Reproductive Health Challenges Research Articles

Provider perspectives on adolescent access to contraception in South Africa.

Poor access to contraception influences adolescent health outcomes and may lead to sexual and reproductive health challenges. Unmet sexual and reproductive health should contribute to unplanned adolescent pregnancies, sexually transmitted infections, and other conditions. Therefore, it is crucial to enable adolescents to access appropriate contraceptive methods easily. This study explored factors influencing adolescents' access to contraceptive methods from the perspective of primary healthcare providers in South Africa. This study was conducted in two health districts of the Western Cape province in South Africa: the City of Cape Town Metropolitan Municipality and the West Coast district. Using a qualitative research design, in-depth semi-structured interviews were conducted with 24 healthcare providers who work in primary healthcare clinics. Subsequently, the interviews were transcribed and verified for errors. Braun and Clarke's thematic analysis model guided the data analysis using ATLAS.ti software (version 22). The study adhered to the consolidated criteria for reporting qualitative studies checklist for qualitative research. Four themes emerged through the data analysis: (1) personal influences, (2) community-level influences, (3) health system influences, and (4) policy-level influences. Representative quotations were used to illustrate the themes and sub-themes. Adolescence is shaped by various influences that affect adolescents' ability to access contraception. These factors include their awareness of contraception, social environment, provider biases and school policies. Understanding these influences is crucial for addressing unintended pregnancies and promoting sexual and reproductive health among this age group.Contribution:This study highlights strategies that facilitate and hinder adolescents' access to contraception.

P-491 Reproductive mental health empowerment: enhancing mental health literacy among women with reproductive health issues

Abstract Study question What is the role of mental health literacy and its impact on women’s help-seeking when there are reproductive mental health issues? Summary answer Mental health literacy and attitudes toward seeking professional help significantly predict one’s emotional well-being and help-seeking behaviour. What is known already Women who encounter reproductive health issues can experience an array of physical issues as well as emotional hurdles. There are barriers at the societal level that impede women from addressing these reproductive health-related mental health challenges, such as social stigma, lack of attention on mental wellness and a disproportionate amount of focus on the fertility treatments’ outcomes. There is limited understanding regarding the relationship between women’s reproductive mental health literacy and their tendencies to seek help in the literature. Study design, size, duration This study used cross-sectional data from an online questionnaire that explored the participants’ reproductive mental health literacy, attitudes towards seeking professional help and their actual help-seeking behaviour. Data were collected between July and September 2023. Participants/materials, setting, methods Participants were 356 Chinese women (mean age = 32.64±7.15) recruited through community network and social media. Participants answered questions related to their knowledge of mental illness, ability of seeking professional help, recognition of mental illness, acceptance of patients with mental illness, recognition of need for psychotherapeutic help, stigma tolerance, interpersonal openness, confidence in mental health practitioner, knowledge on community resource and their actual help seeking behaviour. Main results and the role of chance 59% of the participants attained a Bachelor’s degree or above and 74% were married. 43.5% of the participants experienced emotional disturbances triggered by reproductive health issues. Among these participants, 52% chose not to seek help from others. Among different types of reproductive problems, participants with fertility and reproductive health problem scored lowest in terms of help-seeking behavior (M = .28, SD = .45, p<.05., reproductive mental health knowledge (M = 27.29, SD = 4.39, p<.01), recognition of mental illness (M = 16.73, SD = 4.0,p<.05), recognition of need for psychotherapeutic help (M = 17.99, SD = 3.63, p<.01), and interpersonal openness (M = 16.85, SD = 3.35, p<.01). In terms of emotional disturbances, the result indicated that acceptance of patients with mental illness (b = -.035, p <.05) and recognition of the need for psychotherapeutic help (b = .068, p <.05) predicted the numbers of emotional disturbances one experienced. In terms of help-seeking behaviour, knowledge of mental illness (B = 1.30, p < .01), recognition of the need for psychotherapeutic help (B = 1.49, p < .01), and knowledge of community resources (B = 2.15, p < .01) significantly predicted one’s actual help-seeking behaviour. Limitations, reasons for caution There may be potential confounding factors that influenced the results, such as previous mental health history and use of mental health facilities. The ability to establish a causal relationship between reproductive mental health literacy, help-seeking attitude, and actual help-seeking is constrained due to the study’s utilization of a cross-sectional design. Wider implications of the findings Providing counseling for infertility plays a crucial role in addressing the emotional and psychological needs of individuals by reducing the stigma surrounding reproductive mental health challenges. Incorporating infertility counseling into fertility treatment empowers women with information and facilitates open and honest communication on mental well-being. Trial registration number Not applicable

P-353 Perfluorooctanoic acid (PFOA) impacts murine ovarian follicle development through apoptotic signaling pathways and exhibits transgenerational effects

Abstract Study question How does Perfluorooctanoic Acid (PFOA) exposure impact ovarian function and the physiological and reproductive health of subsequent offspring? Summary answer PFOA exposure leads to ovarian dysfunction, characterized by follicular depletion and hormonal imbalances, and adversely affects the reproductive health of offspring. What is known already Mass spectrometry reveals higher perfluorinated compound levels in premature ovarian failure patients compared to healthy individuals. PFOA, an environmental contaminant, is known for its endocrine-disrupting effects, but its specific impact on ovarian function and transgenerational health remains less explored. This study addresses the gap by examining PFOA’s direct ovarian effects and its consequential impacts on offspring, using both in vivo and in vitro models. Study design, size, duration This study employs mouse models and ovarian granulosa cells to assess PFOA’s impact. Mice were administered PFOA (50mg/Kg) and evaluated for ovarian function and offspring health. Ovarian tissue underwent histological analysis and hormone assays. RNA transcriptome sequencing identified activated apoptotic pathways post-PFOA exposure. Offspring physiological and reproductive parameters were also examined. Parallel in vitro experiments with ovarian granulosa cells at 50uM PFOA concentration provided insights into cellular apoptosis. Participants/materials, setting, methods Clinically, we collected serum samples from approximately 100 Premature Ovarian Insufficiency (POI) patients and 100 healthy individuals, analyzed using mass spectrometry. In murine experiments, we simulated human environmental exposure to PFOA (particularly in high-exposure professions) using a 50mg/Kg dose administered via gavage. Transcriptome sequencing analyzed potential signaling pathways in both experimental and control mice. Offspring underwent physiological metabolic assessments and fertility evaluations, including fertilization and blastocyst rates. Main results and the role of chance Mass spectrometry results from human samples revealed significantly higher levels of perfluorinated compounds in POI patients compared to healthy controls, suggesting a potential link between PFOA exposure and ovarian dysfunction. In murine models, PFOA administration at 50mg/Kg resulted in notable ovarian changes. Histological analysis showed a reduction in follicle counts and abnormalities in AMH and FSH levels, indicative of premature ovarian failure. Transcriptome sequencing of these mice highlighted the activation of apoptotic pathways, especially the PI3K/Akt/mTOR signaling, post-PFOA exposure. This suggests a mechanistic pathway through which PFOA may induce ovarian dysfunction. Furthermore, offspring of PFOA-exposed mice displayed significant reproductive health challenges. They exhibited irregularities in estrous cycles and a decrease in oocyte fertilization rates, pointing to potential transgenerational effects of PFOA exposure. These findings in murine models align with the elevated perfluorinated compound levels observed in human POI patients, reinforcing the hypothesis of PFOA’s detrimental impact on ovarian health and subsequent generational fertility. The consistency of results across human clinical data and animal models strengthens the argument for a causal relationship between PFOA exposure and reproductive health risks. Limitations, reasons for caution While these findings highlight PFOA’s detrimental effects on ovarian function and offspring health, translating results from animal models to humans necessitates caution. The specific mechanisms and potential variability in human response to environmental PFOA exposure require further investigation. Wider implications of the findings This research underscores the far-reaching impacts of environmental contaminants like PFOA on reproductive health. It emphasizes the need for stringent regulation of such pollutants and further studies to understand their long-term effects on human health, particularly regarding fertility and intergenerational wellbeing. Trial registration number not applicable

A pharmacist's role in increasing access to menstrual products: an education and advocacy approach.

Individuals who menstruate grapple with diverse challenges in menstrual and reproductive health. This includes financial burdens, societal stigmas, and negative mental and physical health implications. Period poverty, marked by insufficient access to menstrual products, education, and sanitation, remains a prevalent and poorly addressed issue. Alarming statistics highlight the extent of this problem and shed light on the staggering number of individuals lacking access to essential menstrual products. The discourse extends to the safety and accessibility of a diverse array of menstrual products. A comprehensive comparison of the cost of available period products was conducted using data obtained from various retail websites. The often-overlooked potential indirect expenses and profound impacts on quality of life were also discussed. Amidst other public health initiatives, pharmacists have emerged as pivotal advocates and educators. Pharmacists are poised to drive initiatives that increase access to menstrual products through public health education and advocacy. By providing education on different menstrual product options, pharmacists can empower individuals to make informed decisions based on their needs. This perspective illuminates the complex impacts of menstruation on individuals and proposes that pharmacists can play a role in overcoming barriers to access. The proposed strategies, rooted in education, research, and advocacy, pave the way for enhancing access, reducing stigma, and elevating the quality of life for those navigating the intricate complexities of menstruation.

Women and Reproductive Health Challenges in Igboland: A Historical Study

The objective of the work is women and reproductive health challenges in south east, Nigeria. The research also treats the nature of reproductive health challenges in Igboland before and after 1970, and the official reaction to reproductive health challenges in contemporary Igboland. The research method employed was the qualitative analytical method which involved content analysis of relevant documentary data on the subject. The approach adopted was also thematic. The research findings indicate that reproductive health challenges in Igboland before and after 1970 can be classified into five, namely: genetic reproductive health challenge, witchcraft and curses, labor and accident, harmful socio-cultural practices, as well as infectious and communicable disease. The government response to reproductive health challenges includes the different frameworks for the protection of the reproductive health rights of women. These include the domestic instruments as well as the international instruments ratified by the government. The study observed that a number of factors inhibit the provision and availability of reproductive health rights in south east Nigeria, and it includes the social and economic factors as well as cultural and religious factors. It also argues that in spite of these challenges, some successes have been recorded as a result of the official responses to reproductive health challenges in Igboland. These include the elimination of child marriages, reduction in the violence against women and reduction of the harmful cultural practices, such as female genital mutilation (known as women circumcision) and polygamy.

Qualitative Study to Explore the Occupational and Reproductive Health Challenges among Women Tobacco Farm Laborers in Mysore District, India.

Tobacco farm laborers are primarily women and children working for very low wages. The aim of this study was to explore occupational and reproductive health challenges faced by women tobacco farm laborers in Mysore District, India. We conducted interviews and six focus group discussions among 41 women tobacco farm laborers. Codes and themes were generated based on deductive and inductive approaches using the socioecological model. Participants reported symptoms of green tobacco sickness including headaches, back pain, gastric problems, weakness, and allergies during menstruation, pre-natal, and post-natal periods. Participants had poor awareness about the health effects of tobacco farming, and there were gender inequalities in wages and the use of personal protective equipment. Participants received support from family and community health workers during their pregnancy and post-natal period. Women reported wanting maternity benefits from the tobacco board, as well as monetary support and nutritional supplements. There is a need for health education about the environmental dangers of tobacco among farm laborers, and more supportive policies for women farmworkers during pregnancy and post-natal periods.

The magnitude of gender-based violence, health consequences, and associated factors among women living in post-war woredas of North Shewa zone, Amhara, Ethiopia, 2022.

Gender-based violence (GBV) is a pervasive global public health concern and a violation of human rights, particularly pronounced in conflict settings where it is often used as a tool of warfare to instill fear and control populations. Assessment of Magnitude, Associated Factors, and Health Consequences of GBV among women living in war-affected woredas of North Shewa zone, Ethiopia, 2022. A community-based cross-sectional study was conducted, involving 845 randomly selected women living in conflict zones. Data on GBV experiences over the previous 3 months were collected through interviewer-administered questionnaires developed from literature review. The collected data underwent validation, entry into EPI data, and analysis using SPSS. Findings are summarized using descriptive statistics, AOR and 95% confidence interval. The magnitude of GBV in this study was (490, 58.0%) where, (466, 55.0%) psychological violence, (254, 30.1%) physical violence, and (135, 16.0%) reported sexual violence. A majority of the physical violence, (161, 63.4%), occurred during conflict period, with (143, 56.3%) of these cases involving armed forces, and (161, 63.4%) women experiencing physical violence in their homes. Urban Residence AOR = 2.65, CI, (1.82-3.89), Educational status of Secondary education AOR = 0.33, CI, (0.19-0.57, and ≥College AOR = 0.17, CI, (0.09-0.35), Occupation of Housewife AOR = 1.88, CI, (1.20-2.94), Private employee AOR = 6.95, CI, (3.70-13.04), Gov't employee AOR = 5.80, CI, (2.92-11.50), and others (Students) AOR = 3.46, CI, (1.98-6.01), Ever had sexual intercourse AOR = 0.46, CI, (0.25-0.83), Have heard about SRH AOR = 0.59, CI, (0.40-0.89), Have had previous GBV exposure AOR = 0.24, CI, (0.15-0.38), having a previous history of sexual violence AOR = 0.30, CI, (0.16-0.57), and Number of sexual partner AOR = 1.84, CI, (1.13-2.99) were identified to be associated factors of GBV in our study area. The most commonly reported consequences of GBV were Anxiety, depression, physical injuries, self-blame, women had school dropout, and abortion. The study reveals a higher prevalence of GBV, resulting in profound physical, social, mental, and reproductive health challenges for survivors. To address this, multi-sectoral cooperation is advised to enhance women's empowerment, access to information, and psycho-social support in affected areas. Furthermore, national policymakers are urged to implement preventive measures during conflict and establish legal mechanisms to ensure accountability for perpetrators.

Patient satisfaction with nursing care in infertility patients: A questionnaire survey.

Infertility remains a persistent global reproductive health challenge, with causative factors encompassing abnormalities in both the male and female reproductive systems. Typically, female partners seek initial consultations for infertility concerns, often within the context of routine annual well-woman check-ups. Nurses providing preventive care play a crucial role, conducting initial diagnostic assessments, and addressing certain causes of infertility. Patient satisfaction serves as a vital indicator of care quality. Identifying factors contributing to patient satisfaction with nursing services is crucial, yet research in this area has been limited. This study aimed to compare infertility patients' assessments of nurse quality and satisfaction with hospital services. The findings could offer valuable insights for healthcare providers, hospitals, and policymakers, guiding improvements in nursing care delivery and enhancing patient satisfaction in China's infertility treatment sector. By understanding patients' perspectives and experiences, healthcare providers can make necessary adjustments to improve care quality and patient outcomes. The sample included 1200 patients, and data collection utilized a self-assessment questionnaire, with percentages employed for analysis. Nurses are integral to caring for infertility patients during visits and conducting research to advance fertility care practices.

Exploring the multi-level impacts of a youth-led comprehensive sexuality education model in Madagascar using Human-centered Design methods.

Comprehensive sexuality education (CSE) is recognized as a critical tool for addressing sexuality and reproductive health challenges among adolescents. However, little is known about the broader impacts of CSE on populations beyond adolescents, such as schools, families, and communities. This study explores multi-level impacts of an innovative CSE program in Madagascar, which employs young adult CSE educators to teach a three-year curriculum in government middle schools across the country. The two-phased study embraced a participatory approach and qualitative Human-centered Design (HCD) methods. In phase 1, 90 school principals and administrators representing 45 schools participated in HCD workshops, which were held in six regional cities. Phase 2 took place one year later, which included 50 principals from partner schools, and focused on expanding and validating findings from phase 1. From the perspective of school principals and administrators, the results indicate several areas in which CSE programming is having spill-over effects, beyond direct adolescent student sexuality knowledge and behaviors. In the case of this youth-led model in Madagascar, the program has impacted the lives of students (e.g., increased academic motivation and confidence), their parents (e.g., strengthened family relationships and increased parental involvement in schools), their schools (e.g., increased perceived value of schools and teacher effectiveness), their communities (e.g., increased community connections), and impacted broader structural issues (e.g., improved equity and access to resources such as menstrual pads). While not all impacts of the CSE program were perceived as positive, the findings uncovered opportunities for targeting investments and refining CSE programming to maximize positive impacts at family, school, and community levels.

Understanding Adolescent Gynecological Issues: A Cross-Sectional Study at a Tertiary Care Center.

Adolescence is a crucial phase in a woman's life, as it signifies the beginning of her reproductive journey. During this time, there are notable variations in sexual development and a sense of caution that can present challenges for healthcare providers. The rationale for studying adolescent gynecological problems lies in the need to understand and address the unique reproductive health challenges faced by young girls. By investigating these issues, researchers and healthcare professionals can develop effective strategies for prevention, early detection, and treatment of gynecological conditions in adolescents. This knowledge is crucial for promoting the overall well-being and reproductive health of young girls, ensuring they receive appropriate care and support during this critical stage of development. This study focuses on identifying the most common gynecological issues in teenagers, exploring the root causes, examining the available treatment options, and understanding how they are managed at a tertiary care facility. Methods: This cross-sectional observational study took place at a tertiary care center and focused on gynecological issues in adolescent females who sought care at the gynecology department from January 2016 to December 2022. The study participants were categorized into three groups: early adolescence (10-13 years), middle adolescence (14-16 years), and late adolescence (17-19 years) for analysis. Ethical approval was obtained for this hospital-based research, which involved examining, investigating, and treating the study participants. Out of the 49,700 new female patients, 2000 (4.02%) fell within the specified age range. The average age of the participants was 16.87±2.16, and the majority of them sought help for menstrual issues (63.45%), followed by abdominal discomfort (15.6%) and vaginal discharge (7.2%). Menstrual disorders were the most common concern, with dysmenorrhea and puberty menorrhagia being prevalent issues. Abdominal pain was caused by various factors, such as urinary tract infections, ovarian tumors, pelvic inflammatory disease, endometriosis, and endometrial tuberculosis. The majority of cases were treated conservatively, with only a small percentage requiring surgical intervention. The significance of early detection and intervention in addressing gynecological issues among adolescents is highlighted in the findings of this research, underscoring the necessity for specialized healthcare services that cater to the specific needs of this demographic. Adolescent gynecology plays a crucial role in safeguarding the reproductive health and overall well-being of young women, emphasizing the importance of seeking assistance proactively.

Navigating challenges: a socioecological analysis of sexual and reproductive health barriers among Eritrean refugee women in Ethiopia, using a key informant approach

ObjectivesThe study aimed to explore the experiences and perceptions of healthcare providers (HCPs) regarding the sexual and reproductive health (SRH) challenges of Eritrean refugee women in Ethiopia.DesignA qualitative exploratory design...

Malathion exposure may increase infertility risk among US Adults: Results from the 2015–2016 NHANES

Background and PurposeOrganophosphate pesticides such as malathion are the most widely used pesticides. Despite endocrine-disrupting effects, there is a paucity of information regarding chronic exposure to non-persistent organopesticides such as malathion. The purpose of this study is to describe the exposure burden among U.S. residents as well as possible impacts on fertility. MethodsPopulation-based data collected by the National Health and Nutrition Examination Survey (NHANES) between 2015 and 2016 were used to perform a retrospective analysis on urinary concentrations of malathion diacid. Samples were assessed from 1703 adult participants, statistically weighted to represent over 231 million individuals. General linear models were used to examine associations between exposure and reproductive health measures among pre-menopausal women. ResultsDetectable concentrations of malathion diacid were identified in 16.1 % (n = 254) of samples. Concentrations were higher among women who reported seeing a physician due to difficulties becoming pregnant (P < 0.001; r2 = 0.12) as well as among women who reported trying for at least a year to become pregnant (P < 0.001; r2 = 0.06). ConclusionsExposure to malathion is associated with a history of reproductive health challenges among women.

Unraveling reproductive and maternal health challenges of women living with HIV/AIDS in Vietnam: a qualitative study

BackgroundHuman Immunodeficiency Virus (HIV) remains a significant public health concern worldwide. Women living with HIV/AIDS (WLHA) have the additional and unique need to seek sexual and reproductive health services. WLHA’s maternal health journeys can be shaped by the cultural norms and resources that exist in their society. This study sought to understand if and how WLHA’s family planning, pregnancy, and motherhood experiences could be influenced by the patriarchal culture, gender roles, and HIV stigma in Vietnam, specifically.MethodsBetween December 2021 and March 2022, 30 WLHA with diverse socioeconomic backgrounds and childbirth experiences were interviewed in Hanoi, Vietnam. These semi-structured interviews covered topics including HIV stigma, gender norms, pregnancy experiences, and child-rearing challenges. Interviews were audio recorded, transcribed, and analysed using ATLAS.ti.ResultsQualitative analyses of participant quotes revealed how limited information on one’s health prospects and reproductive options posed a significant challenge to family planning. Societal and familial expectations as well as economic circumstances also influenced reproductive decision-making. WLHA often encountered substandard healthcare during pregnancy, labor, and delivery. Stigma and lack of provider attentiveness resulted in cases where women were denied pain relief and other medical services. Communication breakdowns resulted in failure to administer antiretroviral therapy for newborns. Motherhood for WLHA was shadowed by concerns for not only their own health, but also the wellbeing of their children, as HIV stigma affected their children at school and in society as well. Many WLHA highlighted the constructive or destructive role that family members could play in their childbirth decision-making and care-giving experiences.ConclusionsOverall, this study underscores the complex ways that cultural expectations, family support, and stigma in healthcare impact WLHA. Efforts to educate and engage families and healthcare providers are warranted to better understand and address the needs of WLHA, ultimately improving their reproductive and maternal health.

Challenges to epilepsy management in Rwandan women living with epilepsy.

In Rwanda, epilepsy prevalence ranges between 29‰ and 49‰. Many women living with epilepsy (WwE) are of childbearing age. Epilepsy characteristics and management, contraception, pregnancy, puerperium and stigma in WwE presenting at the neurology clinic of Ndera, Rwanda, were investigated. This prospective cross-sectional study investigated demographics, epilepsy characteristics, treatment, contraception, folic acid use, pregnancy, puerperium and stigma in WwE aged ≥18 years. Subgroups were analysed by status of any pregnancy and time of epilepsy diagnosis relative to pregnancy, with significant differences expected. During December 2020 and January 2021, a hundred WwE were enrolled (range 18-67 years). Fifty-two women had never been pregnant, 39 women had epilepsy onset before pregnancy and nine were diagnosed after pregnancy. No significant differences in age, marital status or occupation were observed. Contraception was used by 27%, of whom 50% were taking enzyme-inducing anti-epileptic medication. Valproate was used by 46% of WwE of reproductive age. Thirty-nine women with epilepsy onset before pregnancy reported 91 pregnancies, with 14% spontaneous abortions. None used folic acid before conception, and 59% only during pregnancy. Five of 78 newborns were preterm. No offspring had major congenital malformations. Nearly 25% of WwE were not compliant with their anti-epileptic medication schedule during pregnancy or breastfeeding. Internalized stigma was observed in more than 60%. Up to 25% had been discriminated against at school or work. A comprehensive strategy considering the reproductive health and societal challenges of WwE is needed to drive optimal epilepsy management, reproductive health outcomes and societal inclusion.

Comparing the effect of LINE-based and WhatsApp-based educational interventions on reproductive health knowledge, attitudes, and behaviors among Triad adolescents: A quasi-experimental study.

Adolescent populations face reproductive health challenges. Persisting gaps in Triad Adolescent Reproductive Health (ARH) comprehension and risky behaviors emphasize the necessity of integrating social media apps into health education to address Triad ARH risks among youths. Teenagers commonly use WhatsApp and LINE for social media communication, and determining the effectiveness of these two apps is scarce. This quasi-experimental study aimed to investigate and compare the impacts of educational interventions delivered through WhatsApp and LINE platforms on enhancing the knowledge, attitudes, and behaviors of adolescents concerning the Triad ARH. A total of 154 senior high school students were randomly recruited from two public schools in Bandung Regency, West Java, Indonesia. These students were divided into two groups: Group A, consisting of 78 students who received material messages using LINE, and Group B, consisting of 76 students who received material messages using WhatsApp. Participants completed a pre-test prior to the intervention and a post-test one month after the intervention. Data were collected using validated questionnaires and analyzed using Chi-square and Wilcoxon tests. In the LINE group, there was an average increase in knowledge from 15.68 to 20.21, attitudes from 29.05 to 59.12, and behavior from 55.95 to 64.81 before and after the intervention period (p = 0.001). In the WhatsApp group, there was an increase in knowledge from 15.16 to 19.67, in attitudes from 34.71 to 59.54, and behavior from 54.75 to 65.97 before and after the intervention period (p = 0.001). Further analysis showed no significant difference between the LINE and WhatsApp groups in increasing the average level of knowledge (p = 0.973), attitude (p = 0.682), and behavior (p = 0.067) before and after the intervention. However, it was observed that the increase in knowledge and attitude was slightly higher in the LINE group, while the increase in behavior was slightly higher in the WhatsApp group. This study demonstrates that educational interventions using LINE and WhatsApp both increased the knowledge, attitudes, and behavior of adolescents related to the Triad ARH. This finding is valuable, considering the popularity of LINE and WhatsApp as mobile applications. Leveraging these platforms by nurses and other healthcare professionals can significantly improve adolescents' health, influencing their knowledge, attitudes, and behavior regarding reproductive health.

The end point of it is abstinence: a qualitative analysis of underlying factors influencing Christian leaders’ adoption and implementation of sex and sexuality education in Bolgatanga, Ghana

Adolescents’ sexual and reproductive health challenges are of global public health concern and good quality sexual and reproductive health (SRH) education has an important role to play in addressing these negative sexual health outcomes. Yet in most Sub-Saharan African countries including Ghana, there is limited implementation of SRH education. Several environmental factors hinder the implementation of SRH education with the attitudes expressed by religious leaders having a major impact. We conducted semi-structured interviews with 15 Christian leaders in Bolgatanga, Ghana, to explore the factors influencing their decision to adopt and implement SRH education. Findings show that although Christian leaders were aware of (unsafe) sexual practices among adolescents, they held a conservative position on SRH education. While leaders were open to educating adolescents about sexual health, most held the opinion that SRH education for adolescents should be limited to abstinence-only and not acknowledge sexual activity or promote contraceptive use. Beliefs related to sexual morality, the perceived cause(s) of teenage pregnancy, and perceived responsibility for SRH education influenced Christian leaders’ thinking about SRH education. Implementing SRH education programmes to address young people’s sexual behaviour will require intervention programmes to change Christian leaders’ beliefs and attitudes towards SRH education.

Patterns of Reproductive Health and Sexuality Learning among Private High School Students at Yayasan Perguruan Mayjend Sutoyo in Medan

The surge in premarital sexual incidents among teenagers leading to early marriages, prompted by unintended pregnancies, pervasive dating behavior beyond ethical boundaries, exposure to explicit content, and the prevalence of sexual diseases, underscores the critical need for comprehensive sexual and reproductive health education. This study explores the patterns and strategies employed in imparting sexual education and managing reproductive health among students at Yayasan Perguruan Mayjend Sutoyo High School, Sisingamangaraja Street, Medan. Employing qualitative methods, data was gathered through in-depth interviews and focus group discussions with students, Biology teachers, the School Principal, parents, and other stakeholders. The findings reveal that sexual education primarily stems from Biology teachers, who employ tactful language to teach human anatomy, reproductive organs, and sexual functions, adhering to contextual norms. Reproductive health education addresses the dynamics and consequences of casual sexual relationships, utilizing age-appropriate teaching materials. Teenagers seek diverse knowledge from parents, school descriptions, and online resources to navigate sexual and reproductive health challenges. However, the discreet provision of sexual education is influenced by traditional cultural values, fostering silence and shame, particularly in discussing male and female genitalia.

Perceived risk of child mortality and fertility choices in climate-vulnerable regions of Bangladesh

This research examined the influence of perceived child mortality risk on the fertility choices of married women in Bangladesh. Employing a cross-sectional survey conducted in four rural areas, categorized as either vulnerable or not vulnerable to extreme climate events, a total of 759 married women were surveyed through simple random sampling, while 25 women were selected for in-depth interviews through judgment sampling. The findings indicate that women in climate-vulnerable regions express a greater desire for additional children compared to those in non-vulnerable areas. Furthermore, women who perceive increased child mortality risk and have experienced past child loss show a stronger tendency towards wanting more offspring. The qualitative insights from the interviews shed light on the underlying motivations driving these preferences, emphasizing the significance of child replacement and seeking security against potential child loss. These empirical findings provide valuable insights into the complex dynamics between perceptions of child mortality and reproductive decision-making among women in Bangladesh. The implications of this study are crucial for policymakers and practitioners, as they can guide the development of targeted interventions and policies to address reproductive health challenges in climate-vulnerable areas. By acknowledging women’s perspectives and considering contextual factors, these strategies can effectively address the reproductive implications of climate vulnerability, empowering women to make informed decisions about their fertility and promoting improved reproductive outcomes and overall well-being in vulnerable communities.

Decomposing the rural-urban disparities in overweight and obesity among women of reproductive age in Nigeria

BackgroundOverweight and obese women face various reproductive and other health challenges, and in some cases, even mortality. Despite evidence of rural-urban disparities in overweight and obesity among women of reproductive age, there is limited evidence regarding the predictors of these disparities. This study aims to investigate the factors associated with overweight and obesity and examine the contributors to rural-urban disparities in overweight and obesity among women of reproductive age in Nigeria.MethodsWe utilized the 2018 Nigeria Demographic and Health Survey dataset. The survey employed a two-stage cluster sampling technique based on Nigeria’s 2006 census enumeration areas for sample selection. Overweight and obesity were defined as a body mass index (BMI) ≥ 25. Data analyses were conducted using the Logistic Regression Model and the threefold Blinder-Oaxaca decomposition model (α0.05).ResultsThe study revealed that older women (OR = 2.44; CI = 2.11–2.83), those with higher wealth (OR = 2.05; CI = 1.81–2.31), contraceptive users (OR = 1.41; CI = 1.27–1.57), and residents of the South-South region (OR = 1.24; CI = 1.07–1.45) were more likely to be overweight/obese. The decomposition analysis indicated that the mean predicted prevalence of overweight and obesity is 35.5% in urban areas, compared to 21.1% in rural areas of Nigeria. Factors such as wealth status, educational level, media exposure, and contraceptive use were identified as significant contributors to these disparities.ConclusionThe findings underscore the importance of addressing socioeconomic disparities when designing healthcare interventions to reduce the burden of overweight and obesity, particularly in urban areas. Prioritizing these factors can facilitate efforts to promote healthier lifestyles and enhance overall well-being.

Fostering the wellbeing of adolescent girls through an out-of-school sexuality education programme in Ghana

ABSTRACT Ghanaian adolescents face considerable sexual and reproductive health challenges that can disrupt human capital formation. However, a positive and healthy transition from adolescence to adulthood can be achieved by increasing access to sexual and reproductive health information, education, and services. This paper documents emerging findings from an adolescent girls’ programme delivered in 56 districts of Ghana. Data were collected from girls and young women aged 10–24 years who participated in the programme as part of a larger study that included in-school and out-of-school participants. In-depth interviews (IDI) [N = 49] and focus-group discussions (FGDs) [N = 13] were conducted in November 2021 and November 2022. An abductive approach was used to develop key themes from the data. The analysis revealed that the programme showed promise in changing the attitudes of beneficiaries towards safe sexual practices through condom use, in increasing assertiveness towards sexual and gender-based violence, and in real-life application of the knowledge and skills gained for health and social wellbeing. Out-of-school sexuality education programmes such as the one described here can be important catalysts for developing and maintaining meaningful relationships with others through the provision of information and education, and service delivery.