BackgroundMusic therapy has been widely used in medical practices, demonstrating positive effects on diverse medical procedures. In the context of labor pain management, evidence suggests that music can positively influence pain perception and overall well-being during labor, serving as a distraction and stress reducer. This systematic review and meta-analysis aim to comprehensively evaluate the impact of music therapy on labor pain in primigravida women during vaginal delivery.MethodsFollowing PRISMA guidelines, a thorough literature search was conducted in Google Scholar, PubMed, and Cochrane Central Register of Controlled Trials up to November 2023. Nine randomized control trials (RCTs) met the inclusion criteria, involving primigravida women undergoing vaginal delivery with music therapy intervention. Quality assessment was performed using the Cochrane Risk of Bias assessment tool.ResultsA meta-analysis of the fixed effects was performed using mean differences (MD). Pooled analysis of Visual Analog Scale (VAS) scores revealed statistically significant reductions in pain intensity during latent (MD: − 0.73; 95% CI − 1.01; − 0.45); during the active phase (MD: − 0.56; 95% CI − 1.06; − 0.07) and the second stage (MD: − 0.69; 95% CI − 0.85; − 0.54). The findings indicated no statistically significant variances related to the integration of music therapy in addressing anxiety, both in the latent phase (MD: − 0.88; 95% CI − 1.86; -2.02) and the active phase of labor (MD: -0.30; 95% CI − 1.74; 1.13).ConclusionsIn conclusion, the collective evidence presented in this systematic review underscores the potential of music, especially for women giving for the first time. in mitigating labor pain and anxiety across different stages, offering a holistic approach to enhance the overall childbirth experience for women.

BackgroundPreconception health—the health status of individuals prior to conception—is vital for positive pregnancy outcomes and long-term health. Despite its importance for maternal and infant well-being, it remains under-researched and often overlooked in global maternal and child healthcare.MethodsWe conducted a cross-sectional online survey with adults (18–55 years old) from Kenya, South Africa, Malaysia, the United States, and the United Kingdom (n = 5000), gathering data on preconception health knowledge, attitudes, behavioural intent, and respondents’ preferences regarding factors important before pregnancy and preferred sources of health information. A generalised structural equation model (gSEM) was constructed a priori to assess the relationship between socioeconomic position and preconception health knowledge, and whether this relationship was mediated by preconception attitudes and behavioural intent.ResultsPreconception health knowledge, attitudes, and behavioural intent showed significant variation across the countries. Over half of the respondents reported having adequate preconception knowledge (50.3%), with the USA having the highest proportion of respondents with good knowledge (13.8%) and Malaysia having the highest proportion with poor knowledge (42.5%). In the pooled sample, physical health was considered the most important factor before pregnancy, followed by relationships and family. Clinic doctors were the most preferred source of information, followed by nurses and obstetricians/gynaecologists. The relationship between preconception knowledge and behavioural intent was fully mediated by a combination of preconception attitudes (71.7%).ConclusionPreconception health knowledge, attitudes, and behavioural intent differed across the five economically diverse countries. Pregnancy factors were prioritised differently across settings, likely reflecting disparities in culture, socioeconomic status, and healthcare access, with varying preferences for sources of preconception health information. These findings underscore the importance of designing tailored interventions that consider socioeconomic and cultural differences to enhance overall health outcomes.

BackgroundAsylum-seeking women have an increased risk of sexually transmitted diseases, sexual and gender-based violence, unwanted pregnancies, maternal illness and death. This study examined sexual and reproductive health issues among asylum-seeking women in Finland in 2018. The acceptability of asking questions on sexual health was also evaluated.MethodsData from the Asylum Seekers Health and Wellbeing Survey were used. Women aged 18–50 (n = 278) were included in the analysis and grouped to four categories based on their country of birth. Register information on sex, age group, country of birth, and place of residency was obtained from the Finnish Immigration Service and used in the calculations of analysis weights. Weighted percentages with 95% confidence intervals (Cl) were calculated for sexual activity, the use of contraceptives, female genital mutilation/cutting, pregnancies, previous births, miscarriages, induced abortions and menstrual health. The differences between the groups were compared using the chi-square test. The acceptability was examined based on nonresponse in each question about sexual health.ResultsAmong women from the other African countries (excl. North Africa), 21% (95% Cl 10.4–38.9%) had had six or more sexual partners within the past 12 months. Majority of women (62%, 95% CI 39.9–79.7%) from the ‘other countries’ and 51% (95% Cl 34.1–68.2%) from the other African countries had not used contraceptives during their latest intercourse. Female genital mutilation/cutting was reported by 30% (95% Cl 18.7–45.2%) of women from the other African countries. A total of 10% (95% Cl 6.6–13.9%) of all women and 25% (95% Cl 14.3–39.2%) of those from other African countries were pregnant at the time of study. Moreover, 35% (95% CI 25.5–46.0%) of the women from Russia and former Soviet Union had had at least one induced abortion. Nonresponse varied between 7 and 17%, being the highest in the questions about the gender of the sexual partner(s) and contraceptive use among women from Middle East and Africa.ConclusionIt is both acceptable and important to cover sexual and reproductive health when assessing the health of asylum-seeking women. The sensitivity of this topic must be considered when planning data collection.

BackgroundLassa fever (LF), caused by the Lassa virus (LASV), is a zoonotic viral hemorrhagic disease endemic to West Africa, primarily transmitted through rodent excreta and infected bodily fluids. It poses significant public health challenges due to its high morbidity and mortality rates, particularly among at-risk populations like pregnant persons and children. Despite decades of research, vaccine development has been hindered by the virus’s genetic diversity and complex epidemiology. While several vaccine candidates have been developed, none have received regulatory approval. Given the rapidly evolving vaccine landscape, a living systematic review (LSR) was selected to enable real-time evidence synthesis. This protocol outlines a living systematic review (LSR) to evaluate the safety, efficacy, effectiveness, and immunogenicity of LASV vaccines, providing evidence to guide public health interventions and vaccine recommendations.MethodsWe will conduct a biweekly updated LSR and meta-analysis, systematically searching databases (e.g., MEDLINE, EMBASE, CENTRAL) and clinical trial registries from January 2014 onward to identify studies of LASV vaccines in pregnant persons, children, and adolescents. All study designs, including randomized trials, cohort studies, case–control studies, and case reports, will be eligible. Pairs of reviewers will independently assess eligibility, extract data, and evaluate the risk of bias. Primary outcomes include vaccine safety, efficacy, and effectiveness in pregnant persons (including neonatal outcomes), children, and adolescents, while secondary outcomes assess immunogenicity and reactogenicity. Data on adult populations will also be included, and results on this group will be reported as available. We will conduct paired meta-analyses, including prespecified subgroup and sensitivity analyses. We will use the grading of recommendations assessment, development, and evaluation approach to evaluate the certainty of evidence.DiscussionThis LSR offers a dynamic framework to generate timely evidence on LASV vaccines for vulnerable populations. By integrating findings into an interactive Microsoft Power BI dashboard, stakeholders can access and utilize real-time updates to inform public health strategies. Despite challenges like study heterogeneity and vaccine platform variability, subgroup and sensitivity analyses will mitigate these issues. This review aims to support clinical trial designs, guide policy, and improve health outcomes in Lassa fever-endemic regions.Study registrationTwo protocols were registered in the International Prospective Register of Systematic Reviews (PROSPERO) database: CRD42024514513 and CRD42024516754.

BackgroundHaving a first child is a contributing factor to having a second or third child; however, current research focuses on second and third children, and the present study aims to investigate the intention to have a first child and its main influencing factors among the childless population aged 15–49 in China, as well as analysing the influencing factors by age group.MethodAs part of the ‘Survey on the Psychology and Behaviour of Chinese Residents’, this survey was conducted on 6941 residents aged 15–49 in 32 provinces across China. The survey was conducted from 20 June to 31 August 2022.ResultOut of 6941 respondents, the mean score of willingness to have a first child (score range: 0–100) was 42.51. 17.33% of the respondents had no willingness to have a child (0), while 9.54% had a high willingness to have a child (100). Intention to have a first child seems to peak in the age group 30–34 years (p < 0.0001). Being male (p < 0.000, OR = 0.178), having siblings (p1 < 0.035, OR1 = 1.324; p2 < 0.000, OR2 = 1.995) and good family communication (p < 0.003, OR = 1.023), and high self-efficacy (p = 0.001, OR = 1.558) were associated with higher fertility intentions. Influential factors in the lower age group (15–24 years) were mainly related to family and social support, in the 25–29 years age group they were more related to personal, family and social, while in the 30–39 years age group they were related to economic stability such as property and marital status.ConclusionsThe willingness to have a child is at a low to medium level among those of childbearing age who have not had children in China. There is a need to adopt a staggered policy for the younger age group to reduce perceived economic pressure, reduce occupational pressure on the age group, and increase childcare and occupational fertility friendly environments. In addition, there is a need for multisectoral economic compensation and educational district planning to alleviate the “don’t want to save” and solve the “don’t dare to give birth” problem. People who have had one child are more likely to want to have a second child, so the government and society need to do more to support the desire to have a child, thereby increasing the national fertility rate.

BackgroundBreastfeeding provides health benefits for both mothers and children. However, most families face challenges in initiating and maintaining breastfeeding owing to psychosocial factors. Despite the importance of these factors and their practical implications, comprehensive review research based on a robust theory in this area is lacking. This narrative review addresses this research gap by exploring the utility of the extended theory of planned behavior (ETPB) in understanding and promoting breastfeeding.MethodsA systematic search was conducted using the relevant Web of Science, Scopus, EBSCO, PubMed, and PsycINFO; 22 studies published between January 2000 and March 2023 were identified.ResultsThese included studies understanding the psychosocial factors of breastfeeding by introducing the ETPB framework, incorporating psychosocial factors such as affective attitude, instrumental attitude, injunctive norms, descriptive norms, perceived behavioral control, breastfeeding self-efficacy, moral norms, breastfeeding knowledge, and breastfeeding self-identity. Based on these factors, intervention strategies for breastfeeding enhancement were categorized into professional breastfeeding education, interpersonal social support, and personalized breastfeeding services.ConclusionsThe 22 breastfeeding studies related to the ETPB model demonstrate its effectiveness in explaining the psychosocial factors influencing breastfeeding intention and duration. The model’s application in intervention studies suggests that more diverse and proactive approaches are required to empower mothers. Future research should address societal context and cultural influences and expand interventions beyond essential information provision.

BackgroundExclusive use of hygienic methods during menstruation has not received adequate attention in Nepal, with limited research utilizing nationally representative data. Therefore, this study explored the prevalence and factors influencing exclusive hygienic menstrual practices among women of reproductive age in Nepal.MethodsThis study included 13,065 reproductive-age women from the Nepal Demographic and Health Survey (NDHS-2022). To quantify the proportion of the total variance attributable to differences between communities, the study used multilevel logistic regression and identify significant factors of exclusive use of hygienic methods among women in Nepal. The concentration Index (CI) and Concentration curve (CC) were also calculated to measure the socio-economic inequality of exclusive use of hygienic methods among reproductive age women.ResultsOnly 48% of Nepalese women aged 15- 49 years used exclusively hygienic methods to prevent bloodstains during menstruation. The results from multilevel model revealed that young women aged 15–24 (AOR = 2.52, p < 0.001), women with 10 years and above education (AOR = 1.98, p < 0.001) from the richest wealth quintile (AOR = 2.26, p < 0.001), never married women (AOR = 1.44, p < 0.001), owned a smartphone (AOR = 1.41, p < 0.001) and women with exposure to mass media at least once a week (AOR = 1.35, p < 0.001) are more likely to use hygienic methods as compared to their counterparts. The concentration curve results indicated that the exclusive use of hygiene methods is concentrated in women from higher economic backgrounds (CI: 0.21). Among the geographical regions of Nepal, the highest inequality was witnessed in Madhesh province (CI: 0.25), followed by Bagmati province (CI: 0.22).ConclusionsThe findings suggest the need for multidimensional interventions and educational programs targeting socioeconomically vulnerable women to address unhygienic menstrual practices. Also, there is a need to educate adult women on biological facts and good hygienic practices, as they can impose cultural taboos and restrictions on the next generation.

ObjectiveNiger has among the highest rates of child marriage and lowest rates of modern contraceptive use in the world. This study analyzes the association between contraceptive decision-making and contraceptive use among married adolescent girls in rural Niger, including multiple assessments of decision-making and consideration of overt vs. covert contraceptive use.MethodsWe analyzed cross-sectional survey data collected from married adolescent females (n = 823) participating in the third round of data collection (October–November 2019) for the cluster-randomized controlled trial of a family planning intervention study. Contraceptive decision-making measures assessed participants’ (a) participation in contraceptive decision-making, (b) final say in decision-making in case of spousal disagreement, and (c) satisfaction with participation in decision-making. Outcomes include contraceptive use ever categorized based on whether use was overt (with husband’s knowledge) or covert (without husband’s knowledge). Adjusted multinomial logistic regression models were used to test the associations between each decision-making item and each type of contraceptive use.ResultsOver half of participants reported ever using a contraceptive (59%) and that their husbands were the sole decision-makers regarding contraceptive use (60%). Adolescents’ participation in decision-making was negatively associated with overt contraceptive use (ARRR = 0.41; 95%CI = 0.19–0.91) and positively associated with covert contraceptive use (ARRR = 8.76; 95%CI = 2.45–31.30). Women reporting joint decision-making were more likely to report covert use vs. no use (ARRR = 3.20; 95%CI = 1.14–8.99). Women having final say in contraceptive decision-making in case of disagreements were more likely to report covert contraceptive use over no use (ARRR = 9.14; 95%CI = 3.17–26.40). Women’s satisfaction with decision-making was positively associated with contraceptive use ever (AOR = 2.72; 95%CI = 1.80–4.16), and overt (ARRR = 2.68; 95%CI = 1.75–4.01) and covert contraceptive use (ARRR = 10.9; 95%CI = 2.16–54.80).ConclusionMale control over decision-making and female satisfaction with decision-making are associated with greater contraceptive use. Findings indicate that women’s control over decision-making, and its relation to contraceptive use, is complex and requires more nuanced understanding for married adolescents.

BackgroundAccess to sexual and reproductive healthcare is internationally regarded as an essential human right. Use of modern contraception is typically selected as a key indicator of women’s reproductive rights. However, there is a growing consensus that measuring rates of modern contraceptive use may not provide a full picture of women’s reproductive autonomy. A novel framework to investigate contraceptive autonomy, which includes broader indicators to reflect knowledge, justice, and volition, has been recently proposed.MethodsWe conducted in-depth interviews in three phases in eight rural communities in northwest Tanzania with users and non-users of contraceptives using open-ended questions derived from the proposed contraceptive autonomy framework. Trained female interviewers performed one-on-one interviews in Kiswahili to explore women’s perspectives and knowledge about family planning (FP), decision-making, and experiences. Interviews were digitally recorded, transcribed verbatim, translated into English, and independently coded by two investigators.ResultsA total of 72 women were interviewed. Women had a median age of 29.5 years [interquartile range, 24–38] and a median of 4 [2–5] children. Those using modern contraception (75%) had been doing so for 1.9 [0.75–4.0] years. In the informed choice domain of contraceptive autonomy, most women could correctly name at least 3 contraceptive methods and summarize benefits and side-effects; women described risks and some benefits of non-use. In the full choice domain, health facilities had multiple contraceptives, although some stockouts were noted. In the free choice domain, nearly all women reported being free to choose to use, discontinue, or refuse FP. Many also described strong external influences that affected their decision-making about FP that were not captured by the proposed contraceptive autonomy framework.ConclusionsBoth users and non-users of FP in our study demonstrated many components of contraceptive autonomy. Their experiences have shaped our suggestions for ways to increase comprehensiveness in measuring contraceptive autonomy. These suggestions likely have broad applicability that extends beyond rural Tanzania to many other regions. Integrating assessment of external influences into evaluations of contraceptive autonomy will further expand global capacity to evaluate both access to, and autonomy about, contraceptive use as a fundamental human right.

BackgroundGlobally, adolescent health remains a public health priority given that adolescents often face unique vulnerabilities to health issues like mental disorders, substance abuse, and sexual health risks. In developing countries like Ghana, primary healthcare facilities (PHCs) are often the first point of contact for addressing these issues. However, there is a lack of literature examining the capacity of PHCs to address adolescent sexual and reproductive health (ASRH) issues. This study aims to fill this gap in the literature by assessing the availability and readiness of ASRH services within Ghana’s PHCs.MethodsThe study utilized a multi-stage sampling approach to select 67 PHCs across four districts in the Greater Accra region, reflecting Ghana's broad demographic diversity. We employed the WHO's Services Availability and Readiness Assessment (SARA) tool to measure the availability and readiness of ASRH services. This framework focused on key domains including service availability and readiness, assessing aspects such as HIV testing, family planning, and availability of contraceptives and necessary staff training. Data analysis was conducted using Stata version 17.0, analysing frequencies and percentages to capture the extent of service provision across the selected facilities.ResultsThe study highlighted significant disparities in the availability and readiness of essential ASRH services (HIV services, family planning, contraceptive pills, IUCD provisions, and male condoms) across selected districts and facility types. In Shai Osudoku, 65% of facilities offered a full range of selected ASRH services, the highest among the districts, whereas Ningo Prampram had the lowest at just 16%. In terms of facility types, 57% of CHPS facilities, 59% of health centres, and 44% of clinics provided all the selected ASRH services. Urban areas reported a 51% provision rate of these services, slightly less than the 54% observed in rural areas. Additionally, readiness disparities were evident: only 21% of urban facilities had adequate service guidelines compared to 29% in rural areas, and a higher percentage of rural facilities (46%) had trained staff, compared to 23% in urban areas.ConclusionThis study examined the availability and readiness of ASRH services in PHCs across the Greater Accra region, revealing significant disparities by location and facility type. Particularly, rural and public facilities demonstrated a higher availability of ASRH services compared to urban and private facilities. These findings suggest an uneven distribution of resources and highlight a potential urban underutilization of public health services. Moreover, the study identified a critical lack of service guidelines and trained staff across many facilities, emphasizing the need for enhanced training and resource allocation to improve service readiness. Targeted interventions are necessary to elevate the quality and accessibility of ASRH services, ensuring equitable health care delivery across all regions. Future research should expand to other regions to validate these findings and inform nationwide health strategies.