Disability, sexual and reproductive health: a scoping review of healthcare professionals' views on their confidence and competence in care provision.

BACKGROUND: The sexual and reproductive needs of people with disabilities are often unmet. Healthcare professionals play an important role in meeting these needs. OBJECTIVE: To explore the views of healthcare professionals on their confidence and competence in providing sexual and reproductive healthcare to people with disabilities. METHODOLOGY: Two databases were searched yielding 14 studies included in the review. Studies detailing healthcare professionals' experiences working in the subject area were included alongside results and evaluations of staff training/workshops within the area. Search results were screened for eligibility by the first and second authors and any discrepancies were resolved by the third author. All subsequent stages were carried out by the first author and reviewed by the second and third authors. RESULTS: The study's findings indicate that there is a lack of training, guidelines, patient contact, time, teamwork and collaboration between staff, and a lack of awareness/access to resources within this area. Evaluations of training programmes/workshops showed an increase in knowledge, comfort and skills surrounding the subject. Continuous training would be beneficial to ensure these are maintained at a high level. CONCLUSIONS: Overall healthcare professionals felt they lack confidence and competence in providing sexual and reproductive healthcare to people with disabilities. Further research in this area is recommended to assess this in more depth. Development of guidelines, multidisciplinary training programmes and further resources for both staff and patients are recommended.

Women's experiences of self-referral to an abortion service: qualitative study.

BACKGROUND: Guidelines from the UK recommend that women should be able to self-refer to abortion services. In 2016, a self-referral system was introduced to the abortion service in Edinburgh, Scotland, as an option for women. Women could telephone a dedicated phone line during office hours and speak to an administrative assistant working in the abortion service who provided them the next available appointment to be seen in the service. This study aimed to evaluate a self-referral service to abortion by investigating its impact on women's experiences of the referral process. METHODOLOGY: 21 semistructured interviews of women attending a specialist abortion service in Edinburgh, Scotland, were conducted. Interviews were transcribed verbatim and thematically analysed. The interviews focused on women's experience of the referral process. RESULTS: Three main themes arose from the interviews, including reasons for choosing self-referral, experience of self-referral and challenges to using self-referral. Reasons for choosing self-referral were related to convenience, privacy and autonomy. Women found the experience of self-referral to be pleasant, non-judgemental and patient-centred, and self-referral prepared them for the appointment at the specialist abortion service. However, some women felt rushed, and self-referral made them anxious to attend the appointment. Challenges were difficulty with getting through on telephone lines, varying levels of support required for different individuals and awareness about the option of self-referral. CONCLUSION: Women valued the option of self-referral. Women felt that the service should be expanded to increase availability,and promoted to women more widely within the community .

Sexual and reproductive healthcare providers' opinions on expansion of pharmacy-led provision of contraception.

INTRODUCTION: Reduced funding to contraceptive services in the UK is resulting in restricted access for women. Pharmacists are already embedded in sexual and reproductive health (SRH) care in the UK and could provide an alternative way for women to access contraception. The aim of this study was to determine the views of UK contraception providers about community pharmacist-led contraception provision. METHODS: An anonymous questionnaire was distributed to healthcare professionals at two UK SRH events, asking respondents about: (1) the use of patient group directions (PGDs) for pharmacist provision of oral contraception (OC); (2) the sale of OC as a pharmacy medicine or general sales list medicine; (3) the perceived impact of pharmacy provision of OC on broader SRH outcomes; and (4) if other contraceptive methods should be provided in pharmacies. RESULTS: Of 240 questionnaires distributed, 174 (72.5%) were returned. Respondents largely supported pharmacy-led provision of all non-uterine methods of contraception, excluding the contraceptive implant. Provision of the progestogen-only pill by PGD was most strongly supported (78% supported initiation). Respondents felt that the use of bridging (temporary) contraception would improve (103/144, 71.5%), use of effective contraception would increase (81/141, 57.4%), and unintended pregnancies would decline (71/130, 54.6%); but that use of long-acting reversible contraception would decrease (86/143, 60.1%). Perceived barriers included pharmacists' capacity and competency to provide a full contraception consultation, safeguarding concerns, and women having to pay for contraception. CONCLUSIONS: UK SRH providers were largely supportive of community pharmacy-led provision of contraception, with training and referral pathways being required to support contraception delivery by pharmacists.

Initiating intramuscular depot medroxyprogesterone acetate 24-48 hours after mifepristone administration does not affect success of early medical abortion.

OBJECTIVES: The primary objective of this study was to determine whether intramuscular depot medroxyprogesterone acetate (IM DMPA) given at the time of misoprostol administration, 24-48 hours after mifepristone, affects the rate of continuing pregnancy. In addition, the study explored factors predictive of continuing pregnancy. DESIGN: Case-control study based on database review of women who underwent early medical abortion (EMA) over a 4-year period. SETTING: Single abortion service in Scotland. PARTICIPANTS: 5122 women who underwent an EMA within the timeframe of this study. MAIN OUTCOME MEASURES: Continuing pregnancies among women receiving IM DMPA were compared with those choosing other hormonal methods of contraception, non-hormonal contraception or no contraception at the time of misoprostol administration. Logistic regression was performed to assess the effects of demographic characteristics, gestation at presentation and method of contraception provided, on outcome of pregnancy. RESULTS: A total of 4838 women with complete data were included, of which there were 20 continuing pregnancies (0.4%); 284 women were excluded due to missing data. There was no increased risk of a continuing pregnancy among women who initiated IM DMPA at the time of misoprostol administration (24-48 hours after mifepristone) compared with women who initiated no hormonal contraception at this time (RR 0.48; 95% CI 0.06 to 3.81). Gestation ≥8 weeks and previous terminations were factors associated with increased likelihood of continuing pregnancy. CONCLUSIONS: Women choosing IM DMPA after EMA can be reassured that IM DMPA can be safely initiated at the time of misoprostol administration 24-48 hours after mifepristone without an increase in the risk of a continuing pregnancy. Both increasing gestation and previous termination were factors associated with an increased likelihood of continuing pregnancy following an EMA.

How well do women recall past contraceptive use? A pilot study.

BACKGROUND AND METHODOLOGY: Many women use a variety of contraceptive methods during their reproductive lives. Investigating this exposure is one of the most frequently performed epidemiological investigations. Accurate recall of methods used, as well as validating this information, can be difficult. A pilot study compared recalled contraceptive use over 5 years with that documented in the case notes of 30 women. RESULTS: 47% of episodes of method use were accurately recalled to the month of starting method use; this figure rose to 94% when episodes with disagreement within +/-12 months were also considered. Similarly, 44% and 91% of episodes were accurately recalled to the month and within +/-12 months of stopping method use, respectively. Accuracy of recall for duration of use followed a similar pattern. 7% of users were unable to distinguish between use of a combined pill and a progestogen-only pill and one-third of women using an intrauterine contraceptive were unable to distinguish an intrauterine device (IUD) from the intrauterine system (IUS). DISCUSSION AND CONCLUSIONS: Almost all women can recall accurately which contraceptive methods they have used in the past year but are less accurate in respect of exact starting and stopping dates. Some women confuse the combined pill with the progestogen-only pill and others confuse the IUD and the IUS. The findings need to be replicated in other settings and with populations of less well-educated women.