Provision Of Reproductive Health Services Research Articles

Integrating reproductive health into community development and social work: Strategies for effective engagement and empowerment

The integration of reproductive health into community development and social work represents a critical endeavor in promoting holistic well-being and empowerment at the grassroots level. This review highlights strategies for effective engagement and empowerment within this framework. Firstly, a comprehensive understanding of the community's socio-cultural context is imperative. Cultural sensitivity and competence enable practitioners to navigate sensitive reproductive health issues within diverse communities. Utilizing ethnographic approaches and community-based participatory research facilitates the identification of local beliefs, practices, and barriers related to reproductive health. Secondly, building collaborative partnerships with key stakeholders is essential. Engaging local leaders, healthcare providers, educators, and religious institutions fosters buy-in and facilitates the development of culturally relevant interventions. These partnerships enhance the reach and sustainability of reproductive health initiatives by leveraging existing community resources and networks. Thirdly, incorporating a rights-based approach is fundamental for empowering individuals and communities. By promoting reproductive rights, including access to comprehensive sexuality education, contraception, and safe abortion services, practitioners empower individuals to make informed choices about their sexual and reproductive health. Moreover, advocating for gender equality and addressing harmful gender norms and practices are integral components of fostering reproductive autonomy and empowerment. Furthermore, capacity-building efforts play a pivotal role in enhancing community resilience and sustainability. Equipping community members with knowledge and skills in reproductive health education, advocacy, and service provision enables them to take ownership of their health and drive sustainable change within their communities. Finally, leveraging innovative technologies and communication channels enhances the accessibility and effectiveness of reproductive health interventions. Mobile health applications, telemedicine, and social media platforms provide avenues for disseminating information, delivering services, and promoting dialogue on reproductive health issues. Integrating reproductive health into community development and social work requires a multi-faceted approach that prioritizes cultural competence, collaboration, rights-based empowerment, capacity-building, and innovation. By employing these strategies, practitioners can effectively engage communities and empower individuals to achieve optimal reproductive health outcomes and overall well-being.

Perception and Attitude of Health Care Workers in Tertiary Health Care Facilities in Plateau State, Nigeria towards Sexual and Reproductive Health Services for Unmarried Adolescents

Adolescents are faced with the challenges of having access to and the utilization of quality sexual and reproductive health services, and one of the barriers responsible for this situation is the negative personal attributes of service providers. This study aimed to assess the perception and attitude of health workers in the tertiary health facilities in Plateau State towards sexual and reproductive health services for unmarried adolescents. A cross-sectional study was conducted in December 2020 among 208 doctors and nurses/midwives who were selected using a stratified sampling technique. Data were collected using a semi-structured self-administered questionnaire and analyzed using the Statistical Product and Service Solutions version 23. The mean age of the respondents was 37.1 ± 9.1 years, 131 (63.0%) were doctors and females constituted 120 (57.7%). One hundred and twenty-nine (62.0%) had a good perception, while 105 (50.5%) had a positive attitude towards sexual and reproductive health services for unmarried adolescents. Younger age below 55 years and a good perception were found to be predictors of a positive attitude towards sexual and reproductive health services for unmarried adolescents. A considerable number of the health workers in the tertiary health facilities in Plateau state had a negative attitude towards sexual and reproductive health services for unmarried adolescents, an attribute that was significantly seen more in those who were older and had a poor perception. There is a need to improve healthcare workers’ attitudes towards the provision of sexual and reproductive health services for unmarried adolescents.

US public opinion about reproductive health care in school-based health centers

ObjectivesThis study aimed to examine public support for the provision of seven reproductive health services in school-based health centers, including pregnancy testing, over-the-counter contraceptives, prescription (Rx) contraceptives, sexually transmitted disease testing, sexually transmitted disease treatment, gynecological examinations, sexual violence counseling, and an index measure combining all services. Study designWe administered a large national online survey (N = 4196, response rate 31%) of US adults using Lucid, a large, internet-based, opt-in panel to assess public attitudes about offering sexual and reproductive health services in school-based health centers. We then used t tests and weighted linear regression models to carry out our study objectives. ResultsUnadjusted analysis revealed that 60% of respondents supported the provision of all reproductive health services (combined) at school-based health centers. Regression analysis based on the index measure suggested that individuals identifying as Trump voters (p-value = 0.00) or conservatives (p-value = 0.00) reported the lowest support, while those identifying as liberal (p-value = 0.00) reported the highest support, controlling for demographic and health characteristics. ConclusionsRespondents overwhelmingly support the provision of reproductive health services at school-based health centers, including pregnancy testing, over-the-counter contraceptives, prescription contraceptives, testing and treatment for sexually transmitted infections, and sexual violence counseling. ImplicationsAdolescence is an important stage for sexual maturation, and access to appropriate sexual and reproductive health services can support healthy development into adulthood. Findings suggest that most respondents support the provision of reproductive health services at school-based health centers while there are important factors that influence public support.

Adolescents' perspectives regarding their communication with reproductive health service providers in Rwanda: an explorative study.

Adolescents in low-middle-income countries often face limited access to health information and services due to several different factors. Ineffective communication between healthcare providers and adolescents is among them. This study aims to assess adolescents' perspectives regarding their communication with reproductive health service providers in Rwanda. A phenomenological exploratory qualitative study was used. Eleven focus group discussions were conducted among adolescents aged 10 to 19years between December 2020 and January 2021. All participants were identified through their respective health care providers in youth-friendly centres available in the Kigali district representing the urban area and Kamonyi district representing the rural area. All interviews were transcribed and translated into English and analysed by using thematic content analysis. Poor communication between healthcare providers and adolescents was identified and attributed to the judgmental attitudes of some healthcare providers, while good communication was cited by many adolescents as an important key of access to services. All adolescents were eager to access reproductive health services and be educated about reproductive health issues. Effective communication is essential when it comes to providing reproductive health services, as this establishes a strong relationship between a service provider and an adolescent who wants to talk about their concerns, while poor communication prevents adolescents from asking questions about unknown topics.

The provision of sexual and reproductive health information and services to travellers: an exploratory survey of Australian travel medicine clinicians.

International travel can increase the risk of exposure to infectious diseases including sexually transmissible infections (STI). Pre-travel medical consultation provides an opportunity for travel-related health risk assessments and advice. This study explored how travel medicine clinicians integrate sexual and reproductive health (SRH) services into clinical practice. A convenience sample of travel medicine clinicians completed a cross-sectional survey online or via hard-copy disseminated at an annual national Australian travel medicine conference. Of the 67 respondents, most (n, 51; 76.1%) had a postgraduate qualification relevant to travel medicine and 55.2% (n, 37) had worked in travel medicine for over 10years. Only 22.4% (n, 15) reported conducting a SRH history/STI risk assessment for all travel patients. STI testing pre-departure was conducted on patient request (48, 71.6%), if symptomatic (32, 47.8%) or based on risk history (28, 41.8%). SRH information pre-departure was most frequently provided if prompted by patient questions (n, 42; 62.7%), or based on the patient's history (n, 37; 55.2%). Over half the sample (n, 40; 59.7%) expressed interest in further training in SRH. Providing and engaging with additional training may assist travel medicine clinicians to take a more proactive approach to SRH consultations and STI testing. Additional research is needed to explore models of care that will allow comprehensive SRH and STI services to be integrated into standard pre- and post-travel care.

Community health volunteers' performance in rural areas of Yemen: a community-based satisfaction survey.

Many developing countries utilize the services of community health volunteers (CHVs) to enhance healthcare services in underserved regions. Evaluating client satisfaction with CHVs' performance is crucial for ensuring the effective utilization of their services. This study aims to assess clients' satisfaction with the provision of basic reproductive health services by CHVs in the governorates of Ibb and Al Mahweet, Yemen. A cross-sectional study was conducted, collecting data via structured questionnaires administered by trained data collectors to clients of CHVs. A total of 510 households were interviewed, with 255 from each governorate, distributed across 30 clusters (villages). Each governorate comprised 15 clusters in 12 districts (six districts in Ibb and five in Al Mahweet, excluding one district for security reasons). Within each cluster, 17 households were randomly selected for interviews. Descriptive analysis was performed using the SPSS version 22. The majority of the clients were female (84.7%), most were aged 20-39 years (55.7%), and more than half of them had received at least primary education (54.2%). The study findings indicate that a significant proportion of respondents were highly satisfied with CHVs' performance (93%). Almost all respondents confirmed that CHVs resided in their villages (94%) and were easily accessible for consultation (99%). Most of the respondents (97%) expressed trust in the CHVs, stating that they were helpful to all villagers and treated them well. Additionally, nearly all the respondents reported easy access to services (98.6%), although a considerable percentage experienced a gap of three months or more since their last interaction with a CHV (39.1%). The CHVs contribute to the well-being of the rural populations in Yemen by delivering satisfactory services, particularly regarding family planning. However, ensuring the sustainability of the CHV programs remains a challenge, which requires attention from the program managers and decision makers in the Yemeni healthcare sector.

Perceptions of youth-friendly sexual and reproductive health services in selected Higher and Tertiary Education Institutions of Zambia: A qualitative study on the perspectives of young people and healthcare providers.

The recognition of the need for Adolescent and Youth-Friendly Health Services (AYFHS) is growing. It is important to ensure the provision of high-quality sexual and reproductive health (SRH) services that cater to the unique needs of adolescents and young people (AYP). Adolescents and young people spend a significant amount of time in Higher and Tertiary Education Institutions (HTEIs) where adolescent friendly services are needed. However, there is limited evidence on the availability of sexual and reproductive health services for young people in HTEIs in Zambia. Using the Human Rights Based Approach to healthcare availability, accessibility, acceptability, and quality of care (AAAQ) framework, this study explores young people's perceptions of youth-friendly sexual and reproductive health services in selected HTEIs in Zambia. Between March and June 2021, a qualitative case study was conducted in 12 selected HTEIs located in Lusaka, Central, and Copperbelt provinces of Zambia. The study employed In-depth Interviews (IDIs) and Focus Group Discussions (FGDs) with AYPs, as well as Key-informant Interviews (KIIs) with healthcare providers. The healthcare providers at health facility, district and provincial levels were interviewed to provide insights about the services provided in the HTEIs. A total of 112 interviews were conducted. Data analysis was performed using thematic analysis in NVivo version 11. In the study, young people reported the availability of primary health services like malaria, HIV, and pregnancy testing, as well as screening for STIs. However, their awareness of SRH services was limited. Contraception, STI testing and treatment, and HIV and pregnancy screening and testing were the most accessed services. Equipment and commodity shortages were common, hindering care provision. Young people found healthcare services in educational institutions inaccessible, with limited comprehensive care and understanding from providers. Services lacked tailoring for key populations and privacy/confidentiality. Health care providers also reported inadequate youth-friendly spaces, equipment, medication and trained workers which compromised the quality of care. Peer educators and provider training were seen as essential for improving accessibility and acceptability of services. The findings indicate significant barriers to the accessibility, availability, and acceptability of SRH services for AYP in HTEIs in Zambia. There is a pressing need to enhance AYSRH programming by increasing awareness of services and ensuring their availability and accessibility for young people. Sufficient funding for AYFHS can address challenges related to service quality, including inconsistent availability of medical equipment and supplies. Building the capacity of service providers can potentially enhance the uptake of services by AYP. It is crucial to target services to address the specific vulnerabilities of students with disabilities and key populations, aligning with the goal of achieving universal health coverage and leaving no one behind.

Impact of a capacity-building intervention on views and perceptions of healthcare providers towards the provision of adolescent sexual and reproductive health services in southeast Nigeria: a cross-sectional qualitative study

ObjectivesNegative views of healthcare providers towards adolescent sexual and reproductive health (SRH) services deter adolescents from seeking vital SRH services. This paper assessed the impact of an intervention on the...

Reproductive care in community health centers: Multi-method evaluation of the Illinois Contraceptive Access Now (ICAN!) demonstration program

ObjectivesNearly one-third of low-income women of reproductive age in the U.S. receive care in federally qualified community health centers, but comprehensive reproductive care is not consistently provided. Illinois Contraceptive Access Now (ICAN!) is an initiative addressing the access gap to high-quality contraceptive care with a focus on normalizing reproductive health screening for patients in federally qualified community health centers (FQHCs). Study designThis multi-method program evaluation used the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, with retrospective and prospective data collection from three Illinois FQHCs who participated as Quality Hubs, and from a Community Advisory Board. We conducted descriptive analysis of patient surveys using the Person-Centered Contraceptive Counseling (PCCC) measure (n = 142); clinician and staff pre-and post-training surveys (n = 210); and Community Advisory Board surveys (n = 8) collecting quantitative and qualitative feedback. We ran logistic regression on claims data from 15- to 49-year-old patients identified as female at birth (n = 103,756). ResultsReach assessment showed patients receiving contraceptive or preconception care increased from 1063 per month in 2020 to 1236 per month in 2021 (16% increase), while general volume increased 2%. Effectiveness showed most patients (78%) described the quality of contraceptive counseling as “excellent” on the PCCC. Adoption assessment showed knowledge increases after clinical training on Modern Contraception (85% pre-training, 95% post-training) and Reproductive Justice (RJ) (58% pre-training, 70% post-training). Implementation assessment found that most Community Advisory Board members felt ICAN! was responsive to community needs. ConclusionsThe ICAN! demonstration year increased provider knowledge and volume of reproductive care at three Illinois FQHCs. ImplicationsContraceptive access initiatives that operationalize same day access to birth control methods while training FQHC providers on RJ and modern contraception, show promise on several measures. Early evidence from ICAN! indicates increased reproductive health service provision, as well as increases in provider knowledge of RJ and modern contraceptive care.

Syrian refugee women’s access to family planning services and modern contraception during overlapping crises in Bekaa, Lebanon

BackgroundPolitical, financial, and pandemic crises in Lebanon have affected both provision of reproductive health services including family planning and modern contraception methods as well as women’s interest and ability to seek those services. This study aims to explore the impact of the compounding crises on the provision and use of family planning services including modern contraception methods for Syrian refugees in Lebanon focusing on the perspectives of Syrian refugee women.MethodsWe carried out 12 Focus Group Discussions (FGDs) with 119 Syrian refugee women recruited from two cities in West Bekaa, Lebanon from inside and outside the informal tented settlements. We used Skype video calls to moderate the FGDs due to the limited mobility at the time of the study because of Covid-19. We used thematic analyses to analyse the data.ResultsThe crises seemed to exacerbate supply side barriers, which influenced provision of family planning services and women’s demand for them. These included Covid-19 regulations and maltreatment by staff at public health facilities, disruption of outreach reproductive health services that provide family planning and modern contraception, and reduced supply of modern contraception methods. On the demand side, women reported financial limitations in accessing and paying for services, concern over being infected with Covid-19, and concerns about insecurity.ConclusionsWe suggest possible interventions to address these challenges and better reach these populations. These include using mobile health technology (mHealth) that may provide contraceptive counselling and/or can inform refugee women about where they may receive family planning and modern contraception. These services may also support Syrian refugees to access care they are entitled to receive and may also address disruptions in service provision due to overlapping crises, including availability and rising costs of contraceptives. These can be coupled with mobile outreach reproductive health services that provide family planning. We also suggest considering the provision of Long Acting Reversible Contraception (LARC) for Syrian refugee women, which would reduce a barrier of needing to revisit health facilities to obtain an additional supply of contraception pills.

Awareness of Policy Frameworks that Affect the Provision and Utilization of Sexual and Reproductive Health Services among University Students in Nairobi City County, Kenya

Purpose: the study sought to determine awareness of SRH policy frameworks that impact on the provision and utilization of SRH services among university students.
 Methodology: The study used a cross sectional research design complemented by exploratory research design. The study was conducted in the main campuses of two public universities namely Kenyatta University and Multimedia University and two private universities, United States International University- Africa, KCA-University in Nairobi County in Kenya. The target population were students aged between 18-25 years studying in universities with main campuses in Nairobi County. The total study population was approximately 192,193 students. The study applied stratified random sampling to identify the 370 students who completed the study questionnaires. Purposive sampling was used to select the students and staff who participated in in-depth interviews. The students who participated in focus group discussions were randomly selected. 
 Findings: The study found out that most students, 95 (25.7%) reported to be aware of the Constitution of Kenya (2010) followed by 74 (20%) students who reported to be aware of the National Reproductive Health Policy (2007). When looking at the university level policy frameworks, most students, 229 (61.9%) split in almost equal numbers, male, 120 (32.4%) and female, 109 (29.5%) are aware of the university HIV/AIDS policy. The surveyed students who said they were not aware of any university SRH policies were 94 (25.4%), split in equal numbers between male and female students. The findings indicate low awareness of SRH policy frameworks by either gender which can be interpreted to mean that participation of the students in the development of the policy frameworks and dissemination of the developed policies is poor.
 Recommendations: The study’s recommendation to universities is to regularly disseminate national and university level SRH policy frameworks to the students. This can be done during orientation, as part of their studies and on special days convened to sensitize the students on their health.

Training in Residency and Provision of Reproductive Health Services Among Family Medicine Physicians

Contraception and abortion services are essential health care, and family medicine (FM) physicians are an important part of the workforce providing this care. Residency could inform the reproductive health services FM physicians provide. To determine which residency training factors are associated with FM physicians' provision of reproductive health services to Medicaid beneficiaries. This cross-sectional, population-based observational study of inpatient and outpatient FM physicians who completed residency between 2008 and 2018 and treated at least 1 Medicaid beneficiary in 2019 was conducted from November 2022 to March 2023. The study used 2019 American Medical Association Masterfile and Historical Residency file, as well as the 2019 Transformed Medicaid Statistical Information System claims. Residency training in community-based or reproductive health-focused programs. The outcomes were providing the following to at least 1 Medicaid beneficiary in 2019: prescription contraception (pill, patch, and/or ring), intrauterine device (IUD) and/or contraceptive implant, and dilation and curettage (D&C). Odds of providing each outcome were measured using correlated random-effects regression models adjusted for physician, residency program, and county characteristics. In the sample of 21 904 FM physician graduates from 410 FM residency programs, 12 307 were female (56.3%). More than half prescribed contraception to Medicaid beneficiaries (13 373 physicians [61.1%]), with lower proportions providing IUD or implant (4059 physicians [18.5%]) and D&C (152 physicians [.7%]). FM physicians who graduated from a Reproductive Health Education in Family Medicine program, which fully integrates family planning into residency training, had significantly greater odds of providing prescription contraception (odds ratio [OR], 1.23; 95% CI, 1.07-1.42), IUD or implant (OR, 1.79; 95% CI, 1.28-2.48), and D&C (OR, 3.61; 95% CI, 2.02-6.44). Physicians who completed residency at a Teaching Health Center, which emphasizes community-based care, had higher odds of providing an IUD or implant (OR, 1.51; 95% CI, 1.19-1.91). In this cross-sectional study of FM physicians providing Medicaid service, characteristics of residency training including community-based care and integration of family planning training are associated with greater odds of providing reproductive health services. With growing reproductive health policy restrictions, providing adequate training in reproductive health is critical to maintaining access to care, especially for underserved populations.

Community Pharmacists' Experiences and Attitudes towards the Provision of Sexual and Reproductive Health Services: An International Survey.

Access to comprehensive sexual and reproductive health (SRH) services remains a challenge worldwide. Describing community pharmacists' SRH services in countries with different scopes of practice will aid in understanding how pharmacists view their roles and how to support them in providing needed services. A cross-sectional web-based survey was administered to pharmacists working in community pharmacies in Japan, Thailand, and Canada. The survey covered 7 SRH categories: pregnancy tests, ovulation tests, contraception, emergency contraception, sexually transmitted and blood-borne infections, maternal and perinatal health, and general sexual health. Descriptive statistics were used to analyze the data. A total of 922 eligible responses were included in the analysis (Japan = 534, Thailand = 85, and Canada = 303). Most Thai and Canadian participants reported dispensing hormonal contraceptives (Thailand = 99%, Canada = 98%) and emergency contraceptive pills (Thailand = 98%, Canada = 97%). Most Japanese participants provided patient education on barrier contraceptives for men (56%) and information on the safety of medications in pregnancy (74%) and breastfeeding (76%). The majority of participants expressed interest in additional training and expanding their roles in SRH. Sharing international experiences can guide challenges faced by the evolution of pharmacists' practice in SRH. Providing pharmacists support could help their readiness for this role.

An Assessment of Community Pharmacists' Competence and Involvement in Adolescent Sexuality Education and Reproductive Health Services.

Background: Provision of sexuality education and reproductive health (SERH) services for the adolescent population has been inadequate. Increasing access to adolescent SERH through the community pharmacy is a viable option in bridging this gap. Objective: The study objectives were to assess community pharmacists' involvement, self -reported competence, confidence and comfort level regarding provision of adolescent SERH services and explore barriers to service delivery. Method: A pre-tested questionnaire was distributed to 200 community pharmacists by simple random sampling. Self-reported competency and confidence were measured on a Likert scale ranging from 1-5, midpoint 3. Continuous data was expressed as mean and standard deviation while categorical data was expressed as frequencies and percentages. Results: Community pharmacist' self-reported competence, confidence and comfort levels were high, 4.09 ± 0.14; 3.2±0.75; 4.17± 0.18 respectively on a Scale of 1-5. Majority of the pharmacists, 130 (81.3%) claimed to have had formal training in sexuality education and nearly three quarters, 105 (65.6%) had recently updated their knowledge. Although product availability was adequate, 118 (73.6%), availability of educational materials was low, 37 (23%). Schools were the most frequent place where pharmacists had distributed sexuality education materials 96 (60%). Lack of time and religious objection were the major barriers to service delivery 99(61.9%); 63(39.4%) respectively. Conclusion: Pharmacist' self-reported comfort, competency and confidence levels in delivering adolescent SERH services were high. The major barriers to service delivery were lack of time and religious objection. These findings suggest that community pharmacists have a potentially major impact on improving access to adolescent SERH service. Therefore, the option of delivering SERH services through pharmacies is worth exploring in order to improve access and service delivery to the adolescent population.

Comprehensive sexuality education for the most disadvantaged young people: findings from formative research in Ethiopia

Comprehensive sexuality education (CSE) seeks to improve young people’s knowledge, attitudes and practices in relation to sexual and reproductive health, sexual and social relationships, and dignity and rights. In Ethiopia, young people with disabilities and young women involved in sex work are particularly vulnerable to sexual violence and poor sexual health, yet face stigma and accessibility challenges that continue to exclude them from information, support and services. Because they are often out of school, these groups are also often excluded from programmes that are largely delivered in school settings. This paper explores the challenges faced by these groups of young people in accessing inclusive and age-appropriate sexual and reproductive health knowledge and services in the Ethiopian context and the implications for delivering CSE. The research included literature review, mapping analysis and interviews with young people from those two groups and with service providers and programme implementers. Our findings indicate that young people with disabilities and young women involved in sex work face myriad barriers to accessing information and services that support positive and healthy sexuality, relationships and rights. However, changes over the past decade to national and regional governance structures and a political environment in which CSE has become increasingly contested have generated siloed approaches to the provision of sexual and reproductive health information and services, and poor linkages to complementary services including violence prevention and social protection. It is vital that efforts to implement comprehensive sexuality education are informed by these challenges in the wider policy environment.

The role of midwives in implementing reproductive health services in Islamic Republic of Iran.

It is essential to study the availability of reproductive health services and the capacities of providers, to provide evidence for improving service quality. To identify the role of midwives in the provision of reproductive health services and recommend improvements. A national review of government health resources in the Islamic Republic of Iran was conducted to explore available reproductive health services. Through semi-structured interviews with 30 midwives, information was collected about the compatibility of services with the capacity and scope of the activities of midwives. A panel of 12 experts was assembled to develop a proposed service package. The content analysis method was applied to data analysis and interpretation. The service package developed covered 82 services that midwives can offer at the 8 healthcare facility groups. Although midwives were trained to manage a range of primary and gynaecological care services, certain essential aspects of reproductive health services were not being delivered on the frontline. These include sexually transmitted diseases and human papilloma virus management, diagnosis and treatment of common gynaecological problems, sexual education and counselling, and childbirth services. Midwives were not adequately engaged to provide reproductive health care at the secondary level. There are drawbacks to the current reproductive health service delivery in the Islamic Republic of Iran. The service package designed and proposed in this study aims to strengthen reproductive health care services and planning and better integration of midwife-led programmes.

Impacts of COVID-19 on reproductive health service provision, access, and utilization in Ethiopia: Results from a qualitative study with service users, providers, and stakeholders.

Ethiopia has made significant improvements to sexual and reproductive health (SRH) in recent decades, yet the COVID-19 pandemic brought new challenges to SRH service delivery. In the early months of the pandemic, health facility and health management information system data showed reductions in SRH service utilization, however more evidence is needed on ongoing SRH impacts to inform policy and program decision-making. Our study aimed to assess the impacts of COVID-19 on SRH service utilization and access from the perspective of providers, clients, and stakeholders in Addis Ababa and Amhara Regional State. We collected data from May through July 2021 via six focus group discussions with health service providers, 50 in-depth interviews with SRH service clients and 15 key informant interviews with policy and programmatic stakeholders. All audio recordings were transcribed and translated from Amharic into English. Data were coded and analyzed for content and themes using Excel and NVivo 10. We found that COVID-19 and associated public health mitigation measures had consequences on SRH prioritization, funding, and service delivery. Efforts to halt the spread of COVID-19, such as gathering and transportation restrictions, also reduced access to SRH services. Fear of infection, costly and inaccessible transportation, commodity stockouts, and limited service availability all impeded access to and use of SRH services. For some women, this meant losing timely access to contraception and subsequently facing unwanted pregnancies. Providers experienced increased workloads, anxiety, and stigma as possible sources of infection. Our findings offer useful learnings for program and policy stakeholders aiming to meet SRH needs during the pandemic, and during times of crisis more broadly.

Utilization of sexual and reproductive health services among young people in refugee settings in Uganda.

There is a considerable high level of unmet need for reproductive health services among refugees. Yet, there is limited research about the provision and utilization of sexual and reproductive health (SRH) services among young people in refugee settings. Drawing on a sample of 575 young refugees (15-24 years) from a cross-sectional survey, this study aims to fill this gap by identifying the factors associated with SRH utilization among young people living in refugee settings in Northern Uganda. The utilization of SRH services at the health facilities was significantly different between female and male young people after adjusting for all other variables (aOR = 2.46, 95% CI, 1.58, 3.84). Young people who were not living in a marital union (aOR = 0.38, 95% CI, 0.20, 0.71), or held inequitable gender norms about services (aOR = 0.28, 95% CI, 0.12, 0.66) had about a third of the odds of utilizing SRH services. Young women with comprehensive knowledge about contraception, modern contraceptives, and HIV and STI prevention, had more than twice the odds of utilizing SRH services (aOR = 2.23, 95% CI, 2.67, 6.90). There is need to integrate social norm measurements and social norm change strategies in strategies for promoting utilization of SRH services among refugees in low-income countries especially in Uganda.

57. Pilot Study: Impact of a Pediatric and Adolescent Gynecology Rotation on Confidence in Provision of Adolescent Sexual and Reproductive Health Services Among Pediatric Residents

57. Pilot Study: Impact of a Pediatric and Adolescent Gynecology Rotation on Confidence in Provision of Adolescent Sexual and Reproductive Health Services Among Pediatric Residents

Patients' and health care providers' perspectives of sexual and reproductive health services for people with disability: a scoping review protocol.

The objective of this review is to summarize the nature and focus of research that has been conducted into patients' and health care providers' perspectives of sexual and reproductive health access for people with disability. Article 25 of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) requires people with disability to be provided with equitable access to sexual and reproductive health services. However, there are few scoping or systematic reviews examining the provision of inclusive sexual and reproductive health services to people with disability. Current and planned reviews are either not inclusive of a full range of disabilities or geographical regions, are limited to reproductive health, or focus exclusively on the perspectives of health professionals. Qualitative, quantitative, mixed method studies, and gray literature concerning sexual and reproductive health service access for people with disability will be included. The UNCRPD definition of disability will be adopted, together with a multidimensional conceptualization of "access." The review will be conducted in accordance with JBI methodology. A search strategy has been developed for MEDLINE, Embase, CINAHL, and gray literature. After de-duplication, results will be independently screened against the inclusion criteria by 2 reviewers. There will be no geographical limitations, but non-English-language publications will be excluded. Only literature published after the UNCRPD came into effect (May 3, 2008) will be included. Charting tools will be used for data extraction, and results will be presented in descriptive, diagrammatic, and tabular formats.