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The aim of this International Menopause Society White Paper on premature ovarian insufficiency (POI) is to provide the latest information regarding this distressing condition. The impact of POI has far-reaching consequences due to its impact on general, psychological, and sexual quality of life, fertility prospects, and long-term bone, cardiovascular, and cognitive health. Progress in fully understanding the etiology, diagnosis, and optimal management options has been slow thus far due to the complexity of the condition and fragmented research. Recent advances in epidemiological and genetic research have improved our understanding of this condition and randomized prospective trials are being planned to determine the intervention strategies, which will optimize quality of life and long-term well-being. The International Menopause Society has commissioned a number of experts at the forefront of their specialty to define the state of the art in the understanding of this condition, to advise on practical management strategies, and to propose future research strategies. It is hoped that a global task force will subsequently be convened in order to formulate a consensus statement across key societies, to accelerate date collection and analysis of a global POI registry, and to facilitate progress in the key defined areas of research. [ABSTRACT FROM AUTHOR]

Transgender and gender non-conforming individuals have historically experienced discrimination accessing reproductive rights. This transcends into the ways in which the current systems of healthcare are structured to continue perpetuating the marginalization of this population of gender diverse persons, specifically as it relates to reproductive care. Throughout this paper, we will utilize a reproductive justice framework to explore ways in which transgender patients experience discrimination in unique ways through micro- and macroaggressions within the healthcare system based on the intersection of the reproductive healthcare services in which they are seeking, paying special attention to pregnancy and postpartum care, and their unique social identity. This paper will conclude with specific recommendations for how medical family therapists can impact healthcare systems by integrating trauma-informed care aligned with a reproductive justice framework. [ABSTRACT FROM AUTHOR]

Conscientious objection to provide abortion has been enshrined in laws and policies globally. Insufficient attention has been paid to the direct and indirect ways in which conscientious objection compromises women's access to a lawful abortion. Using a systematic search strategy, this narrative literature review synthesises the literature exploring conscientious objection's impact on women's access to abortion in a range of countries. This narrative literature review builds on an extensive literature review published by Chavkin et al. (2013. Conscientious objection and refusal to provide reproductive healthcare: A white paper examining prevalence, health consequences, and policy responses. International Journal of Gynecology & Obstetrics, 123, S41–S56. https://doi.org/10.1016/S0020-7292(13)60002-8). Searches were undertaken on the Medline (Ovid), Global Health, CINAHL, Scopus and Science Direct databases. Thirty six papers were included for thematic analysis. Conscientious objection to abortion was found to impact women's access to abortion at three main levels: the practitioner level, the healthcare system level and the sociocultural environment level. Conscientious objection was found to impact access directly through attempts by health professionals to restrict access, and indirectly by exacerbating pre-existing barriers to access. Further research is required to better quantify the extent to which this impacts women and whether interventions are effective in reducing the barriers that conscientious objection creates and exacerbates. [ABSTRACT FROM AUTHOR]

During this time, the review and hypothesis 'Oxidative versus reductive stress: a delicate balance for sperm integrity' with Dr. Boissonneault was in press and now leads the 2023 issue papers from the Editorial Board. SBiRM is pleased to welcome two new Editorial Board members, Dr. Adam Krieg, Oregon Health & Science University, who brings expertise in molecular development, cellular differentiation, and ovarian cancer, and Dr. Rebecca Poole, Texas A&M University, with expertise in hormonal and immunological changes in the microbiome. The six papers including current and former Board members are: a review 'Bioethics in human embryology: the double-edged sword of embryo research' led by Dr. Anifandis, that included contributions from fellow board members Drs. [Extracted from the article]

This paper untangles the complex realities of Sexual Reproductive Health and Rights education in Uganda based on a Participatory Action Research with staff and volunteers of an NGO. A detailed portrait is offered of the dilemmas faced by the team around value-contradictions in this culturally sensitive domain, the complex nature of change, programme targets and community expectations. Through double loop learning methodology, the Team reflected on their own mental models and strategies used in dealing with these dilemmas and reframed their action theories towards more effective collaboration with learners and community members. The research process and outcomes illustrate the transformative power of reflection and double loop learning; resulting in practical guidance for education NGOs facing dilemmas in community collaboration. [ABSTRACT FROM AUTHOR]

Introduction. South Africa has an enabling legislative and policy framework that promotes the protection of adolescents and young people's sexual and reproductive health and rights. Much of the literature in this field has identified discriminatory and hostile attitudes from healthcare workers as a major underlying factor to negative sexual and reproductive health outcomes for this age cohort. Not as well understood is the role of structural violence although this type of violence, through its structures of injustice and inequalities, is closely associated with stigma and discrimination. Data and sources. To contribute to closing this research gap, this paper draws on the findings of a larger qualitative study, specifically focus group discussions with young people aged 15–24 years. Results. The consequences of these attitudes within the structural violence framework are illuminated as are recommendations for enhancing access to sexual and reproductive health and services by adolescents and young people. Discussion and conclusion. Key among the latter is that young people's sexual and reproductive health needs and wellbeing should be pursued through a multisectoral approach that encompasses stigma reduction interventions involving the young people, families, and communities collaborating with healthcare workers. [ABSTRACT FROM AUTHOR]

New modes of neoliberal and rights-based reproductive governance are emerging across the world which either paradoxically foreclose access to universal health services or promote legislative reform without providing a continuum of services on the ground. These shifts present new opportunities for the expansion but also the limitation of abortion provision conceptually and ‘on-the-ground’, both in the Global North and South. The collection of papers in this special issue examine current abortion governance discourse and practice in historical, socio-political contexts to analyse the threat posed to women's sexual and reproductive health and rights globally. Focusing on abortion politics in the context of key intersectional themes of morality, law, religion and technology, the papers conceptually ‘re-situate’ the analysis of abortion with reference to a changing global landscape where new modes of consumption, rapid flows of knowledge and information, increasingly routinised recourse to reproductive technologies and related forms of bio-sociality and solidarity amongst recipients and practitioners coalesce. [ABSTRACT FROM AUTHOR]

Research conducted in various parts of the globe suggests that young people who can openly communicate with their parents about sexuality benefit in many ways. Correspondingly, in Bangladesh, the lack of an open communication on sexuality in the youth–parent relationship is considered a barrier to ensuring young people's sexual and reproductive health and overall well-being. Taking 'silence' as a core concept, this paper investigates what silence on sexuality means to Bangladeshi young people in their relationship with parents. It draws on findings from an ethnographic study conducted among 72 middle-class boys and girls aged between 15 and 19 years and 18 parents living in Dhaka over a year between 2016 and 2017. The findings suggest that silence is not always perceived as problematic by young people, and this is particularly true for topics related to sexual pleasure. This paper challenges the monolithic understanding that silence is necessarily bad and hinders young people from getting what they need. It offers an additional conceptual understanding to silence for studying sexuality among youths and designing interventions for their sexual and reproductive well-being. [ABSTRACT FROM AUTHOR]

Over the past decade, we have worked alongside storytellers to bring their stories into the world. These encounters have been challenging, exciting, and intimate. In this paper, we reflect on a digital/multimedia storytelling project in which we engaged with people who have experienced weight stigma in fertility, pregnancy, and motherhood care. We use the metaphors of story midwifery and surrogacy to describe the methodological-substantive interplay between what we do, how we do it, and what emerges in this (un)doing. In this reflexive and methodological paper, we engage with the affect and relationality of doing storywork. We reflect on and theorize around embeddedness, othering, belonging, power, shame, and joy in research encounters. Pragmatically, we consider how relational ethics combine with exhaustion and logistical challenges. Finally, we explore the tensions inherent to (co)producing stories at the boundaries of neoliberal academic temporalities and structures. [ABSTRACT FROM AUTHOR]

AbstractThere has been growing recognition of the need to address the sexual and reproductive health (SRH) needs of men and boys, including a need for more explicit guidance in domestic health policy and plans. This paper reports on a policy analysis, covering five East and Southern African countries, and discusses the extent and ways in which male clinical and non-clinical needs, and their roles in SRH are currently being reflected. It draws attention to the policy discourse, trends, and gaps in including men in the region as clients, partners and change agents to inform a way forward. [ABSTRACT FROM AUTHOR]

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Abortion is a common and safe gynaecological procedure. Yet in film and television it is disproportionately represented as risky, violent, requiring hospitalisation, and affecting young, white, wealthy women. This reinforces stigma, fear and misunderstanding surrounding the procedure. While the majority of television storylines still inaccurately portray abortion, a small minority are directly showing abortion and presenting it as a positive decision. This paper analyses four such storylines in the television shows Sex Education, Shrill, GLOW and Euphoria, as well as media discourse around these plotlines, to understand how contemporary, 'feminist' television shows are representing abortion. The paper argues that contemporary television is increasingly representing abortion in an empathetic way that upholds women's choice to access the procedure, but that these portrayals can be read as post-feminist. Individual choice and empowerment are prioritised in these shows at the expense of showing the complex and unequal power structures that affect how women make reproductive choices. 'Feminist' television still prioritises the abortion storylines of young, white women who face no obstacles to abortion access and so the realities of abortion are still not fully represented on screen. [ABSTRACT FROM AUTHOR]

Purpose: To reflect on the contributions of R. H. Mole to radiobiology. Robin Mole was a very active radiobiologist when the IJRB was first established and had two papers in the first few issues of the journal in 1959. Conclusions: R. H. Mole made significant contributions to radiobiology and is particularly associated with studies of the effects of low dose exposures on the reproductive health of mammals. Many of his ideas are still debated and remain controversial. [ABSTRACT FROM AUTHOR]

Scholarship on abortion travel has examined the places women travel between and why such journeys are necessary. However, there has been scant attention paid to the journeys themselves and how these journeys are undertaken. This paper uses William Walters' notion of 'viapolitics' to better attend to how people travel by focussing on the role of vehicles in abortion politics. This takes three parts: an exploration of the emotional and embodied journeys that women have to take to access abortions; the role of the vehicle as a site of political activism around abortion rights; and the transportation of abortion medication. Viapolitics has to date only been used within migration politics but as this paper shows, it has utility beyond this field to interrogate abortion travels and highlight the role of vehicles in abortion access as well as to explore how abortion transport can be emancipatory for women. This paper furthers viapolitics by arguing that we need to consider the journeys of 'things' and not just people. In the case of abortion access, it is the transportation of abortion medication rather than the travel of women that is the most socially just solution to discriminatory laws and extra-legal barriers. [ABSTRACT FROM AUTHOR]

This paper looks at how shame functions in the teaching of sexual and reproductive health and rights in the classrooms for 13–19 year-olds in secondary schools in Bangladesh. Using the theoretical framework of affect, the paper looks at shame and other experiences of discomfort and hesitation among teachers while teaching these topics to young people. Drawing insights from 25 in-depth interviews with teachers in secondary schools in urban, semi-urban and rural settings, the paper explores how teachers deemed teaching certain topics as 'excessive', unnecessary and inappropriate in school settings. Teachers experience reluctance and discomfort in discussing culturally sensitive sexual and reproductive health and rights topics, and a persistent fear of being ridiculed and excluded from their community. By exploring how affect can be understood to initiate critical reflection about classroom norms, pedagogy and the role of teachers, the paper highlights the challenges for teachers who are seen as gatekeepers of sexual and reproductive health and rights knowledge, and brings forth a more nuanced reflection on the knowledge production process in classrooms. [ABSTRACT FROM AUTHOR]

Reproductive coercion (RC) can be conceptualized as any behavior that limits one's ability to make decisions about their reproductive health. Here, we broaden this definition to consider the impact of systemic and sociocultural factors on RC using an ecological model. Specifically, we use Bronfenbrenner's model as a framework for organizing the multilevel factors that influence reproductive coercion (RC) and its impacts on individual health. This paper is intended to offer a primer to historical, sociocultural, community, interpersonal, and individual processes that may interact to shape reproductive decision-making and its effect on individual health outcomes. We emphasize the importance of conceptualizing RC within the broader sociocultural and community context, and the potential implications for reproductive and sexual health research, clinical care, and policy in the United States. [ABSTRACT FROM AUTHOR]

The Sustainable Development Goals (SDGs) and the proclaimed vision of leaving no one behind are lauded for their transformative potential in redressing inequalities. Yet, too few are interrogations of the root causes and underpinning structures that keep uneven development in place. This paper reflects on this omission in relation to sexual and reproductive health and rights (SRHR) drawing on over three decades of professional experience in advancing SRHR enriched by literature sources. Engaging with the theme of the 9th Asia-Pacific Sexual and Reproductive Health and Rights Conference - Leave NO ONE Behind! Justice in Sexual and Reproductive Health, it asks what it would take to realise the pledge of universal access to SRH services and rights. With a focus on Southeast Asia, the paper offers an account of context-specific drivers of disparity and exclusion that preclude the attainment of comprehensive SRHR for all, and especially for stigmatised and marginalised groups. It then discusses the paradigm shift that needs to occur if the ideals of inclusiveness and equity as promised by the SDGs are to be attained in and through SRHR. [ABSTRACT FROM AUTHOR]

Over the past decade, there has been substantial progress towards integrating our understanding of social determinants of reproductive, maternal, newborn, child, and adolescent health (RMNCAH) into health planning and programs. For these programs, gender inequity remains one of the most harmful factors for women's access to healthcare. Designing RMNCAH programs to be gender-responsive through active engagement with and overcoming of gender-related barriers remains paramount to increasing women's access to and use of health programs. However, the integration of gender within RMNCAH programs and their evaluation is often non-existent or is limited in scope. Building on a prior framework for comprehensive gender analysis in RMNCAH, we discuss key steps used to incorporate a gender lens and analytical approach in the Real Accountability: Data Analysis for Results (RADAR) evaluation framework. In order to effectively address these key areas, gender must be integrated into all stages of the evaluation, including tool development and programmatic activities that are associated with each question. Our paper includes practical activities and tools that evaluators may use to integrate gender into their evaluation tools. [ABSTRACT FROM AUTHOR]

In this paper, we apply the reproductive justice framework to discuss how gendered racism disadvantages pregnant and parenting young Black women aging out of foster care. Specifically, we highlight the reversal of Roe v Wade as reflective of the United States' long legacy of efforts to control Black women's reproduction. We then discuss the structural factors contributing to the reproductive injustices of young Black women aging out of care, including a lack of access to sexual and reproductive health education, barriers to educational attainment, and foster care-based relational and placement deficits. We conclude with research, practice, and policy enhancements. [ABSTRACT FROM AUTHOR]

Despite the potential of leisure to shape the sexual behaviour of young people with disability, there is limited knowledge on the subject. This paper explores the influence of leisure on the sexual behaviour of young people with hearing and vision loss, using data from 2127 young people aged 10–24 years from all the 16 special schools for the deaf and the blind in Ghana. The findings revealed that young people with hearing and vision loss who engaged in leisure have a higher likelihood of engaging in kissing and casual sex with the odds being higher for those with vision loss. Young people with hearing loss who engaged in leisure were, however, more inclined towards sex with a regular partner. The findings illuminate the influence of informal spaces on the sexual behaviour of young people with disability, hence the need to consider such spaces in the provision of reproductive health education. [ABSTRACT FROM AUTHOR]

To conduct this review of primary care, we looked for related papers in PubMed from the last 15 years. WHO's initial concept of Health defined a condition of physical, mental, and social well-being, nowadays extended to quality of life. Infertility or not being able to form a family fits perfectly into the definition. Primary care is responsible for mandatory discussions about fertility as part of a broader aspect regarding reproductive health issues. Having children is a decision taken by heterosexual couples, same sex couples, or single individuals. Understanding factors associated with infertility help guiding propedeutic. Although woman's age is one of the main factors to influence treatment success rates, multifactorial male factor may contribute to 50 percent. Infertility consultations should include partners, alleviating the accompanying stress and anxiety. Anamnesis must focus on duration of infertility, primary or secondary, sexual activity, and lifestyle habits such as smoking, alcohol consumption, diet, physical activity, use of licit and/or illicit drugs, and occupational risks. Previous treatments should be accessed. Management of infertility by primary care is mandatory, and patients requiring specialized treatments must not have their journey protracted. Strategies and couple-based interventions are essential to continuity of care and close follow-up should follow these patients. [ABSTRACT FROM AUTHOR]

Dexamethasone is the first and an important therapy that significantly reduces the risk of death in patients with severe COVID-19 disease. Nevertheless, a lot of studies have revealed that it has adverse impacts on multiple systems of the body especially the reproductive system, and dexamethasone exposure during the human foetal period may be associated with various diseases. In this paper, we reviewed the literature regarding the adverse effects of COVID-19 and dexamethasone administration on the reproductive system as well as related disease pathogenesis, in an attempt to clarify the potential harms of dexamethasone treatment in COVID-19 patients. Overall, we strongly support the application of dexamethasone as a pharmaceutical therapy in critical COVID-19 patients before a better therapy is developed, but the adverse side effects that may arise cannot be ignored. Our review will help medical professionals in the prognosis and follow-up of patients treated with dexamethasone. In addition, given that a considerable amount of uncertainty, confusion and even controversy that still remains, further studies and more clinical trials are urgently needed to improve the understanding of the parameters and the effects of dexamethasone on reproductive function of patients with severe acute respiratory syndrome coronavirus 2 infection. [ABSTRACT FROM AUTHOR]

Interactive community-based theatre is used to engage with audience members and allow for free exchange of ideas relevant to context. It aims to bring about a new understanding of an issue while challenging people's attitudes and perceptions. Its application within the field of sexual and reproductive health has been limited, particularly in low and middle-income contexts. This paper presents the rationale for a research-arts partnership in Jordan and describes the process and some lessons learned from the development and country-wide performances of a research-informed interactive play. The play, Mish 'Ayb (Not a Shame) was designed to address social barriers to accessing sexual and reproductive services in a patriarchal society. The sensitive portrayal by Jordanian actors of real-life scenarios pertaining to specific health issues encouraged identification of the audience with the actors, thereby building trust. This process helped to uncover cultural norms that facilitate and impede people's access to health services and information. Qualitative research designs that incorporate interactive theatre present a strong potential avenue to explore sensitive topics related to sexuality, particularly in patriarchal contexts. [ABSTRACT FROM AUTHOR]

This paper explores the modern challenges hindering access to sexual health resources in the age of Big Tech and their impact on public health. Research data from sexual health organizations, Internet experts, and corporate financial documents shows instances of conflict between Big Tech's business model and the sexual health organizations' efforts to provide accurate information about sexually transmitted diseases and unplanned pregnancy prevention to the youth. Results show that as younger generations turn to the internet for sexual health resources, they are met with misinformation and roadblocks, enabled by the dominant corporations in the market. Sexual pleasure, for instance, remains an overlooked dimension of these resources despite the fact that it is important to people. In conclusion, given the rise in popularity of tech platforms, and the youth's reliance on them as basic information resources, Big Tech must be held accountable for its role and impact on public health, and collaborative closely and actively with sexual health experts to establish appropriate content moderation policies for sexual health content online. [ABSTRACT FROM AUTHOR]

Objectives: Despite billions of dollars in funding spent each year on sexual and reproductive health and rights (SRHR) and HIV programming, sexual pleasure is insufficiently addressed. This paper therefore has three key aims: (1) to introduce the concept of sexual pleasure in SRHR programming, while providing context regarding investment and research, (2) to introduce and situate an upcoming systematic review and meta-analysis to quantify whether and to what extent incorporating sexual pleasure into SRHR interventions can improve health outcomes, and (3) to examine the key practical, methodological, and theoretical challenges in carrying out such a review. Methods: We undertook a literature review and analysis of conference abstract publications to highlight the 'pleasure gap' in evidence in sexual and reproductive health and rights programming and research. We detailed the scope, search strategy and challenges for our subsequent systematic review. Results: This paper and the subsequent review highlights the need to equip the SRHR and HIV fields to better meet the needs of communities by considering key reasons people have sex, and understand the challenges of undertaking a review of this nature. Conclusions: We conclude that this a focus on pleasure is particularly pertinent in the context of the Sustainable Development Goals and the ratification of the declaration on sexual pleasure at the 2021 World Congress of the World Association for Sexual Health. [ABSTRACT FROM AUTHOR]

Mentorship is an important contributor to strengthening research capacity among health researchers. Formal mentorship programmes, targeting women mentees can help mitigate some of the gendered power dynamics and can also help early career researchers learn from others' experiences of navigating these challenges. In 2020, the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction at the World Health Organization launched a mentorship programme geared towards early career women researchers. This paper describes the process of designing and implementing a mentorship programme for early career women sexual and reproductive health and rights researchers from low- and middle-income countries including valuable lessons learned vis-à-vis existing evidence. Some of these findings have been incorporated into iterations of the programme launched in 2022. Critical points include: ensuring considerations for language and geographical distribution; allowing mentees to participate in the matching process; providing training and opportunities to network and learn from other participants; offering the support and structure for developing these relationships. Providing women researchers with the tools – through mentorship – to navigate the unique challenges they face in their career journeys, can have a lasting impact on research capacity. Countries and institutions committed to strengthening research capacity need to focus on the holistic growth and motivation of individuals in a way that ensures gender equality. [ABSTRACT FROM AUTHOR]

Menstrual health is important for adolescent girls and is particularly compromised in displaced communities due to restricted access to information and lack of private spaces to manage menstruation. Menarche is the biological and social milestone of girls' adolescence, marking the onset of puberty and confirming womanhood in many communities. It also marks a difficult transitional period influenced by socio-cultural beliefs and expectations. Menstrual preparedness is critical for this transition, and the lack of accurate, timely, age-appropriate information might impact current, and future reproductive health and well-being. This paper investigates the menstrual preparedness status of adolescents living in Palestinian refugee camps in the West Bank and Jordan. These are long-term refugee camps characterised by a variety of social, economic, and political constraints affecting the health of women and girls. We conducted 39 in-depth interviews and 23 focus-group discussions with adolescent girls. The study reveals inadequate menstrual preparedness among the participants, especially in pre-menarche. Among the barriers to adequate menstrual preparedness is a predominance of practical concerns, such as the use of sanitary pads and hygienic practices, socio-cultural norms that promote secrecy and taboo around menstruation, and divergent notions of timeliness of information among girls, their mothers, and teachers. The study contends that addressing the taboo around menstruation requires joint efforts by the family, school, and social services. Menstrual preparedness should begin early and encompass biological, practical, emotional, and psychological components. The paper advocates for Comprehensive, Contextually Relevant, Timely Menstrual Preparedness (CCTMP) policies and initiatives, empowering adolescent girls, their mothers, and educators. [ABSTRACT FROM AUTHOR]

Women receiving treatment for opioid use disorder have low levels of contraception use and high rates of unintended pregnancies, abortion and children being adopted or fostered. This paper aims to understand the relationship between contraceptive choice and power amongst women receiving Opioid Replacement Therapy (ORT). During 2016/17, semi-structured interviews were undertaken with 40 women (aged 22–49 years) receiving ORT in the South of England. Data relating to the latent concept of power were inductively coded and analysed via Iterative Categorisation. Power manifested itself through six interconnected 'fields': i. 'information about fertility and contraception'; ii. 'access to contraception'; iii. 'relationships with professionals and services'; iv. 'relationships with male partners'; v. 'relationships with sex work clients'; and vi. 'life priorities and preferences'. Each field comprised examples of women's powerlessness and empowerment. Even when women appeared to have limited power or control, they sometimes managed to assert themselves. Power in relation to contraceptive choice is multi-faceted and multi-directional, operating at both individual and structural levels. Informed decision-making depends on the provision of clear, non-judgemental information and advice alongside easy access to contraceptive options. Additional strategies to empower women to make contraceptive choices and prevent unplanned pregnancies are recommended. [ABSTRACT FROM AUTHOR]

Global health donors increasingly embrace international non-governmental organisations (INGOs) as partners, often relying on them to conduct political advocacy in recipient countries, especially in controversial policy domains like reproductive health. Although INGOs are the primary recipients of donor funding, they are expected to work through national affiliates or counterparts to enable 'locally-led' change. Using prospective policy analysis and ethnographic evidence, this paper examines how donor-funded INGOs have influenced the restrictive policy environments for safe abortion and family planning in South Sudan and Malawi. While external actors themselves emphasise the technical nature of their involvement, the paper analyses them as instrumental political actors who strategically broker alliances and resources to shape policy, often working 'behind the scenes' to manage the challenging circumstances they operate under. Consequently, their agency and power are hidden through various practices of effacement or concealment. These practices may be necessary to rationalise the tensions inherent in delivering a global programme with the goal of inducing locally-led change in a highly controversial policy domain, but they also risk inciting suspicion and foreign-national tensions. [ABSTRACT FROM AUTHOR]

The government of India introduced the Accredited Social Health Activist (ASHA) programme in 2006 to connect marginalised communities to the health system. ASHAs are mandated to increase the uptake of modern contraception through the doorstep provision of services. There is currently no evidence on the impact of ASHAs on the uptake of contraception at the national level. This paper examines the impact of ASHAs on the uptake of modern contraception using nationally representative National and Family Health Survey data collected in 2019– 21 in India. A multilevel logistic regression analysis was performed to determine the effect of contact with ASHAs on the uptake of modern contraception, controlling for regional variability and socio-demographic variables. The data provide strong evidence that ASHAs have succeeded in increasing modern contraceptive use. Women exposed to ASHAs had twice the odds of being current users of modern contraception compared to those with no contact, even after controlling for household and individual characteristics. However, only 28.1% of women nationally reported recent contact with ASHA workers. The ASHA programme should remain central to the strategy of the government of India and should be strengthened to achieve universal access to modern contraception and meet sustainable development goals by 2030. [ABSTRACT FROM AUTHOR]

Adolescence and young adulthood are important periods of transition and therefore for action and intervention to ensure future sexual and reproductive health (SRH). Caregiver-adolescent communication about sex and sexuality is a protective factor for SRH, but there are often barriers to this. Adults’ perspectives are limited within the literature but important as they should lead this process. This paper uses exploratory qualitative data from indepth interviews with 40 purposively sampled community stakeholders and key informants to explore their insights into the perceived, experienced or expected challenges adults’ experience when having these conversations within a high HIV prevalence, South African context. Findings suggest that respondents recognised the value of communication and were generally willing to try it. However, they identified barriers such as fear, discomfort and limited knowledge and perceived capacity to do so. They show that in high prevalence contexts adults grapple with their own personal risks, behaviours and fears that may affect their ability to have these conversations. This demonstrates the need to equip caregivers with the confidence and ability to communicate about sex and HIV, alongside managing their own complex risks and situations to overcome barriers. It is also necessary to shift the negative framing of adolescents and sex. [ABSTRACT FROM AUTHOR]

Like many areas of public health, sexual and reproductive health is concerned with politically contentious matters such as abortion and LGBT+ rights. Global setbacks at the hands of the far right highlight the extent to which the rights and practices underpinning sexual and reproductive health are politically mediated. Yet the political is often occluded in mainstream sexual and reproductive health responses. In this paper, I consider the recent travails of sexual and reproductive health in order to critique technocratic knowledge forms that dominate both sexual and reproductive health and public health responses. Exploring sexual and reproductive health responses across time and space, I identify alternative knowledge forms and approaches relevant to public health. [ABSTRACT FROM AUTHOR]

Sexual modesty is the social, cultural, interpersonal, and psychological systems – defined by the tenets of Script Theory – that regulate individuals' sexual expression and experience at the social, legal, and interpersonal boundaries of acceptable/not-acceptable, private/public, and personal/social. Almost all aspects of sexual expression and experience are touched by the pervasive modesty standards for sexual communication, sexual display, sexual relations, and sexual behaviors. Sexual modesty influences an array of sexual and reproductive health outcomes. Many aspects of sexual modesty are enforced by legal as well as social, cultural, and religious proscriptions, including social shaming and ostracism as well as corporal and capital punishments. The purpose of this paper is to summarize a diverse literature related to sexual modesty from the years 2000 to 2021 in order to clarify its role in sexual health and sexual wellbeing and to identify directions for new research. [ABSTRACT FROM AUTHOR]

Migrant access to sexual and reproductive health (SRH) services has been highlighted as an urgent priority for the 800,000+ Venezuelans who have arrived in Peru in recent years due to political and economic crisis. Venezuelan migrants in Peru, however, negotiate their access to SRH services in what anthropologists term a 'geography of blame', and are accused and stigmatised for having imported sexually transmitted infections to the local population. Alongside this blame, female migrants are highly sexualised and face stigma, resulting in real and perceived threats to their safety, wellbeing, and integration. By juxtaposing ethnographic research and 50 interviews conducted with female migrants living in Lima, their Limeño neighbours, and with local NGOs, the paper argues how stigma is itself a neglected public health issue. Addressing SRH needs for Venezuelan migrants is not only a question of rolling out health campaigns or providing pills, but that underlying social issues such as sexualisation and stigma need to also be recognised and incorporated into policy. [ABSTRACT FROM AUTHOR]

Parent-adolescent sexual and reproductive health (SRH) communication plays an important role in reducing sexual risk behaviour and preventing HIV. We sought to enhance limited information about the unique barriers to parent-adolescent SRH communication in the Arab states. This mixed-methods study, using a two-phase sequential explorative design, was conducted in 15 public secondary schools (with grades 5 to 10 students aged 10 to 15 years) in Oman. In phase one, 15 parents participated in two single-sex focus group discussions and two in-depth individual interviews. The qualitative data were analysed using thematic analysis. In phase two, a convenience sample of 250 parents completed a paper-based self-administered questionnaire. Findings showed that parents rarely communicated with their children about SRH concerns, including HIV. Barriers to more open parent-adolescent SRH communication include the fear that such discussion might encourage early sexual debut; feelings of shyness, discomfort and shame; associated socio-cultural taboos; gender mismatch; and lack of SRH knowledge. Findings suggest the need for parental SRH education and training and school based SRH education programmes to improve adolescent SRH. Experience developing these may be helpful to other countries with similar religious beliefs and socio-cultural traditions seeking to improve parent-adolescent SRH communication. [ABSTRACT FROM AUTHOR]

This paper analyses wave 4 the Tsogolo la Thanzi survey of n = 1349 Malawian women aged 16–26 to explore the prevalence and predictors of self-reported fertility impairments (difficulties conceiving and/or difficulties carrying a pregnancy to term) and help-seeking strategies. Using descriptive statistics, logistic regression models, and graphic displays, the correlates of self-reporting an impairment and patterns of help-seeking strategies are examined. Nearly 13% (n = 117) of those who had ever tried to conceive reported experiencing a fertility impairment. Age was positively associated with reporting an impairment, while there was a negative association with education and with parity. Of women who reported an impairment, 85.5% sought help. Visiting a hospital or clinic was the most common response, followed closely by going to a traditional healer. Around one-quarter employed multiple help-seeking strategies, highlighting the need for various help-seeking behaviours to be viewed in tandem rather than in isolation. [ABSTRACT FROM AUTHOR]

High levels of adolescent pregnancy and child marriage rates in low- and middle-income countries is an issue of concern to many stakeholders, including in Zambia where almost one-third of women give birth before age 18. The aim of this paper is to explore and analyse social norms concerning adolescents' sexual behaviour within the context of an intervention trial in rural communities in southern Zambia. It is based on a qualitative study applying individual interviews, focus group discussions and participatory research methods. We apply the distinction between injunctive and descriptive norms to demonstrate that adolescent girls are caught between conflicting norms. Injunctive norms express that premarital sex, contraceptive use, and discussions about sex between adults and youths are socially condemned. At the same time poor girls are reported to feel pressure towards having sexual relations for the economic benefits such relations can bring, and this practice is considered so common that it amounts to a descriptive norm. Norms and structural conditions combine to create a disabling and disempowering environment for adolescent sexual and reproductive health, which limits girls' agency and exposes them to unwanted pregnancies. [ABSTRACT FROM AUTHOR]

Literature on commercial surrogacy argues that assisted reproduction technologies (ARTs) problematise presumed essentialist dichotomies of nature and culture. While technologies of commercial surrogacy naturalise the medicalisation of the body, these technologies in turn also produce new knowledge about the biological facts of the body. In what ways are knowledge about reproductive labour and women's reproductive capacities embedded in these technologies? How do these technologies invite us to imagine maternal bodies? Under regimes of stratified reproduction that inflect reproductive bodies with caste, class and racial politics, how do we read the production of the gendered body within commercial gestational surrogacy practices? The paper draws on ethnographic research conducted in Mumbai to study how technologies of commercial surrogacy interact with the normative idioms of conception. I will attempt to show how assumptions about gendered bodies and gendered roles are embedded within the material teleologies of these technologies, which in turn produce newer material-semiotic significations of the reproductive body. [ABSTRACT FROM AUTHOR]

Poor performance among health service providers is a key barrier to high quality, adolescent-responsive health services. Collaborative learning has been shown to strengthen health service provider performance, but few studies have examined its implementation in adolescent health services. In this paper, we describe a collaborative learning approach for adolescent health service providers implemented as part of a project aiming to prevent HIV in adolescent girls and young women in the Democratic Republic of the Congo (DRC) and explore its feasibility, acceptability, benefits and challenges. To do so, we reviewed plans, budgets and progress reports, as well as nested implementation research related to the project. We also carried out a quantitative analysis of the number, location, participants and topics of collaborative learning sessions conducted as part of this initiative, and thematic analysis to synthesise findings on perceived benefits and challenges. Under the project, 32 collaborative learning sessions of approximately two-hour duration were held with up to 15 participants, most of whom were nurses, between June 2018 and May 2019. The project cost was approximately USD 135,000 over three years. Reported benefits included improving health service provider attitudes, knowledge and skills; ensuring delivery of non-judgemental, empathic and confidential health services; and improving communication and collaboration between health services and adolescents together with their parents. While the novelty of the approach in this context presented challenges, our results suggest that collaborative learning in adolescent health services is feasible, acceptable, and inexpensive. It may help strengthen the knowledge and skills of health service providers, build positive attitudes and motivation, and improve their performance and thereby the adolescent-responsiveness of health services. Further research is needed to confirm these results in other settings and to examine the impact of collaborative learning on the acceptability and uptake of health services. [ABSTRACT FROM AUTHOR]

Evidence suggests that migration increases vulnerability to human immunodeficiency virus (HIV) and other sexually transmitted infections (STI). However, there is limited knowledge about what has been done or needs to be done to address migrants' vulnerability in receiving countries. A scoping review was carried out to map the existing literature in this field, describe its characteristics, identify gaps in knowledge and determine whether a Sexual and Reproductive Health and Rights (SRHR)-perspective was applied. We used the Arksey and O'Malley framework and the Joanna Briggs Institute guidelines for scoping reviews and subsequent enhancements proposed by other authors. We searched three databases and grey literature to identify relevant publications. A total of 1,147 records were found across the three electronic databases and compiled. Of these, only 29 papers that met the inclusion criteria were included. The review shows that research in this field is dominated by studies from the USA that mostly include behavioural interventions for HIV and HBV prevention among migrants from Latin America and Asian countries, respectively. None of the interventions integrated an SRHR perspective. The intervention effects varied across studies and measured outcomes. The observed effects on knowledge, attitudes, perceptions, behavioural intentions and skills were largely positive, but reported effects on testing and sexual risk behaviours were inconsistent. There is a need for good quality research, particularly in parts of the world other than the USA that will address all STIs and specifically target the most vulnerable subgroups of migrants. Further research requires greater scope and depth, including the need to apply an SRHR perspective and incorporate biomedical and structural interventions to address the interacting causes of migrants' vulnerability to HIV/STIs. [ABSTRACT FROM AUTHOR]

This paper uses empirical data collected from 117 female sex workers living in informal settlements in Nairobi and 15 healthcare providers to highlight specific effects of COVID-19 and related restrictions on healthcare access for the sex workers. We highlight the existing gender and health inequalities that have now been reinforced by the initial outbreak of the COVID-19 pandemic. Specifically, we focus on the most concerning healthcare needs for the sex workers including HIV prevention, care and treatment and sexual and reproductive healthcare. Our study findings reveal that the various restrictions imposed by the government to help curb the spread of COVID-19 to a large extent made it difficult for the sex workers to access their healthcare needs. The paper discusses the challenges of healthcare service delivery reflecting on some innovative and pioneering responses from health care providers to address the emergency situation. [ABSTRACT FROM AUTHOR]

Relationships and sexual health education is an accepted part of the school curriculum to support adolescent development. In recent years, the nature of this education has expanded to include topics encompassing a social model of health (e.g. with a focus on gender roles). There has, however, been limited exploration of student views about the inclusion of these topics. This paper presents student feedback on South Australia's Relationships and Sexual Health Programme, a state-wide curriculum produced by the state's major sexual and reproductive health organisation. The findings are drawn from an annual survey conducted from 2006 to 2017, involving 29,533 secondary school students aged 12–16 years. Regression analyses were used to assess the relationship between the year the survey was conducted and student ratings of the programme ('good/excellent' vs 'poor/satisfactory') and, separately, the individual topics students' considered most important. There was a positive association between survey year and rating the programme as 'good/excellent' with regard to providing a 'safe and supportive classroom environment', and a small negative association between survey year and 'overall rating' as 'good/excellent'. Over time, there was an increase in the number of students selecting the topic 'consent' as the most important. These findings demonstrate student support for the inclusion of a range of social health topics in relationships and sexual health education. [ABSTRACT FROM AUTHOR]

This paper highlights the value of an Environmental Reproductive Justice framework in social work and argues that environmental justice and reproductive justice should not be approached as two distinct issues. Because social work is a human right and social justice focused profession, it is uniquely poised to simultaneously address environmental justice issues impacting reproductive health and wellbeing. An Environmental Reproductive Justice framework centers Intersectionality to address sociopolitical issues at the intersection of environmental and reproductive concerns. We offer examples of organizations utilizing Environmental Reproductive Justice approaches, whether implicitly or explicitly. We conclude with implications for social work education and practice. [ABSTRACT FROM AUTHOR]

Child marriage is associated with adverse health and social outcomes for women and girls. Among pastoralists in Kenya, child marriage is believed to be higher compared to the national average. This paper explores how social norms and contextual factors sustain child marriage in communities living in conflict-affected North Eastern Kenya. In-depth interviews were carried out with nomadic and semi-nomadic women and men of reproductive age in Wajir and Mandera counties. Participants were purposively sampled across a range of age groups and community types. Interviews were analysed thematically and guided by a social norms approach. We found changes in the way young couples meet and evidence for negative perceptions of child marriage due to its impact on the girls' reproductive health and gender inequality. Despite this, child marriage was common amongst nomadic and semi-nomadic women. Two overarching themes explained child marriage practices: 1) gender norms, and 2) desire for large family size. Our findings complement the global literature, while contributing perspectives of pastoralist groups. Contextual factors of poverty, traditional pastoral lifestyles and limited formal education opportunities for girls, supported large family norms and gender norms that encouraged and sustained child marriage. [ABSTRACT FROM AUTHOR]

This paper focuses on rural aspects of sexual and reproductive health and sexuality. Disadvantage of access to practitioners with expertise in sexual and reproductive health and sexuality is compounded for rural residents. Retaining and supporting the rural sexual and reproductive health workforce is important in addressing sexual health inequities and promoting the sexual and reproductive rights of rural residents. However, little is known about the role-related challenges encountered by rurally-based sexual and reproductive health practitioners. We draw on 15 qualitative interviews with general practitioners and nurses with recognised expertise in sexual and reproductive health working in three rural regions of Victoria, Australia. Findings highlight the precarious state of sexual and reproductive health delivery in rural contexts and draw attention to the unsustainability of current systems for providing access to care in rural settings. Problems stem from cultural processes and assumptions within the health sector. Adapting organisational cultures and how sexual and reproductive health is structured within the health system are critical to improving access for rural residents. Our findings have relevance for other high-income, Eurocentric and metrocentric countries with public health systems and similar geographies. [ABSTRACT FROM AUTHOR]

This paper reviews the evidence on the sexual and reproductive health (SRH) of young people in Iran from 2001 to 2019 and maps needs, challenges, and opportunities in this area. From among 125 papers, 43 articles were examined for this review. Findings indicated that although the majority of youth abstain from sex before marriage, significant minorities are sexually active before marriage, with a huge heterogeneity based on gender and geographical region. A gender disparity is apparent in high-risk sexual behaviors. Multiple partners, inconsistent condom use, and younger age at sexual debut were more prevalent among men than women. There is a need to narrow gender disparities that expose young women to greater risks, expand health awareness and relevant skills, and enable access to SRH services. While the government has reaffirmed many commitments for young people's wellbeing, policy development falls far short of realizing these commitments. Future success requires increased evidence on the SRH of youth as well as political will and strategic commitment to SRH for young people. The challenge is to develop comprehensive and culturally appropriate SRH education and confidential and nonjudgmental youth services. Due to the importance of families and parents, such programs need to engage families. [ABSTRACT FROM AUTHOR]

The burden of maternal mortality in sub-Saharan Africa is the highest in the world. As high fertility rates present an increased risk to women's health, programmes and services have been put in place to increase access to family planning. Several studies have identified sociocultural factors as limiting access to family planning, including male resistance and women's low decision-making power. However, these studies have often used a behavioural approach that anchors barriers to access in women's attitudes or motivations. In 2019, a qualitative evaluation of a family planning programme using a behavioural approach was conducted in rural Uganda, focusing on women's attitudes and unmet needs. With hindsight, we realised that our evaluation was insufficient to adequately capture barriers that extend beyond women's motivations. This paper shares three case studies that we analysed using a structural health vulnerabilities approach. Our analysis highlights political, economic, social and cultural structures that can impede access to family planning. Using a structural health vulnerabilities approach, we identify structural barriers which have their roots in the local realities women face and propose context-specific structural recommendations. Finally, we contrast our initial results with findings the case studies presented to highlight the relevance of taking structural vulnerabilities into account in future family planning programme evaluation and women's sexual and reproductive health studies. [ABSTRACT FROM AUTHOR]

Child marriage is the practice of marrying an individual below 18 years. The drivers of this practice include poverty, gender inequality, cultural and religious norms among others. While Ghana is one of many countries worldwide in which child marriage is practised, the literature on cultural underpinnings and implications of the practice in Ghana is sparse. This paper aims to discuss how constructions of adolescence, gender and sexuality in Ghana affect the practice of child marriage. It further examines the implications of child marriage for married girls and argues for research into the causes and mental health implications of the practice. [ABSTRACT FROM AUTHOR]

Young women in Uganda are at risk of negative sexual and reproductive health outcomes, in part because of sex with older men. Theoretically grounded in the concept of liminality, this paper examines perceived markers of adolescent girls' suitability for sexual activity. In 2014, we conducted 19 focus group discussions and 44 in-depth interviews in two communities in Uganda. Interviews were conducted using a semi-structured tool, audio-recorded and transcribed verbatim. Interviews examined markers of transition between childhood, adolescence and adulthood and how these were seen as relating to girls' perceived readiness for sex. Analysis was thematic. Pre-liminal status was most often accorded to childhood. Sex with a child was strongly condemned. Physical changes during puberty and children's increasing responsibility, autonomy and awakening sexuality reflected a liminal stage during which girls and young women were not necessarily seen as children and were increasingly described as suitable for sex. Being over 18, leaving home, and occupying 'adult' spaces reflected post-liminal status and perceived appropriateness for sexual activity including for girls under the age of 18. Interventions that seek to prevent early sexual debut and sexual activity with older men have the potential to reduce sexual and reproductive health risks. [ABSTRACT FROM AUTHOR]