Sexual And Reproductive Healthcare Services Research Articles

Impact of COVID-19 on access to and delivery of sexual and reproductive healthcare services in countries with universal healthcare systems: A systematic review.

The COVID-19 pandemic has caused unforeseen impacts on sexual and reproductive healthcare (SRH) services worldwide, and the nature and prevalence of these changes have not been extensively synthesized. We sought to synthesise reported outcomes on the impact of COVID-19 on SRH access and delivery in comparable countries with universal healthcare systems. Following PRISMA guidelines, we searched MEDLINE, Embase, PsycInfo, and CINAHL from January 1st, 2020 to June 6th, 2023. Original research was eligible for inclusion if the study reported on COVID-19 and SRH access and/or delivery. Twenty-eight OECD countries with comparable economies and universal healthcare systems were included. We extracted study characteristics, participant characteristics, study design, and outcome variables. The methodological quality of each article was assessed using the Quality Assessment with Diverse Studies (QuADS) tool. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed for reporting the results. This study was registered on PROSPERO (#CRD42021245596). Eighty-two studies met inclusion criteria. Findings were qualitatively synthesised into the domains of: antepartum care, intrapartum care, postpartum care, assisted reproductive technologies, abortion access, gynaecological care, sexual health services, and HIV care. Research was concentrated in relatively few countries. Access and delivery were negatively impacted by a variety of factors, including service disruptions, unclear communication regarding policy decisions, decreased timeliness of care, and fear of COVID-19 exposure. Across outpatient services, providers favoured models of care that avoided in-person appointments. Hospitals prioritized models of care that reduced time and number of people in hospital and aerosol-generating environments. Overall, studies demonstrated reduced access and delivery across most domains of SRH services during COVID-19. Variations in service restrictions and accommodations were heterogeneous within countries and between institutions. Future work should examine long-term impacts of COVID-19, underserved populations, and underrepresented countries.

Trading in harms: COVID-19 and sexual and reproductive health disparities during the first surge in New York state

In March 2020, New York City was the national epicenter of the novel coronavirus in the United States. This article draws on rapid qualitative research from July to October of 2020 with sexual and reproductive healthcare (SRH) providers who served low-income people from racial and ethnic minority groups in New York State to examine their perceptions of the effects of COVID-related adaptations to care on healthcare access and quality. We found that care delivery protocols during the early months of the pandemic compromised healthcare interactions and clinical experiences by limiting support persons, separating newborns from parents, and restricting care time in hospitals. Additionally, closures of in-person SRH services and prohibitions on prenatal support persons increased obstacles to access and utilization of care. Our intersectional analysis underscores how COVID protocols interacted with other axes of inequality to compound disparities in SRH access and quality of care. Early COVID policies prioritized controlling the risk of viral exposure over the risk of harm from the policies themselves, reflecting zero-sum approaches that we describe as “trading in harms.” Our research thus raises crucial questions about how institutions and governing bodies conceive of, and organize, emergency preparedness. We argue that emergency preparedness must center concerns around racial, class, and gender equity, among others, to foreground the risks and benefits of emergency responses for different groups.

A qualitative study exploring sexual and reproductive health needs among a sample of foreign migrants living in six locations in Southern Africa

Migrants in Southern Africa often lack access to adequate sexual and reproductive healthcare (SRH), which deepens their vulnerability to poor health outcomes. This paper highlights results from a rapid assessment undertaken in six countries in the Southern African Development Community (SADC) region to inform the implementation of the “SRHR-HIV Knows No Borders” project. In-depth interviews were conducted with 16 adult foreign migrants residing in 10 high migration communities where the project was implemented. Data were analysed thematically using an inductive approach. Respondents were found to have good knowledge about HIV, STIs, and male condoms, although they lacked awareness about other contraceptive methods. Many respondents reported barriers to accessing SRH services, mostly as a result of a lack of legal documentation and due to discrimination from healthcare workers. SRH interventions among foreign migrant populations in the Southern African region should focus on developing awareness about contraceptives and ensuring inclusivity within the healthcare system.

"Sex Should Not Be Part of the Lives of Persons with Disabilities, but They Are Human Beings Too": Perceptions of Healthcare Providers and Factors Affecting Service Delivery in Ghana.

Persons with disabilities (PwDs) constitute about 16% of the global population and face many challenges in every society, including access to sexual and reproductive healthcare. The attitudes of healthcare providers (HPs) exert a major influence on PwDs accessing sexual and reproductive healthcare (SRH). A sequential explanatory mixed methods design was used to investigate the attitudes and perceptions of HPs towards PwDs and SRH delivery in Ghana's Ashanti region. Quantitative data analysis indicated that overall, 82% of HPs had received information on disability-related issues and had relatively positive attitude towards PwDs, which varied across sub-scales of the Attitude Towards Disability score and associated with their sociodemographic characteristics. HPs faced several challenges in SRH services delivery to PwDs, which included a lack of funding and training, and inadequate staff. Inductive thematic analysis of the qualitative data revealed eight overarching themes. The findings revealed that HPs had prejudice about the mental and sexual health abilities of PwDs. Inadequate skill set, inadequate resources, and limited funding were major challenges identified. Nonetheless, compassion and benevolence towards PwDs, improvision, economic and educational support, awareness creation, and referrals were strategies adopted to overcome these challenges. Mandatory training of HPs is recommended to ensure improved SRH service delivery to PwDs. Future research could explore the perceptions and coping strategies of PwDs.

Qualitative study of the roles of midwives in the provision of sexual and reproductive healthcare services in the Somaliland health system

ObjectivesTo explore midwives’ perspectives in providing sexual reproductive healthcare services in the Somaliland health system.MethodsAn exploratory qualitative design using focus group discussions (n=6) was used. The study was conducted in...

Practice, attitudes and views of right to access of sexual and reproductive health services by LGBTQI among primary health care nurses in Tshwane.

Sexual and reproductive healthcare services (SRHS) are crucial investments for improving individual well-being and granting an opportunity to exercise sexual and reproductive rights. Primary health care (PHC) nurses are described as gatekeepers, preventing many individuals, including the members of the lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) community, from accessing much-needed healthcare services. The study aimed at exploring the experiences and perceptions of PHC nurses during the provision of SRHS for members of the LGBTQI community. The study was conducted among eight clinics around Tshwane in South Africa. Twenty-seven professional nurses were selected purposively, using an exploratory design approach. A semistructured interview guide and in-depth face-to-face interviews were used to gather data. Data were analysed using thematic content analysis (TCA). Four themes emerged: understanding of SRHS, attitudes of PHC nurses, frequency of rendering services based on utilisation of SHR and views of nurses on the right to access SRHS. A heteronormative approach was mostly indicated when rendering SHRS to the members of the LGBTQI community. Members of the LGBTQI community do not use the SRHS as often as heterosexual patients; lack of training, skills and knowledge were identified as barriers to rendering much-needed SRHS for members of the LGBTQI community.Contribution: The findings of this study assisted in demonstrating the PHC nurses' perceptions, experiences, skills and knowledge of LGBTQI SRHS, thus improving the members of the LGBTQI community's accessibility and utilisation of SRHS.

Providing a Supportive Environment for Disclosure of Sexual Violence and Abuse in a Sexual and Reproductive Healthcare Setting: A Realist Review

Background: Sexual and reproductive healthcare services (SRHS) are an environment where medical care relevant to sexual violence and abuse (SV) is available. However, barriers to disclosure need to be overcome to allow timely access to this care. There is limited research identifying and explaining how interventions remove barriers and create a safe and supportive environment for disclosure. The purpose of this review was to develop and refine theories that explain how, for whom and in what context SRHS facilitate disclosure. Methods: Following published realist standards we undertook a realist review. After focussing the review question and identifying key contextual barriers, articles pertaining to these were identified using a traditional systematic database search. This strategy was supplemented with iterative searches. Results: Searches yielded 3172 citations, and 28 articles with sufficient information were included to develop the emerging theories. Four evidence-informed theories were developed proposing ways in which a safe and supportive environment for the disclosure of SV is enabled in SRHS. The theories consider how interventions may overcome barriers surrounding SV disclosure at individual, service-delivery and societal levels. Conclusions: Benefits of SRHS engagement with health promotion and health activism activities to address societal level barriers like lack of service awareness and stereotypic views on SV are presented. Although trauma informed practice and person-centred care were central in creating a safe and supportive environment for disclosure the review found them to be poorly defined in this setting.

Novel Approach to Improving Confidence in Providing Sexual and Reproductive Healthcare to Adolescents for Pediatric Residents: A Pilot Study

Background: A recent study showed that about only 1/5 of recent graduates feel well trained to care for adolescent patients. There is an insufficient amount of data assessing the confidence of pediatric residents in providing sexual and reproductive healthcare (SRH) services to adolescents. We aimed to assess pediatric residents’ confidence in providing SRH education and services to adolescent patients before and after participating in clinic sessions in a Pediatric Adolescent Gynecology (PAG) Clinic.

Predisposing and enabling factors associated with Venezuelan migrant and refugee women's access to sexual and reproductive health care services and contraceptive usage in Peru

ObjectiveOver 6 million migrants and refugees from Venezuela have left their country in the past decade; 1 million of them reside in Peru. Venezuelan migrant and refugee women are known to have limited access to sexual and reproductive health care services (SRHS) and contraceptive usage. To date, research to understand factors influencing access to those services is limited. This study aims to determine which enabling and predisposing factors influence Venezuelan migrant and refugee women's access to SRHS and contraceptive usage. MethodsThis is a retrospective cross-sectional study of the first survey administered to the Venezuelan population residing in the Peru in 2018. The survey covered six cities in the country (Metropolitan Lima, Callao, Tumbes, Cusco, Trujillo, Arequipa). The sample for the study included Venezuelan migrant women of reproductive age (15–49 years old). Anderson's Behavior Model of Health Services is the conceptual framework of the investigation. Logistic regression models were fit to examine the relationship between different predisposing and enabling factors and women's access to SRHS and contraceptive usage. ResultsThe sample size includes a total of 3378 Venezuelan women of reproductive age. 50.7% of the women were between the ages of 21–30 and over 90.6% of the sample were residing in Metropolitan Lima. Only 20.2% of the women reported they had access to modern contraceptives. Results from the study suggest having insurance, residing in Trujillo, and having a higher socio-economic status were associated with more access to certain sexual reproductive health care services and contraceptive usage. ConclusionThis study identified different predisposing and enabling factors relevant to the access to SRHS and contraceptive usage. Difference in access and usage are particularly pronounced based on insurance status, geographical location, and socio-economic status. Displaced Venezuelans will remain abroad for an extended period of time, if not permanently. Focus should shift from providing humanitarian aid to integrating the migrants and refugees, particularly the most vulnerable groups, into the local economic and healthcare system.

Colombian Adolescents’ Perceptions of Autonomy and Access to Sexual and Reproductive Health Care Services: An Ethical Analysis

There are conceptual and ethical challenges to defining adolescents’ autonomy to access health care, and these can lead to health care norms and practices that could be maladjusted to the needs and preferences of adolescents. Particularly sensitive is access to sexual and reproductive health care services (SRHS). Yet, while there has been substantial conceptual work to conceptualize autonomy (e.g., as independence), there is a lack of empirical research that documents the perceptions of adolescents regarding on how they access or wish to access health care services. The main objectives of this research were to (a) understand how adolescents in Colombia interpret the concept of “autonomy,” (b) describe how these adolescents articulate their autonomy (i.e., preferences) in accessing SRHS, and (c) analyze the ethical issues emerging from these data. Forty-five semi-structured interviews were conducted with participants aged 14 to 23 years old in the Departments of Antioquia and Valle del Cauca in Colombia. Our study showed that participants’ understanding of autonomy was context-based and highly dependent on personal experiences, and these influenced their choice in how to access SRHS. Seen through the ethical lens of a reproductive justice framework, our results highlight the unequal opportunities for adolescents in terms of autonomy to access SRHS.

Access of Migrant Youths in Sweden to Sexual and Reproductive Healthcare: A Cross-sectional Survey.

Background: This study aims to assess migrant youths’ access to sexual and reproductive healthcare (SRHC) in Sweden, to examine the socioeconomic differences in their access, and to explore the reasons behind not seeking SRHC. Methods: A cross-sectional survey was conducted for 1739 migrant youths 16 to 29 years-old during 2018. The survey was self-administered through: ordinary post, web survey and visits to schools and other venues. We measured access as a 4-stage process including: healthcare needs, perception of needs, utilisation of services and met needs. Results: Migrant youths faced difficulties in accessing SRHC services. Around 30% of the participants needed SRHC last year, but only one-third of them fulfilled their needs. Men and women had the same need (27.4% of men [95% CI: 24.2, 30.7] vs. 32.7% of women [95% CI: 28.2, 37.1]), but men faced more difficulties in access. Those who did not categorise themselves as men or women (50.9% [95% CI: 34.0, 67.9]), born in South Asia (SA) (39% [95% CI: 31.7, 46.4]), were waiting for residence permit (45.1% [95% CI: 36.2, 54.0]) or experienced economic stress (34.5% [95% CI: 30.7, 38.3]) had a greater need and found more difficulties in access. The main difficulties were in the step between the perception of needs and utilisation of services. The most commonly reported reasons for refraining from seeking SRHC were the lack of knowledge about the Swedish health system and available SRHC services (23%), long waiting times (7.8%), language difficulties (7.4%) and unable to afford the costs (6.4%). Conclusion: There is an urgent need to improve migrant youths’ access to SRHC in Sweden. Interventions could include: increasing migrant youths’ knowledge about their rights and the available SRHC services; improving the acceptability and cultural responsiveness of available services, especially youth clinics; and improving the quality of language assistance services.

Iranian Migrants’ Lived Experiences of Access to Sexual and Reproductive Healthcare Services in Western Australia: A Conventional Content Analysis

A positive approach towards sexual health should be considered in the policymaking process. There are different obstacles to migrants’ access to sexual and reproductive healthcare services (SRHS). The broad objective of this study was to investigate the perceptions and experiences (barriers and enablers) of Iranian migrants in accessing healthcare services for their reproductive and sexual health needs in Western Australia (WA). The study, which was conducted between June and November 2016, qualitatively addressed two main questions: “What are Iranian migrants’ experiences of accessing healthcare services (public and private) for their reproductive and sexual health needs?” and “What barriers and enablers do Iranian migrants experience in accessing healthcare services and information for their reproductive and sexual health needs?” The data were collected through semi-structured interviews with 10 Iranian adult migrants (seven women and three men), who lived in WA for more than 12 months (< 20 years). The data were evaluated using conventional content analysis. The participants described six major themes: “feeling of being insufficient,” “seeking information,” “seeking trust, credibility, safety, and confidentiality,” “unfavorable experiences,” “facing pre-established beliefs and feelings,” and “seeking Iranian sexologists”. Iranian migrants faced many barriers in accessing SRHS in WA; accordingly, there is a need for addressing these barriers in the Iranian migrant community of Australia. Health professionals and healthcare systems must be appraised with respect to the migrants’ needs. Policymakers need to prioritize the education of both healthcare providers and receivers, to facilitate equitable access to SRHS.

Individual determinants associated with utilisation of sexual and reproductive health care services for HIV and AIDS prevention by male adolescents.

BackgroundAdolescent sexual and reproductive health is one of the essential health care programmes in the world. However, adolescents still face numerous challenges in the area of sexual and reproductive health, which hinder their utilisation of available Sexual and Reproductive HealthCare Services (SRHCS). Male adolescents face further obstacles in accessing and utilising sexual reproductive health services owing to the influence of social constructions of masculinity, which has a bearing on how they view sexual and reproductive health services and their use.ObjectivesThe aim of this study was to investigate individual determinants associated with utilisation of SRHCS for HIV and AIDS prevention by male adolescents.MethodAn exploratory, descriptive and contextual qualitative design was used and semi-structured interviews with 20 purposively selected male adolescents aged 18–24 years living in the South African seat of government were conducted. Data were analysed using Tesch’s approach of data analysis.ResultsKnowledge of existing services was described as a significant individual determinant of utilisation of SRHCS. This was linked to the quality of SRHCS and violation of human rights of male adolescents.ConclusionThe study recommends the development of a strategy that will enhance and promote the utilisation of SRHCS by male adolescents.

Healthcare workers\u2019 beliefs, motivations and behaviours affecting adequate provision of sexual and reproductive healthcare services to adolescents in Cape Town, South Africa: a qualitative study

BackgroundAdolescents’ sexual and reproductive healthcare (SRH) needs have been prioritized globally, and they have the rights to access and utilize SRH services for their needs. However, adolescents under-utilize SRH services, especially in sub-Saharan Africa. Many factors play a role in the under-utilization of SRH services by adolescents, such as the attitude and behaviour of healthcare workers. The aim of this study therefore, was to explore and gain an in-depth understanding of healthcare workers’ beliefs, motivations and behaviours affecting adequate provision of these services to adolescents in South Africa.MethodsTwenty-four healthcare workers in public SRH services in Cape Town, South Africa participated in this qualitative study through focus group discussions. To fulfill the aims of this study, nine focus group discussions were conducted among the SRH nurses.ResultsSRH nurses indicated that they are experiencing challenges with the concept and practice of termination of pregnancy. They explained that this practice contradicted their opposing beliefs and values. Some nurses felt that they had insufficient SRH skills, which hinder their provision of adequate SRH services to adolescents, while others described constraints within the health system such as not enough time to provide the necessary care. They also explained having limited access to schools where they can provide SRH education and pregnancy prevention services in the surrounding area.ConclusionsNurses are faced with numerous challenges when providing SRH services to adolescents. Providing the nurses with training programmes that emphasize value clarification may help them to separate their personal beliefs and norms from the workplace practice. This may help them to focus on the needs of the adolescent in a way that is beneficial to them. At the health systems level, issues such as clinic operating hours need to be structured such that the time pressure and constraints upon the nurse is relieved.

Healthcare workers\u2019 behaviors and personal determinants associated with providing adequate sexual and reproductive healthcare services in sub-Saharan Africa: a systematic review

BackgroundHealthcare workers may affect the utilization of sexual and reproductive healthcare (SRH) services, and quality of care thereof, for example by their behaviours or attitudes they hold. This can become a hindrance to accessing and utilizing SRH services, particularly by young people, and thus a better understanding of these behaviours and associated factors is needed to improve access to and utilization of SRH services.MethodsA systematic review of literature was conducted to identify studies focusing on healthcare workers’ behaviors and personal determinants associated with providing adequate SRH services in sub-Saharan Africa (January 1990 - October 2015). Five databases were searched until 30th October 2015, using a search strategy that was adapted based on the technical requirements of each specific database. Articles were independently screened for eligibility by two researchers. Of the 125-screened full-text articles, 35 studies met all the inclusion criteria.ResultsNegative behaviours and attitudes of healthcare workers, as well as other personal determinants, such as poor knowledge and skills of SRH services, and related factors, like availability of essential drugs and equipment are associated with provision of inadequate SRH services. Some healthcare workers still have negative attitudes towards young people using contraceptives and are more likely to limit access to and utilization of SRH by adolescents especially. Knowledge of and implementation of specific SRH components are below optimum levels according to the WHO recommended guidelines.ConclusionsHealthcare workers’ negative behaviours and attitudes are unlikely to encourage women in general to access and utilize SRH services, but more specifically young women. Knowledge of SRH services, including basic emergency obstetric care (EmOC) is insufficient among healthcare workers in SSA.Trial registrationA protocol for this systematic review was registered with PROSPERO and the registration number is: CRD42015017509.

Patterns and Disparities in Sexual Health Service Utilization among Adolescent Males: A Report From a National Teen Pregnancy Prevention Initiative

Male adolescents have higher rates of risky sexual behaviors compared to females, including earlier age of first sexual intercourse, higher rates of sexual experience, unprotected intercourse, and sex while high on drugs and/or alcohol. However, compared to females, male adolescents are less likely to receive routine primary care, disease screenings, sexual health counseling, and pregnancy prevention service. Although gender disparities in sexual and reproductive healthcare (SRH) have been well documented, there has been little research on racial/ethnic disparities in adolescent male utilization of SRH services. The current report aims to address this gap in research using data from a national initiative to reduce teen pregnancy in communities with the highest rates. Health center data was collected in 2011 for 59 health centers via a Clinical Partner Needs Assessment (CPNA). CPNA data included information describing health center practice setting, number of unduplicated adolescents clients, and utilization of SRH services by adolescent clients, stratified by age, gender, race and ethnicity. Basic descriptive statistics were calculated on the proportion of adolescent male SRH visits, and disaggregated by age, race, and ethnicity. Patterns in utilization of services were compared across age, race, and ethnic categories to identify disparities. All data was analyzed using Stata statistical analytic software. Out of the 59 partner health centers, only 37 (63%) reported valid data. Collectively, these 37 health centers reported serving 27,683 adolescent clients, of which 19,917 (72%) were female and 7,766 (28%) were male. Among all the male client-visits, 19.9% were SRH visits whereas among all the female client-visits, 55.3% were SRH visits. The proportion of adolescent males accessing SRH care services varies considerably across race/ethnic groups. Hispanic males have the lowest proportion of SRH visits compared to the other racial/ethnic groups (6.7%). In contrast, black males have the highest proportion of SRH visits (39.3%). The frequency of visits per client varies substantially among racial/ethnic groups as well. On average, Hispanic male adolescents have the highest frequency of visit per client (2.4) whereas black males have the lowest frequency of visits per client (1.7). Analysis of data point to persistent disparities in access of SRH utilization for adolescent clients, with adolescent males significantly less likely to access SRH services as compared to their female peers. Among adolescent males, black males have the lowest frequency of visits per client. While Hispanic male adolescents visit health centers in a more recurrent manner compared to other racial/ethnic groups, they are less likely to receive SRH services compared to their non-Hispanic peers. Despite efforts to achieve health equity in teen pregnancy prevention efforts, considerable work needs to be done to address disparities in provision of SRH services for male adolescents. Future efforts should focus on addressing barriers to sexual and reproductive healthcare for black and Hispanic adolescent males in particular.