JournalTOCs

BMJ Sexual & Reproductive Health
Number of Followers: 4

Hybrid journal (It can contain Open Access articles)
ISSN (Print) 2515-2009 - ISSN (Online) 2515-1991
Published by BMJ Publishing Group

[62 journals]

Utilisation, effectiveness, and safety of immediate postpartum
intrauterine device insertion: a systematic literature review
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  Authors: Rosa Bolling, K; Wahdan, Y, Warnock, N, Lott, J, Schoendorf, J, Pisa, F, Gomez-Espinosa, E, Kistler, K, Maiese, B.
  Pages: e1 - e1
  Abstract: BackgroundIntrauterine devices (IUDs) are highly effective contraception. IUDs inserted directly following delivery provide immediate birth control and may decrease unintended pregnancies, including short-interval pregnancies, thereby mitigating health risks and associated economic burden.MethodsThis systematic literature review included published global data on the utilisation, effectiveness, and safety of postpartum intrauterine devices (PPIUDs) of any type. English language articles indexed in MEDLINE, Embase, and Cochrane from January 2010–October 2021 were included.Results133 articles met the inclusion criteria (46% interventional studies; 54% observational; n=87 from lower-income countries; n=46 from higher-income countries). PPIUD use was low in higher-income countries (6/10 000 US deliveries in 2013–2016) and varied widely in lower-income countries (2%-46%). Across both higher- and lower-income countries, in most studies (79%),>80% of women with PPIUDs had an IUD in place by 3 months; at 6 and 12 months, 76% and 54% of included studies reported that>80% of women had an IUD in place; reason for discontinuation was infrequently reported. Pregnancies were rare (96 pregnancies across 12 191 women from 37 studies reporting data) and were generally unrelated to device failure, but rather occurred in women no longer using a PPIUD. Expulsions occurred mainly in the early outpatient period and ranged widely (within 3 months: 0–41%). Abnormal bleeding, infections, or perforations were rare.ConclusionsPPIUDs are safe and effective. Long-term follow-up data are limited. Future research elucidating reasons underlying lack of PPIUD use is warranted.
  Keywords: Open access
  PubDate: 2023-04-11T05:50:19-07:00
  DOI: 10.1136/bmjsrh-2022-201579
  Issue No: Vol. 49, No. 2 (2023)
COP27 climate change conference: urgent action needed for Africa and the
world
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  Authors: Zielinski, C; on behalf of the authorship group listed below
  Pages: 71 - 73
  Abstract: Wealthy nations must step up support for Africa and vulnerable countries in addressing past, present and future impacts of climate change The 2022 report of the Intergovernmental Panel on Climate Change paints a dark picture of the future of life on earth, characterised by ecosystem collapse, species extinction and climate hazards such as heatwaves and floods.1 These are all linked to physical and mental health problems, with direct and indirect consequences of increased morbidity and mortality. To avoid these catastrophic health effects across all regions of the globe, there is broad agreement—as 231 health journals argued together in 2021—that the rise in global temperature must be limited to
  Keywords: Open access
  PubDate: 2023-04-11T05:50:18-07:00
  DOI: 10.1136/bmjsrh-2022-201723
  Issue No: Vol. 49, No. 2 (2023)
Words matter: perforation... or transmural migration'
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  Authors: Amaya, S. I; Henkel, A, Blumenthal, P. D.
  Pages: 74 - 75
  Abstract: The intrauterine device (IUD) is a safe and highly effective form of reversible contraception, and IUD use is increasing globally.1 The paper published in this edition is a credible and comprehensive review of early postpartum IUD (PPIUD) experiences.2 In summary, the authors show that PPIUDs decrease unintended pregnancy rates and short-interval pregnancies, lessen economic burden, and are safe for most people seeking contraception. Despite the safety and benefits of IUDs, the authors state that PPIUD insertion is underutilised, and they call for further studies to understand better such low utilisation. Despite the generally positive findings of this paper and the abundance of evidence indicating IUD benefit, it remains important to consider risks and complications around IUD use when discussing potential reasons and solutions for underutilization of PPIUDs. Certainly patients who receive counselling on IUD use are more often counselled about its potential adverse effects than...
  Keywords: Editor''s choice
  PubDate: 2023-04-11T05:50:18-07:00
  DOI: 10.1136/bmjsrh-2022-201738
  Issue No: Vol. 49, No. 2 (2023)
Involving young people in sexual health research and service improvement:
conceptual analysis of patient and public involvement (PPI) in three
projects
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  Authors: Lewis, R; Boydell, N, Blake, C, Clarke, Z, Kernaghan, K, McMellon, C.
  Pages: 76 - 86
  Abstract: BackgroundAlthough increasingly recognised as valuable within sexual and reproductive health (SRH) research and service improvement, examples of patient and public involvement (PPI) are underdocumented, including specific issues relating to young people’s involvement. This article aims to contribute to greater transparency about the practical, methodological and ethical considerations of SRH-related PPI with young people, and to offer recommendations for their meaningful involvement.MethodsGuided by a conceptual tool for evaluating youth participation (the ‘7P’ framework), we analysed learning from PPI within three projects (two academic studies and one service improvement project) that worked with young people to shape sexual health research and practice in Scotland.AnalysisCross-project analysis of seven interconnected domains (purpose, positioning, perspectives, power relations, protection, place and process) generated productive dialogue about the nuances of meaningfully involving young people in shaping SRH research and services. Key learning includes the importance of: young people’s early involvement in agenda-setting for SRH improvement; developing trusting partnerships that can support involvement of diverse groups of young people; creating multiple ways for young people to contribute, including those that do not rely on direct conversation; and formative evaluation of young people’s experiences of involvement.ConclusionsMainstreaming young people’s meaningful involvement in shaping SRH research and services requires systems-level change. Resources are required to support SRH researchers and practitioners to share learning and build sustainable multi-sector partnerships, which in turn can increase opportunities for young people from diverse groups to engage with SRH-related PPI activities.
  Keywords: Open access
  PubDate: 2023-04-11T05:50:19-07:00
  DOI: 10.1136/bmjsrh-2022-201611
  Issue No: Vol. 49, No. 2 (2023)
Improving access to quality contraceptive counselling in community
pharmacy: examining the knowledge, attitudes and practices of community
pharmacists in Australia
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  Authors: Buckingham, P. L. M; Hussainy, S, Soon, J, Norman, W. V, Bateson, D, Mazza, D.
  Pages: 87 - 96
  Abstract: BackgroundAcross most of Australia, the role of community pharmacists in contraceptive care has been unchanged since 2004. To understand their current scope of practice and potential for practice advancements, we examined community pharmacists’ contraceptive knowledge and their attitudes, practices and perceived barriers to and benefits of contraceptive counselling provision.MethodsA nationwide postal survey was conducted between September and December 2020. We contacted a state/territory-stratified sample of 2149 community pharmacies and limited eligibility to one pharmacist per pharmacy. Summary statistics of respondent characteristics and parametric (2, linear regression) and non-parametric (Mann-Whitney, logistic regression) tests were computed for the outcomes: practices, knowledge (reported and tested), confidence, attitudes, barriers and benefits.ResultsEligible responses were received from 366 pharmacies (19%). Pharmacists’ median age was 34. Most (85% of) pharmacists agreed that contraceptive counselling fits within their current professional activities and emphasised benefits to their patients, including improved access to contraceptive decision support (80%), as being key motivators of counselling. A lack of payment mechanisms (66%), training opportunities (55%) and technical assistance tools (54%) were the most important barriers. Self-rated knowledge and confidence were highest for combined oral contraceptive pills and lowest for the copper intrauterine device (IUD). When tested, pharmacists were very knowledgeable about method, dosage, frequencies and costs, and relatively less knowledgeable about side-effects and IUD suitability for adolescents.ConclusionsCommunity pharmacists provide contraceptive information and counselling but lack the necessary resources and support to be able to consistently provide quality, person-centred care. Remuneration mechanisms, training opportunities and pharmacy-specific professional resources need to be explored.
  Keywords: Press releases
  PubDate: 2023-04-11T05:50:19-07:00
  DOI: 10.1136/bmjsrh-2022-201623
  Issue No: Vol. 49, No. 2 (2023)
Very early medical abortion: treatment with mifepristone and misoprostol
before ultrasonographic visualisation of an intrauterine pregnancy
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  Authors: Tai, N. Q. R; Reynolds-Wright, J. J, Cameron, S.
  Pages: 97 - 104
  Abstract: IntroductionAbortion providers may be reluctant to commence abortion before ultrasound evidence of intrauterine pregnancy (IUP) due to concerns of missed ectopic pregnancy. In 2017, very early medical abortion (VEMA) was introduced at an abortion service in Edinburgh, UK. Following ultrasound, patients without confirmed IUP, and without symptoms or risk factors for ectopic pregnancy, could commence treatment immediately after baseline serum-human chorionic gonadotrophin (hCG) measurement, and return for follow-up serum-hCG a week later to determine treatment success (≥80% decline from baseline). This study aimed to compare clinical outcomes between two pathways: (1) VEMA; and (2) standard-of-care delayed treatment where treatment is only commenced on IUP confirmation by serial serum-hCG monitoring and/or repeat ultrasound.MethodsA retrospective database review was conducted of VEMA eligible patients from July 2017 to December 2021. Study groups were determined by patient preference. Records were searched for abortion outcomes, duration of care, number of appointments (clinic visits, ultrasounds, serum-hCG) and clinical data entries.ResultsOf 181 patients included, 77 (43%) chose VEMA and 104 (57%) chose delayed treatment. 11/181 (6.1%) were lost to follow-up. Cohort ectopic prevalence was 4.4% and was not statistically different between groups (2.6% vs 5.8%, VEMA vs delayed group, respectively, p=0.305), as with complete abortion rates (93.3% vs 97.6%, p=0.256). All VEMA group ectopics were detected on the seventh day (from initial visit) while time-to-diagnosis for delayed group ectopics ranged from 7 days to 3 weeks. VEMA patients had significantly reduced duration of care (12 vs 21 days, p
  PubDate: 2023-04-11T05:50:19-07:00
  DOI: 10.1136/bmjsrh-2022-201677
  Issue No: Vol. 49, No. 2 (2023)
Why women choose self-managed telemedicine abortion in the Netherlands
during the COVID-19 pandemic: a national mixed methods study
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  Authors: Cui, N; Gemzell-Danielsson, K, Gomperts, R.
  Pages: 105 - 111
  Abstract: BackgroundThe COVID-19 pandemic has imposed strict lockdown restrictions that have introduced barriers to in-person abortion clinic visits in the Netherlands. Women on Web (WoW) is a global medical abortion telemedicine service operating outside the formal health sector.AimTo understand the motivations and perceived barriers women faced when choosing telemedicine abortion outside the formal health sector, and how this was affected by the pandemic.Methods178 women who completed an online consultation on the Dutch WoW website during the period 6 March 2020 to 5 March 2021 were included in this cross-sectional cohort study and exploratory qualitative study. Patient characteristics and motivations were analysed and associated with the severity of COVID-19 restrictions. Email exchanges in which women could further describe their requests were also examined for recurrent clarification of motivations.ResultsWomen experienced barriers to regular abortion care due to COVID-19 restrictions and had the preference to (1) self-manage their abortion, (2) stay in the comfort of their own home, and (3) keep their abortion private. In particular, women who did not live in the cities where abortion clinics were located experienced barriers to abortion services. As COVID-19 restrictions tightened, it was more frequently mentioned that women sought help from WoW because COVID-19 restrictions and abortion care were not accessible to them in the Netherlands. In the qualitative analysis of email exchanges, the reasons of COVID-19, privacy concerns, and domestic violence were particularly evident.ConclusionsIn the Netherlands, barriers to receiving adequate abortion care were exacerbated for women in vulnerable positions such as being geographically farther away from an abortion clinic, being in a deprived socioeconomic position, or being in an unsafe home situation. Similar to other medical care, abortion care should be deliverable online.
  Keywords: COVID-19
  PubDate: 2023-04-11T05:50:19-07:00
  DOI: 10.1136/bmjsrh-2022-201591
  Issue No: Vol. 49, No. 2 (2023)
Introduction of the London Measure of Unplanned Pregnancy at the booking
visit and the midwives perspective
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  Authors: Cheney, K; Black, K, Pelosi, M, Dorney, E.
  Pages: 112 - 117
  Abstract: BackgroundPregnancy planning and preconception care benefit women, their children, and future generations. The London Measure of Unplanned Pregnancy (LMUP) is a tool that can be used in antenatal care to identify women with unintended pregnancies who require improved access to such services. This tool was recently implemented into routine antenatal care in two maternity centres in New South Wales, Australia. This study explores midwives’ attitudes to the LMUP 12 months after it was introduced into the booking visit and their understanding of its application to their scope of practice.MethodsThis is a qualitative study using in-depth semi-structured interviews with midwives from two maternity care centres in Australia. All midwives performing antenatal booking visits were eligible to take part. Interviews were transcribed, analysed, and coded to define key themes. Recruitment ceased when thematic saturation was reached.ResultsTen midwives from two maternity centres were interviewed. Midwives support the inclusion of the LMUP into the booking visit and felt it was in their scope of practice to be using the tool. Time constraints, the impact of COVID-19 and the lack of structured referral pathways were identified as barriers to the implementation of the LMUP in routine care.ConclusionsMidwives support the inclusion of the LMUP into the antenatal booking visit and see that it falls within their scope of practice. Service barriers were identified at the individual, organisational and external context levels. These need to be addressed to enhance the potential of this tool.
  PubDate: 2023-04-11T05:50:19-07:00
  DOI: 10.1136/bmjsrh-2022-201576
  Issue No: Vol. 49, No. 2 (2023)
Provision of cervical screening for transmasculine patients: a review of
clinical and programmatic guidelines
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  Authors: Nicholls, E. J; McGowan, C. R, Miles, S, Baxter, L, Dix, L, Rowlands, S, McCartney, D, Marston, C.
  Pages: 118 - 128
  Abstract: BackgroundMost cervical cancer can be prevented through routine screening. Disparities in uptake of routine screening therefore translate into disparities in cervical cancer incidence and outcomes. Transmasculine people including transgender men experience multiple barriers to cervical screening and their uptake of screening is low compared with cisgender women. Comprehensive evidence-based guidelines are needed to improve cervical screening for this group.MethodsWe searched for and synthesised clinical and programmatic guidelines for the provision of cervical screening for transmasculine patients.FindingsThe guidelines offer recommendations addressing: (1) reception, check-in and clinic facilities; (2) patient data and invitation to screening; (3) improving inclusion in screening programmes; and (4) sexual history taking, language and identity. Guidelines offer strategies for alleviating physical and psychological discomfort during cervical screening and recommendations on what to do if the screening procedure cannot be completed. Most of the guidelines were from and for high-income countries.DiscussionThe evidence base is limited, but existing guidelines provide recommendations to ensure life-saving screening services are available to all who need them. We were only able to identify one set of guidelines for a middle-income country, and none for low-income countries. We encourage the involvement of transmasculine people in the development of future guidelines.
  PubDate: 2023-04-11T05:50:19-07:00
  DOI: 10.1136/bmjsrh-2022-201526
  Issue No: Vol. 49, No. 2 (2023)
Understanding womens views of and preferences for accessing postpartum
contraception: a qualitative evidence synthesis
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  Authors: Freeman-Spratt, G. J; Botfield, J. R, Lee, G. S, Rajiv, P, Black, K. I.
  Pages: 129 - 141
  Abstract: BackgroundNearly half of women experience unintended pregnancies. These are associated with increased risk of poor maternal physical and psychosocial health outcomes. Many pregnancies in the first year postpartum are unintended, further increasing risks of poor outcomes and complications. We undertook a qualitative evidence synthesis to evaluate qualitative research on women’s views and preferences for accessing postpartum contraception, and identify evidence gaps and opportunities for postpartum contraception provision.MethodsFive databases were searched to identify relevant qualitative studies. Included studies focused on views of, and preferences for, accessing postpartum contraception for women of reproductive age in high-income countries.ResultsOf 1854 studies identified, 28 full texts were assessed and 19 studies included. These were critically appraised using Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) and analysed using thematic synthesis. Included studies indicated the majority of women desire postpartum contraception, but face a range of financial, health system and personal barriers. Women felt unclear about the ideal interpregnancy interval (IPI) and the rationale for this. Women preferred contraceptive counselling at varying times both antenatally and postnatally, and commonly preferred to receive contraception in the immediate postpartum period before hospital discharge. Women commonly saw their obstetrician or general practitioner for contraceptive counselling, but welcomed midwifery involvement.ConclusionsMost women were interested in postpartum contraception and pregnancy spacing, but felt unclear about the optimal IPI, highlighting the need for further education and support around this issue. Contraceptive counselling was viewed as valuable antenatally and postnatally, and by varying maternal health providers, as was the provision of immediate postpartum contraception.
  PubDate: 2023-04-11T05:50:19-07:00
  DOI: 10.1136/bmjsrh-2022-201718
  Issue No: Vol. 49, No. 2 (2023)
Cross-national differences in the use of contraception and abortion
services between England, Wales, and Scotland
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  Authors: Kuang, B; Berrington, A.
  Pages: 143 - 144
  Abstract: Dear Editor, Overall levels of childbearing are significantly higher in England and Wales (total fertility rate of 1.62 and 1.49, respectively, in 2021) than in Scotland (1.31), but few studies have investigated the role of abortion or contraception as proximate determinants of fertility, leaving a key gap in knowledge. This is largely due to a paucity of continuously collected comparable data, since surveys that have historically collected such data (ie, the Omnibus Survey, General Household/Lifestyle Survey) have been discontinued. Existing administrative data on abortion rates collected from 2009 to 2020 show that abortion rates are consistently lower in Scotland than in England and Wales—by approximately eight abortions per 1000 women per year—meaning use of abortion cannot account for the persistently lower fertility levels in Scotland. Our analysis thus focuses on contraception and is the first to identify and quantify the extent of cross-national differences in Britain in contraceptive use, as...
  PubDate: 2023-04-11T05:50:19-07:00
  DOI: 10.1136/bmjsrh-2022-201635
  Issue No: Vol. 49, No. 2 (2023)