Exploring the experiences of English-speaking women who have moved to Israel and subsequently used Israeli fertility treatment services: A qualitative study.

BACKGROUND: Israel's pronatalist cultures result in a social expectation to have children and drive Israel's fertility rate of 2.9. Israeli policy reflects this through funding unlimited fertility treatment up to two children. Societal pressure to have children exacerbates challenges of fertility treatment. Furthermore, the lack of financial burden creates a culture of perseverance following treatment failures. Whilst the experiences of Israeli women using fertility treatment have been studied, the experiences of women who migrated to Israel and were therefore raised in a different society have not. This study aimed to address this gap in knowledge. METHODS: A qualitative study using semi-structured interviews to investigate the experiences of 13 English-speaking women who utilised Israeli state funded fertility treatment. Participants were located across Israel and were recruited using purposive sampling through social media. Data was analysed using framework analysis. RESULTS: Despite not being aimed at specific ethnic or religious groups, all respondents were Jewish. Three themes were identified: 1. Systemic factors: The lack of financial burden was positive, however, participants struggled to navigate the bureaucratic healthcare system, especially when experiencing a language barrier. 2. Influence of others: Encountering a cold bedside manner alongside contending with the expectations of a pronatalist society was challenging. Participants utilised support from other migrants who appreciated the same culture shock. Understanding of healthcare professionals regarding shared religious values further improved treatment experiences. 3. Impact of journey: Participants often withdrew socially and the treatment process implicated upon their lives, jobs and relationships. CONCLUSION: Navigating a bureaucratic system and pronatalist society are difficulties associated with fertility treatment in Israel. The lack of financial burden and an understanding of religious and cultural beliefs by healthcare providers improved treatment experience. Better provision of resources in English and further research into supporting women who are navigating Israel's pronatalist society is required.

Effectiveness and safety of COVID-19 vaccines on maternal and perinatal outcomes: a systematic review and meta-analysis.

OBJECTIVE: To assess the effects of COVID-19 vaccines in women before or during pregnancy on SARS-CoV-2 infection-related, pregnancy, offspring and reactogenicity outcomes. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Major databases between December 2019 and January 2023. STUDY SELECTION: Nine pairs of reviewers contributed to study selection. We included test-negative designs, comparative cohorts and randomised trials on effects of COVID-19 vaccines on infection-related and pregnancy outcomes. Non-comparative cohort studies reporting reactogenicity outcomes were also included. QUALITY ASSESSMENT, DATA EXTRACTION AND ANALYSIS: Two reviewers independently assessed study quality and extracted data. We undertook random-effects meta-analysis and reported findings as HRs, risk ratios (RRs), ORs or rates with 95% CIs. RESULTS: Sixty-seven studies (1 813 947 women) were included. Overall, in test-negative design studies, pregnant women fully vaccinated with any COVID-19 vaccine had 61% reduced odds of SARS-CoV-2 infection during pregnancy (OR 0.39, 95% CI 0.21 to 0.75; 4 studies, 23 927 women; I2=87.2%) and 94% reduced odds of hospital admission (OR 0.06, 95% CI 0.01 to 0.71; 2 studies, 868 women; I2=92%). In adjusted cohort studies, the risk of hypertensive disorders in pregnancy was reduced by 12% (RR 0.88, 95% CI 0.82 to 0.92; 2 studies; 115 085 women), while caesarean section was reduced by 9% (OR 0.91, 95% CI 0.85 to 0.98; 6 studies; 30 192 women). We observed an 8% reduction in the risk of neonatal intensive care unit admission (RR 0.92, 95% CI 0.87 to 0.97; 2 studies; 54 569 women) in babies born to vaccinated versus not vaccinated women. In general, vaccination during pregnancy was not associated with increased risk of adverse pregnancy or perinatal outcomes. Pain at the injection site was the most common side effect reported (77%, 95% CI 52% to 94%; 11 studies; 27 195 women). CONCLUSION: COVID-19 vaccines are effective in preventing SARS-CoV-2 infection and related complications in pregnant women. PROSPERO REGISTRATION NUMBER: CRD42020178076.