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BMJ Sexual & Reproductive Health
Number of Followers: 7

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

[62 journals]

French Parliament ratifies the inclusion in the French Constitution of
"guaranteed freedom" for abortion: but does this really prevent future
restrictions'
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  Authors: Faucher; P.
  Pages: 153 - 154
  Abstract: The two French Parliamentary chambers met on 4 March 2024 in the Congress of Versailles and voted in favour of the constitutional bill to include abortion as a fundamental right in law. Deputies and senators overwhelmingly approved the constitutional revision with 780 votes ‘for’ of 852 votes cast (72 ‘against’). This evolution of the French Constitution completes a process initiated in reaction to the decision of the Supreme Court of the United States (US) in 2022 to repeal the ‘Roe vs Wade’ ruling, which had protected access to abortion in the US at the federal level. The inclusion of abortion in the French Constitution is considered a means of protecting this fundamental right. Although this has been widely applauded, the wording used in the new Constitution leaves some room for concern that abortion may not be as protected as one would assume. Back in November 2022, the members of...
  PubDate: 2024-07-12T07:36:09-07:00
  DOI: 10.1136/bmjsrh-2024-202316
  Issue No: Vol. 50, No. 3 (2024)
Self-managed medication abortion trajectories: results from a prospective
observational study in Argentina, Nigeria and Southeast Asia
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  Authors: Pleasants, E. A; Jayaweera, R. T, Egwuatu, I, Nmezi, S, Kristianingrum, I. A, Zurbriggen, R, Grosso, B, Bercu, C, Motana, R, Gerdts, C, Moseson, H.
  Pages: 155 - 164
  Abstract: ObjectivesTime is a crucial factor in abortion-seeking because options for care change with pregnancy duration, and most people prefer to access abortion care early in pregnancy. We aimed to collect data on the timing of steps in accompanied self-managed abortion-seeking experiences in legally restrictive settings.MethodsIn this prospective, observational, cohort study we recruited callers from three abortion accompaniment groups in Argentina, Nigeria and a country in Southeast Asia. Participants completed a baseline survey before starting a self-managed medication abortion (SMA) and two follow-up surveys (approximately 1 and 3 weeks after taking medication). Primary outcomes of interest included: (1) time from abortion decision to contacting the hotline, (2) time from contacting the hotline to obtaining pills and (3) time from obtaining pills to taking the first dose. We explored relationships between participant characteristics and each of these outcomes and evaluated differences in overall abortion time using survival analyses.ResultsBetween July 31, 2019 and October 01, 2020 we enrolled 1352 eligible callers; 1148 provided data for this analysis. After deciding to have an abortion, participants took 12.2 days on average (95% CI: 11.6, 12.9) to start medications for abortion. On average, participants at later pregnancy durations progressed through the SMA process more quickly (
  PubDate: 2024-07-12T07:36:09-07:00
  DOI: 10.1136/bmjsrh-2023-201979
  Issue No: Vol. 50, No. 3 (2024)
Preconception health risk factors documented in general practice
electronic medical records
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  Authors: Withanage, N. N; Botfield, J. R, Black, K, Mazza, D.
  Pages: 165 - 171
  Abstract: BackgroundDocumenting medical and lifestyle preconception health risk factors in electronic medical records (EMRs) could assist general practitioners (GPs) to identify those reproductive-aged women who could most benefit from preconception care (PCC). However, it is unclear to what extent PCC risk factors are identifiable in general practice records. This study aimed to determine the extent to which medical and lifestyle preconception health risk factors are documented in general practice EMRs.MethodsWe conducted an audit of the documentation of medical and lifestyle preconception risk factors in 10 general practice EMRs in Melbourne, Australia. We retrospectively analysed the EMRs of 100 consecutive women aged 18–44 years who visited each practice between January and September 2022. Using a template informed by PCC guidelines, we extracted data from structured fields in the EMR and conducted a descriptive analysis.ResultsAmong the data extracted, the more commonly documented medical and lifestyle preconception health risk factors in the EMRs included smoking (79%), blood pressure (74%), alcohol consumption (63%) and body mass index (57%). Among the women audited, 14% were smokers, 24% were obese, 7% had high blood pressure, 5% had diabetes, 28% had a mental health condition, 13% had asthma, 6% had thyroid disease and 17% had been prescribed and could be using a potentially teratogenic medication.ConclusionsBetter documentation of medical and lifestyle preconception health risk factors in structured fields in EMRs may potentially assist primary care providers including GPs in identifying and providing PCC to women who could most benefit from it.
  Keywords: Open access
  PubDate: 2024-07-12T07:36:09-07:00
  DOI: 10.1136/bmjsrh-2023-202038
  Issue No: Vol. 50, No. 3 (2024)
Seeking support for abortion online: a qualitative study of womens
experiences
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  Authors: Wilson-Lowe, R. V; Purcell, C, Lewis, R, McDaid, L.
  Pages: 172 - 177
  Abstract: IntroductionSocial support can mitigate the impact of stress and stigma before or after an abortion. However, stigma anticipation can limit access to in-person support. Informal online spaces can offer opportunities to address unmet support needs including supplementing in-person support lacking within stigmatised contexts. While earlier studies have explored content of posts comprising personal accounts of abortion, little is known about the nuances of how and to what end online spaces are navigated.MethodsSemi-structured interviews were conducted remotely (online or by telephone) with 23 women living in Scotland (aged 20–54 years) recruited through social media and online advertisements. Reflexive thematic analysis was supported by NVivo12 software.ResultsKey themes: obtaining support that was unavailable from in-person networks; preparation for abortion; reducing feelings of isolation. The majority of participants independently searched online for accounts of abortion, with only three receiving any signposting to specific resources. Without guidance, finding relevant, supportive content was not straightforward. The search process was additionally complicated by the prevalence of abortion stigma online, which generated an additional burden at a potentially challenging time. Those who received direction towards particular resources reported primarily positive online experiences.ConclusionsWhile online content could address perceived in-person support gaps, the process of finding supportive content without guidance can be complex. Online searching may also expose women to stigmatising material and interactions. Signposting by abortion services towards well-moderated and trustworthy online resources could be constructive in limiting exposure to stigma and misinformation, while allowing those seeking it to access better support.
  Keywords: Open access
  PubDate: 2024-07-12T07:36:09-07:00
  DOI: 10.1136/bmjsrh-2023-202083
  Issue No: Vol. 50, No. 3 (2024)
Patient experiences of undergoing abortion with and without an ultrasound
scan in Britain
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  Authors: Blaylock, R; Lohr, P. A, Hoggart, L, Lowe, P.
  Pages: 178 - 184
  Abstract: BackgroundRoutine ultrasound scanning to determine gestational age and pregnancy location has long been part of pre-abortion assessment in Britain, despite not being legally required or recommended in national clinical guidelines. To support implementation of fully telemedical abortion care (implemented in Britain in April 2020), the Royal College of Obstetricians and Gynaecologists (RCOG) issued clinical guidance for an ‘as-indicated’ approach to pre-abortion ultrasound, removing the need for a clinic visit. We aimed to understand patient experiences of ultrasound in abortion care by conducting a qualitative study with individuals who had abortions with and without an ultrasound scan.MethodsBetween November 2021 and July 2022, we recruited patients who had a medical abortion at home without a pre-procedure ultrasound at 69 days’ gestation or less at British Pregnancy Advisory Service (BPAS), and also had at least one other abortion with an ultrasound from any provider in Britain. We conducted interviews using a semi-structured interview guide to explore our participants’ experiences and conducted reflexive thematic analysis.ResultsWe recruited 24 participants and included 19 interviews in our analysis. We developed three themes from our data. These were ‘Ultrasound scans and their relationship with autonomy and decision-making’, ‘Intrusive and out of place: the ultrasound as an inappropriate technology’ and ‘Towards preference-centred, quality care’.ConclusionsFurther research and user-testing of strategies to improve the scan experience should be undertaken. Patient testimonies on the negative impact of ultrasound scans in abortion care should reassure providers that omitting them according to patient preference is a positive step towards providing patient-centred care.
  PubDate: 2024-07-12T07:36:09-07:00
  DOI: 10.1136/bmjsrh-2023-202116
  Issue No: Vol. 50, No. 3 (2024)
Changes in fertility intention among married Chinese couples with two
children during COVID-19: a cross-sectional study
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  Authors: Ning, N; Tan, X, Li, Y, Tang, J, Lommel, L, Sun, M.
  Pages: 185 - 193
  Abstract: BackgroundA three-child policy was implemented in China to stimulate a rise in fertility levels and coincided with the COVID-19 pandemic. Data suggested that COVID-19 has a negative impact on fertility intention.AimTo describe married couples’ changes in intention to have a third child during the COVID-19 pandemic and determine factors associated with altered intentions.MethodsAn online survey was conducted in October 2021, including sociodemographic characteristics, change of intention to have a third child after the COVID-19 pandemic outbreak, reasons for increased or decreased intention, and the Fertility Intention Scale (FIS). Bivariate and multivariable logistic regression were used to test the potential factors associated with changes in intention.ResultsA total of 1308 participants provided responses. Following the COVID-19 outbreak, 35.8% of participants decreased their third-child intention, while 2.8% of participants increased their third-child intention. Males (aOR 1.90, 95% CI 1.42 to 2.54), youngsters (aOR 1.77, 95% CI 1.08 to 2.93) and those living in Estern China (aOR 2.12, 95% CI 1.13 to 3.98) were more likely to decrease their third-child intention. Perceived risk (aOR 1.07, 95% CI 1.03 to 1.10) and policy support (aOR 1.06, 95% CI 1.03 to 1.09) as measured on the FIS decreased couples’ intention to have a third child. Social support (aOR 0.94, 95% CI 0.91 to 0.98) as measured on the scale protected participants from decreased intention.ConclusionsDuring severe public health emergencies, strong prevention and control policies, together with enhancing support from partners and healthcare professionals for women, are necessary to improve intentions to give birth.
  Keywords: COVID-19
  PubDate: 2024-07-12T07:36:09-07:00
  DOI: 10.1136/bmjsrh-2022-201759
  Issue No: Vol. 50, No. 3 (2024)
Use of contraceptives, empowerment and agency of adolescent girls and
young women: a systematic review and meta-analysis
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  Authors: Lassi, Z. S; Rahim, K. A, Stavropoulos, A. M, Ryan, L. M, Tyagi, J, Adewale, B, Kurji, J, Bhaumik, S, Meherali, S, Ali, M.
  Pages: 195 - 211
  Abstract: IntroductionThe evidence on adolescent empowerment, which involves access to personal and material resources for reproductive autonomy and economic equity, is limited. This systematic review assesses the use of contraceptives in empowering and strengthening the agency and vice versa among adolescents and young women.MethodsWe ran the searches in six electronic databases: Cochrane Database of Systematic Reviews (CDSR) and the Cochrane Central Register of Controlled Trials (CENTRAL), The Campbell Library, MEDLINE (PubMed), EMBASE, Cumulated Index to Nursing and Allied Health Literature (CINAHL) and Web of Science. The methodological quality of studies was assessed using ROBINS-I and ROB-II tools as appropriate. Meta-analysis was performed using Review Manager 5.4.ResultsForty studies that assessed the impact of empowerment on contraceptive use were included. Of these, 14 were non-randomised studies for intervention (NRSIs), and the remaining 26 were randomised controlled trials (RCTs). The results from RCTs show a significant effect of the sexual and reproductive health empowerment in increasing ever use of contraception (RR 1.22; 95% CI 1.02, 1.45; n=9; I²=77%; GRADE: Very Low), and insignificant effect on unprotected sex (RR 0.97; 95% CI 0.74, 1.26; n=5; I²=86%; GRADE: Very Low) and adolescent pregnancy (RR 1.07; 95% CI 0.61, 1.87; n=3; I²=36%; GRADE: Very Low). None of the studies assessed impact of contraceptive use on empowerment.ConclusionsEmpowerment of adolescents and young women certainly improves contraceptive use in the immediate or short-term period. However, more robust studies with low risk of bias, longer-term outcomes, and impact of contraceptive use on empowerment and agency-strengthening are required. To increase contraceptive use uptake, tailored policies and delivery platforms are necessary for youth in low- and middle-income countries.
  Keywords: Open access
  PubDate: 2024-07-12T07:36:09-07:00
  DOI: 10.1136/bmjsrh-2023-202151
  Issue No: Vol. 50, No. 3 (2024)
Association between COVID-19 vaccination and menstruation: a state of the
science review
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  Authors: Payne, L. A; Wise, L. A, Wesselink, A. K, Wang, S, Missmer, S. A, Edelman, A.
  Pages: 212 - 225
  Abstract: IntroductionMenstrual health is a key patient-reported outcome beyond its importance as a general indicator of health and fertility. However, menstrual function was not measured in the clinical trials of COVID-19 vaccines. The purpose of this review was to synthesise the existing literature on the relationship between COVID-19 vaccination and menstrual health outcomes.MethodsA PubMed search to 31 October 2023 identified a total of 53 publications: 11 prospective cohort studies, 11 retrospective cohort studies or registry-based cohort studies, and 31 cross-sectional or retrospective case–control studies.ResultsIdentified studies were generally at moderate-to-high risk of bias due to retrospective design, interviewer bias, and failure to include a non-vaccinated control group. Nonetheless, the bulk of the literature demonstrates that COVID-19 vaccine is associated with temporary changes in menstrual characteristics (cycle length and flow) and menstrual pain. Follicular phase (at the time of vaccination) is associated with greater increases in cycle length. Evidence suggests temporary post-vaccine menstrual changes in adolescents, abnormal vaginal bleeding in postmenopausal individuals, and a potential protective effect of using hormonal contraception.ConclusionsIn this review we found evidence supporting an association between the COVID-19 vaccine and menstrual health outcomes. Given the importance of menstrual function to overall health, we recommend that all future vaccine trials include menstruation as a study outcome. Future vaccine studies should include rigorous assessment of the menstrual cycle as an outcome variable to limit sources of bias, identify biological mechanisms, and elucidate the impact of stress.
  Keywords: Editor''s choice, COVID-19
  PubDate: 2024-07-12T07:36:09-07:00
  DOI: 10.1136/bmjsrh-2024-202274
  Issue No: Vol. 50, No. 3 (2024)
Developing an accessible audiovisual animation to provide information
about postpartum contraception
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  Authors: Cooper, M; Robinson, H, Hughes, L, McCabe, K, Simpson, J, Cameron, S.
  Pages: 226 - 229
  Abstract: Why was this audiovisual animation needed' The postpartum period is a high-risk time for unintended pregnancy and abortion.1 Short inter-pregnancy intervals are associated with an increased risk of most obstetric complications2 but accessing appointments to discuss and initiate contraception can be difficult for new parents after leaving the maternity unit.1 The antenatal period offers a unique opportunity to discuss and provide information about future fertility and contraceptive choices after childbirth, and to facilitate postpartum contraceptive provision.3 Antenatal contraceptive discussions are not routinely offered in the UK, and the quality and consistency of information can be highly variable.3 Those from diverse backgrounds may find it more difficult to access information that suits their needs.4 Audiovisual animation is a useful tool for providing health information. Low literacy levels can mean that written information is not always fully understood....
  Keywords: JFPRHC "A better way of working"
  PubDate: 2024-07-12T07:36:09-07:00
  DOI: 10.1136/bmjsrh-2023-202050
  Issue No: Vol. 50, No. 3 (2024)
Japan initiates a groundbreaking market test of over-the-counter emergency
contraceptive pills with pharmacies as a first access point
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  Authors: Hakariya, H; Hashimoto, T, Suzuki, Y, Hamaki, T, Tanimoto, T.
  Pages: 230 - 231
  Abstract: On 28 November 2023, the Japanese Ministry of Health, Labor and Welfare (MHLW) initiated a market test to allow designated pharmacies to sell emergency contraceptive pills (ECPs), levonorgestrel (approved in 2011 in Japan) or its generic product, behind the pharmacy counter without a prescription.1 The test, commissioned by the MHLW and conducted by the Japan Pharmaceutical Association, will run until at least March 2024, evaluating the future possibility of switching ECPs to either behind-the-counter (BTC) or over-the-counter (OTC) medication. Individuals who consent to participate in the investigative research can administer the pill in front of the pharmacist subsequently after the instruction. The official website estimates the ECP to cost around Japanese yen ¥7000–9000 (US$47–62), which is not covered by health insurance. This BTC framework is epoch-making given that access to ECPs in Japan was previously limited to prescription drugs with expensive costs ranging from ¥6000–20 000 (US$40–136), which...
  PubDate: 2024-07-12T07:36:09-07:00
  DOI: 10.1136/bmjsrh-2024-202221
  Issue No: Vol. 50, No. 3 (2024)
Highlights from literature
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  Pages: 232 - 232
  Abstract: Doxycycline prophylaxis for STI prevention in women This study from Kenya examined the emerging evidence around post-exposure prophylaxis (PEP) with doxycycline in cisgender women. Evidence already exists that doxycycline-PEP in cisgender men and transgender women can reduce sexually transmitted infections (STIs). Some 449 participants were randomised to 200 mg doxycycline post-condomless sex or standard care. Doxycycline was taken within 72 hours of the event and hair samples were obtained to determine doxycycline use. The study found that there was no significant reduction in STI cases over 12 months in the doxycycline-PEP group, and according to the hair analysis there was low doxycycline use suggesting low acceptance in the group assigned to receive it. In addition, there was a notable complete resistance to doxycycline in those testing positive for gonorrhoea. This highlights that although doxycycline-PEP has been used to improve outcomes in other groups, more research is needed with regard...
  PubDate: 2024-07-12T07:36:09-07:00
  DOI: 10.1136/bmjsrh-2023-202105
  Issue No: Vol. 50, No. 3 (2024)

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