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.

Clinic Staff Perceptions of Implementing a Sexual and Reproductive Health Entertainment-Education Program for Young Women of Color.

Objective: Entertainment-education interventions remain underutilized in sexual and reproductive health (SRH) despite evidence that they can be effective and place a low burden on staff. This study explores perceived facilitators and barriers for implementing an entertainment-education video intervention for 18- to 19-year-old African American and Latina women in SRH clinics. Design: Cross-sectional online survey (n=100) and telephone interviews (n=19) were completed May through August 2018. Setting: SRH clinics were located across 32 US states and 1 Canadian province. Participants: SRH clinic staff were diverse in type of clinic, role, and geography and were recruited using purposive sampling. Methods: Bivariate analyses were used for quantitative data, and thematic analysis was used for qualitative data. Main Outcome Measures: Intervention acceptability, perceived feasibility, and likely uptake were assessed using agreement statements (survey) and open-ended questions (interviews and survey). Results: Interviewed clinic staff described the intervention as engaging, educational, and promising for improving client SRH knowledge and behaviors. Nearly all (95%) survey respondents said showing the video would be feasible. Most (56%) indicated likely uptake, which was significantly associated with perceived feasibility (P=.000), acceptability (P≤.001), and working at a public health clinic (P=.023). Implementation barriers included the video's potential relevance to only certain clients and the need for additional information or staff and/or management buy-in. Conclusions: This is the first study to assess perceived implementation facilitators and barriers of an entertainment-education video intervention among SRH clinic staff. The intervention was well received, with certain barriers potentially alleviated by offering information about entertainment-education and multiple implementation methods. These findings can help improve dissemination efforts for video-based entertainment-education interventions in clinics serving young women of color.

Perspectives from the pandemic epicenter: Sexual and reproductive health of immigrant women in New York City.

CONTEXT: The United States' response to COVID-19 created a policy, economic, and healthcare provision environment that had implications for the sexual and reproductive health (SRH) of racialized and minoritized communities. Perspectives from heterogenous immigrant communities in New York City, the pandemic epicenter in the United States (US), provides a glimpse into how restrictive social policy environments shape contraception, abortion, pregnancy preferences, and other aspects of SRH for marginalized immigrant communities. METHODS: We conducted in-depth interviews in 2020 and 2021 with 44 cisgender immigrant women from different national origins and 19 direct service providers for immigrant communities in New York City to explore how immigrants were forced to adapt their SRH preferences and behaviors to the structural barriers of the COVID-19 pandemic. We coded and analyzed the interviews using a constant comparative approach. RESULTS: Pandemic-related fears and structural barriers to healthcare access shaped shifts in contraceptive use and preferences among our participants. Immigrant women weighed their concerns for health and safety and the potential of facing discrimination as part of their contraceptive preferences. Immigrants also described shifts in their pregnancy preferences as rooted in concerns for their health and safety and economic constraints unique to immigrant communities. CONCLUSION: Understanding how immigrant women's SRH shifted in response to the structural and policy constraints of the COVID-19 pandemic can reveal how historically marginalized communities will be impacted by an increasingly restrictive reproductive health and immigration policy landscape.

Navigating challenges: a socioecological analysis of sexual and reproductive health barriers among Eritrean refugee women in Ethiopia, using a key informant approach.

OBJECTIVES: The study aimed to explore the experiences and perceptions of healthcare providers (HCPs) regarding the sexual and reproductive health (SRH) challenges of Eritrean refugee women in Ethiopia. DESIGN: A qualitative exploratory design with the key informant approach. SETTING AND PARTICIPANTS: The study was conducted in the Afar regional state, North East, Ethiopia. The study participants were HCP responsible for providing SRH care for refugee women. RESULTS: Eritrean refugee women have worse health outcomes than the host population. The SRH needs were found to be hindered at multiple layers of socioecological model (SEM). High turnover and shortage of HCP, restrictive laws, language issues, cultural inconsistencies and gender inequalities were among the main barriers reported. Complex multistructural factors are needed to improve SRH needs of Eritrean refugee women. CONCLUSIONS: A complex set of issues spanning individual needs, social norms, community resources, healthcare limitations and structural mismatches create significant barriers to fulfilling the SRH needs of Eritrean refugee women in Ethiopia. Factors like limited awareness, cultural taboos, lack of safe spaces, inadequate healthcare facilities and restrictive policies all contribute to the severe limitations on SRH services available in refugee settings. The overlap in findings underscores the importance of developing multilevel interventions that are culturally sensitive to the needs of refugee women across all SEM levels. A bilateral collaboration between Refugees and Returnees Service (RRS) structures and the Asayta district healthcare system is critically important.

"It Means Being Safe, Having Power over One's Body": Black Female Adolescent Experiences with Reproductive Health Counseling in Primary Care.

STUDY OBJECTIVE: There is limited research examining the sexual and reproductive health (SRH) care needs and experiences of Black adolescents who are assigned female at birth (AFAB). This study aimed to understand the perspectives of Black AFAB adolescents in their receipt of SRH counseling in primary care and elicit preferences for SRH-related communication with clinicians. METHODS: We interviewed English-speaking Black AFAB adolescents, ages 13-17, living in North Carolina between February and June 2022 about their SRH care experiences. The interviews were conducted via video conferencing, audio-recorded, professionally transcribed, and analyzed using a thematic approach. RESULTS: We interviewed 23 adolescents (mean age 15.8 years) across 10 geographically diverse counties in North Carolina. Most conveyed positive perceptions of clinicians regarding trust and comfort. However, many expressed concerns about clinicians not doing enough to ensure patient confidentiality, provide them with enough information to make informed and autonomous decisions, and destigmatize discussing SRH issues during the clinical encounter. Suggested improvements include sociodemographic congruence between patients and clinicians (eg, younger Black women), ensuring time alone with clinicians across adolescence, and proactively sharing information to promote respect and autonomy. CONCLUSION: Although Black AFAB adolescents had positive perceptions of their health care providers regarding relational components of care, many participants shared significant gaps and areas for improvement in the quality of care received to better align services with their preferences for SRH care. These findings can inform the development of SRH counseling best practices and clinician education to support respect and autonomy, which are routinely denied to Black AFAB adolescents.

"I care about sex, I care about my health": A mixed-methods pre-test of a HIV prevention mobile health app for Black women in the southern United States.

BACKGROUND: Black women experience higher rates of adverse sexual and reproductive health and HIV outcomes, however the use of mHealth to address these health disparities in this population has been inadequate. This study involved a one-month pre-test with Black women living in metro-Atlanta to evaluate the usability, acceptability, and engagement of an HIV prevention app SavvyHER. METHODS: An explanatory mixed-methods design was employed in which quantitative data was collected through weekly cross-sectional surveys, and qualitative data was collected through semi-structured in-depth interviews. Descriptive and ANOVA analysis was conducted for the quantitative data using STATA software. Qualitative data was analyzed through qualitative descriptive methods on Atlas.ti. RESULTS: Participants had high levels of acceptability towards the app and used SavvyHER moderately. The most frequently used features were live groups (2.96 ±0.22, 95% CI 2.51,3.41), viewing resources and educational information (2.77 ± 0.21, 95% CI 2.33,3.20), and mental health monitoring (2.73 ±0.21, 95% CI 2.29,3.12). The least used features were pregnancy symptom monitoring (1.92 ±0.27, 95% CI 1.38,2.47) and STI symptom monitoring (2.0 ±0.25, 95% CI 1.48,2.52). In qualitative interviews, several women discussed how the ability to engage in active discussions and join live sessions with other end-users was a favorable aspect of SavvyHER. Although the app's primary focus was on sexual and reproductive health and HIV prevention, women were more likely to access mental health monitoring and physical activity monitoring features. Women expressed their fondness of the app design and interface as it was reflective of the diversity of Black women. CONCLUSION: Further research is needed to explore the efficacy in using SavvyHER and additional mHealth interventions to enhance Black women's sexual and reproductive health and overall wellness.

Demographic and epidemiological transitions and burden of adolescent healthcare in sub-Saharan Africa: A review.

This review's main objective is to discuss how demographic and epidemiological transitions relate to the burden of adolescent healthcare in sub-Saharan Africa (SSA). The review explicitly discussed the burden of adolescent healthcare, the current African policies on adolescent healthcare, and gaps in the African policies compared with Europe and North America. We also examined how adolescent healthcare policies evolve and documented the recommended essential part of the policy for enhancing its sustainability. The burden of adolescent health is high in SSA with diseases and reproductive health-related problems prevailing among adolescents. However, variations exist in the burden of adolescent healthcare across countries in the region. While some SSA countries are currently undergoing demographic and epidemiological transition processes concerning adolescent health care, the majority are either at an early stage of the transition or yet to commence the process. Policy-makers should consider effective ways to improve adolescents' health in SSA through preventive mechanisms and a multi-dimensional approach.

Comparing American Indian/Alaska Native Adolescent Daughters' and Their Mothers' Awareness, Knowledge, Attitudes, and Behaviors Regarding Risk for Gestational Diabetes: Implications for Mother-Daughter Communication on Reproductive Health.

PURPOSE: The purpose of the study was to describe, compare, and examine associations at baseline of reproductive health awareness, knowledge, health beliefs, communication and behaviors related to gestational diabetes (GDM) and GDM risk reduction in a vulnerable population of both American Indian/Alaska Native (AIAN) adolescent girls and their mothers. METHODS: Descriptive/comparative/correlational analyses examined multitribal baseline data on 149 mother-daughter (M-D) dyads (N = 298; daughter age = 12-24 years) enrolled in a longitudinal study to adapt and evaluate a culturally relevant diabetes preconception counseling (PC) program (Stopping-GDM). The associations between GDM risk reduction awareness, knowledge, health beliefs, and behaviors (eg, daughters' eating, physical activity, reproductive-health [RH] choices/planning, M-D communication, daughters' discussions on PC) were examined. Data collected online from 5 national sites. RESULTS: Many M-D lacked awareness/knowledge of GDM and risk reduction. Both M-D were unaware of the girl's risk for GDM. Mothers' knowledge and beliefs on GDM prevention/RH were significantly higher than daughters. Younger daughters had greater self-efficacy healthy living. Overall sample reported low to moderate scores for both M-D communication and daughters' GDM and RH risk-reduction behaviors. CONCLUSIONS: Knowledge, communication, and behaviors to prevent GDM were low in AIAN M-D, especially daughters. More than daughters, mothers perceive greater risk of GDM for daughters. Early culturally responsive dyadic PC programs could help decrease risk of developing GDM. Implications for M-D communication is compelling.

Recognizing racial and ethnic disparities in women's reproductive health is not enough.

This Views and Reviews is a compilation of reports summarizing the published literature describing racial and ethnic disparities in polycystic ovary syndrome, fibroids, endometriosis, assisted reproductive technology, and disorders of mental health in women. The disparities are unique for each of these conditions and encompass disease prevalence and severity, access to care, and the outcomes of treatment.

Necesidades en salud sexual y reproductiva en migrantes de origen venezolano en el municipio de Cali (Colombia) / Sexual and reproductive health needs of Venezuelan migrants in the municipality of Cali, Colombia / Necessidades de saúde sexual e reprodutiva de migrantes de origem venezuelana no município de Cali (Colômbia)

RESUMEN Objetivo. Este estudio busca comprender las necesidades asociadas con la salud sexual y reproductiva (SSR) de migrantes de origen venezolano asentados de forma temporal o permanente en Santiago de Cali, Colombia. Método. Se realizó un estudio cualitativo con migrantes de origen venezolano de entre 15 y 60 años. Los participantes se seleccionaron mediante la técnica de bola de nieve, y la recopilación de la información se inició con personas referenciadas por las organizaciones de personas migrantes y luego con recorridos en zonas de alta concentración de personas migrantes de origen venezolano. Se realizaron entrevistas en profundidad y análisis de contenido temático. Resultados. Participaron 48 personas migrantes, de las cuales 70,8% no tenía regularizada su condición migratoria y se hallaban en condiciones de vulnerabilidad socioeconómica. Las personas participantes contaban con pocos recursos económicos, tenían falta de oportunidades de trabajo, precariedad de capital humano y niveles variables de capital social, sumado a una integración social débil que limitaba su apropiación como titulares de derechos. El estatus migratorio se constituye en una barrera para el acceso a los servicios de salud y otros servicios sociales. Sobresalen las necesidades de información sobre derechos de salud sexual y reproductiva, un mayor riesgo entre jóvenes de 15 y 29 años y en la comunidad LGBTIQ+, debido a la mayor vulnerabilidad y la exposición a espacios inseguros para su autocuidado, aseo personal e intimidad, necesidades de atención y tratamiento de infecciones de transmisión sexual, apoyo psicosocial por violencia, consumo de sustancias psicoactivas, conflictos familiares y procesos de transición de género. Conclusiones. Las necesidades en temas de salud sexual y reproductiva de las personas migrantes de origen venezolano están determinadas por sus condiciones de vida y trayectorias migratorias.

ABSTRACT Objective. This study seeks to understand the needs associated with the sexual and reproductive health of migrants of Venezuelan origin settled temporarily or permanently in Santiago de Cali, Colombia. Methods. A qualitative study was conducted with Venezuelan migrants between 15 and 60 years old. Participants were selected using the snowball technique. Information was initially gathered from people identified by migrant organizations, followed by information gathering in areas with high concentrations of migrants of Venezuelan origin. In-depth interviews were held, and thematic content was analyzed. Results. Of the 48 migrants who participated, 70.8% did not have legal migratory status and were living in conditions of socioeconomic vulnerability. The participants had scarce economic resources, a lack of job opportunities, precarious human capital, and varying levels of social capital, coupled with weak social integration that limited their awareness and appropriation of their rights. Immigration status constituted an access barrier to health services and other social services. There was a particular need for information on sexual and reproductive health rights, with increased risk among young people 15 to 29 years old and members of the LGBTIQ+ community, due to their greater vulnerability and exposure to unsafe spaces for self-care, personal hygiene, and privacy, in addition to their greater need for health care, treatment of sexually transmitted infections, psychosocial support for violence, substance abuse, family conflicts, and gender transition processes. Conclusions. The sexual and reproductive health needs of Venezuelan migrants are determined by their living conditions and migratory experiences.

RESUMO Objetivo. Compreender as necessidades associadas à saúde sexual e reprodutiva (SSR) dos migrantes de origem venezuelana estabelecidos temporária ou permanentemente em Santiago de Cali, Colômbia. Método. Foi realizado um estudo qualitativo com migrantes de origem venezuelana entre 15 e 60 anos. Os participantes foram selecionados pela técnica de bola de neve. A coleta de informações começou com pessoas encaminhadas por organizações de migrantes e, posteriormente, percorrendo áreas com alta concentração de migrantes de origem venezuelana. Foram realizadas entrevistas em profundidade e análise de conteúdo temático. Resultados. Participaram 48 migrantes, dos quais 70,8% não tinham sua situação imigratória regularizada e se encontravam em situação de vulnerabilidade socioeconômica. Os participantes tinham poucos recursos econômicos, falta de oportunidades de trabalho, capital humano precário e níveis variáveis de capital social, somados a uma fraca integração social que limitava a efetivação dos direitos dos quais são titulares. O status migratório é uma barreira ao acesso aos serviços de saúde e outros serviços sociais. Destacam-se as necessidades de informação sobre direitos à saúde sexual e reprodutiva, maior risco entre jovens de 15 a 29 anos e na comunidade LGBTIQ+ - devido à maior vulnerabilidade e exposição a espaços inseguros para autocuidado, higiene pessoal e privacidade -, necessidade de cuidados e tratamento de infecções sexualmente transmissíveis, apoio psicossocial em casos de violência, consumo de substâncias psicoativas, conflitos familiares e processos de transição de gênero. Conclusões. As necessidades em matéria de saúde sexual e reprodutiva dos migrantes de origem venezuelana são determinadas por suas condições de vida e trajetórias migratórias.

Racism and the Reproductive Health Experiences of U.S.-Born Black Women.

OBJECTIVE: To explore Black women's lived experiences of racism and the associated effects on reproductive health decisions and the reproductive health care experience. METHODS: We recruited participants through social media and community outreach. We conducted semi-structured individual interviews focusing on Black women's lived experiences of racism and their effects on reproductive health. We coded and analyzed interview transcripts using process coding methodology. RESULTS: Participants (N=21) were 21-45 years old and from Boston, Chicago, and Atlanta. Our primary themes were: 1) reproductive health racism across the life course, 2) anti-Black racism in the reproductive health care system, and 3) self-protective actions when interacting with the reproductive health care system. Reproductive racism across the life course included subthemes of early sexualization of Black women, heightened awareness of reproductive health inequities, and knowledge of reproductive oppression. Anti-Black racism in the reproductive health care system included subthemes of absence of shared decision making; vicarious reproductive health experiences; stereotyping, invalidation, and dismissal by reproductive health professionals; and medical mistrust. Participants guarded themselves against racism within reproductive health care by engaging in a variety of self-protective actions including seeking a health care professional of color, overpreparing for their appointments, enlisting advocates, seeking care only when desperate, and heightening symptoms to be heard. CONCLUSION: Personal, vicarious, and historical experiences of racism within reproductive health care triggered participants to perform self-protective actions when interacting with the reproductive health care system. These actions served to promote safety, autonomy and rehumanization within a system that has historically and contemporarily devalued Black reproductive health.

Applying a Nursing Perspective to Address the Challenges Experienced by Cisgender Women in the HIV Status Neutral Care Continuum: A Review of the Literature.

ABSTRACT: The field of HIV research has grown over the past 40 years, but there remains an urgent need to address challenges that cisgender women living in the United States experience in the HIV neutral status care continuum, particularly among women such as Black women, who continue to be disproportionately burdened by HIV due to multiple levels of systemic oppression. We used a social ecological framework to provide a detailed review of the risk factors that drive the women's HIV epidemic. By presenting examples of effective approaches, best clinical practices, and identifying existing research gaps in three major categories (behavioral, biomedical, and structural), we provide an overview of the current state of research on HIV prevention among women. To illustrate a nursing viewpoint and take into account the diverse life experiences of women, we provide guidance to strengthen current HIV prevention programs. Future research should examine combined approaches for HIV prevention, and policies should be tailored to ensure that women receive effective services that are evidence-based and which they perceive as important to their lives.

Regional and ethnic differences in semen quality and reproductive hormones in Russia: A Siberian population-based cohort study of young men.

BACKGROUND: This is the first large-scale Russian study describing semen quality and reproductive hormone levels among young men. OBJECTIVES: The aim of the study was to compare semen quality and reproductive hormone levels in young men of four cities and three ethnic groups living in the Siberian region of Russia and to find out ethnic or environmental reasons for regional differences. MATERIALS AND METHODS: The study population consisted of 1291 young men from Novosibirsk, Kemerovo, Ulan-Ude, and Yakutsk, including 1013 men of three most numerous ethnic groups: Slavs, Buryats, and Yakuts. Each participant provided one sperm and blood sample, information about lifestyle and ethnicity. Anthropometric parameters, semen quality and reproductive hormone levels, were evaluated. RESULTS: Significant regional and ethnic differences were detected for semen and reproductive hormone parameters. Median sperm concentrations in Novosibirsk, Kemerovo, Ulan-Ude, and Yakutsk were 54.6, 39.9, 34.7, 33.1 × 106 /ml; total sperm counts-202.5, 138.7, 97.9, 93.4 × 106 ; percentages of morphologically normal spermatozoa-7.8%, 6.5%, 6.3%, 5.0%, respectively. Median sperm concentrations in Slavs, Buryats, and Yakuts were 43.7, 37.0, 30.6 × 106 /ml; total sperm counts-150.0, 102.3 and 74.8 × 106 ; percentages of morphologically normal spermatozoa-6.8%, 6.8%, 4.8%, respectively. DISCUSSION: The young men in Novosibirsk and Kemerovo, populated by Slavs, had a higher semen quality compared to Ulan-Ude and Yakutsk, populated by Buryats and Yakuts, apparently due to the higher testicular function in Slavic compared to Asian ethnicity. Impaired spermatogenesis in young men in Kemerovo compared to Novosibirsk, located in the same climatic zone and having a socio-cultural and ethnic identity, may be due to the influence of a polluted environment. CONCLUSION: The findings suggest that ethnic composition and environment may be responsible for regional differences in semen and reproductive hormone parameters.

A review of the literature on sexual and reproductive health of African migrant and refugee children.

BACKGROUND: Migration and involuntary displacement of children and young people have recently become common features of many African countries due to widespread poverty, rapid urbanization, joblessness, and instability that motivate them to seek livelihoods away from their places of origin. With limited education and skills, children become vulnerable socioeconomically, thereby exposing themselves to sexual and reproductive health (SRH) risks. METHODS: Against this background, the authors undertook a scoping review of the existing literature between January and June 2019 to highlight current knowledge on SRH of African migrant and refugee children. Twenty-two studies that met the inclusion criteria were reviewed. RESULTS: The results identified overcrowding and sexual exploitation of children within refugee camps where reproductive health services are often limited and underutilized. They also reveal language barriers as key obstacles towards young migrants' access to SRH information and services because local languages used to deliver these services are alien to the migrants. Further, cultural practices like genital cutting, which survived migration could have serious reproductive health implications for young migrants. A major gap identified is about SRH risk factors of unaccompanied migrant minors, which have received limited study, and calls for more quantitative and qualitative SRH studies on unaccompanied child migrants. Studies should also focus on the different dimensions of SRH challenges among child migrants differentiated by gender, documented or undocumented, within or across national borders, and within or outside refugee camps to properly inform and situate policies, keeping in mind the economic motive and spatial displacement of children as major considerations. CONCLUSION: The conditions that necessitate economic-driven migration of children will continue to exist in sub-Saharan Africa. This will provide fertile grounds for child migration to continue to thrive, with diverse sexual and reproductive health risks among the child migrants. There is need for further quantitative and qualitative research on child migrants' sexual and reproductive health experiences paying special attention to their differentiation by gender, documented or undocumented, within or across national borders and within or outside refugee camps.

Child migration is increasingly becoming a common feature of many African countries as children migrate within and away from their countries of origin in search of better livelihoods due to widespread poverty, instability and rapid urbanisation. Many of the migrating children have little or no education and limited employable skills, thereby exposing themselves to sexual and reproductive health (SRH) risks. This paper is a scoping review of existing literature from 2000 to 2019 to document relevant findings on SRH of African migrant and refugee children.The review identified migrant children within refugee camps to experience overcrowding and sexual exploitation amidst limited and underutilized reproductive health services. Language barriers are also key obstacles against young migrants' access to SRH information and services as these services are delivered in local languages unfamiliar to them. Child migrants continue to suffer from cultural practices including genital cutting with serious reproductive health implications. SRH risk factors of unaccompanied migrant minors remain as a gap in the review and, therefore, more SRH studies on unaccompanied child migrants are needed. Attention should also be paid to the different dimensions of SRH challenges among child migrants to reflect gender differences, whether documented or undocumented, within or across national borders, and within or outside refugee camps for better understanding.In conclusion, child migration in Africa will continue to be economic-driven and will expose the actors to diverse sexual and reproductive health risks. Further in-depth quantitative and qualitative research is required to inform relevant policies on child migrants' SRH.

Nomadic Tibetan women's reproductive health: findings from cross-sectional surveys with a hard-to-reach population.

BACKGROUND: Western China has undergone substantial sociodemographic change, yet little is known about the health status of ethnic minority populations living in these areas. METHODS: We report findings from two cross-sectional surveys conducted with female Tibetan nomads living in rural areas of Western China/Eastern Tibet. We present results of descriptive analyses of data collected from reproductive-aged females who attended community health fairs in 2014 (n = 193) and 2016 (n = 298). RESULTS: On average, sexual debut preceded marriage among study participants, with fertility near replacement levels (2.7 and 2.1 in 2014 and 2016, respectively). Contraceptive use was common, and dominated by use of IUDs and female sterilization. Although over three-quarters (76%) of 2016 survey participants reported ever having at least one sexually transmitted infection (STI) symptom, there was low awareness of STIs (59%) and action to prevent STIs (21%). Younger women (< 40) were more likely to report having had had an STI symptom, as compared to older women (84% versus 71%; p < 0.05). CONCLUSIONS: We demonstrate feasibility of collecting data with this hard-to-reach population. Reporting of STI symptoms warrants further investigation to identify and address health conditions in this population of Tibetan nomadic women, especially amidst broader social and contextual changes that may affect the Tibetan population.

Western China has undergone substantial sociodemographic change, yet little is known about the health status of ethnic minority populations living in these areas. We report findings from two cross-sectional surveys conducted with female Tibetan nomads living in rural areas of Western China/Eastern Tibet. We present results of descriptive analyses of data collected from reproductive-aged females who attended community health fairs in 2014 (n = 193) and 2016 (n = 298). On average, sexual debut preceded marriage among study participants, with fertility near replacement levels (2.7 and 2.1 in 2014 and 2016, respectively). Contraceptive use was common, and dominated by use of IUDs and female sterilization. Although over three-quarters (76%) of 2016 survey participants reported ever having at least one sexually transmitted infection (STI) symptom, there was low awareness of STIs (59%) and action to prevent STIs (21%). Younger women (less than 40 years old) were more likely to report having had had an STI symptom, as compared to women over 40 years old (84% versus 71%; p < 0.05). We demonstrate feasibility of collecting data with this hard-to-reach population. Reporting of STI symptoms warrants further investigation to identify and address health conditions in this population of Tibetan nomadic women, especially amidst broader social and contextual changes that may affect the Tibetan population.

The politest form of racism: sexual and reproductive health and rights paradigm in Canada.

The Canadian national identity is often understood as what it is not; American. Inundation with American history, news, and culture around race and racism imbues Canadians with a false impression of egalitarianism, resulting in a lack of critical national reflection. While this is true in instances, the cruel reality of inequity, injustice and racism is rampant within the Canadian sexual and reproductive health and rights realm. Indeed, the inequitable health outcomes for Black, Indigenous and people of color (BIPOC) are rooted in policy, research, health promotion and patient care. Built by colonial settlers, many of the systems currently in place have yet to embark on the necessary process of addressing the colonial, racist, and ableist structures perpetuating inequities in health outcomes. The mere fact that Canada sees itself as better than America in terms of race relations is an excuse to overlook its decades of racial and cultural discrimination against Indigenous and Black people. While this commentary may not be ground-breaking for BIPOC communities who have remained vocal about these issues at a grassroots level for decades, there exists a gap in the Canadian literature in exploring these difficult and often underlying dynamics of racism. In this commentary series, the authors aim to promote strategies addressing systemic racism and incorporating a reproductive justice framework in an attempt to reduce health inequities among Indigenous, Black and racialized communities in Canada.

Reproductive health interventions for Inuit youth in the north: a scoping review.

BACKGROUND: Inuit have thrived in the northern regions of Canada and Alaska for thousands of years. Recent evidence suggests that Inuit in this region have experienced systemic barriers to reproductive health with resulting disparities in reproductive health-related outcomes including those among youth. Northern youth-focused reproductive health intervention research or evaluations have not to date been well summarized. The objective of this scoping review was to summarize the literature over the past twenty years focusing on reproductive health interventions for adolescents in northern Inuit communities. METHODS: English-language articles from 2000 to 2020 were identified from seven scientific databases, a general internet search and a review of relevant websites. Two reviewers screened titles, abstracts and full texts and included articles if they mentioned a reproductive health intervention and pertained, directly or indirectly, to reproductive health for Inuit aged 10-19 in northern communities. RESULTS: Seventeen articles met the inclusion criteria, across six themes: (1) Barriers to reproductive health interventions in the north; (2) Northern midwifery; (3) Northern birthing centres; (4) Fetal fibronectin tests for identifying high-risk pregnancies; (5) Prenatal education classes; and (6) Interventions to improve access to and quality of reproductive health supports. CONCLUSION: Overall there is relatively limited evidence base specific to reproductive health interventions and northern Inuit youth. What does exist largely focuses on maternal health interventions and is inclusive of but not specific to youth. There is some evidence that youth specific educational programs, participatory action research approaches and the promotion of northern birthing centres and midwifery can improve reproductive health for adolescents and young mothers in northern Inuit communities. Future initiatives should focus on the creation and evaluation of culturally relevant and youth specific interventions and increasing community and youth participation in intervention research for better reproductive health.

Reproductive Health Disparities in the USA: Self-Reported Race/Ethnicity Predicts Age of Menarche and Live Birth Ratios, but Not Infertility.

Self-identified race/ethnicity and socioeconomic status (SES) contribute to disparities in several health domains, although research on their effects on women's reproductive function has largely focused on links between SES and age of menarche. Here, we assessed whether race/ethnicity, SES, and downstream correlates of SES such as food security and health-insurance security are associated with age of menarche, infertility, and live birth ratios (ratios of recognized pregnancies resulting in live births) in the USA. We used cross-sectional data from 1694 women aged 12-18 years for menarche (2007-2016), 974 women aged 23-45 for infertility (2013-2016), and 1714 women aged 23-45 for live birth ratios (2007-2016) from the National Health and Nutrition Examination Survey. We estimated multiple linear and logistic regressions with survey weights to test these associations. When controlling for lifestyle (activity levels, smoking, alcohol consumption) and physiological factors (diabetes, weight status), non-Hispanic (NH) black and Hispanic girls reported a significantly lower age of menarche by about 4.3 (standard error [SE] = 0.08, p < 0.001), and 3.2 months (SE = 0.09, p < 0.001), respectively, relative to NH white girls. NH black women reported live birth ratios 9% (SE = 0.02, p < 0.001) lower than NH white women. Women with unstable health insurance reported live birth ratios 6% (SE = 0.02, p = 0.02) lower than women with stable health insurance. Race/ethnicity, SES, and its downstream correlates were not associated with infertility. One hypothesized explanation for observed disparities in age of menarche and live birth ratios is the embodiment of discrimination faced by NH black women within the USA. Our findings also underscore the importance of health insurance access for favorable reproductive health outcomes. Future work should elucidate the role of embodied discrimination and other downstream correlates of SES in modulating women's reproductive health outcomes to inform strategies to mitigate health disparities.

Fertility characteristics and related factors impacting on Syrian refugee women living in Istanbul.

BACKGROUND: Women's fertility characteristics are affected by many different factors. AIM: To gain an awareness of fertility characteristics of Syrian refugee women and the influential factors. METHODS: This study was planned as a cross-sectional study to determine the efficiency and related factors of Syrian refugees living in Istanbul. The survey of 300 refugee women applying Arabs who migrated to Turkey, Kurds, Turkmen and Yezidi origin they receive. RESULT: Average age of the women studied was 34.26 ± 10.15, 34.6% of the participants had not received any education, 37% had less than two-year inter-pregnancy interval, 58.6% have not received "Safe Motherhood" service, 43.6% have conceived their last child unwillingly. Women in the study group had in average 3±2,4 children and the number of children they wanted was 3±1,59. These values were substantially affected negatively by the women's education level and positively by the income level. Yezidis had significantly more children than other ethnic groups and did not have a "religious ban" on voluntary abortion. CONCLUSION: It has been noted that fertility characteristics of refugee women who migrated to Turkey changed according to their ethnic backgrounds and were sustained in the country they migrated to. Along with harsh living conditions and insufficient access to health services the situation has been observed to pose serious risks on reproductive health.