Recent research has shown that women often report that their concerns are not listened to in exchanges with clinicians when accessing reproductive healthcare, including contraceptive consultations. When people do not feel listened to, or have their concerns taken seriously, this can lead to disengagement with contraceptive services and distrust of healthcare professionals. A participatory approach, with 18 volunteer researchers interviewing 52 friends and family members about information-seeking and contraceptive methods. Most participants were not satisfied with contraceptive consultations and felt that healthcare professionals did not give them all the information they wanted. Because of this, they found personal stories about contraception to be very important in their information-seeking and decision-making processes. Sharing these stories, both what they heard from others and their own experiences, helped them consider the potential side effects of different contraceptive methods. Participants thereby drew on vernacular knowledge (unofficial, informal and everyday culture of a group), some of which was accessed through social media. Vernacular knowledge also included experiential knowledge, as provided by friends and family members. This kind of knowledge was not covered in their contraceptive consultations. Patients' understanding of side effects does not always align with medical evidence. Dismissing reported side effects can undermine patient experience, leading to disengagement or the seeking of counter-expertise. Practitioner knowledge and patient vernacular knowledge should be considered together when counselling about contraceptives. Our research suggests that a more prominent culture of active listening is required in clinician-patient exchanges that acknowledges and works with patient concerns and lived experiences.

Cervical cancer is predominantly caused by infection with high-risk human papillomavirus (HPV). Prevention efforts rely on vaccination and cervical screening. This study aimed to determine HPV vaccination and in-date cervical screening rates among women seeking abortion to determine whether this care setting could provide an opportunity to deliver catch-up prevention services. Retrospective database study examining HPV vaccination and cervical screening coverage among women accessing abortion in Edinburgh, Scotland, UK from October to December 2024. National Health Service electronic systems recording HPV vaccinations and the Scottish Cervical Call Recall System were examined together with clinical records to determine if an in-person clinical visit was made as part of care. Some 798 individuals presented for abortion over the study period (n=297, ≤25 years and n=501, >25 years). Of those aged ≤25 years reviewed for HPV vaccination, 161/297 (54.2%) were vaccinated, 37 (12.5%) were unvaccinated and 99 (33.3%) had no record of vaccination status. Of the 501 women of cervical screening age >25 years, 289 (57.7%) were up to date, 70 (14%) were overdue and 142 (28.3%) had never been screened. Of the 37 unvaccinated individuals, 29 (78.4%) attended the clinic in person as did 158 (74.5%) of the 212 overdue/never-screened women. A significant proportion of those individuals who present for abortion are not vaccinated against HPV or up to date with cervical screening. Three-quarters of this group made an in-person visit, indicating an opportunity for delivering cervical cancer preventative services in the future. Future research is required to determine the feasibility of HPV vaccination and cervical screening in this setting.

BackgroundThis narrative review examines the time to return to fertility after discontinuation of subcutaneous depot medroxyprogesterone acetate (DMPA SC) 104 mg among women of reproductive age.MethodsThe review was conducted using multiple data sources including PubMed, CINAHL, Web of Science, The Cochrane Library, Google Scholar, Ovid Medline, EMBASE, POPLINE, Global Health/EBSCO, Scopus, WHO Global Index Medicus, International Clinical Trials Registry Platform (ICTRP), Global Index Medicus – WHO, African Index Medicus (AIM), ScienceDirect, Public Library of Science (PLOS), BioMed Central, Dryad and JSTOR. Search terms included DMPA, SC-DMPA, depot medroxyprogesterone acetate, ovulation, pregnancy, Depo Provera, return to ovulation, fertility, return to fertility, subcutaneous and SubQ. We included studies that used the standard and not experimental dosing of DMPA SC.ResultsFour of the 31 articles met the inclusion criteria. The trials compared DMPA SC 104 mg with intramuscular DMPA (DMPA IM) at various dosages and routes. Follow-up varied from 7.5 to 18 months after the last injection. Median time to ovulation for DMPA SC was 212 days and was not statistically significantly different from DMPA IM 150 mg (183 days). There were no differences in time to ovulation by region, body mass index or age. No studies reported on time to pregnancy, effect of duration or frequency of dosing.ConclusionsMedian time to ovulation for DMPA SC 104 mg of 212 days was similar to that of DMPA IM 150 mg of 183 days, suggesting that choice of formulation (SC vs IM) does not impact the timeline for return to fertility.

Women and gender-diverse people are a fast-growing population in prisons in Australia. Incarceration can create barriers to accessing sexual and reproductive healthcare. The objective of this scoping review was to identify what is known about the sexual and reproductive health experiences, needs and outcomes of women and gender-diverse people incarcerated in Australia. We used the Joanna Briggs Institute methodology for systematic scoping reviews. Databases searched included PsycINFO, Gender Studies Database, MEDLINE and CINAHL. The search yielded 658 titles and abstracts of which 17 met the criteria for inclusion. We identified 17 studies published between 2000 and 2023 across three states. The studies included qualitative, quantitative and mixed-methods designs. The main outcomes of interest included: pregnancy and maternal health, contraception, sexually transmitted infections, experiences of sexual violence, and cervical health screening and outcomes. Evidence indicates that women and gender-diverse populations in prison in Australia experience high rates of sexually transmitted infections, poor perinatal health outcomes, and unmet needs related to contraception access and perinatal health services and programmes. The negative health impacts of incarceration are especially pronounced for Aboriginal and/or Torres Strait Islander women, who face additional discriminatory institutional barriers to participating in health programmes and experience a lack of culturally safe and appropriate care.

Since 2020, legislation in Britain has allowed both mifepristone and misoprostol to be taken at home for early medical abortion (EMA). In England and Wales, legislation restricts this to 9+6 weeks, but in Scotland this is permitted up to 11+6 weeks. Data on the outcomes of EMA at home >10 weeks' gestation is limited and so we aimed to establish the safety and efficacy of this in comparison with EMA in a hospital setting. We conducted a retrospective review from our abortion service in Edinburgh, Scotland of outcomes of EMA at home versus hospital between 10+0 and 11+6 weeks' gestation over the 5-year period April 2020-March 2025. The primary outcome was complete abortion rate. Secondary outcomes were rates of incomplete abortion, ongoing pregnancy and serious complications. A total of 371 EMAs occurred at this gestation (n=258 home, n=113 hospital). Complete abortion rates were not statistically significantly different between groups: 251/258 (97%) (95% CI: 94% to 99%) at home and 110/113 (97%) (95% CI: 92% to 99%) in hospital. Neither incomplete abortion rates (home: 4/258, 1.6%; hospital: 3/113, 2.6%) nor ongoing pregnancy rates (home: 3/258, 1.2%; hospital: 0/113, 0%) were significantly different between groups. There was one case of haemorrhage requiring transfusion and three cases of infection receiving intravenous antibiotics, all in the at home group. EMA at home between 10+0 and 11+6 weeks has the same high efficacy and safety as when conducted in hospital. Action is needed to extend EMA at home after 10 weeks' gestation to women across the rest of the UK and beyond.

Medical abortion beyond 12 weeks' gestation increases experienced pain. The effectiveness of pain management protocols remains to be evaluated. This was a secondary analysis of a randomised controlled trial, conducted in six Swedish hospitals from 2019 to 2022, investigating home administration of the first misoprostol dose. Paracetamol 1000 mg and a non-steroidal anti-inflammatory drug (NSAID) were provided with the first misoprostol dose and subsequent breakthrough pain medication as required. We recruited persons >18 years of age, with a viable singleton pregnancy between 12 weeks+1 day and 21 weeks+6 days of gestation. We collected data on patient-reported pain using a visual analogue scale (VAS, 0-100 mm) at fetal expulsion and maximum pain assessed retrospectively prior to discharge. We collected data on the use of breakthrough pain medication, satisfaction scores with pain relief, and VAS scores before/after administration of breakthrough analgesia. We included 425 individuals. The participants reported a mean VAS of 39.1 (SD 34.4) at expulsion and 65.4 (SD 28.6) as maximum pain (assessed after abortion before discharge) and 352/425 (82.8%) received breakthrough pain medication, with 266/425 (62.6%) receiving an oral opioid, 163/425 (38.4%) a paracervical block (PCB) and 86/425 (20.2%) a parenteral opioid. A total of 357/392 (91.1%) participants were satisfied with the pain relief. Administration of a PCB alone or following an opioid resulted in the largest decrease in VAS. Many participants reported high VAS scores but most of them were satisfied with their analgesic treatment. A PCB was associated with the highest effectiveness in alleviating pain.