Background:Despite the formal launch of Nigeria's Maternal and Perinatal Death Surveillance and Response (MPDSR) national guideline in 2016, limited data exist on actual practice among healthcare workers. This study assessed MPDSR practice and its determinants among healthcare workers in three referral hospitals in Edo State, Nigeria. Methodology:A cross-sectional study was conducted among 221 healthcare workers in Central Hospital, Benin, University of Benin Teaching Hospital, and Irrua Specialist Teaching Hospital. MPDSR practice was assessed using three indicators: having received MPDSR training, having ever reported maternal death, and having attended maternal death reviews. Respondents who engaged in at least two of these three practices were classified as having good practice. Data were analyzed using IBM SPSS version 25, with the chi-square test and binary logistic regression. Statistical significance was set at p < 0.05. Results:Only 50 (22.6%) healthcare workers demonstrated good practice of MPDSR, while 171 (77.4%) had poor practice. Training coverage was critically low (8.6%), one-third (33.9%) had ever reported a maternal death, and 48.9% had attended maternal death reviews; of these, 91.7% were passive attendees only. Multivariate analysis identified older age, good knowledge, and positive attitude toward MPDSR as independent predictors of good practice, while female sex was independently associated with lower odds of good practice (all p < 0.05). Conclusion:Poor MPDSR practice prevails in the selected hospitals, with critical deficits in training coverage, death reporting, and meaningful review participation. Improving practice requires scaled-up training, strengthened reporting systems, and targeted strategies addressing knowledge, attitudinal, and gender-related barriers.

For more than three decades, sub-Saharan Africa has invested heavily in the five WHO pillars of safe motherhood.1,2 Governments, development partners, professional associations and civil society organizations have promoted family planning, strengthened antenatal care, expanded skilled birth attendance, improved postnatal care, and, where permitted by law, advocated for safe abortion services. These interventions have undoubtedly contributed to improved maternal and newborn health and have saved countless lives. Yet the region continues to account for approximately 70% of global maternal deaths.3 The persistence of this unacceptable burden raises an important question: why have these investments not translated into the dramatic reductions in maternal mortality that many had anticipated?

Reproductive health has increasingly emerged as a complex, multidimensional field that extends far beyond clinical care into the domains of education, technology, law, culture, and socio-economic systems. This special issue of the African Journal of Reproductive Health brings together fifteen diverse yet interconnected papers that collectively illuminate how reproductive health outcomes are shaped by dynamic interactions across disciplines, geographies, and social structures. The contributions - spanning China, Spain, and Pakistan - underscore a unifying premise: that sustainable reproductive health improvements depend on integrative approaches that harness innovation while remaining grounded in cultural and social realities.

The growing global interest in complementary and traditional medicine has over time extended into the field of reproductive health. Across Africa and Asia, traditional healing systems, herbal remedies, and indigenous birth practices continue to play major roles in maternal and reproductive health care delivery. In many low-and middle-income countries, these approaches are not merely alternatives to modern medicine, they are often the first and most accessible forms of care available to women and families. Two important papers published in this edition of the journal provide timely evidence on this evolving intersection between traditional therapeutics and orthodox reproductive health practice.

The advancement of sexual and reproductive health and rights (SRHR) in sub-Saharan Africa is fundamentally hindered by "health data poverty".1 While many high-income countries have made significant progress in strengthening their health data systems, sub-Saharan Africa continues to face significant gaps.1-3 Despite the critical need for evidence-based practice, the regional data landscape is characterized by a pervasive ignorance regarding the intrinsic value of accurate data. Many countries in the region lack regular population censuses, reliable health records, and functional civil registration and vital statistics systems.

The African Journal of Reproductive Health (AJRH) is proud to mark its 30th anniversary with the release of its second January 2026 issue. Since its inception in 19971, in response to the 1994 International Conference on Population and Development (ICPD) in Cairo, Egypt, the AJRH has remained committed to its mission of documenting and disseminating high-quality research on reproductive health in Africa and beyond. It was phenomenal that world renowned experts in the fields of public health and reproductive health such as the legendary Professors Allan Rosenfield2, and Kelsey Harrison3, contributed to the first issue of the journal, which was immediately indexed in PubMed (Medline).

Mistreatment during facility-based childbirth undermines maternal health outcomes and trust in health systems, particularly in low- and middle-income countries. Nigeria bears one of the highest global burdens of maternal mortality, yet limited large-scale mixed-methods studies have examined how mistreatment is both experienced by women and shaped by health system conditions. This study assessed the prevalence, forms, and drivers of mistreatment during childbirth in Benin City, Nigeria, integrating women’s and skilled birth attendants’ (SBAs) perspectives. We conducted a convergent parallel mixed-methods study between July–August 2024 across three healthcare facilities (tertiary, secondary, and private) in Benin City. Postpartum women (≤ 12 months since delivery) completed a 45-item mistreatment survey (n = 656). Mistreatment was categorized across eight domains. Descriptive statistics and chi-square analyses were performed. In-depth interviews were conducted with postpartum women (n = 20), and four focus group discussions were held with SBAs (n = 26). Qualitative data were analyzed using constructivist grounded theory. Findings were integrated using a joint display matrix to assess convergence, divergence, and complementarity. Overall, 89.5

The article published in this issue of the journal titled "Examining implementation of health exception laws in six countries"1 arrives at a critical juncture in global reproductive health discourse. Across much of the developing world, abortion law - often framed around narrow "health exceptions" - exist in statute but fail in practice. This disjuncture between legal permission and lived access is not merely a technical gap; it is a profound social justice failure with implications for women's health, autonomy, and dignity. Health exception laws typically allow abortion where a woman's physical or mental health is at risk. In theory, they represent a compromise between restrictive legal regimes and broader reproductive rights and social justice. However, evidence consistently shows that legal allowances alone do not guarantee access. Comparative research demonstrates that in many countries, even where abortion is technically legal under health grounds, women are denied services due to poor implementation, lack of guidelines, and restrictive interpretations.2This important article in this issue of the journal extends this insight through a six-country comparative lens, echoing earlier multi-country analyses such as the study by Wendy Chavkin and colleagues3, which examined reforms and implementation strategies across diverse settings including Ethiopia, Ghana, and South Africa. Together, these studies reinforce a crucial point: the effectiveness of abortion law lies not in its wording, but in its operationalization.

The current outbreak of Ebola disease caused by the Bundibugyo virus (species Orthoebolavirus bundibugyoense) in the Democratic Republic of the Congo (DRC) and Uganda is much more than another infectious disease emergency. It reminds us that epidemics come not only from biological pathogens but also from social inequities, environmental disruption, fragile health systems, and persistent armed conflict. While Ebola captures headlines because of its fear-provoking symptoms and high mortality, the conditions that allow it to spread receive far less attention.

Africa cannot achieve universal health coverage, gender equality, or sustainable development while millions of women, adolescents, and couples continue to experience preventable sexual and reproductive health and rights (SRHR) problems. The continent has made important progress, but the pace is far too slow. In 2023, sub-Saharan Africa accounted for approximately 70% of global maternal deaths, with about 182,000 women dying from pregnancy-related causes.1 Although maternal mortality in the region fell by 40% between 2000 and 2023, Africa would need a dramatic acceleration in the annual rate of decline to achieve the Sustainable Development Goal target by 2030.1,2.

The International Conference on Population and Development (ICPD), held in Cairo in 1994, fundamentally transformed global thinking on population and reproductive health. Moving decisively away from the demographic targets and fertility-reduction strategies that had dominated previous decades, the ICPD Program of Action (PoA) established a comprehensive, rights-based framework that placed women and men - not population numbers - at the centre of development. It recognized sexual and reproductive health as a fundamental human right and affirmed that every individual has the right to attain the highest possible standard of sexual and reproductive health, make informed reproductive choices, enjoy bodily autonomy, and access quality health services without discrimination, coercion or violence.

As a scientific journal committed to advancing knowledge about the health and well-being of women, children, and entire communities, we affirm a simple but urgent truth: peace is public health. The fate of humanity and the health of our planet are not separable from the absence of war. When human conflict erupts and escalates, it harms generations of people, planetary ecosystems, and civil society. Indeed, each of the five essential pillars - People, Planet, Peace, Prosperity, and Partnerships - upon which the Sustainable Development Goals are built, is deeply compromised by armed conflict.

BackgroundSocial stigma and the marginalisation of abortion care within medical settings can negatively affect abortion providers. While some research has evaluated stigma interventions in legally restrictive settings, little work has explored the experiences of healthcare professionals (HCPs) providing abortion and post-abortion care (PAC) outside the USA. This study, part of the Royal College of Obstetricians and Gynaecologists’ ‘Making Abortion Safe’ programme, aimed to understand providers’ experiences of abortion stigma in four African countries with restrictive legislation.MethodsIn-depth interviews with 44 abortion and PAC providers were conducted in Nigeria, Rwanda, Sierra Leone and Zimbabwe.ResultsFour themes emerged: personal and professional effects of stigma, multiple manifestations of stigma, driving forces of stigma, and positivity and resilience. Stigma affects providers' professional identity, community belonging and relationships. Restrictive legal frameworks are the main driver of abortion stigma, operating at multiple levels that reinforce each other. The legal status of abortion labels it as ‘dirty work’, conflicting with healthcare principles. Judgmental attitudes from other HCPs negatively impact providers’ well-being and care quality. However, providers showed resilience through professional and personal commitment, and the belief in ‘doing the right thing’ helped them resist stigma.ConclusionsLegal changes are crucial for increasing access and reducing stigma among the workforce. In these countries, providers face challenges in offering legal healthcare. Organisational interventions are needed to address stigmatising values and create positive workplaces. Ongoing support is essential for HCPs to remain resilient against abortion stigma, helping to normalise abortion care and those who provide it.

Introduction Strengthening research capacity in Africa is vital for tackling pressing health, educational and socioeconomic challenges facing the continent. At the core of this effort is the cultivation of innovative research leaders through postgraduate training programmes that incorporate mentorship-infused supervision. Such models have demonstrated potential in improving research skills, boosting academic productivity and fostering leadership development among emerging scholars. This systematic review and meta-synthesis protocol aims to examine existing mentorship-infused supervision practices across African higher education institutions. The review seeks to identify effective models, uncover common challenges and barriers, and generate evidence-based recommendations to develop sustainable, contextually relevant strategies. Insights from this work will inform policies and practices to enhance postgraduate research training, advance research leadership and contribute to the broader goal of strengthening research ecosystems across Africa.Methods and analysis A systematic review and thematic meta-synthesis will be undertaken, focusing on qualitative research studies as well as the qualitative components of mixed-methods studies. Relevant studies published in English will be identified through a comprehensive search strategy. The electronic databases, including Medline/PubMed, Scopus, Web of Science, African Journals Online, EMBASE and CINAHL, will be searched to capture a wide range of peer-reviewed articles and grey literature. Databases will be searched from March 2026. Two reviewers will independently perform study selection, data extraction, quality assessment and evaluation of risk of bias, using the Critical Appraisal Skills Programme checklist.Ethics and dissemination This systematic review and meta-synthesis will analyse publicly available literature and does not require ethical approval, as it involves no primary data collection. It will adhere to established ethical and methodological standards, including proper citation and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The findings will be widely disseminated through open-access journal publication, conference presentations and targeted reports for universities, research institutions and policymakers to inform and support mentorship-based postgraduate research supervision across Africa.PROSPERO registration number CDR420251049878. Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD420251049878.

This edition of the journal publishes two papers1,2 and several others in previous editions of the journal, that establish an interlink between sexual and reproductive health and mental health in women. Given the rising incidence of mental ill-health especially in young women, it is important to flag this relationship and to emphasize the need for further research and related interventions. This editorial synthesizes the evidence from previous studies and underscores the need for integrated care that addresses the interlinked physical and mental health needs of women.

Maternal mortality remains a major public health challenge in Nigeria, particularly in hard to reach communities where access to skilled birth attendance is limited. This study investigates the impact of skilled birth attendance on maternal health outcomes in five underserved local government areas of Adamawa State. Using a mixed methods approach, quantitative data were collected from 300 women of reproductive age and analyzed alongside qualitative insights from interviews with mothers, skilled birth attendants, and health administrators. Findings revealed that only 42 percent of births were attended by skilled personnel, with significantly lower rates of postpartum hemorrhage, prolonged labor, and neonatal complications among those who received skilled care. Barriers to access included geographic isolation, lack of transportation, cultural preferences for traditional birth attendants, and perceived poor quality of facility based care. The study applied the Three Delays Model to interpret how skilled birth attendance mitigates delays in seeking, reaching, and receiving adequate care. Recommendations include deploying mobile clinics, integrating traditional birth attendants into the formal health system, improving transportation and referral networks, and enhancing community health education. The study concludes that expanding skilled birth attendance coverage is essential for reducing maternal mortality and improving maternal health equity in Adamawa State.

Last month, on 15 July 2025, Dr Natalia Kanem stepped down after two terms from 2017 as the Executive Director of the United Nations Population Fund (UNFPA), the sexual and reproductive health agency of the United Nations. Given the pre-eminent role that she played in driving the most endearing principles of women and health development at some of the most critical and difficult times, the Journal considers that it is appropriate and befitting to pay tribute to this leading international development entrepreneur and social change advocate.

Sub-Saharan African countries have the lowest combined contraceptive prevalence rates among the six world regions, partly attributable to men's low participation in family planning activities. The objective of this study was to compare the prevalence and determinants of male perceptions relating to family planning in Malawi, Guinea, Nigeria, and Senegal, and to learn lessons for improving male participation in family planning in the four countries. We analyzed male recode datasets from the most recent Demographic and Health Surveys in the four countries. The total sample size was 28,271 men, consisting of 4,117 from Guinea, 7,478 from Malawi, 13,311 from Nigeria, and 3,365 from Senegal. The results showed poor perceptions of family planning among males in the four countries overall, with nearly 56 % of the men demonstrating negative perceptions of family planning. Men in Guinea and Nigeria had the lowest positive perceptions of family planning as compared to Malawi and Senegal, but when subjected to multivariable logistic regression, only Guinea remained the country with the lowest positive male perception of family planning. The predictors of positive perceptions of family planning were older men, higher educational levels (in all countries but Guinea), a higher household wealth index (but not in Malawi), previous use of contraceptives, previous use of the internet and the media, and being married. By contrast, religious affiliation and preference for more children diminished the odds of positive perception. We conclude that there is a poor perception of family planning among men in Guinea, Senegal, Nigeria, and Malawi, with Guinea showing the most deprived results as compared to the other countries. Efforts to include male participation in policies and programs relating to family planning will increase the uptake of contraceptives and promote overall health and development outcomes in these four countries, with implications for other sub-Saharan African countries.

Introduction There is evidence of increasing use of misoprostol for induction of labour in low-income countries, but fewer reports of rupture of the uterus on account of its misuse. Presentation of case We report two cases of uterine rupture in two pregnant women referred to our centre due to the inadvertent administration of high doses of misoprostol in peripheral health centres. Both patients had hysterectomies, multiple blood transfusions and intrauterine fetal deaths. Discussion Uterine rupture is a grave obstetric emergency with associated adverse perinatal and maternal outcomes. It is now almost unheard of in developed countries and is usually a consequence of inappropriate labour and delivery interventions in low and middle-income countries. Uterine rupture represents a catastrophe that can result from the injudicious use of high doses of misoprostol in late pregnancy especially in unscarred uteri. Conclusion Both cases highlight the dangers of the use of high doses of misoprostol and the need for the training of health workers on the appropriate use of the drug.