The observational study of selected sexual behaviour issues in female organ transplant recipients

ObjectiveTo investigate sexual behaviour in women following solid organ transplantation.Study designA cross-sectional single-centre survey study of 230 female organ transplant recipients, aged 18–45 years.Main outcome measuresSexual behaviour, contraceptive awareness and methods of birth control.Results205 females declared to be post their sexual initiation. The mean age at sexual initiation in our study population was 20.3 ± 3.3 years (range: 14–32). Fifty-three percent (122/230) of the patients declared that they had only one sexual partner at enrolment. After transplantation female organ recipients became more sexually active (71% vs. 83%; p = 0.018). The frequency of sexual intercourse decreased significantly in the post-transplant period (p = 0.004). In the group of sexually active females before transplantation the frequency of sexual intercourses decreased significantly in the post-transplant period (mean Δ −0.16 ± 0.79; p = 0.004). An increase or lack of change in the frequency of sexual intercourse was noted amongst younger transplant-recipients (OR: 0.91; 95%CI 0.86–0.97) and women with effective birth control methods post-transplantation (OR: 3.68; 95%CI 1.60–8.49).ConclusionSexual education of organ transplant recipients is necessary, mainly in younger patients, who present to be more sexually active, thus they need to be taught about effective family planning.     

Tactics employed by healthcare providers in the humanitarian sector to meet the sexual and reproductive healthcare needs of undocumented migrant women in Denmark: A qualitative study

ObjectivesTo explore the tactics adopted by healthcare providers in the humanitarian aid sector to meet the sexual and reproductive healthcare needs of undocumented immigrant women whose entitlements in the Danish national health services are restricted to emergency care only.MethodsWe conducted six semi-structured interviews between January 2020 and April 2020 with healthcare providers working across four health centers providing sexual and reproductive healthcare to undocumented migrants in Copenhagen. The interviews were digitally recorded, transcribed and subjected to a thematic network analysis.ResultsHealthcare providers adopted a number of tactics to meet the SRH needs of undocumented women. They used their position as volunteers to gain women’s trust, drew on personal networks in the public healthcare sector, accompanied women to public hospitals, worked with professionals from the migrant communities, and promoted secondary prevention using their cultural knowledge to respond to the SRH needs of undocumented women. Results highlight that while “informal” settings enable these flexible tactics, fully meeting the SRH needs of undocumented migrants is negatively affected by their limited entitlements to public healthcare.ConclusionThese tactics demonstrated the efforts of healthcare providers to use the NGO space to try to achieve SRH of undocumented women in a restrictive public healthcare sector. Nonetheless, these tactics, particularly the use of personal networks, did not always result in undocumented migrants having their SRH needs met, particularly in cases of serious illness, demonstrating a concerning gap in care.     

Contact between mother,child and partner and attitudes towards breastfeeding in relation to mode of delivery

ObjectiveTo investigate contact between mothers and their newborn child and study if there are differences between those who requested an elective caesarean section compared to women who had a vaginal birth and those who underwent an elective caesarean section due to obstetrical indication. The psychometric properties of a scale that measure the contact between mother and child were also investigated.DesignA prospective cohort study.SettingDanderyd Hospital, Stockholm, Sweden.Sample510 primiparas from three groups: women undergoing caesarean section on maternal request (n = 96), women undergoing caesarean section on obstetrical indication (n = 116) and women planning a vaginal delivery (n = 198). The later were further divided into subgroups; women who underwent assisted vaginal delivery (n = 35) and women who had an emergency caesarean section (n = 65).MethodsThe instrument used was the Alliance Scale.Main outcome measureThe contact between mother and child in relation to mode of delivery.ResultsThe contact with the child was rated as positive on all occasions: there were no significant differences between the groups. The relation to the partner was rated as positive at all occasions. Mothers with a vaginal delivery experienced breastfeeding less stressful than the mothers with a caesarean delivery. Three and nine months after delivery the mothers with a caesarean delivery on request reported more breastfeeding problems than mothers in the other groups. Mothers with a vaginal delivery rated less sadness at every occasion.ConclusionMode of delivery does not seem to affect how mothers experience their contact towards the newborn child.     

Cause-specific mortality among women of reproductive age: Results from a population-based study in an Iranian community

Purpose of studyThis study was conducted to evaluate the levels, patterns, and causes of mortality among women of reproductive age in Northwestern Iran.MethodsDeaths were determined for females resident in West Azerbaijan Province of Iran and who died between March 2013 to February 2014 using reproductive age mortality survey (RAMOS). Causes of death were ascertained by verbal autopsy (VA) and classified based on the International Classification of Diseases, tenth revision (ICD-10). Overall and cause-specific mortality rates (MRs) per 100,000 women with 95% confidence intervals were calculated.ResultsA total of 510 deaths were detected, and VA interviews were conducted with the relatives of the deceased Cases; overall MR was 56.59 per 100,000 women (95% CI: 56.49-56.69). The highest MR was observed in suicide cases (MR = 10.21 per 100,000 women, 95% CI: 10.15-10.27), accounting for 18% of all deaths. The most common method of suicide was self-inflicted burns (45.6%), followed by deaths due to breast cancer (MR = 4.22 per 100,000 women, 95% CI: 4.18-4.26), which accounted for the most cancer-related mortality. All-cause mortality was associated with age, area of residence, marital status, level of education, and ethnic (religious) status relationship (P < 0.001).ConclusionSuicide, especially self-immolation, was the main cause of death among women of reproductive age, and both suicides and breast cancer are major public health problems for this group of women.     

Influence of intimate partner violence during pregnancy on fear of childbirth

ObjectiveWomen are at increased risk of intimate partner violence (IPV) during pregnancy. This may impact women’s positive anticipation for birth. Negative feelings around birth often translate to a fear of childbirth. Our aim was to examine the prevalence IPV and whether physical, sexual, psychological IPV during pregnancy predicts fear of childbirth among Iranian pregnant women.MethodA population-based cross sectional study was conducted in North-East Iran. Pregnant women (n = 174) at least 14 weeks gestation attending health centers were selected for inclusion through a stratified sampling method. IPV, fear of birth, state and trait anxiety and socio-demographic variables were collected using validated instruments. To achieve the final models the Bayesian information criterion was used. A p value of <0.05 was considered statistically significant.ResultsSeventy-three percent of women reported experiencing IPV at least once within their current pregnancy. Fear of birth was prevalent (61.5%). Logistic regression analysis revealed that after adjusting for confounding factors, in nulliparous physical IPV significantly predicted fear of birth (adjusted OR = 12.15; 95% CI, 1.33, 110.96) while, in multiparous psychological IPV associated inversely with fear of birth (adjusted OR = 0.18; 95% CI, 0.04, 0.73). For all participants, physical IPV increased the chance of fear of birth, (adjusted OR = 2.47; 95% CI, 1.01, 6.02).ConclusionAll pregnant women experiencing physical violence had a higher chance of fear of birth. Screening programs for fear of birth and IPV need to be implemented in particular for nulliparous women. Providing continuity of midwifery care and family therapy may be strategies for early support to reduce IPV to pregnant women.     

Married women’s negotiation for safer sexual intercourse in Kenya: Does experience of female genital mutilation matter?

ObjectiveMarried women’s ability to negotiate for safer sex is important for HIV prevention in sub-Saharan Africa, including Kenya. Yet, its relationship to female genital mutilation is rarely explored, although female genital mutilation has been described as a social norm and marker of womanhood that can control women’s sexuality. Drawing on the social normative influence theory, this study addressed this void in the literature.MethodsWe analysed data from the 2014 Kenya Demographic and Health Survey using logistic regression. Our sample included 8,602 married women. Two indicators of safer sex, namely the ability to refuse sex and the ability to ask for condom use, were explored.ResultsWe found that women who had undergone genital mutilation were significantly less likely to report that they can refuse sex (OR = 0.87; p < .05) and that they can ask for condom use during sexual intercourse (OR = 0.62; p < .001) than their counterparts who had not undergone genital mutilation, while controlling for theoretically relevant variables.ConclusionOur findings indicate that the experience of female genital mutilation may influence married women’s ability to negotiate for safer sex through gendered socialization and expectations. Based on these findings, several policy implications are suggested. For instance, culturally sensitive programmes are needed that target both married women who have undergone genital mutilation and their husbands to understand the importance of safer sexual practices within marriage.     

Trends of contraception use among married reproductive age women: Tehran lipid and glucose cohort study 2002–2011

ObjectivesThis study aimed to examine the trends of contraception use among married reproductive age women in Tehran Lipid and Glucose study between 2002 and 2011.MethodsThis analysis investigated a proportion of women users and non-users of family planning, using data from 10 year population-based Tehran Lipid Glucose Study from surveys conducted in 2002, 2005, 2008, and 2011.Of the 6813, 6993, 7077, and 6789 women in the four phases mentioned, 34.1%, 33.9%, 33.5% and 35% of participants in each phase preferred to use contraception. Number of participants studied were 2506 women in 2002, 2529 women in 2005, 2594 women in 2008 and 2525 women in 2011.ResultsTypes of methods and patterns of change in contraception differed across time. The percentage of women using traditional methods increased significantly from 25.7% in 2002 to 34.6% in 2011 (p value for trend = 0.001). Accordingly, modern contraception use showed a reverse trend. From 2002 to 2011, 61.4%, 61%, 57.7%, and 51% of married women reported currently using various modern contraceptives, respectively (p value for trend = 0.001). The proportion of users relying on condoms showed a significant increase during this decade, being 10.9% in 2002, 15.2% in 2005, 20% in 2008 and 21.9% in 2011. The prevalence of non-users for contraception was generally low; 12.7%, 8.2%, 8% and 14.3%, respectively from 2002 to 2011, but increased significantly across time (p = 0.005)ConclusionRelying on less effective contraceptive methods has increased rapidly among women in the Tehran Lipid and Glucose cohort study, a trend that could be a warning to policy makers about the possibility of higher unsafe abortion and maternal mortality/morbidity rates in the near future.     

Marital violence and sexually transmitted infections among women in post-revolution Egypt

ObjectivesTo explore the relationship between past year physical or sexual partner violence against women and women’s self-report of sexually transmitted infection (STI) symptoms in post-revolution Egypt; and to examine the effects of men’s and women’s risky sexual behavioural characteristics and structural dimensions of poverty and gender inequality on this relationship.Study designThis study uses the nationally representative cross-sectional demographic and health survey data conducted in 2014. Multivariate logistic regression was used to assess the relationship between past year partner violence and self-report of STI symptoms among currently married women.Main outcome measureswomen’s self-report of STI was based on their responses to three questions; whether in the past year they had: got a disease through sexual contact?, a genital sore or ulcer?, or a bad smelling abnormal genital discharge? Women who gave an affirmative response to one or more of these questions were assumed to self-report STI.ResultsAlmost one-third of women self-reported symptoms of STI. Fourteen percent of women reported they had experienced physical or sexual violence by a male partner in the past 12 months. Abused women had a 2.76 times higher odds of self-reported STI symptoms (95% CI 2.25–3.38). The significant relationship between self-reported STI and past year partner violence against women did not alter when adjusting for men’s and women’s behavioural characteristics and factors related to poverty and gender inequality.ConclusionsPublic health interventions that address women’s sexual and reproductive health need to consider violence response and prevention strategies.     

The correlation between breastfeeding self-efficacy and maternal postpartum depression in southern Brazil

ObjectiveTo investigate the relationship between breastfeeding self-efficacy and postpartum depression symptoms in a sample of Portuguese-speaking mothers in southern Brazil.BackgroundThere remains equivocal evidence regarding a putative association between breastfeeding self-efficacy and postpartum depression.MethodThis is a cross-sectional study in which eligible research participants completed screening questionnaires and other assessment tools. Mothers were interviewed once only in their homes between the 2nd and 12th week of the postpartum period. Research participants completed the Portuguese version of the Postpartum Depression Screening Scale (PDSS) and Edinburgh Postnatal Depression Scale (EPDS). Breastfeeding self-efficacy was evaluated through the Breastfeeding Self-Efficacy Scale (BSES-SF).ResultsA total number of 89 mothers completed the investigation: 69 (77%) were exclusively breastfeeding, whereas 20 mothers (22.7%) were partially breastfeeding at the time of the interview. Mothers who combined breastfeeding and bottle-feeding presented higher PDSS and EPDS scores. The breastfeeding self-efficacy scores were higher in mothers who exclusively breastfed and were negatively associated (p < 0.001) with both EPDS and PDSS (postpartum depression) scores.ConclusionThese findings suggest that mothers who suffer from depressive symptoms may experience less confidence in their ability to breastfeed. This association may be particularly relevant for the purpose of screening procedures for depression and unsatisfactory breastfeeding during the postpartum period.     

Young women’s decision-making process for HPV vaccination

ObjectivesTo explore young women’s decision-making process for HPV vaccination and to identify their beliefs about HPV vaccination.MethodsThis study employs a qualitative design. Data was collected by audio-taped interviews with 16 HPV vaccinated Swedish women, 17–26 years old. The data was analysed using latent content analysis.ResultsThree themes emerged from the data: “Fear of cancer”, “Reliance on vaccination” and “Mother – the main motivational factor”. One of the major reasons for taking the decision to be HPV vaccinated was fear of cancer: vaccination was seen as a way to protect oneself against this. The young women’s decision-making surrounding HPV vaccination was based on reliance on vaccination and trust in health care. Support from the mothers of the young women and mothers’ sponsorship of costs initiated HPV vaccination. Other motivational factors were advertisements and friends. Despite having been vaccinated, the young women were unaware of the relation between cervical cancer, sexual behaviour and HPV.ConclusionThese HPV vaccinated young women had limited knowledge about HPV. Therefore it is important that health professionals provide comprehensible information about HPV vaccination in attaining informed consent. In order to avoid misunderstandings, health care professionals in youth clinics and schools need to initiate discussion with young women, clarifying the relation between cervical cancer, HPV and sexual transmission.     

The hazard of pregnancy loss and stillbirth among women in Kersa,East Ethiopia: A follow up study

BackgroundAlthough pregnancy loss causes considerable challenge to women’s health, population-based studies in rural areas are not widely available in low-income countries. This study aims to determine the hazard of pregnancy loss and related factors in the rural communities of Ethiopia.MethodologyA prospective community-based study was conducted over a period of 1 year. Pregnancy was identified as early as possible by a pregnancy urine test. All pregnant women identified during the screening were followed up at their home until termination of pregnancy or delivery of the neonate. The total follow-up time was 7802 ‘pregnant person months’. A Cox regression analysis was done to estimate the hazard of pregnancy loss.ResultOut of a total of 1438 terminated pregnancies, 143 (9.9%) did not end in live birth, 116 ended due to bleeding and 27 were stillbirths. Whilst the hazard of pregnancy loss was low among women with pregnancy interval of two or more years [AHR 0.3 (95% CI: 0.15, 0.43)], it was high among women having unplanned pregnancy [AHR 2.2 (95% CI: 1.56, 3.11)], among those who complained STI like symptoms during the index pregnancy [AHR 4.5 (95% CI: 2.79, 7.38)] and among those never received antenatal care [AHR 1.8 (95% CI: 1.13, 2.73)].ConclusionPregnancy loss was higher amongst women experienced unplanned pregnancy, complained STI like symptoms and women who had not attended antenatal care services.RecommendationTo reduce pregnancy loss in rural Ethiopia expanding and promoting the use of family planning, antenatal services and other reproductive health care is necessary.     

The relationship between history of hormonal contraceptive use and iron status among women in Tanzania: A population-based study

ObjectivesApproximately 30% of the Tanzanian women in the reproductive age group are iron deficient. At population-level, there is a dearth of research on the relationship between hormonal contraceptive use and iron deficiency. The study objective was to examine the relationship between history of hormonal contraceptive use and iron status among women in Tanzania.Study designWe conducted a cross-sectional study analysis including 4186 women who participated in the population-based 2010 Tanzania Demographic and Health Survey.Main outcome measureIron status determined by iron deficiency, anemia, and iron deficiency anemia.ResultsAlmost 19.0% women reported history of hormonal contraceptive use. Nearly, 30.0%, 39.5%, and 14.3% women had iron deficiency, anemia and iron deficiency anemia respectively. History of hormonal contraceptive use was negatively associated with iron deficiency, anemia and iron deficiency anemia, independent of potential confounders. Compared to non-users, the multivariable-adjusted odds ratio OR (95% CI) among hormonal contraceptive users was 0.73 (0.56–0.94, p < 0.05) for iron deficiency, 0.58 (0.46–0.72, p < 0.001) for anemia, and 0.53 (0.37–0.74; p < 0.001) for iron deficiency anemia. Longer duration of hormonal contraceptive use (>2 years) had lesser odds of iron deficiency 0.63 (0.43–0.91, p for trend 0.005), anemia 0.51 (0.36–0.73, p for trend <0.001) and iron deficiency anemia 0.35 (0.19–0.65, p for trend <0.001).ConclusionOur finding has important implications for educating healthcare providers and women about additional nutritional benefits of the use of hormonal contraceptives.     

Women’s perceptions of fetal movements in full-term pregnancy

BackgroundBesides the frequency of the fetal movements the woman’s perceptions of the movements can give additional information about the unborn baby’s wellbeing.ObjectiveTo explore women’s perceptions of fetal movements in full-term pregnancy.MethodsInterviews with 40 women in gestational weeks 37 + 2 to 41 + 5, all with uncomplicated pregnancies. All women were recruited from one antenatal clinic in the capital of Sweden. With an inductive approach using a content analysis the answers to the question: “Can you describe how your baby has moved this week?” was analysed.ResultsFetal movements were categorized into seven categories: strong and powerful, large, slow, stretching, from side to side, light, and startled.ConclusionsAlmost all the women perceived the fetal movements at the end of pregnancy as strong and powerful, and internal pressure. Including women’s perceptions of fetal movements in the obstetric anamneses, gives valuable information about the fetus.     

Risk factors for Chlamydia trachomatis infection among users of an Internet-based testing service in Sweden

ObjectiveThis study aims to assess potential risk factors for Chlamydia trachomatis infection among users of an Internet-based testing service in Sweden.MethodUsers of an Internet-based C. trachomatis testing service sent in home urine samples by post which were analysed for C. trachomatis and answered a questionnaire regarding their socio-demographic background, sexual risk behaviour, and sexual health. Potential risk factors for C. trachomatis were determined by logistic regression models.ResultsThe questionnaire response rate was 86% (6025/6978) with a male and female response rate of 77% and 93%, respectively. 5763 subjects both answered questionnaire and supplied urine sample. Mean age was 24.4 years (range 15–67 years) and 62% were women. The participants’ C. trachomatis prevalence in men was 8.0% (73/2163) and 5.6% in women (201/3600). Compared to non-infected individuals, the C. trachomatis infected men and women were younger, had a higher number of sexual partners, more intercourse without condom (only men). After adjusting for age, civil status, and geographical region, the risk factors significantly associated with C. trachomatis infection were multiple partners during the previous year, non-condom usage, and having symptoms (only men). A novel finding was that, in women, believing to be infected and having been requested to be tested by a sexual partner, was associated with an increased risk of having a C. trachomatis infection.ConclusionThe Internet-based C. trachomatis testing service reaches a risk group of men and women. The results emphasise the value of self-risk assessment for C. trachomatis infection and the importance of easy accessible and simple sexual transmitted infection testing services.     

Association between contraceptive use and socio-demographic factors of young fecund women in Bangladesh

ObjectiveThis study aimed to explore the association between socio-demographic factors and contraceptive use among fecund women under 25 years old.MethodsThis study utilized a cross-sectional data (n = 3744) extracted from the Bangladesh Demographic and Health Survey 2011. Differences in the use of contraceptives by socio-demographic characteristics were assessed by χ² analyses. Binary logistic regression was used to identify the determinants of contraceptive use among young women.ResultsThis study observed that 71% fecund women aged below 25 years used contraceptives. Getting family planning (FP) methods from FP workers increases the likelihood of using contraceptives among young women because outreach activities by FP workers and accessibility of FP related information pave the way of using contraceptives. Husband-wife joint participation in decision making on health care increases the likelihood of using contraceptives. Participation of women in decision making on health care could be achieved by promoting higher education and gainful employment for women.ConclusionsReproductive and sex education should be introduced in schools to prepare the young for healthy and responsible living. Moreover, policy makers should focus on developing negotiation skills in young women by creating educational and employment opportunities since husband-wife joint participation in decision making increases contraceptive use.     

Care seeking during the latent phase of labour – Frequencies and birth outcomes in two delivery wards in Sweden

ObjectiveTo explore the frequency of women seeking care during the latent phase of labour at two delivery wards. Also, to investigate interventions during labour and birth outcomes in relation to parity and remaining in hospital or not during the latent phase.MethodsA retrospective, population-based cohort study in two delivery wards in Sweden. The sample was based on electronic childbirth records of all births with spontaneous onset.ResultsOf 5797 women, 17.6% (n = 1023) sought care during the latent phase. Of these, 57.8% (n = 591) remained at the hospital, and 50.5% (n = 517) had a prolonged latent phase. Nulliparae remaining in hospital had a lower rate of spontaneous vaginal births (p = 0.007), more emergency Caesarean sections (CSs) (p < 0.001) and more babies with Apgar <7 at 5 min (p = 0.045) compared with those returning home. Nulliparae having a prolonged latent phase and remaining in hospital had fewer spontaneous vaginal births (p = 0.045), more emergency CSs (p = 0.002) and more babies with Apgar <7 at 5 min (p = 0.023) compared with those returning home. For multiparous women with a previous vaginal birth, with or without prolonged latent phase, mode of delivery was not influenced by remaining in hospital or not.ConclusionThese findings indicate a need for different guidelines for nulliparous and multiparous women seeking hospital care during the latent phase, and for special attention to be given to nulliparous with a prolonged latent phase remaining in hospital during the latent phase.     

The attitudes of Dutch fertility specialists towards the addition of genetic testing in screening of tubal factor infertility

BackgroundThis study aims to identify elements perceived by Dutch fertility specialists as barriers and facilitators for the introduction of genetic testing, and their attitudes towards the use of genetic information. The genetic test would be implemented in routine screening for tubal pathology and identifies SNPs relevant for the immune response causing tubal pathology.MethodsExperienced reproductive specialists working in Dutch Academic Hospitals were interviewed. Based on the results of four interviews a questionnaire was developed and used to survey medical doctors in six out of eight Dutch Academic hospitals.Results60.4% (n = 91) stated that the addition of genetic markers to the Chlamydia trachomatis antibody test (CAT) in screening for tubal pathology would increase screening accuracy. 68.2% (n = 90) agreed they would require additional training on clinical genetics. Clinical utility (91.2%, n = 91) and cost-effectiveness (95.6%, n = 91) were recognized by the respondents as important factors in gaining support for the new screening strategy.ConclusionIn summary, respondents showed a positive attitude towards the implementation of a genetic test combined with CAT for tubal factor infertility (TFI) screening. To gain their support the majority of respondents agreed that clinical utility, specifically cost-effectiveness, is an important factor. Comprehensive research about economic implications and utility regarding the introduction of genomic markers should be the next step in the implementation strategy. Furthermore, education and training would need to be developed and offered to fertility care professionals about genetic markers, their interpretation, and implications for clinical decision-making.