Reproductive Health Needs Research Articles

Reproductive Health Needs of the Military and Veterans: Part 3.

Reproductive Health Needs of the Military and Veterans: Part 3.

Sexual and Reproductive Health Needs of Adolescent Girls and Young Women in Sub-Saharan Africa: Research, Policy, and Practice

Seventeen articles make up this special collection, covering a range of different, but cross-cutting themes. These highlight contemporary concerns in African research and scholarship about the factors configuring the sexual and reproductive health needs of adolescent girls and young women (AGYW). The articles interrogate contextual and cultural impediments, problematic representations, perceptions of vulnerabilities and rights, experiences of gender-based violence, coercive sex, unplanned motherhood—and agency, resistance and strategic interventions. While a diverse range of issues, theories, and methodologies are evident, all the articles reflect on how the circumstances of young women in Africa can be effectively improved to engender empowerment, good health, and personal and sexual autonomy.

Women's reproductive health needs assessment questionnaire: development and validation.

Assessment of reproductive health (RH) needs is necessary for describing the status of women's RH and identification of the actions needed. This study aimed to develop and validate a questionnaire for the assessment of the women's RH needs. A sequential exploratory mixed method study (qualitative and quantitative) was conducted with Iranian women of reproductive age (age 15-49 years) living in Rasht. The qualitative exploratory phase was used to explain the concept and dimensions of RH needs. The qualitative exploratory phase was used to develop and validate a questionnaire. The results of the qualitative section, RH needs consists of two themes "Reproductive Health Education Needs" and "Reproductive Health Services Features". A Women's Reproductive Health Needs Assessment Questionnaire (WRHNAQ) was designed with 19 items. The content validity ratio (CVR) and content validity index (CVI) of the questionnaire were 0.89 and 0.93, respectively. The instrument's internal consistency was confirmed by an alpha coefficient of 0.881. The results of this study showed that the WRHNAQ is a culturally sensitive, valid and reliable scale for assessing the RH needs. The WRHNAQ will be helpful for identifying needs and need-based intervention.

Reproductive Health Care Knowledge, Needs, and Access Among Transgender Men: A Mixed Methods Study [6R

INTRODUCTION: Most transgender men retain their natal reproductive organs and genitalia. Approximately 70% of OB-GYN's report discomfort when providing care for this population. To ascertain the needs and experiences of transgender men who seek reproductive health care we conducted a mixed methods study among transgender men. METHODS: Self-identified transgender men participated in focus groups featuring questions about reproductive health care and completed a survey regarding reproductive goals. Descriptive statistical analysis was performed on survey data, and focus group data were transcribed and analyzed to identify emergent themes. RESULTS: Nine transgender men participated; mean age was 29, six were on hormone therapy. All had their uterus and ovaries in situ, and four reported recent vaginal receptive intercourse. Only two reported receiving fertility preservation information from a physician; five desired future children. Five reported current or past use of contraception, even after starting testosterone. Two reported history of unintended pregnancy and miscarriage. Themes identified through focus groups: reference to gynecologists as the “necessary evil”; sensing provider uncertainty about or avoidance of reproductive health topics, especially during the patients' reproductive transition'; systemic issues including insurance and financial barriers for gynecologic care and fertility preservation; and avoidance of gynecologic care due to dysphoria and lack of transgender-knowledgeable OB/GYN providers. CONCLUSION: These findings indicate that transgender men often retain their reproductive organs, use contraception, and desire childbearing, necessitating reproductive health care from OB/GYN providers. Strategies to increase providers awareness of these findings are needed so transgender men's access to and experiences of reproductive health are improved.

An Examination of Turkish Nurses’ Attitudes, Awareness and Practices Regarding Reproductive Health Needs of Individuals With Schizophrenia

Aim: This study was conducted to evaluate Turkish nurses’ attitudes, awareness and practices regarding reproductive health needs of individuals with schizophrenia.Method: The sample of this descriptive study consisted of 96 psychiatric nurses and 90 nurses and midwives working in family health centers who agreed to participate. The data were presented as numbers and percentages, and chi-square analyses were used to compare the groups.Findings: Although the majority of nurses stated that family planning education should be given to individuals with schizophrenia, to both genders and to both single and married patients, the proportion of those who give family planning education is only 23.5%. Of the nurses, 58.8% recommend tubal ligation as a method of family planning for individuals with schizophrenia, 39.6% of nurses think that involuntary abortion or sterilization for individuals with schizophrenia is necessary even if they do not support it culturally, and 20.3% of nurses provide sexual health counseling to individuals with schizophrenia. It appears that nurses, as members of society, do not approve of marriage or parenting by individuals with schizophrenia.Result: This study found that both nurses working in primary care and psychiatric clinics had negative attitudes towards the reproductive health of individuals with schizophrenia.

Reproductive Health Needs of the Military and Veterans, Part 2.

Reproductive Health Needs of the Military and Veterans, Part 2.

Reproductive Health Needs of the Military and Veterans.

Reproductive Health Needs of the Military and Veterans.

Reproductive Health Needs of the Military and Veterans: Part 1.

Reproductive Health Needs of the Military and Veterans: Part 1.

Cultural Consensus Modeling to Understand the Reproductive Health Needs of South African Adolescent Girls

Background. Cultural consensus modelling (CCM) is an approach whereby individuals define the boundaries regarding a set of knowledge or behaviours shared by a group within a culture using an ethnographic approach. Objectives. To provide an overview of CCM methods and the application of CCM to examine South African adolescent girls’ contraceptive and HIV prevention practices. Methods. In phase 1 of a CCM approach, individuals respond to questions about their culture rather than their individual behaviours, allowing individuals to draw upon a shared cultural knowledge. Utilising these identified group beliefs, phase 2 asks individuals to rate the extent to which factors identified in phase 1 are valued. Phase 3 utilises qualitative interviews with key informants from phase 2 to gather in-depth information regarding the identified determinants of the health behaviour. Lastly, phase 4 of this approach conducts a quantitative survey to determine the extent to which cultural consensus model types are associated with differences in actual behaviours. Results. CCM data analytic approaches are described. Frequencies and descriptive statistics for the free listing are conducted. For phase 2, cultural consensus analysis is conducted to examine whether one or several consensus models exist and competence scores are calculated. Standard qualitative analysis approaches are utilised for phase 3. Phase 4 employs regression to examine the association between cultural models and an outcome of interest. Conclusion. CCM provides a novel, culturally sensitive understanding of reproductive health practices among South African adolescent girls; CCM also has broad applicability to other adolescent health research domains.

Reproductive Health Need Assessment of Adolescent Boys and Girls during Puberty: A Qualitative Study

Background Adolescence is the transient period from childhood to adulthood and the beginning of physical, mental and social changes. Understanding and meeting adolescents’ needs may have important effects on reducing theirs dangerous behaviors and therefore, will result in a more health society. This study aimed to assess the reproductive health needs of Iranian adolescent. Materials and Methods This qualitative design study explored the reproductive health needs among Iranian adolescent boys and girls. Purposeful sampling method was used until data saturation was reached. Data was gathered using focus group for girls and face to face interviews for boys. The interviews used semi-structured questions. Data analysis was carried out using the method proposed by Altschuld for need assessment. Trustworthiness of the data was assessed using Guba and Lincoln Indicators. Results Participants were 10 adolescent girls (age range from 13-15) and ten 14-17 year age male adolescences. The reproductive health needs of girls included 4 categories: Menarche and puberty health, Discrimination in family and society, Sexual orientation, education and Consultation demands. The needs extracted from interviews of adolescent boys included adaptation with changes in puberty, sexual orientation, educational and consultation demands. Conclusion Despite some differences between males and females needs, their reproductive health needs are greatly similar. Adolescents need more Education and consultation

Randomized controlled trial of the effect of a reproductive health survivorship care plan on fertility and pregnancy concerns, vasomotor symptoms, sexual health, and contraception in young breast cancer survivors

Young breast cancer survivors (YBCS) have unmet reproductive health needs in managing fertility/pregnancy concerns, hot flashes, vaginal dryness, and contraception. Following development of an evidence-based, online educational intervention targeting YBCS and their healthcare providers (HCP), we hypothesized that YBCS who received the Reproductive Health Survivorship Care Plan (SCP-R) would be more likely to improve on fertility/pregnancy concerns, vasomotor symptoms, sexual health, or contraceptive practices, compared to waitlist controls (NCT02667626). Randomized controlled trial. YBCS and their nominated HCP were recruited from cancer advocacy and physician referrals across the U.S. Eligible YBCS were aged 18-45 at diagnosis, 18-50 at enrollment, Stages 0-III, able to read English, access the Internet and complete daily hot flash text messages. Participants had ≥1 of the following reproductive health needs: > moderate fertility/pregnancy concerns, >4 hot flashes/day with >1 of moderate severity, >1 moderate vaginal atrophy symptoms, not contracepting/using less effective methods. YBCS underwent computer-generated, stratified randomization to the study arms and were followed for 24 weeks. The intervention group accessed the online SCP-R; the waitlist controls accessed a curated resource list. HCPs could access their patient’s materials. In an intention-to-treat analysis, the primary outcome of an improvement in at least 1 late effect by 24 weeks was compared by intervention group. A priori sample size calculations based on hot flashes estimated 50 participants per arm to detect a 2.2 decrease in hot flash score (80% power, a=0.05). 182 YBCS (86 intervention, 96 waitlist control), mean age 40.0±5.9 and mean years since diagnosis 4.4± 3.2, were randomized. Loss to follow up was 3%. 61 YBCS (70.9%) in the intervention arm improved in at least one reproductive health outcome, compared to 55 (57.3%) of waitlist controls (OR 1.82, 95% CI 0.99-3.4, p=0.057). Table 1 summarizes improvement of individual reproductive health need by study arm. A novel, web-based intervention improved clinically significant reproductive health late effects for a substantial proportion of YBCS, supporting the importance of dissemination of accessible curated resources to YBCS and their HCPs.Table 1Improvement of individual reproductive health late effects by study arm (n=182)Reproductive Health Late EffectTreatment Arm N(%) (n=86)Waitlist Control Arm N(%) (n=96)OR (95% CI)p-valuePregnancy/fertility concerns ≤324 (53.3)14 (30.4)2.6 (1.1-6.3)0.0350% decrease in hot flash score26 (57.8)24 (51.1)1.3 (0.6-3.0)0.5250% decrease in vaginal atrophy symptoms10 (25.6)11 (23.9)1.1 (0.4-3.0)0.85Reporting tier I/II contraception23 (44.2)21 (34.4)1.5 (0.7-3.2)0.29 Open table in a new tab

An evaluation of a community-based mobile referral system to improve reproductive health; care in Kenya

Objectives: Given widespread mobile phone use and high unmet need for reproductive health; care, designing a mobile referral system for community health volunteers provides a promising opportunity to improve access to reproductive health care, particularly for stigmatized services such as abortion and contraception. The objectives of this study were to determine if this system was acceptable to users and enabled tracking of referrals from the community to the health facility.

Iranian Female Adolescents’ Reproductive Health Needs: A Systematic Review

Iranian Female Adolescents’ Reproductive Health Needs: A Systematic Review

The \u2018Dream Team\u2019 for sexual, reproductive, maternal, newborn and adolescent health: an adjusted service target model to estimate the ideal mix of health care professionals to cover population need

BackgroundA competent, enabled and efficiently deployed health workforce is crucial to the achievement of the health-related sustainable development goals (SDGs). Methods for workforce planning have tended to focus on ‘one size fits all’ benchmarks, but because populations vary in terms of their demography (e.g. fertility rates) and epidemiology (e.g. HIV prevalence), the level of need for sexual, reproductive, maternal, newborn and adolescent health (SRMNAH) workers also varies, as does the ideal composition of the workforce. In this paper, we aim to provide proof of concept for a new method of workforce planning which takes into account these variations, and allocates tasks to SRMNAH workers according to their competencies, so countries can assess not only the needed size of the SRMNAH workforce, but also its ideal composition (the ‘Dream Team’).MethodsAn adjusted service target model was developed, to estimate (i) the amount of health worker time needed to deliver essential SRMNAH care, and (ii) how many workers from different cadres would be required to meet this need if tasks were allocated according to competencies. The model was applied to six low- and middle-income countries, which varied in terms of current levels of need for health workers, geographical location and stage of economic development: Azerbaijan, Malawi, Myanmar, Peru, Uzbekistan and Zambia.ResultsCountries with high rates of fertility and/or HIV need more SRMNAH workers (e.g. Malawi and Zambia each need 44 per 10,000 women of reproductive age, compared with 20–27 in the other four countries). All six countries need between 1.7 and 1.9 midwives per 175 births, i.e. more than the established 1 per 175 births benchmark.ConclusionsThere is a need to move beyond universal benchmarks for SRMNAH workforce planning, by taking into account demography and epidemiology. The number and range of workers needed varies according to context. Allocation of tasks according to health worker competencies represents an efficient way to allocate resources and maximise quality of care, and therefore will be useful for countries working towards SDG targets. Midwives/nurse-midwives who are educated according to established global standards can meet 90% or more of the need, if they are part of a wider team operating within an enabled environment.

High rates of Unintended Pregnancies among Young Women Sex Workers in Conflict-affected Northern Uganda: The Social Contexts of Brothels/Lodges and Substance Use.

This study aimed to examine the correlates of unintended pregnancies among young women sex workers in conflict-affected northern Uganda. Data were drawn from the Gulu Sexual Health Study, a cross-sectional study of young women engaged in sex work. Bivariable and multivariable logistic regression was used to examine the correlates of ever having an unintended pregnancy. Among 400 sex workers (median age=20 years; IQR 19-25), 175 (43.8%) reported at least one unintended pregnancy. In multivariable analysis, primarily servicing clients in lodges/brothels [Adjusted Odds Ratio (AOR= 2.24; 95% Confidence Interval: 1.03-4.84)], hormonal contraceptive usage [AOR=1.68; 95%CI 1.11-2.59] and drug/alcohol use while working [AOR= 1.64; 95%CI 1.04-2.60] were positively correlated with previous unintended pregnancy. Given that unintended pregnancy is an indicator of unmet reproductive health need, these findings highlight a need for improved access to integrated reproductive health and HIV services, catered to sex workers' needs. Sex work-led strategies (e.g., peer outreach) should be considered, alongside structural strategies and education targeting brothel/lodge owners and managers.

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

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

A community-based survey on Syrian refugee women’s health and its predictors in Şanliurfa, Turkey

ABSTRACTReproductive characteristics, mental health symptoms, micronutrient deficiencies, and symptoms of sexually transmitted infections (STIs) were determined among married Syrian refugee women aged 15–49 years who were living outside of camps in 2015, using probability sampling. Of the 458 participants, 51.3 percent married before the age of 18 years. Early-age marriages and number of desired children increased after the war. In multivariable analyses, education (adjusted odds ratio [aOR] = 1.2; 95% confidence interval [CI] = 1.2–1.3) and length of stay in Şanlıurfa (aOR = 1.2; 95% CI = 1.1–1.2) were independently associated with early marriage. Approximately 16 percent of women were pregnant, and 26.7 percent of them had not received prenatal care; 47.7 percent had had a pregnancy loss; 50.8 percent reported symptoms of STIs. Of those who were sexually active, 37.8 percent were not using contraception. The prevalence of iron, B12, and folic acid deficiencies was 50 percent, 45.6 percent, and 10.5 percent, respectively. Early marriage (aOR = 2.2; 95% CI = 1.4–3.5) and number of desired children (aOR = 5.03; 95% CI = 3.2–7.9) were associated with not using contraception. Most (89.7 percent) women reported at least two mental health symptoms; lack of social support (aOR = 2.6; 95% CI = 1.3–5.3), language barrier (aOR = 2.3; 95% CI = 1.01–5.2), and B12 deficiency (aOR = 1.8; 95% CI = 1.01–3.4) were associated with such symptoms. The findings demonstrate the need for reproductive health and psychosocial services.

Meeting the Reproductive Health Needs of Female Key Populations Affected by HIV in Low- and Middle-Income Countries: A Review of the Evidence.

Female sex workers and other women at high risk of acquiring HIV have the right to sexual and reproductive health, including the right to determine the number and timing of pregnancies. We conducted a literature review to examine the data that exist regarding the family planning and reproductive health needs of female key populations, the underlying determinants of these populations' vulnerability to poor reproductive health outcomes, and the obstacles they face in accessing high-quality reproductive health services. Findings indicate that female key populations experience high rates of unmet need for family planning and safer conception services, unintended pregnancies, sexual violence, and abortion, and that they practice inconsistent condom use. Restrictive policy environments, stigma and discrimination in health care settings, gender inequality, and economic marginalization restrict access to services and undermine the ability to safely achieve reproductive intentions. We offer recommendations for structural, health system, community, and individual-level interventions that can mitigate the effects of these barriers and improve reproductive health outcomes.

Sexual, Reproductive Health Needs, and Rights of Young People in Slum Areas of Kampala, Uganda: A Cross Sectional Study.

BackgroundYoung people in Uganda face various sexual and reproductive health risks, especially those living in urban slums. The aim of this study was to examine factors associated with comprehensive categories of sexual and reproductive health, including sexual behaviours; sexual education and access to contraceptive services; family planning; prevention of STDs; sexual consent as a right; gender based violence; as well as HIV testing, counselling, disclosure and support.MethodsThe study was cross-sectional in design and was carried out in July 2014 in Makindye and Nakawa Divisions of Kampala City, Uganda. Using systematic random sampling, data were collected on 663 participants aged between 13 and 24 years in Kampala’s urban slums.ResultsSixty two percent of participants reported having ever had sex and the mean age of sexual debut was 16 years (95%CI: 15.6, 16.4 years, range: 5–23 years). The odds of reporting ever having had sexual intercourse were higher among respondents living alone (OR: 2.75; 95%CI: 1.35, 5.61; p<0.01) than those living in a nuclear family. However, condom use was only 54%. The number of sexual partners in the last 12 months preceding the survey averaged 1.8 partners (95%CI: 1.7, 1.9; range 1–4) with 18.1% reporting an age gap of 10 years or older. More than three quarters (80.6%) of sexually active participants reported that their first sexual encounter was consensual, suggesting that most young people are choosing when they make their sexual debut. Low prevalence of willing first sexual intercourse was associated with younger age (OR = 0.48, 95%CI: 0.25, 0.90, p<0.05), having a disability (OR = 0.40, 95%CI: 0.16, 0.98, p<0.05), living with non-relatives (OR = 0.44, 95%CI: 0.16, 0.97, p<0.05), and being still at school (OR = 0.29, 95%CI: 0.12, 0.67, p<0.01). These results remained significant after adjusting for covariates, except for disability and the age of participants. The proportion of unwilling first sexual intercourse was significantly higher among women for persuasion (13.2% vs. 2.4%, p<0.001), being tricked (7.1% vs 2.9%, p<0.05) and being forced or raped (9.9% vs 4.4%, p<0.05) than men. A high level of sexual abuse emerged from the data with 34.3% affirming that it was alright for a boy to force a girl to have sex if he had feelings for her; 73.3% affirming that it was common for strangers and relatives to force young females to have sexual intercourse with them without consent; 26.3% indicating that it was sometimes justifiable for a boy to hit his girlfriend, as long as they loved each other.ConclusionThis study has explored current sexual practice among young people in a specific part of urban Kampala. Young people’s sexual and reproductive health remains a challenge in Uganda. To address these barriers, a comprehensive and harmonised sexual and reproductive health system that is youth friendly and takes into account local socio-cultural contexts is urgently needed.

Routine Screening for Pregnancy Intention to Address Unmet Reproductive Health Needs in Two Urban Federally Qualified Health Centers.

The goal of this project was to increase rates of screening for pregnancy intention in primary care. Two urban federally qualified health centers with diverse patient populations undertook a quality improvement project to increase rates of routine screening for pregnancy intention among pre-menopausal non-pregnant women ages 12-45 without history of sterilization. Responses were recorded in the electronic medical record (EMR). Screening rates of eligible women increased from 0% to 68.3% and from 49.0% to 80.3% at Sites 1 and 2, respectively. Adolescents were screened at lower rates than adults (p &lt; .0001). There was no significant difference in screening rates between English and non-English speaking patients. Project challenges included cultural relevance to certain patient groups, staff turnover, and time for follow-up counseling. Implementation of routine pregnancy intention screening is important to address unmet reproductive health needs, and can be successfully implemented through an EMR regardless of primary language.