research topics on reproductive health

📕 Studying HQ

30+ Reproductive and Sexual Health Research Topics: A Guide for Nursing Scholars

Carla johnson.

• September 8, 2023
• Essay Topics and Ideas

Reproductive and sexual health is significant in healthcare, impacting individuals across their lifespans. For nursing scholars, comprehending these topics is vital for holistic patient care and overall well-being. This article delves into reproductive and sexual health research topics, giving nursing scholars insights into these sensitive subjects adeptly.

What You'll Learn

Understanding Reproductive and Sexual Health

Reproductive and sexual health covers various subjects, from family planning to sexually transmitted infections. It encompasses physical, emotional, and social aspects, demanding nursing scholars’ adeptness in offering respectful, compassionate care .

10 PICOT Questions in Reproductive and Sexual Health

• P: Adolescents seeking contraception knowledge; I: Introducing comprehensive sexual education; C: Traditional education; O: Lower teen pregnancies ; T: 2 years. Teens often lack contraceptive knowledge. Can comprehensive education reduce unintended pregnancies?
• P: Menopausal women; I: Offering hormone replacement therapy choices; C: No therapy; O: Better life quality, fewer symptoms; T: 6 months. Menopausal symptoms can disrupt life. Can hormone therapy choices alleviate these symptoms?
• P: Couples planning conception; I: Using fertility tracking apps; C: Traditional methods; O: Accurate fertile period identification; T: 1 year. Can fertility apps aid couples in conceiving?
• P: STI-diagnosed individuals; I: Partner notification strategies; C: No notification; O: Improved STI management, reduced transmission; T: 3 months. How effective is notifying and testing partners of STI-diagnosed individuals?
• P: Postpartum women; I: Offering contraception counseling ; C: Standard care; O: Increased contraception use; T: 6 weeks. Postpartum contraception is vital. Can counseling enhance postpartum contraception rates?
• P: LGBTQ+ youth in schools; I: Integrating inclusive sexual education; C: Traditional curriculum; O: Better understanding of diverse sexualities; T: 1 school year. Can inclusive education improve LGBTQ+ sexual education experiences?
• P: Elderly in care homes; I: Implementing sexual health discussions; C: No structured talks; O: Enhanced sexual well-being, reduced stigma; T: 6 months. Elderly sexual health needs attention. Can open discussions improve well-being?
• P: Individuals with disabilities; I: Providing accessible sexual health resources; C: Limited resources; O: Empowered choices, better sexual health; T: 1 year. Disabilities limit resources. Can tailored materials improve sexual health understanding?
• P: Reproductive-age women; I: Introducing telehealth for reproductive care; C: In-person consultations; O: Enhanced access, improved outcomes; T: 6 months. Reproductive care access is limited. Can telehealth bridge the gap?
• P: Inconsistent contraceptive users; I: Dual contraceptive method counseling; C: Single method advice; O: Fewer unintended pregnancies; T: 1 year. Inconsistent contraception usage can lead to pregnancies. Can counseling on dual methods help?

20 Reproductive and Sexual Health Research EBP Topics

• Assess online sexual education effectiveness for adolescents.
• Implement a peer-led contraception campaign on campuses.
• Evaluate cultural sensitivity training for sexual health discussions.
• Investigate postpartum sexual dysfunction’s mental health impact.
• Develop sexual education for long-term care.
• Compare contraceptives in preventing STIs.
• Examine religious beliefs and contraception choices.
• Explore telehealth for remote STI counseling.
• Assess reproductive health issues among transgender individuals.
• Investigate rural reproductive care barriers.
• Analyze sex education’s teenage pregnancy impact.
• Develop elder sexual health provider training.
• Evaluate mobile apps for youth sexual health awareness.
• Investigate knowledge’s effect on student behaviors.
• Assess comprehensive sexual education’s STI impact.
• Investigate reproductive health in marginalized communities.
• Develop school nurse adolescent sexual health training.
• Explore LGBTQ+ reproductive healthcare experiences.

20 Nursing Capstone Project Ideas for Reproductive and Sexual Health 

• Designing college sexual consent education.
• Creating diverse cultural sexual health guides.
• Intervention to reduce STI stigma.
• Investigating prenatal sex education’s impact.
• Sexual health toolkit for foster care adolescents.
• Linking sexual education to partner violence prevention.
• Support for fertility-challenged individuals.
• Sexual health education for intellectual disabilities.
• Empowering marginalized populations’ sexual health.
• Inclusive LGBTQ+ youth sexual health resources.
• Elder sexual health in nursing homes.
• Inclusive sexual education educator training.
• Online sexual health forum impact.
• Media influence on body image and satisfaction.
• Nurses discussing sexual health with chronic patients.
• Telehealth for remote sexual health services.
• Campus campaign for healthy relationships.
• Refugee reproductive healthcare access.
• Parent-adolescent sexual health communication.
• Nursing advocacy in comprehensive sexual education.

20 Reproductive and Sexual Health Research Topics

• Pornography’s impact on adolescent body perceptions.
• Cultural influences on immigrant contraceptive choices.
• Factors delaying STI treatment-seeking in young adults.
• Nurse practitioners’ LGBTQ+ sexual healthcare role.
• Sexual education impact on unintended pregnancies.
• Low-income women’s preconception care access.
• Transgender reproductive healthcare experiences.
• Parental views on school sexual education.
• Aging population sexual health discussions.
• Marginalized community reproductive health disparities .
• Hormonal contraception’s mental health implications.
• Abstinence-only education’s effects on youth behavior.
• Disabilities and sexual health understanding.
• Media influence on sexual attitudes.
• Ethics of older fertility treatments.
• Reproductive healthcare disparities and marginalized groups.
• Socioeconomics affecting contraception access.
• Reproductive healthcare in conservative societies.
• Intimate partner violence’s impact on sexual health .
• Media portrayal of sexuality’s societal effects.

30 Reproductive and Sexual Health Essay Topics for In-Depth Discussions

• Ethics of compulsory sexual education.
• Media’s effect on adolescent sexuality.
• Sexual autonomy and healthcare.
• Healthcare policies shaping access.
• Disabilities and reproductive care.
• Cultural norms influencing contraception .
• Abstinence-only education debate.
• Gender identity in reproductive care.
• Evolution of reproductive rights .
• Nursing elderly sexual health.
• Sexual education and violence prevention.
• Religion’s influence on healthcare.
• Media’s effect on body image.
• Ethical older fertility treatments.
• Healthcare policies and disparities.
• Access in conservative societies.
• Socioeconomic factors in contraception.
• Chronic illnesses and sexual health.
• Reproductive health in marginalized groups.
• Aging population’s sexual well-being.
• LGBTQ+ sexual education needs.
• STI transmission and education.
• Gender norms and behavior.
• Sexuality portrayal in media.
• Ethical implications of reproductive technology.
• Disabilities’ impact on sexual health.
• Media’s effect on sexual perceptions.
• Medical tourism’s reproductive impact.
• Intersection of sexuality and disabilities.
• Nursing advocacy in sexual education.

Nursing scholars possess the potential to influence reproductive and sexual health. By exploring projects, capstones, research, and essays, you contribute to a comprehensive understanding of these essential topics. Seek assistance from our expert writing services to ensure your academic success. Embrace your role as an advocate for sexual well-being, working towards a future where reproductive and sexual health is respected and promoted for all.

FAQs: Exploring Reproductive and Sexual Health for Nursing Students

Q1: What is the role of a nurse in sexual and reproductive health?

A1: Nurses play a pivotal role in providing comprehensive education, counseling, and care related to sexual and reproductive health. They empower individuals to make informed decisions and promote overall well-being.

Q2: What are the 4 pillars of reproductive health?

A2: The four pillars of reproductive health include the right to reproductive choices, access to quality reproductive healthcare services, sexual education , and eliminating discrimination and stigma surrounding reproductive and sexual health.

Q3: Why is reproductive health and sexual health important?

A3: Reproductive and sexual health is crucial for individual well-being, gender equality, and public health. It encompasses physical, emotional, and social aspects and is essential for family planning, disease prevention, and overall quality of life.

Q4: What is the concept of reproductive health and sexual health?

A4: Reproductive health focuses on the physical, emotional, and social well-being in all matters related to the reproductive system, while sexual health includes the physical, emotional, and psychological aspects of sexual well-being and relationships. Both concepts encompass rights, choices, and access to healthcare services.

Start by filling this short order form order.studyinghq.com

And then follow the progressive flow. 

Having an issue, chat with us here

Cathy, CS. 

New Concept ? Let a subject expert write your paper for You​

Have a subject expert write for you now, have a subject expert finish your paper for you, edit my paper for me, have an expert write your dissertation's chapter.

Typically replies within minutes

Hey! 👋 Need help with an assignment?

🟢 Online | Privacy policy

WhatsApp us

• Copy/Paste Link Link Copied

Reproductive Health

Understanding and promoting reproductive health has been a key research theme for NICHD since it was founded. Research conducted and supported by the institute continues to broaden available knowledge about the spectrum of reproductive health issues that affect all people.

NICHD continues to expand its research to improve reproductive health, including studies of the basic biology of typical and atypical reproductive system development, the mechanisms and management of gynecologic disorders and their timing, options that allow all people to manage their fertility, social and environmental influences on reproductive health, and identification of biomarkers for reproductive aging.

Visit any one of the following health topics to learn more about the institute's research efforts to related to reproductive health.

NICHD Health Topics Related to Reproductive Health

Bacterial Vaginosis

Contraception and Birth Control

Endometriosis

Fragile X-Associated Primary Ovarian Insufficiency (FXPOI)

High-Risk Pregnancy

Infertility and Fertility

Labor and Delivery

Maternal Morbidity and Mortality

Men's Reproductive Health

Menstruation and Menstrual Problems

Pelvic Floor Disorders (PFDs)

Pelvic Pain

Polycystic Ovary Syndrome (PCOS)

Pre-Pregnancy Care and Prenatal Care

Pregnancy Loss (Before 20 Weeks of Pregnancy)

Preterm Labor and Birth

Primary Ovarian Insufficiency (POI)

Puberty and Precocious Puberty

Sexually Transmitted Diseases

Urinary Tract Health

Uterine Fibroids

Women's Health

• Biochemistry and Molecular Biology
• Biostatistics
• Environmental Health and Engineering
• Epidemiology
• Health Policy and Management
• Health, Behavior and Society
• International Health
• Mental Health
• Molecular Microbiology and Immunology
• Population, Family and Reproductive Health
• Program Finder
• Admissions Services
• Course Directory
• Academic Calendar
• Hybrid Campus
• Lecture Series
• Convocation
• Strategy and Development
• Implementation and Impact
• Integrity and Oversight
• In the School
• In the Field
• In Baltimore
• Resources for Practitioners
• Articles & News Releases
• In The News
• Statements & Announcements
• At a Glance
• Student Life
• Strategic Priorities
• Inclusion, Diversity, Anti-Racism, and Equity (IDARE)
• What is Public Health?
• Research and Practice
• Inclusion, Diversity, Anti-Racism and Equity (IDARE)
• Job Openings
• Alumni Employment
• Courses by Areas of Interest
• Introduction
• Project Development
• Implementation
• Dissemination
• Tools and Templates
• Publications
• CAHMI - Child and Adolescent Health Measurement Initiative
• COVID-19 Policies and Childhood Obesity Study
• Childcare Wellness Practices & Policies Project
• Evaluation of COVID-19 School Meals Response
• Maryland Wellness Policies and Practices Project (MWPPP)
• Wellness Champions for Change
• Healthiest Maryland Schools
• Project SELECT
• Tools and Resources
• For Families
• Volunteer and Employment
• Master's Students
• PhD Students
• News and Events
• Make a Gift
• Adolescent Sexual and Reproductive Health

Gender Based Violence

Gender disparities, maternal health.

• Men’s Sexual and Reproductive Health
• Pregnancy prevention: Family Planning/Unintended pregnancy and Abortion

Adolescent Sexual and Reproductive Health

Clinical correlates of mycoplasma genitalium in young women.

Maria Trent The primary aims of this study are to determine the rate and 12-month longitudinal clinical correlates of MG and TV infection among a sample of young pregnant women 13-29 years of age seeking reproductive health care in an urban hospital setting. The outcomes of this work will be critical for determining need for integration of MG testing in routine laboratory testing once available.

Evaluation of Sexual Health Curriculum for Health Students in Tanzania

Maria Trent As documented in the US Surgeon General's Call to Action to Promote Sexual Health and Responsible Sexual Behavior, training of health providers in sexual health care is critical to addressing a broad array of the nation's sexual and reproductive health concerns. Yet rigorous trials evaluating the effects of sexual health curricula on provider behavior are rare. In sub-Saharan Africa, an environment which has the highest rates of HIV, STI, teen pregnancy, unwanted pregnancy, unsafe abortion, child marriage of girls and sexual assault of boys in the world, and where female genital cutting, wife-beating, marital rape, criminalization of homosexuality, stigmatization of Lesbian, Gay, Bisexual and Transgender (LGBT) persons, myths about masturbation leading to dysfunction, and rates of sexual dysfunction in both men and women are common, we could find no formalized training of health providers in sexual health care. Sexual health education, even of health providers, is a sensitive issue in Africa. Consequently, a rigorous study of its effects is needed, if such education is to be widely adopted. Recently, at Muhimbili University of Health and Allied Sciences (MUHAS) in Dar es Salaam, we adapted a PAHO/WHO sexual health curriculum training for healthcare providers for implementation in Tanzania. Participants were 87 nursing, midwifery, and allied health science students. Pre-post evaluations show the curriculum to be highly acceptable, needed, and desired by students, feasible in implementation, and effective in improving student knowledge, attitudes, and skills in providing sexual health care to patients. The logical next step in this line of research is to conduct the first rigorous trial of a comprehensive sexual health training curriculum for health professionals in Tanzania. There are three specific aims. Aim 1 is to conduct a social ecological needs assessment of sexual health care delivery in Tanzania. To determine whether midwifery, nursing, medical, and allied health science students would benefit from one curriculum or separate curricula tailored by discipline, we will conduct focus groups (3 from each discipline). We will also conduct individual interviews with key informants to address structural and cultural issues. In Aim 2, we will further adapt our curriculum, ensure it is culturally tailored to the Tanzanian/sub-Saharan context, and pilot test it. Aim 3 is to evaluate the effectiveness of an African-based, culturally-appropriate, sexual health curriculum. We will conduct a randomized, controlled, single blinded trial of the curriculum against a waitlist control assessing effects on sexual health knowledge, attitudes, and counseling skills (n=206 students per arm; 412 in total). Hypotheses will test if the curriculum is effective, and whether it is more effective for one discipline than another. If effective, MUHAS has committed to implement the curriculum for all their health students. Given MUHAS is preeminent in health student education across Africa, the curriculum assessed in this study has high potential to be widely adopted as a new standard of training for health professionals across Africa.

Faith-based Adolescents Involved in Total Health

Terrinieka Williams Powell Focused on those areas of Baltimore where the adolescent pregnancy rates are the highest, this study aims to understand what is currently being done in the churches of those communities to address pregnancy prevention and to identify the potentials and barriers for effective interventions.

The Global Early Adolescent Study

Robert Blum, Caroline Moreau, Kristin Mmari, Saifuddin Ahmed, Lori Heise, Leah Keonig, Mengmeng Li, Mark Emerson The Global Early Adolescent Study (GEAS) seeks to understand how norms, attitudes and expectations about gender influence health outcomes and behaviors across the adolescent period. Building upon formative, mixed-methods research conducted in sixteen countries between 2014 and 2016, the GEAS has collected baseline data from over 13,000 adolescents on five continents since 2017. Additional survey topics include sexual and reproductive health, mental health, body comfort, school retention and empowerment. In four countries, the GEAS is used to evaluate the longitudinal impact of gender-transformative interventions carried out by Rutgers, Netherlands; Save the Children and the Institute of Women and Ethnic Studies. Participating GEAS sites include New Orleans, USA; Cuenca, Ecuador; Santiago, Chile; São Paolo, Brazil; Belgium; Indonesia; Shanghai, China; Kinshasa, DRC; Cape Town, South Africa; and Blantyre, Malawi. Results from the longitudinal GEAS will help to answer important questions about the formation and manifestations of gender inequality, its relationship to health and well-being and the interventions that are effective in promoting gender equality.

Current activities include efforts to improve awareness of and response to ethical issues in research and programming with adolescents living in vulnerable contexts the development of a special supplement using baseline GEAS focused on gender equality. At present, students are involved in manuscript development with partners in China, Ecuador, Bolivia and Malawi. For more information about the GEAS, including our global network of collaborators, recent reports and publications and open-access survey and training instruments, please visit the GEAS website.

Harriet Lane Clinic’s Title X Program

Arik V. Marcell Funded by the Office of Population Affairs, to provide reproductive health services to adolescents & young adults who are uninsured, underinsured or seeking confidential services and conduct quality improvement strategies to ensure providers are delivering quality family planning and sexual and reproductive health care services.

Technology Enchanced Community Health Nursing to Reduce Recurrent STIs after PID

Maria Trent This study examines the efficacy of a technology-enhanced community health nursing intervention on adherence to PID treatment recommendations and subsequent short-term sexually transmitted infection acquisition using a randomized controlled trial.

Community-partnered technology for partner violence prevention and response: MyPlanKenya

Michele Decker, Nancy Glass (School of Nursing) This initiative adapts and refines a safety planning “app” intervention for women in urban Kenya, followed by evaluation via randomized controlled trial. The app enables priority-setting for safety-related decisions and provides support and referrals to local resources. It harnesses community health volunteers (CHVs) as key lay professionals poised to play a critical role in partner violence prevention and response. With support from ideas42.

Continuum of Shelter and Housing Models for Victims of Intimate Partner Violence

Michele Decker, Charvonne Holliday With support from the National Institute of Justice, this initiative entails formative evaluation and evaluability assessment for leading models of housing stabilization for partner violence survivors, specifically rapid rehousing and transitional housing, in partnership with House of Ruth Maryland. Following a formative phase, we monitor health, safety, and well-being indicators among IPV survivors receiving housing support over a 6-month follow-up period, and evaluate readiness to support IPV survivors among housing providers.

Developing and Piloting A Gender-Based Violence Intervention Module to Reduce HIV Risk among Female Sex Workers (FSWs)

Michele Decker, Susan Sherman (Epi), Nancy Glass (School of Nursing) With support from the Johns Hopkins Center for AIDS Research (P30AI094189, PI Chaisson), this initiative uses a community-based participatory approach to develop and pilot test a brief violence intervention module to encourage violence-related harm reduction, provide social support related to violence victimization, and reduce related HIV risk behavior among women who trade sex or are sexually exploited.

Collaborative for Gender Equity and Empowerment in Education, Health and Labor Systems

Michele Decker, Lori Heise, Nancy Glass, Rosemary Morgan, Colleen Stuart, Toni Ungaretti, Vivian Lee This collaborative blends gender analysis with case studies and development and field testing of new indicators for gendered aspects of labor, education and health systems, in collaboration with academic and community partners.

Duration of Hormonal Contraceptive Use: Immune Responses & Vaginal Microbiota

PI: Dr. Khalil Ghanem – Co-investigator: Anne Burke This NIH-funded study investigates the impact of hormonal contraceptives on the vaginal microbiome. Use of postpartum IUDs and implants. This study evaluates outcomes in women who receive long-acting contraception in the immediate postpartum period.

Gender barriers to non-communicable disease prevention, treatment and management

Michele Decker, Rosemary Morgan, Nancy Glass This collaboration with World Health Organization applies gender analysis frameworks to non-communicable diseases via a scoping review of gender barriers to care, primarily in low and middle income countries.

Bob Blum, Caroline Moreau, Kristin Mmari, Saifuddin Ahmed, Lori Heise, Leah Keonig, Mengmeng Li, Mark Emerson The purpose of The Global Early Adolescent Study is to understand how gender norms influence sexual attitudes and relationship formation in early adolescence as well as subsequent sexual activity and contraceptive practices in older adolescence. Specifically, the study explores: 1) gender socialization in early adolescents; 2) how gender norms inform sexual and reproductive health (SRH) across adolescent years 3) how gender transformative interventions can improve SRH trajectories. The study takes place in 9 urban poor sites across 4 continents (South Africa, Malawi, DRC, Belgium, China, Indonesia, Chili, Brazil and the United States) and follows between 600 and 3000 young adolescents 10-14 years in each site over a 3 to 5 year period. This research provides empirical evidence testing gender pathways to SRH while guiding programs to overcome gender discrimination and promote women’s and girls’ wellbeing. To learn more please visit the GEAS page .

Antihypertensive Medication in Pregnancy: An Update from the 2011 WHO Recommendations for Prevention and Treatment of Preeclampsia and Eclampsia

Donna Strobino, Saifuddin Ahmed, Erika Werner (Brown Univ, school of Medicine), Mahua Mandal, Laina Gagliardi, and Roxanne Beltran The aim of this project is to update the science behind WHO recommended anti-hypertensive medications in pregnancy to prevent preeclampsia and manage hypertension and to estimates the prevalence of chronic hypertension, preeclampsia and all hypertensive disorders in pregnancy using data from population- based studies worldwide and facility based studies in resource poor settings. The study also using extant data to estimate unmet need and potential demand for antihypertensive medications in pregnancy in low resource settings.

Contraceptive Efficacy of a Novel Vaginal Ring

Anne Burke This is an upcoming NICHD-funded, prospective study evaluating use of a vaginal contraceptive ring in healthy women. Pharmacokinetics of oral contraceptives before and after bariatric surgery. This study compares pharmacokinetic and pharmacodynamic profiles of oral contraceptive use for women undergoing gastric bypass surgery.

Men's Sexual and Reproductive Health

Project connect baltimore.

Arik V. Marcell This is a CDC-funded program to evaluate school and community-based methods to engage males in HIV/STD testing and sexual and reproductive health care in Baltimore City by training youth-serving professionals on a web-based clinical services provider guide for male-specific clinical services (Y2CONNECT.org). If successful, this project will advance the field of male health promotion through its use of innovative approaches and technology that are easily transferable to a variety of settings and implemented at low cost

Technology Enchanced Community Health Nursing Study

Maria Trent The study involves 350 young women 13-21years old diagnosed with PID in Baltimore and randomize them to receive CHN clinical support using a single post-PID face-to-face clinical evaluation and SMS communication support. We hypothesize that repackaging the recommended CDC-follow-up visit using a technology-enhanced community health nursing intervention (TECH-N) with integration of an evidence-based STI prevention curriculum will reduce rates of short-term repeat infection by improving adherence to PID treatment and reducing unprotected intercourse and be more cost-effective compared with outpatient standard of care (and hospitalization). To learn more, please visit the Study Record Detail page .

Pregnancy Prevention: Family Planning/Unintended Pregnancy and Abortion

Advance family planning.

Duff Gillespie, Beth Fredrick Advance Family Planning (AFP) is an advocacy initiative established in 2009 at the William H. Gates Sr. Institute for Population and Reproductive Health. AFP aims to increase the financial investment and political commitment needed to ensure access to high-quality, voluntary family planning through collaborative, evidence-based advocacy aimed at working effectively with decision-makers. AFP is supported by the Bill & Melinda Gates Foundation, the David & Lucile Packard Foundation, and the William and Flora Hewlett Foundation.

Evidence of COVID-19’s Potential Impact on Inequities in Abortion Access

Suzanne Bell, Anne Burke,  Carolyn Sufrin

Results from a small study completed by Bloomberg School faculty and students found that COVID-19 potentially increased existing inequities related to abortion. The study looked at abortion service availability and care seeking experiences in the Washington, DC, Maryland, and Virginia region during the pandemic and found that financially disadvantaged groups were disproportionately negatively impacted.  More information is found in the facsheet,  

FP quality metrics in Maryland

Caroline Moreau, Anne Burke This project aims to test a framework for monitoring quality of care for family planning among all women of reproductive age in Maryland, using computerized data found in health insurance claims and electronic health record (EHR) systems

Measuring the incidence and safety of Abortion

Caroline Moreau, Suzanne Bell The PMA Abortion project aims to use the PMA platform to conduct research on Abortion in 3 geographies (Cote D’Ivoire, Nigeria, Rajasthan) to assess abortion prevalence and safety using both direct and indirect measures and to explore women’s access to care for abortion procedures.

PMA Agile: Monitoring family planning service delivery and use at the subnational level

Amy Tsui, Scott Radloff, Phil Anglewicz This project is being implemented in 13 urban sites in collaboration with research partners in Burkina Faso, DR Congo, India, Kenya, Niger and Nigeria. PMA Agile conducts quarterly surveys of health facilities and semi-annual surveys of clients to monitor change in service preparedness and quality as well as client satisfaction and their continued use of contraception.

Performance Monitoring in Action

Scott Radloff Performance Monitoring for Action or PMA for short (formerly PMA2020) is a Bill and Melinda Gates Foundation funded project, implemented in partnership with Jhpiego and a network of university and research institutions, that supports rapid-turnaround surveys to monitor progress in reproductive health indicators. The project was launched in 2013.

PMA implements cross-sectional and longitudinal surveys to fill a data gap – collecting information to understand the drivers of contraceptive use dynamics – information that is not currently measured by other large-scale surveys. While having a core family planning focus, the PMA platform can be used for data collection in other health topics. To date the platform has been used to collect data for guiding programs in abortion, adolescent sexual and reproductive health, women and girls’ empowerment, maternal and child health, nutrition, water and sanitation, menstrual hygiene management, neglected tropical diseases (schistosomiasis), sample vital registration systems, and primary health care.

The project employs a network of female resident enumerators recruited from near the selected survey clusters who are trained to use smartphones to gather survey data. The PMA platform has been deployed in 11 countries so far with plans to expand. Countries include Ghana, Democratic Republic of Congo, Ethiopia, Uganda, Burkina Faso, Niger, Nigeria, Indonesia, India, Cote d’Ivoire, and Kenya.

For more information please visit pmadata.org .

The predictive utility of unmet need and intentions to use contraception in Uganda

Amy Tsui, Scott Radloff, Saifuddin Ahmed The study team is assessing the predictive utility of a leading indicator, unmet need for contraception, and that of a less prominent one, future intention to use, as influencing contraceptive adoption, using data from a four-year panel follow-up of a national sample of Ugandan women.

Quality improvement to integrate HIV testing in the Harriet Lane Clinic’s Title X Program

Arik V. Marcell Funded by the Office of Population Affairs, the goal of this program is to integrate rapid HIV testing as part of Title X services and increase the proportion of clients receiving HIV test results and evaluate increased use using rapid Plan-Do-Study-Act cycles.

Jump to navigation

• Why "Ibis"?
• Accomplishments
• Safe, affordable abortion care access
• Bold service-delivery & technology innovations
• Comprehensive SRH info & services
• South Africa
• United States
• Latin America & the Caribbean
• Africa region
• Multi-regional/other
• Justice and Equity
• Our Strategy
• Our Approach
• Publications

Research Topics

Contraception, linking reproductive health & hiv, hiv/sti prevention, other areas.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Wiley - PMC COVID-19 Collection

The Sexual and Reproductive Health of Adolescents and Young Adults During the COVID ‐19 Pandemic

Laura d. lindberg.

1 Guttmacher Institute, New York

David L. Bell

2 Department of Pediatrics and Department of Population and Family Health, Columbia University Medical Center, New York

Leslie M. Kantor

3 Department of Urban—Global Public Health, Rutgers School of Public Health, Rutgers University, New Yark NJ

The COVID‐19 public health crisis is having rapid and profound effects on how people around the world are living their lives. Adolescents and young adults (AYA) aged 12–24 in the United States are at low risk for hospitalization and death from COVID‐19 compared with other age‐groups. * However, the disease may affect other aspects of their physical, mental and social health. Sexual and reproductive health (SRH) touches upon all of these domains, and involves intimate relationships, sexual activity, contraceptive use and abortion care. Evidence of the SRH impacts of previous large‐scale disruptions in the United States, including natural disasters 1 and the 2008 recession, 2 suggests that the current pandemic will have serious and sustained effects on young people. AYA will experience the current pandemic in ways that reflect their unique developmental and cohort situations. 3 In this viewpoint, we review potential immediate and longer term impacts of the COVID‐19 pandemic on the SRH needs and behaviors of AYA, and provide direct evidence of COVID‐19 impacts where available.

Impact on Sexual and Reproductive Health

Adolescents’ and young adults’ sexual and reproductive health is being and will continue to be impacted by the COVID‐19 pandemic through both distal and proximal pathways (Figure  1 ). The pandemic has brought about dramatic social and economic changes, including social distancing, a period of stay‐at‐home requirements, nearly universal school closures, increased engagement with parents or other household members, and growing economic insecurity. Among older AYA, college closings, financial issues and the desire to be with family have brought some back into their parents’ household after a period of having gained some independence. These widespread social and economic shifts have disrupted AYA romantic and sexual relationships, as well as their access to affordable and confidential health care services and resources. We explore how these social, economic and proximal influences may affect AYA intimate and sexual behaviors and the use of a range of SRH services.

Pathways of COVID‐19–related influence on the sexual and reproductive health of adolescents and young adults

Relationships and sex

The COVID‐19 pandemic has interrupted many of the normative aspects of AYA development, a period that should be marked by growing independence 3 and strengthening peer relationships. 4 Many young people currently face increased parental monitoring and reduced privacy. This increased monitoring, diminished independence and reduced physical interaction with peers will likely have yet unknown effects on this cohort's developmental trajectory, † especially since we don't know how prolonged or widespread the disruptions will be, and whether they will recur.

For most young people, social distancing and stay‐at‐home guidelines have likely resulted in less partnered sex. However, during the pandemic's initial peak, about one‐third of 13–17‐year‐olds in a national survey reported that they were still meeting close friends in person. ‡ , 5 Some AYA will continue to engage in partnered sexual behaviors, either in established relationships (including cohabiting ones) or with new partners. Online social connections are also important. Today's youth are digital natives who are frequently online for entertainment, learning and socializing, and these digital interactions offer options to connect despite the social disruptions inherent in physical distancing and stay‐at‐home orders. 4 In fact, as a result of social distancing during the pandemic, 65% of teenagers were texting with friends and family, or interacting with them via social media, more often than usual. 5 These forms of digital communication also offer a means for romantic or sexual interactions, including conversations, online dating, sexting, virtual sex and other online activities. 6

For AYA in established or new relationships, physical separation may influence relationship quality or stability. For some, physical distancing from partners results in less sexual or physical intimate partner violence (IPV). § For individuals who cohabit with a partner, however, stay‐at‐home orders may increase the risk of experiencing IPV. Online emotional abuse by a partner may also occur for those who are currently physically separated. Disruptions such as school or workplace closures and reduced access to health care may exacerbate these issues and make it harder for young people to seek support or interventions. 7

Access to and use of SRH care

The pandemic has imposed economic and logistical barriers to obtaining contraceptive and other SRH services for all ages, but has particular implications for AYA. Loss of their own or parents’ earnings or health insurance creates economic barriers to accessing care and paying for contraceptive methods. Beyond cost issues, the ability to obtain SRH care that is confidential and private is hampered for young people sheltering in place with parents or guardians and may influence their behaviors. Research has found that AYA who have concerns about confidentiality are less likely to use SRH services and report lower levels of contraceptive use. 8 , 9 Pandemic‐driven changes in how services are provided, such as limiting in‐person care and deferring new and walk‐in patients, also create barriers. In addition, individuals may want to avoid obtaining in‐person care during this time to reduce the risk of viral transmission. Recently, a group of clinicians offered guidelines and practice protocols for providing contraceptives to young people as an essential service despite COVID‐19 disruptions, as well as strategies for maximizing access and confidentiality. 10

Increasing use of telemedicine approaches (by either video or phone) and online contraceptive provision may ultimately expand access to SRH care for AYA. But for now, many issues make telemedicine particularly challenging for this age‐group. 11 , 12 Although medical guidelines strongly endorse patient privacy, such privacy may be difficult to obtain during a young person's telemedicine visit. 13 Young people at home with family may not have a private place where they won't be overheard. Further, many commercial telemedicine services do not accept insurance or offer sliding‐fee scales. 14 Telemedicine visits generally require that prescriptions be submitted to a pharmacy, which means AYA who are uninsured must pay the retail cost of these medications, rather than the low out‐of‐pocket costs they would pay in many SRH clinics. Moreover, the “digital divide” that exists in the United States means that individuals who live in certain areas or have low socioeconomic status may not have adequate access to online health care. 15

The pandemic has increased barriers to SRH care for already underserved youth, including LGBTQ young people, unhoused individuals, and those in the foster care system, the criminal justice system and immigrant detention centers. Although telemedicine may be an option for some, these groups are less likely than others to have an established relationship with a health care provider and may find the cost of services prohibitive. Furthermore, providers who are available through telemedicine may not offer inclusive or culturally aware care, or be able to provide needed specialized services; for example, access to gender‐affirming hormone therapy may still require in‐person visits, and providers report delaying new visits for such care. 16 The pandemic may also increase the need for SRH care for the most vulnerable youth if trading sex for money or food becomes a more common survival strategy. 17

Preventive and screening services

The COVID‐19 pandemic is also impacting young people's use of SRH preventive and screening services. Analysis of pediatric electronic health records found that HPV vaccinations declined by 68% from February to early April of 2020; this decline was greater than that observed for other pediatric vaccines (e.g., measles, mumps and rubella shots dropped by 50%). 18 Similarly, the Centers for Disease Control's tracking of vaccine‐ordering statistics through late April found less of a decline in vaccinations for children younger than two than for those two or older, 19 and vaccination data for New York City echo this. 20 Together, these data suggest that adolescents are more likely than younger children to miss well‐visits or receive incomplete ones.

Although STI testing and treatment are critical for health, access for young people is likely diminished in the absence of regular well‐visits. 14 Routine screening for STIs may not occur, despite medical guidance for universal chlamydia screening of sexually active females younger than 25. 21 STIs are often asymptomatic, so missed screenings will result in untreated infections, which may have serious negative sequelae. Telemedicine treatment for patients and their sex partners can minimize in‐person health care contacts. Although young people's STI rates may decline because of reduced physical access to sexual partners, delays in getting screened and treated, or the inability to do so, will make the situation worse for those infected.

Abortion care

The logistical and economic challenges to obtaining needed SRH care as a result of the COVID‐19 pandemic are even more significant regarding young people's ability to obtain abortions. As of May 19, 2020, at least 11 states had exploited the pandemic to ban or restrict access to abortion, ostensibly on the grounds that abortion provision is “nonessential health care”; 22 these declarations contradict the statements of leading medical experts asserting that abortion remains an essential and time‐sensitive health service during the COVID‐19 crisis. 23 Moreover, the abortion bans increase patients’ costs and travel distances, which may cause AYA to delay obtaining an abortion or make such care completely inaccessible. 24 For young people living in states with COVID‐19–related abortion bans, the option of traveling out of state may not be as feasible as it is for older women, owing to lack of transportation or financial resources, and lack of autonomy and privacy. Evidence from earlier state efforts to limit minors’ access to abortion showed that the distance to providers is a significant barrier. 25 For minors who need an alternative to meeting parental permission requirements, the process of obtaining a judicial bypass has become even more complicated and burdensome during the pandemic. Although most adolescents who decide to terminate their pregnancy involve a parent, 26 others fear that their parents will react with violence or kick them out of their home. 27 The current crisis may also shift AYA pregnancy desires away from intending or wanting to have a child. Data collected online in early May found that nearly four in 10 female respondents aged 18–24 reported that because of the pandemic they now want to have a baby later than they had previously planned. 28

Sex education

Sex education is critical to AYA sexual and reproductive health and is associated with positive health outcomes. 29 , 30 Before the pandemic, schools were a key source of formal sex education for young people. 31 Sex education, which was already limited in many areas of the country, 32 , 33 has likely not been included in the national shift to online learning. Even when in‐person schooling resumes, missed sex education instruction is unlikely to be made up, given the modest attention it received prior to the pandemic. Exacerbating this missed instruction, funding for sex education may be cut as a result of the economic downturn, and hence schools may reduce its provision even more. AYA often go online to find SRH information, and such resources will become more critical for youth who are unable to obtain information from schools or health care providers. Yet young people may receive inaccurate information when they search for answers online, and specific information may be unavailable. 34 For example, guidelines for making sex safer during the pandemic that were released by the New York City Department of Health and Mental Hygiene were removed from their website at one point because of controversy (the guidelines were later reinstated when that action became public). 35 The risk of contracting COVID‐19 from sexual transmission is still unknown, but the virus has been identified in semen. 36

Future Shifts in Behavior and Health Care

Although the impacts of the pandemic are still unfolding, there are potential longer term consequences that will shape AYA sexual and reproductive health. These may include shifts in individual SRH behaviors and outcomes, and in the health care services and systems that serve young people. All of these elements will influence future SRH trends.

First, behavioral shifts among adolescents and young adults may continue. As social isolation and physical distancing practices diminish, there may be a period of “making up for lost time” in which sexual activity increases; this may be particularly true in the upcoming summer months when schools are closed and conventional summer activities are hampered. Also, psychological fatigue from following behavioral restrictions because of COVID‐19 could lead to AYA having more unprotected sex, especially if restrictions persist over the long term. 37 Young people's ability to leave abusive relationships will likely be constrained by financial factors, including high levels of sustained unemployment.

Second, some of the potential adverse health outcomes of the COVID‐19 crisis may be mitigated if in the months following the end of stay‐at‐home orders there is a period of health care catch‐up and individuals seek out delayed care, including well‐visits, contraceptive care and HPV vaccinations. The demonstrated decline in vaccination uptake may eventually be made up, but it is unclear how long it will take to get those rates back to their previous levels, and this could lead to higher rates of cervical cancer for this cohort. One positive outcome of the epidemic could be that the appetite for a COVID‐19 vaccine may shift the public's perceptions of vaccines in a positive direction and ultimately increase HPV vaccine acceptance.

A third pandemic‐driven shift involves telemedicine. If this remains an option for SRH services moving forward, we expect AYA to be the age‐group most likely to continue that approach rather than returning to traditional in‐person visits. Innovations in health care service provision, such as use of telemedicine and obtaining contraceptives and STI testing by mail, will help expand access to SRH care for young people. However, use of these innovative approaches to care may increase access differentially (e.g., between the insured and the uninsured) and heighten service gaps for particularly marginalized young people, such as homeless youth, youth living in or transitioning out of foster care, incarcerated youth and immigrants in detention. Shifts in contraceptive method mix will be another important area to evaluate over the coming years, as anticipation of future waves of coronavirus infection could further the trend toward use of long‐acting reversible methods. Ongoing and future research is needed to follow this cohort's individual experiences and interactions with the SRH care system.

Another development that may occur encompasses SRH services more broadly. The SRH field has often been innovative in advancing service provision and reducing onerous medical requirements. For example, same‐day start of contraception, elimination of pelvic exams for obtaining birth control and telemedicine‐directed medication abortion are examples of expanding access to and availability of care. Greater use of telemedicine for AYA care and providing many contraceptive methods by mail could go a long way to improving overall access to SRH services. However, such mode of delivery changes will not be enough to compensate for the inability to pay for care because of young people's loss of parents’ or their own employer‐provided insurance.

Finally, many reproductive health care providers and SRH facilities that are part of larger systems may go out of business as a result of the pandemic‐driven reductions in patient volume. In addition, demands on state budgets may cause further closures and restrict access to needed services for years to come. Economic public policies for health care during the COVID‐19 crisis have focused primarily on supporting hospitals rather than the freestanding health centers and individual practices at which most SRH care is provided. The publicly funded clinic network, especially the segment funded by Title X, has always served the most marginalized AYA, including those who are low‐income or without insurance, or who need the confidentiality protections assured through Title X mandates. In the 2010–2015 period, more than one‐fourth of AYA women who received contraceptive care went to a publicly funded clinic. 38 Service demand at these clinics may increase as young people's loss of private insurance makes care at private providers unaffordable. However, Title X–funded clinics are not well positioned fiscally to meet such increased demand, especially given that the network's service capacity has been slashed nearly in half by the imposition of the domestic “gag rule”—and its restrictive regulations that prohibit referrals for abortion care—that led clinics to leave the program. 39

Policy Recommendations

The COVID‐19 pandemic has highlighted a number of critical policy opportunities that can improve SRH care and services for adolescents and young adults. Proposed policies focus on the need to approach SRH care, including contraceptive services, as essential health care for all people regardless of age. 40 , 41 Future policies must also remain responsive to the unique and changing needs of AYA. To support and strengthen young people's sexual and reproductive health, new policies should:

•Prioritize the provision of confidential care for AYA and ensure privacy for their insurance and medical records.

•Eliminate restrictions on any SRH service that can be provided via telemedicine, including those on telemedicine medication abortion, and support providers in expanding digital access.

•Ensure continued coverage of birth control methods and counseling, HPV vaccinations and other SRH preventive services through the Affordable Care Act and within public and private health care plans.

•Create effective programs to assist AYA and their families to sign up for the Child Health Insurance Program (CHIP), Medicaid or other insurance coverage for those who are newly uninsured or experiencing reduced income because of COVID‐19–induced economic changes.

•Increase funding for the Title X national family planning program to address the likely growing numbers of uninsured individuals and increased demand for publicly funded SRH services among AYA.

•Reduce barriers to meeting AYA health care needs by removing inappropriate restrictions that ban Title X–funded providers from sharing information about abortion and by assuring that young people's care is confidential.

•Develop and disseminate online sex education curricula, and ensure the availability of both in‐person and online instruction in response to school closures caused by the pandemic.

•Fund ongoing surveillance of young people's SRH in light of the widespread COVID‐19 disruptions, including methodologies that allow for robust analyses of vulnerable subpopulations such as young people of color and LGBTQ individuals.

Efforts to support adolescents and young adults must also attend to broader impacts on their sexual and reproductive lives, including their ability to form and maintain romantic relationships and experience their sexuality in positive ways. How they navigate their transitions to adulthood—including decisions about education, work, union formation and fertility—may be affected by the pandemic and its economic and societal consequences. Even when social distancing is no longer as necessary, the COVID‐19 pandemic will have caused and may continue to create far‐reaching social disruptions in young people's lives, which may continue to affect their health. During the current public health crisis, the sexual and reproductive health of adolescents and young adults must not be overlooked, as it is integral to both their and the larger society's well‐being.

Laura D. Lindberg is principal research scientist, Guttmacher Institute, New York. David L. Bell is associate professor, Department of Pediatrics and Department of Population and Family Health, Columbia University Medical Center, New York. Leslie M. Kantor is professor and chair, Department of Urban–Global Public Health, Rutgers School of Public Health, Rutgers University, Newark, NJ.

* There is growing concern about COVID‐19 health impacts that have been seen in small numbers of children and adolescents.

† The adolescent developmental trajectory includes physical, cognitive, emotional and social changes that are typically defined as beginning at puberty and ending with the attainment of adult roles and responsibilities.

‡ This survey was conducted by Common Sense Media between March 24 and April 1, 2020, and collected data from 849 individuals aged 13 – 17; data were weighted for age and sex using the U.S. Census Bureau's American Community Survey to reflect the demographic composition of this age‐group.

§ Before the pandemic, 8% of high school students reported having experienced physical dating violence, and 7% sexual dating violence, in the last year.

• Open access
• Published: 05 March 2018

Research gaps and emerging priorities in sexual and reproductive health in Africa and the eastern Mediterranean regions

• Moazzam Ali   ORCID: orcid.org/0000-0001-6949-8976 1 ,
• Madeline Farron 1 ,
• Leopold Ouedraogo 2 ,
• Ramez Khairi Mahaini 3 ,
• Kelsey Miller 1 &
• Rita Kabra 1  

Reproductive Health volume  15 , Article number:  39 ( 2018 ) Cite this article

13k Accesses

14 Citations

13 Altmetric

Metrics details

In-country research capacity is key to creating improvements in local implementation of health programs and can help prioritize health issues in a landscape of limited funding. Research prioritization has shown to be particularly useful to help answer strategic and programmatic issues in health care, including sexual and reproductive health (SRH). The purpose of this paper is to present the results of a priority setting exercise that brought together researchers and program managers from the WHO Africa and Eastern Mediterranean regions to identify key SRH issues.

In June 2015, researchers and program managers from the WHO Africa and Eastern Mediterranean regions met for a three-day meeting to discuss strategies to strengthen research capacity in the regions. A prioritization exercise was carried out to identify key priority areas for research in SRH. The process included five criteria: answerability, effectiveness, deliverability and acceptability, potential impact of the intervention/program to improve reproductive, maternal and newborn health substantially, and equity.

The six main priorities identified include: creation and investment in multipurpose prevention technologies, addressing adolescent violence and early pregnancy (especially in the context of early marriage), improved maternal and newborn emergency care, increased evaluation and improvement of adolescent health interventions including contraception, further focus on family planning uptake and barriers, and improving care for mothers and children during childbirth.

The setting of priorities is the first step in a dynamic process to identify where research funding should be focused to maximize health benefits. The key elements identified in this exercise provides guidance for decision makers to focus action on identified research priorities and goals. Prioritization and identifying/acting on research gaps can have great impact across multiple sectors in the regions for improved reproductive, maternal and children health.

Research capacity building in health fields is important specially in low and middle-income countries (LMICs). According to the World Health Report 2013 it can strengthen health systems and can help move countries towards universal health coverage [ 1 ]. Despite the large body of scientific research, protocols and strategic models to address health problems, there is an increased need for better implementation methods in order to make an impact on health outcomes. Through increased research capacity building, implementation of existing strategies and scaling up interventions may find more success as local researchers bring local knowledge and much needed perspective to these endeavors. Research capacity can also improve health system development, inform more effective policy and lead to better governance in individual countries [ 2 ].

Research capacity building on the African continent has particularly great potential as Africa has the greatest burden of disease and the lowest-density of healthcare professionals in the world [ 3 ]. Shortages of researchers, faculty members, infrastructure, and a dearth of career opportunities for upcoming researchers in Africa to build up a critical mass of scientists to prioritize and carry out policy relevant research exists [ 3 ]. Moreover, multiple factors act as barriers and issues to the health system, hindering the ability of effective health care to be delivered in these contexts. One of the largest complications is that numerous, diverse issues have been identified as health care priorities in the region, which has led to a competition for resources [ 4 ]. This lack of a coherent message is exacerbated by a lack of political will, infrastructural inadequacies, and logistical weaknesses [ 4 ] thereby paralyzing action.

Research priority setting is acknowledged to be a key function of national health research systems and is perceived to be an important process in terms of ensuring the alignment of research funding with national evidence needs [ 5 ]. It is usually done at different hierarchical levels of the health research system (national, institutional, departmental, or at a program level). Ideally health policy and systems research priorities would emerge through priority setting processes. However priority setting for health research is often not performed well or not performed at all [ 6 ]. Priorities need to be reviewed and updated periodically. Through prioritization, SRH could be given more attention, research, and action providing a great benefit to individuals in Africa.

Research prioritization is one of the key nodal points in the research cycle, which includes research planning, research priority setting, strategies and implementation of research priorities, research utilization, research monitoring and evaluation (part of the research information system) and overall research management. The final aim of research prioritization is how “balanced research can support and complement the health system to achieve the national goals for health.” With research prioritization, a forward-looking research system can be firmly established [ 7 ].

Research can play a critical role in the response to global health challenges. But when resources are limited, guidelines are needed to assist decisions on defining the priorities for health research investments [ 8 ]. Setting priorities for health research is essential to maximize the impact of investments, which is especially relevant in resource-poor environments [ 9 , 10 , 11 ].

In June 2015, the WHO/HRP’s Regional Committee meeting for the African and Eastern Mediterranean regions on research capacity strengthening in Sexual and Reproductive Health and Rights (SRH) met in Nairobi, Kenya. The three-day meeting was attended by 38 participants, including 17 women, who represented the research partners of the HRP, the collaborating centers of the WHO, the country offices of WHO, the regional offices of the WHO, the long-term institutional development grantees, and the staff from headquarters in Geneva. The main purpose of this meeting was to discuss the issues related to research capacity strengthening and the future research priorities in sexual and reproductive health and rights in the area and for the WHO.

The meeting was dedicated to discussing the challenges and the lessons learned regarding research capacity strengthening in the regions. This discussion included the emerging research priorities in the two regions. The research prioritization session was mainly dedicated to aid countries in prioritizing their research goals and to identify the main SRH research priorities for the African and Eastern Mediterranean Regions.

The discussion focused on regional experiences on research implementation plans and strategies for strengthening research capacity in SRH, identification of potential barriers and challenges inherent in these proposed plans. The challenges included lack of adequate funding, inadequate capacity to support research, regional brain drain in LMICs, poor communication within the WHO, understaffing, inadequate involvement of policy makers, and poor dissemination and use of research results.

The main objective of this paper is to present the findings of the exercise in identifying an actionable, prioritized research agenda on sexual and reproductive health in the WHO African and Eastern Mediterranean Regions.

Priorities for research on SRH were identified in three main stages in our exercise. In the first stage, the group of researchers, program managers, and other stakeholders from the African and Eastern Mediterranean regions were provided with an overview on various prioritization techniques. The framework of prioritization was presented which included five criteria: answerability (likelihood that research question can be answered ethically), effectiveness (likelihood that the new knowledge would lead to an effective intervention or program), deliverability and acceptability (likelihood that the intervention or program would be deliverable and affordable), potential impact (likelihood that the intervention or program could improve maternal and newborn health substantially), and equity (likelihood that the intervention or program will reach the most vulnerable groups).

Following the discussion of these criteria for prioritization, participants were divided into groups for the prioritization activity. In the second stage, a broad list of sample topics within sexual and reproductive health and maternal and child health were offered as jumping off point. Each group using the prioritization criteria came up with five priorities after deliberation and discussion that were then presented to the entire group. In the third and final stage, the three groups’ priorities were discussed in the large group and a consensus was reached on the six main priorities presented below by attendees.

The aim of this exercise was to create a comprehensive set of broad goals with actionable priorities to combat the problems identified in SRH as recognized by the participating members. The goals were identified to be broad, focusing more on overarching trends of need in the region and in the field of sexual and reproductive health in general. The participants were able to identify main goals that addressed these broad trends and needs in the region.

Three main high-level goals were identified for both of the regions: quality of care, contraception, and adolescent health.

The first two goals relate to sexual education and contraception. The first goal emphasizes early adolescent sexuality education in out of school, and the delay of sexual activity for all adolescents. The second goal is the development of contraception services, including post-partum and post-abortion services. This second goal also aims to address barriers to contraceptive methods, including long-acting reversible contraceptives (LARCs) and emergency contraception.

The third goal is the development of quality of care in three areas: childbirth, general sexual and reproductive services, and disrespect or abuse in childbirth. This also includes improving Emergency Obstetric Care, covering multiple topics, including blood practices, organization of services, assisted vacuum delivery, and unsafe abortion practices.

Priorities and actions from the goals identified

In addition to developing the above broad goals, the team also created a list of priorities for future SRH research. The list of priorities was extensive and comprehensive for sexual and reproductive health research in the region. While all the priorities are important and will play a major role in the future of sexual and reproductive health research in the region, the top six research priorities are given increased attention based on their effectiveness to improve sexual and reproductive health in the regions.

The below mentioned six priority areas were highlighted and selected by the meeting participants as the most pressing and prioritized aspects of sexual and reproductive health to be addressed in the near future. The priorities are written in no particular order and carry equal weight.

The first priority area is the creation and investment in multipurpose prevention technologies. This is especially relevant in the context of condoms and their unique place in sexual and reproductive health. Condoms are one of the major prevention techniques for two pressing issues in SRH: family planning and HIV/AIDS prevention. Because condoms are used in both contexts they are the only examples of a multipurpose sexual health technology. While this is a new field, there is potential in expanding research in this area to create more technologies that can address multiple issues and move toward a more comprehensive sexual and reproductive health product market.

The second priority area is addressing adolescent violence and preventing early pregnancy using contraception, particularly in the context of early marriage . Adolescent violence includes sexual violence, physical violence, and psychological violence. Early marriage greatly affects SRH as girls have an earlier sexual debut, give birth to more children, have higher mortality and morbidity rates (with pregnancy being the leading cause of death for women 15-19), have higher infant and child mortality rates, have an increased risk of experiencing partner violence, and affects educational opportunities for the girl [ 12 ]. The participants wanted to prioritize girls aged 10-14 years old and increase access to services to delay marriage, first births, and violence for women in or out of relationships.

The third priority is to increase the quality of care and safety associated with maternal and newborn emergency care in the region, and more specifically a focus on blood products and the organization of maternal services . Blood services and products are a priority for multiple health outcomes. Practices for blood transmission and safety in pregnancy are a concern, particularly when it comes to minimizing transmission of blood-borne illness and viruses (particularly HIV and hepatitis) from mother to child. The standards and practices surrounding the quality and safety of blood in hospitals and health care facilities need to be examined and improved including: examination and improvement of the systems surrounding acquisition of blood, storage of blood, transport of blood and proper documentation and data analysis of all blood product-related health care practices.

The fourth priority is to evaluate and improve adolescent health interventions in and out of schools in the region. This is to include the promotion and utilization of comprehensive sexual education and the human rights based approach for students and youth in general. This will include a curriculum that uses a comprehensive sex education program, and will emphasize information on menstruation, menstrual hygiene, puberty and access to contraception as key aspects to delivering the best health care to adolescents. Menstrual care and hygiene is specifically important for adolescent girls leading to overall increased health and dignity, as promoted by the current ELRHA toolkit [ 11 ].

The fifth priority is to focus on family planning uptake, methods used, and engagement. It was recognized that it was essential to ensure access to and availability of effective contraceptive methods to all. Participants advocated for increased usage and also identified many of the barriers to FP with possible solutions. Mixed method use and additional contraception options are needed (including lactational amenorrhea and IUDs). Access to emergency contraception was acknowledged as a priority as well as post-partum and post-abortion family planning counseling. Finally, participants felt male involvement should be emphasized in the regions and discussed ways to engage men.

The sixth priority identified focuses improvement of the services, practices and quality of care for both mother and newborn during child birth . This includes promotion of companionship in birthing services. This companionship support will encompass both the presence of fully trained community health workers in the pre-natal and birthing processes, as well as encourage the full support and participation of fathers in both the prenatal stage and at the time of delivery. The trained health workers will be able to support pregnant women, provide respectful care as well as properly refer women to hospital care, as well as provide prenatal support and counselling. Organization and standardization of childbirth care facilities were also prioritized in order to provide improved care, service, and safety to clients. This relates to other priorities identified such as elimination of obstetric fistulas and management of postpartum hemorrhages.

Other priorities identified included increased attention to cervical cancer including treatment and prevention with the HPV vaccination, need of more reliable data and studies regarding STI prevalence in the populations for the regions.

Additional priorities included general commitments to increasing quality of care, access, and increased impact evaluation to identify and implement best practices for SRH. Participants identified task-shifting as a possible solution. Participants prioritized the need to improve the access to reproductive health services for women with disabilities in the region. Finally, there was a priority established to address and combat violence against women in all forms and in all populations.

In the past two decades since the ICPD’s Cairo consensus, research has helped to define what works and at what cost to improve sexual and reproductive health. However, the remaining gaps in our knowledge and understanding are substantial, and impede greater progress and success. Conducting prioritization exercises will assist the regions and countries to understand (i) the full spectrum of research investment options, (ii) the potential risks and benefits that can result from investments in different research options, and (iii) the likelihood of achieving reductions in the persisting burden of maternal and child health morbidity and mortality. Increasingly, there is a need for national governments, public-private partnerships, private sector and other funding agencies to set priorities in health research investments in a fair and transparent way.

There are many approaches to health research prioritization. The identification of common themes for good practice fulfils the need for guidance on this varied and intricate process. The opportunity allowed participants to thoroughly think about the role of SRH in their own health systems and how they would prioritize and improve research capacity building and move forward with possible evidence-based policy solutions or interventions addressing the identified priorities. By identifying goals and priorities, governments may realize the importance of developing research capacity in their own countries in order to produce more relevant solutions and improved implementation in country. The prioritization exercise may also be applied to other health issues in countries since there are competing health issues and limited funding.

Governments should invest in prioritizing research in their own countries and follow through with their goals by increasing focus on sexual and reproductive health issues in their own countries, which can only be developed and implemented with strong research capacity. There should also be additional in-country research on the six priorities mentioned. With this research on these prioritized areas, additional context-specific implementation strategies can be developed and a new, expanded research culture may flourish in the regions. The setting of research priorities is the first step in a dynamic process to identify where research funding should be focused to maximize health benefits. It is important to realize that these results represent a regional discussion of the issues in sexual and reproductive health. They should be interpreted carefully when applied at the country levels because of the differences in needs and context of individual countries.

In conclusion, respective governments must seriously invest in research capacity in order to create a critical mass of researchers in country who can do prioritization and help create impactful and useful policy for the local context. Prioritization is key to taking action in the face of limited funding. Investing in this cadre of researchers will lead to more successful implementation compared with foreign researchers providing implementation advice, as local researchers know their communities and countries best. This is particularly important in the realm of sexual and reproductive health as it has been underserved. With prioritization and research capacity, governments make headway on improving quality, care, and health of their citizens.

The prioritization exercise helped identify concrete issues for action and implementation. Hopefully, more attention and funding can be shifted towards this useful and often neglected element of research development. Further research is needed to determine how best to evaluate success of priority setting at country and regional levels.

Abbreviations

Human reproduction program

International Conference on Population and Development

Intra uterine device

Long-acting reversible contraceptives

Low and middle-income countries

Sexual and reproductive health

Sexually transmitted infections

World Health Organization

Sewankambo N, Tumwine JK, Tomson G, Obua C, Bwanga F, Waiswa P, et al. Enabling dynamic partnerships through joint degrees between low- and high-income countries for capacity development in global health research: experience from the Karolinska Institutet/Makerere University partnership. PLoS Med. 2015;12(2):e1001784.

Article   PubMed   PubMed Central   Google Scholar  

Beran D, Byass P, Gbakima A, Kahn K, Sankoh O, Tollman S, et al. Research capacity building-obligations for global health partners. Lancet Glob Health. 2017;5(6):e567–e8.

Article   PubMed   Google Scholar  

Davies J, Mullan Z. Research capacity in Africa--will the sun rise again? Lancet Glob Health. 2016;4(5):e287.

Whitworth J, Sewankambo NK, Snewin VA. Improving implementation: building research capacity in maternal, neonatal, and child health in Africa. PLoS Med. 2010;7(7):e1000299.

Yvo Nuyens. Setting priorities for health research: lessons from low- and middle-income countries. Bull World Health Organ. 2007;85(4):319–21. https://doi.org/10.2471/BLT.06.032375 .

Organization WH. World report on knowledge for better health: strengthening health systems. Geneva: World Health Organization; 2004.

Google Scholar  

Tomlinson M, Chopra M, Sanders D, Bradshaw D, Hendricks M, Greenfield D, et al. Setting priorities in child health research investments for South Africa. PLoS Med. 2007;4(8):1293–8.

Article   Google Scholar  

Viergever RF. Health research prioritization at WHO: an overview of methodology and high level analysis of WHO led health research priority setting exercises. Geneva: World Health Organization; 2010.

Kok M, de Souza DK. Young voices demand health research goals. Lancet. 2010;375(9724):1416–7.

The Bamako call to action: research for health . Editorial. The Lancet. 2008;372(9653):1855. https://doi.org/10.1016/S0140-6736(08)61789-4 .

ELRHA. Building a Cross-Sectoral Toolkit and Research Foundation for the Intergration of Menstral Hygiene Management into Emergency Response. Available from: http://www.elrha.org/map-location/irc-menstrual-hygiene-call2/ . Accessed 22 Feb 2018.

Walker JA. Early marriage in Africa—trends, harmful effects and interventions. Afr J Reprod Health. 2012;16(2):231–40.

PubMed   Google Scholar  

Download references

Acknowledgements

The authors would like to extend thanks to all participant researchers and colleagues at WHO offices, who kindly took time to participate in the exercise and shared the information.

The WHO/HRP’s Regional Committee meeting for the African and Eastern Mediterranean regions on research capacity strengthening in Sexual and Reproductive Health and Rights was funded by: (i) the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored program executed by the World Health Organization.

Availability of data and materials

The exercise for research prioritization was carried out during a WHO regional meeting for Africa and Eastern Mediterranean. The data was analysed and report was prepared in Geneva, Switzerland. The WHO regional meeting report and data can be shared, if needed.

This report contains the collective views of an international group of experts, and does not necessarily represent the decisions or the stated policy of the World Health Organization.

Author information

Authors and affiliations.

Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland

Moazzam Ali, Madeline Farron, Kelsey Miller & Rita Kabra

Reproductive and Women’s Health, Africa Region, World Health Organization, Brazzaville, Democratic Republic of the Congo

Leopold Ouedraogo

Women’s Reproductive Health, Eastern Mediterranean Region, World Health Organization, Cairo, Egypt

Ramez Khairi Mahaini

You can also search for this author in PubMed   Google Scholar

Contributions

MA conceptualized the manuscript. KM, MF, MA drafted an initial version and LO, RKM, RK provided technical inputs and edits. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Moazzam Ali .

Ethics declarations

Ethics approval and consent to participate.

Approval were obtained from the meeting participants to publish the results of the discussions and collective agreements on the research priorities in Africa and Eastern Mediterranean regions.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Cite this article.

Ali, M., Farron, M., Ouedraogo, L. et al. Research gaps and emerging priorities in sexual and reproductive health in Africa and the eastern Mediterranean regions. Reprod Health 15 , 39 (2018). https://doi.org/10.1186/s12978-018-0484-9

Download citation

Received : 14 November 2017

Accepted : 20 February 2018

Published : 05 March 2018

DOI : https://doi.org/10.1186/s12978-018-0484-9

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Research priority
• Maternal health
• Contraception
• Eastern Mediterranean

Reproductive Health

ISSN: 1742-4755

• General enquiries: [email protected]

Climate change and sexual and reproductive health and rights research in low-income and middle-income countries: a scoping review

María Barreix ,

Doris Chou ,

Caron Rahn Kim ,

https://doi.org/ 10.1136/bmjph-2024-001090

Introduction This study aimed to provide an overview of the research landscape and to identify research gaps linking climate change events and sexual and reproductive health and rights (SRHR) in low-income and middle-income countries (LMICs), where the negative impacts of climate change are most severe.

Methods We conducted a scoping review to map research studies that link climate change events or factors and SRHR aspects in LMICs. We performed a structured literature search across six databases to identify relevant peer-reviewed publications between January 1994 and 6 September 2023. The literature search yielded 14 674 peer-reviewed articles. After screening, 75 articles were included, spanning 99 countries across the globe.

Results Climate change events such as extreme temperatures, drought, rainfall shocks, cyclones and floods were found to be associated with negative maternal and newborn health outcomes ranging from reduced or low birth weight, preterm births and low Apgar scores, to lack of pregnancy care, pregnancy complications, stillbirths, and newborn and maternal deaths. Associations were also found between climate-related events and increased gender-based violence and HIV prevalence, as well as fertility decisions and harmful practices such as female genital mutilations and early and forced marriages. About two-thirds (48/75) of the articles were from the African or Western Pacific regions. The main research gaps on climate change-related events and SRHR included abortion, reproductive cancers and contraception use.

Conclusion Complementing existing evidence with targeted research to fill these knowledge gaps could enhance mitigation programmes and policies.

What is already known on this topic

Earlier systematic, scoping and narrative reviews have examined the impact of climate change or specific climate change phenomena such as extreme heat on general or specific health aspects such as mental health, or HIV, and pregnancy outcomes including preterm birth, or on specific groups such as children. However, there is a notable absence of review studies that map the existing research body concerning the impact of climate change on broader sexual and reproductive health and rights (SRHR) in low-income and middle-income countries (LMICs).

What this study adds

Our study contributes a distinctive and extensive overview of existing research on the interconnections between various climate change phenomena and all major SRHR domains, highlighting existing evidence and specific knowledge gaps to guide future research and mitigation efforts in LMICs, where populations in the most vulnerable situations to the effects of climate change live.

How this study might affect research, practice or policy

The review reveals under-researched or unexplored areas to guide future scientific investigations on climate change phenomena and SRHR such as abortion, contraception and reproductive cancers. It also highlights how methodologies and research collaborations may be expanded moving forward to enable a more comprehensive understanding of SRHR and climate to guide future policies and intervention programmes addressing critical climate change-related threats.

• Introduction

Long-term shifts in temperatures and changing weather patterns (ie, climate change) pose a major challenge to public health in the 21st century. 1 Rising temperatures, rainfall shocks and an increase in the intensity and frequency of extreme weather events such as cyclones, directly and indirectly, threaten the health and well-being of populations worldwide, particularly those that already face risks and vulnerabilities in low-income settings. 2 Climate change affects the entire planet, but its effects are often more dramatic around the equator, and the negative impacts are more severe in low-income and middle-income countries (LMICs) with less financial, infrastructural and geographical resources to mitigate the consequences. 3 LMICs are also often heavily reliant on climate-sensitive sectors for income and survival, such as agriculture, fishing/aquaculture and tourism and may have less resources and adaptive capacity to address the impacts of extreme weather changes than high-income countries. 3

Climate change may further aggravate pre-existing disparities in health, related to factors such as age, socioeconomic status, ethnicity, race, disability, indigeneity, as well as sex and gender differences. 2 The impacts of climate change on sexual and reproductive health and rights (SRHR) may be exacerbated due to gender inequalities. 4 As a result, women and children, particularly girls, as well as other vulnerable populations, face additional challenges when it comes to mitigating climate-related poor health consequences. 4–6 For instance, drought conditions can cause food insecurity which disproportionately impacts women and children. 6 7 Situations of food insecurity can exacerbate existing nutritional vulnerabilities (eg, iron deficiency) among pregnant or breastfeeding women. 5 Studies also show that climate change-induced floods contribute to population displacement and disrupt the provision of healthcare services, including life-saving sexual and reproductive health services such as facility-based childbirth, HIV prevention and contraception. 5 8 Furthermore, experimental studies and reviews reveal that extreme temperatures, floods and droughts directly impact SRHR through several mechanisms. For instance, Hnat et al found that among pregnant women, extreme temperatures can lead to increased sweating due to thermoregulation, which can cause dehydration and trigger early labour. 9 Heat stress also causes a rise in cortisol levels, potentially leading to decreased blood flow to the placenta as blood is diverted for other immediate bodily needs. This can consequently affect fetal growth due to reduced oxygen levels in the fetus. 10

While the evidence base for gender, health and climate change interlinkages is growing, considerable research gaps remain at the intersection of climate change and SRHR which to date has received inadequate attention. 2 Previous systematic, scoping and narrative reviews of climate change in LMICs have focused on overall health, specific health areas such as child health, mental health, chronic illnesses and nutritional health or health systems of specific populations (eg, children). 1 6–8 Yet, to the best of our knowledge, none has documented existing published literature on SRHR and climate change in LMICs. In order to bridge this gap, the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), housed at the WHO, through its HRP Alliance for research capacity strengthening convened a group of experts to scope existing evidence at this intersection. 11 The goal is to provide an exploratory mapping of research that links climate change factors or events and SRHR aspects in LMICs and to identify existing research gaps. By highlighting research gaps particular to sexual and reproductive health, we aim to advance evidence-based interventions, mitigation, adaptation and policy improvements. This review charts existing research and thereby can guide the direction of future research in this space.

We conducted a scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis—scoping reviews extension (PRISMA-ScR, https://www.prisma-statement.org/scoping —see online supplemental file 1 , pages 25–27). The protocol was registered in the Open Science Framework available at https://osf.io/a4wm5/

Search strategy

A structured literature search was conducted in the following databases: Medline, Embase, Web of Science Core Collection, CINAHL, Google Scholar and World Health Organization (WHO) Global Index Medicus in December 2022 and repeated on 6 September 2023, to identify relevant peer-reviewed publications between January 1994 and 6 September 2023. The search strategy was developed on Medline (Ovid) in collaboration with librarians at the Karolinska Institutet University Library. For each search concept, relevant Medical Subject Headings (MeSH terms) and free-text terms were identified. The search was then translated, in part using Polyglot Search Translator, 12 into the other databases.

The search strategy focused on identifying articles that explored the intersections of climate change and SRHR. Distinct keywords and MeSH terms specific to SRHR (eg, “maternal health” or “abortion”) and climate change (eg, “drought” or “floods”) were cross-combined and searched with search terms specific to LMICs (eg, “Philippines” or “Sierra Leone”). The detailed search strategy, including how deduplication and additional steps for comparing DOIs were done, can be found in online supplemental file 1 (pages 27–50).

We adopted the 2018 definition of SRHR by the Guttmacher-Lancet Commission as ‘a state of physical, emotional, mental and social well-being in relation to all aspects of sexuality and reproduction, not merely the absence of disease, dysfunction or infirmity’, relying on the ‘realisation of sexual and reproductive rights’ that builds on globally established human rights conventions such as the Universal Declaration of Human Rights, the right to health, the rights of the child, the Convention on the Elimination of All Forms of Discrimination against Women and the Sustainable Development Goals (SDGs). 13 In this review, our understanding of climate change events, such as heat waves, droughts and floods, is based on the Intergovernmental Panel on Climate Change (IPCC) 2022 report. 14

Selection criteria

Peer-reviewed articles in any language were considered for inclusion if they empirically measured or explicitly analysed the intersection of climate change and SRHR. We limited the search to publications from January 1994 to reflect when the United Nations Framework Convention on Climate Change was ratified, and when the United Nations International Conference on Population and Development in Cairo adopted a human rights approach to sexual and reproductive health. The final database search and inclusion date was 6 September 2023.

We included only original research articles based on quantitative (eg, cohort-based, cross-sectional and time-series), qualitative and mixed-methods study designs. We included all articles that explored SRHR and climate change in LMICs affecting all populations regardless of age, sex or gender. Since there is no standardised classification of SRHR factors with respect to climate change, we adapted the Guttmacher-Lancet Commission framework together with specific SDG targets focusing on broad sexual and reproductive health domains and related essential services. 13 Based on this framework, we divided included articles into the following categories: maternal and newborn health, abortion, HIV and other sexually transmitted infections (STIs), contraception, fertility care (including pregnancy intentions and timing, family size, and infertility), reproductive cancers, gender-based violence (GBV), harmful practices (including early/forced marriage and female genital mutilation (FGM), and multiple (a few studies researched several SRHR aspects including maternal and newborn health, GBV, harmful practices and fertility care).

Similarly, due to the absence of a standardised classification for climate change phenomena, we categorised climate change events based on those identified as detrimental to health and well-being by the IPCC. 14 Articles were included if they (1) explicitly measured how climatic/weather events changed over time by increasing in frequency or intensity or duration in the study context and/or (2) used reference measures to denote how those events were ‘extreme’ (eg, temperature ≥95th percentile or ≤5th percentile) and/or (3) defined that the phenomena analysed were anomalies. If articles did not use the term ‘climate change’ but used the above description, they were still included. Thus, the following major climate change events were considered: extreme temperature (including the subcategories of increasing/extreme heat and decreasing temperature/cold spells), rainfall shocks (including positive and negative shocks), drought, floods, cyclone/typhoons and multiple climate change events (a few studies researched several of the included events such as drought, abnormal temperatures and precipitation, floods and cyclones). 14

We excluded articles focusing on predictions or projections of future scenarios. Systematic reviews, scoping and literature reviews, meta-analyses, conceptual frameworks, book reviews, news reports, editorials, letters, commentaries, viewpoints, theoretical articles, mathematical models and non-peer-reviewed reports were excluded. Articles that did not report their methodology or focused on populations living in high-income countries were excluded. Articles on child health beyond the perinatal period were also excluded, except if the article(s) related to SRHR outcomes such as in early/forced marriage FGM or GBV. We excluded studies on natural disasters unrelated to anthropogenic climate change (eg, earthquakes and tsunamis), dust storms and air pollution (including those related to volcanic eruptions and wildfires) since their connection to climate change is complex and less direct. Specific to air pollution, the complexity can be seen in how several reviews have examined the impact of air pollution on SRHR including in LMICs without mentioning climate change, 15 while a most recent review only examined the impacts of air pollution and climate change separately on SRHR. 16 Further, studies that focused on interventions related to climate change adaptation, mitigation, resilience and coping were excluded unless they were directly linked to SRHR outcomes.

Study selection

The search results were first imported into an EndNote Library and then uploaded to Rayyan, a web-based software platform for conducting reviews (available from: https://www.rayyan.ai ) from where identified duplicates were removed. Three authors (MOA, RS and APFC) screened the articles by titles and abstracts for inclusion and removed any remaining duplicates. This was followed by full-text extraction of relevant articles by two reviewers (RS and APFC) to create a literature database; a third reviewer (MOA) verified all final inclusion decisions and was the tiebreaker in cases of conflict.

Data abstraction and charting

For all included articles, we extracted information regarding title, year of publication, study country and income level following the World Bank classification, study setting (urban, rural, mixed), study design (quantitative, qualitative or both), sample and data source, SRHR domain, climate change event, climate data source and key findings. Additionally, we categorised all study countries by WHO regional classification. 17 We also reported the first and corresponding authors’ affiliated institution, country and income classification, and affiliations of any other author. Complete details are presented in online supplemental file 1 .

We identified a total of 23 338 records and after removal of 8573 duplicates, 14 674 were screened for eligibility by title and abstract. 262 records were retrieved for full text review and 75 articles were finally included in this scoping review. Figure 1 displays the PRISMA flow diagram showing a summary of the article selection process for the scoping review.

PRISMA diagram showing the study selection process of articles. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; SRHR, sexual and reproductive health and rights.

Characteristics of included articles

Table 1 and online supplemental file 2 present an overview of the characteristics of the 75 articles included. 18–92 The search yielded articles across 99 LMICs, with over 80% published between 2018 and 2023. Figure 2 shows that the majority of the articles focused exclusively on African (26), Western Pacific (22) and South-East Asian regions (15) constituting 84% of the total articles. A detailed synthesis of the 75 studies and a list of study countries can be found in online supplemental file 1 (tables A (p 27–50) and B (p 51–52), respectively). 47 (63%) articles had at least one author affiliated with institutions in LMICs, the majority of whom were from the countries where the studies were conducted.

Distribution of 75 articles on climate change and sexual and reproductive health and rights, published 1994–2023 in low-income and middle-income countries by WHO regions.

Populations studied, sample size and study design

Figure 3 displays the distribution of populations studied by a number of articles, with newborns and women of reproductive age accounting for 28 and 20 articles, respectively, constituting more than half (55%) of all the articles. Four (5%) articles focused on men and women living with HIV, aged 15+ years. Quantitative studies constituted three-quarters (57 out of 75) of the articles, with the sample sizes ranging from 105 to 5.44 million and were mainly cross-sectional and retrospective designs. 13 (17%) articles employed qualitative approaches, mainly key informant interviews and focus group discussion, and five (7%) were mixed-methods studies.

Populations studied by 75 articles on climate change and sexual and reproductive health and rights, published 1994–2023 in low-income and middle-income countries.

Climate change exposures

The impact of extreme temperatures on SRHR was the most extensively studied area including 33 articles (44.0%) encompassing factors such as heat waves, cold spells and increasing ambient temperatures. This was followed by articles on drought (18), rainfall shocks (14), floods (10) and cyclones/typhoons (4), with a few articles examining more than 2 climate change events. Six articles examining the impact of three or more climate change events on SRHR.

SRHR outcomes and key findings

Figure 4 is a matrix showing SRHR domains studied with respect to specific climate change events.

A matrix of climate change events and SRHR categories, studied by 75 articles, published between 1994 and September 2023 in LMICs. LMICs, low-income and middle-income countries.

Maternal and newborn health

This was the most studied SRHR domain with 37 (49%) out of 75 articles across various climate change events. Among these, 73% (27/37) focused on the impact of extreme temperatures 36 37 40–45 48–51 53–57 61–69 92 on maternal and newborn health, with 21 out of the 27 from the Western Pacific region, primarily China. There were no articles on extreme temperatures from South-East Asian, European and Eastern Mediterranean regions in this SRHR domain. Other studies of climate change factors with respect to maternal/newborn health included drought, 35 rainfall shocks, 37 46 47 58 92 floods 34 38 52 60 and cyclones/typhoons. 59 One study looked at multiple climatic events. 39 Generally, the studies reported associations between climate change events such as extreme temperatures (hot or cold), prolonged drought and neonatal outcomes such as reduced or low birth weight, 35–37 41 42 45–48 51 54 58 63 65 92 increased preterm birth, 43 44 50 53 56 57 62 64 66 68 low Apgar scores, 36 40 shorter length at birth, 36 congenital heart defects, 67 69 macrosomia 49 and stillbirth. 52 55 Studies also found associations between flooding, cyclones and typhoons with lack of appropriate pregnancy care, pregnancy complications and maternal death. 34 38 52 59 60 Further, rainfall shocks were associated with shorter gestational periods, infant mortality 58 and large birth weights. 37 92

Gender-based violence

Nine articles studied GBV or violence against women and girls in relation to climate change events. Five out of the nine articles were exclusively from the African region. Climate change phenomena researched in this domain included drought, 20–22 24 25 floods, 19 cyclones and typhoons, 26 rainfall shocks 23 and multiple climate change events including extreme temperatures. 18 Studies reported associations between floods, drought, cyclones and GBV including sexual violence, 19 24 26 psychological 26 and physical violence. 19 23 24 26 However, no study reported on sex trafficking or sex work in the context of the climate crisis.

HIV and other STIs

Nine articles studied climate change and HIV, seven of which were exclusively from the African region. Drought was the predominant climate factor examined with respect to HIV. Others included floods and rainfall shocks. The studies reported associations between extreme climatic events particularly droughts, floods, rainfall shocks and increased HIV prevalence. 70 73 75–78 Studies also found these climate-related events and HIV risk factors such as multiple sexual partners, 77 condomless sex 72 and other risky sexual behaviours, 71 78 as well as decreased antiretroviral therapy adherence and retention in care. 74 There were few to no studies on the climate change events in this study and other STIs and certain aspects of HIV, including coinfections, discrimination and stigma.

Fertility care

Fertility care, encompassing pregnancy intentions and timing, family size and infertility, was studied by eight articles from across all regions. Fertility was studied in the context of extreme temperatures, floods and rainfall shocks. 79–85 89 Decreases in total fertility rates 79 and reduced semen quality 80 were reported to be associated with extreme temperatures. Increased birth rates were reported during below-average temperatures and above-average rainfall, 83 but ideal family size lowered with exposure to higher temperatures in Africa. 81

Harmful practices

Seven articles examined harmful practices such as forced marriages, and FGM and climate change. All the articles in this domain were from South-East Asian and African regions. Negative impacts were reported between extreme weather events such as storms, 27 28 32 extreme temperatures, 29 33 and drought 30 31 and forced marriages and FGM. 27–33 Of note, while most studies showed a greater risk of early and forced marriages and FGM, one study reported a 3% decrease in the risk of marriage between ages 12 and 17 in sub-Saharan Africa and a 4% decrease in India due to drought. 30

Contraception

Only one article addressed contraception in this review, reporting associations between rainfall shocks and increased demand for modern and traditional contraceptives. 91 No studies addressed associations between modern contraception preferences, whether long-acting or short-acting, or permanent as well as access, costs or user satisfaction.

Multiple SRHR domains

Five articles studied the interplay of climate change events and multiple SRHR domains. Three studies examined how fertility care, family planning and harmful practices are impacted by drought 86 88 and extreme temperatures. 90 One article analysed how floods impact SRHR services, fertility care including unwanted pregnancies, GBV, and maternal and newborn health through the lens of maternal death. 87 Lastly, one article examined how more than three climatic events combined influence fertility care and contraception use. 89

Main research gaps

Notably, no studies were conducted within the SRHR areas of induced abortion and reproductive cancers in the context of climate change, indicating research gaps that could be explored by future studies.

This scoping review is among the first to map peer-reviewed publications over the past three decades at the intersection of climate change and SRHR in LMICs across WHO regions worldwide. We identified 75 articles investigating the impact of climate change on SRHR. Most of these articles were published in 2018 and were conducted on populations in African, Western Pacific and South-East Asian regions. Most studies employed quantitative methodologies and targeted newborns and women of reproductive age. Maternal and newborn health was the most researched aspect of SRHR in the context of climate change; meanwhile, we did not find any studies exploring the impact of climate change on induced abortion or reproductive cancers. Extreme temperatures and drought were the most studied climate change phenomena, especially as they relate to maternal and newborn health.

The exponential increase in the articles published since 2018 indicates a growing recognition of the need to understand the impact of climate change on SRHR. This aligns with the growing attention on climate change and health as a global research priority, as demonstrated by the 2017/2018 WHO surveys conducted among national health services on health and climate change, involving 101 countries. These highlighted the profiled countries’ expected health impacts of climate change with the aim to raise awareness of health and climate linkages. 93 The fact that most articles relied on data from cross-sectional surveys implies that the captured climate impacts are either from ongoing or past extreme weather events. This poses challenges in ascertaining some impact associations found due to the risk of recall or social desirability biases and other systematic errors, for example, regarding identifying links between forced marriage and floods in a community where early and forced marriage are already highly prevalent. Using health records from registries on maternal/newborn health, HIV, abortion or reproductive cancers could allow for longitudinal analysis and impact comparisons of extreme climatic events at different times with higher validity.

While the intersection of climate change and maternal and newborn health has received significant attention in published articles, including a recent call to action by several UN actors, 5 a substantial amount (73%) of these articles focused on the impact of extreme temperatures. Moreover, most of these articles were from the Western Pacific region, particularly China. Conversely, there is limited literature on the impact of floods, rainfall shocks, drought and cyclones on maternal and newborn health in regions prone to these climate change events and where the risk of maternal and newborn morbidity and mortality due to climate change is higher such as in African and South-East Asian regions. 94 Filling such research gaps in these regions is critical to inform tailored interventions and policies. Further, certain climate change and SRHR areas are predominantly studied in certain regions, perhaps due to heightened vulnerabilities in those regions and subsequent investments for research. For instance, floods and cyclones are well studied in South-East Asia, mainly Bangladesh, likely owing to their susceptibility to such events. 84 Articles on HIV, GBV and drought from the African region reflect the substantial challenges related to HIV and drought in this region. 73–76 A recent review by Logie et al 95 revealed an association between extreme weather events—such as hurricanes, floods, drought and storms—and adverse HIV outcomes attributable to limited access to antiretroviral treatment and deteriorating mental health. Notably, very few articles focused on Latin America and the Caribbean, although many communities in this region are highly vulnerable to weather extremes and are dependent on weather-sensitive activities such as agriculture and tourism. 96

This scarcity of studies looking at climate change events and contraception, abortion or reproductive cancers revealed in this review could be partly due to a lack of reliable data across LMICs. 97 Addressing these data gaps is crucial in the context of climate change. Furthermore, despite only one article that exclusively studied climate change and harmful practices in Kenya, 31 reliable organisational reports have continued to highlight the implications of climate change on early and forced marriages and FGM across the African region. 98 While FGM is a practice deeply embedded in culture and social norms, it is also a requirement for marriage in many settings, therefore, an increase in FGM can be a precursor to early marriage in response to existential and livelihood threats posed by climate change. 31 Certain SRHR domains such as abortion, GBV and harmful practices may require a special long-term framework to study in the context of climate change in LMICs given that reporting and documentation of such incidences may be hindered due to sociocultural limitations in certain communities. Longitudinal research and greater involvement of local researchers and local stakeholders could improve measurement.

In all regions, the predominant study populations were newborns and women of reproductive age. Subsequent studies could endeavour to broaden the scope of research at the intersection of climate change and SRHR in LMICs to include other demographics such as boys, men and individuals with diverse sexual orientations, gender identities/expressions and sex characteristics. Additionally, studies could explore these associations among migrant and indigenous populations. Across all populations, more attention could be given to the ‘rights’ aspect of SRHR. 99 In essence, the achievement of SRHR relies on adopting a rights-based approach to health; a perspective that emphasises that all individuals have a right to make decisions regarding their bodies and should have access to services that uphold and support that right. 99

Implications for future research

Regarding the methods, several studies highlighted limitations related to the available health data for climate change research. 32 36 37 This emphasises the need for improved climate-related routine health data collection. There were relatively very few articles that employed mixed quantitative and qualitative approaches where findings were merged and triangulated. Researchers could harness the power of both methods for a better understanding of climate change-related and SRHR-related topics. More registry-based data and longitudinal studies could also be helpful for studying rare impacts of climate change events on SRHR in LMICs, including those related to changes in air quality.

Over one-third of the articles were authored exclusively by authors from institutions in high-income countries, with limited involvement of institutions in LMICs. This may be due to imbalances of power and funding resources skewed towards high-income countries and, perhaps, an underappreciation of prioritising indigenous, context-specific knowledge in research. 100 Considering that climate change disproportionately impacts LMICs, collaborating with local researchers in affected areas can be vital, especially when employing mixed methods and qualitative approaches. Moving forward, fostering cross-institutional collaborations between high-income countries and LMICs, as well as South-South partnerships, would not only enhance research capabilities and the validity, credibility and transferability of findings but also address ethical considerations 100 and equitable partnerships in this critical field.

Limitations

There are limitations to this review. First, given the lack of standard classification of climate change factors, there is a possibility that the search may have left out other potential intersection areas, for instance, climate change and SRHR-related infectious diseases and social conflicts. Relatedly, our categorisation of SRHR domains and climate change phenomena is but one way to classify these issues, there could be others. For example, we did not find studies on broader sexual or menstrual health which could alter this categorisation in the future. Second, we excluded studies on projections and predictions which could have provided valuable insights concerning the future impacts of climate change on SRHR. Similarly, we also excluded one important factor related to climate change: air pollution. Given the broad range of air pollution factors, including the confounding or mediating effects, it is complicated to determine the impact of air pollution attributable to climate change. These factors are outside the scope of this review and best placed as a separate standalone review. Third, since this is a scoping review, we leave it to future systematic reviews to conduct critical appraisals to assess the quality of extant research. Fourth, by focusing on studies in LMICs, we excluded studies on forcibly displaced people, asylum seekers, refugees and other migrants originating from LMICs but located in high-income countries.

The findings of this scoping review underscore the growing, but still emerging, field of research that links climate change and SRHR in LMICs. We mapped existing studies and identified knowledge gaps that could guide future research priorities. In the context of climate change, maternal and newborn health was the most studied while potential climate change links to abortion, reproductive cancers and contraception were the least researched SRHR domains. The review underscores the urgent need to complement existing evidence with targeted research to fill knowledge gaps and strengthen the evidence base to guide interventions and policy development on SRHR and climate change.

• Supplementary files
• Publication history
• Rapid Responses

A .gov website belongs to an official government organization in the United States.

A lock ( ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

• About Reproductive Health
• Depression Among Women
• Reproductive Health in Emergency Preparedness and Response
• Teen Pregnancy
• Infertility - Frequently Asked Questions
• Data and Statistics
• Women's Reproductive Health
• Epidemiology Glossary
• Adolescent Reproductive Health
• Unintended Pregnancy
• Emergency Preparedness and Response Tools and Resources
• Evidence-Based Teen Pregnancy Prevention Programs
• Teen Pregnancy Projects
• FROM DATA TO ACTION

Related Topics:

• View All Home
• HEAR HER Campaign
• Maternal Mortality Prevention

CDC’s Division of Reproductive Health focuses on issues related to reproductive health, maternal health, and infant health.

• For over 50 years, we have worked to improve the lives of women, children, and families through science, data, programs, and partnerships.

CDC supports national and state efforts to collect data and information to better understand health issues impacting reproductive, maternal, and infant health. CDC also works with partners to translate research into practice. This increases quality of care and informs prevention approaches. CDC provides technical assistance and training to help improve male and female reproductive health, maternal health, and infant health. A key part of our work is assessing the drivers of health disparities. This informs efforts to improve equity in care and outcomes.

CDC also works with partners to translate research into practice. This increases quality of care and informs prevention approaches. CDC provides technical assistance and training to help improve male and female reproductive health, maternal health, and infant health.

What CDC is doing

Through key investments, CDC promotes optimal reproductive and infant health and quality of life. By ensuring women get the right care at the right time, we can ensure we are making a difference.

Strategic Areas of Focus

These strategic areas of focus are priority topics for CDC's Division of Reproductive Health efforts. They are not inclusive of all work, but help to measure progress in key areas.

Maternal Mortality and Complications of Pregnancy Identify, review, and monitor maternal deaths and complications of pregnancy to prevent them.

Infant Morbidity and Mortality Provide epidemiologic and programmatic subject matter expertise in infant (0-12 months) morbidity and mortality, with special emphases on sudden unexpected infant deaths.

Chronic Disease Prevention among Women of Reproductive Age (WRA) Advance evidence-based guidelines, policies, and practice related to chronic disease prevention among WRA to improve pregnancy outcomes and improve women's health through the life course.

Reducing Teen and Unintended Pregnancy Advance evidence-based practices, policies, and programs related to reducing teen and unintended pregnancies, focusing on improving access to and use of quality family planning services.

Global Reproductive Health Provide technical assistance for activities to reduce maternal and neonatal mortality and severe morbidity in high mortality settings, primarily through program monitoring and evaluation, and building in-country capacity.

Science to Practice Identify and implement effective strategies for promoting the translation of science to practice and policy to impact population health outcomes.

Reproductive Health

For everyone, health care providers, public health.

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

• View all journals
• Explore content
• About the journal
• Publish with us
• Sign up for alerts
• Published: 27 August 2024

The interplay between male fertility, mental health and sexual function

• Vincent J. Straub   ORCID: orcid.org/0000-0003-3393-6027 1 &
• Melinda C. Mills   ORCID: orcid.org/0000-0003-1704-0001 1 , 2 , 3  

Nature Reviews Urology ( 2024 ) Cite this article

10 Altmetric

Metrics details

• Health policy
• Risk factors

Declining birth rates are drawing attention to male reproductive health, with infertility receiving overdue interest. Alongside genetic and environmental factors, lifestyle behaviours are a key risk factor. Exploring how lifestyle behaviour links to mental health and its interplay with sexual function and fertility can improve understanding of trends in live births and improve men’s health overall.

This is a preview of subscription content, access via your institution

Access options

Access Nature and 54 other Nature Portfolio journals

Get Nature+, our best-value online-access subscription

24,99 € / 30 days

cancel any time

Subscribe to this journal

Receive 12 print issues and online access

195,33 € per year

only 16,28 € per issue

Buy this article

• Purchase on SpringerLink
• Instant access to full article PDF

Prices may be subject to local taxes which are calculated during checkout

GBD 2021 Fertility and Forecasting Collaborators. Global fertility in 204 countries and territories, 1950–2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. Lancet 403 , 2057–2099 (2024).

Eisenberg, M. L. et al. Male infertility. Nat. Rev. Dis. Primers 9 , 49 (2023).

Article   PubMed   Google Scholar  

Kimmins, S. et al. Frequency, morbidity and equity — the case for increased research on male fertility. Nat. Rev. Urol. 21 , 102–124 (2024).

Skakkebæk, N. E. et al. Environmental factors in declining human fertility. Nat. Rev. Endocrinol. 18 , 139–157 (2022).

Liu, A. et al. Evidence from Finland and Sweden on the relationship between early-life diseases and lifetime childlessness in men and women. Nat. Hum. Behav. 8 , 276–287 (2024).

Platt, M. L. & Sterling, P. Declining human fertility and the epidemic of despair. Nat. Mental Health 2 , 463–465 (2024).

Article   Google Scholar  

Belladelli, F., Muncey, W. & Eisenberg, M. L. Reproduction as a window for health in men. Fertil. Steril. 120 , 429–437 (2023).

Herrera-Luis, E., Benke, K., Volk, H., Ladd-Acosta, C. & Wojcik, G. L. Gene–environment interactions in human health. Nat. Rev. Genet . https://doi.org/10.1038/s41576-024-00731-z (2024).

Nargund, V. H. Effects of psychological stress on male fertility. Nat. Rev. Urol. 12 , 373–382 (2015).

Article   PubMed   CAS   Google Scholar  

Vandello, J. A., Wilkerson, M., Bosson, J. K., Wiernik, B. M. & Kosakowska-Berezecka, N. Precarious manhood and men’s physical health around the world. Psychol. Men Masc. 24 , 1–15 (2023).

Google Scholar  

Lo, J. O. et al. Influence of substance use on male reproductive health and offspring outcomes. Nat. Rev. Urol . https://doi.org/10.1038/s41585-024-00868-w (2024).

Benónísdóttir, S., Straub, V. J., Kong, A. & Mills, M. C. Genetics of 44 female and male reproductive traits and their relationship with health, longevity and consequences for offspring. Nat. Aging (in the press).

Straub, V. Letter: declining birth rates are a symptom of a male malaise. Financial Times (26 February 2024).

White, A. & Tod, M. The need for a strategy on men’s health. Trends Urol. Mens Health 13 , 2–8 (2022).

Download references

Acknowledgements

V.J.S. and M.C.M. are supported by ESSGN (HORIZON - MSCA - DN - 2021 (101073237)) and the Leverhulme Trust Large Centre Grant LCDS (RC - 2018 – 003). M.C.M. is additionally supported by ESRC/UKRI Connecting Generations (ES/W002116/1), an ERC Advanced Grant (835079), EU MapIneq (202061645) and Einstein Foundation Berlin (EZ - 2019 - 555 - 2).

Author information

Authors and affiliations.

Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, University of Oxford, Oxford, UK

Vincent J. Straub & Melinda C. Mills

Department of Economics, Econometrics & Finance, University of Groningen, Groningen, the Netherlands

Melinda C. Mills

Nuffield College, University of Oxford, Oxford, UK

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Vincent J. Straub .

Ethics declarations

Competing interests.

M.C.M. is a Trustee of the UK Biobank, on the Scientific Advisory Boards of Our Future Health and Lifelines Biobank and on the Data Management Advisory Board of the Health and Retirement Survey. V.J.S. declares no competing interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article.

Straub, V.J., Mills, M.C. The interplay between male fertility, mental health and sexual function. Nat Rev Urol (2024). https://doi.org/10.1038/s41585-024-00936-1

Download citation

Published : 27 August 2024

DOI : https://doi.org/10.1038/s41585-024-00936-1

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Quick links

• Explore articles by subject
• Guide to authors
• Editorial policies

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

• Subscribe to Our Newsletter

Reproductive and Sexual Health

The prevention of gender-based violence and trauma, sexually transmitted infections, and maternal and neonatal deaths

Reproductive and Sexual Health Headlines

Explore the latest public health research and insights about reproductive and sexual health.

Student Spotlight: Amy Ozinsky

MSPH student Amy Ozinksy speaks to how her values show up in her educational journey - and what she loves best about Baltimore.

Important Abortion Cases in a Holding Pattern Following SCOTUS Decisions

The court upholds the status quo for now, but reproductive law experts expect mifepristone and EMTALA to be litigated again in the future.

Internship Spotlight: Zoey Hall

Through the Diversity Summer Internship Program for Undergraduates, Zoey Hall is interning in the Department of Biostatistics, working on research related to the Boston Birth Study Cohort.

Abortion Bans and Infant Deaths

The year after Texas passed its restrictive abortion law, infant deaths in the state increased.

We Must Safeguard the Health of Haiti’s Women and Girls

The destruction of Haiti’s health system has left women and girls especially vulnerable to maternal mortality, unintended pregnancies, and severe health complications.

Analysis Suggests 2021 Texas Abortion Ban Resulted in Increase in Infant Deaths in State in Year After Law Went into Effect

Researchers use statistical modeling to estimate infant deaths expected if one of the country’s most stringent state abortion laws had not been enacted.

• View more Headlines

Reproductive and Sexual Health Faculty Experts

Looking for prominent public health experts in the field of reproductive and sexual health? They’re here at the Bloomberg School of Public Health.

Cynthia Schaffer Minkovitz

Cynthia Minkovitz, MD, MPP, focuses on enhancing the quality of preventive services for children and understanding how policies and programs impact child and family well-being.

Michele R. Decker

Michele Decker, ScD, leads research at the cutting edge of gender equity, and gender-based violence prevention and response, in close partnership with practitioners and communities most affected.

Saifuddin Ahmed

Saifuddin Ahmed, MBBS, PhD ‘96, his research includes reproductive epidemiology, particularly maternal mortality estimation; program evaluation for family planning and MCH care.

Departments

Health, Behavior and Society

International Health

Population, Family and Reproductive Health

Centers & Institutes

Center of Excellence in Maternal and Child Health

Johns Hopkins Center for Communication Programs

William H. Gates Sr. Institute for Population and Reproductive Health

Upcoming Events

Integrating Sexual and Reproductive Health Equity Into Public Health Goals and Metrics: Comparative Analysis of Healthy People 2030’s Approach and a Person-Centered Approach to Contraceptive Access Using Population-Based Data

Background:

The Healthy People initiative is a national effort to lay out public health goals in the United States every decade. In its latest iteration, Healthy People 2030, key goals related to contraception focus on increasing the use of effective birth control (contraceptive methods classified as most or moderately effective for pregnancy prevention) among women at risk of unintended pregnancy. This narrow focus is misaligned with sexual and reproductive health equity, which recognizes that individuals’ self-defined contraceptive needs are critical for monitoring contraceptive access and designing policy and programmatic strategies to increase access.

We aimed to compare 2 population-level metrics of contraceptive access: a conventional metric, use of contraceptive methods considered most or moderately effective for pregnancy prevention among those considered at risk of unintended pregnancy (approximating the Healthy People 2030 approach), and a person-centered metric, use of preferred contraceptive method among current and prospective contraceptive users.

We used nationally representative data collected in 2022 to construct the 2 metrics of contraceptive access; the overall sample included individuals assigned female at birth not using female sterilization or otherwise infecund and who were not pregnant or trying to become pregnant (unweighted N=2760; population estimate: 43.9 million). We conducted a comparative analysis to examine the convergence and divergence of the metrics by examining whether individuals met the inclusion criteria for the denominators of both metrics, neither metric, only the conventional metric, or only the person-centered metric.

Comparing the 2 approaches to measuring contraceptive access, we found that 79% of respondents were either included in or excluded from both metrics (reflecting that the metrics converged when individuals were treated the same by both). The remaining 21% represented divergence in the metrics, with an estimated 5.7 million individuals who did not want to use contraception included only in the conventional metric denominator and an estimated 3.5 million individuals who were using or wanted to use contraception but had never had penile-vaginal sex included only in the person-centered metric denominator. Among those included only in the conventional metric, 100% were content nonusers—individuals who were not using contraception, nor did they want to. Among those included only in the person-centered metric, 68% were currently using contraception. Despite their current or desired contraceptive use, these individuals were excluded from the conventional metric because they had never had penile-vaginal sex.

Conclusions:

Our analysis highlights that a frequently used metric of contraceptive access misses the needs of millions of people by simultaneously including content nonusers and excluding those who are using or want to use contraception who have never had sex. Documenting and quantifying the gap between current approaches to assessing contraceptive access and more person-centered ones helps clearly identify where programmatic and policy efforts should focus going forward.

First published on JMIR Publications: August 20, 2024

United States

• Contraception

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

National Institute of Environmental Health Sciences

Your environment. your health., reproductive health, what is niehs doing, further reading, introduction.

Reproductive health refers to the condition of male and female reproductive systems during all life stages. These systems are made of organs and hormone-producing glands, including the pituitary gland in the brain. Ovaries in females and testicles in males are reproductive organs, or gonads, that maintain health of their respective systems. They also function as glands because they produce and release hormones.

Reproductive disorders affect millions of Americans each year.

Female disorders include:

• Early or delayed puberty.
• Endometriosis, a condition where the tissue that normally lines the inside of the womb, known as the endometrium, grows outside of it.
• Inadequate breastmilk supply.
• Infertility or reduced fertility (difficulty getting pregnant).
• Menstrual problems including heavy or irregular bleeding.
• Polycystic ovary syndrome, ovaries produce more male hormones than normal.
• Problems during pregnancy.
• Uterine fibroids, noncancerous growths in a woman’s uterus or womb.

Male disorders include:

• Impotence or erectile dysfunction.
• Low sperm count.

Scientists believe environmental factors likely play a role in some reproductive disorders. Research shows exposure to environmental factors could affect reproductive health in the following ways:

• Exposure to lead is linked to reduced fertility in both men and women. 1
• Mercury exposure has been linked to issues of the nervous system like memory, attention, and fine motor skills. 2
• Exposure to diethylstilbestrol (DES), a drug once prescribed to women during pregnancy, can lead to increased risks in their daughters of cancer, infertility, and pregnancy complications. 3
• Exposure to endocrine-disrupting compounds , chemicals that interfere with the body’s hormones, may contribute to problems with puberty, fertility, and pregnancy. 4
• Karen Clay, Margarita Portnykh, Edson Severnini. Toxic Truth: Lead and Fertility. 2019. NBER Working Paper No. 24607. [Accessed online 25 June 2019] [ Available Karen Clay, Margarita Portnykh, Edson Severnini. Toxic Truth: Lead and Fertility. 2019. NBER Working Paper No. 24607. [Accessed online 25 June 2019] ]
• U.S. Environmental Protection Agency (EPA). 2019. Health Effects of Exposures to Mercury. [Accessed June 25, 2019] [ Available U.S. Environmental Protection Agency (EPA). 2019. Health Effects of Exposures to Mercury. [Accessed June 25, 2019] ]
• American Cancer Society. 2019. DES Exposure: Questions and Answers. [Accessed June 25, 2019] [ Available American Cancer Society. 2019. DES Exposure: Questions and Answers. [Accessed June 25, 2019] ]
• Endocrine Society. Impact of Endocrine-disrupting Chemicals on Reproductive Systems. [Accessed June 25, 2019] [ Available Endocrine Society. Impact of Endocrine-disrupting Chemicals on Reproductive Systems. [Accessed June 25, 2019] ]

NIEHS conducts and funds research to understand environmental factors that may affect human reproductive health.

Heat exposure during pregnancy – NIEHS-funded researchers studied more than 400,000 pregnancies and found that both long- and short-term maternal heat exposures during pregnancy are associated with increased risk of severe maternal morbidity . The Centers for Disease Control and Prevention lists 21 different indicators of this medical condition that unexpectedly occurs after labor and delivery. The prevalence of severe maternal morbidity has continued to increase in the U.S. despite improvements in improvements in prenatal care coverage and quality.

Heavy lifting or shift work and decreased fertility – Two occupational factors for women – lifting heavy loads or working non-daytime schedules – are associated with fewer eggs in their ovaries, which could indicate decreased fertility. 5

Chemical exposure and assisted reproductive technology – Exposure to high levels of flame retardants 6  and plasticizers 7  may have a negative impact on the outcomes of in vitro fertilization (IVF), a technology used to help people get pregnant. The researchers found that women with higher levels of these chemicals in their urine had lower levels of ovary cells necessary for reproduction, and fewer successful pregnancies and live births.

Soy formula and menstrual pain – Girls who were fed soy formula as infants are more likely to develop heavy menstrual bleeding 8 , severe menstrual pain 9 , endometriosis 10 , and larger fibroids 11  later in life.

Vitamin D and uterine fibroids – Women with adequate levels of vitamin D are less likely to develop uterine fibroids than those with inadequate levels. 12

Uterine cancer – Women who used chemical hair-straightening products were at higher risk for uterine cancer compared to women who did not report using these products, according to research from The Sister Study that included more than 33,000 women. The researchers found that women who reported frequent use of hair-straightening products, defined as more than four times in the previous year, were more than twice as likely to go on to develop uterine cancer compared to those who did not use the products. Uterine cancer is relatively rare and accounts for about 3% of all new cancer cases. But it is the most common cancer of the female reproductive system.

Sperm quality – A comprehensive study, which included systematic review and meta-analysis, found sufficient evidence of an association between higher insecticide exposure—organophosphates and methyl carbamates—and lower sperm concentration in adult males. People can be exposed to insecticides through residential, occupational, and recreational sources.

NIEHS-supported researchers found prenatal exposure to air pollution (PM2.5) may shorten the distance between the anus and genitals, or the anogenital distance. Anogenital distance is a way to gauge reproductive health related to hormone levels, such as testosterone. Shorter anogenital lengths in newborn males are an indicator of lower testosterone activity in the womb, which may have implications for fertility and semen quality in adults.

• Mínguez-Alarcon L, Souter I, Williams PL, Ford JB, Hauser R, Chavarro JE, Gaskins AJ; Earth Study Team. 2017. Occupational Factors and Markers of Ovarian Reserve and Response Among Women at a Fertility Centre. Occup Environ Med 74(6):426-431. [ Abstract Mínguez-Alarcon L, Souter I, Williams PL, Ford JB, Hauser R, Chavarro JE, Gaskins AJ; Earth Study Team. 2017. Occupational Factors and Markers of Ovarian Reserve and Response Among Women at a Fertility Centre. Occup Environ Med 74(6):426-431. ]
• Carignan CC, Mínguez-Alarcon L, Butt CM, Williams PL, Meeker JD, Stapleton HM, Toth TL, Ford JB, Hauser R, EARTH Study Team. 2017. Urinary Concentrations of Organophosphate Flame Retardant Metabolites and Pregnancy Outcomes among Women Undergoing in Vitro Fertilization. Environ Health Perspect 125(8):087018. [ Abstract Carignan CC, Mínguez-Alarcon L, Butt CM, Williams PL, Meeker JD, Stapleton HM, Toth TL, Ford JB, Hauser R, EARTH Study Team. 2017. Urinary Concentrations of Organophosphate Flame Retardant Metabolites and Pregnancy Outcomes among Women Undergoing in Vitro Fertilization. Environ Health Perspect 125(8):087018. ]
• Hauser R, Gaskins AJ, Souter I, Smith KW, Dodge LE, Ehrlich S, Meeker JD, Calafat AM, Williams PL; Earth Study Team. 2016. Urinary Phthalate Metabolite Concentrations and Reproductive Outcomes among Women Undergoing in Vitro Fertilization: Results from the EARTH Study. Environ Health Perspect 124(6):831–839. [ Abstract Hauser R, Gaskins AJ, Souter I, Smith KW, Dodge LE, Ehrlich S, Meeker JD, Calafat AM, Williams PL; Earth Study Team. 2016. Urinary Phthalate Metabolite Concentrations and Reproductive Outcomes among Women Undergoing in Vitro Fertilization: Results from the EARTH Study. Environ Health Perspect 124(6):831–839. ]
• Upson K, Harmon QE, Laughlin-Tommaso SK, Umbach DM, Baird DD. 2016. Soy-based Infant Formula Feeding and Heavy Menstrual Bleeding Among Young African American Women. Epidemiology 27(5):716-25. [ Abstract Upson K, Harmon QE, Laughlin-Tommaso SK, Umbach DM, Baird DD. 2016. Soy-based Infant Formula Feeding and Heavy Menstrual Bleeding Among Young African American Women. Epidemiology 27(5):716-25. ]
• Upson K, Adgent MA, Wegienka G, Baird DD. 2019. Soy-based Infant Formula Feeding and Menstrual Pain in a Cohort of Women Aged 23-35 Years. Hum Reprod 34(1):148-154. [ Abstract Upson K, Adgent MA, Wegienka G, Baird DD. 2019. Soy-based Infant Formula Feeding and Menstrual Pain in a Cohort of Women Aged 23-35 Years. Hum Reprod 34(1):148-154. ]
• Upson K, Sathyanarayana S, Scholes D, Holt V. 2015. Early-life Factors and Endometriosis Risk. Fertil Steril 104(4):964-9761. [ Abstract Upson K, Sathyanarayana S, Scholes D, Holt V. 2015. Early-life Factors and Endometriosis Risk. Fertil Steril 104(4):964-9761. ]
• Upson K, Harmon QE, Baird DD. 2016. Soy-Based Infant Formula Feeding and Ultrasound-Detected Uterine Fibroids Among Young African-American Women With No Prior Clinical Diagnosis of Fibroids. Environ Health Perspect. 124(6):769-75. [ Abstract Upson K, Harmon QE, Baird DD. 2016. Soy-Based Infant Formula Feeding and Ultrasound-Detected Uterine Fibroids Among Young African-American Women With No Prior Clinical Diagnosis of Fibroids. Environ Health Perspect. 124(6):769-75. ]
• Baird DD, Hill MC, Schectman JM, Hollis BW. 2013. Vitamin D and the Risk of Uterine Fibroids. Epidemiology. 24(3):447-453. [ Abstract Baird DD, Hill MC, Schectman JM, Hollis BW. 2013. Vitamin D and the Risk of Uterine Fibroids. Epidemiology. 24(3):447-453. ]

NIEHS Research Efforts

• Calorie Restriction, Environment, and Fitness: Reproductive Effects Evaluation (CaREFREE) – A study, conducted at NIEHS, that investigates how nutrition, fitness, and environmental factors affect women’s menstrual cycles.
• Environment and Reproductive Health (EARTH) Study – Conducted by grantees in Massachusetts, analyzes the effects of environmental contaminants on male and female fertility and pregnancy outcomes.
• LifeCodes – A pregnancy cohort, led by Brigham and Women's Hospital in Boston, providing samples and data from more than 5,000 pregnancies for research projects such as investigating the association between environmental exposures and spontaneous preterm birth. It is one of the nation’s largest pregnancy cohorts and specimen banks.
• Pregnancy And Childhood Epigenetics (PACE) – A consortium of researchers at NIEHS, and around the world, that studies how environmental exposures in early life affect pregnancy outcomes and child health.
• Reproductive System Disorders – NIEHS supports research that is developing a fuller understanding of the relationship between exposures and risk of reproductive health problems. For example, grantees are studying the effects of arsenic exposure on birth outcomes; ties between dioxin exposure and endometriosis; and the role endocrine disruptors might play in sperm chromosomal abnormalities.
• Study of Environment, Lifestyle, and Fibroids (SELF) – A study conducted at NIEHS that uses ultrasound screening to identify risk factors for uterine fibroid development in African-American women.

Stories from the Environmental Factor (NIEHS Newsletter)

• Early-life Exposures, Assisted Reproductive Technologies Can Alter Gene Expression, Says Falk Lecturer (November 2023)
• Risk for Female Reproductive Cancer May Increase After Early-life Exposure to Endocrine-disrupting Substances (November 2023)
• Exposures Affect Men’s Biological Clocks, Too (June 2023)
• Scientific Excellence, Mentorship Go Hand in Hand for NIEHS Researcher (June 2023)
• Anne Marie Jukic wins NIH Bench-to-Bedside award (January 2021)
• Early embryos develop successfully through molecule called tankyrase (June 2020)
• Humphrey Yao elected to board of Society for the Study of Reproduction (May 2021)
• On the road again: NIEHS shines at the Endocrine Society’s annual conference (July 2022)
• Researchers Identify Cells Involved in Development of Genitalia (July 2021)
• Preterm Birth, Prolonged Labor Influenced by Progesterone Balance (April 2021)
• Replacement Chemicals May Put Pregnancies at Risk (February 2020)
• Pregnancy Hypertension Risk Increased by Traffic-related Air Pollution (January 2020)

Fact Sheets

Cosmetics and Your Health: NIEHS Research Findings

Environment and Health A to Z

Reproductive Health in Females and Males

Press releases.

• Preterm Birth More Likely With Exposure to Phthalates (July 11, 2022)
• Menopause and the Environment (2024) - NIEHS grant recipient Jodi Flaws, Ph.D., provides a brief overview of menopause and discusses her research that examines how exposure to phthalates may affect women’s reproductive aging. She also describes gaps in what we know about menopause and how research can inform clinical care to help women manage and treat their symptoms during the transition to menopause.

Additional Resources

• Common Reproductive Health Concerns for Women – Information and educational materials for women and health care providers provided by the U.S. Centers for Disease Control and Prevention (CDC).
• Journal of Women's Health Maternal Morbidity and Mortality – In the U.S., women are more likely to die from complications related to pregnancy or childbirth than in peer nations, and many health inequities are present among those who die. This special issue offers a research road map to help end this public health crisis. It showcases the work of NIH including NIEHS, other federal agencies, and the scientific community.
• Polycystic Ovary/Ovarian Syndrome – The NIH Office of Research on Women’s Health published an informational booklet on PCOS, an endocrine disease affecting millions of women that is often missed during medical examination.

Related Health Topics

• Bisphenol A (BPA)
• Cosmetics and Your Health
• Endocrine Disruptors
• Women's Health and the Environment

This content is available to use on your website.

• All health topics »
• Coronavirus disease (COVID-19)
• Reproductive health
• Air pollution
• Mental health
• Publications

• Initiatives
• Health security and AMR
• NCDs and ageing
• Climate change
• Reaching the unreached

• News releases
• Feature stories
• Photo stories
• Commentaries
• Photo library
• Press contact
• People of the Western Pacific

• Dzud in Mongolia
• Mpox outbreak
• Seasonal influenza
• Avian influenza
• Pacific islands
• Emergency medical teams
• The Global Outbreak Alert and Response Network (GOARN)
• Preparedness
• Health Data Platform >>
• How we work
• Where we work
• Our programmes
• Country support
• Pacific technical support
• Regional Director
• Regional Committee
• Collaborating Centers
• Regional health initiatives

• Health topics /

Reproductive health in the Western Pacific

Reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. Reproductive health implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.

Technical links

• Sexually transmitted infections (STIs)
• Cervical cancer
• HIV and AIDS
• Family planning/contraception methods
• Emergency contraception
• Adolescent pregnancy
• Maternal mortality
• Maternal and reproductive health
• Reproductive health (WPR/RC46.RI5)  

25% of maternal deaths

85% of women, 87,000,000 women.

worldwide become pregnant unintentionally because of underuse of modern contraceptives.

Supporting people-centred, integrated health service delivery

Protecting, supporting and promoting breastfeeding

Eliminating mother to child transmission of HIV, hepatitis and syphilis

Improving access to prevention, testing and treatment of HIV and STIs

Eliminating mother-to-child transmission of HIV, hepatitis B and syphilis

Triple Elimination of Mother-to-Child Transmission of HIV, Hepatitis B and Syphilis

View series of infographics

Infographics

Malaysia eliminates mother-to-child transmission of HIV and syphilis

Addressing the HIV and health needs of transgender people

International Women's Day 2013: Responding to epidemic of violence against women

Featured publications

Regional framework for reproductive health in the Western Pacific Region Regional framework for reproductive health in the Western Pacific Region

Related links

Related Health Topics

Adolescent health

Gender and health

Health workforce

• Digestive Health
• Immunization
• Infectious Disease

• Conferences
• Publications
• Practice Type

Q&A: Opill Ushers in New Era of Access to Birth Control

Stephanie Sober, MD, MSHP, investigator on the pivotal research that supported the prescription-to-OTC switch of Opill, shares insights on how the medicine is reshaping the reproductive landscape.

Oral contraceptives, pioneered in the 1950s, were the first drugs explicitly designed to serve a social purpose—a departure from traditional medicine focused on treating illness. 1 This innovation was met with resistance, even from the FDA , which initially hesitated to approve the drug for contraceptive use. Although eventually greenlit by the agency, the discomfort surrounding birth control has persisted.

Birth control blister packs / areeya_ann - stock.adobe.com

For some women, this shame and stigma is enough to deter them from seeking the necessary medication. The administrative process to obtain a prescription adds more challenges, as women must often navigate insurance hurdles, find a reliable health care provider, and deal with logistical issues such as transportation and wait times. This is particularly concerning given the reproductive backdrop of the nation, as more than half of the states in the US have banned abortion in its entirety. 2

However, in the 6 decades since approval of the first birth control, contraceptive medicine has progressed rapidly. Last year, a major milestone was achieved with FDA approval of the first over-the-counter (OTC) birth control pill, Opill. The decision was supported by a study demonstrating that women could determine their suitability for contraception without a health care provider. Now, Opill is available on pharmacy shelves nationwide without a prescription.

Developers of Opill hope that its availability in pharmacies will help reduce the stigma surrounding the medicine. According to Stephanie Sober, MD, MSHP, global director of medical affairs for women's health at Perrigo and investigator on the pivotal research that supported the prescription-to-OTC switch of Opill, in an interview with Drug Topics , the science is simple. "The more [contraceptive] options [people] have and the easier access [people] have, the more likely people are to find something that works for them and to be able to continue it," she said.

READ MORE: How Pharmacists Are Expanding Reproductive Care Access

Drug Topics: Can you tell us about the study that supported OTC FDA approval of Opill? Specifically, how did the study demonstrate that women can effectively determine their suitability for Opill without consulting a doctor?

Stephanie Sober, MD, MSHP: One of the key things to understand here is a little bit about the FDA process for prescription-to-OTC switches. It’s a fairly standardized and quite rigorous process especially for a first-in-class switch, which was the case with Opill, since there was no other OTC birth control pill available prior to this. We had to do all the steps, which is not necessarily the case when other products that are similar to OTC products are coming onto the market.

But there are a few key steps in that process. The first is that you need to develop a label. Any OTC medication you're probably familiar with, if you look at the back, it has that standard Drug Facts label template on it. You need to figure out how to get all the key information that consumers need to use the product appropriately into that little template. That piece of the process is actually a big chunk of it and involves numerous studies.

It’s really an iterative process where you test the template with consumers—test a draft—and then go back and see the places where they maybe didn't understand quite as well. Then, you try to make it more easily understandable and go back and test it again. You keep doing that and honing the label until you get to the point where you feel as though it is well understood by the consumers that you're trying to target.

Once the label has been developed, you then take it a step further and do what's called a self-selection study, where now you are going to consumers and no longer asking them hypothetical questions about another person. For example, in a label-comprehension study, you would ask somebody something like, “Sally is pregnant. Is this product appropriate or not appropriate for Sally to use?” But now, with the self-selection study, you're asking about the person themselves, and so they are taking their own medical history into account. So now they're thinking, “Do I want to use this, and is it appropriate for me based on my own medical history?”

Once you do the self-selection part, then you do what's called an actual use trial, where the folks who have decided that the medicine is appropriate for them and they want to try it, then take the product home and use it using only that Drug Facts label. So, no involvement of a health care provider.

Then you monitor it in some way. In the case of our study, we had folks record in a diary whether they took their pill each day, whether they had sex that day, and if they missed a pill, whether they took appropriate actions based on that. What we found, as you might imagine, since the directions for taking Opill are not all that complicated—they’re just to take 1 pill at the same time every day—we found that people really were able to do this and use the product appropriately without the involvement of a health care provider. People did it actually really, really well.

In our self-selection study, 99% of people were able to appropriately choose whether the product was right for them. And then in the actual use trial, on 97% of the days in the trial, folks either appropriately took their pill or took appropriate mitigating action if they missed their pill. So, we found—not all that surprisingly—people can do this on their own. That data was part of the package we submitted to FDA that led to the ultimate approval of the switch.

Drug Topics: How has Opill changed the dynamic between patients and health care providers? Do you believe it has opened new avenues for patient education and empowerment?

Sober: This is a tremendous achievement, and a game changer. I think it definitely opens up new access and new avenues for empowerment and increased options and increased choice.

In terms of the relationship between patients and health care providers, though, I think we may see lots of different things. For people who do have access to the health care system and have a provider that they want to see, this doesn't change that. They can still see their provider if they want to have a conversation about contraceptive options.

The important thing that this does, though, is for folks who don't have ready access to a health care provider. This opens the door for them to have access to a more highly effective contraceptive option than what was previously available OTC. Because, you know, when you think back to what was previously available, it’s things like condoms and spermicides, and those unfortunately fall into the less effective contraceptive methods. So now we're giving folks who don't have that access to the health care system increased options and freedom to choose a new option.

One important thing to note is that there are many folks in this country who live in what are called contraceptive deserts. The number is around 19 million women who live in these areas. To be deemed a contraceptive desert, there has to be a lack of access to the full range of birth control options. That’s quite a large number of folks who, depending on where they live, wouldn't have access. And so, this really does open opportunities for them to access a more highly effective method of contraception.

Drug Topics: Historically, birth control has faced significant stigma and shame. How do you think the availability of OTC birth control can help destigmatize reproductive health care and encourage open conversations about contraception?

Sober: This is extremely important, and hopefully the availability of Opill, and raising awareness about Opill and providing education about it in a stigma- and shame-free way, can really help to open lines of communication about contraception more generally.

Getting birth control should never be a process that involves shame or stigma. But as it was previously, having to jump through hoops and navigate barriers—certainly some of that has come into play. We hear stories from folks who feel that they haven't had a positive process acquiring contraception. So, hopefully by providing them a new option where they can avoid some of those barriers, but also trying to promote people getting educated about their reproductive health and contraception more generally, we can help to tamp down some of that stigma that does exist.

Drug Topics: What are the potential benefits of OTC birth control in terms of improving access to contraception, particularly for marginalized populations who may face barriers to health care?

Sober: The impetus for this switch was an unmet need in this country for access to contraception. We know that even with all of the contraception methods that were previously available, almost half of the 6 million pregnancies that occur in the US each year are unintended. Some of that is because folks either don't have access to contraception or have barriers to accessing contraception. And we know that even folks who are getting their prescription from their doctor, if there's some interruption in that care that causes them to be in need—all those things were really part of the reason why this was such an important and groundbreaking achievement.

I still work clinically, part time at this point, but those of us who prescribe contraception and do this as part of our clinical work know that the more options you have and the easier access you have, the more likely people are to find something that works for them and to be able to continue it. Even folks who want to have children at some point in their life can spend over 30 years trying to prevent getting pregnant. And what they need and what they want can change, and that's fine, but this certainly can fill in the gaps for those who can't get access in other ways, or who just don't want to have to deal with the health care system and want a highly effective and safe method of birth control.

Drug Topics: Looking ahead, what are the potential implications of OTC birth control for the future of reproductive health care? Do you see any opportunities for further innovations or advancements in this area?

Sober: The short answer is, I hope so. I'm not sure I can fully speculate on what's to come, but I think that certainly the Opill switch is a step in the right direction. I would hope that this switch would pave the way for future reproductive health products or other innovations that would lead folks to have easier access to health care.

READ MORE: Women's Health Resource Center

Are you ready to elevate your pharmacy practice? Sign up today for our free Drug Topics newsletter and get the latest drug information, industry trends, and patient care tips, straight to your inbox.

1. The birth control pill a history. Fact sheet. Planned Parenthood. Accessed August 29, 2024. https://www.plannedparenthood.org/files/1514/3518/7100/Pill_History_FactSheet.pdf

2. choi a, cole d. see where abortions are banned and legal—and where it's still in limbo. cnn. august 21, 2024. accessed august 29, 2024. https://www.cnn.com/us/abortion-access-restrictions-bans-us-dg/index.html.

Pharmacy Deserts Prominent in Areas of High Social Vulnerability

Researchers analyzed data from every county in the US and aimed to address the association between high social vulnerability and pharmacy deserts.

Disparities Hinder HPV Vaccine Goals in USAPI Jurisdictions

Access inequities are preventing the US-affiliated Pacific Island (USAPI) jurisdictions from meeting the WHO 2030 goal of 90% human papillomavirus (HPV) vaccination series completion coverage.

Q&A: Discussing the Dangers of Buying GLP-1s From Online Pharmacies

Timothy Mackey, MAS, PhD, discusses a study that sought to determine the risk of sourcing semaglutide from online platforms.

Majority of Savings from CMS Price Negotiations Comes From 3 Drugs

Research experts at the Brookings Institution in Washington, D.C., analyzed the savings estimates provided by CMS for its drug price negotiations and compared them with the institution’s own estimates.

Health Care Costs, Financial Scams Top List of Health Concerns Among Older Adults

Participants were asked to rate their level of concern on 26 health topics.

2 Commerce Drive Cranbury, NJ 08512

609-716-7777

• ISPOR Europe 2024

17 - 20 November

• Upcoming Conferences & Events

Utilization Rates of in Vitro Fertilization Procedures in Hungary Between 2010-2023

Pónusz-Kovács D 1 , Kajos L 1 , Csákvári T 2 , Pónusz R 1 , Kovács B 1 , Kovács K 1 , Bódis J 1 , Boncz I 1 1 University of Pécs, Pécs, BA, Hungary, 2 University of Pécs Faculty of Health Sciences, Zalaegerszeg, ZA, Hungary

OBJECTIVES: The prevalence of infertility ranges widely, affecting around 186 million people worldwide. Between 12-17% of couples of reproductive age experience unwanted childbearing. The high prevalence of infertility has led to an increasing demand for assisted reproductive techniques (ART), of which in vitro fertilization (IVF) is one of the most widely used. Our aims to analyze the utilization of IVF in the publicly funded Hungarian healthcare system.

METHODS: The necessary database was obtained from National Hospital General Directorate, Pulvita Health Data Warehouse. During the research, the number of cases in inpatient care linked to IVF was assessed from 2010 to 2023. Further analyses were conducted related to the contribution of Hungarian hospitals in IVF, the territorial inequalities of the utilization in a county breakdown, and accounted Diagnosis Related Groups as well.

RESULTS: In the study period a total of 127,692 cases were treated in publicly funded inpatient care. The patient turnover in 2023 exceeded nearly the 2,8 times higher the number of cases in 2010. Increased state involvement from 2019 onwards has had a noticeable impact on the IVF patents’ turnover. Nevertheless, significant inequalities are still registered in the utilization on a territorial basis. Our results show a negative directional and explicitly strong correlation between the total fertility rate (TFR) in the county and the number of IVF cases (r=-0.80). The average age of the study population shows an upward tendency as the study date progresses.

Clinical Outcomes, Economic Evaluation, Health Policy & Regulatory, Real World Data & Information Systems

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis, Health & Insurance Records Systems, Insurance Systems & National Health Care, Performance-based Outcomes

No Additional Disease & Conditions/Specialized Treatment Areas, Reproductive & Sexual Health

• Alzheimer's disease & dementia
• Arthritis & Rheumatism
• Attention deficit disorders
• Autism spectrum disorders
• Biomedical technology
• Diseases, Conditions, Syndromes
• Endocrinology & Metabolism
• Gastroenterology
• Gerontology & Geriatrics
• Health informatics
• Inflammatory disorders
• Medical economics
• Medical research
• Medications
• Neuroscience
• Obstetrics & gynaecology
• Oncology & Cancer
• Ophthalmology
• Overweight & Obesity
• Parkinson's & Movement disorders
• Psychology & Psychiatry
• Radiology & Imaging
• Sleep disorders
• Sports medicine & Kinesiology
• Vaccination
• Breast cancer
• Cardiovascular disease
• Chronic obstructive pulmonary disease
• Colon cancer
• Coronary artery disease
• Heart attack
• Heart disease
• High blood pressure
• Kidney disease
• Lung cancer
• Multiple sclerosis
• Myocardial infarction
• Ovarian cancer
• Post traumatic stress disorder
• Rheumatoid arthritis
• Schizophrenia
• Skin cancer
• Type 2 diabetes
• Full List »

share this!

August 29, 2024

This article has been reviewed according to Science X's editorial process and policies . Editors have highlighted the following attributes while ensuring the content's credibility:

fact-checked

peer-reviewed publication

trusted source

Fluid 'stickiness' in female reproductive tract could influence fertility

by Monash University

In a study providing important new insights into the development of the female reproductive tract and fertility, researchers have revealed how the thickness of fluid surrounding the egg can impact the cellular structure of the fallopian tube and how well the egg or embryo travels along it.

Published in Nature Communications , the Monash University study sheds light on how variations in the "stickiness" or viscosity of the fluid in the female reproductive tract influence how cells are modified to facilitate the transport of eggs for fertilization.

Led by Melati Abdul Halim, a Ph.D. candidate in the Department of Mechanical and Aerospace Engineering, the study highlights the potential for new treatments that could mimic or modify the natural stickiness of fluids in the reproductive system, offering hope for advancements in fertility therapies.

"Imagine the difference between walking through water versus thick mud. This is what it's like for tiny cells in the female reproductive tract , where the stickiness of the fluid can vary," Halim said.

"When the fluid is thicker, the extra resistance causes the cells to change their behavior. Some cells start growing tiny hair-like structures called cilia, which help move things like eggs along the reproductive tract. The thicker the fluid, the more cilia these cells produce, and the more coordinated their movements become. This coordinated beating pattern can facilitate the formation of metachronal waves, essential for the transport of eggs and embryos."

Corresponding and senior author Dr. Reza Nosrati said the findings suggest that the natural stickiness of fluid in our bodies could play a key role in processes like fertilization.

"The study suggests that the elevated viscosity at certain stages of the menstrual cycle could be a natural mechanism to enhance the formation and coordination of cilia, thus facilitating fertilization. This important aspect of natural fertilization and the role of higher viscosity fluid in the reproductive tract may need more careful evaluation as part of infertility diagnosis and assisted reproduction practices," Dr. Nosrati said.

"It provides insights into how the viscosity (thickness, stickiness ) of extracellular fluid influences the behavior of epithelial cells lining the fallopian tubes and could be key to understanding and potentially treating fertility issues."

Explore further

Feedback to editors

Brain training: Study links cardiovascular fitness to brain health

4 minutes ago

Managing early stages of abortion care at home after 12 weeks is safe and reduces time spent in hospital, study finds

11 hours ago

Billions worldwide consume inadequate levels of micronutrients critical to human health, new study finds

Blocking the longevity gene S6K1 extends lifespan in mice by reducing inflammation

12 hours ago

Machine learning predicts which patients will continue taking opioids after hand surgery

13 hours ago

Study describes a new molecular pathway involved in the control of reproduction

Machine learning helps identify rheumatoid arthritis subtypes

Immune protection against tuberculosis reinfection driven by cells that dampen lung inflammation, shows study

Girls with mental health conditions have lower HPV vaccination coverage

14 hours ago

Mankai plant found to reduce post-meal sugar levels in diabetics

Related stories.

Sperm can adjust their swimming style to adapt to fluctuating fluid conditions

Nov 1, 2023

Cilia beat to an unexpected rhythm in male reproductive tract, study in mice reveals

Jan 14, 2019

Researcher solves longstanding fallopian tube transport debate

May 24, 2021

The unexpected journey of the egg and the embryo through the fallopian tube

Jul 13, 2021

Molecular 'barcode' helps decide which sperm will reach an egg

Dec 1, 2020

Imaging advance poised to provide new insights into reproduction and infertility

Nov 2, 2023

Recommended for you

Cochlear implant users reveal basic approaches for how people recognize words

Aug 29, 2024

Maternal death statistics skewed by COVID, not decreased by end of Roe v. Wade: Study

Aug 28, 2024

Human endometrial map uncovers hidden health clues

Let us know if there is a problem with our content.

Use this form if you have come across a typo, inaccuracy or would like to send an edit request for the content on this page. For general inquiries, please use our contact form . For general feedback, use the public comments section below (please adhere to guidelines ).

Please select the most appropriate category to facilitate processing of your request

Thank you for taking time to provide your feedback to the editors.

Your feedback is important to us. However, we do not guarantee individual replies due to the high volume of messages.

E-mail the story

Your email address is used only to let the recipient know who sent the email. Neither your address nor the recipient's address will be used for any other purpose. The information you enter will appear in your e-mail message and is not retained by Medical Xpress in any form.

Newsletter sign up

Get weekly and/or daily updates delivered to your inbox. You can unsubscribe at any time and we'll never share your details to third parties.

More information Privacy policy

Donate and enjoy an ad-free experience

We keep our content available to everyone. Consider supporting Science X's mission by getting a premium account.

E-mail newsletter

Science for Living: Sybil Crawford explains research on menopause hormone therapy and disease prevention

By Susan E.W. Spencer

Other interventions were also analyzed and little impact on prevention was found. The study didn’t find evidence that routine supplementation with calcium plus vitamin D prevented fractures, or that a low-fat diet high in fruits, vegetables and grains prevented breast or colorectal cancer. However, a low-fat diet may help reduce breast cancer mortality, which researchers are studying further.

How did we get here? Conflicting research findings on menopause have given midlife and older women whiplash over the past few decades.

Now, long-term data from the Women’s Health Initiative (WHI) and a longitudinal, epidemiologic study of women in their middle years and older, called the Study of Women’s Health Across the Nation or SWAN , are providing more guidance for women’s health throughout the post-reproductive lifespan, according to Sybil Crawford, PhD, professor of nursing. Dr. Crawford has conducted extensive research focused on menopause for 30 years and leads a statistical team for the SWAN study.

A generation ago, hormone replacement therapy was considered the cure-all for menopause symptoms such as hot flashes, disrupted sleep and brain fog, and some studies suggested it could also prevent a number of chronic diseases, including heart disease, dementia and some cancers.

“Before the Women’s Health Initiative, physicians were relying on observational studies of exogenous hormones, which found that in younger woman who were having symptoms and using it, it worked great,” said Crawford. “But two things make that not generally applicable. These women were younger and they tended to be healthier before they started hormones.”

  “I’ve been reading in the news, ‘We don’t have information on menopause’, but we’ve been doing the research and trying to get it out there.”  

The WHI was designed to test, through randomized clinical trials as well as observation, the risks and benefits of hormone therapy—either a combination of estrogen and progesterone or estrogen alone—in addressing menopause symptoms and disease prevention. Nearly 162,000 women aged 50 to 79 were enrolled between 1993 and 1998, with 68,000 randomized in clinical trials and followed for up to 20 years.

In 2002, the National Heart, Lung and Blood Institute stopped the hormone therapy trial three years early based on an evaluation that the risks of breast cancer and heart disease were increased, and other health risks of hormone therapy were greater than the benefits. The use of hormone treatments plummeted, Crawford said.

Further analyses looked at the WHI population by age group, not just as a whole, and found that hormone therapy was safe and effective for treating perimenopause and menopause symptoms in women younger than 60 or within 10 years of their last menstrual period. That recommendation still holds.

But hormone therapy may not be effective for many other uses. Crawford said the most recent study supported previous analyses that hormone therapy does not prevent cardiovascular disease, cancer or other chronic diseases in postmenopausal women.

So, what’s a peri- or postmenopausal woman to do to stay healthy? Crawford said the SWAN study, which follows a racially and ethnically diverse population of approximately 3,300 women who were 42 to 52 years old when enrolled between 1996 and 1997, has fact sheets with tips for several women’s health topics on its website, swanstudy.org .

“A lot happens during this age period. It’s not just going through menopause,” Crawford said. “There are so many other factors going on in women’s lives. That’s why it’s important to pay attention to staying healthy, following what the American Heart Association calls ‘Life’s Essential 8 .’”

Whether or not to use hormone therapy in early menopause depends on individual factors a woman should discuss with her health care provider. A directory of practitioners who specialize in menopause can be found on The Menopause Society website, according to Crawford. Some endocrinologists also specialize in menopause.

“I’ve been reading in the news, ‘We don’t have information on menopause,’” said Crawford. “But we’ve been doing the research and trying to get it out there.”

Science for Living  stories feature the perspectives of UMass Chan Medical School experts on the research behind health news headlines. If you have ideas for topics  you ’d  like to see explored, reach out to   [email protected] .

Related UMass Chan news

Umass chan study finds some women may be missing out on benefits of menopausal hormone therapy, sybil crawford receives 2020 best paper award from north american menopause society.

Sign up for weekly news emails