Insights from focus groups with trans and gender-diverse people with endometriosis: stories you tell, stories you don't
Endometriosis is a chronic condition characterised by cyclic pain symptoms that often significantly affect health-related quality of life. Predominantly framed as a "woman's condition", current research overlooks the experiences of transgender and gender-diverse (TGD) individuals with endometriosis. This jeopardises the right to health for a community that faces historically rooted social and health disparities. This study aims to explore the embodied relationship between gender and endometriosis symptoms among TGD people living with endometriosis. A secondary objective is to examine the accessibility and competence of healthcare systems in addressing the needs of this community. The methodology included two focus group discussions conducted across four focus groups (4 × 2). Fourteen participants representing diverse gender identities, various stages of endometriosis and ages, were recruited online from nine countries across three continents, forming a heterogeneous group. Reflexive thematic analysis identified 15 codes and 7 clusters. The results were organised into themes, following the four embodiment epidemiological notions. Participants reported their gender self-perception and endometriosis symptoms to be interrelated and mutually influential. Feelings of disconnection and alienation were prevalent, particularly during life events such as menarche. Due to mistrust and experiences of discrimination, many TGD individuals withhold critical information during medical consultations. TGD people with endometriosis have unique health needs, e.g. how to combine gender-affirming and endometriosis care, and they are often concerned about future employability. Overall, the study underscores the urgent need to improve healthcare for TGD individuals with endometriosis as a matter of health justice.
Embracing complexity to challenge stigma: a qualitative analysis of representations of abortion in a Polish storytelling initiative
Testimonies of abortion experiences are largely silenced in many contexts around the world, including Poland, and stigma affects how abortion is represented. Pro-choice initiatives, which support abortion rights, aim to challenge stigma through the sharing of personal abortion experiences (i.e. abortion storytelling). However, these initiatives may simultaneously construct normative hierarchies of abortion and stigmatise abortion stories which do not fit context-specific, politicised norms. This study draws on data purposefully sampled from a pro-choice abortion storytelling initiative in Poland, conducted between 2020 and 2021, and organised by the Abortion Dream Team (ADT; Aborcyjny Dream Team), an influential Polish organisation campaigning for abortion access and rights. By conducting a qualitative document analysis of 73 first-person abortion stories shared in this initiative, I explored how abortion was represented, and whether, and how, these representations challenged abortion stigma and its manifestation in normative hierarchies of abortion. Using reflexive thematic analysis, I identified four main themes. My findings show that abortion is represented as a valid decision, both a positive and challenging experience, and an embodied process. The stories shared in the ADT storytelling initiative challenge stigma and deconstruct normative hierarchies of abortion by representing abortion as a complex experience imbued with multiple, and often contradictory, meanings. This study highlights the existence of positive and non-stigmatising representations of abortion in Poland and shows that abortion storytelling can challenge dominant narratives around abortion. These findings therefore have broader significance, as they suggest that abortion storytelling may serve as an effective tool to destigmatise abortion and advance abortion rights. DOI:10.1080/26410397.2025.2535835.
Constructing criminality: a thematic analysis of national news media reporting on self-managed abortion criminalisation in the United States
Self-managed abortion (SMA) is prevalent in the United States (US) and has become increasingly common since the 2022 Supreme Court ruling in that allowed states to enact early abortion bans. Although SMA is legal in nearly every US state, the number of people who have been arrested for alleged participation in SMA has continued to grow in recent years. Reproductive justice advocates have identified news media portrayals of these cases as a likely contributor to adverse legal outcomes for criminalised individuals; however, researchers have not yet investigated this. Therefore, we aimed to qualitatively assess the ways in which national news media outlets depict instances of SMA criminalisation. We identified 41 articles published by the top five national newspapers between 2000 and 2023 and conducted a reflexive thematic analysis. Our analysis revealed concerning patterns in news media coverage, in which journalists frequently personified the fetus as a victim while vilifying the criminalised person, undermined the character of the criminalised person through selected personal histories, and promoted the presumption of guilt by treating biased police statements as objective accounts. These findings contribute to the literature by describing the ways in which reproductive injustice is legitimised through news media and provide empirical support for reproductive justice advocates' calls for more responsible journalism in news media coverage of SMA criminalisation.
Facilitators and barriers of maternal and infant healthcare access for undocumented migrants in the first 1000 days of life: a systematic review of the literature
Adequate access to maternal and infant healthcare in the first 1000 days of life is concurrent with lifelong well-being and should be guaranteed regardless of nationality, legal status, and social conditions. By exploring how migration status affects the social determinants of health, this review provides a nuanced understanding of the barriers and facilitators encountered accessing healthcare by undocumented women and their infants in the first 1000 days of life. Following the PRISMA guidelines and the registered protocol (CRD42022328220), a literature search was conducted in PubMed, Embase, CINAHL, PsycInfo, and Scopus. The search focused on manuscripts including undocumented migrants as study participants and reported direct or indirect data on the utilisation or outcomes of maternal and infant healthcare within the defined first 1000 days of life. Fifty-two studies met the inclusion criteria. A narrative synthesis was performed to summarise the information obtained from the data extraction process. Identified barriers include legal barriers (e.g. criminalisation of migrants or complexity of administrative procedures) and socio-cultural barriers (e.g. inadequate health literacy and financial challenges). Facilitators encompassed legal facilitators, like dedicated healthcare clinics, and socio-cultural facilitators, such as language support and healthier lifestyle habits. Ethical issues in connection to healthcare access of undocumented migrants in the first 1000 days were also mapped from the included papers. Considering the health consequences on future generations, the economic implications, and the vulnerability of migrant women, the findings offer positive examples that could be put into place to move towards universal health coverage through a holistic approach that shifts from exclusion and criminalisation to support and compassion. .
Experiences of South African youth living with HIV who became parents during COVID-19 lockdowns
The COVID-19 pandemic negatively affected sexual and reproductive health and rights (SRHR) and increased unwanted pregnancies among young people, yet scant evidence documents SRH service-access trajectories and experiences of young people living with HIV during this time. We conducted a remote study, comprised of qualitative Facebook and telephonic data collection with adolescents living with HIV and young parents in South Africa (n = 41, ages 16-29) in 2020/2021. Following this, we conducted in-depth research through calls, WhatsApp and Facebook to explore narratives of two young people living with perinatally-acquired HIV who accessed SRH services and became parents during COVID-19 lockdowns. We engage a narrative approach to illustrate the trajectories of these two young people - documenting their biopsychosocial lives and experiences accessing SRH services - with attention to personal, structural and relational factors. Findings illustrate their agency while detailing gaps in provisions that significantly affected their health and well-being. This study applies practice theory, exploring how gendered, relational, social and geographic factors shaped young people's experiences and SRH. Despite being well-acquainted with the biomedical technologies and relationships governing their care, they struggled to navigate an altered health landscape. Findings document how they were subject to narratives of individual responsibility for their SRH amidst system-level shortcomings. Results highlight significant gaps in service provision and an imperative to enhance the material conditions for young parents living with HIV in South Africa. They underscore the need for resilient, shock-responsive health and social protection systems to maintain continuous SRH services for adolescents living with HIV during crises.
Determinants of short interpregnancy intervals in high-income countries: a systematic review
Short interpregnancy intervals (IPIs) of <6-18 months are associated with adverse maternal and child outcomes. This study aimed to identify the individual, relationship, community, and societal factors that influence short IPIs in high-income countries. A comprehensive search was undertaken in CINAHL Plus, Ovid/EMBASE, Ovid/MEDLINE, Ovid/PsycINFO, ProQuest, PubMed, Scopus, Web of Science, and Google Scholar for articles published in English from 1st January 1990 to 26th October 2023. Studies were included if they reported an effect estimate of at least one determinant of pregnancy spacing in a high-income country. The quality of the included studies was assessed using the Johanna Briggs Institute Critical Appraisal Tool and Cochrane Risk Assessment Tool. Multi-level factors at the individual, relationship, community, and societal level were systematically identified through the socio-ecological model. This study is registered with PROSPERO (CRD42020176311). Of 2005 unique articles, 220 were identified for full-text review, and 55 met the inclusion criteria representing a total of 27,103,055 women from 13 high-income countries. All the included studies were deemed to be of moderate to high quality. Most of the studies reported determinants of short IPI at the individual level, with non-use of contraception the most common reported factor. Peer influence was a factor at the relationship level, and access to health care and reproductive services were impactful at the community and societal levels, respectively. Future research and efforts should support the development and implementation of policies and practices that support optimum pregnancy spacing from a comprehensive socio-ecological position.
Midwives as agents of change: a qualitative analysis of midwives' experiences with abortion care provision in Canada
Midwives possess the skills and competencies required to provide abortion care in Canada, yet their role is constrained in health systems. They are well suited to address barriers to abortion access related to geographical and social inequities, which deprive many Canadians of essential healthcare and impede reproductive justice. To address current gaps, this study explores midwives' experiences providing abortion care in Canada. Qualitative data were collected from 25 in-depth interviews and three focus group discussions with midwives between August and December 2023. Using reflexive thematic analysis, we explored how midwives work in communities to provide or work toward providing abortion care, including health system facilitators, barriers, and their values, needs, and preferences for implementation. Findings highlight the barriers midwives face, including regulatory restrictions and a lack of flexible funding arrangements. Despite these challenges, midwives are leveraging their skills to advance reproductive justice, offering culturally safe, client-centred abortion care to underserved populations, including uninsured individuals. The study also identifies facilitators, such as applying midwifery values and philosophies to provide the midwifery model of abortion care. This research contributes to the growing body of knowledge on midwifery and abortion care, advocating for the removal of regulatory and funding barriers that limit midwives' potential to provide comprehensive sexual and reproductive healthcare. The findings have significant implications for policymakers and health system leaders in Canada and beyond, calling for the optimisation of midwives' roles to improve access to abortion care and advance reproductive rights globally.
Few rights, great threats, endless struggles: setbacks and resistance in the last decade of fights for legal abortion in Brazil
This commentary analyses the state of legal abortion in Brazil over the past decade, contextualising the increasing restrictions and political disputes surrounding the issue within broader anti-gender offensives. While Brazilian law permits abortion only in limited cases - rape, risk to the pregnant person's life, and anencephaly - access to these rights has been consistently undermined, particularly amid the strengthening of far-right political forces. We explore how moral arguments and conservative discourses - often framed through the notion of "gender ideology" - have been mobilised to roll back sexual and reproductive rights, resulting in significant institutional and legislative setbacks, including attempts to criminalise legal abortion practices. In contrast, the commentary highlights forms of resistance led by feminist movements, progressive lawmakers, and the judiciary, such as mass protests, strategic litigation, and efforts to socially decriminalise abortion. Furthermore, it addresses the role of strategic ignorance in perpetuating state inaction and the importance of academic research in illuminating these dynamics and resisting the erosion of rights. The struggle for reproductive justice in Brazil is ongoing, marked by both persistent threats and collective resistance.
Shaping the WHO Sexual Health Assessment of Practices and Experiences questionnaire: a descriptive study on the real-world example from Portugal
Sexual health is a major dimension of global health and well-being. Yet, evidence regarding its assessment at a worldwide level is scarce. Most population-based studies are conducted in a limited number of countries from the Global North using specific measures that do not allow for country comparison. The World Health Organization (WHO) led a process to create a global survey called the Sexual Health Assessment of Practices and Experiences (SHAPE) to assess sexual practices and behaviours that impact on health. This article aims to describe the application and feasibility of this questionnaire in an extended real-world context. It presents the results of the implementation process in Portugal, the first country to use it with a nationally representative sample. This descriptive study was conducted between 14th June and 15th October 2023, involving a sample of 2,010 individuals (52% women) living in Portugal, aged 18-95 (mean = 49.6 years). 1,426 participants responded online and 584 by telephone. Overall response rate was 30.9% (79.5% online, 12.4% by telephone) and 94% of responses were valid. The original SHAPE questionnaire took 17.7 min to answer on average (16.6 min online and 20.3 min by telephone). Including module G (assessing sexual problems), average time was 29.2 minutes. The relatively short response time and choice of formats suggest this tool provides a comprehensive picture of sexual health. It is hoped that it will be widely used in different health and research contexts, to enhance the global evidence base for the development of policies that promote sexual health.This article aims to describe the application and feasibility of this questionnaire in an extended real-world context.
Effects of the decision on abortion and related service provision among sexual and reproductive health clinics in the United States: results from a qualitative study
Since the release of the Supreme Court decision in June 2022, researchers have been working to better understand the impact that the growing number of abortion restrictions is having on the provision of and access to abortion services in the United States (US). Less is known about the impact of abortion restrictions on the provision of sexual and reproductive health (SRH) services more broadly, including at clinics that do not directly offer abortion. Between November 2023 and February 2024, we conducted interviews with SRH managers, clinic managers, and other administrators at publicly funded SRH clinics around the US to generate evidence on the effects of state-level abortion restrictions on the provision of abortion and related services, such as pregnancy options counselling and abortion referrals, at facilities providing contraceptive services. Through content analysis, we found that, while clinics in states with abortion restrictions have stopped providing abortions or are struggling to provide abortions amidst the variety of restrictive policies, clinics in states without these restrictions are also facing difficulties, specifically having to adjust their care provision due to the increase in patients seeking abortion. Simultaneously, the complicated web of abortion regulations has led providers in all states to experience challenges related to combating misinformation and protecting reproductive autonomy. These findings demonstrate the ways in which the ripple effects of extend well beyond abortion and affect the wider network of publicly funded SRH care.
Unmet needs and new challenges in young women's sexual and reproductive health and rights: a qualitative study in Chile's Metropolitan Region
In Chile, despite important advances in access to contraception and a steady reduction in unplanned pregnancy, longstanding barriers for young people to access sexual and reproductive health (SRH) and rights - rooted in a conservative and religious background - have been highlighted by recent socio-political movements, including the feminist student wave of 2018 and the social uprising of 2019. The COVID-19 pandemic further strained access, leading to the suspension of many in-person services. In this context, we conducted a qualitative study between 2020 and 2023 to explore young women's perceptions of sexuality and SRH, their interactions with the formal healthcare system, and the diverse resources they engage with to access support and care. 23 in-depth interviews were carried out with heterosexual and non-heterosexual women aged 18-25 in Chile's Metropolitan Region. The findings reveal a mismatch between young women's holistic understanding of sexuality - which includes emotional, biological, and political dimensions - and the healthcare system's reductionist, heteronormative, and risk-based approach, which became more visible after these societal upheavals. As a result, young women may use biomedical SRH services strategically for prescriptions and testing, while seeking more comprehensive support outside the formal system through virtual platforms, health professionals giving online support, and civil society organisations. The study concludes that systemic changes in the health system are needed to bridge these divides and uphold the sexual and reproductive rights of young women in Chile, especially those who identify as non-heterosexual. .
Self-care strategies that support PrEP adherence: a qualitative study with female sex workers in rural Uganda
The World Health Organization (WHO) recently released revised guidelines on self-care interventions for health and well-being, which, in 2022, included recommendations supporting equitable access to information about and availability of pre-exposure prophylaxis (PrEP) as a self-care strategy. Successful implementation of PrEP as an HIV prevention strategy extends beyond providing access to medication. It hinges on individuals adopting self-care strategies to ensure adherence to PrEP in their daily lives. This paper aims to explore self-care strategies that bolster adherence to oral PrEP among female sex workers in two rural Ugandan settings. Through in-depth interviews with 20 female sex workers residing in fishing communities or Trans-Africa highway towns, we used deductive thematic analysis to explore people-centred and health system-centred perspectives on women's PrEP-related self-care strategies. A people-centred perspective on self-care illustrated a range of self-care strategies to support PrEP adherence conducted by women individually (medication reminders; pairing PrEP with daily habits), and with support from others in familial and social networks (verbal reminders to take tablets; information sharing; shared clinic visits; shared pill-taking routines). A health system-centred perspective illustrated the importance of support from health services and professionals. Examples included information provision; NGO clinics as friendly, safe, non-judgemental spaces; PrEP distribution through home-based care outreach strategies; in-bulk PrEP provision for work-related travel periods; formal integration of female sex workers into the system as peer health workers. By considering both person-centred and health system-centred perspectives on self-care, we can pinpoint strategies for health systems to assist female sex workers and their communities in preventing the acquisition and transmission of HIV.
A qualitative study on healthcare providers' biases towards transgender and gender diverse people accessing contraceptive care
Bias in sexual and reproductive health care (SRH) undermines the quality and delivery of essential services. For transgender and gender diverse (TGD) patients, barriers to care may be acute when seeking gendered services, such as contraception. Few studies have assessed providers' perceptions of TGD patients in SRH. Our objective was to examine bias in contraceptive providers' attitudes towards and experiences with TGD patients. We conducted in-depth interviews, from August 2022 to August 2024, with 41 healthcare providers located throughout the US and attending CME-accredited trainings on contraceptive counselling. We utilised deductive thematic analysis to identify the domains of implicit and explicit bias specific to TGD patients. Many providers struggled to understand gender diversity and had difficulty using gender-inclusive frameworks in care delivery. Explicit biases were exemplified in the pervasiveness of gender binarism within the healthcare system and providers' lack of experience with TGD patients. Providers demonstrated implicit biases through their deficits in knowledge regarding TGD patients' medical needs and culturally insensitive approaches. They offered suggestions to mitigate bias, including institutional changes to make clinics more trans-inclusive and affirming. Biases and disparities specific to TGD patients are perpetuated through a lack of awareness and stigmatisation in healthcare settings. Our findings highlight areas to improve awareness of bias, dispel confusion with evidence on gender-inclusive care, and integrate structural changes within clinics to reduce the burdensome impacts of bias on TGD patients. Advocacy at both the provider and institutional levels is needed to offer quality contraceptive care for TGD patients.
Hegemonic medicine and self-managed abortion: reclaiming Latin American feminists' contributions to knowledge and practice development
In this commentary, we challenge the narrative that presents self-managed medication abortion (SMA) as a recent "discovery" of Western biomedicine. Drawing on our lived experience and a literature review, we compare how different key concepts - autonomy, empowerment, person-centred care, privacy, confidentiality, and demedicalisation - are understood by the feminist SMA movement in Latin America, versus hegemonic medicine. We argue that when the radical ideas of the feminist SMA movement are appropriated by mainstream health systems without proper recognition of their political foundations, they lose their original meaning and may fail to achieve the positive outcomes envisioned by activists. For instance, autonomy, privacy, and demedicalisation may result in individuals feeling unsupported, while person-centred care often means merely being treated without stigma or violence. Maintaining medical control over SMA restricts access, while neoliberal policies that promote "self-care" and the commodification of abortion pills enable states to evade responsibility with regard to abortion care. We advocate for integrating key concepts taken from SMA activism into formal health systems, while honouring their origins and political significance. This requires meaningful, horizontal collaborations between SMA activists and biomedical professionals, acknowledging that SMA activists are abortion experts and should be treated as such.
Between contraception and hormones: a qualitative analysis of the lived experiences of former contraceptive pill users
Contraceptive decision-making is an ongoing process that affects reproductive life and involves method uptake, use, and discontinuation. Contraceptive pills have been widely studied for their side effects, lived experiences, and links to biomedicalisation. However, there is a lack of research that integrates the entire subjective contraceptive pill experience from implementation to the period after discontinuation. This study explores the lived experience of pill use in Germany through 19 oral contraceptive pill biographies using thematic analysis, a deductive-inductive, iterative coding approach, and team-based discussions. This work is grounded in the theoretical framework of the contraceptive journey and feminist inquiry. Our analysis illustrated the complexity of pill use, with frequent switching, stopping, and restarting influenced by biopsychological issues, normalisation of use, and adverse effects. Attitudes towards hormones and pregnancy risk evolve over time and age. Former users consider their contraceptive journey to be successful in preventing pregnancy, but desire more male contraceptive options and improved information and counselling services. These findings emphasise the importance of prioritising former users' informal knowledge and lived experiences in future research, policy, and practice. This approach can support healthcare providers in incorporating individual and diverse health needs, aligning with the principles of reproductive justice.
The sex effect: the prevalence of sex life reasons for contraceptive discontinuation. A systematic review and meta-analysis
The ability to have sex without having an unintended pregnancy is a key motivator for contraceptive use, yet factors related to patients' sexual lives are critically understudied in contraceptive decision-making. We report the first systematic review and meta-analysis examining the extent to which a contraceptive method's effect on a satisfying sexual life results in contraception discontinuation or switching. We searched for relevant qualitative and quantitative literature published during 2004-2023 in 9 databases and included 64 studies, comprising a total of 125,586 participants and corresponding to at least 52,705 discontinuers in need, aged 12-54 and surveyed in clinical or public health settings in diverse global contexts. Our main outcome measures were discontinuation or switching of modern contraceptive methods (excluding condoms) while in need. A meta-analysis of 25 studies indicated that sex life concerns as a reason for contraceptive discontinuation have an overall prevalence of 5% (95% CI: 0.03, 0.08; = 94%, = 1.31; = 381, < 0.001). Sub-group meta-analyses and follow-up meta-regressions do not support any differences based on the hormonal content of the contraceptive method, the specific contraceptive method type, or the specific type of sex life reasons. Sex life reasons are important, common reasons for contraceptive discontinuation. Their prevalence is comparable to other reasons for discontinuation, such as cost or access. Future research should investigate impacts of contraceptive methods on sex life more directly and clinicians should include counselling on a method's sexual acceptability as part of the wider conversation on common contraceptive side effects.
How hatred of abortion providers is propagated in social media: an investigation of YouTube videos
Since abortion was legalised in 1973, the United States anti-abortion movement has sought to eliminate abortion services. One strategy has been to foment hatred of abortion providers, which legitimises anti-abortion activists' attacks on providers and facilities, thereby dissuading pregnant people from seeking abortions and hindering providers' willingness to offer services. After the 2022 decision overturning , these attacks escalated. The goal of our study was to examine a social media platform, YouTube, to identify the categories of videos promulgated by the anti-abortion movement and to investigate how these videos might be propagating hatred of providers. We also sought to discern differences post-. Using three search terms - "pro-life," "abortionist" and "abortion providers" - we developed a sample of 291 YouTube videos with high viewership, of which 217 had content about providers or patients. Videos took numerous forms, including debates, testimonials and undercover investigations. We identified four major dimensions of abortion provider depictions, in order of frequency: manipulative (deceptive, greedy and biased), villainous (brutal murderers), uncaring (callously harming women) and immoral. Abortion facilities were characterised as "death camps" and abortions as "baby funerals." Patients were reviled if they "celebrated" their abortions, but not if they were remorseful. Videos post- seemed more geared to reducing demand by emphasising patient regret and provider harms. We concluded that despite YouTube content moderation, abortion providers were being maligned in videos, which potentially contributes to clinic attacks. To increase support for abortion providers, content creators may want to specifically extol providers' contributions to public well-being.
Beyond reproductive rights: implementing the Africentric reproductive justice framework in sexual and reproductive health and rights litigations in Africa
This paper analyses emerging trends in judicial approaches to sexual and reproductive health and rights (SRHR) in Africa, arguing for a paradigm shift from the conventional rights-based framework that emphasises "choice" to an Africentric Reproductive Justice framework (ARJ). It employs a qualitative research design, combining a literature review with an in-depth analysis of eight purposively selected SRHR court cases from African countries and the United States to examine how recent judicial decisions reflect a growing integration of reproductive rights with broader social justice issues. The proposed ARJ framework is grounded in the reproductive justice theory, incorporating conceptual principles of decoloniality and Africentrism, which emphasises amplifying positive African narratives, leveraging African-based judicial institutions, involving civil society organisations, and empowering African individuals to engage with judicial systems for reproductive justice. This approach addresses intersectionality, race, class, gender, and socioeconomic status in SRHR issues in Africa. The findings demonstrate that African courts are increasingly balancing competing rights and interests in culturally sensitive ways, reflecting an evolving understanding of reproductive justice in African contexts. This paper concludes by arguing that achieving genuine reproductive justice necessitates moving beyond the "right to choice". It requires deconstructing enduring structural barriers and addressing historical injustices perpetuated by colonial legacies, and the ARJ framework, rooted in decolonial principles, presents a holistic, context-specific approach towards achieving equitable SRHR for all individuals on the continent.
From conception to care: a systematic review of the impact of the climate crisis on reproductive justice
The climate crisis poses major challenges to reproductive justice. Climate-related events and natural disasters are severely impacting sexual and reproductive rights as well as the ability of individuals to become parents and care for their children. Through a systematic review conducted using the PRISMA method, this article addresses the impact of the climate crisis on the three core principles of reproductive justice: (1) the right not to have a child; (2) the right to have a child; and (3) the right to parent children in safe and healthy environments. While the review found no empirical studies addressing how the climate crisis impacts the right not to have children, the findings suggest that hurricanes, floods, heatwaves, droughts, and coastal erosion are associated with greater intentions of remaining childless and having fewer children, increasing fetal mortality and preterm births, decreasing newborn sex ratios and birth weight, rising birth risks, declining birth rates, and increasing challenges to parenting and childcare. We argue that the climate crisis fundamentally undermines reproductive justice by preventing individuals from fully and equitably exercising their reproductive rights to have children and to parent in safe and sustainable environments. In doing so, we stress that the climate crisis should be considered when addressing the challenges of reproductive justice and that addressing these challenges requires implementing policies that not only seek to mitigate the effects of climate disruptions, but also strengthen the capacity of individuals and communities to adapt to changing environmental conditions, ensuring more sustainable reproductive futures.
Strategies to address reproductive coercion and intimate partner violence in Nairobi family planning services: qualitative client and provider perspectives
Reproductive coercion (RC) and intimate partner violence (IPV) threaten women's health and reproductive agency globally. The Addressing Reproductive Coercion in Health Settings (ARCHES) intervention integrates screening for RC and IPV, covert contraceptive options, IPV referrals, and an educational booklet into family planning (FP) services. This study examines client and provider perspectives on ARCHES in Nairobi, Kenya. A qualitative study was conducted in the three private clinics implementing ARCHES. Data were collected through 35 in-depth client interviews and 12 provider interviews three months post-intervention. Participants were purposively sampled based on age and RC/IPV experience. Thematic content analysis was used. Clients reported greater reproductive autonomy through increased knowledge of covert contraception, IPV services, and reproductive rights. Providers reported gaining confidence to address RC and IPV and building stronger relationships with clients. Barriers included stigma around IPV referrals and limited counseling time. Screening for RC/IPV was widely accepted, with some clients recognising abuse for the first time. The compact educational booklet improved knowledge retention and community outreach. Perspectives on male partner engagement were mixed due to concerns about safety and confidentiality. ARCHES was well-received by clients and providers, enhancing FP care and addressing critical gaps in RC and IPV support. Future adaptations should address barriers to IPV referral uptake and provider first-line IPV support, and carefully track implementation to ensure continued client-centered counseling. These findings support ARCHES as a scalable model for integrating FP and violence prevention interventions in Kenya and similar contexts.The parent study for this trial was prospectively registered on ClinicalTrials.gov [NCT03534401] on May, 21, 2018.
Digital justice and rights: bridging the fault lines in digital technology and SRHR
