Black women are under-represented in clinical research, contributing to persistent health inequities and undermining the validity and generalisability of research findings. Understanding facilitators and barriers to their research engagement is essential to addressing these challenges. This study aimed to identify and synthesise evidence on barriers and facilitators which influence Black women's participation in healthcare research, to inform inclusive recruitment strategies and equitable research designs. This systematic review was conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD42024587308). Findings were narratively synthesised using thematic analysis and discussed iteratively through Patient and Public Involvement. Five databases were searched (CINAHL, PsycInfo, Embase, MIDIRS, MEDLINE) for studies published since 2010. Papers in any language were screened for inclusion. Patient and Public Involvement members informed review objectives and data interpretation. Primary research studies reporting on Black women's experiences, attitudes, and facilitators/barriers to participating in any type of healthcare research. Studies were included if ≥ 50% (to ensure primary representation) of the sample recruited were Black women. Seventy-two studies were included. Most were from America and spanned research areas relating to oncology, Human Immunodeficiency Virus (HIV), dementia, maternity, and general health. Five overarching themes identified how Black women's participation in healthcare research is shaped by a complexity of factors. These were mistrust, interpersonal experiences, altruism, self-interest, and low health/research literacy and awareness. Patient and Public Involvement consultations concurred that the findings aligned with a "bridge and barriers" analogy, illustrating how various factors can facilitate or prevent Black women from engaging with research opportunities. This provided a clear framework to guide culturally sensitive implementation for researchers, healthcare professionals, and policymakers. Inclusive strategies for recruiting Black women into research must focus on co-constructing a bridge between communities and research systems. This requires structural and systemic change in research delivery environments and ongoing collaborations with all stakeholders including Black women, healthcare system providers, and research teams. PROSPERO (CRD42024587308).
Good-quality care in the intrapartum and early postnatal period are critical to ensuring maternal, fetal and newborn survival and well-being. There is currently no standardised approach to assess the quality of intrapartum and early postnatal care provided in health facilities, women's experiences of that care, and whether the services provided are aligned with the latest WHO recommendations. The Global Maternal and Newborn Health Platform (GMP) aims to establish and sustain a multi-country network of health facilities providing childbirth services, to measure and improve the quality of intrapartum and early postnatal care. The main objectives of this Platform are (i) to measure coverage of key intrapartum and early postnatal care practices and their alignment with WHO recommendations, (ii) to describe women's experiences of care, (iii) to measure key maternal and newborn health outcomes. GMP will use periodic, cross-sectional, observational data collection in a multi-country network of health facilities from up to 63 low- and middle-income countries (LMICs). In the first wave, GMP is being implemented in 74 facilities in 10 Asia-Pacific countries. In participating facilities data will be collected at level of the individual woman/baby, maternal and newborn health providers, and facility. This multi-country initiative aims to assess the quality of intrapartum and early postnatal care in health facilities, with a "person-centred" approach that emphasizes women's experiences during birth and postnatal admission. In its first wave, data will be collected from over 100,000 women and their babies, alongside nearly 30,000 pre-discharge surveys on care experiences, complemented by responses from over 2,000 healthcare providers across 74 facilities in 10 Asia-Pacific countries. The resulting dataset will enable multi-country, country-specific, and facility-level analyses to identify actionable priorities for improving maternal and newborn health outcomes. GMP's tools and methods are developed using an evidence-based approach and foster multidisciplinary networks among healthcare professionals, researchers, and policymakers. GMP provides a robust, scalable approach for periodic and standardised data collection, informing evidence-based policy and practice to enhance care quality. GMP will provide global situational analyses on intrapartum and early postnatal care quality to address the Sustainable Development Goals (SDG) and will help to addresses the WHA 77.5 resolution to accelerate progress towards reducing maternal, newborn and child mortality, including stillbirths.
Male labour migration is common across India and often results in extended periods of spousal separation. This absence changes who holds responsibility and decision-making power at home, and can reshape traditional gender roles and women's autonomy. Sexual autonomy, a woman's ability to control her own body, negotiate safe sex, and make her own reproductive choices, is one part of this shift. Because separation changes spousal dynamics, it can also create different expectations around this autonomy. Our study looks at how male labour migration relates to men's own perceptions of women's sexual autonomy. We use data from the fifth round of the National Family Health Survey (NFHS-5). The sample includes women aged 15-49 and men aged 15-54. After excluding non-working respondents, the final sample is 82,598 individuals. Migration status is defined as an employment-related absence from the place of residence for at least one month, classified as short-term or long-term migration. We use binary logistic regression to examine the link between migration status and men's perceptions of women's sexual autonomy, adjusting for relevant socioeconomic and demographic factors. Our study finds that 15.3% of men were temporary migrants (8.9% short-term, 6.4% long-term), confirming migration as a major livelihood strategy in India. In unadjusted models, both short- and long-term migrants, along with men who reported substance use, were significantly more likely to hold negative attitudes toward women's sexual autonomy. After adjusting for sociodemographic factors, the odds of holding negative attitudes were significantly lower among middle-aged men (45-54 years), men from the Scheduled Castes, and men with higher education. Migration status has a significant role to play in the male perspective on the sexual autonomy of women. Both short- and long-term labour migrants are more likely than non-migrants to hold negative attitudes toward women's sexual autonomy. Our findings point to the need for targeted social and behavioural interventions aimed specifically at younger male migrants who are engaged in substance abuse.
Polycystic Ovary Syndrome (PCOS) is a disorder commonly seen in females of reproductive age. Significant associations have been reported between oral inflammation, periodontal diseases, and PCOS. An increase in inflammatory markers may be a factor for quality of life in patients with PCOS. The aim of this study was to evaluate the relationship between xerostomia and oral health-related quality of life in females with PCOS. In face-to-face interviews, patients diagnosed with PCOS and a healthy control group completed a questionnaire including demographic data, the Oral Health Impact Profile (OHIP-14) and the Xerostomia Inventory. The data obtained were analyzed statistically in the IBM SPSS vn. 27 program. The OHIP-14 total points and the xerostomia points were determined to be statistically significantly higher in the PCOS group than in the control group (p < 0.05). A positive, moderate-level correlation was seen between the OHIP-14 total points and the xerostomia points (p < 0.05). The study results showed that xerostomia was associated with PCOS and the oral health-related quality of life was affected in these patients. In females diagnosed with PCOS, keeping oral health under control can improve quality of life. It highlights the importance of integrating routine oral health assessments into the standard clinical management of women with PCOS. Healthcare professionals should adopt a multidisciplinary approach to identify and manage oral health problems that could adversely affect patients' quality of life.
Primigravida women's health and well-being during pregnancy are crucial as they promote healthy fetal development and birth outcomes, reduce complications for both mother and baby, and positively impact the whole family. Primigravida is a term referred to a woman who is pregnant for the first time. This study evaluated an educational program's effect on health knowledge and well-being among primigravida women. A quasi-experimental design was conducted with 95 primigravida women in Cairo. The intervention involved six weekly sessions (45-60 min) based on the Health Promotion Model. Pre- and post-tests assessed knowledge and well-being. Cohen's d was used for effect size. Post-intervention, participants' high knowledge levels significantly increased from 26.3% to 74.7% (p < 0.001). Similarly, high well-being levels improved from 10.5% to 71.6% (p < 0.001). A strong positive correlation (r = 0.65, p < 0.001) was established between health-related knowledge gains and overall well-being scores following the program implementation. The structured educational program effectively improved maternal knowledge and well-being among primigravida women. Integrating such tailored interventions into primary healthcare services is essential for enhancing maternal outcomes and promoting a positive pregnancy experience.
Flood disasters, intensified by climate change, are increasing in frequency and severity globally, disproportionately affecting vulnerable populations, particularly women. Women's vulnerability during flood disasters extends beyond biological or physical differences and is shaped by broader social, economic, cultural, and institutional conditions. However, synthesised evidence on women's vulnerabilities in flood contexts remains limited. A scoping review was conducted using the Arksey and O'Malley framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A systematic search of PubMed, Web of Science (WoS), and Scopus databases identified 19 studies published between 2020 and 2024 that met the predefined inclusion criteria. Studies were eligible if they examined women's vulnerabilities in the context of flood disasters and were original peer-reviewed articles. Data were extracted and analysed thematically to identify patterns and relationships among factors contributing to women's vulnerabilities. Five interacting vulnerability domains were identified: physical (including sexual and reproductive health), social, psychological, economic, and environmental. Evidence across studies indicated that these domains are influenced by broader structural conditions such as gender norms, governance exclusion, and socioeconomic inequality, which may interact across exposure, sensitivity, and adaptive capacity to shape compounded gendered flood impacts. In addition, findings highlighted cross-domain patterns of adaptive capacity, where women employed context-specific strategies to respond to constrained conditions. Based on this synthesis, a conceptual framework was developed to illustrate how structural conditions relate to vulnerability processes, adaptive responses, and disaster outcomes. Women's vulnerability to flood disasters reflects a complex interplay of multidimensional risks shaped by gendered roles, socioeconomic disadvantage, limited resource access, and gaps in disaster planning and response. While caregiving responsibilities and health risks increase direct exposure, structural constraints may limit coping and recovery capacity. At the same time, adaptive capacity is actively expressed but often constrained and underrecognised within formal disaster systems. The proposed framework positions gender as a cross-cutting determinant and offers a conceptual lens for identifying policy entry points for gender-responsive disaster risk reduction.
Pregnant women's emotional well-being is a major determinant of maternal and pregnancy outcomes. This study aimed to estimate the prevalence of pregnant women's perceived unhappiness with their current pregnancy, and to examine the reasons and factors associated with such feelings in Quelimane district, Central Mozambique. A population-based pregnancy surveillance study was conducted during 2023-2024. Data included pregnant women's perceived status of unhappiness with their current pregnancy at realization, reasons for such feelings, and perceived reactions of their sexual partners. Variables associated with women's unhappiness were investigated within a couple-centered conceptual framework that views pregnancy-related unhappiness as the result of interacting socio-demographic, reproductive, and partner-level factors; using descriptive statistics and multivariate logistic regression (three sequentially adjusted models). Among the 1546 participating women, 24.5% referred being unhappy with their pregnancy, and this was higher among adolescents (42.2%), in daughters/grand-daughters/daughters-sisters-in-law (33.5%), residing in larger households (29.7%), un-married women (36.6%), first trimester of gestation (37.7%), without couple's communication about childbirth (48.9%), and with unhappy partner (74.5%). The leading reasons for unhappiness were unplanned pregnancy (30.2%), unwanted/undesired pregnancy (26.5%), and fear of consequences (17.7%). In the multivariate logistic regression analysis, the associations of socio-demographic (first model) and reproductive (second model) variables with unhappiness were progressively attenuated as the models were being fitted. In the fully adjusted model (third model), women's age and gestational age maintained strong association with unhappiness, with adolescents and older women showing higher odds of unhappiness compared to middle-aged adults (OR = 2.18, 95% CI:1.43-3.32) and (OR = 2.21, 95% CI:1.25-3.93), respectively; and women interviewed in the first and third trimester being more likely to be unhappy than those in the second trimester (OR = 2.19, 95% CI:1.10-4.37) and (OR = 1.51, 95% CI:1.08-2.11), respectively. However, partner-related variables emerged as strongly associated with maternal unhappiness, with partner's unhappiness with pregnancy showing ORs of 8.23 (95% CI:5.04-13.43), lack of couple's communication (OR = 2.23, 95% CI:1.34-3.74), and partner's pregnancy intendedness showing ORs of 1.73 (95% CI:1.12-2.65). Nearly one in four women in Quelimane reported being unhappy with their pregnancy, and unhappiness was particularly frequent among adolescents, non-married, women in first gestational age, those without couple's communication, and with unhappy partners. While women's socio-demographic and reproductive factors contributed to unhappiness, partner's emotional response and couple communication were the most influential factors. These findings highlight the importance of couple-centered approaches in maternal health research and interventions, particularly for adolescents and other vulnerable groups.
Pregnant women with gestational diabetes mellitus (GDM) face complex challenges in managing their condition, especially in low-resource settings with limited healthcare and social support. Digital health interventions show promise, but their real-world applicability in rural contexts remains underexplored. This study explores the experiences of women using an online intervention for GDM self-care in Thai Binh, Vietnam. A qualitative study was conducted between February and December 2024 involving 21 pregnant women diagnosed with GDM. Participants were enrolled in a digital self-care program and interviewed in-depth during late pregnancy (29-39 weeks of gestation). The study drew on ethnographic methods, including attention to women's contexts and the use of fieldnotes. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed. Participants reported improved self-management of GDM through healthier diets, increased physical activity, and regular glucose monitoring. Five main themes emerged: (1) making healthy food choices with family and peer support, (2) learning and practicing blood glucose self-monitoring with guidance, (3) engagement in physical activity encouraged by others, (4) emotional well-being supported by social relationships, and (5) challenges affecting women's acceptance of the online intervention. Professional support enhanced trust in medical advice, while the peer-support component fostered motivation, companionship, and emotional resilience. The intervention also encouraged family involvement in care. Online interventions that combine expert guidance with peer and family support can support women to manage the physical and mental aspects of living with GDM. This hybrid model shows promise for broader application in low- and middle-income countries. Further research is recommended to assess long-term impacts and scalability. NCT05744856 (Registration Date 20230215 and Last Update Posted 20240430).
Psychological distress among university students is a pressing public health concern. Emerging research in nutritional psychology links eating patterns to mental health outcomes, while emotion regulation processes shape individual stress responses. Female university students in Pakistan are particularly vulnerable due to compounding sociocultural pressures, rigorous academic demands, and limited mental health resources. This cross-sectional study investigates the association between eating patterns and psychological distress in this demographic, specifically examining whether cognitive reappraisal (an adaptive emotion regulation strategy) moderates this relationship. Data were collected via purposive sampling from 354 female university students in Lahore, Pakistan. Assessments utilized the Healthy Eating Index (HEI) for dietary patterns, the Emotion Regulation Questionnaire (ERQ) for cognitive reappraisal, and the Depression Anxiety Stress Scales-21 (DASS-21) for psychological distress. Data were analyzed using Pearson correlations, linear regression, and hierarchical moderation. Healthier eating patterns were significantly associated with reduced levels of depression (r = - .233, p < .001), anxiety (r = - .174, p < .05), and stress (r = - .192, p < .05). Cognitive reappraisal correlated positively with healthier eating (r = .215, p < .05) and negatively correlated with depression (r = - .412, p < .01), anxiety (r = - .367, p < .01), and stress (r = - .389, p < .01). Regression models confirmed that eating patterns significantly predicted depression (β = - 0.23, p < .01), anxiety (β = - 0.17, p < .05), and stress (β = - 0.19, p < .01). Moderation analyses indicated that cognitive reappraisal significantly moderated the relationship between eating patterns and psychological distress (interaction β range = - 0.12 to - 0.17), explaining an additional 2-3% of variance. Specifically, higher cognitive reappraisal strengthened the protective association between healthier eating patterns and lower psychological distress while attenuating distress associated with unhealthy eating patterns. Healthier eating patterns and higher levels of cognitive reappraisal were associated with lower psychological distress among young women in academic settings. Cognitive reappraisal appeared to play a protective moderating role by strengthening the beneficial association between healthier eating patterns and lower levels of depression, anxiety, and stress while reducing psychological vulnerability associated with poorer eating habits. These findings highlight the importance of holistic university mental health initiatives that integrate nutritional awareness with adaptive emotion-regulation training to promote psychological well-being among female students.
Intention to use contraceptives reflects an individual's or couple's plan to adopt contraceptive methods, supporting women's reproductive autonomy. It is associated with reduced unintended pregnancies, unsafe abortions, and high fertility rates, thereby improving maternal and infant health outcomes. Machine learning approaches can strengthen prediction accuracy and support evidence-based reproductive health planning. This study aimed to predict women's intention to use contraceptives in East Africa using machine-learning methods. We analyzed Demographic and Health Survey (DHS) data from 11 East African countries (2015-2024) in a community-based cross-sectional design. Country-specific sampling weights, stratification, and clustering were applied to account for the complex survey design. Missing data were imputed using the KNNImputer, and predictors were harmonized across surveys. Data preprocessing included cleaning, transformation, integration, and one-hot encoding, with an 80/20 train-test split. Seven machine learning algorithms were evaluated: adaptive boosting, CatBoost, random forest, light gradient boosting, extreme gradient boosting, logistic regression, and decision tree. Hyperparameters for CatBoost were tuned using Bayesian optimization under stratified 10-fold cross-validation. Model transportability was assessed using leave-one-country-out cross-validation. Among 123,290 reproductive-age women in East Africa, 51.23% reported intention to use contraceptives. Boosted tree algorithms performed best, particularly CatBoost achieving the highest discrimination with an AUC of 80.09% and an accuracy of 73.48%. Leave-one-country-out cross-validation confirmed moderate transportability with an AUC 74%, while calibration analysis showed reliable probability estimates (Brier score 0.179). SHAP feature importance identified employment, education, age, hearing about family planning, pregnancy, breastfeeding, barriers to healthcare access, and fertility preference as the most influential predictors of contraceptive intention. This study provides a transparent, reproducible framework for pooled DHS prediction modeling, offering actionable insights for policymakers and health planners while serving as a methodological foundation for future applied work.
Female farmers are exposed to combined biomechanical and pelvic-floor stressors during agricultural work. However, musculoskeletal discomfort, urinary incontinence, and health-related quality of life have seldom been evaluated together in this population. This exploratory study therefore compared these outcomes between female farmers and rural homemakers and examined associations between regional discomfort and quality of life. This cross-sectional comparative study included 70 women recruited by snowball sampling: 35 farmers and 35 homemakers aged 40-65 years from rural districts of Aydın Province, Türkiye. Outcomes were assessed using the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ), the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and the 36-item Short Form Health Survey (SF-36). Group comparisons, regression models adjusted for age, body mass index, and menopausal status, and Spearman correlations corrected for the false discovery rate (FDR; significance at q < 0.05) were performed. Farmers reported a higher discomfort prevalence in 12 of 18 CMDQ regions. The largest unadjusted differences were observed for the left shoulder (48.6% vs. 26.5%; +22.1% points), left knee (65.7% vs. 45.7%; +20.0), hip (42.9% vs. 25.7%; +17.1), and right forearm (20.0% vs. 8.6%; +11.4). These differences were not statistically robust: no region remained significant after FDR correction (minimum q = 0.626), and adjusted logistic models showed no independent group associations (p = 0.081-0.993). ICIQ-SF scores tended to be higher among farmers (4.0 ± 3.8 vs. 3.0 ± 4.2; unadjusted p = 0.127; adjusted p = 0.578), and self-reported leakage during physical activity/exercise was more frequent (31.4% vs. 11.4%; p = 0.078). SF-36 domains were numerically lower among farmers, with no significant adjusted differences (adjusted p ranging from 0.296 for role emotional to 0.886 for physical functioning). FDR-significant inverse correlations included farmers' upper-back discomfort with general health (rho=-0.700, q < 0.001), farmers' right-knee discomfort with bodily pain (rho=-0.672, q < 0.001), and homemakers' low-back discomfort with bodily pain (rho=-0.632, q = 0.003). In this exploratory rural sample, female farmers showed a broader distribution of musculoskeletal discomfort and a nonsignificant tendency toward more activity-related urinary leakage. Adjusted analyses did not confirm independent group effects; the results should therefore be interpreted as hypothesis-generating. They nonetheless suggest the value of considering combined musculoskeletal and urinary screening, and of more detailed exposure assessment, in rural women's health.
Academic achievement anxiety is a common psychosocial stressor among university students and may be associated with menstrual health outcomes. However, limited research has examined the relationships between academic achievement anxiety, perceived stress, menstrual pain, and menstrual hygiene behaviors simultaneously in female university populations. This cross-sectional study included 307 female university students in Turkiye (mean age = 20.59 ± 2.02 years). Participants completed online self-report measures assessing academic achievement anxiety, perceived stress, menstrual pain severity and menstrual hygiene behaviors. Descriptive statistics, Pearson correlations and regression analyses were conducted to examine associations among the variables. Academic achievement anxiety was positively associated with perceived stress and menstrual pain and negatively associated with genital hygiene behaviors. Multiple linear regression analyses showed that these associations remained significant after controlling for relevant covariates, including age, income level, menstrual regularity, and faculty. Academic achievement anxiety emerged as a significant predictor of perceived stress(β = 0.315, p < 0.001), menstrual pain (β = 0.211, p < 0.001), and genital hygiene behaviors (β = -0.126, p = 0.026). Academic achievement anxiety was associated with higher perceived stress, increased menstrual pain and slightly less optimal menstrual hygiene practices among female university students. However, these associations were modest, suggesting that academic-related stress may represent one of several factors related to menstrual health outcomes. Addressing academic-related stress within a broader context that includes psychological and structural factors may support student wellbeing. Future research should further explore these relationships using more comprehensive designs.
Appropriate management of health and nutritional status is essential for athletes to maintain performance, enhance recovery, and prevent injuries. Nutrition education aims to improve health and nutritional status through changes in dietary behaviors, thereby supporting athletic sustainability and quality of life. Previous systematic reviews have primarily focused on intermediate outcomes such as nutrition knowledge and behaviors, whereas health and nutritional status as final outcomes and the effectiveness of nutrition education interventions have not been systematically organized. This review aimed to (1) summarize health and nutritional status outcome measures used in nutrition education intervention studies targeting athletes and (2) examine the effectiveness of these interventions in relation to outcome consistency and alignment with intervention objectives. This systematic review was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD42023417419). Seven databases were searched for studies published between April 2003 and March 2025. Eligible studies included randomized controlled trials, non-randomized controlled trials, and pre-post intervention studies involving athletes aged ≥ 12 years. Nutrition education interventions included lectures, counseling, and face-to-face or online programs delivered to individuals and/or groups. Outcomes included objective and/or subjective indicators of health and nutritional status. Twenty-four studies involving 845 athletes were included. All studies assessed anthropometric or body composition measures such as body weight, fat mass, and fat-free mass. Biochemical indicators were less frequently used, with hydration status assessed by urine specific gravity in three studies and blood biomarkers in three studies. Subjective health-related outcomes were rarely evaluated. Intermediate outcomes such as nutrition knowledge and dietary behaviors were assessed in 12 studies. Studies in which intervention objectives, educational content, and outcome measures were aligned tended to report improvements corresponding to their stated objectives. In nutrition education intervention studies targeting athletes, objective measures of body weight and body composition are commonly used, whereas subjective health status assessments remain limited. Nutrition education may be effective for intermediate outcomes such as nutrition knowledge and dietary behaviors, but evidence for effectiveness in physiological and biochemical outcomes remains inconclusive. Aligning intervention objectives, educational content, and evaluation measures within a nutrition management framework may be important for appropriately evaluating effectiveness. Repeated nutrition education interventions may contribute to sustainable behavioral and health-related changes in athletes.
Clarifying the concept of fear of childbirth in pregnant women is crucial, especially for medical professionals like midwives and nurses. This research aims to analyze the concept of fear of childbirth based on the experiences and perspectives of Iranian pregnant women, as no previous study has focused on clarifying this phenomenon. In this study, the hybrid concept analysis model will be used to analyze the concept of fear of childbirth in pregnant women. This model consists of three theoretical stages: literature review, field work, and final analysis. A literature review will be conducted to retrieve any definition and measurement, behaviors, antecedents, and consequences about concept of fear of childbirth in pregnant women. In the second phase the qualitative study will be conducted for extracting experiences and perspectives of pregnant women of fear of childbirth, using semi-structural interviews. In the third phase will involve a comprehensive analysis that combines the results from the previous two phases. We will compare the concept of fear of childbirth in the articles with the findings from the fieldwork phase, highlighting any differences between the data obtained from the fieldwork and the theoretical phase. We will then extract and report these differences. The present study aims to provide an overview of the concept of fear of childbirth by reviewing texts, articles, tools, and the perceptions of pregnant women based on their lived experiences. The concept of "fear of childbirth" encompasses various types of anxiety and fear that women experience in relation to pregnancy and childbirth. Understanding the characteristics of this concept can help develop it in health systems and improve care before and during pregnancy.
Pregnancy and postpartum are critical phases with major physical, psychological, and relational changes. Sexuality, though central to well-being, is underexplored in clinical practice and clouded by social taboos. Literature mainly focuses on dysfunctions, overlooking the interplay of psychological and relational factors shaping women's sexual satisfaction. Little is known about why women may engage in sex to satisfy their partner. We investigated self-reported sexual health experiences during pregnancy and postpartum, focusing on psychological, relational, and physical factors. We explored factors associated with reporting intercourse for a partner's pleasure. A cross-sectional online survey was conducted in Italy (September 2024-March 2025). Women ≥ 18, pregnant or within six months postpartum, anonymously completed a questionnaire on six domains: sexual activity and desire, relationship dynamics, physical and psychological changes, fears and difficulties, the gynecologist's role, and puerperium. The primary outcome was having sex for the partner's pleasure. Multivariate logistic regression was used to explore the associations with the primary outcome. Among 629 respondents (246 pregnant, 383 postpartum), sexual behavior changed markedly across pregnancy and postpartum. During pregnancy, 56% of women in the first trimester and 50% in the third reported sex only to satisfy their partner, rising to 69% postpartum. Pain during intercourse was reported by 28% in the first/second trimester and 45% in the third, while fear of vaginal penetration increased from 60% to 75%. Postpartum, 47% reported difficulty in sexual intercourse within two months of delivery, rising to 63% within six months. Having sex for the partner's pleasure was associated to being postpartum (OR 1.9) and reporting decreased physical energy (OR 2.0). Among pregnant women, dyspareunia and fear of jeopardizing the relationship were significant predictors; after childbirth, resuming sex within two months was associated with the same outcome. Findings highlight a gap in perinatal care, where sexual health is often neglected. Integrating counseling into routine obstetric care, and addressing fatigue, pain, body image, and partner dynamics, could foster healthier and more autonomous sexual experiences. Proactive counseling and greater clinical attention to fatigue, pain, and relational dynamics are needed to promote women's sexual well-being perinatally.
Street-based sex work raises women's risks regarding sexual health, particularly concerning STIs, due to factors such as violence, limited condom negotiation power, and inadequate access to health services. Evidence on STIs among female sex workers in Southwest Ethiopia is notably scarce, despite the public health implications. To assess the prevalence of laboratory-confirmed sexually transmitted infections and associated factors among street-based female sex workers in Southwest Ethiopia. A facility-based cross-sectional study was conducted among 203 street-based female sex workers attending key population clinics in Jimma and Agaro key population clinic towns. Data were collected using structured face-to-face interviews, and biological samples were analyzed for HIV, gonorrhea, chlamydia, and syphilis using standard serological and nucleic acid amplification tests in accordance with national STI testing algorithms at three key population clinics from March to December 2025. To avoid duplicate enrollment during the prolonged study period, unique identification codes and clinic records were used to ensure that each participant was included only once. Data were analyzed using SPSS version 26, and variables with P ≤ 0.25 in the bivariable analysis were entered into the multivariable logistic regression model. Overall, 38.9% (95% CI: 32.2-45.8) of participants had at least one laboratory-confirmed STI. The prevalence of HIV, syphilis, gonorrhea, and chlamydia was 10.3%, 11.0%, 8.4%, and 8.9%, respectively. More than half (54%) reported initiating sex work before age 18. Early initiation of sex work was independently associated with laboratory-confirmed STIs (AOR = 3.16, 95% CI, 2.02-7.22). Other significant predictors included illiteracy (AOR = 2.34, 95% CI: 1.22-6.35), rural origin (AOR = 2.90, 95% CI: 1.57-5.81), having more than two clients per day (AOR = 2.55, 95% CI: 1.32-4.95), inconsistent condom use (AOR = 3.03, 95% CI: 2.14-5.93), and experience of sexual violence (AOR = 2.77, 95% CI: 1.48-5.20). The prevalence of laboratory-confirmed STIs was high among street-based female sex workers in southwest Ethiopia. Early initiation of sex work, low educational status, rural origin, high client numbers, inconsistent condom use, sexual violence, and limited access to services were independently associated with increased STI risk. These findings highlight the need for integrated, targeted interventions focusing on prevention, improved service access, and structural vulnerabilities.
Insufficient physical activity (PA) and excessive sedentary behaviour is associated with several cancers. Personalised approaches to increasing healthy movement behaviours over unhealthy behaviours may be more effective than a one-size-fits-all approach. Exploring both postures, and intensities across the 24-hour day may reveal actionable behavioural alternatives from current guidance. Using a novel dual-compositional approach, we assessed how differences in participant's composition of 24-hour daily movement (postures and intensities) and sleep are differentially associated with PA-related cancer incidence (a composite of 13 sites linked with physical inactivity). This prospective analysis involved adults drawn from the UK Biobank accelerometry subsample each followed-up by health linkage. Participant's daily movement was classified into two 24-hour compositions. Composition 1 (posture-focused): sleep duration, sedentary behaviour (SB), standing, moving at any intensity. Composition 2 (intensity-focused): sleep duration, sedentary time (ST), light PA (LPA), moderate PA (MPA), and vigorous PA (VPA). Secondary analysis combined VPA and MPA as moderate-to-vigorous PA (MVPA). PA-related cancer diagnoses were captured from health registry data for up to 9.5 years (y). Cox-proportional hazards models were adjusted for age, sex, education, smoking, alcohol, diet, parental cancer history, cardiovascular disease and medication use. Analyses included 59,218 (55% female) participants (mean [SD] age: 61.7 [7.8]y), with a median follow-up of 8.0y [IQR: 7.4-8.5y; 464,640 person years] with 2,385 (4%) incident cancer events. Among the average, active participant, greater moving in place of other behaviours was associated with lower cancer risk, e.g. theoretically replacing 15 min of sleep or SB with 15 min of moving was associated with hazard ratios (HR) of 0.98 (95% Confidence Interval (95%CI): 0.97-0.99) and 0.98 (95%CI: 0.97-0.99), respectively. Similar risk reduction was observed with 30 min additional standing in place of sleep or SB. Regarding intensity, greater MVPA, in place of any behaviour proved most robustly associated with lower risk, although notably, the VPA component within MVPA proved the critical intensity. Beyond MVPA, moving at any intensity, in place of other postures, was associated with reduced risk of cancer. However, greater standing may also provide a plausible behavioural adjunct or alternative, warranting further investigation.
Osteoporosis is a major public health concern worldwide. Although female reproductive factors have been suggested to influence bone health, their associations with osteoporosis remain inconclusive. This study aimed to investigate the associations between reproductive characteristics and the odds of osteoporosis in Taiwanese women. We conducted a cross-sectional analysis using data from women randomly selected from the Taiwan Biobank. Bone mineral density (BMD) status was classified into three categories according to the World Health Organization (WHO) criteria: normal BMD (T-score > - 1.0), osteopenia (- 2.5 < T-score ≤ - 1.0), and osteoporosis (T-score ≤ - 2.5). Univariable and multivariable logistic regression analyses were performed to assess the association between reproductive factors and the odds of BMD status. Among the 4,854 participants, 3,107 (64.0%) were classified as having normal BMD, 1,374 (28.3%) as having osteopenia, and 373 (7.7%) as having osteoporosis. Univariate analysis showed that a history of pregnancy was associated with a higher odd of osteopenia (odds ratio [OR] = 1.946, 95% CI: 1.589-2.382, p < 0.001), osteoporosis (OR = 1.825, 95% CI: 1.288-2.586, p = 0.001), and low BMD level (T-score < -0.1) (OR = 1.919, 95% CI: 1.597-2.306, p < 0.001). After adjusting for known confounders, pregnancy history was associated with a lower odd of osteoporosis (adjusted OR = 0.644, 95% CI: 0.422-0.981, p = 0.041), but not significantly associated with the odds of osteopenia or low BMD level. Pregnancy history was independently associated with lower odds of osteoporosis among Taiwanese women after adjustment for known confounding factors. However, given the cross-sectional nature of this study, causal relationships cannot be established. Future longitudinal studies are warranted to validate this finding.
Despite rapid digitization in India, internet usage of rural women still remains lagged behind. The rural-urban divide in internet usage particularly among the women of reproductive age (15-49 years) though being a key concern to resolve, yet limited evidence exists on the factors driving this disparity. This study addresses the research gap by examining the magnitude of the rural-urban gap and identifying the underlying contributors to this gap. This study utilized information collected from 105,373 women aged 15 to 49 years, (Rural-79,012 and urban-26,361) from the fifth round of of National family Health survey (NFHS-5), conducted in India during 2019-2021. Initially, descriptive statistics, bivariate analysis and logistic regression were performed. To quantify the factors contributing to the rural-urban gap in internet usage among women, non-linear Fairlie decomposition analysis was applied. A substantial and persistent rural-urban gap in internet use was observed among the women of reproductive age. The largest share of the gap was explained by household wealth status (45.75%), followed by household ownership of a mobile phone (27.28%) and women's educational attainment (21.61%). Addressing rural-urban divide in internet use requires a holistic and intersectional approach. Policies must extend beyond improving connectivity to actively dismantling the social and economic barriers that inhibit women's digital participation irrespective of the place of residence.
Disparities in up-to-date cervical cancer screening rates persist among women, including those identifying as lesbian, gay, bisexual or other sexual orientation (LGB+), highlighting the need for more inclusive and targeted screening interventions. With human papillomavirus at-home self-testing recently approved, we studied cervical cancer screening preferences by sexual orientation among persons assigned female at birth. We examined cervical cancer screening preferences among a nationally representative sample of persons assigned female at birth aged 25-65 years in the 2024 Health Information National Trends Survey who did not self-report a history of cervical cancer. We assessed variation in preference for at-home self-testing or clinician-delivered cervical cancer screening by sexual orientation using weighted Rao-Scott chi-square tests and multivariate multinomial regression. We also examined reasons for preferring at-home self-testing. The analytical sample included 2,168 respondents. Most self-identified as heterosexual (88.43%) and preferred cervical cancer screening by clinicians (61.45%). Cervical cancer screening preferences differed by sexual orientation (p = 0.02). LGB+ versus heterosexual respondents more frequently preferred at-home self-testing (30.97% versus 19.53%), whereas heterosexual respondents more frequently preferred testing by clinician than their LGB+ counterparts (62.81% versus 50.38%). The odds of preferring at-home self-testing over clinician-delivered screening were higher among LGB+ versus heterosexual respondents (adjusted odds ratio = 2.04, 95% confidence interval = 1.17-3.53), after adjusting for age, household annual income, marital status, health care utilization, race/ethnicity, and health insurance. The most frequently endorsed reason for preferring at-home self-testing was privacy (66.25%). Preferring at-home self-testing due to not taking time off work (35.22%), saving transportation cost (34.24%), and avoiding embarrassment (39.41%) were endorsed less frequently. Reasons for preferring at-home self-testing did not differ by sexual orientation. LGB+ respondents more frequently preferred at-home self-testing compared to heterosexual respondents. These findings highlight the potential utility of at-home self-testing in addressing screening preferences and barriers among LGB+ persons.