Obstetric fistula, an abnormal opening between a woman's genital tract and her urinary tract or rectum. It's caused by prolonged, obstructed labor without access to timely, high-quality medical treatment. A significant number of women face barriers in accessing care, prompting this study to focus on the complicated obstacles hindering effective healthcare, and preventing timely diagnosis, treatment, and prevention. This study investigates the health-seeking behaviors and experiences of obstetric fistula survivors, spanning from the onset of the condition until surgical treatment is obtained. A qualitative study design, drawing from a phenomenological approach, was employed to explore the lived experience of a purposively selected sample of eight women with obstetric fistula and six key informant interviews which are 5 Experts and 1 Fistula ambassador/ treated. Transcription was used, entered as primary documents into Atlas. ti 9 software. Thematic categories were identified. The study identified barriers for health-care seeking and experiences of women with obstetric fistula, Women's experiences were marked by prolonged suffering, social isolation, and delayed healthcare-seeking. Many initially believed obstetric fistula was caused by spiritual punishment or witchcraft, leading them to seek help from traditional healers rather than medical facilities. Fear of shame, leaking urine, and social rejection discouraged public disclosure and prevented them from traveling to hospitals. Some women remained untreated for years due to lack of financial means or because male family members discouraged seeking help. However, survivors who accessed care typically did so with the encouragement of community health workers or NGOs, and often described the surgery as life-changing. Women suffering from obstetric fistula often face complicated routes to seek treatment due to multiple factors. Primary barriers include financial difficulties, lack of awareness about the condition and its treatment, social and cultural challenges, and war. To alleviate the prolonged suffering experienced by women awaiting fistula treatment, it is crucial to increase awareness and improve access to fistula treatment center.

BackgroundFor young adults seeking new experiences, international travel provides opportunities for casual sexual encounters. The aim of this study was to identify the predictive factors associated with travel-associated sex and consistent condom use in a non-random sample of single and partnered young travelers.MethodsSexually-active Canadians, aged 18–25 years, who traveled abroad in 2016, were purposively recruited to participate in an online survey. Two binomial logistic regressions were performed to examine the demographic, sexual health and lifestyle factors associated with (1) having sex abroad (N = 646), or (2) consistent external condom use abroad (n = 271 sexually-active travelers).ResultsPacking condoms for international travel was associated with more than twice the odds of both having sex abroad (AOR: 2.58, 95% CI: 1.47–4.51 p < 0.001) and using condoms consistently during intercourse (AOR: 2.62, 95% CI: 1.62–5.32, p = 0.008). Sex under the influence of alcohol at-home, history of sexually transmitted infections, travel-related plans to have sex and drug consumption were also associated with sex abroad. Consistent external condom use abroad was associated with prior condom use at-home and penetrative sexual practices abroad. Unlike previous studies, gender, sexual orientation and relationship status were not significantly associated with either travel-associated sex nor condom use.ConclusionTravelers’ characteristics and domestic sexual behaviors will inform travel health interventions, but our findings support universal promotion of barrier protection during travel regardless of relationship status, sexual orientation or gender identity. Given the increasingly open and fluid nature of sexual expressions and relationships, pre-travel sexual health interventions should be sex-positive, broadly inclusive and promote strategies for safe sexual behaviors while travelling.

BackgroundAccess to Sexual and Reproductive Health (SRH) services remains a significant public health challenge, particularly in rural and underserved areas. The Health Bazaar initiative was introduced as a community-based intervention to improve SRH service utilization and family planning uptake among reproductive-age women in Ethiopia. This study evaluates the effectiveness of the Health Bazaar model in improving access to SRH services in intervention (Health Bazaar) compared to non-intervention areas (running SRH services in the routine health system).MethodsA comparative cross-sectional study was conducted in five Ethiopian regions where the Health Bazaar model was implemented. Data were collected from 1,284 reproductive-age women (15–49 years), equally distributed between intervention (n = 642) and non-intervention (n = 642) areas. Additionally, secondary data from the District Health Information System (DHIS2) (2018–2024) were analysed to assess trends in SRH service utilization. A multistage cluster sampling approach was used, and data were analysed using descriptive statistics, trend analysis, and multilevel mixed-effects logistic regression to identify factors associated with SRH service uptake.ResultsThe study found that SRH service utilization was significantly higher in intervention areas (65.1%, 95% CI:59.02, 68.21) compared to non-intervention areas (47.6%;95% CI: 42.01, 51.41) (p < 0.001). Contraceptive prevalence was also higher in intervention areas (53.3% vs. 41.8%, p = 0.001), with injectables (45.8%) and implants (44.5%) being the most commonly used methods. ANC service utilization was higher in intervention areas (87.3%) compared to non-intervention areas (77.1%), and institutional birth rates were 89.4% in intervention areas compared to 80.6% in non-intervention areas. Trend analysis showed a greater increase in ANC (10.2 per quarter), institutional births (5.8 per quarter), and PNC utilization (9.5 per quarter) in intervention areas compared to non-intervention areas. These differences remained statistically significant after adjusting for potential confounding factors, including age, marital status, education, household income, region, and participation in SRH-related discussions.ConclusionThe study highlights that individual factors, particularly participation in SRH discussions, are major drivers of service use, while community-based interventions such as the Health Bazaar program further enhance uptake. Age and marital status also shape service-seeking behaviour, underscoring the need for tailored approaches for different subgroups. The Health Bazaar intervention notably improved SRH service utilization, family planning uptake, and maternal health access in Ethiopia, demonstrating the potential of this community-driven model for scaling up in similar low-resource settings.

PurposeNumerous systematic reviews have examined the non-genetic factors associated with the risk of miscarriage. Therefore, this study aimed to conduct an umbrella review on non-genetic factors associated with the risk of miscarriage.MethodsScopus, PubMed, Embase, and Web of Science were searched until 2025 and the systematic review and meta-analysis articles that were conducted on observational studies were extracted. Quality assessment of the selected review articles was done by AMSTAR. For each selected meta-analysis, the summary effect size with the 95% confidence interval was estimated using the random-effects model and the predictive interval (PI) at 95% was estimated too. The between-study heterogeneity was assessed by the I2 index. In addition, two biases, including small-study effects and excess statistical significance, were investigated.ResultsFinally, 147 meta-analyses and 29 systematic review studies remained. None of the factors met all the necessary criteria and showed a definite association. However, 45 factors were classified as associations supported by suggestive evidence. Among these 45 factors, three factors—hypothyroidism, high serum β-human chorionic gonadotropin, and hairdressers—included the most complete information (they had more than 1,000 cases, significant based on the random-effects model, p < 0.001, respectively; (2/01(1/66–2/44), 2/88(1/76–4/68), 1/28(1/11–1/47)).ConclusionsOnly 45 non-genetic factors had statistically significant associations without bias and heterogeneity, but were classified in the associations supported by suggestive evidence group because the PI (95%) included the null value.

BackgroundDemand for family planning satisfied (DFPS) is one of the core indicators for monitoring reproductive health. However, it involves a series of questions that are not always available in national health surveys, hindering the international comparability and tracking progress in those settings. This study updates an alternative method for calculating DFPS based on contraceptive prevalence (CPR) when direct estimation is not feasible.MethodsBased on survey data from 1,099 subnational regions across 103 countries, we fitted least-squares regression models that predicts DFPS for both any contraceptive methods and modern methods. A fractional polynomial approach was employed to account for non-linear relationships. Model performance was assessed using a 5-fold cross-validation strategy, evaluating bias, mean absolute error and correlation.ResultsThe models, using CPR and the difference between total and modern CPR as predictors, were able to explain over 97% of the variability of DFPS by any and modern contraceptives. Bias and the magnitude of the errors were around 0.1 in the cross-validated sample. Validating the results for other inequality dimensions beyond subnational region yielded even better metrics.ConclusionsThe predicted estimates proved to be a good approximation for DFPS in circumstances where direct estimation is not possible. This study confirms that modeling DFPS through contraceptive prevalence remains valid and extends its applicability to DFPS based on modern methods. Furthermore, the estimates were robust for varying inequality dimensions, allowing equity analyses to be performed when appropriate.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12978-025-02187-8.

Sexual self-efficacy is a critical factor in promoting protected and satisfying sexual health. This study aimed to examine the relationship between structural/intermediary health determinants (socioeconomic status, social support, stress, intimate partner violence) and sexual self-efficacy among Iranian women of reproductive age, using path analysis. In this cross-sectional study, 424 reproductive-aged women completed validated questionnaires that assessed socio-demographics, socioeconomic status, perceived social support, perceived stress, intimate partner violence, and sexual self-efficacy. Data were analyzed using SPSS 27 for descriptive statistics and AMOS 24 for path analysis. According to the path analysis, perceived social support and socioeconomic status were positively associated with sexual self-efficacy, while perceived stress and intimate partner violence were negatively associated with sexual self-efficacy. Therefore, intimate partner violence, perceived stress and social support play a mediating role between age, socioeconomic status and sexual self-efficacy. The model demonstrated a strong fit, with RMSEA = 0.05, GFI = 0.99, CFI = 0.99, NFI = 0.96, and χ²/df = 1.56, confirming its strength. Based on the results of this study, it is crucial to focus more on the sexual self-efficacy of women, particularly those with low socioeconomic status. Furthermore, it is advisable to implement specialized programs to alleviate stress and reduce domestic violence, as well as to increase social support for women facing sexual issues.

Infertility is much more than a quality-of-life concern. Its consequences stream into public health domains such as psychological distress, social stigma and marital disagreements. The estimation of infertility is one of the most crucial activities concerning informing policymakers. Therefore, this review was conducted to estimate the pooled prevalence of infertility and coping mechanisms in Ethiopia. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guideline to adhere to standards in conducting and reporting of evidence synthesis. An internet-based search of noninterventional studies in Ethiopia was performed in CINAHL, EMBASE, PubMed/MEDLINE, Cochrane Library, Scopus, Web of Science, and Google Scholar. A total of 332 studies were screened, and only 11 studies satisfied the inclusion criteria. Studies were included if they described the prevalence and/or coping mechanisms of infertility. The Newcastle–Ottawa Scale and Joanna Briggs Institute critical appraisal checklist were used for quantitative and qualitative studies, respectively. The random-effects meta-analysis was done in Stata version 17, and forest plots, test of heterogeneity, and funnel plots were all generated. The pooled prevalence of lifetime and/or specific period of infertility was 25.77% [95% CI: 20.10, 31.45], with a heterogeneity index (I2 = 99.48, P = 0.00). The subgroup prevalence of primary infertility was 22.76% [-0.95–46.47], with heterogeneity (I2 = 99.54, p = 00), and that of secondary was 12.67% [9.14–16.20], with I2 = 98.57, p = 0.00. Spiritual activity, medical treatment, cultural practice, seeking support from family, adoption, acceptance, having a godchild, estranged social life, helplessness, extramarital engagement, and marital separation were the identified coping mechanisms. Compared with the global standard, the pooled prevalence of infertility in Ethiopia is relatively high. Most of the identified coping strategies of infertility were problem-focused mechanisms. The identified coping mechanisms were grouped in the following main themes: (i) seeking medical treatment, (ii) religious/spiritual practices, (iii) seeking social support, (iv) using cultural remedies, (v) acceptance, and (vi) avoidance/harmful behaviors. Policy makers, health authorities and professionals should improve the delivery of infertility prevention and treatment services and ensure coping support is culturally sensitive and integrated with the national health strategy. Infertility is unable to be pregnant after 12 months or more of regular unprotected sex. It can be a primary or secondary type. It leads to distress, social isolation and even marital separation. Estimating infertility is one of the most crucial activities for informing policymakers. Therefore, this review was conducted to determine the prevalence of infertility and coping methods in Ethiopia. The search of studies was conducted in different databases. A total of 332 studies were reviewed, of which 11 studies were included. The New Castle-Ottawa Scale and Joanna Briggs Institute critical appraisal checklist were used to assess quantitative and qualitative studies, respectively. Meta-analysis was carried out via Stata version 17. Forest plots, heterogeneity tests, and funnel plots were performed. The total prevalence of infertility was 25.77%. The subgroup prevalence of primary infertility was 22.76%, and that of secondary infertility was 12.67%. Spiritual activity, medical treatment, cultural practice, seeking support from family, adoption, acceptance, having a godchild, estranged social life, helplessness, extramarital engagement, and marital separation were the identified coping mechanisms among infertile couples. There is limited evidence of infertility in Ethiopia. Its magnitude in Ethiopia is high compared to standards. Most of the reported strategies were problem-focused coping mechanisms. The lives of infertile women are burdened with deep emotional and social effects. The health delivery system and health service providers need to look at the psychosocial aspects of advanced infertility treatment options and effective counselling.

BackgroundIncreasingly, people use medication abortion pills to end their pregnancies on their own, without clinical supervision–a practice known as self-managed abortion (SMA). Additionally, some obtain support through a community-based care model known as the “accompaniment” model, in which volunteer-activists provide evidence-based information about medication abortion and counseling through the SMA process over the phone or in-person. Understanding factors associated with the support and care received during SMA with accompaniment can provide insight into people’s satisfaction with this community-based model of abortion care and identify opportunities to further improve it, which is particularly important in legally restrictive settings. Additionally, a large proportion of people who have abortions are parents, but little research has explored the unique needs and preferences for SMA among parents.MethodsThis was a secondary analysis of a prospective, observational cohort study conducted in three countries among people who self-managed an abortion with accompaniment support. We implemented bivariate analyses to evaluate differences between participants who reported feeling sufficient social support during their abortion with those who did not, and those who preferred SMA over facility-based care. We used multivariable logistic regression models to explore whether the number of children a participant had was associated with feeling supported during the SMA process, and separately with preference for SMA.ResultsWhile most participants felt fully supported by their social group and preferred SMA, several characteristics were associated with not having felt supported and preferring facility-based abortion care in bivariate analyses: namely, those with less formal education, a history of prior abortion, and those who sought care at a health facility during their SMA. In adjusted logistic regression models, we found no association between number of children and feeling sufficient social support, or preference for SMA.ConclusionsThese results establish that most people who have SMA with accompaniment feel fully supported during their abortion process and prefer SMA over facility-based care with no difference between parents and non-parents.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12978-025-02145-4.

BackgroundReproductive coercion and abuse (RCA) is a hidden form of violence against women, involving controlling behaviours by a partner or family member to manipulate a woman’s reproductive autonomy, either to prevent or promote pregnancy. It correlates with partner violence, unintended pregnancy, contraceptive non-adherence, and poor sexual and reproductive health. However, research often oversimplifies RCA, treating it as a uniform phenomenon and neglecting its diverse manifestations. Additionally, there is scarce evidence on RCA in low- and middle-income countries. This study examines the conceptualisation and discourse surrounding reproductive coercion among health workers and women victims/survivors in Brazil, Nepal, occupied Palestinian Territories, and Sri Lanka. The main objectives include: 1) Investigating acts of reproductive coercion reported by women and health workers. 2) Exploring how health workers approach reproductive coercion in their practice. 3) Understanding the structural, institutional, and social barriers affecting victim/survivors encounters with reproductive coercion.MethodsWe conducted 62 qualitative interviews with health workers and domestic violence victims/survivors across the four countries, plus three focus groups with women in Nepal. Data were analysed thematically.ResultsThe findings reveal that reproductive coercion emerged as a form of domestic violence across all settings studied. Reported acts of coercion and violence by both women and health workers included attempts to force pregnancy against a woman's wishes and to hinder contraceptive use, driven by jealousy or the desire to promote pregnancy. Perpetrators, mainly husbands and family members (particularly in-laws in Nepal and Sri Lanka), employed various coercive behaviours such as pressure, decision-making control, threats (e.g., leaving the partner or violence), verbal harassment, and physical violence. The analysis also underscored broader structural and social challenges constraining women's reproductive choices and health workers' responses, encompassing religious beliefs surrounding contraception and abortion, cultural norms regarding son preference (notably in Nepal), and restrictive health policies concerning abortion and spousal consent for family planning (observed in Nepal and Sri Lanka).ConclusionsThe study emphasises the necessity for further research to comprehensively understand acts of reproductive coercion and abuse and guide health workers in effectively addressing this issue.

BackgroundIn Ethiopia, adolescents and youth continue to experience a high burden of morbidity and mortality related to reproductive health problems. However, the implementation of the adolescents and youth health program in Woliso Town has not yet been evaluated. Therefore, this study aimed to evaluate the process of the program implementation in the primary healthcare facilities of Woliso Town, Oromia Regional State, Ethiopia.MethodsA convergent parallel case study design with a formative evaluation approach was employed from May 21 to June 20, 2023. The evaluation focused on three key dimensions: the availability of required resources, the compliance of healthcare providers with recommended practices, and the satisfaction of service users — measured using a total of 30 indicators. Data were collected from 411 adolescents and youth through exit interviews. Additionally, direct observations of service delivery, resource inventory, and key informant interviews were conducted. Quantitative data were analyzed using descriptive statistics and multivariable linear regression methods. A p-value of < 0.05 and a 95% Confidence Interval (CI) were used to determine statistically significant factors associated with adolescents’ and youth’s satisfactions. Qualitative data were transcribed in the language of the interview, translated into English, coded, and analyzed thematically. The overall process of the program implementation was evaluated based on predetermined judgment criteria.ResultsThe overall process of adolescents and youth health program implementation was 69.6%, with contributions from resource availability (81.1%), healthcare providers’ compliance with the guidelines (51.3%), and adolescent and youth satisfaction (75.7%). Factors associated with adolescents and youth satisfaction were being served at a youth center (β = 0.084, 95% CI: 0.049, 0.119); having previous experience with adolescents and youth health services (β = 0.031, 95% CI: 0.004, 0.058); getting the needed service free of charge (β = 0.060, 95% CI: 0.029, 0.090); and obtaining all the services they demanded (β = 0.099, 95% CI: 0.065, 0.132).ConclusionThe overall process of adolescents and youth health program implementation was evaluated to be fair. Healthcare providers demonstrated low compliance with the adolescents and youth health service guidelines. To improve the process of adolescents and youth health program implementation and enhance the satisfaction of service adolescents and youth, it is recommended that the concerned stakeholders and health facility managers need to explore alternative financing mechanisms to ensure these services are provided either free of charge or at reasonable prices considering the income level of the adolescents and youth. Furthermore, strengthening healthcare providers’ adherence to the national guidelines, and ensuring the availability of all essential services across health facilities are of paramount importance to improve adolescents and youth satisfaction, thereby increase service utilization.LimitationsThe role of chance, information bias, and social desirability bias is likely, as adolescents and youth were interviewed within the health facility compound, which might have led to an overestimation of the findings.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12978-025-02144-5.