International Centre for Reproductive Health

The increasing complexity of sexual and reproductive health research is strengthened by interdisciplinary collaboration. While technical proficiency receives significant attention in research capacity-strengthening, the development of core collaborative skills, such as communication, teamwork, conflict resolution, and leadership, remains underemphasized. The Center for International Reproductive Health Training at the University of Michigan (CIRHT-UM) integrated collaborative skills training into a comprehensive research-capacity strengthening program for health professionals in Zambia, combining technical research instruction with explicit interpersonal skill development. This study explored CIRHT-UM participants’ experiences, perceptions, and outcomes related to collaborative research skills developed during a health research capacity strengthening program in Zambia. Data were collected in June 2025, following completion of the training and seed grant activities, to explore participants’ experiences, perceptions, and outcomes related to collaborative skill development during the program, using a qualitative phenomenological approach, through nine in-depth interviews and three focus group discussions with 28 Zambian professionals, including lecturers, nurses, midwives, physicians, and public health practitioners, who received CIRHT-UM seed grants. Thematic analysis, informed by Bronfenbrenner’s Ecological Systems Theory and Gearing Up frameworks, enabled exploration of ecological influences and readiness factors in collaborative skill development to capture barriers, enablers, application, and impacts of training. Thematic analysis generated four key themes: (1) expansion of professional networks and interdisciplinary exposure; (2) barriers created by hierarchies, siloed work, and inequities; (3) growth in communication, leadership, and problem-solving skills; and (4) influence of environmental constraints and systemic supports on collaboration. Participants reported increased confidence and teamwork abilities, but highlighted ongoing challenges from heavy workloads and limited institutional support. Focus groups emphasized organizational barriers, while interviews provided deeper insights into personal growth and readiness for collaboration. Embedding collaborative skill development within a research training program in Zambia enhances both personal growth and research quality. Egalitarian team environments, structured mentorship, and peer learning were identified as critical facilitators, while entrenched hierarchies and lack of protected time remained significant barriers in Zambian academic and clinical environments. Purposefully designed, inclusive, and well-supported collaboration initiatives improve team effectiveness and professional satisfaction. Sustained institutional policies, research training, and adaptive team structures are essential for lasting interdisciplinary engagement. While these strategies may be relevant to other low-resource or sub-Saharan African contexts facing similar barriers, their impact is closely tied to specific local conditions and institutional structures. Future adaptation should be tailored to each country’s unique setting, workforce, and policy landscape for research training programs that intentionally cultivate collaboration to drive innovation and improve health outcomes.

Abstract Background Cervical cancer screening (CCS) programs are crucial for the early detection and timely treatment of cervical cancer (CC), thus reducing disease mortality and morbidity. However, Europe is still experiencing disparities in screening coverage, particularly among the most vulnerable and underserved populations, who generally face difficulties in accessing healthcare services. In Portugal, several women remain at heightened risk of CC due to lower screening participation. This study aimed to assess the willingness of socially vulnerable women to participate in CCS and determine the associated factors. Methods: A community-based cross-sectional study was conducted in the Lisbon Metropolitan Area. Participants aged 30–65 years were identified through organizations serving vulnerable populations. Data were collected via a self-administered questionnaire covering sociodemographic characteristics, awareness and knowledge of CC, history of screening and willingness to participate in the CCS. Poisson regression with robust variance was used to assess factors associated with screening willingness. Results: A total of 246 women were included in the study. Of these, 218 (90.1%) reported being willing to be screened, but 35.8% (n = 88) had never received CCS. A lower age at first sexual intercourse (aPR = 1.076, 95% CI = [1.017; 1.138]), greater number of pregnancies (aPR = 1.048, 95% CI = [1.009; 1.089]) and perception that the CCS is advantageous (aPR = 1.303, 95% CI = [1.126; 1.508]) were factors significantly associated with willingness to undergo a Pap smear test. Conclusions: These findings suggest that the willingness for cervical cancer screening among socially vulnerable and underserved women may be linked to factors such as earlier sexual debut and a greater number of pregnancies, which might reflect increased contact with healthcare services. This highlights the need for alternative strategies to improve healthcare access and utilization, as well as targeted outreach efforts to raise awareness about cervical cancer and screening in this population.

ABSTRACT Background Community-based differentiated service delivery (DSD) models are critical for sustaining high-quality HIV care in resource-limited settings. However, these models often rely on labor-intensive documentation processes that reduce efficiency. The Community-based ART Retention and Suppression (CARES) app, a tablet-based electronic medical record system designed through a human-centered design process, was developed to extend Malawi’s national electronic medical record system into community settings used by Lighthouse Trust’s nurse-led community ART program (NCAP). This study evaluated the cost–benefit of implementing CARES within NCAP. Methods A cost–benefit analysis was conducted from the payer perspective, using data from a time–motion study of NCAP nurses and staff observed before and after CARES implementation. Observations were collected over 28 days between 2022 and 2024. Costs included one-time development, equipment, and training expenses, and annual maintenance costs. Benefits included annual time savings for healthcare workers and reduced documentation errors. All costs were converted to USD, discounted at 5%, and modeled over a 10-year horizon. Outcomes included present value (PV), net present value (NPV), benefit–cost ratio (BCR), and break-even benefit. Results CARES reduced total time spent on observed NCAP tasks from 8 hours and 9 minutes pre-implementation to 4 hours and 23 minutes post-implementation. Annual benefits totaled $7,108, primarily from nurse time savings. The 10-year present value (PV) of benefits was $54,883, compared with PV costs of $46,499, yielding a net present value of $8,384 and a benefit–cost ratio of 1.18. CARES exceeded the annual benefit required for cost-neutrality by approximately $1,086, indicating a positive economic return under routine implementation. Conclusion CARES substantially reduced the time required for healthcare worker documentation within a routine community-based DSD model and surpassed cost-neutrality, generating a net economic benefit over 10 years. These efficiency gains create additional capacity for patient care and reinforce the platform’s operational sustainability. CARES provides a practical foundation for additional, future AI-enabled enhancements. Continued evaluation is needed to quantify clinical and system-wide benefits beyond time savings.

The manuscript outlines the establishment of a remote consultation service for clinicians in Mozambique, highlighting best practices and lessons learned. It discusses the transition to full management by the Ministry of Health and the challenges of sustaining the service post-transition within the MoH Telehealth Program. The program evaluation results focus on the national telephone consultation service for HIV/AIDS care and treatment, which, between 2013 and 2019, received calls from a wide range of health facilities and cadres, including nonmedical prescribers, doctors, clinical assistants, and nurses. A 2017 clinician satisfaction survey indicated high satisfaction rates. Key implementation lessons emphasized the necessity of staffing the consultation line with highly trained clinicians, leveraging training to enhance service awareness and trust, supporting the public health system, maintaining operational flexibility, and strengthening pre-service clinical training.

The Architectonicidae of the Miocene of the Central Paratethys Sea comprise 18 species placed in eight genera. The coeval Mathildidae are documented by nine species, placed into three genera. We present descriptions of these species and illustrate type material wherever possible. Several species suggest relationships with Late Miocene to Holocene species of the Mediterranean Sea, although none of the species is known from modern faunas. Both families attained their maximum diversity during the early Middle Miocene (Langhian), and both families experienced a dramatic loss in species richness at the Langhian/Serravallian boundary. This Architectonicidae/Mathildidae turnover evidently coincided with the Miocene Climatic Transition, suggesting climate as the driving force. As members of both families feed on coelenterates, we assume that the climatic cooling of that phase caused a retreat of cnidarians, which is reflected in a decline in their predators. Ammotectonica nov. gen., Simplexollata nov. gen. and Pseudotuba nov. gen. are introduced as new genera. Ammotectonica gregorovae nov. sp., Simplexollata anticollata nov. sp., Nipteraxis deformatus nov. sp., Solatisonax? transversa nov. sp., Heliacus globosus nov. sp., Solatisonax tavianii nov. sp., and Pseudotorinia grasemanni nov. sp. are described as new species. Solarium (Torinia) criticum Boettger, 1907 and Discohelix quinquangularis Boettger, 1902 are treated as subjective junior synonyms of Heliacus berthae (Boettger, 1902) and Spirolaxis cornicula (Boettger, 1902).

Abstract In this article, we describe the results of a rapid qualitative study conducted between May 19 and June 25, 2020 on the work experience of midwives during the first wave of the COVID-19 pandemic in Brussels and Wallonia (Belgium). Using semi-structured interviews conducted with fifteen midwives working in hospitals or practicing privately, we investigated the impact of the first COVID-19 wave on their work experience, the woman-midwife relationship, and midwife-perceived changes in quality of care. Findings include high levels of stress and insecurity related to the lack of resources and personal protective equipment, feelings of distrust from midwives towards the Belgian State and public health authorities, as well as structural and organizational challenges within maternity wards which negatively affected quality of care. Moreover, based on the midwives’ experiences, we demonstrate the need to recognise the views of all stakeholders involved in maternal and newborn care provision, and share five essential lessons learned from this study: 1) it is crucial to acknowledge the central role of midwives for maintaining maternal and newborn care amidst the pandemic and beyond; 2) creating unified national guidelines could support ensuring best practice; 3) efforts must be put in place to diminish the climate of mistrust towards health authorities and to repair the relationship between midwives and decision-makers which was damaged during the pandemic; 4) caring for front-line healthcare workers’ mental health is critical, and 5) quality of maternal care can be improved, even in the midst of a pandemic, through team effort and creative solutions tailored to the needs and demands of each setting.

ABSTRACT We investigated the feasibility of agarose-gel microcapsules to cryopreserve extremely small numbers of sperm for assisted reproductive technology. Semen samples were collected from 16 patients attending the center for reproductive medicine male infertility clinic at a university hospital. We used agarose microcapsules to cryopreserve extremely small numbers of sperm from 16 patients with male infertility (10 with sperm concentration ≥1 million/mL; 6 with sperm concentration <1 million/mL). Six spermatozoa were injected into agarose-gel microcapsules and cryopreserved in a liquid nitrogen tank for 7 days. The Crytop method was used for cryopreservation as a control. After thawing, spermatozoa were recovered. Sperm recovery rates, motility and viability, and recovery time were compared. The post-thawing recovery rate, motility rate, and viability rate were higher whereas the recovery time was shorter in samples preserved using the agarose-gel microcapsule method compared to samples preserved using the Cryotop method in both the group with sperm concentrations of 1 million/mL or above and the group with sperm concentrations of less than 1 million/mL. This study demonstrated that using the agarose-gel microcapsule method increased post-thawing sperm recovery rate, sperm motility rate, and sperm viability rate, and reduced sperm recovery time compared with the conventional Cryotop method when cryopreserving samples with low sperm count. Although requiring further study, the agarose-gel microcapsule method shows much promise as a new option for freezing sperm.

Abstract BackgroundUnderstanding the differences in timing and composition of physical distancing policies is important to evaluate the early global response to COVID-19. A physical distancing intensity framework comprising 16 domains was recently published to compare physical distancing approaches between U.S. States. We applied this framework to a diverse set of low and middle-income countries (LMICs) (Botswana, India, Jamaica, Mozambique, Namibia, and Ukraine) to test the appropriateness of this framework in the global context and to compare the policy responses in this set of LMICs and with a sample of U.S. States during the first 100-days of the epidemic.ResultsAll six of the LMICs in our sample adopted wide ranging physical distancing policies. The highest peak daily physical distancing intensity in each country was: Botswana (4.60); India (4.40); Ukraine (4.40); Namibia (4.20); and Jamaica (3.80). The number of days each country stayed at peak intensity ranged from 12-days (Jamaica) to more than 67-days (Mozambique). We found some key similarities and differences, including substantial differences in whether and how countries expressly required certain groups to stay at home. We also found that the LMICs generally implemented physical distancing policies when there were few confirmed cases and the easing of physical distancing policies did not discernably correlate with change in COVID-19 incidence. The physical distancing responses in the LMIC sample were generally more intense than in a sample of U.S. States, but results vary depending on the U.S. State. For example, California had a peak intensity of 4.29, which would place California below the peak intensity for Botswana, India, and Ukraine but above Mozambique, Namibia and Jamaica. The U.S. State of Georgia had a peak intensity of 3.07, which would place it lower than all of the LMICs in this sample. The peak intensity for the U.S. 12-state average was 3.84, which would place it lower than every LMIC in this sample except Jamaica.ConclusionThis analysis helps to highlight the differing paths taken by the countries in this sample and may provide lessons to other countries regarding options for structuring physical distancing policies in response to COVID-19 and future outbreaks.

IntroductionComplications due to unsafe abortions are an important cause of morbidity and mortality in many sub-Saharan African countries. We aimed to characterise abortion-related complication severity, describe their management, and to report women’s experience of abortion care in Africa.MethodsA cross-sectional study was implemented in 210 health facilities across 11 sub-Saharan African countries. Data were collected on women’s characteristics, clinical information and women’s experience of abortion care (using the audio computer-assisted self-interviewing (ACASI) system). Severity of abortion complications were organised in five hierarchical mutually exclusive categories based on indicators present at assessment. Descriptive bivariate analysis was performed for women’s characteristics, management of complications and reported experiences of abortion care by severity. Generalised linear estimation models were used to assess the association between women’s characteristics and severity of complications.ResultsThere were 13 657 women who had an abortion-related complication: 323 (2.4%) women were classified with severe maternal outcomes, 957 (7.0%) had potentially life-threatening complications, 7953 (58.2%) had moderate complications and 4424 (32.4%) women had mild complications. Women who were single, multiparous, presenting ≥13 weeks of gestational age and where expulsion of products of conception occurred prior to arrival to facility were more likely to experience severe complications. For management, the commonly used mechanical methods of uterine evacuation were manual vacuum aspiration (76.9%), followed by dilation and curettage (D&C) (20.1%). Most frequently used uterotonics were oxytocin (50∙9%) and misoprostol (22.7%). Via ACASI, 602 (19.5%) women reported having an induced abortion. Of those, misoprostol was the most commonly reported method (54.3%).ConclusionThere is a critical need to increase access to and quality of evidence-based safe abortion, postabortion care and to improve understanding around women’s experiences of abortion care.