What is the association between IPV and Fertility in Uganda?

Abstract IPV, which emanates as a severe consequence of gender inequality in society, is the most pervasive form of IPV as most cases of abuse is perpetrated by intimate partners and has major health consequences for women. Women with a history of abuse are also at increased risk of reproductive health outcomes; such as high parity, inconsistent and lower levels of contraceptive use, unintended pregnancies, and adverse pregnancy outcomes. Despite concerted efforts by African governments, fertility levels in the region remain high. Africa is the region that has been least responsive to family planning programmes. This study investigates the associations between IPV and fertility in Uganda, using the Ugandan Demographic and Health Survey of 2011. Adult women of reproductive ages (15-49) that were included in the domestic violence module of the individual recode, were included in this study. Univariate, bivariate analysis, and unadjusted and adjusted Poisson Regression models were conducted for children ever born and the different forms of IPV (emotional, physical and sexual), as well as the socio-demographic and women’s empowerment variables. Both bivariate and multivariate analyses show a strong association between both these pervasive health problematics; and may therefore be one of the unexplained proximate determinants of persistently high fertility in countries such as Uganda. These results have important implications for understanding both the fertility transition in Uganda, but also for programmes and policies addressing unwanted pregnancies and unmet need for contraception that is driving fertility up, and IPV amongst women which we know from previous work has severe reproductive health outcomes but which we have now identified is a contributor to high fertility as well.

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Contraception

Oxford Textbook of Obstetrics and Gynaecology ◽

10.1093/med/9780198766360.003.0053 ◽

2020 ◽

pp. 665-677

Author(s):

Zephne M. van der Spuy ◽

Petrus S. Steyn

Keyword(s):

Reproductive Health ◽

Unplanned Pregnancy ◽

Unmet Need ◽

Eligibility Criteria ◽

Development Goal ◽

Contraceptive Counselling ◽

Unintended Pregnancies ◽

Contraceptive Service ◽

Effective Contraception ◽

Health Organization

Effective contraception is central to reproductive health and unintended pregnancies have a major negative impact on both maternal and child health. It is recognized that there is a global unmet need for effective contraception and often the unplanned pregnancy is terminated, sometimes by unsafe practices. There is recognition of the importance of accessible, effective fertility regulation both in the Millennium Development Goal 5b and now in Sustainable Development Goal 3. It is hoped that contraceptive provision will be expanded and made accessible to many women who previously were not able to address their fertility needs. The World Health Organization offers input and excellent clinical advice through the Medical Eligibility Criteria for contraceptive use which are regularly updated. It is recommended that these should be adapted for local use where appropriate. An understanding of the success of contraceptive methods with typical rather than perfect use is central to advising women and their partners on their contraceptive options. Attention to women with special needs such as those with medical disorders, young women, and women living with HIV must be central to any contraceptive service. Counselling should include discussing the risks and benefits of appropriate methods, the availability of emergency contraception, and the ongoing access to contraceptive counselling and reproductive health services. The aim of contraceptive service provision is to avoid unintended pregnancies and ensure that women feel empowered in the choices they make. Services providers are encouraged to provide a spectrum of contraceptive options which are accessible and acceptable to all clients.

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Using Social Ecological Theory to Identify Factors Associated With Risky Sexual Behavior in Cambodian Adolescent Girls and Young Women Aged 10 to 24 Years: A Systematic Review

Asia Pacific Journal of Public Health ◽

10.1177/1010539520911493 ◽

2020 ◽

Vol 32 (2-3) ◽

pp. 71-80 ◽

Cited By ~ 2

Author(s):

Farwa Rizvi ◽

Joanne Williams ◽

Humaira Maheen ◽

Elizabeth Hoban

Keyword(s):

Sexual Behavior ◽

Reproductive Health ◽

Sex Education ◽

Risky Sexual Behavior ◽

Sexual And Reproductive Health ◽

Sexual Debut ◽

Modern Contraceptive ◽

Unintended Pregnancies ◽

Social Ecological ◽

Increased Risk

There is an increase in risky sexual behavior (RSB) in Cambodian female youth aged 10 to 24 years, which can contribute to detrimental sexual and reproductive health due to the increased risk of acquiring sexually transmitted infections, unintended pregnancies, or abortions. Bronfenbrenner’s social ecological model was used to identify factors at personal, microenvironment, and macroenvironment levels potentially associated with RSB. A systematic literature review employing PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was conducted to search 8 databases for articles published between 1994 and 2019. A risk of bias tool was applied for methodological quality of the 4 included studies. RSB is associated with multiple factors including sexual debut at young age, alcohol and substance abuse, multiple partners, living away from parents or orphan status, peer delinquency, non-use of condoms by partners, transactional sex, low education and socioeconomic status, and no access to sexual and reproductive health services. Multipronged preventive strategies operating at different levels are recommended in terms of including sex education and increasing reproductive health literacy programs at the schools and community programs for safe sex, condom use and sexual negotiation skills, and access to modern contraceptive methods.

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Population attributable risk for multimorbidity among adult women in India: Do smoking tobacco, chewing tobacco and consuming alcohol make a difference?

PLoS ONE ◽

10.1371/journal.pone.0259578 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0259578

Author(s):

Vivek K. Mishra ◽

Shobhit Srivastava ◽

Muhammad T. ◽

P. V. Murthy

Keyword(s):

Population Attributable Risk ◽

Family Health ◽

Attributable Risk ◽

Bivariate Analysis ◽

Binary Logistic Regression Analysis ◽

Effective Sample Size ◽

Adult Women ◽

Chewing Tobacco ◽

Increased Risk ◽

Smoke Tobacco

Background The present study aims to estimate the prevalence and correlates of multimorbidity among women aged 15–49 years in India. Additionally, the population attributable risk for multi-morbidity in reference to those women who smoke tobacco, chew tobacco, and consume alcohol is estimated. Methods The data was derived from the National Family Health Survey which was conducted in 2015–16. The effective sample size for the present paper 699,686 women aged 15–49 years in India. Descriptive statistics along with bivariate analysis were used to do the preliminary analysis. Additionally, binary logistic regression analysis was used to fulfil the objectives. Results About 1.6% of women had multimorbidity in India. The prevalence of multimorbidity was high among women from southern region of India. Women who smoke tobacco, chew tobacco and consume alcohol had 87% [AOR: 1.87CI: 1.65, 2.10], 18% [AOR: 1.18; CI: 1.10, 1.26] and 18% [AOR: 1.18; CI: 1.04, 1.33] significantly higher likelihood to suffer from multi-morbidity than their counterparts respectively. Population Attributable Risk for women who smoke tobacco was 1.2% (p<0.001), chew tobacco was 0.2% (p<0.001) and it was 0.2% (p<0.001) among women who consumed alcohol. Conclusion The findings indicate the important role of lifestyle and behavioural factors such as smoking and chewing tobacco and consuming alcohol in the prevalence of multimorbidity among adult Indian women. The subgroups identified as at increased risk in the present study can be targeted while making policies and health decisions and appropriate comorbidity management can be implemented.

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The effect of physical activity on reproductive health outcomes in young women: a systematic review and meta-analysis

Human Reproduction Update ◽

10.1093/humupd/dmz013 ◽

2019 ◽

Vol 25 (5) ◽

pp. 542-564 ◽

Cited By ~ 3

Author(s):

Gabriela P Mena ◽

Gregore I Mielke ◽

Wendy J Brown

Keyword(s):

Physical Activity ◽

Systematic Review ◽

Reproductive Health ◽

Health Outcomes ◽

Meta Analysis ◽

Pooled Analysis ◽

Fertility Treatment ◽

Adult Women ◽

Young Adult Women ◽

Comparison Groups

Abstract BACKGROUND In the context of increasing rates of overweight and obesity in young adult women, and the increasing numbers of women seeking help for fertility problems, it is important to understand whether physical activity (PA) could help with management of reproductive health problems, with or without weight loss. OBJECTIVE AND RATIONALE The primary aim of this systematic review and meta-analysis was to assess the effects of PA on selected reproductive health outcomes in young adult women, in order to inform best practice advice for women in terms of promoting fertility and reproductive health in young adulthood. SEARCH METHODS An electronic search of PubMed, EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science, SportDiscus, and Cochrane was performed for studies published between January 2000 and May 2018. Keywords and Medical Subject Headings terms related to PA, reproductive health, and weight gain were used. Studies were selected if they were intervention studies, if PA was delivered as part of an intervention to pre-menopausal women, and if any reproductive health outcome was reported. Quality analysis was performed using the Tool for the assEssment of Study qualiTy and reporting in EXercise. OUTCOMES Eighteen studies, with a mix of four types of study design (4 randomized controlled trials (RCTs), 11 randomized comparison trials, 2 non-randomized comparison trials, and 1 single-arm clinical trial), were identified. Comparisons included fertility treatment (four studies) and common treatments for women with polycystic ovary syndrome (PCOS) symptoms (nine studies). Pooled analysis of data from three of the four studies with a control group showed higher pregnancy [risk ratio (RR) 2.10, 95% CI (1.32, 3.35); three studies] and live birth [RR 2.11, 95% CI (1.02, 4.39); two studies] rates in the intervention groups compared with non-therapy controls. Aggregated data from the fertility treatment comparative studies (i.e. those that compared PA with standard fertility treatment such as clomiphene, gonadotrophins, and/or IVF) showed no significant intervention differences: RR 1.46, 95% CI (0.87, 2.45) for clinical pregnancy (four studies) and RR 1.09, 95% CI (0.56, 2.12) for live births (two studies). Pooled analysis from the comparison trials that used pharmaceutical or dietary treatment for PCOS as comparison showed higher pregnancy rates [RR 1.59, 95% CI (1.06, 2.38); five studies] and live birth rates [RR 2.45, 95% CI (1.24, 4.83); two observations] in the PA intervention groups than in the comparison groups. Analysis of other outcomes, such as ovulation rates, menstrual regularity, and conception rates, showed no differences between the PA intervention and comparison groups. WIDER IMPLICATIONS There is emerging evidence from RCT that PA may improve pregnancy rates in women with reproductive health problems. Comparative studies indicate that PA intervention may be as effective as other commonly used clinical intervention strategies for improving reproductive health outcomes. While the type, intensity, frequency, and duration of optimal PA intervention, and the role of PA independent of weight loss, remain unclear, these preliminary findings suggest that PA may be an affordable and feasible alternative or complementary therapy to fertility treatments.

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Intersections of Immigration and Sexual/Reproductive Health: An Umbrella Literature Review with a Focus on Health Equity

Social Sciences ◽

10.3390/socsci10020063 ◽

2021 ◽

Vol 10 (2) ◽

pp. 63

Author(s):

Violeta Alarcão ◽

Miodraga Stefanovska-Petkovska ◽

Ana Virgolino ◽

Osvaldo Santos ◽

Andreia Costa

Keyword(s):

Reproductive Health ◽

Health Outcomes ◽

Systematic Reviews ◽

Sexual And Reproductive Health ◽

Meta Analysis ◽

Scientific Evidence ◽

Maternal Health Services ◽

Structural Factors ◽

Native Population ◽

Increased Risk

Identifying the opportunities and barriers of promoting and fulfilling the sexual health rights of migrants remains a challenge that requires systematic assessment. Such an assessment would include estimating the influence of acculturation processes on sexual and reproductive health, and mapping intersectional inequities that influence migrants’ sexual and reproductive health in comparison with the native population. The aim of this research was to locate, select, and critically assess/summarize scientific evidence regarding the social, cultural, and structural factors influencing migrants’ sexual and reproductive health outcomes in comparison with native population. An umbrella review of systematic reviews and/or meta-analyses, following preferred reporting items for systematic reviews and meta-analysis (PRISMA) standards was undertaken. Medline, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews were searched from their start date until June 2019. The quality of the included articles was determined using the assessment of multiple systematic reviews tool (AMSTAR 2). From the 36 selected studies, only 12 compared migrant with native populations. Overall, the findings indicated that migrants tend to underuse maternal health services and have an increased risk of poor sexual and reproductive health outcomes. Specific intersectional inequities were identified and discussed.

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Age disparities in unmet need for contraception among all sexually active women in Colombia: an analysis of the 2015 Demographic Health Survey

10.21203/rs.2.16341/v1 ◽

2019 ◽

Author(s):

Sharon Sánchez-Franco ◽

Catalina González-Uribe

Keyword(s):

Reproductive Health ◽

Health Survey ◽

Health Care Services ◽

Age Groups ◽

Unmet Need ◽

Social Determinant ◽

Sexually Active ◽

Unintended Pregnancies ◽

Age Disparities ◽

Unmet Need For Contraception

Abstract Background Unmet need for contraception increases unintended pregnancies and puts the health and reproductive rights of women at risk. Social determinants are associated with unmet need for contraception, but it is unclear if age is a social determinant of disparities in reproductive health-related outcomes in all Colombian women irrespective of marital status.Methods This study used the 2015 Colombian Demographic and Health Survey. The outcome of interest was the unmet need for contraception among 24,245 sexually active women aged 13-49. Age was associated with unmet need for contraception in Colombia through multivariate analysis. Absolute and relative inequalities were estimated using prevalence differences and odds ratios, respectively.Results The prevalence of unmet need was significantly higher in women in marital union aged 13 to 19 years old (19.8%), than their unmarried counterparts (16.8%), and all older age groups either married or unmarried. Women 13 to 19 years old [OR=2.98 (2.49-3.57)] and 20-29 year old [OR=1.71(1.48-1.97)] are more likely to have an unmet need for contraception than those 40-49-year-old.Conclusions Age disparities are barriers to attaining the Sustainable Development Goals for sexual and reproductive health. Cultural, social, and access barriers demand to tailor health care services to meet the needs of younger women to narrow the age gap.

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Mycotoxin exposure and adverse reproductive health outcomes in Africa: a review

World Mycotoxin Journal ◽

10.3920/wmj2017.2261 ◽

2018 ◽

Vol 11 (3) ◽

pp. 321-339 ◽

Cited By ~ 8

Author(s):

U.A. Eze ◽

M.N. Routledge ◽

F.E. Okonofua ◽

J. Huntriss ◽

Y.Y. Gong

Keyword(s):

Reproductive Health ◽

Health Outcomes ◽

Sperm Quality ◽

Reproductive Potential ◽

Reproductive Function ◽

Child Growth ◽

High Serum ◽

Foetal Development ◽

Premature Thelarche ◽

Increased Risk

It is well established that mycotoxin exposure can have adverse effects on reproductive health resulting to poor reproductive potential. The most studied mycotoxin in relation to poor reproductive health in humans is aflatoxin, although fumonisins, trichothecenes and zearalenone have also been reported to impair reproductive function and cause abnormal foetal development. These potent fungal toxins contaminate many food products making them a prominent agricultural, food safety and public health challenge, especially in Africa due to little or lack of mycotoxin regulation in agricultural products. Neonates can be exposed to aflatoxins in utero, as the toxins pass from mother to the foetus through the placenta. This exposure may continue during breast feeding, to the introduction of weaning foods, and then foods taken by adults. The consequences of aflatoxin exposure in mothers, foetus and children are many, including anaemia in pregnancy, low birth weight, interference with nutrient absorption, suppression of immune function, child growth retardation and abnormal liver function. In males, reports have indicated a possible relationship between aflatoxin exposure and poor sperm quality culminating in infertility. Maternal exposure to fumonisin during early pregnancy has been associated with increased risk of neural tube defects among newborns in regions where maize is the common dietary staple with the possibility of chronic fumonisin exposure. Furthermore, zearalenone has been linked to precocious puberty and premature thelarche in girls, correlating with extremely high serum oestrogen levels. This review presents an overview of the several reports linking aflatoxins, fumonisins, trichothecenes, and zearalenone exposure to poor reproductive health outcomes in Africa, with emphasis on birth outcomes, foetal health and infertility.

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Integrating Sexual and Reproductive Health Services Within HIV Services: WHO Guidance

Frontiers in Global Women's Health ◽

10.3389/fgwh.2021.735281 ◽

2021 ◽

Vol 2 ◽

Author(s):

Nathan Ford ◽

Morkor Newman ◽

Sarai Malumo ◽

Lastone Chitembo ◽

Mary E. Gaffield

Keyword(s):

Reproductive Health ◽

Health Services ◽

Sexual And Reproductive Health ◽

Unmet Need ◽

Social Contexts ◽

Reproductive Age ◽

World Health ◽

Reproductive Health Services ◽

Hiv Services ◽

Unintended Pregnancies

Among the 1.9 billion women of reproductive age worldwide in 2019, 1.1 billion need family planning and 270 million have an unmet need for contraception. For women and adolescent girls living with human immunodeficiency virus (HIV), using effective contraception reduces the mother-to-child transmission of HIV by preventing unintended pregnancies and enabling the planning and safer conception of desired pregnancies with optimal maternal and child health outcomes. The World Health Organization (WHO) recommends that sexual and reproductive health services, including contraception, may be integrated within HIV services. Integration is associated with increased offers and uptake of sexual and reproductive health services, including contraception, which is likely to result in improved downstream clinical outcomes. Integrating HIV and sexual and reproductive health services has been found to improve access, the quality of antenatal care and nurse productivity while reducing stigma and without compromising uptake of care. Research is encouraged to identify approaches to integration that lead to better uptake of sexual and reproductive health services, including contraception. Implementation research is encouraged to evaluate different strategies of integration in different health systems and social contexts; such research should include providing contraception, including long-acting contraception, in the context of less frequent clinical and ART refill visits.

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Mapping evidence on predictors of adverse sexual and reproductive health outcomes among young women in South Africa: A scoping review

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v13i1.3091 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Obasanjo A. Bolarinwa ◽

Tlou Boikhutso

Keyword(s):

South Africa ◽

Reproductive Health ◽

Health Outcomes ◽

Young Women ◽

Scoping Review ◽

Sexual And Reproductive Health ◽

Unmet Need ◽

Health Concern ◽

Gender Based Violence ◽

Gender Based

Background: Globally, most young women have an unmet need for sexual and reproductive health (SRH), which remains a public health concern. Identifying the predictors can help reduce this challenge.Aim: This scoping review maps evidence on predictors of adverse sexual and reproductive health outcomes among young women in South Africa.Method: Askey and O’Malley’s framework guided this review. We searched five databases from January 2000 to December 2020 using relevant keywords, Boolean terms and medical subject heading terms. All relevant extracted data were organised into the study themes, and summary of all the findings were reported in a narrative format.Results: Nine studies met the inclusion criteria out of 1219 studies identified. Four out of the nine studies were national-based studies, while the remaining five studies were conducted in Western Cape (two), Eastern Cape (two) and KwaZulu-Natal (one). Out of the nine studies included, three reported predictors of unintended pregnancy, while six reported predictors of sexually transmitted infections and HIV among young women in South Africa. The most prevailing predictors of adverse sexual and reproductive health outcomes were gender-based violence and alcohol use, while other predictors were lower socio-economic status, place of residence, multiple sexual partnerships, low education and being between the ages of 20–24 years.Conclusion: We conclude that gender-based violence and alcohol abuse are the most prevailing predictors of adverse sexual and reproductive health outcomes among young women in South Africa.

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