1
|
Khisa AM, Wao H, Brizuela V, Compaoré R, Baguiya A, López Gómez A, Bonet M, Kouanda S, Thorson A, Gitau E. Embedding research capacity strengthening in multi-country studies in low-and middle-income countries: learnings from sexual and reproductive health research. Glob Health Action 2024; 17:2338634. [PMID: 38607331 PMCID: PMC11018088 DOI: 10.1080/16549716.2024.2338634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 03/31/2024] [Indexed: 04/13/2024] Open
Abstract
Research capacity strengthening (RCS) can empower individuals, institutions, networks, or countries to define and prioritize problems systematically; develop and scientifically evaluate appropriate solutions; and reinforce or improve capacities to translate knowledge into policy and practice. However, how to embed RCS into multi-country studies focusing on sexual and reproductive health and rights (SRHR) is largely undocumented. We used findings from a qualitative study, from a review of the literature, and from a validation exercise from a panel of experts from research institutions that work on SRHR RCS. We provide a framework for embedded RCS; suggest a set of seven concrete actions that research project planners, designers, implementers, and funders can utilise to guide embedded RCS activities in low- and middle-income countries; and present a practical checklist for planning and assessing embedded RCS in research projects.
Collapse
Affiliation(s)
- Anne M. Khisa
- Capacity Strengthening and SRHR Research, African Population and Health Research Center, Nairobi, Kenya
| | - Hesborn Wao
- Capacity Strengthening and SRHR Research, African Population and Health Research Center, Nairobi, Kenya
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rachidatou Compaoré
- Department of Biomedical and Public Health, Research Institute for Health Sciences, Ouagadougou, Burkina Faso
| | - Adama Baguiya
- Department of Biomedical and Public Health, Research Institute for Health Sciences, Ouagadougou, Burkina Faso
| | | | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Seni Kouanda
- Department of Biomedical and Public Health, Research Institute for Health Sciences, Ouagadougou, Burkina Faso
- African Institute of Public Health, Ouagadougou, Burkina Faso
| | - Anna Thorson
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Evelyn Gitau
- Capacity Strengthening and SRHR Research, African Population and Health Research Center, Nairobi, Kenya
| |
Collapse
|
2
|
Henderson H, Soares Xavier HA, da Silva M, da Silva AM, Mendonca SA, de Araújo RM, Vaughan C, Bohren MA. 'If we take the engine out, how will the car go?': beliefs, understanding and access to vasectomy services in Timor-Leste. Cult Health Sex 2024:1-17. [PMID: 38634414 DOI: 10.1080/13691058.2024.2341847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 04/08/2024] [Indexed: 04/19/2024]
Abstract
Vasectomy is a safe, highly effective and affordable method of permanent contraception, and one of the few currently available contraceptive methods for men. Despite this, vasectomy uptake remains overall low, making up just 2% of the global contraceptive method mix. To better understand access to vasectomy in a country with negligible uptake, we conducted participatory and operational research in the Democratic Republic of Timor-Leste (Timor-Leste). We held 14 participatory group discussions with 175 community participants (84 men, 91 women; aged 18-72) across seven municipalities (Ainaro, Baucau, Bobonaro, Dili, Lautem, Manufahi, and Oecusse), and individual in-depth interviews with 24 healthcare providers (16 women, 8 men; aged 25-56 years). Data were analysed using reflexive thematic analysis. Community awareness and understanding about vasectomy were limited, with concerns expressed about physical and social side effects. Healthcare providers had limited experience and knowledge about vasectomy, and about male sexual and reproductive health more generally. However, our findings also indicate a small but existing demand for vasectomy services that could be grown and better met through health systems strengthening initiatives. Insights from our research have informed programmatic decision-making in Timor-Leste and can be further used to inform national health policy and practice.
Collapse
Affiliation(s)
- Helen Henderson
- Marie Stopes Timor-Leste, Rua Belarmino Lobo, Bidau Lecidere, Dili, Timor-Leste
- Gender and Women's Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
- MSI Asia Pacific, Melbourne, VIC, Australia
| | | | - Mariano da Silva
- Marie Stopes Timor-Leste, Rua Belarmino Lobo, Bidau Lecidere, Dili, Timor-Leste
| | | | | | | | - Cathy Vaughan
- Gender and Women's Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Meghan A Bohren
- Gender and Women's Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| |
Collapse
|
3
|
Bonifaz Alfonzo L, Mora Sierra R. Decriminalization of abortion by the Mexican Supreme Court. Int J Gynaecol Obstet 2024; 165:375-381. [PMID: 38362912 DOI: 10.1002/ijgo.15433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
In September 2021, the Mexican Supreme Court issued a decision disallowing any federal or local judicial authority to indict someone for the offense of voluntary or consensual abortion. This decision also declared unconstitutional penalties imposed on medical personnel who facilitate or assist such procedures. Furthermore, the Court decided that limiting access to abortion in cases of rape to a specific time frame was disproportionate. Later on, in September 2023, the Supreme Court confirmed that absolute criminalization of abortion was unconstitutional and declared that the rule supporting criminalization in the Federal Penal Code was without effects. Consequently, healthcare providers who work in public federal health institutions cannot be criminalized for guaranteeing the right to abortion. This article reviews the reasons advanced by the Supreme Court to guarantee the right of reproductive self-determination, as well as the effects of both decisions beyond the decriminalization of abortion by Mexican federal and state legislatures. The paper also examines the scope and limitations of these rulings and identifies the remaining challenges regarding voluntary abortion procedures in Mexico.
Collapse
Affiliation(s)
- Leticia Bonifaz Alfonzo
- Committee on the Elimination of Discrimination Against Women and National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Rosalba Mora Sierra
- Direction of Access to Justice at the General Unit of Scientific Knowledge and Human Rights, Mexican Supreme Court, Mexico City, Mexico
| |
Collapse
|
4
|
Sidamo NB, Kerbo AA, Gidebo KD, Wado YD. Exploring Barriers to Accessing Adolescents Sexual and Reproductive Health Services in South Ethiopia Regional State: A Phenomenological Study Using Levesque's Framework. Adolesc Health Med Ther 2024; 15:45-61. [PMID: 38562442 PMCID: PMC10984202 DOI: 10.2147/ahmt.s455517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Evidence suggests that adolescents face multiple barriers to accessing Sexual and Reproductive Health (SRH) services. However, there remains a notable gap in the literature regarding the nuanced interplay between supply-side and demand-side barriers. Therefore, this study aimed to examine barriers to accessing SRH services in the Gamo Zone of South Ethiopia Regional State. Methods A descriptive phenomenology study was conducted from September 04 to October 15, 2023. A total of seven Focus Group Discussions (FGDs), four with girls and three with boys, with a total of 75 adolescents, and ten Key informant interviews (KIIs)with healthcare providers participated in the study. A semi-structured interview guide was used to explore their lived experiences. All interviews and discussions were audio-recorded. To analyze and manage data framework analysis approach was applied using ATLAS Ti version 7 software. Results The major barriers preventing adolescents from accessing SRH services are related to the interplay between supply and demand-side barriers across all five domains of the Levesque framework. Despite the high need for access to health care, lack of SRH literacy, lack of outreach activities, and integration of SRH information in health facilities often hampered adolescents' healthcare need. Additionally, fear of stigma from family and community, social norms, and lack of discussion of SRH issues hindered their ability to seek health care. Shortage of supplies and healthcare providers' behaviors further hindering adolescents' ability to access health care services. Furthermore, the limited involvement of adolescents in decision-making and the lack of effective coordination further complicate the appropriateness of services for adolescents. Conclusion The finding of this study reveals that adolescents face multifaceted barriers. Therefore, there is a need for high-impact complex interventions, program and policy that address both supply and demand side barriers needs to give due intention to improve access to SRH services for adolescents.
Collapse
Affiliation(s)
- Negussie Boti Sidamo
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Amene Abebe Kerbo
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Kassa Daka Gidebo
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | | |
Collapse
|
5
|
Robbers GML, Cousins N, Lim YL, Estoesta J, Botfield JR. Views and experiences of young women from a migrant or refugee background regarding the contraceptive implant in Australia. Cult Health Sex 2024:1-18. [PMID: 38497422 DOI: 10.1080/13691058.2024.2328223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 03/05/2024] [Indexed: 03/19/2024]
Abstract
Young people comprise a significant proportion of migrants and refugees in Australia. Many encounter challenges in accessing contraception information and services. This study explored the views and experiences of young women from migrant and/or refugee backgrounds regarding the contraceptive implant and related decision-making. Interviews were conducted with 33 women, aged 15-24, living in New South Wales, Australia, who spoke a language other than English and had some experience of the implant. Three themes were developed from the data as follows: 'Finding your own path': contraception decision-making (in which participants described sex and contraception as being taboo in their community, yet still made independent contraceptive choices); Accessing 'trustworthy' contraception information and navigating services (in which participants consulted online resources and social media for contraception information, and preferred discussions with healthcare providers from outside their community); and Views and experiences of the contraceptive implant (while the implant was described as a 'Western' method, most participants regarded it as an acceptable, convenient, cost-effective, and confidential means of contraception). Decision-making regarding the implant is influenced by many factors which must be considered in health promotion efforts and when providing clinical care. Consideration of more informative health promotion resources, peer education strategies, and healthcare provider training is warranted to support contraception decision-making and choice.
Collapse
Affiliation(s)
| | | | - Yen Li Lim
- Family Planning Australia, Newington, NSW, Australia
| | - Jane Estoesta
- Family Planning Australia, Newington, NSW, Australia
| | - Jessica R Botfield
- Family Planning Australia, Newington, NSW, Australia
- Monash University, Clayton, VIC, Australia
| |
Collapse
|
6
|
Gazzetta S, Valent F, Sala A, Driul L, Brunelli L. Sexually transmitted infections and the HPV-related burden: evolution of Italian epidemiology and policy. Front Public Health 2024; 12:1336250. [PMID: 38560434 PMCID: PMC10978588 DOI: 10.3389/fpubh.2024.1336250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
Sexually transmitted infections (STIs) are a major public health problem worldwide, with a high prevalence between the ages of 15 and 25 in most Western countries. High notification rates of chlamydia, gonorrhea, and syphilis are reported in the WHO European Region, with differences between countries. In Italy, the total number of STIs alerts increased by 18% from 2020 to 2021. HPV is the most common sexually transmitted infection; globally one in seven women is infected by this virus, and certain sexual behaviors are important risk factors for HPV-related cancers, particularly cervical cancer (CC), anogenital cancers and cancers of the head and neck. The burden of CC is relevant worldwide, in particular in Europe CC is the third leading cause of cancer-related deaths in women aged 15-44. This HPV-related tumor is preventable through a combined strategy of vaccination and screening for precursor lesions. In Italy, the coverage of organized screening varies from region to region and the average HPV vaccination rate is still far from the expected optimal threshold of 95% at the age of 12. To address the challenges of health promotion and HPV prevention, priority actions are needed such as: promoting education and information at every level, from schools to healthcare professionals. In Italy, education of adolescents on sexual and reproductive health, still remains critical, regionally inhomogeneous and much lower than in other European countries. Equitable measures need to be taken, and schools are an important place for health promotion activities.
Collapse
Affiliation(s)
| | - Francesca Valent
- Institute of Hygiene and Clinical Epidemiology, Friuli Centrale University Healthcare Trust, Udine, Italy
| | - Alessia Sala
- Departement of Medicine, University of Udine, Udine, Italy
| | - Lorenza Driul
- Departement of Medicine, University of Udine, Udine, Italy
- Department of Obstetrics and Gynaecology, ASUFC, Ospedale Santa Maria Della Misericordia, Udine, Italy
| | - Laura Brunelli
- Departement of Medicine, University of Udine, Udine, Italy
- Accreditation, Quality and Clinical Risk Unit, Friuli Centrale University Healthcare Trust, Udine, Italy
| |
Collapse
|
7
|
Peng K, Tu K, Li Z, Hallinan CM, Laughlin A, Manski-Nankervis JA, Apajee J, Lapadula MC, Ortigoza A, Da Roza CC, Baste V, Flottorp S, Wensaas KA, Goh LH, Ling ZJ, Kristiansson R, Gaona G, Pace WD, Westfall JM, Ng APP, Wong WCW. Global impacts of COVID-19 pandemic on sexual and reproductive health services: An international comparative study on primary care from the INTRePID Consortium. BJOG 2024; 131:508-517. [PMID: 37935645 DOI: 10.1111/1471-0528.17704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVE To understand how the COVID-19 pandemic has impacted sexual and reproductive health (SRH) visits. DESIGN An ecological study comparing SRH services volume in different countries before and after the onset of the COVID-19 pandemic. SETTING Seven countries from the INTernational ConsoRtium of Primary Care BIg Data Researchers (INTRePID) across four continents. POPULATION Over 3.8 million SRH visits to primary care physicians in Australia, China, Canada, Norway, Singapore, Sweden and the USA. METHODS Difference in average SRH monthly visits before and during the pandemic, with negative binomial regression modelling to compare predicted and observed number of visits during the pandemic for SRH visits. MAIN OUTCOME MEASURES Monthly number of visits to primary care physicians from 2018 to 2021. RESULTS During the pandemic, the average volume of monthly SRH visits increased in Canada (15.6%, 99% CI 8.1-23.0%) where virtual care was pronounced. China, Singapore, Sweden and the USA experienced a decline (-56.5%, 99% CI -74.5 to -38.5%; -22.7%, 99% CI -38.8 to -6.5%; -19.4%, 99% CI -28.3 to -10.6%; and -22.7%, 99% CI -38.8 to -6.5%, respectively); while Australia and Norway showed insignificant changes (6.5%, 99% CI -0.7 to -13.8% and 1.7%, 99% CI -6.4 to -9.8%). The countries that maintained (Australia, Norway) or surpassed (Canada) pre-pandemic visit rates had the greatest use of virtual care. CONCLUSIONS In-person SRH visits to primary care decreased during the pandemic. Virtual care seemed to counterbalance that decline. Although cervical cancer screening appeared insensitive to virtual care, strategies such as incorporating self-collected samples for HPV testing may provide a solution in a future pandemic.
Collapse
Affiliation(s)
- Kangning Peng
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Karen Tu
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Departments of Research and Innovation and Family Medicine-North York General Hospital, Toronto Western Family Health Team-University Health Network, Toronto, Ontario, Canada
| | - Zhuo Li
- Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Christine Mary Hallinan
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Adrian Laughlin
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jo-Anne Manski-Nankervis
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jemisha Apajee
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - María Carla Lapadula
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Angela Ortigoza
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cecilia Clara Da Roza
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Valborg Baste
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Signe Flottorp
- Norwegian Institute of Public Health, Oslo, Norway
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Knut-Arne Wensaas
- Research Unit for General Practice, NORCE Norwegian Research Centre AS, Bergen, Norway
| | - Lay Hoon Goh
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Zheng Jye Ling
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Robert Kristiansson
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden
| | | | | | | | - Amy Pui Pui Ng
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - William Chi-Wai Wong
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| |
Collapse
|
8
|
Phillips-Howard PA, Osire E, Akinyi C, Zulaika G, Otieno FO, Mehta SD. Water, sanitation and hygiene at sex work venues to support menstrual needs. Front Public Health 2024; 12:1305601. [PMID: 38481834 PMCID: PMC10936742 DOI: 10.3389/fpubh.2024.1305601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/05/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction Adequate menstrual health and hygiene (MHH) is necessary for women's health and equity of all menstruators. Female sex workers (FSW) require good MHH to prevent discomfort and exposure to pathogens. No studies have evaluated water, sanitation, and hygiene (WASH) conditions of FSW. We report on a cross-sectional WASH assessment at FSW venues in Kisumu, western Kenya. Methods Stakeholders identified 77 FSW venues in Kisumu, of which 47 were randomly sampled and visited between April-May 2023. A standardized structured survey of WASH conditions was deployed by trained research staff using Android tablets after proprietor's consent. WASH scores ranging 0-3 were computed based on point each for direct observation of water available, soap available, and acceptable latrine. MHH scores ranging between 0-4 were computed (one point each) for direct observation of: currently available soap and water, locking door on a usable latrine, functional lighting, and a private area for changing clothes or menstrual materials, separate from the latrine(s). WASH and MHH scores were compared by venue type using non-parametric Kruskal-Wallis tests, and non-parametric Spearman rank tests. Results Full WASH criteria was met by 29.8% of venues; 34.0% had no adequate WASH facilities; 46.8% had no female latrine; and 25.5% provided soap and water in private spaces for women. While 76.6% had menstrual waste disposal only 14 (29.8%) had covered bins. One in 10 venues provided adequate MHM facilities. Poorest WASH facilities were in brothels and in bars, and three-quarters of bars with accommodation had no MHH facilities. Discussion WASH and MHH services were sub-optimal in the majority of FSW venues, preventing menstrual management safely, effectively, with dignity and privacy. This study highlights the unmet need for MHH support for this population. Poor MHH can deleteriously impact FSW health and wellbeing and compound the stigma and shame associated with their work and ability to stay clean. Acceptable and cost-effective solutions to sustainably improve WASH facilities for these populations are needed. Trial registration Clinicaltrial.gov NCT0566678.
Collapse
Affiliation(s)
| | - Edyth Osire
- Nyanza Reproductive Health Society, Kisumu, Kenya
| | | | - Garazi Zulaika
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Supriya D. Mehta
- Department of Internal Medicine, Division of Infectious Diseases, Rush Medical College, Chicago, IL, United States
- Division of Epidemiology & Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| |
Collapse
|
9
|
Nelson TJ, Butcher BDC, Delgado A, McLemore MR. Perspectives of Certified Nurse-Midwives and Physicians on the Structural and Institutional Barriers that Contribute to the Reproductive Inequities of Black Birthing People in the San Francisco Bay Area. J Midwifery Womens Health 2024. [PMID: 38369871 DOI: 10.1111/jmwh.13614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/31/2023] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Black birthing people in the United States disproportionately endure inequitable experiences and outcomes during pregnancy and childbirth via structural, interpersonal, and obstetric racism. In this study, the researchers explore provider perspectives of how racism is perpetuated in institutional perinatal and reproductive health care. METHODS Critical Race Theory, Reproductive Justice, and midwifery theory were operationalized through secondary thematic analysis of existing qualitative data from the Community Racial Equity and Training Interventions and Evaluation of Current and Future Healthcare Clinicians Study. Twenty-four perinatal providers (certified nurse-midwives [n = 7] and physicians [n = 17]) voluntarily participated in interviews. A comparative approach was used to determine how professional identity and model of care influence physicians' and certified nurse-midwives' perceptions of equity. RESULTS Thematic analysis produced 5 themes: racism as a comorbidity, health care systems' inability to address the needs of Black birthing people, health care systems prioritizing providers over patients are failed systems, patients are the experts in the optimal health care model, and benefits of interprofessional teams grounded in Reproductive Justice. Additionally, both physicians and midwives expressed a need for a new care model. DISCUSSION With these findings, our team proposes a modification of the midwifery model for application by all provider types that could radically shift the experience and outcomes of perinatal and reproductive health care and reduce mortality. Using a human rights approach to care, a Reproductive Justice-Public Health Critical Race praxis-informed midwifery model may be operationalized by all perinatal and reproductive health care providers. This novel model reflects an iterative process that may offer institutions and providers methods to build on past research supporting midwifery-centered care for improving outcomes for all patients by specifically focusing on improving care of Black birthing people. The implications of this work offer broad application in current clinical practice, quality improvement, research, technology, and patient resources.
Collapse
Affiliation(s)
- Tamara J Nelson
- Department of Family Health Care Nursing School of Nursing, University of California San Francisco, San Francisco, California
| | - Brittany D Chambers Butcher
- Department of Human Ecology, Human Development and Family Studies, University of California Davis, Davis, California
| | - Ana Delgado
- Department of Family Health Care Nursing School of Nursing, University of California San Francisco, San Francisco, California
| | - Monica R McLemore
- Department of Family Health Care Nursing School of Nursing, University of California San Francisco, San Francisco, California
| |
Collapse
|
10
|
Meherali S, Bhaumik S, Idrees S, Kennedy M, Lassi ZS. Digital Knowledge Translation Tools for Disseminating Sexual and Reproductive Health Information to Adolescents: Protocol for an Evidence Gap Map Review. JMIR Res Protoc 2024; 13:e55081. [PMID: 38349722 PMCID: PMC10900081 DOI: 10.2196/55081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/03/2024] [Accepted: 01/07/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Digital or eHealth knowledge translation (KT) interventions have been identified as useful public health tools, particularly to advance sexual and reproductive health (SRH) among adolescents. Existing literature reviews on digital health interventions for adolescents' SRH demonstrate limitations, including shortcomings in reporting and comprehensiveness that limit the utility and trustworthiness of findings. However, there is a lack of evidence synthesis on the effectiveness of available digital or mobile health KT tools to promote SRH interventions for adolescents. OBJECTIVE We aim to identify, map, and describe existing empirical evidence on the digital KT tools developed to improve adolescent SRH outcomes globally. METHODS This study will be conducted using an evidence gap map (EGM) approach to address the objectives, including reviewing relevant literature and a landscape analysis of the outcomes of interest. The following electronic databases will be searched for retrieval of literature: MEDLINE (1946-present), Embase (1974-present), and Global Health (1910-present) via OVID; CINAHL (1936-present) via EBSCOhost; Scopus (1976-present); and Cochrane Library (1993-present) via Wiley. We will include only those studies that focused on adolescents aged 10-19 years and addressed SRH outcomes. We will include experimental studies (randomized or cluster randomized and nonrandomized controlled trials, including quasi-randomized, controlled before-after, and interruptive time series) and observational studies, that is, including prospective cohort and case-control studies. The experimental and observational studies will only be included in the presence of control or comparison arms. Studies with a historical control arm will be excluded. The systematic review software, Covidence (Ventas Health Innovation), will be used to screen and select the studies. Further, 2 independent reviewers will complete the first and second levels of screening of studies and any conflicts arising will be resolved by consensus between the 2 reviewers or by involving the third reviewer. We will conduct the quality assessment of all included studies using the Risk of Bias tool for randomized controlled trials and nonrandomized controlled trials, and AMSTAR2 for systematic reviews. RESULTS Papers screening, data extraction, and synthesis will be completed by March 2024. We will use EPPI-Mapper (The International Public Policy Observatory) software to generate an online evidence map and to produce the tables and figures for the descriptive report. This EGM review will identify areas with high-quality, evidence-based digital KT tools (for immediate scale and spread) and areas where few or no KT tools exist (for targeted KT tool development and research or policy prioritization). CONCLUSIONS This protocol focused on mapping eHealth KT tools that have been used in the literature to address SRH among adolescents. This will be the first EGM exercise to map digital KT tools to promote adolescents' SRH and will incorporate a range of published sources. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55081.
Collapse
Affiliation(s)
- Salima Meherali
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Soumyadeep Bhaumik
- Meta-research and Evidence Synthesis Unit, Health Systems Science, George Institute for Global Health, Sydney, Australia
| | - Sobia Idrees
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Megan Kennedy
- Health Science Library, University of Alberta, Edmonton, AB, Canada
| | - Zohra S Lassi
- Robinson Research Institute, Helen Mayo North, Adelaide, Australia
| |
Collapse
|
11
|
Boku GG, Abeya SG, Ayers N, Abera M. Leadership Commitment and the Quality of Adolescent-Friendly Sexual Reproductive Health Services in Public Health Facilities Among Pastoral Districts of Guji Zone, Ethiopia. J Healthc Leadersh 2024; 16:53-66. [PMID: 38370150 PMCID: PMC10871142 DOI: 10.2147/jhl.s441951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/06/2024] [Indexed: 02/20/2024] Open
Abstract
Background Accessible and high-quality sexual and reproductive health services are essential for adolescents. However, there is a need for more knowledge about the role of leadership and the quality of these services in Ethiopia, where a significant proportion of the population consists of adolescents. Inadequate quality of friendly health services may lead to underutilization and higher rates of unintended pregnancies and sexually transmitted infections. This study aimed to evaluate the leadership role and quality of friendly health services in the pastoral community of East Guji Zone, Ethiopia. Methods We implemented in-depth interviews and focus group discussions with eight key informants and fifty participants. Study design: We used a programmatic qualitative research design. Data were collected using 22 semi-structured questions and analyzed using ATLAS.ti7. Results The findings indicate significantly less commitment to health sector leadership and substandard quality of adolescent-friendly sexual and reproductive health services. Inadequate achievement of the quality of care frameworks, including accessibility, equitability, availability, acceptability, and appropriateness, contributed to the insufficient quality of friendly health services. Conclusions and Recommendations Poor commitment of health facility leaders influenced the quality of adolescent-friendly sexual and reproductive health services in the pastoral community of the East Guji Zone, according to the study. We recommend enhancing organizational and provider readiness, ensuring equitability, and redesigning services through improving leadership commitment, which is crucial to improving the quality of adolescent-friendly health services. The Ministry of Health Ethiopia and relevant stakeholders should consider these recommendations to improve the quality of friendly health services for adolescents in Ethiopia.
Collapse
Affiliation(s)
- Gobena Godana Boku
- Department of Population and Family Health, Faculty of Public Health, Jimma University, Jimma, Ethiopia
- Department of Nursing, BPP University, London, UK
| | | | - Nicola Ayers
- Department of Nursing, BPP University, London, UK
| | - Muluembet Abera
- Department of Population and Family Health, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| |
Collapse
|
12
|
Davidson N, Hammarberg K, Fisher J. 'If I'm not sick, I'm not going to see the doctor': Access to preventive sexual and reproductive health care for Karen women from refugee backgrounds living in Melbourne, Australia-A qualitative study. Health Promot J Austr 2024. [PMID: 38325438 DOI: 10.1002/hpja.844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 10/30/2023] [Accepted: 01/22/2024] [Indexed: 02/09/2024] Open
Abstract
ISSUE ADDRESSED Women from refugee backgrounds have poorer health outcomes than host country populations. People from Myanmar, most of whom are from the Karen ethnic minority constitute one of the largest groups of humanitarian visa entrants to Australia since 2015. Barriers to and enablers of preventive sexual and reproductive health (SRH) for this group of women are poorly understood. The objective is to establish the preventive SRH care needs and experiences of Karen women from refugee backgrounds living in Australia. METHODS A qualitative study using semi-structured interviews was conducted with a purposive sample of Karen women. A bi-cultural worker assisted in recruitment and interpreting during data collection. All interviews were conducted in Karen language with a bi-cultural worker interpreting into English during the interview. Audio recordings of English dialogue were transcribed verbatim. Thematic analysis was used to analyse and report data. RESULTS Thirteen women were interviewed. Five major themes were identified: (1) prevention awareness including lack of access to education and knowledge of services pre-arrival; appreciation of the new health system; limited vaccination knowledge, (2) perceived need for prevention including consequences of not screening; health care provider (HCP) attendance, (3) health information seeking including providing a comprehensive approach to information delivery; trusted sources of information, (4) barriers including missed opportunities; communication, language, illiteracy; lack of continuity of care and, (5) enablers including HCP' characteristics; peer support and individual responsibility. CONCLUSION Findings from this study indicate that to improve access to preventive SRH services a multi-component strategy is needed. Provision of preventive SRH information using a multi-pronged approach; peer and community support interventions; and HCPs offering services and information opportunistically would benefit Karen women unfamiliar with preventive SRH care. SO WHAT?: Primary prevention services and education codesigned with community members may be effective in improving Karen women's access to SRH care.
Collapse
Affiliation(s)
- Natasha Davidson
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Karin Hammarberg
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Jane Fisher
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
| |
Collapse
|
13
|
Woodson LL, Garcia Saldivar A, Brown HE, Magrath PA, Farland LV, Blas MM, Madhivanan P. 'You have a lot of mirrors': structural and socioecological factors impacting adolescent pregnancy and reproductive health in the Amazon basin, Peru, a qualitative study. Cult Health Sex 2024:1-17. [PMID: 38315608 DOI: 10.1080/13691058.2024.2308666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 01/18/2024] [Indexed: 02/07/2024]
Abstract
Loreto, in the Peruvian Amazon, has one of the highest adolescent pregnancy rates in the country. However, underlying causes of adolescent pregnancy are not fully understood as data are limited in Indigenous and remote Amazonian communities. This study investigated adolescent reproductive health within Loreto using an ecological systems framework. Forty-one semi-structured interviews were conducted in June 2022: community leaders (n = 12) and adolescent participants between 15 and 17 years of age (pregnant girls, n = 11; never pregnant girls, n = 9; and boys, n = 9). We also conducted focus group discussions with community health workers and educators in October 2022 (three focus groups, n = 15). Adolescent reproductive health is complex with multi-layered factors that put girls at higher risk of pregnancy. We found a paradoxical relationship between expected social and gender norms and individual desires. This research provides a contextual understanding of the lived experience of adolescents and young people in the Amazon region of Peru. Our findings suggest the need for greater exploration of the contradictory ideas surrounding adolescent pregnancy and female sexuality.
Collapse
Affiliation(s)
- Lisa Labita Woodson
- Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | | | - Heidi E Brown
- Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Priscilla A Magrath
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Leslie V Farland
- Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Magaly M Blas
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| |
Collapse
|
14
|
Kumah A, Aidoo LA, Amesawu VE, Issah AR, Nutakor HS. Assessment of Structural and Process Factors in Delivering Quality Adolescent Sexual and Reproductive Health Services in Ghana. Glob J Qual Saf Healthc 2024; 7:1-8. [PMID: 38406655 PMCID: PMC10887489 DOI: 10.36401/jqsh-23-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/19/2023] [Accepted: 10/16/2023] [Indexed: 02/27/2024]
Abstract
Introduction Sexual and reproductive health services are often underserved to adolescents in many societies. For many of these sexually active adolescents, reproductive health services such as the provision of contraception and treatment for sexually transmitted infections, either are not available or are provided in a way that makes adolescents feel unwelcome and embarrassed. This study assessed the structural and process factors available in delivering quality adolescent sexual and reproductive health (ASRH) services in health facilities across three regions in Ghana. Methods A facility-based descriptive cross-sectional study assessed the structural and process factors available for delivering quality adolescent sexual reproductive health services in 158 selected health facilities across three regions (Oti, Eastern, and Volta) of Ghana. A simple random sampling by balloting was used to select the health facilities and a total of 158 adolescents who used ASRH services in the selected facilities were sampled for an existing interview. The Donabedian model of quality assessment was adopted and modified into an assessment tool and a questionnaire to assess the selected health facilities and respondents. The Statistical Package for the Social Sciences (SPSS) version 20.0 was used to analyze the data collected and the findings presented in the tables. Results The study found some structural and process barriers that affected the delivery of quality ASRH services in Ghana. A proportion of 85 (53.50%) of the facilities assessed did not have separate spaces for delivering services for adolescents. All 158 health facilities had the National Health Insurance Scheme (NHIS) covering contraceptive/family planning services for adolescents. Most (128, 81.01%) facilities had available educational materials on ASRH but were not made available for take home by adolescents. The findings indicated that most respondents did not require parental, spouse, or guardian consent before using ASRH services. The average waiting time for adolescents to be attended to by service providers was ≤30 minutes. Conclusions The study found some structural and process barriers that affected the delivery of quality ASRH services in Ghana. ASRH services, particularly contraceptive/family planning services, were well integrated into NHIS to improve access and utilization by adolescents.
Collapse
Affiliation(s)
| | | | - Vera Edem Amesawu
- Department of Population and Reproductive Health, University of Ghana, Legon, Ghana
| | - Abdul-Razak Issah
- Department of Health Information Management, College of Health, Yamfo, Ghana
| | - Hillary Selassi Nutakor
- Department of Addiction, Recovery and Rehabilitation, Accra Psychiatric Hospital, Accra, Ghana
| |
Collapse
|
15
|
Vamos CA, Puccio JA, Griner SB, Logan RG, Piepenbrink R, Richardson Cayama M, Lovett SM, Mahony H, Daley EM. Health literacy needs and preferences for a technology-based intervention to improve college students' sexual and reproductive health. J Am Coll Health 2024; 72:477-486. [PMID: 35298353 DOI: 10.1080/07448481.2022.2040517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 01/13/2022] [Accepted: 02/06/2022] [Indexed: 06/14/2023]
Abstract
Objective: To explore health literacy needs and preferences for a technology-based intervention (app) to improve sexual and reproductive health (SRH) among college students. Participants: In Spring 2019, in-depth interviews were conducted with 20 participants (10 male, 10 female) from a large, public university. Methods: Interview guide was developed based on Integrated Model of Health Literacy domains and Diffusion of Innovation constructs. Data were analyzed in MaxQDA using applied thematic analysis. Results: Dominant themes included accessing health information and services, evaluating options to make decisions, intervention utility and characteristics, and the emergent theme of credibility. Specific topics included accessing STI testing, contraceptive decision making, information on human papillomavirus (HPV) and the HPV vaccine, patient-provider communication, app design and function elements, and modifying the app to meet the SRH needs of diverse college students. Conclusions: Findings identified areas where an app could address college students' SRH literacy, ultimately improving SRH outcomes among this population.
Collapse
Affiliation(s)
- Cheryl A Vamos
- University of South Florida, College of Public Health, Tampa, FL, USA
| | - Joseph A Puccio
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Stacey B Griner
- University of North Texas Health Science Center at Fort Worth, School of Public Health, Fort Worth, TX, USA
| | | | | | | | - Sharonda M Lovett
- University of South Florida, College of Public Health, Tampa, FL, USA
| | - Helen Mahony
- University of South Florida, College of Public Health, Tampa, FL, USA
| | - Ellen M Daley
- University of South Florida, College of Public Health, Tampa, FL, USA
| |
Collapse
|
16
|
Mfeka-Nkabinde NG, Moletsane R, Voce A. 'Parents are gudlists!' Experiences of puberty and parent-child sexual communication in rural KwaZulu-Natal, South Africa. Cult Health Sex 2024:1-20. [PMID: 38299577 DOI: 10.1080/13691058.2024.2306228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/12/2024] [Indexed: 02/02/2024]
Abstract
This paper explores young people's experiences of puberty and their perspectives on parent-child sexual communication in rural northern KwaZulu-Natal. In-depth individual interviews, focus group discussions, and participatory visual research methodology were employed with 18 and 19-year-old young women (n = 30) and young men (n = 16) attending three primary health care facilities and a local high school in Jozini municipality. The findings suggest a complex interplay between unequal gender and socio-cultural norms that results in divergent puberty experiences and ambiguous and inconsistent patterns of parent-child sexual communication. Young people referred to their parents as gudlists, a local colloquialism for someone who is evasive, vague, ambiguous and indirect. Lack of open parent-child sexual communication hinders discussion of healthy sexuality, neglecting the sexual and reproductive health education and needs of young people. Reflective of their desire for change, young women in particular contest current parenting norms and suggest returning to cultural practices linked to traditional forms of courtship and sexual communication among young Zulu people.
Collapse
Affiliation(s)
| | | | - Anna Voce
- School of Nursing & Public Health, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
17
|
Hartmann M, Nyblade L, Otticha S, Marton T, Agot K, Roberts ST. The development of a conceptual framework on PrEP stigma among adolescent girls and young women in sub-Saharan Africa. J Int AIDS Soc 2024; 27:e26213. [PMID: 38379129 PMCID: PMC10879468 DOI: 10.1002/jia2.26213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/17/2024] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Stigma is a well-known barrier to HIV testing and treatment and is an emerging barrier to pre-exposure prophylaxis (PrEP) use. To guide future research, measurement and interventions, we developed a conceptual framework for PrEP stigma among adolescent girls and young women (AGYW) in sub-Saharan Africa, a priority population for PrEP. METHODS A literature review, expert consultations and focus group discussions (FGDs) were conducted to adapt the Health Stigma and Discrimination Framework, describing the stigmatization process nested within the socio-ecological framework. We reviewed all articles on PrEP stigma and on HIV, contraceptive or sexuality stigma among AGYW from 2009 to 2019. Expert consultations were conducted with 10 stigma or PrEP researchers and two Kenyan youth advisory boards to revise the framework. Finally, FGDs were conducted with AGYW PrEP users (4 FGDs; n = 20) and key influencers (14 FGDs; n = 72) in Kenya with the help of a Youth Research Team who aided in FGD conduct and results interpretation. Results from each phase were reviewed and the framework was updated to incorporate new and divergent findings. This was validated against an updated literature search from 2020 to 2023. RESULTS The conceptual framework identifies potential drivers, facilitators and manifestations of PrEP stigma, its outcomes and health impacts, and relevant intersecting stigmas. The main findings include: (1) PrEP stigma is driven by HIV, gender and sexuality stigmas, and low PrEP community awareness. (2) Stigma is facilitated by factors at multiple levels: policy (e.g. targeting of PrEP to high-risk populations), health systems (e.g. youth-friendly service availability), community (e.g. social capital) and individual (e.g. empowerment). (3) Similar to other stigmas, manifestations include labelling, violence and shame. (4) PrEP stigma results in decreased access to and acceptability of PrEP, limited social support and community resistance, which can impact mental health and decrease PrEP uptake and adherence. (5) Stigma may engender resilience by motivating AGYW to think of PrEP as an exercise in personal agency. CONCLUSIONS Our PrEP stigma conceptual framework highlights potential intervention targets at multiple levels in the stigmatization process. Its adoption would enable researchers to develop standardized measures and compare stigma across timepoints and populations as well as design and evaluate interventions.
Collapse
Affiliation(s)
- Miriam Hartmann
- Women's Global Health ImperativeRTI InternationalBerkeleyCaliforniaUSA
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
| | - Laura Nyblade
- Women's Global Health ImperativeRTI InternationalBerkeleyCaliforniaUSA
| | | | - Tozoe Marton
- Women's Global Health ImperativeRTI InternationalBerkeleyCaliforniaUSA
| | - Kawango Agot
- Impact Research Development OrganizationKisumuKenya
| | - Sarah T. Roberts
- Women's Global Health ImperativeRTI InternationalBerkeleyCaliforniaUSA
| |
Collapse
|
18
|
Chofakian CBDN, Borges ALV. Contraceptive switch and abandonment among women using the pill, condoms and injectables in Brazil. EUR J CONTRACEP REPR 2024; 29:15-23. [PMID: 38108084 DOI: 10.1080/13625187.2023.2289831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE The aim of our study was to assess the covariates of contraceptive switching and abandonment among Brazilian women stratified by oral pills, condoms and injectables. MATERIALS AND METHODS Women attending primary health care services in three Brazilian mid- to large-sized cities were interviewed face-to-face about their contraceptive practices (n = 2,051). Data were collected using a contraceptive calendar. Analysis included estimates using Kaplan-Meier multiple-decrement life-table probabilities and discrete-time hazards modelling of switching from a method to another or to no method. RESULTS Among 3,280 segments of contraceptive use, we observed that five-year contraceptive switching rates ranged from 34.9% among injectable users to 56.1% among pill users. Of particular concern were the high discontinuation rates of abandonment, which ranged from 50.9% among injectable users to 77.4% among pill users. Covariates of method switching and abandonment varied by type of method, but age, race/ethnicity, religion and relationship status must be highlighted as key elements of discontinuation. CONCLUSION Contraceptive method switching and abandoning are frequent outcomes of contraceptive use. Understanding the factors that shape women's decisions to continue or discontinue the use of a contraceptive method can help tailoring comprehensive contraceptive counselling that meet their expectations and reproductive needs when starting using a method.
Collapse
Affiliation(s)
| | - Ana Luiza Vilela Borges
- Department of Public Health Nursing, School of Nursing, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
19
|
Schlegel EC, Pickler RH, Tate JA, Williams KP, Smith LH. The EMeRGE theory of emerging adult-aged women's sexual and reproductive health self-management: A grounded theory study. J Adv Nurs 2024; 80:510-525. [PMID: 37533185 PMCID: PMC10834842 DOI: 10.1111/jan.15814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 06/26/2023] [Accepted: 07/20/2023] [Indexed: 08/04/2023]
Abstract
AIMS To explore how emerging adult-aged women self-manage their sexual and reproductive health and to generate a grounded theory of these self-management processes. DESIGN Grounded theory methods using a constructivist approach. METHODS Between September 2019 and September 2020, 18- to 25-years-old women (n = 13) were recruited from a 4-year university, a 2-year community college, and neighbourhoods surrounding the institutions of higher education. Individual interviews were transcribed verbatim and qualitatively analysed using a constant comparative method and inductive coding. RESULTS The theory purports that core processes of sexual and reproductive health self-management used by the women in this study included both passive and (re)active processes. These processes expanded upon and/or maintained the women's accessible sexual and reproductive health knowledge, behaviour and beliefs, defined as the sexual and reproductive health repertoire. The processes appeared to be cyclical and were often initiated by a catalysing event or catalyst and resulted in conversations with confidantes, or trusted individuals. A catalyst was either resolved or normalized by expanding or maintaining the sexual and reproductive health repertoire. CONCLUSION The resulting theory, EMeRGE Theory, offers insight into the complex and cyclical processes emerging adult-aged women use to simultaneously develop and adapt their foundational sexual and reproductive health knowledge, behaviours and beliefs. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE This explication of emerging adult-aged women's sexual and reproductive health self-management processes can be used by nurses and nurse researchers to better address this population's unique health needs. IMPACT The EMeRGE Theory provides valuable guidance for future exploratory and intervention research aimed at improving the health and well-being of emerging adult-aged women. REPORTING METHOD The authors adhered to the Consolidated Criteria for Reporting Qualitative studies (COREQ) in preparation of this publication. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
Collapse
Affiliation(s)
- Emma C Schlegel
- Center for Nursing Research, Scholarship and Innovation, College of Nursing, Michigan State University, East Lansing, Michigan, USA
- Martha S. Pitzer Center for Women, Children and Youth, College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Rita H Pickler
- Martha S. Pitzer Center for Women, Children and Youth, College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Judith A Tate
- Center for Aging, Self-Management and Complex Care, College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Karen Patricia Williams
- Martha S. Pitzer Center for Women, Children and Youth, College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Laureen H Smith
- Martha S. Pitzer Center for Women, Children and Youth, College of Nursing, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
20
|
Bambara A, Wayack-Pambè M, Ouili I, Guiella G, Delamou A. Effets identitaires de la socialisation différentielle de genre sur les aspirations au premier enfant et au mariage des jeunes adolescent(e)s à Ouagadougou: une étude mixte. Sex Reprod Health Matters 2024; 31:2294824. [PMID: 38294681 PMCID: PMC10833111 DOI: 10.1080/26410397.2023.2294824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
Studies show that gender socialisation shapes differently the gendered identity, self-esteem, and sexual behaviours of girls and boys. While pre-adolescence is viewed as a pivotal period for gendered socialisation, few studies in francophone Africa investigate the role of gender identity effects on aspirations and sexual and reproductive behaviours at this life stage. This article explores how the internalisation of gender stereotypes during socialisation is linked to the aspirations of girls and boys for certain life events, such as having their first child or getting married. A survey was conducted in 10 primary schools in Ouagadougou, among pupils aged between 9 and 16 years, as well as seven focus group discussions with their parents. The findings indicate a gender-based variation in the effects of adherence to unequal gender norms among young adolescents. As a result, girls tend to have earlier aspirations towards marriage and later aspirations for childbearing, while boys show earlier aspirations for childbearing and later ones for marriage. These effects may expose both girls and boys to risks of poor sexual and reproductive health. Interventions promoting egalitarian gender norms could boost girls' self-esteem as well as mutual respect among young adolescents of both genders, aiming to improve their sexual and reproductive health during adolescence and into adulthood.
Collapse
Affiliation(s)
- Alis Bambara
- Chercheuse, Doctorante en démographie, Institut supérieur des sciences de la population (ISSP) / Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso; Institut de démographie et socioéconomie (IDESO)/ Université de Genève, Genève, Suisse
| | - Madeleine Wayack-Pambè
- Enseignante-chercheuse, Maîtresse de conférences en démographie, Institut supérieur des sciences de la population (ISSP)/Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Idrissa Ouili
- Enseignant-chercheur, Maitre assistant en démographie, Institut supérieur des sciences de la population (ISSP)/Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Georges Guiella
- Enseignant-chercheur, Maitre de conférences en démographie, Institut supérieur des sciences de la population (ISSP)/Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Alexandre Delamou
- Enseignant-chercheur, Professeur en santé publique, Centre d’Excellence (CEA-PCMT), Université Gamal Abdel Nasser de Conakry, Conakry, Guinée; Centre de formation et de recherche en santé rurale de Maferinyah, Forécariah, Guinea
| |
Collapse
|
21
|
Jahan I, Vuckovic M, Sara Kabir S, Rashid SF, Bouey J. Reproductive health service access and utilisation among migrant women in Dhaka's urban slums: a qualitative study. Cult Health Sex 2024:1-15. [PMID: 38279843 DOI: 10.1080/13691058.2024.2302052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 01/02/2024] [Indexed: 01/29/2024]
Abstract
This study explores the impact of migration on the access and utilisation of sexual and reproductive health services by women living in an informal settlement in Dhaka, Bangladesh. A total of 16 in-depth interviews were conducted in March and April of 2019 with women (18-49 years old) who had migrated from rural areas to Dhaka. They reported continued economic insecurity while receiving minimal support from the state. All women reported financial and infrastructural barriers to accessing formal sexual and reproductive health services and tended to seek resources and support through social networks within the slum and from informal health services. Compared with more recent migrants, women who had migrated and resided in the slums for longer found it easier to utilise social networks and resources for sexual and reproductive health. Women had more agency in experimenting with contraceptives but had less power in making decisions during pregnancy and when seeking health care. Menstrual health was a neglected aspect of public health. The study indicates that public health policy targeting the urban poor needs to address the unique challenges faced by migrant women in informal settlements to rectify inequities in health services that leave significant portions of the urban poor population behind.
Collapse
Affiliation(s)
- Ishrat Jahan
- BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Myriam Vuckovic
- Department of Global Health, School of Health, Georgetown University, Washington, DC, USA
| | - Selima Sara Kabir
- BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Sabina Faiz Rashid
- BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Jennifer Bouey
- Department of Global Health, School of Health, Georgetown University, Washington, DC, USA
| |
Collapse
|
22
|
Zell B, Effland K, Snyder M, Hays K, Gordon W. Prescriptive Authority for Direct Entry Midwives in Washington State: Increasing Client Access to Contraception. J Midwifery Womens Health 2024. [PMID: 38229277 DOI: 10.1111/jmwh.13606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/18/2023] [Indexed: 01/18/2024]
Abstract
Improving health and achieving health equity includes access to sexual and reproductive health care for all populations, especially those most in need. However, access to life-saving and life-affirming contraception with an individual's chosen perinatal provider can be impeded by restrictive regulations that limit scope and practice authority. This is especially true for the majority of community and direct entry midwives in the United States who have historically been unable to legally provide effective contraceptive methods. Recently, licensed midwives in Washington state were the first in the nation to achieve prescriptive authority, enabling their clients to directly obtain contraception and access to medications for common prenatal and postpartum conditions. Sustained advocacy efforts in the state's capitol enabled the Midwives' Association of Washington State to build relationships over time with legislators and government agencies to achieve this long-term goal. We present a successful midwifery-led innovation that achieved scope expansion for licensed midwives whose practice authority was limited by restrictive laws. Lessons learned are described and strategies offered to aid midwives and their advocates in other locales who want to improve health equity and access to contraception. Midwives are well positioned to provide this essential care to individuals living in underserved rural and urban areas and those from historically marginalized communities, but their ability to do so is limited by restrictive legislation.
Collapse
Affiliation(s)
| | - Kristin Effland
- Department of Midwifery, Bastyr University, Kenmore, Washington, USA
| | | | - Karen Hays
- Department of Midwifery, Bastyr University, Kenmore, Washington, USA
| | - Wendy Gordon
- Department of Midwifery, Bastyr University, Kenmore, Washington, USA
| |
Collapse
|
23
|
Nimbi FM, Cavagnis S, Eleuteri S. Changes in Sexual Behavior and Satisfaction and Violent Behavior during COVID-19 Lockdown: Explorative Results from the Italian Cross-Sectional Study of the I-SHARE Multi-Country Project. Int J Environ Res Public Health 2024; 21:96. [PMID: 38248559 PMCID: PMC10815040 DOI: 10.3390/ijerph21010096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/04/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND The COVID-19 pandemic has had effects on sexual and reproductive health and intimate partner violence (IPV). This study aims to describe changes in sexual health and IPV in the Italian population both during and after the lockdowns. METHODS This cross-sectional online study was conducted, as part of the I-SHARE multicountry project, between June 2020 and January 2021. Recruitment was carried out through convenience sampling; a total of 329 participants were included in the analysis. A generalized linear model was used to analyze the difference in sexual health and IPV variables before, during, and after the lockdown. RESULTS Fifty-three percent of the participants reported having sexual problems during the first wave of the pandemic. Sexual satisfaction decreased during the first wave, and then, returned to the pre-lockdown level. While during the lockdown, some activities were reduced (such as kissing, cuddling, and sexual activities with a steady partner), for other activities, no difference was reported (such as masturbation, sexual activities with casual partners, or sexting). Few participants reported having issues accessing HIV testing and contraception. There was no difference in terms of physical and sexual violence, while there was a significant decrease in feeling vulnerable to sexual or physical assault during the first wave. CONCLUSIONS The first wave of the pandemic has had significant effects on sexual health. This should be taken into consideration when preparing for future epidemics and health emergencies.
Collapse
Affiliation(s)
- Filippo Maria Nimbi
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, 00185 Rome, Italy;
| | - Sara Cavagnis
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
| | - Stefano Eleuteri
- Faculty of Medicine and Psychology, Sapienza University of Rome, 00185 Rome, Italy;
| |
Collapse
|
24
|
Gill R, Ogilvie G, Norman WV, Fitzsimmons B, Maher C, Renner R. Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care After Surgical Abortion (the FACTS Study Phase 3): Mixed Methods Prospective Pilot Study. JMIR Form Res 2024; 8:e46284. [PMID: 38194252 PMCID: PMC10807380 DOI: 10.2196/46284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND In Canada, 1 in 3 women and people of gestational age undergo an abortion in their lifetime. Despite the liberal legal context, barriers continue to exist for women and people who can become pregnant to access this service. OBJECTIVE This study aims to (1) conduct a pilot study to demonstrate the feasibility and acceptability of myPostCare to support follow-up care after a procedural abortion; (2) use the findings to understand whether myPostCare has the potential to improve contraceptive behavior and knowledge, emotional well-being, and sexual health knowledge; and (3) develop a better understanding of how innovative mobile solutions can support integrative health programs in British Columbia with the goal of expanding to other sites across Canada. METHODS People of gestational age (aged 14-45 y) who underwent a procedural abortion were recruited from 2 urban abortion facilities in British Columbia. The participants completed a baseline quantitative survey and were provided access to myPostCare for up to 30 days. A follow-up quantitative survey was sent via email on day 30. Qualitative interviews were conducted to explore user satisfaction and usability of myPostCare. Responses to the survey questions were summarized using descriptive statistics, and the system usability scale (SUS) was scored according to the instructions. A secure analytics platform was implemented to obtain data on the overall use of the website by users. Qualitative analysis was conducted with NVivo using a thematic analysis approach. This study was approved by the Women's and Children's Research Ethics Board. RESULTS Overall, 62 participants were recruited (average age 30 y); 40% (25/62) of the participants completed the exit surveys, and 24% (6/25) consented to participate in the semistructured interviews; 40 participants had undergone an immediate postabortion intrauterine device (IUD) insertion, and 22 did not have an IUD inserted. Participants were satisfied with myPostCare. The SUS average score was 81.5 (SD 9.7; median 82.5, IQR 77.5-87.5), indicating high usability of the tool. Overall, 88% (22/25) of the participants changed their contraceptive method to an IUD. Web-based analytics demonstrated that there were 61 unique visitors to the site, and the top pages visited were Postprocedure Care, Emotional Well-Being, and Contraception Explorer. The longest time spent on the website was 56 minutes. The overall email open rate was 80%, with a click rate of 36%. CONCLUSIONS This study demonstrates that communities and individuals are important collaborators in developing a mobile innovation that facilitates access to high-quality patient-centered abortion care. Through the cocreation process, a digital platform such as myPostCare highlighted a gap in abortion care in Canada, particularly around follow-up support after a procedural abortion.
Collapse
Affiliation(s)
- Roopan Gill
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
- Women's Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Gina Ogilvie
- Women's Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Wendy V Norman
- Women's Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Brian Fitzsimmons
- Women's Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Ciana Maher
- Women's Health Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Regina Renner
- Women's Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
25
|
Hentges M, Kågesten AE, Brandén G, Kosidou K, Michielsen K, Ekström AM, Larsson EC. Effects of COVID-19 measures on access to HIV/STI testing and condoms among adults in Sweden: a cross-sectional online survey. Scand J Public Health 2024:14034948231217020. [PMID: 38166520 DOI: 10.1177/14034948231217020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
AIMS To investigate the self-reported impact of COVID-19 measures on access to testing for HIV and other sexually transmitted infections (STIs) and condoms and factors associated with reduced access among adults in Sweden. METHODS Cross-sectional data were collected in late 2020 through a web panel with adults (18-49 years) in Sweden as part of the International Sexual Health And REproductive health survey (I-SHARE) (N=1307). The primary outcome was self-reported access to HIV/STI testing and condoms during COVID-19 measures. Logistic regression was used to assess adjusted odds ratios of experiencing reduced access to HIV/STI testing and condoms in relation to sociodemographic characteristics, changes in sexual behaviours and COVID-19-related factors. RESULTS Of the 1138 sexually active respondents, 17% wanted an HIV/STI test, and of those over half (57%) reported reduced access during the COVID-19 measures in 2020. Compared with cis-women, transgender or non-binary respondents were more likely to experience lower access to testing. Among those who usually used condoms (n=568), 23% reported hampered condom access due to COVID-19 restrictions. Reduced condom access was associated with identifying as non-cis gender and a cis-man compared with cis-woman, non-heterosexual orientation, being foreign-born and financially worried. CONCLUSIONS Findings indicate that access to HIV/STI testing and condoms among sexually active adults of reproductive age in Sweden was disrupted during the COVID-19 pandemic in 2020 with varied impact depending on sexual orientation, gender identity or socioeconomic situation. This signals the importance of ensuring equitable access to sexual and reproductive health services and commodities in future crises response.
Collapse
Affiliation(s)
- Maike Hentges
- Department of Global Public Health, Karolinska Institutet, Sweden
| | - Anna E Kågesten
- Department of Global Public Health, Karolinska Institutet, Sweden
| | - Gunnar Brandén
- Department of Global Public Health, Karolinska Institutet, Sweden
- Center for Epidemiology and Community Medicine, Region Stockholm, Sweden
| | - Kyriaki Kosidou
- Department of Global Public Health, Karolinska Institutet, Sweden
- Center for Epidemiology and Community Medicine, Region Stockholm, Sweden
| | | | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Sweden
- Department of Infectious Diseases, South General Hospital, Sweden
| | - Elin C Larsson
- Department of Global Public Health, Karolinska Institutet, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Sweden
- Department of Women's and Children's Health, Uppsala University, Sweden
| |
Collapse
|
26
|
Lewandowska M, Carter DJ, Gasparrini A, Lohr PA, Wellings K. Impact of approval of home use of misoprostol in England on access to medical abortion: An interrupted time series analysis. Int J Gynaecol Obstet 2024; 164:286-297. [PMID: 37621171 DOI: 10.1002/ijgo.15044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/18/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE In 2018, the Department of Health and Social Care in England approved the use of misoprostol at home for early medical abortions, following administration of mifepristone at clinic. The objective of the present study was to assess the impact of the approval of home administration of misoprostol in England on access to medical abortion, assessed through proxy measures of the proportion of all abortions that were medical and gestational age. METHODS This study uses the clinical data from the British Pregnancy Advisory Service on abortions in England in years 2018-2019, containing demographic and procedure characteristics of patients. We conducted an interrupted time series analysis to establish the differences before and after the approval in access to medical abortion, measured by the proportion of all abortions that were medical, and gestational age. The analysis also examined whether these changes were equitable, with focus on area-level deprivation. RESULTS The analysis of the data (145 529 abortions) suggested that there was an increase in the proportion of medical abortions and decrease in gestational age of abortions after the approval. Compared with the situation if former trends had continued, the actual proportion of early medical abortions was 4.2% higher in December 2019, and the mean gestational age 3.4 days lower. We found that the acceleration of existing trends in increase in proportion of medical abortions and decrease in gestational age were larger in the most deprived quintiles and in those reporting a disability, but not equal across ethnic groups, with Black and Black British women experiencing little change in trajectories post-approval. CONCLUSION The approval of home use of misoprostol as part of an early medical abortion regimen in England was associated with material and equitable improvements in abortion access. Pre-approval trends toward greater uptake of medical abortion and declining gestational age were accelerated post-approval and were greatest in the most deprived areas of England, but not across all racial/ethnic groups. The present findings strongly support the continuation or introduction of home management of medical abortions.
Collapse
Affiliation(s)
- Maria Lewandowska
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Daniel J Carter
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Antonio Gasparrini
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Patricia A Lohr
- Centre for Reproductive Research and Communication, British Pregnancy Advisory Service, London, UK
| | - Kaye Wellings
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
27
|
Brault MA, Linnander EL, Ginindza TM, Mabuza K, Christie S, Canavan ME, Jones A, Desai MM. Assessing changes in adolescent girls' and young women's sexual and reproductive health service utilisation following a COVID-19 lockdown in eSwatini. Glob Health Action 2023; 16:2243760. [PMID: 37565704 PMCID: PMC10424588 DOI: 10.1080/16549716.2023.2243760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023] Open
Abstract
The effects of COVID-19-associated restrictions on youth sexual and reproductive health (SRH) care during the pandemic remain unclear, particularly in sub-Saharan Africa. This study uses interrupted time series analyses to assess changes in SRH care utilisation (including visits for HIV testing and treatment, family planning, and antenatal care) adolescent girls' and young women's (AGYW; aged 15-24 years old) in eSwatini following COVID-19 lockdown beginning in March 2020. SRH utilisation data from 32 clinics in the Manzini region that remained open throughout the 2020 COVID-19 period were extracted from eSwatini's electronic health record system. We tabulated and graphed monthly visits (both overall and by visit type) by AGYW during the two-year period between January 2019 and December 2020. Despite the March to September 2020 lockdown, we did not detect significant changes in monthly visit trends from 2019 to 2020. Our findings suggest little change to AGYW's SRH utilisation in eSwatini during the 2020 COVID-19 lockdown period.
Collapse
Affiliation(s)
- Marie A. Brault
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, San Antonio, TX, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Erika L. Linnander
- Global Health Leadership Initiative, Yale School of Public Health, New Haven, CT, USA
- Department of Health Policy & Management, Yale School of Public Health, New Haven, CT, USA
| | - Thokozani M. Ginindza
- Health Management Information Systems (HMIS), eSwatini Ministry of Health, Mbabane, eSwatini
| | | | - Sarah Christie
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
- School of Public Health, University of the Western Cape, Bellville, Republic of South Africa
| | - Maureen E. Canavan
- Yale School of Medicine, Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT, USA
| | - Anastasia Jones
- Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, San Antonio, TX, USA
| | - Mayur M. Desai
- Global Health Leadership Initiative, Yale School of Public Health, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| |
Collapse
|
28
|
Mhlongo S, Mason-Jones AJ, Ford K. Sexual, reproductive and mental health among young men (10-24) in low-and-middle income countries: a scoping review. Front Reprod Health 2023; 5:1119407. [PMID: 38111839 PMCID: PMC10725937 DOI: 10.3389/frph.2023.1119407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 11/06/2023] [Indexed: 12/20/2023] Open
Abstract
Background The relationship between SRH and mental health among men is not well documented, especially in the 10-24 age group. This scoping review aimed to investigate what is known about the association between SRH and mental health among young men (10-24) in LMICs. Methods Embase, APA PsycInfo, MEDLINE(R) ALL, ASSIA and the Cochrane Library of Database of Systematic Reviews were searched from the year of establishment up to August 2022. The review was reported using the PRISMA-ScR checklist. Results A total of (n = 2636) studies were identified from the five databases. After the completion of screening, only ten studies (n = 8 cross-sectional, n = 1 mixed methods and n = 1 qualitative) met the eligibility criteria and were included in the review. The findings suggest that there is a reciprocal relationship between mental health and SRH. Sperm concentration and total sperm count were found to be lower in depressed men. Poor mental health was associated with early sexual debut, higher rates of sexual activity and an increased number of sexual partners. Poor mental health was also found among men who had sex with men (MSM). In addition, we found a relationship between sexual abuse, sexual coercion and poor mental health. Conclusion The findings of this unique study indicate that poor mental health is associated with poor SRH outcomes and vice versa among young men (10-24) living in LMICs. However, further research will be needed to establish the temporal relationship between SRH and mental health outcomes.
Collapse
|
29
|
Adu J, Roemer M, Page G, Dekonor E, Akanlu G, Fofie C, Teye MD, Afriyie PO, Affram AA, Ohemeng F, Tabong PTN, Dwomoh D. Expanding access to early medical abortion services in Ghana with telemedicine: findings from a pilot evaluation. Sex Reprod Health Matters 2023; 31:2250621. [PMID: 37728548 PMCID: PMC10512762 DOI: 10.1080/26410397.2023.2250621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
Abortion in Ghana is legally permissible under certain conditions. Updated in June 2021, the National Comprehensive Abortion Care Services Standards and Protocols included telemedicine as a recognised option for early medical abortion (EMA). Subsequently, Marie Stopes Ghana launched this pilot project to understand the feasibility and acceptability of providing EMA services through telemedicine. The pilot evaluation drew on two research protocols - a process evaluation and a qualitative study. The process evaluation focused on existing routine data sources and additional pilot-specific monitoring, while the qualitative protocol included in-depth interviews with a range of key stakeholders, including telemedicine and in-person patients, healthcare managers, and service providers. Telemedicine for EMA is feasible, acceptable, and has likely expanded access to safe abortion in Ghana. The MSIG telemedicine service package enabled 97% of patients to have a successful EMA at home. Thirty-six per cent of the total 878 patients during the pilot reported that they had no other option for accessing an abortion. Patients described telemedicine EMA services as a highly acceptable and appealing service option. Eighty-four per cent reported they would opt for the telemedicine service again and 83% reported they were very likely to recommend the service. There is potential for telemedicine to expand and improve access to critical SRH services. EMA via telemedicine can be delivered effectively in a low-resource setting. This pilot also showed how telemedicine provides access to patients who feel they do not have other safe service options, meeting specific patient needs in terms of discretion, convenience, and timing.
Collapse
Affiliation(s)
- Joseph Adu
- Director of Medical Services, MSI Reproductive Choices, Ghana
| | - Matthea Roemer
- Innovation, Evidence and Research Manager, MSI Reproductive Choices, Accra, Ghana
| | - Georgina Page
- Head of SBC and Inclusion, MSI Reproductive Choices, Accra, Ghana
| | - Elymas Dekonor
- Head of Marketing, MSI Reproductive Choices, Accra, Ghana
| | - George Akanlu
- Country Director, MSI Reproductive Choices, Accra, Ghana
| | - Chris Fofie
- Deputy Director, Reproductive and Child Health, Ghana Health Services, Accra, Ghana
| | | | - Patricia Opoku Afriyie
- Monitoring, Evaluation, Research and Learning (MERL) Manager, MSI Reproductive Choices, Ghana
| | - Adjeiwa Akosua Affram
- PhD Candidate, Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Accra, Ghana
| | - Fidelia Ohemeng
- Senior Lecturer, Department of Sociology, University of Ghana, Accra, Ghana
| | - Philip Teg-Nefaah Tabong
- Lecturer, Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Duah Dwomoh
- Director, D&D Statistical Consulting Services Limited, Accra, Ghana
| |
Collapse
|
30
|
Kaunda-Khangamwa BN, Munthali A, Manderson L. Ethnographic understandings of sexual and reproductive health and HIV care for adolescents in Blantyre, Malawi. Sex Reprod Health Matters 2023; 31:2209956. [PMID: 37224431 DOI: 10.1080/26410397.2023.2209956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Sexual and reproductive health (SRH) care and support are provided to adolescents living with HIV, with the aim to build safer sex negotiation skills, sexual readiness and reproductive preparedness while reducing unintended pregnancies and sexually transmitted infections. We consider how different settings might either constrain or facilitate access to resources and support. Ethnographic research was conducted in Malawi in teen club clinic sessions at an enhanced antiretroviral clinic from November 2018 to June 2019. Twenty-one individual and five group interviews were conducted with young people, caregivers, and healthcare workers, and were digitally recorded, transcribed, and translated into English for thematic analysis. Drawing on socio-ecological and resilience theories, we considered the different ways in which homes, schools, teen club clinics, and community settings all functioned as interactional, relational, and transformational spaces to allow young people to talk about and receive information on sexuality and health. Young people perceived that comprehensive SRH support enhanced their knowledge, sexual readiness, and reproductive preparedness. However, their desire to reproduce at an early age complicated their adoption of safer sex negotiation skills and SRH care. Engaging and talking about SRH and related issues varied according to physical and social space, suggesting the value of multiple locations for support and resources for young people with HIV.
Collapse
Affiliation(s)
- Blessings N Kaunda-Khangamwa
- Research Consultant, School of Global and Public Health, Kamuzu University of Health Sciences, MAC CDAC, Blantyre, Malawi
- Honorary Researcher, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Alister Munthali
- Professor of Research, Centre for Social Research, University of Malawi, Zomba, Malawi
| | - Lenore Manderson
- Distinguished Professor of Public Health and Medical Anthropology, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Adjunct Professor, School of Social Sciences, Monash University, Melbourne, Australia
| |
Collapse
|
31
|
Marzouk M, Lam ST, Durrance-Bagale A, Nagashima-Hayashi M, Neo P, Ung M, Zaseela A, Aribou ZM, Agarwal S, Howard N. Effects of COVID-19 on sexual and reproductive health services access in the Asia-Pacific region: a qualitative study of expert and policymaker perspectives. Sex Reprod Health Matters 2023; 31:2247237. [PMID: 37682084 PMCID: PMC10494729 DOI: 10.1080/26410397.2023.2247237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
The COVID-19 pandemic has strained health systems globally, with governments imposing strict distancing and movement restrictions. Little is known about the effects of the COVID-19 pandemic on sexual and reproductive health (SRH). This study examined perceived effects of COVID-19 on SRH service provision and use in the Asia-Pacific region. We conducted a qualitative study using semi-structured interviews with 28 purposively sampled SRH experts in 12 Asia-Pacific countries (e.g. United Nations, international and national non-governmental organisations, ministries of health, academia) between November 2020 and January 2021. We analysed data using the six-stage thematic analysis approach proposed by Braun and Clarke (2019). Interviewees reported that COVID-19 mitigation measures, such as transport restrictions and those that decreased the availability of personal protective equipment (PPE), reduced SRH service provision and use in most countries. SRH needs related to service barriers and gender-based violence increased. Systemic challenges included fragmented COVID-19 response plans and insufficient communication and collaboration, particularly between public and private sectors. SRH service-delivery challenges included COVID-19 response prioritisation, e.g. SRH staff task-shifting to COVID-19 screening and contact tracing, and lack of necessary supplies and equipment. Innovative SRH delivery responses included door-to-door antenatal care and family planning provision in the Philippines, online platforms for SRH education and outreach in Viet Nam, and increasing SRH service engagement through social media in Myanmar and Indonesia. To ensure continuation of SRH services during health emergencies, governments should earmark human and financial resources and prioritise frontline health-worker safety; work with communities and the private sector; and develop effective risk communications.
Collapse
Affiliation(s)
- Manar Marzouk
- Research Fellow, London School of Hygiene & Tropical Medicine, Department of Global Health & Development, London, UK; Overseas Research Associate], Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Sze Tung Lam
- Visiting Scholar Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Alumnus, London School of Hygiene & Tropical Medicine, Department of Global Health & Development, London, UK
| | - Anna Durrance-Bagale
- Research Fellow, London School of Hygiene & Tropical Medicine, Department of Global Health & Development, London, UK
| | - Michiko Nagashima-Hayashi
- Research Associate, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Pearlyn Neo
- Research Associate, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Mengieng Ung
- Research Fellow, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Ayshath Zaseela
- Intern, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Zeenathnisa Mougammadou Aribou
- Senior Resident, Preventive Medicine, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Sunanda Agarwal
- Partner, Stanford University, Stanford Distinguished Careers Institute, Stanford, USA
| | - Natasha Howard
- Associate Professor, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Associate Professor, London School of Hygiene & Tropical Medicine, Department of Global Health & Development, London, UK
| |
Collapse
|
32
|
Njogu J, Jaworski G, Oduor C, Chea A, Malmqvist A, Rothschild CW. Assessing acceptability and effectiveness of a pleasure-oriented sexual and reproductive health chatbot in Kenya: an exploratory mixed-methods study. Sex Reprod Health Matters 2023; 31:2269008. [PMID: 37982143 PMCID: PMC11003647 DOI: 10.1080/26410397.2023.2269008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023] Open
Abstract
Integrating pleasure may be a successful strategy for reaching young people with sexual and reproductive health and rights (SRHR) interventions. However, sexual pleasure-related programming and research remains sparse. We aimed to assess chatbot acceptability and describe changes in SRHR attitudes and behaviours among Kenyan young adults engaging with a pleasure-oriented SRHR chatbot. We used an exploratory mixed-methods study design. Between November 2021 and January 2022, participants completed a self-administered online questionnaire before and after chatbot engagement. In-depth phone interviews were conducted among a select group of participants after their initial chatbot engagement. Quantitative data were analysed using paired analyses and interviews were analysed using thematic content analysis. Of 301 baseline participants, 38% (115/301) completed the endline survey, with no measured baseline differences between participants who did and did not complete the endline survey. In-depth interviews were conducted among 41 participants. We observed higher satisfaction at endline vs. baseline on reported ability to exercise sexual rights (P ≤ 0.01), confidence discussing contraception (P ≤ 0.02) and sexual feelings/needs (P ≤ 0.001) with their sexual partner(s). Qualitative interviews indicated that most participants valued the chatbot as a confidential and free-of-judgment source of trustworthy "on-demand" SRHR information. Participants reported improvements in sex-positive communication with partners and safer sex practices due to new learnings from the chatbot. We observed increases in SRHR empowerment among young Kenyans after engagement with the chatbot. Integrating sexual pleasure into traditional SRHR content delivered through digital tools is a promising strategy to advance positive SRHR attitudes and practices among youth.
Collapse
Affiliation(s)
- Julius Njogu
- Evidence and Learning Advisor, Population Services International, Nairobi, Kenya
| | - Grace Jaworski
- Research Advisor, Population Services International, Washington, DC, USA
| | - Christine Oduor
- Head of Program Management, Digital Health and Monitoring, Population Services International, Nairobi, Kenya
| | | | - Alison Malmqvist
- Director of Sexual and Reproductive Health, Population Services International, Washington, DC, USA
| | | |
Collapse
|
33
|
Ibitoye M, Sommer M, Davidson LL, Sandfort TGM. Exploring the effect of early menarche on sexual violence among adolescent girls and young women in southeastern Ghana: a longitudinal mediation analysis. Sex Reprod Health Matters 2023; 31:2244271. [PMID: 37656485 PMCID: PMC10478596 DOI: 10.1080/26410397.2023.2244271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Research from several high-income countries links early menarche with an increased risk for sexual violence. However, the role of early menarche in adolescent girls' and young women's sexual violence risk in sub-Saharan Africa, where sexual violence rates are high, is not well understood. The current study explores the association between early menarche and sexual violence in Ghana with secondary analysis of data collected from 700 adolescent girls and young women followed over three years. Logistic regressions were used to assess the cross-sectional association between early menarche and sexual violence. Generalised estimating equations were used to assess whether the association between early menarche and sexual violence persisted over time. Inverse odds weighting was used to test potential mediators of the association between early menarche and sexual violence. Sexual violence was fairly common in the study sample, with 27% reporting having experienced sexual violence at baseline, and approximately 50% at year three. Early menarche was associated with 72% greater odds of having experienced sexual violence at baseline (95% confidence interval: 1.01-2.93). However, the odds ratio attenuated and lost significance over the three-year study period, with a lower risk of sexual violence among girls with early menarche at year three. Neither child marriage nor early sexual initiation significantly mediated the association between early menarche and sexual violence. The findings suggest that early-maturing girls may be particularly vulnerable to sexual violence in early adolescence, thus necessitating prevention interventions around the time of menarche to reduce the risk for sexual violence.
Collapse
Affiliation(s)
- Mobolaji Ibitoye
- Postdoctoral Scholar, Institute for Population Research, Ohio State University, Columbus, OH, USA
| | - Marni Sommer
- Professor of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Leslie L. Davidson
- Professor Emerita of Epidemiology and of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Theo G. M. Sandfort
- Professor of Clinical Sociomedical Sciences (in Psychiatry), Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| |
Collapse
|
34
|
Akwara E, Chandra-Mouli V. Good progress in a number of areas of ASRH, but there is much more that needs to be done. Sex Reprod Health Matters 2023; 31:2266657. [PMID: 37870260 PMCID: PMC10595384 DOI: 10.1080/26410397.2023.2266657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Affiliation(s)
- Elsie Akwara
- Social Statistician and Consultant, Geneva, Switzerland
| | - Venkatraman Chandra-Mouli
- Formerly Scientist, Human Reproduction Programme, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| |
Collapse
|
35
|
Sharma R, Kumar A, Suri V, Kaur S, Singh AJ. An integrated qualitative and quantitative study on sexual and reproductive health problems faced by women with disabilities in Chandigarh, India. Int J Gynaecol Obstet 2023; 163:818-824. [PMID: 37345270 DOI: 10.1002/ijgo.14931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 03/14/2023] [Accepted: 05/28/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVES To estimate the prevalence of sexual and reproductive health (SRH) problems among women with disabilities (WWD) in Chandigarh, India, and to ascertain the difficulties experienced by WWD in accessing hospital services. METHODS This cross-sectional study was conducted during 2014 to 2017 in Chandigarh, India. The study participants were women 15 years and older with at least 40% disability. A pretested questionnaire and in-depth interview were used to determine sociodemographic profile, medical history, sexual and reproductive morbidity, treatment-seeking behavior, and the type, extent, and course of the disability. Verbatim responses of the participants were noted. Data were manually coded and collated into possible themes. RESULTS Postpolio residual paralysis (80; 30.7%) was the main reported disability, followed by severe sight impairment (52; 19.9%). A majority (170; 65%) of participants were unmarried. Of them, 66 (39%) were not willing to get married. The prevalence of SRH problems was high (151; 57.9%) among WWD, and only 82 (54%) took treatment. Dysmenorrhea (47; 31.1%), irregular periods (36; 23.8%), and vaginal discharge (17; 11.3%) were the main problems reported. The WWD in this study were likely to hide their SRH problems from others out of shame or fear. CONCLUSION Among WWD, the prevalence of SRH problems is high and obtaining relief is difficult.
Collapse
Affiliation(s)
- Ruchi Sharma
- Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | | | - Vanita Suri
- Obstetrics and Gynecology, PGIMER, Chandigarh, India
| | | | - Amar Jeet Singh
- Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| |
Collapse
|
36
|
Footman K, Page P, Boydell V, McLaren M, Mudhune S. Adapting to a global pandemic: a qualitative assessment of programmatic responses to COVID-19 in the multi-country Women's Integrated Sexual Health (WISH) programme. Sex Reprod Health Matters 2023; 31:2260174. [PMID: 37830779 PMCID: PMC10578083 DOI: 10.1080/26410397.2023.2260174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
The COVID-19 pandemic caused significant disruption to sexual and reproductive health and rights (SRHR) globally but there is little published evidence on the COVID-19 response of SRHR programmes, or lessons learned through their adaptations. To document the COVID-19 response of a global SRHR programme (the Women's Integrated Sexual Health programme), in-depth interviews were conducted between April and July 2021 with 22 key informants from implementing partners in Sierra Leone, Ethiopia and central or regional offices, the UK Foreign, Commonwealth and Development Office and the third-party monitoring partner. Framework analysis methods were used. Several rapid COVID-19 adaptations were identified: the development of crisis management and communication teams; increased partnership and engagement with government; reduced contact and risk in service delivery; reformulated community mobilisation; flexible performance management and remote methods of quality assurance; and sharing of learnings alongside the development of new guidance and tools. Throughout the pandemic, the programme was able to continue high-quality service delivery, though equity goals proved more difficult to reach. Challenges included the continually changing environment, competing pressures on governments, burdensome reporting, and staff burnout. The pandemic response was facilitated by prior experience of health emergencies, strong government relationships, a supportive workforce and some pre-existing approaches, tools, and systems. This study has identified important lessons that can inform programming in future crises, including the need for immediate recognition of SRHR as essential, sustained support for staff, use of multiple mechanisms to reach marginalised groups, adequate funding for equity goals, and a better balance between the burden of reporting and accountability needs.
Collapse
Affiliation(s)
- Katy Footman
- Consultant, Itad, Hove, UK; PhD Student, London School of Economics, London, UK
| | | | - Victoria Boydell
- Consultant, Itad, Hove, UK; Lecturer in Global Public Health, University of Essex, Colchester, UK
| | - Megan McLaren
- Evidence and Impact Advisor, MSI Reproductive Choices, London, UK
| | - Sandra Mudhune
- Deputy Director, Evidence and Learning – WISH2ACTION, International Planned Parenthood Federation, Nairobi, Kenya
| |
Collapse
|
37
|
Luigi-Bravo G, Maria Ramirez A, Gerdts C, Gill R. Lessons learned from developing and implementing digital health tools for self-managed abortion and sexual and reproductive healthcare in Canada, the United States, and Venezuela. Sex Reprod Health Matters 2023; 31:2266305. [PMID: 37870150 PMCID: PMC10595388 DOI: 10.1080/26410397.2023.2266305] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Affiliation(s)
| | | | - Caitlin Gerdts
- Vice President for Research, Ibis Reproductive Health, Oakland, CA, USA
| | - Roopan Gill
- Executive Director and Co-founder, Vitala Global Foundation, Vancouver, Canada
- Clinician Investigator, Assistant Professor, Department of Obstetrics & Gynecology, University of Toronto, Toronto, Canada
| |
Collapse
|
38
|
Ochola E, Andhavarapu M, Sun P, Mohiddin A, Ferdinand O, Temmerman M. The impact of COVID-19 mitigation measures on sexual and reproductive health in low- and middle-income countries: a rapid review. Sex Reprod Health Matters 2023; 31:2203001. [PMID: 37294328 DOI: 10.1080/26410397.2023.2203001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
Pandemic mitigation measures can have a negative impact on access and provision of essential healthcare services including sexual and reproductive health (SRH) services. This rapid review looked at the literature on the impact of COVID-19 mitigation measures on SRH and gender-based violence (GBV) on women in low- and middle-income countries (LMIC) using WHO rapid review guidance. We looked at relevant literature published in the English language from January 2020 to October 2021 from LMICs using WHO rapid review methods. A total of 114 articles were obtained from PubMed, Google Scholar and grey literature of which 20 met the eligible criteria. Our review found that there was an overall reduction in; (a) uptake of services as shown by lower antenatal, postnatal and family planning clinic attendance, (b) service delivery as shown by reduced health facility deliveries, and post abortion care services and (c) reproductive health outcomes as shown by an increase in incidence of GBV especially intimate partner violence. COVID-19 mitigation measures negatively impact SRH of women in LMICs. Findings from this review could inform policy makers in the health sector to recognise the potential adverse effects of COVID-19 responses on SRH in the country, and therefore implement mitigation measures.
Collapse
Affiliation(s)
- Elizabeth Ochola
- Resident, Department of Obstetrics and Gynaecology, Aga Khan University, Nairobi, Kenya
| | | | - Poppy Sun
- Intern, Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Abdu Mohiddin
- Assistant Professor, Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Okwaro Ferdinand
- Assistant Professor, Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Marleen Temmerman
- Professor, Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| |
Collapse
|
39
|
Rogers K, Ranganathan M, Kajula L, Lorraine Collins R, Livingston JA, Palermo T. The influence of gender-equitable attitudes on sexual behaviour among unmarried adolescents in rural Tanzania: a longitudinal study. Sex Reprod Health Matters 2023; 31:2260169. [PMID: 37850724 PMCID: PMC10586071 DOI: 10.1080/26410397.2023.2260169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
PLAIN LANGUAGE STATEMENT Gender norms that centre men and disadvantage women create gender inequality, which can lead to risky sexual behaviour. This study examined how both community and individual attitudes toward gender norms influenced risky sexual behaviour in adolescents, and whether that influence was different between males and females. We found that higher gender-equitable attitudes were linked to increased odds of HIV testing in the last 12 months, and decreased odds of engaging in a sexual relationship with a much older partner. Individual high gender-equitable attitudes among girls were also linked to higher odds of them using condoms and contraceptives. Gender-equitable attitudes did not seem to influence early sexual debut, engagement in transactional sex, having multiple sexual partners at the same time, or the number of sexual partners a participant had in the last 12 months. Based on these findings, programming designed to increase gender-equitable attitudes might be helpful in increasing HIV testing and condom and contraceptive use, but it needs to involve the entire community, not just individual boys and girls.
Collapse
Affiliation(s)
- Kate Rogers
- PhD Candidate, Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, SUNY, 330 Kimball Tower, Buffalo, NY14212, USA
| | - Meghna Ranganathan
- Assistant Professor, London School of Hygiene and Tropical Medicine, London, UK
| | - Lusajo Kajula
- Independent Consultant, UNICEF Office of Research-Innocenti, Dar es Salaam, Tanzania
| | - R. Lorraine Collins
- Associate Dean for Research, Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
| | | | - Tia Palermo
- Associate Professor, Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA
| | | |
Collapse
|
40
|
Umbelino-Walker I, Wong F, Cassolato M, Pantelias A, Jacobson J, Kalume C. Integration of female genital schistosomiasis into HIV/ sexual and reproductive health and rights and neglected tropical diseases programmes and services: a scoping review. Sex Reprod Health Matters 2023; 31:2262882. [PMID: 37850814 PMCID: PMC10586082 DOI: 10.1080/26410397.2023.2262882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
Female genital schistosomiasis (FGS) affects approximately 56 million women and girls across sub-Saharan Africa and is associated with up to a threefold increased prevalence of HIV. Integrating FGS with HIV programmes as part of comprehensive sexual and reproductive health (SRH) services may be one of the most significant missed opportunities for preventing HIV incidence among girls and women. A search of studies published until October 2021 via Scopus and ProQuest was conducted using PRISMA guidelines to assess how FGS can be integrated into HIV/SRH and neglected tropical diseases (NTDs) programmes and services. Data extraction included studies that integrated interventions and described the opportunities and challenges. A total of 334 studies were identified, with 22 eligible for analysis and summarised conducting a descriptive numerical analysis and qualitative review. We adapted a framework for integrated implementation of FGS, HIV, and HPV/cervical cancer to thematically organise the results, classifying them into five themes: awareness and community engagement, diagnosis, treatment, burden assessment, and economic evaluation. Most activities pertained to awareness and community engagement (n = 9), diagnosis (n = 9) and were primarily connected to HIV/AIDS (n = 8) and school-based services and programming (n = 8). The studies mainly described the opportunities and challenges for integration, rather than presenting results from implemented integration interventions, highlighting an evidence gap on FGS integration into HIV/SRH and NTD programmes. Investments are needed to realise the potential of FGS integration to address the burden of this neglected disease and improve HIV and SRH outcomes for millions of women and girls at risk.
Collapse
Affiliation(s)
| | - Felicia Wong
- Independent Consultant, Frontline AIDS, Worthing, UK
| | | | | | - Julie Jacobson
- Managing Partner, Co-Founder, Bridges to Development, Seattle, WA, USA
| | | |
Collapse
|
41
|
Napier-Raman S, Hossain SZ, Mpofu E, Lee MJ, Liamputtong P, Dune T. Sexual and reproductive health and rights decision-making among Australian migrant and refugee youth: a group concept mapping study. Cult Health Sex 2023:1-18. [PMID: 37975673 DOI: 10.1080/13691058.2023.2275303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023]
Abstract
Sexual and reproductive health (SRH) is a human right. Young people, particularly from marginalised groups such as migrant and refugees, are vulnerable to compromised sexual and reproductive health and rights. In this study, we aimed to identify socioecological factors influencing migrant and refugee youth SRH decision-making and compare perspectives of youth with key stakeholders. Data were collected using Group Concept Mapping (GCM), a mixed-methods participatory approach. Participants included migrant and refugee young people, aged 16-26 from Western Sydney (n = 55), and key stakeholders comprising clinicians, service providers and researchers (n = 13). GCM involved participants brainstorming statements about how migrant and refugee youth make SRH decisions. Participants then sorted statements into groups based on similarity, and rated statements on importance and impact. Multidimensional scaling and hierarchical cluster analysis were used to cluster statements into concept maps that represented participants' perspectives. The resulting maps comprised six clusters representing main concepts informing decision-making. The most important clusters were 'healthy relationships' and 'safe-sex practices'. Youth rated healthy relationships more important than stakeholders did. This study reveals factors informing migrant and refugee youth's decision-making. Future policy should go beyond biomedical constructions of SRH to incorporate emotional and relational factors, which young people consider to be equally important and beneficial to their agency.
Collapse
Affiliation(s)
- Sharanya Napier-Raman
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Syeda Zakia Hossain
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Elias Mpofu
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Rehabilitation and Health Services, University of North Texas, Denton, Texas, USA
- School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Mi-Joung Lee
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Tinashe Dune
- Translational Health Research Institute, Western Sydney University, Campbeltown, New South Wales, Australia
- Discipline of Psychological Science, Australian College of Applied Professions, Sydney, New South Wales, Australia
| |
Collapse
|
42
|
Dziva Chikwari C, Dauya E, Bandason T, Tembo M, Mavodza C, Simms V, Mackworth-Young CRS, Apollo T, Grundy C, Weiss H, Kranzer K, Mavimba T, Indravudh P, Doyle A, Mugurungi O, Machiha A, Bernays S, Busza J, Madzima B, Terris-Prestholt F, McCarthy O, Hayes R, Francis S, Ferrand RA. The impact of community-based integrated HIV and sexual and reproductive health services for youth on population-level HIV viral load and sexually transmitted infections in Zimbabwe: protocol for the CHIEDZA cluster-randomised trial. Wellcome Open Res 2023; 7:54. [PMID: 38162283 PMCID: PMC10755263 DOI: 10.12688/wellcomeopenres.17530.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 03/29/2024] Open
Abstract
BACKGROUND Youth have poorer HIV-related outcomes when compared to other age-groups. We describe the protocol for a cluster randomised trial (CRT) to evaluate the effectiveness of community-based, integrated HIV and sexual and reproductive health services for youth on HIV outcomes. PROTOCOL The CHIEDZA trial is being conducted in three provinces in Zimbabwe, each with eight geographically demarcated areas (clusters) (total 24 clusters) randomised 1:1 to standard of care (existing health services) or to the intervention. The intervention comprises community-based delivery of HIV services including testing, antiretroviral therapy, treatment monitoring and adherence support as well as family planning, syndromic management of sexually transmitted infections (STIs), menstrual health management, condoms and HIV prevention and general health counselling. Youth aged 16-24 years living within intervention clusters are eligible to access CHIEDZA services. A CRT of STI screening (chlamydia, gonorrhoea and trichomoniasis) is nested in two provinces (16 of 24 clusters). The intervention is delivered over a 30-month period by a multidisciplinary team trained and configured to provide high-quality, youth friendly services.Outcomes will be ascertained through a population-based survey of 18-24-year-olds. The primary outcome is HIV viral load <1000 copies/ml in those living with HIV and proportion who test positive for STIs (for the nested trial). A detailed process and cost evaluation of the trial will be conducted. ETHICS AND DISSEMINATION The trial protocol was approved by the Medical Research Council of Zimbabwe, the Biomedical Research and Training Institute Institutional Review Board and the London School of Hygiene & Tropical Medicine Research Ethics Committee. Results will be submitted to open-access peer-reviewed journals, presented at academic meetings and shared with participating communities and with national and international policy-making bodies. TRIAL REGISTRATION https://clinicaltrials.gov/: NCT03719521.
Collapse
Affiliation(s)
- Chido Dziva Chikwari
- Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ethel Dauya
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Mandikudza Tembo
- Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Constancia Mavodza
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Victoria Simms
- Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Tsitsi Apollo
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Chris Grundy
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen Weiss
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Katharina Kranzer
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
| | | | - Pitchaya Indravudh
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Aoife Doyle
- Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Owen Mugurungi
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Anna Machiha
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Sarah Bernays
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- School of Public Health, University of Sydney, Sydney, Australia
| | - Joanna Busza
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Fern Terris-Prestholt
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Ona McCarthy
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard Hayes
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Suzanna Francis
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rashida A. Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
43
|
Dziva Chikwari C, Dauya E, Bandason T, Tembo M, Mavodza C, Simms V, Mackworth-Young CRS, Apollo T, Grundy C, Weiss H, Kranzer K, Mavimba T, Indravudh P, Doyle A, Mugurungi O, Machiha A, Bernays S, Busza J, Madzima B, Terris-Prestholt F, McCarthy O, Hayes R, Francis S, Ferrand RA. The impact of community-based integrated HIV and sexual and reproductive health services for youth on population-level HIV viral load and sexually transmitted infections in Zimbabwe: protocol for the CHIEDZA cluster-randomised trial. Wellcome Open Res 2023; 7:54. [PMID: 38162283 PMCID: PMC10755263 DOI: 10.12688/wellcomeopenres.17530.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 01/03/2024] Open
Abstract
Background Youth have poorer HIV-related outcomes when compared to other age-groups. We describe the protocol for a cluster randomised trial (CRT) to evaluate the effectiveness of community-based, integrated HIV and sexual and reproductive health services for youth on HIV outcomes. Protocol The CHIEDZA trial is being conducted in three provinces in Zimbabwe, each with eight geographically demarcated areas (clusters) (total 24 clusters) randomised 1:1 to standard of care (existing health services) or to the intervention. The intervention comprises community-based delivery of HIV services including testing, antiretroviral therapy, treatment monitoring and adherence support as well as family planning, syndromic management of sexually transmitted infections (STIs), menstrual health management, condoms and HIV prevention and general health counselling. Youth aged 16-24 years living within intervention clusters are eligible to access CHIEDZA services. A CRT of STI screening (chlamydia, gonorrhoea and trichomoniasis) is nested in two provinces (16 of 24 clusters). The intervention is delivered over a 30-month period by a multidisciplinary team trained and configured to provide high-quality, youth friendly services.Outcomes will be ascertained through a population-based survey of 18-24-year-olds. The primary outcome is HIV viral load <1000 copies/ml in those living with HIV and proportion who test positive for STIs (for the nested trial). A detailed process and cost evaluation of the trial will be conducted. Ethics and Dissemination The trial protocol was approved by the Medical Research Council of Zimbabwe, the Biomedical Research and Training Institute Institutional Review Board and the London School of Hygiene & Tropical Medicine Research Ethics Committee. Results will be submitted to open-access peer-reviewed journals, presented at academic meetings and shared with participating communities and with national and international policy-making bodies. Trial Registration https://clinicaltrials.gov/: NCT03719521.
Collapse
Affiliation(s)
- Chido Dziva Chikwari
- Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ethel Dauya
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Mandikudza Tembo
- Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Constancia Mavodza
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Victoria Simms
- Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Tsitsi Apollo
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Chris Grundy
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen Weiss
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Katharina Kranzer
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
| | | | - Pitchaya Indravudh
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Aoife Doyle
- Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Owen Mugurungi
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Anna Machiha
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Sarah Bernays
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- School of Public Health, University of Sydney, Sydney, Australia
| | - Joanna Busza
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Fern Terris-Prestholt
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Ona McCarthy
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard Hayes
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Suzanna Francis
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rashida A. Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
44
|
Kenner C, Cherry J, Mizock L, DiStefano A, Tosh J, Gurse C. Reimagining sexual and reproductive healthcare for LGBTQ communities. Cult Health Sex 2023; 25:1419-1432. [PMID: 36592957 DOI: 10.1080/13691058.2022.2159066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
Qualitative interviews were conducted with nine individuals identifying as LGBTQ to identify recommendations for improving sexual and reproductive healthcare at a local clinic on the California Central Coast. Interviewees were recruited at local Pride events. Grounded theory methodology revealed several themes related to participants' desires for a LGBTQ-affirmative sexual and reproductive healthcare setting. Themes identified included: Beyond Enacted Inclusivity (avoiding a performative demonstration of LGBTQ-affirming care); Anti-Institutional Care (a political and visual challenge to what the healthcare setting should look like), a One-Stop-Shop (encompassing several types of care under one roof); Constrained Visibility (where LGBTQ identities are reflected but not exposed); and Community and Social Wellness (to be in community with other LGBTQ-serving organisations and one another in mutual support and celebration). Research implications and clinical recommendations are described at the local and system levels.
Collapse
Affiliation(s)
- Catelynn Kenner
- Catelynn Kenner Consulting Collective, San Luis Obispo, CA, USA
| | - Jennifer Cherry
- School of Psychology, Fielding Graduate University, Santa Barbara, CA, USA
| | - Lauren Mizock
- School of Psychology, Fielding Graduate University, Santa Barbara, CA, USA
| | - Anna DiStefano
- School of Leadership Studies, Fielding Graduate University, Santa Barbara, CA, USA
| | - Jenna Tosh
- Planned Parenthood California Central Coast, Santa Barbara, CA, USA
| | - Cheri Gurse
- Independent Consultant, Santa Barbara, CA, USA
| |
Collapse
|
45
|
Jenkins J, Pitney C, Nuzzo M, Eagen-Torkko M. Midwifery and APRN Scope of Practice in Abortion Care in the Early Post-Roe Era: Everything Old Is New Again. J Midwifery Womens Health 2023; 68:734-743. [PMID: 38078694 DOI: 10.1111/jmwh.13599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/20/2023] [Indexed: 12/17/2023]
Abstract
Over the past 10 years, there has been a rapid expansion of legal and legislative changes in abortion care provision for advanced practice clinicians (APCs), including nurse practitioners, midwives, and physician associates (formerly physician assistants), with most of that expansion occurring in the last several years. This expansion has occurred via several routes (eg, legislative, popular vote, court decision, attorney general opinion), and the patchwork of legal statuses nationally creates confusion for clinicians who are unclear on current regulations. This review explores the historical context of abortion practice for APCs, as well as the primary philosophical and legal concepts relevant to this role development. Since 2012, the number of states permitting abortion practice by APCs has more than quintupled, and the changes to abortion law in the United States in the wake of the 2022 Supreme Court decision in the case of Dobbs v. Jackson Women's Center creates a new imperative to understand the role of APCs in accessing abortion care. Additionally, although the research on abortion safety for APC abortion providers is well-established, the physician-centered paradigm of abortion care has limited the ability of APCs to develop expertise in this essential public and clinical health service.
Collapse
Affiliation(s)
- Julie Jenkins
- National Abortion Federation, Washington, District of Columbia
| | - Christie Pitney
- Forward Midwifery, Abortion Freedom Fund, Saratoga, California
| | - Morgan Nuzzo
- Partners in Abortion Care, College Park, Maryland
| | - Meghan Eagen-Torkko
- University of Washington Bothell, Bothell, Washington
- Public Health Seattle-King County, Seattle, Washington
| |
Collapse
|
46
|
Ahmed N, Pike C, Lee J, Wagner C, Bekker LG. School-based healthcare services in Cape Town, South Africa: When there's a will, there's a way. Afr J Prim Health Care Fam Med 2023; 15:e1-e3. [PMID: 37916715 PMCID: PMC10623473 DOI: 10.4102/phcfm.v15i1.4216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/30/2023] [Accepted: 09/07/2023] [Indexed: 11/03/2023] Open
Abstract
South African secondary schools do not deliver school-based healthcare services despite high rates of human immunodeficiency virus (HIV) infection, sexually transmitted infections, and unplanned pregnancies among adolescents, ongoing sub-optimal uptake of healthcare services from public healthcare facilities by adolescents, and national policy support for such services. A pilot school health nursing programme (SHNP) was offered to 44 secondary schools in a single health sub-district within the Western Cape, South Africa. The programme included fortnightly nurse visits that offered a standard package of healthcare services, including sexual and reproductive health services tailored according to school preference.Of the 44 schools, 42 gave permission for the SHNP to operate, with the majority of schools selecting the full comprehensive package of services. Programme implementation was truncated such that delivery only occurred over two school terms (20 weeks); however, 344 students attended the service. The majority of service users were female with a median age of 16 years, and over a half attended the service for sexual and reproductive health services.Contribution: A key challenge to school-based health service delivery arose from inadequate stakeholder support and differential views of adolescent healthcare needs among government officials, parents, guardians, school staff and governing bodies. These findings motivate for ongoing multi-level stakeholder engagement around the reality of adolescent healthcare needs and further opportunities to deliver school health services for longer time periods such that their feasibility, acceptability, and potential to impact healthcare outcomes can be assessed in this setting.
Collapse
Affiliation(s)
- Nadia Ahmed
- Mortimer Market Centre, Central North West London NHS Trust, London, United Kingdom; and, Desmond Tutu HIV Centre, Faculty of Health Sciences, University of Cape Town, Cape Town.
| | | | | | | | | |
Collapse
|
47
|
Agyei FB, Kaura DMK, Bell JD. Exploring the culturally sensitive sexual and reproductive health information communication skill needs of parents in Ghana. Afr J Prim Health Care Fam Med 2023; 15:e1-e11. [PMID: 37916722 PMCID: PMC10623484 DOI: 10.4102/phcfm.v15i1.4101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Parents play a vital role in the sexual and reproductive health (SRH) of adolescents. Parents' communication with their adolescents regarding SRH is considered an important part of adolescent development, as this contributes to optimising safe SRH. AIM This phase of the study explored the culturally sensitive SRH information communication skill needs of parents, based on their personal and social motivation, within the Ghanaian context. SETTING The study was conducted at the Asante Akyem North Municipality of Ghana. METHODS This article describes the second phase of an explanatory, sequential, mixed-method study. Following on from the first phase systematic review, this second phase comprised a qualitative descriptive study where 10 purposively sampled parents of adolescents participated in semi-structured interviews to elicit data. Braun and Clarke's thematic data analysis process was applied. Data were saved and managed in Atlas.ti (version 23.0.7). RESULTS Four themes emerged on communication skills: SRH information, parent and adolescent factors, contextual factors and communication skill needs. Parent and adolescent communication on SRH takes place occasionally. Parents lack the skills to communicate with adolescents regarding SRH. CONCLUSION Parents in this context require skills to communicate SRH information with their adolescent children. A culturally appropriate intervention that supports SRH information communication between parents and adolescents may have value in guiding this communication process.Contribution: The findings of this study can contribute to the adaptation of a culturally sensitive SRH information communication intervention in Ghana which will promote adolescent SRH.
Collapse
Affiliation(s)
- Frank B Agyei
- Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg.
| | | | | |
Collapse
|
48
|
Taiwo MO, Oyekenu O, Hussaini R. Understanding how social norms influence access to and utilization of adolescent sexual and reproductive health services in Northern Nigeria. Front Sociol 2023; 8:865499. [PMID: 37899781 PMCID: PMC10603227 DOI: 10.3389/fsoc.2023.865499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 09/14/2023] [Indexed: 10/31/2023]
Abstract
Background This study explored the influence of social norms on the access and utilization of sexual and reproductive health services by adolescents. Apart from individual and environmental barriers, social norms influence contraceptive decisions and ultimately sexual and reproductive health outcomes. Social norms that shape group behavior describe acceptable standards of behavior and evoke sanctions when such behavior standards are not adhered to. Sexually active adolescents in Nigeria have a relatively low level of modern contraceptive use being influenced by social norms. Scaling up adolescent reproductive health interventions that integrate normative change for a wider impact of programs remains challenging. Methods Using data from 18 communities, 188 married and unmarried adolescents (F52% and M48%) and 69 (F37%; M63%) reference group participants were purposively sampled and participated in a social norms exploration intervention study conducted through focus group discussion and in-depth interviews between October and November 2019. The Advancing Learning and Innovation on Gender Norms (ALIGN) Social Norms Exploration Tool (SNET) was adapted for the data collection into discussion guides and vignettes. Pilot testing of the tools informed review and validation prior to actual data collection. Findings Low contraceptive uptake by adolescents was characterized by early and forced marriage in childhood; a prominent practice enshrined in social norms around girl-childchastity, family honor, and disapproval of pre-marital sex and pregnancy out of wedlock. Conclusion The understanding of harmful social norms, normative change actors, and potential norm-shifting factors for contraceptive decisions by adolescents is essential for effective adolescent sexual and reproductive health interventions for wider impact and adaptive programming in behavior change interventions for improving the access to and utilization of modern contraceptives by adolescents for improved sexual health outcomes, the attainment of the Family Planning (FP) 2030 commitment and universal health coverage policy.
Collapse
Affiliation(s)
| | | | - Rahinatu Hussaini
- Save the Children International, London, United Kingdom
- Global Alliance for Improved Nutrition, Abuja, Nigeria
| |
Collapse
|
49
|
Sedrati H, Bougdira A, Kamal N, Alidrissi N, Sehli S, Hamdi S, Mazti A, Elfazazi H, Aboutaib R, Rhalem W, Dini N, Assarrag B, Bezad N, Acharai L, Hachri H, Rabie R, Amzazi S, Nejjari C, Al-Shorbaji N, Ghazal H. Self-care intervention using mobile apps for sexual and reproductive health in the WHO Eastern Mediterranean Region. Inform Health Soc Care 2023; 48:333-352. [PMID: 37560900 DOI: 10.1080/17538157.2023.2239914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Sexual and reproductive health (SRH) concerns physical, mental, and social well-being as related to sexual and reproductive systems. Self-care, which is the ability to promote health without the support of a health-care provider, can advance SRH, especially for fragile populations. Mobile health (mHealth) solutions can be used to raise awareness about SRH. We performed a structured literature review and analysis of mHealth-based approaches for delivering self-SRH services and interventions in the WHO Eastern Mediterranean Region (EMR). A fuzzy-based framework for assessing those mHealth apps was proposed. We identified 6 out of 737 papers, and 23 (5.7%) out of 400 mHealth apps retrieved from app-stores, describing mHealth use for self SRH with only 10 apps developed in EMR countries, namely Morocco, Pakistan, Egypt, Iran, and Jordan. Our fuzzy-based framework proposes guidelines regarding the implementation of self-care interventions to help project leaders promote their adoption in the SRH systems.
Collapse
Affiliation(s)
- Hayat Sedrati
- ICES Team, ENSIAS College, Mohammed V University in Rabat, Rabat, Morocco
- National School of Public Health, Ministry of Health, Rabat, Morocco
| | - Abdesselam Bougdira
- Laboratory of Engineering Sciences, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Nabiha Kamal
- Biochemistry Laboratory, Ibn Rochd University Hospital Center, Casablanca, Morocco
| | - Najib Alidrissi
- Department of Genomics, Bioinformatics and Digital Health, School of Medicine, Mohammed VI University of Science and Health, Casablanca, Morocco
| | - Sofia Sehli
- Department of Genomics, Bioinformatics and Digital Health, School of Medicine, Mohammed VI University of Science and Health, Casablanca, Morocco
| | - Salsabil Hamdi
- Environnemental health lab, Teaching and research department, Institut pasteur du Maroc, Casablanca, Morocco
| | - Asmae Mazti
- Department of Pathology, Hassan II University Hospital, Fez, Morocco
- Faculty of Medicine, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Hicham Elfazazi
- Sexual and Reproductive Health Laboratory, School of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Rachid Aboutaib
- Sexual and Reproductive Health Laboratory, School of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Wajih Rhalem
- E2SN Research Team, ENSAM, Mohammed V University in Rabat, Morocco
- Association Marocaine pour l'Écoute et le Dialogue, Rabat, Morocco
| | - Nezha Dini
- Department of Genomics, Bioinformatics and Digital Health, School of Medicine, Mohammed VI University of Science and Health, Casablanca, Morocco
- School of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - Bouchra Assarrag
- National School of Public Health, Ministry of Health, Rabat, Morocco
| | - Nadia Bezad
- Pan African Anti-Aids Organization, Rabat, Morocco
| | - Laila Acharai
- Rabat Office, United Nations Population Fund (UNFPA), Rabat, Morocco
| | - Hafid Hachri
- Health system unit, World Health Organization (WHO), Rabat, Morocco
| | - Redouane Rabie
- Department of Genomics, Bioinformatics and Digital Health, School of Medicine, Mohammed VI University of Science and Health, Casablanca, Morocco
| | - Saaid Amzazi
- Laboratory of Human Pathologies Biology, Department of Biology, Faculty of Sciences, Mohammed V University, Rabat, Morocco, and Genomic Center of Human Pathologies, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Chakib Nejjari
- Department of Epidemiology and Public Health, Faculty of Medicine, Pharmacy and Dental Medicine, University Sidi Mohammed Ben Abdellah, Fez, Morocco
| | | | - Hassan Ghazal
- Department of Genomics, Bioinformatics and Digital Health, School of Medicine, Mohammed VI University of Science and Health, Casablanca, Morocco
- Department of Sciences, National Centre for Scientific and Technical Research, Rabat, Morocco
| |
Collapse
|
50
|
Piantedosi DK, Reed K, O'Shea A. Supporting occupational therapists to initiate conversations about sexuality with people with intellectual disability: Co-design by deliberative dialogue. Aust Occup Ther J 2023; 70:581-598. [PMID: 37337378 DOI: 10.1111/1440-1630.12888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/16/2023] [Accepted: 05/13/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Occupational therapists routinely report low levels of confidence in addressing needs related to sexuality and intimacy. These issues are compounded when supporting clients with intellectual disability, due to prevailing assumptions about capacity and few practical support resources. At a disciplinary level, there is ongoing discourse around how to best conceptualise and support sexual and gender identities generally, within models of human occupation. Leveraging interdisciplinarity, where sexuality overlaps as a sphere of interest, can aid the development of practical support resources. Engagement with sociology (focussed on relationality) and disability studies (focussed on embodiment) offers a generative path forward. METHODS The deliberative dialogues framework was used to develop a co-designed resource by occupational therapists for occupational therapists. Six Australian occupational therapists with experience working with clients with intellectual disability and/or sexuality were purposively recruited to participate in co-design groups. Using the eight features of deliberative dialogue, data was collected and analysed by an interdisciplinary research team to collaboratively produce a practical support resource. RESULTS Participants agreed the greatest need was to develop a resource for clinicians, to support conversations with clients about sexuality. Five key themes emerged: (1) Theoretical explanations addressing why sexuality is important must be paired with practical advice; (2) make a conversational call to action from 'OTs' for 'OTs' by locating sexuality within the domain of occupational therapy; (3) make explicit that people with intellectual disability are sexual beings; (4) need for self-reflection; and (5) demonstrate how existing understandings of occupation apply to sexuality. CONCLUSION A resource in the form of a brochure was developed, intended to be used as a conversation primer. The process used to develop the resource demonstrated the value of interdisciplinary collaboration and the utility of deliberative dialogue as a co-design method.
Collapse
Affiliation(s)
- Diana K Piantedosi
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia
- School of Humanities and Social Sciences, La Trobe University, Melbourne, Victoria, Australia
- Women with Disabilities Victoria (WDV), Victoria, Australia
| | - Kirk Reed
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Amie O'Shea
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia
- Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|