beyond two years but who are not using any modern or traditional method of contraception. Despite the provision of family planning services, the unmet need of family planning remains a challenge in low- and middle-income countries (LMICs). Thus, this study aimed to assess the spatial distribution and determinant factors of unmet need for family planning among all reproductive‑age women in Uganda.

METHODS

A secondary data analysis was done based on 2016 Ugandan Demographic and Health Surveys (UDHS). Total weighted samples of 18,506 women were included. Data processing and analysis were performed using SPSS Version 26, STATA 14.2, ArcGIS 10.8, and SaTScan 10.1.2 software. Spatial autocorrelation and hotspot analysis was made using Global Moran's index (Moran's I) and Gettis-OrdGi*statistics, respectively. Determinants of unmet needs for family planning were identified by multi-level logistic regression analysis. Variables with a p-value < 0.05 were declared statistically significant predictors.

RESULTS

The spatial distribution of unmet need for family planning among women of reproductive age in Uganda was found to be clustered (Global Moran's I = 0.27, Z-score of 12.71, and p-value < 0.0001). In the multivariable multilevel logistic regression analysis; women in West Nile (AOR = 1.86, 95% CI: 1.39, 2.47), aged 25-49 years old (AOR = .84; 95% CI .72, .99), highly educated (AOR = .69; 95% CI .54, .88), Muslim (AOR = 1.20, 95% CI: 1.03, 1.39), high wealth status (AOR = .73, 95% CI: .64, .82), and had five or more living child (AOR = 1.69, 95% CI: 1.51, 1.88) were significant predictors of unmet need for family planning. Significant hotspot areas were identified in West Nile, Acholi, Teso, and Busoga regions.

CONCLUSION

A significant clustering of unmet need for family planning were found in Uganda. Moreover, age, educational status, religion, wealth status, number of alive children, and region were significant predictors of unmet need for family planning. Therefore, in order to minimize the burdens associated with unmet need, an interventions focusing on promotion of sexual and reproductive health service should be addressed to the identified hotspot areas.

Early removal of the etonogestrel contraceptive implant in Spanish women: a prospective cohort study

Purpose

To know the discontinuation rate and characterize predictors and reasons of contraceptive implant removal within 12 months of insertion in our community setting.

Methods

This prospective cohort study included women receiving the etonogestrel contraceptive implant at sexual and reproductive health centers between September 2019 and September 2020. The variables collected were implanted insertion timing, reproductive and demographic characteristics, medical conditions, sexual activity and counseling. Our primary outcome was implant discontinuation. Kaplan-Meier survival curves were used to show the cumulative discontinuation rate of implants contraceptive within the first year of insertion. We also identified factors that increased the risk of implant removal using the log-rank test and the Cox regression model. Reasons for discontinuation were documented.

Results

199 women were followed up. Implant discontinuation was documented in 17.1% of implant users prior to 12 months. Factors that increase the risk of implant removal are living with a partner, being aged 25-34 years and not receiving comprehensive and structured counseling from the midwife. The main reason for removal was unsatisfactory bleeding (97.1%), but this was combined with other reasons such as cessation of sexual intercourse (58.8%), worsening mood (58.8%), weight gain (55.9%) or decreased libido (50.0%).

Conclusion

The rate of discontinuous implant uses in the first year is relevant in relation to cost-effectiveness, there is room for improvement that should not be overlooked. Comprehensive and structured midwife-led counseling can reduce early implant abandonment removal. The development in different countries of the role of midwives in the management of contraceptives can contribute to the economic benefit of health services and the satisfaction of women.

Factors associated with bacterial sexually transmitted infections among people of South Asian ethnicity in England

OBJECTIVES

Despite being the largest ethnic minority group in England, South Asians have historically had low levels of utilisation of sexual health services (SHS) and sexually transmitted infection (STI) diagnoses, although recent data suggests this may be changing. This study aimed to investigate factors associated with a bacterial STI diagnosis among South Asians attending SHS in England.

METHODS

Using data from the GUMCAD STI Surveillance system, a descriptive analysis of South Asians attending SHS in England in 2019 was carried out. Factors associated with a bacterial STI diagnosis were examined using univariate and multivariable logistic regression models adjusted for age, Asian ethnic subgroup, HIV status, patient's region of residence and Index of Multiple Deprivation quintile. Analyses were stratified by gender and sexual orientation (heterosexual male versus gay, bisexual and other men who have sex with men (GBMSM) versus women of any sexual orientation). Crude and adjusted associations were derived using binary logistic regression.

RESULTS

There were 121 842 attendances by South Asians to SHS in England in 2019. Compared with heterosexual South Asian men, GBMSM had a higher odds of being diagnosed with a bacterial STI (adjusted odds ratio (aOR) 2.32, 95% CI 2.19 to 2.44) and South Asian women had a lower odds (aOR 0.83, 95% CI 0.78 to 0.87). For women and heterosexual South Asian men, a diagnosis was associated with younger age, being of any other Asian background other than Bangladeshi, Indian or Pakistani and not being HIV positive. For heterosexual South Asian men, there was an association with increasing socioeconomic deprivation. For GBMSM, a bacterial STI diagnosis was associated with known HIV-positive status and living in London.

CONCLUSION

People of South Asian ethnicity in England are heterogeneous with regard to their sexual health needs, which should be explored further through focused research and policy.

Family planning behaviours among women with diabetes mellitus: a scoping review

INTRODUCTION

Diabetes mellitus in pregnancies is associated with adverse outcomes both for the mothers and babies. Postponing pregnancy in unoptimized conditions and stabilisation of glucose should be prioritized. This scoping review is aimed to determine the scope and at the same time map the types of evidence available that is related to family planning behaviours among women with diabetes mellitus, with a particular focus on their factors which influence family planning usage and subsequently enable the identification of knowledge gaps in preventing unintended pregnancies among this high-risk population.

METHODS

This scoping review is guided by the methodological framework by Arksey and O'Malley's and Prisma-ScR checklist. PubMed, EBSCO and OVID were searched for empirical studies between 2000 and February 2022 using the search terms "family planning", "contraceptive" and "diabetes mellitus". Data were summarized according to the study characteristics and levels of factors influencing family planning behaviours.

RESULTS

Thirty-five articles that met the eligibility criteria included 33 quantitative studies, one qualitative study and one mixed-methods study. The prevalence of family planning methods used by women with diabetes mellitus varied ranging from 4.8 to 89.8% among the studied population. Women with diabetes mellitus were reported to be less likely to utilise any family planning methods compared to women without diabetes mellitus.

CONCLUSIONS

Most of the evidence to date on family planning behaviours among women with diabetes mellitus focuses on the role of individual level sociodemographic factors. Few studies focused on exploring determinants at multiple levels. In this review we found that there is limited evidence on disease control and pregnancy intention in relation to their family planning practices. Future studies with more clinical and contextual factors are needed to guide the strengthening of family planning services for high-risk group women specifically for women with diabetes mellitus.

Barriers and Facilitators to Accessing Sexual and Reproductive Health Services Among Transgender People: A Meta-Synthesis

The availability and accessibility of sexual and reproductive health (SRH) services for transgender individuals are crucial. This population is deprived of health care due to rejection, stigma, gender-based discrimination, confidentiality, and violence. This review attempts to provide readers with an account of the fundamental problems that the transgender population faces regarding experiences of SRH. This meta-synthesis review applied the Social-Ecological Model (SEM) to address trans individuals' SRH factors. The databases were searched using "SRH" and "transgender" keywords. Fifty studies were finally selected. All studies were qualitative, including 36 semi-structured/ in-depth interviews, two focus group studies, and 12 interviews and focus group studies. The Social-Ecological Model application illustrates the impact of individual, interpersonal, institutional, and social factors on the condition of SRH among transgender individuals. This meta-synthesis reinforces multiple levels of factors that influence the SRH of transgender individuals. These include limited information, lack of awareness, low socioeconomic status, stigma and discrimination, and social deprivation. Interventions are urgently needed to provide better sexual and reproductive well-being for transgender individuals.

Muslim women's views and experiences of family planning in Saudi Arabia: a qualitative study

BACKGROUND

Islamic beliefs are associated with decreased contraceptive use compared to other religions, and Muslim women's contraceptive needs are often unmet. Research is needed to provide an in-depth understanding of the complex set of barriers to Muslim women's contraceptive use. Therefore, we aimed to explore Muslim women's awareness and experiences with family planning in Saudi Arabia and investigate barriers to contraceptive use and access to family planning.

METHODS

A qualitative study using semi-structured interviews with women in a public hospital, in Riyadh, Saudi Arabia, between January and June 2019. Data was analysed using reflexive thematic analysis.

RESULTS

Twenty-eight women participated in the study. Women's contraceptive awareness was limited to two methods. Women expressed positive attitudes towards family planning and did not believe it is forbidden in Islam. Barriers to contraception use included lack of knowledge, misconceptions, fear of side effects, family and community and social norms. Many women expressed that they have the right to use contraception, even if their husbands disapprove. Our findings show that healthcare providers rarely offered contraceptive advice, even when requested. Healthcare providers often prescribe oral contraceptives without offering information on other methods available.

CONCLUSION

Our findings suggest that education plays a fundamental role in reproductive autonomy. Men's role in family planning should be encouraged through sharing reproductive responsibility and supporting women's contraceptive choices. Efforts should be directed towards improving women's awareness of different methods of contraception.

Muslim women's perspectives on the barriers to sexually transmitted infections testing and diagnosis in Saudi Arabia

Background

Muslim women are especially vulnerable to sexually transmitted infections (STI) and are at higher risk of under-detection. Evidence on the unique barriers to STI testing and diagnosis among Muslim communities is severely lacking. Understanding the complexity of accessing STI testing and diagnosis in Muslim communities is an area that requires further exploration. We aimed to explore the multilevel barriers to STI testing and diagnosis among Muslim women.

Methods

We conducted qualitative semi-structured interviews informed by the ecological model of health. This study took place in Riyadh Saudi Arabia in 2019 with women aged over 18. Data were analysed using reflexive thematic analysis.

Results

Twenty-eight women were interviewed from different ages, marital status, employment, and educational levels. Muslim women's perceived barriers to STI testing and diagnosis included personal, socio-cultural, and service-level barriers. Lack of knowledge about STIs, denial, and underestimating the seriousness of infection and symptoms were among the many individual barriers to STIs testing and diagnosis. Religious views towards extramarital sex and negative views of people with STIs is a significant barrier to STI testing and diagnosis. Lack of patient confidentiality and providers' judgement and mistreatment were also cited as barriers to seeking healthcare.

Conclusion

Barriers to STI testing and diagnosis exist on many levels including personal, socio-cultural, religious, and healthcare services, and at policy level. Multilevel interventions are needed to reduce the stigma of STIs and facilitate access to sexual health services among Muslims. It is our recommendation that policy and research efforts are directed to enhance trust in the doctor-patient relationship through better clinical training as well as implementing stricter regulations to protect patients' confidentiality in healthcare settings.

Explaining barriers to childbearing using the risk communication and community engagement (RCCE) strategy: Based on action research

Background and Aims

Reluctance to childbearing and then the reduction of the total fertility rate are common experiences of developed countries and many developing countries, including Iran, therefore, the purpose of this study was explaining barriers to childbearing using the risk communication and community engagement (RCCE) strategy.

Methods

The study was conducted by action research and according to RCCE during 9 months in Ardabil city. The statistical population consisted of 41 married women aged 15-54 who were eligible for childbearing, these women were purposefully selected from among the people covered by Ardabil health centers and interviewed. Data were collected using open and in-depth interviews by the researcher and analyzed by content analysis.

Results

The results of data analysis led to the extraction of three main categories, personal, familial, and social barriers. The "personal barriers" category was classified into three subcategories, namely mental, belief, and awareness barriers, the "familial barriers" category was classified into two subcategories, namely social and financial barriers, and the "social barriers" category was classified into two subcategories, political and managerial barriers.

Conclusions

According to the results, a set of personal, familial, and social factors could affect childbearing among married women. Identification of these factors can play an effective role in designing educational and managerial programs.

Socio-Ecological Analysis of Barriers to Access and Utilization of Adolescent Sexual and Reproductive Health Services in Sub-Saharan Africa: A Qualitative Systematic Review

Background

In sub-Saharan African countries (SSA), despite the efforts to enable adolescents to access sexual and reproductive health (SRH) services, there are limited systematic review studies that comprehensively synthesize barriers to accessing services using a social-ecological model. Therefore, this review was conducted to fill this gap.

Methods

This study protocol was registered in the PROSPERO database (CRD42022259095). We followed PRISMA guideline to conduct this review. PubMed, Google Scholar, Embase and African Journal Online databases were used. Two authors individually screened articles. Only qualitative articles published in the English in last 10 years were included in this review.

Results

From the total of 4890 studies, 23 qualitative studies fulfilled the eligibility criteria. Those studies were from 11 SSA countries. This review finding revealed that inadequate information about the services, the incorrect perception about services, low self-esteem, fear of being noticed by family members, and financial constraints are barriers at the intrapersonal level. Unsupportive families and lack of open communication between adolescent-parent about sexuality issues were interpersonal barriers to access. Lack of provider competency, provider attitude, an unsupportive environment, physical inaccessibility of services, and shortage of medicine, and supplies were identified as institutional-level barriers. Moreover, community-level barriers like community stigma, social, religious, and gender norms within the society were identified as the main barriers to accessing services for adolescents.

Conclusion

This review finding reveals that the main barriers to access SRH services for adolescents living in SSA are misperception about services, low self-esteem to access services, financial constraints, unsupportive families, community stigma and social norms, unsupportive environments in health facilities, healthcare provider behavior, poor competency, being judgmental attitude, and breaking privacy and confidentiality. This study finding calls for new approach like a multi-pronged that works with service providers, with community, with families, and with adolescent to improve SRH services utilization of adolescent.

Muslim women's knowledge, views, and attitudes towards sexually transmitted infections in Saudi Arabia: A qualitative study

BACKGROUND

The cultural sensitivity surrounding sexuality in Islamic communities has an impact on awareness and prevention of sexually transmitted infections (STIs). This study explores Muslim women's knowledge, views, and attitudes towards STIs and people living with HIV/AIDs in Saudi Arabia.

METHODS

We conducted qualitative semi-structured interviews with Muslim women from Saudi Arabia. Interviews took place in a public hospital in Riyadh, Saudi Arabia in 2019. Data were transcribed, coded, and analysed using a reflexive thematic analysis.

RESULTS

Twenty-eight women were interviewed, the majority were college educated and employed. Participants lacked knowledge about STIs, and there were significant misconceptions. The majority of women expressed extremely negative attitudes towards STIs, particularly towards people living with HIV/AIDS. Participants believed that judgemental attitudes and stigmatisation of people with HIV/AIDS were justified if an infection was transmitted through extramarital sex. Men were believed to be the source of STIs, and STIs were viewed as punishment from God for extramarital sexual relations that are forbidden in Islam. Protection against STIs was believed to be achieved by strengthening religious beliefs.

CONCLUSION

Attitudes towards people with STIs, HIV/AIDS in particular, were highly influenced by religious views towards extramarital sex, as well as lack of knowledge and misconceptions. There is an urgent need for accurate information and improved awareness of sexual health including STIs among Muslims in Saudi Arabia. Public health efforts should be directed towards reducing stigma and discrimination against people living with HIV/AIDS in Saudi Arabia and other Islamic communities.

Gynecological morbidity and treatment-seeking among older adult (aged 45-59) women in India

BACKGROUND

Women's gynecological health needs are not limited to the reproductive years of their life. Women are at risk of hormonal changes, gynecological malignancies, and various genitourinary conditions as they move toward menopause and beyond. Concerns about older women's sexual and reproductive health and rights (SRHR) continue to be taboo in many countries, of little interest to researchers and professionals in the field of healthcare, and a "blind spot" in discussions about policy as a whole. Despite the widespread agreement, the life course approach to addressing SRHR concerns has received minimal attention. The study estimates the prevalence, assesses the correlates, and treatment-seeking of gynecological morbidity (GM) among older adult women aged 45-59 years (N = 18,547) in India.

METHOD

The analysis was based on the nationally representative Longitudinal Ageing Study (2016-2017) data that adopted a multistage stratified area probability cluster sampling to select respondents. The outcome variables used in this analysis were 'had any GM' and 'sought treatment for any GM.' Women with any morbidity such as per vaginal bleeding, foul-smelling vaginal discharge, uterus prolapses, mood swings/irritability, fibroid/cyst, and dry vagina causing painful intercourse were considered to have any GM. Of the respondents with GM, who sought a doctor's consultation or treatment were considered 'sought treatment for any GM.' Binary logistic regression was conducted to examine the adjusted effect of socioeconomic and demographic predictors of GM and treatment-seeking. Stata (V 16) was used for statistical analyses with a 5% significance level.

RESULTS

Fifteen percent of the women had any GM, and only 41% of them sought treatment. Age, marital status, education, number of pregnancies, hysterectomy, involvement in household decision-making, social group, religion, wealth status, and region were significantly associated with GM. The odds of treatment-seeking were higher among women with 10+ years of schooling (OR 1.66, CI 1.23, 2.23), with hysterectomy (OR 7.36, CI 5.92, 9.14), with five-plus pregnancies (OR 1.25, CI 0.96, 1.64), and those from the richest (OR 1.91, CI 1.40, 2.60) households than their respective counterparts.

CONCLUSION

Many older adult women experience GM, and treatment-seeking is inadequate. The GM prevalence and treatment-seeking vary considerably by socioeconomic and demographic characteristics. Results suggest community-level awareness generation and the inclusion of this otherwise ignored group in programs targeting better health and wellbeing of women.

Development and Validation of the Adolescent Sexual and Reproductive Competency Assessment Tool (ASRH-CAT) for Healthcare Providers

OBJECTIVES

This study aimed to validate a competency assessment tool for adolescent sexual and reproductive health (ASRH) services for healthcare providers (HCP) at primary healthcare (PHC) facilities that require a specific set of competency skills to address ASRH problems.

METHODS

The tool development process used the nine steps of scale development and validation. Fifty-four items were yielded through the expert panel discussion. Two hundred and forty respondents were recruited for an online questionnaire using non-probability sampling. The item content validity index (I-CVI) and exploratory factor analysis (EFA) were used for construct validity.

RESULTS

Fourteen items were removed based on the I-CVI (scores < 0.8) and two items were removed in the EFA (factor loadings < 0.4). The reliability analysis, according to the latent factor, yielded a good item-total correlation (ITC) and a good internal consistency value, with Cronbach's alpha values of 0.905-0.949.

CONCLUSIONS

The final ASRH competency assessment tool (ASRH_CAT) contains 40 items and is reliable and suitable for use in studies related to the ASRH competency assessment of HCPs at the PHC level.

Teachers' conflicts in implementing comprehensive sexuality education: a qualitative systematic review and meta-synthesis

INTRODUCTION

Comprehensive sexuality education (CSE) enables children and young people to learn about the cognitive, emotional, physical, and social characteristics of sexuality. Teachers experience conflicts in teaching CSE due to different cultural and religious backgrounds. This qualitative systematic review aimed to describe the conflicts experienced by teachers in the implementation of CSE in schools. Furthermore, this study aimed to identify the causes of conflict among teachers in implementing CSE.

METHODS

This article focused on teachers' conflicts in implementing CSE from 2010 to 2022. Online bibliographic databases, such as PubMed, Web of Science, and ERIC, were used to search for relevant articles. The following search term was used: Teacher, Comprehensive Sexuality Education, and Conflict.

RESULTS

A total of 11 studies were included in the review. All 11 studies were conducted in countries with a predominantly Christian population. The majority of the studies were conducted in Africa. The study respondents included teachers, school principals, and school coordinators. The studies identified that CSE implementation is related to multiple conflicts, depending on the context of the country. Five themes on the causes of conflict emerged from the thematic meta-synthesis: (1) Hesitancy in talking about sex education among teachers due to the cultural and religious context; (2) non-integration of traditional sex education into comprehensive sexuality education, (3) fostering effective facilitation of CSE among teachers, (4) determining the appropriate age to start sex education, and (5) roles of stakeholders outside the school.

CONCLUSIONS

This qualitative systematic review and thematic meta-synthesis highlighted several conflicts among teachers in CSE implementation. Despite the teachers having a perception that sex education should be provided, traditional sex education has not yet transformed to CSE. The study findings also emphasize the need to identify the teacher's role in CSE implementation. The thematic meta-synthesis also strongly reflected the context of Christianity in Europe and Africa; thus, further research on the religious context in other regions is needed.

Knowledge of the abortion law and key legal issues of sexual and reproductive health and rights among recently arrived migrants in Sweden: a cross-sectional survey

Background

Sexual and reproductive health and rights (SRHR), including access and information on the laws and policies related to abortion, varies considerably between countries. Migrants may have limited knowledge of SRHR and related resources in their new country. This study investigates migrants’ knowledge of the right to safe and legal abortion and other associated factors including the recent law on sexual consent, the legal age for sexual consent and age to marry in Sweden.

Methods

We conducted a cross-sectional study from 2018 to 2019 among recent migrants attending high schools or Swedish language schools. Descriptive statistics were computed on the knowledge of the Swedish abortion law and other legal aspects. Univariable and multivariable logistic regression analyses were conducted to assess if migrants’ socio-demographic characteristics were associated with knowledge (i.e. correct/incorrect) of the Swedish abortion law and other key SRHR-related legal issues.

Results

Of the total 6,263 participants, 3,557 (57%) responded about whether it is legal to have an induced abortion in Sweden, and of these, 2,632 (74%) answered incorrectly. While more than half (61%) of the respondents knew the sexual consent law, nearly half (48%) did not know that sexual consent is also required for married couples. About 90% correctly responded that it is illegal to have sex with a minor (under the age of 15) and were aware of the legal age (18 years) to marry in Sweden. Incorrect knowledge of the Swedish abortion law was associated with being religious (adjusted odds ratio (AOR), 2.12; 95% confidence interval (CI), 1.42–3.15), not having previous sexual health education (AOR, 1.68; 95% CI, 1.38–2.05), coming from a country with predominantly restrictive abortion laws (AOR, 1.46; 95% CI, 1.16–1.84), low level of education (AOR, 1.29; 95% CI, 1.04–1.61) and having a temporary residence permit (AOR, 1.27; 95% CI, 1.02–1.57).

Conclusion

We found a substantial lack of knowledge among migrants of reproductive age in Sweden regarding important laws and policies of SRHR, particularly the right to abortion. SRHR-related programmes and comprehensive sexual health education for recently arrived migrants could include components to increase knowledge of legal and safe abortions and other laws concerning SRHR.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-023-15399-z.

The process of overcoming conflicts among teachers in the implementation of comprehensive sexuality education at ordinary public senior high schools in Mataram City, Indonesia: a qualitative study

BACKGROUND

Comprehensive sexuality education (CSE), which aims to help young people make responsible choices and acquire scientific knowledge and skills, has been promoted by UNESCO. Teachers experience conflicts in implementing CSE when teaching sexual topics in the local context, especially as the delivery of sexual knowledge and contraceptive methods is often prohibited by religious and traditional cultural norms. It was reported that there were multiple challenges in the implementation of sex education due to the religious and cultural background of societies and communities in Islamic countries. This study aimed to clarify the process of overcoming the conflicts, explore teachers' recognition and perception related to the implementation of CSE, and to suggest recommendations for promoting CSE in Islamic areas.

METHODS

This qualitative study combined the methods of focus group discussions (FGDs) and in-depth interviews (IDIs) to explore the conflict among teachers. Ten ordinary public senior high schools in Mataram City, Indonesia, agreed to participate, and in total, 59 participants were involved in this study. FGDs were conducted with teachers (n = 49), and IDIs were focused on school principals (n = 10) in each school. The collected interview data were analyzed using a deductive thematic analysis and the findings triangulated for both the FGDs and IDIs.

RESULTS

Overall, the teachers experienced conflicts in relation to religion, cultural background, and gender inequality in implementing CSE. The present study revealed the mutual recognition among teachers and acceptance of diverse backgrounds in the implementation of CSE at ordinary public senior high schools in Mataram City. Despite teachers reporting multiple conflicts, they made efforts to overcome these conflicts through mutual recognition and provided comprehensive guidance. The present findings indicated that teachers adapted CSE to follow multiple religions and cultural backgrounds.

CONCLUSIONS

The teachers accepted diverse backgrounds and provided CSE by collaborating with related educational subjects and external institutions to overcome conflicts. To provide more specialized education, it would be necessary to advocate a formal policy that might be accepted by diverse societies. Further research is necessary to apply the findings and recommendations for CSE implementation globally in the contexts of different countries.

The role of community and culture in abortion perceptions, decisions, and experiences among Asian Americans

Introduction

Culture and community can play a role in views, stigma, and access related to abortion. No research to date has documented the influence of culture and community attitudes on Asian American (AA) experiences accessing abortion care in the United States (US). This paper aims to fill gaps in research and understand how cultural and community views influence medication abortion access and experiences among AAs.

Methods

We used a community-based participatory research approach, which included collaboration among experts in public health, advocates, practitioners, and community partners to understand abortion knowledge, attitudes, and experiences among AAs. Using a semi-structured interview guide, we interviewed twenty-nine eligible people of reproductive age over 18 that self-identified as Asian American or mixed race including Asian American, Native Hawaiian, and/or Pacific Islander (AANHPI), and had a medication abortion in the US between January 2016 and March 2021. Interviews were analyzed and coded in NVivo 12 using a modified grounded theory approach.

Results

Participants described various influences of religion negatively impacting acceptability of abortion among their family and community. Lack of openness around sexual and reproductive health (SRH) topics contributed to stigma and influenced most participants' decision not to disclose their abortion to family members, which resulted in participants feeling isolated throughout their abortion experience. When seeking abortion care, participants preferred to seek care with providers of color, especially if they were AANHPI due to past experiences involving stigma and judgment from White providers. Based on their experiences, respondents recommended ways to improve the abortion experience for AAs in the US including, (1) more culturally aware abortion providers from one's community who better understand their needs; (2) clinics providing abortion services located in or near AA communities with signage in local languages; and (3) tailored mental health resources with culturally aware therapists.

Conclusion

This study demonstrates ways in which culture and community opinions toward SRH can influence both the acceptability of abortion and experiences seeking abortion care among AAs. It is important to consider family and community dynamics among AAs to better tailor services and meet the needs of AAs seeking abortion care in the US.

Reason and Associated Factors for Nonuse of Contraceptives Among Ethiopian Rural Married Women: A Multilevel Mixed Effect Analysis

Introduction

Contraception has a clear impact on the health of women and families in developing countries. This study aims to identify multilevel determinants of nonuse of modern contraceptives among Ethiopian rural married women in their productive age group.

Method

The study relied on data from the 2016 Ethiopian Demographic and Health Surveys. A multilevel logistic regression model was used for analysis.

Result

In rural areas, nonuse of modern contraceptives is surprising high (81.7%), primarily due to fear of side effects (12.89%) and breastfeeding (8.2%). Among women aged 35 to 49 years (adjusted odds ratio [AOR] = 0.66; 95% confidence interval [CI]: 0.540.81), husbands with secondary and above education levels (AOR = 0.83; 95% CI: 0.7-1), those in the high wealth index (AOR = 0.61; 95% CI: 0.51-0.72), and those who have had 1 to 2 children in the past 5 years (AOR  =  0.28; 95% CI: 0.24-0.33), there was a lower chance of not using contraception. Muslims are less likely to want to use modern contraceptives (AOR = 1.2; 95% CI: 0.96-1.4). Women living in Afar (AOR  =  20.9; 95% CI: 9.6-44.7), Oromia (AOR =  1.5; 95% CI: 1.01-2.3), Somali (AOR = 71.1; 95% CI: 24.1-209.2), Gambela (AOR = 2.3; 95% CI: 1.4-3.9), Harari (AOR  =  4.4; 95% CI: 2.24-8.72), and Dire Dawa (AOR = 3.2; 95% CI: 1.5-6.9), regional states, were less likely to want to use modern contraceptives as compared to those in Tigray.

Conclusion

Family planning interventions should target younger women, women living in rural areas, the poor, and Muslim women. In order to maximize the effectiveness of family planning promotion policies, it's important to address the reasons for nonuse of contraceptives identified in each region and contextual differences regarding women of reproductive age.

C. Singh Y, Karkee R, Khatri RB. Knowledge and practices of modern contraceptives among religious minority (Muslim) women: A cross-sectional study from Southern Nepal

BACKGROUND

Uptake of family planning (FP) services could prevent many unwanted pregnancies, and unsafe abortions and avert maternal deaths. However, women, especially from ethnic and religious minorities, have a low practice of contraceptives in Nepal. This study examined the knowledge and practices of modern contraceptive methods among Muslim women in Nepal.

METHODS

A cross-sectional study was conducted among 400 Muslim women in the Khajura Rural Municipality of Banke district. Data were collected using face to face structured interviews. Two outcome variables included i) knowledge of and ii) practices of contraceptives. Knowledge and practice scores were estimated using the list of questions. Using median as a cut-off point, scores were categorised into two categories for each outcome variable (e.g., good knowledge and poor knowledge). Independent variables were several sociodemographic factors. The study employed logistic regression analysis, and odds ratios (OR) were reported with 95% confidence intervals (CIs) at a significance level of p<0.05 (two-tailed).

RESULTS

Almost two-thirds (69.2%) of respondents had good knowledge of modern contraceptive methods, but only 47.3% practised these methods. Women of nuclear family (adjusted odds ratio (aOR) = 0.60; 95% CI: 0.38,0.95), and who work in agricultural sector (aOR = 0.38; 95% CI: 0.22, 0.64) were less likely to have good knowledge on modern contraceptives. Women with primary (aOR = 2.59; 95% CI: 1.43, 4.72), secondary and above education (aOR = 4.41; 95% CI:2.02,9.63), women with good knowledge of modern contraceptives (aOR = 2.73; 95% CI: 1.66, 4.51), who ever visited a health facility for FP counselling (aOR = 4.40; 95% CI: 2.58, 7.50) had higher odds of modern contraceptives practices.

CONCLUSION

Muslim women had low use of modern contraceptive methods despite having satisfactory knowledge about them. There is a need for more equitable and focused high-quality FP practices. Targeted interventions are needed to increase the knowledge and practices of contraceptives in the Muslim community. The study highlights the need to target FP interventions among socially disadvantaged women, those living in a nuclear family, and those with poor knowledge of modern contraceptives.

Levels and sources of adolescents' sexual knowledge in traditional societies: A cross-sectional study

Gender rules, patriarchy, and cultural taboos on sexual issues in traditional societies may compel adolescents to seek sexual information from informal and inadequate sources. The aim of this cross-sectional study was to determine whether the level and sources of sexual knowledge differed by gender in the traditional community comprising Palestinian-Israeli high school students. Guided by the Human Ecological Systems Model and informed by a community-based participatory research approach, a convenience sample of high school students (n = 558) was recruited. Although findings indicated that both boys and girls had low levels of sexual knowledge, the areas of knowledge deficits varied by gender. The model demonstrated good fit for boys but not for girls. Post hoc analyses indicated that girls obtained sexual knowledge solely from close family members, while boys obtained sexual knowledge from multiple sources. Very few students of either gender obtained sexual knowledge from doctors or nurses, but with community input on cultural issues, nurses can play a pivotal role in creating comprehensive, school-based sex education for adolescents living in traditional societies.

Factors associated with non-use of modern contraceptives among sexually active women in Ethiopia: a multi-level mixed effect analysis of 2016 Ethiopian Demographic and Health Survey

Background

Appropriate contraceptive use prevents unintended pregnancy, protects the health of mother and child, and promotes women’s well-being. Use of modern Family planning in Ethiopia was still very low. The purpose of this study was to assess the factors that are associated with non-use of modern family planning services among women of reproductive age.

Method

A nationally representative 2016 EDHS women data were used for analysis. A total of 15,683 women in the reproductive age group were included in this study. Descriptive and multilevel multivariable binary logistic regression models were used to summarize descriptive data and measure statistical association between the dependent and the individual and community level variable, respectively. Adjusted Odds Ratio (AOR) and confidence interval were respectively used to measure association and its statistical significance.

Result

Among women in the reproductive age group 79.49% (95% CI: 78.85%, 80.12%) did not use a modern contraceptive method. Women age between 25–34 years (AOR = 0.54, 95% CI: 0.47–0.61) and age between 34–49 year (AOR = 0.62, 95% CI: 0.55–0.71), having primary educated women (AOR = 0.0.77, 95% CI: 0.68–0.87),secondary and above educational (AOR = 0.88, CI: 0.75–1.03), Secondary and above-educated husband (AOR = 0.84, 95% CI: 0.72–0.96), rich women (AOR = 0.74,95%CI:0.65–0.85), health facility delivery (AOR = 0.84, 95%CI: 0.73–0.0.98), being watching TV (AOR = 0.74, 95% CI: 0.65–0.85), having 1–2 living children (AOR = 0.21, 95% CI: 0.19–0.23) are less likely to not use contraception were identified. Furthermore, Muslim women (AOR = 1.43, 95% CI: 1.23–1.62), women living in rural area (AOR = 3.43; 95% CI: 2.72–4.32), and ANC visit 1.25(1.07–1.47) were more likely to not use contraception. Further, Women in Afar, Somali, Gambela, Harari, and Dire Dawa were less likely to use modern contraception methods than women in Tigray, but Amhara region had a lower rate of non-use.

Conclusion

Family planning interventions should target younger women, women living in rural areas, the poor, and Muslim women. Moreover, initiatives to empower women associated to family planning programs would be beneficial in increasing contraceptive uptake among sexually active women in Ethiopia.

Prenatal folic acid supplementation and folate status in early pregnancy: ECLIPSES study

This research evaluates the prevalence of inadequate folate status in early pregnancy, the pattern of prenatal folic acid (FA) supplementation and associated factors in Spanish pregnant women from the ECLIPSES study, which included 791 participants prior gestational week 12. A cross-sectional evaluation of erythrocyte folate levels was performed at recruitment and used to calculate the prevalence of folate deficiency (erythrocyte folate < 340 nmol/l) and insufficiency (erythrocyte folate < 906 nmol/l). Sociodemographic and lifestyle data as well as information on prenatal FA supplementation were recorded. Descriptive and multivariate statistical analyses were performed. The prevalence of folate deficiency and insufficiency were 9·6 % and 86·5 %, respectively. Most of women used prenatal FA supplements, but only 6·3 % did so as recommended. Supplementation with FA during the periconceptional period abolished folate deficiency and reduced folate insufficiency. Prenatal FA supplementation with ≥1000 µg/d in periconceptional time and pregnancy planning increased erythrocyte folate levels. The main risk factor for folate insufficiency in early pregnancy was getting prenatal FA supplementation out of the periconceptional time (OR 3·32, 95 % CI 1·02, 15·36), while for folate deficiency they were young age (OR 2·02, 95 % CI 1·05, 3·99), and smoking (OR 2·39, 95 % CI 1·30, 4·37). In addition, social and ethnic differences according to folate status were also identified. As conclusion, periconceptional FA use is crucial for achieving optimal folate levels in early pregnancy. Pregnancy planning should focus on young women, smokers, those with low consumption of folate-rich foods, low socio-economic status or from ethnic minorities.

Sexual knowledge based on Islamic values and sexual risk behaviors of HIV/STIs among Thai Muslim army conscripts: A cross-sectional study

BACKGROUND

Sexually transmitted infections (STIs), including human immunodeficiency virus (HIV), are commonly associated with conflict areas. In Thailand, conflict situations have occurred from 2004 until the present in three Muslim-majority southernmost provinces, including Yala, Pattani, and Narathiwat. However, Islam provides strict guidelines on sexuality. Therefore, those who strictly practice Islam will have lower sexual risk behavior.

OBJECTIVE

This study aimed to examine the relationship between Islamic values-based sexual knowledge, sociodemographic factors, and risk for HIV/STIs among Thai Muslim army conscripts in the unrest situation area.

METHODS

A cross-sectional study was conducted between May and July 2020. Data were collected using a validated questionnaire among 421 participants. Descriptive statistics and Chi-square were used to examine the association among variables.

RESULTS

57.5% of Muslim army conscripts had poor sexual knowledge based on Islamic aspects, and the participants showed high-risk profiles for HIV/STIs (32.5%). Marital status, hometown, smoking and drinking status, and Islamic values-based sexual knowledge were significantly associated with the risk of HIV/STIs (p <0.05).

CONCLUSION

Participants with poor sexual knowledge according to Islamic values, smokers, single-status, alcoholic drinkers, and non-three southernmost provinces' hometowns had higher risks of HIV/STIs. Thus, it is suggested that nurses and public health professionals implement sexual health promotion and prevention for HIV/STIs. In addition, misperceptions of Islamic aspects toward sexual behavior should receive immediate adjustments.

Awareness of human papillomavirus and acceptability of the vaccine among women in Palestine: is it time for policy adjustment?

Background

Progress has been made in the reduction of morbidity and mortality of cervical cancer by the implementation of human papillomavirus (HPV) vaccination programs. This study aimed to assess the awareness of Palestinian women about HPV as well as their knowledge and acceptability of the HPV vaccine and to examine the factors associated with good awareness.

Methods

This was a national cross-sectional study. Adult women were recruited from hospitals, primary healthcare centers, and public spaces in 11 Palestinian governorates using convenience sampling. A structured questionnaire was used for data collection. For each correctly answered question, one point was given. The total score was calculated and categorized into poor (0–10) and good awareness (11–21).

Results

The questionnaire was completed by 7223 women out of 8086 who were approached (response rate = 89.3%). A total of 7058 questionnaires were included in the final analysis; 4403 from the West Bank and Jerusalem (WBJ) and 2655 from the Gaza Strip. Women recruited from the Gaza Strip were younger, getting lower monthly incomes, and with fewer chronic diseases than women recruited from the WBJ.

Only 33 women (0.5%) displayed good awareness of HPV and its vaccine with 0.7% of women from WBJ and only 0.2% of women from the Gaza Strip. Completing post-secondary education, being employed or a student, and having a higher monthly income were associated with an increase in the likelihood of having good awareness.

Among women who had heard of HPV (n = 571, 8.1%), only 46 women (8.1%) reported familiarity with its vaccine. Women from the WBJ were more likely than women from the Gaza Strip to have heard about the HPV vaccine (0.9% vs. 0.2%). Most women agreed to receive the HPV vaccine themselves or for their daughters if it was given without cost or with a co-payment. No differences were found in the likelihood of agreeing to receive the HPV vaccine among women in the WBJ versus the Gaza Strip.

Conclusion

The overall awareness of HPV and its vaccine was extremely low. Inclusion of the HPV vaccine in the national immunization program could change this, especially as the HPV vaccine appeared to be acceptable.

Sexual and reproductive health knowledge, perceptions and experiences of women in Saudi Arabia: a qualitative study

BACKGROUND

There is no formal sexual and reproductive health (SRH) education currently offered in Saudi Arabia. Lack of knowledge and misconceptions are evident among Saudi women, which can lead to negative sexual and reproductive experiences. The aim of this study is to explore Saudi women's SRH knowledge, perceptions and experiences.

METHODS

Qualitative semi-structured interviews with Saudi women were conducted. Interviews took place in a public hospital in Riyadh, Saudi Arabia. Interviews were conducted in Arabic, recorded and transcribed verbatim, to allow for thematic analysis of the data. The following themes were identified: experience with menarche, deep-rooted negative views towards sex, difficulty discussing SRH topics, knowledge of sex and reproduction, generational gap, sources of SRH information and the role of the mother.

RESULTS

A total of 28 women, both married and unmarried, aged 20-50 years were interviewed. A profound lack of SRH knowledge was observed among Saudi women which contributed greatly to negative experiences both in childhood and adulthood. Lack of knowledge about menstruation often caused emotional distress for young girls, and menarche was associated with bad memories and negative emotions. Lack of knowledge about sexual intercourse and the deep-rooted negative views towards sex were linked with physical and psychological issues for women. Women rarely received information from their parents or teachers and preferred the internet for their SRH information.

CONCLUSION

There is a substantial unmet need for SRH education for women in Saudi Arabia. It is our recommendation that SRH education should be tailored to meet Saudi women's unique needs, while understanding specific socio-cultural barriers to SRH education and discussions. Research and policy efforts should be directed towards regulating and producing evidence-based health information on the internet, particularly Arabic language websites.

Views, attitudes and experiences of South Asian women concerning sexual health services in the UK: a qualitative study

OBJECTIVE

To explore the views, attitudes, and experiences of South Asian women in the UK regarding sexual health services.

METHODS

We performed virtual semi-structured interviews with South Asian women 18 and over living in the UK. We explored participants' experiences of accessing sexual health services, including contraception, smear tests and sexually transmitted infection (STI) tests. We coded interview transcripts and analysed them thematically.

RESULTS

From February to April 2021, we conducted 14 interviews with South Asian women between the ages of 18 and 40 living in England and Wales, from February to April 2021. We identified four overarching themes: Access to sexual health services, entry to sexual health services, quality of sexual health services and stigma associated with sexual health services. Important barriers to sexual health services include limited knowledge of local provision, stigma and shame, and concerns about confidentiality. Participants found it difficult to discuss their sexual health (with anyone) and were often being met with judgement and a lack of partnership from clinicians.

CONCLUSION

Our results suggest that South Asian women are uncomfortable accessing sexual health services and communicating their sexual health concerns with health care professionals. Service providers should collaborate with community-based organisations to ensure that services are discrete, confidential, and culturally appropriate.

Male partners' role in maternal health service utilization: a secondary analysis using 2015-16 National Family Health Survey (NFHS) data

OBJECTIVE

While prior research has documented several socio-demographic and policy level determinants of maternal health service utilization, the influence of partners and family on women's decisions to use maternal health services has received limited attention. This study focuses on the role of male partners in antenatal care, and examines the association between male partner attendance at antenatal care and maternal health service utilization.

DESIGN

Cross-sectional observational study.

SETTING

India.

PARTICIPANTS

This study utilized data from the 2015-16 National Family Health Survey (NFHS-4). Of all the ever-married women who had at least one live birth in the past five years, a total number of 144,840 respondents were included for the analysis on antenatal care utilization and 146,378 respondents were included for the analysis on institutional delivery.

MEASUREMENTS

The key dependent variables used for the study were timing and frequency of antenatal care, and institutional delivery; while the primary independent variable for the study was male partner attendance in antenatal care. Weighted descriptive statistics and multivariable logistic regression models were constructed to examine the association between male partner attendance in antenatal care and maternal health service utilization, controlling for participants' sociodemographic characteristics.

RESULTS

Controlling for all socio-demographic variables, the results showed that women who were accompanied by a male partner during antenatal care contacts were 18% more likely to report initiating antenatal care in the first trimester (OR= 1.18, 95% CI [1.13- 1.23]), 72% more likely to report having 4 or more antenatal care contacts (OR= 1.72, 95% CI [1.64 - 1.80]), 45% more likely to report having 8 or more antenatal care contacts during their pregnancy (OR= 1.45, CI [1.35 - 1.55]) and 40% more likely to have an institutional delivery (OR= 1.40, 95% CI [1.34 - 1.48).

KEY CONCLUSIONS

Few studies have examined the role of partners and family in influencing women's maternal health service utilization. The results of this study add to the growing knowledge base in the area of male partner involvement in maternal care by demonstrating that male partner attendance in antenatal care is positively associated with maternal health service utilization.

IMPLICATIONS FOR PRACTICE

These results provide support for interventions that aim at a gender transformative approach to maternal health. Engaging with male partners and educating them in antenatal care could lead to improved knowledge levels among the couple, and increased support and access to maternal health services.

Long-acting reversible contraception and satisfaction with structured contraceptive counselling among non-migrant, foreign-born migrant and second-generation migrant women: evidence from a cluster randomised controlled trial (the LOWE trial) in Sweden

OBJECTIVE

This trial aimed to evaluate effects of structured contraceptive counselling among non-migrants, foreign-born migrants and second-generation migrants.

METHODS

A cluster randomised controlled trial was conducted in 2017-2019 at abortion, youth and maternal health clinics in Stockholm, Sweden (the LOWE trial). Patients were eligible if they were 18 years or older, could understand Swedish or English (or if assisted by an interpreter), were sexually active or planning to be, and were seeking contraception for pregnancy prevention. We randomised clinics at a 1:1 allocation ratio to give either structured contraceptive counselling (intervention) or to maintain standard contraceptive counselling (control). Blinding was not deemed feasibile. A study-specific package for structured contraceptive counselling was used and comprised an educational video, an effectiveness chart, four key questions and a box with contraceptive models. Outcomes were effects of the intervention on long-acting reversible contraception (LARC) choice, initiation and use, and satisfaction with the intervention material among the participants.

RESULTS

We involved 14 clinics in each of the intervention and control groups, respectively. A total of 1295 participants were included: 1010 non-migrants, 169 foreign-born migrants and 116 second-generation migrants. Participants in the intervention group chose LARC to a higher extent than the control group (adjusted OR (aOR) 2.85, 95% CI 2.04-3.99), had higher LARC initiation rates (aOR 2.90, 95% CI 1.97 to 4.27) and higher LARC use within the 12-month follow-up period (aOR 2.09, 95% CI 1.47 to 2.96). The majority of the participants who received the intervention package found all the different parts to be supportive in contraceptive choice. The effectiveness chart was the only part of the package that a higher proportion of foreign-born migrants (58/84, 69%) and second-generation migrants (40/54, 74.1%) found supportive in contraceptive choice compared to non-migrants (259/434, 59.7%) (p = 0.048).

CONCLUSIONS

Structured contraceptive counselling increased LARC choice, initiation and use, controlled for participants' migration background. The effectiveness chart was found to be significantly more supportive among foreign-born migrants and second-generation migrants compared to non-migrants when choosing contraceptive methods.

TRIAL REGISTRATION NUMBER

NCT03269357.

'It is a disease which comes and kills directly': What refugees know about COVID-19 and key influences of compliance with preventive measures

BACKGROUND

Refugees are at increased risk for COVID-19 infection in part due to their living conditions, which make it harder to adopt and adhere to widely accepted preventive measures. Little empirical evidence exists about what refugees know about COVID-19 and what they do to prevent infection. This study explored what refugee women and their health care workers understand about COVID-19 prevention, the extent of their compliance to public health recommendations, and what influences the adoption of these measures.

METHODS

In October 2020, we conducted 25 in-depth interviews with facility and community health care staff (n = 10) and refugee women attending antenatal and postnatal care services (n = 15) in Eastleigh, Nairobi.

FINDINGS

While researchers found a high level of awareness about COVID-19 and related prevention and control measures among refugee women, various barriers affected compliance with such measures, due in part to poverty and in part to rampant misconceptions informed by religious beliefs and political narratives about the virus.

CONCLUSIONS

These findings indicated that Kenya's Ministry of Health needs to institute a concerted and continuous education program to bring refugee communities up to speed about COVID-19 and its prevention. In addition to disseminating information about the need to wear masks and repeatedly wash hands, supplies-masks, soap and access to water-need to be made available to poor refugee communities. Future research could explore which measures for disseminating factual information work best in refugee populations with different cultural norms and how best to target interventions to these groups.

Global myth busting in family planning

PURPOSE OF REVIEW

Myths and misconceptions about family planning are pervasive around the world and can adversely affect both initiation and continuation of family planning services. Here, we review the current literature and identify major themes among them to better understand these myths and misconceptions.

RECENT FINDINGS

Myths and misconceptions regarding family planning are a global phenomenon with the most recent studies focused on sub-Saharan Africa and West Africa.The belief that family planning negatively impacts future fertility was mentioned in all studies reviewed.Other major themes include misconceptions about the adverse effects, complications, mechanisms of action, and reproductive health.

SUMMARY

Myths and misconceptions regarding family planning are widespread. Current literature suggests that there is a globally prevalent belief that family planning negatively impacts future fertility. Misconceptions related to adverse effects and mechanism of action were also identified. There is overall poor knowledge of sexual and reproductive health in the populations studied. Recent studies focus primarily on sub-Saharan Africa and West Africa. These findings and lessons learned may be helpful in customizing contraceptive counseling and increasing both global access to family planning and satisfied clients.

Knowledge, attitudes, and perception patterns of contraception methods: Cross-sectional study among Saudi males

Purpose:

The aim of this study is to assess the knowledge, attitude, and perception pattern of contraception and family planning among males in Saudi Arabia.

Methods:

A cross-sectional study was conducted using a self-administered questionnaire. Study sample were Saudi males who presented to the urology clinics in one tertiary center. Beside demographic data, we evaluate the responders’ knowledge about types of contraceptive methods, usage of one or more methods, reasons for using contraceptives, knowledge of contraception complications, awareness of religious opinion on contraception, the ideal number of children, and birth interval between them. Statistical analysis was performed using the Chi-square and Fisher's exact tests. A value of P < 0.05 was considered statistically significant.

Results:

Two hundred and forty-three subjects filled the questioner. The participants’ mean age was 42.7 years (range, 19–81); 227 (93.4%) were married. The majority of the participants were aware of the concept of contraception (79%). However, only 54% of the cohort reported using at least one type of contraception. A high percentage of the participants wanted a limited number of children with longer birth intervals. Many factors are responsible for increasing awareness and practice of contraception, additionally; there is limited knowledge and practice regarding male contraception, particularly vasectomy. Withdrawal technique and oral contraceptive pills for females were the most commonly used contraceptive methods for Saudi family planning. The most common reason for using birth control methods was having a lot of children. More than two-thirds of males believed that birth control methods are not prohibited by Islamic law.

Conclusions:

Younger age, shorter duration of marriage, governmental employee, less number of children, higher education degree, and higher monthly income had higher impact on contraception awareness and utilization. Couples still prefer noninvasive methods for contraception. Despite the relatively low use of contraceptive methods, particularly the male methods, the majority of the participants know about contraception. Efforts to advocate and promote the effective use of reproductive and sexual health services among newly married couples are warranted.

Prevalence of STIs, sexual practices and substance use among 2083 sexually active unmarried women in Lebanon

Access to sexual and reproductive health in conservative communities and in the MENA region are particularly limited and, as such, increase women's vulnerability to unwanted pregnancies, unsafe abortions, and sexually transmitted infections (STIs). The aim was to assess the prevalence of STIs, sexual practices, recreational drug-use and their possible associations among cisgender unmarried women residing in Lebanon. Data on demographics, sexual practices and substance-use were collected from 2083 unmarried cisgender women who voluntarily attended a sexual health clinic in Lebanon between 2015 and 2019. They tested for HIV, Hepatitis B, Hepatitis C and Syphilis through rapid testing. Other infections (genital warts, Neisseria gonorrhea/Chlamydia trachomatis) were screened for. Regression models were computed between variables. There were two cases of HIV, one of Hepatitis B and syphilis, and no cases of Hepatitis C. Genital warts were present in 15% and symptoms indicative of Neisseria gonorrhea/Chlamydia trachomatis in 14%. Inconsistent condom-use (81%) was significantly associated with number of partners (adj. OR: 0.4). Inconsistent condom-use discussion with partners (33%) was significantly associated with unemployment (adj OR: 1.7), recreational drug-use (adj. OR: 1.4), and number of partners (adj. ORs 3.7-4.4). Unwanted pregnancies (11%) were significantly associated with age (adj. ORs 0.1-0.37), recreational drug-use (adj. OR: 2), using intrauterine device (adj. OR:2.9) and natural birth control methods (adj. OR: 2.4). Recreational drug-use (33%) was significantly associated with age (adj ORs 1.9-2.2), and smoking status (adj. OR: 0.6). The results indicate an urgent need for: (1) Accessible, non-stigmatizing, and inclusive sexual health services dedicated to women's sexual health; (2) Comprehensive and non-stigmatizing sexual health education for all, but especially women, in order to promote safer sexual practices and effective decision making with regards to contraception and condom-use.

The role of community pharmacists in increasing access and use of self-care interventions for sexual and reproductive health in the Eastern Mediterranean Region: examples from Egypt, Jordan, Lebanon and Somalia

BACKGROUND

Self-care interventions offer a solution to support the achievement of three goals of the World Health Organization (WHO): to improve universal health coverage, reach people in humanitarian situations, and improve health and well-being. In light of implementing WHO consolidated guidelines on self-care interventions to strengthen sexual and reproductive health (SRH) in the Eastern Mediterranean Region (EMR), especially during the COVID-19 pandemic, pharmacists from four different EMR countries discussed the current SRH situation, inequality gaps, barriers to SRH service access and the pharmacist's crucial role as a first-line responder to patients before, during and after COVID-19.

CASE PRESENTATION

Self-care interventions for SRH allow health care providers to serve a greater number of patients, improve progress toward universal health coverage, and reach people in humanitarian crises. In fact, these interventions can be significantly enhanced by utilizing community pharmacists as first-line health care providers. This review highlights the important role of community pharmacists in promoting self-care interventions and empowering individuals, families and communities. As a result, well-informed individuals will be authoritative in their health decisions. Exploring self-care interventions in the EMR was done through reviewing selected SRH services delivery through community pharmacists before and during the COVID-19 pandemic in Egypt, Jordan, Lebanon and Somalia. Before the COVID-19 pandemic, community pharmacists were found to be excluded from both governmental and nongovernmental SRH programmes. During the pandemic, community pharmacists managed to support patients with self-care interventions, whether voluntarily or through their pharmacy associations. This highlights the need for the health care decision-makers to involve and support community pharmacists in influencing policies and promoting self-care interventions.

CONCLUSION

Self-care interventions can increase individuals' choice and autonomy over SRH. Supporting community pharmacists will definitely strengthen SRH in the EMR and may help make the health system more efficient and more targeted.

Current Resources for Evidence-Based Practice, May 2021

An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of the prenatal prediction of fetal macrosomia and commentaries on reviews focused on the effects of date palm and dill seed on labor outcomes and the current research available on SARS-CoV-2 and pregnancy outcomes.

Providing Culturally Competent Mental Health Care for Muslim Women

Providing culturally competent care for Muslim women poses specific challenges to the mental health provider. The importance of recognizing the strong link of postpartum depression, stigma against mental illness and medications, unique cultural beliefs, effect of discrimination, and emphasis on modesty in this patient population can serve as important tools in understanding the patient and establishing patient-provider alliance. This article will review and analyze illustrative cases related to the mental health treatment of Muslim women as well as the approach that providers can utilize to deliver culturally competent treatment for this patient population.

Culture clash of female Somali adolescents and sexual and reproductive health services in Oslo, Norway

OBJECTIVE

Culture influences an individual's perception of health needs. The influence of culture also applies to Somali individuals' perception of their sexual and reproductive health (SRH) and uptake of related services. An understanding of female Somali adolescents' SRH needs is vital to achieve inclusive health coverage. No research has, however, been conducted to explore the SRH needs of this population group in Oslo; hence, the aim of this qualitative study was to minimise the knowledge gap.

METHODS

Fourteen young women aged 16-20 years were recruited using the snowball technique with purposive sampling. In-depth interviews using a semi-structured interview guide were used to collect data, and thematic analysis was applied.

RESULTS

Participants perceived SRH as a very private matter and open discussion of SRH was extremely limited owing to certain Somali cultural beliefs and values. As the participants intend to practise chastity before marriage, they believed that existing SRH services were largely irrelevant and inappropriate. Where they felt the need to access SRH services, participants wished to do so in a way they considered culturally appropriate.

CONCLUSION

Somali culture markedly influences individuals' perceptions of SRH services. It is recommended to modify existing SRH services by increasing confidentiality and anonymity in order to take into account the cultural requirements of female Somali adolescents.

Conducting household surveys on reproductive health in urban settings: lessons from Karachi, Pakistan

Background

Data collection is the most critical stage in any population health study and correctly implementing fieldwork enhances the quality of collected information. However, even the most carefully planned large-scale household surveys can encounter many context-specific issues. This paper reflected on our research team’s recent experience conducting surveys for a quasi-experimental evaluation of a reproductive health program in urban areas of Karachi, Pakistan. We aim to describe the issues encountered and lessons learned from this process, and present some potential solutions for conducting future household surveys in similar urban environments.

Methods

The study followed a three-stage random sampling design. Initially, a Geographical Information System (GIS) was used to construct the sampling frame with union council (UC) area mapping and cluster demarcation followed by random selection of clusters in the selected UCs within the intervention and control sites. The second stage involved a complete household listing in selected clusters and the final stage was a random sampling of households with eligible women.

Result

This paper describes the issues that were encountered including technical problems related to GIS demarcation of cluster boundaries and hand-held devices for computer assisted personal interviews (CAPI), household listing, interviewing respondents on sensitive topics and their expectations, and ensuring privacy during the survey.

Conclusion

This study identifies a number of unique barriers to conducting household surveys in Karachi and highlights some key lessons for survey research in urban settlements. GIS mapping technology is a cost-effective method for developing sampling frames in resource-constrained settings. Secondly, the strategy of interviewing women immediately after the cluster is listed may be applied to make it easier to re-locate selected respondents and to reduce loss-to-follow up. Understanding local norms and developing culturally appropriate strategies to build trust with communities may significantly improve survey participation. Researchers should hire experienced female enumerators and provide continuous training on best practices for interviewing women on sensitive reproductive health topics in urban communities.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12874-021-01216-x.

Cross-Cultural Analysis of Sexual Response and Relationship Satisfaction in Women With and Without Orgasmic Difficulty During Partnered Sex

Objective To investigate how orgasmic difficulty may impact women's sexual/relationship quality depending upon their cultural origin. Method: We used a cross-sectional, multinational survey designed to assess orgasmic difficulty during partnered sex and other sexual/relationship factors in 88 Pakistani and 188 U.S. women. Results: Pakistani women reported less orgasmic difficulty than U.S. women, but those Pakistani women having orgasmic difficulty reported lower relationship satisfaction, less interest in sex, and greater difficulty becoming sexually aroused compared to U.S. respondents with orgasmic difficulty. Conclusions: The presence of orgasmic difficulty affected sexual and relationship factors more in Pakistani women than U.S. women.

Knowledge and awareness about human papillomavirus infection and its vaccination among women in Arab communities

Cervical cancer (CC) is one of the most common types of cancer that affect females worldwide with hundreds of thousands of women dying annually due to this disease, mainly in developing countries. Infection with human papillomavirus (HPV) is the main risk factor for this cancer. There are no public awareness and national immunization programs in most Arab countries. This study aimed to investigate the knowledge and awareness about the HPV vaccine among females in four Arab countries and their acceptance to receive the vaccine. A cross-sectional study was conducted in several Arab countries: Jordan, Qatar, the United Arab Emirates (UAE), and Iraq. Respondents that fulfilled the desired criteria and were willing to participate in the study were asked to fill out the survey. Knowledge and awareness were assessed using 13 questions. Ethical approvals were given from the four countries. A total of 3658 individuals participated in the study; however, 2804 responses were included in the analysis and more than one third of participants (n = 1007) were aged between 18 and 25 years old. This study revealed poor awareness and knowledge of the participants about HPV and its vaccine among all four countries’ participants with relatively better knowledge among participants from the UAE. Participants who are younger (18–25 years old), have a postgraduate education, have an education or career related to the medical field, or had a Pap smear in the last three years tend to have higher knowledge about the HPV vaccine compared to others. Poor knowledge and awareness findings in this study were expected, considering the lack of public education campaigns regarding the HPV virus coupled with the absence of the HPV vaccination from the national immunization schedule in three participating countries (Jordan, Qatar, and Iraq). It is recommended that there is a need to provide national educational campaigns about the HPV vaccine to the public in all Arab populations.

From hopelessness to some hope: A qualitative interpretive research project to improve birthing experiences in Jordan

BACKGROUND

Many women living in Middle Eastern countries report negative, dehumanising experiences of childbirth. Finding effective ways of changing maternity care to improve women's experience is needed but is challenging.

AIM

This paper explores the potential strategies to improve birthing experiences of women in Jordan and identifies the facilitators and obstacles to change.

METHOD

A qualitative interpretive research design underpinned by a feminist approach was used. Seventeen community women, 14 midwives and midwifery leaders were engaged in workshops and face-to-face semi-structured interviews. Data were transcribed verbatim and thematic analysis undertaken.

RESULTS

An overarching theme "From hopelessness to some hope" emerged from data analysis and comprised of two themes: 'It's hopeless-there are so many obstacles'; and 'Finding some hope for the way forward'. The community women were unhappy with the current maternity services but accepted the situation. Midwives offered explanations for the way women are treated, including that women have no voice. For these participants, the obstacles seemed almost insurmountable; however, there was some hope expressed about potential for small changes to occur.

CONCLUSIONS

This study highlights the value of women and midwives sharing experiences and listening to the stories of women. Listening to women's birth stories may also be an important element of undergraduate and continuing education in Jordan. Small changes, such as promoting women's dignity by ensuring they are covered during birth are possible, but real change needs to be generated at a professional and societal level.

Risk and protective factors for intention of contraception use among women in Ghana

The use of various forms of contraception in Ghana gained prominence after the government resorted to investing more in family planning programs when maternal mortality was declared an emergency in the country. In Ghana, the intention to use and actual usage of contraceptives is influenced by many factors, which may lead to non-usage or discontinuation. This quantitative study was conducted to determine risk and protective factors impacting on the intention and usage of contraceptives. Survey data from the Ghana 2014 Demographic and Health Survey (DHS) (n = 9396) was used. A sub-sample of 7661 women in their reproductive age were included in this study, who reported being sexually active within the last year. Logistic regression analyses were conducted to test the association between a broad range of risk and protective factors including religion, early sexual intercourse, frequency of sex, number of lifetime sexual partners with intention to use contraception. We controlled for income, educational attainment, and age. Overall (n = 3661; 47.8%) reported no intention of contraception use. Logistic regression analysis revealed that no formal education (OR = 1.49; 95% CI, 1.29–1.72; p < 0.001), and primary school as highest educational level (OR = 1.19; 95% CI, 1.04–1.25; p < 0.001), Islamic religion (OR = 0.73; 95% CI, 0.59–0.90; p < 0.001), not currently employed (OR = 1.50; 95% CI, 1.34–1.69; p < 0.001), husband opposing contraception use (OR = 2.19; 95% CI, 1.42–3.46; p < 0.001), and currently pregnant (OR = 1.30; 95% CI, 1.09–1.54; p < 0.001) were also positively associated with no intention of use. Engaging religious leaders for advocacy in the community was identified as an approach to address barriers and increase awareness on contraceptive use. Targeted family planning programs should intensify public education on safe sex behaviors.

Challenges and strategies in conducting sexual and reproductive health research among Rohingya refugees in Cox's Bazar, Bangladesh

Background

Rohingya diaspora or Forcibly Displaced Myanmar Nationals (FDMNs), took shelter in the refugee camps of Cox’s Bazar, Bangladesh due to armed conflict in the Rakhine state of Myanmar. In such humanitarian crises, delivering sexual and reproductive health (SRH) services is critical for better health outcomes of this most-at-risk population where more than half are adolescent girls and women. This is a reflective paper on challenges and related mitigation strategies to conduct SRH research among FDMNs. The research on which this paper is based employed a concurrent mixed-method design combining a cross-sectional survey and qualitative interviews and group discussions with FDMNs to understand their SRH needs and demand-side barriers. Assessment of health facilities and qualitative interviews with healthcare providers and key stakeholders were carried out to assess facility readiness and supply-side barriers.

Challenges and strategies

The researchers faced different challenges while conducting this study due to the unique characteristics of the FDMN population and the location of the refugee camps. The three key challenges researchers encountered include: sensitivity regarding SRH in the FDMNs, identifying appropriate sampling strategies, and community trust issues. The key approaches to overcome these challenges involved: actively engaging community members and gatekeepers in the data collection process to access respondents, identifying sensitive SRH issues through survey and exploring in-depth during qualitative interviews; and contextually modifying the sampling strategy.

Conclusion

Contextual adaptation of research methods and involving community and local key stakeholders in data collection are the key lessons learnt from this study. Another important lesson was researchers’ identity and positionality as a member of the host country may create distrust and suspicion among the refugees. The multi-level complexities of humanitarian settings may introduce unforeseen challenges and interrupt research plans at different stages of research which require timely and contextual adaptations.