Family planning policy and gender in Nigeria: A thematic analysis of the government's health policy perspective.

Family Planning (FP) lets people control the number and timing of child-births through using contraceptives and/or restoring fertility. Nigeria has several FP policies for managing its population, yet contraceptives usage remains suboptimal despite high FP awareness, suggesting that several factors might be inhibiting FP uptake. The literature spotlights gender as factoring into FP use due to Nigeria's patriarchal society, with men positioned as gatekeepers to women's sexual/reproductive health/expression. Therefore, we investigate if/how gender is considered in Nigeria's FP policies. We thematically analysed the 'National Reproductive Health Policy', 'National Family Planning Communication Plan' and 'Nigeria Family Planning Blueprint (Scale-Up Plan)', from a critical realist viewpoint. Our analysis generated an overarching theme-'A Gendered Human Right', with three further themes: Women's Right-Women's Issue', 'Adolescent Girls-not left out' and 'Men's Right as Supporters'. FP was portrayed as the right of women, adolescents (particularly girls ≥ 10 yrs) and men. It was highly feminised, with women, not men, majorly shouldering the FP responsibility and women's FP access was presented as hindered by men. Moreover, we advance recommendations for optimising Nigeria's policies to address gender imbalances hampering women's FP access and uphold the rights of all people, women/girls especially.

A premarital services education model of preventing stunting among prospective newlyweds from North Sumatera, Indonesia.

Stunting, attributed to insufficient nutrition during the critical first 1000 days of life, remains a pressing public health issue in North Sumatera, Indonesia. This study investigates the influence of pre-marital education on prospective couples' knowledge and nutritional status as a stunting prevention strategy. Employing a quantitative, cross-sectional design, the study involved 1000 prospective couples across 10 districts. Data were collected through structured questionnaires and analyzed using Structural Equation Modeling (SEM). The findings demonstrate that pre-marital education significantly enhances knowledge of nutrition, family planning, and stunting prevention, leading to improved nutritional status. However, increased knowledge of stunting was inversely related to nutritional status. The study concludes that comprehensive pre-marital education is vital for effective stunting prevention. It recommends a thorough revision of pre-marital educational content, emphasizing a tailored and integrative approach to health and nutrition, to address specific regional challenges and enhance overall program efficacy.

Le retard de croissance, attribué à une nutrition insuffisante au cours des 1 000 premiers jours critiques de la vie, reste un problème de santé publique urgent dans le nord de Sumatera, en Indonésie. Cette étude examine l'influence de l'éducation prénuptiale sur les connaissances et l'état nutritionnel des futurs couples en tant que stratégie de prévention du retard de croissance. Utilisant une conception quantitative et transversale, l'étude a porté sur 1 000 couples potentiels dans 10 districts. Les données ont été collectées au moyen de questionnaires structurés et analysées à l'aide de la modélisation d'équations structurelles (SEM). Les résultats démontrent que l'éducation prénuptiale améliore considérablement les connaissances en matière de nutrition, de planification familiale et de prévention du retard de croissance, conduisant ainsi à une amélioration de l'état nutritionnel. Cependant, une meilleure connaissance du retard de croissance était inversement liée à l'état nutritionnel. L'étude conclut qu'une éducation prénuptiale complète est essentielle pour une prévention efficace du retard de croissance. Il recommande une révision approfondie du contenu éducatif prénuptial, en mettant l'accent sur une approche adaptée et intégrative de la santé et de la nutrition, pour relever les défis régionaux spécifiques et améliorer l'efficacité globale du programme.

Unmet need for family planning among pastoralist community of West Omo zone, Ethiopia: A community based cross-sectional study.

Introduction: Family planning is among the best suggested strategies to decrease the high maternal mortality and morbidity prevailing among pastoral communities. Despite this fact, there is no sufficient information regarding the unmet need for family planning in the study area. Therefore, this study was intended to assess the prevalence of unmet need for family planning and its associated factors among currently married women residing in pastoralist community of West Omo zone, Ethiopia. Methods: Community-based cross-sectional study was conducted from 01 January to 01 April 2021 in West Omo zone. Five-hundred-sixty currently married women aged 15-49 were interviewed, and the study participants were randomly selected by employing a modified random walk approach. Data were checked manually for completeness and consistency, then entered into Epidata 3.1 and exported to SPSS version 22 for analysis. Multivariate binary logistic regression was used to identify the associated factors, and Adjusted Odds Ratio (AOR) at 95% CI with p-value < 0.05 was considered as significant variables. Result: A total of 560 currently married women agreed to participate in this study making a response rate of 93.17%. Two hundred three, that is, about 36.3% (95% CI: 32.1, 40.2%) currently married women had an unmet need for family planning, with 119 (58.6%) wishing to delay childbirth and 84 (41.4%) seeking to limit. Have no formal education (AOR = 2.86 (95% CI: 1.61, 5.10)), having poor knowledge of family planning (AOR = 2.83 (95% CI: 1.45, 5.54)), and lack of husband support of family planning (AOR = 2.38 (95% CI: 1.22, 4.67)) are positively associated with unmet need for family planning. Conclusion: The magnitude of unmet need for family planning in this study is fairly high as compared to previous studies done among non-pastoral community. Hence, it's important to consider the above identified factors while designing effective public health intervention.

Training in the symptothermal method to ameliorate unmet need for family planning: knowledge, attitudes and satisfaction.

BACKGROUND: Addressing the unmet need for family planning to prevent unintended pregnancies is a high priority for women's health, and training as an element of the symptothermal method (STM) is deemed to be an effective strategy. This study assessed training on knowledge, attitudes and satisfaction with STM to ameliorate the unmet need for family planning. METHODS: The study adopted a pre-post study design. A total of 136 women participated in this study. Knowledge and attitudes were assessed pre- and post-training as well as the level of satisfaction, using cycle charts and questionnaires. The χ2 test (p<0.05) was used to analyse data on sociodemographics, attitudinal characteristics and satisfaction. Paired samples t-test (p<0.05) was used to establish the mean difference of the two groups (knowledge and attitudes pre- and post-training). RESULTS: The paired samples t-test established that women have significant (t=-058.716, p=0.001) knowledge post-training (1.0000±0.00000) compared with pre-training (0.0682±0.01587) on STM. There was no significant (t=-1.419, p=0.158) difference in attitudes towards STM pre- and post-training. There was a significant level of satisfaction (p=0.001). CONCLUSIONS: Our interventional study has enabled women to acquire robust knowledge, positive attitudes and satisfaction with the utilization of STM. This has ameliorated unmet need for family planning among participants.

Contraception used by people assigned female at birth with spinal cord injury.

OBJECTIVE: There is limited data on contraception used by people assigned female at birth with spinal cord injury (SCI). Pregnancy in people with SCI can be medically complex, therefore access to contraception to prevent unplanned pregnancies is imperative. This study aimed to assess the availability of contraception from health care providers (HCPs) to people with SCI and contraception methods used. METHODS: An online international questionnaire was distributed. Demographic data and reproductive histories were recorded. 780 responses were received from participants in 33 different countries. Most participants lived in North America and self-identified as white. 75% had a traumatic SCI. Most SCIs were at cervical and thoracic levels and ASIA-A and ASIA-B. Descriptive and chi square statistics were used. RESULTS: The recruitment rate was 85.4% and completion rate was 73.8%. 93.6% of participants reported ever having been sexually active, while 60.7% reported sexual activity over the past year. Of people who were injured under the age of 50 and who have been sexually active, 63.6% were offered birth control by a HCP. Condoms were used by 44.5% of participants, withdrawal by 20.1%, the combined oral contraceptive pill by 28.4% and intra-uterine device by 20.1% of respondents. CONCLUSIONS: This is the largest known study on SCI and contraception. Most people with SCI are sexually active. The withdrawal method and no contraception are used by many individuals, which may increase the risk of unplanned pregnancy. Increased use of highly effective contraception in this population may be achieved through HCP-initiated conversations about sexual health. OBJECTIF: Les données sont limitées en ce qui concerne la contraception utilisée par les personnes de sexe féminin assigné à la naissance atteinte de lésions médullaires (LM). La prise en charge de la grossesse en contexte de LM peut s'avérer complexe; il est donc primordial que les personnes atteintes aient accès à la contraception pour éviter une grossesse non planifiée. Cette étude visait à évaluer l'offre contraceptive des prestataires de soins et les méthodes contraceptives utilisées chez les personnes atteintes d'une LM. MéTHODES: Un questionnaire en ligne a été distribué à des personnes de partout dans le monde. Les données démographiques et les antécédents reproductifs ont été recueillis. Au total, 780 réponses de participantes provenant de 33 pays ont été reçues. La plupart vivaient en Amérique du Nord et s'identifiaient comme Blanches. De ces participantes, 75 % ont indiqué avoir une LM traumatique. Les LM étaient généralement cervicaux ou thoraciques et de grades A ou B sur l'échelle de l'ASIA. L'analyse des données repose sur les statistiques descriptives et le test du chi carré. RéSULTATS: Le taux de recrutement s'élevait à 85,4 % et le taux de questionnaires remplis à 73,8 %. Parmi les participantes, 93,6 % ont déclaré avoir déjà été sexuellement actives et 60,7 % ont déclaré avoir eu des activités sexuelles dans la dernière année. Chez les personnes sexuellement actives ayant contracté une LM avant 50 ans, 63,6 % se sont fait offrir un contraceptif par un prestataire de soins. Dans l'ensemble, 44,5 % des participantes ont utilisé le condom; 20,1 %, la méthode du retrait; 28,4 %, la contraception orale combinée; et 20,1 %, le dispositif intra-utérin. CONCLUSIONS: Cette étude sur les LM et la contraception est la plus vaste à ce jour. La plupart des personnes atteintes d'une LM sont sexuellement actives. Bon nombre d'entre elles utilisent la méthode du retrait ou n'utilisent aucune méthode contraceptive; des facteurs qui peuvent augmenter le risque de grossesse non planifiée. Il serait sans doute possible d'augmenter l'utilisation de méthodes contraceptives hautement efficaces dans cette population au moyen de conversations sur la santé sexuelle amorcées par le prestataire de soins.

The reasons for and influences of unintended teenage pregnancy in Kericho county, Kenya: a qualitative study.

BACKGROUND: Unintended teenage pregnancies are associated with greater health and socio-economic risks for teenage mothers and newborns. In Kenya, the government has declared a target for ending teenage pregnancy by 2030. However, the prevalence of teenage pregnancy has only decreased slightly, demonstrating the need for further efforts. Understanding teenage mothers' own experiences and perspectives is necessary to design appropriate interventions. METHODS: A community-based qualitative study was conducted from March to May 2023. Two focus group discussions were conducted with community health volunteers and the mothers of teenage girls. Semi-structured interviews were conducted on the case histories of 19 teenage mothers and 18 key informants. Thematic analysis was subsequently performed using MAXQDA 2022. FINDINGS: Four major reasons emerged for unintended teenage pregnancies: (1) lack of knowledge or awareness about the human reproductive system, (2) lack of knowledge about family planning (FP), (3) financial challenges, and (4) low access to FP. At the study site, cultural norms and stereotypes, such as "infertility caused by FP," "freedom of sex by promoting FP," and "cultural taboos on having sex before marriage and talking about sexuality," were observed as barriers in promoting FP to teenagers. In addition, teenagers from low socio-economic backgrounds were found to be more vulnerable because they can be easily exploited by men who can afford to provide for some of their basic needs. Regarding the influences of unintended teenage pregnancy on teenage mothers' lives, the 19 cases were classified into four categories: (1) dropping out of school, (2) financial challenges, (3) changing relationships with parents, and (4) no major influence. Crucially, unintended teenage pregnancies negatively influenced most study participants. Continuing education, supportive parental attitudes, positive perceptions of the relationship with the child's father, and having future perspectives were identified as factors mitigating the negative influences. CONCLUSIONS: Strengthening culturally appropriate comprehensive sexuality education and the school re-entry policy with a supportive environment may prevent unintended teenage pregnancy and mitigate its negative influences. As financial challenges can be both a reason for and a negative influence of unintended teenage pregnancy, economic empowerment interventions are necessary.

Teenage girls becoming pregnant unexpectedly face higher health and socio-economic risks, which can affect both the lives of teenage mothers and newborns. In Kenya, the government has targeted ending teenage pregnancies by 2030, but the decrease has been limited. Although understanding teenage mothers' experiences and perspectives is important for designing appropriate interventions, only a few studies have been conducted. This study focused on 19 teenage mothers and other key participants to gain a deeper understanding of their backgrounds.Four major reasons were identified for unintended teenage pregnancies: (1) lack of knowledge or awareness about the human reproductive system, (2) lack of knowledge about birth control methods, (3) financial challenges, and (4) low access to birth control methods. At the study site, cultural norms and stereotypes were observed as barriers in promoting the use of birth control methods to teenagers. In addition, teenagers from poor backgrounds were found to be more vulnerable because they can be easily taken advantage of by men who can afford to provide for some of their basic needs. Regarding the influences of unintended teenage pregnancy on teenage mothers' lives, the 19 cases were classified into four categories: (1) dropping out of school, (2) financial challenges, (3) changing relationships with parents, and (4) no major influence. In this study, unintended teenage pregnancies negatively influenced most participants. Continuing education, supportive parental attitudes, positive perceptions of the relationship with the child's father, and having future perspectives were identified as factors mitigating the negative influences.

Men's involvement in family planning programs: an exploratory study from Karachi, Pakistan.

BACKGROUND: In Pakistan, family planning has traditionally been perceived as primarily a women's concern, resulting in the exclusion of men from relevant initiatives. This situation is further exacerbated by cultural and social barriers that hinder men's access to family planning services. This study addresses a significant research gap by assessing the extent of family planning service provision for men in urban areas of Karachi. It delves into the exploration of men's involvement in family planning service delivery, identifies existing gaps in services catering to men, records men's perceptions of accessibility and acceptability of these services, and ultimately offers recommendations to enhance men's involvement and strengthen service provision to better meet their needs. METHODS: We employed a qualitative exploratory research design using semi-structured interviews to investigate perceptions regarding family planning service provision to men. This approach involved 25 interviews, comprising eight key informant interviews with stakeholders, eight with service providers, and nine in-depth interviews with married men. RESULTS: This study highlights the limited engagement of men in family planning programs, primarily due to entrenched sociocultural norms that confine female healthcare providers to serving women, hindering men's involvement. While national and provincial policies endorse men's participation, they lack defined roles for male providers. Behavioral and information-sharing barriers at the community level discourage male healthcare providers from collaborating with females. Family planning programs, except for NGO-led vasectomy projects, fail to adequately address men's needs. Despite policy recognition, implementation remains inadequate. Bridging the men's involvement gap necessitates more male providers and improved contraceptive stigma combat training. Further research is vital to explore effective methods for involving men in community and service delivery in family planning. CONCLUSION: There is a need to change the perception that contraception is solely the responsibility of women, as men's participation in family planning in Karachi is limited. Engaging men can yield positive health and non-health outcomes. Culturally sensitive services, developed with community input using a couple-centered approach, are crucial for equitable family planning. Further research is needed to explore men's inclusion strategies in service provision and utilization.

Many family planning efforts focus solely on women, leaving out men, especially in Pakistan, due to cultural and social barriers. This study aimed to explore men's involvement in family planning programs in Karachi. We talked to 25 different people, such as those who run family planning programs, provide services, and married men. We found that men aren't much involved in these programs. Female health providers usually help women, which discourages men from participating or getting involved in such programs. Even though there have been policies to include men since 2002, they don't have specific roles defined. Men don't  discuss family planning much with female providers due to behavioral differences and lack of open communication. Men mostly prefer condoms, and apart from a small NGO-run vasectomy project, there are few programs-tailored to their needs. Although policies exist, they're not fully in practice. To change this, we need more male providers and improved training to reduce the stigma around contraception. Future research should  explore more effective ways to involve men in family planning, both in communities and service levels. Overall, getting men involved in family planning is important, and services need to be developed with input from communities and couples to ensure fairness. More research is needed to figure out the best ways to do this.

Nurse practitioner medication abortion providers in Canada: results from a national survey.

BACKGROUND: In 2017, nurse practitioners (NPs) became the first non-physician healthcare providers authorised to independently provide medication abortion (MA) in Canada. We aimed to report on demographic and clinical characteristics of NPs providing mifepristone/misoprostol MA in Canada and to identify context-specific barriers and enablers to NP provision of mifepristone/misoprostol MA in Canada among MA providers and non-providers. METHODS: From August 2020 to February 2021, we invited Canadian NPs to complete a national, web-based, bilingual (English/French) survey. The survey was distributed through national and provincial nursing associations and national abortion health professional organisations. We collected demographic and clinical care characteristics and present descriptive statistics and bivariate analyses to compare the experiences of NP providers and non-providers of MA. RESULTS: The 181 respondents represented all Canadian provinces and territories. Sixty-five NPs (36%) had provided MA at the time of the survey and 116 (64%) had not. Nearly half (47%) of respondents worked in rural or remote communities and 81% in primary care clinics. Significant barriers impacting non-providers' abilities to provide MA included limited proximity to a pharmacy that dispensed mifepristone/misoprostol, few experienced abortion providers in their community of practice, poor access to procedural abortion services, policy restrictions in NPs' places of employment, and no access to clinical mentorship. Some 98% of NPs providing MA services had never encountered anti-choice protest activity. CONCLUSIONS: NPs appear prepared and able to provide MA, yet barriers remain, particularly for NPs in smaller, lower-resourced communities. Our findings inform the development of supports for NPs in this new practice to improve abortion access in Canada.

Implementation of Genetic Carrier Screening at Gynecologic-Related Visits.

OBJECTIVE: To increase patients' knowledge and access to genetic carrier screening (GCS) in a gynecologic setting by implementing a protocol to universally offer GCS education and screening to reproductive-age women during the preconception period at gynecologic-related visits. DESIGN: The model for improvement quality improvement process model was used to guide this initiative. LOCAL PROBLEM/SETTING: Screening for genetic disease has been a part of preconception and genetic care for the past 50 years. Despite its longstanding presence and better accessibility and affordability of testing, there are no established protocols to universally offer screening to reproductive-age women during preconception care in the United States. The project was implemented at an outpatient gynecology clinic in Phoenix, Arizona. PARTICIPANTS: Fifty-one women ages 18 to 51 years. INTERVENTION/MEASUREMENTS: A protocol was implemented to universally offer expanded GCS and health education to reproductive-age women during the preconception period at gynecologic-related visits. Women's responses to being offered GCS and the rationale for their response was documented on a spreadsheet. RESULTS: All 51 participants were offered GCS during their visit. None of those 51 participants had any previous knowledge of GCS. All 51 participants declined GCS; reasons included the following: would consider it once closer to childbearing (53%), did not have any childbearing plans (31.3%), did not have any further childbearing plans (9.8%), or were not worried about the possibility of genetic disease (5.8%). None cited cost as a reason for declining GCS. After project completion, 3 of the 51 participants returned to the clinic to undergo GCS, and the clinic has adopted the intervention described here as its standard of care for patients who meet criteria for GCS. CONCLUSION: It is imperative to provide health education about GCS to women during preconception care so that they can make informed choices about family planning.

Influences on ethnic minority women's experiences and access to contraception in the UK: a systematic qualitative evidence synthesis.

BACKGROUND: Accessible contraception is critical for promoting the health and well-being of women and their families. In the UK, contraception is free at the point of access, but only 55% of pregnancies are planned, with negative implications for maternal and infant outcomes. In general, women from ethnic minorities use contraceptives less than white women. Barriers to the uptake of contraceptives have been identified, including perceived poor information from healthcare professionals and concerns about side effects. However, most studies do not include representative proportions of women from ethnic minorities. Evidence suggests that ethnic minority (EM) women feel targeted and coerced by healthcare professionals regarding contraception. METHODS: A systematic search of Medline, Embase, and PsycINFO via Ovid, CINAHL, and Web of Science was conducted to identify primary qualitative and mixed-methods studies exploring ethnic minority women's experience of contraception in the UK. The data were charted using thematic analysis, using both summary and synthesis. RESULTS AND CONCLUSIONS: 16 studies met the inclusion criteria, including the perspectives of 717 participants from an ethnic minority. Four overarching themes were developed: contraceptive knowledge, beliefs, family, and services. Similar to women in general, ethnic minority women have concerns about side effects, especially infertility, value the perspectives of their peers and male partners, and express a preference for female healthcare professionals. Novel perspectives included conflicting ideas about the influence of religion and stereotyping of ethnic minority women. Culturally competent consultations and a better understanding of hormonal hesitancy are essential.

Barriers and enablers to utilisation of postpartum long-acting reversible contraception in Eastern Uganda: a qualitative study.

INTRODUCTION: In Uganda, although most women wish to delay or prevent future pregnancies, uptake of postpartum family planning (PPFP) is low. We explored behavioural factors influencing the utilisation of postpartum long-acting reversible contraceptives (LARCs) in Eastern Uganda. METHODS: We conducted a qualitative study in two districts of Eastern Uganda. We conducted 20 in-depth interviews and three focus group discussions with postpartum women, male partners, midwives, and village health team members. We analysed transcripts using framework analysis, based on the COM-B framework. RESULTS: The use of immediate postpartum LARC was affected by the capabilities of women in terms of their knowledge and misconceptions. Limited capabilities of health workers to provide counselling and insert IUDs, as well as shortages of implants, reduced the physical opportunites for women to access PPFP. Social opportunities for women were limited because men wanted to be involved in the decision but rarely had time to accompany their partners to health facilities, and health workers often appeared too stressed. Men also feared that PPFP would enable their partners to be unfaithful. Motivation to take up immediate postpartum LARC included the desire to space births, preference for contraceptive implants over intra uterine devices (IUD) at the 6-week postpartum period, resumption of sex and menses, partner support, and perceived effectiveness of postpartum contraception. Participants thought that uptake of immediate postpartum LARC could be improved by health education and outreach visits, male involvement and couples' counselling in antenatal clinic appointments, and enabling switching between family planning methods (in case of side-effects) . CONCLUSION: Low uptake of PPFP was caused by inadequate knowledge and misconceptions about LARC by women and their partners, insufficient numbers of midwives trained to provide PPFP, stock-outs of PPFP methods, and few social opportunities for couples to be counselled together. These factors could be addressed by scaling up effective, low cost and innovative ways to provide health education (such as films), involving men in decision-making, as well as training more midwives to provide PPFP services, and ensuring that they have sufficient time and supplies.

Multiple sclerosis: Pregnancy, fertility, and assisted reproductive technology-a review.

BACKGROUND: Pregnancy is not discouraged in multiple sclerosis (MS) patients. However, MS patients tend to delay motherhood since they must wait for a low clinical and radiological activity before considering pregnancy, which impacts their fertility and their need for assisted reproductive technology (ART). This review aimed to cover, from a multidisciplinary perspective, the most critical aspects revolving around pregnancy in MS patients. METHODS: A group of seven experts (four neurologists and three gynaecologists) met for three discussion sessions to review current knowledge on ART in patients with MS. PubMed searches for journal articles published in English or Spanish between 2000 and 2024 were undertaken. 354 articles were revised at the title level. RESULTS: We reviewed current evidence on fertility in women and men with MS, on the effects of pregnancy on MS, the disease's pharmacological treatment during pregnancy, MS during delivery and breastfeeding, ART (intrauterine insemination, in vitro fertilisation, intracytoplasmic sperm injection, and oocyte cryopreservation) in patients with MS. CONCLUSION: Early family planning, supported by good coordination between neurology and gynaecology departments, is paramount to managing MS women with motherhood desire. Besides, although a well-planned, early pregnancy is always the most desirable outcome, ART is considered safe and valuable for MS patients. Finally, multidisciplinary units are deemed pivotal to guide MS patients with parenthood desire through pregnancy.

An Eye on Childbearing, Fertility, and Lactation Experiences: A Survey of Canadian Ophthalmologists and Trainees.

OBJECTIVE: To synthesize the experiences of childbearing, fertility, and lactation among Canadian ophthalmologists and trainees. DESIGN: Online, cross-sectional survey. METHODS: A survey was distributed to Canadian ophthalmologists and trainees between April and August 2022. Likert-type scales were used to measure respondents' agreement with each survey item. Fisher's exact test was used to identify significant differences based on gender. RESULTS: Data were obtained from a total of 137 survey respondents (46% females). Women more than men reported that training and clinical practice influenced the number of children they chose to have (p = 0.002), as well as their ability to conceive (p < 0.001). Compared to their male counterparts, more women had concerns about future fertility (p = 0.040) and parental leave (p = 0.037). Among factors affecting parental leave, pressure from colleagues (p = 0.046) and difficulty finding coverage for clinical practice (p = 0.022) were statistically significant among women more than men. More women reported taking parental leave during medical school, residency, and clinical practice than men (p < 0.001). Childbearing (p = 0.005) and parental leave (p = 0.031) influenced pursuit of leadership roles and opportunities for career advancement among women more than men. Of those with lactation experiences, one-third of women felt they did not have adequate space or storage to facilitate their breastfeeding goals in the workplace. CONCLUSIONS: Over the span of their careers, female ophthalmologists and trainees face unparalleled challenges related to childbearing and parenthood duties, coping with infertility and obstetric risks, stigma, inadequate parental leaves, and poor supports for lactation and childcare, while balancing their career demands and aspirations. Garnering an understanding of gender inequities is essential to promote work-family integration within the surgical culture and address the systemic and structural barriers which impose a glass ceiling for female surgeons.

Exposure to family planning messages on social media and its association with maternal healthcare services in Mauritania.

BACKGROUND: Mauritania, a lower-middle-income country in Northwest Africa, has one of the highest maternal and infant mortality rates worldwide and struggles to ensure optimal use of maternal healthcare services. Raising health awareness through family planning messages can promote maternal healthcare use, potentially reducing preventable maternal and child mortalities. The objective of the study was to assess the potential impact of exposure to family planning messages through social media on the utilization of maternal healthcare services among Mauritanian women. METHODS: Data from the 2019-20 Mauritania Demographic and Health Survey (MDHS) on 7,640 women were analyzed. Multiple logistic regression models were applied to examine the associations between exposure to family planning messages through social media and maternal healthcare services, specifically the timing and adequacy of ANC visits, and facility-based childbirth. Adjusted odds ratios with 95% confidence intervals (CI) were estimated. RESULTS: The percentage of timely initiation and adequate use of ANC among the participants were 65.6% and 45.1%, respectively. Approximately 75.0% of the women reported giving birth to their last child at a healthcare facility. Exposure to family planning messages on social media was significantly associated with increased odds of receiving adequate antenatal care visits (OR = 1.38, 95% CI = 1.12,1.71) and giving birth in a health facility (OR = 1.83, 95% CI = 1.09,3.08), Other factors such as age, health insurance, wealth, and desired timing of the last child were also found to be important predictors of maternal healthcare. CONCLUSION: The findings suggest that exposure to family planning messages on social media is strongly associated with adequate antenatal care and health facility-based childbirth, but not with early timing of antenatal care. Comprehensive maternal healthcare policies should consider the role of social media in promoting family planning messages.

Understanding the State and Local Policies Affecting Abortion Care Administration, Access, and Delivery: A Case Study in North Carolina.

The implementation and enforcement of state and local abortion policy can vary significantly between medical clinics and depend on the context and the individual decisionmakers involved. Research conducted prior to the U.S. Supreme Court decision in Dobbs v. Jackson Women's Health Organization showed that, when providers are unclear about potentially conflicting or changing local and state policies (formal and informal) or enforcement, many err on the side of caution and become more restrictive in their practices. However, it is unknown whether and to what extent state and local policies and practices adapted in the wake of Dobbs have influenced providers' practices. The authors conducted an initial study of laws and policies post-Dobbs in one state, North Carolina, to better understand the policy landscape and gather perspectives from staff in facilities or organizations that provide or support abortion care. This study served as a unique opportunity to explore laws and policies, as well as implementation experiences, given North Carolina's Senate Bill 20, which instituted a gestational limit of 12 weeks and 6 days, as well as other provisions, including a 72-hour in-person consent requirement. The findings highlight the reported impacts of Senate Bill 20 on facilities, providers, and patients, as well as other local and institutional policies on abortion care access. This work highlights the importance of understanding legislation and its underlying provisions to ensure a complete picture of implementation factors and potential impacts.

Dr. Nitya Anand: The Visionary Behind Saheli and the Advances in Medicinal Chemistry.

Dr. Nitya Anand was a leading figure in Indian pharmaceutical research. His career spanned several decades, during which he significantly contributed to advancement in drug development and public health. His innovation of Centchroman (Saheli), the world's first non-steroidal oral contraceptive pill, changes the course of contraception use in India. He had done groundbreaking work in leprosy treatment, synthetic peptides, and antibiotics. With over 400 publications and 130 patents, he supervised over 100 PhD students. His work has been recognized with many prestigious awards, including the Padma Shri and the National Nehru Science Award, which have left a long-lasting impact on medicinal chemistry and public health.

Planned pregnancy affects primigravida readiness in role transitions.

OBJECTIVE: To identify the correlation between planned pregnancy and role transition in primigravida. METHODS: The cross-sectional study was conducted at the Bandarharjo Health Centre, Semarang, Indonesia, from February to July 2022, and comprised married primigravida's regardless of trimester who had never had a miscarriage. Data was collected using the London Measure of Unplanned Pregnancy, and the Body Understanding Measure for Pregnancy Scale instruments. Data was analysed using. the software SPSS version 26. P<0.05 was considered significant. RESULTS: Of the 86 subjects, 40(46.5%) were aged 17-25 years, while 34(40.7%) were aged 12-16 years. All the 86 (100%) were married, although some of them acquired pregnancy before the wedding. There were 40(46.5%) unplanned pregnancies, and 36(41.9%) participants were ready for role change compared to 18(20.9%) who were not ready to face the new role. Planned pregnancy significantly correlated with primigravida readiness for role transitions (p=0.001). CONCLUSIONS: There was a significant relationship between planned pregnancy and readiness to face the role.

How does person-centered maternity care relate to postpartum contraceptive counseling and use? Evidence from a longitudinal study of women delivering at health facilities in Ethiopia.

Objectives: This study examines the relationship between integrated, person-centered maternity care (PCMC), the provision of postpartum family planning (PPFP) services, and postpartum contraceptive use among women delivering at health facilities in Ethiopia. Study design: We analyze 2019-2021 longitudinal data from a representative sample of pregnant and recently postpartum women in Ethiopia. This study examines baseline, 6-week, and 6-month survey data collected from women who delivered at a health facility. Results: Maternity patients who reported more person-centered care were more likely to be counseled on postpartum contraceptive methods before discharge. Overall, 27.5% of women delivering in a health facility received family planning counseling before discharge, ranging from 15.2% in the lowest PCMC quintile to 36.3% in the highest PCMC quintile. The receipt of PPFP counseling was associated with increased odds of postpartum contraceptive use. Conclusions: Findings suggest dimensions of quality care are interlinked, and person-centered care is associated with greater integration of recommended PPFP services into predischarge procedures. However, even among women who report relatively high levels of person-centered care, our results highlight that family planning is not routinely discussed prior to discharge from delivery, and very few women receive a contraceptive method or referral prior to discharge. Implications: While most postpartum women report they wish to limit or space future pregnancies, the uptake of modern contraceptive methods in the postpartum period is low. As women increasingly opt to deliver in health facilities, further integration of family planning services into predischarge procedures within maternity care can improve contraceptive access. Data statement: The data used in these analyses were collected as part of the PMA Ethiopia study. Data are publicly available at https://www.pmadata.org/data/request-access-datasets.

Asymmetry in contraceptive information at two sites in Burkina Faso.

Background: Family planning programs are foundationally important to public health, but like any medical intervention, contraception has drawbacks in addition to its benefits. Knowledge of these drawbacks in addition to benefits is essential for informed choice. Despite a general consensus among family planning researchers and providers that contraceptive counseling should be unbiased, little quantitative research has assessed the extent of bias in contraceptive counseling, and in people's contraceptive knowledge more broadly. Objective: To understand the extent to which women report being told more about the advantages of contraception than the disadvantages-a concept we call "asymmetry" in contraceptive counseling, at two research sites in Burkina Faso. Methods: We use data from a cross-sectional population-based survey of 3,929 women residing in the catchment areas of the Ouagadougou (urban) and the Nouna (rural) Health and Demographic Surveillance Systems in Burkina Faso. We use descriptive statistics to explore asymmetry in knowledge of the benefits/advantages and risks/disadvantages of contraceptive use overall, as well as method-specific asymmetry among current method users regarding their counseling experience. Findings: Results show substantial asymmetry in knowledge of advantages/benefits of contraception compared to disadvantages/risks. 86% of respondents said they could name any advantage of family planning, while half of that proportion (43%) could name any disadvantage. We find a similarly stark asymmetry in method-specific results among contraceptive users, especially for hormonal/biomedical methods. We also find substantial variation between research sites, with urban respondents much less likely to self-report complete family planning knowledge than their rural counterparts. Conclusion: Our results suggest that family planning messaging in Burkina Faso may place an emphasis on the advantages without a commensurate focus on disadvantages. Family planning programs worldwide must ensure that people can make informed choices based on balanced, accurate information about both the benefits and the disadvantages of contraception.