ART Innovations: Fostering Women’s Psychophysical Health between Bioethics Precepts and Human Rights

Infertility is a highly relevant global issue affecting the reproductive health of at least 15% of reproductive-aged couples worldwide. The scope and severity of the infertility problem is even more prevalent in developing countries, mostly due to untreated reproductive tract infections (RTIs). Infertility, however, goes beyond the mere inability to procreate, but brings about profound psychological, social, and ethical implications of enormous magnitude. In vitro fertilization (IVF) and other assisted reproduction technologies (ARTs) have gradually become widespread therapeutic options. After all, the implementation of medically assisted reproductive procedures in order to overcome infertility is in keeping with the tenets of the reproductive rights agenda laid out at the International Conference on Population and Development (ICPD) in Cairo in 1994. Nonetheless, concerns still linger about how to implement and regulate such interventions in an ethically tenable fashion. The unremitting pace at which such techniques develop have upset the very notion of sexuality relating to reproduction as well as the concept of family itself. That rift risks causing a crisis in terms of bioethics sustainability and enforcement, which is bound to happen when science and innovation outpace the bioethical precepts on which we rely for essential guidance in medical practice. The authors argue in favor of an approach to regulation and policy-making that puts on the forefront a thorough assessment as to potential risks that such interventions might entail for foundational bioethics principles and inalienable human rights.

Prevalence of self-reported reproductive tract infections/sexually transmitted infections symptoms and treatment seeking behavior among the married tribal women in Udaipur, Rajasthan

Background: Indian tribes are culturally distinct communities, with unique traditions and practices. Lack of awareness and “culture of silence” about reproductive health issues among women in rural areas contributes to high burden of reproductive tract infections/sexually tract infections. Rural tribal women also suffer from ignorance, poverty and lack of access to quality health care, which makes them more vulnerable to RTIs/STIs.Methods: It was a community based cross sectional study conducted among 200 tribal women living in rural Udaipur, Rajasthan. The study was conducted from May 2019 to November 2019. A predesigned, pretested and structured questionnaire was used to take the interview of eligible women. Questionnaire included questions about sociodemographic profile, questions to assess the knowledge regarding RTIs and history of occurrence of any RTI symptom in the past six months and; questions to assess the treatment seeking behaviour for RTI symptoms.Results: Most of the participants were 26-35 years old.About 37% gave the history of experiencing RTI symptoms, vaginal discharge being the most common (46%) symptom. Regarding the treatment, most (34%) of the females took treatment from government hospital, followed by 26% of women who bought the medicines direct from pharmacy (over the counter), about 16% consulted a private practitioner. Prevalence was found to be significantly higher in less educated, belonging to lower socioeconomic status and among non-users of contraceptive methods.Conclusions: Health education and active participation of stakeholders in the reproductive health programs is essential to strengthen the ongoing schemes about improving reproductive health of tribal women.

Reproductive tract microbiota of women in childbearing age shifts upon gynecological infections and menstrual cycle

Background This study was undertaken to discover whether the vaginal microbe of women at childbearing age is different among groups defined by urogenital tract infections, childbearing history and menstrual cycle, respectively. Results This was a multiple case-control study of women at childbearing age who were assigned to case or control groups according to their states of urogenital tract infections. The participants were also grouped by childbearing history and menstrual cycle. Vaginal swabs were collected and stored at − 70 °C until assayed. The V3-V4 region of 16S rRNA gene was amplified using PCR and sequenced on the Illumina MiSeq platform. We tested the hypothesis of whether the relative abundance of microbial species in vaginal microbiota was varied with urogenital tract infections, childbearing history and menstrual cycle. The vaginal microbial richness (Alpha diversity measured by PD_whole tree) was decreased in normal women (without reproductive tract infections) than in those with bacterial vaginosis (BV), and decreased in pregnant women than in other groups of non-pregnancy. Similarly, women from groups of normal and in pregnancy had lower beta diversity on measure of unweighted_unifrac distance in comparison to those of infected and non-pregnant. The top 10 genus relative abundance, especially Lactobacillus, which was the most dominant genus with the relative abundance of 71.55% among all samples, did not differ significantly between groups of childbearing history and menstrual cycle analyzed by ANOVA and nonparametric kruskal_wallis. Lactobacillus iners and Lactobacillus helveticus have the most abundance, totally account for 97.92% relative abundance of genus Lactobacillus. We also found that a higher L.helveticus/L.iners ratio is more likely to present in normal women than in the infected and in pregnant than in non-pregnant, although these comparisons lack statistical significance. Conclusions The relative abundance of dominant bacterial taxa in vaginal microbial communities of women at childbearing age were not different among groups of childbearing history and menstrual cycle. Women from groups of in pregnancy and without reproductive tract infections had lower alpha and beta diversity. The composition of the main lactobacillus species may shift upon phases of a menstrual cycle and the status of reproductive tract infections.

Identifying Risk Factors for Lower Reproductive Tract Infections among Women Using Reusable Absorbents in Odisha, India

A large proportion of women in Odisha, India, use reusable absorbents to manage their menstruation. Yet, the risk factors for lower reproductive tract infections (RTIs) related to menstrual hygiene management (MHM) have not been studied among reusable absorbent users. Women of reproductive age attending one of two hospitals from two different cities in Odisha during two separate study intervals were recruited for the study. Laboratory diagnosis of bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC) were conducted. A questionnaire was used to collect information on MHM practices, water, sanitation, and socio-demographic factors. Among the 509 women who used reusable absorbents, 71.7% were diagnosed with at least one infection. After adjusting for confounders, women with BV were more likely to identify as being a housewife (aOR: 1.8 (1.1–2.9)). Frequent absorbent changing was protective against BV (aOR: 0.5 (0.3–0.8)), whereas frequent body washing increased the odds of BV (aOR: 1.5 (1.0–2.2)). Women with VVC were more likely to be older (aOR: 1.6 (1.0–2.5)), live below the poverty line (aOR: 1.5 (1.1–2.2)), have a non-private household latrine (aOR: 2.2 (1.3–4.0)), dry their absorbents inside the house (aOR: 3.7 (2.5–4.5)), and store absorbents in the latrine area (aOR: 2.0 (1.3–2.9)). Washing absorbents outside the house was protective against VVC (aOR: 0.7 (0.4–1.0)). This study highlights the importance of improving MHM practices among reusable absorbent users to prevent lower RTIs among women reusing menstrual materials in Odisha.

Predictors of preterm birth in Western Ethiopia: A case control study

Background Early neonatal death caused by preterm birth contributes the most for perinatal death. The prevalence of preterm birth continues to rise and is a significant public health problem. The exact cause of preterm birth is yet unanswered, as mostly preterm birth happens spontaneously. Predictors of preterm birth in developing countries like Ethiopia were not well investigated, and no study was conducted before this in the study area. Objectives To identify predictors of preterm birth in Western Ethiopia, 2017/2018. Methods Health facility-based unmatched case-control study was conducted from October 20/2017-march 20/2018 in 4 Hospitals. A total sample size of 358 women was recruited. From this 72 were cases and 286 were controls. Cases were mothers who gave Preterm birth, and controls were mothers who gave birth at term. Ethical clearance was obtained from Wollega University ethical review committee. A pre tested, structured questionnaire was used to collect data. Data entry and analysis was done using Epi Data 3.1 and SPSS version 21, respectively. Logistic regression was done to identify predictors of preterm birth. Result Three hundred fifty-eight women participated in this study of which 72 were cases and 286 were controls; making the overall response rate of 100%. Lack of antenatal care visit [AOR = 3.18, 95% CI 1.37–7.38]),(Having 1–2 antenatal care visit [AOR = 2.27, 95% CI 1.18–4.35]),history of previous preterm)[AOR = 5.19, 95% CI1.29–20.88],Short Interpregnancy Interval [AOR = 4.41.95% CI 2.05–9.47],Having Reproductive tract infections [AOR = 2.54, 95% CI 1.02–6.32] and having Obstetric complications [AOR = 2.48,95% CI 1.31–4.71] were found to be predictors of preterm birth. Conclusion and recommendation Risk factors of preterm delivery are multifactorial and depend on geographical and demographic features of the population studied. Hence results of studies from one area might not be applicable to another area. Antenatal care visits are unique opportunities for early diagnosis and treatment of problems. Therefore, antenatal care should be strengthened, and appropriate counseling should be given at each antenatal care follow up. Maintainning optimum birth interval through family planning, and early identification and treatment of reproductive tract infections are mandatory.