Involving men in reproductive health: making the mandate a reality

When men are provided with information about reproductive health issues, they are more likely to support their partners' family planning decisions. Such support is particularly important in cultures where women are unable to negotiate sexual relationships, and may therefore be exposing themselves to sexually transmitted diseases (STDs) and unwanted pregnancies. Good communication between partners ensures that women receive the reproductive health care they need. AVSC International developed the Men As Partners (MAP) initiative with the goals of increasing men's awareness and support of their partners' reproductive health choices; men's awareness of the need to safeguard reproductive health, especially through the prevention of STDs; and the use of contraceptive methods which require the participation and cooperation of men among couples who want to use them. In May 1997, AVSC organized the first-ever interregional workshop on men's involvement in reproductive health. More than 150 participants from 5 continents attended the event in Mombasa, Kenya, where they discussed ways to involve men in the health of their female partners. Main workshop themes were gender issues, reproductive health services for men, community outreach and workplace programs, access to services, and adolescents.     

"He told me it would be extremely selfish of me to even consider [having kids]": The importance of reproductive health to women with spina bifida and the lack of support from their providers

BackgroundAs more women with spina bifida (SB) enter their reproductive years, the number having children is significantly increasing. However, little is known about their understanding of their ability to get pregnant or their experiences in considering, planning, or interacting with providers during a pregnancy.ObjectiveWe sought to determine what women have been told and understand about their reproductive health, their attitudes towards having children, and their experiences interacting with providers when seeking reproductive health care.MethodsIn this exploratory study employing qualitative research methods and following Grounded Theory, interviews with women with SB 16 years or older were transcribed verbatim and analyzed by three coders.ResultsInterviews of 25 women with SB ages 16–52 (median 26) revealed the following themes about their reproductive health perceptions and experiences: 1) poor understanding of reproductive health and potential, 2) interest in having a family, 3) facing provider's opposition to their reproductive goals, 4) going into pregnancy and delivery unprepared, 5) the importance of provider support for reproductive goals. Five women experienced an unintended pregnancy.ConclusionsAlthough having children is important to most women with SB in this study, they report a poor understanding of their reproductive potential with several noting unintended pregnancies. They feel uninformed and unprepared during pregnancy and face discouragement from providers. Those experiencing supportive providers report a more positive experience. This demonstrates the urgent need to educate women with SB about their reproductive health and the providers who care for them how to support and counsel these women.     

Building a national model for knowledge exchange in Malawi: findings from a health information needs assessment

Getting the right information into the right hands at the right time is a challenge for many health systems in developing countries. Health workers need access to reliable and up-to-date health information in order to support their clients. This health information needs assessment, conducted in the capital city and 3 districts of Malawi from July 2009 to September 2009, aimed to determine access to, and need for, health information in HIV/AIDS and family planning/reproductive health at all levels of the health system. Using qualitative research methods, the study showed the need to (a) build the capacity of government technical working groups to collect and store information and to promote information exchange at all levels of the health system; (b) improve information synthesis and packaging, particularly for users at peripheral levels; (c) strengthen the district level to serve as an information hub for district- and community-level providers; and (d) explore mobile technologies to increase provider access to knowledge and information.     

Unintended pregnancies in Hamedan,Iran: Levels and determinants

The recent limitation in the provision of publicly funded family planning services in Iran has concerned stakeholders in reproductive health about the incidence of unintended pregnancies. This study used data from Hamedan Survey of Fertility (HSF), conducted in April–June 2015 among a representative sample of 3,000 married women aged 15–49 years living in the city of Hamedan (Iran), to estimate levels of unintended pregnancies and examine factors related to pregnancy intentions for the most recent birth, using multinomial logistic regression analyses. Results showed that 23 percent of pregnant women reported their pregnancy as unintended (17 percent mistimed and 6 percent unwanted). Moreover, unintended pregnancies in the five years preceding the survey were the result of failures of withdrawal (35 percent) and of modern contraceptive use (33 percent), along with contraceptive discontinuation (23 percent) and non-use (9 percent). Multivariate results indicated that the risk of unintended pregnancy was lower among women reporting modern contraceptive failures and lower among those reporting contraceptive discontinuation and non-use, compared with women experiencing withdrawal failures. The high incidence of unintended pregnancies among women experiencing contraceptive failures and discontinuation imply their high unmet need for contraceptive knowledge and counseling rather than for access to contraceptive methods.     

Reproductive Health Care Experiences of People with Physical Disabilities in Vietnam

This qualitative research explored the reproductive health care experiences of people with physical disabilities in Vietnam. Data from 20 participants (10 males and 10 females) was collected from in-depth interviews with the use of drawing and photo elicitation methods. The findings revealed that people with physical disabilities in Vietnam experienced difficulties with their reproductive health care that included: physically inaccessible hospitals; negative attitudes from health care providers; discouraging experiences with reproductive healthcare including assistance with fertility control; and limitations with public health insurance. Almost all the participants only saw a doctor if they became ill, but often bought over-the-counter medication from pharmacies. Some participants chose private rather than public hospitals where environments were inaccessibility, and health care providers were perceived as insensitive. In terms of contraception, study participants mostly used condoms, although some did not use any contraceptive methods resulting in unplanned pregnancies or abortion. People with disabilities in Vietnam have access to public health insurance but its limitations can affect the experiences of people with physical disabilities attempting to access reproductive health care. In Vietnam, people with physical disabilities work hard to overcome discrimination to achieve full and satisfying lives.

     

Pregnancies,Abortions, and Births among Women with and without Borderline Personality Disorder

BackgroundThe purpose of this study was to examine history of pregnancies among women with and without borderline personality disorder (BPD), to determine whether BPD symptoms are associated with teenage pregnancies, unplanned pregnancies, elective and spontaneous abortions, and live births.MethodsThree hundred seventy-nine women completed the Structured Clinical Interview for DSM-IV Axis I diagnoses, Structured Interview for DSM-IV Personality for Axis II diagnoses, and a reproductive health interview. African-American (AA) women were oversampled, because little is known about BPD in AA women and they are at greater risk of teenage pregnancy, unplanned pregnancies, and spontaneous abortions.ResultsBPD symptom severity was associated with a teenage pregnancy, even after controlling for race and socioeconomic status. Symptom severity was also associated with unplanned pregnancies and live births, but only for women without a history of a substance use disorder. BPD symptom severity was not associated with abortion.ConclusionWomen with BPD become pregnant and have children, often during the period when BPD symptoms emerge and intensify. They are at increased risk of teenage pregnancies and unintended pregnancies compared with women with Axis I disorders. Treatment planning for this population should include attention to their reproductive health and better integration of physical and mental health services.     

成都市流动人口生殖保健需求服务现状调查

对成都市3479例流动人口进行生殖保健需求服务现状调查。结果显示,流动人口平均年龄23.07岁,他们对生殖保健知识了解率普遍偏低,自我保护意识差,对这方面知识的需求也不强烈,在现住地生殖保健可得性差,自控避孕法使用率高,无计划生育现象值得注意。对他们提供持续优质的生殖保健服务十分必要。     

“Yo No Sabía...”—Immigrant Women’s Use of National Health Systems for Reproductive and Abortion Care

Half of pregnancies worldwide are unintended; half of these end in abortion. Immigrant women encounter more obstacles to reproductive healthcare than non-immigrant women, and access to national healthcare is a particularly important factor in abortion access. Spain’s government recently liberalized abortion laws, including abortion services in the national health system available to immigrants. Evidence suggests that immigrant women in Spain experience difficulties navigating the health system—the impact of the changed abortion laws on immigrant’s women’s access to care is not yet clear. Through a literature review and analysis, this paper examines the experiences of immigrant women with national health systems, and their use of such systems for reproductive and abortion care, in order to explore what could be expected in Spain as the national health system expands to include abortion care, and to illuminate immigrant women’s experiences with using national health systems for reproductive healthcare more broadly.     

Knowledge of Sexuality and Reproductive Health of People with Physical Disabilities in Vietnam

This paper discusses the knowledge of sexual and reproductive health among people with physical disabilities in Vietnam. A qualitative research design was adopted. In-depth interviewing and photo elicitation methods were used to collect stories from 20 participants. The findings suggest that without formal education about sexual and reproductive health people with physical disabilities in Vietnam gain knowledge through their experiences and from informal sources of information. Participants perceived safe sex to include contraceptive methods, prevention of sexually transmitted diseases, having orgasm together and finding balance between health and sexual needs. Participants related reproductive health to fertility, restriction of family size, sexually transmitted diseases, and self-care in pregnancy. Reasons for insufficient knowledge included limited education due to: disability and poor family background; limited education on sexual and reproductive health issues; absence of family and community discourse about sexual and reproductive health; and lack of information resources. Participants acknowledged that their knowledge was inadequate. They wanted to know more about sexual and reproductive health but lacked access to the relevant information. Health care providers, researchers, and policy-makers in Vietnam should address the gaps in sexual and reproductive health care knowledge among people with disabilities in Vietnam and those that provide care to them.     

Facilitators and barriers to accessing reproductive health care for migrant beer promoters in Cambodia, Laos, Thailand and Vietnam: A mixed methods study

ABSTRACT: BACKGROUND: The purpose of the research was to assess access to sexual and reproductive health services for migrant women who work as beer promoters. This mixed methods research was conducted in Phnom Penh, Cambodia, Bangkok, Thailand, Vientiane, Laos, and Hanoi, Vietnam during 2010 to 2011. METHODS: Focus groups were held with beer promoters and separate focus groups or interviews with key informants to explore the factors affecting beer promoters' access to health care institutions for reproductive health care. The findings of the focus groups were used to develop a survey for beer promoters. This survey was conducted in popular health institutions for these women in each of the four Asian cities. RESULTS: Several common themes were evident. Work demands prevented beer promoters from accessing health care. Institutional factors affecting care included cost, location, environmental factors (e.g. waiting times, cleanliness and confidentiality) and service factors (e.g. staff attitudes, clinic hours, and availability of medications). Personal factors affecting access were shyness and fear, lack of knowledge, and support from family and friends. The survey of the beer promoters confirmed that cost, location and both environmental and service factors impact on access to health care services for beer promoters. Many beer promoters are sexually active, and a significant proportion of those surveyed rely on sex work to supplement their income. Many also drink with their clients. Despite a few differences amongst the surveyed population, the findings were remarkably similar across the four research sites. CONCLUSIONS: Recommendations from the research include the provision of evening and weekend clinic hours to facilitate access, free or low cost clinics, and health insurance through employer or government plans which are easy to access for migrants. Other improvements that would facilitate the access of beer promoters to these services include increased funding to hire more staff (reducing waiting times) and to stock more needed medications, mobile clinics to come to the workplace or free transportation for beer promoters to the clinics, improved training to reduce health care provider stigma against beer promoters, and public education about the importance of reproductive health care, including preventative services.     

中国国家出生队列研究的理念与实践

出生队列研究在探讨生命早期暴露对子代远期健康的影响中发挥重要作用。随着育龄人口生殖健康问题的凸显, 辅助生殖技术被广泛应用于临床。而关于辅助生殖技术对母婴健康的远期影响尚未得到充分研究。2016年, 以家庭为单位, 同步招募辅助受孕家庭和自然受孕家庭的多中心前瞻性的中国国家出生队列(CNBC)研究正式启动。截至2021年6月30日, 已累计在全国招募7.2万个家庭, 包括辅助生殖家庭3.9万个和自然妊娠家庭3.3万个, 本队列以面对面随访的形式在辅助生殖治疗前、胚胎移植、孕早期、孕中期、孕晚期及分娩时以及婴儿出生后42 d、6个月、1岁、3岁时采集数据信息和生物样本。其主要目标为评估使用辅助生殖技术后诞生子代的发育和健康状况, 发现与不良出生结局和儿童期疾病相关的危险因素, 为提升出生人口质量的策略制定提供科学依据。本文将对国家出生队列的建设概况和研究进展做简要介绍。     

Support for school-based reproductive health services among South Carolina voters

In 1997 a statewide random digit-dialed telephone survey of 534 South Carolina registered voters was conducted to determine level of support for school-based reproductive health services. Results indicated most voters supported services in secondary schools that would provide students with information and counseling about contraceptive methods and refer students to community-based agencies for abstinence education and counseling. Voters were less supportive of reproductive health services that would diagnose or treat sexually transmitted diseases, test for pregnancy, refer students to community-based agencies for contraceptives, or make contraceptives available to students at school. Significant associations in support for school-based reproductive health services were reported based on income, personal beliefs, intentions, and outcome expectations regarding sexuality education and contraceptive availability. These data reinforce the need for school-aged youth in South Carolina to have access to reproductive health services within their communities, outside of the school setting.     

Women’s Autonomy and Unintended Pregnancy Among Currently Pregnant Women in Bangladesh

This paper examines the net effect of women's autonomy on their pregnancy intention status among currently pregnant Bangladeshi women. This study is based on data from the Bangladesh Demographic Health Survey, 2007 (BDHS). A subset of interviews from currently pregnant women (718) were extracted from 10,146 married women of reproductive age. The BDHS 2007 used a pre-tested, structured questionnaire to collect sociodemographic, women's empowerment, and pregnancy information. Associations between unintended pregnancy and explanatory variables were assessed using bivariate analysis. Logistic regression was used to assess the net effect of women's autonomy on current pregnancy intention status after controlling for other variables. Results indicate that women's autonomy is a significant predictor of unintended pregnancy after adjusting for other factors. A unit increase in the autonomy scale decreases the odds of unintended pregnancy by 16%. Besides autonomy, our results also indicate that current age, number of children ever born, age at marriage, religion, media access, and contraceptive use exert strong influences over unintended pregnancy. Women who have ever used contraceptives are 82% more likely to classify their current pregnancies as unintended compared with women who are non-users of contraceptives. Improvement in women's autonomy and effective and efficient use of contraceptives may reduce unintended pregnancies as well as improve reproductive health outcomes.     

Up against eugenics: Disabled women's challenge to receive reproductive health services

This is an overview of disabled women's reproductive health status. It focuses on the politics of eugenics, which explains why disabled women are devalued as sources of reproduction, have little access to women's health services, and are faced with methods of contraception which continue to pose a threat to their reproductive health and freedom. The ultimate goal of the author is to bring forth questions for research, and to help set the reproductive rights agenda for the aspiring disabled feminist movement.     

Contraceptive Use and Unintended Pregnancies Among HIV-Infected Women in Mumbai

Background:

Access to reproductive health services in Human Immunodeficiency Virus (HIV) programs can greatly enhance program''s potential to limit the spread of disease, reduce unintended pregnancies and safeguard the health of infected people.

Objectives:

To assess (i) knowledge, attitude, and use regarding contraceptives; safe sex and dual protection; (ii) fertility desires and unintended pregnancies post HIV and (iii) symptoms of reproductive tract infection/sexually transmitted infection (RTI/STI) among women infected with HIV.

Materials and Methods:

A cross-sectional study among 300 currently married HIV-positive women who had not undergone permanent sterilization with no immediate desire for pregnancy. Study site was Integrated Counseling and Testing Centers (ICTC) in tertiary hospitals of Mumbai and women were interviewed using a semistructured questionnaire.

Results:

In spite of good awareness about modern methods, 42.7 felt that contraceptives other than condoms were harmful to use due to their HIV status. Knowledge on dual protection was limited to condom (75%). Condom use increased from 5.7% pre-HIV to 71.7% post-HIV, with 89.6% reporting regular use. Future fertility desire was expressed by 8.7% women. Induced abortions post-HIV was reported by16.6% women, as pregnancies were unintended. About 69% wished to use dual contraceptive methods for effective protection if it was not harmful to be used by people living with HIV (PLHIV).

Conclusion:

Data reveals a need to promote modern contraceptive methods along with regular condom use to prevent unintended pregnancies and improve health-seeking behavior for contraception. Health system models that converge or link HIV services with other reproductive health services need to be tested to provide comprehensive reproductive healthcare to infected women in India.     

Sexual and Reproductive Health Trends Among Women With Enduring Mental Illness: A Survey of Western Australian Community Mental Health Services

An exploratory cross-sectional survey was conducted to determine associations and potential modifiable risk factors for management of sexual and reproductive health needs for women attending community mental health services. Women (n = 220) had on average three pregnancies; 61.2% were unplanned. One quarter who were sexually active within the past 12 months denied using contraception with 51% using less effective methods. The majority (81.7%) engaged in Pap smear screening, and those with a general practitioner (GP) were more likely to participate (p =.004). Findings highlight GPs’ potential in optimizing women's health. Considering unplanned pregnancies and contraception trends, we suggest improved access to contraception options, particularly long-acting reversible methods.     

Access to health care, reproductive health and disability: a large scale survey in Sierra Leone

This is the first study to compare health status and access to health care services between disabled and non-disabled men and women in urban and peri-urban areas of Sierra Leone. It pays particular attention to access to reproductive health care services and maternal health care for disabled women. A cross-sectional study was conducted in 2009 in 5 districts of Sierra Leone, randomly selecting 17 clusters for a total sample of 425 households. All adults who were identified as being disabled, as well as a control group of randomly selected non-disabled adults, were interviewed about health and reproductive health. As expected, we showed that people with severe disabilities had less access to public health care services than non-disabled people after adjustment for other socioeconomic characteristics (bivariate modelling). However, there were no significant differences in reporting use of contraception between disabled and non-disabled people; contrary to expectations, women with disabilities were as likely to report access to maternal health care services as did non-disabled women. Rather than disability, it is socioeconomic inequality that governs access to such services. We also found that disabled women were as likely as non-disabled women to report having children and to desiring another child: they are not only sexually active, but also need access to reproductive health services. We conclude that disparity in access to government-supported health care facilities constitutes a major and persisting health inequity between persons with and without disabilities in Sierra Leone. Ensuring equal access will require further strengthening of the country's health care system. Furthermore, because the morbidity and mortality rates of pregnant women are persistently high in Sierra Leone, assessing the quality of services received is an important priority for future research.     

Emergency contraception in Honduras: knowledge, attitudes, and practice among urban family planning clients

Emergency contraception (EC) has the potential to improve women's reproductive health significantly. In Honduras, where nearly one-fourth of pregnancies are unplanned, the need for EC is substantial. To increase awareness of this option, nongovernmental organizations launched countrywide EC outreach activities in 2001-03. We conducted pre- and postintervention cross-sectional surveys among a total of 2,693 family planning clinic clients to assess EC knowledge, attitudes, and practice at baseline and at two years postintroduction. EC awareness increased over time, but remained at just 20 percent at follow-up. Respondents generally demonstrated a positive attitude and low rates of concern about EC. Awareness of and willingness to use EC were strongly associated with age, educational status, and city of residence. Public-sector acceptance of the method is essential to increase awareness of and access to EC. This study is intended to fill an information gap regarding EC in Latin America and the Caribbean and to be useful in determining educational messages and target audiences for future awareness campaigns in Honduras.