Reproductive Health Clinics Research Articles

28. Acceptance of Expedited Partner Therapy Among Adolescents in an Urban Reproductive Health Clinic

28. Acceptance of Expedited Partner Therapy Among Adolescents in an Urban Reproductive Health Clinic

Women’s experiences and acceptability of medical termination of pregnancy

Purpose The purpose of this paper is to understand women’s experiences, acceptability and outcomes of using the medical termination of pregnancy (MTP). The study is conducted at nine reproductive health and family planning clinics at university hospitals as well as regional and provincial hospitals located in Bangkok and the locations within Thailand. Design/methodology/approach This is a descriptive research recruiting healthy women with pregnancy up to 63 days since the last menstrual period (LMP) who opted for MTP during 2012–2014. Findings A total of 443 women who were referred from the reproductive health networks voluntarily participated in the study. Overall, 92.6 percent of participants had a complete abortion. No serious adverse events were found for cases using misoprostol at home or at clinic. More than 98.3 percent of the women felt satisfied or very satisfied with the method. More than 80 percent of participants thought that the side-effects of the method were as expected or less than expected. More than 95 percent of the women recommended having MTP available in Thailand. Originality/value The introduction of MTP that uses a mifepristone and misoprostol regimen (Medabon®) in pregnancies up to 63 days, since LMP demonstrates that misoprostol can be safely used by women at home or at clinic. The administration of misoprostol at home reduces the number of hospital visits, which saves time and costs for traveling from home to the facility. In addition, women have more privacy and control over their bodies by self-administering misoprostol. The MTP’s introductory results also show that MTP service provision is well integrated into reproductive health and family planning services. It is useful for stakeholders who would be involved in design and planning of health system services before the MTP is made broadly available throughout the country.

Emotional Competence in a Gender Perspective: The Experiences of Male Nursing Students in the Sexual and Reproductive Health Clinical Teaching

<em>In the Nursing Degree clinical teaching, gender stereotypes can influence the emotional experience of male students, with implications on their learning and competence’s development in a health care area that is predominantly female, since it is consensual that the emotional dimension of learning can stipulate the experiences of caring. The development of emotional competence promotes a greater capacity for adaptive resilience in the face of stressful situations; consequently, to be emotionally competent is to be able to find solutions in internal resources that emerge from emotions (especially its management) and from the motivation of each individual. This interrelation between emotions and gender prompts the understanding of the male nursing students’ emotional experience of provision of care in sexual and reproductive health. In order to understand this phenomenon, is proposed a research project with a qualitative approach, exploratory and descriptive. The data will be obtained from narratives written by nursing degree male student and also from clinical teaching supervisor nurses. Understanding students’ emotional experiences in clinical teaching of sexual and reproductive health, related to possible gender stereotypes and restrictions to care in this area, leading us to understand how emotion itself manages these genderized experiences, what sense it gives them and how it incorporates them into learning in clinical teaching.</em>

Chlamydia trachomatis infection among patients attending sexual and reproductive health clinics: A cross-sectional study in Bao'an District, Shenzhen, China.

This study aimed to estimate the prevalence of chlamydial trachomatis (CT) infection and explore its risk factors among patients attending sexual and reproductive health clinics in Shenzhen, China. We collected demographic and clinical information from attendees (aged 18–49). CT and Neisseria gonorrhoeae (NG) infection was determined by nucleic acid amplification test (NAAT) on self-collected urine specimens. Of 1,938 participants recruited, 10.3% (95% confidence interval [CI]: 9.6%-11.0%) tested positive for CT. Prevalence was similar between men (10.6% [85/804]; 95% CI, 9.5%–11.7%) and women (10.1% [115/1134]; 95% CI: 9.2%–11.0%). Being 18–25 years old (adjusted odds ratio [aOR] = 2.52; 95%CI:1.35–4.71), never tested for CT before (aOR = 2.42; 95%CI: 1.05–5.61) and infected with NG(aOR = 3.87; 95%CI: 2.10–7.10) were independently associated with CT infection. We found that CT infection is prevalent among patients attending sexual and reproductive health clinics in Shenzhen, China. A comprehensive program including CT screening, surveillance and treatment is urgently needed.

The risk of birth defects is not associated with semen parameters or mode of conception in offspring of men visiting a reproductive health clinic.

What is the relationship between semen parameters and birth defect (BD) rates in offspring of men evaluated for infertility? Among men undergoing infertility evaluation, there is no significant relationship between semen parameters and defect rates in live or still births, even when considering mode of conception. Approximately 15% of couples have fertility difficulties, with up to a 50% male factor contribution. An increased risk of BDs exists in couples using ART, particularly IVF and ICSI, but it is unknown if this related to the ART procedures or an underlying male factor. To determine if the severity of male factor infertilty, as assessed via sperm quality and mode of conception, is associated with BD rates, we performed a retrospective cohort study. Fathers with semen analysis data in the Baylor College of Medicine Semen Database (BCMSD) were linked with their offspring using Texas Birth Defects Registry (TBDFR) data between 1999 and 2009. In this 10-year period, a total of 1382 men were identified in linkage between the BCMSD and TBDFR. A total of 109 infants with and 2115 infants without BDs were identified. To determine the association between BDs and semen parameters, we used hierarchical linear modeling to determine odds ratios between BD rates, semen parameters, and mode of conception before and after adjustment for paternal, maternal and birth covariates. Semen parameters were stratified based on thresholds defined by the WHO fifth edition laboratory manual for the examination and processing of human semen. In total 4.9% of 2224 infants were identified with a BD. No statistically significant association was observed between BD rates and semen parameters, before or after adjustment for covariates. The association between sperm concentration and BDs demonstrated an odds ratio (OR) of 1.07 (95% confidence interval: 0.63-1.83); motility: OR 0.91 (0.52-2.22); and total motile count: OR 1.21 (0.70-2.08). Likewise, mode of conception, including infertility treatment and ART, did not affect BD rates (P > 0.05). BDs recorded in the TBDFR only include live born infants or still births after 20 weeks, our study did not evaluate the effect of impaired semen parameters on developmental defects prior to 20 weeks of gestation. With 109 BDs, our statistical analysis was powered to detect moderate differences associated with particular semen parameters. Additionally, data about mode of conception was not available for 1053 of 2224 births. BD rates are not associated with semen quality or mode of conception. The current study suggests that the severity of male factor infertility does not impact the rate of congenital anomalies. This information is important when counseling couples concerned about the relationship between impaired semen quality and BDs. Supported in part by the NIH Men's Reproductive Health Research (MRHR) K12 HD073917 (D.J.L.), the Multidisciplinary K12 Urologic Research (KURe) Career Development Program (D.J.L.), P01HD36289 from the Eunice Kennedy Shriver National Institute for Child Health and Human Development, NIH (D.J.L.), and by U01DD000494 from the Centers for Disease Control and Prevention and the Title V Block Grant to the Texas Department of State Health Services. A.W.P. is a National Institutes of Health K08 Scholar supported by a Mentored Career Development Award (K08DK115835-01) from the from the National Institute of Diabetes and Digestive and Kidney Diseases. This work is also supported in part through a Urology Care Foundation Rising Stars in Urology Award (to A.W.P.) None of the authors has a conflict of interest. Not applicable.

Sexual risk behavior and substance use among young, diverse women seeking care at a reproductive health clinic

BackgroundTo describe sexual risk behavior, alcohol (and other substance) use, and perceived health promotion needs among young adult women seeking care from an urban reproductive health care clinic in the Northeastern United States, and to examine if these needs differ by race and ethnicity.MethodsWomen 18–29 years old presenting for a routine medical visit were invited to participate. Of 486 eligible women, 466 (96%) agreed to participate and completed a brief survey on a tablet computer. Most of the sample (53%) identified as non-Hispanic White. One-quarter (25%) identified as Hispanic/Latina. A smaller proportion of women identified as African American (19%).ResultsOne-third (31%) of women reported a history of sexually transmitted infection (STI), and women reported infrequent condom use with recent sexual partners. Regarding behavioral health needs, nearly three-quarters of women (72%) reported regular alcohol use, approximately one-third had used marijuana (37%) or tobacco (33%) in the last month, and 19% reported clinically significant depressive symptoms in the last two weeks. Women reported moderate-to-strong interest in receiving information about relationships and sexual health; however, the majority were not interested in information about their substance use. Hispanic and African-American women were more likely to report STI history despite reporting fewer sexual partners than non-Hispanic White women. Minority women also reported significantly less alcohol and cigarette use, but more water pipe tobacco use, and reported significantly greater interest in interventions to promote sexual health. Hispanic women also evidenced significantly elevated rates of depressive symptoms, with 26% of Hispanic women reporting a clinically significant level of depressive symptoms.ConclusionsReproductive health centers are opportune settings to address a broad range of healthcare needs, including sexual health, substance use, and mental health. These centers engage a diverse group of women, which is important given observed disparities in health outcomes based on race/ethnicity. Young women, particularly racial and ethnic minority women, report the most interest in services addressing sexual and relationship health.

A Study to Assess the Knowledge of Primigravida Mothers Regarding Exclusive Breastfeeding in Selected Hospital at Guntur District, Andhra Pradesh

Background: Human milk is the ideal nourishment for infants’ survival, growth, and development. Breast milk contains all the nutrients an infant needs in the first six months of life. Exclusive breast feeding means that the infant receives only breast milk. Exclusive breast feeding in the first six months of life stimulates babies’ immune systems and protects them from diarrhea and acute respiratory infections. Exclusive breast feeding for the first six months of life is now considered as a global public heath goal that is linked to reduction of infant morbidity and mortality, especially in the developing world. Aim: The aim of the study was to assess the knowledge of Primigravida mothers regarding exclusive breastfeeding and to associate the knowledge with their demographic variables. Methodology: Quantitative approach with descriptive design was used to assess the knowledge of the Primigravida mothers at selected hospital at Guntur district, Andhra Pradesh in May 2018. A total of one hundred Primigravida mothers were selected by using convenient sampling technique. A structured knowledge questionnaire was used to collect the data. Results: Out of 100 participants, majority (71%) had moderate knowledge, many (27%) had inadequate knowledge and very few (2%) had adequate knowledge. Significant association was found between the knowledge of exclusive breastfeeding among the Primigravida mothers with their occupation (?2=40.22) at 0.05% level of significance. Conclusion: Breastfeeding is very important for an infant. Prevalence of exclusive breastfeeding up to six months is still low in India. Majority of the Primigravida mothers had inadequate knowledge regarding exclusive breastfeeding. Exclusive breastfeeding counseling in all reproductive and child health clinics especially during the antenatal and postnatal periods may help to improve the mothers’ knowledge on exclusive breastfeeding.

Prediction of Risky Alcohol Use among Ugandan Youth: A Case Study of at Marie Stopes and Youth Reproductive Health Clinics

Background: Alcohol use imposes a significant global burden of disease among the youth. Objective: We investigated the level and risk factors of alcohol use among the youth seeking health services at Marie Stopes Uganda (MSU) and Reproductive Health Uganda (RHU) clinics in Mbarara Municipality, Southwestern Uganda. Methods: This was a descriptive cross sectional study conducted at Marie Stopes Uganda (MSU) and Reproductive Health Uganda (RHU) Clinics in Mbarara Municipality, southwestern Uganda. 336 youth attending the MSU and RHU clinics for health care services between August 1, 2012 and September 1, 2012 were included in the study.. We used the AUDIT to examine alcohol use. Descriptive statistics and logistic regression models were used to test the study objectives. Results: About 80% of youth reported any alcohol use (n=270). Residing closer to the source of alcohol drank in the past fortnight, history of familial alcohol misuse, other substance use and being employed youth were positively associated with alcohol use. Conclusion: Prevalence of alcohol use among the youth was found to be high. Residing closer to the source of alcohol, history of familial alcohol misuse, other substance use and being employed bear implications for alcohol use.

Factors affecting uptake of natural family planning methods among clients at the reproductive health clinic of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Background: The use of natural family planning (NFP) methods is low worldwide with few existing data. Aim: The aim of the study is to determine the factors affecting the use and discontinuation of NFP methods in our setting. Methodology: In this descriptive cross-sectional study, 302 clients who presented at the Reproductive Health Clinic of Ahmadu Bello University, Zaria, were interviewed, with the aid of pretested questionnaires. Sociodemographic variables, reasons affecting the use, and discontinuation of NFP methods were recorded and analyzed using SPSS software version 15. Results: Among the 302 clients interviewed, 88.1% (266) had used a form of family planning method: 38.4% (116) used NFP, 49.7% (150) used artificial methods, whereas 37.1% (43) discontinued the NFP methods. Major factors hindering the use of an NFP method include lack of awareness (24%), been single (17%), unknown reason (17%), irregular menstrual cycle (10%), and fear of method failure (8%). Major factors for discontinuing the NFP methods include high failure rates (21%), irregular menstrual cycle (18%), introduction to other methods (14%), want of conception (12%), and fear of pregnancy (12%). Conclusion: The most common factor affecting the uptake of NFP was lack of awareness. Failure rates and irregular menstrual cycles were the common denominators, affecting both the use and discontinuation of NFP methods.

Atypical cervical cytomorphologic predictors: a descriptive study of pre-cervical cancer patients of low education in Kenya.

Introductionhigh risk HPV is the perpetrator of cervical cancer disease, however screening and vaccination is not included in cervical cancer prevention program within public hospitals in Kenya. This descriptive study assessed the association of specific microbial STI and socio-demographic characteristics and practices with cervical cytomorphologic presentations in regards to pre cervical cancer grades amongst health seeking patients attending the reproductive health clinic of Nakuru County referral hospital, a public hospital under newly devolved health services governance.Methodsa total of 142 patients (AGC/AIS, n=8; HSIL, n=59; LSIL, n=35; controls, n=40) whose median age ranged between 20-70 years were purposively sampled. A structured questionnaire with closed and open ended entries was administered and STI screening including Pap smear examination for cytomorphological profiling done according to revised 2014 Bethesda classification. Associations were established using chi-square and multivariate logistic regression model to determine prediction of cervical atypia manifestations.Resultsa majority of the study participants had only primary education or no education in AGC/AIS (63%) and HSIL (73%) relative to LSIL (49%) and controls (53%) (P=0.017). Koilocyte rates were higher in AGC/AIS (25%), HSIL (52%) and LSIL (77%) compared controls (12.5%) (P<0.0001). ASCUS predominated in HSIL (61%) and LSIL (86%), while almost all AGC/AIS had AGCUS (88%). HR HPV 16/18 infection rates were higher in AGC/AIS (100%), HSIL (80%) and LSIL (83%) relative to controls (10%) (P<0.0001), and was associated with higher risk of having AGC/AIS (OR, 2.0; 95% CI, 1.940-1.947; P<0.0001); HSIL, (OR, 36.3; 95% CI, 9.5-139.5; P<0.0001); and LSIL (OR, 50.1; 95% CI, 12.0-209.0; P<0.0001).Conclusionaltogether, pre-cervical cancer in Kenyan women is characterized by koilocytosis and ASCUS probably from the high rates of HPV 16/18 infections. Promoting cancer education and screening for high risk HPV infections and pre-cancerous lesions will improve women's reproductive health.

Implementing Adolescent Sexual and Reproductive Health Clinical Best Practice in the Bronx, New York

PurposeInequitable access to quality adolescent sexual and reproductive health (ASRH) care may contribute to the high rate of teen pregnancy in the Bronx, New York. Bronx Teens Connection (BxTC), a community-wide intervention, sought to increase the number of ASRH best practices implemented and the number of females 12–19 years old receiving services by health centers in the Bronx. MethodsTo promote best practices, BxTC provided training and technical assistance to partnering health centers from 2011 to 2014. Health center staff completed a 26-item survey annually to document clinic practices and service utilization. Significance of changes was assessed with paired t tests. ResultsBxTC provided 285 hours of training and technical assistance to 12 partnering health centers. Eight health centers consistently completed the survey. Of the possible 31 ASRH best practices, the average number implemented increased from 23 in 2011 to 28 in 2014. Increases in unduplicated female adolescent patients were observed among Hispanics/Latinas (p = .026) and all females aged 15–17 (p = .035). Contraceptive coverage reported by six of the eight health centers increased among Hispanic/Latinas (32%–55%, p = .006), patients ages 15–17 (33%–53%, p = .005), and patients 18–19 (38%–56%, p = .036). The total number of hormonal implants provided to teens increased from two in 2011 to 173 in 2014. ConclusionsOther jurisdictions may consider prioritizing clinical linkages in order to improve ASRH outcomes by supporting best practices and expanding access to services in the most disinvested neighborhoods.

Addressing occupational stress among health staff in nongovernment controlled Northern Syria: Supporting resilience in a dangerous workplace.

Syrian medical staff working in non-government controlled areas of Syria operate in situations that expose them to great personal danger, while they must often face the same challenges as the people they help. Supporting the wellbeing of these staff is crucial to the operation of health services for internally displaced Syrians given the large-scale destruction of healthcare infrastructure. Findings from a staffcare programme designed by a grassroots Syrian psychosocial organisation in Southern Turkey and implemented in a medical nongovernment organisation in Idlib in Northern Syria are presented. An iterative and collaborative process employed individual, team and organisational level consultation to identify occupational stresses within the workplace. A six-month programme involved group sessions across eight sites with 56 staff working in three primary health clinics, two mobile teams and one sexual and reproductive health clinic, serving eight internally displaced persons camps in Idlib. Following the programme, staff reported significant reductions in role ambiguity, and improvements in the nature of their work, personal relationships with colleagues and superiors and physical conditions in the workplace. There were no significant differences in reported organisational structure or job satisfaction. This evaluation of a grassroots programme, designed to address the expressed needs of displaced staff, suggests that reductions in daily living stresses can be achieved even in the context of ongoing crisis.

Alcohol Use and Sexual Risk Behavior in Young Women: A Qualitative Study.

Alcohol use and sexual behavior co-occur frequently in young women, increasing risk for HIV and other sexually transmitted infections. To inform preventive interventions, we used qualitative methods to better understand how women think about the contribution of alcohol use to sexual risk-taking. Young women (N = 25; M = 22.8years; 64% White) were recruited from a community-based reproductive health clinic to attend focus groups; a semi-structured agenda was used to investigate both a priori explanatory mechanisms as well as participant-driven explanations for the alcohol-sex association. Women reported that alcohol reduced their social anxiety, helped them to feel outgoing and confident, and lowered inhibitions and other barriers to sexual encounters (consistent with alcohol expectancies). During drinking events, women described being less concerned with risks, less discriminating regarding sexual partners, and less likely to insist on safer sex practices (consistent with alcohol myopia). These empirical findings support previous theory-based guidance for tailoring preventive programs for alcohol use and sexual risk reduction for young women.

Urinary Bisphenol A Levels and Male Fertility

Bisphenol A (BPA) is a high-production volume industrial chemical found in many consumer products. BPA is a suspected potent endocrine disruptor, with endocrine-disrupting properties demonstrated in animal studies. Few human studies have examined bisphenol A exposure in relation to male fertility and, results are divergent. The aim of the study is to examine the associations between urinary BPA concentration and male fertility. Bisphenol A urinary concentrations were measured using gas chromatography coupled with tandem mass spectrometry in 315 men under 45 years of age with normal sperm concentration (⩾15 mln/ml) recruited from a male reproductive health clinic. Participants were interviewed and provided a semen sample. BPA was detected in 98.10% of urine samples, with a median concentration of 1.87 µg/l (1.63 µg/ g creatinine). A multiple linear regression analysis identified a positive association between the urinary concentrations of bisphenol A 25th–50th percentile and total sperm sex chromosome disomy (p = .004). Also when modeled as continuous variable urinary BPA concentration increased total sperm sex chromosome disomy (p = .01). Urinary concentration of BPA also increase the percentage of immature sperm (HDS) (p = .018) and decrease motility (p = .03). The study provides evidence that exposure to BPA is associated with poorer semen quality. Future studies are needed to confirm these findings.

Knowledge of Periodontal Diseases, Oral Hygiene Practices, and Self-Reported Periodontal Problems among Pregnant Women and Postnatal Mothers Attending Reproductive and Child Health Clinics in Rural Zambia.

Aim To determine the level of knowledge of periodontal diseases, practices regarding oral hygiene, and self-perceived periodontal problems among pregnant and postnatal women attending reproductive and child health clinics in rural districts of Zambia. Methodology This was a quantitative, questionnaire-based, descriptive, and cross-sectional study that recruited 410 women aged 15 to 43 years. Data were analyzed using SPSS v19.0 computer program. Results Participants knowledgeable of periodontal diseases were 62%; gingivitis signs included gum swelling (87.4%) and bleeding (93.3%). Of all participants, 95.6% practiced tooth brushing: twice/day (38.5%), using plastic toothbrush (95.6%), chewing stick (12.2%), toothpick (10.7%), dental floss (2.0%), and tongue cleaning (55.4%). Self-reported periodontal problems were bleeding gums (23.2%), gums that were reddish (10.5%), swollen (11.0%), painful (15.9%), and mobile teeth (3.4%). In logistic regression analysis, painful gums, reddish gums, and toothpick use were 21.9, 4.7, and 4.3 respectively, significantly more likely to cause gum bleeding on tooth brushing. Conclusions Most studied women had general knowledge of periodontal diseases but only few knew the cause. All participants performed tooth cleaning; however, majority did not know appropriate practices, and only few had periodontal problems. Integration of oral health to general health promotion and periodontal therapy to pregnant women at high risk is recommended.

The Net Promoter Score (NPS) for Insight Into Client Experiences in Sexual and Reproductive Health Clinics.

The Net Promoter Score (NPS) metric, commonly used by Fortune 500 companies to measure the customer experience, is calculated using a 0-to-10 scale to answer 1 question: "How likely is it that you would recommend [company X] to a friend or colleague?" Despite the value of this methodology as a predictor of growth and indicator of customer satisfaction in for-profit industries, uptake of the NPS has been slower in the social sector due to concerns about its applicability and acceptability in noncommercial settings, particularly among low-literacy populations. To address these concerns, we conducted a series of small-scale pilots in El Salvador, India, Kenya, and Nigeria to test different implementation approaches of the NPS in sexual and reproductive health clinics-including face-to-face interviews, a guided drop box, integration of the NPS question into an existing client exit interview, and self-administered and volunteer-assisted online surveys using tablets in clinics-and compared the traditional 0-to-10 number scale with an emoji-face scale. Findings showed that the NPS can be effectively adapted for use in low-resource health clinics among low-literacy clients using the number scale. There was no statistically significant difference in mean likeliness to recommend services when using the emoji versus numerical scales in India; however, there was a statistically significant difference when using the guided drop box approach versus face-to-face interviews. When combined with demographic and service-use questions, the NPS generated useful insights on client groups that were more or less likely to recommend the services. While providing an online survey on tablets can be an efficient methodology for implementing the NPS, self-administered approaches may be limited by a client's level of literacy or comfort with technology. For those client populations with a lower NPS, we advise using a qualitative feedback process that can elicit critical feedback to identify actions to improve their experience. Our experience with testing and implementing the NPS in SRH clinics in diverse settings suggests it is a promising approach to gaining insight into the client experience in nonprofit health care settings.

Red reflex examination in reproductive and child health clinics for early detection of paediatric cataract/ ocular media disorders: evidence from Kilimanjaro, Tanzania

Red reflex examination in reproductive and child health clinics for early detection of paediatric cataract/ ocular media disorders: evidence from Kilimanjaro, Tanzania

Knowledge towards cervical cancer prevention and screening practices among women who attended reproductive and child health clinic at Magu district hospital, Lake Zone Tanzania: a cross-sectional study

BackgroundCervical cancer is a global leading cause of morbidity and mortality, attributable to the death of approximately 266,000 women every year. Majority (87%) of cervical cancer deaths occur in developing countries including Tanzania. Though knowledge of cervical cancer is an important determinant of women’s participation in prevention and screening for cervical cancer, little is known about this topic in Tanzania. This study aimed to determine the knowledge of cervical cancer prevention services and screening practices among women who attended Reproductive Child Health clinic at a district hospital in Lake Zone, Tanzania. This information is important to help designing appropriate interventions and scaling up cervical cancer control programs, hence accelerate the achievement towards Sustainable Development Goals.MethodsA cross-sectional study was conducted from March to June 2017, involving 307 women attending reproductive and child health clinic at Magu district hospital. A questionnaire adopted from the validated Cervical Cancer Awareness Measure was used to collect data from the study participants. Data was analysed using SPSS version 20. Descriptive statistics were summarized using frequencies and percentages for categorical variables while mean and standard deviation was used for continuous variables. Multivariable logistic regressions model was used to estimate Adjusted Odds ratio with 95% CI for factors associated with knowledge.ResultsKnowledge of cervical cancer was low, where 82.7% of the women scored less than 50%. Majority (82.4%) were aware about cervical cancer. Secondary education or higher (OR = 7.77, 95% CI: 1.70-35.48) and “knowing someone who has ever had cervical cancer” (OR = 2.19, 95% CI: 1.16-4.13) were significantly associated with higher knowledge. Only 14.3% of participants practiced cervical cancer screening.ConclusionsMajority of women lack comprehensive knowledge of cervical cancer and only few utilize screening services. Strategies for awareness creation about cervical cancer may help to improve knowledge and utilization of cancer screening practices.

Implementing Evidence-Based HIV Prevention for Female Sex Workers in Mexico: Provider Assessments of Feasibility and Acceptability.

This study examined service provider perceptions of feasibility and acceptability of implementing evidence-based practices for preventing HIV/AIDS and STIs in female sex workers (FSWs) in Mexico. Semi-structured interviews were conducted with 124 directors, supervisors and counselors from 12 reproductive health clinics located throughout Mexico participating in a large randomized controlled trial to scale-up the use of a psychoeducational intervention designed to promote FSW condom use and enhance safer sex negotiation skills. Feasibility was based on assessment of personal, organizational and social costs, benefits, and capacity. Costs included anxiety over intervention competency, purchase of condoms and other supplies, expenses of laboratory tests for HIV/STIs, and stigma associated with FSWs. Benefits included increase in personal knowledge and experience, enhanced clinic reputation and service delivery capacity, and increased public health. Capacity was expressed in terms of provider skills to deliver the intervention and additional workload. Acceptability was expressed in terms of provider enthusiasm in delivering these services and FSWs willingness to receive the services. Service provider evaluations of feasibility and acceptability of implementing evidence-based prevention interventions are grounded in local contexts that define costs and benefits of and capacity for implementation and determine features of the intervention and its implementation that are acceptable.

Clinic access and teenage birth rates: Racial/ethnic and spatial disparities in Houston, TX

Teenage motherhood is a pressing issue in the United States, and one that is disproportionately affecting racial/ethnic minorities. In this research, we examine the relationship between the distance to the nearest reproductive health clinic and teenage birth rates across all zip codes in Houston, Texas. Our primary data come from the Texas Department of State Health Services. We use spatial regression analysis techniques to examine the link between clinic proximity and local teenage birth rates for all females aged 15 to 19, and separately by maternal race/ethnicity. We find, overall, limited support for a connection between clinic distance and local teenage birth rates. However, clinics seem to matter most for explaining non-Hispanic white teenage birth rates, particularly in high-poverty zip codes. The racial/ethnic and economic variation in the importance of clinic distance suggests tailoring clinic outreach to more effectively serve a wider range of teenage populations. We argue social accessibility should be considered in addition to geographic accessibility in order for clinics to help prevent teenage pregnancy.