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• v.29(1); 2021

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Mapping the scientific literature on reproductive health among transgender and gender diverse people: a scoping review

Madina agénor.

a Gerald R. Gill Assistant Professor, Department of Community Health, Tufts University, Medford, MA, USA; Adjunct Faculty, Department of Obstetrics and Gynecology, Tufts University School of Medicine, and The Fenway Institute, Fenway Health, Boston, MA, USA

Gabriel R. Murchison

b PhD Student, Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA

Jesse Najarro

c Undergraduate Student, Department of Community Health, Tufts University, Medford, MA, USA

Alyssa Grimshaw

d Clinical Research and Education Librarian, Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA

Alischer A. Cottrill

e Research Coordinator, Planned Parenthood League of Massachusetts, Boston, MA, USA

Elizabeth Janiak

f Director of Social Science Research, Planned Parenthood League of Massachusetts, Boston, MA, USA; Assistant Professor, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital, Boston, MA, USA and Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA; Instructor, Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA

Allegra R. Gordon

g Assistant Professor, Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA; Instructor, Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA, and Department of Pediatrics, Harvard Medical School, Boston, MA, USA

Brittany M. Charlton

h Assistant Professor, Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA, Department of Pediatrics, Harvard Medical School, Boston, MA, USA and Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA

We conducted a scoping review to map the extent, range and nature of the scientific research literature on the reproductive health (RH) of transgender and gender diverse assigned female at birth and assigned male at birth persons. A research librarian conducted literature searches in Ovid MEDLINE®, Ovid Embase, the Cochrane Library, PubMed, Google Scholar, Gender Studies Database, Gender Watch, and Web of Science Core Collection. The results were limited to peer-reviewed journal articles published between 2000 and 2018 involving human participants, written in English, pertaining to RH, and including disaggregated data for transgender and gender diverse people. A total of 2197 unique citations with abstracts were identified and entered into Covidence. Two independent screeners performed a title and abstract review and selected 75 records for full-text review. The two screeners independently extracted data from 37 eligible articles, which were reviewed, collated, summarised, and analysed using a numerical summary and thematic analysis approach. The existing scientific research literature was limited in terms of RH topics, geographic locations, study designs, sampling and analytical strategies, and populations studied. Research is needed that: focuses on the full range of RH issues; includes transgender and gender diverse people from the Global South and understudied and multiply marginalised subpopulations; is guided by intersectionality; and uses intervention, implementation science, and community-based participatory research approaches. Further, programmes, practices, and policies that address the multilevel barriers to RH among transgender and gender diverse people addressed in the existing scientific literature are warranted.

Résumé

Nous avons réalisé une étude bibliographique pour répertorier l’étendue, la portée et la nature des publications sur la recherche scientifique relative à la santé reproductive des personnes transgenres ou de genre divers désignées de genre féminin à la naissance (AFAB) et désignées de genre masculin à la naissance (AMAB). Une bibliothécaire a mené des recherches documentaires sur Ovid MEDLINE®, Ovid Embase, la Cochrane Library, PubMed, Google Scholar, Gender Studies Database, Gender Watch et Web of Science – Core Collection. Les résultats étaient limités aux articles de revues à comité de lecture publiés entre 2000 et 2018 avec des participants humains, rédigés en anglais, en rapport avec la santé reproductive et qui comprenaient des données ventilées pour les personnes transgenres et de genre divers. Un total de 2197 documents avec des résumés ont été identifiés et enregistrés dans Covidence. Deux personnes indépendantes chargées de la sélection ont analysé les titres et les résumés et 75 entrées ont été retenues pour un examen du texte intégral. Les deux sélectionneurs ont extrait de manière indépendante des données de 37 articles éligibles, qui ont été examinées, compilées, résumées et analysées à l’aide d’une méthode de synthèse numérique et d’analyse thématique. Les publications disponibles sur des recherches scientifiques étaient limitées du point de vue des thèmes de santé reproductive, des lieux géographiques, des conceptions des études, des échantillons et des stratégies d’analyse, ainsi que des populations étudiées. Nous avons besoin de recherches qui se concentrent sur tout l’éventail des questions de santé reproductive, qui comprennent les populations transgenres et de genre divers originaires des pays du Sud ainsi que des sous-populations sous-étudiées et marginalisées à plus d’un titre, des recherches qui soient guidées par l’intersectionnalité et aient recours à l’intervention, aux sciences de l’implémentation et à des approches de recherche participative à assise communautaire. Des programmes, des pratiques et des politiques portant sur les obstacles à la santé reproductive sur plusieurs niveaux parmi les personnes transgenres et de genre divers qui sont traités dans les publications scientifiques existantes sont aussi justifiés.

Realizamos una revisión de alcance para mapear el alcance, la extensión y la naturaleza de la literatura de investigaciones científicas sobre la salud reproductiva de personas transgénero y de género diverso asignadas el género femenino al nacer (AFAB) y asignadas el género masculino al nacer (AMAB). Una bibliotecaria de investigación realizó búsquedas de la literatura en Ovid MEDLINE®, Ovid Embase, la Biblioteca de Cochrane, PubMed, Google Scholar, la Base de Datos de Estudios de Género, Gender Watch y en la Colección Principal de Web of Science. Los resultados fueron limitados a artículos en revistas revisadas por pares, publicados entre los años 2000 y 2018, con participantes humanos, redactados en inglés, relativos a la salud reproductiva, y que incluían datos desagregados para personas transgénero y de género diverso. Un total de 2,197 citas únicas con resúmenes fueron identificadas e ingresadas en Covidence. Dos examinadores independientes realizaron la revisión de títulos y resúmenes, y 75 registros fueron seleccionados para la revisión del texto completo. Los dos examinadores extrajeron independientemente datos de 37 artículos elegibles, que fueron revisados, compilados, resumidos y analizados utilizando un resumen numérico y el enfoque de análisis temático. La literatura existente de investigaciones científicas estuvo limitada con relación a los temas de salud reproductiva, lugares geográficos, diseños de estudio, muestreo, estrategias analíticas y poblaciones estudiadas. Se necesitan investigaciones enfocadas en la gama completa de temas de salud reproductiva, que incluyan a personas transgénero y de género diverso del Sur Global, así como a subpoblaciones poco estudiadas y múltiples subpoblaciones marginadas, que estén guiadas por la interseccionalidad, y que utilicen enfoques de intervención, de ciencia de la implementación y de investigación participativa comunitaria. Además, se necesitan programas, prácticas y políticas que aborden las barreras multinivel a la salud reproductiva entre personas transgénero y de género diverso tratadas en la literatura científica existente.

Introduction

In 1994, the International Conference on Population and Development (ICPD) defined reproductive health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes”. 1 The ICPD agreed on a broad definition of reproductive health that includes a quality and safe sex life, the opportunity to reproduce, and the autonomy to decide if, when, and how to pursue reproduction. 2 , 3 While some progress has been made, the reproductive health and rights of all groups – especially those who are socially and economically marginalised as a result of structural and interpersonal discrimination – have yet to be actualised. 4–6 In particular, transgender and gender diverse people – namely, people whose gender identity differs from social expectations based on their sex assigned at birth (e.g. transgender women, transgender men, non-binary, gender non-conforming, genderqueer, gender fluid, Two Spirit, and agender individuals) – experience pronounced barriers to reproductive health and rights as a result of bias, stigma, and discrimination within political, economic, social, education and healthcare structures and institutions. 7–9

Research shows that transgender and gender diverse assigned female at birth (AFAB) people (i.e. people assigned female at birth who identify as men, transgender men, masculine, transmasculine, non-binary, gender non-conforming, genderqueer, gender fluid, Two Spirit, and/or agender, among other identities) have various unmet reproductive health needs. 10 , 11 For instance, although transgender and gender diverse AFAB people can experience pregnancy, 12–14 they face notable barriers to contraception, including limited access to high-quality health care, a lack of healthcare provider training and competence in transgender health, cis- and hetero-normative healthcare provider assumptions, and gender identity-related bias, stigma, and discrimination in healthcare settings in particular, and society in general. 15–17 Similarly, research shows that transgender and gender diverse AFAB people are also less likely to obtain regular Pap tests compared to cisgender women (i.e. AFAB individuals who identify as women in terms of gender identity) as a result of institutional discrimination in healthcare systems, a lack of healthcare provider knowledge and training, and limited access to gender-affirming care. 18

Additionally, although many transgender and gender diverse AFAB people have expressed an interest in pregnancy, childbearing, and parenthood, 19–21 studies indicate that they also face notable challenges in these areas, including limited access to gender-affirming fertility preservation and assisted reproduction services and erasure, stigma, and discrimination in the reproductive healthcare system in particular and society in general. 5 , 7 , 9 , 22 Similarly, transgender and gender diverse assigned male at birth (AMAB) individuals (i.e. people assigned male at birth who identify as women, transgender women, feminine, transfeminine, non-binary, gender non-conforming, genderqueer, gender fluid, Two Spirit, and/or agender, among other identities) also experience notable challenges to becoming parents. Indeed, although many transgender and gender diverse AMAB people report a desire to have children, 21 , 23 , 24 they experience significant barriers in accessing and utilising fertility preservation and assisted reproduction services, including a lack of gender-affirming healthcare providers and organisations that competently and respectfully address their fertility intentions and desires and reproductive health needs and concerns. 23–25

To our knowledge, the extent, scope, and nature of research on the reproductive health of transgender and gender diverse AFAB and AMAB people has yet to be characterised. Therefore, we conducted a scoping review to systematically identify, ascertain, and summarise the research literature on the reproductive health of transgender and gender diverse AFAB and AMAB individuals. 26–28 The results of this scoping review will allow us to make recommendations for future research, practice, and policy on reproductive health among transgender and gender diverse people, with the goal of advancing the reproductive health and rights of this structurally marginalised and medically underserved population.

Scoping reviews are an approach to knowledge synthesis that incorporates a range of study designs and uses rigorous, systematic, and transparent methods to map the extent, range, and nature of the research literature on a given topic, summarise research findings on this topic, and identify research gaps in the existing literature with the goal of informing future research, policy, and practice. 27 , 28 The purpose of our scoping review was to determine the range and nature of and identify research gaps in the scientific literature on transgender and gender diverse individuals’ reproductive health. We sought to answer the following research question: What is known and what is not known from the scientific literature about the reproductive health needs and experiences of transgender and gender diverse AFAB and AMAB people? We then identified, selected, charted, and summarised relevant studies using the methodological framework proposed by Arksey and O’Malley. 27 Our approach also incorporated Levac et al.’s 26 adaptations to the Arksey and O’Malley 27 framework, including linking the scoping review purpose and research question, using an iterative team-based approach to study selection and data extraction with multiple reviewers, and incorporating both a numerical summary and thematic analysis in the summary and reporting of research findings.

Specifically, a research librarian conducted literature searches for relevant articles in Ovid MEDLINE®, Ovid Embase, the Cochrane Library, PubMed, Google Scholar, Gender Studies Database, Gender Watch, and Web of Science Core Collection. Final searches were performed in all databases on November 7, 2018. Databases were searched using a combination of controlled vocabulary and free text terms (Appendix A). The Yale MeSH Analyzer ( http://mesh.med.yale.edu ) was used in the initial stages of strategy formulation to harvest controlled vocabulary and keyword terms from relevant known articles included in the MEDLINE database. The results were limited to peer-reviewed journal articles; case reports, commentaries, editorials, newspaper articles, literature or systematic reviews, reports, committee opinions, clinical guidelines, and letters were filtered out. Peer-reviewed journal articles were included if they were published between 2000 and 2018, involved human participants, were written in English, pertained to a reproductive health topic, and disaggregated data for transgender and gender diverse people (rather than, for example, presenting aggregate data for lesbian, gay, bisexual, transgender, and queer [LGBTQ] individuals combined). Only studies pertaining to transgender and gender diverse people’s own reproductive health experiences, preferences, concerns, needs, or priorities were included. In contrast, papers that focused on others’ (e.g. health care providers’, family members’) views and experiences pertaining to the reproductive health of transgender and gender diverse people or on transgender and gender diverse people’s reproductive organs or cells rather than their reproductive health outcomes or experiences, were excluded ( Table 1 ).

Study inclusion and exclusion criteria

Citations from all databases were imported into an EndNote X9 library. Duplicate citations were removed in Endnote, and final citations and their abstracts were entered into Covidence, a screening and data extraction tool. 29 Two independent screeners performed a title and abstract review on all citations based on the inclusion and exclusion criteria ( Table 1 ). The first author resolved any disagreement on study inclusion (e.g. whether a study had disaggregated data for transgender and gender diverse people, whether a study addressed transgender and gender diverse people’s own reproductive health views and experiences vs. others’ such as their parents) between the screeners. Through this process, the screeners and first author selected records for full-text review, from which the two screeners independently extracted data on study characteristics (i.e. year, country, study design, methodology, methods, and sampling strategy), sample characteristics (i.e. number of transgender and gender diverse study participants and distributions of sex assigned at birth, gender identity, age, race/ethnicity, and educational attainment) and reproductive health topic.

The data extraction form was developed collaboratively by the screeners and first author, tested independently by the two screeners using a subset of the articles, and revised iteratively during the data extraction process. The standard data extraction form in Covidence was supplemented to capture additional study characteristics of interest to the research team, including study samples’ gender identity, racial/ethnic, socioeconomic, and age composition. The two independent screeners and the first author reviewed all the extracted data, and all discrepancies (mostly related to study type, sample size, and participant demographic characteristics) between the screeners were resolved by discussion and consensus. The agreed upon extracted data were reviewed, collated, and analysed by the first author in collaboration with the screeners and served as the basis for the results presented in this article. Specifically, they grouped the studies by reproductive health topic, characterised the study population, study design, and sample characteristics for each one, identified research gaps in the scientific literature, and summarised the studies’ main findings using both a numerical summary and thematic analysis approach. 26 , 27 Of note, our scoping review did not include a formal quality assessment of each study, which is not a required component of this approach. However, we globally ascertained to what extent the existing literature provided valid, generalisable, and actionable information on the reproductive health of transgender and gender diverse people. 26–28

Our search strategy generated a total of 5861 citations. Duplicate citations were removed, reducing the total number of citations to 2197. The title and abstract review of these citations yielded 75 records for full-text review. A total of 38 articles were excluded from full-text review for not being empirical research ( n  = 11), having the wrong outcomes ( n  = 10), being duplicates ( n  = 7), conference abstracts ( n  = 3), study protocols ( n  = 2), or case reports ( n  = 1), and not disaggregating data for transgender and gender diverse individuals ( n  = 4; Figure 1 ).

PRISMA flow chart. Adapted from Moher et al. 55

Of the 37 articles included in the full-text review (Appendix B), Table 2 shows that the vast majority ( n  = 34, 91.9%) were published after 2013, with a steady increase in the number of articles published between 2014 ( n  = 4, 10.8%) and 2018 ( n  = 10, 27.0%). Moreover, most studies were conducted in the United States ( n  = 25, 67.6%), followed by Canada ( n  = 6, 16.2%), Australia ( n  = 2, 5.4%), Belgium ( n  = 2, 5.4%), Sweden ( n  = 1, 2.7%) and Germany ( n  = 1, 2.7%). Further, almost all ( n  = 36, 97.3%) studies were observational and relied on convenience or purposive sampling strategies ( n  = 36, 97.3%). Of note, we only identified one (2.7%) intervention research study and one (2.7%) study that utilised a (sub-national) probability sample. Additionally, most studies used quantitative ( n  = 15, 40.5%), followed by qualitative ( n  = 13, 35.1%), research methodologies. Approximately one quarter ( n  = 9, 24.3%) used a mixed-methods research approach that combined both quantitative and qualitative data and two (5.4%) adopted a participatory research methodology. In terms of methods, the majority of studies utilised cross-sectional surveys ( n  = 17, 46.0%) and/or in-depth interviews ( n  = 17, 45.9%), followed by clinical chart reviews ( n  = 7, 18.9%; Table 2 ).

Study characteristics of included articles ( N  = 37)

*Categories are not mutually exclusive.

   Note: Percentages may not add to 100% due to non-mutually exclusive categories and rounding error.

Table 3 shows that the majority ( n  = 27, 73.0%) of studies relied on samples including fewer than 125 transgender and gender diverse participants. Additionally, most ( n  = 23, 62.2%) articles included in the full text review solely pertained to the reproductive health of AFAB individuals, including transgender men, transmasculine individuals, and gender diverse AFAB people. Approximately one third ( n  = 13, 35.1%) included both transgender and gender diverse AFAB and AMAB participants (of which only n  = 5, 13.5% included disaggregated study results), while only one (2.7%) study exclusively focused on the reproductive health needs and experiences of AMAB participants. Further, none of the studies included in the full-text review solely pertained to non-binary and other gender diverse individuals, whose needs and experiences were addressed in conjunction with ( n  = 20, 54.1%) and rarely disaggregated from ( n  = 2, 5.4%) those of transgender individuals with binary gender identities. Moreover, the vast majority ( n  = 31, 83.8%) of articles pertained to young and midlife adults, with only three (8.1%) addressing adolescent reproductive health and none addressing the reproductive health concerns of older adults. Almost all studies that specified their sample’s racial/ethnic ( n  = 24, 64.9%) and educational ( n  = 17, 45.9%) composition included a majority of White ( n  = 24/24, 100%) and college-educated ( n  = 16/17, 94.1%) transgender and gender diverse participants, with no disaggregation of study findings by race/ethnicity or educational attainment in any study ( Table 3 ). Moreover, of the studies that reported the racial/ethnic breakdown of participants at all or beyond the proportion of White participants ( n  = 23, 62%), most included only small numbers of Black, Latinx, Asian, Native Hawaiian/Pacific Islander, and multiracial individuals. Of note, only four (17%) studies reported including Native, Indigenous, or Aboriginal people (data not shown).

Sample characteristics of included articles ( N  = 37)

*Pertains to number of transgender and gender diverse study participants only.

   Note: Percentages may not add to 100% due to rounding error.

Further, we found that the articles included in the full-text review addressed a variety of reproductive health topics and sub-topics ( Table 4 ). The topic addressed in the largest number of studies was cervical cancer screening ( n  = 14, 37.8%), including cervical cancer screening results ( n  = 2, 5.4%), frequency ( n  = 6, 16.2%), perceptions, attitudes and preferences ( n  = 6, 16.2%), experiences ( n  = 4, 10.8%), and performance ( n  = 1, 2.7%). Other commonly examined topics were fertility, ( n  = 10, 27.0%) including fertility desires, intentions, and attitudes ( n  = 8, 21.6%) and fertility services use and experiences ( n  = 2, 5.4%); and fertility preservation ( n  = 8, 21.6%) namely, fertility preservation counselling or consultation ( n  = 3, 8.1%), fertility preservation services use and experiences ( n  = 5, 13.5%), and fertility preservation knowledge and attitudes ( n  = 4, 10.8%). Other less commonly studied topics were pregnancy ( n  = 7, 18.9%), reproductive health care (in general; n  = 2, 5.4%), contraceptive use ( n  = 3, 8.1%), birth ( n  = 5, 13.5%), cervical cancer risk perceptions and treatment experiences ( n  = 2, 5.4%), parenthood experiences ( n  = 1, 2.7%), and chest feeding experiences ( n  = 1, 2.7%; Table 4 ).

Reproductive health topic of included articles ( N  = 37)

Note: Percentages may not add to 100% due to non-mutually exclusive categories and rounding error.

In general, researchers found that transgender and gender diverse AFAB and AMAB people faced notable barriers to achieving their fertility intentions and desires due to a lack of access to reproductive health services, including fertility preservation, reproduction assistance, pregnancy-related care, and contraception, that addressed their unique and specific needs. Additionally, when utilising reproductive health services pertaining to pregnancy, birth, contraception and cervical cancer screening, transgender and gender diverse individuals experienced several barriers to obtaining high-quality care, including cost, 25 , 30 , 31 a lack of health care provider knowledge of and training in transgender reproductive health, 5 , 11 , 30 non-inclusive and non-affirming clinical environments and practices, 5 , 6 , 12 , 32 and gender identity bias, stigma, and discrimination in reproductive healthcare settings and in patient–provider interactions. 7 , 12 , 15 , 19 , 30 Moreover, several studies found that gender dysphoria (i.e. distress due to persistent feelings of conflict between one’s gender identity and sex assigned at birth) also posed a challenge to accessing and utilising reproductive health care, 10 , 13 , 32 which is often branded as “women’s health care”, among many transgender and gender diverse AFAB individuals.

The results of this scoping review suggest several significant gaps in the scientific research literature addressing the reproductive health of transgender and gender diverse AFAB and AMAB people. Although we found that the number of studies focusing on this topic increased between 2010 and 2018, the scientific literature on the reproductive health needs and experiences of transgender and gender diverse people was heavily weighted towards particular countries, study designs, study populations, reproductive health topics, and sampling and analytical strategies. Of note, the majority of studies were conducted in the Global North, especially the United States, and were observational and cross-sectional in nature. In terms of study population, most studies pertained to transgender and gender diverse AFAB individuals, with few articles devoted to or inclusive of transgender and gender diverse AMAB people. Similarly, no study exclusively focused on gender diverse (e.g. non-binary, gender fluid, gender non-conforming, genderqueer, agender) people and almost all of those that included both transgender and gender diverse participants aggregated the data for these distinct gender identity groups.

Further, the scientific literature on the reproductive health of transgender and gender diverse individuals has focused on a small number of topics, especially cervical cancer screening but also pregnancy, fertility preservation, and fertility intentions, desires, and attitudes. In contrast, topics such as contraceptive use and birth have received much less attention, and no study pertained to abortion care among transgender and gender diverse people. In terms of sampling and analytical strategies, the vast majority of studies relied on small, convenience or purposive samples of predominately White, college-educated, and young and midlife adult transgender and gender diverse people. Additionally, among the studies that included both transgender and gender diverse people, very few presented results disaggregated by gender identity, and no study disaggregated their research findings by age, race/ethnicity, or socioeconomic position. Therefore, the existing literature does not address the full range of reproductive health topics relevant to transgender and gender diverse people or accurately reflect the reproductive health concerns and experiences of AMAB people, gender diverse people, Black, Latinx, Indigenous, and Asian/Pacific Islander people, poor or low-income people, or adolescents.

To continue expanding the small but growing scientific literature on the reproductive health of transgender and gender diverse people, researchers should broaden the reproductive health topics and populations included. Specifically, future studies should address the full range of reproductive health issues relevant to transgender and gender diverse people, including contraceptive use, abortion care, and birth. Further, additional reproductive health studies should be conducted among not only AFAB but also AMAB transgender and gender diverse people from across the globe, including the Global South, with data disaggregated by gender identity and other social categories as feasible. Further, studies that adopt longitudinal and probability sampling research approaches are needed to facilitate causal inference, capture reproductive health concerns across the life course, and promote the generalisability of research findings to transgender and gender diverse people overall. 33 Of note, existing cross-sectional (e.g. National Survey of Family Growth, Demographic Health Surveys) and longitudinal (e.g. National Longitudinal Study of Adolescent to Adult Health) national probability sample surveys that address reproductive health topics should include validated gender identity measures and oversample transgender and gender diverse people. 34 , 35 Additionally, population-based transgender health studies (e.g. TransPOP Study) should collect detailed information on various reproductive health outcomes over time.

To adequately reflect the reproductive health needs, preferences, and experiences of multiply marginalised transgender and gender diverse people – including but not limited to gender diverse people, Black, Indigenous, Latinx, and Asian/Pacific Islander people, adolescents, and poor and low-income individuals – scientific research on the reproductive health of transgender and gender diverse people should be guided by intersectionality. Intersectionality is an analytical framework rooted in Black feminist theory and practice that posits that the lived experiences of individuals and social groups are simultaneously shaped by multiple and mutually constitutive forms of discrimination and oppression, including but not limited to racism, sexism, transphobia and cisgenderism, heterosexism, and classism as linked to White supremacy, patriarchy, colonialism, and capitalism. 36–39 Of note, intersectionality suggests that multiply marginalised transgender and gender diverse people have different and unique health needs and experiences from those who occupy privileged social, economic, and political positions. 40 Similarly, empirical research has identified disparities in various health and health care outcomes among transgender and gender diverse people by gender identity, race/ethnicity, socioeconomic position, sexual orientation, and age. 7 , 41 , 42 Health disparities related to nativity, disability, and other social determinants of health are also likely among transgender and gender diverse people, 43 although they have not yet been documented in the scientific literature. Thus, research that is guided by intersectionality is urgently needed to promote the reproductive health and rights of all transgender and gender diverse people, including those who are multiply marginalised as a result of not only transphobia and cisgenderism but also racism, classism, heterosexism, age, xenophobia, and ableism, among other dimensions of social stratification and inequality.

Despite the need for probability sample surveys that generate generalisable estimates of reproductive health outcomes among transgender and gender diverse people, quantitative, qualitative, and mixed-methods research studies that rely on purposive sampling strategies will continue to be necessary to ensure the generation of meaningful research findings for multiply marginalised transgender and gender diverse people. In line with an intersectional approach, researchers can use various purposive sampling strategies, including quota sampling and respondent driven, participant referral, or snowball sampling, to ensure that their reproductive health studies include multiply marginalised transgender and gender diverse populations, who are underrepresented in the general population, in sufficient numbers to generate meaningful results for these subpopulations. 44 , 45 Investigators can also use intersectionality throughout the research process to ensure that their research teams, research questions, and data collection, analysis, and interpretation efforts centre the lived experiences of diverse groups of transgender and gender diverse people at the intersection of multiple forms of social inequality. 40 , 45–47 In particular, future studies should include transgender and gender diverse individuals from diverse social backgrounds on their research teams, measure multiple dimensions of not only social identity (e.g. gender identity, race/ethnicity, sexual orientation) but also discrimination (e.g. transphobia, racism, heterosexism) at both the interpersonal and structural level, analyse study results in relation to multiple dimensions of social identity and inequality, both within and across subpopulations, and interpret research findings in their social and historical context. 40 , 45–47

Intersectionality can also guide researchers not only to generate research findings to increase knowledge but also to develop, test, implement, and disseminate interventions that promote the reproductive health and rights of transgender and gender diverse people using intervention research, implementation science, and community-based participatory research (CBPR) approaches. In particular, researchers should develop and test interventions that address barriers to and facilitators of reproductive health among transgender and gender diverse people, including those who are multiply marginalised, at multiple levels of influence, including the individual (e.g. knowledge, risk perceptions), interpersonal (e.g. patient–provider communication), institutional (e.g. gender-affirming procedures and protocols), community (e.g. community norms), and societal (e.g. health and social policies) levels. 48 Further, implementation science can help scientists identify and address the factors that influence both the implementation and dissemination of these interventions to ensure that they are tailored to and address the specific and unique needs of transgender and gender diverse people from various social backgrounds and geographic locations. 49 Finally, CBPR, which provides a collaborative approach to research that equitably involves community members in all phases of the process to inform action on a given population health issue and its social determinants, 50 is particularly well aligned with intersectionality, which seeks to advance social justice by linking both theory and practice and addressing power imbalances. 47 Studies that use this collaborative and equitable approach are needed to ensure that research informs programmes, practices, and policies that address the reproductive health needs of transgender and gender diverse people, including those who are multiply marginalised, as they define them for themselves. 50

The studies included in our scoping review have important implications for not only research but also practice and policy. Specifically, healthcare providers should receive ongoing training in transgender and gender diverse reproductive health, person-centered care, gender-affirming care, transphobia, cisgenderism, and other forms of bias, stigma and discrimination in health care, structural competence, and shared decision-making in order to facilitate access to and utilisation of high-quality reproductive health care that is inclusive and respectful of transgender and gender diverse people’s lived experiences and reproductive health needs. Further, reproductive healthcare settings can be more welcoming to transgender and gender diverse people by avoiding branding reproductive health as “women’s health care,” ensuring that facilities are visibly inclusive and affirming of transgender and gender diverse people, providing educational materials that are inclusive of transgender and gender diverse individuals, designing intake forms that use gender-affirming language and response options, training all front desk and health care staff to use patients’ correct names and pronouns, and providing patients with opportunities to report (and then addressing) biased, stigmatising, or discriminatory treatment. 17 , 51–53 Additionally, because transgender and gender diverse people may prefer receiving reproductive health care in community settings that are especially tailored to their needs, community-based organisations that serve transgender and gender diverse people should receive the funding, support, and technical assistance they need from state and local health departments and health care institutions to deliver reproductive health services. 54

The results and implications of our scoping review should be understood in the context of several limitations. First, our findings only pertain to empirical research studies written in English and published in peer-reviewed journals. As such, they may not be applicable to studies published in other languages and in other formats or venues (e.g. reports, briefs, theses, dissertations, websites), which may differ in important ways from the English-language scientific research literature. Additionally, the results of our scoping review findings only apply to the 2000–2018 period. As such, they may not reflect the scientific literature published before 2000 or after 2018. Therefore, future scoping reviews pertaining to transgender and gender diverse people’s reproductive health should seek to include studies written in languages other than English, include both the scientific and grey literature, and consider a longer time period, as feasible given available resources.

The existing scientific literature represents an important first step in describing the reproductive health of transgender and gender diverse people. However, our scoping review shows that this literature is limited in terms of geographic regions represented, reproductive health topics addressed, methods used, and populations included. As a result, existing scientific research does not reflect the full range of reproductive health issues that are relevant to transgender and gender diverse people and may not be generalisable to those who are multiply marginalised or living in the Global South. Moreover, research that uses an intersectional approach is needed to promote our understanding of how multiple forms of social inequality influence the reproductive health of transgender and gender diverse people from various social backgrounds, both within and across subpopulations defined in relation to race/ethnicity, gender identity, socioeconomic position, age, nativity and disability, among other social categories. Lastly, investigators should conduct studies that use intervention research, implementation science, and CBPR approaches to develop, test, implement, and disseminate programmes, practices, and policies that collaboratively address transgender and gender diverse people’s reproductive health concerns as they define them for themselves. Together, these efforts will help ensure that the reproductive health and rights of all transgender and gender diverse people are understood and addressed with dignity and respect.

Appendices. 

Appendix a. search strategy.

Search for Ovid MEDLINE®

Searches for additional databases available upon request ([email protected])

• (trans$gender* or trans$sex* or trans$women or trans$woman or trans$men or trans$man or trans$feminine or trans$masculine or trans$person* or trans$girl or trans$boy or trans$girls or trans$boys or transex* or trans$spectrum).mp.
• (koti or hijra or mahuvahine or mahu or waria or katoey or bantut or nadleehi or berdache or xanith).mp.
• (two spirit* or third gender* or third sex or gender variant* or gender queer or blended spirit or non$binary or gender diverse or sex* divers* or gender expansive or gender cross* or cross gender or gender incongruen* or gender dysphor*).mp.
• (male-to-female and MtF).mp.
• (female-to-male and FtM).mp.
• (gender adj3 non$conform*).mp.
• exp transgender persons/ or exp health services for transgender persons/ or exp transsexualism/ or exp gender dysphoria/
• 1 or 2 or 3 or 4 or 5 or 6 or 7
• exp Reproductive Health Services/ or exp Reproductive Health/ or exp Women’s Health/ or exp Reproductive Rights/ or exp Fertility Preservation/ or exp Reproductive Techniques/ or exp Infertility/ or exp Fertility/ or exp Genital Neoplasms, Female/
• exp oocyte retrieval/ or exp embryo transfer/ or exp ovulation induction/ or exp cryopreservation/ or exp Semen preservation/
• exp Fertilization in Vitro/ or exp Pregnancy/ or exp Pregnancy Outcome/ or exp Pregnancy Complications/
• (reproductive health or reproductive service* or women’s health or women’s service* or women’s care or gynecologic care).mp.
• (fertil* or contraception* or abort* or pregnan* or family plan* or assisted reproduction or IVF or surrog* or prenatal care or postnatal care or preconception care or delivery or miscarr* or egg* freez* or sperm freez* or egg preserv* or sperm preserv* or in vitro fertilization or cytopreserv* or uterine transplant*).mp.
• ((endomet* or cervical or uterus or uterine or gynecolog*) and (cancer* or neoplasm* or carinoma*)).mp.
• 9 or 10 or 11 or 12 or 13 or 14
• limit 16 to english language
• limit 17 to yr=“2000 – Current”
• limit 18 to (case reports or comment or editorial or letter)
• exp animals/
• exp animals/ and exp humans/

Appendix B. Table of included studies ( N  = 37)

Disclosure statement.

No potential conflict of interest was reported by the author(s).

114 Reproductive Health Essay Topic Ideas & Examples

🏆 best reproductive health topic ideas & essay examples, 💡 interesting topics to write about reproductive health, ⭐ simple & easy reproductive health essay titles, 👍 good essay topics on reproductive health, ❓ essay questions about reproductive health.

• Adolescent Sexual and Reproductive Health The human rights and gender model of dealing with the sexual and reproductive health is effective in making sure that the right of adolescents are protected in the government policies and practice.
• Sexual and Reproductive Health This is considering the fact that the low income people in the society are highly vulnerable to sexual and reproductive health problems.
• Reproductive Isolation and Its Potential Effects Reproductive isolation pertains to the fact that in case a population of the same species is separated into two parts and they are not able to breed with one another, genetic makeup will change according […]
• Sexual Violence and Reproductive Health Among Black Women The five were approached in a face-to-face conversation and were taken through the purpose of having them on board for this assignment.
• Sex Tourism: Reproductive History and Pregnancy Incidence The topic of sex tourism as it relates to prostitution, purity, pollution, trafficking in sex, children, and gender will be discussed in this essay.
• International Center for Reproductive Health The organization has, over the past, designed and implemented innovative and cost-effective evidence-based interventions on research in the reproductive and sexual fields of women and young girls. The organization’s mission has remained on the course […]
• Reproductive Technologies: Ways of Regulation For instance, through the use of in-vitro fertilisation IVF, assistance has now been given to those who have problems in conception; also the use of PDGs prevents conception of severely abnormal children.
• Cancer Survivorship and Reproductive Health Outcomes This life includes the social, emotional, psychological, and financial effects that start at the beginning of diagnosis and commences up to the final stage of the disease.
• Human Reproductive Biology: Organs, Structure, Functions The main functions of the testes are to produce testosterone which is main male sex hormone and generating sperm. The epididymis refers to the long, coiled tube at the back of the testicles.
• Future Harms of Reproductive Technologies It is important to know the author of the writing to understand the main message and the underlying idea of the essay.
• Male Reproductive System and Anatomical Structures Male and female reproductive systems have several similarities including the fact that most of the reproductive organs are developed from similar embryonic tissue that make these organs homologous. In male and female reproductive systems, […]
• Terms in Male and Female Reproductive System Primary Organs are the organs that are used to produce the hormones, sperms and the eggs. Ureter is an independent duct that is existent in birds and reptiles to drain the waste from the kidney.
• The Ethics of Reproduction Technology Book by Alpern This book is centered on the moral implications of reproduction technology to modern society, and its prevailing differences from the beliefs of early society. Ideas in this book are straightforward, and they do not sideline […]
• Reproductive System Disorders Epididymitis is a reproductive disorder that entails the inflammation of the epididymitis, which is the coiled tubular location that holds the sperms before they mature and pass on to the vas deferens.
• The Female Reproductive System and Ovarian Cancer The ovary is the one of the central organs of the female reproductive system. The zona granulosa is the exterior layer of cells enclosing the follicles.
• Ethics and Reproduction Health: Surrogacy, Multiple Pregnancies, Abortion When the child is born, the contracting woman becomes the mother of the child, but she is not a biological mother because the child has the genes of the husband and the surrogate mother.
• Problems of the Female Reproductive Tract A person who is suffering from this condition will experience inflammations in the vaginal area. This condition is characterized by the protrusion of the cervix in the opening of the vagina.
• Federal Law Regulate Assisted Reproduction Reproduction is a highly private issue that is supposed to be left in the hands of the mother or the father.
• Impact of Obesity on Reproduction The number of calories that one consumes should balance with the amount of the same used in day-to-day activities, failure to balance the two leads to obesity.
• Reproductive Biology: Ovarian Surface Epithelium The germinal epithelium was a preferred term over OSE because this outer ovarian epithelium was assumed to be the source of germ cells in embryos and adults, and besides this, pre-follicular and granulosa cells that […]
• Reproductive Biology, Ovarian Surface Epithelial Further, based on the morphological appearance of granulosa cells, the frequency of primordial, transitory, primary, preantral, and antral follicles was determined in the three groups of animals.
• Reproductive Biology: Review and Analysis To ascertain a direct effect of the hormones, especially estradiol, progesterone and insuline-like growth factor, we have chosen cultured OSE cells grown in a serum-free medium.
• Reproductive Biology Analysis At pre-ovulation, OSE in proximity to the rupture site undergoes apoptotic cell death, and the wound caused by ovulation is repaired by highly proliferating OSE cells from the surroundings of the ruptured follicle.
• Reproductive Health Access During Covid-19 Health systems in the United States of America, especially access to reproductive health, have been majorly affected during the period of the Covid-19 pandemic.
• The Male Reproductive System: Male Infertility In other words, both the anatomy and physiology of male infertility are complex issues that require a comprehensive approach to prevent and treat male reproductive system diseases.
• Biotechnology, Genetics and Reproduction On the one hand, this is an opportunity to become parents for infertile couples, on the other hand, the ART industry acts as a new type of business and, therefore, we can talk about the […]
• The Role of Brain Structures in Governing the Timing and Cycles of Reproduction in Humans The adenohypophysis cells in the pituitary gland are then stimulated by the Gonadotropin-Releasing Hormone to secrete both the Follicle Stimulating Hormone and the Luteinizing Hormone.
• Medical Ethics. Reproductive and Therapeutic Cloning I suppose that cloning is one of the breakthroughs that need the system of counterbalance providing a holistic approach to the problem.
• The Sperm and the Egg: Fertilization and Reproductive System He is helped by the motion of the cilia which act as a lining at the cervix and also the muscle contractions during orgasm.
• New Reproduction Methods and Technologies This is because a treatment plan must be threshed out at the very beginning and should a physician sense a problem with the treatment, be it on a moral or medical ground, he has the […]
• The Sexual and Reproductive Needs of Men: A Global Perspective Each of the elements of reproductive health is phrased as a social entitlement which forms the foundation of reproductive choice and freedom.
• Therapeutic and Reproductive Cloning, Ethical Issues However, a common problem is that though the person may have consented to the use of his biological samples for genetic research, he may not be aware of the future developments of genetic research to […]
• Oligospermia: A Reproductive Issue After Age 40 A variety of treatments are available for low sperm count and quality, depending on the root of the issue. Patients with hypogonadism as the cause of oligospermia may respond well to gonadotropin-releasing hormone therapy, effective […]
• Disorders of the Reproductive Systems Infertility is a disorder that limits people’s ability to reproduce; its causes vary due to the construction of the reproductive systems, age often is a determining factor in female but not in male health. Similarly, […]
• Woman Studies: Reproduction Policies and Practices This perhaps gives, a better explanation of how a male or a female offspring comes about from biological perspectives, the paradigm saw the female development as a byproduct of passiveness of the Y chromosome.
• Debate on Human Reproductive Cloning According to Baird, human cloning should be prohibited for the simple reason that the onus of justification will be placed on the shoulders of those performing the cloning rather than those who want the cloning […]
• Family Formation and Assisted Reproductive Technologies However, it is possible to note that there is no evident correlation between biological ties and well-being of the family. Therefore, biological ties are not essential factors that affect the well-being of the family as […]
• Adolescent Sexual and Reproductive Health Awareness Additionally, ASRH programs must be attractive to the youth and therefore the incorporation of ICT and entertainment in the program is crucial.
• Reproductive and Genetic Technology in Infertility Treatment Parenthood is a critical criterion of selection because it helps to minimize the emotional attachment to the fetus and reduce the risk of the psychological disturbance caused by the separation of the surrogate mother from […]
• Reproductive Technologies in US In essence, infertility will be regarded as the death of one branch of the family tree and as such the relations towards this side of the family will be strained.
• Ethical Issues on Human Therapeutic and Reproductive Cloning The two types of cloning differ in the procedure involved and the objective of the process. In the case of reproductive cloning, the egg is already fertilized and its failure to develop into a complete […]
• Adoption, Childlessness or Reproductive Technology Thus, adoption would be a better option to follow in comparison to the use of reproductive technology to produce a baby.
• Research Effect of Environmental Disasters on Human Reproductive Health Chemicals start seeping into the soil of the surrounding area under the guidance of underground streams resulting in health complications of the community of Love Canal, New York; these complications range from reproductive health complications […]
• Reproductive Choices: Awareness and Education Some of the choices accorded, under the bracket of reproductive rights, include the choice to do a safe and legal abortion; the right to use birth control means; the right to receive superior reproductive health […]
• Healthy Sexual Relationships One of the birth control methods which most people decide to undertake is the hormonal birth control method which functions by hindering the growth and development of the conceived egg in the reproductive system of […]
• The Reproductive Policy and Its Impact on American Women In the United States, there have been a number of health policies targeting largely the women. The federal government is not ready to splash millions of dollars to facilitate contraception but rather encourages sexual education […]
• Ethics in Assisted Reproductive Technology (ART) A big part of the public is of the opinion that regulations should be in place to ensure that the rights of the fetus or babies are not violated.
• Addressing the Sexual and Reproductive Health Needs of Young Adolescents
• Overcoming the Reproductive Health Challenges to Young Women’s Employment Prospects
• Endogenous Female Autonomy and the Use of Reproductive Health Services
• The Importance of Adolescent Reproductive Health Education
• Reproductive Health Counseling for Women
• Priorities and Sequelae in Reproductive Health
• Life Skill and Reproductive Health Education at School
• Common Reproductive Health Concerns for Women
• Women’s Control Over Reproductive Health
• Reproductive Health of Adolescent Girls
• Bisphenols and Male Reproductive Health
• Addressing Adolescent Reproductive Health
• Health Sector Reforms and Reproductive Health Rights in Zambia
• Women’s Sexual and Reproductive Health
• Problems of Reproductive Health Awareness
• Link Between Birth Control and Reproductive Health
• Adolescent Reproductive Health: The Role of Agency and Autonomy
• Reproductive Health of Young Women With Cystic Fibrosis
• International Policy on Reproductive Health Services in Conflict
• Improving Reproductive Health in South Asia
• Controversial Policy of Reproductive Health Care Availability
• Women’s Political and Reproductive Health Empowerment in Africa
• Sexual Behavior and the Reproductive Health of Adolescents
• Problems of Male Reproductive Health in Medical Research
• Adolescent and Youth Reproductive Health in Bangladesh
• Reproductive Health Services in Low- And Middle-Income Countries
• Advantages and Disadvantages of the Reproductive Health Bill
• Family Planning and Reproductive Health Consultants
• Neo-Liberal Development and Reproductive Health in India
• Perspectives on Sexual and Reproductive Health
• US Department of Adolescent Reproductive Health
• Reproductive Health and Population Development Bill
• Adolescents in the Area of Sexual Reproductive Health
• Addressing Adolescent Sexual and Reproductive Health in Niger
• Reproductive Health in Environmental Programs in Kenya
• Reproductive Health: A Framework for Understanding the Linkages
• Reproductive Health Literacy and Fertility Awareness
• Expansion of the Anti-women’s Reproductive Health Legislation in America
• Promoting Reproductive Health in the Labe Regions
• Health, Sexual, and Reproductive Health Services
• What Is Reproductive Health in Science?
• What Is the Scope of Reproductive Health?
• Why Is It Important to Study Reproductive Health?
• What Is Reproductive Health Education?
• What Are the Four Components of Reproductive Health?
• Is Reproductive Health Part of Public Health?
• What Are the Gender Issues in Reproductive Health?
• What Is Reproductive Health Topper?
• How Do You Maintain Reproductive Health?
• What Are the Most Common Reproductive Health Problems for a Male?
• What Factors Affect Reproductive Health?
• What Foods Are Good for the Female Reproductive Health?
• What Are the Different Strategies for Reproductive Health?
• What Are the Common Reproductive Health Problems?
• How Can Reproductive Health Problems Be Prevented?
• What Are the Reproductive Health Problems in the Philippines?
• What Is Reproductive Health CDC?
• What Strategies Can Be Implemented in India to Attain Total Reproductive Health?
• What Are Reproductive Health Interventions?
• Why Is It Important to Maintain Reproductive Health?
• What Are the Problems Affecting the Female Reproductive System?
• What Are the Strategies in Promoting Good Reproductive Health as Adolescent?
• How Can an Individual Achieve a Good Reproductive Health?
• What Are the Problems of Reproductive Health in India?
• What Is the Significance of Reproductive Health in a Society?
• How Can Adolescent Reproductive Health Problems Be Prevented?
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• Schools & departments

Reproductive Health PhD

Awards: PhD

Study modes: Full-time, Part-time

Funding opportunities

Programme website: Reproductive Health

Upcoming Introduction to Postgraduate Study and Research events

Join us online on the 19th June or 26th June to learn more about studying and researching at Edinburgh.

Choose your event and register

Research profile

The Centre for Reproductive Health ( CRH ) offers PhD programmes, and a one-year full-time MSc by Research programme, which aims to introduce students to modern, up-to-date molecular and cellular biological research in the field of:

• reproductive sciences
• reproductive health
• reproductive medicine

You will study in a stimulating, challenging and vibrant research atmosphere, at the interface between basic science and clinical patient care.

Research topics

Topics that can be offered include using a wide range of models and in human, studying a number of important problems associated with human reproductive health and disease in:

• the uterus during the menstrual cycle and throughout pregnancy and labour
• the fetus and neonate
• fetal programming resulting in increased risk of chronic disease in adulthood

MSc by Research

The MSc forms an ideal insight into a PhD. You will undertake some core teaching and two 20-week research projects, performed on a very wide range of research fields within the reproductive sciences.

• Read more about the Masters by Research in Reproductive Sciences

The Centre for Reproductive Health is recognised internationally as a centre of excellence in research and teaching in reproductive sciences, health and medicine.

The most recent Research Assessment Exercise rated Reproductive Biology as 5*.

Research themes

The CRH has arranged its research under four themes:

• Theme 1: Gonadal function - Including prenatal gonad and germ cell development; spermatogenesis; oocyte maturation and competence; and fertility preservation.
• Theme 2: Sexual health - Including stillbirth and preterm birth; and in-utero programming
• Theme 3: Pregnancy and early life - Including stillbirth and preterm birth; and in-utero programming
• Theme 4: Menstrual health - Including pelvic pain and heavy menstrual bleeding; endometriosis, adenomyosis and fibroids; and reproductive cancer

These theme titles illustrate some of the remarkable properties that make reproductive systems such relevant and powerful models for translational studies across a wide spectrum of human diseases and pathologies in other systems.

Training and support

The CRH has close links with other internationally recognised research centres in the Institute for Regeneration and Repair (IRR) and Edinburgh BioQuarter, including:

• the Clinical Department of Obstetrics and Gynaecology
• the Simpson’s Centre for Reproductive Health
• other research centres on the same Edinburgh Royal Infirmary site and elsewhere within Edinburgh

Many student projects are organised with and between these centres, reflecting the interdisciplinary research environment, where students and trainees are regarded as the ‘lifeblood’ for the future.

The CRH has:

• well-equipped, high-quality research laboratories
• excellent imaging and histological facilities
• an on-site biological research facility

It utilises and links with a wide spectrum of state-of-the-art clinical imaging, genomics, proteomics, metabolomics and bioinformatics centres and core facilities.

Entry requirements

These entry requirements are for the 2024/25 academic year and requirements for future academic years may differ. Entry requirements for the 2025/26 academic year will be published on 1 Oct 2024.

A UK 2:1 honours degree or its international equivalent.

International qualifications

Check whether your international qualifications meet our general entry requirements:

• Entry requirements by country
• English language requirements

Regardless of your nationality or country of residence, you must demonstrate a level of English language competency at a level that will enable you to succeed in your studies.

English language tests

We accept the following English language qualifications at the grades specified:

• IELTS Academic: total 6.5 with at least 6.0 in each component. We do not accept IELTS One Skill Retake to meet our English language requirements.
• TOEFL-iBT (including Home Edition): total 92 with at least 20 in each component. We do not accept TOEFL MyBest Score to meet our English language requirements.
• C1 Advanced ( CAE ) / C2 Proficiency ( CPE ): total 176 with at least 169 in each component.
• Trinity ISE : ISE II with distinctions in all four components.
• PTE Academic: total 62 with at least 59 in each component.

Your English language qualification must be no more than three and a half years old from the start date of the programme you are applying to study, unless you are using IELTS , TOEFL, Trinity ISE or PTE , in which case it must be no more than two years old.

Degrees taught and assessed in English

We also accept an undergraduate or postgraduate degree that has been taught and assessed in English in a majority English speaking country, as defined by UK Visas and Immigration:

• UKVI list of majority English speaking countries

We also accept a degree that has been taught and assessed in English from a university on our list of approved universities in non-majority English speaking countries (non-MESC).

• Approved universities in non-MESC

If you are not a national of a majority English speaking country, then your degree must be no more than five years old* at the beginning of your programme of study. (*Revised 05 March 2024 to extend degree validity to five years.)

Find out more about our language requirements:

Fees and costs

Tuition fees, scholarships and funding, featured funding.

• College of Medicine & Veterinary Medicine funding opportunities
• Research scholarships for international students
• Principal's Career Development PhD Scholarships

UK government postgraduate loans

If you live in the UK, you may be able to apply for a postgraduate loan from one of the UK’s governments.

The type and amount of financial support you are eligible for will depend on:

• your programme
• the duration of your studies
• your residency status

Programmes studied on a part-time intermittent basis are not eligible.

• UK government and other external funding

Other funding opportunities

Search for scholarships and funding opportunities:

• Search for funding

Further information

• IRR Postgraduate Team
• Phone: +44 (0)131 651 8100
• Contact: [email protected]
• Centre for Reproductive Health
• Institute for Regeneration and Repair
• 5 Little France Drive
• Little France
• Programme: Reproductive Health
• School: Edinburgh Medical School: Clinical Sciences
• College: Medicine & Veterinary Medicine

Select your programme and preferred start date to begin your application.

PhD Reproductive Health - 3 Years (Full-time)

Phd reproductive health - 6 years (part-time), application deadlines.

We encourage you to apply at least one month prior to entry so that we have enough time to process your application. If you are also applying for funding or will require a visa then we strongly recommend you apply as early as possible.

• How to apply

You must submit two references with your application.

Before making your application, as well as meeting the minimum requirements for entry you must have agreed a research proposal with a potential supervisor from the Centre for Reproductive Health and have been successful at interview.

Further information on making a research degree application can be found on the College website:

• How to apply for a research degree

Find out more about the general application process for postgraduate programmes:

• [How to apply] ( https://www.ed.ac.uk/studying/postgraduate/applying )

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Gender Based Violence

Gender disparities, maternal health.

• Men’s Sexual and Reproductive Health
• Pregnancy prevention: Family Planning/Unintended pregnancy and Abortion

Adolescent Sexual and Reproductive Health

Clinical correlates of mycoplasma genitalium in young women.

Maria Trent The primary aims of this study are to determine the rate and 12-month longitudinal clinical correlates of MG and TV infection among a sample of young pregnant women 13-29 years of age seeking reproductive health care in an urban hospital setting. The outcomes of this work will be critical for determining need for integration of MG testing in routine laboratory testing once available.

Evaluation of Sexual Health Curriculum for Health Students in Tanzania

Maria Trent As documented in the US Surgeon General's Call to Action to Promote Sexual Health and Responsible Sexual Behavior, training of health providers in sexual health care is critical to addressing a broad array of the nation's sexual and reproductive health concerns. Yet rigorous trials evaluating the effects of sexual health curricula on provider behavior are rare. In sub-Saharan Africa, an environment which has the highest rates of HIV, STI, teen pregnancy, unwanted pregnancy, unsafe abortion, child marriage of girls and sexual assault of boys in the world, and where female genital cutting, wife-beating, marital rape, criminalization of homosexuality, stigmatization of Lesbian, Gay, Bisexual and Transgender (LGBT) persons, myths about masturbation leading to dysfunction, and rates of sexual dysfunction in both men and women are common, we could find no formalized training of health providers in sexual health care. Sexual health education, even of health providers, is a sensitive issue in Africa. Consequently, a rigorous study of its effects is needed, if such education is to be widely adopted. Recently, at Muhimbili University of Health and Allied Sciences (MUHAS) in Dar es Salaam, we adapted a PAHO/WHO sexual health curriculum training for healthcare providers for implementation in Tanzania. Participants were 87 nursing, midwifery, and allied health science students. Pre-post evaluations show the curriculum to be highly acceptable, needed, and desired by students, feasible in implementation, and effective in improving student knowledge, attitudes, and skills in providing sexual health care to patients. The logical next step in this line of research is to conduct the first rigorous trial of a comprehensive sexual health training curriculum for health professionals in Tanzania. There are three specific aims. Aim 1 is to conduct a social ecological needs assessment of sexual health care delivery in Tanzania. To determine whether midwifery, nursing, medical, and allied health science students would benefit from one curriculum or separate curricula tailored by discipline, we will conduct focus groups (3 from each discipline). We will also conduct individual interviews with key informants to address structural and cultural issues. In Aim 2, we will further adapt our curriculum, ensure it is culturally tailored to the Tanzanian/sub-Saharan context, and pilot test it. Aim 3 is to evaluate the effectiveness of an African-based, culturally-appropriate, sexual health curriculum. We will conduct a randomized, controlled, single blinded trial of the curriculum against a waitlist control assessing effects on sexual health knowledge, attitudes, and counseling skills (n=206 students per arm; 412 in total). Hypotheses will test if the curriculum is effective, and whether it is more effective for one discipline than another. If effective, MUHAS has committed to implement the curriculum for all their health students. Given MUHAS is preeminent in health student education across Africa, the curriculum assessed in this study has high potential to be widely adopted as a new standard of training for health professionals across Africa.

Faith-based Adolescents Involved in Total Health

Terrinieka Williams Powell Focused on those areas of Baltimore where the adolescent pregnancy rates are the highest, this study aims to understand what is currently being done in the churches of those communities to address pregnancy prevention and to identify the potentials and barriers for effective interventions.

The Global Early Adolescent Study

Robert Blum, Caroline Moreau, Kristin Mmari, Saifuddin Ahmed, Lori Heise, Leah Keonig, Mengmeng Li, Mark Emerson The Global Early Adolescent Study (GEAS) seeks to understand how norms, attitudes and expectations about gender influence health outcomes and behaviors across the adolescent period. Building upon formative, mixed-methods research conducted in sixteen countries between 2014 and 2016, the GEAS has collected baseline data from over 13,000 adolescents on five continents since 2017. Additional survey topics include sexual and reproductive health, mental health, body comfort, school retention and empowerment. In four countries, the GEAS is used to evaluate the longitudinal impact of gender-transformative interventions carried out by Rutgers, Netherlands; Save the Children and the Institute of Women and Ethnic Studies. Participating GEAS sites include New Orleans, USA; Cuenca, Ecuador; Santiago, Chile; São Paolo, Brazil; Belgium; Indonesia; Shanghai, China; Kinshasa, DRC; Cape Town, South Africa; and Blantyre, Malawi. Results from the longitudinal GEAS will help to answer important questions about the formation and manifestations of gender inequality, its relationship to health and well-being and the interventions that are effective in promoting gender equality.

Current activities include efforts to improve awareness of and response to ethical issues in research and programming with adolescents living in vulnerable contexts the development of a special supplement using baseline GEAS focused on gender equality. At present, students are involved in manuscript development with partners in China, Ecuador, Bolivia and Malawi. For more information about the GEAS, including our global network of collaborators, recent reports and publications and open-access survey and training instruments, please visit the GEAS website.

Harriet Lane Clinic’s Title X Program

Arik V. Marcell Funded by the Office of Population Affairs, to provide reproductive health services to adolescents & young adults who are uninsured, underinsured or seeking confidential services and conduct quality improvement strategies to ensure providers are delivering quality family planning and sexual and reproductive health care services.

Technology Enchanced Community Health Nursing to Reduce Recurrent STIs after PID

Maria Trent This study examines the efficacy of a technology-enhanced community health nursing intervention on adherence to PID treatment recommendations and subsequent short-term sexually transmitted infection acquisition using a randomized controlled trial.

Community-partnered technology for partner violence prevention and response: MyPlanKenya

Michele Decker, Nancy Glass (School of Nursing) This initiative adapts and refines a safety planning “app” intervention for women in urban Kenya, followed by evaluation via randomized controlled trial. The app enables priority-setting for safety-related decisions and provides support and referrals to local resources. It harnesses community health volunteers (CHVs) as key lay professionals poised to play a critical role in partner violence prevention and response. With support from ideas42.

Continuum of Shelter and Housing Models for Victims of Intimate Partner Violence

Michele Decker, Charvonne Holliday With support from the National Institute of Justice, this initiative entails formative evaluation and evaluability assessment for leading models of housing stabilization for partner violence survivors, specifically rapid rehousing and transitional housing, in partnership with House of Ruth Maryland. Following a formative phase, we monitor health, safety, and well-being indicators among IPV survivors receiving housing support over a 6-month follow-up period, and evaluate readiness to support IPV survivors among housing providers.

Developing and Piloting A Gender-Based Violence Intervention Module to Reduce HIV Risk among Female Sex Workers (FSWs)

Michele Decker, Susan Sherman (Epi), Nancy Glass (School of Nursing) With support from the Johns Hopkins Center for AIDS Research (P30AI094189, PI Chaisson), this initiative uses a community-based participatory approach to develop and pilot test a brief violence intervention module to encourage violence-related harm reduction, provide social support related to violence victimization, and reduce related HIV risk behavior among women who trade sex or are sexually exploited.

Collaborative for Gender Equity and Empowerment in Education, Health and Labor Systems

Michele Decker, Lori Heise, Nancy Glass, Rosemary Morgan, Colleen Stuart, Toni Ungaretti, Vivian Lee This collaborative blends gender analysis with case studies and development and field testing of new indicators for gendered aspects of labor, education and health systems, in collaboration with academic and community partners.

Duration of Hormonal Contraceptive Use: Immune Responses & Vaginal Microbiota

PI: Dr. Khalil Ghanem – Co-investigator: Anne Burke This NIH-funded study investigates the impact of hormonal contraceptives on the vaginal microbiome. Use of postpartum IUDs and implants. This study evaluates outcomes in women who receive long-acting contraception in the immediate postpartum period.

Gender barriers to non-communicable disease prevention, treatment and management

Michele Decker, Rosemary Morgan, Nancy Glass This collaboration with World Health Organization applies gender analysis frameworks to non-communicable diseases via a scoping review of gender barriers to care, primarily in low and middle income countries.

Bob Blum, Caroline Moreau, Kristin Mmari, Saifuddin Ahmed, Lori Heise, Leah Keonig, Mengmeng Li, Mark Emerson The purpose of The Global Early Adolescent Study is to understand how gender norms influence sexual attitudes and relationship formation in early adolescence as well as subsequent sexual activity and contraceptive practices in older adolescence. Specifically, the study explores: 1) gender socialization in early adolescents; 2) how gender norms inform sexual and reproductive health (SRH) across adolescent years 3) how gender transformative interventions can improve SRH trajectories. The study takes place in 9 urban poor sites across 4 continents (South Africa, Malawi, DRC, Belgium, China, Indonesia, Chili, Brazil and the United States) and follows between 600 and 3000 young adolescents 10-14 years in each site over a 3 to 5 year period. This research provides empirical evidence testing gender pathways to SRH while guiding programs to overcome gender discrimination and promote women’s and girls’ wellbeing. To learn more please visit the GEAS page .

Antihypertensive Medication in Pregnancy: An Update from the 2011 WHO Recommendations for Prevention and Treatment of Preeclampsia and Eclampsia

Donna Strobino, Saifuddin Ahmed, Erika Werner (Brown Univ, school of Medicine), Mahua Mandal, Laina Gagliardi, and Roxanne Beltran The aim of this project is to update the science behind WHO recommended anti-hypertensive medications in pregnancy to prevent preeclampsia and manage hypertension and to estimates the prevalence of chronic hypertension, preeclampsia and all hypertensive disorders in pregnancy using data from population- based studies worldwide and facility based studies in resource poor settings. The study also using extant data to estimate unmet need and potential demand for antihypertensive medications in pregnancy in low resource settings.

Contraceptive Efficacy of a Novel Vaginal Ring

Anne Burke This is an upcoming NICHD-funded, prospective study evaluating use of a vaginal contraceptive ring in healthy women. Pharmacokinetics of oral contraceptives before and after bariatric surgery. This study compares pharmacokinetic and pharmacodynamic profiles of oral contraceptive use for women undergoing gastric bypass surgery.

Men's Sexual and Reproductive Health

Project connect baltimore.

Arik V. Marcell This is a CDC-funded program to evaluate school and community-based methods to engage males in HIV/STD testing and sexual and reproductive health care in Baltimore City by training youth-serving professionals on a web-based clinical services provider guide for male-specific clinical services (Y2CONNECT.org). If successful, this project will advance the field of male health promotion through its use of innovative approaches and technology that are easily transferable to a variety of settings and implemented at low cost

Technology Enchanced Community Health Nursing Study

Maria Trent The study involves 350 young women 13-21years old diagnosed with PID in Baltimore and randomize them to receive CHN clinical support using a single post-PID face-to-face clinical evaluation and SMS communication support. We hypothesize that repackaging the recommended CDC-follow-up visit using a technology-enhanced community health nursing intervention (TECH-N) with integration of an evidence-based STI prevention curriculum will reduce rates of short-term repeat infection by improving adherence to PID treatment and reducing unprotected intercourse and be more cost-effective compared with outpatient standard of care (and hospitalization). To learn more, please visit the Study Record Detail page .

Pregnancy Prevention: Family Planning/Unintended Pregnancy and Abortion

Advance family planning.

Duff Gillespie, Beth Fredrick Advance Family Planning (AFP) is an advocacy initiative established in 2009 at the William H. Gates Sr. Institute for Population and Reproductive Health. AFP aims to increase the financial investment and political commitment needed to ensure access to high-quality, voluntary family planning through collaborative, evidence-based advocacy aimed at working effectively with decision-makers. AFP is supported by the Bill & Melinda Gates Foundation, the David & Lucile Packard Foundation, and the William and Flora Hewlett Foundation.

Evidence of COVID-19’s Potential Impact on Inequities in Abortion Access

Suzanne Bell, Anne Burke,  Carolyn Sufrin

Results from a small study completed by Bloomberg School faculty and students found that COVID-19 potentially increased existing inequities related to abortion. The study looked at abortion service availability and care seeking experiences in the Washington, DC, Maryland, and Virginia region during the pandemic and found that financially disadvantaged groups were disproportionately negatively impacted.  More information is found in the facsheet,  

FP quality metrics in Maryland

Caroline Moreau, Anne Burke This project aims to test a framework for monitoring quality of care for family planning among all women of reproductive age in Maryland, using computerized data found in health insurance claims and electronic health record (EHR) systems

Measuring the incidence and safety of Abortion

Caroline Moreau, Suzanne Bell The PMA Abortion project aims to use the PMA platform to conduct research on Abortion in 3 geographies (Cote D’Ivoire, Nigeria, Rajasthan) to assess abortion prevalence and safety using both direct and indirect measures and to explore women’s access to care for abortion procedures.

PMA Agile: Monitoring family planning service delivery and use at the subnational level

Amy Tsui, Scott Radloff, Phil Anglewicz This project is being implemented in 13 urban sites in collaboration with research partners in Burkina Faso, DR Congo, India, Kenya, Niger and Nigeria. PMA Agile conducts quarterly surveys of health facilities and semi-annual surveys of clients to monitor change in service preparedness and quality as well as client satisfaction and their continued use of contraception.

Performance Monitoring in Action

Scott Radloff Performance Monitoring for Action or PMA for short (formerly PMA2020) is a Bill and Melinda Gates Foundation funded project, implemented in partnership with Jhpiego and a network of university and research institutions, that supports rapid-turnaround surveys to monitor progress in reproductive health indicators. The project was launched in 2013.

PMA implements cross-sectional and longitudinal surveys to fill a data gap – collecting information to understand the drivers of contraceptive use dynamics – information that is not currently measured by other large-scale surveys. While having a core family planning focus, the PMA platform can be used for data collection in other health topics. To date the platform has been used to collect data for guiding programs in abortion, adolescent sexual and reproductive health, women and girls’ empowerment, maternal and child health, nutrition, water and sanitation, menstrual hygiene management, neglected tropical diseases (schistosomiasis), sample vital registration systems, and primary health care.

The project employs a network of female resident enumerators recruited from near the selected survey clusters who are trained to use smartphones to gather survey data. The PMA platform has been deployed in 11 countries so far with plans to expand. Countries include Ghana, Democratic Republic of Congo, Ethiopia, Uganda, Burkina Faso, Niger, Nigeria, Indonesia, India, Cote d’Ivoire, and Kenya.

For more information please visit pmadata.org .

The predictive utility of unmet need and intentions to use contraception in Uganda

Amy Tsui, Scott Radloff, Saifuddin Ahmed The study team is assessing the predictive utility of a leading indicator, unmet need for contraception, and that of a less prominent one, future intention to use, as influencing contraceptive adoption, using data from a four-year panel follow-up of a national sample of Ugandan women.

Quality improvement to integrate HIV testing in the Harriet Lane Clinic’s Title X Program

Arik V. Marcell Funded by the Office of Population Affairs, the goal of this program is to integrate rapid HIV testing as part of Title X services and increase the proportion of clients receiving HIV test results and evaluate increased use using rapid Plan-Do-Study-Act cycles.

• Open access
• Published: 05 March 2018

Research gaps and emerging priorities in sexual and reproductive health in Africa and the eastern Mediterranean regions

• Moazzam Ali   ORCID: orcid.org/0000-0001-6949-8976 1 ,
• Madeline Farron 1 ,
• Leopold Ouedraogo 2 ,
• Ramez Khairi Mahaini 3 ,
• Kelsey Miller 1 &
• Rita Kabra 1  

Reproductive Health volume  15 , Article number:  39 ( 2018 ) Cite this article

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In-country research capacity is key to creating improvements in local implementation of health programs and can help prioritize health issues in a landscape of limited funding. Research prioritization has shown to be particularly useful to help answer strategic and programmatic issues in health care, including sexual and reproductive health (SRH). The purpose of this paper is to present the results of a priority setting exercise that brought together researchers and program managers from the WHO Africa and Eastern Mediterranean regions to identify key SRH issues.

In June 2015, researchers and program managers from the WHO Africa and Eastern Mediterranean regions met for a three-day meeting to discuss strategies to strengthen research capacity in the regions. A prioritization exercise was carried out to identify key priority areas for research in SRH. The process included five criteria: answerability, effectiveness, deliverability and acceptability, potential impact of the intervention/program to improve reproductive, maternal and newborn health substantially, and equity.

The six main priorities identified include: creation and investment in multipurpose prevention technologies, addressing adolescent violence and early pregnancy (especially in the context of early marriage), improved maternal and newborn emergency care, increased evaluation and improvement of adolescent health interventions including contraception, further focus on family planning uptake and barriers, and improving care for mothers and children during childbirth.

The setting of priorities is the first step in a dynamic process to identify where research funding should be focused to maximize health benefits. The key elements identified in this exercise provides guidance for decision makers to focus action on identified research priorities and goals. Prioritization and identifying/acting on research gaps can have great impact across multiple sectors in the regions for improved reproductive, maternal and children health.

Research capacity building in health fields is important specially in low and middle-income countries (LMICs). According to the World Health Report 2013 it can strengthen health systems and can help move countries towards universal health coverage [ 1 ]. Despite the large body of scientific research, protocols and strategic models to address health problems, there is an increased need for better implementation methods in order to make an impact on health outcomes. Through increased research capacity building, implementation of existing strategies and scaling up interventions may find more success as local researchers bring local knowledge and much needed perspective to these endeavors. Research capacity can also improve health system development, inform more effective policy and lead to better governance in individual countries [ 2 ].

Research capacity building on the African continent has particularly great potential as Africa has the greatest burden of disease and the lowest-density of healthcare professionals in the world [ 3 ]. Shortages of researchers, faculty members, infrastructure, and a dearth of career opportunities for upcoming researchers in Africa to build up a critical mass of scientists to prioritize and carry out policy relevant research exists [ 3 ]. Moreover, multiple factors act as barriers and issues to the health system, hindering the ability of effective health care to be delivered in these contexts. One of the largest complications is that numerous, diverse issues have been identified as health care priorities in the region, which has led to a competition for resources [ 4 ]. This lack of a coherent message is exacerbated by a lack of political will, infrastructural inadequacies, and logistical weaknesses [ 4 ] thereby paralyzing action.

Research priority setting is acknowledged to be a key function of national health research systems and is perceived to be an important process in terms of ensuring the alignment of research funding with national evidence needs [ 5 ]. It is usually done at different hierarchical levels of the health research system (national, institutional, departmental, or at a program level). Ideally health policy and systems research priorities would emerge through priority setting processes. However priority setting for health research is often not performed well or not performed at all [ 6 ]. Priorities need to be reviewed and updated periodically. Through prioritization, SRH could be given more attention, research, and action providing a great benefit to individuals in Africa.

Research prioritization is one of the key nodal points in the research cycle, which includes research planning, research priority setting, strategies and implementation of research priorities, research utilization, research monitoring and evaluation (part of the research information system) and overall research management. The final aim of research prioritization is how “balanced research can support and complement the health system to achieve the national goals for health.” With research prioritization, a forward-looking research system can be firmly established [ 7 ].

Research can play a critical role in the response to global health challenges. But when resources are limited, guidelines are needed to assist decisions on defining the priorities for health research investments [ 8 ]. Setting priorities for health research is essential to maximize the impact of investments, which is especially relevant in resource-poor environments [ 9 , 10 , 11 ].

In June 2015, the WHO/HRP’s Regional Committee meeting for the African and Eastern Mediterranean regions on research capacity strengthening in Sexual and Reproductive Health and Rights (SRH) met in Nairobi, Kenya. The three-day meeting was attended by 38 participants, including 17 women, who represented the research partners of the HRP, the collaborating centers of the WHO, the country offices of WHO, the regional offices of the WHO, the long-term institutional development grantees, and the staff from headquarters in Geneva. The main purpose of this meeting was to discuss the issues related to research capacity strengthening and the future research priorities in sexual and reproductive health and rights in the area and for the WHO.

The meeting was dedicated to discussing the challenges and the lessons learned regarding research capacity strengthening in the regions. This discussion included the emerging research priorities in the two regions. The research prioritization session was mainly dedicated to aid countries in prioritizing their research goals and to identify the main SRH research priorities for the African and Eastern Mediterranean Regions.

The discussion focused on regional experiences on research implementation plans and strategies for strengthening research capacity in SRH, identification of potential barriers and challenges inherent in these proposed plans. The challenges included lack of adequate funding, inadequate capacity to support research, regional brain drain in LMICs, poor communication within the WHO, understaffing, inadequate involvement of policy makers, and poor dissemination and use of research results.

The main objective of this paper is to present the findings of the exercise in identifying an actionable, prioritized research agenda on sexual and reproductive health in the WHO African and Eastern Mediterranean Regions.

Priorities for research on SRH were identified in three main stages in our exercise. In the first stage, the group of researchers, program managers, and other stakeholders from the African and Eastern Mediterranean regions were provided with an overview on various prioritization techniques. The framework of prioritization was presented which included five criteria: answerability (likelihood that research question can be answered ethically), effectiveness (likelihood that the new knowledge would lead to an effective intervention or program), deliverability and acceptability (likelihood that the intervention or program would be deliverable and affordable), potential impact (likelihood that the intervention or program could improve maternal and newborn health substantially), and equity (likelihood that the intervention or program will reach the most vulnerable groups).

Following the discussion of these criteria for prioritization, participants were divided into groups for the prioritization activity. In the second stage, a broad list of sample topics within sexual and reproductive health and maternal and child health were offered as jumping off point. Each group using the prioritization criteria came up with five priorities after deliberation and discussion that were then presented to the entire group. In the third and final stage, the three groups’ priorities were discussed in the large group and a consensus was reached on the six main priorities presented below by attendees.

The aim of this exercise was to create a comprehensive set of broad goals with actionable priorities to combat the problems identified in SRH as recognized by the participating members. The goals were identified to be broad, focusing more on overarching trends of need in the region and in the field of sexual and reproductive health in general. The participants were able to identify main goals that addressed these broad trends and needs in the region.

Three main high-level goals were identified for both of the regions: quality of care, contraception, and adolescent health.

The first two goals relate to sexual education and contraception. The first goal emphasizes early adolescent sexuality education in out of school, and the delay of sexual activity for all adolescents. The second goal is the development of contraception services, including post-partum and post-abortion services. This second goal also aims to address barriers to contraceptive methods, including long-acting reversible contraceptives (LARCs) and emergency contraception.

The third goal is the development of quality of care in three areas: childbirth, general sexual and reproductive services, and disrespect or abuse in childbirth. This also includes improving Emergency Obstetric Care, covering multiple topics, including blood practices, organization of services, assisted vacuum delivery, and unsafe abortion practices.

Priorities and actions from the goals identified

In addition to developing the above broad goals, the team also created a list of priorities for future SRH research. The list of priorities was extensive and comprehensive for sexual and reproductive health research in the region. While all the priorities are important and will play a major role in the future of sexual and reproductive health research in the region, the top six research priorities are given increased attention based on their effectiveness to improve sexual and reproductive health in the regions.

The below mentioned six priority areas were highlighted and selected by the meeting participants as the most pressing and prioritized aspects of sexual and reproductive health to be addressed in the near future. The priorities are written in no particular order and carry equal weight.

The first priority area is the creation and investment in multipurpose prevention technologies. This is especially relevant in the context of condoms and their unique place in sexual and reproductive health. Condoms are one of the major prevention techniques for two pressing issues in SRH: family planning and HIV/AIDS prevention. Because condoms are used in both contexts they are the only examples of a multipurpose sexual health technology. While this is a new field, there is potential in expanding research in this area to create more technologies that can address multiple issues and move toward a more comprehensive sexual and reproductive health product market.

The second priority area is addressing adolescent violence and preventing early pregnancy using contraception, particularly in the context of early marriage . Adolescent violence includes sexual violence, physical violence, and psychological violence. Early marriage greatly affects SRH as girls have an earlier sexual debut, give birth to more children, have higher mortality and morbidity rates (with pregnancy being the leading cause of death for women 15-19), have higher infant and child mortality rates, have an increased risk of experiencing partner violence, and affects educational opportunities for the girl [ 12 ]. The participants wanted to prioritize girls aged 10-14 years old and increase access to services to delay marriage, first births, and violence for women in or out of relationships.

The third priority is to increase the quality of care and safety associated with maternal and newborn emergency care in the region, and more specifically a focus on blood products and the organization of maternal services . Blood services and products are a priority for multiple health outcomes. Practices for blood transmission and safety in pregnancy are a concern, particularly when it comes to minimizing transmission of blood-borne illness and viruses (particularly HIV and hepatitis) from mother to child. The standards and practices surrounding the quality and safety of blood in hospitals and health care facilities need to be examined and improved including: examination and improvement of the systems surrounding acquisition of blood, storage of blood, transport of blood and proper documentation and data analysis of all blood product-related health care practices.

The fourth priority is to evaluate and improve adolescent health interventions in and out of schools in the region. This is to include the promotion and utilization of comprehensive sexual education and the human rights based approach for students and youth in general. This will include a curriculum that uses a comprehensive sex education program, and will emphasize information on menstruation, menstrual hygiene, puberty and access to contraception as key aspects to delivering the best health care to adolescents. Menstrual care and hygiene is specifically important for adolescent girls leading to overall increased health and dignity, as promoted by the current ELRHA toolkit [ 11 ].

The fifth priority is to focus on family planning uptake, methods used, and engagement. It was recognized that it was essential to ensure access to and availability of effective contraceptive methods to all. Participants advocated for increased usage and also identified many of the barriers to FP with possible solutions. Mixed method use and additional contraception options are needed (including lactational amenorrhea and IUDs). Access to emergency contraception was acknowledged as a priority as well as post-partum and post-abortion family planning counseling. Finally, participants felt male involvement should be emphasized in the regions and discussed ways to engage men.

The sixth priority identified focuses improvement of the services, practices and quality of care for both mother and newborn during child birth . This includes promotion of companionship in birthing services. This companionship support will encompass both the presence of fully trained community health workers in the pre-natal and birthing processes, as well as encourage the full support and participation of fathers in both the prenatal stage and at the time of delivery. The trained health workers will be able to support pregnant women, provide respectful care as well as properly refer women to hospital care, as well as provide prenatal support and counselling. Organization and standardization of childbirth care facilities were also prioritized in order to provide improved care, service, and safety to clients. This relates to other priorities identified such as elimination of obstetric fistulas and management of postpartum hemorrhages.

Other priorities identified included increased attention to cervical cancer including treatment and prevention with the HPV vaccination, need of more reliable data and studies regarding STI prevalence in the populations for the regions.

Additional priorities included general commitments to increasing quality of care, access, and increased impact evaluation to identify and implement best practices for SRH. Participants identified task-shifting as a possible solution. Participants prioritized the need to improve the access to reproductive health services for women with disabilities in the region. Finally, there was a priority established to address and combat violence against women in all forms and in all populations.

In the past two decades since the ICPD’s Cairo consensus, research has helped to define what works and at what cost to improve sexual and reproductive health. However, the remaining gaps in our knowledge and understanding are substantial, and impede greater progress and success. Conducting prioritization exercises will assist the regions and countries to understand (i) the full spectrum of research investment options, (ii) the potential risks and benefits that can result from investments in different research options, and (iii) the likelihood of achieving reductions in the persisting burden of maternal and child health morbidity and mortality. Increasingly, there is a need for national governments, public-private partnerships, private sector and other funding agencies to set priorities in health research investments in a fair and transparent way.

There are many approaches to health research prioritization. The identification of common themes for good practice fulfils the need for guidance on this varied and intricate process. The opportunity allowed participants to thoroughly think about the role of SRH in their own health systems and how they would prioritize and improve research capacity building and move forward with possible evidence-based policy solutions or interventions addressing the identified priorities. By identifying goals and priorities, governments may realize the importance of developing research capacity in their own countries in order to produce more relevant solutions and improved implementation in country. The prioritization exercise may also be applied to other health issues in countries since there are competing health issues and limited funding.

Governments should invest in prioritizing research in their own countries and follow through with their goals by increasing focus on sexual and reproductive health issues in their own countries, which can only be developed and implemented with strong research capacity. There should also be additional in-country research on the six priorities mentioned. With this research on these prioritized areas, additional context-specific implementation strategies can be developed and a new, expanded research culture may flourish in the regions. The setting of research priorities is the first step in a dynamic process to identify where research funding should be focused to maximize health benefits. It is important to realize that these results represent a regional discussion of the issues in sexual and reproductive health. They should be interpreted carefully when applied at the country levels because of the differences in needs and context of individual countries.

In conclusion, respective governments must seriously invest in research capacity in order to create a critical mass of researchers in country who can do prioritization and help create impactful and useful policy for the local context. Prioritization is key to taking action in the face of limited funding. Investing in this cadre of researchers will lead to more successful implementation compared with foreign researchers providing implementation advice, as local researchers know their communities and countries best. This is particularly important in the realm of sexual and reproductive health as it has been underserved. With prioritization and research capacity, governments make headway on improving quality, care, and health of their citizens.

The prioritization exercise helped identify concrete issues for action and implementation. Hopefully, more attention and funding can be shifted towards this useful and often neglected element of research development. Further research is needed to determine how best to evaluate success of priority setting at country and regional levels.

Abbreviations

Human reproduction program

International Conference on Population and Development

Intra uterine device

Long-acting reversible contraceptives

Low and middle-income countries

Sexual and reproductive health

Sexually transmitted infections

World Health Organization

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Acknowledgements

The authors would like to extend thanks to all participant researchers and colleagues at WHO offices, who kindly took time to participate in the exercise and shared the information.

The WHO/HRP’s Regional Committee meeting for the African and Eastern Mediterranean regions on research capacity strengthening in Sexual and Reproductive Health and Rights was funded by: (i) the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored program executed by the World Health Organization.

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The exercise for research prioritization was carried out during a WHO regional meeting for Africa and Eastern Mediterranean. The data was analysed and report was prepared in Geneva, Switzerland. The WHO regional meeting report and data can be shared, if needed.

This report contains the collective views of an international group of experts, and does not necessarily represent the decisions or the stated policy of the World Health Organization.

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Moazzam Ali, Madeline Farron, Kelsey Miller & Rita Kabra

Reproductive and Women’s Health, Africa Region, World Health Organization, Brazzaville, Democratic Republic of the Congo

Leopold Ouedraogo

Women’s Reproductive Health, Eastern Mediterranean Region, World Health Organization, Cairo, Egypt

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MA conceptualized the manuscript. KM, MF, MA drafted an initial version and LO, RKM, RK provided technical inputs and edits. All authors read and approved the final manuscript.

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Ali, M., Farron, M., Ouedraogo, L. et al. Research gaps and emerging priorities in sexual and reproductive health in Africa and the eastern Mediterranean regions. Reprod Health 15 , 39 (2018). https://doi.org/10.1186/s12978-018-0484-9

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Foy, Robbie. "Promoting effective reproductive health care." Thesis, University of Edinburgh, 2005. http://hdl.handle.net/1842/29108.

Tshiswaka-Kashalala, Gauthier. "Reproductive Health and Labour Outcomes." Thesis, University of Pretoria, 2014. http://hdl.handle.net/2263/45867.

Topelko, Katherine Mary. "The reproductive health of Guyanese women." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape17/PQDD_0006/MQ33514.pdf.

Ragúz, María. "Sexual and reproductive health and women development from a gender perspective: The role of men." Pontificia Universidad Católica del Perú, 2013. http://repositorio.pucp.edu.pe/index/handle/123456789/101096.

Cornish, Julie Ann. "Inflammatory bowel disease & female reproductive health." Thesis, Imperial College London, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.539280.

Islam, Mohammad Amirul. "Male involvement in reproductive health in Bangladesh." Thesis, University of Southampton, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.436920.

Sunil, Thankam Sukumaran. "Reproductive Health in Yemen: A Theoretical Approach." Thesis, University of North Texas, 2002. https://digital.library.unt.edu/ark:/67531/metadc3112/.

Goel, Hersh Vivek. "Adolescent's Reproductive Health Knowledge in Dehli, India." Thesis, The University of Arizona, 2010. http://hdl.handle.net/10150/146834.

Ozden, Asli. "Can Reproductive Health Program Empower Women? A Feminist Post-development Critique Of European Union Funded Reproductrive Health Program In Turkey." Master's thesis, METU, 2010. http://etd.lib.metu.edu.tr/upload/3/12612107/index.pdf.

Pacheco, Christy Lee. "Program Evaluation of a County Reproductive Health Program." Diss., The University of Arizona, 2012. http://hdl.handle.net/10150/228158.

Yalahow, Abdiasis. "Exploring the Reproductive Health Education of Health Service Professionals in Mogadishu, Somalia." Thesis, Université d'Ottawa / University of Ottawa, 2017. http://hdl.handle.net/10393/36709.

Gallipeau, Sherrie. "Altered Reproductive Function and Amphibian Declines." Thesis, University of California, Berkeley, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3640434.

Agrochemical exposure is one of the factors that contributes to worldwide amphibian declines. Most studies that examine agrochemicals and amphibian declines focus on toxicity. However, declines are more likely caused by the sub-lethal effects of agrochemical exposure. Past emphases on the lethal effects of agrochemical exposure have overshadowed the contribution of decreased recruitment in amphibian declines. Additionally, studies that examine agrochemicals and reproductive function tend to focus on the effects of single chemical exposures instead of the effects of ecologically relevant mixtures. To address these issues, this dissertation examined the effects of ecologically relevant agrochemical exposures on the stress response and the reproductive endocrinology, morphology, and behaviors of male amphibians in the laboratory and the wild.

Chapter 1 provides a general review of the factors implicated in amphibian declines and provides an overview of the previous research conducted on the effects of agrochemical exposure on recruitment.

Chapter 2 is a field study that examined whether agricultural run-off alters the stress response and reproductive function of male bullfrogs ( Lithobates catesbeianus ). Bullfrogs were collected upstream and downstream of agricultural activity across three California river systems (Salinas, Sacramento and San Joaquin). Size, primary and secondary sex traits, sperm count, and corticosterone and testosterone levels were examined. Overall, bullfrogs living downstream of agricultural activity (i.e. exposure to agricultural run-off) were small and had elevated testosterone and corticosterone levels. In addition, downstream males from the Salinas and San Joaquin Rivers were also small in size and had elevated testosterone levels. However, only downstream males of the San Joaquin River had elevated corticosterone and exaggerated secondary sex traits. Together, these data suggest that living downstream of agriculture can alter size, hormone levels, and the expression of sexually dimorphic sex traits. Such changes to the reproductive endocrinology and morphology of male amphibians can be detrimental to the reproductive health and long-term reproductive success of amphibian populations.

In Chapter 3, I examined corticosterone, testosterone, and the reproductive clasping behaviors of adult male African clawed frogs (Xenopus laevis) exposed to field collected and simulated agricultural run-off. This experiment implemented a novel eco-relevant experimental design to mimic real-life agrochemical exposures. Male frogs were exposed to field water collected downstream (agricultural run-off) and upstream (negative control) of agricultural activity along the Salinas River, CA. In addition, a pesticide mixture containing the top agrochemicals used in the Monterey County was included to simulate agricultural run-off. Mating behavior was suppressed in males exposed to simulated agricultural run-off but enhanced in males exposed to field collected agricultural run-off. In addition, testosterone levels of clasping males were elevated in comparison to controls. Males immersed in simulated agricultural run-off had significantly lower testosterone levels than control males in 2010. These data suggest that agrochemical exposure (both field collected and simulated) can alter reproductive hormones and clasping behaviors. Altered sex hormones and behaviors in male amphibians may play a role in amphibian declines.

Lastly, this dissertation is summarized in Chapter 4. The applicability of this dissertation as a model for amphibian declines and other reproductive related human health concerns are also introduced.

Rokicki, Slawa. "Improving Reproductive Health: Assessing Determinants and Measuring Policy Impacts." Thesis, Harvard University, 2016. http://nrs.harvard.edu/urn-3:HUL.InstRepos:33493534.

Spring, Marline Ann. "Reproductive health and fertility of Hmong immigrants in Minnesota. /." ON-CAMPUS Access For University of Minnesota, Twin Cities Click on "Connect to Digital Dissertations", 2001. http://www.lib.umn.edu/articles/proquest.phtml.

Yakong, Vida Nyagre. "Rural Ghanaian women's experience of seeking reproductive health care." Thesis, University of British Columbia, 2008. http://hdl.handle.net/2429/3805.

Presern, Carole Bridget. "Reproductive health care in poor urban areas of Nepal." Thesis, University of London, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.243545.

Richiello, Isabella. "Women's experience of a sexual and reproductive health chatbot." Thesis, KTH, Medieteknik och interaktionsdesign, MID, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-231819.

Darbha, Subrahmanyam. "Reproductive Health Trends In Female Sex Workers In Madagascar." The Ohio State University, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=osu1309360596.

Upton, Dannielle Heather. "Follicle stimulating hormone: ovarian reproductive function, health and aging." Thesis, The University of Sydney, 2016. http://hdl.handle.net/2123/15845.

Lui, Paraniala Silas Celebi. "Reproductive health problems faced by men in Solomon Islands." Thesis, Queensland University of Technology, 2016. https://eprints.qut.edu.au/101163/1/Paraniala%20Silas%20Celebi_Lui_Thesis.pdf.

Oskorouchi, Hamid R. "Health and Fertility among Afghan Women of Reproductive Age." Doctoral thesis, Università degli studi di Trento, 2018. https://hdl.handle.net/11572/368978.

Oskorouchi, Hamid R. "Health and Fertility among Afghan Women of Reproductive Age." Doctoral thesis, University of Trento, 2018. http://eprints-phd.biblio.unitn.it/2883/1/OskorouchiPhDThesis_01_2018.pdf.

Forsyth, Patricia Eileen. "Investigating the reproductive health knowledge, attitudes and practices among student nurses at a selected private nursing college in South Africa." University of the Western Cape, 2018. http://hdl.handle.net/11394/6865.

Kashyap, Sonya. "Assisted reproductive medicine: Systematic reviews and randomized controlled trials." Thesis, University of Ottawa (Canada), 2005. http://hdl.handle.net/10393/26940.

Ahmed, Misbah Uddin Pimonpan Isarabhakdi. "Married female adolescents' reproductive health behavior in Bangladesh : evidence from Demography and Health Survey /." Abstract, 2006. http://mulinet3.li.mahidol.ac.th/thesis/2549/cd393/4838752.pdf.

Bath, Louise E. "The reproductive health of women treated for cancer in childhood." Thesis, University of Edinburgh, 2005. http://hdl.handle.net/1842/24986.

Sheehy, Grace. "A Reproductive Health Needs Assessment in Peri-Urban Yangon, Myanmar." Thesis, Université d'Ottawa / University of Ottawa, 2015. http://hdl.handle.net/10393/32785.

Farragher, Tracey Marie. "Spatial epidemiology of indicators of male reproductive health in Scotland." Thesis, University of Edinburgh, 2005. http://hdl.handle.net/1842/29096.

Gupta, Vaibhav. "Reproductive and child health service delivery and utilization in India." CONNECT TO ELECTRONIC THESIS, 2007. http://dspace.wrlc.org/handle/1961/4164.

Begum, Farhana. "Women's reproductive illnesses and health seeking in a Bangladeshi village." Thesis, University of British Columbia, 2012. http://hdl.handle.net/2429/42492.

Schoeman, Jeanne. "Violence against women : impact on reproductive health and pregnancy outcome." Thesis, Stellenbosch : Stellenbosch University, 2003. http://hdl.handle.net/10019.1/53713.

Englund, Linnéa, and Evelina Persson. "Young women's sexual and reproductive health and rights in Ecuador." Thesis, Högskolan i Jönköping, Hälsohögskolan, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-34734.

Mumtaz, Zubia. "Gender and reproductive health in Pakistan : a need for reconceptualisation." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2003. http://researchonline.lshtm.ac.uk/4646513/.

Macleod, Catriona. "Public reproductive health and ‘unintended’ pregnancies: introducing the construct ‘supportability’." Oxford University Press, 2015. http://hdl.handle.net/10962/d1019881.

Milanes, Lilian. "Health care providers' perspectives on male involvement in their sexual and reproductive health care needs." Honors in the Major Thesis, University of Central Florida, 2012. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/590.

Hawkins, Kirstan. "Rights, health and power : a critical social analysis of the reproductive health and rights discourse." Thesis, Swansea University, 2002. https://cronfa.swan.ac.uk/Record/cronfa42673.

Graham, Elizabeth Miall Charlene. "An intensified pragmatism in repsonse [sic] to reproductive experiences and medicalization : a case study of Cape Breton women /." *McMaster only, 2003.

Liao, Rui Oratai Rauyajin. "Reproductive health rights a wareness of the rural-to-urban migrants in Yunnan, China /." Abstract, 2007. http://mulinet3.li.mahidol.ac.th/thesis/2550/cd400/4838031.pdf.

Jimmy-Gama, Dixon. "An assessment of the capacity of faculty-based youth friendly reproductive health services to promote sexual and reproductive health among unmarried adolescents : evidence from rural Malawi." Thesis, Queen Margaret University, 2009. https://eresearch.qmu.ac.uk/handle/20.500.12289/7456.

Olmo, Luisa. "Investigating smallholder cattle and buffalo reproductive health and management in Lao PDR to enhance reproductive efficiency and improve livelihoods." Thesis, The University of Sydney, 2020. https://hdl.handle.net/2123/21744.

Dahlbäck, Elisabeth. "Between opportunities and risks : adolescent sexual and reproductive health in Zambia /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-978-5/.

Nilses, Carin. "Health in Women of Reproductive Age : A Survey in Rural Zimbabwe." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2000. http://publications.uu.se/theses/91-554-4893-3/.

Kirkham, Jacqueline. "Sexual and reproductive health in Romania and Moldova : contexts, actors, challenges." Thesis, University of Glasgow, 2011. http://theses.gla.ac.uk/2586/.

Chanchani, Devanshi. "Social inequality, reproductive health and child development : a Chhattisgarh village study." Thesis, University of East Anglia, 2015. https://ueaeprints.uea.ac.uk/53407/.

Nara, Ruth. "Understanding the Reproductive Health Needs of Displaced Congolese Women in Uganda." Thesis, Université d'Ottawa / University of Ottawa, 2018. http://hdl.handle.net/10393/38394.

Mpilambo, Jacques Elengemoke. "Reproductive health situation among youth in the Democratic Republic of Congo." Thesis, University of the Western Cape, 2015. http://hdl.handle.net/11394/5195.

Hoque, A. M. Mozibul Santhat Sermsri. "Sexual behaviour, contraceptive practice and reproductive health among Thai school adolescents /." Abstract, 1999. http://mulinet3.li.mahidol.ac.th/thesis/2542/42E-MozibulH.pdf.

Zerucelli, Rucell Jessica. "Obstetric violence & colonial conditioning in South Africa's reproductive health system." Thesis, University of Leeds, 2017. http://etheses.whiterose.ac.uk/20747/.

Nguyen, Quynh Anh. "Economic evaluation of adolescent reproductive health education interventions in Chilinh, Vietnam." Thesis, Queensland University of Technology, 2014. https://eprints.qut.edu.au/79547/1/Quynh%20Anh_Nguyen_Thesis.pdf.

Magnusson, Brianna. "Contextual Factors and Reproductive Control in U.S. Women." VCU Scholars Compass, 2011. http://scholarscompass.vcu.edu/etd/190.

102 Reproductive Health Essay Topics

🏆 best essay topics on reproductive health, ✍️ reproductive health essay topics for college, 🎓 most interesting reproductive health research titles, 💡 simple reproductive health essay ideas, ❓ essay questions about reproductive system.

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• Octopuses: The Reproductive Process Octopuses are oviparous animals, which means that they lay the eggs outside their body. The female octopus’ mission is to produce viable eggs and ensure that its children come out.
• A Peacock Spider’s Mating Rituals and Reproduction This report will cover the mating rituals and all other aspects of the reproductive cycle of a peacock spider.
• The Reproductive System of Females The female reproductive system is a complex system of organs and processes intended primarily for producing offspring.
• Reproductive Health and Abortion Practices in Fiji The legalization of abortion has always been a difficult and contentious topic of discussion, both in the academic field and in politics.
• The Effects of Drugs on a Man’s Reproductive System In this article, the author examines the reasons why drug and alcohol abuse negatively affects the reproductive health of men.
• Family Planning: Reproductive Health The role of family planning in regards to the risks of maternal mortality remains to be limited, and this statement can be easily explained.
• Human Reproduction: Reproductive Development Process The ability to reproduce, that is, the formation of new generations of individuals of the same species, is one of the main features of living organisms.
• Human Reproductive Cloning: Benefits and Drawbacks Although the general public opposes reproductive cloning, some argue that its use by different couples would be ethically justified.
• Reproductive Adaptations and Embryonic Development Sexual reproduction is characterized by the process of gene combination, which is important for adaptation in unstable, unpredictable environments.
• Nationalist Ideology on Women’s Reproductive Rights in Ireland and Iran Irish literature entails oral and published literature of the inhabitants of Ireland, which is geographically part of the UK.
• The Reproductive System in Females and Males This paper discusses reproductive system anatomy, reproductive system physiology, functions, relationship to secondary system, and medical issues.
• “Decolonizing Feminism”: Reproductive Violence in Canada “Decolonizing feminism: From reproductive abuse to reproductive justice” examines reproductive violence against Indigenous women in Canada.
• Reproductive Organs With Similar Functions in Males and Females Testes and ovaries – both testes and ovaries are called gonads, which are the primary reproductive organs. They produce gametes.
• Pregnancy and Reproductive Health in Public Views Depending on the society and culture in which the couple lives, the attitude towards pregnancy and childbirth may differ.
• Anabolic Steroids for Male Reproductive System The paper states that anabolic steroids have been associated with serious health effects, including insulin resistance and infertility in men.
• Discussion of Posthumous Reproduction The issue of posthumous reproduction is controversial and oftentimes meets double-sided ethical and legal questions.
• Affordable Abortions as a Reproductive Right of Women This paper examines the issue of abortion affordability as a public health and human right concern from legal and judicial perspectives.
• Artificial Reproductive Technologies: Legislative Regulation Many difficulties arise in the legislative regulation of artificial reproductive technologies, because it is difficult to include all of these technologies in the legislation.
• Reproductive Coercion Among Latina Women The article shows the experiences of reproductive coercion among Latina women. It reveals that they disproportionately experience reproductive coercion.
• Female Genital Mutilation and Reproductive Rights This annotated bibliography aims to discuss the studies on the issue of female genital mutilation from different perspectives.
• Deserts of the United States. Reproductive Ecology The United States has arguably the most diverse types of deserts. These deserts present unique characteristics ranging from the nature of the climatic conditions.
• Relationships Between Reproduction, Heredity, and DNA Genetic information in DNA is transcribed to RNA and then translated into the amino acid sequence of a Protein.
• Assisted Reproduction: Description Induced or assisted reproduction refers to a treatment against infertility that involves clinical manipulation of both the egg and sperm.
• The Basics of Reproductive Health and Hygiene Menstrual practices in the USA and India differ radically. In the second country, the theme is taboo, and girls have to conceal it.
• The Reproductive System. Endocrine Glands and Hormones The reproductive system is formed by organs in an organism. These organs function together for the reason of reproduction.
• Reproductive Diseases and Disorders This exemplar focuses on analyzing reproductive diseases and disorders and on determining the benefits of using assisted reproductive technology like in vitro fertilization
• Reproductive Rights: Plan B Many people are hostile to emergency contraception, equating it with abortion. However, in many cases, pills such as Plan B are the best way to avoid an emergency.
• Reproductive Health Care and the LGBTQ Community The purpose of this paper is to outline the competent treatment for those LGBTQ who are seeking reproductive care.
• The Ethics of Abortion and Reproductive Rights The debate over the issue of abortion is intense and involves many doctors, ethicists, policymakers, and researchers all over the world.
• Women’s Sexual and Reproductive Health Issues In The Ottawa Charter for Health Promotion, it is stated that health promotion is “the process of enabling people to increase control over and to improve, their health.”
• Reproductive Success and Distributive Justice The notion of social construction helps to define and explain social relations, realities, and the importance of knowledge sharing.
• Women’s Sexual and Reproductive Health Literacy The effectiveness of sex education may be traced via females’ awareness of gender identity, sexuality, and the increased quality of life.
• Reproductive System and Dominant Gene A dominant gene reflects patterns of inheritance. It is expressed in the phenotype regardless of the presence of another allele (variant) of this gene in the genome.
• Reproductive Technology in Ethical Debates Advocates and opponents of surrogacy appealed to cultural and social tradition, law, psychophysiology, religious belief, without coming close to a definitive conclusion.
• Women’s Reproductive Health and Its Factors Women’s reproductive health can depend on sexual orientation. Thus, bisexual and lesbian adolescents and young women demonstrated different reproductive health risks.
• Neo-Liberal Development and Reproductive Health in India
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• Reproductive Health Literacy and Fertility Awareness Among Polish Female Students
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• Reproductive Health Care Availability and Controversial Policies
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• Sexual and Reproductive Health Services
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• Reproductive Health Issues Faced by Adolescents and Young Products
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• Culture and Religious Beliefs in Relation to Reproductive Health
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• Trade Liberalization and Reproductive Health: A Framework for Understanding the Linkages
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• Inflammatory Pathways in Female Reproductive Health and Disease
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• How Pesticides Have Negatively Impacted Men’s Reproductive Health?
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• What Is the Effect of Celiac Disease on the Reproductive System?
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• Research article
• Open access
• Published: 24 January 2018

Adolescents’ reproductive health knowledge, choices and factors affecting reproductive health choices: a qualitative study in the West Gonja District in Northern region, Ghana

• Joseph Maaminu Kyilleh 1 ,
• Philip Teg-Nefaah Tabong 2 &
• Benson Boinkum Konlaan 3  

BMC International Health and Human Rights volume  18 , Article number:  6 ( 2018 ) Cite this article

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In Ghana, adolescents constitute about a quarter of the total population. These adolescents make reproductive health decisions and choices based on their knowledge and the availability of such choices. These reproductive health decisions and choices can either negatively or positively affect their lives. This study therefore explored adolescents’ reproductive health knowledge and choices, the type of choices they make and the factors that affect these choices.

This qualitative study adopted a narrative approach to qualitative enquiry. Eight focus group discussions ( N  = 80) were conducted among both in-school and out-of-school adolescents aged 10–19 years. The discussions were stratified by sex and studentship. In addition, nine in-depth interviews were conducted with various stakeholders in reproductive health services and community opinion leaders. Both the focus group discussions and in-depth interviews were recorded, transcribed and analysed using NVivo 11. Thematic analysis was employed in analysing data.

The study found that knowledge on reproductive health choices was low among respondents with majority of them relying on their peers for information on sexual and reproductive health. Having a sexual partner(s) and engaging in premarital sex was common and viewed as normal. Adolescents engaged in unprotected sexual practices as a way of testing their fertility, assurance of love, bait for marriage and for livelihood. Inserting herbs into the vagina, drinking concoctions and boiled pawpaw leaves were identified as local methods employed by adolescents to induce abortion. Reproductive health services were available in the community but received low utilization because of perceived negative attitude of health workers, confidentiality and social norms.

Conclusions

Adolescents in this study generally engaged in risky reproductive health choices that can negatively affect their reproductive health. Adolescents in this part of Ghana have challenges utilizing available reproductive health services because of socio-cultural and health system barriers.

Peer Review reports

Adolescence is a period of life during which individuals reach sexual maturity [ 1 ]. It is the period of transition from childhood to adulthood and it is often characterized by biological and psychosocial changes as well as sexual experimentation [ 2 ]. Globally, adolescents constitute about one billion of the world’s population, with 70% living in developing nations [ 3 ]. In sub-Saharan Africa, young people constitute about 33% of the 973.4 million population. The population of adolescents and young adults is expected to continue to increase over the next 35 years [ 4 , 5 ]. In sub-Saharan Africa, where a fourth of all adolescents are reported to have sexual experience, education on sexual and reproductive health are generally reported to be low [ 3 ]. In Ghana, the 2010 Population and Housing Census reported that the ratio of adolescents between 10 and 19 years to the total population is 1: 4.5; meaning this age group constitute about 22.4% of the national population [ 6 ]. In the northern region of Ghana, adolescents between 10 and 19 years are about 22.3% of the regional population and about 10.1% of the national adolescents’ population [ 7 ].

Evidence abound that adolescents experience very critical and life defining events, namely; first marriage, first sexual intercourse, and parenthood [ 8 ]. The downward trend in age at menarche from 15.5 years [ 9 ] to an average of 12–13 years in most developing countries [ 10 ] also means an increase in the interval between menarche and marriage. According to the Ghana National Population Council, the age at first marriage was 18.3 years for females and around 25 years for males in 1988, but this age has increased to around 21.4 years for females living in urban areas and 20.9 years for their counterparts in rural areas. For males, it increased to 26.1 years (urban residents) and 24.9 years for rural dwellers [ 11 ].

Adolescents’ knowledge and access to reproductive health services is important for their physical and psychosocial wellbeing. It has been found in an earlier study that the lack of knowledge about the consequences of unprotected premarital sex among adolescent females predisposed them to unwanted pregnancies, unsafe abortion and its complications, and sexually transmitted infections [ 12 ]. According to the 2014 Ghana Demographic and Health Survey (GDHS), about 14% of females aged 15–19 years had begun child bearing. Of these 14%; about 11% have had a life births and 3% were pregnant at the time of the survey [ 13 ]. Abstinence, use of condom, use of contraceptives, decision to keep a pregnancy, use of safe abortions services are some of the choices and reproductive health decisions adolescents make [ 14 ]. The International Conference on Population and Development (ICPD) which was held in Cairo in 1993 recognised the negative effects of risky sexual behaviour. Several countries including Ghana were implored to institute measures to ameliorate the situation [ 15 ]. Therefore, adolescent-friendly reproductive health services and comprehensive abortion care were instituted in Ghana to increase access to reproductive health and safe abortion services. This notwithstanding, many adolescents still encounter significant obstacles in accessing sexual and reproductive health services [ 16 ]. Knowledge on reproductive health services is essential to enable them make informed choices. The type of choices made by these young adults could either impact positively or negatively on their lives, their families and the society at large [ 15 ]. This study therefore explored adolescents’ knowledge about reproductive health and choices, what choices they make and the factors that affect those choices.

Study design

This study adopted a narrative approach to qualitative enquiry. Narrative research allows participants in a study to share their experiences in the community [ 17 ]. Since the researchers were interested in exploring the adolescents’ knowledge on reproductive health services and choices, factors affecting their reproductive health choices, and how these choices affects their lives, the narrative approach was deemed appropriate [ 18 ]. We conducted focus groups discussions with adolescents and individual interviews with stakeholders. In this study, we adopted the ecological model (Fig.  1 ). The ecological model provides a framework for understanding the multiple and interacting factors of adolescent sexual and reproductive health behaviour and their effects [ 19 , 20 ]. This framework posits that adolescent sexual and reproductive health behaviour and their choices are influenced by interpersonal, organisational, community and public policy factors. This model recognises that these factors (interpersonal, organisational, community and public policy) interact across different levels, focus on specific health behaviour and that interventions that address the multiple levels are more effective [ 21 ]. In the entire research process, steps were taken to adhere to the requirements of RATS guideline for conducting and reviewing a qualitative research [ 22 ].

Ecological model for adolescents’ reproductive health choices and factors influencing the choices [ 20 ]

The study was conducted in the West Gonja district of the Northern region of Ghana. The West Gonja district is one of the 26 districts in the region which lies within the savannah belt. The district has an estimated population of 46,803 with an annual growth rate of 2.9%. There are four major religious groups in the district, namely: Islam (about 70%), Catholics (10%), Protestants (8%) and Traditional Worshippers (12%) [ 23 ]. The 2011 and 2012 annual reports of the West Gonja District Health Directorate showed that the district recorded 13.7% and 14.4% of teenage pregnancies with 9.9% and 11.4% delivery rates respectively.

Selection of participants and data collection

The participants in this study were adolescents aged 10–19 years who lived in the West Gonja District at the time of the study. Both male and female in-school and out-of-school adolescents were recruited for the study. The communities were selected based on two criteria; high school dropout rates and teenage pregnancies. The researcher first collected the annual reports from the district and based on that communities were grouped into two; those with high teenage pregnancy and school dropout rates; and those with low teenage pregnancies and school dropout rates. From each category four communities were selected where the study was conducted. At the community level, school authorities were contacted for approval to recruit in-school adolescents. However, for the out-of-school participants, these were selected through the assistance of community leaders.

For stakeholders in adolescents’ sexual and reproductive health, a purposive sampling technique was used. In purposive sampling technique, researchers choose the sample based on who they think are appropriate for the study [ 24 ]. Hence, community opinion leaders and health workers who provide adolescent reproductive health services were selected.

Two main data collection strategies were employed in this study namely; focus group discussions (FGDs) and in-depth interviews (IDIs). Focus group discussion (FGD) refers to a qualitative data collection method where between 6 and 10 individuals with similar background or experiences are brought together to discuss a specific topic of interest with a researcher [ 25 ]. Thus, the use of focus group allows small number of participants to discuss a study topic led by a moderator using a discussion guide [ 26 ]. The focus discussion groups were homogenous for sex and studentship. The FGDs aimed at capturing the local context of sexual and reproductive health of the adolescents and, to enable the investigators get a true picture of the social reality. The FGD guide focused on individual, relationship, and community level factors that affect adolescents’ reproductive health knowledge and choices as required by the ecological framework used for this study. With the aid of an interview guide the investigators introduced the topic to the group and gave them leeway to express themselves. Their responses gave room for further probes. Participants’ responses were written in a field note book and recorded using a digital recorder as well.

Eight FGDs were conducted; four among in-school adolescents (2 males, 2 females) and four among adolescents who were out of school (2 males, 2 females). Each group comprised of 10 discussants making a total of 80 participants in all. Some of the adolescents were married whilst others were not married.

In-depth interviews using semi-structured topic guide were conducted with individuals who were engaged in reproductive health services in the district as well as opinion leaders in the community. This was done to elicit information on both community and the health service related factors that may inform the choices that adolescents make. In all nine IDIs were conducted among various stakeholders. The stakeholders were: one medical doctor, one public health nurse, two midwives, two community health nurses, two community opinion leaders (1 male, 1 female) and the programme manager of World Vision International, a non-governmental organisation engaged in child and adolescent educational programmes in the study area. The data collection was ended at the point of saturation as required in qualitative research [ 24 ]. The IDI topic guide covered areas such community and health system related factors, policies and strategies to ensure safe reproductive health practices among adolescents in line with the societal construct in the ecological model.

Data analysis

Data collected during the FGDs and IDIs were digitally recorded and transcribed verbatim. The field notes were converted into data documents. All transcripts were reviewed by an independent person who is an experienced qualitative researcher. In the review, the independent person listened to the recorded voices and compared the voices with the transcripts. Qualitative narrative data in English were then entered into a word processor (Microsoft Word) and imported into NVivo 11 for analysis.

Thematic analysis was employed in analysing the data. Thematic data analysis process involves data reduction, data display and data conclusion-drawing/verifying [ 27 ]. Line-by-line coding of the various transcripts were done as either free nodes or tree nodes. Queries (analysis in Nvivo) were performed to compare the coding against nodes and attributes to compare and contrast within-group and between-group responses and themes.

Knowledge on reproductive health services and choices

The results from the study revealed that both in-school and out-of-school adolescents had little or no understanding of adolescent reproductive health services and choices. However, some adolescents (15 in-school, and 6 out-of-school) were able to identify abstinence, use of condoms, and other contraceptives to prevent unplanned pregnancies. The following quotes illustrate the understanding of participants as to what reproductive health services are all about:

“Reproductive health services are the service that teach us how to protect ourselves from getting pregnant through the use of condom during sex…also use contraceptives though it is sometimes difficult for us to use contraceptive” (female, FGD, in-school).

“As adolescents, we have to make choices between not having sex until we are married, or if we cannot wait we have to use contraceptive methods that would prevent us from becoming pregnant” (Female, FGD, in-school).

Sources of reproductive health knowledge

FGDs respondents identified peers, parents, teachers, radio and television as the main sources of information on reproductive health. However, most of the adolescents especially those out of school relied mostly on their peers for information on reproductive health. The results showed that parents were an important source of information. For in-school adolescents, teachers emerged as another important source of information on reproductive health as it was unanimous among FGD participants. The following are quotes from some participants to illustrate these views:

“….the major sources of information are through our teachers and nurses. Most of us actually prefer getting our “filla” [information] from our friends and sometimes nurses” (female, FGD, in-school).

“…we get some information from the schools we attend. Sometimes too our parents give us some of the information we need in the form of a warning. I think most of the time when we discuss about it with friends we get to know more about the issues” (male, FGD, in-school).

“When we meet our friends who are more experienced they teach us how to protect ourselves from becoming pregnant. If you have a problem then you bring it out and people will advise you appropriately” (female, FGD, out-of-school).

The study also found that health workers generally believed that there was the need to provide adolescents with reproductive health information. Therefore health education sessions are organized in schools by trained nurses to talk to the students about sexual and reproductive health matters. This opinion is captured in the following statements:

“We have arranged with the schools so that from time to time we give them health talks on sexual and reproductive health” (Midwife-1, IDI).

“In one of the communities here, we noticed that teenage pregnancy was very common resulting in high school dropout rate among female adolescents. So we organised to go and educate them and also provide them with some contraceptives at the school, but the school authorities did not agree. When the community heard about it, they sent a delegation to warn us to desist from such acts. They said we wanted to encourage premarital sex. But you see, the teenagers were becoming pregnant and when you ask about the one responsible, you see it is usually an adult not a colleague teenager” (Public Health Nurse, IDI).

Views on having sexual partners and premarital sex

The findings of this study showed that having multiple sexual partners was considered a source of pride among both male and female participants. It emerged also that while the adolescent male had adolescent female as partners; majority of their counterparts (females) had adult males as partners. The following are quotes from the FGDs to buttress these points:

“As for boyfriends most of us have them, and some girls have sexual intercourse with their boyfriends. So teen pregnancies among the youth are uncountable around here” ( female, FGD, in-school).

“Abstinence among the youth is very difficult. Some people try to abstain from having intercourse, but they are usually described in derogatory terms such as; your penis is not good or manhood is not working” ( male, FGD, in-school).

“For us males, our sexual partners are our colleagues but for the females, their partners are mostly adults. So it is common to find a female having multiple partners because they will have one schoolmate as a boyfriend and an adult who will be providing her with material things and money” ( male, FGD, out-of-school).

Furthermore, both adolescents and stakeholders in this study perceive that sexual activities was rife among both in-school and out-of-school adolescents. The reasons adduced for adolescent engaging in sexual activities include: for sexual pleasure, to comply with his/her group norms, for gifts and also as an expression of love to their partners. Though adolescents in this study acknowledged that premarital sex is risky, it was equally generally believed to be worth the risk and therefore perceived to be indispensable. It also emerged that having sex with multiple partners by female adolescents was common especially sexual activities for gifts or favour from men. The following quotes support these points:

“Their expectations are that they will marry each other. Some expects to have fun and feel good as a girl or boy. Others expect support like money, gifts, clothing and other things from the boyfriend or the girlfriend. Some too expect trust from their girlfriends such that the girl should not have any other boy as a friend” (male, FGD, out-of-school).

“Yes the risk is there because one can get pregnant by having sex but we still do it. You can also get other sicknesses by having sex but what can we do? We have to do it to get what we want” (female, FGD, in-school).

“For us girls, it mostly for gifts from adults. Sometimes, there is nothing you can do about it because that adult is the one taking care of you so you risk losing him to another girl if you do not oblige. My first sex was with a man taking care of me. When I wanted to resist, he threatened to stop taking care of me and get another girl. So because of that I agreed” (female, FGD, in-school).

Interview with community opinion leaders revealed that this practice was really common and many female adolescents relied on it for their upkeep and also to take care of their education. Despite acknowledging this fact, opinion leaders we interviewed believed that advocating for the use of contraceptives was not the way to go. In their view, modern contraceptives can cause infertility among female users. To community opinion leaders, men who are not biological parents to adolescent females take care of their educational needs with the intention of marrying them in future. Also, a woman’s ability to beget children for the husband was perceived as a reward for the investment the man made in her education. So, with the belief that modern contraceptives could cause infertility, their use was seen as something that could lead to a loss in the man’s investment in the adolescent female. The following quotes illustrate these points:

“Premarital sex is very common in the community and for the girls, it is the adults that take them as their partner. Because of poverty, the girls have to rely on these adults for money and upkeep, so they take advantage of them” (Female, Opinion Leader, IDI).

“As for the contraceptives, the men will not agree because, it is believed that it can cause infertility in future. Men in this community take care of female adolescents to marry and have children with them in future. So, if the girl uses contraceptives and become infertile in future, it will mean the man has invested in vain. It is a serious problem, so some NGO is assisting the girls” (Male Opinion Leader, IDI).

The study also explored the use of condoms during such premarital sex since the use of female contraceptives were deemed inappropriate. Adolescents in this study believed most of them engage in unprotected sex. Condoms were believed to inhibit the pleasure in sex and since many engaged in sex for pleasure, the use of a condom was also regarded as impracticable. Another reason for the non-use of condom during sex was the inconvenience or challenges involved in getting one. Some adolescents were of the view that it was difficult going to buy condoms. This is because an adolescent who goes to buy a condom will be perceived as a “bad boy or girl” In their opinion, many of the drugstore sellers in the community know their parents. Therefore they were afraid the sellers may convey that information to their parents. The following quotes illustrate these points:

“Oh yes, condom is a waste of time and no feelings. Everything in life there is a risk and sex itself is a risk. The risk is there in having sex because most do not use condoms; some too have about two or more girlfriends and always have sex with all of them. Through that you can get any disease or even impregnate a girl that you may not even like to marry or have a child with” (male, FGD, out-of-school).

“Yes sometimes when you want to have sex you tell the boy to use condom. Some males agree and use but there are some males who will tell you that if you put a toffee with the wrapper in your mouth do you get the sweetness of the toffee?” ( female, FGD, out-of-school).

“You know, the condoms are sold at drug stores so when you want it, it is difficult to go there and buy especially us the girls. Yes, because of your age some say, you are too small to buy condoms” (female adolescent, FGD in-school).

“….Young people feel shy or afraid to buy condoms because the chemist shop owner may go and tell your parents that you have started using condoms or having sex” (male adolescent, FGD in-school).

Common strategies adopted to prevent pregnancy

This study explored what adolescents do to prevent getting pregnant. The results revealed that local remedies were available and widely used by community members. One of the strategies adopted by adolescents to prevent pregnancy is the use of a local herb called “yigewulso”. This herb is believed to have contraceptive effects. Other herbs also believed to have similar effects are used as emergency contraceptives after unprotected sex. This study also found that some adolescents believed that wearing of some local beads around the waist during sexual intercourse could prevent a pregnancy outcome. The following quotes serve to illustrate their views:

“We have this herb called “yigewulso” which is usually taken before sexual intercourse if you don’t want to get pregnant” (male, FGD, in-school).

“If you have sexual intercourse and you don’t want to be pregnant, you have to take “kaligutim” immediately. Normally, we buy it from the local chemist shop. It can be used either as an emergency contraceptive or when you miss your period” (Female, FGD, Out-school).

“In this community there is a belief that you can prevent getting yourself pregnant if you wear beads in your waist during sexual intercourse. This is why most girls wear beads around the waist before they have sex. Even women who are breastfeeding babies also wear beads to avoid pregnancy while the child is still young”. (IDI, Midwife-1).

These adolescents also reported that other techniques they employed to prevent pregnancy outcome was for the female to lie in the prone position or wash her vagina with soap and water immediately after sexual intercourse. These practices in their opinion would evacuate or kill the sperms in their vagina. They were also of the view that these practices were safe and produced no adverse effects. They had this to say:

“I was told by my friend that when you wash your vagina with soap and water and also lie on your stomach (prone position) immediately after sex, you won’t get pregnant. So, we do it to prevent pregnancy” (female, FGD, out-of-school).

“ ..Some of the traditional methods are better. If your girlfriend knows them and practice them there is no way she will get pregnant, and won’t have problems like those who use the modern contraceptive method” (male, FGD, out-of-school).

Unplanned pregnancies, abortions and sexually transmitted infections

Participants in this study were of the view that unplanned pregnancies were common among adolescents in the district. It emerged that some adolescents in this community believed that getting oneself pregnant was the guarantee or proof of one’s fertility. Male adolescents will also test their manhood by insisting on having unprotected sexual intercourse with the partner and hoping to be told she had “missed her period” (meaning she is pregnant). Sometimes the females may also prefer to have unprotected sexual intercourse in the hope of becoming pregnant as a bait for marriage as well as test for future fertility. The following quotes support these assertions:

“A lady became pregnant and she decides to abort it because she has nobody to take care of the baby. Another lady became pregnant for a guy she loved but her parents disapproved of their relationship because the boyfriend was not doing any work” (Female, FGD, out-of-school).

“Their knowledge level is little. This is because, data gathered in the district indicates high rate of teenage pregnancy and sexually transmitted infections” ( IDI, Midwife-2).

“In this community some of the girls try to get pregnant intentionally to show that they are fertile. Even a girl can tell the colleague you have been having sex with your boyfriend without ever becoming pregnant, it means either you or boyfriend is infertile” (IDI, Opinion Leader).

The results from this study also suggest that most of these unplanned pregnancies are aborted through unsafe practices using a combination of methods such as drinking concoctions of boiled pawpaw leaves, Nescafe, grinded bottles, alcoholic beverages and inserting herbs into the vagina. Participants in this study were of the view that these methods of terminating pregnancy are widely used in the community. The information gathered by this study suggest that some of the unsafe abortions have often resulted in fatal outcomes as illustrated by the following quotes:

“In fact we have plenty illegal abortion in this district particularly in Damongo town. For example one girl just died here last week. What we found out later was that she was given grinded bottles to drink. It is a very common practice” (IDI, Midwife).

“….A friend recently got pregnant and decided to abort using “Salaamalekum” leaves [herb] to do the abortion. Some also use some type of fruits, pawpaw leaves, Nescafe and sugar, alcoholic and non-alcoholic drinks as well as broken bottles to cause the abortion” ( female, FGD, out-of-school).

“I know a girl who was pregnant and the boyfriend bought malt and mixed it with grinded bottle and gave it to her and she drank, few hours after drinking that she bled and finally died” (female, FGD, in-school).

Participants in this study also indicated that sexually transmitted infections (STIs) were common in the community. They attributed this to the youth practicing unprotected sexual intercourse with multiple partners. In their opinion, there is risk in every activity. So it was normal to enjoy sexual intercourse and treat any STI that may arise. The following quotes illustrate these points:

“Sexually transmitted infections especially white (candidiasis) is very common among the females in the area. Often when they come they will just say…madam I have white and we have to test them for STIs” (IDI, Midwife-3).

“The STIs you are talking about is very common in this community because many of the youth have multiple partners which they call it “inter” and “exter” one in your school and one outside your school” (male, FGD, in-school).

“There is risk in everything we do, so it is better to enjoy yourself during sexual intercourse and if you get a disease, you treat it. I don’t ask the man to use condom, I don’t like it myself” (female, FGD, in-school).

Access to reproductive and sexual health services in the community

The findings of our study show that reproductive health services are generally available in the community. There are outreach services for the communities. These include; health education, counselling, and provision of contraceptive services. The study also found that adolescents were generally aware of some of these services and how to access them except for comprehensive abortion care. The following quotes illustrate these points:

“We have service-points for adolescent reproductive health service in this district where we provide education, counselling, contraceptive service and comprehensive abortion care to adolescent who visit us” (IDI, Public Health Nurse).

“There are outreach services for communities where there is no clinic or hospital to provide reproductive health service” (IDI, Midwife-2).

“The nurses have been coming to tell us that we can come to them for reproductive health service, so we know those services are available at the hospitals and clinics” (female, FGD, in-school).

The above notwithstanding, the results of this study show that there were some barriers to accessing these services. Four main sub-themes emerged in this respect, namely; sociocultural, attitude of service-providers, lack of privacy and confidentiality on the part of service providers and finally perceived adverse effects. The study found that the community generally perceived issues about sexual and reproductive health as only suitable for adults. Therefore, it was the general believe that it would be inappropriate to discuss such issues with adolescents. Though health workers were trained to provide these services to adolescents, there was the general believe and fear among adolescents that they may be scolded or described as “bad boys or girls” if they should go for such services. Some adolescents were also of the view that health care providers do not treat adolescents who seek for reproductive sexual health services well. The poor attitude of health providers towards adolescents deters the later from patronizing the available services.

Another barrier reported in this study was the lack of privacy. Adolescents who participated in this study were of the view that the service points did not provide enough privacy and confidentiality. In their opinion, the present environment does make it possible for people to see adolescents who seek such services as ‘spoilt children’ or may even conclude that you have come to do abortion or contraception. Another issue of confidentiality was the general believe that service providers sometimes tell parents of adolescents who seek such services that their ward was sexually active. The following quotes support these points:

“In this community, if an adolescent ask about sexual and reproductive issues, the person will be seen as a bad girl or boy. So we are afraid to go to the clinic and hospital for such services. Imagine a girl going to the hospital to do something and the information comes out that you went there to do abortion. People will say you are bad, and if you are not lucky, the information could spread to all over town the next day” (female, FGD, out-of-school).

“… Some of the nurses are not polite especially to us the young people. You go there with a problem then they will be shouting at you or even insulting you saying you are bad girl or boy. The authorities should punish or even sack such people, but you see, some of us do complain about these things but nothing happens to them” (Male, FGD, In-school).

Interviews with services providers revealed that the design of some of the service points makes it difficult to provide optimum privacy to clients. The study also found that some staff were not trained on adolescent friendly reproductive health services as illustrated:

“…The lack of privacy is due to how our facilities were designed. Many of our facilities in this district have no space provided for that. Lack of confidentiality from health personnel, as well as inadequate qualified personnel are serious challenges that we face on the daily basis” (IDI, Midwife-1).

“Our staff are not well trained as adolescent friendly reproductive health service providers. We are all using our previous knowledge from school which may not be enough and also the working experiences… everybody is committed in helping out to make the situation better. Inadequate staff numbers is also a big problem for us. The work is, actually too much for us” (IDI, Midwife-2).

“….Our consulting rooms are not safe. When a person comes with a sexually transmitted infection, they often not able tell us because some people may hear the conversation. They rather try to hide the truth from you and begin to tell you about other things, leaving you to guess the problem” (IDI, Public Health Nurse).

Stakeholders interviewed in this study noted that access to SRH information and services could reduce school dropout rate among females. However, stakeholders indicated that some health workers were uncomfortable providing adolescents with reproductive health services. In their view, availing condoms to adolescents may lead them to experiment with sex. Also, increasing access to comprehensive abortion services will encourage sexual activity among adolescents. Some stakeholders were of the view that some health workers have a negative attitude towards comprehensive abortion service because it conflicts with their religious beliefs. The following quotes illustrate these points:

“Allowing adolescent access to condom will encourage sexual practice among them. As for access to abortion, it means we will be encourage them to experiment with sex. After all when you become pregnant you can abort it at the hospital” (IDI, Opinion Leader).

“Some health workers are uncomfortable providing comprehensive abortion care to adolescents. They perceive abortion as something that is against their religious beliefs. So, it is even worse when they are to provide such a service to adolescent” (IDI, Public Health Nurse).

Knowledge on reproductive health and sources of information

The study found that both in-school and out-of-school adolescents in this part of Ghana did not have comprehensive knowledge on reproductive health issues and choices. The lack of knowledge makes them vulnerable to unsafe reproductive health behaviour and inappropriate choices. Some of these choices may have detrimental effects on their reproductive health and future. For example, a wrong choice can lead to unplanned pregnancy or STI infection [ 28 ]. In another study, it was found that lack of knowledge on reproductive health was associated with early initiation of coital relations and of unwanted pregnancies [ 29 ]. The effects of these unplanned pregnancies are multifarious with some capable of lasting for a lifetime. These potential human resource and future leaders end up as school dropouts due to unplanned pregnancy and other attendant complications. Additionally, a good number of adolescents who indulge in early sexual debut may contract HIV and other STIs [ 30 ]. These have social and economic implications for their households and the nation as whole as funds will be required to provide lifetime medication for people with HIV [ 31 ], and may even affect their line of generations yet unborn [ 32 ].

As we have shown, most out-of-school adolescents are reliant on their peers who are in-school and the mass media for information on reproductive health. These sources make them vulnerable to misinformation. In that case, they will be making decisions based on an incorrect information which can negatively affect them. Parents who could be the most appropriate source of information are inhibited by socio-cultural barriers that prevent them from discussing reproductive health issues with their children as has been reported by Owusu, Blankson & Abane [ 33 ] in the Central Region of Ghana. Similarly, studies in Nigeria and Uganda found that adolescents preferred parents as a source of information about sexual and reproductive health, however cultural sensitivity and social norms inhibited them [parents] from playing that role effectively [ 34 , 35 , 36 ]. Talking about sex is often frowned upon by both traditional and religious adherents in the Ghanaian society. This environment makes it difficult and sometimes impossible for adolescents to discuss sex and related issues with parents or adult family members [ 37 ]. The findings of this study underscore the need for innovative ways to expand access to reproductive health education and services to both in-school and out-of-school adolescents. School-based approaches which are linked to the community have been found to be effective in other countries [ 21 , 38 , 39 ]. These approaches could be adopted for Ghanaian adolescents as a community-related strategy (intervention) in the ecological model.

Views on having sexual partners and premarital sexual practices

The study found that having a sexual partner was a common practice among adolescents in the community, and is widely viewed as an acceptable practice. Among adolescents, this is done to conform to peer norms and a way of demonstrating that one had what it takes to be a woman or man. The act of engaging in sexual practice among adolescents has been widely reported across the sub-Saharan African region, with about 25% reporting having sexual contact before attaining 15 years of age [ 40 ].

This study also found that having multiple partners was a common practice. Similar findings were reported among adolescents in Tanzania [ 41 ]. Despite the fact that many adolescents reported having multiple partners, the use of condom was reportedly low during sexual encounters. This is a challenge to public health workers involved in sensitizing the population against risk of STIs and HIV among Ghanaians. The use of condom is one of the key strategies employed by the National AIDS Control Programme (NACP) to reduce the burden of HIV and STIs. Having sex with multiple partners without the use condom is one of the risk factors in HIV transmission and many studies have documented high prevalence of HIV infection among people with multiple partners [ 42 , 43 , 44 ].

The study found that transactional sex (sex for gift) was common in the community and many adolescents were engaging in this type of sexual acts with adults in the community. Female adolescents were engaged is this practice as a way of survival as a result of endemic poverty in the community [ 45 ]. This will require interventions at the community level to empower females. Also enforcing laws that protect the human right of females in the community and use of mass media approaches to create awareness about the existing laws and policies about adolescent sexual and reproductive health related issues may be essential in addressing transactional sexual practices. The policies and laws fall under the societal construct in the ecological model. Transactional sex has been found to be associated with having multiple partners as well as engaging in HIV-related risky behaviour [ 46 ]. An earlier study has found high prevalence of HIV infection among people engaged in transactional sex [ 47 ]. This high prevalence may not necessarily be due to the high level of exposure as a result of multiple partners [ 47 , 48 ] but it also creates a situation which makes it impossible for females especially to negotiate for the use of condom as found in this study. Therefore people engaged in HIV prevention must be concern about transactional sex.

Strategies against unplanned pregnancies, and abortions

From this study, it emerged that respondents believe that some local preparations and herbs are effective abortifacients. Such believes were widespread and well-known thereby resulting in low patronage for modern contraceptives. A study in southern Ghana reported similar believes where there was the widespread notion that ingestion of panacin and cafalgen (painkillers) before sex had some contraceptive effects [ 49 ]. Washing of the vagina and vulva with soap and water which is another local practice to avoid pregnancy after unprotected sex has implications on the reproductive health of adolescents. This practice can predispose adolescents to reproductive tract infections which can negatively affect their reproductive functions. Washing the vagina with soap is capable of destroying the normal flora of the vagina and vulva predisposing the female to vaginosis [ 50 ]. Vagina cleaning using soap and water has also been reported to increase HIV infection [ 50 , 51 ]. Health education to community should highlight the negative effects of these practices on the future reproductive health of adolescents.

It is however obvious in the study that these preparations believed to be abortifacients were ineffective as participants in this study indicated that the incidence of unplanned pregnancies was high even among people who had used these items to prevent pregnancy. The findings of this study further show that adolescents who become pregnant do not seek for safe abortion services but engage in unsafe abortion practices using grinded bottles, inserting herbs into the vagina and use of drinks that contain alcohol. These unsafe abortion practices have very serious implications on the health of adolescents as it can result in complications and death. Unsafe abortion is one of the leading preventable causes of maternal mortality across the world [ 52 , 53 , 54 , 55 ]. Increasing access to safe abortion and comprehensive abortion care were introduced to ameliorate the negative effects of unsafe abortion. Comprehensive abortion care have been found to have high impact in reducing maternal mortality [ 56 , 57 , 58 ]. Though Ghana has been implementing comprehensive abortion care in health facilities across all regions [ 59 ], the finding of this study reveals a lack of knowledge and awareness about comprehensive abortion care among adolescents as many still engaged in unsafe practices with detrimental effects on their health. More community sensitization should be done to create awareness on the existence of comprehensive abortion care service in health facilities in Ghana.

The study generally found that reproductive health services were available in the community. Also, efforts are being made to bring service close to the communities through outreach programme. However, these efforts were undermined by service-related barriers. Key amongst these was the attitude of health workers towards providing services to adolescents. The study reported there was widespread feeling of negative attitude of service providers towards adolescents, hence their refusal to patronize the services. The negative attitude was reported by both adolescents and stakeholders in this study. This negative attitude was due to community norms and beliefs of health workers concerning some services such as contraceptive use and safe abortion. This will require training of health workers on adolescent-friendly approaches to reproductive health services. Sensitization of community will also be required to increase acceptance. Adolescents’ reproductive health service programmes that target health workers to provide adolescent friendly facility-based services with the approval of community have been found to be more effective [ 39 ]. Lack of training has been found to negatively affect the quality of care provided to adolescents in an earlier study [ 60 ]. When the attitude of health service providers improves, it will lead to utilization of the services. A study in Kenya found a significant association between friendliness of service provider, and proximity to service provider and uptake of contraceptives [ 61 ].

Adolescents in this study were of the view that the designs of reproductive health service outlets did not provide enough privacy. This was therefore a barrier to uptake of such services in the community. Service outlets for adolescent reproductive health services should be designed to provide good privacy. This is because there are socio-cultural norms that prevent adolescent from using reproductive health services. Therefore, adolescents found utilizing reproductive health service risk been described in derogatory terms. This therefore call for measure to ensure strict privacy as that is the only way such services can be patronized by adolescents.

Limitation of the study

The main limitation of this study is that it was conducted in one rural district in Northern Ghana and the findings cannot be assumed to be the same in other settings. However, the study provides insight into areas to target for health promotion and interventions on adolescent reproductive health choices.

This study concludes that adolescents in this study generally engaged in risky reproductive health choices with potential of negatively affecting their reproductive health in future. Social and health systems barriers inhibited the utilization of existing reproductive health services. Advocates for reproductive health service providers need to develop better innovative ways to provide this important service to adolescent especially those who are out of school. Sexual and reproductive health promotional activities should target parents as a way of breaking the social barriers. Community sensitization and training of health workers is required to remove barriers and increase the utilization of reproductive health services.

Abbreviations

Focus group discussion

Ghana Demographic and Health Survey

Human Immunodeficiency Virus

International Conference on Population and Development

in-depth interview

National AIDS/STIs Control Programme

Sexual Transmitted Infections

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Acknowledgements

We wish to thank the district director of health services of the West Gonja District in Northern region and all the participants for their cooperation in this study.

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Conceived and designed the experiments: JMK, BBK, PT-NT. Performed the experiments: JMK Analyzed the data: PT-NT, JMK, BBK. Contributed reagents/materials/analysis tools: JMK, PT-NT, BBK. Wrote the paper: PT-NT, JMK BBK. All authors read and approved the final manuscript

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Kyilleh, J.M., Tabong, P.TN. & Konlaan, B.B. Adolescents’ reproductive health knowledge, choices and factors affecting reproductive health choices: a qualitative study in the West Gonja District in Northern region, Ghana. BMC Int Health Hum Rights 18 , 6 (2018). https://doi.org/10.1186/s12914-018-0147-5

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10 Essential Essays About Women’s Reproductive Rights

“Reproductive rights” let a person decide whether they want to have children, use contraception, or terminate a pregnancy. Reproductive rights also include access to sex education and reproductive health services. Throughout history, the reproductive rights of women in particular have been restricted. Girls and women today still face significant challenges. In places that have seen reproductive rights expand, protections are rolling back. Here are ten essential essays about reproductive rights:

“Our Bodies, Ourselves: Reproductive Rights”

bell hooks Published in Feminism Is For Everyone (2014)

This essay opens strong: when the modern feminism movement started, the most important issues were the ones linked to highly-educated and privileged white women. The sexual revolution led the way, with “free love” as shorthand for having as much sex as someone wanted with whoever they wanted. This naturally led to the issue of unwanted pregnancies. Birth control and abortions were needed.

Sexual freedom isn’t possible without access to safe, effective birth control and the right to safe, legal abortion. However, other reproductive rights like prenatal care and sex education were not as promoted due to class bias. Including these other rights more prominently might have, in hooks’ words, “galvanized the masses.” The right to abortion in particular drew the focus of mass media. Including other reproductive issues would mean a full reckoning about gender and women’s bodies. The media wasn’t (and arguably still isn’t) ready for that.

“Racism, Birth Control, and Reproductive Rights”

Angela Davis Published in Women, Race, & Class (1981)

Davis’ essay covers the birth control movement in detail, including its race-based history. Davis argues that birth control always included racism due to the belief that poor women (specifically poor Black and immigrant women) had a “moral obligation” to birth fewer children. Race was also part of the movement from the beginning because only wealthy white women could achieve the goals (like more economic and political freedom) driving access to birth control.

In light of this history, Davis emphasizes that the fight for reproductive freedom hasn’t led to equal victories. In fact, the movements driving the gains women achieved actively neglected racial inequality. One clear example is how reproductive rights groups ignored forced sterilization within communities of color. Davis ends her essay with a call to end sterilization abuse.

“Reproductive Justice, Not Just Rights”

Dorothy Roberts Published in Dissent Magazine (2015)

Dorothy Roberts, author of Killing the Black Body and Fatal Invention , describes attending the March for Women’s Lives. She was especially happy to be there because co-sponsor SisterSong (a collective founded by 16 organizations led by women of color) shifted the focus from “choice” to “social justice.” Why does this matter? Roberts argues that the rhetoric of “choice” favors women who have options that aren’t available to low-income women, especially women of color. Conservatives face criticism for their stance on reproductive rights, but liberals also cause harm when they frame birth control as the solution to global “overpopulation” or lean on fetal anomalies as an argument for abortion choice.

Instead of “the right to choose,” a reproductive justice framework is necessary. This requires a living wage, universal healthcare, and prison abolition. Reproductive justice goes beyond the current pro-choice/anti-choice rhetoric that still favors the privileged.

“The Color of Choice: White Supremacy and Reproductive Justice”

Loretta J. Ross, SisterSong Published in Color of Violence: The INCITE! Anthology (2016)

White supremacy in the United States has always created different outcomes for its ethnic populations. The method? Population control. Ross points out that even a glance at reproductive politics in the headlines makes it clear that some women are encouraged to have more children while others are discouraged. Ross defines “reproductive justice,” which goes beyond the concept of “rights.” Reproductive justice is when reproductive rights are “embedded in a human rights and social justice framework.”

In the essay, Ross explores topics like white supremacy and population control on both the right and left sides of politics. She acknowledges that while the right is often blunter in restricting women of color and their fertility, white supremacy is embedded in both political aisles. The essay closes with a section on mobilizing for reproductive justice, describing SisterSong (where Ross is a founding member) and the March for Women’s Lives in 2004.

“Abortion Care Is Not Just For Cis Women”

Sachiko Ragosta Published in Ms. Magazine (2021)

Cisgender women are the focus of abortion and reproductive health services even though nonbinary and trans people access these services all the time. In their essay, Ragosta describes the criticism Ibis Reproductive Health received when it used the term “pregnant people.” The term alienates women, the critics said, but acting as if only cis women need reproductive care is simply inaccurate. As Ragosta writes, no one is denying that cis women experience pregnancy. The reaction to more inclusive language around pregnancy and abortion reveals a clear bias against trans people.

Normalizing terms like “pregnant people” help spaces become more inclusive, whether it’s in research, medical offices, or in day-to-day life. Inclusiveness leads to better health outcomes, which is essential considering the barriers nonbinary and gender-expansive people face in general and sexual/reproductive care.

“We Cannot Leave Black Women, Trans People, and Gender Expansive People Behind: Why We Need Reproductive Justice”

Karla Mendez Published in Black Women Radicals

Mendez, a freelance writer and (and the time of the essay’s publication) a student studying Interdisciplinary Studies, Political Science, and Women’s and Gender Studies, responds to the Texas abortion ban. Terms like “reproductive rights” and “abortion rights” are part of the mainstream white feminist movement, but the benefits of birth control and abortions are not equal. Also, as the Texas ban shows, these benefits are not secure. In the face of this reality, it’s essential to center Black people of all genders.

In her essay, Mendez describes recent restrictive legislation and the failure of the reproductive rights movement to address anti-Blackness, transphobia, food insecurity, and more. Groups like SisterSong have led the way on reproductive justice. As reproductive rights are eroded in the United States, the reproductive rights movement needs to focus on justice.

“Gee’s Bend: A Reproductive Justice Quilt Story From the South”

Mary Lee Bendolph Published in Radical Reproductive Justice (2017)

One of Mary Lee Bendolph’s quilt designs appears as the cover of Radical Reproductive Justice. She was one of the most important strip quilters associated with Gee’s Bend, Alabama. During the Civil Rights era, the 700 residents of Gee’s Bend were isolated and found it hard to vote or gain educational and economic power outside the village. Bendolph’s work didn’t become well-known outside her town until the mid-1990s.

Through an interview by the Souls Grown Foundation, we learn that Bendolph didn’t receive any sex education as a girl. When she became pregnant in sixth grade, she had to stop attending school. “They say it was against the law for a lady to go to school and be pregnant,” she said, because it would influence the other kids. “Soon as you have a baby, you couldn’t never go to school again.”

“Underground Activists in Brazil Fight for Women’s Reproductive Rights”

Alejandra Marks Published in The North American Congress on Latin America (2021)

While short, this essay provides a good introduction to abortion activism in Brazil, where abortion is legal only in the case of rape, fetal anencephaly, or when a woman’s life is at risk. The reader meets “Taís,” a single mother faced with an unwanted pregnancy. With no legal options, she researched methods online, including teas and pills. She eventually connected with a lawyer and activist who walked her through using Cytotec, a medication she got online. The activist stayed on the phone while Taís completed her abortion at home.

For decades, Latin American activists have helped pregnant people get abortion medications while wealthy Brazilians enter private clinics or travel to other countries. Government intimidation makes activism risky, but the stakes are high. Hundreds of Brazilians die each year from dangerous abortion methods. In the past decade, religious conservatives in Congress have blocked even mild reform. Even if a new president is elected, Brazil’s abortion rights movement will fight an uphill battle.

“The Ambivalent Activist”

Lauren Groff Published in Fight of the Century: Writers Reflect on 100 years of Landmark ACLU Cases (2020)

Before Roe v. Wade, abortion regulation around the country was spotty. 37 states still had near-bans on the procedure while only four states had repealed anti-abortion laws completely. In her essay, Groff summarizes the case in accessible, engaging prose. The “Jane Roe” of the case was Norma McCorvey. When she got pregnant, she’d already had two children, one of whom she’d given up for adoption. McCorvey couldn’t access an abortion provider because the pregnancy didn’t endanger her life. She eventually connected with two attorneys: Sarah Weddington and Linda Coffee. In 1973 on January 2, the Supreme Court ruled 7-2 that abortion was a fundamental right.

Norma McCorvey was a complicated woman. She later became an anti-choice activist (in an interview released after her death, she said Evangelical anti-choice groups paid her to switch her position), but as Groff writes, McCorvey had once been proud that it was her case that gave women bodily autonomy.

“The Abortion I Didn’t Want”

Caitlin McDonnell Published in Salon (2015) and Choice Words: Writers on Abortion (2020)

While talking about abortion is less demonized than in the past, it’s still fairly unusual to hear directly from people who’ve experienced it. It’s certainly unusual to hear more complicated stories. Caitlin McDonnell, a poet and teacher from Brooklyn, shares her experience. In clear, raw prose, this piece brings home what can be an abstract “issue” for people who haven’t experienced it or been close to someone who has.

In debates about abortion rights, those who carry the physical and emotional effects are often neglected. Their complicated feelings are weaponized to serve agendas or make judgments about others. It’s important to read essays like McDonnell’s and hear stories as nuanced and multi-faceted as humans themselves.

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About the author, emmaline soken-huberty.

Emmaline Soken-Huberty is a freelance writer based in Portland, Oregon. She started to become interested in human rights while attending college, eventually getting a concentration in human rights and humanitarianism. LGBTQ+ rights, women’s rights, and climate change are of special concern to her. In her spare time, she can be found reading or enjoying Oregon’s natural beauty with her husband and dog.

Taking Stock: Sexual and Reproductive and Health and Rights in Climate Commitments: An Arab States Review Summary

Resource date: May 2024

Publisher: UNFPA, Queen Mary University London and IDRC Canada

This document serves as a summary of the report, Taking Stock: Sexual and Reproductive and Health and Rights in Climate Commitments: An Arab States Review.

The Nationally Determined Contributions (NDCs) are the most central and globally representative climate policy documents that outline the national climate plans of countries that have ratified the Paris Climate Agreement. Submitted every five years, the NDCs indicate the voluntary commitments of countries to achieving agreed-upon mitigation and adaptation goals.

With climate impacts increasing in scale and intensity, communities on the frontlines are becoming more vulnerable, especially women and girls. As the year 2023 marked the conclusion of the first global stocktake of the Paris Agreement, this report reflects on how Arab States NDCs incorporated SRHR issues, and seeks to inform the third cycle of NDCs from the region to be submitted in 2025 . It is equally timely with the 30th anniversary of the International Conference on Population and Development (ICPD) to reassert the powerful links between population, sexual and reproductive health and rights, gender equality, and climate change.

UNFPA, in collaboration with Queen Mary University of London, conducted a systematic content analysis of SRHR references and related thematic areas in NDC documents for 15 of the 20 Arab States countries. 

This regional report examines the integration of sexual reproductive health and rights and related themes - including health, gender, population dynamics, youth,  human rights, vulnerable groups and participation - in the NDCs of countries from 2020 onwards. It  offers recommendations on how the next submissions can more effectively  address these intersections in terms of impact, commitments, budget and other critical actions. 

Following the outcome of COP28 in Dubai, countries were requested to submit their next NDCs “at least 9-12 months in advance” of COP30 in Brazil at the end of 2025. These reports will help guide stakeholders across the region to ensure that the next submissions of NDCs have a full and substantive reflection of the intersections of climate, SRHR, GBV and harmful practices. 

Access the full report here .

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• Sexual & reproductive health

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Common Reproductive Health Concerns for Women

At a glance.

Find information on some common reproductive health concerns such as endometriosis, uterine fibroids, gynecologic cancer, HIV, interstitial cystitis, polycystic ovary syndrome, sexually transmitted infections, and sexual and intimate partner violence.

Endometriosis

Endometriosis is a problem affecting a woman's uterus—the place where a baby grows when a woman is pregnant. Endometriosis occurs when the kind of tissue that normally lines the uterus grows somewhere else. It can grow on the ovaries, behind the uterus, on the bowels, or on the bladder. Rarely, it grows in other parts of the body.

This "misplaced" tissue can cause pain, infertility, and very heavy periods. The pain is usually in the abdomen, lower back, or pelvic areas. Some women have no symptoms at all. For these women, the first sign they have endometriosis may be that they have trouble getting pregnant.

Uterine Fibroids

Uterine fibroids are the most common noncancerous tumors in women of reproductive age. Fibroids are made of muscle cells and other tissues that grow in and around the wall of the uterus, or womb. The cause of fibroids is unknown. Risk factors include being African American or being overweight. The symptoms of fibroids include:

• Heavy or painful periods or bleeding between periods.
• Feeling "full" in the lower abdomen.
• Urinating often.
• Pain during sex.
• Lower back pain.
• Infertility.
• Multiple miscarriages.

But some women will have no symptoms.

Gynecologic Cancer

Gynecologic cancer is any cancer that starts in a woman's reproductive organs. Gynecologic cancers begin in different places within a woman's pelvis, the area below the stomach and between the hip bones.

• Cervical cancer begins in the cervix, which is the lower, narrow end of the uterus.
• Ovarian cancer begins in the ovaries, which are located on each side of the uterus.
• Uterine cancer begins in the uterus, the pear-shaped organ in a woman's pelvis where the baby grows when a woman is pregnant.
• Vaginal cancer begins in the vagina, which is the hollow, tube-like channel between the bottom of the uterus and the outside of the body.
• Vulvar cancer begins in the vulva, the outer part of the female genital organs.

HIV is the human immunodeficiency virus. HIV affects specific cells of the immune system (called CD4 cells). Over time, HIV can destroy so many of these cells that the body can't fight off infection anymore.

The human body cannot get rid of HIV—that means once a person has HIV, he or she has it for life. There is no cure at this time, but with proper medical care, the virus can be controlled. HIV is the virus that can lead to acquired immune deficiency syndrome, or AIDS. AIDS is the late stage of HIV infection, when a person's immune system is severely damaged.

HIV in Women

Women who are infected with HIV typically get it by having sex with a man who is infected or by sharing needles with an infected person.

While HIV affects all races and ethnicities in the United States and U.S. territories, some groups are disproportionately affected compared to their population size. Black/African American people and Hispanic/Latino people are particularly affected by HIV. Racism, HIV stigma, homophobia, poverty, and barriers to health care continue to drive these disparities.

Pregnant Women

All pregnant women should know their HIV status. It is possible for a mother to have HIV and not spread it to her baby, especially if she knows about her HIV status early and works with her health care provider to reduce the risk. Pregnant women who are HIV-positive can work with their health care providers to ensure their babies do not contract HIV during pregnancy, delivery, or after delivery (through breast milk).

Learn more from CDC's Let's Stop HIV Together campaign, including how HIV is spread and how to prevent HIV.

Interstitial Cystitis

Interstitial cystitis (IC) is a chronic bladder condition resulting in recurring discomfort or pain in the bladder or surrounding pelvic region. People with IC usually have inflamed or irritated bladder walls. This can cause scarring and stiffening of the bladder.

IC can affect anyone; however, it is more common in women than men. People could have some or none of the following symptoms:

• Abdominal or pelvic mild discomfort.
• Frequent urination.
• A feeling of urgency to urinate.
• Feeling of abdominal or pelvic pressure.
• Tenderness.
• Intense pain in the bladder or pelvic region.
• Severe lower abdominal pain that intensifies as the urinary bladder fills or empties.

Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome happens when a woman's ovaries or adrenal glands produce more male hormones than normal. One result is that cysts (fluid-filled sacs) develop on the ovaries. Women who are obese are more likely to have PCOS. Women with PCOS are at increased risk of developing diabetes and heart disease. Symptoms may include:

• Infertility .
• Pelvic pain.
• Excess hair growth on the face, chest, stomach, thumbs, or toes.
• Baldness or thinning hair.
• Acne, oily skin, or dandruff.
• Patches of thickened dark brown or black skin.

Sexually Transmitted Infections (STIs)

STIs, also known as sexually transmitted diseases (STDs), are infections that you can get from having sex with someone who has the infection. The causes of STIs are bacteria, parasites, and viruses. There are more than 20 types of STIs. Read more about specific STIs from these CDC fact sheets .

Most STIs affect both men and women, but in many cases the health problems they cause can be more severe for women. If a pregnant woman has an STI, it can cause serious health problems for the baby.

If you have an STI caused by bacteria or parasites, it can be treated with antibiotics or other medicines. If you have an STI caused by a virus, there is no cure, but antiviral medication can help control symptoms. Correct usage of latex condoms greatly reduces but does not eliminate the risk of catching or spreading STIs.

Sexual and Intimate Partner Violence

Sexual violence (SV) is a significant problem in the United States. SV refers to sexual activity where consent is not obtained or freely given. Learn more about sexual violence risk and protective factors .

Intimate partner violence (IPV) is a serious, preventable public health problem that affects millions of Americans. The term intimate partner violence describes physical, sexual, or psychological harm by a current or former partner or spouse. This type of violence can occur among heterosexual or same-sex couples and does not require sexual intimacy.

Find a Health Center

Health Resources Services Administration (HRSA) health centers care for you, even if you have no health insurance. You pay what you can afford, based on your income.

• Health Resources and Services Administration. Find a Health Center. Accessed January 1, 2024. https://findahealthcenter.hrsa.gov/
• Office of Women's Health. Sexually Transmitted Infections. Accessed January 1, 2024. https://www.womenshealth.gov/a-z-topics/sexually-transmitted-infections

Reproductive Health

CDC’s Division of Reproductive Health focuses on issues related to reproductive health, maternal health, and infant health.

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Charlotte Urban: Biden, Harris understand stakes of reproductive health

Charlotte Urban

• May 25, 2024

Last month, I received a surprise call and was asked to introduce Vice President Kamala Harris at her event in La Crosse.

I was shocked and surprised — and thought “why me?” — but as a third-year medical student at the University of Wisconsin-Madison, where I’m a co-lead of the Reproductive Health Task Force and in the Rural Medicine Program, I was also excited. I know the stakes in this November’s election couldn’t be any higher for women, particularly for women in rural Wisconsin.

After Roe v. Wade was overturned, Wisconsin women lost the fundamental right to control their bodies overnight. This unjust and dangerous decision had a direct impact on my life and on my future. I’m a medical student who’s currently completing rotations at a hospital in La Crosse, and my goal is to be an OB/GYN in a rural community like Wood County, Wisconsin, where I grew up. But with access to reproductive health care still in flux in Wisconsin, I’ve been forced to consider leaving the state to get the training and opportunities that I need to provide that critical care.

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Wisconsin can’t afford to lose aspiring OB/GYNs like me. We’re already facing a shortage of health care professionals, and of OB/GYNs in rural areas in particular. And let’s be clear: Donald Trump and his allies are to blame for the extreme anti-abortion agenda that has left OB/GYNs with fewer options and women across the country without access to life-saving care.

Trump has bragged about being “proudly the person responsible” for ending Roe and the extreme state bans that have followed, and Trump recently endorsed prosecuting women who have an abortion and allowing states to monitor pregnant women.

UW-Madison student Charlotte Urban, who is completing her clinical rotations at a La Crosse hospital, introduced U.S. Vice President Kamala Harris during her visit to La Crosse in April.

This is obscene and fully out of step with the vast majority of Wisconsinites who support reproductive rights. When I met Harris in La Crosse, I told her my dreams of being a rural OB/GYN and how I want to care for others in communities like the one I grew up in — but because of Trump, my dreams may not be possible.

In her remarks, the Vice President said she believes “freedom is fundamental to the promise of America. The promise of America is the promise of protecting and respecting individuals’ rights and liberty and freedom to make certain decisions, including those of heart and home.”

I agree, but it’s clear Trump and Republicans do not respect our freedoms – and that they won’t stop at restricting abortion. They are hellbent on inserting themselves into the most personal decisions women can make, including contraception and in vitro fertilization.

Meanwhile, President Joe Biden and Harris have stood by reproductive freedom time and time again. They’re fighting to restore the protections of Roe v. Wade in federal law to protect reproductive health care access in every state, so that doctors don’t have to choose between going to jail or providing the care that they were trained to provide.

It was the honor of a lifetime to meet and introduce Harris, and in November, women in Wisconsin will choose between Trump, who has endorsed prosecuting women who receive abortions, and Biden and Harris, who will always protect our fundamental freedoms. The choice couldn’t be more clear.

Charlotte Urban is a third-year medical student in the rural medicine program at the University of Wisconsin, where she is also the co-lead on the Reproductive Health Task Force. She is currently completing her clinical rotations at a hospital in La Crosse. Are you a local expert about a particular subject in the news? The Tribune encourages and promotes Community Voices to speak up about important local matters. Send a Community Voices Guest Column of 400-600 words with a headshot and brief biography to [email protected] for consideration.

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• HHS Supports Reproductive Health Care Privacy by Modifying the HIPAA Privacy Rule

The Department of Health and Human Services’ (“HHS”) Office for Civil Rights recently published a final rule (the “ Final Rule “) which provides additional privacy protections related to the use and disclosure of reproductive health care information.  Covered entities (e.g., health plans) and their business associates must comply with all of the provisions of the Final Rule by December 22, 2024, except for the requirement to update their Notice of Privacy Practices, which must be updated by February 16, 2026.

At a high level, the Final Rule amended the privacy regulations promulgated under HIPAA (the “Privacy Rule”) to:

• Prohibit the use or disclosure of protected health information (“PHI”) when it is requested to identify, investigate, or impose liability on individuals who seek, obtain, provide, or facilitate reproductive health care that is lawful under the circumstances in which the health care is provided;
• Require that covered entities and business associates obtain a valid attestation from the person or entity requesting PHI that is potentially related to reproductive health care if the request is for: (a) health care activities, (b) judicial and administrative proceedings, (c) law enforcement purposes, and (d) disclosures to coroners and medical examiners; and
• Require covered entities to modify their Notice of Privacy Practices to implement the changes made to reproductive health care privacy.

Below are a few important takeaways related to the Final Rule:

Presumption of Lawful Health Care – Reproductive health care is presumed to be lawful unless the covered entity or business associate either (a) has actual knowledge that the care was unlawful, or (b) receives information from the person requesting the use or disclosure of PHI and the information provides a substantial factual basis that the care was unlawful.

Attestation Requirement – The attestation may not be combined with any other document. While covered entities and business associates can develop their own attestation form, the HHS has indicated that it will publish a model attestation form prior to the compliance date.

Compliance Considerations for Covered Entities and Business Associates – If you are a covered entity or business associate, you should take the following steps to remain HIPAA compliant after the Final Rule’s compliance dates:

• HIPAA Policies and Procedures :  You should review and update your HIPAA policies and procedures regarding the use and disclosure of PHI related to reproductive health care.
• Attestation :  You should develop an attestation form, or use the HHS’s model attestation form, which should be published prior to the compliance date.
• Workforce Training :  You should update workforce training materials and provide workforce training to describe the limitations on the use and disclosure of PHI related to reproductive health care and the new attestation requirement.
• Notice of Privacy Practices :  You should update the Notice of Privacy Practices to include the new Final Rule requirements no later than February 16, 2026.  

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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