Integrating sex and gender into biomedical research requires policy and culture change.

Most biomedical, health and care research does not adequately account for sex and gender dimensions of health and illness. Overlooking and disregarding the influence of sex and gender in research reduces scientific rigour and reproducibility, which leads to less effective treatments and worse health outcomes for all, particularly women and sex and gender diverse people. Historically, there has been minimal sex and gender policy innovation in UK medical research. To address this, stakeholders from across the UK research sector have been collaborating since spring 2023 to co-design a sex and gender policy framework to be implemented by research funders, as part of the MESSAGE (Medical Science Sex and Gender Equity) project. In the first Policy Lab, held in London in May 2023, 50 participants, including representatives from funding organisations, medical journals, regulators, clinicians, academics and people with lived experience, identified two key priorities for future action: 1) A whole system approach to policy change, and 2) Technical capacity-building and wider culture change efforts. In pursuing these priorities and collaborating cross-sectorally, UK stakeholders are engaged in an internationally innovative approach aimed at realising sustainable and impactful sex and gender policy change. Drawing on MESSAGE Policy Lab discussions, we set out key actions needed for the UK research sector to embed meaningful accounting for sex and gender as a new norm for research practice.

Promotion of an Algorithm-Based Tool for Pregnancy Prevention by Instagram Influencers.

Objective: Despite growing concerns that some digital algorithm-reliant fertility awareness-based methods of pregnancy prevention are marketed in an inaccurate, opaque, and potentially harmful manner online, there has been limited systematic examination of such marketing practices. This article therefore provides an empirical examination of how social media influencers have promoted the fertility tracking tool Daysy on Instagram. We investigate: (1) how the tool is framed in relation to pregnancy prevention using Health Belief Model (HBM) constructs, and (2) the promotional and disclosure practices adopted by influencers. Materials and Methods: We collected Instagram posts mentioning Daysy made between June 2018 and May 2022 using the tool CrowdTangle. Using a qualitative content analysis approach, we coded a random sample of 400 Daysy posts. This yielded 122 Instagram influencer posts promoting Daysy for pregnancy prevention that we coded for promotional content and HBM constructs. Results: Posts originated primarily from Europe (n = 62, 50.82%) and the United States (n = 37, 30.33%). Findings indicate that barriers to use (n = 18, 15.57%) and the severity of risks from unplanned pregnancy (n = 8, 6.56%) were rarely conveyed, whereas benefits of use (n = 122, 100%) and the severity of risks of hormonal contraception (n = 31, 25.41%) were covered more extensively. Only about one third of posts disclosed any formal relationship to the brand Daysy. Conclusions: With many posts emphasizing benefits and obscuring potential limitations, we argue that accurate and transparent information about the effectiveness and limitations of fertility tracking technologies is critical for supporting informed decision-making and, as such, should remain a public health priority.

Understanding ethical challenges of family planning interventions in sub-Saharan Africa: a scoping review.

Background: Improving the design of family planning (FP) interventions is essential to advancing gender equality, maternal health outcomes, and reproductive autonomy for both men and women. While progress has been made towards applying a rights-based approach to FP interventions in sub-Saharan Africa, the ethical implications of FP interventions has been underreported and underexplored. Several ethical challenges persist related to measuring success, choice, and target population. Methods: We conducted a scoping review to understand if and how FP interventions published between 2000 and 2020 within sub-Saharan Africa address the ethical challenges raised within the literature. We identified a total of 1,652 papers, of which 40 were included in the review. Results: Our review demonstrated that the majority of family planning interventions in sub-Saharan Africa place a strong emphasis, on measuring success through quantitative indicators such as uptake of modern contraception methods among women, specifically those that are married and visiting healthcare centres. They also tend to bias the provision of family planning by promoting long-acting reversible contraception over other forms of contraception methods potentially undermining individuals' autonomy and choice. The interventions in our review also found most interventions exclusively target women, not recognising the importance of gender norms and social networks on women's choice in using contraception and the need for more equitable FP services. Conclusion: The results of this review highlight how FP interventions measured success through quantitative indicators that focus on uptake of modern contraception methods among women. Utilising these measures makes it difficult to break away from the legacy of FP as a tool for population control as they limit the ability to incorporate autonomy, choice, and rights. Our results are meant to encourage members of the global family planning community to think critically about the ethical implications of their existing interventions and how they may be improved. More public health and policy research is required to assess the effect of applying the new indicators with the FP community as well as explicitly outlining monitoring and evaluation strategies for new interventions to allow for programme improvement and the dissemination of lessons learned.

Putting our money where our mouth is? The degree of women-centred family planning in the era of FP2020.

The 1994 International Conference on Population and Development was a landmark moment for the international family planning community, who committed to adopt a women-centred approach to programming-one that would prioritise the reproductive and contraceptive intentions, or autonomy, of individuals over population-level demographic concerns. The FP2020 partnership, established in 2012 and lasting until 2020, also described itself using women-centred language. However, throughout the period of FP2020, critics questioned the extent to which women-centred principles truly defined why family planning programmes were funded and how they were implemented. In this study, we use thematic discourse analysis to examine six major international donors' rationale(s) for funding family planning and the measurements they used to articulate successful programming. We present an overview of the rationales and measurements used by all six donors before offering four case studies to demonstrate divergences in their approaches. Our analysis demonstrates that, although donors described the importance of family planning for fostering women's autonomy and empowerment, they also justified family planning on the basis of demographic concerns. In addition, we identified a misalignment between how donors described family planning programmes-using the language of voluntarism and choice-and how they measured their success-through increased uptake and use of contraceptive methods. We call on the international family planning community to reflect on their true motives for funding and implementing family planning and engage in radically rethinking how they capture programme success, in order to better align their rhetoric with their practice.