Exploring the uptake of sexual and reproductive health services for lesbians and bisexual women in Bulawayo, Zimbabwe. A quantitative enquiry.

Background: Sexual and reproductive healthcare is essential for all individuals, including LGBTQ+ individuals. However, lesbians and bisexual women often lack tailored services, leading to underutilization. This study aimed to assess the availability and uptake of sexual and reproductive health services for lesbian and bisexual Bulawayo women. Methods: A cross-sectional study surveyed 67 lesbian and bisexual women recruited through the Voice of the Voiceless Organization. The participants completed a structured questionnaire on available services, factors influencing their uptake, and access challenges. Cross-tabulation was used to examine the associations between variables. Data were analyzed using Microsoft Excel and STATA Version 15 S.E. Results: Most respondents were bisexual women aged 35 years. Cross-tabulations revealed significant associations between delayed or avoided services and the absence of specific services for lesbians and bisexual women as well as the presence of gender identity nondiscrimination policies. Conclusion: Sexual and reproductive health programs play a vital role in meeting lesbian and bisexual women's needs. Improving service uptake requires strengthening the linkages between clinics and sexual health education programs, providing lesbian and bisexual women-friendly clinical services, and ensuring access to comprehensive information.

The effects of khat (Catha edulis) use on the genitourinary system: A systematic review and meta-analysis.

The objective of the current study is to conduct a meta-analysis of the existing literature concerning the potential impact of khat on the reproductive systems. Five international databases, Embase, Medline/PubMed, Scopus, Web of Knowledge (ISI), and ProQuest, were searched from inception up to the end of January 2024. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist was used for quality assessment of included studies. After several screening phases,10 articles were included in the final analysis. The pooled meta-analysis showed that women who use khat during pregnancy had a significantly higher chance of having low birth weight (LBW) (OR= 2.51, 95% CI: 1.61-3.95, p-value < 0.001) and congenital anomalies (OR= 3.17, 95% CI: 1.31-7.73, p-value = 0.011) compared to nonusers. The obtained results of the meta-analysis showed that the consumption of khat significantly reduces semen volume (standardized mean difference = -0.903, 95% CI: -1.801 to -0.007, p = 0.048). In conclusion, our study show that significant associations with LBW, congenital anomalies, and reduced semen volume underscores the necessity for additional research to delve deeper into the intricate complexities of how khat affects reproductive health in both women and men.

Effect of male partners' involvement and support on reproductive, maternal and child health and well-being in East Africa: A scoping review.

Background and Aims: East African countries have high rates of maternal and child mortality and morbidity. Studies have shown that the involvement of male partners in reproductive health can benefit maternal and child health (MCH). This scoping review aims to provide an overview of the evidence across East Africa that describes male partner involvement and its effect on maternal, reproductive, and child well-being. Methods: Ten databases were searched to identify quantitative data on male's involvement in East Africa. Studies reporting qualitative data, "intention to use" data or only reporting on male partner's education or economic status were excluded. Studies were organized into five a priori categories: antenatal care (ANC), human immunodeficiency virus, breastfeeding, family planning, and intimate partner violence with further categories developed based on studies included. Results: A total of 2787 records were identified; 644 full texts were reviewed, and 96 studies were included in this review. Data were reported on 118,967 mothers/pregnant women and 15,361 male partners. Most of the studies (n = 83) were reported from four countries Ethiopia (n = 49), Kenya (n = 14), Tanzania (n = 12) and Uganda (n = 10). The evidence indicates that male partner involvement and support is associated with improved reproductive, MCH across a wide range of outcomes. However, the studies were heterogeneous, using diverse exposure and outcome measures. Also, male partners' lack of practical and emotional support, and engagement in violent behaviors towards partners, were associated with profound negative impacts on MCH and well-being. Conclusions: The body of evidence, although heterogeneous, provides compelling support for male involvement in reproductive health programs designed to support MCH. To advance research in this field, an agreement is needed on a measure of male partner "involvement." To optimize benefits of male partners' involvement, developing core outcome sets and regional coordination are recommended.

The care of Transgender and Gender Nonbinary Adolescents and Young Adults.

Transgender and gender nonbinary (TGNB) adolescents and young adults (AYA) may present to clinicians with reproductive health expertise for the spectrum of gynecologic, sexual, and reproductive care. As such, clinicians should be knowledgeable in the many facets of gender-affirming care. This clinical opinion reviews language associated with gender diversity and gender-affirming care; current clinical, social, and political barriers faced by TGNB AYA; and the creation of welcoming and inclusive clinical spaces for TGNB AYA. It discusses social, medical, and surgical affirmation processes, and focuses on gynecologic care topics which may arise in the care of TGNB AYA, including those who undergo medical or surgical therapies. This includes menstrual suppression, breakthrough bleeding on testosterone, sexual health, fertility, and the pelvic care of individuals following gender affirming vulvovaginoplasty.

Adverse pregnancy outcomes associated with endometriosis in Ukraine: results a multicenter study.

OBJECTIVE: Aim: To estimate pregnancy outcomes associated with endometriosis in Ukraine. PATIENTS AND METHODS: Materials and Methods: We performed the multicentre prospective cohort study during the period from January 1st, 2019 to December 31st, 2021. The study included pregnant women aged ≥18 years hospitalized in 17 hospitals from 15 regions of Ukraine. Logistic regression analysis provided odds ratios (OR) with 95% confidence intervals (CI). RESULTS: Results: Of the 27,558 women, 990 (3,6%) reported a diagnosis of endometriosis before pregnancy. In 990 deliveries, women with endometriosis had a higher risk of hypertension in pregnancy (OR 1.2, 95% CI 1.0-1.3), preeclampsia (OR 1.4, 95% CI 1.3-1.5), severe preeclampsia (OR 1.7, 95% CI 1.5-2.3), hemorrhage in pregnancy (OR 2.3, 95% CI 2.0-2.5), placental abruption (OR 2.0, 95% CI 1.7-2.3), placenta previa (OR 3.9, 95% CI 3.5-4.3), premature rupture of membranes (OR 1.7, 95% CI 1.5-1.8), and retained placenta (OR 3.1, 95% CI 1.4-6.6). The neonates had increased risks of preterm birth before 28 weeks (OR 3.1, 95% CI 2.7-3.6), birth before 34 weeks (OR 3.2, 95% CI 2.8-3.6), being small for gestational age (OR 1.5, 95% CI 1.4-1.6), being diagnosed with congenital malformations (OR 1.3, 95% CI 1.3-1.4), and neonatal death (OR 1.8, 95% CI 1.4-2.1). CONCLUSION: Conclusions: Pregnant women with endometriosis are at elevated risk for serious and important adverse maternal, fetal and neonatal outcomes. The magnitude of these complications calls for more intensive antenatal care of pregnant women with endometriosis.

History of Midwifery at Tuskegee: Vanguards of Midwifery Education.

Tuskegee, in Macon County, Alabama, has played an important role in Alabama's midwifery legacy and was home to 2 different midwifery education programs from the 1920s through the 1940s. In response to a 1918 state law requiring midwives to pass an examination to receive a practice permit in their county, stakeholders developed a four-week course for Black Alabamian midwives on the grounds of Tuskegee Institute at the John A. Andrew Memorial Hospital. In the 1940s, in the same location on the grounds of Tuskegee Institute, the Tuskegee School of Nurse-Midwifery educated Black nurse-midwives to improve Black maternal and neonatal outcomes in the South.

Rights-based sexual and reproductive health services: a call for improved access for youth.

Constituting a valuable resource, youth deserve more attention regarding their rights through increased access to sexual and reproductive health services. Limitations in health service delivery for youth should be overcome, whether pertaining to restrictive legislation and policies or technical approaches. Clear clinical guidelines will improve quality of care thereby complying with national commitments to international legal instruments. It is apt for both decision-makers and service providers to celebrate International Youth Day on Monday 12 August, by paying special consideration to innovative approaches for the delivery of youth-friendly sexual and reproductive health services that are adaptable to local circumstances.

Constituant une ressource précieuse, les jeunes méritent davantage d'attention quant à leurs droits grâce à un accès accru aux services de santé sexuelle et reproductive. Les limites de la prestation de services de santé destinés aux jeunes doivent être surmontées, qu'elles soient liées à des législations et politiques restrictives ou à des approches techniques. Des directives cliniques claires amélioreront la qualité des soins, respectant ainsi les engagements nationaux envers les instruments juridiques internationaux. Il convient que les décideurs et les prestataires de services célèbrent la Journée internationale de la jeunesse le lundi 12 août, en accordant une attention particulière aux approches innovantes pour la fourniture de services de santé sexuelle et reproductive adaptés aux jeunes et adaptables aux circonstances locales.

The sexual and reproductive health knowledge of women in Australia: A scoping review.

ISSUE ADDRESSED: Sexual and reproductive health (SRH) knowledge influences health literacy and promotes positive health behaviours. This scoping review explores the SRH knowledge of women in Australia and reports on knowledge assessment, ways of learning, enablers and barriers, and interventions to improve knowledge. METHODS: Seven databases were searched for eligible articles published in English between 2012 and 2022. RESULTS: Eighty-five sources were included for analysis. Data were mapped by knowledge topic and population group and charted against four review objectives. Assessment of knowledge was the primary focus in 59% of sources. Two sources used a validated knowledge assessment tool. Knowledge was assessed using self-assessment, a measurement of correctness, or both. Women learnt about SRH through a range of sources, including healthcare providers, peers, family, internet, and school. Enablers and barriers spanned information content, delivery, timing, accessibility, interactions with those providing information, cultural and gendered norms, pre-migration experiences, and functional health literacy. Nine sources reported on interventions to facilitate SRH knowledge. CONCLUSIONS: This review identified topics, population groups, and gaps in assessment of SRH knowledge of women in Australia. Overall, the measurement of women's SRH knowledge is largely conducted using unvalidated tools focusing on specific topics. SO WHAT?: It is recommended a validated tool be developed to comprehensively assess the SRH knowledge of women in Australia allowing for intersectional population analysis and exploration of knowledge conceptualisation. This would enable assessment of interventions aiming to improve SRH knowledge thereby facilitating improved health literacy and outcomes.

Pubertal Labial Fusion: A Case Study.

Labial fusion, though rare, can present during puberty, or even adolescence leading to challenges in diagnosis and management. This case report offers a detailed examination of the clinical manifestation, diagnostic process, and therapeutic approach in an adolescent girl with labial fusion. This report emphasizes the importance of early intervention to improve patient outcomes for this complex medical condition.

Real Talk: Conversations on HIV with Black Heterosexual Men in Healthcare Settings.

Nearly half of heterosexually transmitted human immunodeficiency virus (HIV) infections occur among Black men in the United States. Yet Black heterosexual men (BHM) are largely ignored in HIV programming, policy implementation, and research. This study explores how masculinity, mental health, and socioeconomic factors such as income, education, and insurance (e.g., enrollment and coverage) correlate with the likelihood of BHM having important conversations surrounding HIV with their healthcare providers and family members. Conversations among social networks (e.g., peers, family, and neighbors) create an opportunity to increase comfortability while discussing HIV-related topics around condom use and testing. This study used a cross-sectional survey design and convenience sampling (N = 279) to recruit participants from a community-academic partnership involving a Federally Qualified Health Center (FQHC) in Detroit between June 1, 2020, and July 31, 2020. Descriptive statistics were used to report demographics, socioeconomic information, and sexual health-related behavior variables. Spearman's correlation test was used to report bivariate correlations between predictor and outcome variables. 49.3% of the study participants disclosed having ever talked to a healthcare provider about HIV/acquired immune deficiency syndrome (AIDS), and 40.9% disclosed having ever talked to a family member about HIV/AIDS and sexually transmitted infections (STIs). The results from this article highlight potential barriers that may inhibit BHM from engaging in conversations about HIV with their healthcare providers and family members. It is important to include BHM in future research that focuses on HIV prevention and education to support community leaders and clinicians who work to address these disparities.

Polycystic Ovary Syndrome and the Risk of Asthma in Reproductive-Age Women: Insights from two real-world large cohorts.

CLINICAL IMPLICATION: Clinicians should consider screening women of childbearing age with Polycystic Ovary Syndrome (PCOS) for asthma symptoms to avoid delays in diagnosis and management. In addition, weight management and obesity prevention in PCOS patients should be prioritized to reduce the risk of asthma. Future studies should assess the role of hormonal supplementation/therapy in this patient population to improve asthma severity and outcomes.

Provider perspectives on adolescent access to contraception in South Africa.

BACKGROUND:  Poor access to contraception influences adolescent health outcomes and may lead to sexual and reproductive health challenges. Unmet sexual and reproductive health should contribute to unplanned adolescent pregnancies, sexually transmitted infections, and other conditions. Therefore, it is crucial to enable adolescents to access appropriate contraceptive methods easily. AIM:  This study explored factors influencing adolescents' access to contraceptive methods from the perspective of primary healthcare providers in South Africa. SETTING:  This study was conducted in two health districts of the Western Cape province in South Africa: the City of Cape Town Metropolitan Municipality and the West Coast district. METHODS:  Using a qualitative research design, in-depth semi-structured interviews were conducted with 24 healthcare providers who work in primary healthcare clinics. Subsequently, the interviews were transcribed and verified for errors. Braun and Clarke's thematic analysis model guided the data analysis using ATLAS.ti software (version 22). The study adhered to the consolidated criteria for reporting qualitative studies checklist for qualitative research. RESULTS:  Four themes emerged through the data analysis: (1) personal influences, (2) community-level influences, (3) health system influences, and (4) policy-level influences. Representative quotations were used to illustrate the themes and sub-themes. CONCLUSION:  Adolescence is shaped by various influences that affect adolescents' ability to access contraception. These factors include their awareness of contraception, social environment, provider biases and school policies. Understanding these influences is crucial for addressing unintended pregnancies and promoting sexual and reproductive health among this age group.Contribution: This study highlights strategies that facilitate and hinder adolescents' access to contraception.

How do South African policies address provision of contraception among adolescents?

BACKGROUND:  The South African government has pioneered several policy documents that emphasise the importance of sexual and reproductive health (SRH). AIM:  We examined how national policies address access and provision of contraception to adolescents in South Africa. SETTING:  South African national policies. METHODS:  We systematically searched various academic databases such as EbscoHost, Science Direct, Google Scholar, PubMed and Scopus, and other relevant sources to obtain 854 policy documents. Using a set of explicit inclusion criteria, we screened and selected 11 South African policies for analysis. Next, we analysed three international policies and frameworks to extract the key elements from them. Thereafter, we used these key elements to develop an analytical framework for conducting the analysis of the South African national policies. RESULTS:  We found that South Africa's SRH policies largely address the provision of contraception by following international guidelines. These policies recognise the value of providing contraception to adolescent girls. However, we also found gaps in some policies, which could impede how they are translated into practice. These include recognising that adolescent boys can play a role in contraception; adolescents have varying SRH needs and are a key stakeholder not only for policy development but also for monitoring and accountability. CONCLUSION:  With a specific focus on South Africa's contraception services in the public sector, these findings are relevant to policymakers, providers and users of contraceptives.Contribution: This review proposes recommendations that will assist with strengthening health policy development and thus improve primary health care services related to contraception for adolescents.

Neuronal network dynamics in the posterodorsal amygdala: shaping reproductive hormone pulsatility.

Normal reproductive function and fertility rely on the rhythmic secretion of gonadotropin-releasing hormone (GnRH), which is driven by the hypothalamic GnRH pulse generator. A key regulator of the GnRH pulse generator is the posterodorsal subnucleus of the medial amygdala (MePD), a brain region that is involved in processing external environmental cues, including the effect of stress. However, the neuronal pathways enabling the dynamic, stress-triggered modulation of GnRH secretion remain largely unknown. Here, we employ in silico modelling in order to explore the impact of dynamic inputs on GnRH pulse generator activity. We introduce and analyse a mathematical model representing MePD neuronal circuits composed of GABAergic and glutamatergic neuronal populations, integrating it with our GnRH pulse generator model. Our analysis dissects the influence of excitatory and inhibitory MePD projections' outputs on the GnRH pulse generator's activity and reveals a functionally relevant MePD glutamatergic projection to the GnRH pulse generator, which we probe with in vivo optogenetics. Our study sheds light on how MePD neuronal dynamics affect the GnRH pulse generator activity and offers insights into stress-related dysregulation.

Reduced ovarian cholesterol and steroid biosynthesis along with increased inflammation are associated with high DEHP metabolite levels in human ovarian follicular fluids.

The plasticizer di(2-ethylhexyl) phthalate (DEHP) is known to have endocrine-disrupting properties mediated by its many metabolites that form upon exposure in biological systems. In a previous study, we reported an inverse association between DEHP metabolites in the human ovarian follicular fluid (FF) and the responsiveness of the follicles to controlled ovarian stimulation during in vitro fertilization (IVF) treatments. Here, we explored this association further through molecular analysis of the ovarian FF samples. Ninety-six IVF patients from Swedish (N = 48) and Estonian (N = 48) infertility clinics were selected from the previous cohort (N = 333) based on the molar sum of DEHP metabolites in their FF samples to arrive at "high" (mean 7.7 ± SD 2.3 nM, N = 48) and "low" (0.8 ± 0.4 nM, N = 48) exposure groups. Extracellular miRNA levels and concentrations of 15 steroid hormones were measured across FF samples. In addition, FF somatic cells, available for the Estonian patients, were used for RNA sequencing. Differential expression (DE) and interactions between miRNA and mRNA networks revealed that the expression levels of genes in the cholesterol biosynthesis and steroidogenesis pathways were significantly decreased in the high compared to the low DEHP group. In addition, the DE miRNAs were predicted to target key enzymes within these pathways (FDR < 0.05). A decreased 17-OH-progesterone to progesterone ratio was observed in the FF of the high DEHP group (p < 0.05). Additionally, the expression levels of genes associated with inflammatory processes were elevated in the FF somatic cells, and a computational cell-type deconvolution analysis suggested an increased immune cell infiltration into the high DEHP follicles (p < 0.05). In conclusion, elevated DEHP levels in FF were associated with a significantly altered follicular milieu within human ovaries, involving a pro-inflammatory environment and reduced cholesterol metabolism, including steroid synthesis. These results contribute to our understanding of the molecular mechanisms of female reprotoxic effects of DEHP.

Flow cytometric analysis of the murine placenta to evaluate nanoparticle platforms during pregnancy.

Clinically approved therapeutics for obstetric conditions are extremely limited, with over 80% of drugs lacking appropriate labeling information for pregnant individuals. The pathology for many of these obstetric conditions can be linked to the placenta, necessitating the development of therapeutic platforms for selective drug delivery to the placenta. When evaluating therapeutics for placental delivery, literature has focused on ex vivo delivery to human placental cells and tissue, which can be difficult to source for non-clinical researchers. Evaluating in vivo drug delivery to the placenta using small animal models can be more accessible than using human tissue, but robust, quantitative methods to characterize delivery remain poorly established. Here, we report a flow cytometric method to evaluate in vivo drug delivery to the murine placenta. Specifically, we describe techniques to identify key cell types in the murine placenta - trophoblasts, endothelial cells, and immune cells - via flow cytometric analysis. While we have employed this method to detect lipid nanoparticle-mediated nucleic acid delivery, this approach can extend to a variety of drug carriers (e.g., liposomes, exosomes, polymeric and metallic nanoparticles) and payloads (e.g., small molecules, proteins, other nucleic acids). Similarly, we describe the application of this method toward immunophenotypic analysis to assess changes in the placental immune environment during disease or in response to a therapeutic. Together, the techniques reported herein aim to broaden the accessibility of placental research in an effort to encourage collaboration between physician-scientists, engineers, placental biologists, and clinicians for developing novel therapeutics to treat placental conditions during pregnancy.

Understanding inequalities in the coverage of adolescent sexual and reproductive health services: a qualitative case study of the selected regions of Zambia.

Introduction: Despite substantial investment in improving healthcare among adolescents in low- and middle-income countries, barriers to access and utilization of services persist, especially to sexual and reproductive health (SRH) services. In response to adolescents' health service needs due to their vulnerability, interventions aimed at improving access and utilization of sexual and reproductive health services have been implemented in specific regions of Zambia. To highlight progress in the access and the overall delivery of services in Zambia, in the wake of a system-level funding mechanism, this paper aims to understand the accessibility, availability, acceptability and quality (AAAQ) of health services provided to young people. Materials and methods: In a qualitative case study, 48 discussions- 32 individual interviews with stakeholders and 16 focus group discussions, consisting of 128 male and female adolescents were conducted in six districts from Eastern, Southern and Muchinga provinces of Zambia. Interviews were audio-recorded, recordings transcribed verbatim, and transcripts were analysed using deductive thematic analysis, using the AAAQ framework and Atun's framework on integration, as a guide to reporting the findings. Results: We found that adolescents knew of and had access to common commodities and services- male condoms, health education and HIV counselling and testing. However, availability was affected by access-related barriers such as frequent stock-outs and insufficiently trained healthcare providers. In addition, accessibility was more restricted during the COVID-19 pandemic lockdown and compounded by the low acceptability of SRH service among adolescents across all contexts. This led to the use of alternatives such as herbal medicine and maintained common myths and misconceptions. The overall quality was marred by the lack of dedicated spaces for adolescent health services and the lack of information, education and communication (IEC) materials in some spaces. Conclusion: While it was noted that some services were available for adolescents in all the study sites, numerous barriers inhibited access to these services and had an impact on the quality-of-service provision. With the added restriction to SRH service asses for young people, due to the low acceptability of adolescent SRH service use, the overall integration of adolescent SRH interventions into routine service provision was low and can be improved by targeting contextual barriers and maintaining best practices.

Development of an mHealth App by Experts for Queer Individuals' Sexual-Reproductive Health Care Services and Needs: Nominal Group Technique Study.

BACKGROUND: Queer individuals continue to be marginalized in South Africa; they experience various health care challenges (eg, stigma, discrimination, prejudice, harassment, and humiliation), mental health issues (eg, suicide and depression), and an increased spread of HIV or AIDS and sexually transmitted illnesses (STIs; chlamydia, gonorrhea, and syphilis). Mobile health (mHealth) apps have the potential to resolve the health care deficits experienced by health care providers when managing queer individuals and by queer individuals when accessing sexual-reproductive health care services and needs, thus ensuring inclusivity and the promotion of health and well-being. Studies have proven that the nominal group technique (NGT) could be used to solve different social and health problems and develop innovative solutions. This technique ensures that different voices are represented during decision-making processes and leads to robust results. OBJECTIVE: This study aims to identify important contents to include in the development of an mHealth app for addressing the sexual-reproductive health care services and needs of queer individuals. METHODS: We invited a group of 13 experts from different fields, such as researchers, queer activists, sexual and reproductive health experts, private practicing health care providers, innovators, and private health care stakeholders, to take part in a face-to-face NGT. The NGT was conducted in the form of a workshop with 1 moderator, 2 research assistants, and 1 principal investigator. The workshop lasted approximately 2 hours 46 minutes and 55 seconds. We followed and applied 5 NGT steps in the workshop for experts to reach consensus. The main question that experts were expected to answer was as follows: Which content should be included in the mHealth app for addressing sexual-reproductive health care services and needs for queer individuals? This question was guided by user demographics and background, health education and information, privacy and security, accessibility and inclusivity, functionality and menu options, personalization and user engagement, service integration and partnerships, feedback and improvement, cultural sensitivity and ethical considerations, legal and regulatory compliance, and connectivity and data use. RESULTS: Overall, experts voted and ranked the following main icons: menu options (66 points), privacy and security (39 points), user engagement (27 points), information hub (26 points), user demographics (20 points), connectivity (16 points), service integration and partnerships (10 points), functionalities (10 points), and accessibility and inclusivity (7 points). CONCLUSIONS: Conducting an NGT with experts from different fields, possessing vast skill sets, knowledge, and expertise, enabled us to obtain targeted data on the development of an mHealth app to address sexual-reproductive health care services and needs for queer individuals. This approach emphasized the usefulness of a multidisciplinary perspective to inform the development of our mHealth app and demonstrated the future need for continuity in using this approach for other digital health care innovations and interventions.