Population Council

IntroductionFactors underlying reproductive decisions, including contraceptive method choice, are poorly understood, especially in humanitarian settings where sexual and reproductive health (SRH) needs may be highest due to heightened risk of sexual violence and disruptions of health services. The study examined the association between method-specific beliefs and future method choice among women in refugee settlements in Uganda.MethodsData were from a baseline of a one-year prospective study involving a cohort of 2,498 women aged 15–45 years living in Kiryadongo and Kyangwali refugee settlements. Analysis used cross-tabulation with chi-square test and conditional logistic regression analysis to examine associations between method-specific beliefs and intention to use injectables, implants, or pills among contraceptive non-users.ResultAmong contraceptive non-users (n = 1,486), 32% intended to use a method within the next 12 months or later. Injectable was the most preferred future method (39%), followed by implants (25%) and pills (17%). Concerns about interference with menstruation, unpleasant side effects, and safety for long-term use were common across all three methods (range 58% – 90%). The likelihood that a woman intended to use injectable, implant, or pill in future was positively associated with perceived ease to access (AOR = 1.95; 95% CI: 1.03–3.66), ease of use (AOR = 4.17; 95% CI: 2.22–7.86), safety for long use (AOR = 4.51; 95% CI: 1.61–12.64), and satisfaction with past use (AOR = 2.87; 95% CI: 1.51–5.46).ConclusionIntention to use contraception in future among non-users in refugee settlements is low, coupled with widespread negative beliefs about available methods. There is need to improve counseling to counter negative beliefs and to expand access to a range of modern contraceptive methods.

Health workers providing maternal and newborn care can experience burnout and emotional distress, which harms their well-being and, consequently, their ability to deliver respectful care. The World Health Organization (WHO) Compendium on respectful maternal and newborn care identifies health workers’ well-being as a critical area for intervention, but no specific definition or domains of well-being exist for this group. We conducted a qualitative evidence synthesis to synthesise key domains of well-being for health workers providing maternal and newborn care, by exploring health workers’ perceptions and experiences about their well-being. We searched MEDLINE, CINAHL and MIDIRS from 2010 to 20 August 2025 to identify studies reporting health workers’ perceptions and experiences of well-being while providing routine maternal and newborn care in any context. Using maximum variation purposive sampling, we sampled papers for data extraction. Thematic synthesis was employed for analysis, with GRADE-CERQual assessing confidence in findings. A mixed inductive-deductive approach informed the development of well-being domains. Potential implementation strategies to improve well-being were developed using Theoretical Domains Framework (TDF); Capability, Opportunity, and Motivation Model of Behaviour (COM-B); and Behaviour Change Wheel (BCW). Consultations with health workers validated findings and implementation strategies. We analysed 51 papers from five WHO regions, except the South-East Asia Region, with 61% from high-income and 39% from low-middle-income countries. We identified 18 findings on factors influencing health workers’ well-being. Eight key domains of well-being identified: 1) physical health and access to care and support, 2) emotional and psychological health and access to care and support, 3) fair, safe, and supportive environment, 4) fair and equitable remuneration, 5) adequate housing and a safe community, 6) strong professional identity, 7) positive relationship with women and their families, and 8) work and personal life harmony. The TDF, COM-B, and BCW mapping suggest that interventions should address motivation and external influences.

IntroductionHIV prevention and treatment supported by the United States President's Emergency Plan for AIDS Relief (PEPFAR) have saved millions of lives. Rwanda is among the most successful countries worldwide in achieving global targets with PEPFAR support. Abrupt PEPFAR funding uncertainty raises concerns about continued HIV epidemic control. We projected the impact of the Government of Rwanda's (GoR's) capacity to offset PEPFAR funding elimination on adult HIV epidemic and care continuum outcomes over 10 years.MethodsUsing an HIV policy model calibrated to Rwanda, we assessed capacity to sustain HIV services at: 50% (with no capacity by GoR to cover the PEPFAR funding gap), 75%, 90% and 100% (with full capacity by GoR to cover the gap). Scenarios involved reducing the number on antiretroviral therapy (ART), immediately discontinuing ART and proportionally decreasing HIV diagnosis, ART initiation, and care re‐engagement. We projected epidemic outcomes (HIV prevalence, HIV incidence, number with HIV, new HIV infections, deaths) and care continuum outcomes (percentage diagnosed, percentage on ART among those diagnosed, percentage virally suppressed among those on ART). We calculated differences in projected outcomes for partial or no capacity versus full capacity. Secondary analyses assessed the timing of the GoR's response.ResultsCompared to full capacity at 10 years, the model projected a 13.9%–38.7% increase in HIV prevalence and 69.0%–246.7% increase in HIV incidence across coverage capacity scenarios. This translated to 29,000–64,000 additional adults with HIV and 20,000–92,000 cumulative new adult HIV infections. Cumulative projected deaths increased by 10,000–51,200. The model projected continual reductions in percentage diagnosed at 10 years; percentage virally suppressed among those on ART was similar across scenarios. Higher, and more delayed, coverage capacity had projected outcomes similar to lower, and less delayed, coverage capacity. Outcomes for gradual increases in coverage capacity were generally similar to or better than full, but delayed, coverage capacity.ConclusionsEven in countries like Rwanda that have achieved epidemic control, abrupt and persistent elimination of PEPFAR funding could drastically reverse critical gains. Evidence quantifying the consequences of different capacities to sustain HIV services underscores the high stakes of rapid and sufficient action.

Abstract Aim/background Ethnic inequalities in stroke incidence are well-established, but long-term trends and the impact of socioeconomic status (SES) remain understudied. We estimated incidence rates by ethnicity over 30-years, and differences by SES, using the South London Stroke Register (1995–2024). Methods We conducted a population-based study including all residents of a geographically defined area of South London, calculating standardised incidence rates using census-derived denominators and the 2013 European Standard Population. The area-level Index of Multiple Deprivation was the indicator of SES. Poisson regression estimated incidence rate ratios comparing ethnic-minority vs White groups, adjusting for age, sex, and SES, with ethnicity-SES interaction testing and marginal rates derived by subgroup. Results Among 7,726 people with first-ever stroke, overall standardised incidence decreased 34% between 1995–1999 and 2010–2014 (198;[187.8–208] to 131;[122.4–138.9] per 100,000), then increased 13% in 2020–2024. Black-African and Black-Caribbean populations had higher baseline incidence persisting across all periods. Ethnic inequalities narrowed initially but subsequently widened, with incidence twice as high in Black-African (IRR=2.31;[2.03–2.62]) and Black-Caribbean (IRR=2.00;[1.73–2.31]) groups compared to White groups in 2020–2024. Patterns were consistent across stroke subtypes, with the largest inequalities in primary intracerebral haemorrhage. Ethnic differences in incidence attenuated on SES adjustment but remained significant. Within ethnic groups, most deprived Black-African and Black-Caribbean populations showed highest incidence. Conclusion Stroke incidence has risen sharply in the past five years, driven by rising incidence rates in Black-African and Black-Caribbean populations, with reduction in the White population. Achieving equity requires ensuring uptake of cardiovascular risk programmes across all socioeconomic and ethnic groups, with earlier risk management for groups who develop stroke 10-12 years younger than the general population.

BackgroundPlasma biomarkers may allow efficient, less invasive methods to assess early‐stage AD/ADRD. Moreover, they can canvas multiple processes, including inflammation, vascular disease, and blood‐brain barrier (BBB) dysfunction. How they reflect cerebral amyloid and tau deposition remains an area of active exploration.MethodParticipants were enrolled at the NYU Alzheimer's Disease Research Center. PET assessment of amyloid pathology was conducted in 163 subjects of whom 62 had normal cognition (NL‐mean age=71.2, 60% female), 82 had subject cognitive decline (SCD‐mean age=76.2, 72% female), and 19 had mild cognitive impairment (MCI‐mean age=73.8, 68% female). Tau PET was conducted in 122 subjects, who were categorized as follows: NL n = 44(mean age=71.5, 59% female); SCD n = 64 (mean age=76.5, 72% female), and MCI n = 14 (mean age=76.8, 71% female). Plasma biomarkers assays were conducted for Aβ40, Aβ42, NfL, GFAP, pTau 181 measured using the SIMOA HD‐X. Plasma biomarkers of neuroinflammation (hIL12p70, hIL1b, hIL4, hIL5, hIFNg, hIL6, hIL8, hIL22, hTNFa, hIL10) and BBB dysfunction (hang2, hHBEGF, hPLGF, hFGFB, hVEGF) was measured with Corplex Cytokine 10‐Plex kit and the angiogenesis 6‐Plex kit, respectively using the Simoa SP‐X.ResultIn linear regression models on n = 163 participants, amyloid PET uptake values were regressed on the plasma biomarkers adjusted for age, sex, and cognitive group. Higher amyloid PET uptake was trending with lower plasma Aβ42 (standardized β=‐0.11, 95%CI [‐0.24,0.02], p = .09), and associated with higher pTau181 (standardized β=0.19, 95%CI [0.02,0.36], p = .03), and higher pTau181/Aβ42 ratio levels (standardized β=0.21, 95%CI[0.06,0.36], p = .008). In n = 122 participants, tau PET uptake values were regressed on the plasma biomarkers adjusted for age, sex, and cognitive group. Higher tau PET uptake was associated with lower plasma Aβ42 (standardized β=‐0.26, 95%CI [‐0.46,‐0.06], p = .013), higher GFAP levels (standardized β=0.20, 95%CI[0.04,0.36], p = .015), and lower hVEGF levels (standardized β= 0.27, 95%CI[‐0.45,‐0.08], p = .005).ConclusionLinear regression with adjustment for age, sex and cognitive group showed a higher amyloid PET uptake associated with high pTau 181, and high pTau 181/Aβ42 ratio. Higher tau PET uptake was associated with lower Aβ42, higher GFAP and lower hVEGF

In a society whose needs are constantly changing, family planning plays a central role for women, men, and sustainable development. This comprehensive review and position statement summarises the proceedings of a meeting on contraception held in Rome in March 2024, supported by major scientific societies in the field. The aim is to inform the medical community about current medical and ethical issues of contraception use. First, the review addresses the complex ethical, religious, and social dimensions of contraceptive use and access; second, it provides a comprehensive analysis of traditional and modern contraceptive methods, discussing their safety and effectiveness; third, it examines current knowledge about male hormonal contraception. When prescribing a contraceptive method, medical indications or contraindications must be integrated to women’s religious beliefs, the geopolitical context in which they live, the risk of violence, their need for self-determination and their right to make decisions for themselves. If a partner is involved, the couple’s dynamics and shared needs must be considered. Healthcare providers are responsible for providing them with all the information they need to make informed choices, while ensuring individual autonomy. This position statement provides recommendations on how to guide contraceptive choice and identifies knowledge gaps about contraception today.

Key populations (KP), including men who have sex with men, people who inject drugs, sex workers, transgender people and people in closed settings, are disproportionately affected by HIV and face structural and legal barriers to care. While community-led responses are central to reaching KP, services are often disease-specific and disconnected from national primary healthcare (PHC) systems. PHC, defined by WHO as a whole-of-society approach to delivering integrated and person-centred services, is rarely designed to meet the broader health needs of KP, who also experience high burdens of non-communicable diseases, mental health conditions and violence. This paper describes three service delivery models, supported by PEPFAR, that integrate HIV and PHC services for KP in Vietnam, Nigeria and Eswatini. The three models are community-led, client-centred, and tailored to KP health and social needs. Each integrates HIV services-including testing, antiretroviral therapy, viral load monitoring, pre-exposure prophylaxis (PrEP) and advanced HIV disease management-alongside broader PHC services such as mental healthcare, sexual and reproductive health, non-communicable disease screening and tuberculosis services. All models include structural and community-based interventions such as gender-based violence support, stigma reduction, peer navigation and economic empowerment. These services are delivered in safe, trusted spaces by multidisciplinary teams including peer and clinical providers. While the models demonstrate alignment with PHC principles (accessibility, cultural competence, continuity and community empowerment), challenges remain related to integration within national health systems, financing and provider training. Recent U.S. global health policy shifts, including reductions in funding for KP-specific programming and limited PrEP access, pose additional threats to programme sustainability and client trust. Integrated models of HIV and PHC for KP can improve access, engagement and health outcomes across a range of services. They represent promising approaches for addressing intersecting health and structural needs, particularly in settings where stigma and criminalization persist. Sustained progress will require inclusion of KP in PHC policies and planning, protection of community-led services and domestic financing strategies that ensure continuity in the face of shifting donor priorities.

Unwanted family planning often refers to fertility desires as a proxy for contraceptive desire and lacks alignment with the tenets of person‐centered care. We construct a person‐centered measure of unwanted family planning by asking women whether they wanted to use a method, examine its alignment with the fertility‐derived measure, and describe the characteristics of women with unwanted family planning and reasons women state for not wanting to use a method. We conducted a cross‐sectional study of women aged 15–49 in Argentina, Ghana, and India. Data were collected on stated desire to use contraception and basic sociodemographic characteristics. Fertility desire was collected using the standard Demographic and Health Survey questionnaire. In total, 4794 women were included in our study. Among women using a method, 2.5 percent (n = 53) of women had unwanted family planning, with 4.2 percent in Ghana, 2.2 percent in Argentina, and 2.0 percent in India. Most unwanted family planning (85.2 percent, n = 23) occurred among women who did not want a child within the next nine months. Sexual infrequency was the most common reason behind a lack of desire to use a method. Our results highlight the substantial differences found between classifying women's contraceptive needs from a person‐centered versus a fertility‐derived approach.