BMJ Sexual & Reproductive Health

Objective: to describe the provision of preconception care across publicly funded or contracted health and social care settings in the UK. Design and setting: online cross-sectional survey conducted October-December 2025. Population: healthcare professionals delivering preconception care, recruited via professional organisations and networks. Methods: quantitative data were analysed using descriptive statistics and qualitative free-text responses using inductive content analysis. Outcome measures: preconception care content, target population, frequency of provision, funding and commissioning models, and approaches for reporting and monitoring. Results: Eighty-seven healthcare professionals completed the survey. Most were women (89.3%), aged 41-60 (63.1%) and based in England (84.5%). Participants represented diverse roles, mainly obstetric/maternal-fetal specialists (23.0%), specialist nurses (16.0%), GPs and midwives (13.8% each). Preconception care primarily targeted women [≥]20 years (98.9%), with fewer targeting men and adolescents. Care was usually embedded within relevant consultations (69.4%), particularly contraception, medication and health condition reviews, and often a one-off interaction (75.3%). Content focused on condition-related management/medication (68.6%), folic acid (66.3%), risky behaviours (smoking, alcohol, illicit drugs) (40.7%), diet (37.2%) and weight (36.0%). Services were mostly not formally commissioned (62.4%), lacked financial incentives (84.7%) and had no audit/service evaluation requirements (81.2%). Conclusions: Preconception care in the UK is delivered by a wide range of healthcare professionals. Their engagement has improved considerably when compared with studies conducted over a decade ago, but preconception care remains fragmented, opportunistic and poorly supported by commissioning and system infrastructure. Strengthening integrated care pathways, funding mechanisms and use of standardised resources is essential to achieve consistent and equitable preconception care.

Objective: Since 2020, medication abortion provision in the U.S. has been reshaped by changing abortion policies and expanded telehealth access, yet little is known about how medication abortion service delivery has evolved. We examined national trends in service delivery from 2020 to 2025, including changes in abortion facility types, telehealth provision, and gestational limits. Study Design: Using ANSIRHs Abortion Facility Database, a national census of publicly advertising abortion facilities (2020 to 2025), we analyzed trends in medication abortion service delivery. Systematic web searches and mystery shopper calls gathered data on facility types, telehealth provision, and gestational limits. Data analysis included frequencies and comparisons across regions and states. Results: Medication abortion-only facilities increased nationally, from 35% of facilities in 2020 to 65% in 2025, with substantial growth in abortion-restrictive regions such as the Midwest and South. By 2025, 99% of facilities provided medication abortion. Telehealth provision expanded from 7 facilities in 2020 to 606 facilities by 2025, driven by growth in both brick-and-mortar facilities offering telehealth care and new virtual clinics. Overall, 46% of all facilities offered medication abortion by telehealth in 2025. Gestational limits for medication abortion increased nationally, from <1% of facilities offering medication abortion after 11 weeks in 2020 to 38% in 2025. Conclusions: Medication abortion service delivery has adapted to legal and logistical challenges by increasing telehealth options and expanding gestational limits. These changes improve access for abortion seekers, especially those living in restrictive environments. Sustaining abortion access will require ongoing provider adaptation and supportive policy environments.

Background Recent research has documented poor reproductive health among women and people assigned female in England. Access to reproductive health services is hindered by an opaque and fragmented system. Methods We conducted the 2023 Reproductive Health Survey for England, a non-probability online survey, in September and October 2023 (N = 59,332). In this analysis, we examined access to reproductive health services across three domains: heavy menstrual bleeding and severe pain, gynaecological symptoms and conditions and menopause-related symptoms. Weighting the sample to match the 2021 Census age distribution, we assessed differences by ethnic group, subjective financial situation, educational attainment and region across the domains using logistic regression analysis and controlling for age. Results Respondents reported low access to reproductive health services overall, including 34.8% (8,644/24,952) of those with heavy bleeding or severe period pain, 44.7% (6,709/15,569) with menopausal symptoms and 55.3% (21,010/37,411) with gynaecological symptoms or conditions. When controlling for age, there were decreased odds of service access for menopause-related symptoms and increased odds of service access for gynaecological symptoms or conditions among Black ethnic groups. Respondents with a higher education degree had greater access to services for heavy bleeding or severe pain and gynaecological symptoms and conditions. Compared to London, all other regions had lower access to services for heavy bleeding or severe pain. Satisfaction ranged from 16.5% (741/4,666) for polycystic ovary syndrome services to 80.2% (166/207) for reproductive cancer services. Conclusions Access to reproductive health services is poor in England and requires urgent action to address barriers to access.

Background: Female sterilisation is the most widely used contraceptive method in India. But nationally representative evidence on the frequency, outcome and correlates of sterilisation failure remains scarce. The objectives of this study were to estimate the prevalence of contraceptive failure, describe the outcomes of pregnancies resulting from failure, determine the time interval between sterilisation and failure, and compute the Pearl Index. Methods: This secondary data analysis used the Individual Recode dataset of the National Family Health Survey 5 (NFHS 5). Sterilisation failure was derived from reproductive and contraceptive history variables. Weighted prevalence, socio-demographic and procedural correlates, and a Pearl Index were estimated using survey-adjusted statistical methods. Results: Among 189,021 women who had adopted sterilisation, 623 (weighted prevalence 0.34%) experienced a failure. The most common outcome of sterilisation failure was abortion (96.0%). The Pearl Index was 2.87 failures per 100 woman-years (95% CI: 2.58, 3.20). Failure was significantly associated with years since sterilisation, decade and age at sterilisation, marital duration, parity, place and type of sterilisation (all p<0.05), but not with education, religion, caste, or wealth index. Failures occurred at any point from one month to over a decade after the procedure, with a disproportionately higher share among women sterilised at mobile clinics/camps. Conclusion: Female sterilisation failure in India, while uncommon, is not negligible and persists well beyond the immediate postoperative period. Procedural quality of care, particularly at camp-based settings, appears to be a key modifiable driver. The postoperative counselling needs to include a clear message that a missed period any time after (months to year) sterilisation can be a pregnancy resulting from failure of sterilization.

Background: Unintended pregnancies can introduce stress and shift life trajectories. Social support may buffer these effects, yet its influence during an unintended pregnancy and into the early parenthood period is not clear. This study aimed to understand the types and gaps of social support experienced throughout this period. Methods: This study utilized interview data under the RISE UP study in The Hague, the Netherlands. 13 mothers and 8 partners who experienced an unintended pregnancy participated in semi structured interviews between 2024 and 2025. Interviews were thematically analyzed using House's social support framework. Results: Different types of support were highlighted across the entire timeline from pregnancy to early parenthood, underlining its dynamic nature. Emotional and instrumental support stood out the most throughout. A key form of emotional support was knowing that support is available, even if not needed immediately. Conclusions: Perceived support during unintended pregnancy is shaped more by contextual factors than by pregnancy intention. While emotional and instrumental support are valued throughout, their form differs by the family's unique circumstances, emphasizing the need for tailored support across the perinatal and postpartum periods.

Background Parental health before pregnancy influences maternal and child outcomes. Primary care professionals, including general practitioners [GPs], midwives, and naturopaths, can provide preconception care, yet many report limited knowledge and difficulty accessing relevant information. This study described Australian GPs, midwives, and naturopaths preconception health literacy, including knowledge and ability to access information. Methods Between July and September 2022, Australian GPs, midwives, and naturopaths completed a 32-item online cross-sectional survey. Participants were recruited through professional associations, and data were analysed using descriptive and inferential statistics Results Participants (N=373) included naturopaths (40.7%), GPs (32.4%), and midwives (26.8%). Reported barriers to clinician health literacy including lack of preconception care resources (25.5%), and limited clinician knowledge (23.6%). The proportion identifying limited clinician knowledge differed significantly between professions (GP: 31.4%; midwives: 23.0%; naturopaths: 17.8%; p=0.030). The highest level of accurate knowledge regarding preconception exposures was for pre-pregnancy obesity (82.7%), while low birth weight was the most accurately identified preconception outcomes (83.7%). Incorrect responses were most common for maternal multivitamin use as an exposure (28.3%) and childhood leukaemia as an outcome (26.3%). Differences between professions were strongest for infant outcomes, with moderate associations observed for shoulder dystocia (V=.2355), precipitous labour (V=.2173), macrosomia (V=.2060), labour dystocia (V=.2018) and cryptorchidism (V=.2018). Discussion Preconception health literacy varies across primary care professions. Clinicians require greater access to targeted resources and education tailored to their differing scopes of practice and experience. Improving clinician preconception health literacy may strengthen consistent evidence-based care and support better maternal, child, and long-term family health outcomes.

Background There has been a proliferation of new person-centered and human rights-based contraception measures in recent years, though their application in research remains limited. Improved measures offer an opportunity to examine how contraceptive decision-making agency relates to individuals ability to act in line with their contraceptive preferences. We sought to assess the association between contraceptive agency and subsequent Preference-aligned Fertility Management (PFM) over 12 months in a cohort of women in rural Uganda. Methods We analyzed data from a prospective cohort study conducted in five largely rural Ugandan districts from 2022 to 2024. Data were collected at baseline, 6 and 12 months from a convenience sample of women who were new users of contraception or not using contraception. We used mixed-effects logistic regression models to examine the association between baseline Agency in Contraceptive Decisions Scale overall and subscale scores and future PFM Index scores at 6 and 12 months, assessing whether associations varied over time using interaction terms for follow-up time point. We used interactions between agency scores and follow-up visit to assess whether associations differed between the 6- and 12-month visits. We assessed effect modification by age group and baseline contraceptive method category using three-way interaction terms and predicted probabilities. Results The analytic sample comprised 2,227 women. The percentage of women practicing PFM increased from 85.7% at baseline to 93.3% at 12 months. A one-unit increase in Agency in Contraceptive Decisions Scale score was associated with higher odds of subsequent PFM (aOR: 1.68, 95% CI: 1.10-2.54). Subscales 3 (knowledge aligned with preferences) and 4 (control over use or non-use) of the Agency in Contraceptive Decisions Scale were significantly associated with future PFM (aOR: 1.31, 95% CI: 1.04-1.66 and aOR: 1.27, 95% CI: 1.06-1.51, respectively). The association between overall contraceptive agency and PFM did not differ between the 6- and 12-month visits. Three-way interaction tests suggested that the associations between the overall Agency in Contraceptive Decisions Scale score and the PFM outcomes varied jointly by age group and baseline contraceptive method category: overall PFM Index (p<0.001), PFM1 (p=0.011), and PFM2 (p<0.001). Conclusion Our findings suggest that higher levels of contraceptive agency may help women act in line with their contraceptive preferences. Increasing womens knowledge and control over contraceptive use may be particularly essential for preferred contraceptive use. The findings also suggest that the association between contraceptive agency and PFM may vary by womens age group and the method of choice, though further exploration is necessary to examine this influence.

Objective To evaluate the feasibility, safety, patient acceptance, and preliminary clinical relevance of automated self-operated transvaginal ultrasound for ovarian stimulation monitoring. Design Prospective observational pilot study. Subjects Ten women undergoing ovarian stimulation for in vitro fertilization or fertility preservation at a single high-volume private IVF center. Exposure Participants performed investigational self-operated transvaginal ultrasound examinations immediately following standard monitoring visits. Patients inserted and stabilized the ultrasound probe while ovarian and endometrial imaging was acquired through controlled motorized probe rotation without real-time anatomical guidance. Main Outcome Measure(s) The primary outcome was feasibility, defined as the generation of evaluable imaging datasets suitable for ovarian stimulation monitoring. Secondary outcomes included bilateral ovarian visualization, procedural safety, patient-reported outcomes, follicular assessment, and agreement of endometrial thickness measurements with standard transvaginal ultrasound. Result(s) Nineteen investigational scan attempts were performed, yielding 18 evaluable datasets (94.7%). Bilateral ovarian visualization was achieved in 16 of 18 evaluable examinations (88.9%), whereas partial ovarian visualization occurred in 2 examinations (11.1%). No adverse events, adverse device effects, vaginal injury, bleeding, or infection were observed. Patient-reported outcomes demonstrated high procedural acceptability, with all participants expressing willingness to reuse the system. Compared with standard transvaginal ultrasound monitoring, investigational self-operated acquisition significantly improved overall examination experience (Wilcoxon p=0.002). Investigational imaging demonstrated clinically relevant agreement with standard transvaginal ultrasound for follicular categorization and endometrial assessment. Counts of follicles [&ge;]14 mm correlated strongly with mature oocyte recovery for both investigational and standard ultrasound measurements (Spearman {rho}=0.83 and {rho}=0.80, respectively). Endometrial thickness measurements also demonstrated strong correlation between modalities (Spearman {rho}=0.91). Conclusion(s) This prospective pilot study demonstrates the feasibility of automated self-operated transvaginal ultrasound during ovarian stimulation monitoring. Investigational imaging generated clinically relevant monitoring information without observed safety concerns and was associated with high patient acceptance. These findings support further investigation of patient-operated acquisition strategies and standardized imaging workflows in reproductive medicine.

Background Preventing sexually transmitted re-infections brings health benefits and can be significantly less costly than treating their sequelae. Safetxt is a potential novel digital intervention developed to promote safer sexual behaviours. However, a recent randomised controlled trial of safetxt found no effect on reinfection at 1 year (OR 1.13, 95%CI: 0.98-1.31). We investigated if safetxt's effect was mediated through sexually risky behaviours. Methods We used data from 6248 young people with STIs from 92 UK sexual health clinics. The direct and indirect effects of safetxt on reinfection were estimated using the counterfactual approach. Condom use at last sexual encounter, number of sexual partners and STI testing were assessed as mediators. These were analysed singly and together, using regression models and a formal weighting approach. The assumptions of each approach were considered and tested. Analyses were repeated in the subgroup showing the most promising effect of safetxt: men who have sex with men or with men and women (MSM/MSMW). Results No evidence was found for the total, indirect or direct effects differing from the null. Despite not being significant, for MSM/MSMW, some of safetxt's effect on reducing reinfection was identified as being offset through its effect on number of sexual partners. Conclusions There was no evidence that safetxt's effect on reinfection was mediated through changes in sexually risky behaviours. Adaptations to specifically target these behaviours are unlikely to improve safetxt's overall effect. However, improving safetxt's effect on the number of sexual partners a participant has may improve its effect for MSM/MSMW.

Introduction: The preconception period (i.e. the weeks and months before pregnancy) is a critical window during which parental health behaviours can influence pregnancy outcomes and the childs long-term health. Modifiable factors such as nutrition, physical activity, substance use, and environmental exposures play a key role, yet womens ability to adopt and sustain healthy behaviours is shaped by complex psychological, social and environmental influences. This study applies the Theory of Planned Behaviour to identify the beliefs underpinning womens preconception behaviours, with the aim of informing support for effective and sustained health behaviour change. Methods: An Australian national retrospective cross-sectional survey of pregnant women (18-49 years), recruited through social media platforms. The 92-item survey captured respondent socio-demographics, pregnancy status and health conditions, health behaviours, and beliefs regarding preconception health behaviours. Respondents level of pregnancy planning was categorised using the London Measure of Unplanned Pregnancy (LMUP). Items regarding preconception beliefs were structured in accordance with the Theory of Planned Behaviour, with a focus on regular exercise, healthy diet, and alcohol avoidance. These beliefs variables were analysed using structured equation modelling to identify paths between latent variables and the items used to estimate each concept. Results: The study was completed by 430 pregnant women of whom 72.7% had a planned pregnancy. Most had a partner, were university educated and in good health. Structural equation modelling showed intention strongly predicted exercise ({beta}=0.65), healthy diet ({beta}=0.54) and alcohol avoidance ({beta}=0.64). Perceived control and partner norms influenced intentions, whereas health professional norms had limited effect. Positive beliefs were associated with folate supplement use and smoking cessation. Conclusion: These findings highlight intention as a key driver of preconception health behaviours, with perceived control and partner influences playing a more significant role than individual beliefs or health professional input. Effective interventions should therefore address structural barriers and actively involve partners, while respecting womens autonomy. Overall, couples-focused, multi-level strategies are likely essential to support meaningful and sustained preconception health behaviour change.

BACKGROUND: Sexual pleasure is integral to sexual health, offering important physical and mental benefits. Yet, sex education programs often neglect pleasure, focusing instead on preventing sexual risk behaviors (SRBs), which young adults are particularly vulnerable to. AIM: This study investigates the association between SRBs and sexual pleasure in young adults and whether sex assigned at birth moderates this relationship. METHODS: Embedded within the Generation R cohort, 1010 young adults completed an online questionnaire assessing sexual pleasure using the six subscales of the Amsterdam Sexual Pleasure Inventory (ASPI 1.0), Arousal Enjoyment, Enjoyment-Related Self-Efficacy, Enjoyment-Related Self-Worth, Interaction Enjoyment, Bonding Enjoyment, and Sexual Experience Enjoyment, and various SRBs including sexual debut <15 years, six or more lifetime partners, frequent unprotected sex, and substance use during sex. Multiple linear regression analyses were performed for each SRB and sexual pleasure subscale, adjusting for demographics, self-esteem, relationship status, socioeconomic status, and psychopathology, with additional stratification by sex assigned at birth. OUTCOMES: The primary outcome measure is sexual pleasure, measured across six domains, examined in relation to SRBs. RESULTS: Fully adjusted regression analyses showed that engaging in SRB was positively associated with several dimensions of sexual pleasure. All SRBs were associated with higher Enjoyment-Related Self-Efficacy (ERSE) scores (p<0.002). Early sexual debut was additionally linked to higher Interaction Enjoyment scores, while having six or more lifetime partners was associated with increased Enjoyment-Related Self-Worth and Sexual Experience Enjoyment scores (p<0.002). Some associations, particularly involving ERSE, were only significant among males. Individuals without partnered sexual experience reported lower sexual pleasure scores. CLINICAL IMPLICATIONS: Incorporating sexual pleasure into sex education could promote a more balanced, realistic understanding of sexuality among young adults, emphasizing both enjoyment and responsible sexual decision-making. STRENGHTS & LIMITATIONS: Key strengths of this study are the use of the multidimensional Amsterdam Sexual Pleasure Inventory (ASPI 1.0) and the large population-based cohort study design, enabling a nuanced and generalizable analysis. This study is limited by potential selection and reporting bias, the cross-sectional design, residual confounding, and the absence of universally agreed-upon thresholds for defining SRBs. CONCLUSION: These findings suggest there is a positive association between engagement in SRB and sexual pleasure, possibly reflecting greater overall sexual experience. The stronger associations observed among males might reflect gendered differences in the role of self-esteem and societal expectations.

Aim: To determine the prevalence, degree and timing of pregnancy planning among pregnant women in Australia and identify the specific health behaviours with which pregnant women engage during specified preconception timeframes. Methods: A national retrospective cross-sectional survey conducted December 2020 to September 2021 including a convenience sample of pregnant women aged 18 to 49 years in Australia and their reproductive partners, recruited through social media platforms. Results: Overall, 615 eligible women with relevant survey items were included in this study with 59.6% (95% CI 55.6, 63.4) of pregnancies categorised as planned, 38.3% (95% CI 34.5, 42.2) as ambivalent and 2.1% (95% CI 1.2, 3.6) as unplanned. Unplanned/ambivalent pregnancies were most common in women under 20 years old and least common in women aged 30 to 39 years (p=0.05). They were also most common among women who were married (56.6% vs 47.8%; p=0.001), university qualified (70.3% vs 52.6%; p<0.001) and in full-time employment (56.9% vs 44.9%, p=0.002). Actions to improve preconception health were generally uncommon; however, they were more likely in women who planned their pregnancies. For example, 42.7% of women with ambivalent/unplanned pregnancies reported consuming folic acid/pregnancy multivitamin before pregnancy compared with 83.3% among those who planned their pregnancy (p<0.001). Preconception financial status, BMI and general health were also associated with pregnancy planning (p<0.05). Conclusion: Almost all women in this survey identified some level of pregnancy planning -- including planned and ambivalent pregnancies -- yet actions to improve their preconception health were uncommon. In addition to promoting specific actions that individuals can undertake with regards to preconception health, it is vital that the impact of structural barriers and wider determinants of health (e.g., out-of-pocket health costs, health literacy, and clear identification of health professionals trained to deliver preconception care) be adequately considered and addressed in terms of preconception health promotion, planning and policy. Such a broad approach can help strengthen attempts to improve pregnancy planning and preconception health.

Background: Post-abortion care (PAC) encompasses emergency treatment, counselling, contraceptive services, and referral linkages. Emergency post-abortion care (EPAC), the life-saving component of PAC, addresses acute abortion-related complications, including haemorrhage, sepsis, retained products of conception, and severe pain. In Uganda, where abortion is legally restricted and socially stigmatised, womens care experiences are shaped by clinical urgency, fear, moral vulnerability, provider interactions, and structural health system constraints. Despite EPACs centrality to maternal survival, qualitative evidence on how women interpret and evaluate their care experiences in referral hospital settings in Uganda remains limited. This study explored womens experiences of EPAC at Kawempe National Referral Hospital (KNRH) and identified the factors that shaped those experiences. Methods: A qualitative phenomenological design was employed. Sixteen in-depth interview transcripts from women who received EPAC at KNRH in March-April 2026 were analysed using inductive thematic analysis. The Socio-Ecological Model (SEM) was applied as an interpretive framework. Results: Six themes were identified: (1) survival and physical relief as the immediate measure of good care; (2) pain, fear, and emotional distress during treatment; (3) reassurance and support as buffers against vulnerability; (4) dignity under pressure: communication and privacy in EPAC; (5) structural barriers across the pathway of care; and (6) experiences beyond discharge: incomplete recovery and uncertainty. Care was frequently evaluated through the lens of survival, yet these accounts co-existed with intense procedural pain, compromised privacy, delays, financial burden, and inadequate post-discharge support. EPAC at KNRH was experienced as a complex encounter shaped by bodily vulnerability, interpersonal dynamics, and system-level constraints. Conclusions: Strengthening EPAC requires patient-centred approaches that integrate clinical effectiveness with respectful communication, pain management, improved triage, and structured post-discharge support.

Background: Patients with high-risk pregnancies due to placenta accreta spectrum (PAS) are at high risk of morbidity and mortality, which may increase risk for childbirth related mental health sequelae including postpartum post-traumatic stress disorder (PTSD) and trauma symptoms. However, there has been limited investigation into these patients' mental health needs. We aimed to use qualitative data to understand PAS patients' mental health experiences through their obstetric course, and to generate recommendations for the delivery of mental health support to these patients. Methods: This exploratory study used a focus group format with patients who had a history of PAS. General questions about patient's pregnancies, births, and postpartum experiences were asked by mental health professionals. Using a rapid qualitative analysis approach, transcriptions of these focus groups were coded by three psychiatrists and core themes were extracted. Results: We conducted four focus groups with a total of 22 women. Major emotional themes included fear and isolation during the antepartum period, and grief, anxiety, and trauma in the postpartum period. Both periods were associated with a negative emotional impact on relationships with family members. Sadness & depression were less prominent among participants' experiences. Participants felt that mental health care resources needed to be integrated with their obstetric care, extend further into the postpartum period, and should be as specific as possible to their medical condition. Conclusions: Based on the results of these focus groups, we propose that patients with high-risk pregnancies and/or a history of traumatic birth should have access to expert mental health care that is integrated with their obstetric care. These patients may benefit from extended obstetric follow-up. Mental health screening in these populations should focus on anxiety and trauma symptoms rather than only screening for depression. Future studies should continue to examine these factors in a broader group of women with high-risk pregnancies beyond PAS.

Stigmatizing language in medical documentation may reflect and perpetuate bias, but its prevalence in obstetrics has not been systematically quantified. We applied a keyword-guided BERT classifier to 640,345 obstetric notes from 26,178 pregnancies at an academic medical center. Stigmatizing language was detected in 47% of 26,178 pregnancies. Black pregnancies had significantly higher odds of stigmatizing language compared with Asian (aOR=1.5, p=3x10-8) or White (aOR=1.4, p=6x10-6). Indicated and spontaneous preterm births were also significantly associated with stigmatizing language compared to term (aORs=1.5, 1.2; p=7x10-12, 0.01). Pregnant individuals with only 12th-grade maternal education were more likely to experience stigma than those with college (aOR=1.5; p=4x10-14). These findings provide evidence of differences in clinical documentation across race, education levels, and clinical conditions. They also demonstrate how automated natural language processing can enable systematic monitoring of bias in healthcare language at scale.

Introduction:Relational dynamics between partners within a couple planning pregnancy are critical to their preconception health behaviour change and are largely underexamined. Given the need for both reproductive partners to engage in beneficial preconception health behaviours and the influence couples have on each others behaviour, this study examines the concordance between pregnancy planning and preconception health behaviours and health information-seeking within reproductive partner dyads. Methods:A retrospective observational study was undertaken utilizing data from two online cross-sectional 80-item surveys administered simultaneously between December 2020 and September 2021. Eligible study participants were females or birthing people aged 18-49 living in Australia during any stage of pregnancy, and reproductive partners of those that met these criteria. The survey items covered sociodemographic characteristics, level of pregnancy planning, preconception health behaviours, health information seeking, and health history. Cohens kappa (K) (categorical variables) and interclass correlation coefficients (ICC) (continuous variables) were used to identify agreement within the couples. Results:Eighty matched dyads of pregnant females and non-pregnant partners were included. Concordance in pregnancy planning was fair (K=0.27) and was primarily seen in couples where both partners reported the pregnancy as planned (42.5%) or ambivalent (18.8%). Couples had very low similarity (ICC:0.22) in weekday alcohol consumption 3 months preconception (pregnant females: 1.2 standard drinks per day (SD1.7); non-pregnant partners: 2.5/day (SD3.5)). Approximately one quarter (26.3%) of couples reported similarities in partners attempting and succeeding in preconception health information-seeking 12 months before pregnancy. There was greater concordance in not discussing preconception health topics with GPs, including topics explicitly covered within clinical guidelines. Conclusion:There is notable discordance in couples preparation for pregnancy in many behaviours relevant to positive pregnancy outcomes, and in their health service engagement and experience. There is a clear need to provide care to both reproductive partners to ensure the best possible outcome for the future generations.

Abstract Introduction Intrauterine fetal death (IUFD) beyond 24 weeks of gestation, particularly when accompanied by an unfavourable cervix, poses a distinct obstetric challenge in achieving safe and timely vaginal delivery while minimising maternal distress. Mifepristone priming followed by misoprostol and intracervical Foley's catheter combined with misoprostol are both established approaches for cervical ripening and induction of labour in this setting, but direct comparative data especially from Indian tertiary care populations remain limited. Methods This prospective comparative study was conducted in the Department of Obstetrics and Gynaecology, Kamla Raja Hospital, Gajra Raja Medical College (GRMC), Gwalior, Madhya Pradesh, India, over a two-year period (November 2020 - October 2022). One hundred and fourteen women with ultrasonography-confirmed IUFD beyond 24 weeks of gestation were alternately allocated to Group A (n=57; oral mifepristone 200 mg followed by gestational-age-adjusted vaginal misoprostol) or Group B (n=57; intracervical 16F Foley's catheter followed by gestational-age-adjusted vaginal misoprostol). Outcomes assessed included pre- and post-induction Bishop score, induction-to-delivery interval, misoprostol dose requirement, need for oxytocin augmentation, mode of delivery, blood loss, maternal complications, pain (visual analogue scale, VAS), and patient satisfaction. Results Baseline age, parity, gestational age, and pre-induction Bishop score were comparable between groups (p>0.05). The mean post-induction (24-hour) Bishop score was significantly higher in Group A (7.39+/- 2.07) than Group B (6.37+/-1.89; p=0.007). The mean induction-to-delivery interval was significantly shorter in Group A (25.43+/- 6.84 hours) than Group B (29.26+/- 5.54 hours; p=0.0014), and the median misoprostol dose requirement was significantly lower in Group A (50 mcg) than Group B (100 mcg; p<0.01). Mode of delivery, blood loss, oxytocin augmentation requirement, and overall maternal complication rates did not differ significantly between groups (all p>0.05). Pain scores were significantly lower in Group A (VAS 2.83+/- 1.16) than Group B (VAS 6.18+/- 1.69; p<0.0001), while patient satisfaction was comparable between groups (96.5% vs. 91.23%; p=0.244). Conclusions Both mifepristone-misoprostol and Foley's catheter-misoprostol regimens are safe and effective methods for induction of labour following IUFD beyond 24 weeks of gestation with an unfavourable cervix. Mifepristone priming achieved a shorter induction-to-delivery interval, lower total misoprostol requirement, and substantially less procedural pain, making it an attractive first-line option where available, while Foley's catheter remains a safe, low-cost, and widely accessible alternative, notwithstanding lower patient comfort.

Background: Unintended adolescent pregnancies remain a public health challenge in Zambia, where LARC use is low despite their effectiveness. Barriers such as stigma, misconceptions, and limited access persist. Previous studies conducted in Lusaka district did not explore the challenges faced by adolescents in trying to access and use LARCs. Understanding these challenges is crucial for developing targeted interventions to promote safe and effective contraception practices. This study examined factors influencing adolescent knowledge, willingness, and uptake of LARCs in public health facilities in Lusaka. Methods: A cross-sectional study was conducted between November 2024 and March 2025 among adolescent girls aged 15-19 years in five first-level hospitals in Lusaka, Zambia, using structured questionnaires to obtain quantitative data1. LARC use was measured as a binary outcome, with multiple regression identifying associated factors. Results: There were 400 participants in total, of whom 48% (181/376) had ever used a LARC. In the adjusted model, age was significantly associated with LARC use (AOR = 1.27, 95% CI: 1.11-1.77; p < 0.001). Adolescents who were willing to delay pregnancy had markedly higher odds of using LARCs (AOR = 7.46, 95% CI: 1.42-39.06; p = 0.017). Knowledge of LARCs remained a strong independent predictor, more than doubling the likelihood of uptake (AOR = 2.69, 95% CI: 1.12-6.46; p = 0.027). Having children was also significantly associated with higher LARC use (AOR = 2.62, 95% CI: 1.11-6.23; p = 0.029), while participants with unknown HIV status had lower odds of LARC use (AOR = 0.31, 95% CI: 0.10-0.97; p = 0.044). In addition, adolescents residing in Chipata had substantially higher odds of LARC uptake compared to those in Kanyama (AOR = 317.93, 95% CI: 35.01-2887.2; p < 0.001). Conclusions: The findings indicate that age, knowledge of LARCs, reproductive experience (having children), and willingness to delay pregnancy were significantly associated with higher odds of LARC uptake, and almost half of the participants had already used a LARC method. Although higher education showed an upward trend, it was not statistically significant in the adjusted model. Limited awareness and variability in service delivery across clinics highlight the need for strengthened counseling and reliable access to LARCs. As this study focused only on adolescents already attending Family Planning Clinics, further research is needed to assess LARC availability, accessibility, and quality of counseling across different settings in Zambia.

Introduction: Oxytocin is commonly used in the process of induction of labour and is associated with uterine hyperstimulation and abnormal fetal heart rate patterns that can increase the risk of adverse perinatal outcomes. Cessation of oxytocin in the active phase of induced labour has been shown in randomised trials to reduce uterine tachysystole and abnormal fetal heart rate traces, and may reduce caesarean section. We introduced a policy recommending cessation of oxytocin infusion in the active phase of the first stage of induced labour at a tertiary hospital in Sydney, Australia, and collated both clinical outcomes and maternal satisfaction following implementation. Methods: This was a prospective audit of a policy change at Royal Prince Alfred Hospital, comparing 600 women induced with oxytocin in the 6 months before the policy (November 2019 to May 2020) with 556 women induced in the 6 months after implementation (June to December 2020). Eligible women had a cervix [&ge;] 5cm, an oxytocin infusion, and regular uterine contractions. The primary clinical outcome was caesarean delivery. The primary patient-centred outcome, maternal satisfaction, measured using the Six Simple Questions questionnaire, was collected in a subset of participants. Secondary outcomes included mode of birth, length of labour, uterine hyperstimulation, and perinatal outcomes. Results: Caesarean delivery occurred in 29% of women before and 28% after policy implementation (p=0.77). Instrumental birth increased from 25% to 27%; and instrumental birth for maternal indications increased from 6.8% to 13% (p=0.0005). Median length of labour increased by one hour (5.4 vs 6.4 hours, p=0.006). Oxytocin was ceased for at least two hours or until birth in 13% of women before the policy versus 35% after. Maternal satisfaction scores were modestly lower after implementation (median 41 vs 38, p=0.03). Perinatal outcomes, including abnormal cord gases, Apgar scores, and NICU admission, were similar between groups. Conclusions: Implementing a policy of recommending cessation of oxytocin in the active phase of induced labour did not reduce caesarean delivery rates in a real-world tertiary hospital setting, despite trial-level evidence supporting the intervention. Poor uptake, negative staff perceptions, and a modest reduction in maternal satisfaction highlight barriers to translating trial efficacy into routine clinical practice. Adequately powered trials are needed to clarify optimal protocols for oxytocin cessation and its effects on maternal and perinatal outcomes.

Background The Democratic Republic of Congo (DRC) bears one of the highest maternal mortality ratios globally (746 per 100,000 live births), with nearly 11% of deaths attributable to complications of unsafe abortion. Despite ratification of the Maputo Protocol and related national policies, access to safe abortion remains limited, largely due to entrenched stigma. Social support, encompassing emotional, informational, and instrumental assistance, is critical in shaping womens abortion-seeking behaviors and health outcomes. This study examines the influence of community-level knowledge on stigma and social support for women seeking abortion care. Methods A cross-sectional survey was conducted from May 2024 to June 2024 among 1,715 adults in Kinshasa and North Kivu provinces. Analyses focused on a sub-sample of 574 respondents reporting familiarity with women who had undergone abortion. Structural Equation Modeling (SEM) was applied to estimate direct and indirect pathways linking community knowledge, stigma, and social support. Results Two core knowledge indicators, recognition of abortion as a safe medical procedure and awareness of legal conditions for access, were significantly associated with outcomes. A one-unit increase in knowledge corresponded to a 0.39-point increase in social support and a 0.19-point reduction in stigma. Enhanced knowledge promoted empathetic attitudes, reinforced practical support, and mitigated moralizing judgments toward women seeking abortion. Conclusions Strengthening community knowledge emerges as a strategic lever to reduce abortion-related stigma and enhance social support in the DRC. These findings underscore the importance of integrating stigma-reduction and knowledge-enhancement interventions into reproductive health programs to improve womens access to safe and dignified abortion care.