Fertility decline in Latin America suggests that an increasing share of the reduction occurs before the first birth. In Peru, population-level evidence on trends in first-child desire, reproductive indecision, and preferred timing of first birth among nulliparous women remains scarce. To describe temporal trends in stated fertility preferences among Peruvian nulliparous women between 2005 and 2024, and to identify sociodemographic factors associated with first-child desire and a preference to wait more than two years for a first birth. We conducted a repeated cross-sectional analysis of 20 annual ENDES rounds (2005–2024). We included women aged 15–49 years with zero live births and excluded those currently pregnant from the main analysis. Stated fertility preference and preferred timing of first birth were derived from standard ENDES/DHS questions. Associations are reported as prevalence ratios (PRs) with 95
Parity is an important indicator of women’s reproductive experience. Repeated pregnancy and birth may be linked to women’s health-related quality of life (HRQoL) through cumulative physical strain, psychological stress, caregiving demands, and socioeconomic disadvantage. However, longitudinal evidence on the parity-HRQoL association remains limited and inconsistent, especially in settings marked by urban-rural and ethnic differences. This study examined the association between baseline parity and HRQoL over time among women in Southwest China, and explored whether this association differed by region and ethnicity. This longitudinal study included 6,625 women from the China Multi-Ethnic Cohort who completed baseline and follow-up surveys over a mean follow-up period of 2.0 ± 0.5 years. Baseline parity was categorised as 1, 2, and ≥ 3, and HRQoL was assessed at both waves using the EQ-5D-5 L Index Value and VAS Score. Repeated HRQoL measurements were jointly analysed using linear mixed models with participant-level random intercepts. Models included parity, time (survey wave), and parity-by-time interaction terms, and adjusted for baseline age, region, ethnicity, marital status, educational level, occupation, household income, self-reported disease, Healthy Lifestyle Index, and social support score. Effect modification by region and ethnicity was assessed using parity-by-region and parity-by-ethnicity interaction terms, given substantial variation in social conditions, resource access, and sociocultural context in Southwest China. The parity-by-time interaction was statistically significant for both the Index Value (F = 5.975, P = 0.003) and VAS Score (F = 6.746, P = 0.001). Women with parity of 1 or 2 had higher adjusted HRQoL than those with parity of ≥ 3 at both baseline and follow-up, although between-group differences attenuated at follow-up. The adjusted differences were statistically significant but modest in magnitude. In dimension-specific analyses, the largest adjusted differences were observed for mobility. Joint tests showed significant parity-by-region and parity-by-ethnicity interactions for the VAS Score, with clearer parity-related differences among rural and ethnic minority women. Higher parity was associated with lower HRQoL over time, although the adjusted differences were modest. The association was clearer among rural and ethnic minority women, and the largest dimension-specific differences were observed for mobility. These findings suggest that reproductive history, particularly parity, may be considered when assessing women’s HRQoL. Higher-parity women, especially those in rural and ethnic minority communities, may benefit from routine HRQoL assessment and mobility-related health support.
Respectful maternity care (RMC) is a fundamental human right that ensures women’s dignity, privacy, and autonomy during childbirth. In humanitarian settings, however, RMC is often neglected. Despite Ethiopia hosting one of Africa's largest refugee populations, research on RMC in refugee camps, particularly in the Melkadida camps, remains limited. This study aimed to estimate the prevalence of respectful maternity care and examine factors associated with receiving respectful maternity care among Somali refugee women following facility-based childbirth in Melkadida refugee camps, Ethiopia. A convergent mixed-methods study was conducted from March 1 to March 30, 2025. Quantitative data were collected from 417 women using a structured questionnaire, while qualitative data were gathered through in-depth interviews with 16 participants. Data were analyzed using SPSS for quantitative analysis and open code software for thematic analysis of qualitative data. The study had a 98.6
It is important to recognize that childbirth and the transition to the maternal role constitute a profound identity reconstruction, involving both the physical experience of labor and the psychological adaptation to motherhood, during which many women experience unstable and intense emotional fluctuations. This study compared the pregnancy outcomes among women who exhibit varying emotional states during childbirth. Pregnant women recruited from a maternal and child health hospital had their maternal mood states assessed using the Profile of Mood States (POMS) during the active period of labor. Based on individual POMS item responses, latent profile analysis (LPA) was conducted to classify maternal emotional patterns during labor and to identify emotional patterns specific to the latent phase. Outcome measures included labor outcomes (e.g., cervical dilation and duration of labor) as well as neonatal health indicators. Analysis of covariance (ANCOVA) was used to compare pregnancy outcomes across different groups. A total of 244 women giving birth were investigated, among whom two distinct emotional groups emerged based on their experiences during childbirth: a positive mood cohort comprised 213 individuals (87.5
Although the outcomes of comprehensive sexuality education are generally promising and positive, limited research has been conducted on how and under what conditions these outcomes are achieved. This article analyses the contextual factors that underpin mechanisms influencing the implementation and outcomes of comprehensive sexuality education. Using the realist evaluation approach, data collection and analysis were conducted iteratively, beginning with an existing program theory, followed by a literature review and then primary data collection through four realist workshops with 50 stakeholders (including trained teachers and staff from the training college, district, and provincial offices) and 60 learners. Thematic analysis, informed by realist evaluation of demi-regularities, was used. We identified three key demi-regularities centred on the mechanisms of autonomy, curiosity, fear, and juggling. These are the ‘autonomy to make the right decision,’ ‘curiosity to learn about and explore adolescents’ sexuality,’ ‘fear in adolescents’ and young people’s sexual health related to the negative consequences of sex, fear of judgment and stigma for being sexually active, and fear that CSE might undermine traditional cultural values,’ and the juggling of various mechanisms, contextual conditions, and sources of information. The study highlights that while comprehensive sexuality education seeks to empower learners, this empowerment was constrained because topics were taught selectively, particularly in more contentious areas such as sexual relationships, gender identity, condom and contraception use, and abortion, due to broader societal, cultural, and religious influences. To fully realize the benefits of comprehensive sexuality education, an approach that is holistic and also sensitive to culture and religion is needed. This approach should enable adolescents and young people to explore all aspects of sexual and reproductive health and rights while making informed decisions without undue pressure or fear.
Intimate partner violence (IPV) is prevalent globally, adversely impacting women’s health and autonomy. Covert contraceptive use (CCU), using contraception without a partner’s knowledge, may arise in response to IPV and restrictive gender norms. This study examines associations between verbal, physical, and sexual IPV and CCU among Ugandan women, providing insight into the socio-cultural dynamics influencing reproductive health choices. We conducted a secondary analysis using data from the 2011–2013 Rakai Community Cohort Survey, which collected demographic, reproductive, and IPV-related data from women in South-Central Uganda. We included women who reported (1) ever having sex, (2) no current pregnancies, and (3) current use of contraception, including intra-uterine devices, pills, injectables, or implants. Adjusted prevalence ratios (APR) and 95
Male involvement is essential for effective family planning, yet men in most of sub-Saharan Africa remain less engaged than women. Their participation is shaped by the socioeconomic context, but evidence on how modern contraceptive use varies across socioeconomic groups among men is limited. This study therefore examined socioeconomic inequalities in modern contraceptive use among men in East Africa. This study analyzed weighted, nationally representative Demographic and Health Survey data from two survey rounds per country for sexually active men aged 15–54 years in Burundi (2010 and 2016), Kenya (2014 and 2022), Rwanda (2014 and 2019), Tanzania (2010 and 2022), and Uganda (2011 and 2016). Inequalities in modern contraceptive use were assessed using HEAT Plus, applying simple (Difference) and complex (Population Attributable Fraction) measures. Modern contraceptive use among men varied across the five countries. Burundi recorded a modest increase between 2010 and 2016, Rwanda and Uganda showed a consistent increase, while Tanzania and Kenya experienced declines between 2014 and 2022. Across the five countries, education, place of residence, wealth index, and decision making on how to spend earnings emerged as the most salient dimensions of inequality in modern contraceptive use among men. Education-related inequalities were particularly pronounced, with PAF estimates indicating that national levels of modern contraceptive use could have been higher by up to about 34.6
Each year, about half of pregnancies in adolescents (15–19 years of age) are unintended, and the rate of adolescent pregnancy in sub-Saharan Africa is twice the global rate. Adolescent pregnancies have similar social determinants as those of HIV acquisition, resulting in adverse health outcomes for adolescent girls and young women (AGYW) and exacerbating adverse HIV-related health outcomes. To better understand reproductive choice for AGYW living with HIV (AGYWLWH), this study examined family planning attitudes, knowledge, and experiences among young women living with HIV in Moshi, Tanzania. Young female participants previously enrolled in the SYV pilot trial were purposively sampled to understand their attitudes, knowledge, and experiences with family planning services through in-depth interviews and a focus group discussion. Participants with a pregnancy experience (PE) and those without (NPE) were recruited to explore contextually relevant factors shaping these constructs. Thematic analysis included inductive and deductive coding, a data reduction matrix, and memo writing to identify and synthesize themes. Of 16 enrolled participants, 13 had a pregnancy experience. The average age at first pregnancy was 20 years old, and almost two-thirds of participants experienced an unintended pregnancy (9/13). Participants shared that family planning services and hormonal contraception felt inaccessible until they had a pregnancy, often due to perceived social norms around sexual promiscuity or due to a fear of contraception-induced infertility. As a result, participants shared they did not feel well-informed about contraceptive options prior to their first pregnancy, while mentioning that contraceptive information pre-pregnancy often did not feel relevant. Therefore, no participants used hormonal contraception prior to their first pregnancy, and the most common method ever used was the male condom (8/16). After a first pregnancy, hormonal method use was more prevalent (9/13), and the most common hormonal method used was the implant (5/13). Almost all participants felt contraception was useful and promoted reproductive choice, citing the importance of birth spacing, particularly related to the successful prevention of maternal to child transmission. Despite perceived social norms related to family planning use pre-pregnancy, participants recommended AGYWLWH use family planning to achieve their personal and family composition goals, and they called for increased access to family planning information. A perceived social norm to have a child before family planning use emerged as the primary barrier to AGYWLWH reproductive choice, and almost all participants shared that family planning services were useful and promoted their autonomy. Looking to future generations, participants recommended increased access to contraceptive information for adolescents and young adults to improve reproductive choice for AGYWLWH. Adolescent girls and young women living with HIV (AGYWLWH) face higher health risks from unplanned pregnancies. These young women often have limited access to family planning, increasing their pregnancy risk and reducing their reproductive choice. This study examined factors that influenced reproductive choice for AGYWLWH in Moshi, Tanzania through interviews and a focus group discussion. We found that participants believed family planning and hormonal contraceptive use was most appropriate for women who already had children. Many participants worried hormonal contraceptives caused infertility, and they perceived that AGYW seeking family planning services were labeled promiscuous. Despite these concerns, participants post-pregnancy expressed that contraception provided them with choice and freedom, and they shared preferences for individualized clinical counseling. Given their experiences with hormonal contraceptive use post-pregnancy, participants recommended increased access to contraceptive information for all adolescents and young people and encouraged family planning use for AGYWLWH. Based on these findings, we suggest implementing adolescent-responsive contraceptive services, comprehensive sex education in schools, and exploring family planning integration and evaluation in HIV clinics to increase reproductive choice for AGYWLWH.
Adolescent pregnancy remains a significant global public health issue. Thailand enacted the Act on Prevention and Solution to the Adolescent Pregnancy Problem and implemented a public health policy that provides free long-acting reversible contraceptives (LARCs) access to adolescents. At our institution, a structured, adolescent-focused protocol was developed to improve contraceptive counselling and access for postpartum and postabortion adolescents. This study aimed to determine the LARC initiation rate following implementation of this practice. Continuation rates and factors associated with LARC initiation and early discontinuation were also analyzed. This retrospective study was conducted at a tertiary referral university hospital. Thai adolescents aged under 20 years at the time of delivery or abortion at our hospital were included. Demographic and clinical data were collected, including selected contraceptive method, LARC insertion and removal dates, and follow-up data for up to 36 months. Independent sample t-tests, Mann–Whitney U tests and chi-square tests were used as appropriated. The primary outcome was reported as frequency and percentages. Kaplan–Meier survival analysis assessed continuation rates, while logistic regression and Cox proportional hazards models identified factors associated with initiation and early discontinuation (defined as LARC removal before 3 years), respectively. Of 1,081 postpartum and post-abortion adolescents, 839 (77.6
Despite medical advances and widespread use, approximately 1 in 4 current and prospective female contraceptive users in the United States do not access their preferred method of contraception. Understanding how to address cultural barriers to contraceptives is critical to improving access. This study investigated how different aspects of cultural background influence contraceptive perceptions and experiences. We explored this question with an intersectional lens, recruiting participants with a range of multicultural identities. Between 2023 and 2024, we conducted 32 in-depth interviews with a diverse sample of pregnancy-capable people around the puget sound in Washington, asking how culture influences attitudes and decisions regarding birth control. Codes were created inductively from interview transcripts and were grouped by definitional similarities and co-occurrences with each other. The research team identified themes that represented the overarching influences of cultural norms and experiences on birth control perceptions and use. From analysis of 32 in-depth interviews, our analysis revealed four main themes: (1) Cultural Birth Control Stigma Spread Through Gossip, Misinformation, and Silence; (2) Expectations from Family and Gendered Norms Hinder Preferred Birth Control Use; (3) Autonomy, Access to Culturally Competent Providers, and Access to Comprehensive Information Facilitate Positive Perceptions of Birth Control; (4) Desire for Birth Control Accessibility, Comprehensive Education, Decreased Stigma, and Shared Contraceptive Responsibility. A diverse group of participants reported nuanced themes of cultural birth control stigma and familial and gendered expectations as barriers to positive birth control perceptions and use, while values of autonomy, culturally understanding healthcare providers, and comprehensive education facilitated positive birth control perceptions. To address unique patient needs, providers should acknowledge perceptions of stigma, address patient and familial knowledge gaps through tailored contraceptive counseling, and prioritize full transparency on benefits and side effects. Providers must recognize patients’ individual experiences and consider culture as a nuanced and complex influence. In the United States, access to preferred contraception remains out of reach for almost a quarter of current and prospective female contraceptive users. This study explores themes of social and cultural influences on contraceptive perceptions as well as the contraceptive narratives of 32 pregnancy-capable individuals from the greater Puget Sound region in Washington State. In-depth interviews of participants were coded and thematically analyzed to identify themes that represented overarching concepts of cultural influences on birth control perceptions and experiences. Our thematic analysis found themes of stigma and familial and gendered expectations acting as barriers to positive birth control perceptions and use amongst our sample, while values of autonomy, access to understanding healthcare providers, and access to comprehensive birth control information improved positive perceptions of birth control. Participants expressed desire for reduced contraceptive stigma, better education, and greater transparency from healthcare providers. Our participants’ narratives highlight the importance of healthcare providers tailoring contraceptive counseling to each individual’s unique experiences and needs. With growing legal challenges to contraceptive access, it is more important than ever to protect patients’ reproductive autonomy. Our findings add nuanced cultural birth control narratives from the Puget Sound region to the emerging understanding of factors influencing perceptions of birth control and connect these findings to how healthcare providers can play a positive role in navigating reproductive decision making with patients.
Sustainable Development Goal 3, target seven, aims to ensure universal access to sexual and reproductive health care services, including family planning information and education. Mobile health interventions may be an effective means to achieve this target. Mobile health (mhealth) involves the use of mobile phone applications (MPAs) and text messages (SMS) on devices such as cell phones to provide relevant information to improve well-being and health. Given the growing interest in the use of mobile health to improve healthcare delivery, especially in sub-Saharan Africa (SSA), up-to-date information must be available to guide practice. To provide up-to-date evidence on the effectiveness of mhealth interventions in enhancing contraceptive use among women of reproductive age in SSA. We conducted a systematic review of the literature in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The review was guided by a protocol registered in PROSPERO and aimed to provide up-to-date evidence on the effectiveness of mhealth interventions in enhancing contraceptive use. The PICO framework guided the literature search, and the review was conducted with an information specialist. The literature search covered studies published from 1994 to 2022 in the following databases: Medline, CINAHL, PubMed CENTRAL, the Cochrane Library, and EMBASE. Two independent reviewers conducted the screening in three stages. The title, abstract, and full-text were screened to identify studies that met the inclusion criteria. Data were extracted using a standardised data extraction form, synthesised, and assessed for quality. The quality of randomised controlled trials (RCTs) was evaluated using the JBI critical appraisal tool for RCTs. The JBI critical appraisal tool for cross-sectional studies was used to assess the non-randomised studies. A meta-analysis was conducted for studies that met the meta-analysis criteria. A total of 9,768 records were retrieved following the searches. Eight (8) studies were included in the final review: 6 RCTs, and 2 cross-sectional studies. A positive effect of mhealth on modern contraceptive use was reported in 4 out of the 8 studies, while the remaining 4 did not report any significant effect. A meta-analysis of data pooled from the 6 RCTs demonstrated a statistically significant effect of the intervention on contraceptive use (OR = 1.46, 95
Pregnancies conceived through assisted reproductive technology (ART) have a substantially elevated risk of pre-eclampsia, and international guideline classify ART as a high-risk factor warranting low-dose aspirin prophylaxis. However, data on aspirin utilisation and effectiveness in ART pregnancies in sub-Saharan Africa are scare. A prospective cohort study was conducted at four private ART centres in Kumasi, Ghana, from August 2024 to February 2025. Women with ongoing In Vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI) pregnancies at ≥ 20 weeks of gestation were consecutively enrolled and categorized by aspirin status (50 exposed and 50 unexposed). Pre-eclampsia was diagnosed according to the 2021 International Society for the Study of Hypertension in Pregnancy criteria. Data were analysed using SPSS version 27 with significance set at p < 0.05. In a cohort of 100 women (mean age of 40.8 years), aspirin use was associated with a lower incidence of pre-eclampsia (10.0
Abstract Background Ghana’s caesarean section (CS) rate has increased from 16% in 2017 to 21% in 2022 which matches the global CS rate (Ghana Demographic and Health Survey 2022) (Ghana Health Service 2016 Annual REport. 2017). Given that the World Health Organisation (WHO) recommends a range of 10% to 15% per live birth, Ghana, as of 2017, joined other countries that have exceeded this range (WHO Statement on Caesarean Section Rates. 2015) (Journal of Public Health (Germany) 25(5):557–64, 2017). This review set out to explore the prevalence of CS across regions of Ghana and to understand influences on CS uptake. Methods The Joanna Briggs Institute methodological guidelines for scoping reviews were followed, and the review was reported in line with the Preferred Reporting Items for Systematic and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Literature searches were conducted in MEDLINE, PsycINFO, EMBASE, Web of Science and CINAHL (EBSCO). The review included primary qualitative, quantitative, mixed methods studies, systematic reviews, scoping reviews, and grey literature. Narrative synthesis was used to present CS prevalence. The Theoretical Domains Framework (TDF) was used to assess factors influencing CS uptake. Results Substantial variation in CS uptake is evident across Ghana regions, ranging from 15.7% (Menoufia Medical Journal 35, 2022) to 26% (BMC Pregnancy and Childbirth 19(1), 2019) in the Northern and 6.6% (BMC Pregnancy and Childbirth 18(1), 2018) to 40.6% (Texila International Journal of Public Health 11(2), 2023) across the Southern sector. Quantitative factors such as maternal age (older women), free maternal healthcare policy, and high household socio-economic status were among the specific factors influencing CS uptake in Ghana (Pan African Medical Journal 29, 2018), (BMC Pregnancy Childbirth 21(1), 2021), (BMC Pregnancy Childbirth 22(1), 2022), (Health Services Insights 2024), (Glob J Health Sci 6(4):9–21, 2014). Despite this, and several reports on clinical and demographic factors associated with CS uptake, there is very little in-depth evidence published on the nature of the barriers and facilitators to CS uptake; thus, future qualitative research is warranted. Conclusion The review found variation in CS prevalence across regions of Ghana, ranging from 6.6% to 40.6%. The reason for this variation is not well understood. The limited evidence demonstrating potential influences on CS uptake in Ghana is mainly quantitative. Hence, we recommend further qualitative research with a range of stakeholders to better understand in-depth contextual issues influencing CS uptake in Ghana.
Maternal serum uric acid (UA) levels have been linked to adverse pregnancy outcomes, but no studies have yet examined this association in women undergoing assisted reproductive technology. This study aimed to investigate the relationship between pre-pregnancy UA levels and adverse pregnancy outcomes in women conceived via in vitro fertilization and embryo transfer (IVF-ET). This retrospective cohort study included 2 111 singleton pregnancies conceived via IVF-ET, delivered at Peking University Third Hospital between 1 January 2017 and 30 April 2022. Restricted cubic splines were used to test nonlinear relationships between serum UA during pre-pregnancy and adverse outcomes, and multivariable logistic regression to calculate odds ratio (OR) and 95
Despite being a physiological process for human development, menstruation can be burdened with a complex interplay of interpersonal, social, and structural factors. Evidence on menstrual health remains scarce across Eastern Europe and Central Asia, and published research specifically addressing adolescent girls’ menstrual health experiences in Georgia is lacking, despite cultural and historical factors that suggest unique challenges in this setting. Public schools represent a critical but understudied environment where infrastructural, educational, and social barriers to menstrual health converge for adolescent girls. This study aims to explore menstrual health knowledge, attitudes, and experiences among schoolgirls in Georgia. We conducted a qualitative study using in-depth interviews and focus group discussions in public schools across urban and rural areas of three cities in Georgia in 2020. An inductive-deductive approach was used for data analysis. We used the Social Ecological Model (SEM) to report and interpret the findings. Nine teachers and 39 schoolgirls (28 in six focus groups, 11 in interviews) participated. The Social Ecological Model revealed multilevel challenges: knowledge gaps and misconceptions (individual level); hindered family communication and peer stigma (interpersonal level); inadequate school infrastructure and insufficient teacher training (organizational level); cultural taboos shaping attitudes and practices (community level); and curriculum deficiencies preventing comprehensive education (policy level). These interconnected factors negatively affected schoolgirls’ menstrual health knowledge, hygiene management, and participation in school activities. The findings demonstrate that formal educational settings in Georgia inadequately address the schoolgirls’ menstrual health needs. Comprehensive menstrual health education, improved school infrastructure, and teacher training are essential to reduce menstrual stigma and provide accurate information and resources. Addressing these multilevel barriers can significantly enhance menstrual health, educational participation, and overall well-being among schoolgirls across Georgia.
To compare postpartum contraceptive receipt among (i) Medicaid beneficiaries with stimulant-related substance use disorder (SUD) to those without SUD; and (ii) Medicaid beneficiaries with other SUD to those without SUD. This was a retrospective cohort study of birthing events using Oregon’s linked Medicaid claims and vital statistics data 2012–2019 (N = 141,479). We described demographic characteristics, birth outcomes, and substances used, and compared rates of contraception receipt (i) immediately postpartum (IPP), (ii) within 60 days postpartum excluding IPP, and (iii) within 60 days postpartum including IPP. Prevalence of stimulant-related and other SUD diagnosis was 3.8
One in every 27 people worldwide belongs to the East African Community, a region with shared cultural traits and free movement. Despite recent declines, the fertility rates in this Community remain high. This study assesses the link between women’s empowerment and remaining within the woman’s ideal family size, considering the women’s perceptions of their husbands’ desired family size. This study used Demographic and Health Survey datasets of Burundi (2015–2016), The Democratic Republic of the Congo (2013–2014), Kenya (2022), Rwanda (2019), Tanzania (2022), and Uganda (2016). A total of 5855 married or cohabiting women aged 35–49 who perceive that their husband wants more children than they do were included in this study. IBM SPSS Statistics 24 (SPSS: Statistical Package for the Social Sciences) was employed for data analysis. The Survey-based Women’s empowerment (SWPER) index, across its three domains (attitude toward violence, social independence, and decision-making) was adopted to evaluate empowerment levels. Binary logistic regression was implemented to examine the association between the domains and the outcome variable, which indicates whether a woman has remained within her ideal number of children. Additionally, the link between potential confounders and the outcome variable was assessed. Univariable and multivariable models including country fixed effects were estimated. Sensitivity analyses excluded women below their ideal number. Variables showing p-values < 0.05 were considered statistically significant. Overall, 63.3
The UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) has a mandate to lead in sexual and reproductive health and rights research and to support research capacity strengthening. Starting in 2016, it did so through supporting the latter through a large network of research institutions called the HRP Alliance. This commentary highlights the work of the HRP Alliance in response to the coronavirus disease (COVID-19) pandemic. The onset of the COVID-19 pandemic prompted the HRP Alliance to adapt the way they had been working. HRP Alliance research capacity strengthening hubs actively contributed to developing a research agenda based on WHO’s research and development blueprint and country-specific needs. They also took on leading roles in developing, adapting to each country/setting, and implementing research projects aimed at understanding how the COVID-19 pandemic was affecting SRHR in different contexts and income settings. These studies provided opportunities for early career researchers and students to lead in project management, study implementation, training, and data analysis. Through a network of nimble research institutions, the HRP Alliance collaborated to generate evidence on the impact of COVID-19 on pregnancy, pregnancy outcomes, access to SRHR services, gender-based violence, and abortion care. The success of implementing these research response mechanisms and developing global networks of research and healthcare institutions, provided solid ground upon which to build SRHR research responses to future pandemics and other emerging diseases. Adequate readiness and response to global health emergencies require high quality and timely evidence generation. Global networks of research partner institutions, brought together through research capacity strengthening initiatives, can provide a fruitful platform ready and able to swiftly respond. However, inherent power imbalances and challenges to equitable partnerships need to be considered to ensure sustainable ways of working together.
Abstract Background The Coronavirus Disease 2019 (COVID-19) pandemic disrupted the capacity of healthcare systems. This study aimed to provide a better understanding of the impact of the COVID-19 pandemic on sexual and reproductive healthcare (SRH) services. Methods We conducted a mixed-method cross-sectional study at the SRH services of the tertiary care university hospital of Verona, Veneto region, Italy. Questionnaires based on WHO validated tools were administered to all consecutive clients once per month for 11 months (December 2021 to November 2022) to assess SRH services availability and readiness. In-depth interviews (IDIs) have been used to understand participants’ perspectives. Results The questionnaire was completed by 100 clients (average age 35.34 years; sexually transmitted infection care service: n =49; abortion service: n =24, family planning and contraception service: n =16, and anti-violence service: n =11). All SRH services continued to operate without a shortage of supplies, although some facilities had relocation of staff and a location change. IDIs involved 25 clients at the abortion and family planning services, and 5 clients at the sexually transmitted infection care service. Most clients self-referred to SRH services and sought information online, which was described as helpful, clear, and informative. Remote consultation was the primary access method, allowing planning for in-person attendance after initial triage. This approach was appreciated and considered time-saving and facilitating. Slight delays or longer than anticipated waits were reported by some clients, although mainly in the initial pandemic phase. The relocation of facilities and the restriction of supportive persons were significant barriers to some SRH services. The risk of COVID-19 was perceived as low or less relevant than the reason for accessing SRH care, and it did not limit the decision to access. Conclusions Results of the present study reflect the importance of maintaining SRH services for clients during health emergencies. Expanding pre-existing remote services and innovations in SRH care delivery had a key role and were appreciated by clients. Telemedicine for initial triage or online consultations and prescriptions should be implemented in regular practice or predisposed for rapid implementation in emergencies, along with ensuring up-to-date information, particularly online.
