2026-04-02
Ephraim Senkyire, Robert Kogi, Gloria Senkyire, Jude Ameyaw, Magdalena Ohaja, Emmanuel Lamptey, Ernestina Asiedua
BackgroundBreast ironing is a harmful cultural practice reported in some African communities and, although often culturally justified, it is increasingly recognised as a violation of the rights of affected girls. This review aims to answer: (1) What is the prevalence of breast ironing? (2) What motivations are reported? (3) What are its health and social impacts?ObjectiveThe objective of this scoping review is to map evidence on prevalence, drivers, consequences, and interventions related to breast ironing.Method and analysisSearches will be conducted in MEDLINE (PubMed), CINAHL (EBSCOhost), Scopus, and Web of Science, with grey literature identified through Google Scholar and institutional repositories, including African Journals Online (AJOL). The review will follow the Joanna Briggs Institute (JBI) scoping review methodology, and study selection will be reported in accordance with PRISMA-ScR guidelines. Two reviewers will independently screen titles/abstracts and full texts, while two reviewers will extract data. Findings will be synthesised using a descriptive analytical approach and presented as a structured narrative summary.DiscussionThis review will strengthen the existing evidence base on the impact of breast ironing across Africa. Across studies, common motivations are expected to centre on perceived protection from sexual attention, early pregnancy, sexual violence, or forced marriage, while consistently reporting substantial physical harms—such as pain and tissue damage—and psychological consequences, including fear, shame, trauma, and loss of bodily autonomy. Recognising the practice within gender-based violence legislation may enhance legal accountability and protection for girls, while targeted training for healthcare providers and community-based education initiatives may support efforts to prevent the practice and mitigate its health and social consequences.
DOI: 10.3389/frph.2026.17917672026-04-02
Natasha D. Ratnayaka-Gamage, Yujie Cao, Anna Tran, Kate Rainczuk, Jessica M. Stringer, Karla J. Hutt, Kelli Sorby, Amy L. Winship
IntroductionClimate change is increasing the frequency and severity of wildfires globally, leading to elevated air pollution and potential human health risks. This study examines whether large-scale wildfires impact indoor air quality within fertility clinics and affect assisted reproductive technology (ART) outcomes.MethodsA retrospective cohort study of 1,647 ART cycles (IVF and/or ICSI) at Number One Fertility clinics in Victoria, Australia, explored cycles occurring before, during, and after the 2019–2020 ‘Black Summer’ wildfires. ART outcomes were compared across quartiles in 2019–2020 and stratified by maternal age (<38 or ≥38 years). Concentrations of particulate matter (PM2.5, PM10, and total PM) were measured indoors and outdoors at three clinical sites during and following wildfire exposure.ResultsResults indicated that PM concentrations were consistently lower indoors than outdoors at all clinic locations. Embryology laboratories maintained negligible particulate levels despite elevated outdoor pollution during the wildfires. No significant differences in ART outcomes were observed across cycles performed before, during, or after the wildfire period. Key outcomes such as oocyte yield, fertilisation rates, embryo utilization, clinical pregnancy, and live birth rates remained unaffected.DiscussionThis study highlights the effectiveness of air filtration systems in maintaining air quality within embryology laboratories during wildfire events and emphasizes the importance of such controls in fertility clinics. Future research is needed to investigate the long-term reproductive effects of environmental exposures on fertility, ART cycles and pregnancy outcomes.
DOI: 10.3389/frph.2026.18043272026-04-01
Deema AL Shawan, Maryam Alsaad, Bayan Alhumaid, Fatimah Shabib, Salma Almulla, Danah AlThukair, Haneen Alfawwaz
BackgroundPolycystic Ovary Syndrome is a common condition among women of reproductive age, yet many cases remain undiagnosed. While several studies have assessed awareness in Saudi Arabia, data from the Eastern Province are limited.ObjectivesTo measure the prevalence of Polycystic Ovary Syndrome among women aged 18–45 in the Eastern Province, evaluate their knowledge of the condition, and examine demographic factors associated with prevalence and knowledge levels.MethodsA cross-sectional online survey was administered to 408 women recruited. The questionnaire collected data on sociodemographic characteristics, knowledge levels, and symptom-based indicators related to Polycystic Ovary Syndrome. Data were analyzed using descriptive statistics and multiple linear regression analysis.ResultsSymptom-based prevalence was 19.9 per cent, and 16.7 per cent reported a formal diagnosis. Awareness was high (83.1 percent), and 61.5 percent showed good knowledge. Demographic factors were not significantly associated with prevalence. Knowledge was significantly associated with age, medical or health-related background, and income (p > 0.05).ConclusionAlthough awareness is relatively high, knowledge gaps remain, especially among women without health-related backgrounds. Tailored educational and early detection efforts are needed to improve understanding and support timely diagnosis and management.
DOI: 10.3389/frph.2026.17805682026-04-01
Zuzana Holubcová
DOI: 10.3389/frph.2026.17912262026-03-27
Tomas Rokos, Veronika Holubekova, Lucia Mackova, Erik Kozubik, Marian Grendar, Lucia Kotulova, Andrea Hornakova, Zuzana Kolkova, Terezia Pribulova, Elena Novakova, Kamil Biringer, Erik Kudela
PurposeThe aim of this study was to observe the vaginal microbiota composition in patients with cervical dysplasia.MethodsIn this prospective study, 91 samples for vaginal microbial diversity examination were taken from the cervix and posterior vaginal fornix. Eighteen bacterial species, including Lactobacillus species, were identified by real-time PCR. Relative bacterial quantities (RQs) were calculated, and log2-transformed RQs were visualised with boxplots. The relationships between cytological abnormalities and bacterial species were calculated by nonparametric one-way ANOVA (Kruskal–Wallis test). For determination of bacterial diversity, the Shannon index was used.Main findingWe demonstrated an increase in the abundance of vaginal microbes dominated by L. iners with increasing severity of cytologically and histologically confirmed cervical lesions, while HPV infection was present in 73.1% of community state type 3 samples. The presence of G. vaginalis and U. parvum in combination with L. iners was statistically significant. Our study also revealed considerably higher bacterial diversity in the community state type IV category. An increasing trend of bacterial diversity with increasing cytological severity of cervical lesions was also observed, although the difference was nonsignificant.ConclusionThis study suggests that L. iners has adverse effects on the development of cervical dysplasia, while L. gasseri and L. crispatus may play protective roles. We also pointed out the association of L. iners with anaerobic bacteria, and we suggest the potential role of bacterial diversity in cervical carcinogenesis.
DOI: 10.3389/frph.2026.17976432026-03-25
Sananthya Karthikeyan, Saivarsaa Alwar, Rajiv Janardhanan, Madhumitha Haridoss
IntroductionReproductive health-seeking behaviour is critical to maternal health and overall well-being, yet many reproductive disorders remain underdiagnosed and contribute substantially to morbidity in India. Health-seeking for reproductive health conditions is often limited by symptom normalization, stigma, lack of awareness, and restricted access to female healthcare providers. This systematic review and meta-analysis aimed to quantify the prevalence of health-seeking behaviour for reproductive morbidities among Indian women and to summarise key factors influencing care utilisation.MethodsThe protocol was registered in PROSPERO (CRD42024562508), and the review followed PRISMA 2020 guidelines. PubMed, Scopus, and Google Scholar were searched from inception to January 29, 2026, for studies reporting reproductive health-seeking behaviour among women in India. Eligible studies addressed reproductive morbidities, including menstrual disorders, gynecological infections, pregnancy complications, menopause-related problems, infertility, structural abnormalities, including uterine prolapse, pelvic organ prolapse, vaginal prolapse, and chronic pelvic pain. Data were extracted, risk of bias was assessed, and quantitative findings were synthesized using a meta-analysis of proportions with the inverse-variance method. Heterogeneity was examined using Cochran's Q and the I2 statistic.ResultsThe pooled prevalence of reproductive morbidities among women was 41.5% (95% CI: 31.2%–52.7%). Overall, 54.8% (95% CI: 46.0%–63.4%) sought treatment for at least one morbidity. Among care seekers, 31.4% used government facilities and 54.7% used private facilities. Allopathic medicine was the most common treatment modality (66%), followed by home remedies (27.9%), AYUSH therapies (12.7%), and over-the-counter medications (15.4%). While 47% perceived no need for treatment, the key barriers included symptom normalisation (60%), embarrassment (16.3%), lack of awareness (13.5%), financial constraints (12.3%), communication difficulties (27.3%), and distance to facilities (8.4%).ConclusionThis SRMA highlights substantial gaps in health-seeking among Indian women with reproductive morbidities, with only about half seeking formal treatment. Education and socioeconomic status remain key determinants of health-seeking, while limited awareness and poor knowledge of reproductive health services continue to impede timely treatment.Systematic Review RegistrationPROSPERO CRD42024562508.
DOI: 10.3389/frph.2026.17695362026-03-25
Maxence Arutkin, Alexandre Vallée
BackgroundSexual partnership heterogeneity strongly conditions the epidemic potential of sexually transmitted infections (STIs), while bisexual partnerships can connect otherwise distinct sexual networks and enable spillover across populations. An actionable summary of this structure is the configuration-model critical bond transmissibility Tc, which links right-tail heterogeneity in partner counts to a static percolation threshold (interpreted here as a structural susceptibility index under a lifetime-partner proxy).MethodsWe analyzed the lifetime number of sexual partners of 405,740 UK Biobank participants (aged 40–69), stratified into men with male partners (MSM), men with female-only partners (MSW), women with male-only partners (WSM), and women with female partners (WSW). Candidate heavy-tail models were fitted to the fixed top-50% tail in each stratum using discrete maximum likelihood on identical integer support. Robustness to digit preference was assessed under prespecified RAW/EXCLUDE/EM-like modes. Epidemic thresholds were estimated from empirical moments, and a two-group next-generation matrix was used to derive minimal bisexual-bridging conditions for cross-group transmission.ResultsIn non-MSM strata, the tails were heavy but finite, with discretized lognormal or stretched-exponential models outperforming a pure power law and strictly positive thresholds (WSM Tc≈0.055; MSW Tc≈0.005; WSW Tc≈0.006). In MSM, extreme right-tail heterogeneity yielded a near-zero threshold (Tc≈3×10−4), indicating high structural susceptibility to sustained spread. Threshold ordering was robust across sensitivity modes. The bridging analysis showed that modest cross-group mixing (illustratively ∼5%–7%) can sustain transmission under plausible within-group controls.ConclusionSexual network tail structure differs sharply by sexual behavior stratum and translates into large, interpretable gaps in epidemic thresholds. These results support targeted, tail-sensitive STI prevention and explicit control of bridging pathways.
DOI: 10.3389/frph.2026.17905572026-03-25
Susannah H. Mayhew, Alethea Osborne, Dana Kusnir, Gift Namanya, Ruth K. Kisuza, Claire Nimusiima, Richard Muhumuza, Manuela Colombini
IntroductionClimate and environmental stresses have a disproportionate impact on women and girls, acting as a trigger for intimate partner violence (IPV) and compromising access to needed sexual and reproductive health and rights (SRHR) services. Little is known about the impact of cross-sector programmes and services, and programmes responding to these linked crises remain siloed. This paper examines the effect of a novel partnership between environmental protection and livelihoods NGOs and government health services providing integrated programmes in a climate-stressed rural district in Uganda.MethodsQualitative research examined whether and how integrated programmes could lead to improvements in IPV, SRHR and wider gender equity in eight villages in Rukiga, Uganda. Forty-four focus group discussions in integrated and non-integrated (“parallel”) sites gathered lived experiences comparing pre- and post-intervention between April 2021–December 2023.ResultsOver time, although participants still described food insecurity, poverty and IPV (prevalent at baseline) many also reported positive shifts in IPV-triggers including gender-dynamics and male attitudes towards family planning (FP). Overall, participants in integrated sites reported increased male acceptance of family planning—reducing a potential IPV trigger - and greater community support for women's economic participation. Integrated delivery that engaged all adults in livelihoods as well as reproductive health activities helped disrupt gendered information (and practice) silos and promote greater reported community cohesion supporting women's legitimate participation in economic activities alongside better male support for women's reproductive rights.DiscussionFindings suggest that integrated programmes pairing climate-resilient livelihood strategies with rights-based family planning and reproductive health services can enhance reproductive choice for women and help address root-causes of IPV, reproductive coercion and abuse by partners. Protecting women's reproductive rights and wider social wellbeing in the context of severe climate stress means health services and systems must move beyond siloed SRHR programming and service delivery, to embrace partnerships with organisations tackling linked livelihoods and wider wellbeing issues. To be effective, health services and systems must explicitly embed gender-responsive and justice-oriented approaches that ensure the safety of women while addressing persistent inequalities, resource scarcity, and power dynamics.
DOI: 10.3389/frph.2026.17815862026-03-19
Barsha Gadapani Pathak, Gitau Mburu, Ndema Habib, Rita Kabra, James Kiarie, Ranadip Chowdhury, Neeta Dhabhai, Sarmila Mazumder
BackgroundInfertility affects a substantial proportion of couples in low- and middle-income countries, yet access to fertility care remains limited. In India, research has primarily focused on psychosocial and biomedical aspects of infertility, with comparatively limited attention to care-seeking behaviours. Understanding the determinants of care-seeking is critical for promoting equitable access to infertility services.MethodsWe conducted a cross-sectional study among 1,530 married women, aged 18–30 years, who intended to conceive and lived in low- to middle-socioeconomic urban neighbourhoods of Delhi. All participants had not conceived after 18 months of participation in a preconception randomized-control trial. Structured interviews captured information on sociodemographic characteristics, fertility intentions, psychosocial experiences, and care-seeking actions. Care-seeking was categorized as formal (health system providers), informal (family or traditional healers), or mixed.Results69.9% of women sought some form of help for delayed conception and, among them 85.5% consulted both formal and informal sources. Logistic regressions identified predictors of care-seeking where longer duration of trying to conceive [adjusted odds ratio (aOR) 1.6 per year, 95% CI: 1.4–1.7], perceiving conception as taking too long (aOR 3.1, 95% CI: 2.1–4.5), feeling isolated (aOR 1.7, 95% CI: 1.2–2.4), emotional abuse from husbands (aOR 1.7, 95% CI: 1.2–2.4) or family members (aOR 1.6, 95% CI: 1.2–2.2), and heavy menstrual bleeding (aOR 1.5, 95% CI: 1.0–2.2) were associated with greater odds of care-seeking, while regular menstrual cycles were associated with lower odds (aOR 0.6, 95% CI: 0.4–0.9). The negative association of regular cycles with care-seeking was significantly modified by social isolation (interaction aOR 3.78, 95% CI: 1.20–11.89).ConclusionThese findings underscore the importance of integrating psychosocial support and fertility education into accessible, affordable infertility services within the public health system.
DOI: 10.3389/frph.2026.17728072026-03-19
Tara Mantler, C. Nadine Wathen
Intimate Partner Violence (IPV) is a pervasive global health and human rights wherein experiences are shaped by intersecting social positions. Despite the complex manifestations of violence, health-sector responses often prioritize acute crises while neglecting the structural forces that perpetuate it. Trauma- and Violence-Informed Care (TVIC) offers a transformative, equity-oriented approach bridging clinical practice with social change by explicitly acknowledging the role of systemic oppression, institutional violence, and inequitable hierarchies that shape access to care. By expanding trauma-informed practice to incorporate an understanding of structural and interpersonal violence, TVIC reframes trauma as both an individual and collective experience rooted in social and structural determinants of health. The “V” in TVIC highlights the need to address systemic harms that position some survivors as more deserving of care than others, perpetuating cycles of revictimization. TVIC calls for multi-level action: fostering compassionate, non-judgmental, strengths-based care at the individual level; embedding culturally, emotionally, and physically safe organizational practices; and promoting intersectoral collaboration to reduce systemic barriers. In SRHR contexts, TVIC restores dignity and autonomy by challenging entrenched inequities and mitigating risks of retraumatization. Adopting TVIC offers an equity promoting, tangible way to optimize systems of care and finally interrupt violence cycles of oppression.
DOI: 10.3389/frph.2026.17708362026-03-19
María M. Jimenez, Cristian Jesam, Karina Sequeira, Karina Alcantar
ObjectiveTo compare the effectiveness of medroxyprogesterone acetate (MPA) vs. cetrorelix (GnRH antagonist) in preventing premature LH surge during ovarian stimulation in assisted reproductive technology (ART) cycles, including cycles for intracytoplasmic sperm injection (ICSI) and fertility preservation.DesignSingle-center, retrospective observational cohort study.SettingPrivate fertility clinic in Santiago, Chile.PatientsA total of 2,964 ART cycles conducted between January 2018 and December 2022 were included after excluding 425 cycles that were cancelled. Among these, 1,793 were ICSI cycles (1,529 antagonist, 264 MPA) and 1,171 were fertility preservation cycles (862 antagonist, 309 MPA).InterventionsOvarian stimulation using recombinant FSH and/or menotropins with ovulatory suppression by either oral MPA (10 mg/day) or daily cetrorelix (0.25 mg).Main outcomeFollicular response, oocyte yield, embryo development, euploidy and mosaicism rates, implantation, clinical pregnancy, miscarriage, and live birth outcomes.ResultsIn fertility preservation cycles, MPA produced higher numbers of follicles ≥17 mm (8.7 vs. 6.7), oocytes retrieved (12.2 vs. 10.7), and mature oocytes (9.1 vs. 7.9; p < 0.01 for all). In ICSI PGT-A cycles, MPA was associated with a higher number of biopsied blastocysts and frozen embryos per patient, while euploid, implantation, and live birth rates were comparable to the antagonist group. Cancellation, fertilization, and miscarriage rates did not differ significantly.ConclusionsMPA is a safe and effective oral alternative to GnRH antagonists for LH suppression during ovarian stimulation in ART, providing comparable reproductive outcomes while reducing treatment burden.
DOI: 10.3389/frph.2026.1793207