Contraceptive Use Research Articles

Analysis of Fertility Determinants and Regional Disparities in Nigeria using Geo-Additive Regression

This study applied geo-additive regression modelling on high-dimensional data with metrical and categorical predictors, using data from the latest Nigeria Demographic and Health Survey (NDHS-6). The sampled data comprises ninety-three predictors of total children ever born by eighty women of age group between fifteen and forty-nine years. Three penalty-based variable selection criteria—Elastic Net, Smoothly Clipped Absolute Deviation (SCAD), and Minimax Concave Penalty (MCP) were employed to reduce the dimensionality of the data. Geo-additive regression model were thereafter applied on the selected predictors to determine the impact of metrical, categorical and spatial predictors on the response variable. Findings revealed that predictors such as contraceptive use, age at first birth, and marital status are major determinants of total children ever born by a woman in Nigeria. Furthermore, spatial analysis revealed regional disparities in fertility rates within Nigeria, with notably higher fertility rate in northeastern states. This study’s findings have broad applications across disciplines. By providing robust methodologies for handling complex datasets, this research supports evidence-based decision-making in public health, agriculture, and environmental policy. Ultimately, these findings contribute to efforts aimed at promoting sustainable development and enhancing maternal and child health outcomes in Nigeria and similar contexts globally.

The impact of COVID-19 pandemic on fertility behaviour in Indian states: Evidence from the National Family Health Survey (2019/21).

The COVID-19 pandemic affected a broad spectrum of people's lives very quickly. Although the pandemic could influence people's fertility behaviours in several ways, there is little knowledge about such influence in diverse socioeconomic and cultural settings. This study investigated the impact of the COVID-19 pandemic on fertility behaviours and desires among women in a lower-middle-income country, India. Our study analyzed cross-sectional data from 13 states and union territories (UTs) in India that were surveyed in pre- and post-lockdown periods by the 2019/21 National Family Health Survey (NFHS). The data were analysed using the descriptive analysis technique and the multilevel logit model. All these analyses were performed using the technique developed for complex sample design. The poverty-stricken states of Uttar Pradesh and Jharkhand and the Odisha state with moderate socioeconomic status experienced a significant decrease in contraceptive use and non-significant changes in the desire for birth and sexual activities after the lockdown. Contraceptive use significantly increased after the lockdown in the rich states of Punjab, Delhi, and Tamil Nadu, as well as in the Arunachal Pradesh state with moderate socioeconomic status. The changes in fertility behaviours in Uttar Pradesh, Jharkhand, and Odisha may influence fertility positively, while those changes in Punjab, Delhi, Tamil Nadu, and Arunachal Pradesh may influence fertility negatively. At the aggregate level, there was a significant increase in desire for another child and a decrease in contraceptive use after the lockdown, which may influence fertility positively but can be compensated by reduced sexual activities. The influence of the fertility trends in the states with pro-natalist changes on India's recent fertility trend could be greater than those with anti-natalist changes, which can be better understood by analyzing reliable data from a couple of years following the 2019/21 NFHS.

Determinants of Modern Contraceptive Use in Aceh Province in 2023

Determinants of Modern Contraceptive Use in Aceh Province in 2023

Estrogen administration enhances the adverse effects of cigarette smoking on the heart in cycling female mice

Smoking, particularly chronic smoking (CS), is a threat to global health, contributing to increased mortality and morbidity associated with cardiovascular disease (CVD). CS induces oxidative stress and endothelial dysfunction, which has a profound impact on cardiac structure and function. While the protective effects of estrogen, particularly 17β-estradiol (E2), on cardiovascular health are well-documented in premenopausal women, the interaction between estrogen and CS remains poorly understood. The aim of this study is to investigate the impact of chronic cigarette smoking on cardiac health in relation to ethinylestradiol (EE) oral contraceptive (OC) usage in premenopausal females. Female mice were exposed to chronic cigarette smoke and co-administered EE. Cardiac structural and functional parameters were assessed alongside inflammatory markers, oxidative stress indicators, and histological changes. Results revealed that the combination of EE and CS led to adverse cardiac remodeling characterized by increased left ventricular end-diastolic volume and elevated left ventricular mass. In addition, an inflammatory state was evident, marked by increased expression of IL-4, IL-1β, IL-13, IL-10, and PARP-1, as well as increased interstitial collagen deposition. These findings suggest a progression towards adverse cardiac remodeling resembling dilated cardiomyopathy. Furthermore, our observations highlight the complexity of the inflammatory response triggered by smoking, potentially exacerbated by estrogen supplementation. The main finding of this study is that the combination of CS and EE enhanced adverse cardiac remodeling, which was shown structurally, histologically, and biochemically.

Association of metalloestrogens exposure with depression in women across reproductive lifespan.

Exposure to metal could impact women's depression risk. However, the connection and mechanisms between metalloestrogens exposure and depression are still not fully understood. We aim to explore the associations between metalloestrogens and the risk of depression in women across reproductive lifespan. Using data from NHANES 2011-2018, we employed logistic regression and baknernel machine regression (BKMR) to study links between metalloestrogen exposure and depression in US women. We analyzed how contraceptive use affects this relationship. The study involved 3,374 adult women, with 345 of them experiencing depression. Our research revealed that certain metalloestrogens like Ba, Ca, Pb, Sb, and Sn were linked to higher depression risk in women, while Hg was associated with lower depression risk in older women. For women aged 18-44, a blend of metalloestrogens showed a significant positive correlation with depression risk, and the likelihood of depression in later years notably rose when the metal mixture concentration reached or exceeded the 60th percentile. Oral contraceptives would have an effect on the impact of metalloestrogen mixture exposure on depression in women during the reproductive stage. Our study indicates a significant link between metalloestrogen exposure and a higher risk of depression in adult women in the United States. This finding can aid in identifying the connection and enhancing women's mental well-being.

A Narrative Review of the Impact of Public Family Planning Policies and Programs on the Contraceptive Transition in Low‐ and Middle‐Income Countries

AbstractIn this paper, I provide a narrative review of the literature addressing the contribution of public family planning programs and policies to the contraceptive transition in low‐ and middle‐income countries. I address the long‐running debate between economists and demographers who examine the relative contribution of preferences compared to programs to fertility decline, but I steer the paper towards a deeper discussion of the kinds of programs that have been effective in shaping contraceptive use (not necessarily fertility). I will discuss why public family planning programs and policies are needed, and the differing motivations of governments, implementers, and program designers are also discussed. Specific country‐level policy examples are given for Peru, Rwanda, and Vietnam to illustrate how public programs affected contractive use in these cases. A variety of programs are reviewed for relative success (e.g., mass media, or postpartum family planning programs). The success (and failure) stories highlight the need to be attentive to context and external validity when scaling up or adapting programs to national‐level policies. The review highlights the types of programs and policies that have been successful and the context in which the successes occurred.

Contraceptive Coercion in Pre-Abortion Counseling: A Conversation Analysis

We explored how contraception is addressed in pre-abortion counseling, with a focus on the conversational strategies used by healthcare providers. We recorded 28 pre-abortion counseling sessions at three South African public hospitals and analyzed them using conversation analysis. In discussions about past contraceptive use, patients were often positioned as irresponsible and required to account for assumed inadequate contraceptive practices. This framing laid the groundwork for the coercive provision of post-abortion contraception, particularly long-acting reversible contraceptives (LARCs). Short-term users and younger patients were singled out, receiving repeated warnings about daily adherence or parental enforcement. Providers’ efforts to prevent the perceived “mistake” of abortion led to the use of coercive conversational tactics.

Contraceptive Care Visit Objectives and Outcomes: Evidence From Burkina Faso, Pakistan, and Tanzania.

Globally, care experiences of the growing population of contraceptive users are not well-understood. We leverage a large client dataset (n = 71,602) from three countries (Burkina Faso, Pakistan, and Tanzania) to characterize contraceptive services sought (visit objective and method preference), assess whether these visit objectives were met and for whom, and explore if visit objective fulfillment was associated with care quality. Most people in all three countries said they were seeking to continue their current method or adopt a method for the first time. Clients seeking to change their method were least likely to have their objective met: 63.7 percent of clients in Burkina Faso, 73.3 percent in Pakistan, and 61.1 percent in Tanzania who wanted to switch actually achieved this during the visit. In Burkina Faso, people with lower socioeconomic standing, lower educational attainment, and lower parity less commonly had their switching objective, fulfilled. Method preference fulfillment was generally high, although approximately 15 percent of Tanzanian clients were given implants despite wanting another method. Among those seeking to adopt or restart a method in Pakistan and Tanzania, having this visit objective fulfilled, was correlated with better perceived treatment and higher person-centeredness of care.

Intentions, Barriers and Attitudes towards Improving Postpartum Long-acting Reversible Contraceptive Usage among Pregnant Women in Urban Ghana

Aims: Long-acting reversible contraceptives (LARCs) are the most effective reversible methods of contraception with a failure rate of less than 1%. Despite their safety and effectiveness, LARCs are underutilized. This study investigated postpartum LARC use intentions and suggestions to improve postpartum LARC usage among pregnant women seeking antenatal care services in a Ghanaian Urban municipality. Study Design: A facility-based cross-sectional design. Place and Duration of Study: The study was conducted at the antenatal care unit of the Ashanti Regional Hospital in the Kumasi Metropolis of Ghana among 298 pregnant women from August to September, 2018. Methodology: A systematic sampling technique was conducted. A 55-item questionnaire containing socio-demographic, reproductive, intention and attitude, barriers and contraceptive knowledge characteristics was used to gather responses. A multivariable logistic regression analysis was done using (IBM-SPSS version 22.0) to determine predictors of the women’s intention and attitude towards postpartum LARC use. Results: Out of 298 pregnant women included for analysis, 33.9% had postpartum intentions to use LARCs. “I like implant for myself” (AOR=9.00, 95% CI: 4.75-17.05), “I like IUD for myself” (AOR=7.38, 95% CI: 2.93-18.58) and previous use of LARC (AOR=7.03, 95% CI: 2.41-20.52) were predictors of postpartum intentions to use LARC. Intensive education and “worried about the side effects” were the main recommendations and barriers to postpartum LARC usage respectively. Conclusion: Postpartum intention to use LARC was minimal. I like implant for myself”, “I like IUD for myself” and previous use of LARC were associated with intentions to use LARC postpartum. Intensive education and “worried about the side effects” were the main recommendations and barriers to postpartum LARC usage respectively. Attitudinal change towards LARC use through intensive education, easy accessibility of LARC and religious body involvement is key to increase postpartum LARC usage in Ghana and clearing its myths and misconceptions could advance modern contraceptive usage.

Young men's everyday life experiences with contraception and unintended pregnancy in Papua New Guinea.

Unintended adolescent pregnancy is a public health priority in Papua New Guinea (PNG), where national policies specify need for easier access to reliable modern contraceptives. To reduce young people's experiences of unintended pregnancy in PNG, improved understandings of use of modern and other forms of contraception within young people's relationships is required to support the development of new sexual and reproductive health (SRH) programs and policies. The aim of this paper is to understand young men's use of modern and other contraceptives. This qualitative study involved semi-structured interviews with 35 sexually active young men aged 15-24 years, who were sampled purposively from the general population within community-based settings. Data were analysed using inductive thematic analysis techniques. Our analysis of young men's everyday experiences of using condoms and other contraceptives highlights clear drivers of unintended adolescent pregnancies. Across three settings, these included non-use of any modern method at first sex or during early sexual experiences; inconsistent use of condoms, often only after first pregnancy experiences; difficulties accessing condoms from health service providers, pharmacies and stores; a lack of understanding of other modern contraceptive strategies; inconsistent use of the withdrawal method; and inconsistent and incorrect use of calendar approaches due to misunderstandings about women's fertile period. Ten young men had never used any form of contraception. These occurred largely because young men's sexual agency is constrained within sexual and peer relationships, and community, school and health service settings, in ways that inhibit pregnancy prevention. It is important to engage meaningfully with young men to build sexual and reproductive health policies and programs that pay honest, respectful attention to young people's everyday sexual and social lives. Young men's everyday stories provide a unique lens through which we can identify mechanisms of change required to address the health and social inequities associated with unintended pregnancy among young men and young women in PNG and beyond.

Healthcare provider communication and current contraceptive use among transgender men and gender-diverse people: results from an online, cross-sectional survey in the United States.

To explore whether discussing contraceptive use with a healthcare provider is associated with current contraceptive use among transgender men and gender-diverse (TMGD) individuals. In 2019, we conducted a cross-sectional survey among transgender men and gender-diverse adults in the United States who were assigned female or intersex at birth. We measured whether respondents had ever discussed contraception with a healthcare provider as well as current use of contraception, reasons for use, and barriers to use. We described frequencies and ranges for key variables and implemented a series of nested logistic regression models to evaluate the association between ever having spoken to a provider about contraception and current use of contraception for any reason, overall and by method type. Among 1,694 respondents, about half (48%) were currently using a method of contraception for any reason, most commonly barrier methods (17%) and long-acting-reversible-contraception (LARC) (17%). Compared to those who never had a conversation about contraception with a provider, respondents who spoke with a provider were more likely to be currently using contraception - particularly among those who self-initiated the conversation (aOR: 3.8, 95% CI: 2.5-5.6). Having discussed contraception with a healthcare provider was most strongly associated with current LARC use. Having had a conversation with a provider about contraception use was positively associated with current contraception use among a large, national sample of transgender men and gender-diverse people. Facilitating patient participation in contraception counseling for transgender and gender-diverse patients should be emphasized in provider training. Given formidable barriers to healthcare faced by TMGD people, training providers on how to initiate affirming and relevant conversations with TMGD patients about contraceptive needs and preferences is essential, as are efforts to educate and empower TMGD individuals to advocate for the information they need in these interactions.

Analysis of risk factor microflora colonization on pregnancy vagina in makassar

Introduction: Worldwide infection rates based on estimated 20-30 % colonization at 35 weeks gestation. During normal pregnancy colonization transient, intermittent, or chronic infection and the spectrum varies from asymptomatic colonization to the sepsis. Intrapartum transmission of bacteria from mother to neonatal, will cause the infection develops into neonatal sepsis during childbirth. This study aimed to determine the proportion of the colonization of gram positive and negative bacteria in pregnant women over 31 weeks of age. Research Methodology: This research uses vaginal swab samples from pregnant women and blood samples from babies who are born, then these samples will be examined in the Unhas Hospital laboratory. Vaginal swab samples via transport medium will be placed in BHIB medium then incubated at 270 C for 24 hours. Result: Prevalence of gram-positive bacterium identified Streptococcus species (0.9%), S. Aureus (11.8%) and S. Epidermidis (78.4%). For gram-negative bacteria had identified; Enterobacter Sp (32.3%), Providencia Sp (12.7%), Proteus Sp (8.8%), Acinetobacter sp (5.9%) and E. Coli (6.9%). Candida Sp obtained on SDA culture and gram staining followed by a number of 54 samples (55.1%). The symptom was to be is Discharge Vagina over 30% cases. Among 76.6% with habitually antiseptic usual. Based on data statistical analysis can be concluded that the age have a significance level 0:01 (ρ < 0.05) .and contraceptive used have a significance level of 0.038 (ρ < 0.05), had a relationship with a potential fetomaternal infection to infant. Conclusion: that maternal age and history of contraceptive use are significantly associated with bacterial colonization in pregnant women. These findings underscore the need to consider demographic and behavioral factors when assessing and managing vaginal health during pregnancy. Effective educational interventions focusing on proper hygiene practices and the risks associated with antiseptic soap use, coupled with targeted monitoring of older pregnant women and those with a history of contraceptive use, are recommended to reduce the risks associated with vaginal microbial colonization

Assessment of services provided by urban ASHAs to mothers of urban slums in Lucknow district – A cross-sectional study

ABSTRACT Context: Maternal and child health is an important public health issue which indicates the level of socioeconomic development in any country. Urban accredited social health activist (U-ASHA) workers in India are the main front-line urban health workers in primary health care delivery for slum and urban poor. Aims: To assess the services provided by U-ASHA workers to mothers of urban slums for antenatal and postnatal care. Settings and Design: Cross-sectional study in urban slums of Lucknow where recently delivered women (up to 2 years) were selected. Methods and Material: To include the desired sample size of 320 recently delivered women (RDW), the U-ASHAs of the selected slums were contacted and a list of RDWs was made for each slum. By simple random sampling, 20 RDWs were selected from each slum. A predesigned and pretested interview schedule was used for data collection. Statistical Analysis Used: SPSS-version-26 was used. P <0.05 was considered statistically significant. Results: The registered pregnancies were 95%. Only 43.1% of RDW had at least four ANC visits. The institutional delivery was 84.7%. Only 27.7% of RDW visited health facilities for PNC services. About 39.4% received Janani Suraksha Yojana incentives. Contraceptive users were only 41.9%. Counseling by U-ASHA workers regarding all the ANC and PNC services had better utilization among counseled RDW except for child-care counseling. Conclusions: Counseling services regarding ANC and PNC services have a significant impact on their utilization. Better results can be achieved if the counseling by U-ASHA is enhanced to reach out more beneficiaries.

Contraceptives and conditioning: Different profiles of fear and expectancy ratings during fear conditioning and extinction according to menstrual cycle phase and hormonal contraceptive use.

Hormonal contraceptives (HC) such as the oral contraceptive pill (OC) and the hormonal intrauterine device (IUD) have been associated with depressed mood, but research on their role in anxiety is scarce and inconsistent. In a fear acquisition and extinction paradigm, self-report fear, expectancy, and skin conductance responses (SCR) were assessed, along with sex hormone levels. Naturally cycling (NC) participants were measured during the mid-follicular and mid-luteal phases (within subjects, n = 26) and compared with OC (n = 36) and IUD (n = 25) users. IUD users and -participants in the luteal phase showed overall reduced self-reported CS+ vs CS- differentiation compared to the follicular phase and OC use (which both reflect relatively low levels of endogenous gonadal hormones). This overall reduced differentiation in self-reported fear in the luteal phase was attributed to a generalization of fear from CS+ to CS-. NC-individuals with high premenstrual syndrome (PMS) ratings had higher overall fear ratings regardless of cycle phase. For SCR, hormonal status effects were restricted to specific experimental phases during acquisition. SCR to the CS+ was higher at the end of acquisition in the luteal phase compared to the follicular phase, and in OC users during early acquisition (compared to the follicular phase) and mid acquisition (compared to the IUD group). There were no direct associations with sex hormone levels. These findings demonstrate the impact of menstrual cycle and HC use on fear learning and highlight the need for further research that considers different outcome measures across a wide array of menstrual cycle and HC-related characteristics.

Association of the number of pregnancies and births with cognitive performance in older postmenopausal women: a cross-sectional study.

Cognitive impairment in the elderly is a serious public health problem. However, the effect of the number of pregnancies and births in the early years of life on cognitive function in postmenopausal women remains controversial. This study aims to investigate the relationship between these two factors. We used the National Health and Nutrition Examination Survey 2011-2014 data on women aged ≥60 years. This study included sociodemographic data, history of estrogen use, and contraceptive use as confounding variables. The combined scores of the Consortium to Establish a Registry for Alzheimer's Disease Word Learning (CERAD-WL), delayed word recall (CERAD-DR), the Animal Fluency test (AF), and the Digit Symbol Substitution Test (DSST) were used to assess the cognitive performance of participants. Hierarchical multiple regression analysis explored the relationship between the number of pregnancies and births and cognitive function. The study screened 1,259 postmenopausal women and found that 24.3% had low cognitive performance. The study found a significant increase in low cognitive performance among older adults, Mexican Americans, those with a lower education level and poverty-income ratio, those who were widowed, and those with diabetes and hypertension (P < 0.001). In the multiple regression analysis, the number of pregnancies remained a significant determinant of cognitive performance (B = -0.188, P < 0.001). The number of pregnancies was associated with cognitive performance in a population of postmenopausal women in the United States. A lower number of pregnancies is associated with better cognitive performance.

Increase in Lipid Levels With Oral Contraceptive Use

Increase in Lipid Levels With Oral Contraceptive Use

Assessment of satisfaction of using socially marketed health consumables at government settings among beneficiaries in a rural area of Hooghly District, West Bengal

ABSTRACT Introduction: India is committed to achieving universal health care for all by 2030. The objective of social marketing is to promote public health and its goal is to improve health for all, but there are some challenges like irregular availability, quality issue, inadequacy of marketing causes under- utilization of the government supplied health consumables. Objectives: Present study aims to find out the usage pattern and assess the perceived satisfaction level of beneficiaries of using various socially marketed health consumables at government settings and explore the perception of healthcare personnel regarding barriers to its usage in a rural area of India. Materials and Methods: A community-based, Mixed-Methods study (Convergent parallel design) was done in the service area of the Rural Health Unit and Training Centre (RHU&amp;TC), Singur of Hooghly district, West Bengal, between January 2023 and December 2023, where the quantitative component was carried out by face-to-face interview among 150 beneficiary household respondents selected by two-stage cluster sampling; and qualitative component was done by 4 Key informant interviews (KII) among healthcare personnel (medical officer, public health nurse, pharmacist). Statistical data were analyzed by descriptive statistics using SPSS 16 version and Microsoft Excel for the quantitative part, and thematic analysis was done for the qualitative part. Institutional Ethics Committee clearance was obtained. Results: Ever use of government-supplied contraceptives like Chhaya (Ormeloxifene), Antara (Injectable contraceptive), emergency contraceptive pills, and intrauterine contraceptive devices (IUCD) was done by only 15.3%, 10.7%, 7.3%, 32% of eligible beneficiary households, respectively. The major reasons cited for irregular use were unawareness of availability of the products (Chhaya = 76.3%, Antara = 64.9%, EC pills = 46.7%), poor faith regarding quality (Male condom = 40%, Generic medicines = 70%), inadequate promotion (IUCD = 53.9%). The majority of users of male condoms (90%), IFA tablets (52.9%), ORS (51.1%), and generic medicines (55.7%) were not satisfied after using those products. Key informant interviews among healthcare personnel revealed avoidance of using modern contraceptive methods and frequent unavailability of some socially marketed health consumables were the predominant causes of reduced uptake of those products by beneficiaries. Conclusions: Proper social marketing strategies, adequate promotion, regular awareness campaigns, and tailored training of field healthcare workers are required to improve the acceptability, availability, and marketing of these health consumables.

Evolution of contraceptive methods usage among women aged 15-49: comparative analysis between regions of Northern Argentina, 2011-2012 and 2019-2020

Introducción: El acceso a métodos anticonceptivos modernos constituye un determinante clave en la salud sexual y reproductiva, particularmente en regiones con desigualdades socioeconómicas. En Argentina, diversas políticas públicas han buscado garantizar este acceso, especialmente en las regiones del Norte del país. Objetivo: Analizar las variaciones en el uso de métodos anticonceptivos entre mujeres de 15-49 años en Argentina, con énfasis en las regiones NOA y NEA durante 2011-2012 y 2019-2020, examinando su distribución según estratos socioeconómicos. Materiales y métodos: Estudio cuantitativo, transversal descriptivo. Se analizaron datos de las Encuestas Nacionales de Indicadores Múltiples por Conglomerados (MICS) 2011-2012 (n=20844) y 2019-2020 (n=11763). Se realizó análisis comparativo de prevalencias con intervalos de confianza del 95%. Resultados: Se observó un incremento significativo en el uso de métodos anticonceptivos en Argentina (57,69% a 61,33%) y NOA (43,78% a 57,46%) entre 2011-2012 y 2019-2020. Los implantes subdérmicos mostraron el mayor aumento en adolescentes del NOA (0% a 35,24%) y NEA (0% a 32,59%). En los quintiles más pobres, el uso de anticonceptivos aumentó significativamente, especialmente en el NEA (31,04% a 52,30%). Conclusión: El incremento en el uso de métodos anticonceptivos modernos, particularmente en poblaciones vulnerables del Norte argentino, sugiere un impacto positivo de las políticas públicas implementadas, especialmente del Plan ENIA, en la mejora del acceso a la anticoncepción.

From Menarche to Menopause: Exploring reproductive health awareness among pakistani women

Introduction: Women's reproductive health knowledge is crucial for their well-being, particularly in LMICs like Pakistan, where cultural barriers often prevent open discussions. This study explores the reproductive health awareness among Pakistani women, focusing on menstruation, contraception, STD prevention, pregnancy, and menopause. Methods: Data were collected from 125 Pakistani women aged 15–49, covering demographics, menstrual knowledge, STD awareness, contraception, AIDS awareness, menopause, and general reproductive health knowledge. Results: Participants, aged 17–46, were mostly married, urban, educated, and from middle-income backgrounds. Only 45.6% knew about menarche before it occurred, and 54% received counseling at its onset. Medical help was preferred for fertility issues, but traditional methods were used for pregnancy termination. While 65.6% were aware of STDs, awareness was higher in urban areas. Only 37% were aware of menopause-related health risks. Contraceptive use was low, with educated women showing better timing knowledge. About 59% knew about AIDS, with media as a primary source. The term “reproductive health” was unfamiliar to 78% of participants. Cultural norms, shyness, and limited sources were reported as major barriers. Discussion: Significant gaps in reproductive health knowledge highlight urban-rural disparities and the influence of cultural barriers. Women sought medical advice for fertility but relied on traditional practices for terminations. Effective educational initiatives could address misconceptions, especially around STDs, contraception, and menopause. Conclusion: Reproductive health education in Pakistan is essential for empowering women. Enhanced programs, culturally sensitive approaches, and accessible platforms are needed to address knowledge gaps, enabling informed decisions and better health outcomes.

Risk beyond the pap: A review of key epidemiological studies on cervical cancer risk factors and populations at highest risk

Cervical cancer remains a significant public health concern, with notable mortality rates worldwide despite advancements in screening technologies such as the Pap smear. While screening has substantially reduced the disease's incidence, understanding risk factors that extend beyond regular screening practices is essential for comprehensive cervical cancer prevention. This review synthesizes key epidemiological studies focused on the various biological, lifestyle, and demographic factors influencing cervical cancer risk, thereby identifying the populations at the highest risk. The methodology encompasses rigorous selection criteria, including studies from renowned databases such as PubMed and Scopus, and evaluates the strengths and limitations of common epidemiological study designs like case-control and cohort studies. The review categorizes risk factors into four primary areas: HPV infection, smoking, sexual behavior and contraceptive use, and genetic predisposition, each substantiated by evidence from recent epidemiological research. Additionally, it assesses populations facing elevated risk, such as those influenced by socioeconomic, geographic, and ethnic disparities, as well as immunocompromised and age-defined groups, to outline how these variables affect cervical cancer susceptibility. The findings underscore persistent disparities in cervical cancer incidence, especially among underserved and minority populations, where access to healthcare and awareness of risk factors remain limited. This review emphasizes the importance of addressing these disparities through targeted public health policies and enhanced screening protocols. Finally, the paper recommends future research directions, highlighting the need for longitudinal and multi-population studies to better understand the complex interplay of risk factors. Insights from this review can inform public health initiatives and shape preventative measures that extend beyond screening to reduce cervical cancer risk across vulnerable populations.