ABSTRACT
The ongoing coronavirus disease-2019 (COVID-19) pandemic continues to be a public health emergency of global concern. The findings of the studies have reported that owing to the pandemic, the delivery of essential and emergency sexual and reproductive health-care services has been significantly jeopardized. This has resulted in a considerable rise in the number of episodes of gender-based violence, with the situation being grimmer in settings with poor health systems or among people who are being exposed to some form of humanitarian emergencies. This calls for an indispensable need to improve the delivery of sexual and reproductive health-related services to all women, especially those living in low-resource settings. To conclude, the COVID-19 pandemic has accounted for the disruption of almost all types of health-care services and the same thing has been observed with regard to the delivery of sexual and reproductive health-care needs of women. It is the need of the hour to bridge the existing gap and give adequate priority to the special needs of women, which very much determine their quality of life.
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Background: Current published Faculty of Sexual and Reproductive Health (FSRH) guidelines recommend annual cervical screening for women living with HIV(WLHIV) but do not reflect current evidence. Aim(s): 1. To assess the impact of the Covid-19 pandemic on frequency and interval of cervical screening in WLHIV 2. To report any changes in outcomes of cervical screening in WLHIV during Covid-19 Method: Data were collected retrospectively over 3 years defined as Pre-Covid (23/3/2019-22/3/2020), during Covid lockdowns (23/3/2020-22/3/2021) and Post-Covid lockdowns (23/3/2021-22/3/2022). Data was collated on demographics, HIV-related data, previous abnormal cervical screens/colposcopy, smoking and high-risk Human Papilloma Virus(hrHPV) vaccination. Result(s): Data was available for 70 women. Mean age was 48 years, 44.3%(n=31) were of African ethnicity. Mean duration of HIV diagnosis was 19 years. 22.9% (n=16) had a previous ADI, median CD4 was 768(range 35-1891), median nadir-CD4 439(range 3-1472), 94.3% (n=66) were taking ARVs and 87.1%(n=61) had HIV-VL <40 copies/ml. 42.9%(n=30) had a previous abnormal cervical screen and 78.6%(n=55) had undergone colposcopy. 4.3%(n=3) were vaccinated against hrHPV. 18.6% (n=13) currently smoked. 60%(n=42) women underwent cervical screening Pre- Covid, 41.4%(n=29) during and 78.6%(n=55) Post-Covid. 19.6-37.2% fewer women were screened during Covid compared to Pre and Post-Covid. 9.5%(n=4) women screened Pre-Covid tested positive for hrHPV compared with 6.9%(n=2) during Covid and 12.7%(n=7) Post-Covid. No cytology changes were seen for the majority however cervical intraepithelial neoplasia(CIN) grade 1 was detected in 2.4%(n=1) Pre- Covid, compared with 3.4%(n=1) during covid and 5.4% (n=3) Post-covid. Post-Covid 1.82%(n=1) had CIN grade 2 detected, no women pre or during covid had CIN grade 2 detected. No women Pre, during or Post-covid had CIN grade 3 or cervical neoplasm detected on cytology. Conclusion(s): Covid increased cervical screening intervals for WLHIV but did not result in delayed cervical cancer diagnosis. FSRH guidelines are currently under review regarding screening intervals. This data, although small in number, may support European AIDS Clinical Society and Department of Health and Human Services guidelines which have extended screening intervals for PWLH especially for those who tested negative for hrHPV.
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Male reproductive health depends on many factors, including whether infectious diseases occur in the reproductive system. Such changes may be reflected in the semen analysis. In the past three years, the number of individuals who fell ill with COVID-19 caused by SARS-CoV-2 has been growing worldwide, including in Russia. This infection causes dysfunction and a negative effect on many organs and systems, including reproductive organs, which is reflected in abnormal semen parameters. Despite the high efficacy and small number of side effects found in clinical trials, only 56% of the population in the US and 49% in the Russian Federation reported wanting the vaccine. One of the reasons for distrust of vaccines is the potential negative impact on fertility. A literature review is devoted to the study of the effect of SARS-CoV-2 and vaccination on male reproductive health. The search was carried out using Medline, PubMed, and EMBASE databases.Copyright © 2023 Authors. All rights reserved.
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Introduction: Despite policy actions and strategic efforts for improving the reproductive and sexual health of adolescents by promoting the uptake of adolescent reproductive and sexual health (ARSH) services, the utilisation rate remains significantly low, especially in rural areas of India. This study aimed to assess the utilisation of these services by adolescents in rural West Bengal and its associated determinants. Method: This mixed-method study was conducted from May to September 2021 in the Gosaba rural block of South 24 Parganas, West Bengal. Quantitative data were collected from 326 adolescents using a pre-tested structured questionnaire. Qualitative data were collected via four focus group discussions among 30 adolescents and key-informant interviews among six healthcare workers. Quantitative data were analysed using SPSS, while qualitative data were analysed thematically. Results: Ninety-six (29.4%) adolescents had utilised ARSH services at least once during adolescence. The factors associated with non-utilisation of ARSH services were younger age, female sex, increasing reproductive health stigma and decreasing parent-adolescent communication related to sexual health. Qualitative exploration revealed that unawareness regarding services, perceived lack of privacy and confidentiality at healthcare facilities and disruption of services post-emergence of the COVID-19 pandemic were some major barriers to ARSH service utilisation. Conclusion: A multi-component strategy, including promotion of adolescent-friendly health clinics, community support interventions associated with motivation and counselling of parents regarding the importance of adolescent reproductive health, is needed to improve the utilisation of ARSH services. Necessary steps to correct the deficiencies at the facility level should also be prioritised.
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BACKGROUND: The COVID-19 pandemic pushed governments worldwide to implement unprecedented mitigation measures, including safe-distancing, lockdowns, disruption of non-essential services, border closures and travel restrictions, with both potential to affect rural and urban service-users differently and unintended consequences including reductions in sexual and reproductive health (SRH) services. We aimed to explore rural-urban differences in progress and challenges in SRH services provision in Cambodia, particularly during initial months of the COVID-19 pandemic. METHODS: We used a mixed-methods study design, including a household survey of 423 adolescents and women aged 18-49 and semi-structured interviews with 21 healthcare providers. We analysed survey data using multivariable logistic regression to identify associations between rural-urban setting and contraceptive perceptions or access. We analysed interview data thematically. RESULTS: Rural-urban residence was significantly associated with reported perceptions about and access to contraceptives. Rural participants had higher odds of stating it was possible to change contraceptive methods early in the COVID-19 pandemic, compared with urban participants. Qualitative data showed that although SRH services continued, health-workers faced differential challenges in rural and urban areas, e.g. service-users not attending due to job losses in urban areas and not complying with safe-distancing and mask-wearing requests in rural areas. CONCLUSIONS: COVID-19 and inadequate mitigation responses differentially affected rural and urban SRH service providers and service-users, exacerbating existing socioeconomic stressors while adding new fears of infection, transport constraints, and reduced livelihoods. Added financial support could help mitigate challenges in both rural and urban areas.
Subject(s)
COVID-19 , Reproductive Health Services , Adolescent , Humans , Female , Cambodia/epidemiology , Pandemics , COVID-19/epidemiology , Communicable Disease Control , Reproductive HealthABSTRACT
The World Health Organization (WHO) defines an infodemic as the proliferation of false or misleading information that leads to confusion, mistrust in health authorities, and the rejection of public health recommendations. The devastating impacts of an infodemic on public health were felt during the COVID-19 pandemic. We are now on the precipice of another infodemic, this one regarding abortion. On June 24, 2022, the Supreme Court of the United States (SCOTUS) decision in Dobbs v. Jackson Women's Health Organization resulted in the reversal of Roe v. Wade, which had protected a woman's right to have an abortion for nearly 50 years. The reversal of Roe v. Wade has given way to an abortion infodemic that is being exacerbated by a confusing and rapidly changing legislative landscape, the proliferation of abortion disinformants on the web, lax efforts by social media companies to abate abortion misinformation, and proposed legislation that threatens to prohibit the distribution of evidence-based abortion information. The abortion infodemic threatens to worsen the detrimental effects of the Roe v. Wade reversal on maternal morbidity and mortality. It also comes with unique barriers to traditional abatement efforts. In this piece, we lay out these challenges and urgently call for a public health research agenda on the abortion infodemic to stimulate the development of evidence-based public health efforts to mitigate the impact of misinformation on the increased maternal morbidity and mortality that is expected to result from abortion restrictions, particularly among marginalized populations.
Subject(s)
Abortion, Induced , COVID-19 , Pregnancy , Female , United States , Humans , Abortion, Legal , Infodemic , PandemicsABSTRACT
BACKGROUND: Refugee women who leave their country due to persecution and violence have multiple barriers to sexual and reproductive health (SRH) services. The COVID-19 pandemic added an additional barrier to in-person reproductive health education, dialogue, and clinical care. This study aimed to assess the potential of using virtual group meetings as a forum for refugee women to learn about and discuss reproductive health concerns such as cervical cancer screening, family planning, childbirth, and postpartum care. METHOD: We conducted semi-structured interviews with 36 refugee women and stakeholders to assess factors that impact refugee women's receptiveness for virtual platforms to obtain information and engage in discussions on reproductive health. Thematic analysis was conducted using the software Dedoose. RESULTS: Openness to engage in virtual platforms varied by refugee community, women's demographic, and life experience. The women's involvement with local refugee groups facilitated their engagement with virtual platforms. Furthermore, individuals' family structure and marital relationship, along with literacy and English proficiency, and access to and familiarity with technology impacted engagement. Virtual groups needed to mirror confidentiality and women expressed a strong preference that groups were all-women. CONCLUSION: Refugee women are receptive to virtual groups on SRH when they are offered in a culturally appropriate manner that considers the living situations and access to technology after arrival to the USA. Findings from this study provide a framework to develop and tailor effective virtual or hybrid virtual-in-person programs for women in refugee communities.
ABSTRACT
Introduction: Today, we are facing increased and continued adverse sexual health outcomes in the United States, including high post-COVID-19 pandemic rates of sexually transmitted infections (STIs). For the past 20 years, there have been calls for a national health strategy and a more comprehensive sexual health approach to address the myriad of persistent sexual health problems in this country. Employing a sexual health approach requires shifting from a longstanding, stigmatizing focus on morbidity toward a holistic and integrated focus on health rather than disease. While strategies are being implemented by multisectoral stakeholders, it is also important to establish a core set of indicators that broadly describe the state of sexual health in the U.S. and allow for measurement across time. The development of a comprehensive scorecard with key sexual health indicators has been proposed by other entities (e.g., Public Health England, World Health Organization), but such an attempt has not been made in the U.S. Methods: A review of national U.S. surveys and surveillance systems with items related to sexual health was conducted for years 2010-2022 to develop an inventory of existing data that yield national estimates for potential indicators of sexual health. Results: We selected 23 sexual health indicators in four broad domains including: (1) knowledge; communication and attitudes (five indicators); (2) behaviors and relationships (four indicators); (3) service access and utilization (seven indicators); and (4) adverse health outcomes (seven indicators). Recent data for each indicator are provided. Discussion: A growing body of evidence shows the positive effects of moving away from a morbidity focus toward an integrated, health-promoting approach to sexual health. Yet, not much has been done in terms of how we implement this national shift. We argue that measurement and monitoring are key to future change. We envision these core sexual health indicators would be published in the form of an index that is publicly available and updated frequently. These sexual health indicators could be used for ongoing monitoring, and to guide related research, programming, and policy development to help promote sexual health in coming years.
Subject(s)
COVID-19 , Sexual Health , Humans , United States/epidemiology , Pandemics , Public Health , Population SurveillanceABSTRACT
OBJECTIVE: A weak and politicised COVID-19 pandemic response in the United States (US) that failed to prioritise sexual and reproductive health and rights (SRHR) overlaid longstanding SRHR inequities. In this study we investigated how COVID-19 affected SRHR service provision in the US during the first 6 months of the pandemic. METHODS: We used a multiphase, three-part, mixed method approach incorporating: (1) a comprehensive review of state-by-state emergency response policies that mapped state-level actions to protect or suspend SRHR services including abortion, (2) a survey of SRHR service providers (n=40) in a sample of 10 states that either protected or suspended services and (3) in-depth interviews (n=15) with SRHR service providers and advocacy organisations. RESULTS: Twenty-one states designated some or all SRHR services as essential and therefore exempt from emergency restrictions. Protections, however, varied by state and were not always comprehensive. Fourteen states acted to suspend abortion. Five cross-cutting themes surrounding COVID-19's impact on SRHR services emerged across the survey and interviews: reductions in SRHR service provision; shifts in service utilisation; infrastructural impacts; the critical role of state and local governments; and exacerbation of SRHR inequities for certain groups. CONCLUSIONS: This study demonstrates serious disruptions to the provision of SRHR care that exacerbated existing SRHR inequities. The presence or absence of policy protections for SRHR services had critical implications for providers and patients. Policymakers and service providers must prioritise and integrate SRHR into emergency preparedness planning and implementation, with earmarked funding and tailored service delivery for historically oppressed groups.