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BMJ Sexual & Reproductive Health
Number of Followers: 0  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 2515-2009 - ISSN (Online) 2515-1991
Published by BMJ Publishing Group Homepage  [66 journals]
  • In this issue
    • Pages: 173 - 174
      Abstract: Sexting and pornography associated with risky sex among pupils in Tigray, Northern Ethiopia An increase in sexting and pornography viewing among teenagers has provoked widespread questions about safety. This is the first study from Ethiopia to investigate whether there is an association between access to digital sexual communication and risky sexual behaviour among school attendees, and adds to a small number of other studies from resource-poor settings. Using a cross-sectional questionnaire, the authors collated responses from 5306 male and female students. Nearly a quarter said they were involved in risky sex, a third had experience in sexting, and half said they viewed pornography. Pornography viewers had a three-fold prevalence rate of risky sex when compared with their counterparts, while sexters had double the risk. Although this association between exposure to sexually explicit materials and risk does not establish causality, the authors argue that sex education programmes should acknowledge...
      PubDate: 2019-07-09T06:22:27-07:00
      DOI: 10.1136/bmjsrh-2019-200419
      Issue No: Vol. 45, No. 3 (2019)
       
  • HIV in men who have sex with men in Lebanon: clinical and psychosocial
           aspects
    • Authors: Maatouk, I; Jaspal, R.
      Pages: 175 - 176
      Abstract: A concerted global effort to end HIV transmissions is necessary. In the Middle East and North Africa (MENA), men who have sex with men (MSM) constitute a hard-to-reach population, due to the social stigma and criminalisation of homosexuality in most countries.1 When compared with other MENA countries, Lebanon is one of the safest for sexual minority groups. Its capital city, Beirut, is one of the most socially progressive cities in MENA, with a vibrant MSM community and gay bars, clubs and community centres.2 Yet, we know little about HIV prevalence, incidence and risk factors in MSM in Lebanon, a group disproportionately affected by the condition. This editorial sets an agenda for HIV research in this key population. HIV care in Lebanon is offered through a collaboration between the National AIDS Control Program (NACP) (jointly funded by the Lebanese state and the World Health Organization) and...
      PubDate: 2019-07-09T06:22:27-07:00
      DOI: 10.1136/bmjsrh-2018-200199
      Issue No: Vol. 45, No. 3 (2019)
       
  • A prospective study of mifepristone and unlimited dosing of sublingual
           misoprostol for termination of second-trimester pregnancy in Uzbekistan
           and Ukraine
    • Authors: Platais, I; Tsereteli, T, Maystruk, G, Kurbanbekova, D, Winikoff, B.
      Pages: 177 - 182
      Abstract: IntroductionWe aimed to assess the feasibility and acceptability of a second-trimester medical abortion regimen using mifepristone and sublingual misoprostol with no maximum number of misoprostol doses in Uzbekistan and Ukraine.MethodsThis prospective open-label study enrolled 306 women with pregnancies of 13–22 weeks in Uzbekistan (n=134) and Ukraine (n=172). Women took 200 mg mifepristone at a place of their choosing, and 24–48 hours later received 400 μg sublingual misoprostol every 3 hours until the expulsion of both fetus and placenta. Study staff interviewed women about the intensity of pain, side effects, and satisfaction with the procedure. The primary outcome was the rate of complete uterine evacuation without surgical intervention or oxytocin at 15 hours after the first dose of misoprostol.ResultsThe median gestational age was 18.1 weeks, and half of the women (n=149, 48.9%) chose to take mifepristone at home. The majority of women (n=266, 86.9%, 95% CI 82.6% to 90.5%) expelled by 15 hours after the start of misoprostol treatment, and by 48 hours complete uterine evacuation was achieved in 296 (96.7%) women. Most women found pain (76.1%) and side effects (89.0%) to be acceptable or very acceptable, and reported high satisfaction (89.8%) with the procedure.ConclusionMedical abortion in pregnancies of 13–22 weeks with 200 mg mifepristone followed 24–48 hours later by 400 μg sublingual misoprostol administered every 3 hours until complete expulsion is effective, safe and acceptable to women. Women can be given the option to take mifepristone at home and return to the hospital.Clinical trials registration numberClinicalTrials.gov, www.clinicaltrials.gov, NCT02415894, NCT02235155.
      PubDate: 2019-07-09T06:22:27-07:00
      DOI: 10.1136/bmjsrh-2018-200167
      Issue No: Vol. 45, No. 3 (2019)
       
  • Sexual and reproductive healthcare providers opinions on expansion of
           pharmacy-led provision of contraception
    • Authors: Boog, K; Chen, Z. E, Cameron, S.
      Pages: 183 - 189
      Abstract: IntroductionReduced 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.MethodsAn 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.ResultsOf 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.ConclusionsUK 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.
      Keywords: Editor''s choice
      PubDate: 2019-07-09T06:22:27-07:00
      DOI: 10.1136/bmjsrh-2018-200252
      Issue No: Vol. 45, No. 3 (2019)
       
  • Collaboratively seeking to improve contraceptive counselling at the time
           of an abortion: a case study of quality improvement efforts in Sweden
    • Authors: Kilander, H; Brynhildsen, J, Alehagen, S, Fagerkrantz, A, Thor, J.
      Pages: 190 - 199
      Abstract: BackgroundMany women find it difficult to choose and initiate a contraceptive method at the time of an abortion. There is a gap between regular clinical practice and existing evidence on motivational and person-centred counselling, as well as on use of long-acting reversible contraception (LARC). This study aims to describe and evaluate a Quality Improvement Collaborative (QIC) designed to enhance contraceptive services, with regard to changes in healthcare professionals’ (HCPs’) counselling in clinical practice, and in women’s subsequent choice of, and access to, contraception.MethodsThree multiprofessional teams working in abortion services from three hospitals in Sweden, and two women contributing with user experience, participated in a QIC during the period March–November 2017. Using a case study design, we collected and analysed both quantitative and qualitative data.ResultsTeams agreed on QIC goals, including that ≥50% of women would start LARC within 30 days post-abortion, and tested multiple evidence-based changes, aided by the two women’s feedback. During the QIC, participating HCPs reported that they gained new knowledge and developed skills in contraceptive counselling at the time of an abortion. The teams welcomed the development of a performance feedback system regarding women’s post-abortion contraception. While the majority of women counselled during the QIC chose LARC, only 20%–40% received it within 30 days post-abortion.ConclusionThe QIC, incorporating user feedback, helped HCPs to develop capability in providing contraceptive services at the time of an abortion. Timely access to LARC remains a challenge in the present setting.
      PubDate: 2019-07-09T06:22:27-07:00
      DOI: 10.1136/bmjsrh-2018-200299
      Issue No: Vol. 45, No. 3 (2019)
       
  • Sexting and high sexual risk-taking behaviours among school youth in
           northern Ethiopia: estimating using prevalence ratio
    • Authors: Abrha, K; Worku, A, Lerebo, W, Berhane, Y.
      Pages: 200 - 206
      Abstract: BackgroundIncreasing access to digital technology to young people in low-income settings has greatly influenced their porngraphy viewing and sexting, receiving and/or sending of sexual explicit materials via electronic devices. These change the sexual communication and behaviour of the young population. However, evidence to attest this change is not available in our setting. Thus, this study examined the relationship of high sexual risk-taking behaviour with sexting and pornography viewing among school youth in Ethiopia.MethodsA cross-sectional study was conducted from March to April 2015 by selecting school youth using a multistage sampling procedure. Data were collected using a pre-validated anonymous facilitator-guided self-administered questionnaire. Poisson regression was run to calculate adjusted prevalence ratio with its 95% confidence intervals. All differences were considered as significant for p values ≤0.05.ResultsIn total, 5924 questionnaires were distributed, and 5306 (89.57%) school youth responded in full to questions related to outcome variables. Of these respondents, 1220 (22.99%; 95% CI 19.45 to 26.96) were involved in high sexual risk-taking behaviour; 1769 (33.37%; 95% CI 30.52 to 36.35) had experienced sexting and 2679 (50.26%; 95% CI 46.92 to 53.61) were viewing pornography. The proportion of high sexual risk-taking behaviour was three-fold among pornography viewers (adjusted prevalence ratio (APR) 95% CI 3.02 (2.52 to 3.62)) and two-fold among sexters (APR 95% CI 2.48 (1.88 to 3.27)) as compared with their counterparts.ConclusionsExposure to sexually explicit materials via communication technology is associated with increased high sexual risk-taking behaviour among school youth in northern Ethiopia. Considering these emerged predictors of sexual behaviours in our sexual education programmes, further research in this area is essential.
      PubDate: 2019-07-09T06:22:27-07:00
      DOI: 10.1136/bmjsrh-2018-200085
      Issue No: Vol. 45, No. 3 (2019)
       
  • Current barriers, facilitators and future improvements to advance quality
           of abortion care: views of women
    • Authors: Smith, J. L; Cameron, S.
      Pages: 207 - 212
      Abstract: BackgroundBarriers to accessing abortion care continue to exist even in settings where abortion is legal. We aimed to determine current barriers faced by women seeking abortion, factors that facilitate access to care, and what future improvements women would like made to abortion care in Scotland.MethodsA self-administered anonymous questionnaire of women requesting abortion care at a community abortion service in Edinburgh. Women selected the top three options from predefined lists of barriers to seeking abortion, facilitators of care, and future service improvements.Results154/165 (93%) questionnaires were completed by women presenting for abortion. The most commonly ranked number one barrier to seeking an abortion (n = 49; 32%) was ‘being scared about what the abortion process involved’. The highest ranked facilitator of care was information provided to women via the abortion clinic website. The most commonly chosen number one response for potential improvement to abortion services was the option to get an early medical abortion from a general practitioner, which was chosen by 70 (45%) women.ConclusionsThis study suggests that lack of knowledge and information surrounding the abortion process and the ease with which women can receive abortion care are areas of concern. Efforts are needed to reduce waiting times, to ensure that high-quality, standardised information is widely and publicly available regarding what women can expect during the abortion process, and to expand provision of early medical abortion within the community, in order to improve abortion care.
      PubDate: 2019-07-09T06:22:27-07:00
      DOI: 10.1136/bmjsrh-2018-200264
      Issue No: Vol. 45, No. 3 (2019)
       
  • Comparing reporting of abortions in three nationally representative
           surveys: methodological and contextual influences
    • Authors: Scott, R. H; Bajos, N, Wellings, K, Slaymaker, E.
      Pages: 213 - 219
      Abstract: BackgroundAbortions are known to be underreported in surveys. Previous research has found a number of ways in which survey methodology may affect respondents’ willingness to disclose abortions. The social and political climate surrounding abortion may also create stigma affecting abortion reporting, and this may vary between countries and over time.MethodsWe estimate the extent of underreporting in three nationally representative population surveys by comparing survey rates with routine statistics, in order to explore the ways in which survey methodology and cultural context might influence reporting of abortion. Data are analysed from two National Surveys of Sexual Attitudes and Lifestyles, conducted in 2000 and 2010 (Natsal-2 and Natsal-3) in Britain, and the Fertility, Contraception and Sexual Dysfunction survey (FECOND) conducted in 2010 in France. The three surveys differ with regard to survey methodology and context.ResultsThere was no strong evidence of underreporting in Natsal-2, which collected data on abortion using a direct question. There was evidence of underreporting in Natsal-3 and FECOND, both of which collected data on abortion through a pregnancy-history module. There was no evidence of a difference in the extent of underreporting between Natsal-3 and FECOND, which differed with regard to survey methodology (self-administered module in Natsal-3, telephone interview in FECOND) and country context.ConclusionA direct question may be more effective in eliciting reports of abortion than a pregnancy-history module.
      PubDate: 2019-07-09T06:22:27-07:00
      DOI: 10.1136/bmjsrh-2019-200321
      Issue No: Vol. 45, No. 3 (2019)
       
  • Learning from patients
    • Authors: Berger A.
      Pages: 220 - 220
      Abstract: Behavioural change is something we all face, and it can be hard. Sexual and reproductive healthcare (SRH) service users are as affected by this as anyone: maybe a man needs to tackle a problem with chemsex; maybe a woman would benefit from trying an unfamiliar contraceptive – despite reservations – or maybe someone needs to find the courage to discuss a sensitive sexual issue with a partner. A completely unexpected discussion I had with a patient last week taught me something important about this. He had made and kept an appointment with me, a general practitioner (GP) he had never met, to convey his appreciation of the services he’d received from the practice and also to tell me about what he’d done for himself in the last month. In short, he had taken himself in hand and joined a 12-step programme for people with compulsive eating. Over many years...
      PubDate: 2019-07-09T06:22:27-07:00
      DOI: 10.1136/bmjsrh-2018-200256
      Issue No: Vol. 45, No. 3 (2019)
       
  • Lets talk about conscientious objection
    • Authors: Gull S. E.
      Pages: 221 - 223
      Abstract: Some years ago I had a registrar who was and remains a devout Buddhist. He was shocked when he attended my gynaecology operating list: "Abortion is a sin!" he exclaimed. Sometime later he revised his thoughts: "Abortion is a sin, but I don’t see why you should have all the sin. I will share this sin with you". He had, in his own way, changed his mind. Conscientious objection (CO) remains an important issue in clinical practice, particularly in relation to the provision of abortion. In England, Scotland and Wales the Abortion Act 19671 states that: "no person shall be under any duty, whether by contract or by any statutory or other legal requirement, to participate in any treatment authorised by this Act to which he has a conscientious objection". The Royal College of Obstetricians and Gynaecologists (RCOG) has issued guidance for trainees2 for further...
      PubDate: 2019-07-09T06:22:27-07:00
      DOI: 10.1136/bmjsrh-2019-200361
      Issue No: Vol. 45, No. 3 (2019)
       
  • Delayed presentation of uterine and bowel perforation following insertion
           of an intrauterine device
    • Authors: Reynolds-Wright, J. J; Heller, R. L.
      Pages: 224 - 225
      Abstract: IntroductionInsertion of intrauterine methods of contraception (IUC) carries an inherent but small risk of perforation of the uterus, usually quoted at 2 in 1000. If perforation occurs, it is usually discovered either when a patient presents with ‘missing threads’ or with an unplanned pregnancy. Rarely, if the IUC has perforated bowel, patients can present acutely unwell although this sometimes occurs years after insertion. Asymptomatic perforation of the bowel (with IUC insertion or otherwise) is not common.Case historyIn January 2018, a 41-year-old woman attended our community sexual and reproductive health service requesting removal of her intrauterine system (IUS). The clinic nurse performed this and during the consultation the patient revealed that several days earlier she had passed a previous ‘lost’ intrauterine device (IUD) when she opened her bowels. She came to believe this was an IUD inserted in 2006 that had been ‘lost’ and resulted in a pregnancy with her third child. We counselled her about her options and she had the IUS removed as she was worried this could happen again and opted to use condoms.ConclusionThis case reports an unusual presentation of a delayed and importantly ‘silent’ perforation of the uterus and bowel on insertion of IUC. The case highlights the importance of cross-specialty communication when an IUD has perforated or expelled resulting in a continuing pregnancy, so that appropriate imaging can be arranged following delivery of the baby.
      PubDate: 2019-07-09T06:22:27-07:00
      DOI: 10.1136/bmjsrh-2018-200288
      Issue No: Vol. 45, No. 3 (2019)
       
  • The impact of David Paintin's work
    • Authors: Paterson K. M.
      Pages: 226 - 226
      Abstract: David Paintin, Hon FFSRH, MB ChB, FRCOG Emeritus Reader in Obstetrics and Gynaecology, University of London, London, UK 18 December 1930–30 March 2019 David Paintin believed that women should have equal status, rights and total control over their fertility. He spent his life working towards this end, committed to public service, and never practising privately . He was a remarkable obstetrician, gynaecologist and teacher with ideas ahead of his time. David trained in Aberdeen where he was influenced by Professor Baird's work on the effects of social deprivation on maternal and child health, as well as the need for safe abortion. The Offences Against the Person Act of 1861 stated that abortions performed unlawfully could be prosecuted, but case law (such as the Aleck Bourne judgment in 1939) suggested that a woman’s health could be taken into consideration. However, the lack of clarity meant practitioners of abortion remained at...
      PubDate: 2019-07-09T06:22:27-07:00
      DOI: 10.1136/bmjsrh-2019-200387
      Issue No: Vol. 45, No. 3 (2019)
       
  • Venus
    • Pages: 228 - 228
      Abstract: Online HIV testing seems not to impair condom use and HIV-related knowledge One of the concerns about online testing for sexually transmitted infections is that we lose the opportunity to provide targeted health advice to higher-risk groups. A serial questionnaire-based study administered to men who have sex with men (MSM) testing online at getcheckedonline.com and at a sexual health clinic in Vancouver has shown that baseline knowledge about HIV and condom use behaviours were the same in both groups and they are no different 3 months post-testing. The website was designed by healthcare professionals and incorporated targeted, evidence-based educational material. It is important when commissioning services to consider the value of this component of an online testing service, rather than simply offering tests alone. Sex Transm Infect 2019; https://doi.org/10.1136/sextrans-2018-053652 Midwives discussing contraception with women with learning difficulties need clear and consistent guidance Contraceptive counselling...
      PubDate: 2019-07-09T06:22:27-07:00
      DOI: 10.1136/bmjsrh-2018-200261
      Issue No: Vol. 45, No. 3 (2019)
       
 
 
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