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Introduction: Short inter-birth intervals negatively impact maternal and child health; however, data on their prevalence and associated factors in Tanzania are limited. This study investigates the prevalence of short inter-birth intervals and the associated factors among women of reproductive age in Tanzania. Methods: This was a cross-sectional study utilizing the 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey dataset. The study population included women aged 15–49 years with at least two births within five years preceding the survey. A short inter-birth interval was defined as a birth occurring < 33 months after the preceding birth. A generalized linear model with Poisson as a link and robust standard errors was used to examine factors associated with short inter-birth intervals. A p-value < 0.05 was considered statistically significant. Results: A total of 8,350 births from 6,034 women were included in this analysis. The mean (± SD) age of the women was 31.6 ± 6.8 years. The overall prevalence of short inter-birth intervals was 42.6%. Younger age (aPR 3.12, 95% CI 2.88–3.52 for age 15–24 years, and aPR 1.74, 95% CI 1.62–1.1.86 for age 25–34 years), being married (aPR 1.27, 95% CI 1.03–1.57), late age at first childbirth (aPR 1.24, 95% CI 1.17–1.32) for a 20–24 years and aPR 1.55, 95% CI 1.39–1.73 for ≥ 25 years), and higher birth order (aPR 1.02, 95% CI 1.03–1.19; aPR 1.24, 95% CI 1.14–1.34; aPR 1.72, 95% CI 1.58–1.86 for 3rd, 4th, and 5th or more birth orders, respectively, compared to 2nd birth order) were independently associated with short inter-birth intervals. Additionally, there was significant variation in the prevalence of short inter-birth intervals across different zones and levels of household wealth. Women from richer (aPR 0.87, 95% CI: 0.80–0.95) and richest (aPR 0.84, 95% CI: 0.74–0.94) households exhibited a lower prevalence of short inter-birth intervals. Conclusion: This study highlights the significant prevalence of short inter-birth intervals among women of reproductive age in Tanzania. The associated factors include younger age, marital status, delayed first childbirth, higher birth order, geographical disparities, and lower household wealth. These findings highlight the need for targeted interventions to promote birth spacing and improve maternal and child health outcomes. [ABSTRACT FROM AUTHOR]

Background: Local-level socioeconomic gradients significantly influence access to reproductive health services in developing countries. This study examines disparities in family planning use among married women of reproductive age across Cameroon's subnational territories, highlighting inequities often overlooked in national analyses. Furthermore, it incorporates HIV status (a key yet frequently omitted covariate) into the assessment of family planning determinants. Methods: A Bayesian hierarchical model incorporated with Cameroon Demographic and Health Survey cross-sectional data (between 1991 and 2018) was employed to generate estimates of family planning indicators per residence, wealth, and education categories within each region. Slope index of inequality was used to quantify disparities. The determinants analysis involved Bayesian logistic regression. Results: Estimates for 2023 revealed that the Centre region's urban and rural areas had the highest modern contraceptive prevalence rate overall, with 49.0% (24.9–73.8) and 28.2% (12.4–52.3), respectively. The rural Far North had the least estimate [3.9% (1.5–10.5)]. Demand satisfied with modern methods was highest among Adamawa region's richest quintile [82.9% (58.1 to 94.4)] and higher educated [85.9% (69.5 to 94.2)], and lowest among the East region's poorest [5.3% (1.5 to 16.5)] and Far North's none-educated [8.6% (3.3 to 20.4)]. Unmet need for modern methods was lowest among the West region's richest [5.1% (1.8 to 13.5)] and highest among the Littoral's poorest [23.1% (9.4 to 47.4)]. 2030 projections show the widest wealth- and education-based gaps for demand satisfied with modern methods in the Adamawa [27.0 percentage points (%p) (2.3 to 51.6) and 79.3%p (73.9 to 84.7), respectively]. Age ≥ 20 years, higher education level, practising Catholic/Christian religion, having ≥ one living child(ren), and higher household wealth quintile, were associated with increased odds of modern contraceptive use. Conclusion: Increased focus is essential on rural, poorer, and less educated populations, particularly in the Northern regions, to effectively address family planning inequities across Cameroon. [ABSTRACT FROM AUTHOR]

The novel Severe Acute Respiratory Syndrome Coronavirus type 2 (SARS-CoV-2) threatens the global economy and public health, and therefore it is significant to research the intervention measures of this virus. In this study, we estimated the serial interval and reproductive number of the SARS-CoV-2 Omicron B1.1.529 variation, which can serve as indicators of the transmission potential of the Omicron variant in Korea from November 25 to December 30, 2021. By examining 427 local omicron cases and constructing 65 transmission pairs, we estimated a mean continuous interval of 2.23 days and a mean number of regenerations of 1.30 for one of the kindergarten transmission chains using maximum likelihood estimation. Our research indicates that Omicron has a shorter serial interval, faster transmission, and greater immune evasion capacity than earlier variants. To effectively control community transmission of Omicron, it is necessary to rapidly track recent contacts, isolate asymptomatic individuals, adhere rigorously to public health policies, and enhance immunization efforts among teenagers. The retrospective analysis of the indexes may give us new guidance for the new infectious diseases in the future. [ABSTRACT FROM AUTHOR]

Background: Gestational age limits (GLs) are common in abortion laws and policies. They restrict when lawful abortion may be accessed by reference to the gestational duration of a pregnancy, in some cases specifying that abortion is a criminal offense after, but not before, the GL. This synthesis of legal and health evidence addresses knowledge gaps on the health and non-health outcomes plausibly related to the effects of GLs on abortion-related outcomes. Methods: This paper synthesizes the results of a systemic review with the identification and application of relevant international human rights standards. A search strategy was drawn up to capture public health, international human rights law, and policy evidence related to the impacts of GLs. We limited our search to papers published in English since 2010, including quantitative studies (comparative and non-comparative), qualitative and mixed-methods studies, reports, PhD theses, and economic or legal analyses. Only studies that undertook original data collection or analysis were included. Review of treaties, opinions, interpretations, general comments, and special procedures of UN human rights bodies identified relevant human rights standards, which were then synthesized with the extracted data to create a comprehensive evidence synthesis. Results: GLs do not prevent people from seeking abortion but do operate as a regulatory barrier that can result in people seeking abortion outside of the formal health system or unwillingly continuing pregnancy. In many jurisdictions, they interact with the criminalization of abortion, with significant health and non-health impacts. GLs impact most on people who are least able to access abortion because of later detection of pregnancy, lack of access to abortion provision, and lack of access to the resources required to avail of abortion. Conclusions: Although paradigmatic in abortion law, GLs are not based on evidence of either the safety or effectiveness of abortion or the needs and preferences of pregnant people. They produce rights-limiting impacts for pregnant people and, in some cases, result in arbitrary and disproportionate violations of legally protected rights. The persistence of GLs as part of the regulatory framework for abortion provision cannot be said to ensure an enabling environment for quality abortion care. [ABSTRACT FROM AUTHOR]

Background: Research examining young people's healthcare-seeking behaviors in Sub-Saharan Africa has largely focused on university or out-of-school youth who are sexually active and/or HIV-positive. Healthcare-seeking behavior in younger adolescents has been less well studied even though it is during secondary school years that the majority of adolescents become sexually active. There is limited evidence to guide strategies that schools, health facilities, and social service agencies use to encourage adolescents to utilize sexual and reproductive health resources prior to sexual debut. Methods: This study used cross-sectional data collected in 2021 during school hours from eleven secondary schools in the Northwest District of Botswana. Adolescents ages 14–19 years completed surveys using hand-held tablets. Descriptive statistics were run for all variables; bivariate analyses examined their association with skipped visits. Logistic regression identified correlates of forgone visits. The outcome variable of interest was whether a respondent had ever forgone a visit to a health clinic for sexual and reproductive health information or services. Results: 553 adolescents, provided information used for analysis. One fifth of respondents had had sexual intercourse (21%). Most had not been tested for HIV (54%), did not know their HIV status (60%), or had not had an STI other than HIV (92%). Teachers (31%) and female family members (31%) were the most frequently consulted sources on bodily changes during adolescence. In the bivariate analysis, age, gender, sexual experience, HIV testing, awareness of HIV status, and having had an STI were significantly associated with forgone visits. At the multivariate level, younger respondents and those who had never been tested for HIV or had an STI had lower odds of forgone visits compared to their older peers and those who had been tested or had an STI. The most common reasons for forgoing visits reflected perceptions that nurses were unfriendly and did not believe adolescents should have sex. Students identified logistical barriers, including not knowing where to go, long distances to services, and limited operating hours. Conclusions: While logistical barriers might be easily addressed, perceived barriers, including negative staff attitudes and behaviors towards adolescents, require concerted and collaborative efforts by educators, health professionals, and policy makers to change. [ABSTRACT FROM AUTHOR]

The study investigated the prevalence and determinants of family planning services uptake among women of reproductive age (15 to 49 years) in the Yendi municipality in the northern region of Ghana. A health facility-based cross-sectional study was conducted among 396 reproductive-aged women, sampled from 6 randomly selected health facilities in the Yendi municipality. The child welfare clinic (CWC) served as the point for the sampling of study respondents. Data was collected with questionnaires adapted from previously validated tools. Data was analysed using SPSS v27 in descriptive and inferential statistics. More than half of the respondents (54.3%) said they had ever used a family planning method and almost half of them said they were still using a family planning method. The desire to control pregnancy was a key factor for wanting family planning (79.3%). Most respondents (80.6%) had high knowledge of family planning services and injectables (37.1%) and condoms (24.7%) were the preferred family planning methods. The significant sociodemographic determinants of family planning uptake were religion (Christians (aOR: 7.51; 95%CI: 1.48–38.00:; p = 0.015), traditionalist (aOR: 12.1; 95%CI: 1.90–78.36; p = 0.009)), education (secondary education (aOR: 84.99; 95%CI: 20.02–360.84:; p = 0.000), tertiary education (aOR: 158.74; 95%CI: 33.71–747.52; p = 0.000), no formal education (aOR: 11.83; 95%CI: 2.10–46.76:; p = 0.000)), occupation (farmers (aOR: 12.30; 95%CI: 3.21–47.03; p = 0.000)), and marital status (married (aOR: 0.13; 95%CI: 0.03–0.57; p = 0.007)). Factors that made women less likely to use family planning were unfriendly service providers (aOR: 2.33; 95%CI: 1.28–4.21; p = 0.005), fear of side effects (aOR: 2.19; 95%CI: 1.19–4.05; p = 0.012), and lack of knowledge about available FP services (aOR: 0.45; 95%CI: 0.26–0.77; p = 0.004). Though the knowledge of family planning was high, current uptake of family planning services was modest and there are still sociodemographic and health-related barriers to family planning utilization. Highlighting the need for training programs and policy interventions to improve uptake, reduce financial barriers, and foster a supportive environment. [ABSTRACT FROM AUTHOR]

Background: Women who experience intimate partner violence (IPV) are likely to experience reduced sexual and reproductive health (SRH). This paper aims to describe the prevalence of IPV and family planning use, and explore how IPV intersects with SRH among young Kiribati women; including met and unmet need for family planning, and use of contraception. Methods: Data for this paper were drawn from the Kiribati Social Development Indicator Survey [1], conducted in 2018–2019. Chi-square tests for independence were conducted, with 95% confidence intervals to identify the strength of association. Associations were considered statistically significant at p <.05. Results: Of the n = 3,106 women who had been intimately partnered or sexually active in the last year, 20% had unmet need for either spacing or limiting, the greatest unmet need being observed in women aged 15–24 years (28.8%). Half (51%) of ever-partnered Kiribati women experienced physical IPV from an ex/partner in their lifetime, one quarter experienced sexual IPV (24%) and 46% psychological IPV. Women aged 15–24 years reported higher rates of physical and/or sexual IPV over their lifetime and within the last year. Women who had experienced IPV from their partner in the last 12 months were significantly less likely to show unmet need for spacing or limiting (46.5%) than women who had not experienced any IPV (53.5%) and were more likely to be using a modern method of contraception (31%) than women who had not experienced IPV (26%). Women who experienced lifetime IPV were more also more likely to report met need for family planning. Conclusions: This study shows women in Kiribati experience elevated rates of IPV and unmet need for family planning. Inclusion of young women (including single women) and rural women, especially women living with IPV must be prioritised as an international goal if the SRH needs are to be met for all. In order to overcome the difficulties faced by young women, women in remote areas and those experiencing IPV, health-care providers would benefit from further training and information on the issues around IPV. [ABSTRACT FROM AUTHOR]

Background: Adolescents in Sub-Saharan Africa (SSA) face significant health and social challenges related to sexual and reproductive health (SRH), including unwanted pregnancies, unsafe abortions, and sexually transmitted infections (STI). Barriers to information and services are compounded by lack of access to appropriate information, fear of being judged, health provider attitudes and contextual factors such as culture, religion, poverty, and illiteracy. Facility-based service delivery models for adolescents offer a structured environment and provide an opportunity to deliver such information and services. The review critically examined how well these models meet the SRH needs of adolescents in SSA. Methods: A systematic search was conducted using five databases: Web of Science, MEDLINE, Scopus, PubMed, and Google Scholar. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to maintain transparency and completeness. Covidence software was used for screening and data extraction, and NVIVO 12 PRO was used to manage the analysis. A narrative synthesis using Thomas and Harden's thematic analysis was used to identify themes. Results: The search yielded 14,415 articles, and 20 papers met the inclusion criteria and were included in this review. From the findings, adolescents expressed the need for comprehensive SRH information, adolescent-friendly facilities, parental and male involvement, and respectful healthcare providers. Three facility-based adolescent-friendly SRH delivery models are used in SSA: Stand-alone clinics, Youth-friendly corners, and Integrated/mainstreamed models. Adolescent-friendly interventions, friendly staff, and accessibility were reported as facilitators to services meeting the needs of adolescents and promoting positive experiences. However, several barriers were identified: negative attitudes of health workers, financial constraints, transportation challenges, waiting time, intimidating environments, and lack of confidentiality pose a challenge to the effectiveness of the model. Conclusion: Facility-based SRH service delivery models can improve access to information and services when complemented with community-based interventions, adolescent-friendly providers, and assurance of service accessibility. However, significant gaps, such as healthcare providers' negative attitudes and behaviours, concerns about privacy and confidentiality, financial constraints, and transportation challenges, limit their effectiveness. These findings call for expanding out-of-facility services, adopting mHealth solutions, enhancing provider training, strengthening confidentiality, and reducing financial barriers to ensure equitable and effective access to services. [ABSTRACT FROM AUTHOR]

Background: Teenage childbirth is an issue of social and public health concern in Ghana, with high prevalence in some regions, including the Central Region. There is a dire need to understand the experiences of teenagers beyond pregnancies to facilitate comprehensive sexual and reproductive health information and service provision. We explored the postnatal experiences of teenage mothers in five communities in the Central Region of Ghana. Methods: We adopted a descriptive phenomenological design. Using in-depth interview guides and pictorial diaries/guides, 30 teenage mothers who had given birth less than two years before our study, were recruited. Data were analysed thematically using a systematic qualitative-oriented text analysis with QSR NVivo 12 Pro software. Results: Teenage mothers experienced pregnancy and childbirth related complications such as postpartum haemorrhage, preterm births, and low birth weight of their babies. Socio-cultural, psychological, and economic-related experiences were also observed. Teenage mothers were inexperienced and lacked financial support after childbirth. They often depended on the microsystem consisting of the family, friends, and the children's fathers as major source of support to enable them and their babies to survive, develop, and become healthy and happy in life. Conclusions: Teenage mothers are confronted with challenges that require the assistance of actors within the microsystem to address. We recommend that stakeholders including healthcare professionals, traditional birth attendants (TBAs), and parents be sensitive to the postnatal challenges faced by teenage mothers so that they can work at providing the necessary skills and support to enable them to cope better with motherhood. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer screening program in Uganda is opportunistic and focuses mainly on women aged 25–49 years. Female sex workers (FSWs) are at increased risk of developing invasive cervical cancer. There is limited data regarding the uptake and acceptability of cervical cancer screening among FSWs in Uganda. This study aimed at identifying factors associated with uptake and acceptability of cervical cancer screening among FSWs in Eastern Uganda. Methods: This was a cross-sectional study conducted among 423 FSWs aged 18–49 years attending care at six health facilities serving Key Populations (FSWs, Men who have sex with men, transgender people, people who inject drugs and people in prisons) in the Teso sub-region. Data was collected using structured investigator administered questionnaire and analyzed using Stata statistical software version 15.0 (Stata Corp, Texas, USA). The primary outcome was uptake of cervical cancer screening measured as the proportion of female sex workers who have ever been screened for cervical cancer. Chi-square test was used to compare the differences in uptake of cervical cancer screening by HIV status. Modified Poisson regression model with a robust variance estimator was used to determine association between the outcome variables and selected independent variables including demographic characteristics. Prevalence ratios (PR) with accompanying 95% confidence intervals have been reported. Statistical significance was considered at two-sided p-values ≤ 0.05. Results: The mean age of the participants was 28.1 (±SD = 6.6) years. The self-reported HIV prevalence was 21.5% (n = 91). There were 138 (32.6%) participants who had ever been screened for cervical cancer (uptake), while 397 (93.9%) were willing to be screened (acceptability). There was a significant difference in cervical cancer screening uptake between women living with HIV (WLHIV) and those who were HIV negative, 59.3% vs 26.9% respectively (P < 0.001). The significant factors associated with uptake of cervical cancer screening included living with HIV, adjusted prevalence ratio (aPR) = 1.53 (95%CI: 1.15–2.07), increasing number of biological children, aPR = 1.14 (1.06–1.24) living near a private not for profit (PNFP) facility, aPR = 2.84 (95% CI; 1.68–4.80) and availability of screening services at the nearest health facility, aPR = 1.83 (95% CI, 1.30–2.57). Factors significantly associated with acceptability of cervical cancer screening included being 40 years or older, aPR = 1.22 (95%CI: 1.01–1.47), having a family history of cervical cancer, aPR = 1.05 (1.01–1.10), and living near a PNFP facility, aPR = 1.17 (95% CI, 1.09–1.27) and having ever screened before, aPR = 0.92 (0.86–0.98). Conclusion: Female sex workers living with HIV are more likely to screen for cervical cancer than the HIV negative clients. Cervical cancer screening uptake is relatively low among the female sex workers. However, majority of the FSWs are willing to be screened for cervical cancer if the services are provided in the nearby healthcare facilities. There is need to make cervical cancer screening services available to all eligible women especially the female sex workers and integrate the services with sexual reproductive health services in general and not just HIV/ART clinics services. [ABSTRACT FROM AUTHOR]

Background: Although abortion was completely decriminalized in Canada 36 years ago, barriers to pregnancy prevention and termination persist across the country, such as travel and information gaps. Research demonstrates incarcerated people face barriers to family planning care, yet there is no systematic data collection of sexual and reproductive health experiences and outcomes among incarcerated people in Canada. The aim of this study was to explore family planning care experiences among women and gender diverse people who have experienced incarceration in Canada. Methods: We conducted a qualitative community-based research study using focus groups for data collection and reflexive thematic analysis to generate key themes. Our study team included members with lived experience of incarceration. We conducted recruitment in partnership with community organizations. We asked about accessing abortion and contraception while incarcerated and on release. Results: We conducted six focus groups with 35 recently incarcerated participants. Five themes emerged: (1) Competing health needs; (2) Institutional barriers to care; (3) Mistreatment and unethical care; (4) Health knowledge gaps; and (5) Challenges to care-seeking in community. Conclusion: People in prison experience concurrent unmet health needs that crowd out sexual and reproductive health. Prison procedures and perceived unethical professional behaviours impinge care-seeking. Information about abortion and contraception is not readily available in prison. Barriers to care persist upon release. Family planning professionals may improve care for people who experience incarceration by recognizing concurrent mental health needs; anticipating impact of prior negative experiences on care-seeking; challenging limitations to health education in prison; and addressing post-release challenges for patients. [ABSTRACT FROM AUTHOR]

Background: Our objective was to describe differences among adolescents and young adults (AYAs) with rheumatic disease using teratogens compared to non-users in receipt of sexual and reproductive health (SRH) counseling, teratogenicity knowledge, perceived importance of SRH topics, and preferences around counseling. Methods: AYAs ages 14–23 years and assigned female at birth were recruited from pediatric rheumatology clinics at a Midwest tertiary care program. Participants completed a one-time online survey assessing SRH. Results: One-hundred eight participants completed the survey, representing a range of rheumatic diseases. 24% reported ever having sex. 36% used a teratogen. Rates of screening and counseling regarding SRH topics were low. Notably, pregnancy prevention and emergency contraception (EC) counseling by rheumatologists were uncommon and not associated with teratogen use or sexual activity. Among AYAs on teratogens, only half reported screening for sexual activity or counseling on teratogenicity or pregnancy prevention. Gaps in pregnancy prevention and EC counseling remained even when accounting for counseling by other providers. Knowledge of medication teratogenicity was also low. AYAs reported SRH topics of high importance, and many reported recent concerns. They preferred to receive information from their rheumatologist, and most agreed it is important to talk to their rheumatologist regarding these topics. Conclusions: AYAs with rheumatic disease report low levels of SRH screening and counseling by their rheumatologist yet report these topics are important and want to discuss them. Gaps in teratogenicity knowledge were identified. This study identifies a need for improved communication with AYAs regarding their SRH. [ABSTRACT FROM AUTHOR]

Introduction: The utilization of sexual and reproductive health (SRH) services by males globally is significantly low despite their considerable sexual and reproductive health needs. This study aimed to understand the factors that influence the utilization of male sexual and reproductive health SRH services. Methods: We used an explanatory sequential mixed methods research design, with qualitative description to explore the perceptions of males (15-49years) on the utilization of male SRH services in Anambra State, Nigeria. In October 2021, 56 males participated in seven focus group discussions conducted across seven communities. The data were analysed by thematic analysis. A composite narrative was used to report the results. Results: Males in both urban and rural areas of Anambra State preferred informal health facilities; male-focused health facilities and male health workers. The participants perceived services as costly; and criticized healthcare workers' attitudes. Some rural areas had inadequate SRH facilities, staff and commodities. The participants exhibited varying levels of SRH awareness. Conclusion: To improve male SRH service utilization, clinics should be more male-centric and cost-effective. Healthcare providers require retraining to offer patient-centered care. Additionally, ward development committees should advocate for better staffing and the availability of SRH commodities. [ABSTRACT FROM AUTHOR]

Introduction: HIV poses a significant global health concern, affecting adolescents among other populations. This is attributed to various vulnerabilities including biological factors, gender inequalities and limited access to comprehensive sexual and reproductive health services in sub-Saharan Africa. In Tanzania, adolescent girls, and young women (AGYW) face double the risk of HIV infection compared to their male counterparts. The introduction of pre-exposure prophylaxis (PrEP) in early 2018 brought hope for changing the HIV cascade in the country. However, numerous challenges still hinder PrEP uptake. Therefore, this study explored experiences of PrEP uptake among vulnerable AGYW in Tanzania. Methods: This study employed a phenomenological qualitative approach; 52 semi-structured interviews were carried out between May to November 2022 in the selected healthcare facilities in Tanzania. The study adopted inductive-deductive thematic analysis guided by the Social Ecological Model (SEM) to elicit the views of AGYW aged 15–24. Nvivo software was utilised to organise data. Results: This study has uplifted barriers and facilitators on PrEP uptake among AGYW in Tanzania. The barriers are categorized at individual, interpersonal, and institutional levels. The individual level barriers included pre-requisites for initiating PrEP, disbelief in the effectiveness of PrEP, interference of refill hours with working hours, financial constraints, and adherence to the pills. The interpersonal level barriers included misconceptions about PrEP pills, and labelling of PrEP users. The institutional level barriers included inadequate privacy, PrEP drug stockout, being turned away by health care facilities (HCF), long waiting times, and distance to the HCF. Facilitators included factors at individual level (experienced benefit of PrEP, adequate PrEP knowledge, having multiple partners, perceived risk due to the nature of the work, PrEP ensuring privacy), interpersonal level (support from social networks), and institutional level (Free availability of PrEP, receiving refill reminders). Conclusions: To overcome barriers to PrEP uptake among AGYW, it is crucial to develop multi-level interventions that consider personal, social, and structural factors hindering PrEP uptake. Implementing strategies like prioritizing off-site PrEP delivery and expanding community outreach for PrEP awareness can help dispel misconceptions and enhance uptake. [ABSTRACT FROM AUTHOR]

Despite consensually non-monogamous people being a minority population with specific healthcare needs, research on this group is minimal, especially in relation to sexual healthcare. This study explores the motivations behind consensually non-monogamous individuals' choices of sexual healthcare service options. Qualitative survey data was collected from 67 consensual non-monogamists and analysed using thematic analysis. Two key themes captured participants' perspectives on the selection of sexual healthcare services. 'Feeling Comfortable' highlighted preferences for sexually inclusive clinics and LGBT+- focused services due to perceived better quality of care and comfort. 'Practicalities' emphasised convenience, proximity and the availability of STI testing options as critical factors influencing service selection. Accordingly, this research provides insight into the specific sexual healthcare service needs, desires and motivations of those who are consensually non-monogamous. Suggestions are made for increased training and awareness when working with relationship diverse patients. [ABSTRACT FROM AUTHOR]

Gender relations are a set of socially determined norms and rules that assign values, characteristics, and expectations to individuals based on their biological sex. These aspects also influence the clinician–patient relationship, since it has been for a long time based on cisheteronormativity. However, this attitude alienated the LGBTQIA+ community from health services. Global and specific gynecologic care needs to be offered to the LGBTQIA+ population, which has demands for sexual and reproductive health care. In this narrative review, we bring conceptual aspects, gender identity and expression, sexual history, screening for cancer and other care to the community. Synopsis: Gynecologic care needs to be offered to LGBTQIA+ people. This narrative review discusses gender identity, sexual history, reproductive healthcare, and screening for cancers. [ABSTRACT FROM AUTHOR]

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Background As survival rates for individuals with sickle cell disease (SCD) increase, calls have been made to improve their reproductive healthcare and outcomes. The research team created a web-based program entitled Fertility edUcaTion to Understand ReproductivE health in Sickle cell disease (FUTURES). The study aim was to use the Consolidated Framework for Implementation Research (CFIR) during pre-implementation to identify challenges and opportunities from the individual to systems level of implementation to ultimately optimize the integration of FUTURES into clinical practice. Methods Semi-structured interviews were conducted with clinicians, research team members, and adolescent and young adult (AYA) males with SCD and their caregivers who participated in pilot testing. Interviews (N  = 31) were coded inductively and then mapped onto CFIR domains (i.e. outer setting, inner setting, characteristics of individuals, and intervention characteristics). Results Research team interviews indicated the lack of universal guidelines for reproductive care in this population and gaps in reproductive health knowledge as key reasons for developing FUTURES, also highlighting the importance of collaboration with community members during development. Clinicians reported intraorganizational communication as essential to implementing FUTURES and discussed challenges in addressing reproductive health due to competing priorities. Clinicians, AYAs, and caregivers reported positive views of FUTURES regarding length, engagement, accessibility, and content. Suggestions for the best setting and timing for implementation varied. Conclusions Using CFIR during the pre-implementation phase highlighted challenges and opportunities regarding integrating this program into SCD care. These findings will inform adaptation and further testing of FUTURES to ensure effective implementation of this novel education program. [ABSTRACT FROM AUTHOR]

Introduction: The provision of youth-friendly sexual and reproductive health services (YFSRHS) is critical to improving young people’s health outcomes. However, millions of young people in Nigeria face numerous barriers to accessing YFSRHS. Therefore, this study assessed the health workers’ knowledge, attitude, and practices towards the delivery of YFSRHS in Calabar Metropolis. Methods: A quantitative cross-sectional descriptive design was utilised for this study. A stratified random sampling technique was employed to select 424 health workers from 50 primary healthcare facilities in Calabar Metropolis. Data was collected using a 30-item structured questionnaire and analysed using SPSS version 26. Results: The majority (72.8%) of the health workers were females, with 44.7% aged between 21 and 30. A considerable proportion of the respondents had moderate (56.3%) to high (29.9%) knowledge of YFSRHS. Despite most respondents having positive attitudes, a high proportion recorded poor practices, as 58.3% provided sexual and reproductive health services without the use of written guidelines, 87.4% were not trained, and a further 52.9% reported that they did not provide these services in a safe space. Lack of motivation, religious and cultural beliefs, and lack of training were identified as barriers to the delivery of YFSRHS. Conclusion: Moderate to high levels of knowledge and positive attitudes among health workers did not translate into desired practices in YFSRH service delivery. A re-orientation of healthcare workers within Calabar Metropolis is needed to improve the delivery of YFSRHS for the prevention of sexually transmitted infections (STIs), teenage pregnancy and maternal deaths among young people.

Objective. To examine maternal mortality in Panama, analyzing its direct obstetric deaths, indirect obstetric deaths, and contributory conditions. Methods. This cohort study used publicly available data from the National Institute of Statistics and Census to present a 25-year retrospective analysis of maternal deaths in the Republic of Panama from 1998 to 2022. Public data were sourced from the National Institute of Statistics and Census website of Panama. Relevant codes from the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD) were used. The maternal mortality ratio (MMR) was defined as the number of maternal deaths per 100 000 live births. Trendline reliability with R2 was performed to analyze the data. Results. A total of 1 026 maternal deaths occurred in Panama from 1998 through 2022, of which 61.2% were attributed to direct obstetric causes; 23.9%, indirect obstetric causes; 13.6%, contributory conditions; and 1.4% were unknown or undetermined. The average MMR was 60.1. The trendline reliability resulted in R2 = 0.1 (y = –0.5147x + 1094.7), which is not statistically significant but meets the 2030 Sustainable Development Goals. The specific primary causes of direct obstetric deaths were: 12.9% due to postpartum hemorrhage (ICD O72); 9.2%, eclampsia (ICD O15); 6.7%, puerperal sepsis (ICD O85); and 6.3%, pre-eclampsia (ICD O14). For indirect obstetric deaths, the primary causes were: 14.9% due to other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth, and the puerperium (ICD O99); and 7.3%, maternal infectious and parasitic diseases classifiable elsewhere but complicating pregnancy, childbirth, and the puerperium (ICD O98). Conclusions. The findings of this study confirmed that there were substantially more direct obstetric causes (61.2%) than indirect obstetric causes (23.9%), contributory causes (13.6%), or unknown/undetermined causes (1.4%) of maternal mortality, despite being highly preventable. Although Panama is right on track to fulfill the target of 70 MMR by 2030, these results highlight the lack of health care access due to the absence of obstetrician-gynecologists per 100 000 population in indigenous comarcas, where 30.8% of the maternal mortalities occur. Furthermore, the health system in Panama is not immune to pandemics and crises. From 1998 to 2022, there were 5 years when the MMR in Panama exceeded 70: 2001, 2002, 2006, 2011, and 2020. These findings also underscore the dichotomy between statistics and health policy. While the trendline reliability was insignificant (R2 = 0.1), the MMR satisfies requirements for the 2030 Sustainable Development Goals. Future studies should consider factors related to indirect obstetrics and contributory causes of deaths, health care access, COVID-19, cesarean section and natural birth, age, economic income, prenatal and postpartum care, as well as the quality of private and public health facilities in the Americas.

Globally, teenage pregnancies, unsafe abortions and sexually transmitted infections are on the increase among young people. However, their knowledge and uptake of youth-friendly sexual and reproductive health services are low. This study evaluated young people's knowledge, attitude and utilization of youth-friendly health services in the Tamale Metropolis. 420 young people aged between 15 and 24 years were proportionately selected from four suburbs within the Tamale metropolis and a Likert scale was used to collect quantitative data. To determine the correlation between the relevant characteristics and attitudes toward youth-friendly health services, a logit model and chi-square statistics were applied. Respondents' knowledge of youth-friendly health services was low (69%). A majority (71%) of them had a negative attitude towards youth-friendly health services and 63% of them had never used such services before. Level of education and religion were significantly associated with the knowledge levels of respondents while religion, employment status and individuals contributing to decision-making concerning the health of the participants were associated with attitudes towards the services. Cost and level of education were also associated with the uptake of youth-friendly health services. In conclusion, most young people had low knowledge, poor attitudes and low uptake of youth-friendly health services. Predictors of uptake of youth-friendly services were cost and educational level. The study suggests the need for Ghana Health Service to rigorously embark on sensitization programmes on the benefits of utilising youth-friendly health services and the cost of patronising these services could be subsidized to promote its utilization among the youth. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusions There is currently limited research exploring the extent to which women with an intellectual disability experience autonomy over contraception, pregnancy timing and pregnancy outcome decisions. Previous studies have highlighted inequities in sexual and reproductive health outcomes. However, barriers and facilitators of reproductive autonomy for women with an intellectual disability across the reproductive journey, including health care experiences, are poorly described; this is the focus of the current study.Ten women with intellectual disabilities participated in focus groups or individual interviews where they discussed their experiences of accessing sexual and reproductive health services and making reproductive health decisions. Data were analysed using reflexive thematic analysis.Three themes elucidate how a lack of sexual and reproductive health information and violence impacted many participants' ability to control timing of conception and make informed pregnancy outcome decisions. The first theme describes contraceptive literacy as a barrier to reproductive autonomy. Most participants received no contraception or reproductive health education prior to their first pregnancy. While most women were aware of common forms of contraception and pregnancy options, their contraceptive knowledge was incomplete or incorrect. The second theme explores how most participants experienced agency over pregnancy outcome decisions, though informed decision‐making was hampered by reproductive coercion and abuse, delayed pregnancy detection and insufficient information about all pregnancy options. The third theme identifies health professionals as pivotal in empowering reproductive agency and facilitating informed decision‐making.Women with intellectual disabilities demonstrate the willingness and the ability to make informed and autonomous reproductive health decisions when appropriately supported with care and information. However, they face reproductive coercion and abuse and are often required to overcome numerous systemic challenges to assert their reproductive rights. Significant efforts are needed to better understand and address barriers to informed reproductive decision‐making. [ABSTRACT FROM AUTHOR]

In Asia as elsewhere, strict regulations on who is authorized to provide abortion services and to prescribe or dispense medical abortion adversely impact access, especially for marginalized persons and residents in remote areas. The WHO's 2022 Abortion Care Guideline provides an important framework for states to formulate and implement policies to serve sexual and reproductive rights of access to abortion services. The Guideline calls for decriminalization of abortion services to increase authorization to provide abortion services and to promote self‐managed medical abortion. This review examines the legal and policy frameworks of Bangladesh, India, Indonesia, Malaysia, and Nepal against the WHO Guideline. Legal and policy reforms successfully introduced in Bangladesh and Nepal to grow the provider base allow healthcare systems to expand safe abortion. This review outlines further challenges where the WHO Guideline on decriminalization and availability of medical abortion is disregarded and advocates a reproductive justice approach promoting egalitarian access to services even among the most marginalized. [ABSTRACT FROM AUTHOR]

Chronic respiratory diseases (CRDs) are one of the major noncommunicable diseases, which affect adult women more than men, especially in a lower-middle-income country like India. The study was aimed to understand the district-wise prevalence and spatial distribution of CRDs among reproductive women and to reveal the significant influencing factors of the disease in India. The study was executed based on the data from the Indian fifth NFHS (2019–2021). Descriptive statistics, spatial mapping, and non-parametric statistical analysis have been executed in this study. The study results reflect that the prevalence of women having CRDs is found mainly in the districts of the northeast, east, and southeast parts. There is an association between CRDs with age, women's smoking habits, currently have diabetes, hypertension, and heart disease, and the kitchen without ventilation. We hope this work will add new facts and findings to the issue. It will guide policymakers in adopting and implementing proper local, regional, and national-level policies that consider the deprived districts and raise awareness about improving women's health by controlling the CRD burden. [ABSTRACT FROM AUTHOR]

Abstract:\nPlain language summaryThe COVID-19 pandemic has had a detrimental impact on sexual and reproductive health (SRH) and rights globally. However, little is known about the experiences of people with disabilities accessing SRH services during the COVID-19 pandemic. In this community-engaged qualitative study, we examined COVID-related impacts on access to SRH services for people with disabilities. We interviewed 61 women and transgender people in Canada from May 2022 to March 2023. Informed by disability reproductive justice, we identified four major themes through constructivist analysis. First, COVID-related changes to SRH service delivery disrupted access to care and caused disability-related health implications. Second, pandemic response measures changed SRH service accessibility: in-person accessibility barriers were amplified, new in-person accessibility barriers were introduced, and the transition to telehealth amplified, as well as mitigated, accessibility barriers. Third, COVID-related social changes (e.g., lockdowns) had disability-related SRH and rights implications. Fourth, disabled people recommended improving SRH services by enhancing funding, provider training, information and communication, disability accommodations, representation, and comprehensive community engagement. Cutting across these themes were disproportionate negative impacts of the COVID-19 pandemic on access to SRH services for racialized women and transgender people with disabilities. Failure to ensure SRH and rights for women and transgender people with disabilities during the COVID-19 pandemic undermined disability reproductive justice. Comprehensive disability community engagement is necessary to inform accessible SRH services and policies, both during and beyond a pandemic.The COVID-19 pandemic has hurt sexual and reproductive health and rights worldwide. However, there is little information on how it has affected the sexual and reproductive health of people with disabilities. We worked with disability communities in Canada to understand COVID-19 impacts on sexual and reproductive health for 61 women and transgender people with disabilities. These participants discussed four main topics: (1) The pandemic changed access to sexual and reproductive health services. This harmed mental and physical health. (2) The pandemic changed the accessibility of services. This caused new barriers to these services, such as not allowing support persons to attend appointments. (3) The pandemic caused social changes that harmed sexual and reproductive health. (4) Participants suggested solutions like more government funding, better provider education, and involving disability communities in decision-making. Policymakers and health providers need to work with disability communities to create accessible health services during and after pandemics. [ABSTRACT FROM AUTHOR]

Background: Women with disabilities in rural Nepal face many challenges in accessing sexual and reproductive health services including harassment and unpleasant behavior by the healthcare providers. Though National Guideline for Disability Inclusive Health Service in Nepal is in place, there are gaps in providing the sexual and reproductive health needs of women with disabilities. There has been limited research exploring the competency and capacity of health care providers on providing sexual and reproductive health services and information for women living with disabilities. Thus, this study aims to explore the competencies of rural healthcare providers in delivering disability inclusive sexual and reproductive health services for women with disabilities. Methods: The study used qualitative research methodology using thematic research design. Key informant interviews and focus group discussions were conducted using semi-structured interview guidelines to obtain information. Data collection was carried out till the data saturation was reached. Inductive coding was done using Dedoose software. The codebook was developed, sub-themes and themes were developed and presented as result of this study. Results: Knowledge gaps in disability management, procedural skills and biased perception towards sexual and reproductive health need of women with disabilities, were evident among healthcare providers. Additionally, an inadequate skill among health care providers to communicate with women with disabilities for service provision was evident. To address these challenges and enhance the competency of the health care providers there is need for disability management trainings for them. Other important measures such as inclusion of disability and sexual and reproductive health in medical education curriculum, provision of sign language interpreter and disability inclusive information system, decision-making abilities and authority for disability inclusive infrastructure and tool is necessary. Conclusion: To address the existing challenges for disability inclusive health services, it is essential to strengthen the competency and agency of the healthcare providers, and improve the ecosystem of health institution. For this, it is important for health institutions to be disability inclusive, improved behavior and attitude of health care providers, enhanced clinical knowledge on disability management and procedural skills of healthcare providers. Additionally, improving interpersonal communication skills and decision-making autonomy of health care providers is important for disability inclusive SRH services. [ABSTRACT FROM AUTHOR]

Introduction: All across the world, youths struggle with a variety of health issues. Adolescents everywhere are entering puberty earlier and engaging in more premarital sex. There was limited evidence about the current adolescent sexual reproductive health (RH) service utilization status and its associated factors in the study area, especially after the occurrence of COVID‐19 and the war between the Ethiopian federal government and Tigray regional forces. Objective: The study is aimed at assessing the magnitude of sexual RH service utilization and associated factors among Bahir Dar City high school students, Amhara region, Ethiopia, in 2022. Methods: An institution‐based cross‐sectional study design was conducted among Bahir Dar City high school students from December 18, 2022, to January 12, 2022. A multistage sampling technique was applied to select study participants. A total of 629 respondents participated in the study. The data were collected using a pretested, structured, self‐administered questionnaire. The data were entered into EpiData Version 3.1 and then exported to SPSS Version 25 for analysis. Bivariable and multivariable logistic regression was used for analysis. Results: The magnitude of adolescent sexual RH service utilization was found to be 30.4%. School RH club participation (AOR = 5.93, CI: 3.29–10.71), having ever had sexual exposure (AOR = 6.03, CI: 3.31–10.98), history of sexual RH problems (AOR = 3.26, CI: 1.41–7.51), being perceived as at risk of sexual RH problems (AOR = 6, CI: 3.26–11.04), hearing information about adolescent sexual RH (AOR = 5.19, CI: 3–8.97), and knowing the place to use RH service (AOR = 2.37, CI: 1.47–3.82) were associated with utilization of adolescent sexual RH service. Conclusions: The magnitude of adolescent sexual RH service utilization was found to be 30.4%. School RH club participation, having ever had sexual exposure, a history of sexual RH problems, being perceived as at risk of sexual RH problems, hearing information about sexual RH, and knowing the place where to get RH services were associated with the utilization of sexual RH services. [ABSTRACT FROM AUTHOR]

Background: Ensuring uninterrupted access and utilisation of sexual and reproductive health (SRH) services remains crucial for preventing adverse SRH outcomes. However, the unprecedented emergence of the 2019 coronavirus disease (COVID-19) significantly disrupted most of these services in Africa. Thus, we systematically reviewed and examined barriers and facilitators to accessing and utilising SRH services during the COVID-19 pandemic in Africa. Methods: We systematically searched five databases for relevant articles published between January 2020 to December 2022, and the articles were screened following the JBI and PRISMA guidelines. Meta-synthesis of barriers and facilitators to accessing and utilising SRH services during the COVID-19 pandemic were reported, while a meta-analysis of the pooled prevalence of barriers to accessing and utilising SRH services during the COVID-19 pandemic in Africa was analysed using R. Results: The pooled prevalence of barriers to accessing and utilising SRH services during the COVID-19 pandemic in Africa was 26%. Seven themes were developed for the identified barriers (disruption of healthcare services, fear and misinformation, limited availability of resources, place & region of residence, healthcare staff attitude/manpower, limited access to transportation, and stigma and discrimination), whilst six themes were developed for the identified facilitators (support for vulnerable populations, socio-demographic characteristics, community outreach programs, policy adaptations, telemedicine and digital health, and change in choice of sexual and reproductive commodities). Conclusion: This study found that the COVID-19 pandemic significantly impacted SRH service access and utilisation in Africa. We recommend that future research consider a longitudinal examination of the pandemic on African SRH services. Trial registration: PROSPERO registration number: CRD42022373335. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to explore the direct and indirect influences of COVID-19-related restrictions on adolescents and young people's (AYP's) sexual and reproductive health and rights (SRHR) in Malawi, Zambia, and Zimbabwe, with a focus on teenage pregnancy and access to and utilization of HIV testing and counselling services. Methods: Thirty-four purposively sampled interviews that comprised of selected representatives of organizations involved in activities aimed at addressing adolescent sexual and reproductive health and rights (ASRHR), teenage pregnancies, and HIV testing were conducted in Malawi, Zambia and Zimbabwe. In Zambia, the study conducted an additional four group discussions with adolescents and young people. Adolescents and young people were asked to describe their experience and perceptions of the impact of COVID-19 on their SRHR. Thematic analysis was used to analyze the data. Results: Priority shifts resulted in the focus of service provision to the COVID-19 response. This led to shortages of already insufficient human resources due to infection and/or isolation, supply chain disruptions leading to shortages of important sexual and reproductive health (SRH)-related commodities and supplies, compromised quality of services such as counselling for HIV and overall limited AYP's access to SRH information. Suggestions for interventions to improve SRH services include the need for a disaster preparedness strategy, increased funding for ASRHR, the use of community health workers and community-based ASRHR strategies, and the use of technology and social media platforms such as mHealth. Conclusion: Disruption of SRH services for adolescents and young people due to pandemic related-restrictions, and diversion of resources/funding has had a ripple effect that may have long-term consequences for adolescents and young people throughout the East and Southern African region. This calls for further investment in adolescents and young people's access to SRHR services as progress made may have been deterred. [ABSTRACT FROM AUTHOR]

Background: Understanding what adolescents want and how preferences are likely to vary among different groups is important to make the healthcare system responsive to the needs of adolescents and to maximize service utilization. Despite this, evidence is scarce in this aspect. Therefore, this study aimed to explore preferences for accessing Sexual and Reproductive Health (SRH) services from the perspective of adolescents and health care providers in the South Ethiopia Regional State. Methods: A phenomenological qualitative study was conducted from September 04 to October 15, 2023. Seven Focus Group Discussions (FGDs) and ten Key Informant Interviews (KIIs) were conducted with purposively selected seventy-five adolescents and ten healthcare providers respectively. A semi-structured interview guide was used to explore their lived experiences. All interviews and discussions were audio-recorded. The research team transcribed the collected data verbatim and translated it into English. The data was analyzed using a thematic analysis approach. Results: In this study, five main themes were identified. The identified main themes were preferred SRH services provider, preferred SRH services venue, preferred SRH services provision time, preferred SRH services information sources, and preferred strategies to improve access to SRH services. Regarding preferred SRH service providers, adolescents prefer males by sex, younger health care providers by age, and not neighborhood health providers by residence. Concerning preferred SRH services venue, adolescents prefer pharmacies as a venue to access condoms and emergency pills, while they prefer traditional medical centers as a source of abortion services. Besides this, schools are a preferred venue for adolescents to access SRH information. Moreover, sexual partners, close friends, and peers who experienced similar problems are the preferred sources of SRH information for adolescents. Furthermore, engagement of private health facilities, strengthening engagement of faith-based organization, and strengthening community-based SRH services provision were identified as preferred strategies to improve access to SRH services. Conclusion: Improving access to sexual and reproductive health services necessitates the implementation of innovative and responsive strategies that address the diverse preferences and needs of adolescents. Prioritizing adolescent engagement in healthcare is vital, as it fosters a better understanding of their unique perspectives and ultimately enhances the accessibility and utilization of these essential services. [ABSTRACT FROM AUTHOR]

Background-Reproductive health is important for women's over all well-being. Indian culture is deeply rooted in patriarchal values, this has attributed to female reproductive health being largely ignored and treated as taboo. Rural women of India due to associated stigma do not seek timely medical intervention related to reproductive health thus leading to huge repercussions on health mainly in the form of pelvic inflammatory disease, infertility, sexually transmitted infections and other RTIs. The present study aims to assess the existing level of information related to reproductive health among rural women of Patiala District. Another objective was to assess the efficacy of the reproductive health awareness program. A semi structured close-ended questionnaire consisting of 57 items was designed to assess the existing level of reproductive health knowledge, taboos, and hygiene associated with menstruation. The sample comprised of 70 rural women from low socio-economic status in the age range of 35 49 years. The study was conducted in three phases; (phase i) existing level of awareness and need was assessed; (phaseii) modules were developed; (phase iii) information was disseminated and evaluated. The results indicated that women had very low levels of information related to reproductive health. Furthermore t-test was applied to study the efficacy of the awareness program and it indicated significant improvement related to the knowledge about reproductive health. [ABSTRACT FROM AUTHOR]

Background: Similar to other countries, reproductive-age women in Nepal frequently encounter diverse mental disorders, yet they receive inadequate screening and attention. This research seeks to address this gap by conducting a comprehensive examination of the prevalence and factors associated with mental disorders of reproductive-age women in Nepal. Methods: This study used the nationally representative Nepal Demographic and Health Survey 2022 dataset to examine the association between mental disorders and potential confounders. Screening tools for Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) were employed, and descriptive and inferential statistics, including linear regression and structural equation modeling, were utilized in the analysis. Results: The study found that 22% of Nepalese women aged 15 to 49 reported anxiety symptoms, while 5% reported depressive symptoms. The Structural Equation Modeling (SEM) reveals that anxiety had the most significant positive effect on depression (β = 0.683, p < 0.001), followed by emotional violence (β = 0.139, p < 0.001). Marital status (β = 0.072, p < 0.001) and the presence of genital discharge (β = 0.084, p < 0.001) or ulcer (β = 0.058, p < 0.001) in the last 12 months were also associated with higher levels of depression. Conversely, self-rated health status (β=-0.121, p < 0.001) was negatively associated with depression, indicating that better-perceived health was linked to lower levels of depression. Conclusion: Although the prevalence of anxiety symptoms is higher than that of depression, there is a positive relationship between these two. Consequently, it is crucial to address the identified factors contributing to anxiety and depression in this population group through behavioral and policy interventions to enhance the mental well-being of reproductive-age women. [ABSTRACT FROM AUTHOR]

Transgender and gender nonbinary (TGNB) adolescents and young adults (AYA) may present to clinicians with reproductive health expertise for the spectrum of gynecologic, sexual, and reproductive care. As such, clinicians should be knowledgeable in the many facets of gender-affirming care. This clinical opinion reviews language associated with gender diversity and gender-affirming care; current clinical, social, and political barriers faced by TGNB AYA; and the creation of welcoming and inclusive clinical spaces for TGNB AYA. It discusses social, medical, and surgical affirmation processes, and focuses on gynecologic care topics which may arise in the care of TGNB AYA, including those who undergo medical or surgical therapies. This includes menstrual suppression, breakthrough bleeding on testosterone, sexual health, fertility, and the pelvic care of individuals following gender affirming vulvovaginoplasty. [ABSTRACT FROM AUTHOR]

Women with autoimmune rheumatic disease (ARDs) experience difficulties with BF in addition to those concerning their own disease. The aim of this study is to identify the impact factors as infant feeding attitude, the level of BF knowledge, BF self-efficacy, and the sociodemographic have in the intention to BF in women with ARDs. We performed an observational, retrospective, and analytical study. Reproductive-age women (18–50 years old) with ARDs with prior pregnancy history and who filled out self-reported BF surveys as part of the Rheumatology Integral Care Program were included. Sociodemographic and clinical characteristics were retrieved from medical charts. We analyzed three validated BF questionnaires. Sixty-five participants with a mean age of 41.32 ± 7.48 were evaluated. Of these, 63 (97%) women agreed with BF in the first 6 months. The most prevalent infant feeding attitude was neutral with 42 (64.6%) women. The most common level of BF knowledge was poor with 45 (69.2%) patients. There were significant correlations of BF knowledge with education years (p = < 0.001, r = 0.464) and age (p = 0.049, r=-0.245). A significant correlation was found between BF self-efficacy and age (p = 0.039, r = 0.257). Attitude toward BF was significantly associated with education level > 9 years (OR = 3.400; 95% CI = 1.091–10.593) and a history of miscarriage (OR = 3.670; 95% CI = 1.051–12.813). Although most women with ARDs agreed with BF, we identified a poor level of BF knowledge and a neutral infant feeding attitude as the most predominant. By identifying this data in women with ARDs, BF practices may be improved. [ABSTRACT FROM AUTHOR]

Proactively engaging patients in conversations about their needs and desires for sexual and reproductive health (SRH) is an essential part of providing client-centered care. This systematic literature identifies screening tools and approaches for assessing needs and desires for pregnancy- and STI-related services. PubMed and the Cochrane Library were searched for articles published between July 1, 2018 and July 26, 2023. Eligible studies examined the use of screening tools for various SRH services. This manuscript focuses on evidence from 28 articles that examine findings related to pregnancy and STI screening. The evidence suggests that using these tools can increase the number of patients who receive care. The tools also facilitate clients' discussions with their providers about reproductive health goals and needs. Patients appreciate tools that are easy to use and help them have non-judgmental interactions with providers and promote shared decision-making and bodily autonomy. Providers reported a preference for screening tools that are easy to use, quick to administer, and can be integrated into existing workflows. Screening tools are important for identifying clients' needs and desires as well as informing and streamlining care. More research is needed to better understand the diversity of provider and patient experiences with screening tools and whether the use of such tools promotes accessible and equitable service provision. There was insufficient evidence to recommend any specific screening tool or approach for assessing pregnancy or STI needs and desires because most tools were reported either in a single study or results were mixed. Prospero - CRD420234486 [ABSTRACT FROM AUTHOR]

Updating the Quality Family Planning recommendations is an essential step toward offering all people evidenced-informed, person-centered, equitable, and inclusive sexual and reproductive health care. What constitutes quality sexual and reproductive health care constantly evolves as scientific research generates new evidence. In addition, the context in which people seek and receive sexual and reproductive health care has changed significantly in recent years. Today's sexual and reproductive health context is also complex and evolving against the backdrop of an increasing awareness of the impact of structural and interpersonal racism, classism, discrimination (or bias) based on sexual orientation and/or gender identity, and ableism on health and sexual and reproductive health care. The Office of Population Affairs of the HHS sought to be responsive to these complex conditions by centering equity in the update of its Quality Family Planning recommendations from start to finish, including in its approach to reviews of published literature, the creation of expert and technical workgroups to assess the literature and make recommendations, and actively engaging persons with lived experience to gather their insights so that the final product could genuinely respond to the needs of the community. [ABSTRACT FROM AUTHOR]

This update, titled Providing Quality Family Planning Services a a The title of this document is Providing Quality Family Planning Services, to retain consistency with the title of the initial 2014 publication. However, the recommendations included in this document are broader than the provision of family planning services, and include recommendations for providing quality sexual and reproductive health services. For purposes of this document, "family planning services" are defined as a broad range of medically approved services, which include Food and Drug Administration (FDA)-approved or FDA-cleared contraceptive products and natural family planning methods for patients who want to prevent pregnancy and space births; pregnancy testing and counseling; assistance to achieve pregnancy; basic infertility services; sexually transmitted infection (STI) services; and other pre-pregnancy health services. Family planning services do not include abortion. in the United States: Recommendations of the U.S. Office of Population Affairs (Revised 2024), provides recommendations developed by the Office of Population Affairs (OPA) within the Office of the Assistant Secretary for Health at the U.S. Department of Health and Human Services (HHS). These recommendations represent an update to Providing Quality Family Planning (QFP) Services: Recommendations of the Centers for Disease Control and Prevention (CDC) and the U.S. Office of Population Affairs (OPA), originally published in 2014. The updated recommendations outline how to provide quality sexual and reproductive health (SRH) services for people of reproductive age but can also be used to guide the care of people of any age when the content is relevant to their needs, including family-building services, contraception, pregnancy testing and counseling, early pregnancy management, sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) prevention and testing services, and other preventive health services. The recommendations aim to enable health care providers with the knowledge, skills, and attitudes to ensure that all people, regardless of individual characteristics such as sex, sexual orientation and gender identity, age, disability, or race, can have their SRH needs met. The primary audience for these recommendations is providers and potential providers of SRH services to people of reproductive age, such as providers working in clinical settings dedicated to SRH service delivery, including those funded by the Title X family planning program b as well as primary care providers and other subspecialty providers who may identify SRH needs and make referrals. During the past decade, several changes have taken place in the United States that have affected SRH care delivery, including technological advances, recognition of long-standing inequities, and other legal and regulatory changes. This broader context has been considered in designing the updated recommendations. This update of the QFP aims to provide guidance on the provision of person-centered SRH care focused on individuals' needs, values, and preferences. The update offers specific recommendations for how to provide high-quality SRH care and connects users to relevant guidelines, primary research, and other resources to inform best practices. In addition to incorporating new evidence, this update incorporates newer approaches to care, including adopting a health equity lens that recognizes the impact of structural and interpersonal racism, classism, ableism, and bias based on sexual orientation and/or gender identity on health and the provision of quality SRH care. OPA will update these QFP recommendations periodically to reflect new findings in the scientific literature and revisions to the clinical guidelines referenced in this update. b Title X projects must comply with statutory and regulatory requirements set out in the Title X statute (42 U.S.C. §300 et seq.), any legislative mandates included in annual HHS appropriations, Title X implementing regulations at 42 CFR Part 59, Subpart A (86 Fed. Reg. 56144), and any applicable court orders. As these requirements include restrictions related to abortion and certain related activities, Title X providers are prohibited from using Title X funds for some of the recommendations set out in this document. A separate guidance has been issued to current Title X recipients, which clearly specifies which services in this QFP document are outside the scope of Title X and may not be paid for with Title X funding. This guidance can be found at https://opa.hhs.gov/grant-programs/title-x-service-grants/about-title-x-service-grants/program-policy-notices. Additionally, in places where recommendations in this QFP document may conflict with the Title X statute, legislative mandates, regulations, or court orders, the Title X federal requirements control. [ABSTRACT FROM AUTHOR]

BACKGROUND: Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities experience significant health disparities related to sexual health, including sexually transmitted infections (STIs). Improved access to culturally congruent primary care and sexual health services, including HIV/STI prevention and care, are needed. We describe how we developed a new community-based LGBTQ+ primary care clinic and implemented safety-net sexual health and STI screening and care services in Providence, Rhode Island. METHODS: Open Door Health in Providence, Rhode Island, was started in 2020 to improve access to HIV/STI care and prevention services, primary care, and genderaffirming care for the LGBTQ+ community. We reviewed demographics and behaviors of patients presenting for STI screening services from February 2021 to October 2023 at the clinic. Bivariate and multivariate analyses were used to evaluate demographics and behaviors among patients testing positive for HIV and other STIs. RESULTS: A total of N=1,633 people presented for STI screening. Of these, 56% were 30 years or younger, 65% identified as male, 24% as female, and 9% as non-binary or gender diverse. Forty-three percent were MSM, 19% were Black/African American (B/AA), and 22% were Hispanic/ Latino (H/L). Seventy-one percent reported two or more partners in the last three months. The prevalence of STIs was 22.3% (4.4% syphilis, 7.5% gonorrhea, and 9.7% chlamydia). Those who tested positive for an STI were more likely to be B/AA (23.3% of B/AA individuals versus 15.9% of White, p<0.05), H/L (23.1% versus 17.4%, p<0.05), and MSM (25% versus 16.9%, p<0.05). CONCLUSION: Open Door Health provides important safety-net STI services for the LGBTQ+ community. Individuals presenting for services had a high prevalence of HIV/STIs. Improved approaches are needed for HIV/ STI care and prevention in this group, including among B/AA and H/L communities. [ABSTRACT FROM AUTHOR]

A fundamental component of the basic right to health is the right to sexual health, encompassing an individual's right to decide freely on matters of sexual and reproductive health without discrimination. Provision of these rights is inextricably linked with a wide range of other internationally agreed upon human rights, including the right to information, participation, and equality. Evidence has shown that provision of these rights not only improves maternal and neonatal health, but also healthcare worker safety and the provision of a vast array of critical and necessary medical care. And yet, too often—and with increasing frequency—sexual and reproductive rights are being violated worldwide, with rising taboos, stigma, and discrimination, particularly within abortion, contraception, and fertility care. FIGO strongly supports comprehensive, equitable, and accessible sexual and reproductive health care for all individuals, recognizing that these rights are essential components of global health and fundamental human rights. This includes a particular emphasis on special populations, healthcare workers, and women and girls in crisis zones. FIGO encourages its member societies to deliver comprehensive sexual and reproductive health care, advocate for coverage for sexual and reproductive health care, become involved in analyzing barriers to access within health systems, and provide nonjudgemental, confidential, person‐centered care. Synopsis: FIGO calls for the delivery, advocacy and provision of comprehensive sexual and reproductive health care among member societies, to improve access to care within health systems. [ABSTRACT FROM AUTHOR]

Chronic Kidney Disease (CKD) affects millions globally, with a notable impact on biological females of reproductive age. This population faces specific issues such as fertility concerns, complex contraceptive decisions, and complications related to pregnancy that can exacerbate CKD. Given the increasing prevalence of CKD among young men and women owing to rising rates of hypertension, obesity, and diabetes, there is a need for early and tailored interventions among women of childbearing age. Current Kidney Disease Improving Global Outcomes (KDIGO) guidelines suggest nephrology referral primarily for advanced CKD stages or significant proteinuria. However, women at any CKD stage may face complex pregnancy-related decisions and increased risks that are not adequately addressed by these guidelines, warranting early specialty care. This review explores the distinct needs of women of reproductive age with CKD, identifies gaps in the existing management framework, and advocates for earlier and more comprehensive nephrology involvement. By focusing on preconception planning, risk factor management, adverse pregnancy outcomes, and existing disparities in care, this review seeks to improve understanding of the needs of women of reproductive age with CKD and calls for a shift towards more proactive, nephrology-driven care. [ABSTRACT FROM AUTHOR]

The National Hospital Insurance Fund (NHIF) of Kenya was upgraded to improve access to healthcare for impoverished households, expand universal health coverage, and boost the uptake of essential reproductive, maternal, newborn and child health (RMNCH) services. However, premiums may be unaffordable for the poorest households. The Innovative Partnership for Universal Sustainable Healthcare (i -PUSH) programme targets low-income women and their households to improve their access to and utilization of quality healthcare, including RMNCH services, by providing subsidized, mobile phone-based NHIF coverage in combination with enhanced, digital training of community health volunteers and upgrading of health facilities. This study evaluated whether expanded NHIF coverage increased the accessibility and utilization of quality basic RMNCH services in areas where i -PUSH was implemented using a longitudinal cluster randomized controlled trial in Kakamega, Kenya. A total of 24 pair-matched villages were randomly assigned either to the treatment or the control group. Within each village, 10 eligible households (i.e. with a woman aged 15–49 years who was either pregnant or with a child <4 years old) were randomly selected. The study applied a difference-in-difference methodology based on a pooled cross-sectional analysis of baseline, midline and endline data, with robustness checks based on balanced panels and Analysis of Covariance methods. The analysis sample included 346 women, of whom 248 had had a live birth in the 3 years prior to any of the surveys, and 424 children aged 0–59 months. Improved NHIF coverage did not have a statistically significant impact on any of the RMNCH outcome indicators at midline nor endline. Uptake of RMNCH services, however, improved substantially in both control and treatment areas at endline compared to baseline. For instance, significant increases were observed in the number of antenatal care visits from baseline to midline (mean = 2.62–2.92, P  < 0.01) and delivery with a skilled birth attendant from baseline to midline (mean = 0.91–0.97, P  < 0.01). Expanded NHIF coverage, providing enhanced access to RMNCH services of unlimited duration at both public and private facilities, did not result in an increased uptake of care, in a context where access to basic public RMNCH services was already widespread. However, the positive overall trend in RMNCH utilization indicators, in a period of constrained access due to the COVID-19 pandemic, suggests that the other components of the i -PUSH programme may have been beneficial. Further research is needed to better understand how the provision of insurance, enhanced community health volunteer training and improved healthcare quality interact to ensure pregnant women and young children can make full use of the continuum of care. [ABSTRACT FROM AUTHOR]

Background: Sexual health service engagement is important for the healthy sexual development of young people. Further, as later adolescence and early adulthood are critical periods for relationship development, sexual health needs may vary across this period and be associated with relationship status. Methods: A total of 468 participants, aged 16–25 years (mean age: 19.7 years) and living in the United Kingdom, completed an anonymous, online survey about their sexual health service use. To explore how relationship status is associated with engagement for five different sexual health services, we conducted chi-squared and multivariable logistic regression analyses. Results: In general, engagement with sexual health services was low: 28.2% reported accessing free condoms, 21.4% reported STI testing, and 9.4% had used relationship advice services. Among women only, 57.2% had accessed services to start the pill and 19.6% had done so for pregnancy testing. Among all participants, those in relationships were more likely to have accessed sexual health services for free condoms (aOR: 1.71, 95% CI: 1.13, 2.59). Among female participants, those in relationships were more likely to have accessed sexual health services to start the pill (aOR: 2.21, 95% CI: 1.45, 3.36) and for pregnancy testing (aOR: 3.86, 95% CI: 2.20, 6.78). There were no differences by relationship status for accessing sexual health services for STI testing or relationship advice. Conclusions: Health care providers and relationship and sexual education providers should encourage all young people to engage with sexual health services, while also recognising that sexual health needs are likely to vary depending on relationship status. Sexual health service engagement among young people is important and needs may vary depending on relationship status. We explored use of five different sexual health services and found that, in general, engagement was low and those in relationships were more likely to have used services for free condoms, to start the pill, and for pregnancy testing. Healthcare and relationship and sexual education providers should encourage all young people to engage with sexual health services, whatever their relationship status. [ABSTRACT FROM AUTHOR]

Background: Sub-Sahara Africa (SSA) has the greatest unmet need for family planning use, but young people are reported to under-utilise family planning services compared to other groups of women of the reproductive age in the region. Thus, promoting contraceptive services use among adolescents is vital in achieving universal access to sexual and reproductive health services. Objective: The main objective of this study was to assess the prevalence and motivators for family planning services utilization among youth students in higher learning institutions in Dodoma, Tanzania. Methods: An analytical cross-sectional study was conducted among 421 randomly selected youths in higher learning institutions in Dodoma. A self-administered structured questionnaire adopted from previous studies was used to collect data. Bivariate and multivariate logistic regression analysis using SPSS version 25 established association between variables. Statistical significance was declared at 95% confidence interval with α<0.05 and strength of association was reported by Odds Ratio (OR) and Adjusted Odds Ratio (AOR). Results: Majority of the participants 221 (52.5%) were females, and most of them 320 (76.0%) were aged between 21 to 24 years. Of all participants, bachelor's degree scholar were 257 (61.0%). About 305, (72.4%) participants reported to have had sexual intercourse in the past 12 month. Of these 50.5% had their first intercourse at the age between 15 to 19 years. Most participants 239 (56.8%) reported to have used contraceptive method in the past 12 months. After adjusting for confounders (participants' socio-demographic characteristics), the motivators for family planning use among youth students were: living with relatives (AOR = 2.904, p 0.006), adequate FP knowledge (AOR = 2.230 p 0.003), positive perception (AOR = 1.772, p 0.025) and discussing FP matters with sexual partners (AOR = 6.045, p <0. 001). Conclusion: This study highlights a significant unmet need for family planning services among youth students in higher learning institutions in Dodoma, Tanzania, reflecting broader trends in Sub-Saharan Africa. Despite high sexual activity, family planning utilization remains suboptimal. Key motivators for using family planning services include living with relatives, having adequate knowledge, positive perceptions, and discussing family planning with sexual partners. These findings emphasize the need for targeted interventions focusing on education, fostering positive perceptions, and encouraging open partner discussions to enhance family planning utilization among adolescents, contributing to universal access to sexual and reproductive health services. [ABSTRACT FROM AUTHOR]

AbstractDisparities in contraceptive access by ethnicity are widely documented. We drew on 2019–2022 panel data from patients seeking family planning in Arizona and estimated ordinal conditional logistic regression models to examine whether disruptions in access to care led to poor contraceptive outcomes and whether this differed by ethnicity. We found associations between experiencing increased barriers to accessing preferred contraception and reduced odds of using it. We also found associations between location of care and use of preferred contraception that differ by ethnicity. Our study highlights that access barriers can restrict people’s reproductive autonomy and healthcare systems are inadequately set up to ensure sexual and reproductive equity for all. [ABSTRACT FROM AUTHOR]

Background: People who use drugs are at elevated sexual and reproductive health risk but experience barriers to services. Syringe services programs (SSP) are an important venue to provide integrated health services. Few studies have examined SSP use within intersecting gender, racial, and ethnic groups, including by injection drug use (IDU), and differences in sexual and reproductive health among these groups. Methods: Within a cohort study among people who use unprescribed opioids in New York City, we conducted a nested cross-sectional study from November 2021-August 2022 assessing sexual health with a survey (n = 120). The parent study measured baseline characteristics, and the cross-sectional study survey measured self-reported past-year SSP use and sexual and reproductive health. We estimated SSP use within gender, racial, and ethnic groups by IDU, and the prevalence of sexual and reproductive health outcomes by gender, race, ethnicity, and SSP use. Results: Among men (n = 61) and women (n = 54), SSP use was disproportionately low among Black participants irrespective of IDU. Women reporting SSP use had a higher prevalence of multiple, new, sex trade, and/or casual sex partners, history of STI symptoms, and lack of effective STI prevention, although women who did not use SSP had non-negligible levels of risk with variation between racial and ethnic groups. Among men, sexual and reproductive health varied across racial and ethnic groups but not as clearly by SSP use. Conclusions: SSP offer opportunity to address elevated STI risk among people who use drugs but may miss certain intersecting gender, race, and ethnic groups. [ABSTRACT FROM AUTHOR]

Background: The lack of adequate access to and use of sexual and reproductive health care by youth and adolescent, n low- and middle-income countries persists despite international accords on their rights, which exposes them to violence against children; early and unintended pregnancies; and sexually transmitted infections. This study examined functional sexual and reproductive health and right-based friendly services as perceived by exit male and female adolescents, caregivers, and health workers at the Tanzanian health services delivery points as they were the ones who would share their opinions to establish a diversified and representative reality about the matter based on sex. Methods: This was a multicentric study among 205 randomly selected participants in eleven selected health facilities within the three regions of Tanzania including Dar es Salaam, Dodoma, and Kigoma regions using a one-time descriptive cross-sectional design with a quantitative research approach from 01 to 30 November 2022. Triangulation technique of data collection activities using structured questionnaires and observation checklist adopted from the Tanzanian Ministry of Health was used to collect data. IBM Statistical Package for Social Sciences version 26 data entry templates (Sa PSS – 26) were used to analyze data descriptively to establish frequencies and percentages. Results: Results indicated that 205 participants were assessed in this study with a response rate of 100%. Exit adolescents (46%); health workers in dispensaries (60%), and community members (42%) were more likely to confirm the availability of functional SRH right-based adolescent and youth-friendly services at the health services delivery points. The SRH displays (50%); adolescent rights (6%) and confidentiality (5%) were the least reported functional SRH aspects by the study participants. It was noted that the 11 health services delivery points in their totality did not fully implement the National standards in providing the services to adolescents and youth of which standards III (54.0%) and VIII (46.1%) scored the lowest. Conclusion: The results of this study have uncovered that there is disperities in the availability and accessibility of functional SRH right-based adolescent and youth-friendly services across the levels of health facilities; among adolescents and community members. Hospitals were more likely to confirm the availability of Functional Right Based Youth Friendly Services than at health centers and dispensaries with female adolescents, youth, and community members being disadvantaged. There is a need to address issues of differentials in equity to the accessibility of services among adolescents, youth, and community members by improving functional sexual and reproductive health and right-based friendly services provision infrastructures, health care workers capacity building, and mechanisms or approaches to increase adolescents' access and uptake to SRHR services. [ABSTRACT FROM AUTHOR]

Background: Refugee and asylum-seeking women are known to experience a myriad of intersecting sociocultural, institutional, and systemic barriers when accessing healthcare services after resettlement in high-income countries. Barriers can negatively affect service uptake and engagement, contributing to health inequities and forgone care. Access to sexual and reproductive healthcare (e.g., family planning, cervical cancer prevention) has largely been understudied. This scoping review sought to: i) examine the use of sexual and reproductive health services among refugee and asylum-seeking women in high-income countries; and ii) identify barriers and facilitators influencing access to sexual and reproductive healthcare for refugee and asylum-seeking women in high-income countries. Methods: This review was conducted in accordance with Joanna Briggs Institute Methodology for Scoping Reviews. Ten databases (e.g., CINAHL, MEDLINE, Embase) were searched for qualitative, quantitative, mixed method studies, and gray literature published anytime before February 2024 across high-income countries (defined by the World Bank). The Health Behaviour Model was used to examine and understand factors influencing service use and access. Results: 3,997 titles and abstracts were screened, with 66 empirical studies included. Most were conducted in the United States (44%), Australia (25%), Europe (18%) and elsewhere and were qualitative (68%). Papers largely addressed contraception, abortion, cervical cancer screening, gender-based violence, and sexual health education. Included studies indicated that refugee and asylum-seeking women in high-income countries face a greater unmet need for contraception, higher use of abortion care, and lower engagement with cervical cancer screening, all when compared to women born in the resettlement country. Frequently reported barriers included differences in health literacy, shame and stigma around sexual health, language and communication challenges, racial or xenophobic interactions with healthcare providers, and healthcare/medication costs. Conclusions: Studies across the globe identified consistent empirical evidence demonstrating health inequities facing refugee and asylum-seeking and myriad intersecting barriers contributing to underuse of essential sexual and reproductive health services. Facilitators included multilingual healthcare provider, use of interpreters and interpretation services, community health promotion work shops, and financial aid/Medicare. [ABSTRACT FROM AUTHOR]

Background: Macrosomia is a forgotten health problem that directly or indirectly affects maternal and neonatal health outcomes. There is a lack of evidence on the factors that affect macrosomia in eastern Ethiopia. This study aimed to assess the determinants of macrosomia among newborns delivered in Jigjiga City, Eastern Ethiopia. Methods: An institutional-based case-control study was conducted among 82 cases and 164 controls in Jigjiga City from June 25 to August 24, 2023. Bivariable and multivariable logistic regression were used to identify the determinants of macrosomia. An adjusted odds ratio (AOR) with a 95% confidence interval was used to report the strength of the association, and the statistical significance was declared at a p-value < 0.05. Results: This study found that lack of preconception care (AOR = 2.48, 95% CI: 1.29, 4.76); post-term pregnancy (AOR = 2.90, 95% CI: 1.16, 7.28); inadequate physical activity (AOR = 3.52, 95% CI: 1.55, 7.98), having previous macrosomia (AOR = 4.52, 95% CI: 2.18, 9.36), and gestational diabetic mellitus (AOR = 2.58, 95% CI: 1.10, 6.28) were the main risk factors of macrosomia. Conclusion: This study indicated that failed utilization of preconception care, inadequate physical activity during pregnancy, post-term pregnancy, gestational diabetic mellitus, and having previous macrosomia were the risk factors for fetal macrosomia. Encouraging women to utilize reproductive health services and providing special care for high-risk mothers are essential to reducing and preventing the level of fetal macrosomia and its consequences. [ABSTRACT FROM AUTHOR]