Predictors of sexual and reproductive health knowledge and utilization of services among adolescents in Ghana's Adaklu district.

Objective: To explore factors associated with adolescents' sexual and reproductive health (SRH) knowledge and their engagement with educational and clinical services. Design: Regression analysis of secondary data collected during a community survey. Setting: Adaklu district, Volta Region, Ghana. Participants: 221 adolescent caregiver pairs. Main outcome measures: The study employed three main outcome measures: (1) adolescents' level of SRH knowledge (assessed via questionnaire), (2) membership in district-sponsored adolescent health clubs (AHCs), and (3) ever-utilization of clinical SRH services. Results: Greater SRH knowledge was significantly associated with older age, AHC membership, and relying primarily on teachers or friends for SRH information. Increased odds of AHC membership were observed among females (AOR = 2.38, 95% CI 1.14-4.95); those who had communicated with one parent about sexual issues (OR 2.70, 95% CI 1.17-6.21); and those with a history of transactional sex (OR 5.53, 95% CI 1.04-29.37). Decreased odds were observed among adolescents whose caregivers were educated to the primary level (AOR = 0.24, 95% CI = 0.07-0.79). Overall, utilization of clinical SRH services was low, but higher odds were detected among individuals reporting a history of forced sex (AOR = 117.07, 95% CI 3.82-3588.52) and those who had discussed sexual issues with both of their parents (AOR = 13.11, 95% CI 1.85-92.93). Conclusions: Awareness of the predictors of knowledge, AHC involvement, and clinical service utilization can empower adolescent SRH initiatives-both present and future-to enhance their teaching, develop targeted outreach to underserved groups, and promote engagement with key clinical resources. Funding: This work has been supported by grants from the International Development Research Centre [108936] (IDRC), Canada.

Access to PrEP and other sexual health services for cisgender women in the United States: a review of state policy and Medicaid expansion.

Pre-exposure prophylaxis (PrEP) has the potential to prevent new HIV infections, but it is unclear how state policies governing sexual and reproductive health services (SRH) impact access for cisgender women. The objective of this review is to identify barriers to PrEP access for cisgender women in the United States. Using the CDC Atlas Program, 20 states with the highest HIV incidence among cisgender women were included in this analysis. Through a search conducted in May-July 2022 of CDC, PrEPWatch.org, and other State Department and Insurance websites, Medicaid expansion status, pharmacist PrEP prescribing laws, financial support programs, and Traditional Medicaid coverage of PrEP, HIV testing, and emergency contraception were reviewed. Of the included states, nearly half did not expand Medicaid at the state level. Emergency contraception and HIV testing was covered under Traditional Medicaid for almost all included states, but insurance stipulations and eligibility requirements remain. Although PrEP is covered under all Traditional Medicaid plans, six states require pre-authorization. Three states have HIV testing mandates, four allow pharmacists to prescribe PrEP and six have financial support programs to cover the cost of PrEP. Medicaid expansion, pre-authorization requirements for PrEP prescriptions and emergency contraception, and limitations on pharmacist prescribing abilities were identified as barriers to SRH access for cisgender women. Medicaid expansion should be prioritized as an approach to expanding access to HIV prevention services at the state level.

Costs and cost drivers of comprehensive sexual reproductive health services to female sex workers in Kenya.

BACKGROUND: Comprehensive sexual reproductive health (SRH) programs for female sex workers (FSW) offering clinical, behavioural, and structural interventions have contributed to declining rates of HIV in this population. However, data on costs and cost drivers is needed to support programs and their donors to better allocate resources, make an investment case for continued funding, and to identify areas of improvement in program design and implementation. We aimed to estimate the annual per-FSW costs of comprehensive services for a standalone FSW program in Kenya. METHODS: We implemented a top-bottom and activity-based costing study of comprehensive FSW services at two drop-in centres (DICs), Mtwapa and Kilifi town, in Kilifi County, Kenya. Service costs were obtained from routinely collected patient data during FSW scheduled and unscheduled visits using Kenyan Ministry of Health records. Costing data were from the program and organization's expenditure reports, cross checked against bank documents and supported by information from in-depth interviews. Data were collected retrospectively for the fiscal year 2019. We obtained approval from the AMREF Research Ethics Committee (AMREF-ESRC P862/2020). RESULTS: In 2019, the unit cost of comprehensive services was 105.93 USD per FSW per year, roughly equivalent to 10,593 Kenya shillings. Costs were higher at Mtwapa DICs compared to Kilifi town DIC; 121.90 USD and 89.90 USD respectively. HIV counselling and testing cost 63.90 USD per person, PrEP was 34.20 USD and family planning was 9.93 USD. Of the total costs, staff salaries accounted for about 60%. Adjusted for inflation, costs in 2024 would be approximately 146.60. CONCLUSION: Programs should strive to maximize the number of FSW served to benefit from economies of scale. Given that personnel costs contribute most to the unit costs, programs should consider alternative designs which reduce personnel and other costs.

Using the Nominal Group Technique to Inform Approaches for Enhancing Men's Utilization of Sexual and Reproductive Health Services.

Sexual and reproductive health (SRH) services' underutilization by men remains a global public health challenge. SRH problems constitute major health challenges in that they form almost one-seventh of the disease burden and contribute to higher and earlier morbidity among men. We, therefore, invited subject matter experts to collaborate in co-creating intervention strategies to enhance men's utilization of SRH services. We employed the nominal group technique (NGT) for data collection. The NGT is a structured method that involves gathering a group of people to discuss a problem for the purpose of achieving a group consensus and planning actions for the selected problem. The participants who were purposively sampled included researchers, scientists, academics, clinicians, and policymakers. The participants suggested the need to improve men's knowledge, provide healthcare resources such as equipment, medical supplies, and SRH-trained male healthcare workers, deal with healthcare workers' negative attitudes through training and capacitation, and destigmatize socially constructed gender norms that deter men from seeking medical help. These important intervention strategies can be implemented to encourage men's use of SRH services. Men's current underutilization of SRH services requires the urgent implementation of evidence-based interventions. Collaborating with SRH experts in identifying appropriate intervention strategies can assist program managers and policymakers in designing SRH services tailored to men's sexual health needs.

Wealth and education-related inequalities in the utilisation of reproductive, maternal, newborn, and child health interventions within scheduled tribes in India: an analysis of Odisha and Jharkhand.

BACKGROUND: The utilisation of Reproductive, Maternal, Newborn and Child Health (RMNCH) services remains lower among the Scheduled Tribes (ST) in India than among the rest of the country's population. The tribal population's poorest and least-educated households are further denied access to RMNCH care due to the intersection of their social status, wealth, and education levels. The study analyses the wealth- and education-related inequalities in the utilisation of RMNCH services within the ST population in Odisha and Jharkhand. METHODOLOGY: We have constructed two summary measures, namely, the Co-coverage indicator and a modified Composite Coverage Index (CC), to determine wealth- and education-related inequalities in the utilisation of RMNCH indicators within the ST population in Odisha and Jharkhand. The absolute and relative inequalities with respect to wealth and education within the ST population are estimated by employing the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII). RESULTS: The results of the study highlight that access to RMNCH services is easier for women who are better educated and belong to wealthier households. The SII and RII values in the co-coverage indicator and modified CCI exhibit an increase in wealth-related inequalities in Odisha between NFHS-4 (2015-16) and NFHS-5 (2019-21) whereas in Jharkhand, the wealth- and education-related absolute and relative inequalities present a reduction between 2016 and 2021. Among the indicators, utilisation of vaccination was high, while the uptake of Antenatal Care Centre Visits and Vitamin A supplementation should be improved. INTERPRETATION: The study results underscore the urgent need of targeted policies and interventions to address the inequalities in accessing RMNCH services among ST communities. A multi-dimensional approach that considers the socioeconomic, cultural and geographical factors affecting healthcare should be adopted while formulating health policies to reduce inequalities in access to healthcare.

Adolescent sexual and reproductive health needs and utilisation of health services in the Bono East Region, Ghana.

BACKGROUND: Adolescents in Ghana are vulnerable to unequal power relations at the personal, community and structural levels which in turn limits their opportunities in access to critical sexual and reproductive health information and services. There is therefore high unmet need for sexual and reproductive health (SRH) information and services and the Bono East region typifies this situation, recording some of the poorest SRHR outcomes among adolescents. We, therefore, aimed to investigate the SRH needs (unmet), behaviors and utilization of SRH services among adolescents in the Bono East region. METHODS: Using a maximum variation sampling approach, this qualitative study conducted in-depth interviews and focused group discussions with adolescent boys and girls, parents, community leaders, and healthcare providers. RESULTS: Our findings are presented under two broad categories: major SRHR concerns of adolescents, and perspectives about that influences adolescents' utilization of SRHR services. Under the major SRHR need of adolescents, the following themes emerged: information and services on pregnancy prevention, menstrual hygiene management, availability of comprehensive abortion care services, and attitudes towards adolescent pregnancy. The perspectives about the factors that influence adolescent children were discussed at multiple levels: individual/personal. interpersonal and community/societal. At the individual level, limited understanding of adolescence/puberty, desire of adolescents to belong and misperceptions about contraceptives. At the interpersonal level, issues relating to technical capacity needs of service providers, disrespect exhibited by service providers, and parental failure were identified as influential factors. Then at the community/societal level, we identified structural constraints and compromised social safety concerns in accessing contraceptives and services. CONCLUSION: In conclusion, the findings from this study offer valuable insights into the complex landscape of adolescent sexual and reproductive health in the Bono East region. The implications for policy and practice are manifold, ranging from comprehensive education to addressing menstrual hygiene, involving parents, training healthcare providers, and promoting respectful care.

Intersectionality analysis of young people's experiences and perceptions of discrimination in primary health centers in Ebonyi State, Southeast Nigeria.

BACKGROUND: Young people (aged 10 to 24 years) in sub-Saharan Africa bear a huge and disproportionate burden of poor sexual and reproductive health (SRH) outcomes due to inequalities and discrimination in accessing sexual and reproductive health services (SRHS). This study assessed the experiences and perceptions of discrimination among young people seeking SRH services in Primary Health Centers (PHCs) using an intersectionality lens. METHODS: A cross-sectional mixed-methods study was undertaken in six local government areas (LGAs) in Ebonyi State, southeast Nigeria. The LGAs comprise both urban and rural locations. The study population for the quantitative survey consisted of 1025 randomly selected young boys and girls aged 15-24 years. Eleven focus group discussions (FGDs) were conducted with the young people. Descriptive and inferential analyses were performed for quantitative data, while thematic analysis was performed for the qualitative data, using NVivo. RESULTS: A total of 16.68% participants in the survey reported that young girls/women were treated badly/unfairly compared to young boys/men when seeking SRH services in PHCs; 15.22% reported that young clients get treated badly/unfairly from adults; and 12.49% reported that young clients with poor economic status were treated unfairly. Respondents also reported that young clients with disability (12.12%), and those who are poorly educated or uneducated (10.63%) are treated badly by healthcare providers when they access SRH services. Young people in urban areas were about 7 times more likely to believe that girls/young women are treated badly than boys/young men when seeking SRH services in PHCs compared to those who live in rural areas (p < 0.001). Among the young girls/women, residing in urban areas, being poor and in school increased the likelihood of getting treated badly/unfairly when receiving SRH services by 4 times (p < 0.001). The qualitative results revealed that health workers were generally harsh to young people seeking SRH services and the level of harshness or unfriendliness of the health workers varied depending on the young person's social identity. CONCLUSION: There are varieties of intersecting factors that contribute to the discrimination of young clients in PHCs. This underscores the urgent need to prioritize intersectional perspectives in the design and implementation of interventions that will improve access and use of SRH services by young people.

Utilization of reproductive health services among undergraduate regular class students in Assosa University, BGRS: a comparison among three varieties of multilevel binary logistic regression models.

INTRODUCTION: Reproductive health service (RHS) helps for people to have a delighted and safe sex through their life journey. It enables especially for women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant. Therefore, this study aimed to identify the significant determinants of RHS utilization among undergraduate regular class students in Assosa University by using advanced methodology. METHODS: We used cross-sectional study design to collect RHS data from 362 students in Assosa University from 5 to 16, may 2021. These students were selected using stratified random sampling technique. We also used cross-tabulation to summarize the extents of RHS utilization across all predictors in terms of percentage and three varieties of multilevel binary logistic regression model to model the determinants of RHS. RESULTS: 42.27% of undergraduate regular class students in Assosa University utilize at least one type of RHS during their time at Assosa University whereas, 57.73% of undergraduate regular class students in this University are not utilized it. Among three varieties of multilevel binary logistic regression models, the random slopes two-level model was selected as a best fitted model for the datasets. At 5% level of significance, awareness about RHS, gender, preference of service fees and student's monthly average income were significant predictor variables in this model. In addition, the covariates; age, gender and preference of service fees have a significant random effects on utilization of RHS across all colleges/school. CONCLUSION: Students who; preferred service fee as usual rate, have awareness about RHS, are females and have high monthly average income were more likely to utilize RHS. RHS utilization among undergraduate regular students in Assosa University is likely to increase more effectively with interventions that address these factors.

Utilisation of Reproductive Health Services among Adolescents in Ghana: Analysis of the 2007 and 2017 Ghana Maternal Health Surveys.

Early pubertal development induces early sexual activities among adolescents. In Ghana, despite the high sexual activity among Ghanaian adolescents, sexual and reproductive health (SRH) services are underutilised, primarily due to SRH stigma and a lack of SRH knowledge and information. This study examined the use of SRH services among adolescents aged 15-19 years in Ghana over a ten year period. The study utilised data from the 2007 and 2017 Ghana Maternal Health Surveys (GMHSs). Responses from 2056 and 4909 adolescent females captured in the 2007 and 2017 GMHSs, respectively, were used. The results showed a declining utilisation of SRH services among adolescents from 28.3% in 2007 to 22.5% in 2017. The odds of using family planning among sexually active adolescents increased from 2007 [AOR-0.32, CI-(0.135, 0.77), p < 0.001] to 2017 [AOR-68.62, CI-(36.104, 130.404), p < 0.001]. With increasing age at first sex, adolescents were less likely to use a family planning method in 2007 [AOR-0.94, CI-(0.89,0.99) p < 0.001], but this improved in 2017 [AOR-1.26, CI-(1.220, 1.293), p < 0.001]. Despite this, knowledge of sources for family planning was found to predict its lower utilisation in both 2007 [AOR = 0.15 (95% CI-0.081, 0.283), p < 0.0001] and 2017 [AOR = 0.206 (95% CI-(0.099, 0.426), p < 0.001]. The findings show that even though knowledge of family planning methods predicted low utilisation, knowledge of sources, age at first sex, and educational level positively predicted the utilisation of SRH services from 2007 to 2017. Opportunities for both enhancing the clinical environment and health provider attitudes exist and should be explored for improving SRH outcomes among sexually active adolescents in Ghana.

When one door closes: a qualitative exploration of women's experiences of access to sexual and reproductive health services during the COVID-19 lockdown in Nigeria.

BACKGROUND: COVID-19 pandemic widely disrupted health services provision, especially during the lockdown period, with females disproportionately affected. Very little is known about alternative healthcare sources used by women when access to conventional health services became challenging. This study examined the experiences of women and adolescent girls regarding access to sexual and reproductive health (SRH) services during the COVID-19 lockdown in Nigeria and their choices of alternative healthcare sources. METHODS: The study sites were two northern states, two southern states, and the Federal Capital Territory. Qualitative data were obtained through 10 focus group discussion sessions held with married adolescents, unmarried adolescents, and older women of reproductive age. The data were transcribed verbatim and analysed using a thematic approach and with the aid of Atlas ti software. RESULTS: Women reported that access to family planning services was the most affected SRH services during the COVID-19 lockdown. Several barriers to accessing SRH services during COVID-19 lockdown were reported, including restriction of vehicular movement, harassment by law enforcement officers, fear of contracting COVID-19 from health facilities, and fear of undergoing compulsory COVID-19 tests when seeking care in health facilities. In the face of constrained access to SRH services in public sector facilities during the COVID-19 lockdown, women sought care from several alternative sources, mostly locally available and informal services, including medicine vendors, traditional birth attendants, and neighbours with some health experience. Women also widely engaged in self-medication, using both orthodox drugs and non-orthodox preparations like herbs. The lockdown negatively impacted on women's SRH, with increased incidence of sexual- and gender-based violence, unplanned pregnancy resulting from lack of access to contraceptives, and early marriage involving adolescents with unplanned pregnancies. CONCLUSION: COVID-19 negatively impacted access to SRH services and forced women to utilise mostly informal service outlets and home remedies as alternatives to conventional health services. There is a need to ensure the continuity of essential SRH services during future lockdowns occasioned by disease outbreaks. Also, community systems strengthening that ensures effective community-based health services, empowered community resource persons, and health-literate populations are imperative for overcoming barriers to healthcare access during future lockdowns.

Accessibility and availability of maternal and reproductive health care services: ensuring health equity among rural women in Southern India.

INTRODUCTION: The health of women is of particular concern because they often have greater health needs than men and many women still lack access to quality healthcare services, preventing their ability to attain the best possible level of health. Hence, this study aimed to assess the accessibility and availability of health services among rural women. METHODS: A household survey was conducted by using a multi-stage sample with 407 married women aged 18-45 years, having at least one child and living in Tiruchirappalli District, Tamil Nadu were recruited for this study. A semi-structured questionnaire was used to collect data about the demographic status, and accessibility and availability of health services. RESULTS: Of the 407 respondents, 70% were aged between 26 and 40 years, 73% were working as farmers and labourers and 77% were living in nuclear families. 71% of them had enjoyed hospital facilities near their residence and 83% of the hospitals were run by the government. In village health nurse service (VHN), 34% of the respondents had received all services from VHN and 86% did not face any kind of gender inequality and almost all of them were satisfied with the service provided by the VHN. Almost all the respondents (98%) were satisfied with the availability of health services and 92% of them benefited from the government scheme related to childbirth. CONCLUSION: This study showed that overall, the women were satisfied with the availability of healthcare services and reproductive health services. Moreover, almost all of them benefited from the government scheme related to childbirth.

High uptake of menstrual health information, products and analgesics within an integrated sexual reproductive health service for young people in Zimbabwe.

BACKGROUND: Despite being integral to women's well-being, achieving good menstrual health (MH) remains a challenge. This study examined MH services uptake (including information, analgesics, and a choice of MH products - the menstrual cup and reusable pads) and sustained use of MH products within an integrated sexual and reproductive health intervention for young people in Zimbabwe. METHODS: This mixed-methods study was nested within a cluster randomised trial of integrated sexual and reproductive health services (CHIEDZA) for youth in three provinces (Harare, Mashonaland East, and Bulawayo). The study collected qualitative and quantitative data from 27,725 female clients aged 16-24 years, who accessed CHIEDZA from April 2019 - March 2022. Using a biometric (fingerprint recognition) identification system, known as SIMPRINTS, uptake of MH information, products, and analgesics and other services was tracked for each client. Descriptive statistics and logistic regression were used to investigate MH service uptake and product choice and use over time, and the factors associated with these outcomes. Thematic analysis of focus group discussions and interviews were used to further explore providers' and participants' experiences of the MH service and CHIEDZA intervention. RESULTS: Overall, 36,991 clients accessed CHIEDZA of whom 27,725 (75%) were female. Almost all (n = 26,448; 95.4%) took up the MH service at least once: 25433 took up an MH product with the majority (23,346; 92.8%) choosing reusable pads. The uptake of cups varied across province with Bulawayo province having the highest uptake (13.4%). Clients aged 20-24 years old were more likely to choose cups than reusable pads compared with those aged 16-19 years (9.4% vs 6.0%; p < 0.001). Over the implementation period, 300/1819 (16.5%) of clients swapped from the menstrual cup to reusable pads and 83/23346 (0.4%) swapped from reusable pads to the menstrual cup. Provision of the MH service encouraged uptake of other important SRH services. Qualitative findings highlighted the provision of free integrated SRH and MH services that included a choice of MH products and analgesics in a youth-friendly environment were key to high uptake and overall female engagement with SRH services. CONCLUSIONS: High uptake demonstrates how the MH service provided much needed access to MH products and information. Integration of MH within an SRH intervention proved central to young women accessing other SRH services.

Correlates of sexual and reproductive health service utilization among older adults in China: Findings from the sexual well-being (SWELL) study.

BACKGROUND: Sexual and reproductive health (SRH) is critical to the overall health of older adults. We assessed the utilization of SRH services and its correlates among older adults in China. METHODS: We recruited community-dwelling adults aged 50 and above in five Chinese cities between June 2020 and December 2022. In this study SRH services included reproductive health examination, cervical cancer screening, and sexual life counselling. Logistic regression was used to assess correlates of SRH services utilization. RESULTS: A total of 3001 older adults (1819 men and 1182 women) were enrolled. Among them, 11.4 % (343/3001) of participants received a reproductive health examination, 35.4 % (418/1182) of female participants received cervical cancer screening, and 30.1 % (401/1332) of sexually active participants sought help for their sexual lives. Older men with an annual income of USD 7500 or more (aOR = 3.21, 95%CI: 1.39-7.44), two or more chronic conditions (2.38, 1.39-4.08), and reproductive health problems (2.01, 1.18-3.43) were more likely to receive a urological examination. For older women, individuals who were younger (aged 50-59 years: 5.18, 2.84-9.43; aged 60-69 years: 2.67, 1.49-4.79), lived in an urban area (1.88, 1.31-2.71), were employed (1.73, 1.21-2.47), had two or more chronic conditions (2.04, 1.37-3.05), were sexually active (1.72, 1.15-2.58) and talked about sex (1.69, 1.21-2.36) were more likely to receive a gynecological examination. CONCLUSION: SRH services utilization among older adults was low, with urological examination among older men particularly low. SRH messages and services tailored for older adults are needed to enhance their utilization of SRH services.

Reproductive healthcare in adolescents with autism and other developmental disabilities.

BACKGROUND: Adults with developmental disabilities often have less access to reproductive health services than adults without these disabilities. However, little is known about how adolescents with developmental disabilities, including autism, access reproductive healthcare. OBJECTIVE: We aimed to characterize the use of reproductive healthcare services among adolescents with autism and those with other developmental disabilities in comparison with adolescents with typical development. STUDY DESIGN: We conducted a cohort study of a sample of adolescents who were continuously enrolled members of Kaiser Permanente Northern California, an integrated healthcare system, from ages 14 to 18 years. The final analytical sample included 700 adolescents with autism, 836 adolescents with other developmental disabilities, and 2187 typically developing adolescents who sought care between 2000 and 2017. Using the electronic health record, we obtained information on menstrual conditions, the use of obstetrical-gynecologic care, and prescriptions of hormonal contraception. We compared healthcare use between the groups using chi-square tests and covariate-adjusted risk ratios estimated using modified Poisson regression. RESULTS: Adolescents with autism and those with other developmental disabilities were significantly more likely to have diagnoses of menstrual disorders, polycystic ovary syndrome, and premenstrual syndrome than typically developing adolescents. These 2 groups also were less likely than typically developing peers to visit the obstetrician-gynecologist or to use any form of hormonal contraception, including oral contraception, hormonal implants, and intrauterine devices. Adolescents in all 3 groups accessed hormonal contraception most frequently through their primary care provider, followed by an obstetrician-gynecologist. CONCLUSION: Adolescents with autism and those with other developmental disabilities are less likely than their typically developing peers to visit the obstetrician-gynecologist and to use hormonal contraception, suggesting possible care disparities that may persist into adulthood. Efforts to improve access to reproductive healthcare in these populations should target care delivered in both the pediatric and obstetrics-gynecology settings.

Síntesis de la situación y respuesta al VIH e ITS en CABA: abril 2024 / Summary of the situation and response to HIV and STI in CABA: april 2024

Documento que agrupa los siguientes temas: situación epidemiológica del VIH; gestantes con VIH y transmisión vertical; respuesta preventivo-asistencial: prevención combinada de VIH e ITS; acceso al diagnóstico de VIH y sífilis; atención de la salud de las personas trans, travestis y no binarias; profilaxis posexposición al VIH (PPE); profilaxis pre-exposición al VIH (PrEP); tamizaje del virus del papiloma humano (VPH); y atención y seguimiento de las personas con VIH.

Salud sexual y reproductiva en la Ciudad de Buenos Aires: Situación y respuesta: Actualización 2022 / Sexual and reproductive health in the City of Buenos Aires: Situation and response 2022

Esta 5ª actualización del informe sistematiza la información que se viene produciendo a través de las acciones de monitoreo iniciadas en 2016 e incorpora aquella referida al año 2022. Se entiende que las acciones de monitoreo y evaluación son valiosas para cinco objetivos complementarios, que son: a. disponer de un basamento para la planificación de las necesidades de insumos (estimar necesidades de compras); b. identificar las mejoras/cambios de escenario que se van produciendo con el trabajo cotidiano y las nuevas necesidades o desafíos que van surgiendo; c. planificar acciones novedosas basadas en diagnósticos afinados; d. valorizar y visibilizar el trabajo que realizan los equipos todos los días en los establecimientos públicos de salud donde se brinda respuesta a la población y e. producir información de utilidad tanto para los actores del subsistema público de salud como para otros actores interesados en la temática. (AU)

Salud sexual y reproductiva en la Ciudad de Buenos Aires: Situación y respuesta: Actualización 2021 / Sexual and reproductive health in the City of Buenos Aires: Situation and response: 2021

Para esta edición del informe, se realizó un corte de los indicadores que permitan detenerse en el período 2016-2021, con la intención de recuperar el significado del trabajo de monitoreo y evaluación, al que se entiende con cuatro objetivos o sentidos complementarios: a. facilitar la toma de decisiones para la planificación de actividades y estimación de insumos con sustento; b. visibilizar y valorar el trabajo cotidiano de los equipos; c. evaluar cada cierto tiempo en qué medida el accionar permanente del trabajo ha generado cambios en la realidad y la necesidad de producir cambios donde fuera preciso; y d. brindar una herramienta que se confía sea de utilidad para los diferentes actores estatales y de la sociedad civil involucrados e interesados en conocer los logros y desafíos de la política. (AU)

Achieving universal reproductive health coverage for deaf women in Ghana: an explanatory study of knowledge of contraceptive methods, pregnancy and safe abortion practices.

BACKGROUND: The first world conference on sexual and reproductive health (SRH) in 1994 helped create the awareness that reproductive health is a human right. Over the years, attempts have been made to extend services to all persons; however, lapses persist in service provision for all in need. Recently, countries have been encouraged to target minority groups in their reproductive health service provision. However, studies have rarely attempted to develop deeper insights into the experiences of deaf men and women regarding their knowledge of SRH. The purpose of this study was to develop an in-depth understanding of the knowledge of deaf persons regarding services such as knowledge of contraceptive methods, pregnancy and safe abortion practices. METHODS: A sequential explanatory mixed-methods approach was adopted for this study. In the first quantitative phase, 288 deaf persons recruited from three out of the 16 regions in Ghana participated in this study. They completed a 31-item questionnaire on the main issues (knowledge of contraceptive methods, pregnancy and safe abortion practices) addressed in this study. In the second phase, a semi-structured interview guide was used to collect data from 60 participants who took part in the first phase. The key trend emerging in the first phase underpinned the interview guide used for the data collection. While the quantitative data were subjected to the computation of means, t-tests, analyses of variance, correlations and linear regressions to understand the predictors, the in-depth interviews were analysed using the thematic method of analysis. RESULTS: The results showed a convergence between the quantitative and qualitative data. For instance, the interview material supported the initial findings that deaf women had little knowledge of contraceptive methods. The participants offered reasons explaining their inability to access services and the role of religion in their understanding of SRH. CONCLUSION: The study concludes by calling on policymakers to consider the needs of deaf persons in future SRH policies. The study limitations and other implications for future policymaking are discussed.

Initial impacts of the COVID-19 pandemic on sexual and reproductive health service use and unmet need in Britain: findings from a quasi-representative survey (Natsal-COVID).

BACKGROUND: The COVID-19 pandemic has affected sexual and reproductive health (SRH) service use and unmet need, but the impact is unknown. We aimed to determine the proportion of participants reporting sexual risk behaviours, SRH service use and unmet need, and to assess remote sexually transmitted infection (STI) testing service use after the first national lockdown in Britain. METHODS: We used data from the National Surveys of Sexual Attitudes and Lifestyles (Natsal)-COVID cross-sectional, quasi-representative web survey (Natsal-COVID Wave 1). Adults aged 18-59 years who resided in England, Scotland, or Wales completed the survey between July 29 and Aug 10, 2020, which included questions about the approximate 4-month period after announcement of the initial lockdown in Britain (March 23, 2020). Quota-based sampling and weighting were used to achieve a quasi-representative population sample. Participants aged 45-59 years were excluded from services analysis due to low rates of SRH service use. Among individuals aged 18-44 years, we estimated reported SRH service use and inability to access, and calculated age-adjusted odds ratios (aORs) among sexually experienced individuals (those reporting any sexual partner in their lifetime) and sexually active individuals (those reporting any sexual partner in the past year). Unweighted denominators and weighted estimates are presented hereafter. FINDINGS: 6654 individuals had complete interviews and were included in the analysis. Among 3758 participants aged 18-44 years, 82·0% reported being sexually experienced, and 73·7% reported being sexually active. 20·8% of sexually experienced participants aged 18-44 years reported using SRH services in the 4-month period. Overall, 9·7% of 3108 participants (9·5% of men; 9·9% of women) reported being unable to use a service they needed, although of the participants who reported trying but not being able to use a SRH service at least once, 76·4% of participants also reported an instance of successful use. 5·9% of 1221 sexually active men and 3·6% of 1560 sexually active women reported use of STI-related services and 14·8% of 1728 sexually experienced women reported use of contraceptive services, with SRH service use highest among individuals aged 18-24 years. Sexually active participants reporting condomless sex with new partners since lockdown were much more likely to report using STI-related services than those who did not report condomless sex (aOR 23·8 [95% CI 11·6-48·9]) for men, 10·5 [3·9-28·2] for women) and, among men, were also more likely to have an unsuccessful attempt at STI-service use (aOR 13·3 [5·3-32·9]). Among 106 individuals who reported using STI testing services, 64·4% accessed services remotely (telephone, video, or online). Among 2581 women aged 25-59 years, 2·4% reported cervical screening compared with an estimated 6% in a comparable 4-month period before the pandemic. INTERPRETATION: Many people accessed SRH care during the initial lockdown; however, young people and those reporting sexual risk behaviours reported difficulties in accessing services and thus such services might need to address a backlog of need. FUNDING: Wellcome Trust, The Economic and Social Research Council, The National Institute for Health Research, Medical Research Council/Chief Scientist Office and Public Health Sciences Unit, and UCL Coronavirus Response Fund.

Violence and sexual and reproductive health service disruption among girls and young women during COVID-19 pandemic in Nepal: A cross-sectional study using interactive voice response survey.

INTRODUCTION: There is a paucity of data on the impact of COVID-19 pandemic on girls and young women. The study examines the prevalence and correlates of violence and sexual and reproductive health (SRH) service disruption among girls and young women during COVID-19 restrictions and lockdown. METHODS: An interactive voice response survey was conducted among girls and women aged 18-24 years between 10th March to 24th April 2021. The survey enrolled 1314 participants. Descriptive analysis was used to assess prevalence of violence and SRH service disruption. Two sampled test of proportion was used to asses difference in prevalence of violence before and after the pandemic. Logistic regression was used to examine relationship between the outcome variables and socio demographic predictors. RESULTS: The study did not find significant difference in prevalence of violence before and after the pandemic. Education was found to be protective against experience of both physical and sexual violence after the pandemic. Dalit participants were four times more likely to report physical violence after the pandemic than Brahmin/Chhetri participants (OR:3.80; CI:1.41-10.24). Participants from 22-24-year age group were twice as likely to experience sexual violence compared to girls and participants from 18-21year age group (OR:2.25; CI:1.04-4.84). Participants from urban municipalities were 29% less likely to report SRH services disruption than participants from rural municipalities (OR-0.71, 95% CI: 0.55-0.91). Participants with disability were twice as likely to report disruption than participants without disability (OR-2.35, 95% CI: 1.45-3.82). CONCLUSIONS: To reduce violence against girls and women due to the pandemic, interventions should focus on Dalit women and on preventing education discontinuation among girls and women. SRH service during the pandemic needs to be improved for girls and women with focus on girls and women from rural municipalities and girls and women with disability.