BACKGROUND:Respondent-driven sampling (RDS) is a social network sampling technique used to study hidden behaviours. We used web-based RDS (webRDS) to estimate the prevalence of self-managed abortion (SMA) outside the formal healthcare system in Argentina where abortion was legalised in 2020, but access remains uneven. METHODS:A cross-sectional web survey (February-May 2024) among individuals aged 16-49 years, ever pregnant, and residing in Argentina. Our primary outcome was the proportion of SMA occurring outside the formal healthcare system. Estimates were generated using the RDS II estimator. RESULTS:Seven recruitment chains generated 2437 participants (mean of 19.8 recruitment waves, the longest being 51). We filtered for suspected repeat and ineligible participation and generated RDS estimates for the remaining 1340 participants. The estimated personal network size was 4.9; participants knew an average of 2.7 peers with abortion experience. An estimated 17.1% reported ≥1 abortion, ever in life. Among these, an estimated 20.7% (95% CI 14.2 to 28.0) reported an SMA outside the formal healthcare system; 65.3% before and 24.7% after the legal reform. An estimated 42.2% completed the SMA alone. Reported advantages included autonomy in timing and setting, and support person choice. Disadvantages included concerns about pill quality and uncertainties around the process. CONCLUSIONS:A substantial proportion of women in Argentina with abortion experience have had an SMA outside the formal healthcare system, including post-legalisation. Our findings highlight the need to better address the preferences and needs of those facing unintended pregnancy and the potential of webRDS to study SMA.

Background Measles and rubella continue to be a significant global health challenge, disproportionately impacting marginalised communities in low-and middle-income countries (LMICs). Innovative technologies such as measles-rubella microarray patches (MR-MAPs) are currently in development and can potentially improve immunisation coverage and equity through their unique product characteristics. Nonetheless, the limited evidence around their use cases, optimal implementation, cost-effectiveness, and integration into national immunisation programmes raises the need for the development of a prioritised implementation research agenda. Methods We used the Child Health and Nutrition Research Initiative (CHNRI) methodology to prioritise 36 research questions (RQs), which we identified through a rapid literature assessment and consultations with experts. We then prepared an online survey and asked stakeholders to assess each question considering the selected CHNRI criteria. We calculated research priority scores (RPS) and average expert agreement (AEA) and conducted stratified analyses restricted to: LMIC government representatives, respondents based in middle-income countries, those with at least moderate experience in implementing health products in LMICs, those with at least moderate knowledge of MR-MAPs, and representatives from academic or research institutions. Results A total of 139 respondents identified a diverse range of priorities for MR-MAP implementation research. The 36 RQs had a median RPS of 80%. The key priorities identified included research on vaccine supply chain management, vaccine uptake among underserved populations, and human resource implications for integration in routine immunisation services. Stratified analyses revealed a diversity of scores, with representatives from LMIC governments generally prioritising operational questions related to human resources, vaccine administration, and managing dual delivery mechanisms. Fifteen RQs were prioritised to accommodate different perspectives. Conclusion This exercise prioritised implementation questions that will inform MR-MAPs' research investments and efforts over the next 10 years in order to prepare for their introduction in LMICs. While the questions identified in this exercise were specifically about MR-MAPs, the RQs and potential evidence may apply to other vaccine MAPs. This research addresses critical evidence needed towards the successful roll-out of this innovative technology in LMICs, to ensure equitable access to measles and rubella vaccination and accelerate progress towards measles and rubella control and elimination.

Abstract Background 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. Main body 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. Conclusion 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.

The inequitable global distribution of resources for research parallels the unequal global distribution of morbidity and mortality due to infectious diseases. Significant gaps in research capacity prevail, and equitable and accessible opportunities for research remain a priority. We argue for the democratisation of research: without equitable participation in, and ownership of, research, by those who are implementing the research or are part of the communities being researched, contextualised research needs and health system bottlenecks will remain unresolved. This perpetuates an inequitable power balance related to research and innovation. Equitable research capacity is fundamental to tackling global health challenges and reducing health inequity. We emphasise the evolution from externally driven, high-income-centric models of research capacity strengthening towards inclusive, context-sensitive approaches that prioritise local ownership, diversity and sustainability. A paradigm shift from ‘imposing technical support’ to ‘fostering ownership of knowledge’ has catalysed new models of engagement, such as implementation research capacity among health professionals and communities, and regionally anchored postgraduate training. Institutionalised, inclusive research can align with national priorities and yield measurable improvements in health outcomes. However, persistent inequities rooted in gender, geography and institutional hierarchies continue to constrain participation and impact. Addressing these requires deliberate strategies to democratise access, diversify partnerships and support under-represented institutions and individuals. Allowing dynamic roles in long-term partnerships and regional networks on a continuum between academic partners and capacity-strengthening recipients can support mitigation of intersectional inequities and lead to capacity strengthening.

Recent discussions on self-managed abortion highlight its potential to reduce risks and delays while supporting reproductive rights. This qualitative paper analyses the stories of 12 women who self-managed their abortions in Argentina. In-depth interviews were conducted in April and May 2024. Using a framework of reproductive agency, the paper explores how legal, social, economic and personal circumstances shaped self-management experiences. We conducted a narrative analysis, resulting in four narrative types: self-managed abortion as empowerment, as navigating the unexpected, as moral hesitation and perceived health risk, and as a private experience. Some participants described their experience as empowering, while others expressed ambivalence, fear and concern about health risks while exercising reproductive choice. Access to sexual and reproductive health information emerged as a key enabler of agency, though it was unevenly distributed, reflecting broader structural inequalities. Emotional and physical challenges were common, even among those confident in their decision, highlighting the need for care models that acknowledge the complexity of abortion practices. The findings call for a person-centred approach that support diverse pathways to abortion care. Such flexibility is essential to advancing reproductive agency and equity.

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.

INTRODUCTION:A generic research protocol was developed for a prospective cohort study to allow systematic, harmonized data collection of the impact of SARS-CoV-2 infection and vaccination during pregnancy on maternal, obstetric, and neonatal outcomes across different settings. This article describes the study conception, development, implementation, challenges, and key lessons learned within study sites across the world. METHODS:The protocol was implemented in 43 facilities in 10 countries during the pandemic, involving consecutive recruitment of over 16,000 pregnant or postpartum women. We evaluated selection of study sites, ethical approvals, staff recruitment and training, recruitment and follow-up, and incorporation of new elements over the course of the pandemic across the study sites. RESULTS:Study implementation in multiple LMIC settings was feasible; however, major challenges included delays in study implementation due to ethical approval procedures and availability of testing for exposure assessment. Implementation of research during a constantly evolving pandemic context led to the need for amended protocols, adjusted sample sizes, new outcomes and variables, repeated review by the Ethical Committees and adapted laboratory protocols. For example, the first COVID-19 vaccines became available after the study had started, with the need to modify the data collection forms and serologic testing algorithm to allow incorporation of this information in the study structure and analysis. CONCLUSION:Study implementation during a pandemic in different countries and periods was challenging but is not only expected to provide important information on the effects of SARS-CoV-2 infection and vaccination on pregnancy, but also on conducting research during future outbreaks. More streamlined ethics reviews during pandemics, availability of generic protocols in advance, and sites in LMICs ready to activate in an outbreak, as opposed to triggering processes during a crisis, would be highly beneficial.

Background Our aim was to determine if SARS-CoV-2 infection during pregnancy increased the risk of adverse maternal, perinatal, neonatal, or postpartum outcomes during pre-Omicron and Omicron periods. Methods We conducted a prospective cohort study across 43 health facilities, in 10 predominantly primarily low- and middle-income countries, comprising mainly maternity, public and private hospitals in rural and urban areas. A total of 16,007 pregnant women were consecutively recruited between January 2021 and October 2023 (75% in pre-Omicron period and 25% in Omicron period), followed from enrollment through delivery and to six weeks postpartum. The main outcomes are: miscarriage, haemorrhage, preeclampsia/eclampsia, hypertensive disorders of pregnancy, thromboembolic disease, preterm labour, placental abruption, near-miss at delivery, Cesarean delivery, maternal death, modified maternal morbidity and mortality index (MMMI); stillbirth, preterm birth, low birth weight, congenital anomalies, NICU admission, perinatal death, severe perinatal morbidity and mortality index (SPMMI); haemorrhage, infection, or readmission to hospital during postpartum period. Results Based on RT-PCR or antigen testing at enrolment and serial serologic testing, 2,189 participants had confirmed SARS-CoV-2 infection during pregnancy, 116 were classified as probable infection, 7,332 as possible infection, 402 participants were considered probably uninfected, 1,053 had no evidence of infection, and 4,915 had unknown infection status. During the pre-Omicron era, the risk of several outcomes was significantly higher among the infected group compared to those uninfected: emergency Cesarean delivery (RR 1.26, CI 1.03–1.53); MMMI (RR 1.27, CI 1.12–1.44), preterm birth < 37 weeks (RR 1.73, CI 1.32–2.28), < 34 weeks (RR 3.69, CI 1.92–7.09), < 32 weeks (RR 7.58, CI 2.19–26.19), NICU admission (RR 1.90, CI 1.28–2.82) and SPMMI (RR 1.76, CI 1.01–3.05). During the Omicron era, the only outcome with a significantly elevated risk was preterm birth < 34 weeks (RR 1.88, CI 1.04–3.39). Conclusions SARS-CoV-2 infection during pregnancy was associated with an increased risk of several adverse maternal, perinatal, and neonatal outcomes, particularly in the pre-Omicron era. These risks were largely attenuated during the Omicron period; however, the persistent elevated risk for preterm birth < 34 weeks gestation underscores the need for updated evidence on SARS-CoV-2 infection and pregnancy outcomes, especially in relation to emerging Omicron sub-variants.

BACKGROUND:Pregnant and recently pregnant women infected with SARS-CoV-2 are at increased risk of death and serious complications than those without the infection. The extent of variation in mortality rates in pregnant women with SARS-CoV-2 infection across regions, and the causes of death are not known. We systematically reviewed all available evidence on the variation in mortality rates in pregnant women with SARS-CoV-2 infection across geographical and country income groups, and the reported cause of death. METHODS:We searched major databases (December 2019-January 2023) including Medline, LILACS, BIREME and Embase. We included studies that reported deaths in at least 10 consecutive pregnant or recently pregnant women with confirmed SARS-CoV-2 infection and assessed the studies' risk of bias. We calculated the summary estimates of any cause of death as proportions with 95% CIs using a multilevel random-effects logistic regression model. Subgroup analyses were performed by geographical region and country income groups. We used International Statistical Classification of Diseases and Related Health Problems-Maternal Mortality to categorise the reported cause of death. FINDINGS:From 1 326 315 citations, we included 169 studies (319 172 women with confirmed SARS-CoV-2 infection; 4253 women died). The overall rate of unspecified maternal death was 0.87% (95% CI 0.64% to 1.16%). There were significant differences between geographical regions in rates of maternal mortality, with the highest rates in Sub-Saharan Africa (3.48%; 95% CI 0.66% to 16.42%) and Latin America and the Caribbean (3.16%, 95% CI 1.53% to 6.43%). Rates of maternal mortality varied by country income groups, with the highest rates in low-income countries (4.66%, 95% CI 0.75% to 24.07%). Among women with reported cause of death, 98.6% (2,390/2,423) of deaths were attributable to COVID-19. INTERPRETATION:Rates of deaths in pregnant and recently pregnant women with SARS-CoV-2 infection vary significantly across regions and by country income groups, with the highest burden in Sub-Saharan Africa and low-income countries. COVID-19 is the main reported cause of death. PROSPERO REGISTRATION NUMBER:CRD42020224120.

Objective To identify and summarise the evidence on the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA detection and persistence in body fluids associated with sexual activity (saliva, semen, vaginal secretion, urine and faeces/rectal secretion).Eligibility All studies that reported detection of SARS-CoV-2 in saliva, semen, vaginal secretion, urine and faeces/rectal swabs.Information sources The WHO COVID-19 database from inception to 20 April 2022.Risk of bias assessment The National Institutes of Health tools.Synthesis of results The proportion of patients with positive results for SARS-CoV-2 and the proportion of patients with a viral duration/persistence of at least 14 days in each fluid was calculated using fixed or random effects models.Included studies A total of 182 studies with 10 023 participants.Results The combined proportion of individuals with detection of SARS-CoV-2 was 82.6% (95% CI: 68.8% to 91.0%) in saliva, 1.6% (95% CI: 0.9% to 2.6%) in semen, 2.7% (95% CI: 1.8% to 4.0%) in vaginal secretion, 3.8% (95% CI: 1.9% to 7.6%) in urine and 31.8% (95% CI: 26.4% to 37.7%) in faeces/rectal swabs. The maximum viral persistence for faeces/rectal secretions was 210 days, followed by semen 121 days, saliva 112 days, urine 77 days and vaginal secretions 13 days. Culturable SARS-CoV-2 was positive for saliva and faeces.Limitations Scarcity of longitudinal studies with follow-up until negative results.Interpretation SARS-CoV-2 RNA was detected in all fluids associated with sexual activity but was rare in semen and vaginal secretions. Ongoing droplet precautions and awareness of the potential risk of contact with faecal matter/rectal mucosa are needed.PROSPERO registration number CRD42020204741.

Research capacity strengthening (RCS) can empower individuals, institutions, networks, or countries to define and prioritize problems systematically; develop and scientifically evaluate appropriate solutions; and reinforce or improve capacities to translate knowledge into policy and practice. However, how to embed RCS into multi-country studies focusing on sexual and reproductive health and rights (SRHR) is largely undocumented. We used findings from a qualitative study, from a review of the literature, and from a validation exercise from a panel of experts from research institutions that work on SRHR RCS. We provide a framework for embedded RCS; suggest a set of seven concrete actions that research project planners, designers, implementers, and funders can utilise to guide embedded RCS activities in low- and middle-income countries; and present a practical checklist for planning and assessing embedded RCS in research projects.

Introduction This study aimed to provide an overview of the research landscape and to identify research gaps linking climate change events and sexual and reproductive health and rights (SRHR) in low-income and middle-income countries (LMICs), where the negative impacts of climate change are most severe.Methods We conducted a scoping review to map research studies that link climate change events or factors and SRHR aspects in LMICs. We performed a structured literature search across six databases to identify relevant peer-reviewed publications between January 1994 and 6 September 2023. The literature search yielded 14 674 peer-reviewed articles. After screening, 75 articles were included, spanning 99 countries across the globe.Results Climate change events such as extreme temperatures, drought, rainfall shocks, cyclones and floods were found to be associated with negative maternal and newborn health outcomes ranging from reduced or low birth weight, preterm births and low Apgar scores, to lack of pregnancy care, pregnancy complications, stillbirths, and newborn and maternal deaths. Associations were also found between climate-related events and increased gender-based violence and HIV prevalence, as well as fertility decisions and harmful practices such as female genital mutilations and early and forced marriages. About two-thirds (48/75) of the articles were from the African or Western Pacific regions. The main research gaps on climate change-related events and SRHR included abortion, reproductive cancers and contraception use.Conclusion Complementing existing evidence with targeted research to fill these knowledge gaps could enhance mitigation programmes and policies.

Objective To assess the effects of COVID-19 vaccines in women before or during pregnancy on SARS-CoV-2 infection-related, pregnancy, offspring and reactogenicity outcomes.Design Systematic review and meta-analysis.Data sources Major databases between December 2019 and January 2023.Study selection Nine pairs of reviewers contributed to study selection. We included test-negative designs, comparative cohorts and randomised trials on effects of COVID-19 vaccines on infection-related and pregnancy outcomes. Non-comparative cohort studies reporting reactogenicity outcomes were also included.Quality assessment, data extraction and analysis Two reviewers independently assessed study quality and extracted data. We undertook random-effects meta-analysis and reported findings as HRs, risk ratios (RRs), ORs or rates with 95% CIs.Results Sixty-seven studies (1 813 947 women) were included. Overall, in test-negative design studies, pregnant women fully vaccinated with any COVID-19 vaccine had 61% reduced odds of SARS-CoV-2 infection during pregnancy (OR 0.39, 95% CI 0.21 to 0.75; 4 studies, 23 927 women; I2=87.2%) and 94% reduced odds of hospital admission (OR 0.06, 95% CI 0.01 to 0.71; 2 studies, 868 women; I2=92%). In adjusted cohort studies, the risk of hypertensive disorders in pregnancy was reduced by 12% (RR 0.88, 95% CI 0.82 to 0.92; 2 studies; 115 085 women), while caesarean section was reduced by 9% (OR 0.91, 95% CI 0.85 to 0.98; 6 studies; 30 192 women). We observed an 8% reduction in the risk of neonatal intensive care unit admission (RR 0.92, 95% CI 0.87 to 0.97; 2 studies; 54 569 women) in babies born to vaccinated versus not vaccinated women. In general, vaccination during pregnancy was not associated with increased risk of adverse pregnancy or perinatal outcomes. Pain at the injection site was the most common side effect reported (77%, 95% CI 52% to 94%; 11 studies; 27 195 women).Conclusion COVID-19 vaccines are effective in preventing SARS-CoV-2 infection and related complications in pregnant women.PROSPERO registration number CRD42020178076.

Introduction A theory of change is a visual representation of the pathway by which a programme anticipates it will achieve its goal. It usually starts with discussions around the goal and works backwards through outcomes and outputs to activities. Methods We used a theory of change to improve coherence across three research entities at the WHO. Part of the remit of all three entities is to strengthen capacity in low-income and middle-income countries for implementation research. Results Representatives from the three entities were able to formulate a joint goal for strengthening capacity in implementation research. They identified three pathways by which this could be achieved: (a) conducting implementation research, (b) strengthening implementation research systems and (c) using implementation research for public health priorities. Conclusion The process of developing the theory of change and the logic framework it created, provided a means to track progress towards the goal and to guide improvements in programmes within their lifetime. The process we used to develop the theory of change and the pathways to achieve the joint goal are adaptable and could be used by other organisations that also aim to strengthen research capacity. This would lead to more coherence, better translation of research findings into decision-making and ultimately improvements in public health.

This study explores the barriers encountered by participants in applying knowledge gained from a massive open online course (MOOC) on implementation research (IR), particularly among learners in low- and middle-income countries (LMICs). Despite the rising demand for quality IR training, access remains limited in LMICs. The IR MOOC, created by the Special Program for Research and Training in Tropical Diseases, seeks to bridge this gap by providing free online IR training. Twenty-three interviews were conducted with participants from the French, Spanish, and English language sessions of the MOOC, and were analyzed using a general inductive approach. Barriers were identified at individual, organizational, community, and health authority levels. Individually, learners requested opportunities for deeper training and expert guidance. Organizational barriers included a lack of understanding and resistance to adopting IR methodologies. Community barriers involved limited roles and opportunities in IR and a lack of networking. Health authorities exhibited a lack of awareness and funding to support IR. Challenges in completing the course included language barriers, strict deadlines, limited internet connectivity, and a lack of localized case examples. This study highlights the importance of pairing online training with practical opportunities to apply newly learned skills. Our findings emphasize the need for expert guidance, improved language accessibility, and diverse case studies to support the development of a robust cadre of IR practitioners. Networking opportunities are crucial for connecting learners with IR practitioners and applying the knowledge acquired. Efforts to address these barriers could improve the effectiveness of IR training programs in LMICs.

In December 2020, Argentina approved a new abortion law following decades of feminist and social advocacy. This paper presents qualitative findings from interviews and focus group discussions with people in local communities focusing on how individuals of reproductive age access and communicate sexual and reproductive health information, particularly regarding abortion. Sixteen in-depth interviews were conducted with key informants working in the field of SRHR and four focus group discussions took place with cisgender women and girls, transmasculine people and non-binary people of reproductive age. We found that information exchange and communication about sexual and reproductive health issues, particularly abortion, took place mainly through informal social networks engaging with activists and feminist grass-root organisations. These informal social networks were built on trust as a collective affect that enabled open communication about abortion. Information sharing through word of mouth, in person and via digital means using different social media platforms, is an important means of information sharing and communication in Argentina. Monitoring the implementation of abortion policies in this country should include investigating the impact of people accessing abortion through informal social networks in terms of abortion pathways and intersections with the formal health system.

Introduction Peer-reviewed literature is commonly used to assess academic progress and research excellency. However, representation in authorship of global health publications is biased and unfair. In order to shed light on current gaps towards attaining gender equality in scientific production and shift power asymmetries in global health research, we conducted an assessment of authorship trends from 1972 to 2021 with a focus on gender and geographic representation in scientific articles authored or co-authored by researchers affiliated with UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP). Methods We searched PubMed, Web of Science, and HRP public reports for publications where at least one author was affiliated with HRP. Our main outcome measures were author gender and location of author affiliation, classified by region and country income group. We used descriptive statistics to characterize the publications under analysis as well as the total number of authors from the included papers. We applied a logistic regression model to explore associations between author gender and other characteristics of published articles and a time series analysis to assess how time can influence the inclusion of women as authors in a publication. Python and R were used for all analyses. Results A total of 1,484 publications with 14,424 listed authors representing 5,950 unique authors were included in our analysis: 42.5% were female, 35.1% male, and 22.4% unknown (p<0.0001). First authorship was more likely female (56.9%) and from a high-income country (74.6%, p<0.0001) while last authorship was mostly male (53.7%) also from a high-income country (82.5%, p<0.0001). Females more frequently published papers using qualitative data (61.4%) and reviews/estimates (59.4%) while men published more case control (70.7%) and randomised controlled studies (53.0%), p<0.0001. The adjusted odds of there being a female author increased 4% for every additional year that passed. Conclusion While there are more females authoring articles as compared to the past, they are still lagging behind with regards to seniority and prestige. Likewise, female representation is closely tied to what institution they are affiliated with and where that institution is located. Global health research institutions need to actively promote change by ensuring women are included in research and research outputs, giving them opportunities to lead.

Objectives Daily calcium supplements are recommended for pregnant women from 20 weeks’ gestation to prevent pre-eclampsia in populations with low dietary calcium intake. We aimed to improve understanding of barriers and facilitators for calcium supplement intake during pregnancy to prevent pre-eclampsia.Design Mixed-method systematic review, with confidence assessed using the Grading of Recommendations, Assessment, Development and Evaluations-Confidence in the Evidence from Reviews of Qualitative research approach.Data sources MEDLINE and EMBASE (via Ovid), CINAHL and Global Health (via EBSCO) and grey literature databases were searched up to 17 September 2022.Eligibility criteria We included primary qualitative, quantitative and mixed-methods studies reporting implementation or use of calcium supplements during pregnancy, excluding calcium fortification and non-primary studies. No restrictions were imposed on settings, language or publication date.Data extraction and synthesis Two independent reviewers extracted data and assessed risk of bias. We analysed the qualitative data using thematic synthesis, and quantitative findings were thematically mapped to qualitative findings. We then mapped the results to behavioural change frameworks to identify barriers and facilitators.Results Eighteen reports from nine studies were included in this review. Women reported barriers to consuming calcium supplements included limited knowledge about calcium supplements and pre-eclampsia, fears and experiences of side effects, varying preferences for tablets, dosing, working schedules, being away from home and taking other supplements. Receiving information regarding pre-eclampsia and safety of calcium supplement use from reliable sources, alternative dosing options, supplement reminders, early antenatal care, free supplements and support from families and communities were reported as facilitators. Healthcare providers felt that consistent messaging about benefits and risks of calcium, training, and ensuring adequate staffing and calcium supply is available would be able to help them in promoting calcium.Conclusion Relevant stakeholders should consider the identified barriers and facilitators when formulating interventions and policies on calcium supplement use. These review findings can inform implementation to ensure effective and equitable provision and scale-up of calcium interventions.PROSPERO registration number CRD42021239143.

BACKGROUND:Training has been used to develop research skills among sexual and reproductive health and rights (SRHR) researchers. Remote education may accelerate transfer of skills and reduce barriers to strengthening research capacity. This systematic review aimed to assess the effectiveness of remote training on SRHR research and describe enablers and barriers of effective remote training. METHODS:PubMed, Embase, and Scielo were searched up to December 2022 for studies that evaluated in any language online research training programmes either on a SRHR topic or tailored for professionals working in SRHR published since 1990. Characteristics of included studies, the programmes they evaluated, the programme's effectiveness, and reported barriers and enablers to remote learning were extracted. Three researchers synthesized and described findings on effectiveness, impact and outcomes mapping them against the Kirkpatrick model. Additionally, thematic analysis from qualitative data was conducted to identify themes relating to the barriers and enablers of remote learning. RESULTS:Of 1,510 articles retrieved, six studies that included 2,058 remote learners met the inclusion criteria. Five out of six studies described empirical improvements in participant research knowledge/skills and three studies reported improvements in attitudes/self-efficacy towards research. Follow-up surveys from four studies revealed frequent application of new research skills and improved opportunities for career advancement and publication following online trainings. Cited barriers to effective online SRHR research training included time management challenges and participants' competing professional obligations; limited opportunities for interaction; and lack of support from home institutions. Cited enablers included well-structured and clear courses, learning objectives and expectations with participants; ensuring a manageable workload; facilitating interactions with mentors and hands-on experience; and selecting programme topics relevant to participants' jobs. CONCLUSION:Remote SRHR training can lead to improvements in research knowledge, skills, and attitudes, particularly when course learning objectives, structure, and expectations are outlined clearly, and ongoing mentorship is provided.