Critical Commentary: Beyond growth and density: Recentring the demographic drivers of urban health and risk in the global south

Debates within urban studies concerning the relationship between urbanisation and infectious disease focus on issues of urban population growth, density, migration and connectivity. However, an effective long-term risk and wellbeing agenda, without which the threat of future pandemics cannot be mitigated, must also take account of demographic forces and changes as critical drivers of transmission and mortality risk within and beyond cities. A better understanding of the dynamics of fertility, mortality and changing age structures – key determinants of urban decline/growth in addition to migration – provides the foundation upon which healthier cities and a healthy global urban system can be developed. The study of how basic demographic attributes and trends are distributed in space and how they interact with risks, including those of infectious disease, must be incorporated as a priority into a post-COVID-19 urban public health agenda. This perspective concurs with recent debates in urban studies emphasising the demographic drivers of urban change. Moreover, it raises critical questions about the microbial and environmental emphasis of much research on the interface of urban health and governance.

Impacts of COVID-19 on Public Health in Urban Slums in India and Lessons for the Future

This paper examines the impact of the pandemic on India's public health system of the country, especially from the perspective of urban slumdwellers. Drawing on a qualitative study carried out by the Urban Health Resource Centre in selected slums in Indore and Agra, the paper reflects the impact of the pandemic on the provision of essential health services such as maternal and child healthcare, family planning, immunization for children and the detection and treatment of non-COVID ailments such as tuberculosis. The authors argue that the veritable collapse of healthcare to the most vulnerable sections of the population exposed the structural weaknesses of India's healthcare system. To build a more robust public health system in India to tackle future crises of this kind, the authors call for strengthening the health infrastructure in small to medium-sized cities and reinforcing other crucial determinants of well-being such as food security, livelihood opportunities and support and enhanced education opportunities. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023.

Insurance Status Predicts Endoscopy No-Show

Introduction: Lyndon B. Johnson (LBJ) hospital is a part of the Harris Health System, which provides comprehensive care to the uninsured and underinsured population in Harris County, TX. LBJ serves a population with 55% unemployment and a median household income of $22000. Access to endoscopy is limited by resource availability, and the completion of scheduled endoscopies is essential for public health. We aimed to assess if insurance status was associated with no- show for scheduled endoscopic procedures at the LBJ GI Lab. Method(s): All patients scheduled for outpatient endoscopy during the year 2021 were collected. Included patients must have completed a GI clinic appointment, anesthesia screening, pre-procedural COVID test, confirmed attendance on pre-procedure call, and not showed for scheduled endoscopy (Figure 1). Patient's insurances statuses were: FAP (county payment assistance), Harris County Prisoners (no costs), Medicare/Medicaid (variable costs), Private Insurance (variable costs), Self-Pay, and Texas Family Planning/HCHD Presumed (temporary FAP) (Table 1). Result(s): Comparative analysis of insurance types demonstrated that patients who were Self-Pay were 5.96 times more likely (P< 0.002) not to show up for previously scheduled endoscopic procedures, while patients with the TFP/HCHD insurance were 10.1 times more likely (P< 0.001) to not show when compared to patients who were covered by the county's FAP. Conclusion(s): Our analysis demonstrated a statistically significant association between insurance status and the incidence of no-showing for endoscopy. Upon literature review, there was limited data on rates of endoscopy no-shows in relation to the out-of-pocket commitment for individuals. Further investigation into this topic would significantly affect both the academic and private practice of gastroenterologists. We plan to continue this quality assessment by meeting with the patient eligibility department to assess if modifications of benefit profiles could optimize procedural attendance.

Determining the Impact of the COVID-19 Pandemic on Availability, Use, and Readiness of Family Planning and Contraceptive Services at Selected Primary Health Care Facilities in Africa and Asia: Protocol for a Mixed Methods Study.

BACKGROUND: The COVID-19 pandemic and the associated social restrictions may have disrupted the provision of essential services, including family planning (FP) and contraceptive services. This protocol is adapted from a generic study protocol titled "Health systems analysis and evaluations of the barriers to availability and readiness of sexual and reproductive health services in COVID-19 affected areas," conducted by the World Health Organization (WHO) Department of Reproductive Health and Research. OBJECTIVE: This study aims to assess the availability and use of FP and contraceptive services in primary health facilities during and after the COVID-19 pandemic; assess the risk perceptions of COVID-19 stigma, barriers to access, and quality of services from clients' and providers' perspectives in the COVID-19-affected areas; and assess the postpandemic recovery of the facilities in the provision of FP and contraceptive services. METHODS: In-depth interviews will be conducted with clients-women in the reproductive age group and their male partners who visit the selected health facilities for FP and contraceptive services-and health providers (the most knowledgeable person on FP and contraceptive service provision) at the selected health facilities. Focus group discussions will be conducted with clients at the selected health facilities and in the community. The in-depth interviews and focus group discussions will help to understand clients' and health service providers' perspectives of FP and contraceptive service availability and readiness in COVID-19-affected areas. A cross-sectional health facility assessment will be conducted in all the selected health facilities to determine the health facility infrastructure's ability and readiness to provide FP and contraceptive services and to capture the trends in FP and contraceptive services available during the COVID-19 pandemic. Scientific approval for this study is obtained from the WHO Research Project Review Panel, and the WHO Ethics Review Committee has given ethical approval in the 3 countries. RESULTS: Using a standardized research protocol will ensure that the results from this study can be compared across regions and countries. The study was funded in March 2021. It received ethics approval from the WHO Ethics Review Committee in February 2022. We completed data collection in September 2022. We plan to complete the data analysis by March 2023. We plan to publish the study results by Summer 2023. CONCLUSIONS: The findings from this study will provide a better understanding of the impact of the COVID-19 pandemic on FP and contraceptive services at the facility level, which will help policy makers and health managers develop and strengthen FP policies and services in health facilities to be more responsive to community needs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/43329.

Access to Family Planning Services Following Natural Disasters and Pandemics: A Review of the English Literature.

BACKGROUND: When natural disasters strike, there is a sudden decrease in access to care due to infrastructure loss and displacement. A pandemic has the similar ability to acutely limit access to care. The relationship between decreased access to care and natural disasters has been previously explored. OBJECTIVE: The purpose of this article is to present a focused review of the available and emerging literature regarding the overall impact of natural disasters and pandemics on unintended pregnancy and decreased care in this setting. METHODS: A literature search was conducted on PubMed, Cochrane, Google Scholar, and Embase databases. The search was restricted to studies that were population-based, prospective or retrospective. Only peer-reviewed articles were considered. The search was further restricted to manuscripts in English or officially translated manuscripts. All qualifying papers from which data were extracted were subjected to a quality assessment conducted by two independent investigators (SK and AA). Each investigator reviewed all nine papers relevant to data collection using the Effective Public Health Practice Project (EPHP). MeSH terms were utilized across various databases. Studies were selected that were population-based, prospective or retrospective. Case reports and case series were not used. The primary outcomes were the rates of unintended pregnancy. Secondary outcomes included the use of contraception, short interval pregnancy, and access to reproductive services. RESULTS: An initial search yielded 74 papers, of which nine papers were reviewed for qualitative data, examining the subjects affected by natural disasters or pandemics. An additional two papers regarding theoretical data and COVID-19 were analyzed. Although there seems to be a rise in unintended pregnancy and more difficulty accessing care following natural disasters and pandemics, there are variations in the rates based on region and event. CONCLUSIONS: The full effects of the COVID-19 pandemic on the rates of unplanned pregnancies will become apparent in the months and years to come. As obstetrician-gynecologists, we must communicate openly with our patients regarding the use of available contraception, sexual education, and family planning services at times of natural disasters and pandemics.

"Disconnected from the World:" Exploring How the COVID- 19 Pandemic Shaped Adolescent and Young Adult (AYA) Cancer Survivors' Daily Lives

Background/Purpose: Adolescent and young adult (AYA) cancer survivors experience acute and long-term challenges, including disruptions to developmental milestones, altered relationships, and difficulty managing follow-up care. The COVID-19 pandemic likely exacerbated these challenges, but, to date, we know little about young survivors' day-to-day lives during this time. Here, we qualitatively assessed AYA cancer survivors' pandemic-related experiences. Method(s): Thirty-five AYA cancer survivors (85% female, Mage = 32.7 years, 71% White, September 2020-March 2021) wrote factual details about their day-to-day lives (e.g., "what is a typical day like?") as part of a larger randomized controlled trial. Participants were, on average, 5.9 years post-diagnosis;the majority were diagnosed with lymphoma (25.7%) or thyroid cancer (17.1%). Data were analyzed using constant comparative method. Result(s): Five themes emerged: (1) job changes (e.g., inability to work due to immunosuppression, fear career would become less viable);(2) limited interactions/relational depth (e.g., feeling "left out" due to immunosuppression, inability to date, risky family behaviors limit meaningful connection);(3) varying reactions to virtual communication (e.g., gratitude for online schooling, exercise, and social media, withdrawing from friendships due to "zoom burn out," not attending therapy due to lack of engagement);(4) difficulty engaging in health-promoting behaviors and attending/interacting in medical appointments (e.g., problems maintaining nutrition and exercise routines, postponing surveillance appointments, missing family member presence in medical appointments), and (5) disruptions/ delays to post-treatment milestones/plans (e.g., delaying vocational changes, wedding and family planning, and celebratory travel). Notably, no themes associated with positive adjustment emerged. Conclusions and Implications: Goals within multiple domains were obstructed and unmet needs were identified, namely, assistance navigating isolation, relationship disruptions, career/financial barriers, and access to medical care. Results are limited due to the methodology, as this was not a structured interview. Nonetheless, individual counsel with AYA cancer survivors is recommended to provide resources and address pandemic-induced barriers to health and well-being.

Investigation of the Motivations and Thoughts of Women Planning a Pregnancy During the Covid-19 Pandemic

Background: today, with the covid-19 pandemic, we see that health should be handled as a whole, including physical, mental, social, and economic dimensions. planning a pregnancy during the pandemic is a personal choice despite all possible risks. Aim: to evaluate women's motivations for planning pregnancy during the covid-19 pandemic and their thoughts about the effects of the pandemic on their pregnancy Method: this study used a descriptive research design based on a general survey model using a quantitative approach and was conducted with 145 women who accessed the online questionnaire, conceived during the covid-19 pandemic. Findings: it was found that the frequency of sexual activity of the women included in the study did not change during the pandemic process, and 107 (73.8%) of them had a planned pregnancy. the participants decided to get pregnant for several reasons during the pandemic;for example, they thought it was a natural consequence of marriage (37, 34.6%), they wanted to fill in the gap in their life (36, 33.6%), and that the pandemic would continue for a long time (35, 32.7%). a statistically significant relationship was found between the status of women's willingness for pregnancy and their status of feeling concerned and receiving midwife support during pregnancy follow-up (%2 = 13.856;p = 0.000 and %2 = 9.944;p = 0.007, respectively). Conclusion: concerns about covid-19 negatively impact people's lives;yet, women continue pregnancy plans. planning a pregnancy during a pandemic is a personal choice despite all possible risks. women who feel stress and anxiety even under normal pregnancy conditions experience increased stress and anxiety levels in such a global pandemic. it is very important to ensure that women have access to more intensive midwife-supported information, care, and support in this process.

Beyond the crisis: fertility variations and the family policies in the Portuguese municipalities

In a profound ageing context, such as the Portuguese, fertility becomes a key variable for the analysis of population dynamics, with increased importance given the very low levels recorded in the country. According to INE [2020], Portugal has a total fertility rate (TFR) of 1.40 children per woman, one of the lowest in the EU [Eurostat, 2022]. The economic and financial crisis of 2008 and the Troika intervention (European Commission, European Central Bank, and the International Monetary Fund, the three authorities that monitored international bailout programs) in 2011, had impacted on the socioeconomic conditions of the Portuguese population, with repercussions in other behaviors as well as in fertility. Thus, the childbearing postponement led the TFR to fall to its lowest levels on record, reaching 1.21 children per woman in 2013. Although the economic recovery has allowed a slight recovery in fertility levels, the new crisis caused by COVID-19 was reflected in a new historic decline in births in the country in 2021, when the number of live births fell below 80 000, a decrease of 8% compared to 2019 [INE, 2022]. Although this downward trend is common to almost all developed European countries [Aassve et al., 2020;Aassve et al., 2021], for Portuguese society it is a new wake-up call and a cause for concern given the population decline confirmed in the provisional data release from the 2021 Population Census (-2.1% compared to 2011). However, fertility patterns are not uniform, as they involve regional heterogeneity, which highlights a multiplicity of factors and behavioral patterns. This paper aims to approach fertility from a regional perspective to distinguish the diversity of patterns across the territory in the last two decades, and to discuss the extent to which the crises were a point of change or reinforcement of the transformations that were taking place. In the analysis, in addition to the framework and contextualisation of fertility trends by NUTS 3, the policy responses that have emerged at a local/municipal scale will be analysed. Although the crisis has contributed to the fertility decline in Portugal, its decline goes beyond the crisis reflecting changes in behavioral patterns and social and economic constraints. Thus, there persist constraints in the population dynamics that have prevented the reversal or mitigation of the decline in the inland territories that currently are also felt at the country level. © 2022 Authors. All rights reserved.

Investigation of the Attitudes of Women of Reproductive Age to Family Planning with the Anxiety they Experienced during the Pandemic Period

Objective: It was planned to investigate the anxiety experienced by women of reproductive age during the pandemic and their attitudes towards family planning. Method: A descriptive and correlational study was conducted across the country between June and August 2021 with women of reproductive age, sexually active, without sexual dysfunction and anxiety disorder. "Personal Information Form", "State-Trait Anxiety Scale" and "Family Planning Attitude Scale" were used to collect data. Results: The mean age of the women participating in the study was 31.96±7.48 years, and the majority (38.2%) use condoms as a family planning method. Anxiety total scale score average was 102.17±23.48 and Family Planning Attitude Scale total score average was 129.19±20.67. There was a weak negative correlation between the Anxiety Total score of women and the Attitude of the Society towards Family Planning sub-dimension score (r:- .341, p:.000), and a very weak negative statistically significant relationship between the Family Planning Attitude Scale score (r:-.242, p:.000). Conclusion: It was found that the state anxiety levels of women were higher than the trait anxiety levels during the pandemic period, and it was determined that high anxiety had a negative effect on family planning attitudes.

Contraceptive services in Oregon's state-funded network during the COVID-19 pandemic.

OBJECTIVES: To understand how changes to in-person health care during the COVID pandemic impacted contraceptive use in Oregon's state-funded network. STUDY DESIGN: A retrospective cohort of 245,600 visits (virtual and in-person) among 70,295 women presenting to publicly funded family planning clinics in Oregon between January 2019 and June 2021. Data were abstracted from clinic records and restricted to visits of patients identifying as female, 12-51 years old, not using sterilization as a method. Contraception was grouped by effectiveness Tier (Tier 1: intrauterine device, implants; Tier 2: progestin injectable, pill/patch/ring). Multivariable logistic regression predicted the use of contraception by stage of the COVID pandemic which corresponded to service availability (prepandemic, acute: nonemergency services halted, subacute: restricted services), patient demographics, including insurance type, and clinic and geospatial characteristics. RESULTS: Overall during the acute stage, people with visits were more likely to leave with a method of contraception odds ratios (OR) 1.39 (95% confidence interval [CI] 1.24-1.57); however, it was significantly less likely to be a Tier 1 method (OR 0.82, 95% CI 0.74-0.91) as compared to prepandemic. This finding was particularly marked in rural areas (OR 0.69 [96% CI 0.58-0.83]) and among the publicly insured (OR 0.87 [95% CI 0.80-0.94]). CONCLUSIONS: Demand for contraception increased during the acute phase of the COVID pandemic, and shifts in method mix from Tier 1 to Tier 2 methods occurred. Disparities in contraceptive access persisted for those in rural locations or with public insurance. IMPLICATIONS: Lessons learned from the COVID-19 pandemic are critical to informing our future emergency response. The need for family planning services increased during the public health emergency.

The intention to use long-acting reversible contraception during the COVID-19 pandemic.

Objectives: To assess the factors contributing to the intention to use long-acting reversible contraception among women of reproductive age during the coronavirus disease-2019 pandemic. Method: The cross-sectional study was conducted in Mlajah village, Bangkalan Madura, Indonesia, from May 25 to June 30, 2021, and comprised married women of reproductive age. Attitude, subjective norm, perceived behavioural control and intention to use long-acting reversible contraception were the elements explored using a questionnaire based on the Theory of Planned Behaviour. Data was analysed using Spearman's Rho. RESULTS: Of the 102 subjects, 46(45.1%) were aged 30-39 years, 51(50%) had college or university education, 43(42.2%) had 2 children and 59(57.8%) were using family planning methods. There was a significant relationship of intention to use long-acting reversible contraception with attitude (p=0.000; r=0.566), subjective norm (p=0.000; r=0.475), and perceived behavioural control (p=0.000; r= 0.691). CONCLUSIONS: The intention to use long-acting reversible contraception among married women of reproductive age was significantly associated with attitude, subjective norm and perceived behavioural control.

Perspectives on sexual and reproductive health self-care among women, healthcare providers, and other key informants: a mixed-methods study in South Africa and Zambia.

BACKGROUND: "Self-care" for sexual and reproductive health (SRH) includes contraceptive methods and other supplies that people can use with or without the support of a healthcare provider. Self-administered tests, self-injection of injectable contraception, or self-removal of intrauterine devices (IUDs) can increase people's access to and autonomy over their own SRH. Objectives of this study were to assess women's current interest in and use of SRH self-care and explore key informants' (KI) opinions of self-care, especially during the COVID-19 pandemic. METHODS: Data for this study came from female participants in the longitudinal Contraceptive Use Beyond ECHO (CUBE) study, and KIs, including healthcare providers, in South Africa and Zambia between September 2020 and June 2021. For this analysis, we used data from a participant phone survey (n = 537), and from in-depth interviews (IDIs) completed with a sub-sample of women (n = 39) and KIs (n = 36). Survey data were analyzed with descriptive statistics, and IDI data were analyzed using applied thematic analysis. RESULTS: Female survey participants in South Africa were more interested in learning about emergency contraceptive pills, subcutaneous injectable contraception, and CycleBeads, while Zambian participants wanted more information and access to condoms. However, in IDIs in both countries, women described minimal experience with self-care beyond condom use. In the Zambian KI IDIs, COVID-19 led to increased self-care counseling on subcutaneous injectable contraception and HIV self-testing. KIs who do not counsel on self-care were concerned that women may harm themselves or blame the provider for difficulties. Two KIs thought that women could possibly self-remove IUDs, but most expressed concerns. Reported barriers to self-care included COVID movement restrictions, transport costs, lack of accessible pharmacies, women's low awareness, and possible stigma. CONCLUSIONS: Women surveyed reported interest in learning more about SRH self-care methods and resources, but in IDIs did not report extensive previous use besides condoms. KIs described some concerns about women's ability to use self-care methods. Counseling on and provision of self-care methods and supplies may have increased during the COVID-19 pandemic, but ensuring that self-care is more than just a temporary measure in health systems has the potential to increase access to SRH care and support women's autonomy and healthcare needs.

BACKGROUND: "Self-care" refers to healthcare that does not have to be given by a provider, but that people can use themselves. In sexual and reproductive health (SRH), this includes medicines or supplies like pills and injections that people can use to prevent or test for pregnancy or sexually transmitted infections. This study wanted to better understand women's interest in and use of SRH self-care and explore key informants' opinions of self-care, especially during the COVID-19 pandemic. METHODS: We surveyed 537 women in KwaZulu-Natal province, South Africa and Lusaka, Zambia in 2020­2021. We also conducted interviews with 39 women and 36 key informants, including healthcare providers, government officials, and community advocates. RESULTS: Women surveyed in South Africa were more interested than those in Zambia in learning more about self-care contraception, especially daily pills, emergency pills, and injections they could give themselves. In interviews, some key informants said that they do not tell women about self-care because they worried that women could hurt themselves or blame the provider if they experienced problems. COVID movement restrictions, transport costs, and inaccessible pharmacies were all barriers that key informants mentioned to accessing tests, tools, or contraceptive methods that women could give or use themselves. CONCLUSIONS: Women surveyed were interested in learning more about self-care and those interviewed reported minimal previous use of self-care methods besides condoms. Providers also have some concerns about women's ability to use self-care methods. Counseling on and providing self-care methods and supplies may have increased during COVID-19, but increasing access to self-care could help more women take care of their own sexual and reproductive healthcare.

Very early medical abortion: treatment with mifepristone and misoprostol before ultrasonographic visualisation of an intrauterine pregnancy.

INTRODUCTION: Abortion providers may be reluctant to commence abortion before ultrasound evidence of intrauterine pregnancy (IUP) due to concerns of missed ectopic pregnancy. In 2017, very early medical abortion (VEMA) was introduced at an abortion service in Edinburgh, UK. Following ultrasound, patients without confirmed IUP, and without symptoms or risk factors for ectopic pregnancy, could commence treatment immediately after baseline serum-human chorionic gonadotrophin (hCG) measurement, and return for follow-up serum-hCG a week later to determine treatment success (≥80% decline from baseline). This study aimed to compare clinical outcomes between two pathways: (1) VEMA; and (2) standard-of-care delayed treatment where treatment is only commenced on IUP confirmation by serial serum-hCG monitoring and/or repeat ultrasound. METHODS: A retrospective database review was conducted of VEMA eligible patients from July 2017 to December 2021. Study groups were determined by patient preference. Records were searched for abortion outcomes, duration of care, number of appointments (clinic visits, ultrasounds, serum-hCG) and clinical data entries. RESULTS: Of 181 patients included, 77 (43%) chose VEMA and 104 (57%) chose delayed treatment. 11/181 (6.1%) were lost to follow-up. Cohort ectopic prevalence was 4.4% and was not statistically different between groups (2.6% vs 5.8%, VEMA vs delayed group, respectively, p=0.305), as with complete abortion rates (93.3% vs 97.6%, p=0.256). All VEMA group ectopics were detected on the seventh day (from initial visit) while time-to-diagnosis for delayed group ectopics ranged from 7 days to 3 weeks. VEMA patients had significantly reduced duration of care (12 vs 21 days, p<0.001), number of visits (2 vs 3, p<0.001), ultrasounds (1 vs 2, p<0.001) and data entries (6 vs 9, p<0.001). CONCLUSIONS: VEMA is safe, effective and reduces the duration of care, number of appointments and clinical administrative time. It should be offered to medically eligible patients.

Introduction of the London Measure of Unplanned Pregnancy at the booking visit and the midwives' perspective.

BACKGROUND: Pregnancy planning and preconception care benefit women, their children, and future generations. The London Measure of Unplanned Pregnancy (LMUP) is a tool that can be used in antenatal care to identify women with unintended pregnancies who require improved access to such services. This tool was recently implemented into routine antenatal care in two maternity centres in New South Wales, Australia. This study explores midwives' attitudes to the LMUP 12 months after it was introduced into the booking visit and their understanding of its application to their scope of practice. METHODS: This is a qualitative study using in-depth semi-structured interviews with midwives from two maternity care centres in Australia. All midwives performing antenatal booking visits were eligible to take part. Interviews were transcribed, analysed, and coded to define key themes. Recruitment ceased when thematic saturation was reached. RESULTS: Ten midwives from two maternity centres were interviewed. Midwives support the inclusion of the LMUP into the booking visit and felt it was in their scope of practice to be using the tool. Time constraints, the impact of COVID-19 and the lack of structured referral pathways were identified as barriers to the implementation of the LMUP in routine care. CONCLUSIONS: Midwives support the inclusion of the LMUP into the antenatal booking visit and see that it falls within their scope of practice. Service barriers were identified at the individual, organisational and external context levels. These need to be addressed to enhance the potential of this tool.

Impact of coronavirus 19 pandemic on contraception in Jordan.

The coronavirus 19 (COVID-19) pandemic has negatively impacted family planning services worldwide. There are no published reports from Jordan on the impact of COVID-19 pandemic on family planning methods. This was a web-based cross-sectional study between September and December 2020 with 519 participants; of these 43.5% did not use any method. The most used methods were intrauterine devices, coitus interruptus and male condoms. Furthermore, 38.2% of women changed methods due to limited access to services and non-availability of methods. While 82.1% of women preferred modern methods before the pandemic, 79.7% became more acceptant of traditional methods. Moreover, 35.3% of women got pregnant during the curfew, and 90% were unplanned with a statistically significant higher rate in women who changed their routine method, accepted traditional methods, have been married for less than 10 years and multiparous women. National health policy makers should consider the impact of large-scale pandemics on family planning services.IMPACT STATEMENTWhat is already known on this subject? Family planning services in Jordan have improved significantly over the last decade because of accessibility and availability of a wide range of contraceptive methods. Available methods are either traditional or modern. Because of the high failure rates of traditional methods, public health family planning programmes promote modern methods.What do the results of this study add? There are no published reports from Jordan on the impact of COVID-19 pandemic and curfew on family planning methods. This study aims to report on what family planning methods women used during the pandemic, reporting if women changed their preferred methods and the reasons, assess women's knowledge about the natural methods of family planning which is probably an alternative method in situations where services and accessibility to more effective methods are limited and estimate unplanned pregnancies.What are the implications of these findings for clinical practice and/or further research? National health policy makers should consider the impact of large-scale pandemics on family planning services. Additionally, the implementation of telehealth and home delivery of self-administered methods should be considered. Natural methods of contraception may be an option when access and availability to modern methods is limited.

COVID-19 Impact on Women's Health

Introduction The COVID-19 pandemic and associated social distancing and/or lockdowns have impacted social and personal interactions. Objective To assess COVID's impact on partner relationships, sexual activity, family planning, and menopause management. Methods C Space online communities were surveyed from April 14 to 28, 2021. C Space is an online community platform;each community is unique to the client for which it is designed. For this study, three communities were surveyed: a 100-member community of healthcare professionals (HCPs) who treat women's health issues, a 300-member community of reproductive-age women, and a 300-member community of women in their menopausal years. Of the 100 HCPs, 78 responded (25% OB/GYNs, 49% primary care providers, and 26% nurse practitioners or physician assistants);of the 300 reproductive age women, 184 responded;of the 300 women in their menopausal years, 215 responded. Results Fifty-four percent of reproductive-age women reported that their relationships with their partners have improved during the pandemic, while nearly a third (31%) reported their relationships have suffered. Conversely, just over a third (38%) of menopausal women claim their relationships with their partners improved, while 45% reported that their relationships have suffered. Among women with sexual partners (n=158 reproductive-age women;n=168 menopausal women), 46% of reproductive-age women and 62% of menopausal women reported having sex with the same frequency as before the pandemic. Of the reproductive-age women, 27% reported having sex with more frequency and 22% with less frequency. Among menopausal women, 10% reported having more sex, and 17% reported having less frequent sex than before the pandemic. Nearly half (46%) of those who were considering or actively trying to get pregnant pre-COVID responded they were less likely to try to conceive now, with 36% saying they have not changed, and 18% responded they are more likely to try to conceive.For birth control, the majority (72%) of HCPs reported no change in prescribing, with 14% citing an increase and 14% citing a decline. Of the 75% of reproductive-age women who were taking birth control (n=138), the majority (70%) reported no change in their use of birth control, 22% reported making a change or starting a new treatment, and 11% (n=15) responded that they stopped taking birth control during the pandemic.For menopause management, the majority of HCPs (62%) reported no change in the use of hormone therapy, and nearly a third (31%) reported a decline in use. Of the 20% of menopausal women (n=42) who were on a menopause hormone therapy, over half (52%) responded that they made no change to their treatment, nearly a third (31%) made a change or started a new therapy;17% (n=7) stopped treatment during the pandemic. Conclusions The COVID pandemic has impacted women differently depending on their reproductive or menopause status including their relationships with their partners, sexual activity, family planning and use of birth control or hormone therapy.

Interruption of the Use of Contraceptive Methods During the Quarantine By COVID-19 in Peruvian Women

Background: The covid-19 pandemic affected family planning management and the sexual and reproductive rights of couples. Objective(s): To determine the factors associated with the interruption of the use of contraceptive methods during the quarantine by COVID-19 in Peruvian women. Method(s): Analytical and cross-sectional study, which included 342 women who used a contraceptive method before the COVID-19 quarantine, to whom a virtual questionnaire disseminated on social networks was applied. Pearson's chi-square evaluated associations between method discontinuation and the factors studied. Result(s): Of the total number of women, 45% discontinued the use of contraceptive methods during the COVID-19 quarantine. The predominant age range was from 18 to 34 years (93.9%). The factors associated with this interruption were age (p = 0.044), marital status (p < 0.001), parity (p < 0.001), sexual relations (p < 0.001), and searching for information by digital means (p = 0.044). The main reason for stopping use was fear of contagion by COVID-19 (42.8%). Conclusion(s): About half of contraceptive method users interrupted their use during the COVID-19 quarantine, and the factors associated with said interruption were personal, reproductive, and informa-tional. Therefore, health personnel must provide comprehensive care for women, especially in health emergencies.Copyright © 2023 Bentham Science Publishers.

The role of partners, parents and friends in shaping young women's reproductive choices in Peri-urban Nairobi: a qualitative study.

BACKGROUND: Contraceptive use among young women in Nairobi remains low despite high general knowledge of family planning (FP) methods. This paper draws on social norms theory to explore the role of key influencers (partners, parents and friends) in women's FP use and how women anticipate normative reactions or sanctions. METHODS: A qualitative study with 16 women, 10 men and 14 key influencers across 7 peri-urban wards in Nairobi, Kenya. Interviews were conducted during the COVID-19 pandemic in 2020 by phone. A thematic analysis was conducted. RESULTS: Women identified parents, specifically mothers, aunts, partners, friends and healthcare workers as key influencers on FP. Their interactions with these key influencers varied based on trust, the information they needed about FP, and whether they perceived a key influencer to perpetuate or challenge existing social norms on FP. Mothers were perceived to understand the social risks of using FP and thus could advise on discreet FP use, and aunts were trusted and approachable sources to impartially describe the benefits and drawbacks of FP. Although women identified partners as key FP decision makers, they were cognisant of possible power imbalances affecting a final FP choice. CONCLUSIONS: FP interventions should consider the normative influence key actors have on women's FP choices. Opportunities to design and deliver network-level interventions which seek to engage with social norms surrounding FP in order to challenge misconceptions and misinformation among key influencers should be explored. Intervention design should consider dynamics of secrecy, trust and emotional closeness that mediate discussions of FP to address changing norms. Further training to change norms held by healthcare providers about why women, in particular unmarried young women, access FP should be provided to reduce barriers for FP access.

Women's decisions to use family planning (FP) are influenced by social norms, the unwritten rules of appropriate actions within social networks, and are shaped by advice and information received from key influencers­important individuals who shape what is acceptable within social networks. The aim of this study was to understand how key influencers uphold and transmit information and norms about FP, and explore who women consult as they make FP decisions and why they consult these key influencers.We interviewed 16 women, 10 partners and 14 key influencers in peri-urban Nairobi, Kenya.We found that key influencers for decisions about FP included mothers, aunts, partners, friends and healthcare providers. In making a decision about FP use, women consulted key influencers based on who they deemed trustworthy to keep their FP use secret and described less trust to speak with men about FP in their social networks. Mothers understood the social risks of using FP and so could advise on its discreet use, and aunts were approachable sources of impartial information about FP. Although women identified partners as key decision makers, they were aware that power imbalances might affect final FP choices.Our findings underscore the importance of FP interventions working with women's social networks and to address social norms influencing women's decisions in using FP. Interventions to change FP norms should consider dynamics of secrecy, trust and emotional closeness that affect FP discussions among women's networks.