Access of migrant women to sexual and reproductive health services: A systematic review.

BACKGROUND: The number of people living in a different place from their place of birth is increasing year by year. Although women have always been involved in migratory movements, today they are increasingly doing so independently. Women are migrating from the Global South to higher-income countries. One of the challenges they face is access to sexual and reproductive health (SRH) services. AIM: To identify the policy-level barriers that limit the access of migrant women to SRH services, their consequences, and strategies implemented to overcome these barriers. METHODS: A systematic review of the literature was undertaken in accordance with the PRISMA statement. A search was undertaken for articles published between 2018 and 2023 focusing on migrant women's experiences of SRH services. In total, 462 articles were retrieved from PubMed (n = 135), Scopus (n = 94) and Web of Science (n = 233); of these, 28 articles were included in this review. FINDINGS: The most common barrier to SRH services identified in the reviewed articles was lack of information (57 %), followed by language issues (43 %), cultural differences (39 %), economic status (25 %), administrative barriers (25 %) and discrimination (14 %). These barriers led to under-utilisation of maternity services and contraceptive methods. Strategies used by migrant women to overcome these barriers were primarily based on seeking help within their own community or family settings. CONCLUSION: Strategies at institutional level to improve the access of migrant women to SRH services need to reduce existing barriers, promote health literacy, and train health workers to be culturally sensitive and responsive to the needs of migrant women.

Sexual violence and associated factors among female large-scale industry workers in Bahir Dar city administration, Amhara region, Ethiopia.

Introduction: sexual violence is currently a serious public health problem affecting women´s health. Globally, 1 in 3 women faces sexual violence in their lifetime. Female industry workers are at an increased risk of sexual violence. Assessing the magnitude and factors associated with sexual violence among female industrial workers is important for interventions. The objective was to assess the prevalence and factors associated with sexual violence among female large-scale industries workers in Bahir Dar, Ethiopia, 2021. Methods: institution-based cross-sectional study was conducted on 807 female industry workers from September to October 2021. Participants were selected by systematic random sampling. The data were collected by a structured questionnaire. Data entry and analysis were done by Epi data v.3.1 and SPSS v.23, respectively. Multivariable logistic regression analysis was done to identify factors. Adjusted odds ratios were computed at 95%CI. A P-value below 0.05 was used to declare association. Results: the prevalence of sexual violence were 59.4% (95% CI; 56.0%-62.6%). The significantly associated factors include; age less than twenty-five (AOR=4.01, 95%CI; 2.81, 10.83), never-married women (AOR=3.07, 95%CI; 1.11, 8.46), being secondary education (AOR=2.65, 95%CI; 1.51, 4.66), being contract employee (AOR=4.65, 95%CI; 1.92, 11.22), drinking alcohol (AOR=3.01, 95%CI; 1.49, 6.09), and night work shift (AOR=9.01, 95%CI; 4.53, 17.93). Conclusion: high rate (59.4%) of sexual violence was reported. Age, marital status, educational status, contract type of work agreement, drinking alcohol, and working night work shift were risk factors. Hence, emphasis on creating safe working environment & transportation, education on reproductive rights and reporting of sexual violence.

Reproductive tract complication risks following Chlamydia trachomatis infections: a long-term prospective cohort study from 2008 to 2022.

Background: The clinical and public health relevance of widespread testing for asymptomatic Chlamydia trachomatis (chlamydia) infections is under debate. To address uncertainties in screening programs, we estimate reproductive tract complication risks following asymptomatic and symptomatic chlamydia infections in a long-term prospective cohort. Methods: A cohort of 5704 reproductive-age women recruited from a chlamydia screening study was followed for up to 14 years. Chlamydia positivity was determined using screening polymerase chain reaction test results, self-reported diagnoses (with/without symptoms), and chlamydia Immunoglobulin G antibodies. Outcome data (pregnancies, pelvic inflammatory disease (PID), ectopic pregnancy, and tubal factor infertility) were collected through self-completed questionnaires. Cox regression calculated adjusted hazard ratios (aHR) with confidence intervals (CI) to compare outcomes between time-updated chlamydia groups since sexual debut. Findings: During 104,612 person-years, 2103 (36.9%) women were chlamydia-positive and 3692 women (64.7%) had been pregnant at least once. Risks for PID, ectopic pregnancy and tubal factor infertility were 1.62 (95% CI 1.20-2.17), 1.84 (95% CI 1.14-2.95) and 2.75 (95% CI 1.53-4.94), compared to chlamydia-negatives. aHRs for PID after symptomatic and asymptomatic infections were 2.29 (95% CI 1.62-3.25) and 1.06 (95% CI 0.66-1.69), respectively. Incidence of PID, ectopic pregnancy and tubal factor infertility after symptomatic chlamydia infection remained low with rates per 1000 person-years of 5.8, 1.9, and 1.8, respectively. Interpretation: We found a significantly higher risk of PID, ectopic pregnancy and tubal factor infertility in chlamydia-positive women compared to chlamydia-negative women, although the overall incidence rates of complications remained low. Symptomatic, but not asymptomatic, chlamydia infections were associated with PID risk, suggesting the largest disease burden of complications is in this group. Funding: The Netherlands Organisation for Health Research and Development (ZonMW Netherlands) and Research Funding from the Ministry of Health, Welfare and Sports.

Male infertility and obesity.

PURPOSE OF REVIEW: The increasing rate of obesity is having an adverse impact on male reproduction. RECENT FINDINGS: The negative effect of reactive oxygen species on male reproductive tissues and the age of onset of obesity are new areas of research on male infertility. SUMMARY: This review highlights how obesity impairs male reproduction through complex mechanisms, including metabolic syndrome, lipotoxicity, sexual dysfunction, hormonal and adipokine alterations as well as epigenetic changes, and how new management strategies may improve the reproductive health of men throughout life.

The impact of COVID-19 on the male reproductive system.

OBJECTIVE: The relevance of the study is determined by the deepening understanding of the global consequences of the coronavirus pandemic, which affect not only lung health but also a wide range of other body systems. In light of new data on the long-term effects of coronavirus infection, this study is highly significant. The purpose of this study is to investigate the impact of coronavirus infection on the male reproductive system and assess its potential influence on male fertility to refine the mechanisms of damage and provide recommendations for medical care. METHODS: The study utilised a combination of methods, including a meta-analysis of medical organisation databases, analysis of clinical cases, representative sample method, and quantitative survey method. These approaches allowed for a comprehensive and multifaceted view of the problem. RESULTS: The samples of sperm showed a noticeable decrease in progressive motility, sperm concentration, and volume, especially in patients with moderate and severe symptoms of COVID-19, whereas patients with mild symptoms only experienced a decrease in progressive motility and overall sperm motility. The survey identified symptoms of male reproductive system dysfunction after recovering from COVID-19. Predominant symptoms included decreased libido (15%), impotence (13%), and infections of the genital organs (12%). Most surveyed men lacked sufficient awareness of other aspects of male reproductive health, including infections, genetic defects, chronic diseases, and available medical services. CONCLUSIONS: As a result of the study, it was concluded that coronavirus infection can have a negative impact on the male reproductive system. The practical value of this study lies in improving approaches to medical care for men who have recovered from COVID-19 and creating preventive programmes.

Causal effects of female reproductive features on nonalcoholic fatty liver disease: A mendelian randomization study.

BACKGROUND AND AIMS: Epidemiological evidence on the associations between female reproductive features and nonalcoholic fatty liver disease (NAFLD) is conflicting. To explore their causalities, we conducted a Mendelian randomization (MR) study. METHODS: Summary-level data were obtained, and univariable MR was performed to explore the causalities between female reproductive features and NAFLD. And we performed multivariable MR and MR mediation analysis to explore the mediation effects of educational attainment (EA) and body mass index (BMI) for these associations. Sensitivity analyses were performed to evaluate pleiotropy and heterogeneity. RESULTS: There were causal effects of age at menarche (AAMA) (odds ratio [OR]: 0.817, 95% confidence interval [CI]: 0.736-0.907, per year-increase), age at first birth (AFB) (OR: 0.851, 95%CI: 0.791-0.926, per year-increase) and age at first sexual intercourse (AFS) (OR: 0.676, 95%CI: 0.511-0.896, per standard deviation-increase) on NAFLD risk. Besides, the causal effects were also observed on NAFLD phenotypes including liver fat content (LFC) and alanine aminotransferase (ALT). Further mediation analysis showed that BMI mediated partial proportion of effects of AAMA and AFS on NAFLD/ALT, AFB on NAFLD/LFC/ALT, while EA mediated partial proportion of effects of AFB on NAFLD/LFC/ALT, and AFS on NAFLD/ALT. CONCLUSIONS: This study provided convincing evidence that early AAMA, AFB, and AFS were risk factors for NAFLD. Reproductive health education, obesity management, and education spread might be the beneficial strategies for NAFLD prevention.

Abortion patients' perspectives on enhancing a telemedicine model of post-abortion contraception: a qualitative study.

BACKGROUND: Access to post-abortion contraception (PAC) is critical for reducing unintended pregnancies and supporting reproductive decision-making. Patients often face challenges in identifying, accessing and initiating their preferred contraceptive methods post-abortion. This may be particularly so with telemedicine models of care with absence of in-person appointments, and reduced opportunities to provide some contraceptive methods. This qualitative service evaluation explored patients' perspectives on PAC consultations and decision-making to inform future PAC service models in the era of telemedicine. METHODS: Qualitative interviews with 15 patients who had telemedicine medical abortion at home up to 12 weeks' gestation. Data were analysed using reflexive thematic analysis. RESULTS: Contraceptive discussions during pre-abortion consultations were valued for supporting informed choices about future contraceptive use. Decision-making was influenced by previous contraception experiences, emotional state at the time of abortion and concerns about contraceptive 'failure'. Some preferred non-hormonal methods due to past negative experiences with hormonal contraceptives. However, limited information about 'natural' contraceptive methods and concerns about discussing these with healthcare professionals were described. Barriers to accessing preferred methods, particularly long-acting reversible contraception (LARC), included reduced availability of appointments and caring responsibilities. Fast-tracked appointments for LARC fitting post-abortion were valued. The need for flexible PAC consultations and access after abortion, for example, remote consultations complemented by personalised interactions with sexual and reproductive health experts, was emphasised. CONCLUSION: The findings highlight the need for flexible and more accessible PAC service models in the era of telemedicine care to ensure timely access to preferred contraceptive methods.

Reproductive Health in Kidney Transplant Recipients.

Increasing number of women with kidney transplants are of reproductive age and desire successful pregnancies. Successful outcomes of pregnancy can be achieved with preconception counseling, education about contraception use, the timing of pregnancy (delaying by first year post-transplant), and the choice of immunosuppression medication. Ensuring stable renal function including optimized creatinine, proteinuria, and blood pressure increases successful outcomes. Pregnancy with kidney transplant has an increased risk of preeclampsia, gestational diabetes militeus, cesarean section, and preterm delivery. Multidisciplinary cooperation with high-risk obstetrics and transplant nephrologists is vital.

Facultative Parthenogenesis in a Zoo-Held Northern Water Snake, Nerodia sipedon.

Over the past several decades, facultative parthenogenesis (FP)-the ability of a sexually reproducing species to reproduce asexually-in vertebrates has been removed from the realm of obscurity and placed firmly in a position where it warrants focused scientific attention. Likely fueled by increased recognition of the trait, the availability of molecular tools capable of disentangling FP from long-term sperm storage, and the availability of potential cases originating from both zoological and private collections, a wealth of papers has been published revealing the diversity of vertebrate systems in which FP occurs. Specifically, cases have been reported in squamate reptiles (lizards and snakes), crocodiles, birds, and elasmobranch fishes (sharks, rays, and skates). Nonetheless, gaps remain in species documentation, and it is important to analyze and report on new cases. In this paper, we provide a DNA-based analysis confirming FP in a zoo-maintained northern water snake, Nerodia sipedon, a viviparous natricine species that is common and widely distributed in North America. Additionally, we provide information on the sexual development and health of the male parthenogen. Encouragingly, zoological institutions, aquaria, university laboratories, and private collections continue to be rich sources for the further study and documentation of FP in vertebrate species, advancing our understanding of this reproductive trait.

Findings of an evaluation of a sexual and reproductive health programme in a humanitarian setting for the forcibly displaced Myanmar nationals in Cox's Bazar, Bangladesh.

Background: Since August 2017, around 940 000 forcibly displaced Myanmar nationals (FDMN), mostly women and children, have fled persecution in Myanmar and arrived in the refugee camps across the border in Cox's Bazar, Bangladesh. This large-scale humanitarian crisis created an urgency for sexual and reproductive healthcare-related services among many of the sexually assaulted FDMN women and girls. Ipas, an international non-governmental organisation (NGO) that has been working on expanding access to safe menstrual regulation, post-abortion care, and family planning services in Bangladesh since 2011, initiated an emergency humanitarian response programme in the refugee camps in Cox's Bazar in 2017 for the victim FDMN women and girls who were in desperate need of care. To understand the implementation process and the scope of sustainability and scale-up of Ipas's programme in the current humanitarian settings, icddr,b, a Bangladesh-based international health research institution, conducted an evaluation study. Methods: Due to the emergency crisis situation, Ipas could not collect baseline data while initiating its humanitarian response programme in 2017. Only a post-evaluation was carried out by icddr,b from August to December 2022 based on a desk review, health facility observation and assessment, qualitative interviews, and a stakeholder consultation workshop. Results: In collaboration with relevant stakeholders from the Government of Bangladesh and local and international NGOs, Ipas performed structural renovation and logistical arrangements to ensure facility readiness within the camps. Until December 2022, it provided comprehensive training on menstrual regulation, post-abortion care, and family planning services to around 700 service providers from partner organisations and expanded its activities from 8 to 51 service delivery points in 23 camps. Overall, 42 213 FDMN women received menstrual regulation and post-abortion care, while 339 334 received family planning services from these facilities, with a growing trend over time. Conclusions: Despite the challenges and barriers inherent to a humanitarian setting, Ipas's programme activities have achieved significant progress in providing menstrual regulation, post-abortion care, family planning services, and trauma/survival-centred care to the FDMN women and girls. A flexible approach, stakeholder coordination and commitment, cohesive methods for health systems strengthening, and community engagement were instrumental to the success of Ipas's humanitarian response programme.

Magnitude and determinants of gender-based violence among female students in Ethiopian higher educational institutions: a systematic review and meta-analysis.

Background: Many adolescents are vulnerable to gender-based violence, and it is a major public health issue. Even though the burden of gender-based violence is still high in Ethiopia, there is a lack of summary information to address the problem. Therefore, this study aimed to assess the pooled magnitude and factors associated with gender-based violence among female students in Ethiopian higher educational institutions. Methods: The primary articles were searched using databases like PubMed, Google Scholar, CINAHL, SCOPUS, EMBASE, and African Journal Online. Articles that assessed the magnitude and factors associated with GBV among female students in Ethiopia were included. A Microsoft Excel spreadsheet was used to extract the data, which was then exported to Stata version 14 for further analysis. The statistical heterogeneity was evaluated using the I2 test. Due to heterogeneity, a random effect meta-analysis model was employed. Publication bias was checked through Egger's weighted regression test and funnel plot. Results: This study included twenty-five primary studies with 13,013 participants. The prevalence of lifetime GBV (n = 7), sexual violence (n = 25), and physical violence (n = 7) was found to be 51.42% (42.38, 60.46), 46.53% (39.86, 53.21), and 37.93% (24.68, 51.18), respectively. Witnessing their mother's abuse by their father during childhood, a lack of open discussion in the family about reproductive health and related personal issues, alcohol consumption, and tight family control were some of the factors significantly associated with lifetime gender-based violence. Furthermore, those who had drunken friends, a regular boyfriend, multiple sexual partners, and chat chewing were factors significantly associated with lifetime sexual violence. Conclusions and recommendations: Our findings revealed that half of female students at higher institutions suffered from violence. So it is recommended to provide accessible information about the consequences of GBV and early intervention for students with the above factors. Systematic review registration: https://www.crd.york.ac.uk/prospero/#recordDetails, identifier CRD42023494760.

The relationship between selected sexually transmitted pathogens, HPV and HIV infection status in women presenting with gynaecological symptoms in Maputo City, Mozambique.

Sexually transmitted infections (STIs) have a profound impact on sexual and reproductive health worldwide. Syphilis, gonorrhea, chlamydia, and trichomoniasis are four currently curable STIs. However, most STI cases are asymptomatic and not detected without laboratory diagnostics. Hepatitis B virus, herpes simplex virus, human immunodeficiency virus (HIV), and human papillomavirus (HPV) are four viral and incurable infections, but they can be mitigated by treatment. We investigated the prevalence of selected sexually transmitted pathogens and their relationship with HPV and HIV infection in women from Maputo, the capital of Mozambique. A cross-sectional study was conducted on 233 non-pregnant women seeking health care relating to gynecological symptoms in Mavalane Health facilities in Maputo, between the 1st of February 2018 and the 30th of July 2019. Cervical brush samples were collected and DNA was extracted. Selected STIs including HPV were detected using multiplex STD and HPV Direct Flow Chip Kits through a manual Hybrispot platform (Vitro, Master Diagnostica, Sevilla, Spain). HIV testing was performed using rapid tests: Determine HIV 1/2 test (Alere Abbott Laboratories, Tokyo, Japan) for screening, and UniGold HIV (Trinity Biotech, Ireland) for confirmation. All women (n = 233) were negative for Haemophilus ducreyi and Herpes Simplex Virus-1 (HSV-1). Among the 233 women, a high prevalence of STIs was found (89%), 63% of the women were positive for HPV and 24% were HIV positive. Treponema pallidum (TP), Trichomonas vaginalis (TV), Herpes Simplex Virus-2 (HSV-2), and Chlamydia trachomatis (CT) were detected in 17%, 14%, 8%, and 8% of the women, respectively. As a common phenomenon, vaginal discharge (90%) was the lower genital tract symptom reported by the majority of the women. Co-infection with any STI and HPV was detected in 56% (130/233) while 45% (59/130) of the co-infections were with high-risk HPV (hrHPV) genotypes. Among the HPV-positive participants, infection by TP was the most prevalent (27%). In total, 28% (66/233) of the participants were positive for any hrHPV genotypes. Co-infection with any STI and HIV was found in 15% (34/233) of the study participants. There was a significant association between HPV infection and TP (p = 0.039) and HSV-2 (p = 0.005). TV, TP, and CT-S1-CT-S2 positivity were significantly more prevalent in HIV-positive participants. Pathobionts Ureaplasma urealyticum/parvum and Mycoplasma hominis were detected in 84.0% (195/233) and 45% (105/233), respectively. This present study describes a high prevalence of STIs. Co-infection between HPV and STIs was found in the majority of the study subjects. The high prevalence of HPV emphasizes the need for HPV vaccination to prevent cervical cancer in this population. Management of STIs is also important in women presenting with gynecological symptoms.

A multiscale geographically weighted regression analysis of teenage pregnancy and associated factors among adolescents aged 15 to 19 in Ethiopia using the 2019 mini-demographic and health survey.

BACKGROUND: Teenage pregnancy remains one of the major reproductive health problems, especially in sub-Saharan African countries. It can lead to maternal and neonatal complications and social consequences. The proportion of teenage pregnancy differs across regions of Ethiopia. Thus, this study aimed to determine the spatial variation in determinants of teenage pregnancy among adolescents aged 15-19 years in Ethiopia using the 2019 Demographic and Health Survey (DHS). METHODS: This study included a total weighted sample of 2165 teenage girls aged 15 to 19 years. A mixed-effect binary logistic regression model was employed to consider the hierarchical nature of the DHS data using STATA version 17. Adjusted odds ratios with 95% confidence intervals are reported, and a p-value less than 0.05 was used to identify significant predictors. The spatial analysis was conducted with ArcGIS version 10.7 and Python 3. To identify factors associated with the hotspots of teenage pregnancy, a multiscale geographically weighted regression (MGWR) was performed. Spatial regression models were compared using adjusted R2, the corrected Akaike information criterion (AICc), and the residual sum of squares (RSS). RESULTS: The prevalence of teenage pregnancy among adolescents aged 15 to 19 years was 12.98% (95% CI: 11.6%, 14.5%). It was spatially clustered throughout the country with a significant Moran's I value. Significant hotspot areas were detected in central and southern Afar; northern, central, and western Gambela; northeastern and southern central Oromia; and the eastern Somali region. The MGWR analysis revealed that the significant predictors of spatial variations in teenage pregnancy were being illiterate and being married. Based on the multivariable multilevel analysis, age 17 (AOR = 3.54; 95% CI: 1.60, 7.81), 18 (AOR = 8.21; 95% CI: 3.96, 17.0), 19 (AOR = 15.0; 95% CI: 6.84, 32.9), being literate (AOR = 0.57; 95% CI: 0.35, 0.92), being married (AOR = 22.8; 95% CI: 14.1, 37.0), age of household head (AOR = 0.98; 95% CI: 0.98, 0.99) and residing in the Gambela region (AOR = 3.27; 95% CI: 1.21, 8.86) were significantly associated with teenage pregnancy among adolescents aged 15 to 19. CONCLUSION: Teenage pregnancy is a public health problem in Ethiopia. Policymakers should prioritize addressing early marriage and improving teenage literacy rates, with a focus on the Gambela region and other hotspot areas. It is crucial to implement policies aimed at transforming the traditional practice of early marriage and to take measures to enhance literacy levels and promote awareness about sexual and reproductive health at the family and school levels. This will help ensure that young people have the opportunity to pursue education and make informed decisions about their reproductive health.

Knowledge and Attitudes Regarding Family Planning Options in Armenia.

Objective: In many Transcaucasian and Middle Eastern populations, research in women's sexual and reproductive health remains limited, especially in Armenia despite recent political and cultural changes. This study explores the current state of family planning in Armenia while both highlighting the recent progress and identifying current barriers to reproductive health. Study Design: We conducted a mixed-methods study using both a quantitative survey and qualitative interviews with women and key informants in the field of women's sexual and reproductive health. Results: Armenian women are familiar with many types of contraception. The use of modern methods has increased but remains low. Sexual education for women is uncommon and often sought through independent online searches or books. We found no significant access barriers, however, a prevailing distrust in hormonal contraceptive methods left many women to rely on condoms and withdrawal. Although the majority of surveyed women (72%) believed having access to safe abortions was an important right, only 42% would consider having an abortion in the case of an unintended pregnancy. Interviewees highlighted the lack of sexual education, discrepancies in sexual and reproductive services between rural provinces and the urban capital city of Yerevan, as well as the need for information and the government's responsibility in this field. Conclusions: The lack of comprehensive sexual education in Armenia fuels misinformation regarding family planning options. One option we recommend is a government-funded sexual education program which begins as culturally sensitive, sex-positive education in schools and continues with counseling and support for women within the health care system.

Study protocol for a pre/post study on knowledge, attitudes and behaviors regarding STIs and in particular HPV among Italian adolescents, teachers, and parents in secondary schools.

Sexually transmitted infections (STIs) are one of the most important issues related to sexual and reproductive health, as it is estimated that more than 1 million new infections are acquired every day worldwide and data on the prevalence and incidence of these infections, especially among young people, are increasing. Nevertheless, there are some knowledge and behavioral gaps, and young people need more support from their school and family network to protect themselves and their peers. Therefore, we have designed a multicenter prospective intervention study involving public lower and upper secondary school students, their parents and teachers (ESPRIT). The intervention will take place in the school year 2023-2024, where students will meet with experts and be involved in peer education, while adults (parents and teachers) will participate in distance and face-to-face trainings. All target groups will complete KAP (knowledge, attitudes, practice) questionnaires before and after participating in the intervention to measure its effectiveness. The results of this study will help to assess and improve the level of knowledge of lower and upper secondary school students, parents and teachers about STIs and HPV in particular, raise awareness of sexual and reproductive health issues, including vaccination, among lower and upper secondary school students and their families, and evaluate the effectiveness of these interventions in terms of improving knowledge and changing attitudes and behaviors. The study protocol has been approved by the Regional Unique Ethics Committee of Friuli Venezia Giulia (CEUR-2023-Sper-34). The project is being carried out with the technical and financial support of the Italian Ministry of Health-CCM.

Primary healthcare providers' knowledge, practices and beliefs relating to preventive sexual and reproductive health care for women from refugee and asylum-seeking backgrounds in Australia: a national cross-sectional survey.

Background Many refugee women and women seeking asylum arrive in high-income countries with unmet preventive sexual and reproductive health (SRH) care needs. Primary healthcare providers (HCPs) are usually refugee and asylum seekers' first point of care. This study aimed to identify HCP characteristics associated with initiating conversations and discussing SRH opportunistically during other health interactions. Methods An anonymous online survey was distributed nationally to representatives of health professional organisations and Primary Health Networks. Hierarchical logistic regression analysed factors including HCP demographics, knowledge and awareness, perceived need for training and professional experience with refugee women were included in the models. Results Among 163 HCPs, those initiating conversations ranged from 27.3% (contraceptive care) to 35.2% (cervical screening). Opportunistic discussions ranged from 26.9% (breast screening) to 40.3% (contraceptive care). Positively associated factors included offering care to refugee women or women seeking asylum at least once every 2months 7.64 (95% CI 2.41;24.22, P P P P P P Conclusions Direct professional experience, frequency of service provision, years of practice, and part time work positively influence HCPs' SRH care practices. Enhancing bilingual health worker programs, outreach, education, and support for SRH and cultural competency training are essential to improving the preventive SRH care of refugee women and women seeking asylum.

Health aspects of the presidential election in the United States.

The prospect of a Biden-Trump rematch had raised concerns. The argument of Trump on the older age of Biden led to a boomerang effect when the latter was replaced by the much younger Kamala Harris whose mixed African and Asian ancestry should lead to her support on international issues. Swing voters might be attracted by her potential as the first female president. Assertive on the politically controversial issue of abortion, Kamala Harris already spent a substantial part of her vice-presidency on women issues. Her promotion of sexual and reproductive rights during the presidential campaign augurs well for restoring those priorities on the American political agenda.

La perspective d'une revanche Biden-Trump avait suscité des inquiétudes. L'argument de Trump sur l'âge avancé de Biden a provoqué un effet boomerang lorsque ce dernier a été remplacé par la bien plus jeune Kamala Harris dont l'ascendance mixte africaine et asiatique devrait lui valoir son soutien sur les questions internationales. Les électeurs swing pourraient être attirés par son potentiel en tant que première femme présidente. Affirmée sur la question politiquement controversée de l'avortement, Kamala Harris a déjà consacré une partie substantielle de sa vice-présidence aux questions féminines. Sa promotion des droits sexuels et reproductifs pendant la campagne présidentielle augure bien du rétablissement de ces priorités sur l'agenda politique américain.

Access to and provision of sexual and reproductive health services in Ekurhuleni, South Africa: Experiences and coping strategies of migrant women and healthcare workers.

The importance of universal access to health services including sexual and reproductive health and rights (SRHR) services by migrant populations and the fundamental role of healthcare workers in providing SRHR services, requires a balanced understanding of the experiences of both migrants and healthcare workers. This study explored the experiences of migrant women in accessing and utilising SRHR services and the experiences of healthcare workers in providing SRHR and HIV services in Ekurhuleni, South Africa. In-depth interviews were conducted with five internal migrants, eight international migrant women aged 18-49 years, and four healthcare workers. Migrant women were selected using snowball sampling while healthcare workers were purposively sampled. Migrant women face multifaceted challenges including but not limited to language barriers, discrimination based on migration status, cultural and religious hurdles when accessing and utilising SRHR and HIV services. Similarly, healthcare workers encounter challenges in providing SRHR and HIV services to migrant women which include language barriers and having migrants who seek services without referral documentation and legal migration documents. Training healthcare workers on cultural sensitivity and integration of migrant friendly services in the health policy may improve migrant women's experiences in accessing and utilising as well as healthcare workers' experiences in providing SRHR services.

L'importance de l'accès universel aux services de santé, y compris les services de santé et de droits sexuels et reproductifs (SDSR) pour les populations migrantes et le rôle fondamental des agents de santé dans la fourniture de services SDSR, nécessitent une compréhension équilibrée des expériences des migrants et des agents de santé. Cette étude a exploré les expériences des femmes migrantes en matière d'accès et d'utilisation des services SDSR et les expériences des agents de santé dans la fourniture de services SDSR et VIH à Ekurhuleni, Afrique du Sud. Des entretiens approfondis ont été menés avec cinq migrants internes, huit femmes migrantes internationales âgées de 18 à 49 ans et quatre agents de santé. Les femmes migrantes ont été sélectionnées à l'aide d'un échantillonnage boule de neige tandis que les travailleurs de la santé ont été échantillonnés à dessein. Les femmes migrantes sont confrontées à des défis multiformes, notamment les barrières linguistiques, la discrimination basée sur le statut migratoire, les obstacles culturels et religieux lors de l'accès et de l'utilisation des services SDSR et VIH. De même, les agents de santé rencontrent des difficultés pour fournir des services SDSR et VIH aux femmes migrantes, notamment des barrières linguistiques et le fait que les migrantes recherchent des services sans documents de référence ni documents de migration légaux. La formation des agents de santé à la sensibilité culturelle et à l'intégration de services adaptés aux migrants dans la politique de santé peut améliorer les expériences des femmes migrantes en matière d'accès et d'utilisation, ainsi que les expériences des agents de santé dans la fourniture de services SDSR.