Sexual And Reproductive Health Care Research Articles

Acceptability of Contraceptive Services in the Emergency Department: A Cross-sectional Survey.

IntroductionUnintended pregnancy disproportionately affects marginalized populations and has significant negative health and financial impacts on women, their families, and society. The emergency department (ED) is a promising alternative setting to increase access to sexual and reproductive health (SRH) services including contraception, especially among marginalized populations. The primary objective of this study was to determine the extent to which adult women of childbearing age who present to the ED would be receptive to receiving contraception and/or information about contraception in the ED. As a secondary objective, we sought to identify the barriers faced in attempting to obtain SRH care in the past.MethodsWe conducted a quantitative, cross-sectional, assisted, in-person survey of women aged 18–50 in the ED setting at two large, urban, academic EDs between June 2018–September 2019. The survey was approved by the institutional review board. Survey items included demographics, interest in contraception initiation and/or receiving information about contraception in the ED, desire to conceive, prior SRH care utilization, and barriers to SRH.ResultsA total of 505 patients participated in the survey. Participants were predominantly single and Black, with a mean age of 31 years, and reporting not wanting to become pregnant in the next year. Of those participants, 55.2% (n = 279) stated they would be interested in receiving information about birth control AND receiving birth control in the ED if it were available. Of those who reported the ability to get pregnant, and not desiring pregnancy in the next year (n = 279, 55.2%), 32.6% were not currently using anything to prevent pregnancy (n = 91). Only 10.5% of participants stated they had experienced barriers to SRH care in the past (n = 53). Participants who experienced barriers to SRH reported higher interest in receiving information and birth control in the ED (74%, n = 39) compared to those who had not experienced barriers (53%, n = 240); (P = 0.004, 95% confidence interval, 1.30–4.66).ConclusionThe majority of women of childbearing age indicated the desire to access contraception services in the ED setting. This finding suggests favorable patient acceptability for an implementation study of contraception services in emergency care.

Determinants and Inequities in Sexual and Reproductive Health (SRH) Care Access Among Im/Migrant Women in Canada: Findings of a Comprehensive Review (2008-2018).

Given growing concerns of im/migrant women's access to sexual and reproductive health (SRH) services, we aimed to (1) describe inequities and determinants of their engagement with SRH services in Canada; and (2) understand their lived experiences of barriers and facilitators to healthcare. Using a comprehensive review methodology, we searched the quantitative and qualitative peer-reviewed literature of im/migrant women's access to SRH care in Canada from 2008 to 2018. Of 782 studies, 38 met inclusion criteria. Ontario (n = 18), British Columbia (n = 6), and Alberta (n = 6) were primary settings represented. Studies focused primarily on maternity care (n = 20) and sexual health screenings (n = 12). Determinants included health system navigation and service information; experiences with health personnel; culturally safe and language-specific care; social isolation and support; immigration-specific factors; discrimination and racialization; and gender and power relations. There is a need for research that compares experiences across diverse groups of racialized im/migrants and a broader range of SRH services to inform responsive, equity-focused programs and policies.

Sexual and reproductive health (SRH) needs of women admitted to eileen skellern ward (ES1) psychiatric intensive care unit (PICU)

IntroductionPICU inpatients are likely to be at increased risk of having unmet SRH needs due to barriers to accessing services. Since May 2018, an in-reach SRH assessment has been available to all psychiatric inpatients on ES1 ward, if referred. Analysis of referrals over 15 months identified only 24 had been made during this time.ObjectivesTo assess the SRH needs of women admitted to ES1 PICU, the feasibility of providing a SRH in-reach clinic, and the acceptability of delivering a nurse lead referral programme.MethodsA bi-monthly SRH in-reach clinic and a nurse led SRH referral pathway were implemented on ES1 over a seven-month period. A staff training needs assessment was performed followed by training, a protocol was developed, staff attitudes were explored, and patient engagement was sought.ResultsA total of 41% (32/77) of patients were referred, which was a 29% increase. 53.1% (17/32) of the total referrals had a true SRH need, equating to a 10% increase and 22% (17/77) of all PICU admissions. 90% of referrals were made by nursing staff. A staff focus group (n15) highlighted the acceptability and perceived importance of offering SRH care in PICU, if interventions were appropriately timed and the patient’s individual risk profile was considered.ConclusionsResults identify that SRH needs for PICU admissions are greater than previously realised. Providing a nurse led referral pathway for an SRH in-reach clinic is acceptable, feasible and beneficial for PICU patients. This project has resulted in service improvements including offering asymptomatic STI testing to all PICU admissions.DisclosureNo significant relationships.

Disrupted prevention: condom and contraception access and use among young adults during the initial months of the COVID-19 pandemic. An online survey

BackgroundThe initial response to COVID-19 in the UK involved a rapid contraction of face-to-face sexual and reproductive health (SRH) services and widespread use of remote workarounds. This study sought to...

Managing Precarity: Understanding Latinas' Sexual and Reproductive Care-Seeking in a Midwest Emergent Latino Community.

In this qualitative interview study, we took a two-pronged approach to understand the complexities of sexual and reproductive health (SRH) care access for Latinas in an emerging Latino community (ELC). Phase 1 assessed the SRH resources available for uninsured Latinas through provider interviews. In Phase 2, we interviewed 15 Latina-identified women about their considerations for SRH care-seeking. The scant options for SRH care are focused largely on contraception and pregnancy. Providers viewed themselves as prevention-oriented and perceived Latinas did not prioritize preventive care. Women described compounding challenges and precarious conditions. Annual checkups, accessing contraception, and treating vaginal infections were identified as needs. Barriers to SRH care were enhanced in an ELC. Participants described too much paperwork and limited time as organizational barriers which aggravated others, such as language limitations and feeling embarrassed to ask questions. Further research on SRH care using a reproductive justice approach is needed in ELCs.

Initial Impacts of COVID-19 on Sexual and Reproductive Health Service Use and Unmet Need in Britain: Findings from a Large, Quasi-Representative Survey (Natsal-COVID)

Background: The COVID-19 pandemic has affected sexual and reproductive health (SRH) service use and unmet need, but the impact is unknown. Methods: 6,654 participants (18-59y) completed a web-panel survey (July-August 2020) 4-months after initial lockdown in Britain (March 2020). Quota-based sampling and weighting enabled a quasi-representative population sample. We estimated reported SRH service use and unsuccessful use, and calculated age-adjusted odds ratios (aOR) among sexually-experienced (≥1sexual partner/lifetime;n=3,065) and sexually-active (≥1sexual partner/past year;n=2,752) participants (18-44y). F Findings: 9·1% and 2·7% of sexually-active men and women reported new sexual partners in the four months from March 2020, of whom 80·6% also reported condomless sex. 20·8% of sexually-experienced participants reported using SRH services during this timeframe. 9·7% reported being unable to use a service, though most (76·4%) also reported an instance of successful use. STI-related (4·8% of sexually-active participants) and contraceptive services (14·8% of sexually-experienced women) were most commonly used, with use highest among young people. Sexually-active participants reporting condomless sex with new partner(s) since lockdown (n=99) were particularly likely to report using STI-related services (aOR, men: 23.8(95%CI 11.6-48.9), women: 10.5(3.94-28.2)) and, amongst men, inability to access (aOR 13.3(5.39-32.9)). Among those reporting STI testing, 64·4% accessed remotely (telephone/video/online). 2.4% of women (25-59y) reported cervical screening, compared to an estimated 6% under normal circumstances. Interpretation: Many participants accessed SRH care during the initial lockdown, but young people and those reporting sexual risk behaviours reported difficulties. Services may need to address a backlog of need. Funding: Natsal (Wellcome/ESRC/NIHR), MRC/CSO, and UCL COVID-19 Rapid Response Fund. Declaration of Interest: None to declare. Ethical Approval: We obtained ethics approval from University of Glasgow MVLS College Ethics Committee (reference 20019174) and London School of Hygiene and Tropical Medicine Research Ethics committee (reference 22565). An anonymised dataset will be deposited with the UK Data Service.

Men's health in the modern era of cystic fibrosis

Cystic fibrosis (CF) has a profound impact on men's sexual and reproductive health (SRH) [1]. Over 97% of men with CF are infertile due to obstructive azoospermia from congenital bilateral absence of the vas deferens (CBAVD) [1]. Hypogonadism may result in decreased muscle mass, low bone mineral density (BMD), and potentially poorer quality of life [2]. Men's SRH experiences and care utilization have not been investigated in the modern era of CF, but prior research has shown major gaps in counseling and care [3,4].

Clinician Perspectives on Ethics and COVID-19: Minding the Gap in Sexual and Reproductive Health.

Clinician Perspectives on Ethics and COVID-19: Minding the Gap in Sexual and Reproductive Health.

Reproductive Health Services for Women During COVID-19 Pandemic

Millions of women across the world risk losing access to essential reproductive health services during the prevalent COVID-19 pandemic. The global and national level healthcare contexts are rapidly changing, and strongly influencing the sexual and reproductive health (SRH) and rights of adolescent girls and women [1]. Sustainable SRH services are of paramount importance in this current pandemic scenario. The SRH rights include an individual’s overall well-being for the SRH and reproductive body and considered imperative for the personal, social and economic growth [2]. The Sustainable Development Goals (SDGs) 3 and 5 are concerned with SRH rights pertaining to gender equality, women empowerment, accessible family planning services and contraception use [3]. The deep-rooted, gender-based inequalities for females in accessing SRH care have come to the forefront during the COVID-19 pandemic. Disrupted SRH services, gender inequality, and gender-based violence threatens to become a pandemic within the existing pandemic according to the United Nations Population Fund (UNFPA) [1,4].

Budgeting for comprehensive sexual and reproductive health and rights under universal health coverage

Achieving universal health coverage (UHC) for sexual and reproductive health (SRH) requires informed budgeting that is aligned with UHC objectives. We draw data from Adding It Up 2019 (AIU-2019) to provide critical new country-level and regional, intervention-specific costs for the provision of SRH services. AIU-2019 is a cost-outcomes analysis, undertaken from the health system perspective, which estimates the costs and impacts of offering SRH care in low- and middle-income countries. We present direct cost estimates for 109 SRH interventions and find that human resources comprise the largest category of direct SRH service costs and that the most expensive services in the model are largely preventable. We use scenario analysis to explore the synergistic costs and impacts of providing SRH interventions in clusters, focussing on chlamydia and gonorrhoea treatment, provision of safe abortion and post-abortion care services, and safe childbirth services. When costs are considered for the preventive and impacted services in these three clusters, there are cost savings for some of the impacted services in the packages and for the abortion-related package overall. The direct cost estimates from our analysis can be used to guide UHC budgeting and planning efforts. Having these cost estimates and understanding the potential for cost savings when providing comprehensive SRH services are critical for efforts to fulfil the rights and needs of all individuals, including the most marginalised, to access this essential care.

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.

Unintended Consequences of the COVID-19 Pandemic on the Sexual and Reproductive Health of Youth

The 2020 novel coronavirus (COVID-19) pandemic has led public health officials to recommend a reduction in routine healthcare services. These services are limited to life-saving and urgent evaluations to limit the spread of infection, protect healthcare workers, and conserve personal protective equipment. However, an unintended consequence of a reduction in services is the inaccessibility of sexual and reproductive healthcare (SRH) services, such as contraception and screening and treatment of sexually transmitted infections (STIs).

Stakeholder Perceptions and Experiences Regarding Access to Contraception and Abortion for Transgender, Non-Binary, and Gender-Expansive Individuals Assigned Female at Birth in the U.S.

Sexual and reproductive health (SRH) care often excludes the needs and experiences of transgender, non-binary, and gender-expansive (TGE) individuals. This study aimed to collect diverse stakeholder perspectives on barriers and facilitators to contraception and abortion for TGE individuals assigned female at birth (AFAB), assess knowledge and attitudes about unintended pregnancy prevention in these populations, and identify recommendations for improving SRH services for people of all genders. Between October 2017 and January 2018, we conducted 27 in-depth interviews with SRH stakeholders, including five TGE individuals who had obtained contraception or abortion care, and 22 clinicians, researchers, and advocates experienced in transgender healthcare. We iteratively developed a codebook and conducted thematic analysis to capture the spectrum of perspectives across interviews. Stakeholders reported a range of barriers to contraception and abortion access for TGE people AFAB, including inability to afford services, lack of gender-affirming clinicians, difficulty obtaining insurance coverage, and misconceptions about fertility and unplanned pregnancy risk. Deterrents to care-seeking included gendered healthcare environments, misgendering, and discrimination. Stakeholders described provider knowledge gaps and a perceived lack of medical education relevant to the SRH needs of TGE people. Recommendations included using gender-inclusive language and gender-affirming patient education materials and improving provider training on gender-affirming SRH care. Stakeholders identified substantial barriers to high-quality contraception and abortion care for TGE AFAB people in the U.S. They recommended specific interventions at the provider and institutional levels to improve experiences with care for TGE people and ensure broader access to gender-affirming SRH services.

A Multi-Methods Qualitative Study of the Delivery Care Experiences of Congolese Refugees in Uganda

Uganda hosts over 1.4 million refugees and is regarded as one of the world's most hospitable places for displaced populations. However, reports suggest that comprehensive sexual and reproductive health (SRH) services remain inadequate. We aimed to explore the SRH experiences of Congolese refugees living in Uganda and ways that services could be improved. We focus this article on delivery care-related results. In 2017, we assessed Congolese women's SRH, including pregnancy and delivery care, needs in the Nakivale Refugee Settlement and Kampala. We conducted a review of published literature and institutional records, 11 key informant interviews, four focus group discussions with married and unmarried Congolese women, and 21 in-person in-depth interviews with Congolese women refugees. We analyzed these data for content and themes using inductive and deductive techniques. In the final analytic phase, we integrated findings from each study component to identify concordant and discordant results. Our findings indicate that Congolese refugees experience significant challenges accessing delivery care in both camp and urban settings. The availability of trained healthcare staff is limited, health facilities and medication supplies are inadequate, and referral systems are deficient. Refugee women report that corruption, discrimination, language barriers, and lack of privacy characterize their delivery experiences. Efforts to increase trained healthcare staff, improve supply-chain management, and maintain infrastructure and equipment are imperative. Ensuring compliance with anti-bribery and anti-corruption policies and supporting respectful maternity care is also important. Creating approaches to overcome language barriers is crucial to minimizing miscommunication and building patient-provider trust.

Reproductive Health Goals and Experiences of Women With Cystic Fibrosis [24J

INTRODUCTION: Treatment and management advances are allowing women with many chronic diseases, such as cystic fibrosis (CF), to live longer, healthier lives. As survival improves, addressing women’s sexual and reproductive health (SRH) is increasingly important. This study examines the reproductive goals and experiences of women with CF to inform the development of a disease-specific, patient-centered decision aid (DA) around SRH. METHODS: Adult women with CF participated in individual, semi-structured interviews exploring their experiences and attitudes toward parenthood, pregnancy, contraception, and SRH care provision. Interviews were audio-recorded and transcribed verbatim. Qualitative analysis was conducted using a thematic analysis approach. IRB approval was obtained (#STUDY19040336). RESULTS: To date, 20 women with CF (age 20-63 years) have been interviewed. Emerging themes include: 1) CF team as a de facto primary care provider and related gaps in SRH care provision; 2) Lack of shared language between patients and providers related to SRH care; 3) Impact of CF on the ability to parent; 4) SRH has low priority or is perceived as unconnected to standard CF care; 5) An evidence-based reproductive goals DA would facilitate shared SRH decision-making with CF care teams. CONCLUSION: Women with CF often experience disjointed SRH care and would benefit from the development of a DA that supports them in recognizing and realizing their reproductive goals. Results from this work can serve as a model for the development of interventions that improve patient-centered SRH decision-making, especially for women with other chronic diseases who may face similar challenges and concerns.

Normalising abortion: what role can health professionals play?

BackgroundDespite being a common gynaecological procedure, abortion continues to be widely stigmatised. The research and medical communities are increasingly considering ways of reducing stigma, and health professionals have a role...

Pediatric hematology and oncology fellow education in sexual and reproductive health: A survey of fellowship program directors in the United States.

Pediatric oncology clinicians identify a need for increased sexual and reproductive health (SRH) education with adolescent and young adult (AYA) cancer patients. By surveying pediatric oncology fellowship directors, this study clarifies the state of current fellowship education about SRH for the AYA patient. A survey was sent to all pediatric oncology fellowship program directors (PDs) in the United States consisting of 13 questions pertaining to three primary SRH domains: sexual health, fertility, and safe sex practices. Descriptive statistics and χ2 were used in data analyses. Sixty-three PDs responded to the survey (91% response rate). Of these, 88% reported having formal instruction regarding fertility, 41% reported curriculum regarding contraception and 30% reported some education regarding sexual health. The curriculum "being too full" was identified as a barrier to education on fertility (29%), sexual health (40%), and safe sex practices (38%). Not being a required or expected part of the program was more likely to be endorsed as a barrier for sexual health (26%) and safe sex practices (30%) compared with fertility (8%) (P<0.005). Lack of experts to teach was a more frequently endorsed barrier to education on sexual health (47%) compared with either fertility (23%) or safe sex practices (25%) (P<0.005). This study identifies important gaps in oncology fellow education about SRH. Future research must explore optimal education strategies that are feasible and acceptable by PDs and fellow learners, and effective in optimizing AYA SRH care.

Healthcare Clinician and Staff Perspectives on Facilitators and Barriers to Ideal Sexual Health Care to High-Risk Depressed Young Women: A Qualitative Study of Diverse Clinic Systems

This study identified clinician and clinic staff perspectives on facilitators and barriers to providing sexual and reproductive health (SRH) care to depressed young women, a population at increased risk for adverse SRH outcomes. We conducted in-person semi-structured qualitative interviews, which were audio-recorded, transcribed, and coded by two researchers. We used thematic analysis to identify themes pertaining to care facilitators and barriers within a socio-ecological framework. This study was conducted in seven diverse clinics in the U.S. New England region. Participants were 28 clinicians and staff (4/clinic), including behavioral health clinicians (n=9), nurse practitioners (n=7), nurses (n=3), medical doctors (n=3), administrative associates (n=2), practice managers (n=2), family planning counselor (n=1), and medical assistant (n=1). We queried how clinicians and clinic staff identify and manage depression and sexual risk, and what they perceive as facilitators and barriers affecting provision of ideal SRH care to depressed young women. Themes represented facilitators of and barriers to providing ideal SRH care to high-risk depressed young women at five socio-ecological levels: individual (facilitator: trust in providers; barrier: stigma experiences), interpersonal/provider (facilitator: frequent patient-provider communication; barrier: lack of time during clinic visits to build trust), clinic (facilitator: integration of care; barrier: lack of scheduling flexibility), organization/community (facilitator: training for providers; barrier: funding constraints), and macro/societal (facilitator: supportive policies; barrier: mental health stigma). Optimizing SRH care to high-risk depressed young women necessitates attention to factors on all socio-ecological levels to remove barriers and bolster existing facilitators of care.

Parenting and child-caretaking among black men who have sex with men and associated sexual and reproductive health factors: a brief report

The purpose of this exploratory study was to examine the prevalence of parenting and child-caretaking among a sample of black men who have sex with men (MSM), as well as associations between parenting roles and sexual and reproductive health (SRH) factors. Parenting and SRH data were derived from a survey of 199 black MSM. Nearly half of the sample reported being a father or father-figure (44.4%), almost a third indicated serving as caretaker of a child (29.1%), and one in five have a biological child (20.1%). Over half of the sample reported at least one of these three parenting/child-caretaking roles (52.5%). Two significant differences were observed for sexual health variables: men with biological children were significantly more likely to report using condoms inconsistently (55.0% vs. 35.7%, p = .026) and engaging in transactional sex work (36.8% vs. 21.0%, p = .041). Given the observed prevalence, parenting and child-caretaking among black MSM warrant further inquiry as factors that may influence SRH outcomes and care utilization. Services and interventions tailored to black MSM should consider these men’s potential roles and responsibilities as parents and caretakers of children.

Using Facebook to tell stories of premature ageing and sexual and reproductive healthcare across the life course for women with cerebral palsy in the UK and USA

ObjectiveTo enhance understanding of the bodily and lifestyle effects of ageing with cerebral palsy (CP) for women, with a particular focus on experiences with sexual and reproductive healthcare (SRH) services...